History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: September, 1939 Vancouver Medical Association Sep 30, 1939

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 The BULLETIN
of the
VANCOUVER
MEDICAL ASSOCIATION
Vol. XV.
SEPTEMBER, 1939
No. 12-
With Which Is Incorporated
Transactions of the
Victoria
cal Society
th*
Vancouver General Hospital
St Paul's Hospital
In This Issue:
THE PHYSICIAN IN RELATION TO
THE SOLUTION OF CRIME
NEWS AND NOTES
BRITISH COLUMBIA MEDICAL ASSOCIATION
ANNUAL MEETING, SEPTEMBER 18, 19, 20, 21
i£££3kStfittaitika>i>*2it<Uii>i BULKETTS
(With Cascara and Bile Salts)
. . FOR . .
Chronic  Habitual
Constipation
BULKETTS POSSESS ENORMOUS BULK
PRODUCING PROPERTIES AND BEING
PROCESSED WITH CASCARA AND
BILE SALTS PRODUCE BULK WITH
MOTILITY.
WE WILL BE PLEASED TO PROVIDE
ORIGINAL CONTAINERS FOR TRIAL
ON REQUEST.
Western Wholesale Drug
(1928) Limited   |
456 BROADWAY WEST
VANCOUVEr| -   BRITISH COLUMBIA
(Or at all Vancouver Drug Co. Stores) THE VANCOUVER MEDICAL ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
Offices: 203 Medical-Dental Building, Georgia Street, Vancouver, B. C.
EDITORIAL BOARD:
Dr. J. H. MacDermot
Dr. G. A. Davidson Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XV.
SEPTEMBER, 1939
No. 12
OFFICERS,  1939-1940
Dr. A. M. Agnew Dr. D. F., Busteed Dr. Lavell H. Leeson
President Vice-President Past President
Dr. W. T. Lockhart Dr. W. M. Paton
Hon. Treasurer Son. Secretary
Additional Members of Executive: Dr. M. McC. Baird, Dr. H. A. DesBrisay.
TRUSTEES
Dr. F. Brodie Dr. J. A. Gillespie Dr. F. W. Lees
Historian: Dr. W. L. Pedlow
Auditors: Messrs. Plommer, Whiting & Co.
SECTIONS
Clinical Section
Dr. W. W. Simpson Chairman Dr. Frank Turnbull Secretary
Eye, Ear, Nose and Throat
Dr. W. M. Paton Chairman Dr. G. C. Large Secretary
Pediatric Section
Dr. J. R. Davies Chairman Dr. E. S. James Secretary
STANDING COMMITTEES
Library:
Dr. F. J. Buller, Dr. D. E. H. Cleveland, Dr. J. R. Davies,
Dr. W. A. Bagnall, Dr. T. H. Lennie, Dr. J. E. Walker.
Publications:
Dr. J. H. MacDermot, Dr. D. E. H. Cleveland, Dr. G. A. Davidson.
Summer School:
Dr. A. B. Schinbein, Dr. H. H. Caple, Dr. T. H. Lennie,
Dr. Frank Turnbull, Dr. W. W. Simpson, Dr. Karl Haig.
Credentials:
Dr. A. B. Schinbein, Dr. D. M. Meekison, Dr. F. J. Buller.
V.O.N. Advisory Board:
Dr. I. Day, Dr. G. A. Lamont, Dr. S. Hobbs.
Metropolitan Health Board Advisory Committee:
To be appointed by the Executive Committee.
Greater Vancouver Health League Representatives:
Dr. W. W. Simpson, Dr. W. M. Paton
Representative to B. C. Medical Association: Dr. L. H. Leeson.
Sickness and Benevolent Fund: The President—The Trustees. l!
MANDAM—Tablets Ammonium Mandelate Squibb are now available
in 5 grain Enteric coated tablets. They offer to the clinician the advantage of the ammonium salt in tablet form, enteric coated to minimize
gastric irritation. Mandam tablets are most effective In controlling the
colon bacillus (Escherichia coli). Average dose 3 grams 4 times daily.
