History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: September, 1938 Vancouver Medical Association Sep 30, 1938

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 The IBULLETI
OF THE
VANCOUVER ME
ASSOCIATION
Vol. XIV.
SEPTEMBER,  1938
No. 12
In This Issue:
PROGRAMME OF ANNUAL MEETING OF
BRITISH COLUMBIA MEDICAL ASSOCIATION
SOME SOCIAL AND ECONOMIC ASPECTS OF
HEALTH INSURANCE
NEWS AND NOTES BULKETTS
(With Cascara and Bile Salts)
. . FOR . .
Chronic  Habitual
Constipation
BULKETTS POSSESS ENORMOUS BULK
PRODUCING PROPERTIES AND BEING
PROCESSED WITH CASCARA AND
BILE SALTS PRODUCEJBULK WITH
MOTILITY.
WE WILL BE PLEASED TO PROVIDE
ORIGINAL CONTAINERS FOR TRIAL
ON REQUEST.
Western Wholesale Drug
(1928) Limited
456 BROADWAY WEST
VANCOUVER   -   BRITISH COLUMBIA
(Or at all Vancouver Drug Co. Stores) THE    VANCOUVER    MEDICAL   ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
Offices:
203 Medical-Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. H. MacDebmot
Db. M. McC. Baibd Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XIV.
SEPTEMBER, 1938
No. 12
OFFICERS  193 8-1939
Db. G. H. Clement
Past President
Db. D. F. Busteed
Hon. Secretary
Db. Lavell H. Leeson Db. A. M. Agnew
President Vice-President
Db. W. T. Lockhabt
Hon. Treasurer
Additional Members of Executive: Db. J. P. Bilodeau, Db. J. W. Abbuckle.
Dr. F. Bbodie
TRUSTEES:
Db. J. A. Gillespie
Historian: Db. W. D. Keith
Auditors: Messbs. Shaw, Salteb & Plommeb.
Db. Neil McDougall
SECTIONS
Clinical Section
Db. R. Palmeb Chairman     Db. W. W. Simpson Secretary
Eye, Ear, Nose and Throat
Db. S. G. Elliott Chairman     Dr. W. M. Paton Secretary
Pediatric Section
Dr. G. A. Lamont Chairman     Dr. J. R. Davies Secretary
Cancer Section
Dr. B. J/Harrison Chairman     Dr. Roy Huggard  ....Secretary
STANDING COMMITTEES
Library:
Dr. A. W. Bagnall, Dr. H. A. Rawlings, Dr. D. E. H. Cleveland,
Dr. R. Palmer, Dr. F. J. Buller, Dr. J. R Davies.
Publications:
Dr. J. H. MacDermot, Dr. D. E. H. Cleveland, Dr. Murray Baird.
Summer School:
Dr. J. R. Naden, Dr. A. C. Frost, Dr. A. B. Schinbein, Dr. A. Y. McNair,
Dr. T. H. Lennie, Dr. Frank Turnbull.
Credentials:
Dr. A. B. Schinbein, Dr. D. M. Meekison, Db. F. J. Bullee.
V. O. N. Advisory Board:
Db. I. Day, Db. G. A. Lamont, Db. Keith Bubwell.
Metropolitan Health Board Advisory Committee:
Db. W. T. Ewing, Db. H. A. Spohn, Db. F. J. Bullee.
Greater Vancouver Health League Representatives:
Db. W. W. Simpson, Dr. W. N. Paton.
Representative to B. C. Medical Association: Dr. G. H. Clement.
Sickness and Benevolent Fund: The President—The Trustees. Protection Against Typhoid
Typhoid and Typhoid-Paratyphoid Vaccines
Although not epidemic in Canada, typhoid and paratyphoid infections remain a serious menace—particularly
in rural and unorganized areas. This is borne out by the
fact that during the years 1931-1935 there were reported,
in the Dominion, 12,073 cases and 1,616 deaths due to
these infections.
The preventive values of typhoid vaccine and typhoid-
paratyphoid vaccine have been well established by military and civil experience. In order to ensure that these
values be maximum, it is essential that the vaccines be
prepared in accordance with the findings of recent laboratory studies concerning strains, cultural conditions and
dosage. This essential is observed in production of the
vaccines which are available from the Connaught
Laboratories.
Residents of areas where danger of typhoid exists and
any one planning vacations or travel should have their
attention directed to the protection afforded by vaccination.
Information and prices relating to Typhoid Vaccine and to
Typboid-Paratypboid Vaccine will be supplied
gladly upon request.
CONNAUGHT LABORATORIES
UNIVERSITY   OF   TORONTO
Toronto 5
Canada
Depot for British Columbia
Macdonald's Prescriptions Limited
MEDICAL-DENTAL BUILDING, VANCOUVER, B. C. £-f.
VANCOUVER HEALTH DEPARTMENT
STATISTICS—JULY, 1938
Total Population—estimated lL. L !  259,987
Japanese Population—estimated ,_*  8,685
Chinese Population^—estimated . ; ■  7,808
Hindu Population—estimated .  . 335
Number
Total deaths .  170
Japanese deaths i  3
Chinese deaths    4
Deaths—residents only  145
BIRTH REGISTRATIONS :
Male, 187; Female, 170  357
INFANTILE MORTALITY:
Deaths under one year of age	
Death rate—per 1,000 births	
Stillbirths (not included in above)
July, 1938
8
22.4
~        8'
Rate per 1,000
Population
7.7
4.1
6.0
6.5
16.17
July, 1937
12
35.8
3
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
June, 1938
Cases Deaths
July, 1938
Cases Deaths
August 1st
to 15th, 1938
Cases Deaths
Scarlet Fever  20           0 26           0 7 C
Diphtheria    0           0 0           0 0 C
Chicken Pox  22           0 23           0 8 C
Measles    10 2           0 0 C
Rubella    10 0           0 0 (
Mumps   10 10 0 (
Whooping Cough 11 7           0 15           0 6 (
Typhoid Fever  10 2           0 0 (
Undulant Fever  0           0 0           0 0 (
Poliomyelitis     10 2           0 1 (
Tuberculosis  27           0 44         12 14
Erysipelas  0           0 0           0 0 (
Ep. Cerebrospinal Meningitis 0           0 0           0 0 (
V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH,
DIVISION OF VENEREAL DISEASE CONTROL
Richmond
Syphilis      1
Gonorrhoea-     0
North
Vancouver
0
1
Vancouver.
51
66
Hospitals and
private drs.
23
Totals
74
93
A PRESCRIPTION SERVICE . . .
Conducted in accord with the ethics of the Medical
Profession and maintained to the standard suggested by
our slogan:
Pharmaceutical Excellence
AAcGill 6 Grmo
LIMITED X--'
FORT STREET (opp. Times)      Phone Garden 1196      VICTORIA, B. C
Page 266 Literature and samples from:
ANGLO-FRENCH DRUG CO.   -   MONTREAL, QUE. VANCOUVER MEDICAL ASSOCIATION
Founded 1898
Incorporated 1906.
GENERAL MEETINGS will be held on the first Tuesday of
the month at 8 p.m.
CLINICAL MEETINGS will be held on the Third Tuesday of
the month at 8 p.m.
Place of meeting will appear on the Agenda.
General meetings will conform to the following order:
8: 00 p.m.—Business as per Agenda.
9:00 p.m.—Papers of the evening.
Programme of the 41st Annual Session
1938
October   4th—GENERAL MEETING.
Dr. Frank Turnbull : "Pituitary and Para-pituitary
Tumours."
October   18th—CLINICAL MEETING.
November 1st—GENERAL MEETING.
Dr. J. Ross Davidson : "Some Aspects of Contract Practice."
November 15th—CLINICAL MEETING. §
December 6th—GENERAL MEETING.
Dr. Karl Haig : Subject to be announced later.
December 20th—CLINICAL MEETING.
VANCOUVER MEDICAL ASSOCIATION
PROGRAMME
The Programme for the Fall Session appears in this month's edition of
the Bulletin and gives promise of interest and variety. Dr. Frank Turnbull
will give a paper on Pituitary and Para-pituitary Tumours on October 4th.
This will be a dinner meeting, and on the same evening the Association will
celebrate its Fortieth Anniversary. There may even be a birthday cake, and
it is hoped to have a fine attendance, especially of those older members of
the Association who have seen it grow from infancy. Part of the evening
should be set aside for reminiscences.
In November Dr. J. Ross Davidson will speak to the Association on "Some
Aspects of Contract Practice," a subject with which he is familiar from
experience. Those who have heard him speak on this subject before can
promise that his paper will be full of interest.
Dr. Karl Haig will be the lecturer at the December meeting, but has not
as yet chosen his subject.
ANNUAL DINNER
The Dinner Committee, with Dr. A. M. Agnew as Chairman, have made
reservations at the Hotel Vancouver for November 18th for the Annual
Dinner. Put a red ring around this date in your engagement book, and make
this a "red-letter" occasion.
Page 267 EDITOR'S PAGE
We publish in this issue the address given in July by Prof. Paul A. Dodd,
of the University of California, before the Canadian Congress of Social
Workers, held in Vancouver. Professor Dodd occupies the Chair of Economics, and is a well-known writer on subjects such as the one with which
he deals here—health insurance. Our readers will find this a compact, clearly-
reasoned argument for improvement in the methods by which, on the one
hand, medical advice and aid can be made more freely available to those who
need it but cannot afford it in its present form, and with their present incomes, and on the other hand, the medical man himself may be given freer
opportunity to do the work for which he is trained and may get a reasonable
remuneration therefor.
There are certain things, however, that we feel should be said. To some
extent Professor Dodd is flogging a dead horse, killing the thrice-slain.
Nobody has any argument against his thesis, that there is something rotten
in the state of Denmark, and that we should do something about it. His
figures and data and tables have been given over and over, by the Committee
on the Costs of Medical Care, by countless surveys and Commissions; our
own provincial studies have amply proved the fact that readjustment is
necessary: and the organised medical profession everywhere agrees that a
change of some sort is advisable and necessary—and has even formulated
schemes to that end. Let us take it as said that all Professor Dodd says
is true.
But, in the first place, let us remember that this particular need, this
social injustice, is merely a symptom of a larger and more deep-seated social
disease—this was very ably pointed out in an article in the Atlantic Monthly
of April, 1937, by the Secretary of the American Foundation.
