History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: July, 1941 Vancouver Medical Association Jul 31, 1941

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 of the
{VANCOUVER
MEDICAL ASSOCIATION
•Vol. XVII
JULY, 1941
No. 10-
With Which li Incorporated
Transactions of the
Victoria Medical Society
the
Vancouver General Hospital
and
St Paul's Hospital
In This Issue:
NEWS AND NOTES
NOTES OF ANNUAL MEETING C. M. A. |g -|§g _^;,    _^}|293
BULLETIN WAR RELIEF FUNE^fe; - ~.|||| — l|ltffS |||||  --^294
CYSTOMETRY—Dr. L. G. Woo4J£§H£|- _ — ,    ^^ffl- - 2"
NUTRITIONAL REQUIREMENTS OF THE GROWING CHILD
—Dr. P. C. Jeans-}^pl.     --^— ^^^H 3°4
PROFESSIONAL INSTITUTE MEDAL :|ill jjliill _ ^— 308
ANNUAL MEETING OF BRITISH COLUMBIA MEDICAL ASSN.,
1941 — SEPTEMBER 16, 17, 18.
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AQUAPHEDRIN £.<««S
AQUEOUS ISOTONIC
BACTERIOSTATIC
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equivalent to a \% solution of Ephedrine Alkaloid. Being
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action and, being isotonic, it diffuses rapidly and without
osmosis and, therefore, permits the Ephedrine to exert its
unique decongestive effect.
Unlike most Ephedrine solutions, Aquaphedrin E.B.S. is
effective without stinging and its application is followed
by grateful relief.
Aquaphedrin is effective in reducing swollen or congested
turbinates and in relieving congestion of the mucous lining
in head colds, nasopharyngeal inflammation, sinus blockage,
hay fever, asthma and other nasal conditions.
Aquaphedrin E.B.S. is packaged in ^ °2«ana> 1 °2- dropper
bottles, with detachable labels for convenience in dispensing.   Also supplied in bulk for use in an atomizer.
Specify Aquaphedrin E.BS. on your prescriptions.
til L
THE E. B. SHOTTLEWORTH CHEMICAL C0.4IMITED
TORONTO
MANUFACTURING   CHEMISTS
CANADA
SPICIPY       E. S. S.       ON       YOUI        PIISCIIPTIONS 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:
Db. J. H. MacDermot
Dr. G. A. Davidson Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XVH
July, 1941
No. 10
OFFICERS, 1940-1941
Dr. W. M. Paton Dr. C. McDiarmid 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
TRUSTEES
Dr. F. Brodie Dr. J. A. Gillespie Dr. G. H. Clement
Auditors: Messrs. Plommer, Whiting & Co.
SECTIONS
Clinical Section
Dr. Karl Haig Chairman Dr. Ross Davidson Secretary
Eye, Ear, Nose and Throat
Dr. J. A. McLean Chairman Dr. A. R. Anthonys Secretary
Pediatric Section
Dr. R. P. Kinsman Chairman Dr. G. O. Matthews Secretary
STANDING COMMITTEES
Library:
Dr. F. J. Buller, Dr. D. E. H. Cleveland, Dr. J. R. Davies,
Dr. A. Bagnall, Dr. A. B. Manson, Dr. B. J. Harrison
Publications:
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.
Credentials:
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. J T
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The New Test for
Diabetic Sugar
DIABETICS are easily taught to use Galatest, the new micro-
reagent for detecting diabetic sugar.
No test tubes or boiling necessary. One drop of urine deposited on a little Galatest powder, gives an instantaneous reaction.
Co/or chart accompanies every vial
THE DENVER CHEMICAL MFG. CO., 153 Lagauchetiere St. W., Montreal VANCOUVER     HEALTH     DEPARTMENT
STATISTICS—MAY, 1941
Total population—estimated    272,352
Japanese population—estimated        8,769
Chinese population—estimated ;        8,558
Hindu population—estimated _ ;       360
Rate per 1,000
Number       Population
Total deaths 264 11.4
Japanese deaths        4 5.4
Chinese deaths 16 25.8
Deaths—residents only 223 9.6
BIRTH REGISTRATIONS:
Male, 244; Female, 240-
484
INFANTILE MORTALITY— May, 1941
Deaths under one year of age      11
Death rate—per 1,000 births !      22.7
Stillbirths (not included in above) 7
20.9
May, 1940
9
20.6
8
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
April, 1941     May, 1941   June 1-15,1941
Cases Deaths
 ;  5
  0
  36
  349
  132
  5
  1
  0
  0
Poliomyelitis .  0
Tuberculosis  21
Erysipelas -  1
Meningococcus Meingitis  6
Paratyphoid Fever (Carrier)  0
Scarlet Fever	
Diphtheria	
Chicken Pox	
Measles	
Rubella I	
Mumps _
Whooping Cough	
Typhoid Fever	
Undulant Fever	
0
0
0
0
0
0
0
0
0
0
16
0
0
0
Cases
3
0
73
204
133
16
23
0
1
0
36
2
5
1
Deaths
0
0
0
0
0
0
0
0
0
0
16
0
2
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Cases
3
0
62
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32
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0
0
10
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1
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Deaths
0
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0
0
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V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH,
DIVISION OF VENEREAL DISEASE CONTROL
West North
Burnaby  Vancr.   Richmond   Vancr.
Syphilis 	
Gonorrhoea
Vane. Hospitals &
Clinic Private Drs. Totals
37               30 67
58               23 81
A DYNAMIC MENTAL AND PHYSICAL TONIC
INDICATED IN THESE DAYS OF STRESS
<< A  "
BIOGLAN "A
Another Product of the Bioglan Laboratories, Hertford, England
Phone MA. 4027
Stanley N. Bayne, Representative
1432 MEDICAL-DENTAL BUILDING
Descriptive Literature on Request
THE SCIENTIFIC HORMONE TREATMENT
Vancouver, B. C.
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STILBOiSTROL  B.D.H.
Prolonged clinical trials have now established the value of
Stiiboestrol B.D.H. in all conditions due to defective ovarian follicular function.
Such conditions as delayed puberty, menopausal disorders, pruritus
vulvae, senile vaginitis, vuIvo-vaginitis in children, secondary amen-
orrhcea and sterility with dysmenorrhea associated with uterine
hypoplasia will be found to respond to oral administration of
Stiiboestrol B.D.H.
!n certain patients, however, it is found that stiiboestrol gives rise
to gastro-intestinal disturbances upon administration, these disturbances being characterised by vomiting and a marked feeling
of nausea. Such cases should receive continued treatment with
the natural cestrogenic hormone, Oestroform, which, being a substance that is normally generated in the body, is incapable of
provoking a reaction and is readily tolerated in all cases.
Stocks of Stiiboestrol B.D.H. are held by leading druggists throughout the
Dominion, and full particulars are obtainable from:
THE BRITISH DRUG HOUSES (CANADA) LTD.
Terminal Warehouse
Toronto 2 Ont.
Sti;b/Can/417 BRIEF HISTORICAL NOTES
ON
MEADS CEREAL AND PABLUM
JtiAND in hand with pediatric progress, the introduction of Mead's Cereal
in 1930 marked a new concept in the function of cereals in the child's dietary.
For 150 years before that, since the days of "pap" and "panada," there had
been no noteworthy improvement in the nutritive quality of cereals for
infant feeding.   Cereals were fed principally for their carbohydrate content.
The formula of Mead's Cereal was
designed to supplement the baby's diet in
minerals and vitamins, especially iron and
Bj. How well it has succeeded in these
functions may be seen from two examples:
(l) As little as one-sixth ounce of Mead's
Cereal supplies over half of the iron and
more than one-fifth of the vitamin Bt minimum requirements of the 3-months-old
botde-fed baby. (2) One-half ounce of
Mead's Cereal furnishes all of the iron and
two-thirds of the vitamin Bt minimum
requirements of the 6-months-old breastfed baby.
That the medical profession has recognized the importance of this contribution
is indicated by the fact that cereal is now
included in the baby's diet as early as the
third or fourth month instead of at the
sixth to twelfth month as was the custom
only a decade or two ago.
In 1933 Mead Johnson & Company went
a step further, improving the Mead's Cereal
mixture by a special process of cooking,
which rendered it easily tolerated by the
infant and at the same time did away with
the need for prolonged cereal cooking in
the home. The result is Pablum, an original
product which offers all of the nutritional
qualities of Mead's Cereal, plus the convenience of thorough scientific cooking.
During the last ten years, these products
have been used in a great deal of clinical
investigation on various aspects of nutrition, which have been reported in the
scientific literature.
Many physicians recognize the pioneer efforts on the part of Mead Johnson
& Company by specifying Mead's Cereal and PABLUM.
Pablum is a palatable mixed cereal food, vitamin and mineral enriched, composed of wheatmeal (farina), oatmeal,
cornmeal, wheat embryo, beef bone, brewers' yeast, alfalfa leaf, sodium chloride, and reduced iron. W,l
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Effective treatment of Peptic Ulcer...
"Because, according to Mutch, the antacid power of Hydrated Magnesium
Trisilicate is sustained for hours even in the presence of excess acid, because its absorptive power lasts even for a few days, because it has strong
antipeptic powers, because even in large doses it causes neither constipation
or diarrhoea, and because it cannot produce alkalosis by absorption of
unused excess, I consider this an ideal antacid for use in patients with
peptic ulcer . . . My results have been so gratifying that I am replacing
other alkalis with this preparation."
Kraemer, M.: Am. J. Digest. Dis. 5:422 (Sept.) 1938.
No. 937 "TRICEPIOL"—a palatable
preparation containing, in each average
teaspoonful, 35 grains of hydrated
magnesium trisilicate in a base composed of medicinal glucose, sucrose
and pectin.
No. 938 "TRICEPIOL" COMPOUND—has a similar basic formula
to "Tricepiol" but contains, in addition,
1/500 grain of atropine sulphate and
1 /8 grain of phenobarbital per average
teaspoonful.
t S8.93J
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$f«»ni   of   fiy&eW
in 3 o^su cc--»iposo<J
of wt*o*e*n*l gJacosc,
secfosft   And   p^cHn.
to* ass i??ti>m
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pHNMi
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Available in bottles containing 5% and 16 ounces.
Professional specimens and literature on request.
