History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: June, 1947 Vancouver Medical Association Jun 30, 1947

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Transactions of the
VICTORIA MEDICAL SOCIETY
the
VANCOUVER GENERAL HOSPITAL
and
ST. PAUL'S HOSPITAL
In^This Issue:
Page
POST OFFICE REGULATIONS AND RATES-lp
Applicable to Specimens mailed to the
Division of Laboratories        jgll ^p^^p^  -'§ll§Ipi|| 1| §
ACUTOANTERIOR POLIOMELITIS
By Dr. Stewarf^Murray, MJHF.O. ^^g^gj^^^^^^^pj:".?9 i
THE DIRECTION IN WHICH WeJ&RE GOING
By A. E, Graiier, m^^HHH^^^^Mp •    224
TETANUS—A CASE REPORT
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TniSUm 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. MacDebmot
Db. G. A. Davidson Db. D. E. H. Cleveland.
All communications to be addressed to the Editor at the above address.
Vol. XXIII
JUNE, 1947
No. 9
Db. G. A. Davidson
President
OFFICERS, 1947-48
Dr. Gordon C. Johnston
Vice-President
Dr. H. A. DesBrisay
Past President
Dr. Gordon Burke
Hon. Treasurer
Dr. W. J. Dorrance
Hon. Secretary
Additional Members of Executive: Dr. Roy Huggard, Dr. Henry Scott
TRUSTEES
Dr. A. M. Agnew Dr. G. H. Clement Dr. A. C. Frost "
Auditors: Messrs. Plommer, Whiting & Co.
SECTIONS
Clinical Section
Dr. Reg. Wilson Chairman Dr. E. B. Towbridge Secretary
Eye, Ear, Nose and Throat Section
Dr. Gordon Large Chairman Dr. G. H. Francis Secretary
Paediatric Section
Dr. J. H. B. Grant Chairman Dr. E. S. James Secretary
Orthopaedic and Traumatic Surgery Section
Db. J. R. Naden Chairman Db. Claeence Ryan Secretary
Neurology and Psychiatry
Db. J. C. Thomas Chairman Dr. A. E. Davidson Secretary
STANDING COMMITTEES
Library:
Dr. J. E. Walker, Chairman; Dr. W. J. Dorrance, Dr. D. E. H. Cleveland,
Dr. F. S Hobbs, Dr. R .P. Kinman, Db. S. E. C. Tubvey.
Publications:
Dr. J. H. MacDermot—Chairman; Dr. D. E. H. Cleveland, Dr. H. A.
DesBrisay, Dr. J. H. B. Grant, Dr. D. A. Steele.
V. O. N. Advisory Board:
Dr. Isabel Day, Dr. H. H. Caple, Dr. E. J. Curtis.
Summer School:
Db. L. H. Leeson, Chairman; Db. E. A. Campbell, Dr. J. A. Ganshorn,
Db. D. S. Munbo, Db. D. A. Steele, Db. L. G. Wood.
Credentials:
Db. H. A. DesBbisay, Db. H. H. Pitts, Db. Frank Turnbull.
Representative to B. C. Medical Association : Dr. H. A. DesBrisay.
Sickness and Benevolent Fund: The Presidfnt—The Trustees.
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M'l rtcNfrc PLAGUE
DIARRHEA  JKJB   TO   FOOD   CONTAMINATION,
excessi1^ heat, ^racalioiE^ indulgences or
ehangei|>f drinking water is quicklyljlon-
trolled by Kaomagtna.
AT THE O^^T give 2 lablespoonfuls in a
little water
HFOLU)l£D BY 1 lablespoonfid after every
bowel movement.
FOR   PROMPT   RELIEF   FROM   DIARRHEA
KAOMAGMA
Kaolin in Alumina Gel
« AND 12 FL OZ. BOTTUS
Regi»t«red Trade Mark
CLEANSES  •  COATS   •   PROTECTS  •  SOOTHES
JOHN WYETH & BROTHER (CANADA) LIMITED
WALKERV1LLE, ONTARIO
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Twncvrm
.AT THE MENOPAUSE
HIGHLY POTENT
ORALLY ACTIVE
NATURALLY OCCURRING
ESSENTIALLY SAFE
WATER SOLUBLE
WELL TOLERATED
IMPARTS A HEELING
OF WELL BEING
•
conjugated  oestrogenic substances (equine)
supplied in two strengths:
No. 866 — 1.25 mg. per tablet
No. 867—0.625 mg. per tablet
Both strengths are supplied in bottles of 20 and 100
AYERST,   McKENNA   &   HARRISON  LIMITED
Biological and Pharmaceutical Chemists
MONTREAL
CANADA
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codeine in analgesic power. Furthermore, it possesses
marked spasmolytic and mild sedative action. It causes
less nausea ttnd vomiting and less urinary retention than
morphine, and no constipation. The danger of respiratory
depression is also greatly reduced with Demerol hydrochloride* .Warning: May be habit forming. Ampuls of 2 cc.
(100 mg.) and tablets of 50 mg. Narcotic blank required.
R#i
Write for detailed literature
H V D R 0 C H I 0 R^D E
Brand of meperidine hydrochloride (isonipecaine)
DEMEROL, trademark Reg. U.S. Pdt. Off. & Canada
CHEMICAL COMPANY, INC.
New Yomt 13,N.Y.      '      Windso*, Our. VANCOUVER HEALTH DEPARTMENT
STATISTICS—APRIL, 1947
Total population—estimated  _
Chinese population—estimated
Hindu  population—estimated
Number
Total deaths  3 58
Chinese deaths  19
Deaths,  residents only  306
BIRTH REGISTRATIONS:
Male |  446
Female   427
 339,350
        5,980
  118
Rate per 1,000
Population
12.8
38.7
11.0
873
INFANT MORTALITY: April, 1947
Deaths under 1 year of age 31
Death rate per 1,000 live births ; 3 5.5
Stillbirths (not included above) 8
CASES OF COMMUNICABLE DISEASE REPORTED IN THE CITY
March, 1947
Cases
Scarlet Fever     14
Diphtheria :.       2
Diphtheria Carrier 0
Chicken Pox | 640
Measles   . :  805
Rubella 9
Mumps 432
Whooping Cough '. 39
Typhoid Fever 0
Typhoid Fever  Carrier :        0
Undulant Fever 0
Poliomyelitis 0
Tuberculosis 59
Erysipelas           3
Meningococcus  (Meningitis) 3
Infectious Jaundice 0
Salmonellosis 3
Salmonellosis  (Carrier) :        0
Dysentery         0
Tetanus .___        0
Syphilis 110
Gonorrhoea  189
Cancer  (Reportable)—Resident 103
Non-resident 35
31.3
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April,
1947
May
,1947
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Page Two Hundred and Sixteen
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CRYSTALLINE PENICILLIN IN OIL AND WAX
(R0MANSKY FORMULA)
Crystalline sodium penicillin is now used by
the Laboratories in the preparation of Penicillin
in Oil and Wax (Romansky Formula). The use
of this highly purified form of penicillin marks
a further advance in the development of an
improved product.
Ease of Administration— The improved
mixture flows more freely through a
hypodermic needle.
Minimum of Local Reaction—Because of
the high purity of the crystalline penicillin in the product, local reactions are-
reduced to a minimum.
AN ADDED CONVENIENCE
For the convenience of members of the
medical profession using the B-D* Metal Cartridge Syringe, a sterile 20-gauge needle is now
included in the replacement cartridge package.
Disposable Plastic Syringe
HOW SUPPLIED
DISPOSABLE PLASTIC SYRINGE PACKAGE
Included in this package is a sterile B-D*
Disposable Cartridge Syringe, ready for immediate use with a special cartridge containing
300,000 International Units of crystalline peni-
■cillin in 1 cc. of peanut oil and beeswax. The
plastic syringe is discarded after use.
METAL CARTRIDGE SYRINGE PACKAGE
This package includes a B-D* Metal Cartridge Syringe, two sterile 20-gauge needles,
and a cartridge containing 300,000 International Units of crystalline penicillin in 1 cc
of peanut oil and beeswax. The metal syringe
is designed for repeated use with readily
changeable needles and cartridges.
REPLACEMENT CARTRIDGE PACKAGE
Replacement cartridges containing 300,000
International Units of crystalline penicillin in
1 cc. of peanut oil and beeswax are obtainable
separately from the Laboratories. These cartridges are supplied for use with the metal
cartridge syringe.
A sterile 20-gauge needle is supplied with
each replacement cartridge.
*T. M. Reg. Becton, Dickinson & Co.
Metal Cartridge Syringe
CONNAUGHT MEDICAL RESEARCH LABORATORIES
University of Toronto Toronto 4, Canada
DEPOT FOR BRITISH COLUMBIA
MACDONALD'S PRESCRIPTIONS LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. "Ike. Zdit&A Pcuje
The present outbreak of poliomyelitis in Vancouver has, we have no doubt, been
the source of a great deal of worry and anxiety to our overworked health department.
Not the least of these worries, we believe, is the question of publicity on the matter.
This is always the case, of course, whenever any disease becomes epidemic. How much
should be told to the public, and in what way? What will be the public's reaction?
And will there be a greater danger of causing panic and fear, or will a wise frankness
allay public anxiety, and ensure the co-operation of the community at large? These
are not always easy questions to answer, and especially in the case of poliomyelitis, where
we can only give very general and vague directions, since we do not yet know very well
how the disease is spread, or what precautions we can take to prevent this spread.
Our own opinion, for what it is worth, is that the wisest course, ultimately, is to
give the fullest information possible. We think there are several reasons for this. The
first is, that there is no hope of concealing the fact that there is an epidemic present.
The press sees to that. The public reads daily of the steady increase in the number of
cases. This gives rise to public anxiety, and even fear, and a great deal of this fear, as
in the case of all fear, could be removed or prevented, by a frank presentation of the
facts of the case. That there is this fear present, every family doctor knows—for he is
rung up several times a day by anxious parents who wonder if Johnnie's cold, or Elizabeth's cough, may not mean the onset of polio. It seems to us that a well-considered
statement by the Health Department, whose experts can be trusted, can do much to
allay this ill-founded, but very natural, fear of the unknown.
Again, the modern knowledge of poliomyelitis and its etiology, limited though it is,
still covers ground which is definite. We know for instance, that flies can act as carriers
—and so can warn people to take the greatest care to avoid this form of contamination.
One cannot but feel that the beaches, and especially the bathing pools, are very likely
areas for the spread of the disease, through bladder and intestinal discharges. Crowds,
of course, have their potentialities for danger, and other possible ways of spread come
to mind. We are glad to see that Dr. Stewart Murray and his colleagues, have taken
steps to warn the public of many of these dangers.
We believe, too, that the public is more to be trusted than some people think. This
has been shown again and again, especially in England during the war, where the government took the people completely into their confidence and told them the facts
frankly. When this was done, the whole population responded, and worked loyally with
the authorities. On the other hand, one of the greatest manifestations of public resentment and indignation ever witnessed in that country followed the concealment before
the coal crisis of the facts of the case. And it is the same, we feel, about matters and
conditions threatening the public health. We need have no fear of frightening people—
they are already frightened—and only frankness and a full presentation of the truth
will allay this fear.
We have heard it said that it would be inexpedient to publish all the facts, sincee
this might alarm visitors to Vancouver, and damage the tourist traffic. We mention
this only to say that this is the most short-sighted policy possible, as well as the most
unfair—and amounts to a betrayal of those who come to visit us. This consideration,
of course, would not weigh with the Health Department—but might influence some
others in places of authority.   It is wholly to be condemned.
All this seems to us to be another argument for the establishment of some sort of
Bureau of Medical Publicity, which could be of great value, not only in this matter,
but in a great many other cases.   The amount of misinformation that reaches the public
Page Two Hundred and Seventeen
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a on medical and health matters, is nothing short of a reproach to us as a profession: and
the only answer to this problem, in our opinion, is to have some competent authority
which could be on the watch, and provide the facts, accurately and dispassionately put,
whnever the need arises.
LIBRARY NOTES
!*.*■
ANNOUNCEMENT OF SUMMER HOURS
Evening hours have been discontinued from June 15 th to September 15 th, inclusive.
During this period the daily hours will be:
Monday to Friday—9:00 a.m. to 5:00 p.m.
Saturday—9:00 a.m. to 1:00 p.m.
RECENT ACCESSIONS TO LIBRARY:
Surgical Clinics of North America, Symposium on Tumours, Lahey Clinic Number,
June, 1947.
Transactions of the American Association for the Study of Goitre, 1946-46.
The Treatment of Diabetes Mellitus, 8 th ed. 1947, by Elliott P. Joslin et al.
Principles of Hematology, 3rd ed. 1946, by Russell L. Haden.