Granted that the need for better medical service exists: where is it most
marked? Why can its cost not be met by those who need it? Will health
insurance meet the need? What form of health insurance will best meet it?
Must the forms that, apparently, suit other countries, necessarily be copied
here, in whole or in part? Lastly, what will an adequate health insurance
scheme cost, if everyone is to be fairly paid for the work they do? And how
is this cost to be met, on an equitable basis, and on a basis that is actuarially
sound? These are questions that rise to one's mind, among others, and these
questions must be answered. They are not answered in Professor Dodd's
paper; and perhaps it is not reasonable to expect him to answer them in this
particular paper. But while he has stated his case, he has only formulated
the problem, not solved it. It is a big problem, difficult of solution, and those
who are attempting to solve it have undertaken a heavy task. There can be
no doubt that they appreciate this fact, and are trying, as far as they can, to
consider every angle of the situation adequately. At that we must leave it
for the present.
Again we urge our readers not to miss the B. C. Medical Association's
Annual Meeting, if they can possibly help it. The list of speakers, and their
subjects, assures everyone of a most profitable time.  Sectional meetings are
arranged, and the apostles of preventive medicine have been provided for.
The programme of entertainment, dances, dinners, divots, etc., leaves nothing
to be desired.
*      *      *      *
The October meeting of the Vancouver Medical Association is a most
important one. The Vancouver Medical Association is now forty years old.
This is a respectable age, as things go in this country. In the Old Country,
of course, nothing under a hundred years is entitled to any consideration
at all—but with us, a continuous active existence of forty years is at least a
very good start.
Page 268 So celebrations are in order, and a dinner is to be arranged. One or two
pioneers of the profession will be guests of honour; no doubt a toast or two
will be given by, to or in honour of somebody or something—and we shall at
least drink to the health and long life of the Vancouver Medical Association,
which, thanks to the high idealism and fervour of its founders, has lived
such a useful and honourable life, and has been of such service to its members
and to this city. The sex of the creature is in some doubt, since no woman will
admit to being forty, though she may later boast of being seventy. So it must
be a male, or perhaps what Kipling (page Dr. Cleveland) would call a "giddy
harumfrodite." Let us, perhaps, compromise by calling it "It."
Further details will be given later to each member individually; in the
meantime, we think it an admirable idea of the Executive, and hope all our
members will join in making this meeting a memorable one.
j    NEWS AND NOTES
Dr. and Mrs. Wallace Wilson are spending some time in England. They
went to Halifax in June, where Dr. Wilson attended the Annual Meeting of
the Canadian Medical Association, and then left for the Old Country. While
in England, Dr. Wilson attended the Annual Meeting of the British Medical
Association, which met at Plymouth in July of this year. They are expected
back in time for Dr. Wilson to attend the Annual Meeting of the British
Columbia Medical Association in Victoria in September.
* ♦ H* *
We are delighted to hear that Dr. W. A. Whitelaw has so far recovered
from a long and serious illness as to be able to be out driving. We earnestly
trust that his improvement will steadily continue and that we may see him
back among us before very long. Both of Dr. Whitelaw's sons will be returning to McGill this fall.
H* * * #
Dr. Jack Frost, son of Dr. A. C. Frost, has been doing locum tenens at
Cumberland during the summer. Following his graduation two years ago he
was an interne at the Royal Victoria Hospital at Montreal. He will leave for
England in the fall, to continue his post-graduate studies.
H* % H6 ♦
We offer our best wishes to Dr. and Mrs. L. S. Chipperfield, who were
married on Wednesday, August 17th. Before her marriage Mrs. Chipperfield
was Miss Frances Elizabeth (Betty) Wilson, only daughter of Dr. G. T.
Wilson of New Westminster. Dr. and Mrs. Chipperfield will make their home
in Coquitlam, where he has been in practice for some two years.
$      *      *      *
Dr. R. J. Gibbons, formerly assistant to Dr. C. E. Dolman, at the Con-
naught Laboratories, University of British Columbia, is now Chief Bacteriologist to the Laboratory of Hygiene, Department of Pensions and National
Health. Dr. Gibbons is at present engaged in a two-year survey on Rocky
Mountain spotted fever and sylvatic plague, in British Columbia.
* * ♦ #
Dr: and Mrs. J. A. (Okey) Smith are receiving congratulations on the
birth of a son on August 15th.
The appointment of Dr. Stewart Murray, assistant City Health Officer,
to succees Dr. J. W. Mcintosh, City Health Officer, who will retire on September 30th, will be recommended to the City Council by the Metropolitan
Health Board. Dr. Murray, who will be on probation for a year, obtained his
degree at the University of Toronto, under a Rockefeller Foundation Fellowship. He joined the School Board Medical Staff in 1936 and became Assistant
Health Officer in January, 1938.
Page 269 Dr. L. G. Wood has opened offices in the Medical-Dental Building and will
specialize in G.-U. surgery.      *      *      *      *
Dr. J. N. Ball of Oliver motored down to the Coast and visited the office.
* *      ♦      ♦
Dr. W. O. Green, who has been an interne at the Vancouver General Hospital during the past two years, is now associated in practice with Doctors
Green and MacKinnon of Cranbrook.
*** 1R 3(C )f(
Dr. H. B. McGregor, son of Dr. H. H. McGregor, has returned to Penticton
and is associated with his father in practice.
* *      *      *
Doctors White, Parmley and White are building modern offices which will
also house Dr. J. Parmley, Dentist.
* *      *      *
Dr. R. B. White of Penticton visited the Coast cities and looks and feels
well. He appeared to be enjoying the greater freedom with Doctors Parmley
and W. H. White carrying on.
have invited the members of the British Columbia
Medical Association and their wives, who have
registered at the Annual Meeting,
to attend
j\ |&ttrtg at (Btftertfmmt £3mts#
on
®{ptrsfrag ^toting, JSeptembsr 15% 193S
between the hours of five and six-thirty o'clock.
Please note: Personal invitations will await you at
the main Registration Desk.
Transportation Will Be Arranged for Those Registering.
Dr. G. A. B. Hall of Nanaimo called at the office in August to discuss matters which were considered at a meeting held in Nanaimo when Dr. Thomas,
the Executive Secretary, met the whole profession in meeting on August 11th.
•F *F *F 1*
The members in Nanaimo have formed the Nanaimo Medical Society, with
Dr. G. A. B. Hall as its first President and Dr. C. C. Browne as the Honorary
Secretary.
VANCOUVER MEDICAL ASSOCIATION
1898   ::  FORTIETH ANNIVERSARY  ::   1938
BIRTHDAY DINNER, OCTOBER 4th, 1938.
On October 27, 1898, a small group of medical men met in a room over
Atkins Drug Store, corner of Homer and Hastings Streets, to discuss the
formation of a medical society for the city of Vancouver. Present at the
meeting were Doctors D. H. Wilson, Lefevre, O. Weld, L. N. MacKechnie,
Poole, Brydone-Jack, Bently, Underhill, Senkler, Monro, Kirby, McAlpine
and Pearson. Of all this group only Dr. W. D. Brydone-Jack is living today.
Page 270 Following is a copy of the Minutes of that meeting:
"Dr. Wilson voted into the Chair.
"Drs. Pearson, who sent out the notices calling the meeting, and Underhill
spoke explaining the objects of the meeting, and dwelt upon the desirability of
forming a Society. On the motion of Dr. Lefevre, seconded by Dr. Bently,
and after several gentlemen had spoken, it was decided to proceed with the
formation of such a Society.
"Dr. Brydone-Jack moved, and Dr. Bently seconded, the formation of a
Committee of Drs. Weld, Underhill and Pearson, with the President, to draft
by-laws which would be presented for the consideration of a general meeting
this day week. Carried.
"Dr. Underhill moved, and Dr. Lefevre seconded, that Dr. Wilson be
elected. President for the ensuing year.  Carried.
"Dr. Weld moved, and Dr. Monro seconded, that Dr. Pearson be appointed
Secretary. Carried.
"After further discussion it was decided not to proceed with any further
election until the report of committee was presented.
"The meeting adjourned.
I. Maclean, Secretary."
The first regular meeting of the infant Association was held on December
1st, 1898, in Dr. Jackson's office over Atkins Drug Store. Much water has
flowed under the bridge since that October evening forty years ago. Some
476 men have been members at one time or another, many of whom have
died, while others have left the city. In the handsome blue register of the
Vancouver Medical Association are inscribed the names of all the members,
in order of date of election, and a glance through the pages reveals names
which are outstanding in the medical history of not only the city, but of the
Province. Many of those men who joined the Association in 1898 have been
faithful members ever since.
It is the intention of the Association to celebrate this Fortieth birthday,
and as far as possible honour those early members who are in the city. At
present plans are not complete, but the Executive Committee has the matter
in hand and are planning to hold a dinner. Details are not complete as we
go to press, but announcement will be made at an early date.
BRITISH COLUMBIA MEDICAL ASSOCIATION
FORTY-SIXTH ANNUAL MEETING
VICTORIA:
SEPTEMBER 15th, 16th, 17th.
Headquarters: Empress Hotel.
SPEAKERS:
DR. EDWIN GEORGE BANNICK, Seattle.
Edwin G. Bannick, B.S., M.D., F.A.C.P., has recently come to Seattle.
He confines his practice to Internal Medicine. Prior to his move to the far
West Dr. Bannick was Associate Professor of Medicine in the Mayo
Foundation. Various articles written by him has been published in the
Journals. Dr. Bannick will contribute two lectures to our programme:
Thursday, September 15th* "Acute Pancreatitis"; Saturday, September
17th, "Medical Treatment of Severe Burns."
DR. ALFRED T. BAZIN, Professor Emeritus of Surgery, Faculty of Medicine, McGill University, Montreal.
Dr. Bazin requires no introduction to the profession in British Columbia, or indeed in Canada. Dr. Bazin has been widely recognized through
his attainments in Surgery and as a teacher. The profession in Canada
Page 271 owes its thanks to Dr. Bazin for his outstanding contributions to organized medicine. This has been partially recognized by his election to the
Presidency of the Canadian Medical Association and his years of service
as Chairman of the Executive and General Council.