AYERST, McKENNA & HARRISON LIMITED  • Biological and Pharmaceutical Chemists  .  MONTREAL, CANADA
934
PRESCRIBE CANADIAN MADE PRODUCTS
HELP WIN THE WAR
BUY WAR  SAVINGS CERTIFICATES The natural tendency of humanity is to take good work for granted, and withhold
comment, and especially favourable comment: if anything is amiss, we hasten to express
our unfavourable opinion. This, as Kipling says, is "wunnerful good for the prophet"
—but one sometimes thinks that a prophet who is doing good work might like an
occasional sign that his work is appreciated, and that it is doing the good he hopes
it may do.
During the past two or three years there has been some very remarkably good work
done in this Province by one particular department of the Provincial Board of Health,
namely, the Venereal Disease Division. The moving spirit of this Division is its Director, Dr. D. H. Williams, and while excellent work is being done by all the men on his
staff, he is yet the man chiefly responsible for what is a monumental improvement in
conditions in this Province.
Venereal disease is slowly, but surely, being mastered, and its terrible power for evil,
for economic loss, for loss of health, for moral degradation and injury, is being gradually
controlled and will some day be broken. That this is so is largely due to the indomitable
courage and plain speaking of Dr. Williams, backed up as he has been so loyally and
well by his Departmental Chief, Dr. G. H. Weir, Minister of Health for B. C. We have
had the opportunity of seeing letters, and reading published statements, made by outstanding Public Health authorities, commending and praising the work that is being
done in British Columbia, and holding it up as a model for other parts of the continent
—and the figures of reduction in venereal disease and commercialised vice speak for
themselves.
We make a point of this for several reasons. We do not do it to exalt Dr. Williams,
who would be the last man to want such publicity or praise. But we do not think medical men as a group know enough of the progress being made—and we believe that if
they did, and if they realised how very important a piece of work is being done, they
might contribute their influence, and often their valuable assistance, towards aiding
and reinforcing the work of Dr. Williams and his Division. This is a matter of health,
and is not merely or mainly a moral question. It has, decidedly, moral implications with
which every decent citizen is concerned—but fundamentally, it is a question of health,
and of economic values. With the latter we are only concerned so far as every citizen
and taxpayer is concerned: with the former, we are deeply concerned: and we should do
all in our power to back up Dr. Williams and his co-workers, and the Department of
Public Health, which has exerted all its powers for reform so strongly and so efficiently,
against great and growing opposition, against public ignorance and apathy, against influences of a subversive nature, sometimes even in high places.
A second reason for dealing with this now is by nature of a warning. We tend to
an inertia which may well be fatal. We see this work being done, we see progress being
made, we even applaud, and then we forget. We forget one thing, especially, and that
is that there are powerful forces working against this reform. The work of Dr. Williams
and his associates means positive gain for the community. It means added safety for our
women and children, for our soldiers and sailors and airmen in training—it means
economic gain to the community, it means better health. But it also means positive loss
to certain groups in the community, who make money and acquire profit from human
weakness and folly. And these groups are watching the work of Dr. Williams, and are
fus sworn foes. They will get him. if they can, because they are losing money through
nis efforts. They will, we may depend, bring every influence to bear that they can
possibly do, through political pressure, and in other ways: and unless the community
as a whole, and its leaders in matters of health, economics, and moral and ethical values,
awaken to this danger, and take definite steps to avert it, we shall see the undoing of
Page 286
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much of the good that has been done, the loss of much of the progress made, the reversion to a poorer state of health in the community, physical, economic, and moral: and
with it the discouragement and disillusionment of men who are giving us of their very
best for our own profit, and advantage.
"Eternal vigilance is the price of liberty": and if we are to win and keep our freedom in this matter, if we are going to maintain our gains, consolidate our victories, and
ensure continued advance towards better things, we shall have to be vigilant. As members of a profession on which the public must depend for all its knowledge and security
in health matters, we owe an especial duty here, to keep watch and ward: to support
those who are doing this work—and to keep all with whom we come in contact informed
as to the necessity for watchfulness.
This is not a mere philosophical essay. The remarks we have made here, the warnings we have expressed, are justified by an existing threat to the progress being made by
the Venereal Disease Division, one of the departments of the Provincial Health Department. We must do what we can, individually and collectively, to fight reaction: to
strengthen the hands of those who are supporting this work, and to resist the subversive
work of those who would undermine it. When one reads how'the military authorities
in Seattle went to the City Council, urging control of prostitution, for the sake of
military efficiency, one realises that this is only one small argument for the work that is
being done, and there are countless others. This is a time for ruthless eradication of
anything that wastes money, that threatens physical health, that weakens moral fibre,
and destroys efficiency, and we, as doctors, as exponents of health, and as good citizens,
must do our share.
CORRESPONDENCE
Dr. J. H. MacDermot,
Editor, The Vancouver Medical Association Bulletin,
203 Medical-Dental Building,
Vancouver, B. C.
June 16, 1941.
Hi
Dear Doctor MacDermot:
The Directors asked rhe to thank the Editorial Board for its support in the promotion
of the M-S-A and for the valuable space you have given to the Plan. We feel that
your help has been of inestimable value in acquainting the Professional Members with
our progress.
We would also like to convey our thanks through you to Mr. Macdonald, the Business Manager, who has always been most helpful.
The Provisional Directors retire from office at the Annual General Meeting and in
turning over the direction of the Plan to their successors they feel confident that they
will have your continued co-operation.
Very truly yours,
A. L. McLELLAN,
Secretary-Treasurer.
Page 287
.'
i:ii NEWS    AND    NOTES
Dr. and Mrs. H. A. MacKechnie are receiving congratulations on the birth on June
14th of a daughter.
Congratulations are extended to Dr. and Mrs. G. F. Kincade on the birth of a son
on June 2nd.
The profession extends sympathy to Dr. A. J. MacLachlan in his recent bereavement,
his mother having passed away.
Dr. and Mrs. W. L. Turnbull are receiving congratulations on the birth on June
16th of a daughter.
Congratulotions to Dr. Paul Phillips of Princeton upon his marriage to Miss Edith
Louise Stewart of New Westminster, on June 5 th.
Pr. and Mrs. John McCaffrey are receiving congratulations on the birth of a daughter, on May 27th.
Dr. B. J. Hallowes of Alexis Creek visited the office while in Vancouver recently.
Dr. and Mrs. Hermann M. Robertson of Victoria are at Harrison Hot Springs for a
short period.
Doctors C. C. Browne and E. D. Emery of Nanaimo and Dr. C. E. Davies of Vancouver spent a week cruising on S.S. Ann, up the Gulf Islands. En route they saw Dr.
John McLean at Bowen Island also on a cruise. Fishing was good and the sun-tan
excellent.
A reception was held recently for Dr. G. A. B. Hall of Nanaimo prior to his leaving
to reside in Victoria.
Dr. and Mrs. A. H. Meneely of Nanaimo are on vacation. Doctor Meneely attended
the Annual Meeting of the Canadian Medical Association at Winnipeg while en route
to Rochester.
Capt. J. A. Ireland, R.C.A.M.C., has been transferred from Canadian Infantry Holding Unit in England to be Assistant Radiologist at No. 15 Canadian General Hospital.
Dr. W. H. White of Penticton is attending the C.M.A. Meeting at Winnipeg.
Dr. H. McGregor is holidaying in New Brunswick and Nova Scotia and expects to
attend the C.M.A. Meeting at Winnipeg.
*       *
Dr. M. J. Swartz, formerly of Cranbrook, has left for Montreal.   He will enter the
Royal Victoria Hospital, Department of Urology, as an interne.
Dr. F. W. Green of Cranbrook is away on a short holiday at his summer home at
Mirror Lake on Kootenay Lake.
Page 288
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Dr. W. J. Endicott of Trail is away on a holiday motor trip.
Doctors F. L. Wilson and E. S. Hoare of Trail had a very successful fishing week-end
at Watchan Lakes recently.
Dr. L. W. MacNutt of Vancouver was a recent visitor in Trail.
Doctors A. W. Hunter, R. E. McKechnie and C. W. Prowd of Vancouver, and
W. J. Knox and L. A. C. Panton of Kelowna have returned from their annual fishing
trip to Beaver Lake near Kelowna.
Dr. and Mrs. C. H. Hankinson of Prince Rupert left for Winnipeg to attend the
C.M.A. Meeting.
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Dr. Karl J. Haig is now with the R.C.A.M.C.
Dr. N. Bathurst Hall of Campbell River has joined the R.C.A.M.C. Arrangements
have been made whereby Dr. T. J. Agnew, formerly of Courtenay, where he was associated with Dr. P. L. Straith, will carry on the practice there.
Dr. F. A. Olacke, who has been associated with Dr. J. H. Black at Wells, is now
located at Ashcroft.
Dr. H. E. Hamer is relieving at Revelstoke while Dr. G. L. Watson is on holiday.
Congratulations are extended to Dr. H. S. Hamilton of Alert Bay upon his marriage
to Miss Catherine M. Campbell.
Dr. T. W. Walker of Victoria is expected to be "back on the job" at the beginning
of July, after a serious illness.
Dr. W. H. Moore of Victoria has been away for a month's holiday. Dr. V. W.
Smith, late of St. Joseph's Hospital, has been looking after his practice.
Doctors L. W. Bassett, E. H. W. Elkington, O. C. Lucas and D. B. Roxburgh of
Victoria have just returned from two weeks at military camp.
Dr. William Leonard of Trail visited the office while in Vancouver, recently.
Congratulations to Capt. Brock M. Fahrni, R.C.A.M.C, upon his marriage to Miss
Margaret Morton of Winnipeg.
w-
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LIBRARY NOTES
RECENT ACCESSIONS TO LIBRARY
Medical Annual, 1941.
Collected Papers of the Mayo Clinic and the Mayo Foundation, 1940.
Industrial Medicine, by A. J. Lanza and Jacob A. Goldberg.
The Library has been the recipient recently of a complete original set of "Deutsches
Archiv fur Klinische Medicin." This was presented by Dr. B. D. Gillies, and is a
valuable addition to our collection.
A number of reprints from the Lahey Clinic have been received in the Library and
include such articles as:
Page 289
M "Carcinoma of the Thyroid," by Frank H. Lahey and Hugh F. Hare.
"Esophageal Diverticula," by Frank H. Lahey.
"The Use of Oxygen in Demonstrating Posterior Herniation of Intervertebral Disks,"
jby James L. Poppen, Department of Neurosurgery, Lahey Clinic.