Diseases of the Chest, 2nd reprint, 1946, by Robert Coope.
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CORRESPONDENCE
July 3,  1947
Dr. J. H. MacDermot,
Editor—Bulletin,
Vancouver Medical Association,
925 W. Georgia St.,
Vancouver, B.C.
Dear Dr. MacDermot:
I would appreciate your finding space, if possible, in the forthcoming issue of the
Bulletin for the attached notice for physicians regarding Post Office regulations and
rates applicable to specimens mailed to the Division of Laboratories.. Your bulletin
offers the most effective channel for communicating these facts to the medical profession in the Province.
Thanking you, I am,
Yours very truly,
C. E. DOLMAN,
Director.
The above letter from Dr. Dolman is self-explanatory, and we are glad of the
opportunity to publish his notice below. When one considers the very serious consequences
that might follow careless packing of infective material, and the menace that the escape of
such material might constitute to the public at large, the necessity for the greatest
possible care becomes obvious. Apparently, however, the experience of the Public
Health Laboratories shows that such care is not always exercised. We urge our readers
to pay special attention to this very timely notice.—Ed.
Page Two Hundred and Eighteen
■M' POST OFFICE REGULATIONS AND RATES APPLICABLE TO SPECIMENS
MAILED TO THE DIVISION OF LABORATORIES
Specimen Containers
The attention of physicians is drawn to the regulations governing shipment of
specimens by mail to the Provincial Laboratories. Complaints have been received from
the District Post Office Inspector that potentially infectious material has been discovered in the mails packed in a single container, although the regulations call for an
inner tin and outer carton. Blood specimens for serological tests are also occasionally
being sent by mail without replacement of the cotton packing supplied with the
outfit, so that if the cork of the test tube is loosely inserted, and the screw cap of the
carton improperly fitted, blood may leak into mail bags and stain their contents.
Postal Rates
The diagnostic facilities of the Provincial Laboratories represent a free service to
the public through the medical profession; but no provision is made in the Laboratories'
budget for the free shipment of specimens to the Laboratories. Inadequately stamped
and even unstamped packages are quite often received. For the information of physicians, the following are the postal rates which now apply to the more commonly used
specimen outfits:
Diphtheria outfits .03
Kahn outfits | ; .01
Faeces containers .05
Water containers .05
Slides [ .01
Darkfield outfits . .03
Sputum outfits _: .03
th ■>
Division of Laboratories,
C. E. DOLMAN, Director,
Dept. of Health & Welfare.
June 17th, 1947.
Editor,
Vancouver Medical Association Bulletin,
203 Medical-Dental Building,
925 Georgia Street W., Vancouver, B.C.
Dear Sir: £$£
Attached is some information rgearding recent appointments at the Vancouver
General Hospital namely Dr. Digby Leigh, -Director of the Department of Anaesthesia,
and Dr. H. K. Fidler, Director of Laboratories. I would be pleased if you could give
publicity to these in the next issue of the Bulletin so that the profession at large in
British Columbia would have knowledge of these.
It may be of interest to them to know that Dr. Digby Leigh plans on instituting
a refresher course for any member of the profession who wishes to take a short course in
anaesthesia to assist him in his practice in isolated areas.    Also, physicians sending in
Page Two Hundred and Nineteen
"f It-
specimens for pathological examination would like to know who is in charge of that
Department now, since Dr. Pitts' resignation.
Yours very truly,
R. A. SEYMOUR, M.D.,
Asst.  Superintendent. %;|
The above letter from Dr. Seymour introduces to our profession in B.C., two men
who will undoubtedly be an acquisition to that profession. We publish below a short
summary of their qualifications, and the work they have already done.—Ed.
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H. K. FIDLER, M.D. (Man.) L.M.C.C, B.Sc. (Med.)
Dr. Fidler succeeds Dr. H. H. Pitts as Director of Laboratories at the Vancouver
General Hospital, following Dr. Pitts' resignation, to become Chief Pathologist at
St  .Paul's  Hospital.
Dr. Fidler has had an active and distinguished career for so young a man. He
was a demonstrator in pathology in the University of Manitoba, instructor in pathology
and bacteriology in the University of Alabama—where he became assistant professior
of pathology and bacteriology in the medical school. Following a surgical interneship
in the Royal Jubilee Hospital in Montreal, he joined the R.A.M.C., and served as
pathologist from 1934-45—subsequently becoming director of laboratories at Shaugh-
nessy Hospital.
He is certified as Specialist in Pathology and Bacteriology by the Royal College of
Surgeons of Canada.
He has published various papers dealing with his chosen subject.
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DR. M. DIGBY LEIGH, M.D., CM.,  (McGill)
Dr. Digby Leigh is the new Director of the Department of Anaesthesia at the Vancouver General Hospital. This department, so ably run and developed for many years
by Dr. David D. Freeze, who, we are glad to note, will still remain on the staff, has
lately been reorganized to fit it to deal better with the great increase in volume and
complexity of the work it has to do. Modern anaesthesia, with it tremendous devel-
iopment along new lines in chest, heart and brain surgery, is now a very complex
affair. Dr. Digby Leigh, who comes from Montreal, where he was Assistant Professor
of Anaesthesia at McGill, and chief anaesthetist at the Children's Memorial Hospital.
Dr. Leigh has had a wide experience in anaesthesia and is particularly well qualified
as a teacher. He has served as resident anaesthetist in Wisconsin General Hospital, has
been a Research Fellow in Pharmacology at McGill, in addition to his positions detailed
above. He is the co-author of a book, "Paediatric Anaesthesia", now on the press, and
is a contributing editor of "Anaesthesiology", and a diplomate of the American Board
of Anaesthesiology.
He certified as "Specialist in Anaesthesia" by the Royal College of Physicians and
Surgeons of Canada.
Dr. Leigh comes to the Vancouver General Hospital at an especially significant
period in its existence. The new developments that are contemplated in the Hospital,
the near prospect of the Medical School at the University of British Columbia, and
the growth of Vancouver generally, all make it urgently necessary that nothing should
be left undone to ensure the optimum development of anaesthetics in our hospitals,
along the most up-to-date lines. We welcome very warmly Dr. M. Digby Leigh, who,
by his past accomplishments, and by the witness of his colleagues, is so eminently
fitted to undertake this task.—Ed.
Page Two Hundred and Twenty
S ancouver
President	
Vice-President	
Honorary Treasurer-
Honorary Secretary-
Editor	
cal   Association
 Dr. H. A. DesBrisay
 Dr. G. A. Davidson
 Dr. Gordon Burke
 Dr. Gordon C. Johnston
 Dr. J. H. MacDermot
ACUTE ANTERIOR POLIOMELITIS
(Contributed by DR. STEWART MURRAY, M.H.O.)    .
Brief refresher notes:
"Poliomyelitis is an acute infectious disease caused by a filtrable virus, occurring in
epidemics and sporadically, and characterized by varying degrees of injury and degeneration of the central nervous system, with special localization in the anterior horns and
the motor nuclei of the medulla; clinically it shows marked diversity in symptoms from
mildest malaise to complete flaccid paralysis of many groups of the skeletal muscles with
possible death through involvement of the respiratory centres in the medulla" (Infantile Paralysis 1941).
It is a reportable disease to the Health Department.
a. The quarantine period for contacts—2 weeks.
b. The isolation period for cases—3 weeks.
(a and b, see Provincial Communicable Disease Regulations.)
Incubation period—3-20 days, usually 6-8 days.
Communicability and Transmission
It is highly infectious, the patient probably being infectious from the first day at
least until 10-20 days after the onset, although the virus has been isolated from the stools
of a patient (female 5 years) 125 days after the onset.
"Accumulations of epidemiological data in recent years appear to have strengthened
the hypothesis that poliomyelitis is spread principally by person to person contact. (U.S.
Public Health Report Vol. 62 No. 25 June 20/47.) However, within the last few years
the idea that "Polio" may be an "intestinal disease" has come sharply to the fore and
spread by means of polluted water and milk or foodstuffs contaminated with human
faeces may be quite probable. The virus may be carried by flies feeding on sewage.
Evidence is ample to show that there are many healthy carriers and recovery of the
virus has been reported from several pools of tonsils removed from children admitted
to Los Angeles hospitals in an interepidemic period.
Secondary cases may result from contact with primary cases, from two or three
days before up to several days after the onset of the disease in the primary case, further
indicating the carrier state.
Mild gastro-intestinal upsets or a mild pharyngitis or tonsillitis associated with fever,
headache and nausea or vomiting should be viewed with suspicion in a family or group
from which a frank case arises.
Symptoms
According to Top's Hand Book of Communicable Diseases the clinical manifestations
of poliomyelitis may be divided into three phases; namely the systemic, the central nervous system and the paralytic.
The systemic phase differs in no important essential from the onset of a number of
acute communicable diseases, and if there be no further manifestations it may be considered an abortive case—this is the type described above as a source.
Th central nervous system phase includes those symptoms shown in the first phase,
but in addition may become more marked but not necessarily so, and there is hyper-
Page Two Hundred and Twenty-one
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sensitiveness, increased sweating, stiffness of the neck, stiffness of the spine, muscle
spasm and usually positive spinal fluid findings. The case may subside and be classified
as non-paralytic "polio".
The third or paralytic stage may manifest itself as spinal, spino-bulbar, bulbar,
encephalitic or meningitic. The signs and symptoms then follow the classical descriptions of the disease.
By far the commonest spinal involvement is that affecting the lower extremities.
Prognosis
The prognosis in general is good. It is generally thought that about 70% of cases
have complete recovery, 15% have a slight paralysis and the balance varying types of
severe paralysis.
Treatment
The Polio Committee of the Vancouver General Hospital has adopted the following during the acute stage (see below). After the acute phase treatment is re-education
of muscles (physical medicine) and finally special treatment.
In all cases the morale of the patient must be reinforced. The folowing is the
policy of the Polio Committee, Vancouver General Hospital.
Diagnosis:
Free consultative service is available for any case staff or private on request
through the Supervisor of I.D.H. Consultants include the following who are members
of the V.G.H. "Polio" Committee:
Dr. J. R. Naden
Dr. S. E. C. Turvey
Dr. F. Turnbull
Dr. E. J. Curtis
Dr. J. H. B. Grant
Dr. E. E. Day
Dr. G. A. Greaves.
Special Consultation
In any suspect or proven case the attending physician is urged to have the patient
seen by Dr. Greaves and to confer with him on the course of treatment.
Treatment
All patients, suspect or proven cases of polio will receive hot fomentation treatment
as soon as possible after admission unless the attending physician specifically request
that this treatment be not given. i^
Special Procedures.
Before any operative or other major procedure is performed the patient must be seen
by two members of the "Polio" Committee who must concur in the procedure to be
adapted. This is in accordance with Section 109 of the Hospital By-laws which reads
as follows:
"The General Superintendent may require a consultation whenever, in his opinion,
it will be in the interests of the patient or of the Hospital."
In the Vancouver area and lower mainland to date July 15th some 45 cases have
occurred. There has been one death, diagnosis having been made on the post mortem
micropathological examination.
The cases have occurred in the following age groups as shown. These indicate
the disease is definitely not confined to the infantile or preschool groups.
AGE CLASSIFICATION
0-1 1-5 6-14 15-19 20 over Total
— 10 18 4 10 42
Page Two Hundred and Twenty-two
M SEX CLASSIFICATION
—        7M, 3F 9M, 9F 3M, IF 4M, 6F 24M, 19F
Three cases have been reported from outside the Vancouver area. No histories are
available as to age and sex.
To date there has been no common factor. There is no laboratory test available
here aside from spinal fluid findings. There is no specific treatment or method of
prevention.    The following general advice has been given.
(a) avoid over fatigue
(b) avoid chilling
(c) avoid swimming in polluted water
(d) practice a high standard of personal hygiene
(e) keep flies away from food
(f) avoid crowds
(g) regarding tonsillectomies during epidemics, there is a wide difference of opinion.
The "Polio" Committee of Vancouver General Hospital feels that if there
be any question it is best to delay operation.
NOTE: In the June 28, 1947, Vol. 134, No. 9 of the J.A.M., there are two excellent
articles on "Polio".
(a) P. 749:
Epidemiology of Poliomyelitis, by Albert Sabin, M.D.
(b) P. 757:
Bulbar Form of Poliomyelitis by The Minnesota Poliomyelitis Research Commission.
STEWART MURRAY,
Senior Medical Health Officer.
COLLEGE OF PHYSICIANS AND SURGEONS
The medical profession of British Columbia welcomes Dr. F. L. Whitehead, M.D.,
CM. (Dalhousie) as he takes up his new duties as executive secretary of the College
of Physicians and Surgeons. Dr. Whitehead will also act as executive secretary of the
British Columbia Medical Association. In these positions he takes the place filled
until recently by Dr. M. Caverhill.