Dr. Bazin comes to our Annual Meeting under the aegis of the Department of Cancer Control and will appear on the programme with two
lectures : Friday, September 16th, "Cancer of the Breast" ; Saturday, September 17th, "Cancer of the Colon and Rectum."
(Dr. Bazin will address a large lay luncheon at the Hotel Georgia in
Vancouver on September 15th dealing with "Organization in Cancer Control." Doctors Newburgh and Bazin will address a public meeting in
Vancouver on Thursday evening, dealing respectively with "Normal
Nutrition" and "Your Cancer Problem.")
DR. WILLIAM BOYD, Toronto, Professor of Pathology, Faculty of Medicine, University of Toronto.
Dr. Boyd has enjoyed a deserved popularity with the Canadian profession owing to his outstanding text-books, his writings, and his generous
participation in many lecture programmes. Dr. Boyd will always hold a
warm place in the hearts of medical graduates of the University of Manitoba, where he was Professor of Pathology for many years.
Dr. Boyd will contribute three lectures to this year's programme:
Thursday, September 15th, "Pathology of the Gall-Bladder"; Friday,
September 16th, "Tumours of the Neck"; Saturday, Septmeber 17th,
"Bacterial Infection of the Heart."
DR. ALSON R. KILGORE, San Francisco, who is a graduate of the Harvard
Medical School, has distinguished himself in the field of Surgery. He
occupies a prominent place in California as Associate Clinical Professor of Surgery on the Faculty of the University of California Medical School.
Dr. Kilgore will deliver three lectures: Thursday, September 15th,
"Diagnosis of Bone Lesions Suggesting Tumour"; Friday, September
17th, "Extra-Abdominal Diseases Simulating the Acute Abdomen"; Saturday, September 17th, "Practical Consideration in the Handling of Acute
Appendicitis and Its Complications."
DR. HANS LISSER, San Francisco, is Clinical Professor of Medicine on the
Faculty of the University of California Medical School.
Dr. Lisser is a graduate of Johns Hopkins University School of Medicine. He has achieved eminence through his advanced work in Internal
Medicine. In the field of Endocrinology his contributions have been outstanding.
Dr. Lisser will present three lectures : Thursday, September 15th, 9 :00
a.m., "Masculinizing Syndromes; A Consideration of Cushing's Disease;
The Adrenal Cortical Syndrome and Arrhenoblastoma of the Ovary".
Later on the same morning: "Clinical Observations on the Present Status
of Gonadotropic and Sex Hormone Therapy." Saturday, September 17th,
"Indications for and Proper Use of Thyroid Substance."
DR. KENNETH A. MACKENZIE, Halifax, Nova Scotia, Professor of Medicine and Clinical Medicine on the Faculty of Medicine, Dalhousie
University.
Dr. MacKenzie, as President of the Canadian Medical Association, is
on tour of the four Western Provinces and will participate officially in our
Annual Meeting. He will address the Official Luncheon on Friday, September 16th, which will feature the Canadian Medical Association, in that
Dr. T. C. Routley, General Secretary of the national organization, will
also speak.
We are fortunate in that Dr. MacKenzie is prepared to contribute to the
Page 272 lecture  programme:  Friday,   September  16th,  "Treatment of Hypertension."
(Dr. MacKenzie gave leadership to that fine organization which provided for one's comfort and the successful meeting at Halifax. Through
him we hope to show our appreciation by a partial reciprocation of that
wholesome hospitality of the Haligonians.)
DR. L. H. NEWBURGH, Ann Arbor, Professor of Internal Medicine, University of Michigan Medical School.
Professor Newburgh is a graduate of Harvard Medical School, where
he later was on the teaching staff. His work in the field of Dietetics and
Nutrition has won for him widespread recognition as an authority.
(Professor Newburgh will address a public meeting in Vancouver on
Thursday, September 15th, his subject being "Normal Nutrition.")
Dr. Newburgh has graciously consented to contribute to our programme : Friday, September 16th, "A New Interpretation of Diabetes Mel-
litus in Obese Middle-Aged Persons, Cure by Reduction of Weight."
DR. T. C. ROUTLEY, Toronto, the General Secretary of the Canadian Medical Association, will attend the Annual Meeting.
He is accompanying Dr. K. A. MacKenzie on this Western tour and
will address the Official Luncheon on Friday, September 16th. Dr. Rout-
ley's frequent visits are much welcomed and appreciated.
DR. HOWARD A SPOHN of Vancouver, Chairman of the Committee of
Public Health of the British Columbia Medical Association, and
DR. C. E. DOLMAN, Head of the Department of Bacteriology and Preventive Medicine, University of British Columbia, will address the Official
Luncheon on Thursday, September 15th, when they will deal with the
Milk Situation from the viewpoint of Modern Medicine and the protection
of the health of our people.
♦ ^ ♦ ♦
At this Official Luncheon on Thursday, His Worship the Mayor of the
City of Victoria, and Dr. G. W. C. Bissett, President of the Victoria Medical
Society, will extend a welcome to the Provincial Association in Annual
Meeting.
Contributors to the programme of the Conference on Public Health on
Friday afternoon include Dr. Ethlyn Trapp, who will deal with Cancer organization ; Dr. W. H. Hatfield, Director of the Tuberculosis Division, and Dr.
D. H. Williams, Director of the Division of Venereal Disease Control, of the
Provincial Department of Health, and Dr. K. F. Brandon, Epidemiologist of
Metropolitan Health Board, Vancouver.
BRITISH COLUMBIA MEDICAL ASSOCIATION
FORTY-SIXTH ANNUAL MEETING
SEPTEMBER 15, 16, 17, 1938 |
EMPRESS HOTEL      -     VICTORIA, B. C.
Lectures by
DR. EDWIN GEORGE BANNICK, Seattle, Washington.
DR. A. T. BAZIN, Montreal, Professor Emeritus of Surgery, McGill University.
DR. WILLIAM BOYD, Toronto, Professor of Pathology, University of
Toronto.
DR. ALSON R. KILGORE, San Francisco, Associate Clinical Professor of
Surgery, University of California.
Page
%7o DR. HANS LISSER, San Francisco, Clinical Professor of Medicine, University of California.
DR. K. A. MACKENZIE, Halifax, Professor of Medicine and Clinical Medicine, Dalhousie University.
DR. L. H. NEWBURGH, Ann Arbor, Professor of Internal Medicine, University of Michigan Medical School.
Representatives of the Canadian Medical Association:
President: DR. K. A. MACKENZIE, Halifax.
General Secretary: DR. T. C. ROUTLEY, Toronto.  '
PROGRAMME
First Day—Thursday, September 15, 1938
9: 00 a.m.—LECTURES :
Dr. Hans Lissee : "Masculinizing Syndromes; A Consideration
Of Cushing's Disease; The Adrenal Cortical Syndrome,
and Arrhenoblastoma of the Ovary."
Dr. E. G. Bannick : "Acute Pancreatitis."
Dr. A. R. Kilgore :  "Diagnosis of Bone Lesions Suggesting
Tumour."
Dr. Hans Lisser : "Clinical Observations on the Present Status
of Gonadotropic and Sex Hormone Therapy."
Dr. W. J. Boyd : "Pathology of the Gall-Bladder.
12: 30 p.m.—OFFICIAL LUNCHEON:
Speakers: His Worship Mayor McGavin, Victoria.
Dr. G. W. C. Bissett, President, Victoria Medical
Society.
Dr. A. Howard Spohn.
Dr. C. E. Dolman.
2:30 p.m.—DEMONSTRATIONS  at Provincial Royal Jubilee Hospital..
(See special features.)
9: 00 p.m.—INFORMAL DANCE at the Empress Hotel.
Second Day-—Friday, September 16, 1938
9: 00 a.m.—LECTURES :
Dr. K. A. MacKenzie : "Treatment of Hypertension."
Dr. L. H. Newburgh : "A New Interpretation of Diabetes Mel-
litus in Obese Middle-aged Persons.  Cure by Reduction-
of Weight."
Dr. A. T. Bazin : "Cancer of the Breast."
Dr. A. R. Kilgore : "Extra-Abdominal Diseases Simulating the
Acute Abdomen."
Dr. W. J. Boyd : "Tumours of the Neck."
-LUNCHEON:
Speakers: Dr. K. A. MacKenzie, President, Canadian Medical
Association.
Dr. T. C. Routley, General Secretary, Canadian!
Medical Association.
-PUBLIC HEALTH CONFERENCE  (See special features).
CONFERENCE ON ECONOMICS (See special features).
-TEA at Butchart's Gardens.
-ANNUAL MEETINGS of the
College of Physicians and Surgeons of B. C,
to be followed by that of the
British Columbia Medical Association.
Every member of the medical profession is urged to attend.
these meetings.
Page 274
12:30 p.m.
2:00 p.m.
4: 30 p.m.
8:00 p.m. Third Day—Saturday, September 17, 1938
9: 00 a.m.— LECTURES :
Dr. Hans Lisser : "Indications for and the Proper Use of Thyroid Substance."
Dr. A. T. Bazin : "Cancer of the Colon and Rectum."
Dr. E. G. Bannick : "Medical Treatment of Severe Burns."
Dr. W. J. Boyd : "Bacterial Infection of the Heart."
Dr. A. R. Kilgore : "Practical Considerations in the Handling
of Acute Appendicitis and Its Complications."
12:15 p.m.—LUNCHEON: Board of Directors, British Columbia Medical
Association.
1: 30 p.m.—GOLF—Royal Colwood Golf Club.
7: 30 p.m.—ANNUAL DINNER of the British Columbia Medical Association.
BRITISH COLUMBIA MEDICAL ASSOCIATION
FORTY-SDCTH ANNUAL MEETING
SEPTEMBER 15th, 16th, i7th.
THURSDAY, FRIDAY, SATURDAY.
Our Colleagues and fellow-members in Victoria welcome you to
.your Annual Meeting.
Transportation
Reduced fares—Convention plan.
ft PLEASE NOTE
Purchase single fare one-way tickets on Convention Certificates for
your party—all must register.
Ask the ticket agent, he has them.
Good on Victoria boat and all trains.
SPECIAL I
Members from Vancouver and Lower Mainland must use
Convention Certificates to assure quota.