SERENIUM—An antiseptic dye of high purity and uniformity is bacteriostatic to urinary pyogenic organisms. Effective in acid or alkaline
urine—the average dose of Serenium is only one 0.1 gram tablet twice
or three times daily.
SULPHANILAMIDE SQUIBB—Especially useful against the cocci is
supplied in 5 and 7'/2 grain tablets. Where the clinician prefers not to
write "Sulphanilamide" on his prescriptions, Sulphanilamide Squibb
will be dispensed if he writes for Zennamine.
For literature write
E-R:Squibb & Sons of Canada. Ltd.
MANUFACTURING   CHEMISTS   TO   THE   MEDICAL   PROFESSION   SINCE    1858
36 Caledonia Road, Toronto. VANCOUVER HEALTH DEPARTMENT
STATISTICS—JULY, 1939
Total population—estimated  263,974
Japanese population—estimated !  8,891
Chinese population—estimated  7,728
Hindu population—estimated & _,  389
Rate per 1,000
Number Population
Total deaths      228 10.2
Japanese deaths        4 5.3
Chinese deaths        8 12.2
Deaths—residents only    200 8.9
BIRTH REGISTRATIONS:
Male, 186; Female, 166-
352
INFANTILE MORTALITY:
Deaths under one year of age	
Death ra^e—per 1,000 births	
Stillbirths (not included in above)
July,
1939
6
17.0
6
CASES OF COMMUNICABLE DISEASES REPORTED IN THE
June, 1939
Cases  Deaths
July, 1939
Cases  Deaths
15.7
July, 1938
8
22.4
8
CITY
August 1st
to 15th, 1939
Cases  Deaths
Scarlet Fever  19
Diphtheria  '.  0
Chicken Pox  28
Measles  3
Rubella   0
Mumps   21
Whooping Cough  86
Typhoid Fever	
Undulant Fever	
Poliomyelitis 	
Tuberculosis 	
Erysipelas 	
Ep. Cerebrospinal Meningitis.
0
1
0
30
1
0
0
0
0
0
0
0
0
0
0
0
18
0
0
3
1
12
1
2
4
28
0
0
0
28
0
0
0
0
0
0
0
0
0
0
0
0
16
0
0
6
0
0
0
0
2
4
0
0
0
9
0
0
V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH,
DIVISION OF VENEREAL DISEASE CONTROL.
Burnaby
Syphilis       0
Gonorrhoea       0
West
Vancr.
0
0
Richmond
1
1
North
Vancr.
0
0
33
48
34
11
0
0
0
0
0
0
0
0
0
0
6
0
Vancr.   Hospitals,
Clinic  Private Drs.   Totals
68
60
BIOGLAN
THE SCIENTIFIC HORMONE TREATMENT
Descriptive Literature on Request.
A Product of the Bioglan Laboratories, Hertford, England.
Represented by
STANLEY    N.   BAYNE
Phone: SEy. 4239
1432 Medical-Dental Bldg.
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Vancouver, B. C.
Page 341 ALL
the VITAMINES
from
AtoG
YOUR patient gets all six vitamines in a single tablet
when you prescribe PANVITA. This remarkable concentrate has proved extremely valuable in treatment of
conditions due to multiple vitamine deficiency.
For quick correction of such deficiencies you can depend
on Panvita Tablets. They provide an assured and standardized intake of Vitamines A, B (Bx), C, D, £ and G (B2).
The vitamines in this potent concentrate are obtained
as follows: Vitamine A from carotine, B (Bx) and G (B2)
from activated extract of yeast, C from chlorophyl, D from
irradiated ergosterol, and £ from extract of wheat germ.
It is well recognized that patients receiving an adequate
intake of all six vitamines respond much more readily to all
forms of therapy. Authorities therefore recommend the
use of vitamine concentrates wherever partial deficiency
may be a disturbing factor.
DOSAGE: The average dose is 2 to 6 tablets daily,
according to the severity of the deficiency. In cases of
pronounced- deficiency much larger doses may be used.
