History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: September, 1936 Vancouver Medical Association Sep 30, 1936

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  m
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1.
Hi  '!.<;
BULKETTS
(With Cascara and Bile Salts)
. . FOR . .
Chronic Habitual
Constipation
BULKETTS POSSESS ENORMOUS BULK
PRODUCING PROPERTIES AND BEING
PROCESSED WITH CASCARA AND
BILE SALTS PRODUCE BULK WITH
MOTILITY.
WE WILL BE PLEASED TO PROVIDE
ORIGINAL CONTAINERS FOR TRIAL
ON REQUEST.
Western Wholesale Drug
(1928) Limited
456 BROADWAY WEST
VANCOUVER   -   BRITISH COLUMBIA
(Or at all Vancouver Drug Co. Stores)
=—— THE    VANCOUVER    MEDICAL    ASSOCIATION
BULLETIN
"Published ^Monthly under the ^Auspices of the Vancouver ^Medical ^Association in the
interests of the ^Medical "Profession.
Offices:
203 Medical Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. H. MacDermot
Dr. M. McC. Baird Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address
Vol. XII.
SEPTEMBER, 1936
No. 12
OFFICERS  1936-1937
Dr. W. T. Ewing Dr. G. H. Clement
President Vice-President
Dr. Lavell H. Leeson
Hon. Secretary
Additional Members of Executiv
Dr. F. Brodie
Dr. C H. Vrooman
Past President
Dr. W. T. Lockhart
Hon. Treasurer
Dr. A. M. Agnew, Dr. J. R. Neilson
TRUSTEES:
Dr. J. A. Gillespie Dr. F. P. Patterson
Auditors: Messrs. Shaw, Salter & Plommer.
SECTIONS
Clinical Section
Dr. Roy Huggard Chairman     Dr. Russeix Palmer Secretary
Eye, Ear, Nose and Throat
Dr. H. R. Mustard -Chairman     Dr. L. Leeson Secretary
Pediatric Section
Dr. G. A. Lamont Chairman     Dr. J. R. Davies  —  Secretary
Cancer Section
Dr. B. J. Harrison Chairman     Dr. Roy Huggard  Secretary
STANDING COMMITTEES
Dinner
Dr. A. Lowrie
Dr. A. E. Trites
Dr. J. G. McKay
Library
Dr. A. W. Bagnall
Dr. H. A. Rawlings
Dr. W. D. Keith
Dr. S. Paulin
Dr. W. F. Emmons
Dr. Roy Huggard
Publications
Dr. J. H MacDermot
Dr. Murray Baird
Dr. D. E. H. Cleveland
V. O. N. Advisory Board
Dr. I. T. Day
Dr. W. A. Dobson
Dr. G. A. Lamont
Sickness and Benevolent Fund—The President—The Trustees
Summer School
Dr. J. W. Arbuckle
Dr. J. E. "Walker
Dr. H. A. DesBrisay
Dr. H. R. Mustard
Dr. A. C. Frost
Dr. J. R. Naden
Credentials
Dr. A. B. Schinbein
Dr. H. A. DesBrisay
Dr. J. R. Naden
Rep. to B. C. Medical Assn.
Dr. Wallace Wilson
■ill S33
m
Biological Products |||^S
from the Adrenal Glands
ADRENAL CORTICAL EXTRACT . . .
In the course of extensive research in the Connaught Laboratories on the
preparation and properties of Adrenal Cortical Extract, sufficient quantities
of the material have been obtained to enable the Laboratories to offer this
extract to physicians. Adrenal Cortical Extract contains the active principle of the adrenal cortex and has proved useful in the treatment of
certain cases of Addison's disease. The extract is non-toxic, is free from
pressor or depressor substances and is biologically standardized. It is
supplied as a sterile solution in 25 cc. vials.
EPINEPHRINE .  .  .
During the preparation of Adrenal Cortical Extract, Epinephrine is obtained
as a separate product. This is the active principle of the adrenal medulla
and has, of course, been used for many years to stimulate heart action; to
raise the blood-pressure; to relieve attacks of bronchial asthma, etc.
Two preparations of epinephrine are available from the Connaught
Laboratories:
Epinephrine Hydrochloride Solution  (1:1000)
Physicians are well acquainted with this concentration of
epinephrine. It is distributed by the Connaught Laboratories
in 30 cc rubber-capped vials instead of in corked or stoppered
bottles. Thus, individual doses may be readily withdrawn from
the vials aseptically without occasioning any deleterious
effects upon solution left in the vials for later use.
Epinephrine Hydrochloride Inhalant (1:100)
Recently considerable success has been secured in the alleviation of attacks of bronchial asthma by spraying into the mouth
this more concentrated solution of epinephrine. The solution
is supplied in bottles containing 1/5 fl. oz. (approx. 6 cc), each
bottle being provided with a dropper fastened into its stopper
so that small amounts of the solution may be transferred for
inhalation from an all-glass nebulizer.
Prices and information relating to the use of these products from the
Adrenal Glands will be supplied gladly upon request.
CONNAUGHT LABORATORIES
UNIVERSITY OF TORONTO
TORONTO 5      •      CANADA
Depot for British Columbia
Macdonalds Prescriptions Limited
MEDICAL-DENTAL BUILDING, VANCOUVER, B. C. VANCOUVER HEALTH DEPARTMENT
STATISTICS—JULY, 1936
Total Population  (estimated)  247,J 58
Japanese Population (estimated)   8,05 J
Chinese Population   (estimated)    7,89J
Hindu Population  (estimated)    320
Rate per 1,000
Number Population
Total deaths       206 9.8
Japanese deaths _.             6 8.8
Chinese deaths   _._.          10 15.0
Deaths—Residents only   _      173 8.3
Birth Registrations—Male, 139; Female, 168      307 14.6
INFANTILE MORTALITY— July, 1936 July, 1935
Deaths under one year of age __ _         9 4
Death rate—per  1,000 births   32.6 14.1
Stillbirths   (not included in above)  — 5 8
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
August 1st
June, 1936 July, 1936 to 15th, 1936
Cases   Deaths        Cases   Deaths       Cases   Deaths
Smallpox   _ __   0 0 0 0 0 0
Scarlet Fever  25 0 6 0 3 0
Diphtheria     0 0 0 0 0 0
Chicken Pox   46 0 8 0 4 0
Measles       10 0 4 0 0 0
Rubella   ,  2 57 0 9 0 0 0
Mumps     - _ 174 0 13 0 3 0
Whooping Cough  -- 50 0 4 0 2 0
Typhoid Fever     11 0 0 0 0
Undulant Fever   _. 10 0 0 0 0
Poliomyelitis      __ 0 0 10 2 0
Tuberculosis      3 3 14 27 16 5
Meningitis   (Epidemic)    __   0 0 2 0 0 0
Erysipelas       5 1 5 1 10
Encephalitis Lethargica     0 0 0 0 0 0
Paratyphoid Fever     0 0 0 0 0 0
Bioglan Hormone Treatment
A SCIENTIFIC BIOLOGICAL
PLURIGLANDULAR REMEDY
Its use is being attended with better than ordinary results.
Descriptive literature on request.
MADE  IN  ENGLAND  BY
THE BOWSHER LABORATORIES LTD.   .
Biological and Research
Fonsbourne Manor, Hertford, England.
Hep., S. N. BAYKE
1432 Medical Dental Building       Phone Sey. 4239       Vancouver, B. O.
References: "Ask the Doctor who has used it."
!!!,
Page 26) !l
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MABEflCS
?
Then you know how the average diabetic dreads the
daily hypodermic injection. He will welcome oral medication with Pancrepatine and a moderate restriction of
carbohydrates.
Pancrepatine contains the hormones of pancreas and
liver, ACTIVE BY MOUTH. These hormones are
fully protected from ferment action in the duodenum
by the special capsule of the globule.
Many physicians attest the efficacy of Pancrepatine as
an effective oral treatment for diabetes mellitus. Especially useful in the mild or average uncomplicated case.
Reduces blood and urinary sugar and spares insulin.
Controls the annoying symptoms of polyuria and polydipsia. The general condition of the patient is improved.
When treating your next case of diabetes we invite you
to try Pancrepatine. You will be pleased with the results revealed by Benedict's test.
Prescribe 2 to 4 globules t.i.d. after meals in increasing
doses. Bear in mind the appropriate dietary restriction.
Supplied in bottles of 100 hormone-protected globules.
May we send you a liberal complimentary sample?
Write to Anglo-French Drug Co.
354 St. Catherine Street East,
Montreal,    Quebec
.«.
effective  Oral Treatment for Diabeies
31 EDITOR'S PAGE
There are great days for the medical profession in British Columbia, if
one is to judge from the prominence they have attained in. political matters.
There is no doubt that the body politic is sick—very sick—and we wonder
if it is a sign of grace that the patient has seen lit to call in so many doctors.
There is much food for thought in this picture, and one feels tempted,
in these dying days of summer, to let one's fancy wander a while. Here we
see the Conservatives and the C.C.F. each headed by a, doctor; the Liberal
party is still rebelling against what will probably be its fate. Perhaps there
are no good Liberal doctors left. They have, as a matter of fact, got one
good one, Dr. W. J. Knox of Kelowna, who is the President of the party in
B. C, if we have his title correctly. He may be the salvation of the party yet.
But this is not all the picture. Imagine the plight of a patient who calls
in various doctors to help him recover—when these doctors cannot agree,
either on the diagnosis, or the treatment that should be adopted. Nor will
they even meet in consultation, as is the custom amongst our craft.
Man is a politically-minded animal, and will fight more bitterly and
unreasoningly over politics than over any subject under heaven, unless it
be religion. It is a strange paradox of human nature. There are no two things
on which one would think agreement is more necessary than politics and
religion: since we are all so closely interrelated that, as a body, each part
suffers if any other part suffers. Any political step, as any religious doctrine,
can only be beneficial if it benefits the entire body, and not one part alone.
This truth has been re-stated in various forms by wise people of all ages,
from one of the early Latin kings, whose name we have temporarily forgotten, down through St. Paul to Nurse Cavell. (We will leave our readers
to confirm and identify our allusions.)
But the one thing that human beings will not do, apparently, is to agree
on these two matters. (We confess to certain very definite convictions in
our own mind along both these lines.)