Buy one-way tickets with Certificate for whole party.
Ladies and all—they must register.
We must reach the QUOTA to assure fare and one-third
return rate for all.
Certificates must be validated in Victoria—agent in attendance.
HOTEL RESERVATIONS
Make them directly by letter or wire or let the office know your needs.
Please study your Programme and attend.
Scientific Sessions
LECTURES—Fifteen in all (five each morning).
Special Features
Jubilee Hospital—Thursday afternoon—Demonstrations.
Public Health Conference—Friday afternoon.
Economics Meeting—Friday afternoon.
LUNCHEONS—Thursday and Friday.
ANNUAL MEETINGS—Friday evening.
ANNUAL DINNER—Saturday.
Page 275 GOLF—Saturday. Return your post card. Register for transportation.
DANCE—Thursday evening.
GARDEN PARTY—"Benvenuto," Friday afternoon.  Register for transportation.
SPECIAL FEATURES
THURSDAY AFTERNOON, 2 : 30 o'clock—Jubilee Hospital.
(Register for transportation.)
Demonstrations of new equipment—Preparation of intravenous solutions.
Demonstrations—
Division of Venereal Disease Control: Motion picture of Treatment of
Syphilis.
Department of Radiology.
Department of Pathology.
Pavilion ward: Division of Tuberculosis Control.
FRIDAY AFTERNOON—following Luncheon.
Public Health Conference :
1. Cancer—introduced by Dr. Ethlyn Trapp.
2. Tuberculosis—introduced by Dr. W. H. Hatfield :
"Diagnosis and Differential Diagnosis."
3. Venereal Disease—introduced by Dr. D. H. Williams :'
"Syphilis and Pregnancy."
4. Streptococcal Fevers—introduced by Dr. K. F. Brandon.
FRIDAY AFTERNOON—following Luncheon.
Conference on Economics :
All may attend under Committee on Economics.
Dr. S. Cameron MacEwen, Chairman of Committee, presiding.
LADIES
Reports indicate a large attendance of Ladies. Let us hope that they will
always attend our Medical parties,—will always want to.
Thursday—The Dance.
Friday-—The Tea Party.
Saturday—The Ladies' Dinner.
All are requested to Register—Members and Ladies.
All are asked to visit Commercial Exhibits.
All will attend every function.
All will sign up for Transportation (whether driving or being driven).
All should make Reservations.
All should play Golf.
All should come.
All will buy single fare one-way tickets on Convention Certificate Plan*
This applies to Railways and Victoria boat.
THE LATE DR. GEORGE ARTHUR CHARTER
An Appreciation
The late Doctor Charter obtained his medical education in Edinburgh and
Glasgow. He was the son of the Reverend John Charter, a minister in the
north of England.
After doing duty in hospital in Scotland, he made a fine contribution in
the Mission field in China during fourteen years.
In 1920 Dr. Charter came to Canada and practised in Alberta, and later
in British Columbia at Williams Lake and at Alexis Creek in the Chilcotin.
In 1931 he went to Queen Charlotte City, where he served until very
recently. Dr. Charter and his wife, who predeceased him by a few months,
served faithfully and well. Of recent years neither enjoyed good health and
Page 276 -s.'KH ■    .  ; urnm      -   i i     \     n«M
Mrs. Charter was forced to give up her work as nurse-in-charge at the
Skidegate Inlet Hospital at Queen Charlotte.
These were two lives crowded full of service. Doctor Charter was possessed of those fine ideals and qualities which leave those who knew him well
a. memory of a fine medical gentleman. We regret his passing, and wish his
sons to realize that they have the sincere sympathy of their father's colleagues in their loss.
SOME SOCIAL AND ECONOMIC ASPECTS OF
1 HEALTH INSURANCE
Paul A. Dodd, Ph.D.
Assistant Professor of Economics,
University of California, Los Angeles.
Major political subdivisions of every civilized .nation throughout the
world, except the United States, are now operating extensive systems of
voluntary or compulsory health insurance. A national compulsory health
insurance system was introduced first in Germany in 1883, then in Austria
in 1888, Norway in 1909, Great Britain and Russia in 1911, Japan in 1922,
France in 1928, and Denmark in 1933.1 Recently in several of the neighbouring nations of South America, notably Argentine and Peru, either certain
forms of mandatory health insurance have been enacted, or serious official
study has been given to the problem, with every indication that soon constructive programmes will be initiated there also.
The latest name to be officially added to the list of those legislating such a
programme is that of the Province of British Columbia. Here, early in 1936,
after considerable study, a compulsory health insurance act was passed, the
first to be enacted on the American continent. This is not to mention other
states or nations, such as the neighbouring Province of Alberta, where certain other forms of health insurance are relieving society of much sacrifice
and many financial burdens.
There must be some real reason for individual action in this direction on
the part of so many world powers. Likewise, there must be some fundamental
reasons why the name of the United States is so conspicuously absent from
this imposing list. Only within the past three years has she awakened to the
appalling need for social legislation by enacting the federal Social Security
Act, a programme which now touches the lives of some 38,000,000 American
workers.
This recent legislation, however, has several major weaknesses, one of
the most important of which is that no provisions have been made for protecting the wage earner and his family against the undue economic and social
burdens brought on by illness. Why have some states lagged so far behind
the rest of the world in enacting this type of social legislation? Could it be
that medical science has conquered most of the serious ills of its citizens,
thus making sickness legislation unnecessary? Is it because the system of
the private practice of medicine provides adequate services to the destitute
who otherwise would have to go uncared for, and to the lower income groups
who seldom can afford to pay for all the services they need ? Or is it because
there is an abundance of the basic necessities of life for everyone, and thus
all are properly provided with medical, hospital, dental and other needs upon
which the individual worker and his family are so dependent?.
A searching inquiry into these questions is not possible within the limits,
of this paper. Our discussion, however, will attempt, first to summarize the
findings of recent investigations relative to the cost and adequacy of medical
care, and then to examine critically some of the more important economic
and financial problems that a constructive health insurance programme
entails. Thus two basic issues will be considered: first, how urgent is the
need for extending health services, and (assuming this need can be met best
Page 277 through an extensive health insurance plan) second, can we afford to initiate
such a scheme? Even though most of the factual material upon which this
paper is based has been taken from the United States, it seems apparent that
the broader principles involved are applicable to Canada and all other
communities where fundamental conditions are similar to those in the States.
Many investigations into the cost and adequacy of medical care have been
initiated during the past few years. Among those carried out in the United
States, several stand out pre-eminently as honest endeavours to discover the
true picture of actual conditions.* Without exception objective study has presented several significant facts. One relates to the cost of illness to the nation's
wage-earners. The economic and social costs of illness throughout the nation
are stupendous, amounting to approximately ten billion dollars annually—
equivalent to some 12 to 15 per cent of the total national income.2 This total
loss includes the combined costs of health services and medical care, loss of
wages through disability, and the loss of potential future income through
premature death. Every year seventy million sick people lose over a billion
days from work or other customary activities.3 About half of this period
involves loss of work because of illness, and is shared by three broad age
groups. Persons between the productive ages of 15 and 64 years, inclusive,
are disabled on the average of nine days each year. Those under 15 years
experienc an average of six days of disability annually; those 65 or over are
disabled almost thirty-three days each year.4
Another important fact is that under a system of private practice, as it is
found in the United States, basic medical facilities are unevenly distributed.
Many different agencies help to make up the total medical facilities afforded
to the population of a given community. In some districts no hospitals, clinics
or health agencies exist; in certain localities practically no medical services
are available. In others many costly facilities and much elaborate equipment
are wastefully duplicated at considerable social loss, and the patient usually
is expected to pay the bill for these extravagant circumstances. A public
health official of one of the western states has emphasized the pitiful need
for^a better distribution of facilities and services in reporting the following:
"Many of our families live twenty miles or more from the nearest physician. Under the present system, the doctor charges one dollar per mile for
country calls. It is possible that a socialized system could be devised which
would reduce the cost of calls into the country, but under any system each
call would mean many dollars. And today adequate care means several calls.
Twenty years ago the doctor might call once and pronounce pneumonia, and
that single visit might be considered adequate enough. But today the sputum
must be "typed," the appropriate serum selected and administered. Perhaps
the next day more serum will be required. Oxygen may be needed, and a
skilled attendant to administer the oxygen. To provide such service at twenty
miles from our base will cost, under any system, well into three figures. . . ."5
The uneven distribution of facilities is further illustrated by the fact that
in California alone there is an average of one doctor of medicine for every
677 persons, in contrast to one for every 1,431 in South Carolina, one for
every 1,490 in England, one for every 1,690 in France, and one for every 2,890
in Sweden.6 Yet within the boundary lines of California will be found many
extremes in distribution. Within them are two large and sparsely populated
counties—Eldorado and Imperial—containing one doctor of medicine for
every 2,112 and 1,924 persons respectively. In Los Angeles and San Francisco
Counties the ratios are 1 to 610 and 1 to 424 respectively.7 This is not to mention equally significant maldistributions found among dentists, hospitals,
* The major studies referred to here are The Committee on the Cost of Medical Care Study, 1929-1932; the California Medical-Economic Survey, 1934-1938;
The W. P. A. Study on the Effect of the Depression upon Health, conducted by
Margaret C. Klem, 1935; The National Health Survey, 1935-1936; and the study
of the Technical Committee on Medical Care, a governmental report released
in 1938.
Page 278 public health organizations, laboratory equipment and other health service
facilities.
A third generally accepted fact relates to the adequacy of medical care*
among the population. Even though there exist numerous standards of
"adequacy"! there is at last common agreement (even among the most conservative) on the proposition that medical care throughout the United States,
as offered under the traditional practice of private medicine, is far from
adequate. The general conclusions of scientific investigation in this regard
are:8
1. Millions of people cannot afford—and so do not obtain—the care they
need.
2. The need for medical services at any given time varies inversely with
the family income, and offers a far more serious problem among the
low-income groups than among the higher income groups.
3. The relationship between those who need treatment and those who
receive needed treatment varies inversely with family income.
4. The "free" services dedicated to the "very poor and destitute" (even if
all unpaid services privately given are included) are but a small fraction of the amount necessary under any civilized definition of "adequate" and "very poor."$
In other words, the fact that many people simply do not receive the care
they need because they cannot pay for it has been established beyond the
fear of successful contradiction.