ANNALS OF SURGERY
Symposia on Surgical Preparedness
In its May and June issues, Annals of Surgery presents "Symposia on Surgical Preparedness," including a valuable collection of articles on the care of various war injuries
—plastic surgery, amputations, etc.    It also deals with organization for evacuation and
treatment of war casualties, and treatment of air raid casualties, cases of shock, etc.
Symposium on Gastrointestinal Surgery
The second part of the June issue is devoted to a Symposium on Gastrointestinal
Surgery, composed of abstracts of papers presented before the Central Surgical Association, at Ann Arbor, Mich., February 28th to March 2nd, 1941.
SPECIAL NOTE
During the summer months, the Library will be open from 9:00 a.m. to 5:00 p.m.,
instead of the usual hours from 10:00 a.m. to 6:00 p.m.
SUMMER SCHOOL, VANCOUVER MEDICAL ASSOCIATION
|.    JUNE, 1941 <§     §
If the Committee in charge of the Summer School had any doubts or misgivings
prior to the holding of this year's school, they must have been very pleasantly disappointed by the result. There have been more expressions heard this year, of satisfaction
and commendation, than usual. The prevailing opinion of this year's Summer School
is that it is easily one of the best ever held, and we hereby tender to the Summer School
Committee our heartiest congratulations and thanks for an adrnirable piece of work.
The attendance was excellent. There were 235 registrations, of whom 47 came from
points outside Vancouver. This means that 178 Vancouver men attended, which is
good, but not quite good enough. Those who failed to attend missed a great deal. After
all, it is not the attendance that makes a Summer School, it is the quality of the lecturers,
and there can be no complaint on that score this year. Each one of these men was an
authority in his line, and gave of his best. One hesitates to singularize—but there can
be no doubt that the work of Dr. Long was the highlight of the meeting. His gift of
humour, his friendliness, his amazing versatility, were all incidental to a complete mastery of his subject, and there was never any doubt that we were listening to an authority.
The round table panel discussion on the Sulphonamide group of drugs was an
innovation, and a most successful one. We were able to secure a stenographic record of
it, and hope to publish it in the Bulletin later.
The actual mechanics of the meeting were all that could be desired. The Hotel
Vancouver provided an ideal meeting place, comfortable, and with excellent acoustics,
and Mrs. Craig, our librarian, saw that everything ran smoothly. To her, with her
assistant, Miss Smith, must go a large share of the credit for a well run affair.
Owing to the reduction of the fee from $7.50 to $5, there will, we are told, be a
small deficit—but we do not think this will distress anyone—this School is well worth
paying for, and when happier times come back, it will be time to think in terms of
financial profit. Till then, there can be no question that as long as the Summer School
Committee maintains these standards, as they have done this year, we must go on holding
the Summer School.
Page 290 f &,
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British  Columbia  Medical  Association
(Canadian Medical Association, British Columbia Division)
President \ Dr. Murray Blair, Vancouver
First Vice-President Dr. C. H. Han&tnson, Prince Rupert
Second Vice-President Dr. A. H. Spohn, Vancouver
Honorary Secretary-Treasurer Dr. Walter M. Paton, Vancouver
Immediate Past President '      Dr. F. M. Auld, Nelson
Executive Secretary l_ Dr. M. W. Thomas, Vancouver
A MESSAGE FROM THE PRESIDENT
Once a year for many years now, the doctors of the province and their wives meet
together for, I believe, a triple purpose. First, to discuss the affairs of organized medicine in general and our immediate problems in particular. Secondly, from a scientific
standpoint, to hear outstanding guest speakers in a carefully arranged programme, and
finally, to gather together, men and women in a spirit of fellowship in order that we
might know each other better.
The scientific end of the progremme is well under way, and I know that that committee under the experienced hands of Dr. Strong will supply a well-balanced scientific
programme.   A later copy of the Bulletin will carry a detailed programme.
The social side will, I sincerely hope ,be up to standard. We are going to really try
to entertain you, not in any profuse or expensive manner but by the very sincerity of
our welcome to you and yours.
The ladies are already busy with their plans and, I know, will do everything in
their power to make the visit of the ladies a memorable one. So be sure and come along
yourself and please bring the ladies.
MURRAY BLAIR.
1941   ANNUAL   MEETING
VANCOUVER
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September 16,17,18
IS*3 THREE DAYS—TOLL OF
FINE FEATURES
Make Your Plans and Reservations Early
Dr. Murray Blair, President, and Mrs. Blair extend an invitation to the members and
wives to come.
Again we are fortunate in having Dr. G. F. Strong as Chairman of the Committt
on Programme.     The Committee  on  Programme  is  preparing   for  another splendi
Annual Meeting.
Page 291 The Canadian Medical Association party will consist of Dr. G. S. Fahrni of Winni-
eg, President; Dr. T. C. Routley of Toronto, General Secretary, one speaker under the
igis of the Department of Cancer Control, and we are glad to announce that Dr. Lennox
t Bell of Winnipeg, Professor of Medicine, University of Manitoba, and Dr. F. G.
IcGuinness of Winnipeg, Professor of Obstetrics, University of Manitoba, will be
{resent.
Doctor Thomas Addis of San Francisco, who is well known through his outstanding
>ork on Nephritis, is Professor of Medicine at Stanford University School of Medicine
■rill also participate very generously in our programme. His subjects will be: "Treatment of Medical Diseases of the Kidney" (1) Practical Methods for Diagnosis and
[treatment in the Doctor's Office; (2) The Theory of the Treatment of Blight's Disease;
|3) The Results of Treatment.
Other speakers are being arranged for and will be announced later.
Lectures       -       Conferences       -       Special Features       -       Clinical Sessions
Demonstrations       -       Annual Business Meetings       -       Luncheons
Annual Dinners      -      Golf      -      Ladies' Entertainment
COMMITTEE ON ARRANGEMENTS
Programme
Registration and Reception
Press and Publications
Arrangement and Housing
Clinical Sessions
Entertainment
Golf
Transportation
Commercial Exhibits
•T ^r nr •»?
The Ladies' Committee is already planning for the comfort and entertainment of
doctors' wives.
Drives — Reception and Tea — Ladies' Dinner — are each being arranged by special
committees.
UPPER ISLAND MEDICAL ASSOCIATION
The regular semi-annual meeting of the Upper Island Medical Association was held
at Qualicum Beach on April 23 rd. After an afternoon of golf a large attendance of
members were entertained at a banquet at the Qualicum Beach Hotel. Following a short
business meeting, with President Dr. R. W. Garner in the chair, a very instructive index
of "Pediatric Diseases and Treatment" Was given by Dr. E. J. Curtis of Vancouver. Dr.
J. R. Naden of Vancouver then gave a comprehensive and interesting lecture on "Injuries
of the Knee" and was unfortunately limited to only a few words on "Low Back Pain."
Dr. M. W. Thomas of the parent association was also a guest. A vote of thanks was
moved by Dr. G. K. McNaughton of Cumberland and heartily endorsed by the members
with the amendment that while the instructive ability of the visitors was greatly appreciated, they themselves needed some lessons at golf.
¥$ Page 292
\m
ml Dr. L. H. Appleby | Vancouver
Dr. W. E. Austin Hazelton
Dr. Murray Blair Vancouver
Dr. E. W. Boak ; Victoria
Dr. F. M. Bryant Victoria
Dr. W. A. Coghlin Trail
Dr. G. A. Davidson Vancouver
Dr. W. F. Drysdale Nanaimo
Capt. Brock M. Fahrni Vancouver
Dr.  V.  Goresky Castlegar
Dr. E. R. Hall Vancouver
Dr. C. H. Hankinson Prince Rupert
Dr.  E. K. Hough New Westminster
Dr. W. S. Huckvale Kimberley
Dr. M. J. Keys Victoria
Dr. D. M. Lineham Vancouver
Dr.   Thomas  McPherson Victoria
Dr. Herbert McGregor Penticton
Dr. A. J. MacLachlan Vancouver
Dr. G. A. McLaughlin North Vancouver
Dr. Jack Margulius -New Westminster
well arranged.
CANADIAN MEDICAL ASSOCIATION
ANNUAL MEETING — WINNIPEG
The following members of the British Columbia profession attended the meetings of
the Canadian Medical Association in Winnipeg:
Dr. A. H. Meneely Nanaimo
Dr.  Bernhard Meth ; Britannia Beach
Dr. H. H. Milburn Vancouver
Dr. J. A. Montgomery Vancouver
Dr. G. F. Murphy Vancouver
Dr. J. R. Naden -Vancouver
Dr. A. B. Nash 1 Victoria
Dr. R. A.  Palmer Vancouver
Dr. W. M. Paton . Vancouver
Dr. Stanley Paulin Vancouver
Dr. W. L. Pedlow Vancouver
Dr. D. E. Saxton Ocean Falls
Dr. G. D. Saxton Ocean Falls
Dr. J. M. Swartz —. ^—Cranbrook
Dr. M. W. Thomas- Vancouver
Dr. Ethlyn Trapp Vancouver
Dr. S. E. C. Turvey Vancouver
Dr. G. L. Watson Revelstoke
Dr. W. H. White Penticton
Dr.   Wallace  Wilson Vancouver
Winnipeg gave the Annual Meeting of the Canadian Medical Association a warm
welcome—the meeting was largely attended—the programme of excellent quality and
The registration from British Columbia reached 40. Sessions of General Council were
well attended, British Columbia being represented by: Doctors Murray Blair, President;
C. H. Hankinson, First Vice-President; W. M. Paton, Honorary Secretary; E. W. Boak
and Thomas McPherson of Victoria; A. H. Meneely of Nanaimo; A. J. MacLachlan, H.
H. Milburn and Wallace Wilson of Vancouver, and M. W. Thomas, Executive Secretary.
Dr. H. H. Milburn attended the meetings of the Executive Committee as representative from British Columbia.
Dr. Murray Blair was elected, as representative of British Columbia on the new
Executive Committee of the Canadian Medical Association.
Dr. Wallace Wilson, Chairman of the Committee on Economics of the Canadian
Medical Association, presided at the session on Medical Economics, which followed the
stag dinner on Thursday evening, and was attended by 225 members. This session was
favourably commented upon and an increasing interest shown.
All meetings were well attended, despite the ambitious ascent of the mercury column.