There are times when one is tempted to despair of democracy and popular
government, since it produces! so much conflict, so much apparent waste of
energy and effort, so much apparent loss of power. But since the only
remedies suggested involve a much greater loss, the loss of freedom, which
cost so much in days gone past, we wonder whether, after all, on balance,
ours is not! the better way. There are those who would impose control from
above, by the aristocracies of money or intellect; and this, we confess, is to
us an appalling threat to all that makes lif & worth living. There are others
who would impose control from the other end, and perhaps our sympathies
are very much more on! their side. But we are opposed with all our heart to
both fascism and the type of communism which, equally with fascism,
would regiment and hold in shackles of iron, all that is individual and free
in life, for the sake of imposing what it thinks is the right way of' living.
We feel that the greatest gift of the Creator to man is his free will, his right
to decide: and while, of course, this must be regulated by the needs and
claims of humanity at large, it must not be denied him.
Surely there is a middle way of co-operation and unselfish team-work.
We believe that gradually this day is dawning, that each extreme is beginning to turn in a little towards the other. The physicist says that the universe
is a sphere, and that if one goes far enough in any direction, he will meet
Page 264
mi*.
4 anyone who is going in the exactly opposite directi||_. We may well hope
that this may be so.
In the present number we are publishing a short account, necessarily
very sketchy, of the work that is being carried on in B. C. under the direction of Dr. W. H. Hatfield, in the prevention and treatment of tuberculosis. This work is bringing great credit and profit to British Columbia, and
should engage our attention. One man cannot do it all—and this is not, of
course, the work of one man.' There is a great deal of public spirit and service
on the part of many people in British Columbia that has gone to the building
up of this edifice. But every building must have an architect and a designer
—and we feel that this is the role which Dr. Hatfield plays: since he has
co-ordinated all this effort and made it more effective and productive than
it ever was.
■<M\
NEWS AND NOTES
Word has been received that Sir James Barrett, of Melbourne, Australia,
President of the British Medical Association, will be in Vancouver on Iris'
way from London to Melbourne on September 8th. As this! is the first day
of the Summer School, and as Sir James will only be in town for one day,
the Summer School Committee has invited him to be the speaker at the
luncheon which has been arranged for September 8th at 12:30 in the
Spanish Grill of the Hotel Vancouver. It is hoped that all who can possibly
do so will attend this luncheon, as it will be the only opportunity to welcome
this distinguished visitor and hear him speak.
Sir James Barrett will be the guestl of Dr. and Mrs. G. F. Strong during
his stay in Vancouver.
V.ih
Dr. T. Lane Connold, who has been at St. Mary's Hospital, Pender
Harbor, has now become a mariner, and is the Missioner-Doctor-Skipper
of the new Columbia Coast Mission boat, Florida V, which will serve Jervis
Inlet, Sechelt Inlet, Texada Island, Lasqueti Island and surroundings. This
new vessel is equipped with a Fairbanks-Morse 60 horsepower diesel engine,
and will have an operating room, dispensary, library and chapel.
In addition to having become the skipper of a fine boat, Dr. Connold has
also recently become the father of a daughter.
We are very glad to report that Dr. Frank Turnbull has so far sufficiently recovered from a serious illness to be able to leave the Hospital and
go to Savary Island to convalesce.
Dr. George Clement will take part in the Golf Tournament at Jasper
Park early in September. We wish him the best of luck and a well-earned
holiday.
The various members of the office staff at 203 Medical-Dental Building
have returned from vacation and the winter schedule will be in force after
the first of September. The office will be open then from 9 a.m. till 6 p.m.
Page 265 Dr. H. H. Boucher has returned to Vancouver after a year's postgraduate work, most of which was carried out in Iowa City, la., under
Dr. Arthur Steindler.
Dr. J. H. Blair, formerly of Michel, is now installed in his new office
at the Workmen's Compensation Board.
Dr. R. R. Glasgow, a newcomer from Alberta, will have Dr. Blair's
former position at Michel.
Dr. T. W. Sutherland of Wells, B. C, has left for the East to do postgraduate work, and Dr. G. F. Young will carry on his practice during his
absence. Dr. Sutherland expects to be away six or eight months.
Dr. C. E. Derkson is relieving Dr. D_ M. King at Bralorne, while Dr.
King does post-graduate work at the Vancouver General Hospital.
Dr. R. S. Woodsworth will relieve Dr. W. Bramley Moore at Blue
River during the month of September.
Dr. G. Leroux is assisting Dr. R. W. Irving at Kamloops.
Dr. Harold Caple isf in England, doing post-graduate work in a London
hospital.
RECENT  ADDITIONS  TO THE  LIBRARY
Bailey, H.—Demonstrations of Physical Signs in Clinical Surgery.   193 6.
Buckley, C. W., ed.—Report on Chronic Rheumatic Diseases.   193 6.
Surgical Clinics of N. A., New York Number, June 193.
Medical Clinics of N. A., Philadelphia Number, July 193 6.
New and Non-Official Remedies.   1936.
Lorenz, Adolph—My Life and Work.   1936.
Haldane, J. S.—Philosophy of a Biologist.
An interesting addition to the Library this month is a copy of The
Chronicle of the First World Tour of the British Medical Association, by
Dr. S. Watson Smith. The book was donated to the Vancouver Medical
Association by the Council of the British Medical Association. The author
refers graciously to the reception accorded to the members of the party who
came through Vancouver last August.
NOTICE
The City Relief Department has issued new prescription
blanks and requests that they be used in duplicate for
Relief Prescriptions. Please call for same at the office of the
Vancouver Medical Association, 203 Medical-Dental
Building.
H. R. MUSTARD,
Secretary, Relief Administration Committee.
Page 266 «->*■
NOTICES
B. C. MEDICAL ASSOCIATION LUNCHEON
The B. C. Medical Association will hold a luncheon at the Hotel
Vancouver, Friday, September 11th, 1936, 12:15 noon. This will be open
to all members of the B. C. Medical Association and also to all Doctors
attending the Summer School, which is being held at that time. Special
speakers and reports dealing with such questions as Health Insurance will
be arranged for.
&
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BRITISH  COLUMBIA  MEDICAL  ASSOCIATION
The B. C. Medical Association is now incorporated under the Societies
Act. This incorporation created a new association and it has been necessary
to have applications for membership filed with this office. This is but a
matter of form, and as membership is open to all members of the College
of Physicians and Surgeons with no financial involvement we hope that the
remaining eighty cards approximately will reach us before September has
passed.
The Committee which had the enrolment in hand, under the Chairmanship of Dr. W. LeRoy Pedlow, attempted to make if easy for the members
to return the application cards. Their efforts were successful in that at this
date over 5 50 men are members of the B. C. Medical Association.
Although the summer has intervened, already the organization is working and this portends a busy and successful year. Committees are active and
making plans for the winter programme. The remainder of membership
application cards will come in, we feel.
Executive Committee
The Executive Committee of the B. C. Medical Association will meet
at dinner at 6.00 p.m. on Wednesday, Sept. 9th, in the Vancouver Hotel.
This being held during the sessions of the Summer School of the Vancouver
Medical Association.
COLLEGE OF PHYSICIANS AND SURGEONS
OF BRITISH COLUMBIA
NOTES FROM THE OFFICE OF THE EXECUTIVE SECRETARY
The Health Insurance Committee of the College of Physicians and
Surgeons has never ceased to function and it is fortifying to the profession
to realize that no group is more well informed on this whole question. Much
work has been done and the Committee is in a strong position, knowing
whereof it speaks. The unity which exists within the profession in this
Province is born of confidence in our elected authority, the Council of the
College and its Committee. It is very heartening to the Committee to receive,
increasingly, messages from every section of the Province of goodwill and
support.
Page 267 PLEASE NOTE—INCOME TAX RETURNS, 1936
(Re allowance for automobiles used in the performance of professional
dut
les.
Excerpt from letter from Commissioner of Income Tax, Ottawa, forwarded
to and by Dr. T. C. Routley.
"It is felt that the 10 cents per mile is a too liberal allowance, and while
it is not proposed to reduce this allowance retroactively, yet the Department
has come to the conclusion that for 1936 and subsequently, this allowance
shall be reduced to 8 cents per mile."
The questionnaire regarding contracts and group practice of all kinds
is being returned regularly and it is a source of gratification to this office
to realize that the members of the College are so willing to co-operate. The
completeness of the returns is a matter for comment.
In an effort to avoid confusion, the form provided no space for salary
return but information on this point would be appreciated.'We have information at present on the conditions under which 13 5 separate contracts are
conducted. Kjndly send in form even if a "nil" return is necessary .
The Prevention and Treatment of Tuberculosis in B.C.
British Columbia, while a small country from the point of view of
population, and a relatively poor country, has very many times illustrated
the fact that size and efficiency bear little or no relation to each other.
This province has much to its credit in actual accomplishment. For one
thing, we can point with pride to the athletic feats of many of our sons
and daughters, and there is always Gerry McGeer, who steals the show
wherever he goes. But there are other things too. In social legislation, for
example, British Columbia, more than any province, has led the way for
many years. So we find that B. C. was the first province to have a Workmen's Compensation Act; its work in Old Age and Mothers' Pensions has
been outstanding, the results that have been attained in maternal welfare,
the reduction of infant mortality, the protection of milk, and many other
things, are such as make one proud of one's province.
And now tuberculosis and the prevention and treatment of this disease
are in a fair way to be the biggest achievement of them all. It is only fitting
that the medical profession of British Columbia should know something of
the immense amount of constructive work that has been accomplished and
set in train within the last few months in British Columbia.
Opening of the New Buildings
Within a month, on some date in October which will be published later,
the new addition to the Vancouver Unit of the Tuberculosis Division of the
Provincial! Board of Health will be opened. Every medical man will receive
an invitation to be present at this, and every medical man should make a
point of being there. This building, which was begun only a few months
ago, marks a most important forward step in the history of anti-tuberculosis
work in this province.
The Editor of this Bulletin paid a visit a few days ago to this building.
Having missed his Sunday morning game of golf, he was roaming around
the Hospital in an aimless way, when he ran into Dr. William H. Hatfield,
the Provincial Director of Anti-Tuberculosis Work for British Columbia.