TABLET.
THE REPORTED NEED FOR AND RECEIPT' OF MEDICAL, CARE
ON DATE OF FAMILY INTERVIEW.
Distribution of Persons Needing and Receiving Medical Care, Based on Records
for 60,033 Persons in 18,430 California "White Families of Known
1933 Income and Known Community.
Percentage of Persons Reported in Need of Medical Care Who Were Receiving It.
All Com-           Under             5,000 to          100,000 to       1,000,000
 munities 5,000 99,999 999,999 and over
Summary:
All incomes  58.1 51.9 60.0 64.6 55.0
Under $3.000  56.1 51.6 57.6 62.3 52.3
Over   $3,000  81.8 §1A 83.6 88.6 80.3
Under   $499  44.1 37.5 45.8 46.3 46.2
$      500  to   $    999.. 51.5 48.5 52.9 57.2 47.4
1,000  to     1,999.. 59.9 55.0 59.7 66.5 59.3
1,200  to     1,499- 61.0 58.9 64.8 67.8 52.5
1,500  to     1,999- 66,1 67.5 69.1 70.6 55.3
2,000  to     2,999.. 71.2 70.5 71.1 76.7 67.2
3,000  to     4,999- 78.7 66.7 79.2 85.6 76.9
5,000  to     9,999.. 86,1 38.5 88.4 95.1 88.6
10,000  and over.. 90.4 100.0 92J[ 100.0 85.7
Source: California Medical-Economic Survey.
In California, for example, we have found that almost 15 per cent of the
entire population is in need of medical care at any given time—but only 9
per cent actually receives the care it needs. This means that at the present
time in that state there are more than 325,000 persons who are not getting
the care they need—cases sufficient to provide each licensed doctor with
almost 40 new patients.9 And the need for dental care is even more serious.
Of greater significance in this connection, however, is the relationship
between income and the receipt of care. (See Table I.) Without fail, all
investigations touching upon this phase of the problem prove that the unmet
* Medical care as herein used refers to services of doctors, surgeons, dentists,
hospitals, fitting of glasses, drugs, and all other activities relating to the health
of the patient or person.
t See, for instance, this concept as discussed in Dodd and Penrose, Op. Cit.,
pp. 13-17.
% Services are "adequate" in the sense meant here if, but only if, they are
acce^sible-ajid-available at need in the amount and variety necessary to minimize avoidable prospective damage to the person ofthe patient/" A family is
"very poor" in the sense meant here if~TFcalTnot pay"for "adequate" medical
care without endangering the health of its members bv reason of impairment
of the services of shelter, clothing and food.
Page 279 need is most pressing among families with low incomes, and least so among
those with high incomes. Many persons living in families with low income
groups cannot afford necessary care.
Why, we may inquire, cannot these people purchase adequate medical
care? Most of them are usually able to buy the other necessities of life—
why not those maintaining life itself? The answer to this simple but perplexing question is likewise both simple and perplexing. It is not complicated
in so far as we may answer that the problem of medical costs is not one of
average but rather unpredictable costs. The "average" person in California
spends only $25 each year for medicine, hospital care, and the services of
doctor and dentist: the "average" family spends only $80 for these necessities
during the year. For the "average" family, surely .these "average" expenditures cannot be considered overburdensome.
But our answer is profoundly complex because it is not .one of "average
costs." The fundamental problem that each family faces is rfoe of the unpredictability of illness losses. Medical charges fall without warning and with
great unevenness upon families in all income groups. Almost one-fourth of
all families in the United States incur no medical charges during the course
of a year : this means that the remaining three-fourths must shoulder all the
charges. During 1933 in California one family out of eight, on the average,
experienced medical charges ranging from $100 to $200. (See Table II.)
.One out of nineteen incurred charges of from $400 to $500, and one in every
forty-five was charged from $500 to $1,000 for services during the year. In
fact, one family out of every 125 experienced charges of $1,000 or more, an
amount almost equal to the average wage-earner's income and considerably
above the earnings of 40 per cent of the families within the state.10
TABLE II.
VARIATIONS IN COSTS OF MEDICAL CARE TO CALIFORNIA FAMILIES FOR THE YEAR
SEPTEMBER 1, 1933, TO SEPTEMBER 1, 1934, BY 1933 FAMILY INCOME.
Percentage Distributions of Families According to Charges Incurred for All Medical and Dental
Care Between September 1, 1933, and September 1, 1934; Based on Records for 18,317 White
Families of Known 1933 Income and Known Community, Surveyed Once Between
October 1 and February 1, 1935.
 FAMILY INCOME	
Total Annual       All       Under    500-    1,000-   1,200-   1,500-   2,000-   2,500-   3,000-   5,000-    10,000
Family Chargeslncomes      500        999      1,199    1.499     1.99.9    2.499     2,999    4,999    9,999    & over
Number of
Families      18,317       2,772    4,308     2,195     2,357    2,495     1,500        804     1,135        513        237
Percentage of
Families        100.0       100.0     100.0    100.0     100.0     100.0     100.0     100.0     100.0     100.0     100.0
None     23.8 41.3 30.7 24.1 19.4 16.4 14.0 13.2 10.0 11.5 6.8
Under   $10  8.5 13.8 11.5 8.7 8.0 6.4 4.8 3.5 2.9 1.4 .8
$      10 to $  19.99 11.4 12.5 13.9 12.6 11.9 10.5 9.9 9.4 6.2 3.3 4.2
20 to      39.99 15.0 12.3 15.5 16.5 16.9 16.9 15.0 14.3 13.2 8.6 7.6
40 to      59.99 10.0 6.4 8.5 11.2 11.3 12.0 12.1 11.9 12.4 9.2 6.7
60 to      99.99 7.8 4.8 6.2 8.2 8.7 9.6 10.3 9.5 9.7 8.0 4.2
100 to    199.99 12.1 5.3 8.2 10.7 13.6 15.1 17.2 17.5 19.8 20.3 21.1
200 to   299.99 5.2 2.2 2.9 4.1 5.2 5.9 6.9 7.7 10.0 16.0 16.9
300 to   499.99 3.2 .6 1.7 2.5 3.0 4.0 4.7 6.5 7.5 9.0 11.0
500 to   999.99 2.2 .6 .8 1.0 1.5 2.6 2.9 5.1 6.3 8.6 13.1
1,000 and over .8 .2 .1 .4 .5 .6 2.2 1.4 2.0 4.1 7.6
Source: California Medical-Economic Survey.
The course of action taken by the family when serious accident or illness
overtakes one of its members is well known to everyone—perhaps best of all
to the social case worker. No service but the best will do at any price; and
not until the family receives the charges and plans for payment does it begin
to appreciate fully the financial burden involved in meeting illness costs out
of the family income. When the patient happens to be the bread-earner the
illness often causes a double loss; since with the receipt of medical bills
usually comes a reduced pay-cheque because of wages lost during disability.
Investigations have also revealed interesting relationships between family
income trends and medical costs. Since the broad characteristics of the distribution and shift of family incomes are known to most students of social
problems, they need not be reviewed here. Recent studies have demonstrated
Page 280 r^?&Jg^3Sftt!G«iSimz&ktiXrw^tt&&±+
that depression periods add greatly to the numbers and percentages of families whose incomes fall within the lowest income groups, and that these
numbers, as might be expected, decrease as recovery and prosperity set in.
(See Table III.)
TABLE III.
INCOMES OF WHITE FAMILIES IN CALIFORNIA BY EACH YEAR,  1929 TO 1935.
Percentage Distributions of Families Reporting Incomes for Both 1929 and 1933,
by Income Class and Year, 1929 to 1933; Based on Records for 17,769 Families.
 Percent _^ Cumulative Percent	
1929        1930        1931        1932        1933
Number of 1929        1930        1931        1932        1933
Families 17,769     17,748     17,738    17,732     17,769        17,869     17,748     17,738     17,732    17,769
Percent of
Families    100.0       100.0       100.0       100.0       100.0
Under  $500  776 8.9 1L4 14.3 1572 776 S~79 lO 1473 1572
$      500 - $    999 13.4 15.6 18.4 21.2 23.3 21.0 24.5 29.8 35.5 38.5
1,000  -     1,999 10.6 11.9 12.9 12.6 11.9 31.6 36.4 42.7 48.1 50.4
1,200  -    1,499 12.3 12.8 12.9 12.8 12.8 43.9 49.2 55.6 60.9 63.2
1,500 -     1,999 15.6 15.5 14.6 13.8 13.6 59.5 64.7 70.2 74.7 76.8
2,000  -     2,499 13.6 12.3 10.5 9.2 8.2 73.1 77.0 80.7 83.9 85.0
2,500 -    2,999 7.7 6.6 5.8 4.7 4.5 80.8 83.6 86.5 88.6 89.5
3,000 -     3,499 4.5 4.5 3.8 3.1 2.8 85.3 • 88.1 90.3 91.7 92.3
3,500  -    4,999 6.3 5.3 4.4 3.8 3.6 91.6 93.4 94.7 95.5 95.9
5,000  -     6,999 3.8 3.1 2.6 2.1 1.9 95.4 96.5 97.3 97.6 97.8
7,000 -    9,999 1.7 1.4 1.0 0.9 0.9 97.1 97.9 98.3 98.5 98.7
10,000 and over 2.9 2.1 1.7 1.5 1.3 100.0 100.0 100.0 100.0 100.0
But many are not aware of a fundamental characteristic of the family
income picture. It is that the total number (and percentage) of families
falling within the mhidle^mcomeeroiips—between $500 and $2,500—change
but little, in fact, almost remain the same from year to year regardless of the
condition of business.11 This is of considerable importance to any study of
the problem of medical costs, inasmuch as outside those within the poverty-
stricken groups, who are completely dependent upon charity or state aid
during illness, the major classes affected are within these medium income
groups. (Tn numbers they continue to make up, whether in depression or
prosperity, by far the majority of the citizens of any state.tThe total number
of families in California with incomes ranging between $500 and $2,500 per
year was only 5% more during the depth of the depression in 1933 than it
was at the height of prosperity in 1929. In other words, medical costs under
private practice is a permanent problem for a vast majority of the population.