Dr. W. F. Drysdale of Nanaimo Was present to receive Senior Membership, which
was conferred upon him at the ceremonial on Wednesday evening.
Doctors E. W. Boak, F. M. Bryant, Thomas McPherson and A. B. Nash were not
disposed by the heat.
Dr. Lyon Appleby thinks that Winnipeg temperatures are not conducive to good
racing by B. C. horses—however, Harry Milburn was able to replace the lost hat on
the last race. We think that Dr. Appleby has very fine ponies in Swift Heels, Little De
and Build-Up.
We saw Lt. C. E. Gould, who is with No. 8 Canadian General Hospital, and also
Capt. B. M. Fahrni, who contributed an interesting study before the Section on Military Medicine.
We saw Bill White of Penticton visiting with W. S. Huckvale of Kimberley.
Page 293 Mrs. Eric Boak was happily surprised when her son, Eric, turned up en route West
on leave.  Mrs. Boak thought that he was somewhere on the Atlantic.
Drs. W. E. Austin of Hazelton, F. M. (Wood) Bryant of Victoria, W. A. Coghlin
of Trail, G. A. Davidson of Vancouver, V. B. Goresky of Castlegar, G. A. Leroux of
Fernie, H. McGregor of Penticton, G. A. McLaughlin of North Vancouver, Jack Mar-
gulius of New Westminster, W. L. Pedlow of Vancouver, G. D. and D. E. Saxton of
Ocean Falls, S. E. C. (Ward) Turvey of Vancouver, G. L. (Jerry) Watson of Revelstoke, all graduates of Manitoba, were visiting with old friends.
Dr. C. H. Hankinson of Prince Rupert, First Vice-President of the British Columbia
Medical Association, was accompanied by Mrs. Hankinson. In that the 1942 Meeting of
the Canadian Medical Association will be held at Jasper and the Annual Meeting of the
British Columbia Medical Association will be held at the same time, Dr. Hankinson is
already doing some long-range planning on building a large attendance from British
Columbia at the Jasper meeting. Dr. A. E. Archer of Lamont, Alta., is the new President-Elect of the Canadian Medical Association. He, too, is planning for the 1942
meeting at Jasper.
Dr. and Mrs. Gordon Fahrni are to be congratulated upon the excellent arrangements
for the Winnipeg meeting, and they should be gratified by the success which crowned
their efforts.  Winnipeg did itself very well.
WAR RELIEF FUND
*   *   *
Dominion of Canada
DEPARTMENT OF NATIONAL WAR SERVICES
THE WAR CHARITIES ACT, 1939
I, the undersigned, Minister of National War Services, the registration authority
under the provisions of The War Charities Act, 1939, do certify that
THE BULLETIN FUND FOR CONTRIBUTION TO THE WAR RELIEF FUND
OF THE BRITISH MEDICAL ASSOCIATION OF GREAT BRITAIN
situate at 925 West Georgia Street, Vancouver, in the Province of British Columbia, is
a Fund duly registered under said Act.
Dated this 17th day of June, 1941.
J. T. Thorson,
Minister of National War Services.
S. W. Stapleford,
Director of Voluntary Services.
i;
41
**i
The setting up of the "Bulletin War Relief Fund" has started a similar move
across Canada! At the annual meeting in Winnipeg the C.M.A. made arrangements to
set up "The Canadian Medical Association War Relief Fund" for the purpose of collecting funds for the B.M.A. War Relief Fund. Preparations are already being made to set
up local funds in the other divisions of the C.M.A. and all the funds collected in each
province will be sent forward to the contral C.M.A. fund for transmission from time
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to time to England. This is a splendid move and will give to many hundreds of doctors
across Canada the opportunity they have been looking for—an opportunity of helping
in a tangible way to lessen the terrific burdens so many of the British medical men have
to carry in thes edays of their stress and strain. So many of the doctors remaining in
Canada realize that, under the circumstances, this is the least we could do and the fund
should be a great success.
This fund has got off to a good start, but has temporarily slowed down. It has been
authorized by Ottawa and registered under the name, of The Bulletin Fund for Contribution to the War Relief Fund of the British Medical Association of Great Britain.
The need is desperate, and we are sure every medical man in British Columbia, if
he realized how desperate it is, would want to help. There are hundreds of medical men
in Great Britain who have lost everything they had: practice, homes, all their belongings,
They need'help and they need it badly, and they need it now. Every dollar we can contribute will help greatly, and we urge all our readers, who have not yet contributed to
this fund, to send in what they feel they can afford. The fund is open to every medical
man in British Columbia, and we shall feel honoured to accept and acknowledge contributions.
Please make cheques payable to the Vancouver Medical Association and write on
cheque, "For Bulletin War Fund." A special account has been opened, and money will
be sent forward as fast as possible. Names of contributors, etc., will be published in the
Bulletin, unless a request to the contrary is received.
Last number of the Bulletin contained the names of those whose subscriptions had
been received up to that point.   A fresh list appears in this issue.
So please send in your contributions imrnediately, so that we may be able to make a
worthwhile contribution as soon as we possibly can.
Martianoff,   I.   F i $15.00
I
Anonymous $20.00
Anonymous   10.00
Archibald, M. G 25.00
DeMuth,  O. 25.00
Dunlop,  Frederick C 20.00
Lockhart,   W\   T 25.00
Nelles, T. R. B.
Saunders,  £.  H.
Seldon, G.  E	
Yip,  K.  G	
10.00
._ 50.00
_ 50.00
_ 10.00
COMMITTEE ON THE STUDY OF CANCER
Cancer is a disease that is known to have existed as far back as the Mesozoic penoo.
Down through the ages it has been recognized and many and varied methods devised i
combat its growth. Prayers, incantations and signatures were of no avail. Queer prescriptions were numerous, such as vaginal douches of pig's bile and lime made fro
oyster shells was used in cancer of the uterus. Surgery in varied forms was tried. Fire
and escharotics were the favourites, but we also find Celsus describing the amputation
of a malignant breast with removal of the pectorla muscles and dissection of the axillary
glands, a procedure that sounds strangely modern for those times.
In spite of the multiplicity of therapeutic methods used against cancer, we find an
Egyptian surgeon in 1500 B.C. tesrely stating in reference to cancer of the breast,
"There is no treatment." Again, a thousand years later, a Hippocratic writer, in writing
of occult (non-ulcerated) cancers said, "It is better to omit treatment altogether, for»
treated the patients soon die, whereas, if left alone they may live a long time."
This hopeless attitude was justified until the beginning of the Twentieth Century
At that time pathology had developed as a science, owing to the discovery of the micr
scope; and it was found that cancer originated as a purely local lesion that could t
readily removed with complete cure.    Add to this discovery the rapid strides in surg<
and radiotherapy, and for the first time in the history of mankind a cure for cancer
found.
Page 295 Thus, the cancer problem today is not, "Where is a cure for cancer?", because we
have a cure for cancer. The problem is to overcome the folklore, the old wives' tales,
tbe myths and the teaching that have fixed cancer in the minds of the laity and the
physician down through the ages as a fatal disease consisting of large tumors that had
to metastasize and cause secondary anemia before the disease could be recognized.
CANCER CAN BE RECOGNIZED EARLY, BUT IT DOES NOT LOOK LIKE
LATE CANCER. Thus, let us concentrate our efforts on trying to diagnose cancer
early, so early that our present clinical criteria are insufficient and we have to learn new
ones.   Then we will save many lives of cancer patients.
M-S-A ANNUAL MEETING
The First Annual General Meeting of the Medical Services Association will be held at 8 p.m. on
Friday, July 4th, 1941, in the Auditorium of the Medical-Dental Building, 925 West Georgia Street,
Vancouver, B. C.    It is requested that all Members attend.
Order of Business:
1. Directors' Report.
2. Election of Directors.
3. Appointment of Auditors.
4. New Business.
Each Member present in person shall be entitled to vote, provided that when electing the Directors,
each Member shall vote only for the Director representing the class of members to which he belongs.
The Provisional Directors retire from office and of the four Directors to be elected, two shall be
elected by the Employee Members and one by the Professional Members and one by the Employer
Members.
FIRST ANNUAL REPORT
MEDICAL SERVICES ASSOCIATION
To Our Members:
Directors' Report
Your Provisional Directors submit herewith the Balance Sheet and Financial Statement from
Incorporation to May 31st, 1941.
We are assured by our Members and prospective members that the Plan has been well conceived
—it fulfils a long felt want—it preserves normal patient-physician relationships. In bringing together
slong industrial lines those interested—employees, employers and doctors, it is evident that our Plan
has the personal interest so necessary in a plan budgeting for medical care which includes early
attenton and treatment.
For the seven months of operation the estimates of cost have been adequate to discharge our
obligations and to set aside a reserve for contingencies of 12 per cent of the dues. Claims for medical,
surgical and hospital care in the amount of $2,177.00 have been paid.
We have found the subscribers are pleased with the plan and are happy to report that there has
teen no cases of dissatisfaction with the services or system of payment. Members have gone freely
to doctors of their own choice.    Doctors from all areas included have given service.
Apart from the 10 per cent for administration expense charged against dues and the registration
fees, organization expense has been met from advances. As the plant grows this organization expense
will be liquidated as is customary from registration fees.
Our growth has not been rapid but in comparison with similar plans in other cities we have
made good progress. Our 500 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
<rf 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 130,000
respectively. Experience has shown that with a new development of this kind, progress at the start
is slow but after a fair number of groups have been enrolled the plans gathered momentum. The
Known value of a plan and the "mouth to mouth" recommendations of its participating members
increases the volume. We find that our best prospects are those who have talked to an employee or
employer member or their own doctor.    The plan is gradually being extended to the whole Province.
§1§§ Page 296 St* MP
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The increased payroll deductions and higher living cost leave little for the payment of medical
care and may result in the neglect of health. The more deductions we have the more it is necessary
to budget for health services.
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.
The Committee on Economics and the Council of the College of Physicians and Surgeons and its
officers and staff have devoted an immense amount of time and effort in the development of the plan
and have been ever ready to lend assistance.    Their attitude has always been fair and reasonable.
In retiring from office your Provisional Directors wish to express appreciation of the co-operation
of the College of Physicians and Surgeons and its officers, without whose help and encouragement the
plan would not have been possible. The Executive Secretary of the College, Dr. M. W. Thomas, has
always been helpful. We wish also to thank our Director of Medical Services, Dr. S. Cameron
MacEwen, for the services he has so freely given us. We hope that the plan will soon have sufficient
members to pay him for his services.