One is not long in this individual's company before the subject of TB. comes
Page 268 up—and on this fair Sunday morning the Editor was invited to go over the
new building—and gladly accepted.
From then on, one felt as if one were in' the presence of a force. Power,
to be efficient and to do work, must be concentrated and f ocussed on a point
—must, like "baby dear," come "out of the everywhere into here." The
beam of light diffused is of little value for close work; but concentrate it
on a point and it illumines and even burns.
And Dr. Hatfield is such a concentrated, focussed force. He has given
his life, and all his energy, which is considerable, all his ability as an organiser, all his powers of persuasiveness and eloquence, to one single thing—the
building up of anti-tuberculosis work in B. C, and in consequence he is
getting results.
Of course he is not thei only factor, nor the only person who is keen on
this work. The Minister of Health, Dr. G. M. Weir, and the Provincial
Medical Health Officer, Dr. H. E. Young, are just as keen, and just as
anxious to get on with this work. The Rotary Club and the Kinsmen's Club,
the I.O.D.E. and the Kiwanis Club, and many other organizations, have
done, and are doing, excellent work, and their work is indispensable.
But these were beams of light more or less diffused, and they needed to
be concentrated. This has been done by Dr. Hatfield. The profession of
British Columbia may well be proud of the work that one of their members
is doing, of the high standard to which he has brought the purely medical
work. Through the great improvements in recording, in organisation, in
treatment of large numbers of people, he has attracted medical men from
other provinces who are coming here for post-graduate work: he has instituted research work which
will be of the greatest
value. Dr. Hatfield himself
is especially keen on the
statistical work that is
being done, and the report
showing "Statistical Methods as Applied to the TB.
Division" is a most complete and illuminating document. More of this anon,
however.
The Editor's Trip
To resume our trip.
First we visited the new
building now being fitted
out. The total cost of this
building with equipment,
we gathered, is in the neighbourhood of $260,000. The
tale of how this money was
extracted from a bedevilled
Government, which is more
or less submerged all the
time under a pile of demands for money, all for
W. H. HATFIELD, M.B. (Tor.) vital and urgently necessary
Provincial Medical Director, Tuberculosis Control. expenditures, is one of Very
Page 269 great interest. Suffice it to say, that the providing of this money reflects quite
as much credit on the foresight and vision of the leaders of the Government
as it does on the man who, "because of his much importunity," succeeded
in persuading these leaders that his cause was of an importance that made
refusal a serious piece of folly.
The New Building
This new building is completely up to date. In the course of the past
year or two, Dr. Hatfield has visited cities all over Canada and the United
States, and has thoroughly examined the facilities provided for TB. work.
He has himself many ideas as to what he wants in such a building, and he
has incorporated all of them in the plans of this wing.
As we go to the ground floor, we see that most complete arrangements
have been made for the care of children who have been in contact with
tuberculosis, who are underweight, who are below par generally. A large
room has been completely equipped for quartz-light and sunlamp therapy.
Two hundred children a day can be treated in this. Other rooms provide
for their rest, for minor surgical care.
Especial attention will be paid to tonsils and teeth: and, a most important
point, a complete dental clinic has been provided.
Next, we go upstairs to the first floor. Ihis is the administration floor,
and will give great relief to the terribly crowded offices that house records,
social service workers and office staff generally.
On this floor patients are admitted, sorted and dealt with; women have
ample dressing room accommodation, in cubicle form. A long row of
examining and treatment rooms stretches along one side of the corridor.
The arrangements for case-recording and history-taking are such as
will greatly save time and effort. Ample space is given to the field-workers,
social-service workers, visiting nurses, etc. Lockers and rest rooms are
provided.
This is the X-ray floor, too, and this most important part of the work
is given full consideration. The department fe fully equipped to do all its
own photographic work, even now. It takes pictures, reduces them to lantern-slide size, prepares other photographs of graphs, charts, illustrations
from books, records, etc., and has a very complete library available for
lending to any person who can profit by their use. Any medical man who
wants to lecture on TB., who needs a lantern and slides, can get them here.
The Other Floors
Next, we go to the second floor, which is a standard hospital floor, the
others being built on the same identical plan. But it is very different from
the ordinary hospital plan.
To begin with, every floor has its own Instinctive colour. One floor is
all blue, one all green (i.e., the walls), and another peach-coloured. Presumably one begins on the blue floor and gradually! rises to the couleur de
rose of the top floor, which will be peach-coloured.
This, however, is a very small detail. Of much greater importance is
the interior arrangement. The wards) are small, the largest being a six-bed
ward, others with four and two-bed layouts. Each bed has its own lighting
arrangement, its own radio connections—each patient has a set of earphones. No amount of pressure of overflow can make the wards hold more
than the prescribed number—so each patient will have ample air-space: a
great improvement on the present state of affairs.
Page 270 MK
Mb
,mm
The Master Radio
This is a unique arrangement. There is one radio with a continuous programme going all day. The Edison Co. has built a panel of switches by
which many things can be done. Each patient, as has been said, has! his or
her own ear-phones—so there is no noise in the ward, and one can listen or
not as one feels so minded.
But there is more to it than this. Anyone can speak into this radio at
the master switch: and can speak to every patient in the hospital at once;
or a single ward can be cut in, or a single patient.
The telephone, too, can be plugged in, so that if the doctor on duty
wishes to speak to any patient, ask him questions about himself, from the
doctor's own home or downtown, he can do so.
But this is, again, only one more detail. Bathtubs are done away with,
and showers substituted for the walking patients. The nurses on the floor,
and the staff generally, have also been very carefully thought of. They have
their own locker-rooms, rest-rooms, showers, and dinettes on each floor.
Dr. Hatfield, like the rest of us, has been impressed with the fact that
in most hospitals the staff has been given very little considerationPThey
have nothing to do with the balance of their lunch hour, after they have
spent twenty minutes over their meal—they have to drink their cup of tea
in the afternoon in some corner, standing "with reluctant feet" where
nobody will see them.
But unlike most of us, he has done something about it. He has converted part of the roof, a large clear space, into recreation ground for the
staff. Here they can play deck tennis, etc., and later go down, have a shower,
and freshen up before they return to duty. They have, as has been said, their
own dinette on each floor, where they can eat their meals quietly and privately, and have their afternoon tea in peace and quiet. Time will be provided for this.
This is, in our opinion, a very sound proceeding, and will make for not
VANCOUVER UNIT
(New wing under construction in background)
Page 271 only a happier, but a much more efficient, because more healthy, staff. This
same roof is accessible by elevator, and beds can be taken out there, and
patients given! an airing.
What This Building Will Do
First, it will provide 65 new and urgently needed beds. On the day on
which we visited the TB. department, every available bed in the province,
in Vancouver, Victoria and Tranquille, was full. There was a waiting list
of 70-80 active cases needing treatment very badly, and a longer list of cases
that should be given some hospital treatment. This will ease the strain a bit.
It will do more: it will enable Dr. Hatfield to recondition and remodel
the old building. We visited this. The corridors (on a Tuesday morning)
werepniined with folk, of all ages and both sexes, standing and sitting.
The various administration offices are crowded and overcrowded with cabinets, apparatus and people. There is no room at all, and the appearance of
the place rerninds one of Duranty's description of a Russian railway station.
"One month's consultation list in Vancouver is 1,054 cases, of which
459 are new cases. This gives an idea of the actual amount of work.
With the new btiilding, all this will be changed. The administration will
have room, and there will be some peace and quiet for the medical work to
be done. Doctors will have each his own room.
This' floor, now used for administration, will be converted into a ward
for children who need care. Special emphasis is being laid on the child in
this new addition.
We went round the offices with Dr. Hatfield, and saw something of the
inner workings of this most active department. Time will not allow of a
full description of the machinery but some of the highlights will be of great
interest.
To begin with, there is a most complete system of records, amazingly
complete and thorough. Daily and monthly records are kept, tabulated and
classified, and transferred, in itemized form, to a punch-card system. This
is not only ingenious but very valuable.
Symptoms, for instance, are recorded on a very complex history sheet,
with signs, findings, history, personal details, questions of environment,
sources of infection, etc., etc. These are transferred to a punch card, by
punching in spaces provided for each detail.
If one should want to know, for example, how many cases of haemoptysis there were in the last year, or the last ten years, all these cards are
gathered and run through a machine set at "ha.moptysis," at the rate of
400 a minute. All the cards punched for haemoptysis fall out, and in a couple
of minutes, or ten minutes or so (there are 4000 cards or more on file) we
have this information.
This is what makes a record of actual value.
Every patient in B. C. is carded, and the department can tell you from
day to day about any given patient, where he is, how he is, what treatment he
is getting, etc., etc.
There are three main centres in B. C.:
Vancouver, under Drs. W. H. Hatfield and P. W. Barker;
Victoria, under Dr. F. Kincaid;
Tranquille, under Dr. A. D. Lapp.
In additin to this, Dr. Hatfield has organised three "preventive and
treatment centres." (Note the "preventive.") At these, medical men are
Page 272 VICTORIA UNIT
on part-time service. They test the school-children, do "pneumos," and
carry on educational work about anti-tuberculosis measures. They also see
to the adequate reporting of cases in the area.
These are at Prince Rupert, under Dr. R. G. Large; Trail, under Dr.
D. J. M. Crawford, and Kelowna, under Dr. J. McK. Large.
Victoria has 60 beds available. These are mostly in the TB. unit at the
Royal Jubilee Hospital, but also at Vernon Villa, the TB. Annex of St.
Joseph's Hospital.
There are also three travelling clinics, under the immediate supervision
of Dr. A. S. Lamb, Dr. G. F. Kincade and Dr. F. Kincaid. These cover Vancouver Island, the Lower Mainland and Coast, and the Interior.
Rehabilitation
A most important question with regard to TB. is the helping of the
patient, after recovery, to regain his place as a wage-earner. Recovery is
not complete at one time, so that the patient must be protected while still
partly a patient.
Full consideration is given to that in Dr. Hatfield's plans. Vocational
work is a most important part of the treatment of the TB. patient.
Vancouver Occupational Industries
The following list of officers and members of the Council of the V.O.L
is indicative of the quality of the help given in this regard. Dr. Hatfield
feels that this is one of the most important parts of his work. He is aiming
to put into effect a scheme whereby the municipalities and Provincial Government will combine their forces, put the man on an allowance, which
will allow him to do lightly-paid work, and yet live decently. As he improves and earns more, this will be reduced, till he is discharged, able to
stand on his own feet. This will all be done through the Vancouver Occupational Industries.