The new executive secretary has had an active and varied career, and his experiences
fit him particularly for the work he will have to do. Graduating in 1935, he very soon
joined the R.A.F. (Medical Branch), and served in this organization for ten years,
leaving with the rank of Wing-Commander. During this time he saw service in
Great Britain, Egypt, Palestine and Germany. He was with the R.A.F. in the
Western Desert campaign, in the early days of the war, and shared the grim experiences
and severe hardships of those who took part in that terrible campaign.
Dr. Whitehead spent two years in the Department of Aviation Medical Research,
and travelled a great deal during this time. He also served as Senior Medical Officer of
the Queen Elizabeth for six months, at the height of the submarine campaign, but
missed any personal contact with torpedoes.
Leaving the forces at the end of his ten-year term of service, he practised medicine
in Nova Scotia as a general practitioner in a small town. He knows, therefore, at first
hand, a good deal about the problems and difficulties that confront a medical man in
general practice, and should be able to be of great service in his new position, to the
medical men of British Columbia.
We wish him all success, and believe that in appointing him, the College made a
wise choice.
Page Two Hundred and Twenty-three
m
'   a$! THE DIRECTION IN WHICH WE ARE GOING
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Address-by A. E. Grauer, B.A., Ph.D., President of the B.C. Electric Railway Co.
(Delivered at Annual Meeting of V.M.A., May, 1947)
Oliver Wendell Holmes once said, "I find the great thing in this world is not so
much where we stand as the direction in which we are going". I have taken part of
this statement as my title to cover a talk which I hope will not play the role of the
politician in the story, will be somewhat rambling in nature but I hope of some interest.
The world picture today is a chaotic one. There is no unity in the world, no sense
of common purpose. A creed of hate has been built up, stemming from Karl Marx and
his doctrines of the class struggle and of the exploitation of the masses by the so-called
Capitalists.
Karl Marx was a theoretician. He was a brilliant, embittered recluse who, exiled
from his native Germany, spent years in the library of the British Museum developing
theories that have pretty uniformly been proven wrong by history. Yet the Communists, and to a considerable extent the Socialists, continue to repeat his slogans as if they
were gospel truth.
Socialism and Communism have the same objectives. They believe that human happiness and welfare can best be furthered by putting total economic as well as total
political power into the hands of the State, and thus they are at the opposite poles to
free enterprise.
However, the Socialists and Communists heartily disagree with each other because
they differ radically in their means of achieving their objectives.
Marxism is the most complete formulation of a vast counter movement that has
risen in western nations against the assertion of the rights and liberties of the individual, which until recently, the English speaking nations took for granted. In all
later Socialist, Communist and Fascist phases of this movement we see the same tendency
to consider humanity in the lump as classes and not as individuals, the same acceptance
of hate and conflict as necessary forces in human society.
Through his materialistic interpretation of history, Karl Marx stressed the dominance and inevitably of economic forces over the individual. The great man, for
instance, was simply a product of economic forces, the way he looked at it. Now I want
to suggest to you that one of the reasons why Communism and Socialism continue
to appeal to many people, even in highly developed countries like Canada and the
United States, is because of the discontents of people, whatever may be their cause.
These causes are many. And free enterprise has been weak in not alertly analyzing
them and laying down a positive programme of remedial action. Such a programme
would both preach and practise the virtues, inherent in our pioneer background, of
"cooperation" and "friendship" as against the creed of class struggle and hatred.
Communism and Socialism have been very clever in taking advantage of this
weakness by trying to channel all discontents, from whatever cause, into an indictment
of the economic set-up of free enterprise.
Tactically, both Socialism and Communism continually dwell upon the shortcomings
of the Free Enterprise system, and, by implication at least, take the position that these
shortomings would not exist under their own systems. In short, they preach, directly
or indirectly, a gospel of perfection. This is a tremendous strength, because although
philosophers know that there is no greater illusion than that any system run by human
beings can be perfect, it is nevertheless a great rallying cry for all those who are in any
way discontented with their present lot.
My thesis is then that democratic free enterprise, to develop as a healthy system
and to offset the erroneous direction which totalitarian systems of all descriptions are
trying to give us, must lay down a positive programme of integrating the individual into
the social group, of making him feel that he "belongs", and must do this on a broad
front. Our present preoccupation with material and economic considerations is not
enough.
Page Two Hundred and Twenty-four To illustrate this thesis, I shall take examples from three important but quite
different fields,—health, community organization, and education.
In the field of health, my example is that of mental illnesses of all sorts which I
shall group under the term "mental hygiene".
The importance and ramifications of mental hygiene have only recently been realized.
As Professor His cock of the Yale School of Medicine says, "There is no problem of
public health which is more important and at the same time more difficult of solution
than that which relates to mental hygiene. In the average family throughout a community it is probable that the handicaps due to mental maladjustments are as great
as the handicaps due to all other diseases and defects combined".
The dimensions of the problem are enormous. In the first place, there is the problem
of major psychoses, commonly referred to as insanity. The number of such cases institutionalized in Canada occupy more beds than exist in all General Hospitals. It has
been estimated that 4% of all school children will at some period become patients,
which is almost is many as will graduate from our universities. Dementia praecox is
responsible for more chronic invalidism than tuberculosis or cancer.
In the second place, there are the mental defectives or feeble minded, comprising at
least one percent of the population. It is estimated that specail training in public schools
is needed for over 40,000 mentally deficient children. There is existing provision in
public schools and in residential schools for the specialized training of somewhat over
10,000. There are at least 8,000 adult mental defectives in the Dominion, requiring
institutional care, but provision has been made for little over one half this number. This
lack of accommodation exacts a heavy price in crime and other social problems.
Thirdly, there are the epileptics, a class that, as you know, requires different treatment from that given to the insane. This is the group in which brilliant people are
often found.
Fourthly, there are psycho-neuroses, including nervous breakdowns, neurasthenia,
and severe emotional unbalance—a group of complaints affecting perhaps ten percent of
the population. Like marriage, our modern scientific age simplifies lif e but complicates
living.
Finally, there are emotional factors in connection with physical disabilities, especially
of the more chronic types. Where the mental state connected with the physical disability is overlooked, as is not unusual, it simply means that the period of disability is
greatly prolonged.
As I have said, no adequate survey has ever been made of the size of this problem
of mental hygiene in Canada, but it is obvious from the short analysis given, that the
numbers involved are very large.
Here, then, are a large number of Canadians who, to a greater or less degree, are
dissatisfied and groping because of a mental and nervous condition. To a considerable
extent their troubles have not even been diagnosed, or properly diagnosed, a situation
which, I think it is fair to say, has not been helped by the fact that medical education,
until recently, paid little attention to this side of the doctor's training. Even with
proper diagnosis, our facilities for dealing with them are in their infancy.
Here, then are a large number of people who are not properly oriented, who have a
feeling of inferiority, inadequacy, hurt, or dissatisfaction. They don't know what their
trouble is. What should be more natural than that many of them would fall for the
current left-wing slogans of sexploitation and class struggle, and attribute their troubles
to the nature of the economic system under which they are living. Certainly, anyone
suffering from a sense of inferiority is excellent material for an aggressive movement
that gives him a mission, however wrong that mission may be.
In my opinion, the supporters of the system of democratic Free Enterprise are
working on far too narrow a front. For instance, if the problem of mental hygiene
were properly understood and the correct facilities for treatment worked out, a lot of
people who at present attribute their troubles to the naure of economic organization,
would see their difficulties in a different light. In this great field, the role of the doctor
and of the medical research man is obviously of direct and basic importance.
Page Two Hundred and Twenty-five
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Those who believe in democratic free enterprise, who know that there has been
n omore persistent and difficult struggle throughout history than the struggle to establish
and maintain the rights and liberties of the individual, who see from the history of
the last twenty years that dictatorship is a worse threat in our times than it ever was
before, who appreciate that once dictatorship is esablished, modern armament and modern
methods of communication make a successful revolution practically impossible, will
keenly appreciate that the fight to maintain democratic free enterprise must be constructive, and on the broadest possible front.
Let us look at another important factor of this front.
The community—the local community—is obviously of first-rate importance. This
is where the individual and his family live. This is where the children grow up. Community influences are bound to be basic for good or ill.
• The group activities that go to make a community and that largely orient an individual happily to his community are obviously of crucial importance.
Strangely enough, our social thinkers have perhaps nowhere devoted less scientific
attention and come up with less enlightenment than in this complicated field of the
inter-relationship of our economic and industrial organization with human beings in
their social group and in their community lives. As far as most of us are concerned, we
have been content to make cliches out of the gropings of the clasical economists and
of Karl Marx respectively. Thus, depending upon our point of view, we substitute
"enlightened self interest" for enlightened analysis, and the "class struggle" for mental
struggle.
Amidst the welter of political platforms and speeches that have been based upon these
stereotyped concepts, there has been some encouraging scientific work going on, of which
perhaps the most stimulating has been the industrial research at the Harvard University
School of Business Administration under the direction of Dr. Elton Mayo.
In the green world before the advent of industrial machines, men and women and
their children by and large lived in firmly established societies where everyone knew
what was expected of him in the community and had the sense of "belonging" to the
community. Now we live in what Dr. Mayo calls "adaptive" societies, where scientific
developments force constant change on the community and where the individual, "the
forgotten man", no longer knows where he belongs or what is expected of him.
It is interesting to note that although applied science has until now had its main
impact upon social life through industry, from now on the main impact will probably
be through the arts of war. If we do not learn through international cooperation to
remove the threat of the atomic bomb and the worse threat of radioactive particles
dispersed without explosion, changes will be forced upon our community life and social
habits beside which the changes brought about by the industrial processes will seem
small indeed. Just think, for example, of the impact upon our social organization and
social habits if we must prepare in large numbers to live underground or entirely to
decentralize the activities of our big cities I
Dr. Mayo finds two major symptoms of disruption in modern society, largely brought
about by the effects of technological developments working through industry.
First, the relative number of unhappy persons increases. Forced back upon himself,
with no real social responsibilities, the individual becomes a prey to unhappy and obsessive
personal preoccupation. It is easy to see the connection between the finding of the
economist Mayo here and what I earlier said about the field of mental hygiene.
Second, groups form, says Dr. Mayo, but they are not so well integrated into the
whole society as they used to be. "On the contrary", he states, "their attitude is usually
that of wariness or hostility. It is by this road that society sinks into a confused struggle
of pressure groups and power groups."
It follows, therefore, that community arts and community organizations are an
important sector in the fight against the social disintegration of our times. Where the
individual is thoroughly adjusted to his community through the arts, cultural opportunities, and other group activities, you will have a relatively happy and contented individual
who thinks in terms of cooperation rather than class struggle.
Page Two Hundred and Twenty-six It is obvious too, that if this community revival is left to propaganda groups, the
effect would not be remedial but would be toward further disintegration, because of the
ensuing struggle of competing pressure groups which would try to use the arts and
the community for their own ulterior purposes.
The research studies of Professor Robert Park and his colleagues of the University
of Chicago are fully as significant as those of Harvard in contributing to the social
knowledge of our times. This group of studies has analyzed the City of Chicago, which,
like so many cities on this continent, including Vancouver, has had, and is still in, a
period of rapid growth which has had serious results on the industrial and social sides.
The anatomy of Chicago is revealed by the studies as follows:—A central business
and shopping district, outside this an industrial area and a confusion of slum dwellings,
beyond this again a workers' residential area, and still farther out, a residential area
of a more prosperous type. Moving from the centre outward, one therefore moves
through a stratification in a cultural sense, passing from business and professional activity
to industry and slums, and then through residential areas which grow better with each
remove.
The Chicago studies found a marked relationship between areas of cultural breakdown and areas of social and individual breakdown. Where the cultural fabric of an
area remained whole and strong, there was little evidence of social and individual-disintegration.
By way of example, let us look briefly at two of the Chicago studies—that of "Delinquency Areas" by Clifford Shaw; and that of "Suicide" by Ruth Cavan.
As industry pushed out from the central business area into what had formerly been
residential areas—the expansion, for instance, of the stockyards and the South Chicago
Steel Mills—you had the breakdown of the community life of these residential areas and
the consequent disintegration of social controls. These were the areas of high delinquency areas, and that was true regardless of age and sex. School truancy, juvenile
delinquency and adult crime, all flourished in the areas which were in process of
change from residential to industrial, and fell off markedly in the purely residential
areas.
"In short," says Mr. Shaw, "With the process of growth of the city, the invasion of
residential communities by business and industry causes a disintegration of the community
as a unit of social control". And by "social control" Shaw does not mean legal or
legislative control; he means the inner compulsion to think and act in a way that is
socially acceptable, a compulsion which is imposed upon an ordered community by
social tradition.