Our relations with all members have been on a high level and we feel, confident that our successors will enjoy the same measure of co-operation.
By Order of the Board.
J- T.
MYERS,
President.
MEDICAL SERVICES ASSOCIATION
BALANCE SHEET AS AT MAY 31, 1941
ASSETS
CURRENT ASSETS:
Cash  in  Bank _i
Cash in Hands of Trustees.
$1,465.71
. 2,050.00
FURNITURE AND FIXTURES, less Depreciation	
DEFERRED ORGANIZATION AND ADMINISTRATIVE EXPENSES, ETC
Insurance Unexpired	
-$3,515.71
364.82
.$      10.44
Deferred Organization and Administrative Expenses   (Exhibit B) 4,311.43
4,321.87
$8,202.40
LIABILITIES
CURRENT LIABILITIES:
Accounts  Payable  	
Demand   Notes   Payable-
.$2,033.03
.  5,400.00
DEFERRED CREDIT TO INCOME:
Members'  Contributions  Unearned	
RESERVES:
Medical, Surgical and Hospital Care J
Contingencies	
EXCESS OF INCOME OVER EXPENDITURES, ETC. for the period
from April 16, 1940, to May 31, 1941   (Exhibit A)	
AUDITORS' REPORT
.$   302.00
.     390.72
$8,202.40
To the Members
Medical  Services Association:
w"e  have   made   an   examination   of   the   books   and   accounts   of   the   Medical   Services   Association   for   the period
from date of incorporation, April  16,   1940,  to  May  31,   1941,  and  have obtained   all   the  information  and  explanation!
we have required.     ¥e report that, in our opnion,  the  above  Balance Sheet  as  at  May  31,   1941,  is properly drawn »
so as to exhibit a true and  correct view of the state of the affairs of the Medical Services  Association, accordng ti
best of our information and the explanations given to us and  as shown by the books of the Association.
PRICE, WATERHOUSE & CO.,
Vancouver, B. C. Chartered Accountant*.
June 23,  1941.
?*£«■ 297 Exhibit A
MEDICAL SERVICES ASSOCIATION
STATEMENT OF INCOME AND EXPENDITURE
From Date of Incorporation April 16, 1940, to May 31, 1941
INCOME:
Members' Contributions $3,256.00
Deduct—
EXPENDITURE:
Provision for Medical, Surgical and Hospital Care $2,480.08
Provision for Contingencies 390.72
Operating Expenses [ $4,636.98
Less—
Deferred .: 4,311.43
325.55
3,196.35
Excess of Income over Expenditures, etc., for the period carried to Balance Sheet $     59.65
Exhibit B
MEDICAL SERVICES ASSOCIATION
DEFERRED ORGANIZATION AND ADMINISTRATIVE EXPENSES
As at May 31, 1941
Salaries i $
Printing, Stationery and Supplies	
Telephone	
Postage ! i	
Insurance	
Equipment, Rent and Service Charges	
Interest and Bank Charges ;	
Depreciation of Furniture  and  Fixtures	
Travelling   Expenses	
legal Expense	
Rent	
3,310.00
1,016.60
85.12
74.71
14.56
107.50
107.71
40.53
13.10
176.11
198.04
$5,143.98
Less—
Registration Fees ! 507.00
$4,636.98
Less-
Charged to Current Operations   (Exhibit A) >~     325.55
Balance Deferred, Carried to Balance Sheet $4,311.43
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J. T. MYERS
PROVISIONAL DIRECTORS
A. L. McLELLAN M. W. THOMAS, M.D.
JOHN YOUNG
Page 298 I
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CYSTOMETRY
By L. G. Wood, M.D.
Cystometry was introduced by Rose in 1927 to estimate changes in intravesical
pressure incident to fluid distention of the bladder. It measures the resisting pressure
(tonus) of the detrusor muscle and is recorded in terms of pressure and capacity.
Departures from the normal cystometric curve are due to hypertonia or hypotonia of
the bladder-wall. Cystometric data may or may not support clinical findings, or may
disclose unsuspected alterations in muscle-resistance and furnish a clue to their causes.
They must be interpreted in conjunction with clinical and cystoscopic findings.
Technique:
The cystometer consists of three parts: An irrigating jar, a Y-connector, and a
manometer, these being connected by tubing interrupted by a three-way stopcock. The
irrigating jar is filled with water. All air must be expelled from the system by manipulating the stopcock. A soft-rubber catheter (No. 22F for adults) is introduced and
the urine evacuated, after which the cystometer is connected and the bladder slowly
distended. The resisting pressure of the bladder wall is estimated by operating the stopcock. The pressure data are recorded against the amount of fluid in the bladder. Of
particular importance are the readings when the first desire to void is noted, when discomfort incident to distention first appears, and when this becomes severe. The final
record is made with the patient straining to void. In the absence of this voluntary
effort, changes in the intracystic pressure are entirely involuntary, and the recorded
pressure is dependent upon the bladder muscle alone. The voluntary effort to void produces an upper or voluntary pressure line.
Interpretation :
The normal cystometric curve shows a gradual increase in pressure, and the first
desire to void appears when 125 to 175 c.c. of water has been put into the bladder and
the intracystic pressure is 5 to 15 mm. of mercury. As more fluid flows in, the pressure
rises more rapidly until a sensation of discomfort occurs at a pressure of 40 to 65 mm.
of mercury (amount of fluid 300 to 400 c.c). This denotes that the normal limit of
stretch of the wall of the bladder has been passed, and at this time the fluid may be
expelled around the catheter. By instrucing the patient to void at the conclusion of the
test, one may determine the maximum voluntary pressure, which is from 60 to 80 mm.
of mercury. The normal cystometric curve is constant and departures from it are due
either to hypertonia or hypotonia of the detrusor muscle. (See Figure 4.) The hypertonic curve is characterized by a shift to the left of the first desire to void, a high intracystic pressure is reached rapidly, and there is a high voluntary pressure. (See Figure 1.)
The hypotonic resistance is characterized by flattening of the curve, a shift to the right
of the first desire to void, a low maximum intracystic pressure, and a low voluntary
pressure. (See Figures 2 and 3.) Irritative and destructive lesions of the filling (sympathetic) and emptying (parasympathetic) mechanisms cause changes in the cystometric
curve which in most instances are recognizable as of neurogenic origin. Such changes
afford comparatively little aid, however, in determining the nature or site of the central
lesion. Cystometric findings must be interpreted in the light of neurogenic and cystoscopic data. The hypertonic, neurogenic bladder is much rarer and more difficult to
identify by cystometric methods than the hypotonic type, and especially so in the
presence of vesical lesions such as cystitis or stone, giving rise to irritability of the bladder.   Nevertheless, one suspects  a neurogenic origin of hypertonia when there is no
Page 299
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demonstrable disease of the bladder, and the same is true when hypertonia persists despite
the subsidence of local vesical irritation. Cystometry is far more important in the
identification of neurogenic hypotonia in which the characteristic curve is mimicked only
by that obtained in vesical diverticulosis, cystocele, marked hydro-ureter with reflux,
and certain postpartum bladder disturbances. Spinal and sacral anaesthesia produce the
hypotonic picture. It is said by Muschat that in uncomplicated chronic urinary retention, however marked, the normal cystometric curve is maintained, thus permitting the
important differentiation of uncomplicated obstructive uropathy from that occurring in
association with lesions of the central nervous system.
The Neuro-Muscular Mechanism of the Bladder:
The innervation of the bladder is derived from three principal sources: (1) sympathetic, (2) parasympathetic, and (3) somatic. The sympathetic fibres arise from the
first, second, third and fourth lumbar segments, and pass by Way of the hypogastric
plexus to the bladder. The sympathetic impulses contract the internal sphincter, relax
the detrusor muscle in the wall of the bladder, and cause retention of urine. The parasympathetic fibres arise from the second, third and fourth sacral segments, and pass to
the bladder by way of the pelvic nerves. The parasympathetic impulses relax the internal sphincter and contract the detrusor muscle, producing emptying of the bladder.
The parasympathetic innervation is much more active and stronger than the sympathetic
innervation as regards bladder function. Somatic impulses to the external sphincter and
perineum are transmitted by the pudendal nerves and arise from the third and fourth
sacral segments.    Sensory impulses from the bladder are carried by all three systems.
The neuro-musclar system governing the function of the bladder in adults functions
to a large degree under volitional control. It comprises centres in the spinal cord and
cerebrum, connected by intraspinal association pathways, together with various afferent
and efferent nerves which serve as connecting links between the vesical musculature and
the cord centres. There is in addition to the foregoing a nervous mechanism in the
bladder walls which when dissociated by injury or disease from central influence may
control bladder function reflexly.
Both filling and emptying of the bladder in infants are automatic, since the brain
and intraspinal association pathways are structurally immature.
Bladder filling remains in adults an automatic function, but emptying of the viscus
is partly under voluntary control. That the latter is largely a habit mechanism is indicated by the fact that it functions during sleep.
Filling and emptying are controlled by inhibitory and excitory impulses to the
sphincter and detrusor muscles, originating in response to various cerebral and peripheral
stimuli but emptying is governed by volition. During the filling phase the sphincters
are contracted, the detrusors relaxed.   The reverse occurs in the emptying phase.
Sympathetic (Filling) Mechanism:
Sympathetic fibres collect to form a plexus (the superior hypogastric or inferior
mesenteric). This plexus continues downwards to the promontory of the sacrum as the
presacral nerve. The sympathetic plexus is derived from branches originating from the
first four lumbar sympathetic ganglia, which transmit impulses to and from the lower
thoracic and upper lumbar segments of the cord. The sympathetic mechanism is concerned chiefly with bladder filling, hence the term "filling nerves" is used to distinguish
them from parasympathetic or "emptying nerves.'* The function of the presacral nerve
in relation to the bladder is as follows:
(1) Excitator to the internal sphincter.
(2) Inhibitor to the detrusor muscle.
Stimulation of the presacral nerve with Faradic current causes:
(1) Closure of the ureteral orifices;
(2) Contracture of the trigonal muscle, and
(3) Contraction (increased tonus)  of the internal sphincter muscle.