Page 273 A very complete report is available, made throueh the Council of the
V. O. I.
Research
A very important part of the work is the research now being carried on
by three medical men who, through the activities and generosity of the
Kinsmen's Club, have been given Research Fellowships. Two of these are
physiological, one pathological, and excellent work is being done. It is
hoped that these fellowships will be permanent institutions.
Great praise was given to the work of this department along these lines,
and on account of their marvellously complete system of records, by Dr.
Hugh M. Farris of St. John's, N.B., at the convention last summer of
Health Organisations. Dr. Farris is one of the leaders in Canada in Anti-TB.
work, and spoke very warmly, especially of the Report of the TB. division,
which he said was the fullest he had ever seen. It is of interest to know that
from many centres in Canada and the U.S.A. come enquiries about these
records and the work being done here. The Rockefeller Foundation has taken
notice of it.
From Alberta and other parts of Canada men have come to take postgraduate work in TB. in our province. This is a great tribute to the work
of the B. C. department.
And Dr. Hatfield has other plans and other ideas. He is looking now
toward a convalescent hospital, a hospital for chronic and incurable cases,
more research, wider inclusion of the members of the medical profession in
this work, ond so on and so on.
It is not a case of praising Dr. Hatfield personally. He is not interested
in that, any more than he is deterred or abashed by any unfounded criticisms which may come his way. This is not Dr. Hatfield's fight: and while
he may be regarded as the general in command, he is not, cannot be, does
not want to be, the entire army. He is a man who knows just what he wants,
and how he wants it. And he is always on the job. He has the advantage of
TRANQUILLE UNIT (Main Building)
Page 274 I    j!
singleness of purpose, sincerity, and "an invincible inability to know when
he is licked." He has also; the advantage of the full and exact knowledge of
facts which he has acquired through years of contact with TB. All this
makes his appeals very telling, and very difficult to withstand.
Add to this the sincere desire of the government, especially the Ministry
of Health, to meet the situation adequately, and we get the amazing result
that we have tried to describe.
U.
_«.
THE INCIDENCE OF TUBERCULOSIS IN CHILDREN ENTERING PRIMARY SCHOOLS IN
VANCOUVER, BRTISH COLUMBIA
An Attempt to Trace Their Sources of Infection with a Suggested
New Approach to Case-Finding1' 2
Reprinted from The American Review of Tuberculosis, July, 1936.
Dr. A. R. J. Boyd3
[We are delighted to have the opportunity of publishing this somewhat condensed
form of Dr. Boyd's report. It represents a very great deal of work—and will be,
we believe, the basis of a better understanding, and more effective control, of the
tuberculosis problem in B. C.—Ed.]
This study was primarily undertaken to determine the feasibility of
examining whole families, in an effort to explain the occurrence of tuberculous infection and demonstrable tuberculous lesions in a group of children;
and second, to evaluate the findings from the standpoint of their application
in new methods of case-finding.
The first step was the selection of the group of children with which to
commence the work. It was considered that the primary clas9 of the schools
would be the most promising, in that home-contacts are probably responsible for their infection more frequently than is the case in older children.
A further selection within the group was necessary. For this purpose a
tuberculin survey of the primary class was undertaken. Still further selection was made by the examination of the positive reactors.
The following report will be divided into two parts, the first dealing
with the findings in the children of the primary class, the second with the
findings in the families in which the school beginner has been infected with
the tubercle bacillus.
PART 1
The Incidence of Tuberculosis in Children entering Primary Schools
Tuberculin-testing of the children in the public schools of the city was
begun in October, 1934, and completed for the primary class in November,
1934. The positive reactors were examined at the Clinic during November
and December, 1934, and January, February and March of 193 5.
An attempt was made to obtain consent for examination of all the
receivers in the 53 primary public schools of the city. Shortly after the
beginning of the school-year a pamphlet describing the requested examination, together with a consent form, was given to each child in the primary
class to take home.
1 From the Vancouver Public Health Institute for Diseases of the Chest, Vancouver, B.C.
2 Prize-winning thesis in the 193 5 competition conducted by the Canadian Tuberculo-is
Association.
3 Kinsmen Fellow in Tuberculosis.
Page 275 Of a total receilpig class of 2,247 children, consent to examine was
obtained for 1,25 5, or 5 5.82 per cent. All tests were made and read, by the
writer, in the schools. The intracutaneous (Mantoux) test was used
throughout. An initial injection of 0.1 cc. of a 1-1,000 dilution of O. T.
was made. Negative reactors were given a "repeat" test, using 0.1 cc. of a
1—100 dilution of O. T. The tuberculin used was prepared and standardized
according to international requirements by Connaught Laboratories,
Toronto. Dilutions were prepared freshly each day.
At the time of visiting the various schools, 112 children were absent.
One thousand, one hundred and forty-three children received the first
injection; of these, 61 reacted positively. Consent to examine was withdrawn
for three children after the first injection. They were negative reactors.
One thousand and seventy-eight children were given the "repeat" test; 166
had positive reactions. In all, 227, or 19.86 per cent, of the group were
positive reactors.
Of 3 5 children five years old, 5, or 14.28 per cent, had positive reactions; of 89 seven-year-old children, 17, or 19.10 per cent, reacted; 5, or
27.77 per cent of 18 children over seven years of age had positive reactions.
The remaining 1001 children were six years of age. Of these, 518 were boys
and 483 girls. The group comprised 8 57 children of the white race, 110
Japanese, 29 Chinese, 3 East Indians, and 2 Negroes. Two hundred and one,
or 20.08 per cent, had positive tutarculin reactions.
Very little difference is apparent between the percentage of positive
reactions among boys and girls.
The percentage of children positive to tuberculin skin tests shows a
marked variation in reports from different countries, and from different
parts of the same country. Part of the variation is probably due to differences in stretgth of tuberculin used and in amounts injected, as well as in
the method of testing.
The percentage of positive reactors among Japanese is slightly greater
than among white children, and that among Chinese is considerably higher.
The Chinese group is small and perhaps the results cannot be considered
conclusive for that reason. In the Japanese group the higher percentage of
reactors among girls is more marked than among white children. A higher
percentage of Chinese boys had positive reactions than girls. Doolittle, in a
study of the incidence of tuberculosis in various racial groups in Hawaii,
concludes that the percentage of infection in different races is probably
affected only by the opportunities for contact. Hetherington, et al., found
no appreciable difference in the percentage of tuberculin-positive children
in white and coloured children in Philadelphia, where the death-rate in the
coloured race is higher than in the white.
In Vancouver the death-rate in the Oriental races is much higher than
in the white race. The rate among Chinese is very much the same as for
Japanese. Both Oriental groups, for the most part, live in congested parts
of the city in poor and overcrowded homes. Thus the opportunities for
infection should be more frequent for the Oriental child than for others.
It is difficult to see how they can be more frequent for the Chinese than the
Japanese, although there are probably more unrecognized tuberculous individuals among the Chinese than the Japanese. There are on record 5 tuberculous persons in the Japanese population for each Japanese who died from
tuberculosis, and 3.6 in the Chinese population for each Chinese who died
from tuberculosis in 1933.
Page 276 \m
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Grading of the reactions was done according to the usual method. Only
one four-plus reaction occurred, although the il%ial injection was 0.1 cc.
of a 1—1,000 dilution of O. T. The number of three-plus reactions in those
sensitive to 1—1,000 dilution is almost twice the number of two-plus and
one-plus combined. Over two-thirds of those reacting to 1—100 dilution
had one-plus reactions, while only a small number had three-plus. In general, it was noted that there was less cedema reaction with the greater
dilution of O. T.
There is a larger percentage of large reactions in Oriental children than
in white children. This is in keeping with the findings of Dickey, and is
probably due to greater opportunity for reinfection in the Oriental races,
as he suggests.
The percentage of children 10 per cent or more underweight and overweight, and of those within 9 per cent of standard weight, was found to be
practically the same for those who reacted to tuberculin as for those who
did not react. This is best seen in the large group of white children and in
the total groups. In the Japanese and Chinese, underweight children were
more frequent among positive than among negative reactors. This may be
due to the small numbers considered. In general, the findings agree with
those of Hetherington, Chadwick and| Doolittle.
Children who had positive skin tests were given appointments for
physical and X-ray examination at the chest clinic. Of 201 positive reactors
189 were examined. The remainder failed to keep their appointments.
The percentage of positive X-ray plates was greater in both Oriental
races than in white children; and in Chinese children the percentage of
positive plates was almost twice the percentage in Japanese and three and
one-half times the percentage in white children. As noted before, the
Chinese group is small and the results, therefore, may not give the true
incidence in the race.
A slightly greater percentage of girls than boys of the white race had
positive X-ray findings. If we consider the suspects with the positives this
difference becomes less than 1 per cent. The number examined in both
Chinese and Japanese is small, but the findings indicate a more frequent
occurrence of demonstrable lesions in girls than in boys. Thel incidence of
positive X-rays and positive skin tests for the whole group of 1,001 is 2.49
per cent. Johnson and Chadwick report an incidence of positive plates of
31 per cent for those reacting to tuberculin, and of 4.4 per cent fori the
whole group in children 0-17 years of age.
The percentage of demonstrable lesions in the chest occurred ten times
as frequently in those sensitive to 1—1,000 dilution as compared to those
sensitive to 1—100 dilution. No difference occurred in the two sexes in those
who reacted to 1—1,000 dilution. Slightly more girls than boys among those
who reacted to 1—100 dilution had X-ray demonstrable lesions.
Overweight and underweight children occurred more frequently among
those with positive X-rays than among others.
Schools from districts of approximately the same density of population
were grouped together. It should be pointed out that the schools in the first
district contained the majority of the Japanese and the Chinese children
considered in this study. The districts are arranged in order of decreasing
density of population. It would appear that crowding plays! a part in determining the incidence of infection and has an appreciable effect in increasing
the number of lesions demonstrable by X-ray of the chest. Chadwick and
Page 277 Zacks found that "different sections in the same city may show a wide
variation %p. the percentage of infection" and "Congested areas show a
higher percentage of infection."