Another consideration, too often overlooked in an appraisal of medical
care, has reference to the status of the doctor himself. For him private
practice creates a real economic problem. Under this system, not only is he
expected to extend free services generously, but also is he called upon to
scale down charges and write off many accounts as uncollectable. Moreover,
his professional income is unsteady and many times totally inadequate. In
1929 the average net professional income of California doctors of medicine
was approximately $6,700; in 1930 it was less than $6,000; in 1933 it had
dropped to $3,600.
But average incomes do not portray accurately the earnings of individual
members of the profession. A study of the distribution of net incomes of
doctors of medicine shows that almost one-eighth of the total received net
professional incomes of less than $1,000 each during 1933 ; one-third received
less than $2,000; one-half less than $3,000; and tivo-th irds less than $4,000.
Recovery during the past five years has brought with it an upward trend in
these figures, but still they are surprisingly low for the majority of doctors.
They are even more so for dentists and other practitioners.
This is a glimpse into a small corner of a topsy-turvy world. Under the
system of the private practice of medicine, on the one hand, will be found
hundreds of thousands of deserving people going without the care they need;
on the other are thousands of well-trained doctors and other practitioners,
eager to serve, and in need of more practice and larger incomes. Yet these
two groups, throughout the years, have not been able to profit by each other's
Page 281 presence.   From this results untold human sacrifice and great social loss.
But this is not all: in addition, the medical profession is called upon to
care for thousands of others who cannot pay for emergency treatment they
need. Neither the grocery man nor the shoe store man are expected to deliver
goods from their shelves free to the destitute or the hungry. Why should the
doctor be expected to provide them with free medical services?
Individual medical costs depend in no small way upon the extent to which
public health services are developed and maintained. In the United States
there still remains much to be desired within this field. The cost of illness
presents, as we have seen, a staggering figure, and the spread of preventive
medicine offers a sound way of reducing many of these costs. The past few
years have witnessed the march of medical science into numerous fields of
progress. In the United States the death rate per thousand population has
dropped from 17.6 in 1900 to 11.5 in 1936.12 The span of life is gradually
growing longer and longer. Encouraging inroads have been made upon such
diseases as yellow fever, typhoid fever, diarrhcea, tuperculosis and diphtheria.
But no significant changes have occurred in life expectancy covered during
middle and old age; mortality resulting from certain chronic and organic
diseases,, such as cancer, diabetes and heart trouble, has increased at an
alarming pace.
There is also felt a genuine need for the expansion of maternal and child
health services. Experts state that the death rate of newborn children during
the first month of life can be cut in half.13  From among the children born
into two million homes each year throughout the United States, 69,000 die
during the. first month, and fully 80 per cent of these deaths are caused by
prenatal conditions. Over 35,000 children are left motherless annually. Each
year some 200,000 births occur in families residing over 30 miles from a
hospital. Some 4 out of every 10 illnesses among children under 16 years of
age are the direct results of infectious diseases, and 4 more are due to acute
respiratory diseases.14   There are now encouraging evidences that in a
majority of the cases of lobar pneumonia, fatality can be reduced by as much
as one-half through the skilful use of serum treatment.15  Over 500,000 new
syphilis and over 1,000,000 gonorrhoea patients seek treatment each year;
still 50,000 deaths occur annually, 85 per cent of which could be saved by
proper treatment.  No one knows how many others do not seek treatment
because of medical cost barriers.
II.
A further review of conditions seems entirely out of place, especially
before professional people who come in constant daily contact with an endless
number of cases emphasizing actual conditions. So far our analysis can point
toward but one direction. There is an urgent need present today for extending health services. What are some of the more practical problems that one
may expect to encounter in an attempted solution? Can we afford a health
insurance programme?
Compulsory health insurance seems to offer the possibility of wisest
solution, not because such a scheme offers a "cure-all" for the ills that have
been reviewed, but rather because it offers what appears to be the soundest
method yet designed of approaching the difficulties present in our system.
Schemes involving the application of the insurance principle to the costs of
illness, either upon a voluntary or a compulsory basis, must be meeting—at
least to a better degree than the system of private practice—the basic fcealth
needs of numerous different populations. Otherwise it would be difficult to
explain the change from private practice and the constant extension of the
various health schemes in other parts of the world. A plan of health insurance would insure reasonable fees to the practitioner for practically all of
his services, and at the same time would release a large potential demand
which is constantly,withheld because of the public's inability to buy all the
services needed. It would assure certain hospital institutions of revenues,
and would bring a greater demand for their facilities by enabling a larger
Page 282 :ci3£«w5»tfyu3eK«a:c*;"s.^i
number of people to purchase needed hospital care. Budgeting the uncertain
costs of illness would best meet the existing needs for health services among
low income groups. Health insurance offers the best method known of
insuring against such large and uncertain losses. No means of applying the
pooling principle short of compulsion is known that will assure a more easily
supportable spread of loss. A compulsory health insurance system would
place great emphasis upon preventive as well as curative practice, and would
promote close co-operation between medical practice and public health work.
No authority less powerful than the State can deal effectively with this
grave problem of public health and welfare. Those who need protection
against the costs of illness most are the last who will enter a voluntary
scheme.
III.
Analysis of the problem is not complete for those who arrive at these conclusions. A plan must be practical to be acceptable, even though it may
sound attractive in theory. What of the difficulties that must be anticipated
in initiating a compulsory health insurance programme? Is such a plan
feasible? Can it be financed properly?
In an approach to health insurance one must not be unmindful of the
presence of many serious economic problems. They are bound to arise, even
within the most carefully worked out plan.
But they have not proven to be insurmountable in the case of other
nations; why should they be so here ? A beginning has to be made sometime.
Health insurance plans now starting or soon to be started have a great
advantage over the schemes of Germany and England, since schemes currently formed can draw on the actuarial experience and records of many
older plans. Yet there can be no doubt but that we should proceed cautiously
under a new programme. At the same time, it is important to remember that
the longer the initiation of a constructive scheme is delayed, the more difficult
will be its inevitable launching. The genuine need, which we have just seen
exists, is bound to be met more and more by temporary makeshift programmes
until a well-conceived centralized programme is formulated and launched.
Numerous estimates made in recent years indicate that from 4 toJ5^_per
cent of the total family budget is spent for medical services. We have seen
how this amount under private practice does not provide adequate care. But
this jumount might well serve as a starting point. A considerable volume of
data has been accumulated during recent years in the United States showing
that reputedly high quality basic medical services, including surgery, hospitalization, drugs, x-ray therapy and obstetrics, can be afforded upon a
voluntary health insurance basis for approximately $2.50 per person per
montfc>Granting that the amount of preventive medicine afforded at this price
is still questionable, there are nevertheless sound reasons for believing that if
everyone within a community were to contribute this amount periodically
each month, present medical agencies would actually enjoy a larger income
than they now receive under private practice.
But the problem is actually not so simple as this observation might make
it appear. Social workers will be quick to testify that for many people—
for most of those within the lower income groups—this price would be far
too dear. For the man who is striving to support a wife and four children
on an income of even $100 per month, a total of $15 monthly for medical care
would be an impossible burden. Again, to the man with an income of $1,000
per month, the $10 or $15 spent under this system for medical care probably
would not be missed.
This consideration leads to the conclusion that certain principles should
be incorporated into the insurance plan if it is to most nearly meet the needs
of the vast majority successfully. First, it seems imperative that the financial
burden of such a plan be lightened for all those within the lower income
* See estimates made by the California Medical-Economic Survey, and other
similar studies.
Page 283 groups, and that it be increased for many of those who are quite able to pay
more for the services rendered. This, in a sense, is not far different from
conditions operating under the present system of private practice. Yet there
is present a fundamental distinction between the plans. Under private practice the "average" family in destitute financial circumstances pays practically
nothing at all for the care that it receives (although, as we have seen, there
is much needed care that it completely foregoes). Furthermore, the "average"
family in lower income groups—those whose family incomes are approximately $1,200 to $1,500 yearly—pay more than those in the lowest groups,
but considerably less than those within the higher income groups. The fundamental distinction, however, is that under private practice the burden of
medical costs falls unexpectedly and unevenly upon the shoulders of persons
in all income classifications, and under health insurance these uncertain
burdens are guarded against by means of substituting for them small but
certain losses, so that the costs become definite and budgetable. This is, in
fact, the essence of the insurance principle.
The problem of medical costs is not one faced by the well-to-do; it is
experienced by persons in families whose total family incomes are only
modest, or are meagre or totally inadequate. In the practical application of
such a scheme, several parties stand to bear the brunt of its cost. Medical
needs of the destitute and unemployed are among the greatest, yet these
persons are least able to pay the price of service. For these the state should
be expected to contribute—paying into the insurance pool sufficient funds to
cover the cost of providing adequate basic services for its unfortunate citizens. This cost has to be met in some way even under a system of private
practice, unless the poverty-stricken are allowed or forced to go without.
Under the medical system as practiced in the United States the public is
spending out of the general tax funds enormous sums to support hospitals,
sanatoriums, clinics and other health agencies whose work is largely devoted
to this class of citizens. Is there reason to believe that the cost would be
greater if this work were to be efficiently centralized under a compulsory
health insurance programme? Would it not be logical to assume that great
economies could and would be effected which would permit the further
extension of health services so badly needed among these people at the same
—or even at a lower—total tax cost? Many careful estimates have been
made indicating the probability of large reductions in the total cost of health
services to the community.16
For those who are gainfully employed, the burdens of a compulsory health
insurance scheme should actually be lessened; certainly, over the long run,
they should not increase unless the quality and quantity were to be increased
materially. There is sound economic reason for contending that employers
should share the expense of such a service with their employees. If this were
done, this added tax would be passed on eventually to the consumer as a
part of the cost of production. In so far as loss due to illness results from
an occupational illness, or sickness contracted while on duty because of
exposure to disease, the cost resulting therefrom is a valid charge against
the employer, and as such could be passed on by him to the consumer. If a
tax—let us say, of 2 per cent—were to be imposed upon the employer, certain competitive or trade hardships might be experienced until full, adjustments were effected. But at times industry has to face the problem of increasing costs daily, and this charge should not be any more impossible to assume
than any other of the current mounting costs. In the end it would promise
to reduce the producer's costs, because it should provide him with healthier
and less worried workers.