There are no contra-indications. For young children the
tablets should be crushed and dissolved in a lukewarm
liquid.
SUPPLIED: In bottles of 40 tablets, 100, 300 and 1,000.
PANVITA Tablets
a concentrate of all six vitamines
ANGLO-FRENCH DRUG- COMPANY
354 St. Catherine Street, Bast
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Gentlemen:   Please   send  me  complimentary  sample  of  Panvita
Tablets for clinical trial.
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and Furuncles
two of the main principles of treatment are:
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The   use   of   Antiphlogistine   suits   the   purpose of both requirements — admirably.
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itilagii Each tablet contains:
Theobromine -   -   - - 5 grains
*Neurobarb E.B.S.   - - H gram
Sodium Bicarbonate - 5 grains
Being antispasmodic and sedative in action, the ingredients of
Theobarb E.B.S. act synergistically to relieve spasm.
The prompt relief following its administration greatly improves
the patient's mental outlook and sense of physical well-being.
INDICATIONS: Angina Pectoris, Arteriosclerosis, Cardiovascular Disease, Nervous Manifestations of the
Climacteric Period, Epilepsy, Hyper Tension
and as an Antispasmodic and Sedative.
Also supplied with }4, grain Neurobarb as C.T. No. 691A Theobarb Mild
Literature and sample on request
*Neurobarb is the E.B.S. trade naine for Phenobarbital.
THE E. B. SHUTTLEWORTH CHEMICAL CO. LIMITED
TORONTO
MANUFACTURING   CHEMISTS
CANADA
STOCKS CARRIED AT
WINNIPEG, MAN.—CAMPBELL HYMAN LTD. VANCOUVER. B. C.—J. P. SOUTHCOTT & CO. LTD.
SPECIFY E.   B.   S.      ON  YOUR  PRESCRIPTIONS SPECIAL NOTE
We are at war. All of us must, of course, put our country and her needs first, and be
willing to give up cheerfully anything that may in the least degree conflict with the fullest
co-operation we can give. But, with this clearly undrestood, there are still our daily duties,
our common tasks, our private and public responsibilities, both as individuals and collectively, as members of the medical profession. The question has been raised, whether we
should cancel the forthcoming Annual Meeting of the B. C. Medical Association. It will
be greatly curtailed, no doubt—many of its speakers will be at other tasks and duties. But
we feel that the rest of us should carry on. There are many things that need to be done.
Let us not forget that it was in 1917, in the full tide and flood of war, that the Workmen's
Compensation Act came into force. The B. C. Medical Association, and the Vancouver
Medical Association, functioned then as guides and helpers to the Government of the day
in the shaping of that Act. So today we must still function as an organised medical profession. Other considerations arise. Many of our men are going away. We should organize
to protect them and to protect their practices and incomes in their absence. There must
be no profiteering amongst ourselves, and we hope we shall not again see men coming back
from their period of service overseas to find their work gone, their positions usurped, and
held against all protest, by men whom they had trusted, or by others who had stepped in
and stolen their possessions. We should organise against this.
Let us hold our meeting and make it a success. Let us not allow Herr Hitler and his
gang to panic us or force us to neglect our duties. Let us remember Drake, who was bowling
when the Armada hove in sight, and one came running to tell him—tcLet them wait," said
Drake, and 1 he stooped and finished the game."
We have our game to play, our roles to fill, our duties to do, and we should do> them,
calmly, deliberately, thoroughly, and without haste. For the world will go on, and a new
order will arise, and peace will come; may God grant it be soon. —Ed.
We wish all success to the Annual Meeting of the British Columbia Medical Association, which will be held from the 18th to the 21st of this month inclusive. The programme
is a busy and a most interesting one—full of variety, too. One wishes for a really dual
personality, so that one could take it all in, and still continue one's necessary work. The
wise men of the East will be with us, and are giving us generously of their store: and full
use is being made, too, of our own local opportunities for advancement. We congratulate,
in all sincerity, Dr. M. W. Thomas, Executive Secretary of the Association, who has
worked hard to bring this meeting to a successful ending: and are confident we shall be
able to say, in the old Latin phrase, "Finds coronat opus."