Page 301 Parasympathetic (Emptying) Mechanism:
The fibres are derived from the second, third and fourth sacral nerves and join the
hypogastric ganglia. Efferent fibres from these ganglia carry both filling and emptying
nerves. Sensory fibres from all coats of the bladder are likewise tributory to these
ganglia. The function of the parasympathetic mechanism, the control of which lies in
a cord centre located in the second, third and fourth sacral segments, is as follows:
(1) Inhibitor to the internal vesical sphincter muscle,
(2) Excitator to the detrusor muscle,
(3) Bearer of sensory impulses concerned especially wiht bladder sensations
having to do with the micturition reflex,
(4) Possible bearer of impulses from the deep urethra.
Somatic (Volitional) Nerves:
Somatic nerves (the internal pudendal nerves) are of spinal origin and furnish motor
control of the external vesical sphincter muscle and extrinsic urethral muscles (bulbocavernous, levator ani, compressor urethras), and supply sensory fibres to the deep
urethra.
It is well established that either the internal or external sphincter muscle alone, if
normal, will serve to retain the urine in the male, so that incontinence does not follow
operative destruction of the internal sphincter provided the external sphincter and its
nerve supply are intact.
Normal Micturition:
Normal micturition occurs in response to stimuli derived chiefly from rising intracystic pressure incident to increasing accumulation of urine. That it is not solely a
mechanical problem is evident from the varying amount of urine necessary to inaugurate
the desire to void. Whatever may be the source or the type of the initiatory impulses,
emptying of the bladder is dependent primarily upon inhibitory impulses transmitted to
the sphincters coincidently with the transmission of excitator impulses to the detrusor.
The internal sphincter muscle is then relaxed. Excitator impulses cause contraction of
the detrusor muscles which, aided by increased intra-abdominal pressure incident to
fixation of the diaphragm and contraction of the abdominal muscles, succeed in emptying the bladder completely in normal individuals.
The Neurogenic of Cord Bladder:
Interference with the normal discharge of impulses controlling the vesical musculature leads to disordered vesical function, and to definite physical changes in the bladder.
The condition is usually dependent upon lesions of the spinal cord, but it may occur as
the result of diseases of the brain, and in certain systemic diseases, such as diabetes
mellitus and pernicious anaemia. The term "cord-bladder" should therefore not be used
mdiscriminately. Destructive lesions of the central nervous system lead to vesical hypotonia while irritative ones cause hypertonia of the musculature of the bladder. Certain
lesions which are primarily irritative end in destruction of tissue, thus altering the
cystometric as well as the clinical picture.
The changing clinical picture is well illustraetd by progressive tabes dorsalis. Its early
stages may be attended by slight urinary difficulty and moderate retention which increase
until almost complete retention ensues, perhaps to be finally succeeded by true incontinence.   In other instances, partial true incontinence is an early symptom of the disease.
Cystoscopic Findings in the Neurogenic Bladder:
Every patient presenting himself with symptoms of cord-bladder should be cysto-
scoped. This was not possible in the series of cases presented here due to the limited use
of the cystoscopy room for ambulatory patients.
On cystoscoping a patient with cord-bladder, some very striking points are noted:
(1) The bladder may appear normal in all respects.
(2) The commonest finding, however, is the case in which the cystoscope passes
through the urethral sphincters with little or no resistance.   There is retained
Page 302
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fluid which comes away in a forceless manner. The capacity of the bladder is
almost always increased, sometimes the increase being as much as 1000 c.c.
above normal. The next thing noted is the appearance of a fine trabeculation
throughout the entire bladder excepting the trigonal region. This trabeculation
is always even throughout, as opposed to the trabeculation noted in long standing cases of obstruction due to prostatism or stricture. In these cases the trabeculation is irregular, and in some cases sacculations appear. Another point of
differentiation is the cystogram. The neurogenic bladder shows a spherical
outline with a smooth margin, whereas the cystogram of a long-standing
mechanical obstruction  reveals  a  "christmas  tree"   formation with  a jagged
margin.
Clinical Features of the Neurogenic Bladder:
The various lesions productive of the neurogenic bladder may be grouped into three
classes:
(a) Those causing incomplete dissociation of the voluntary  (cerebral)   and involuntary  (cord)   mechanism,
(b) Those causing complete dissociation of the voluntary (cerebral)  and involuntary (cord) mechanism,
(c) Peripheral lesions.
1. Lesions causing incomplete dissociation:
(a) Tabes Dorsalis,
(b) Neoplasms of the brain,
(c) Neoplasms of the spinal cord,
(d) Subacute combined degeneration of the cord.
2. Lesions causing complete dissociation:
Complete dissociation of the voluntary (cerebral) and involuntary (cord)
nervous mechanism occurs suddenly following traumatic section of the cord,
or it may be somewhat delayed in the case of traumatic injuries which merely
bruise the cord without sectioning it, the dissociation being completed by progressive myelitis.
3. Peripheral lesions:
Acute retention of urine due to spasm of the sphincters occurs reflexly after
operations upon the rectum and other contiguous organs. It may also be due to
detrusor weaknes following neuritis or the hypogastric nerves, to pressure on
these structures by pelvic tumours, or to surgical injury or trauma incident to
childbith.
Page 303 NUTRITIONAL REQUIREMENTS OF THE
GROWING CHILD
Dr. P. C. Jeans
Delivered at Summer School of Vancouver Medical Association, June, 1940.
Let us enquire into what controls our choice of foods and then determine after that
if that choice adequately meets the nutritional needs. There is a large variety of foods
from which we make our choice and a certain amount of selection is not only permitted
but is practised by everybody. The diet of the average family is determined in part by
the availability of food, personal preference and the cost of food, to some extent at
least. To some extent instinct and preference play a very large part.
There have been various studies of racial tribes in the world and these are most
interesting, for instance, in Africa, where two neighbouring tribes will differ very much
in their diet customs—one of these lives largely on cereal foods and the other on meat
and animal foods, and the physique and general health of those on animal foods was
far superior to those on the vegetable and cereal diets. There are many other instances
recorded of similar observations. When it comes to animal observations, this is on record
in the classical literature. Dr. Sherman, using rats, kept a colony for many generations
and these had thrived and the offspring also. The diet was wholly adequate. He supplemented the diet with some milk and there was a very marked difference. They matured
at a more rapid rate; they matured earlier; they had a longer period of adult life. That
kind of an experiment shows that your Bible is not a good criterion. The same is true
for the human being. Some of this may be illustrated by taking growth as an example,
we know that growth is controlled by a number of factors. There is, no doubt, a
hereditary factor which is concerned with endocrine balance. We can do very little as
physicians about this. There is also an environmental angle. It is well known that
chronic disease of almost any kind can interfere seriously with growth on many occasions. It is well known that nutrition also plays a very prominent role. Of these
various factors it is only the nutritional factor over which we have had any considerable
control, and it is with that factor that we are dealing tonight.
One encounters children who are grossly dwarfed, extremely malnourished, wholly
because of the inadequacy of food. Sometimes we consider these as endocrine disorders,
we try to give them pituitary and other products. The food intake is one-third or one-
quarter what it should be. It is difficult to see how any endocrine preparation can be of
any use when the food intake is so small. We encounter obesity, also, due entirely to
errors in nutrition, and here too at times consider endocrine disturbance as a factor.
All of you are acquainted with tables of growth, the height, age and weight tables,
and there are different authors of these tables. The ones we are most familiar with are
those of Baldwin and Wood and there have been some by Hornfelt and in 1933 by
Stewart. The striking thing about these tables is that they show a gradual increase in
the stature and size of our children with the passing of time. Hornfelt shows a more
rapid growth than does Baldwin. I think this is not exclusively due to nutritional
factors. More is being learned of what good nutrition is, and better application is being
made of this knowledge. These tables give us only an incomplete picture of growth and
development and there are so many factors that are not reflected in those tables at all.
There is the eruption of the teeth, the rate of eruption of the teeth, the amount of
muscle tissue that exists in the body. All of these are nutritional factors, and there are
several more which are important and which are not reflected in any way in growth
tables.
Now, these are illustrations of the fact that nutrition is gradually improving but
we have not yet reached our objective. The best example of this very important point of
view, and one with which you may not agree, is the example of dental caries. It is our
belief that this is dependent upon nutrition, and if the nutrition is what it should be
there would be no dental caries. If it is recognized that 90%, more or less, of our
children have tooth decay, then it becomes obvious that the nutrition of our children is
far from what it should be.
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Our knowledge of nutrition is changing very rapidly, particularly in certain fields
—in some of the vitamin fields—and certain scientists are developing knowledge at a
slightly greater rate than a good many of us are able to keep up with. There is always
a lag between the development of new knowledge and the practical use of that knowledge. This is shown by several things in the past. There was a time when no one thought
of giving cod liver oil or orange juice to a baby, but now it is a matter of routine. I
have at least hinted that I believe that the average diet is defective and the things in
which it is most likely to be defective are, perhaps, calcium and vitamin A to some
extent, vitamin Bi to some extent, vitamin D almost certainly to a considerable extent,
and there is a good deal deal of danger of there being a deficiency of protien. Bread,
meat and potatoes form the basis of most of our diets. They are not complete. Those
which supplant this basic diet are spoken of as protective foods—milk, eggs, fruit and
vegetables—so that most of us are accustomed to the emphasis being placed on the so-
called p;^tective foods in order to supplant the basic diet.
To take -\p some of these materials once at a time, let us first consider vitamin A.
This perhaps does not belong strictly to this category because an ordinary good diet does
supply an ample amount of vitamin A. 'Vitamin A is fairly well distributed so that
even an average diet will contain a sufficient amount. Because of this fact, the appearance of vitamin insufficiency has been doubted by a number of people. Vitamin A, of
course, speaking broadly, occurs in green vegetables, in the green leaves and in the
yellow ones, also in milk and butter and eggs. The vitamin A that occurs in our foods
consists of the Keratins and, to a very slight extent, to the vitamin A itself. There are
times when a distinction needs to be made for the purpose of discussion. In the fish oils
we have vitamin A rather than the keratins. Vitamin A deficiency does occur in spite
of the fact that even an average diet seems to contain an adequate amount for the human
need. The causes of deficiency may be considered as two in general: (1) A deficiency
of intake, which is not very common. However, it can occur at very low economic
levels. It is very difficult to devise a diet that is complete in everything else and deficient
in vitamin A. We have done this for experimental purposes, and the experiment points
out that if any individual is deficient in vitamin A, the vitamin A is not the only
thing he is deficient in. (2) A much more common cause is a utilization defect—
inability to utilize the vitamin A of the diet. In the first place, vitamin A is one of the
fat-soluble vitamins and there must be bile in the intestinal tract. There are not many
who are lacking in this and this cause is not a very common one. In liver diseases keratin
cannot be converted into vitamin A. It is known also that mineral oil will dissolve
keratin and it is possible to administer mineral oil in such a manner that keratin is
drained away in a serious manner. So that one need not fear such a disturbance, but as
far as experimental work goes, it may have a very detrimental effect. This has been done
with young rats. Even if vitamin A is administered in only such amount as will permit
resumption of growth, these rate are segregated and one lot given mineral oil; then
those rats will die regularly and in a relatively short time of vitamin A insufficiency. If
to these rats are given valuable amounts of vitamin A, then we don't get these fatal
effects. The most important cause of vitamin A deficiency is infections of various
sorts and particularly upper respiratory infections. These have played a frequent and
highly important role in most of the children with vitamin A deficiency.