Miss Cavan's independent study of "Suicide", disclosed the highest suicide rate in
the same disorganized areas that showed the highest delinquency rates and led her to
state the hypothesis that "personal disorganization" follows a breakdown in community
organization.
Further light is thrown on the question of the effect of industrial development upon
community life by the Harvard University study of the small city of Newburyport in
Massacsusetts. This is the same little city that last week achieved prominence in the
newspapesr by its fight against rising prices. This study holds out enlightenment and
hope from the point of view of keeping modern community life healthy.
Newburyport is a city of 15,000 inhabitants that had the same forces to contend
with as Chicago—industrial expansion, foreign groups divorced from their own cultural
roots—but in a more moderate and smaller way. The survey disclosed that the
citizens of Newburyport, by their own adaptability and resourcefulness, had managed
to defend themselves against the breakdown of their traditional mode of life. The
aspect of this that I wish particularly to stress, is that this city of 15,000 souls had
more than 200 active clubs and associations of varying types.
Here was the main line of defence against the forces of community disintegration.
Each one of these associations, in its particular way, wove its members into the community
fabric, and gave them some explicit communal responsibilities. The result was that
the community and its citizens retained their social health and vigour.
Page Two Hundred and Twenty-seven
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Surveys of Vancouver show serious social disintegration in several areas of our city.
They show, for instance, that areas with a high ratio of juvenile delinquency also show
a high ratio of other symptoms of social disorganization, and vice versa.
We know that we cannot stop industrial and technological development, although we
can channel and mould them through intelligent town planning. But we can at least
be aware of the social and personal problems that such industrial development raises and
take intelligent steps to deal with those problems. One of the most effective ways, as
shown by the City of Newburyport, is to retain and make stronger the arts, cultural
opportunities, and other types of community organization and activity.
Now this is something entirely within our hands as citizens. There are many things
over which, as individuals living in Vancouver, we have no control. When the Big Four
meets in Moscow, for instance, there is nothing we can do about that situation. But
when it comes to community activities, we do not have to wait for agreement between
the Nations of the UNO; we do not have to wait for the successful functioning of
the Pan-American nion, or of the Dominion-Provincial Conference, or even upon
provincial-municipal financial readjustment (although that would help). We can
immediately go ahead as individuals or organized groups of individuals to keep our
community healthy and make it more healthy.
Professional men, in general, have always had the reputation of being little interested
in anything outside their own professions. If we really believe_in_democratic free enterprise and the liberties of the individual, we should, each of us, become firmly interested
in at least one community interest outside our own business or profession. At the worst,
we can follow the words of John Bright who once said, "You should link yourself with
a great cause; you may never do the cause much good but the cause will do you a great
deal of good." At the best, if each individual businessman or professional man
genuinely interested himself in one community activity, there is no doubt that Vancouver
would become a great city,—a city with a spirit and a soul; a city where community
cooperation took the place of class hatred.
Now, I want to turn to an example from my third field, that of Education. To me,
perhaps our greatest lack here is the way we have neglected the child before the
school entry age of six.
Research in the field of educational and child psychology has long shown that the
pattern of the adult is largely formed by the time the child reaches the age of six. We
know now that the influences begin to work upon the child before he is born.
The outstanding lack from the point of view of educational organization, is a
nursery school system, taking the child from the age of two on, which would become
part of our own general educational system. What the nursery school does is to teach
the small child, before non-social habits crystallize, to live in a group and to become
a social being.
Great Britain took steps a few years back toward making nursery schools part of
the public educational system, and there is no doubt that tremendous possibilities lie
in this direction.
In the first place, from the point of view of having well-adjusted individuals, think
of the great advancement that would take place if the child were in a nursery school
for at least half the day from the age of two onwards where he would form the habit
of adjusting himself to a group. I often speculate as to how many of our unbalanced
individuals with a lust for power, like Hitler, Mussolini, and others in various walks of
life nearer home, would have been changed had they been put through a proper educational process from early childhood which stressed getting along with other people.
The nursery school would also pick up the child with anti-social habits at a time
when they could be changed, whether they be the habits learned in the hard school of
underprivileged neighbourhood, or the habits learned by the too privileged child of a
wealthy home.
And from the point of health, think what could be done with the child under the
supervision of proper medical and dental people from the age of two!
Page Two Hundred and Twenty-eight Here then is another example of the broad front that we must proceed along to
realize the possibilities of our system of democratic free enterprise, and, by the same
token, to combat the threat of authoritarian forms of government and social organization.
To sum "up, democratic free enterprise, while realizing the importance of the individual and his rights and liberties, has so far concentrated upon economic and material
factors to the relative exclusion of the more intangible but equally basic considerations
that tie the individual into the group and make for a healthy social organization.
Socialism and Communism have aggressively advanced their solution to present
discontents, but it is based upon a wrong diagnosis. With their stress on material considerations and class antagonisms their proposals would, far from effecting a cure, lead
to the dictatorship of the absolute State. Nevertheless, their fighting slogans and their
incessant reiteration that the States can plan everything perfectly have a great appeal
to those who are discontented for any reason.
The direction in which the democratic free enterprise countries of Canada and the
United States are going depends upon their ability to analyze socail discontents as effectively as they have scientific and technological problems.
In particular, we must work on a broad front, some examples of which I have given,
to ensure that the individual has a sense of belonging to his society and a feeling of social
fulfillment.
This must be done within the factory, within community groups and organizations
and through community activities. It is a programme in which every one of us must take
part, both in the intelligent handling of his own business or profession, and in an intelligent participation in the affairs of the community.
In short, there are various direction in which we can go, but the direction in which
we are going to go depends upon each one of us. With individuals as well as societies,
a destiny dreaded is a doom.   Shall we rise to our Destiny?
i'
SUMMER SCHOOL — 1947
The twenty-fifth annual Summer School was held early in June this year. The
attendance was excellent with a total of 343 registrations. The number of doctors
attending from Washington and Oregon was again gratifying.
The programme of lectures and clinics was designed to be of particular interest to
the general practitioner and all were well attended. Dr. Sturgis' lectures, and his clinic
in Medicine at Shaughnessy, were outstanding. Dr. Smith with his Bostonian sincerity
brought.us many helpful hints in paediatrics, and because of his special interest and
contributions in the pre-natal period, has extended our paediatric outlook. His informal
talk at the opening luncheon on the results of his studies in post-war Holland were most
interesting and informative.
Many of the lectures given during the session will be published during the next few
months in the Bulletin.
A round table discussion on Diseases of the Thyroid was a definite success, with all
speakers participating.
A few films on surgical technique were shown for the first time this year and it is
believed that at future sessions more use will be made of this excellent means of demonstrating physiological and chemical concepts as well as surgical and other techniques.
At the final banquet Rev. Dr. E. D. Braden gave a most entertaining and excellent
address to an unfortunately small audience.
The golf tournament was held this year at the Vancouver Golf and Country Club at
Burquitlam, and the attendance and weather were both excellent. A list of the prizewinners follows:
Page Two Hundred and Twentyrtfine ^^ ^^^^^^Tn  i
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SUMMER SCHOOL GOLF PRIZES
Low Gross—Dr. R. R. M. O'Brien, Spokane, Washington.
Second Low Gross—Dr. M. Share, Vancouver.
Low Net—Dr. W. Laishley, Nelson, B.C.
Second Low Net—Dr. Reg. Wilson, Vancouver.
Low Net (18 and over Handicap)—Dr. Ken Peacock, Vancouver.
Nearest to the Pin—Dr. W. G. Saunders, Vancouver.
Hidden Hole—Dr.'T. A. Johnston, Vancouver.
Long Drive—Dr. W. G. Evans, Vancouver.
High Gross—Dr. Alfred J. Elliott, Toronto.
A complete list of registrants for the Summer School is given below:
SUMMER SCHOOL ATTENDANCE, JUNE, 1947
Ainley, W. E.
Agnew, A. M.
Alton, J. A., Lamont, Alta.
Alexander, J. D. F.
Anderson, John F., V.G.H.
Anderson, W. F., Kelowna, B.C.
Anthony, A.
Appleby, L. H.
Arbuckle, J. W.
Armitage, T. F. H.
Austin, W. E.
Badre, E. J. P., Shaughnessy
Bagnall, A. W.
Baird, Murray
Baker, Harry
Baldwin, S. G.
Balfour, J.
Ball, N. J., Oliver, B.C.
Barg, P., Essondale
Barner, H. A., Bremerton, Wash.
Beach, D. W., West Vancouver, B.C.
Becher, J. C.
Bell, N. N.
Bell-Irving, P., Shaughnessy
Bennett, N. T., V.G.H.
Benwell, C. C, Essondale
Berger, B.
Bie, W. F.
Black, D., V.G.H.
Black, J. H.
Blackwelder, G. E., St. Paul's
Blair, J. H.
Blair, Murray
Bogoch, A., Shaughnessy
Bonnell, S
Boyce, K. C, Shaughnessy
Brown, C E.
Page Two Hundred and Thirty
Brown, Harold
Browne, C. C, Nanaimo
Buller, F. J.
Bryson, B. F., Essondale
Burwell, W. Keith
Byrne, U. P., Essondale
Campbell, Charles, V.G.H.
Campbell, E. A.
Caple, H. H.
Caverhill, M. R.
Cawker, C. A.
Chase, E. F., Seattle, Wash.
Chipperfield, L. S., New Westminster
Chisholm, H. A.
Christie, John
Christopher, H. G, Essondale
Christopherson, E.
Clark, D. AM New Westminster
Clarke, R. S., Shaughnessy
Clarke, W. A.
Clement, G. H.
Cleveland, D. E. H.
Coburn, W. A.
Collison, D. B.
Coltart, G. L.
Cooke, E. H.
Cooper, H. G.
Covernton, C. C, Shaughnessy
Covernton, C. F.
Croft, P. D., Essondale
Crofton, F. D. L., V.G.H.
Curtis, E. J.
Dalrymple, T.
Davies, C. E.
Davies, H. R. L.
Davies, J. R.
Davidson, G. A.
J Davidson, J. R.
Day, E. E.
Day-Smith, F.
DesBrisay, H. A.
Dickey, M. R.
Donnelly, C. W.
Drache, V.
Dumont, H.
Dykes, W.
Eaton, C. M.
Edgar, Murray
Elliot, J. A.
Elliot, S. G.
Elliott, B. S.
Elliott, F. N.
Ellis, J. P.
Evans, W. G.
Ewing, W. T.
Farish, J. R., V.G.H.
Felsted, Eggert T., V.G.H.
Fenwick, J. B., Shaughnessy
Fidler, H. K.
Finlayson, Wm., V.G.H.
Fleck, Elizabeth, V.G.H.
Foster, L. E., Bremerton,  Wash.
Francis, G. H.
Fraser, G. A., St. Paul's
Fraser, G. D.
Fraser, R., St. Paul's
Friesen,  L. •
Frost, A. C.
Frost, A. Gardner
Frost, J. W.
Galbraith, H. B.
Ganshorn, J. A. ,
Gibbings, John S., V.G.H.
Gilchrist, R. A.
Gillespie, H. S., V.G.H.
Glasgow, R. G., Michel, B.C.
Gordon, Arthur, V.G.H.
Gorkin, M.
Gould, G.
Graham, H. C, North Vancouver
Grant, J. H. B.
Grey, E. J.
Greene, I. B., Everson, Wash.
Grimson, J. C
Grisdale, L. C, Langley Prairie
Hall, R. G., Portland, Oregon
Hallowes, B. J.
Halperin, M. L.
Hardyment, A. F.
Hansen, Eugene, Tacoma, Wash.
Harper, R., New Westminster
Harry, B. H.
Harrison, J. E.
Harrison, W. E.
Hebb, Frank
Henderson, H. A.
Henry, A. Taylor
Herberts, Ed. D., V.G.H.
Herstein, Archie
Hicks, E. R., Cumberland
Hobbs, F. S.
Hoehn, M. R., St. Paul's
Hopkins, John A., V.G.H.
Huggard, Roy
Hunt, Leigh
Hutton, G. H.
Ireland,   I. A.
Irish, R. H.
JafFe, F. A.,  Regina
Jackson, J. M., Essondale
James, E. S.
Johnston, D. R., V.G.H.
Johnston, F. D.
Johnston, Gordon
Johnstone, T. A.
Katz, Max, Haney
Keith, W. D.
Kidd, H. M.
Kidd, J. M., V.G.H.
Kinsman, R. P.
Kirby, O. E.
Kirkpatrick, G. J.
Knott, N. D.
Kope, J. H., Enderby
Laishley, W., Nelson, B.C.
Lamont, G.  A.