The health insurance premium paid by the worker himself, to be sure,
would be a fixed and certain cost so long as he remained a party to the plan.
But it would be small—probably not more than 2 per cent of his pay-cheque—
and in the long run would not average as much as he is paying under private
practice.  Of great importance to the worker, it would bring to him and to
Page 284 -.K3tsj««3swiss;.-.-":.«...!
his family real relief by means of less suffering, better health and greater
economic and social security. .
Experience is constantly demonstrating the importance of providing cash
benefits along with medical benefits wherever they can be afforded. This
problem has been forcing its way to the front in the United States during
the past few months in connection with the administration' of unemployment
benefits. Most state unemployment compensation laws provide that a person,
in order to qualify for the receipt of unemployment compensation, among
other things, must be "capable of, and available for work." The courts have
recently ruled that an unemployed wage-earner meeting the qualifications
may receive compensation as long as he remains well, but when he becomes
sick he no longer is capable of and available for work. Therefore his payments
stop—at the very time when he needs money most—until he becomes well
again within the period of qualification. This need for change cannot go
unattended indefinitely, and at present it is proving to be a source of considerable encouragement among students of social insurance who are anxious
to see the Federal Social Security Act properly rounded out with a constructive health insurance programme. No one can doubt but that the handwriting
is on the wall; that health insurance even in the United States is both imminent and inevitable.
Neither time nor personal experience will permit a discussion of the many
practical problems relating to the payment for services rendered and the
determination and administration of benefits. We should have confidence
enough in human ability to believe that these problems are not at all insuperable, and that they can and will be worked out in various parts of the United
States some time in the near future, 'in certain respects the basic problems
involved in initiating and administering a health insurance programme are
less complex and those confronted in some other types of social insurance,
chiefly unemployment compensation and old age benefits. In each of the
latter two types of "insurance" the ability to meet the contractual obligation
—that is, to pay unemployment compensation benefits or old age pension—
is dependent upon the accumulation of a reserve fund during relatively long
periods of employment, and then of liquidating these funds during the months
of unemployment or years of old age when benefits aer paid. No so, however,
with health insurance. Morbidity rates are as certain and reliable as mortality :eates, although, to be sure, they are oftentimes more difficult to determine.' All the reserve needed to insure the successful financing of a compulsory health insurance programme is enough to guarantee the proper payment
for benefits currently offered. Once set in motion, the scheme can feed itself
indefinitely as long as receipts and benefit costs remain equal.
In conclusion, we return once again to our two original questions. To the
first, inquiring into the need for the extension of health services, has come
an undeniable statement that there exists urgent need for extending the
system of medical practice, in order to bring more and better health care_tp^
millions of men, women and children in families within the lower income
groups, and to promote preventive as well as remedial medical practice. To
the second question, a query as to whether a health insurance scheme can
be afforded, we have replied in essence "Why not?" Without such a scheme
we pay more and receive considerably less.
BIBLIOGRAPHY.
Reed, Louis S., Health Insurance, 1937, p. 208.
Interdepartmental Committee to Co-ordinate Health and Welfare Activities, Revort of the Technical Committee on Medical Care, Washington,
D.C., 1938.
Technical Committee on Medical Care, The Need for a National Health
Programme, p. 1.
United States Department of Labor, "National Health Survey, 1935-36,"
Monthly Labor Review, March, 1938, p. 668.
Lake, Esther Everett, The Health of the Nation, The American Foundation Studies in Government, 1937, (reprint) pp. 466-467.
Page 285
r$3J
1.
9
3.
4.
o. 6. Dodd, Paul A., and Penrose, E. F., Economic Aspects of Medical Practice
and Public Health in California, 1938, pp. 22-24 (unpublished).
7. Dodd, Paul A., California Medical-Economic Survey, California Medical
Association, November, 1937, p. 7.
8. Summarized in Ibid, pp. 88-90.
9. Dodd, Paul A., California Medical Economic Survey, op. cit., pp. 34-37.
10. Ibid, p. 21.
11. Also see the shift of incomes among families in California: California
Medical-Economic Survey, op. cit., pp. 52-53.
12. Technical Committee on Medical Care, "The Need for a National Health
Programme," op. cit., p. 3.
13. Ibid.
14. Ibid.
15. Ibid, p. 13.
16. cf. Study made by the Committee on Health Insurance, Victoria, B. C,
1935.
INDEX TO VOL. XIV.
Page
ADAMSON, J. D., M.D.—Blood Sedimentation Rate Supp.    19
Chronic Respiratory Sepsis Supp.       8
Treatment of Chronic Constipation Supp.    31
ANAEMIA, SOME NEWER CONCEPTS REGARDING—
G. A. McCurdy, M.D  260
APPLEBY, LYON H., M.D.—Quo Vadis, Medicina?  155
ARTHRITIS, CHRONIC—Leonard Rowntree, M.D       9
ARTHRITIS, SURGICAL TREATMENT OF—Paul B. Magnuson, M.D     11
BILIARY SURGERY, PROBLEMS IN—M. R. MacCharles, M.D Supp.     11
BONE CHIPS, FUSION OF SPINE WITH—M. O. Henry, M.D Supp.     17
BOYD, WM. E., M.D.—Pathology of Carcinoma of Breast  137
BLOOD SEDIMENTATION RATE]—J. D. Adamson, M.D Supp.     19
BREAST, CANCER OF, SYMPOSIUM—Drs. Boyd, Trueblood and Harrison 137
BREAST, CONDITIONS OTHER THAN CANCER—D. V. Trueblood, M.D.  243
BRITISH COLUMBIA MEDICAL ASSOCIATION 55,  106, 205
Annual Meeting, 1937  5
Cancer  Committee  87, 99, 168
Committee on Public Health  130
BRUNN, HAROLD,  M.D.—Cancer of the Colon  14
Empyema and Interlobar Empyema  58
I/Unsr .Abscess SS
CANADIAN MEDICAL ASSOCIATION,  j^^RA^56^IS^i^^3S-^ 17°
Cancer Control Programme.. 231, 254
COLON, CANCER OF—Harold Brunn, M.D  14
COLON, DIVERTICULA OF—M. R. MacCharles,  M.D Supp.     46
CLEMENT, G. H., M.D.—Retiring President's Remarks  203
CLEVELAND, D. E. H., M.D.—Kipling and  the Doctors  115
Sunlight and the Skin   132
COLLEGE OF PHYSICIANS AND SURGEONS OF B. C—-Notes....  53,  182,  205
CONDITIONED REFLEXES IN RELATION TO CLINICAL MEDICINE—
A. Howard Spohn, M.D     29
CREASE, A. L., M.D.—Psycho-Neuroses     79
CONSTIPATION, TREATMENT OF CHRONIC—
J. D. Adamson, M.D Supp.    31
DAVIDSON, G. A., M.D.—Mental Disorders     78
DAVES, H. R. L., M.D.—Traumatic Enucleation of Fibroma     42
DEODORANT PADS—Daniel McLellan, M.D     43
DODD, PAUL A.—Some Social and Economic Aspects of Health Insurance 277
EDITORIALS   2, 26, 48, 100,  125, 148, 174, 194,  221, 247,  268
EMPYEMA AND INTERLOBAR EMPYEMA—Harold Brunn, M.D     58
FEMUR, FRACTURES" OF NECK OF—Paul B. Magnuson, M.D  140
FIBROMA, TRAUMATIC ENUCLEATION OF: Case Report—
H.  R.  L. Davis,  M.D     42
FROST, GARDINER, M.D.—Pregnancy and Hypertension  254
GEE, EVELYN, M.D.—Physiology of the Ldver and Gail-Bladder  183
GORDON, BURGESS, M.D.—Obesity Supp.    38
GYNAECOLOGICAL ENDOCRINOLOGY: Summary of the Round-
Table Conference—W. N. Kemp, M.D Supp.    54
HARRISON, B. J., M.D.—Radiation in the Treatment of Carcinoma
of the Breast  139
Page 286 INDEX TO VOL. XIV.—Continued
HEALTH INSURANCE: j
FINANCIAL IMPLICATIONS IN COMPULSORY—Hugh H. Wolfenden !
SOME SOCIAL AND ECONOMIC ASPECTS OF—Paul A. Dodd, Ph.D... !
HEALTH   WEEK  ;
HENRY, M. O., M.D.—Fusion of Spine with Bone Chips Supp.
Surgical Treatment of Fractures of the Hip....Supp.
HAEMATOLOGY, RECENT ADVANCES IN—E. E. Osgbdd, M.D Supp.
HIP, SURGICAL TREATMENT OF FRACTURES OF—
M. O. Henry, M.D Supp.
HODGKINS DISEASE: Case Report—W. D. Keith, M.D	
HYPERTENSION AND ITS MANAGEMENT—Leonard Rowntree, M.D	
INTESTINAL OBSTRUCTION—W. L. Pedlow, M.D	
KEITH, W. D., M.D.—Hodgkins Disease	
KEMP, W. N., M.D.—Sources and Clinical Importance of
the Vitamins  67, 92,
KIPLING AND THE DOCTORS—D. E. H. Cleveland, M.D	
LIVER AND GALL-BLADDER, PATHOLOGY OF DISEASES OF—
H. H. Pitts, M.D	
LIVER AND GALL-BLADDER, PHYSIOLOGY OF—Evelyn Gee, M.D	
LUNG ABSCESSES—Harold Brunn, M.D	
MACCHARLES, G. A., M.D.—Diverticula of the Colon Supp.
Problems of Biliary Surgery Supp.
MACCURDY, G. A., M.D.—Some Newer Concepts Regarding the Anaemias
McLELLAN, D., M.D.—Deodorant Pads	
MAGNUSON, PAUL B., M.D.—Surgical Treatment of Arthritis	
MEDICAL ASSOCIATION MEETINGS—
Upper Island Medical Association	
West Kootenay Medical Association	
MEDICAL RELIEF REGULATIONS	
MEMBERSHIP LIST OF LOCAL MEDICAL SOCIETIES   105,  130,
MENTAL CONDITIONS: SYMPOSIUM—Drs. Murray, Davidson,
Crease and Ryan	
MURRAY, S. STEWART, M.D.—Mental Conditions in Children	
NEUROTIC PATIENTS, CARE OF—M. R. Rees and E. G. Billings	
OBITUARIES—
ACHESON,  T.  C	
CARDER,  E.  D	
HAMILTON, J. H	
LARGE,  J.   McK	
PATTERSON,   F.   P	
OBESITY—Burgess Gordon, M.D Supp.