SUMMARY
1. The incidence of positive tuberculin reactions in 1,143 children
entering primary public-schools was found to be 19.86 per cent.
2. For 1,001 six-year-old children the incidence of positive reactors
was 20.08 per cent; for girls, 20.70 per cent; and for boys, 19.49 per cent.
3. The incidence of infection among 29 Chinese children was 37.93
per cent; among 110 Japanese 21.81 per cent; and among 857 white chil-
dren||l9.13 per cent.
4. The majority of positive reactors were not sensitive to 0.1 cc. of
1—1,000 dilution of O. T. Of thosej who reacted to the initial injection of
tuberculin almost two-thirds had 3-plus reactions. Over two-thirds of those
reacting only to the larger amount of tuberculin had 1 -plus reactions.
5. Variations in percentages of standard weight were not reflected in
the percentages of children having positive reactions.
6. The incidence of infection increased with increasing density of
population.
7. Demonstrable tuberculous lesions were found in the X-ray plates of
13.22 per cent of positive reactors, which was found equivalent to 2.49
per cent of the whole group. Positive X-rays were found in 10.32 per cent
of white, 21.73 per cent of Japanese and 36.36 per cent of Chinese children
who reacted to tuberculin. The Japanese and Chinese groups were small
in number. More girls than boys had positive plates.
8. Of 51 children sensitive to 0.1 cc. of 1—1000 dilution of tuberculin,
20, or 39.21 per cent, had positive X-ray plates. Of 138 children positive
to 0.1 cc. of 1—100 dilution, 5, or 3.62 per cent, had positive plates.
9. The incidence of tuberculous lesion demonstrable by X-ray was seven
times as great for those with 3-plus reactions as for those with 1-plus
reactions.
10. Underweight and overweight children were found more frequently
among those whose X-ray plates showed definite lesions than among those
whose chest-plates were negative.
11. The percentage of positive X-ray plates was higher among children
from congested districts than among others.
part 2
The Sources of Tuberculous Infection in Children Entering Primary
Schools
The following is a preliminary report on a suggested new approach to
case-finding.
In an urban community the opportunities for infection of young
children with the tubercle bacillus are many. We must consider, as possibilities, an infectious milk-supply, casual contact with many people and
intimate contact in their own home.
Regarding the possibility of a contaminated milk-supply as being responsible for a large proportion of infection in young children, the following
facts are important:
Eighty-nine per cent of the milk sold in the city is pasteurized. Only
grade-A milk can be sold in the raw state. In 1926 a general test of the
cattle in the area supplying milk to the city revealed 7.8 per cent as posi-
P'age 27'8 ' I''1''
,«
I
tive reactors. Two retests within the same year showed 3.9 and 1.0 per cent
infected cattle. The percentages of positive reactors in general retests in 1927
and 193 3 were 1.1 and 0.6, respectively. Harrington and Myers conclude
that the ingestion of dead tubercle bacilli in pasteurized milk could not
account for a large percentage of positive reactors to tuberculin tests in
children.
In tracing the sources of infection it is obviously impossible to deal with
casual contacts. These children have not been at school a sufficient length
of time to have the number infected appreciably changed by contact with
other pupils and; with teachers.
Intimate association with tuberculous individuals increases theSicidence
of positive reactors. It was considered that school-children of the primary
class have had their intimate contacts more or less limited to their own
household. For this reason examination of the other members of the home
should reveal the source of infection for ,a large proportion of those children
reacting to tuberculin.
Slater and Jordan suggested that "with the percentage of reactors being
as small as it generally is, it would not be an insurmountable task to make
a study of the home contacts for the purpose of discovering the source of
infection, and as ,a result many adults would be discovered with tuberculosis
in the early stages."
Public-health nurses visited the homes of the child reactors to persuade
the contacts to be examined. References from the family physician were
required before the children were admitted to the clinic. Throughout the
survey, the co-operation of family physician, school medical staff and clinic
staff has facilitated the work. The procedure has been to examine and X-ray
those who react to tuberculin.
Seventy-two families have been investigated to date; a total of 144
adults (62 male and 82 female), and 142 children (80 male and 62 female)
were considered. Of the 72 families, 10 were Japanese, 11 Chinese and 51
whites. The source of infection has been definitely traced in 21 families.
The primary case was discovered 18 times in 51 families, in which all adult
members were examined. In the remaining 21 f amilies, in which one or more
adult members, residing at home, were not examined, tuberculosis in an
adult was found only three times. A history of tuberculosis in intimates of
6 additional homes was obtained but not verified.
Of the 21 tuberculous individuals considered to be responsible for the
infection of 21 primary-class children, 13 were previously known and on
record at the Clinic. Eight new cases of tuberculosis were discovered through
this survey. All the nejw cases were classified as minimal, 2 as apparently
healed, and 6 as active. Seven were adults, and one a boy of fifteen years,
with the so-called adolescent type of disease. Of 14 tuberculous individuals
previously diagnosed, 13 were adults and one a girl of fifteen with adolescent
pulmonary tuberculosis. Four have died of tuberculosis: two are far advanced, three moderately advanced, and five nnnimal, apparently healed,
or arrested. Both the father and mother were tuberculous in one family:
the father giving the longer history of illness is considered to be the primary
case in the family and probably responsible for infection of the school child.
The original case was the father in 8 families, the mother in 8 families, a
brother in one, a sister in] one, other relatives in three families, and a lodger
in one.
For a tuberculous person to be the source of infection presupposes that
Page 279 he has had positive sputum at some jlme. Hence, we should not expect to
find the majority of subjects traced through this method to have minimal
lesions. To date, all the new cases discovered through this survey have had
minimal disease. Only five of 14 previously diagnosed tuberculous persons
had minimal lesions. It would appear that, by investigating the home-
contacts of infected children, we find a nutmber of them tuberculous before
their health is sufficiently impaired to bring them unde, observation. They
are beyond the reach of the existing case-finding procedures.
The 7 adults with tuberculosis were found during the examination of
111 members of 59 families, an incidence of 6.30 per cent. The incidence
of tuberculosis among 126 adults examined at the clinic recently was 15
per cent. This includes those examined as contacts, and those examined
because of suspicious signs or symptoms.
Barclay, in a study of tuberculosis contacts in families, found demonstrable tuberculosis in 21.8 per cent of all contacts. He gives the incidence
of tuberculosis in suspects examined at a sanatorium as 2 0 per cent.
Of the 141 children (exclusive of the school beginners) of the 72
families studied to date, the ages range from nine months to nineteen years,
with the average age of the group 8.31 years. The ratio of infection was
66.97 per cent. Tuberculous lesions were found in 18 children, or 12.76 per
cent, of the whole group. Sixteen had positive X-ray plates and an additional 3 had suspicious markings. Two Chinese" girls had tuberculosis of the
cervical lymph nodes, and one of these was5 a suspect as well. Barclay, in a
group of contacts whose average age was 10.1 years, found the incidence of
tuberculosis to be 23.3 per cent. Johnson and Chadwick give the incidence
of positive X-ray findings| in children 0-17 years as 4.4 per cent.
It would seem that there is a marked difference in the incidence of
infection and of demonstrable disease in the racial groups. Infection was
found in 54.16 per cent of white, 83.33 per cent of Japanese and 81.39 per
cent of Chinese children; demonstrable tuberculosis (including extrapulmonary) occurred in 4.11 per cent of white, 13.04 per cent of Japanese
and 26.66 per cent of Chinese children. Certain differences in the findings
in boys and girls occurred in the racial groups. The incidence of infection
in boys was higher than in girls of the white race, while among the Orientals
more girls were infected. In the total group, 66.66 per cent of the boys and
67.24 per cent of the girls had positive skin-tests. More girls than boys had
definite tuberculous lesions, namely 13.11 as-compared with 12.50 per cent.
Of the 16 positive X-ray plates, 5 showed tuberculosis of the tracheobronchial lymph nodes, two pulmonary nodules, three tracheobronchial
tuberculosis with pulmonary nodles, one infiltration of the parenchyma,
one miliary tuberculosis, one adolescent tuberculosis, and three pleurisy.
There was a marked difference between the percentage of families, in
the three races, White, Chinese and Japanese, in which a source of infection
was found.
Regarding these findings, it is pertinent to point out that the mortality
rate for tuberculosis is much higher in Orientals than in the white races.
The ratio is approximately five to one. The rates for Japanese and Chinese
are practically the same. We would therefore expect to be able to trace the
sources of infection more frequently in Oriental than among white children.
Other conditions being equal, there seems no reason why the source of
infection should be found more frequently for Chinese than for Japanese
children. The Japanese are much more co-operative than the Chinese in
Page 280
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RwmfK'" •I Wk
health matters, and, although living conditions for the two races are very
similar, a greater dissemination of infection possibly occurs among the
Chinese through ignorance, indifference and carelessness. But the incidence
of infection in the children of the two races is practically the same. It is
difficult to see how this can explain the more frequent finding of the source
of infection of Chinese children.
There are on record at this Clinic approximately 8 tuberculosis individuals in the white population for each death from tuberculosis, 5 among
the Japanese for each national who died of tuberculosis, and 3.6 in the
Chinese population for each who died of tuberculosis during 1934. This
would explain the finding of new cases of tuberculosis more frequently in
the Chinese than in the Japanese, and more frequently in the Japanese than
in the white population, but it should have no bearing on the percentage of
infections traced for children of each race.
Certain observations in the school-beginners are of interest in connection
with the discovery of the source of infection. It would! seem that the result
of the tuberculin test in the school-child gives a, better clue in tracing the
primary case than does the X-ray of positive reactors.
In other words, the character of the skin reaction is a better index of
the intimacy of contact than is the presence of a definite lesion in the X-ray.
The source of infection was demonstrated in a higher percentage of
families where the school-child had definite X-ray findings than in those
families in which the child had a negative plate, the tuberculin test being
positive in both cases. But in any application of this method in case-finding,
15 out of 21 adults with tuberculosis would be overlooked by omitting the
investigation of the second group of families.
The percentage of families in which the infection of the school-child
is explained rises with increasing size of the skin reaction in the child.