Lamont-Havers, R. W., V.G.H.
Lang, J. W.
Langley, G. E.
Larsen, A. A., St. Paul's
Lawrence, Grant
Lee, G. H.
Leeson, L. H.
Leitch, D. B., Edmonton, Alta.
Lennie, T. H.
Lewison, H.
Lockhart, H. B., Port Moody
Lockhart, W. T.
Lynch, A. L.
Mallek, H.
Mallek, J.
Marshall, R. H.
Masterson, T. L., V.GH.
Margulius, J., New Westminster
Mathias, G., New Westminster
Matthews,   Charles   A.,   V.G.H.
Matthews, G. O.
Maxwell, L D«» Shaughnessy
May, Susan
Melgard, C, Seattle, Wash.
Menzies, A. M.
Menzies, Albert, V.G.H.
Milburn, H. H.
Milbrandt, W. E.
Millar, R. D.
Miller, T., Victoria
Milligan, John, Seattle, Wash.
Minnes,  J. L.
Moffatt, C. D.
Moffatt, D. W.
Mooney, A. W., V.G.H.
Moore, W. H., Victoria
Morton, W. A.
Moscovich, B. B.
Moscovich, Jack
Mugan,  J.  McK., Cranbrook,  B.C.
Mullinger, Margaret
Munroe, D. S.
Murray, Fraser
McAmmond, E. Mc.
McCarley, J. S., North Vancouver
Page Two Hundred and Thirty-one \m-
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McConkey, A. S.
Shuler, I. J. D., Seattle, Wash.
McDonagh, John E., V.G.H.
Simpson, R. A.                                              ■
•
McDonald, J. R.
Simpson, W. W.
McGregor, R.
Sinclair, J. A., New Westminster
MacKay, B. K.
Sinclair, F., Cloverdale
MacKay,  J. H.,  Shaughnessy
Skully, FL J., New Westminster
MacKenzie, H. H, New Westminster
Sleath, G. E„ V.G.H.
McLaughlin, G. A.
Smaill, W. D.
MacLean, K.
Smith, J. A.
McLean, J. A.
Speelmon, Rex, Spokane, Wash.
McLellan, D.
Spooner, J. S., Shaughnessy
McLeod, E. C.
Stanley, Robert
McMurtry, T. S., V.G.H.
Stan wood, D. H.
McNab, J. A.
Steele, D. A.
McNair, A. Y.
Steiman, I.        *
5
McNair, F. E.
Stephenson, G. H., North Vancouver
McNeil, C. G., North Vancouver
Stevenson, G. D., Shaughnessy
McNeill, Neil
. Stevenson, T. K., V.G.H.
j
McCaffrey, R. P.
Stewart, A. J., V.G.H.
Neufeld, W. P.
Stewart, Neil
Nicholson, George, Essondale
Stockton, H. S.
O'Brien, R. M., Spokane, Wash.
Stoffman, I. W.
Olacke, Frank
Story, Boyd
ONeil, Agnes
Stranks, G.
Osier, T. R., Shaughnessy
Strachan, S. A., Shaughnessy
Palmer, R. A.
Strong, G. F.
Paton, W. M.
Swanson, A.  L., Essondale
Peacock, E., West Vancouver
Tait, W. M.
Peacock, K., West Vancouver
Telford, Douglas
Pedlow, A. R., V.G.H.
Telford, K. M.
Perrott, M., Tacoma, Wash.
Thomas, J. C.
Perveseff, T.
Thompson, J. R.
Peterson, S. C
Thompson, W. J., Shaughnessy
Petrie, G. A.
Thomson, Frank
Perry, W. H., Shaughnessy
Townsley, B. R., V.G.H.
Phillips, Paul, Princeton, B.C.
Trapp, Ethelyn
Piters, J.
Treffry, C. J.
Plecash, M., V.G.H.
Trites, A. E.
Porter, J. A.
Turnbull, Andrew
*
Pow, C. G., V.G.H.
Turnbull, F. A.
Pump, K. K.
Turnbull, H. L.
Raynor, E. F.
Upham, G. A.
Riedesel, A. W., Aberdeen, Wash.
Vanderburgh, A. W., Summerland
Roberts, G. A., Chilliwack
Vrooman, C. H.
L                        Robertson, Rocke
Wall, J. T.
-t
Robinson, C E. G., Shaughnessy
Wall, M. D.
Robinson, G. C.
Wallace, S. A., Kamloops
Rose, A. O., Langley Prairie, B.C.
Watson, G. L.
Ross, A. C«, New Westminster
Weaver, H. G., Sea Island
Rothwell, G. S.
Webster, L. H.
Ruskin, S. G.
Rutherford, P. S.
Whaley, T. R.
Sarvis, E. S., Huntingdon, Wash.
Whitelaw, W. A.
Saunders, F. E.
Whittaker, K. W.
Saunders, Leslie, V.G.H.
Wilder, E. M., New Westminster
Saunders, W. G.
Wilks, W. E.
Sarjeant, T. R.
Williams, D. H.
Saxton, George
Williams, L. J., Shaughnessy
Schori, J. W., Bellevue, Wash.
Willits, R. E.
Schreiber, M.,  Coquitlam
Williams, S. L., Shaughnessy
Schilder, G.
Wilson, G. T., New Westminster
Schinbein, A. S.
Wilson, R. A.
Scott, H.
Wilson, W. A.
>
Seldon, G. E.
Wood, Everett G., V.G.H.
Shallard, B.
Wood, L. G.
Share, Milton, Shaughnessy
Woodsworth, R. S., Kelowna
Shier, J. W.
Wylde, E. W., New Westminster
Shea, M. B.
|g.            Yak, J. A.
Page Two Hundred and Thirty-two HISTORY OF V.M.A. (Continued)
SECTIONAL GROUPS
The chief function of the Vancouver Medical Association has always been: "To
cultivate the Sciences of Medicine and Surgery". Previous to 1908 this had consisted
entirely of the reading of papers at the monthly meetings, with subsequent discussions.
It was now decided that the members divide themselves into Sections, whereby each
group might study that particular branch of Medicine in which he was most interested.
Dr. Riggs-was the originator of this new feature of the Society. In April of 1908 he
introduced the following motion: "That the Association be divided into sections, each
to elect its own chairman and secretary. Sections were to meet Once a month from
October until April. The first Section to be so constituted to be called the Clinical
Section, embracing clinical Medicine and Surgery."
The first meeting of this Section took place in October of 1908, the President of
the Association presiding. Several patients were shown and the cases discussed. At first
the Section met in the Board of Trade rooms, but after three months the practice of
holding the meetings in the various hospitals was instituted, rotating from the Vancouver General to St. Paul's, and since 1920, to Shaughnessy Hospital. Originally the
Clinical Section met the fourth Monday of the month, but after the Regular Meeting
night of the Association was changed to the first Tuesday, the Clinical meeting was
also changed to the third Tuesday, and has remained so ever since.
This Section includes every member of the Association, no matter what his specialty.
For a short time the experiment of dividing the Section into two groups, to meet
separately, and representing Medicine and Surgery respectively, was tried; but during the
first World War, owing to the absence of so many members at the front, the group
was reunited, and has remained so ever since.
Meanwhile other Sectional Groups were formed, some of which are still in
existence while others have been disbanded. The first to be so organized was the
Paediatric, followed soon afterwards by the Eye, Ear, Nose and Throat Section. In
March of 1920 a Genito-Urinary and Venereal Disease Section was added, and in
November of the same year a Section to study Physiology and Pathology came into
being. In 1925 a Physiotherapy Section was added, and very recently Sections on
Neurology and Psychiatry, and Orthopaedic and Traumatic Surgery have been
formed. At present only four, in addition to the original Clinical Section, remain.
These are the first two and the last two named above. These groups meet regularly
and report annually to the Association.
K
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REGULATION OF THE SALE OF PATENT MEDICINES
AND OF NARCOTICS
One may wonder why a local Medical Body undertook discussion of such subjects
as patent medicines and narcotics—matters which today we consider to be entirely
within the province of the Federal Authorities. We forget that forty years ago things
were different. There was then no Narcotic Act, and no regulation of the labelling,
advertising and sale of patent medicines. It speaks well for the small group of men
which then composed the Vancouver Medical Association, that they recognized a dangerous condition and strove to correct it, even to the extent of forcing action on a
relcutant Government.
In 1905 a woman in Victoria died as a result of taking a patent medicine, and about
this time other cases were reported where grave injury had been done by their use. As a
result Dr. F. C. McTavish introduced to the Society a recommendation for a more
efficient supervision of the sale of secret nostrums,, as well as of narcotics in general.
Page Two Hundred and Thirty-three
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The question engaged the attention of the Association for several successive meetings,
and for a time was a very live one.
A reolution was adopted recommending that the manufacturers of medicines which
contained more than 5% of opium, morphine, cocain, acetanilid or alcohol, should be
compelled to label them as dangerous, and to state on the label the name of the drug
contained, together with the amount. This resolution was sent to the members of the
legislature in Victoria, and a committee of the Society was appointed to collect and
file any literature bearing on the question of patent medicines; also to prepare for
publication any reports on the subject which the Society may think suitable.
Early in 1906 a delegation was sent to Victoria to interview' the Legislature regarding the question. It received a "courteous hearing", but nothing was done. The next
step was to carry the fight to Ottawa. A resolution was adopted which urged the
Federal Government to appoint a commission to investigate all evils resulting from the
use of unlabelled patent medicines, and to devise suitable laws to eradicate these evils.
Some favourable replies were received from government members, but henceforth all
reference to the question disappears from the pages of the Society's minute books.
The question of writing prescriptions containing narcotics came up in the Association in 1922, and a comprehensive resolution relating to it was drawn up and
adopted. Its more important clauses were: "That whenever a prescription for narcotics
is received by a Druggist, he shall telephone the Physician writing it, for corroboration".
And also: "That members of the Association refuse to write a prescription for narcotics
for any alleged, confessed, or known addict; unless such addict be incarcerated in some
authorized institution under his care".
Succeeding years saw the enactment of legislation which corrected these abuses of
which the men of our Association had been so early aware.
THE OSLER LECTURES
Sir William Osier died in 1919. As a tribute to his memory and to perpetuate it
within the Society, it was decided to institute a series of lectures, each to be given by a
member of the Association, on a subject pertaining to some branch of the Science of
Medicine. The lecture was to be given at a formal dinner to be served at some time
during the spring session of the Society's year. Each Member giving such a lecture
was to be presented with a suitably inscribed bronze plaque, the possession of which was
a recognition by the Association of the recipient's high standing in his profession, as
well as the esteem in which he was held as an individual.
The first Osier lecture was given by Dr. W. D. Keith in 1921, and since that
time with the exception of the war years 1940 and 1942, it has been an uninterrupted
annual event. The names of members who have been chosen to give these lectures, together with the subjects on which they spoke, are given below:
1921, Dr. W. D. Keith. Subject: Sir Wm. Osier, Physician and Teacher.
1922, Dr. Pearson. Subject: On the Value of Style as Exemplified in the Writings
of Sir Wm. Osier.
1923, Dr. G. S. Gordon. Subject: "Our Library."
1924, Dr. B. D. Gillies. Subject: Liver Function.
| 1925, Dr. F. Brodie. Subject: Aphasia.
1926, Dr. E. D. Carder. Subject: The Thymus.
1927, Dr. Geo. Seldon. Subject: Medical Education.
1928, Dr. C. H. Vroorrian. Subject: Development of our Knowledge Concerning
Tuberculosis.
1929, Dr. H. M. Cunningham. Subject: Ourselves, (Retaining the Art of Medicine).
Page Two Hundred and Thirty-four 1^«
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'With good relaxation, trauma can
be reduced and operating time cut
down. Postoperative complications
ncident to prolonged anesthesia
can likewise be reduced." 1
Intocostxin, administered intravenously, facilitates operative procedure by producing abdominal relaxation and intestinal recession without
deep  anesthesia ....   .  through  a
readily reversible myoneural block.
Intocostrin is a purified, standardized extract of chondodendron tomen-
tosum, a selected plant yielding the
curare principle. In surgery, it has
been used to advantage with cyclopropane, ether, nitrous oxide, ethylene and intravenous barbiturates.
1. Sdilesinger, E. B„- Am. J. Med. 7:518 (Nov.) 1946.
Squibb Q*±*eo*tjz«^
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Well established and widely accepted,
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prescribing Creamalin for Hie control of hyperacidity, the physician is assured of prolonged
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New Yokk 13, N. Y. Windsor, Oht. 1930, Dr. J. J. Mason. Subject: A Study of a Personal Series of Hysterectomies and
Myomectomies.
1931, Dr. R. E. McKechnie, Reminiscences of Forty Years Practice.