You are all familiar with the changes that accompany severe vitamin A deficiency.
There are changes in the epithelium and various parts of the body. This has been spoken
of as an anti-infective vitamin and perhaps erroneously. It is not a good term to apply
to it. Changes are in the epithelium, in the nose and throat and the eyes, so that vitamin
A may be considered as an anti-infective material. There has been much discussion as
to the relation between vitamin A deficiency and the common cold. I don't think it is
desirable to review these observations here but to summarize it by giving my own point
of view. In the case of the common cold, we have a disease which is caused by a virus
and I doubt if any of you would expect to prevent a specific infectious disease by any
of the vitamins.  What one might expect, however, would be to decrease the secondary
Page 305 effects, decrease the complications, cut short the period of illness. This is what is accomplished by vitamin A.
There has been much discussion as to the relationship between vitamin A and kidney
stone, and if there is any relationship, vitamin A is only one of many factors responsible
for the formation of kidney stone. Night blindness has been considered to be relatively
rare. Routine ophthalmic examinations can not detect night blindness. Night blindness
in its relationship to vitamin A depends upon the vitamin A content of the body, and
there is a direct relationship between the amount of vitamin A in, the body and in the
retina and the ability of the person to adapt himself to night vision.
There have been a number of instruments devised and by the use of these instruments one can get a very good idea of whether or not the individual is deficient in
vitamin A. There are several types of these instruments—those which show a bright
light into the eye and then measure the time required for recovery, so that the subject
can see the test object at a fixed illumination. There is another type in which a bright
light is shone into the eyes and a curve is taken. At the very beginning a good deal of
light is required, and as time elapses less and less light is required. These various
types of instruments are useful for the small child or baby. By means of these
procedures one can determine whether dark adaptation is normal or not. The
instrument with which we have been working is one of a type which permits the plotting
of recovery time after the shining of the bright light. We have been satisfied with
this instrument. However, it has received some unfavourable criticism, so that I will
speak of that for a moment. There are three criteria which I think we have favoured
in the use of this instrument. One can get results with the normal individual. The
curves all follow within a relatively normal range. When abnormal individuals are
found, one can restore them to normal by the administration of vitamin A. One can use
volunteer subjects and deplete them of vitamin A and they parallel closely the degree of
depletion. All of these points seem to indicate that the test is dependent on the measure
of vitamin A. There has been shown to be quite a bit of lack of insight in making these
criticisms. By means of such a test as this, one can make surveys if one wishes, and
apparently vitamin A deficiency varies greatly in its incidence.
One hundred and twenty school children were examined in the fall of the year. We
found only one subnormal individual and five who had borderline test results. In the
winter in this same group, there were five subnormal individuals and 15 % more of them
had borderline results.' The next spring, when the same group was observed, there were
no subnormals in the group at all and there was only one borderline case. So it makes a
great deal of difference when the group is examined. There is an essential incidence, but
I don't think this depends upon content of vitamin A. I think it depends upon infection.
In one group in which we worked, there were normal results throughout the entire year.
As further evidence of the role that infection plays in vitamin A deficiency, I might cite
just this one type of observation.
Here is a child who gives an abnormal test result with the instrument and because
of that abnormal test result this child was given vitamin A in rather generous amounts,
and about the same time this child developed a cold and instead of giving better tests
with the ingestion of vitamin A, the tests became worse, and with the continuance of
vitamin A and as soon as the cold became better, the results became entirely normal.
This illustrates the effect of infection. It also illustrates the false judgment one might
make. One might find a child giving poorer and poorer results in spite of the ingestion
of vitamin A.
What is the need for supplementing the diet of the average child with vitamin A?
For the child in good health there is no need. An ordinary good diet would contain
about 5,000 units of vitamin A. This is considered ample for the needs of a child. If
one uses this as a criterion, then deficiency is not shown above 1,500 units a day and
it takes an extremely poor diet to bring the vitamin A content down to that level.
Supplementing vitamin A for that reason would be unnecessary in the great majority of
cases. In the case of a child with chronic infection or with repeated respiratory infection,
Page 306
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there is very likely to be vitamin A deficiency and there is much more definite indication
for the ingestion of vitamin A. It would be given to these children with colds and
infections not because it is an anti-infectious vitamin, but because there is a defect in
these children.
Now we consider vitamin Bj. Here the situation is very much the same as in vitamin
A. We are much more to the borderline of the ingestion of minimal amounts but much
the same factors enter into the vitamin Bi deficiency—illness, infections and various
difficulties that lead to poor utilization. In the case of vitamin Bj, however, there is a
smaller proportion of the requirement being ingested. This has been brought about by
the refined food. Something like 25% of the total calories represents refined cereal. In
former times this same type of diet would have supplied 600 untis of vitamin Bj. At
the present time the same materials will supply approximately 50 units of vitamin Bj.
It puts a rather large burden on the so-called protective foods to bring up the vitamin
Bi to an amount that is needed. This condition has been getting progressively worse.
At the present time there has been started a programme of restoration to foods and I
hope it grows. For example, flour that has been milled to a refinement may now have
added to it vitamin Bi and colcium and iron also, back to the content of the original
wheat, so that we may have a flour that is restored in these details without changing the
keeping qualities of the flour, or its taste or its cooking qualities. We hope this programme grows.   It is definitely needed.
It is difficult to say how much vitamin Bj deficiency there is. There are whole districts in which the disease Pellagra exists. There are large areas in which vitamin Bi
deficiency does definitely exist because of low diet intake. Vitamin Bi is known to be
concerned with appetite. In the animal, when the animal is deprived of vitamin Bi, the
appetite is decreased. There is an attempt to transfer this idea to the human being and
no doubt it holds there, too, but in the case of the child with poor appetite, the chances
are that we are dealing with multiple factors again. In the majority of instances, at least,
the difficulty is one of training a child in feeding habits. There may be a vitamin Bj
deficiency.  What is needed is re-training of feeding habits.
We know in the animal that vitamin B^ is concerned with the tone of the bowel.
One encounters the idea that vitamin Bi is a very good thing to give to children with
constipation. I am not sure, but I wonder if that fact is due to vitamin Bi, because
wheat germ and similar materials are laxative even though one has destroyed the vitamin
Bi in them. There is something more than in the effect of bowel tone. It is very definite that clinically there is a laxative effect in most instances from the use of these
preparations.
Now the subject of vitamin C. I will restrict my remarks to the application to the
young infant. We know that infants ordinarily will not develop scurvy if they receive
10 mgs. of vitamin C a day. It is desirable not to restrict the intake to that amount
and with most of them it seems desirable to give amounts larger than those which will
just prevent scurvy. If one converts this into terms of orange juice and considers the
average orange as containing 50 mgs., then we will see that infants normally get their
vitamin C. There has been a rather strong tendency to use smaller amounts of orange
juice than this and to start them somewhat later. It is so often the custom to give a
teaspoon of orange juice after the baby is one month of age and increase gradually a
teaspoon at a time and then stop at an ounce as an intake. It seems to me that there
are no dangers in orange juice and that for nutritional purposes one can consider that
as our guide. It is our own custom to give an ounce of orange juice each day as soon
as the baby comes under paediatric care; at 2 or 3 months of age to give 2 or 3 oz. of
orange juice a day. No harm is done and it is more nearly the theoretical nutritional
requirements.
We don't need to discuss vitamin D. Milk is an excellent source and we hope that
all our babies and children get an ample supply of milk. It is present also in vegetables
but milk is the most important factor. If an abundance of milk is taken and if green
vegetables and other, fruits are eaten, we don't need to worry about it.  There are other
Page 307
* J' 1* vitamin D factors about which we know far too little.  In most parts of this continent
we don't need to worry very much about it.
There is another factor that in the rat seems to control the presence or absence of
hair. Whether this has any application to the human being is not known. We have
often considered that cirrhosis of the liver may be caused by alcohol. It is now becoming
somewhat more evident that these materials are not the direct cause but they are the
direct cause of a deprivation of certain numbers of the vitamin D content and it is
this which leads to these difficulties in the liver. Alcohol does no damage in these
respects, as might be thought.
As to the iron intake of the infant—we don't concern ourselves very much with
the iron intake of the older child but it is highly desirable with the infant.  When the
infant is born, he has 22 gms. of haemoglobin for each 100 c.c. of blood.   This haemoglobin is broken down to 12 gms.   This breakdown leads to the loss of considerable
amounts of iron.   Some of this is lost and a considerable amount is stored.   It is upon
this storage of iron that most of the infants depend for the first 5 or 6 months of
life and this storage is adequate if the baby is not ill.   So often the baby is not wholly
well during that period and the storage is used up more rapidly.   Then, a store if iron
is a normal thing and why should one deplete it at any time?  So keep up the iron supply
after his first couple of months.  There are various ways of doing this.   The best way is
by means of food.  Here it is dsirable to give small quantities of iron.   The quantity is
extremely small: 5 mgs. per day is enough in the first 6 months of life—10 mgs. for the
remainder of the first year.   This amount of iron would be supplied by a teaspoon of
1% solution of iron ammonia citrate.  In the case of supplying it with foods, one would
consider egg yolk and fruits and vegetables as important.  This brings about the question
of feeding cereal as baby's first solid food.   This custom goes back a long way.   It has
come down all through the ages since the Roman Empire.   The feeding of cereal as
baby's first solid food is founded on custom.  It certainly is not through any nutritional
knowledge.  What is it that the baby needs in this early time that he is not getting in
the milk formula, in orange juice and in cod liver oil?  When even whole grain cereals
are compared to fruits and vegetables and egg yolk as a source of vitamin Bi, they are
not good competitors.   Of course, there are cereals which have been fortified with vitamin Bi and this is a good thing, but it is only a custom and not based on sound nutrition.