This would indicate that intimacy of contact with tuberculous subjects
influences sensitiveness to tuberculin. The source of infection was found
for 60.87 per cent of those children with! 3- and 4-plus reactions, and for
only 14.2 8 per cent of those with 1- and 2-plus reactions. Moreover, two-
thirds of the 21 sources found were in families in which the six-year-old
child had a 3- or 4-plus skin reaction. Dickey found that contact children
had larger skin reactions than positive reactors with no history of contact.
His findings are in keeping with those reached here.
SUMMARY
1. The report deals with the investigation of 72 families, 51 complete
and 21 incomplete.
2. A source of infection was found in 21 families.
3. Of 21 primary cases 19 were adults and two were children of 15
years with adolescent type of disease.
4. Thirteen primary cases were previously known to be tuberculous.
5. Seven new primary cases were diagnosed among 111 adults, while
one new primary case was diagnosed among 141 children.
6. All the newly discovered primary cases were minimal, 6 being active
and 2 apparently healed.
7. Sixteen of 141 children had lesions in the chest demonstrable by
X-ray. In addition, two had cervical lymphadenitis, and three were suspects.
8. Of 133 children, who reported the result of the tuberculin test, 89,
or 66.97 per cent, had positive reactions.
Page 281 9. The sensitiveness to tuberculin in the child, both as regards the size
of the reaction and the amount of tuberculin required to produce it, shows
a distinct relationship to the percentage of primary cases found.
10. A higher percentage of primary cases is found for children who
have demonstrable lesions than for those who have not, but the majority
of primary cases are not traceable from this "lead."
11. Racial differences are marked. A higher percentage of primary cases
is found for Orientals than for Whites. The mortality rates for each race
has a bearing on this.
CONCLUSIONS
1. By tracing back into the families of young children infected with
tubercle bacilli, it is possible to discover a fairly large number of tuberculous
addicts before these are discovered by other methods of case finding.
2. The majority of new cases, and the highest percentage for the number
of individuals examined, will be found by examining the contacts of children sensitive to small amounts of tuberculin or of those children who have
marked reactions.
3. In any event, the percentage of new cases found will be much smaller
than is found among "contacts" and "suspects."
4. The presence of demonstrable tuberculous lesions in the children is
not as useful a guide in case-finding as is sensitiveness to tuberculin, since
the percentage yield is not so great and the majority of contact sources
would be overlooked.
5. It would be interesting to determine the reliability of tuberculous
lesions in older children as ai guide in tracing infection.
6. The older children in the family should not be overlooked as possible
primary cases within the family.
7. The incidence of tuberculosis among the children (other than those
of the primary class) in these families is higher than the average in the
childhood population, although not so high as among contacts of known
tuberculosis.
8. Search for a primary case in the families where young children react
to tuberculin is a feasible method of tuberculosis case-finding. Further
investigation in other centres may show this method to be of practical value
to school and municipal health-units.
THE METHOD OF HANDLING MEDICAL
RELIEF  IN  ONTARIO
By an order~in-council in March, 193 5, the government of Ontario
delegated to the Ontario Medical Association the task of administering
medical services to all persons on unemployment relief. For this purpose
it agreed to pay to the medical association, through the Department of
Public Welfare, the sum of 25c monthly for every person on relief (in a
few of the outlying districts the sum was to be 50c), to cover the full
costs of all medical services rendered in the doctors' offices and the patients'
homes, including maternity cases delivered at home, and, in addition, the
full costs of all necessary drugs and supplies.
Although not convinced that the sum of money offered by the Government was sufficient to pay for the services requested, the Ontario Medical
Association agreed to this arrangement, realizing the advantages of having
Page 282 !l
some uniform method of medical relief administration in force throughout
the province, and feeling that this was an unexcelled opportunity to collect
data as to actual demands for, and costs of, medical care. Such data, and the
experience gained in administering even such a very limited scheme, might
prove valuable if and when the need arises of establishing a more extensive
health insurance scheme for the population in general.
To inaugurate and supervise this system, the Board of Directors of the
Ontario Medical Association appointed from its members a Medical Relief
Management Committee of three. At the suggestion of this Committee,
each local medical association, altogether 96 in number, nominated a local
relief committee (consisting of doctors, a druggist, and local relief officials),
whose duties were to supervise the medical attention given, and to review
the monthly accounts of the doctors, passing them for payment, and, when
necessary, reducing or rejecting them. The central committee was to function as a central arbitration board, and was to set up machinery to pay from
the funds available the taxed accounts turned in to it by the Local Relief
Committees. It was to deal with all problems of adrninistration, keep the
Local Relief Committees functioning uniformly, and be the sole body to
enter into negotiations with the Department of Public Welfare.
The division of the 25c per head is upon the following basis: 4c is first
deducted for the payment of drug costs; this leaves 21c available for the
remuneration of physicians.
It was decided at the beginning of the scheme that 4% of this amount
was to be set aside for central office adniinistration costs, and an additional
4% for Local Relief Committee expenses. Actually the costs, although
especially heavy because it was the first year of operation, have worked out
at only 2.644% and 2.5 83% respectively, or a total of 5.227% for administration costs.
After deducting the drug costs and the 8% which was set aside for
administration, the Ontario Medical Association during the first year of
operation actually had $2.32 available per person per year for the payment
of doctors' accounts.
Doctors render their accounts on the basis of this schedule:
House calls $  3.00
Office calls      2.00
Confinements   2 5.00
Winter mileage        .50 (oneway)
Summer mileage        .25 (oneway)
No extra remuneration is given for any surgery or special procedure.
At the central office, the total accounts for each municipality are paid
out of the funds available for each municipality. Where the funds are
insufficient,' to pay the accounts in full, as is generally the case, each doctor
receives only his pro rata share of the total. Naturally, the rates paid vary
with each municipality. For a variety of reasons, the arrangement of keeping
funds for each municipality separate has been found unsatisfactory, and it
has been suggested that the pooling of funds for larger areas would prove
more satisfactory.
During the first year, ending February 29, 1936, there were on the
average 3 84,000 persons on relief throughout the province, and each month
an average of 3,000 doctors participated in the plan.
Although only 45% of the doctors' taxed accounts are paid on the
average, the statistics collected are of great value. The plan has proved
Page 283 beyond a doubt that the sum available is quite insufficient to pay for the
type of medical service expected, in spite of the fact that no attempt was
made to supply care in hospital or to pay for surgery of any kind out of
the funds available. Throughout the province $.89 per call was paid for
office visits, $1.32 for home visi& and $11.18 for confinements.
An average of 2.693 home and office calSwere giveiMn Ontario during
the year for every person on relief.
A great deal has been learned in Ontario of the actual costs of rendering
medical care. The doctors have come to realize that previous haphazard
methods of determining the costs of rendering medical care must be replaced
by scientific methods if the profession is not to suffer at the hands of governments and other agencies who are interesting themselves in purchasing
medical care on a mass basis. A great many errors and pitfalls of administration have been met and successfully overcome.
The valuable information gleaned has been largely due to the wholehearted co-operation of the profession as a whole in overcoming administrative problems, and due to the careful manner in which the profession
has assisted in the accurate compilation of the necessary statistics.
Summary:
1. Administration by the profession:
(a) Local Relief Committees supervise cases and review accounts.
(b) Central Medical Relief Management Committee pays accounts
and administers scheme uniformly.
2. Government pays 25c monthly per head or $3.00 yearly.
This divides (yearly):
Drugs   $    .48
Administration (8%)  S3.        .20
Doctors' accounts      2.32
3. Benefits given—home and office calls, including home confinements,
plus the cost of drugs.
4. Accounts rendered on a set schedule, then paid on a pro rata basis from
the fund available.
5. During 193 5, average fees paid:
Office call  $    .89
Home calls      1.32
Confinements       11.18
6. Average number of home and office calls per person per year: 2,693.
7. Average number of persons on relief: 3 84,000.
8. Average number of doctors participating: 3,000.
MEDICAL PIONEERING IN BRITISH COLUMBIA
By M. W. Thomas, M.D.
Vancouver, B. C.
(Part 2)
One of the most picturesque characters in the early history of British
Columbia was the Honourable Dr. John Sebastian Helmcken, who was the
first doctor to take up regular practice in the provnice. Born in London,
England, in 1824, he secured his medical degree in 1847 and was appointed
Surgeon to the Hudson's Bay Company in 1849, arriving at Victoria in
March, 18 50, after a voyage lasting six months, making landing at Esqui-
malt. Later in the year 1850 he went to Fort Rupert at the northern end
Page 284 Ki
of Vancouver Island, more than 250 miles by water north of Victoria.
Dr. Helmcken was summoned to return to attend Governor Blanchard,
who was ill in Victoria. He made the 250-mile trip in a war canoe paddled
by Indians, and as this was a time-consuming journey he found oxsiUji&pdval
that the Governor had been treating himself (a very) unethical procedure)
and had already recovered. En route the Indians were attacked by hostile
tribes, which enlivened a rather long and tiresome trip.
Dr. Helmcken took up office and surgery in the Fort in part of Mr.
Finlayson, the Chief Trader's office. He distributed the drugs and supplies to
the various Company Posts. Treatment was administered at the Posts by
the Trader. As soon as the patient fell ill he was given an emetic; this was
followed by a purge. The diary states that no one died.
The drugs available were very few but were usually selected for their
strength and efficient action.
A story is recounted which depicts the conduct of the Fort. The men
of the Fort had secured two kegs of whiskey from some source and had
secreted one keg under the men's quarters. Governor Douglas, who was
living in the Fort, learned that the men were indulging too freely and
instructed Mr. Finlayson to take the whiskey from them. All the officials
were pressed into service for the attack. Mr. Staines, the Parson, donned the
sword of his ancestors and dramatically challenged the intoxicated men,
"Who dare pass this?" and while the men, huddled at one end of their
quarters, grumbled, the keg was rolled into the roadway. The Governor
then ordered Finlayson to knock in the head of the keg, which he did, the
whiskey running in rivulets and filling the ruts and making puddles and
pudlets. The Scots of this sad group looked on with watered eyes and
quivering tongues. The men were disappointed but salvaged some of the
precious fluid in their palms, while others lay on the ground and lapped it
from the puddles. Dr. Helmcken hastily brought tartar-emetic from his
surgery and sprinkled the area, and he tells of the effect on the men as they
lay on the ground.