1932, Dr. F. P. Patterson. Subject: Benign Tumours of the Bones.
1933, Dr. Glen Campbell. Subject: The Eye.
1934, Dr. J. C. McKay. Subject: Psychiatry.
1935, Dr. Wallace Wilson. Subject: Goitre, and the Background of its History.
1936, Dr. A. W. Hunter. Subject: Glimpses into Urology of the Past and Present.
1937, Dr. W. A. Whitelaw. Subject: Facts and Fancies in a Ltitle Tour of the
Intestinal Tract.
1938, Dr. L. H. Appleby. Subject: Quo Vadis, Medicina?
1939, Dr. J. H. MacDermot. Subject: The Layman and the Doctors.
1941, Dr. G. F. Strong. Subject:  Some Observations on Coronary Artery Heart
Disease.
1943, Dr. D. E. H. Cleveland. Subject: The Fear of Skin.
1944, Dr. T. H. Lennie. Subject: Goitre.
1945, Dr. H. Spohn. Subject: The Employment of Leisure.
1946, Dr. A. L. Lynch. Subject: Sir William Osier and Associates.
1947, Dr. Bede J. Harrison. Subject: Medicine and Some Orthodoxies.
';*
MODERN MEDICINE METHODS
BENEFIT TO INDUSTRY
WINNIPEG, June 28.—Speaking before the Canadian Medical Association here last
night, Dr. K. E. Dowd, chief medical officer for Canadian National Railways and
Trans-Canada Air Lines revealed that in the interests of the travelling public and the
health of employees his clinics made 43,000 physical examinations yearly.
Industrial medicine was now a well-established feature of both companies, he said,
and the confidence of more than 100,000 employees had been completely won over.
He stated that the work had paid such dividends that four travelling medical cars had
been placed on the rail lines to examine employees at remoter points.
The medical officer revealed that sanitary officers of the company were constantly at
work checking such facilities as trains, restaurants, stations, hotels, commissary stores
and camps. This type of work had been intensified since the war, with the addition of
many ex-servicemen who were all connected with sanitary units in the war theatres.
"Our transportation systems today are operated by a force of men and women
highly trained and physically sound, and behind them is an efficient medical department guarding their welfare and that of the company and its clients," Dr. Dowd said
in concluding a close-reasoned address which stressed the benefits of industrial medicine
in modern society.
*■
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NOTICE
Re "Relief" Forms
An increasing number of Relief Forms are being sent in each month with
inadequate postage.
It is requested that where several forms are enclosed in one envelope, the
weight and postage should be checked before mailing.
Page Two Hundred and Thirty-five V
i
VcuicaiuAen, QewetoU JloAfUtal Section
TETANUS—A CASE REPORT
By W. J. FOWLER, M.D.
(From the Sub-Department of Neurosurgery of the Vancouver General Hospital)
This case was deemed worthy of reporting as it is a case of the rare, so-called
"chronic tetanus" in which no demonstrate avenue of entrance was found. The case
was treated by some modifications of the old methods plus the use of curare.
Case Report:
J. W., a labourer with the Chilliwack Water Works Department, age 25 years,
referred by Dr. J. D. Moore of Chilliwack, was admitted to the Vancouver General
Hospital under Dr. Frank Turnbull, on September 16, 1946. Three weeks before
admission the patient had noticed a stiffness of his jaws. This gradually increased, and
at the same time he noticed a progressive stiffness of his neck, his limbs and back.
For about three days prior to admission, he had been having painful spasms which were
brought on by attempting to move, or on being moved. He had been unable to open
his jaws to eat for eight days, but could drink with difficulty.
When first examined in the General Hospital he was lying in bed with head retracted,
body bowed forward, knees and elbows flexed in a classical picture of opisthotonus, the
face showing risus sardonicus. He was perspiring profusely. The temperature was
recorded as 98.4° (rectal), pulse 100, respirations 20. He was well oriented and in great
pain during spasms. The teeth could be separated only about 0.5 cm. There was tonic
contraction of all muscles of the body, including the recti abdominis, whose outline
could be clearly seen. The patient was able to move the limbs a few degrees but was
unable to flex or rotate the head. Ehiring spasms all the above mentioned flexions were
markedly increased. Tendon reflexes all showed clonus. Crebro-spinal fluid showed no
abnormal findings.   The white blood cell count was 15,200.
Progress:
Treatment with tetanus anti-toxin (Connaught Laboratory) was started immediately with 100,000 units intravenously and 100,000 units intramuscularly; penicillin,
50,000 units; and curare (Squibb) 20 units intramuscularly; and 1,000 cc. of 5%
glucose and saline.
The patient was then carried along on tetanus anti-toxin, 10,000 units intramuscularly
every 3 hours; penicillin, 50,000 units every 3 hours; sodium amytal gr. l7/& every
3 hours, given thirty minutes before tetanus anti-toxin; curare 20 units, every 3 hours
(mid-way between sodium amytal and tetanus anti-toxin). A high protein diet with
a total of 2,000 calories pre 24 hours, and a total fluid intake of 4,500 cc was given.
Twenty-four hours after admission, the patient's temperature was 103.4° rectal,
pulse 160,-respirations 40. He was perspiring profusely and having frequent spasms,
lasting four to ten rninutes, on the slightest noise of movement. Codeine, gr. 1, p.r.n.,
was then ordered for pain and, because the patient was having considerable respiratory
distress ,he was placed in an oxygen tent.
Forty-eight hours after admission, although the patient's temperature was 103.6°
(rectal), pulse had dropped to 134, and respirations varied between 30 and 40. He
looked and felt better. It now took more gross stimuli to produce spasms, which only
lasted one to two minutes.
Medication was changed to tetanus anti-toxin, 100,000 units every 4 hours; sodium
gr. l^g, every four hours (given 30 minutes before tetanus anti-txoin); curare, 20 units
Page Two Hundred and Thirty-six
m every 4 hours (midway between sodium amytal and tetanus anti-toxin); and penicillin,
50,000 units, every 3 hours, as before.
The patient continued to improve and on the fourth day the tempreautre was 100.5°
(rectal), pulse 110, and respirations 30. He was removed from the oxygen tent and
could be moved now without causing very severe spasms. The risus sardonicus had disappeared and curare was discontinued.
On the eighth day, the patient's temperature was 100° (rectal), pulse 100, respirations 28. He was much less spastic and having only occasional short spasms. Tetanus
anti-toxin was reduced to 100,000 units every 6 hours, with sodium amytal, gr. 1%,
30  minutes before tetanus anti-toxin,  and  penicillin continued  as  before.
By the twelfth day, the patient's temperature was 99.6° (rectal), pulse 90, respirations 28. He was now having only very occasional spasms, which were not severe and
lasted only one-half to one minute. The muscles chiefly affected at this time were
the masseters and recti abdominales. Tetanus anti-toxin was reduced to 75,000 units
every 6 hours and sodium amytal was discontinued. By now the patient was able to
take soup and milk puddings.
The patient maintained a steady improvement and on the fifteenth day he had
his last spasm. Tetanus anti-toxin was progressively reduced to one dose every 48 hours,
and on the twenty-sixth day, was discontinued, the patient having had a total of 7,360,-
000 units. On the twenty-third day, he had been able to eat his first meal in a month.
The patient had lost considerable weight but his appetite was good and he was placed
on a full diet, plus egg milkshakes between meals. After an uneventful convalescence
the patient was able to walk out of hospital on the thirty-ninth day after admission. On
the day of discharge, examination showed no stiffness of any group of muscles; the
reflexes were all active but there was no clonus present.
Comment:
The clinical course of tetanus is characterized more or less by five stages: trismus,
general rigidity, convulsions, convulsions in response to the slightest reflex stimulation,
and exhaustion. On admission, our patient was in the fourth stage and we felt he was
getting very close to the fifth stage on the second day after admission.
No demonstrable avenue of infection was found in our case, but as his occupation
brings him into constant contact with the soil and as he states that he frequently
scratches and cuts his hands, one can only assume that at some time prior to the onset
of his illness B. tetam gained entrance and began generating toxins. The incubation
period is usually seven to eleven days but can be as short as five days, and bacilli have
been cultivated from a wound eight hundred and eighty-two days after infection without
the appearance of tetanus during the interim. (1).
The symptomatic treatment of a case of tetanus requires much special care. The
patient should be placed in a quiet darkened room, shielded as much as practicable from
extrinsic stimuli. The profuse sweating that accompanies the high fever necessitates
frequent tepid baths. The diet should be liquid, and the high protein milk shakes made
by the Dietetic Departments here serves the purpose very well. Abundant additional
fluids have to be supplied.
The specific treatment primarily consists of tetanus anti-toxin. The massive dosage
used in this case may have been unnecessarily expensive. We are not prepared to state
that the doses used are the ones required but we do know that the small dosage which is
still recommended by the manufacturers has not been uniformly successful.
The intravenous injection of tetanus anti-toxin was used at first in order to raise
the blood level of anti-toxin to the saturation point but was not used subsequently as it
was felt that the intramuscular injections would mainain that level.
Intrathecal therapy was not used because of the technical difficulty of this method on
a patient with opisthotonus, and as experimental evidence shows that anti-toxin injected
under the arachnoid passes out again almost immediately. (2). When using large amounts
of serum, one must of course be very much on the alert for any serum reaction.
Page Two Hundred and Thirty-seven
it Ii.
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Sodium amytal is a very useful sedative in the control of a case of this nature as
its non-cumulative prpoerties allow for better control.
Curare was found to be a useful adjunct to the treatment of tetanus. This dose used
in this case (units 20) gave immediate relief and is a relatively small dose compared to
that used in anaesthesia. One must be on the alert for possible paralysis of the respiratory muscles.
Penicillin was used because many authorities think that it has a specific action on
B. tetani (3, 4, 5) and because it acts as a preventive against chest and urinary complications.
When last seen three weeks after discharge, the patient was eating, sleeping and
moving well, and was shortly going back to work.
BIBLIOGRAPHY
1. Tulloch, W., Proc Roy. Soc Lond., 529, 1917-19.
2. Wilson, K., Neurology, Arnold, London, Vol. 1, p. 637.
3. Herrell W., Nichols, D. & Heilman, D., J.A.M.A. vbe, 1202, 1944.
4. Buxton, R., & Kurman, R., J.A.M.A., vbg, 26, 1945.
5. Weinstein, L. & Wesselhoeft, C, New Eng. J. Med., 233: 681, 1945.
I 4L
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NOTICE
LOCUM TENENS, ASSIST AN SHIPS, ETC.
All doctors who are available for locum tenens, assistantships, etc., are
requested to forward the particulars to the Executive Secretary of the College
of Physicians and Surgeons, Room 203, Medical-Dental Building, Vancouver.
At present the demand for locums is in excess of the numbers available for
such work and the Executive Secretary is anxious to secure the names of all
doctors who are available.
Every effort will then be made to arrange suitable work in accordance with
the individual's wishes and .to provide relief for doctors who are ill or require
holidays, and for those who are looking for assistants.
F. L. Whitehead, M.D.C.M.,
Executive Secretary,
College of Physicians and Surgeons.
Page Two Hundred and Thirty-eight KERNICTERUS
By DR. H. BAKER
I was rather surprised to find that the single word constituting the title of my paper
tonight was so obscure that I could not find it in the 1930 edition of Dorland's Medical
Dictionary. The derivation of the word is hybrid. Kern is from the German, meaning
nucleus.    Icterus needs  no explanation.
In January of this year I saw a four-year-old female in my office. She was a
definite case of cerebral palsy. She was retarded, she was spastic and showed definite
and constant athetotic movements. The history was most interesting and revealing.
The parents were obviously of healthy, intelligent stock. They had three children.
The oldest a boy, 13 years of age, quite Well and doing well in school. The next one
a girl, 10 years of age, was in an institution, very markedly retarded and helpless j with
marked spasticity and athetosis. This child was born quite easily. At the age of just
a few hours she became markedly jaundiced.. The icterus lasted two months. During
this time she began to show spacticity and athetosis, and signs of marked retardation,
and has remained thus ever since. The third child was the patient whom I saw. Her
actual delivery was relatively easy. She, too, at the age of a few hours became extremely
jaundiced. The parents described it as copper coloured. The severe jaundice lasted
for three weeks and then gradually faded out. She is said to have cried constantly
for three to four months. As I stated before she was very retarded. She did not sit up
until late and did not walk till three years of age. At four years she had very few words.
The father's blood was Rh positive and the mother's Rh negative. Unfortunately I
did not have the patient's blood tested for the Rh factor.   They have since left town.
In my opinion this child and her sibling in the institution represent two cases of
kernicterus.
What is the condition labelled kernicterus?