We have referred to the programme in a previous number, and all members will by now
have it in their hands: so little need be said further in this regard—but there are one or
two things that will bear another reference. Perhaps the chief of these, what the modern
phrase calls the keynote, will be the emphasis on Medical Economics. Our readers, i.e., the
members of the B. C. Medical Association, will shortly receive, in ample time for careful
study before the meeting, a tentative Plan for Voluntary Health Insurance for wage-
earners or groups of persons, whose annual income falls below a certain level. This Plan
has been most carefully worked out by the Committee on Economics, under the chairmanship of Dr. Cameron McEwen, and our readers will perforce agree that it represents a
tremendous amount of work. We regret extremely that Dr. McEwen has been ill—and,
while he is reported to be much better, it is hardly likely he will be able to be with us when
his plan is presented for discussion. We shall all join in hoping for his speedy recovery—
and in the meantime congratulate him and his Committee on an excellent piece of work.
This plan has been most carefully moulded into its present shape. It is not merely a
vague outline: it is a concrete, legally unassailable, workable plan, and has been gone over
Page 342 and put into proper form by a solicitor. Some such arrangement could be offered to the
public without any hesitation on our part, and would be a proof of our sincerity and good
faith—besides being, we believe, a constructive and quite feasible contribution to public
welfare. The trend of the day is towards collective bargaining in all lines of human
endeavor, and in the form of co-operatives one sees it succeeding, and with an adequate
past record of success, in commercial life. There is no a priori reason why it should not
succeed in professional relations, and especially in such things as health. It may yet prove
to be a better way out of our difficulties than any yet suggested, or at any rate a valuable
adjuvant to other methods.
Then we are looking forward to meeting Mr. Hugh Wolfenden, well known to all of
us as an eminent actuary. He will make a very valuable contribution to our efforts to
improve the economic status of medicine. In this connection, Dr. T. C. Routley, General
Secretary of the Canadian Medical Association, will also be able to assist us greatly.
So read your programme, read the reports, study the plan sent to you and come prepared
for a record meeting.
*       *      #       *
In this issue we are printing an excerpt from the 3 6th Annual Report of the Canadian
Medical Protective Association dealing with the dangers of the doctor's position in cases of
sterilization of men or women. We confess that we had not ourselves realized all the implications of this matter, which is fraught with real danger to the conscientious surgeon, who
may have, in perfectly good faith, done an operation with the full consent and knowledge,
and indeed, at the expressed desire, of the patient, only to find himself faced with malpractice and damage claims, because he omitted to protect himself adequately. We urge our
readers to give careful consideration to this. In our next number we propose to print an
extract from a recent publication, dealing with the physician's attitude and conduct in
courts of law as a witness. We think the majority of medical practitioners would be the
happier and safer for instruction along these lines, by an expert such as this writer.
NEWS    AND    NOTES
IMPORTANT
In view of the existing situation of world affairs it will be of special interest
to members to learn that arrangements are being made to hold, during the Annual
Meeting of the British Columbia Medical Association, a special meeting dealing
with "The Role of the Doctor in War." This will probably be arranged for Tuesday, September 19th, at about 4:30 p.m., and should be very informative and
helpful.
Mrs. E. J. Lyon of Prince George is making satisfactory progress following a recent
operation.
News from Penticton shows Dr. D. J. Sweeney of Vancouver as a recent visitor.
Dr. John Gibson, a Penticton boy, graduated from Queen's in 1937 and has, since
finishing his interneship in Regina, been holidaying at home before taking on a practice in
the Mackenzie River District.
Dr. F. O. R. Garner of Tranquille has been conducting a travelling clinic through the
Okanagan.
Dr. M. R. Basted and family of Trail are holidaying in the South.
Page 343 Dr. F. P. Sparks of Nelson is in Chicago doing post-graduate work.
Dr. William Leonard of Trail attended the B. C. Championship Rifle Shoot in July,
returning home with the Championship itself.   Congratulations, Dr. Leonard.