Dr. Helmcken told of witnessing the first operation performed under
ether in Guy's Hospital. Dr. Gull, later Sir William Gull, administered the
anaesthetic. The effect was astounding to all and to the patient, who would
not believe that his leg had been amputated until the nurse threw back
the bed-clothes and said "Look!" . . .
He spoke of the fortitude, pluck and endurance of patients operated
upon prior to the advent of general anaesthesia. Less courage may be required
to go to the gibbet, and he could not help thinking that the user of general
anaesthetics for trivial operations is an abuse, educating the people into
greatly exaggerated conceptions1, of pain and so making them timid.
Dr. Helmcken addressed the nurses at the opening of the first training
school in British Columbia, at the inauguration ceremony, held December
16th, 1891, at the Jubilee Hospital in Victoria. He was a moving factor in
the development of the two Victoria hospitals.
In 1869 he suggested that the Royal Hospital patients be moved to
the Female Infirmary. This was acted upon and the union was named the
Royal Hospital, which was afterwards moved to and became the Provincial
Royal Jubilee Hospital. In 1875 Dr. Helmcken requested and encouraged
the Sisters of St. Ann to open a hospital in Victoria and St. Joseph's Hospital began its growth.
Dr. Helmcken practised his profession in Victoria for many years before
Page 285 the days of telephone. His daughter, Mrs. Higgins, who still lives in the old
home, the only surviving childy tells how her father was called out in the
night—she says, "every night." One night a man, who drove him to his
wife's bedside, said as he whipped up the old horse, "I can buy another horse
but I cannot buy another wife."
The Doctor by appointment attended! the jail at Victoria, and grew to
lave its inmates, often remarking that there were more honest people within
than without. He often gave a financial start to discharged prisoners and
saw many reform under his encouragement and grow into good and useful
^mzens. He was a man of few words during his professional visits. On one
occasion, on seeing a child in an outlying home with ring-worm, he handed
the mother the written prescription and as he took his hat and cane he
turned and simply said, "Rill the cat."
Dr. Helmcken, during the later days of his practice, administered
anaesthetics at the hospitals, and it is told that he made this the occasion for
an enjoyable smoke, providing himself with a cigar the length of which
depended on the nature of the operation and the reputation of the sturgeon
for speed. On one occasion, he was sitting at the head of the patient, dressed
as usual in a frock coat and puffing a cigar as he dropped the ether on the
mask. Dr. Davie, who was operating, suggested that some day the anaesthetist would set the place on fire. Dr. Helmcken pooh-poohed the idea of
the younger man, and to prove that there Was no possibility of such an
accident, he blew through his lighted cigar against the mask. A wet towel
saved damage to the patient, but Dr. Helmcken's whiskers were less fortunate. I need scarcely tell you that there was no further smoking in operating
rooms in Victoria.
At the Seventh Annual Meeting of the British Columbia Medical Association, held in Victoria, August, 1907, Dr. Helmcken, who was at that
time 82 years of age, addressed the members, his subject being "Fifty Years'
Experience in Practice." He explained that he had been asked to crowd into
fifteen minutes the experiences of fifty years. He felt that this was going
even farther than the tinctures of modern medicine, into which so much
was concentrated. His experience had been the same as that of other medical
men; some patients had recovered, some had died, some had done neither
one nor the other.
At one time it had been said that he was head of his profession in
Victoria. "This statement was perfectly true,", he said, "for at that time
there was not another surgeon within a hundred miles." He was said to be
remarkably successful—so he had been. All the citizens of Fort Victoria
then were young men, all healthy, no one1 died—not that he wanted any of
them to die but they didn't die—so his mortality rate was less than one
per cent.
One of the first cases he knew of in Victoria Was when a young lady came
to "Bachelor's Hall" at the Fort and called: "Dr. Benson." "Yes, Maggie,"
came the reply. "Please come down and cut father's throat." "Alright,"
answered the Doctor. Father was suffering from "quinsy."
They all lived the simple life in those days and he gave simple treatment. One of those who came to "Bachelor's Hall," as the surgery at the
Fort was called, was an Indian, Francois, who said he was "very sick." He
was told to take a dose of salts. He insisted that he was "very, very sick."
He was told to take two doses. That was the treatment and it was successful treatment.
Page 286 One beastly night he had been called to Mount Douglas, a distance of
about eight miles. He mounted and rode off. He said "there were no automobile things" and no electric lights then, and the horse had to find the
trail as best it could. When he completed his examination of the sick man
he asked one of his friends which of them was coming to get the medicine.
The man addressed' said, "You've seen him now, Doctor, won't tomorrow
do for the physics?" The man camej to the surgery next day and reported
that the sick man had died. "But you've seen him, Doctor/' the man said,
"we don't want any coroner's inquests."
(To Be Continued)
I t I 1 I t I 1 1 ! t I 1 1 1 1 I I I 1 1 1 1 1 1 1 1 1 I I t I I t 1 I t t t I I I I I t t I t t t
III
PETROLAGAR MISCIBILITY
ASSURES EFFECTIVENESS
To a half-glass of water add a tablespoon of Petrolagar and
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for the treatment of constipation.
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Page 287
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.11)11. .IMIMIIIIIIIIIl
AGRANULOCYTIC ANGINA WITH NUCLEOTIDES—G. C. Large, M.D	
ANGINA PECTORIS—G. F. Strong, M.D	
APPENDICITIS—R  I. Harris, M.D  67,
BOOK REVIEWS—
Hospital Organization: M. T. MacEachern, M.D.—A. K. Hay ward, M.D.
Textbook of Roentgenology: B. J. M. Harrison, M.D.
law,  M.D.  _ __
-W. A. White-
BRAIN ABSCESS—W. Cone, M.D  104
BRAIN TUMOUR, EARLY DIAGNOSIS OF—F. Turnbull, M.D  100
B. C. MEDICAL ASSOCIATION—
Annual Meeting, Vancouver, B. C       6
Annual Meeting, Victoria, B. C ____  228
Constitution and By-Laws __. :  254
Open Letters—Dr. H. H. Milburn, M.D.._~_____„_-.  29, 198
Executive Secretary, Notes from 232, 248, 267
Presidential Address—H. H   Milburn, M.D _     30
BROWN, MAJOR HAROLD—Address delivered before B. C. Medical Assn. 257
CANADIAN MEDICAL ASSOCIATION—
Annual Meeting, Victoria, B. C ....._____
Letter from Secretary to Dr. H. H. Milburn  _______
CHRONIC DUODENAL STASIS—Charles Hunter, M.D	
CHRONIC OSTEOMYELITIS—R. I. Hunter, M.D	
CLEVELAND, D. E   H., M.D.—Neosalvarsan Reactions	
COLBECK, W. K., M.D.—Health Insurance in Ontario	
CONE, W., M.D.—Head Injuries...™ ___„_	
CURTIS, E. JOHNSTON, M.D.—Rheumatic Fever	
DOLMAN, C. E., M.D., B.S., M.R.C.P., Ph.D.—Serum Therapy	
EARLY MEDICAL HISTORY OF THE B. C. COAST—
J. H. MacDermot, M.D  ._. _	
GALL BLADDER DISEASE—Charles Hunter, M.D __	
GRANULOSA CELL CARCINOMA OF THE OVARY—H. H. Pitts, M.D	
HALL, EARLE R.—Present Status of Transurethral Prostatic Resection
HARRIS R. I., M.D.—Appendicitis     _, —  67,
Chronic Osteomyelitis „, . __.	
HEAD INJURIES—W. Crone, M.D __ _.	
HEALTH INSURANCE (See also Medical Economics)—
The Health Insurance Act __J|| ___	
Health Insurance, B. C. Report—Wallace Wilson, M.D __.	
Health Insurance in England—R. G. Leland, M.D 114,
Health Insurance in Ontario—W. K. Colbeck, M.D __—.—_.
Health Insurance, Letter from W. E. Ainley, M.D _.—___.	
218
147
104
140,
HUNT, V. C, M.D.—Considerations of the Major Surgical Lesions of the
Kidney    ™™_  39
Surgical Aspects of Peptic Ulcer _  10
HUNTER, A. W.. M.D.—Glimpses into Urology, Past and Present
(Osier Address)  __ — -—  ~_—  150
HUNTER, CHARLES, M.D.—Chronic Duodenal Stasis __.._ — 81
Diseases of the Extra-Hepatic Biliary Tract 15
Hiatus Hernia. __.  78
Influence of Chronic Gall-Bladder Disease on
the Heart  __ ___... 85 INDEX—Contimted
INCOME  TAX  RETURNS   26S
INTERNAL DERANGEMENTS OF THE KNEE JOINT—J. R. Naden, M.D.  222
KEMP, W. N., M.D.—Physiology and Chemistry of the Female Sex
Hormones  —_ ——■■—-  1^6
KNEE JOINT, INTERNAL DERANGEMENTS—J. R. Naden, M.D  222
LELAND, R. G., M.D.—Income from Medical Practice :  114, 140
Health Insurance in England 162,  191, 212
LIBRARY  ADDITIONS       8, 50, 73, 100, 124, 197, 218, 266
MEDICAL ECONOMICS (See also Health Insurance)—
Income from Medical Practice—R. G. Leland, M.D .__ 114,
MEDICAL PIONEERING IN B. C.—M. W. Thomas, M.D  251,
MEDICAL  RELIEF,  ONTARIO _____ _ -
NADEN, J. R., M.D.—Internal Derangements of the Knee Joint	
NEOSALVARSAN REACTIONS—D. E. H. Cleveland, M.D	
NEUROLYMPHOMATOSIS GALLENARUM—Jacob Biely, M.S., B.S.A	
OBITUARIES—
George V  .—~ _~ ~fr	
Dr. J. M. Pearson  . _ .—.— _~	
Lieut.-Col. A. M. Warner, M.D ™ r—	
Dr. Walter Graham : _	
Dr. H. B. Maxwell ___  	
Dr. F. T. Underhill — _- __„__-_	
ONTARIO, HEALTH INSURANCE—W. K. Colbeck, M.D	
ONTARIO   MEDICAL   RELIEF  _	
OSLER LECTURE—A  W. Hunter, M.D __ _»»_	
PEARSON, JOHN MAWRER, M.D.: Obituary	
PENSIONS AND NATIONAL HEALTH DEPT.—Letter to Dr. McLachlan
PHYSIOLOGY AND CHEMISTRY OF THE FEMALE SEX HORMONES
—W. N. Kemp, M.D __ ,„	
PITTS, H. H., M.D.—Granulosa Cell Carcinoma of the Ovary  _.