It was first described in 1875 by Orth. In 1903 Schmorl coined the word kernicterus. Because the condition has been known and recognized for a long time there
has been a great deal of conjecture about it. In very recent years considerable light
has been thrown upon it. This we will discuss later. Clinically the two cases described
are typical cases of kernicterus. Jaundice early in life which persists, going on to signs
and symptoms of a degenerative central nervous system. The mortality rate of kernicterus is very high, fortunately. In this way only are these two cases unusual, because
they lived.    Kernicterus has always been considered almost 100% fatal.
These cases show early in life signs of erythroblastosis in their peripheral blood. At
post mortem they show other signs of icterus gravis, enlarged spleen and liver with
erythroblastotic areas in them. Forty percent of all cases of icterus gravis show signs
of kernicterus. The following are the changes in the brain: the C.S.F. and the brain
coverings may be yellow. As a. rule the cortex is not stained but microscopically has
been found to contain pigment. The major part of the pigmented areas are in the basal
ganglia. Intense staining is found in the lenticular and caudate nuclei. There is
less often staining of dentate nuclei, mammillary bodies, inferior olives. Sometimes the
bulbar nuclei'and spinal gray matter are stained. Petechial and even massive hemorrhages
may occur.   The ependyma may also be stained.
Histologically it is found that the ganglion cells in the pigmented areas are severely
injured. Many cells have completely disappeared and others show various degrees of disintegration. These changes seem to be most intense in the basal ganglia. Demyelination
of various parts of the white matter has been found even in the spinal cord. If the
child lives long enough it has been found that the pigment tends to disappear leaving
only the destroyed architecture of the cell layers.
The foregoing is a description clinically and pathologically of kernicterus. In the
past, aside from mild variation that was the gist of all cases of kernicterus. They were
considered rare.   In any of the older case reports there was a great deal of theorizing.
Page Two Hundred and Thirty-nine
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Ford in his 1937 edition of Diseases of the Nervous System in Children has this to
say: "The familial incidence suggests that a metabolic disorder of constitutional type
may be to blame. It has been regarded as an expression of an intoxication due to disfunction of the fetal liver or blood forming organs and by other authors as the result
of material toxemia. Zimmerman and Yonnet believe that in the nonfamilial forms
generalized infections are often responsible." I might say that there was just as much
theorizing about icterus gravis.
In 1933 Blackfan and his colleagues showed more or less conclusively that congenital
anaemia, hydrops, feotalis and icterus gravis have a common denominator, erythroblastosis. The three conditions were due to whatever it was that caused erythroblastosis. Up to
this time the three conditions have been treated as being isolated conditions. It was
rathr fortunate that this excellent piece of writing came in 1933 because of what happened in 1941. In that year Levine and his co-workers clearly indicated the importance
of Rh iso-immunization in the etiology of erythroblastosis fetalis. Since kernicterus
is found primarily in children with erythroblastosis this relationship becomes important
in kernicterus. I should like at this moment to review the Rh factor but time does not
permit .
Many of us here will remember the excellent paper Dr. Turvey gave us some time
ago on the Rh factor.   It was published in The Bulletin.
In the light of our added knowledge since 1940 how does tonight's report appear?
To diagnose kernicterus without post mortem evidence we should have:
(1) Father Rh positive.
(2) Mother Rh negative.
(3) Patient Rh positive.
(4) Neonatal history of erythroblastosis or persistent jaundice diagnostic of icterus
gravis.
(5) Evidence of basal ganglion disease.
(6) Severe mental deficiency.
The only thing we lack is the question of whether our patients were Rh positive.
We may reason this way. Since we can in all probability say that they had icterus
gravis, then we can say that they had erythroblastosis and if erythroblastotic then they
were Rh positive.    I will point out the loopholes later.
An isolated report of two cases of kernicterus with some discussion is of little value
except to remind us of the clinical entity. It should make one stop and think of the
relationship of the Rh factor to the whole question of general brain damage and mental
deficiency in children. There has appeared in the literature several articles recently
along this line.
In one report twenty cases of erythroblastosis were analyzed. Of these twenty,
thirteen survived. Five of these thirteen showed some manifestation of kernicterus,
e.g. neurological manifestations. This is rather a disturbing thought. Erythroblastosis
of the new born is quite common. Do 38% of all survivors of erythroblastosis have
some brain damage?
Yannet in 1944 at the Southbury Training School for Mental Defectives divided his
patients into two main groups:
(1) The differentiated, i.e. microcephalics, mongols, and so on.
(2) The undifferentiated, that is those which did not fit into any clinical picture.
In a random sampling of the population at large one would expect to find from
13-15% of individuals Rh negative. In testing the group of mothers of the differentiated group that is exactly what Yannet found.    In testing the group of mothers of
Page Two Hundred and Forty the undifferentiated one he found 25% of them to be Rh negative. He states that the
figures are statistically significant. His conclusion is, "While the demonstration of an
Rh negative mother of an Rh positive mental defective does not make the diagnosis of
foetal central nervous system due to maternal Rh iso-immunization, it does indicate
the group in which this is a distinct possibility. Further clinical study of a large
group of this type, may eventually result in a clinical characterization for which
blood studies may have confirmatory value."
Recently he has analysed another group going to greater detail. Apparently he has
been able to prove to his own satisfaction that in the undifferentiated group he could
prove statistically that the Rh iso-immunization was a factor in the production of
mental deficiency.
Of a group of 350 mental defectives with I.Q. less than 30, it was possible to get
blood samples from 277 mothers. Of this group of 277, 158 could be placed in well
recognized classifications. 119 were placed in the undifferentiated group. 14% of
mothers in the control group wer Rh negative. 22% of mothers in the undifferentiated
were Rh negative. The random distribution of the Rh factor is such that an Rh
negative woman has a 60% chance of giving birth to an Rh positive child.
In the control group this is exactly what was found, 12 Rh positive children. In
the undifferentiated on the same basis one might have expected to find 15 or 16 Rh
positive children.    Actually 19 were found.
Another group of workers studied 68 undifferentiated institutionalized mental defectives and found almost twice the number of Rh negative mothers and incompatible
mother-child relationships than should have been present on the basis of random selection.
In any of the dissertations on the Rh factor that I have read it has always been
stated that the Rh-anti-Rh reaction takes place late in the pregnancy certainly after
the seventh month. This is presumably because the results of the reaction are sought
in the peripheral blood namely signs of erythroblastosis. Apparently it goes deeper than
that. The Rh factor is present in all the tissues of the body. So the destruction of all
the tissues of the body may take place very early in the pregnancy. Because the reparative capacity of the injured neuron is meagre permanent damage may remain. Another theory expressed by Yonnet is that even early in the pregnancy, depending on
the titre of the Rh-anti-Rh reaction, red blood cells are destroyed. When the destruction is greater than the blood formation the developing neuron is deficient in oxygen
and is damaged. Later when the compensation of the bone marrow catches up further
neuronal damage is prevented. Thus, only in those cases in which maternal antibodies
were produced in sufficient concentration relatively early in pregnancy would kernicterus
be observed.
Although we are able to keep children with erythroblastosis alive we cannot repair
the damage done to their brain. If we are to believe one report, 38% of a small group
of surviving erythroblastotic infants showed signs of brain damage. More patients with
kernicterus will survive than in the past.   Of that there is no doubt.
An isolated fact can be very interesting but when it can be fitted into its place in a
larger scheme it is usually enhanced.
The original demonstration, that when the blood of rhesus monkeys was injected
into rabbits and guinea pigs they produced an antibody, was interesting. Later it
was found that most humans had an agglutinogen similar to the rhesus blood. Then it
was shown that when blood with this agglutinogen entered the circulation of an individual without it that they in turn had the power to produce an agglutinin against
it. Later it was shown that this agglutinogen-agglutinin reaction could be productive
of a very serious illness in infancy, i.e. some manifestation of erythroblastosis. Now we
are told that this may explain some of the puzzling cases of feeble-mindedness. Starting
,with a relatively simple idea it has come to colour our thinking in a much broader
field—that of child development, (or rather the lack of it.)
The thought that theoretically the progeny from the mating of people with Rh
incompatibility may result in the production of a certain number of feeble-minded chil-
Page Two Hundred and Forty-one
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If
dren, no matter what we do, can be rather frightening. Certainly in working with
children one must become very conscious of it. This knowledge may become another
weapon in our array of weapons to prevent unhappiness. It can be used in the future
to explain to unhappy parents the cause for the production of more than one blighted
child.   But like all weapons it should be used wisely and in the right place.
Let ine digress a moment. The knowledge of the Rh factor may solve other riddles.
It is even leading us into the ethnological fields. It has been found that among Eskimos,
N. A. Indians, Chinese, Japanese, the Rh factor is almost universal. There are no Rh
negative individuals.
Erythroblastosis fetalis is said to be almost unheard of amongst Chinese infants.
Just what this means I do not know. But this much can be said that even among these
people when there is mixture with the white race Rh negative individuals begin to
appear, with the suggestion that there will be erythroblastosis and all that it connotes.
This is a sour note to end upon but I have no more to say
Bibliography:
1. JORDAN, Dennis—Survey of Blood Grouping and Rh Factor in the Eskimos of the Eastern
Arctic, 1945.    CMAJ—54: 1946.
2. LEVINE, Philip—On Human  Anti-Rh  sera  and  their  Importance  in Racial  Studies.     Science,
vol. 96: 452,  1942.
3. LEVINE, Philip and "WONG, Helena—The Incidence of the Rh Factor and Erythroblastosis etalis
in Chinese. A. . of Obs. & Gyn., Vol. 45: 832, 1943.
4. STRONG, Robert A. and MARKS, H.P.—Icterus Gravis Neonatorum. J. of Ped. 15: 658, 1939.
5. TURVEY, S. E. C.—The Role  of Heredity and the Clinical  Significance of the Rh  Factor.
Bull. V. M. A. 20:  100, 1944.
6. YANNET, Herman and LIEBERMAN, Rose—Central Nervous System Complications Associated
with Kernicterus.   J. A. M. A. 130: 355, 1946.
7. WALLER, Robert K. and LEVINE, Philip—On the Rh and Other Blood Factors in apanese.
Science, 100: 453, 1944.
8. YANNET,  Herman—The  Importance  of  the  Rh  Factor  in  Mental   Deficiency.     Bull.  N.  Y.
Acad, of Med. 20: 512, 1944.
a.
»CT
Page Two Hundred and Forty-two OBITUARIES
DR. S. C. MacEWEN
Obiit IS June 1947.
The recent death of Dr. S. C. MacEwen, better known as Cam MacEwen,
means a very great loss to the profession of British Columbia, to whom he. was
very well known in the later years of his life, as the medical director of the
M.S.A. of this Province.
' Cam MacEwen was a very good fellow—and we think it is true to say that
every medical man who knew him, and came in contact with him officially,
not only respected him, but liked him personally, and trusted him completely.
He tried always to be fair and generous, and succeeded admirably in a very
difficult position. His work on the M.S.A. was outstanding, and he did much
to bring it to its present very high position in the life of B.C. He was approachable and friendly, and his loss will be very keenly felt by this great
organization.
Dr. MacEwen was one of the three MacEwen brothers of New Westminster,
where he practised for many years, and was well known, and very much liked.
His medical work was of a high order, and he sacrificed much to take up
the M.S.A. work.
To those who mourn him as one of their own family, we extend our condolences and sympathy.
DR. BERTIE BLACKWOOD
Vl >   Obiit 7 July 1947.
Very few of the medical men now practising in Vancouver will have
known Dr. Blackwood, whose ill health forced him into virtual retirement
some years, ago—but many of the older men will remember him well, and
will mourn his passing.
Dr. Blackwood resided and practised in Kerrisdale for many years, and
had a large practice. He was very highly esteemed by his fellows, and very
successful as a practitioner. He met his very tragic fate courageously and
philosophically.
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Page Two hundred and Foryt-three
:! We were sorry to learn of the passing of Dr. Bertie Blackwood, a well known doctor
in Vancouver. During the first World War he served with the Canadian Army and
later with the British Army Medical Corps. Following the war he was Medical Health
Officer and Police Surgeon in Vancouver for a number of years before returning to
private practise.    Deepest sympathy is extended to Mrs. Blackwood and family.
The profession extends sincere sympathy to Dr. J. G. McMurchy of Nelson in the
loss of his wife.
We regret to record the death of Dr. George Edward Duncan. Dr. Duncan registered in British Columbia in 1900 and retired from active practise several years ago.
We extend our sympathy to Mrs. Duncan in her bereavement.
Doctors attending the Canadian Medical Association Annual Meeting, held in
Winnipeg during May, report that it was most successful. The British Columbia
Division was well represented, a large number of doctors found it possible to attend
the sessions.
i'j»r
The profession extends to Dr. Honor M. Kidd congratulations on winning the Osier
medal from the American Association of Historical Medicine. Dr. Kidd is the first
woman and the first Canadian to win this award.