Dr. H. R. Christie of Rossland is enjoying a post-graduate course in Gynaecology and
Obstetrics in the Jersey City General Hospital.
Dr. M. G. Archibald of Kamloops returned from his eastern visit, and we are all pleased
to learn that he has recovered from his unfortunate illness while away.
Congratulations are extended to Dr. and Mrs. G. D. Saxton of Ocean Falls on the
birth of a daughter.
Dr. Richard Gibson left for Port Alberni, where he will do locum tenens during Dr.
Jones' absence.
Dr. A. E. Kydd is at Bella Coola relieving Dr. H. Douglas Galbraith.
Dr. John G. Robertson will leave shortly for extended post-graduate study.
Dr. H. Cantor will carry on at Tofino during Dr. Robertson's absence.
Dr. Ethlyn Trapp has left for the Eastern States by air. She will attend the International Cancer Congress to be held at Atlantic City, and then will visit hospitals in Boston
and New York. She will return about the 18 th of September.
Threats of war have interfered with the plans of a number of those planning to go to
Europe for post-graduate work. Dr. F. Bonnell, who had planned, to leave at the end of
August for the East, has changed his plans and is, at the time of going to press, on duty
with the No. 12 Field Ambulance Corps.
Dr. Eleanor Riggs, who was on her way to England and had reached Montreal, has
decided to postpone her sailing until a later date.
Dr. R. R. Laird has been doing locum- tenens in the absence of Dr. Gordon James of
Britannia.
Dr. P. M. McLean is now associated with Dr. R. N. Dick in the practice at Chernainus.
Dr. H. Ostry has been at Port Alice during Dr. G. A. Lawson's absence.
Dr. T. C. Holmes of Burns Lake is out on vacation.
Dr. George Langley of Wells is away doing extended post-graduate work.
Dr. J. H. Black, formerly at the Vancouver General Hospital, is now at Wells.
Dr. James W. Wilson, son of Dr. George T. Wilson of New Westminster, has been
home on a visit.
The many friends of Dr. W. F. Drysdale were relieved to learn by direct news from
Nanaimo that injuries sustained in a car accident on August 21st were not considered
serious. Nevertheless we regret his unnecessary suffering, which, we understand, was
occasioned by being crowded on the road by another car.
Page 344
mam Dr. G. A. B. Hall of Nanaimo is making an extended trip through the Yukon.
Dr. R. N. Dick of Chemainus has acquired the sloop formerly owned by Dr. C. C.
Browne and is on vacation.
Dr. F. H. Bonnell, radiologist, who has been connected with the X-ray Department at
St. Paul's Hospital, has left for a visit to the Eastern States and Canada, following which
Dr. Bonnell expects to go to Great Britain and Europe for an extended period to do postgraduate work in radiological centres.
Dr. C. G. Campbell of Halifax, N.S., will take Dr. F. H. BonneU's'place in the X-ray
Department at St. Paul's Hospital for a year. Dr. Campbell, who is taking his D.M.R.
course, has been working with Dr. W. A. Jones in Kingston, Ontario, and is continuing his
studies in radiology.
Dr. C. M. Eaton has returned from a three months' visit to Eastern Canada. Dr. Eaton
attended the annual meeting of the Canadian Medical Association in Montreal.
Dr. G. A. Davidson has returned from Victoria, where he spent five weeks. Dr. Davidson lectured to the students attending the Summer School, held at the Normal School in
Victoria.
* *      *      *
The Association extends its sympathy to Drs. J. Moscovich and B. B. Moscovich on
the death of their father, Mr. M. H. Moscovich, which occurred recently after an extended
illness.
Dr. J. R. Neilson has returned from England, where he spent six months, taking postgraduate work in surgery. Dr. Neilson is now specializing in surgery.
A A A A
Congratulations are extended to Dr. and Mrs. Russell Palmer upon the birth of a
daughter on July 22nd.