OSGOOD, E. E., M.D.—Hypertensive Cardio-Vascular Renal
Disease  Supp.
Recent Advances in Haematology Supp.
Therapeutic  Thinking Supp.
OSLER LECTURE—L. H. Appleby, M.D	
PEDLOW, W. D., M.D.—Intestinal Obstruction	
PITTS, H. H, M.D.—Pathology of Diseases of the Diver and Gall-Bladder
PREGNANCY AND HYPERTENSION—A. C.  G. Frost, M.D	
QUO VADIS, MEDICINA?..—Lyon H. Appleby, M.D	
ROWNTREE,  LEONARD,  M.D.—Chronic  Arthritis	
Hypertension and Its Management	
RENAL DISEASE, HYPERTENSIVE CARDIOVASCULAR—
E. E. Osgood, M.D Supp.
RESPIRATORY SEPSIS—J. D. Adamson, M.D Supp.
RYAN, E. J., M.D.—Theatment of Mental Disorders	
SPOHN, A. HOWARD, M.D.—Conditional Reflexes in Relation to Medicine
SUMMER SCHOOL,  JUNE,  1938	
SUNLIGHT AND THE SKIN—D. E. H. Cleveland, M.D	
THERAPEUTIC   THINKING—E.  E.   Osgood,   M.D	
TRUEBLOOD, DONALD V., M.D.—Conditions of the Breath, other than
Carcinoma  	
Surgical Treatment of Carcinoma of
the Breast	
VANCOUVER GENERAL HOSPITAL, LABORATORY	
VANCOUVER MEDICAL ASSOCIATION, ANNUAL DINNER	
ANNUAL  MEETING	
VENEREAL DISEASE, CONTROL DIVISION, AIMS AND OBJECTS	
VITAMINS, SOURCES AND CLINICAL IMPORTANCE—
W. N. Kemp, M.D   67,  92,
WOLFENDEN, H. H.—Financial Implications of Compulsory
Health Insurance	
243
Page 287 BRITISH COLUMBIA
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The effectiveness of Kellogg's All-
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not digest, but provides an ideally
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In addition, All-Bran furnishes a
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Also as a source of iron, All-Bran is
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These contributions by Kellogg's
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In tablets each grs. 7%, for
oral use.
SOLUSEPTAZINE
contains the p-aminophenyl sulphonamide in the most concentrated form
available.
A Colourless solution; will not cause
any colouration of the skin or
mucous membranes.
In ampoules of 5 cc. and 10 cc. for
intravenous or intramuscular
injection.
SEPTAZINE and SOLUSEPTAZINE are ethical products
advertised solely to the Medical Profession.
JjaJnriaixnif I avuenx: -fl£/i&6
OF      CANADA       LIMITED  — MONTREAL
204 YOUVILLE SQUARE STEVENS' SAFETY PACKAGE
STERILE GAUZE
is a handy, convenient, clean commodity for the bag or the office. Supplied
in one yard, five yards and twenty-five yard packages.
ESTABLISHED  NEARLY A
,CENTURX*
B. C. STEVENS CO.
Phone Seymour 698
730 Richards St., Vancouver, B. C.
S. BOWELL & SON
DISTINCTIVE FUNERAL
SERVICE
Phone 993
66 SIXTH STREET
NEW WESTMINSTER, B. C.
m^Sg£gi&g&j££i;
His /   mMMmM
1
IP %
I '
I
1
m
m
m
Breaks the vicious circle offperverted
menstrual function in cases of amenorrhea,
tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic
relief by stimulating the innervation of the
uterus  and  stabilizing the tone of its
musculature. Controls the utero-ovarian
circulation and thereby encourages a
normal-menstrual cycle.
• MARTIN H. SMITH COMPANY
feh. ISO LAFATITTI STRUT. NIW YORK, N. Y.
"*%M
Full formula and descriptive
literature on request
Dosage:   l to 2 capsules
3 or 4 times daily.   Supplied
in packages of 20.
Ethical protective mark MHS
embossed on inside of each
capsule, visible only when capsule is cut in half  at seam.
wmm m s 11 ? t m m—®m fimmmm Endocrine Treatment of Sterility
Sterility in the female if due to
Uterine hypoplasia
is treated with the follicular hormone OESTROFORM 50,000 international benzoate units
weekly for the first two weeks of the cycle.
Non-ovulation
is treated with OESTROFORM 50,000 international benzoate units, on the tenth day of the
cycle, or SEROGAN (the follicle-stimulating gonadotropic hormone from the serum of pregnant
mares) may be used.
Nidatory failure of the fertilised ovum
is treated with the luteinising gonadotropic hormone GONAN, 3 injections 500 rat units
during the last two weeks of the intermentstruum.
Sterility in the male if due to
"Defective spermatogenesis
is treated with the gonadotropic hormone SEROGAN (which stimulates the germ cells proper
in the male)   1000 rat units twice weekly.
Stocks of B.D.H. Sex Hormone Preparations are held by leading druggists
throughout the Dominion and full particulars are obtainable from:
THE BRITISH DRUG HOUSES  (CANADA)  LIMITED
Terminal Warehouse
Toronto 2, Ont.
Hor/Caa/389
flDount pleasant XHnoertaktno Co. %tb.
KINGS WAY at 11th AVE. Telephone Fairmont 58 VANCOUVER, B. C.
R. F. HARRISON W. R. REYNOLDS Intrauterine glycerine treatment
has long been considered one of the best methods
of treating
ENDOCERVICITIS      •      CERVICITIS
ENDOMETRITIS    •    PARAMETRITIS
It is appropriately applied by means of a tampon of
Antiphlogistine
With its 45% glycerine content, its iodine,
boric and salicylic
acids and essential oils,
rendered plastic and
penetrating in a vehicle of hygroscopic
silicate of aluminum,
its formula is unusually suitable.
;VAe
Fetv methods render possible such prolonged
glycerine application as does Antiphlogistine
Sample and literature sent on request
5      THE DENVER CHEMICAL MFG. CO.
153 Lagauchetiere St. W. Montreal
Made in Canada Are the Neuritic Symptoms
of Pregnancy <Lue,ta a (Le^^UUe^xu^
SUCH common neuritic symptoms of pregnancy as pains in arms and
legs, muscle weakness, and (less frequent but more serious) paralysis
of the extremities may result from a shortage of antineuritic vitamins,!
recent investigations appear to show. Although neuronitis of pregnancy
has long been considered a toxemia, no toxins have ever been identified.!
Clinical observations of Strauss and McDonald lead to the conclusion!
that the condition is a dietary deficiency disorder similar to beriberi, j
caused by lack of vitamin Bls complicated by symptoms which may bei
traced to shortage of vitamin G. They report recovery in their cases)
receiving this therapy, including dried brewers' yeast.
Hyperemesis as Cause of Avitaminosis
Wechsler observes that all cases of polyneuritis of
pregnancy recorded in the literature were preceded by
long periods of severe vomiting. "It would seem," he adds,
"that because of actual starvation these patients suffered
from avitaminosis and consequent neuritis," a view likewise held by Hirst, Luikart, and Gustafson. Plass and
Mengert observe that the practice of giving high carbohydrate feedings for hyperemesis gravidarum is still more
likely to cause avitaminoses B and G.
Dried brewers' yeast, as it is far richer than any other
food in vitamins Bi and G, is being used with benefit both
in the prevention and treatment of polyneuritic symptoms
of pregnancy. Lewy found that additions of yeast to the
diet reduced electric irritability of the peripheral nerves
and brought clinical improvement. Vorhaus states that he
and his associates, after administering large amounts of
vitamin Bi to 250 patients having various types of neuritis,
including that of pregnancy, observed in about 90% of
cases "varying degrees of improvement, i.e., from partial
relief of pain to complete disappearance of all symptoms."
Need for Vitamins B and G in Lactation
Evans and Burr, Hartwell, Sure and co-workers, and Macy
el al are among numerous authorities who find that the
nursing mother also needs supplements of vitamins Bi and
G, from 3 to 5 times the normal requirement. Tarr and
McNeile report that the physical, mental, and emotional
status of 120 pregnant and lactating women receiving
Mead's Brewers Yeast and other foods high in vitamin B
was superior to that of a control group of 116 women.
Since the management of polyneuritis of pregnancy is difficult at best, it would appear logical
to supply those dietary substances which may
safeguard against it. One of the richest and
most convenient sources of the anti-neuritic
factors/ vitamins Bi and G, is Mead's Brewers
Yeast Tablets. Consisting of nonviable yeast,
they offer not less than 25 International vitamin Bi units and 42 Sherman vitamin G units
per gram.
Supplied  in  bottles of 100
and 250 tablets, also in
6-oz. bottles of powder.
Please enclose professional card when requesting samples of Mead Johnson products to cooperate in preventing their reaching unauthorized persons.
     Mead Johnson & Co. of Canada, Ltd., Belleville, Ont. —	 _MKV
Prescription Specialists
For over 3 0 years the Georgia Pharmacy has been filling prescriptions
to the full satisfaction of Doctors
and patients alike. Doctors depend
upon us to send sickroom supplies
and medicinals anywhere at any
moment.
OHM ALL
MIOHT
Seymour
2263
GEORGIA PHARMACY
LIMITED
W.OEOROIA
STREET
Seymour
2263
Only One Store
(&mtn $c Ijrnura Utin
Established 1893
VANCOUVER, B. C.
North Vancouver, B. C.   Powell River, B. C.
PUBLISHED MONTHLY AT VANCOUVER.  B. C.  BY ROY WRIGLEY  LTD..  300 WE»T PENDER STREET f^^^ji^^^^^^^^^^^^^i^^s^lS^S^i
Hollywood Sanitarium
Limited
For the treatment of
Alcoholic, Nervous and Psychopathic Crises
Exclusively
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
4X*2l*4Q*z!>i)    University of British Columbia Library
DUE DATE
SERIALS
DEC
\980 8 ?$
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FORM 310S  

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