;'*
i*
Congratulations to Dr. and Mrs. W. F. Bie on the birth of a daughter, and to Dr.
and Mrs. C. C. Covernton on the birth of a son.
Among those doctors taking vacations at the present time is Dr. W. H. White holidaying at Christina Lake and Dr. G. S. Purvis who is spending a month at Gunn Lake.
Dr. and Mrs. E. S. Hoare and family, of Trail, are vacationing at the coast.
Dr. and Mrs. G. F. Enns motored to Winnipeg, where Dr. Enns attended the C.M.A.
Meeting, and where they will spend some time visiting relatives and friends.
'*
Congratulations and best wishes extended to the following doctors on their recent
marriages:
Dr. and Mrs. William R. MacEwan, who will reside at South Shalalth.
Dr. and Mrs. W. H. Sutherland who will make their home in Vancouver.
Dr. and Mrs. T. W. Tysoe will live at Britannia Beach where Dr. Tysoe is the
resident doctor.
Page Two Hundred and Forty-four Dr. and Mrs. L. A. Patten are holidaying at Jasper.   We are glad to hear that Dr.
Patten's health is much improved.
* I
Dr. J. H. Sturdy has left the Vancouver General Hospital to join the Department of
Pathology at the Banting Institute in Toronto.
Dr. A. A. Gordon who has been doing post-graduate work at the Vancouver General
Hospital has now joined the Montreal Pathological Institute at McGill University.
Dr. Chas. G. Patten has left Hope to join in the practice at Chilliwack with Dr. R. W.
Patten.
•
Dr. J. H. Stapleton has left Vancouver to take up practise in Penticton.
Dr. R. D. Morrison, formerly of Vancouver, has taken up practice at Hope.
Dr. J. G. MacArthur of Prince George made a rush visit to Saskatoon to see his
father.    We are glad to know Mr. MacArthur is now progressing favourably.
At the annual meeting of the Central Interior Medical Association, recently held in
Prince George, the following officers were elected:
Dr. J. G. MacArthur, President.
Dr. Larry Maxwell, Secretary.
The annual dinner and election of officers of the Westminster Medical Association
was held.   The following officers were elected:
Dr. Bruce Cannon, President.
Dr. J. F. Sparling, Vice-President.
Dr. A. C. Ross, Secretary-Treasurer.
Doctors W. A. Clarke and H. B. Lockhart, Directors.
4>
Dr. T. R. Whaley has added four new Kentucky thoroughbred fillies to his string
at Beverley Place near Chilliwack. Some excellent stock is expected from this choice
line.
'.t
V.\
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Ethical protective mark MHS
embossed on inside of each
capsule, visible only when capsule  is cut in half at seam.
AUTOGENOUS
VACCINES
For the treatment of chronic infections, such as
recurrent boils, pustular acne, chronic sinusitis,
rhinitis, etc.
All vaccines are tested for sterility.
Telephone
PAcific 4839
mEDICPL LABORATORY
OF
Dr. P. 5. RUTHERFORD
312 Vancouver Block,
Vancouver, B.C.
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A New Synthetic Antihistamine]
Agent for the treatment of
INDICATIONS
Hay Fever - Urticaria - Pruritus - Urticarial Dermatitis - Anaphylactic Reactions
Serum   Sickness   -   Vasomotor  Rhinitis
PRESENTATION
I   Neo-Antergan is presented in tubes of
m 50 coated tablets each containing 0.1
iGm. of acid maleate of N-dimethyl
amino-ethyl-N para-methoxy-
benzyl-amino-pyridine.
SS
^idiWf.-:^--
Iff
In the near future:
Neo-Antergan Tablets 0-05 Gm.
Neo-Antergan Ampoules 0.05 Gm.
JxLuvxaJjcruj I aiUenx: jxe/i&4
OF       CANADA       U   M   I   T   I  D   -   M O A/  7 fl f 4  I ^^it^&K£$3M
life.. "Gastro-Intestinal
. SyVflptOYYlS occur more frequently
than any other symptom in
patients over 40."*
When the vague complaints of the middle-aged and
aging can be attributed to hypochlorhydria, chronic
gastritis, and diminished gastric secretion, Gastron provides effective, palatable replacement therapy . . .
hydrochloric acid in therapeutic amount, plus all the
gastric enzymes.
*.
I
For Gastric Hyposecretion
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THERAPEUTIC APPRAISAL: An acidified (pH 3.2—4.0), aromatized extract of the entire mucosa of hog's stomach including the
pylorus. Gastron provides a physiologic mixture of all constituents
of gastric secretion One Gm. of Gastron will digest 150-200 Gm.
of egg albumen.
INDICATED in gastric hyposecretion: gastritis associated with achlorhydria; anacidity and achylia in middle-age and aging; hypochlorhydria accompanying food allergies and nutritional deficiencies.
THE USUAL DOSE is 2 to 4 teaspoonsful diluted with 1 or 2 volumes
of water, after meals.
SUPPLIED in 6 ounce bottles for prescription use, 32 ounce bottles
for dispensing.
**
WINDSOR, ONT.
NEW YORK KANSAS CITY SAN FRANCISCO DETROIT SYDNEY, AUSTRALIA
AUCKLAND, NEW ZEALAND
H
*Kopelowitz, J. O.: J. Missouri St. M. A. 38:55,1941
Gastron Trade-Mark Reg.
S-107A V •
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ORTHO-CREME Vaginal Cream is soft, white
and pleasandy  scented, and has  been formulated
especially for those patients who prefer a cream
to a jelly. Clinical evidence indicates that one out
of three patients has this preference.*
It is effective, tolerable to the vaginal mucosa, and
possesses marked stability. ORTHO-CREME
has received the A.M.A. seal
of approval.
I? ft:
*REFERENCE: Marie Wessels,
M.D. Human Fertility, Vol. 5.
No. 6, December, 1940
ORTHO   PHARMACEUTICAL   CORPORATION   (CANADA)   LIMITED — TORONTO ►
ff Calcium-Sandoz
[calcium-glucono-galacto-gluconate)
often gives dramatic  relief   in   the   treatment   of   estival   ills
INSECT BITES • CONTACT DERMATITIS - HAY FEVER
Wasp, Hornet and Bee Stings
Dermatitis venenata — Poison Ivy
Granules — Chocolate and Effervescent Tablets — Ampoules.
V
tt
Calcibronat-Sandoz
ff
(calcium-bromide-lactobionate)
is most effective in Itching Dermatoses
URTICARIA  -   PRURIGO  -  DERMATITIS   -   ECZEMA
Penicillin Reaction and Allergic Reactions
Granules — Effervescent Tablets — Ampoules
LITERATURE AND  SAMPLES  ON  REQUEST.
SANDOZ
Sandoz Pharmaceutical Dept.
The WINGATE CHEMICAL CO. LTD
378 St. Paul Street West
Montreal
47-1
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flDount pleasant TUnfcertaMno Co. %tb.
KINGSWAY at 11th AVE.
Telephone FAirmont 0058
W. E. REYNOLDS
VANCOUVER, B. C
exclusive HmeuLflnci
SERVICE     |
■
M    m    ft v. • f«* >
V
J. H.
rANCOUVER: 13th Avenue and Heather Street        fflir. 00
NEW WESTMINSTER: 814 London Street              flUJ.  60
We Specialize in Ambulance Service Only
GRELLIN                                                                                                                       W. L. BERTI
80
IAND an EFFECTIVE treatment
FOR  DERMATOPHYTOSIS
Sopronol is effective, yet
mild. It is not only an
efficient fungistat, but is
practically nonirritating
and nonsensitizing. The
active agent is propionic
acid — an ingredient of
human sweat — nature's
own defence against fungous infection.
Kjpsijp
1 * 8R0TWW* ;
5^    \l
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And daily dusting with Sopronol Powder will
destroy .fungi lurking in socks and shoes.
%
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3 FORMS ... J USES
SOLUTION
OINTMENT
POWDER
2 oz. bottles
1 oz. tubes
2 oz. tins
Convenient for
For application
For daytime use, and
office treatment
at bedtime
for prophylaxis
Solution and ointment contain sodium propionate 16.4% and propionic acid
3.6%. Powder contains calcium propionate 15% and zinc propionate 5%.
SOPRONOL
JKSwSf
Registered Trade Mark
JOHN WYETH & BROTHER (CANADA) LIMITED
WALKERVILLE, ONTARIO *
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Carbrital
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—an important hour for sedative-hypnotic medication
be it in the ward or in the home—an hour for KAPSEALS CARBRITAL.
For the sleepless, restless, tense or anxious patient, CARBRITAL
affords prompt sedative action and favors natural sleep
Without residual depression. One KAPSEAL CARBRITAL (hora somni)
is the usual hypnotic dose, providing the effective combination
of pentobarbital sodium and carbromal.
KAPSEALS CARBRITAL is another contribution to the comfort and
well-being of the sick that for the past 80 years has
identified as a symbol of
significance the mark
of Parke-Davis.
KAPSEALS CAHBMTAI.
contains pentobarbital
sodium 1% gr. and
carbromal (bromdiethyl-
acetylurea) 4 gr. As a
sedative-hypnotic, one to two
Kapseals; preoperatively,
two Kapseals two hours
prior to scheduled hour.
PARKE,  DAVIS & COMPANY, LTD.,  WALKERVILLE, ONT.
%   E   U   ► HAY FEVER
RELIEF.. m
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PYRIBENZAMINE
ANTISTINE
r*
ISSUED
PYRIBENZAMINE, for oral use:
Tablets, bottles of 50 and 500.
[ANTISTINE, for parenteral use:
Ampoules, boxes of 5, 20 and 100.
Also available in tablet form for
oral i/se, in bottles of 50 and 500.
From the first signs of Cottonwood pollination in
April, to the end of the Ragweed season in September, in most cases complete alleviation of the
discomforts of seasonal allergies is assured by the use
of -Pyribenzamine Tablets, or Antistine injections.
Detailed Literature on- both preparations will be
sent upon request.
CIBA   COMPANY   LIMITED   •  MONTREAL
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SCIENCE AT THE SERVICE OF MLE D I C I N E <*•
Doctors will find Nivea Creme especially useful for
keeping their hands in good condition. A little massaged
into the hands after operating counteracts the dryness
of skin that results from constant " scrubbing up " and
contact with antiseptic solutions.
Nivea is also a useful corrective measure in cases
where disease has left the skin scaly and irritated, and
it is an excellent cleansing medium when soap and
water is contra-indicated.
Nivea Creme is a water-in-oil emulsion containing
Eucerite, a mixture of solid alcohols closely related
chemically to the fatty substances present in skin
secretions. It penetrates the epidermis and replenishes
any deficiency of the skin's natural fatty elements.
NIVEA CREME
Professional Pack containing lib. 370 A.
'NIVEA' and 'EUCERITE' are registered Trade Marks
Made in Canada by NIVEA PHARMACEUTICALS LTD., 387 College Street, TORONTO
Distributing   Agents:   VANZANT   &   COMPANY,   357   College   Street,   TORONTO
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IF ARTHRITIS and ECZEMA
ARE ALLER6IC
ETIOLOGICALLY
effective treatment suggests the me of
agents to correct mineral deficiency,
increase cellular activity, and secure
adequate elimination ef toxic waste.
LYXANTHINE ASTIER -^
orally given, supplies calcium, sulphur,
iodine, and lysldln hitartrate — an
effective solvent. Amelioration of
symptoms and general functional improvement  may be  expected.
Write for Information.
L-n
Canadian Distributors
ROUGIER FRERES
350   Le  Moyne   Street,   Montreal
J
Ntttttt $c
SHprniaim
t
2559 Cambie Street
Vancouver, B.C.
CAMPBELL & SMITH LIMITED
820 Richards Street   : :   Vancouver, B.C. : :   PAcific 3053
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ective
&,
nnhng
MMMtl Constant Carefulness
Onl^ffear^^nderetandmgi&rofessional
skill ^ouId maintain the confldenc^of
||pe Medical Profession which we enjoy.
Phone MArine 4161
Leslie G. Henderson Gibb G. Henderson
WIOHT
GEORGIA PHARMACY
LIMITED
W.OIOAOIA
STRUT
tefrr jfe llina Situ
ESTABLISHED ItM
VANCOUVER, B. C.
North Vancouver, B. C.
Powell River, B. C.
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New Westminster, B. C.
Far the treatment of
NEUROPSYCHIATRIC
DISORDERS
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, Hew Westminster, |^C
New Westminster 288
or 721 Medical-Dental Building, Vancouver, B. C.
PAcific 7*23 PAcdtic 8036
27

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