PROVINCIAL SECRETARY,  LETTER _____
RHEUMATIC DISEASES, SOCIETY FOR THE STUDY OF—Open Letter
RHEUMATIC FEVER—E   Johnston Curtis, M.D _ ____•
SERUM THERAPY—C. E. Dolman, M.D., B.S., M.R.S.P., Ph.D „___
SPINAL CORD TUMOURS—W. Cone, M.D  .„___	
STRONG, G. F., M.D.—Angina Pectoris __	
TEETH OF B. C. SCHOOL CHILDREN—Provincial Secretary.-. .„.,_..'
THOMAS, M. W., M.D.—Medical Pioneering in B. C    251,
TUBERCULOSIS, INCIDENCE IN CHILDREN IN B. C.—
A. R. J. Boyd, M.D	
TUBERCULOSIS—PREVENTION AND TREATMENT 	
TUMOURS OF THE OVARY—H. H. Pitts, M.D 	
TURNBULL, F, M.D.—Early Diagnosis of Brain Tumours -„	
UROLOGY, PAST AND PRESENT—A. W. Hunter, M.D     .
WARNER, LIEUT.-COL. A. M., M.D.: Obituary  	
WILSON, WALLACE, M.D.—Brief Report on Health Insurance	
140
284
282
222
241
128
97
72
239
98
123
124
234
282
150
72
124
208
208
99
'll3
132
200
105
34
99
284
275
268
208
100
150
239  One of a series of advertisements prepared and published by PARKE, DAVIS & CO. in behalf of thej
medical profession. This "See Your Doctor'' campaign is running in
Maclean's and other leading magazines
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__L_ife is not as gentle to a tiny baby as it
seems to be.
He comes into this world, never having breathed, never having eaten, never
having digested food. Almost immediately, his little body must adjust itself
to these vital functions.
If he is like most babies, he doubles
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it in the first year. Every part of his
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A new baby encounters disease-
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and must build up resistance against
them. If he does become ill, he is without the power to tell what the trouble is
or where it lies. And when upset, he fre
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just what to do.'*
Yes, infancy is so hazardous a period
that, last year, the number of deaths
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The doctor is the one person equipped
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baby's life.
The doctor who sees the baby regularly can often detect sickness or physical trouble in its early stages. He can
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Enlisting the doctor's help—entrusting growth, diet, and general health to
his supervision—is one of the most sensible precautions parents can take in
those dangerous days of the child's
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tardy periods (non-physiological) and dysmenorrhea. Affora-! remagRable symptomatic
relief by stimulating^f^^fp#vation of the
p|||lr_s --{ifd stabiH^ro^tj^^ftone of its
musculature. Controls; the utero-ovarian
circulation and thereby'encourages a
normal menstrual cyclist ,
• MARTIN H. SMITH COMPANY
_V       : -_*I0 lATAYITU STRUT. NiW YORK; N. Y.     ! *59_
Full formula and descriptive
literature on request
Dosage: l to 2 capsules
3 or 4 times daily. Supplied
in packages of 20.
Ethical protective mark MHS
embossed on inside of each
capsule, visible only when cap*
sule  is cut in  half  at seam.
in St   For Acute Tonsillitis
Incipient Peri-tonsillar Abscess
Naso -pharyngitis • Laryngitis
and in MIDDLE and EXTERNAL EAR INFECTIONS, prescribe
ANTIPHLOGISTINE
Exerting a favorable action on the blood chemistry,
it aids the antibodies in their destruction of the infec
tive organisms.
Sample on Request.
THE
Denver Chemical Mfg. Co.
153 Lagauchetiere St. W.
MONTREAL
If   '„*•'<■  i ^w
U fMt/JU'o^iati'a&. 'M
KM
Sf. MM
Made in Canada I
;>;<
Nutritional Anemia |in Infants
0*1
I-
i'3
3-4
4-5
5-6
*•?
Months of Age.
7*8    8-9    9-10    10-11
._--_
7$%
-1
-Q
g.70%
m
i rants
1
ts%
Artificially fed London ii
1        1        1        1
Hemoglobin level in the blood of infants of various ages. Note fall in hemoglobin, which
is closely parallel to that of diminishing iron reserve in liver of average infant. Chart
adapted from Mackay. It is possible to increase significantly the iron intake of the bottle-fed
from birth by feeding Dextri-Maltose With Vitamin B in the milk formula. After the third
month Pablum offers substantial amounts of iron for both breast- and bottle-fed babies.
fX%   Reasons for Early Pablum Feedings   11
1    The iron stored in the infant's liver at birth is rapidly depleted during the first months
of life.   (Mackay,1 Elvehjem.2)
O   During this period the infant's diet contains very little iron—1.44 mg. per day from
S®? the average bottle formulae of 20 ounces, or possibly 1.7 mg. per day from 28 ounces
of breast milk.  (Holt. 3)
For these reasons, and also because of the low hemoglobin
values so frequent among pregnant and nursing mothers
(Coons,4 Galloway5), the pediatric trend is constantly toward
the addition of iron-containing foods at an earlier age, as
early as the third or fourth month. (Blatt,6 Glazier,7 Lynch8).
p The Choice of the Iron-Containing Food
j     Many foods reputed to be high in iron actually-add very few milligrams to the diet
because much of the iron is lost in cooking or because the amount fed is necessarily
small or because the food has a high percentage of water.   Strained spinach, for^
instance, contains only 1 to 1.4 mg. of iron per 100 gm.   (Bridges.9)
Some foods fairly high in total
To be effective, food iron should be in soluble form,
iron are low in soluble iron.  (Summerfeldt.10)
_2   Pablum is high both in total iron (30 mg. per 100 gm.) and soluble iron
*'• (7.8 mg. per 100 gm.) and can be fed in significant amounts without digestive
upsets as early as the third month, before the initial store of iron in the liver
is depleted.   Pablum also forms an iron-valuable addition to the diet of
pregnant and nursing mothers.
Pablum (Mead's Cereal thoroughly cooked and dried) consists of wheatmeal, oatmeal, cornmeal, wheat embryo, brewers' yeast, alfalfa leaf, beef bone, iron salt and sodium chloride.
1--0 Bibliography on request.
MEAD JOHNSON & CO. OF CANADA, LTD., Belleville Onf.
Please enclose professions! card when requesting samples of Head Johnson products to cooperate In preventing their reaching unauthorized persons t VANCOUVER, B. C.
North Vancouver, B. C.    Powell River, B. C.
--BUSHED MONTHLY AT VANCOUVER,  B. C.  BY ROY WRIGLEY LTD.,  300 WKST PENDER STREET K1
Hollywood Sanitarium
Limited
For the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour. 4183
Westminster 288  RS'tS:*
(*' .
VANCOUVER   MEDICAL   ASSOCIATION
SUMMER SCHOOL, 1936
HOTEL VANCOUVER
September 8th, 9th, 10th and 11th
PROGRAMME
i ?
TUESDAY, SEPTEMBER 8th
9 a.m.—Dr. Irvine McQuarrie: "Pathogenesis and treatment of oedema."
10 a.m.—Dr. Evarts A. Graham: "Thoracic Surgery" (1).
11 a.m.—Dr. Rollin T. Woodyatt: "Diabetic Coma."
12:30   —LUNCHEON: Hotel Vancouver.  Speaker: Dr. Gordon B. New.
3 p.m.—CLINIC: Dr. Evarts A. Graham, Vancouver General Hospital.
8 p.m.—Dr. Gordon B. New: 'Malignant diseases of the mouth and accessory structures."
9 p.m.—Dr. J. McF. Bergland: "Accidental complications of pregnancy."
10 p.m.—-Dr. C. B. Farrar: "Evolution of a delusion."
WEDNESDAY, SEPTEMBER 9th
9 a.m.—Dr. J. McF. Bergland: "Direct complications of pregnancy."
10 a.m.—Dr. C. B. Farrar: "Psychoneurosis and psychotherapy."
11 a.m.—Dr. Gordon B. New: "Tumours of the neck."
2 p.m — CLINIC: Dr. C. B. Farrar, St. Paul's Hospital.
8 p.m.—Dr. Irvine McQuarrie: "Clinical significance of the basic minerals of the body."
9 p.m.—Dr. Evarts A. Graham: "Thoracic Surgery" (2).
10 p.m.—Dr. Rollin T. Woodyatt: "Diabetes with surgical complications."
THURSDAY, SEPTEMBER 10th
—Dr. Evarts A. Graham: "Certain phases of gall-bladder disease."
—Dr. Rollin T. Woodyatt: "Protamine insulin, newer preparations and their uses."
—Dr. Irvine McQuarrie: "Special roles of fats and fat-like substances in health and
disease."
m.—GOLF TOURNAMENT.
—Dr. Gordon B. New: "Tumours of the larynx."
Dr. C. E. Dolman: "Undulant Fever."
—Dr. J. McF. Bergland: "Relief of pain."
FRIDAY, SEPTEMBER 11th
-Dr. C. B. Farrar: "Differentiation of benign and malignant symptoms in incipient mental disorders."
-Dr. Evarts A. Graham: "Surgery of the pancreas."
-Dr. J. McF. Bergland: "Puerperal Infections."
-CLINIC: Dr. I. McQuarrie, Vancouver General Hospital.
-Dr. Irvine McQuarrie: "Mechanisms and treatment of various convulsive disorders of childhood."
-Dr. Rollin T. Woodyatt: "Treatment of Nephritis."
-Dr. Gordon B. New: "Reconstructive surgery of the face."
9
a.m.-
10
a.m.-
11
a.m.-
1,
30 p
8
p.m.-
9
p.m.-
10
p.m.-
9 a.m.
10
a.m.
11
a.m.
2
p.m
8
p.m
9
p.m
10
p.m    University of British Columbia Library
DATE DUE
SERIALS
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_-fl-______iSf;
l lit! 1J-
,301
. ".. J .
f IMT C
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g_R
MAR - V
1981
CFP  V7
19R1 5 PHI
W L» J       J-     i
FORM   ND.   31
Q G
I  

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