If one is using natural foods, the egg yolk and fruits and vegetables are definitely
superior to the cereals.
THE PROFESSIONAL INSTITUTE MEDAL
[The Bulletin received this news item from the Professional Institute, and while
adding its congratulations to those already showered on the distinguished medallist, Dr.
Frederick S. Burke, is glad and honoured to publish the following.
This medal is one of the highest laurels a man of science can win in Canada, as is
evidenced by the fact that it is the fourth presented by the Professional Institute, and
by the list of those already so honoured, a truly distinguished company. This is not the
first outstanding contribution made by Dr. Burke to the national well being of Canada,
as our readers will see. Such work, painstaking and conscientious, adds to the sum of
human knowledge and of human happiness, and Dr. Burke has lived up to the highest
standards and ideals of his profession, and there are no higher. —Ed.]
The Professional Institute Medal, awarded annually for outstanding contribution in
"research, administration, or industrial organization by any member of the professional
services of the Provincial or Dominion Governments," was recently presented to Dr.
Frederick S. Burke, of the Department of Pensions and National Health. The presentation was made at the annual luncheon of the Professional Institute of the Civil Service
which precedes the business meetings of the organization opening here. The award was
made to Dr. Burke for his outstanding study, over a number of years, of the mortality
among war pensioners, particularly those suffering from tuberculosis, and the valuable
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findings and suggestions made by him which have had far-reaching influence on the
medical conduct of the present war.
The study of the subject of deaths among war pensioners was an entirely new
departure not previously attempted in Canada or elsewhere. It was not undertaken
because of the present war but was finished before its declaration, so that the conclusions
reached were the result of cold reasoning.    Its timeliness is obvious.
Dr. Burke is a native of Fergus, Ontario, graduated in medicine in 1911 from the
University of Toronto, and saw extended service overseas during the first Great War.
He was twice mentioned in despatches. He was Director of Medical Services in the
Toronto Health Department, prior to joining the Department of Pensions and National
Health. Dr. Burke has three hobbies: the Professional Institute, mechanics and fishing.
His connection with the Institute has been extensive, having served as second vice-
president in 1938, and having been chairman of a number of important committees.
Dr. Burke has an inventive streak in his make-up and the government has adopted an
improved type of mechanical ankle joint for artificial limbs, perfected by him. Among
other things he has invented a folding- trailer for automobiles.
This is the fourth medal presented by the Professional Institute for outstanding
contributions. Former awards were made to Dr. J. H. Craigie of Winnipeg for his
work in solving the grain rust problem, to Mr. H. L. Seamans of Lethbridge for his
discovering a method of controlling the Pale Western Cutworm, and Mr. Herbert Marshall of Ottawa, for his study of the Canadian Balance of International Payments. The
judges of this year's submissions, which were more numerous and of a higher calibre than
ever before, consisted of Dean C. L. Mackenzie, Acting President of the National
Research Council; Dr. Augustin Frigon, Assistant General Manager of the Canadian
Broadcasting Corporation, and Mr. Vernon Knowles, prominent journalist and Publicity
Director of the Canadian Bankers' Association.
Acknowledgement of the importance of Dr. Burke's findings and suggestions have
been received from outstanding members of the medical profession in Canada, the United
States, the United Kingdom and even Australia.    It has also been praised by life assur-
Page 309
;
i** ance companies and the Actuarial Society of America. An article appearing in the
Journal of the Canadian Medical Association, based on Dr. Burke's findings, estimates
the eventual total cost of pensions for conditions that could have been diagnosed by
X-ray, "and much of it eliminated from the pension budget," at the astonishing total of
$500,000,000.
As a result of the lessons learned from this study undertaken by Dr. Burke, the
National Defence Medical Services have put into effect, along the lines suggested,
measures which have already saved vast sums, and will continue to save even greater
amounts. From the humanitarian or public health point of view the gain is equally
great. Tuberculosis is detected very early, when chances of cure are good. Cases are
removed from contact with others, thus protecting the army and the public. Furthermore, early detection followed by early treatment gives the sufferer an almost normal
expectancy of life and efficiency.
Further, if the lessons learned from the study are followed, and steps in that direction
have already been taken, Canadian boys under twenty will not be subject to the rigours
of front line service, and the enhanced diet or rations will greatly aid the efficiency of
the young soldier and prevent the breaking down of many through deficiency diseases.
In his study of deaths among war pensioners, Dr. Burke had revealed the fact that
"the death rate from disease indicated that the after-effects of war service had a less
adverse influence on the seasoned men of 30 years and over than on those of 24 years
and younger." Dr. Burke further revealed that "it therefore seems reasonable to assume,
in the absence of other proof, that with the country on a war footing, the army ration
as provided during the Great War, while otherwise adequate, may have been deficient
in the protective elements, and as a result contributed to the loss of man power by permitting the physical breaking down of many in the younger age groups, and by increasing the difficulty of all ages to ward off infections."
In his survey of mortality of war pensioners, Dr. Burke discovered that those surviving the immediate post-war period and as a result of "excellent medical care and
another element of greater importance, partial if not total freedom from financial worry
... are thrown into ages in which their mortality is more favourable in comparison with
the mortality of Canadian males."
It is the belief of the Medical Group of the Professional Institute of the Civil Service
of Canada, expressed in a summary of Dr. Burke's presentation, "that the revealing facts,
as demonstrated in Dr. Burke's paper, have been the means of giving us a better army
for this present war, as well as saving the Canadian taxpayer staggering sums of money.
Thus work of this nature reflects directly on the financial and the health aspect of every
Canadian citizen, and, as a result, is worthy of encouragement."
The Medical Group feels that in all fairness to Dr. Burke it should draw the attention of the judges to the Standard Morbidity Code for Canada, which Dr. Burke originated and developed during the course of his work as chief of the Division of Medical
Investigation of the Department of Pensions and National Health. Without such a
Code, says the Medical Group in its summary, "medical studies of this nature would
have been well nigh impossible. The chief and most important feature, however, was
that he had the Code, together with an Appendix for war illnesses and injuries, in such
a complete form that the Army Medical Services were able to adopt it for use within a
few days of the outbreak of war and as a result of its timely preparation it has been
accepted as both Morbidity Code and Standard Nomenclature for the Army Medical
Services.
This was immediately followed by its adoption by the Canadian Pension Commission
and the Treatment Branch of the Department of Pensions and National Health. This
means that the same Code numbers indicating illness or injury are carried through from
the Army to Pensions to Treatment, and we believe that this constitutes the greatest
advance yet made towards uniformity of Army Medical Records."
Page 310
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CASE REPORT
R. C. Weldon, M.D.
By E. Chambers, M.D.
In the following paragraphs, we are submitting a case report, which we think mail
be of interest to some of your readers:
About February 25, 1940, a white, married female of 23 years of age, contracted a
common cold, which was followed by general aching, malaise, and extreme prostration**
Symptoms were those of influenza. Temperature of the patient was around 102° F. She
states that she had nausea and vomiting and also some epistaxis. At this time, she also
suffered diarrhoea of three days' duration. Since that time, she has had a general feeling
of malaise, loss of appetite, and some abdominal tenderness. Past history reveals the
fact that the patient had had a boarder who had had typhoid fever and recovered.
Patient was admitted to the hospital March 17, complaining of general weakness ami-
general prostration. Temperature was 99 when she entered, and went up to 1033 that
evening. She continued with cough, feeling of general malaise and prostration, and a
spiked temperature, varying from 99 to 104 until March 23, when she was given a blood
transfusion, 500 c.c, after which time her temperature came down to normal and
remained same. The donor of the blood had been immunized for typhoid fever with
three shots in 1940, and with one shot in 1941. Patient had some clay-coloured stools
the first four or five days. Spleen was enlarged three fingers below the costal margin and
there was evidence of slight abdominal tenderness. Remaining physical examination was
negative.
LABORATORY EXAMINATIONS:
March 19, 1941—
B. typhosus Flagellar "H"  antigen—agglutination to dilution  1:160
Somatic "O" antigen—Titre to follow
B. paratyphosus A .Negative
B. paratyphosus   B Some  agglutination to  dilution   1:160
Br. abortus Negative
March 20,  1941—
B. typhosus  Flagellar "H" antigen  (titre)   Agglutination to dilution 1:1280
Somatic "O" antigen (titre)  Agglutination to dilution 1:2560
April 3,  1941—
B. typhosus  j Flagellar "H" antigen—agglutination to dilution 1:640
Somatic "O" antigen—agglutination to dilution 1:2560
B. paratyphosus A Agglutination to dilution 1:80
B. paratyphosus   B_ Agglutination to dilution 1:80
Br. abortus No   agglutination   in   24   hours.    If   after   further   incubation
agglutination occurs, a subsequent  report  will  be sent.
Urinalysis—Sp.  Gr.   1015;  Reaction—acid;   Albumin—plus   1;  Sugar—negative;
Microscopical—Pus cells—plus 1; Pus in clumps—plus  1; Few epithelial cells.
Blood Count—    Haemoglobin
15.36 gms. 100% R.B.C. "W.B.C. P.M.N.        Eosin        L. Lymphs
Mar. 17— 54% 2,800,000 3,000 36 64
Mar. 24— 73%
Apr.    9— 80%
Mar.  17—Anisocytosis plus 1; Poikilocytosis plus 1
Mar. 19—Icterus Index 4.5
Mar. 19—2 specimens sputum: No T. B. found
Mar. 22—Bl. Culture: (4 p.m.) 72 hours no growth
Mar. 24—Culture stool rec'd 19/3/41: No B. typhosus, B paratyphosus A or B found
Mar. 26—Stool culture: No. B typhosus found
Apr.    3—Stool: No B. typhosus found
Apr. 12—Stool: No. B typhosus found
Mar. 17—Sedimentation rate: 11/55
Mar. 22—Mr. J. D Jones—matched and compat.
Patient group A4.
Lungs were x-rayed and found negative.
Patient was given Phenobarbital grs. iss to sleep, Blands compound gr x one t.i.d and haliver
oil capsule b.i.d.
Page 311

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