* *      *      #
We also congratulate Dr. and Mrs. Wesley Simpson on the birth of a son on August 1st,
and Dr. and Mrs. J. Ross Davidson on the birth of a daughter on August 7th.
A A A A
Dr. Louis E. Sauriol, Medical Supervisor, Provincial Mental Hospital, New Westminster, has returned from a three months' study and survey of hospitals and clinics in
several States.
tL A A '     A
We offer our best wishes to Dr. and Mrs. Austin N. Dobry on the birth of a son on
August 5th.
* *      *      *
Dr. Donald Munroe has left for California. He will spend a year at the University of
California, working under Dr. William Kerr, Professor of Medicine at the University.
* *       *       *
Dr. E. Christopherson is now connected with the offices of Drs. Lennie, Schinbein,
Strong, Vrooman and Wilson, in the place left vacant by Dr. Donald Munroe.
Dr. B. M. Fahrni is now connected with the offices of Dr. Hodgins, at 710 Seymour
Street, together with Drs. R. E. McKechnie II and Dr. S. E. C. Turvey.
Page 345 British  Columbia  Medical  Association
(Canadian Medical Association, British Columbia Division)
President Dr. D. E. H. Cleveland, Vancouver
First Vice-President Dr. F. M. Auld, Nelson
Second Vice-President Dr. E. Murray Blair, Vancouver
Honourary Secretary-Treasurer Dr. A. H. Spohn, Vancouver
Immediate Past President . _Dr. Gordon C. Kenning, Victoria
Acting Honourary Secretary-Treasurer. Dr. Roy Huggard, Vancouver
Executive Secretary Dr. M. W. Thomas, Vancouver
1939    ANNUAL    MEETING
VANCOUVER |
HOTEL VANCOUVER
SEPTEMBER, 18,19, 20, 21
FOUR FULL DAYS
Make Your Plans and Reservations Early
SCIENTIFIC SPEAKERS
DR. R. FRANKLIN CARTER, New York City; Associate Professor of Clinical Surgery,
Post-Graduate School, Columbia University.
DR. W. G. COSBIE, Toronto; Senior Demonstrator in Obstetrics and Gynaecology, University of Toronto.
DR. H. B. CUSHING, Montreal; Emeritus Professor of Paediatrics, McGill University.
DR. ALEXANDER GIBSON, Winnipeg; Associate Professor of Clinical Orthopedic
Surgery, University of Manitoba.
DR. ROSCOE R. GRAHAM, Toronto; Assistant Professor of Surgery, University of
Toronto.
-DR. F. S. PATCH, Montreal; Professor of Urology, Head of the Department of Surgery,
McGill University.
DR. E. P. SCARLETT, Calgary; Internal Medicine.
REPRESENTING CANADIAN MEDICAL ASSOCIATION
DR. F. S. PATCH, Montreal, President.
DR. T. C. ROUTLEY, Toronto, General Secretary.
MR. HUGH H. WOLFENDEN, Toronto, Consulting Actuary to Committee on Economics, Canadian Medical Association.
MONDAY, SEPTEMBER  18th
8:30 a.m.    Registration.
9:30 a.m.    1. Dr. W. G. Cosbie—Cancer of the Cervix.
2. Dr. Roscoe R. Graham—The Surgeon's Responsibility in Cancer.
Page 346 12:30
2:00 p.m.
8:00 p.m.
3. Dr. Frank S. Patch—Renal Infections.
4. Dr. H. B. Cushing—
Indications for and the Results of the Removal of Tonsils and
Adenoids.
Luncheon—Dr. Frank S. Patch, Dr. T. C. Routley, Mayor, President Vancouver Medical Association.
Clinical Demonstration—Vancouver General Hospital.
Annual Meeting—College of Physicians and Surgeons of B. C.
British Columbia Medical Association.
8:30
9:30
a.m.
a.m.
12:30
12:30
2:00 p.m.
8:15 p.m.
8:30
9:30
a.m.
a.m.
12:30
12:30
2:00
8:15
p.m.
p.m.
TUESDAY, SEPTEMBER 19th
Round Table—Obstetrics, Dr. J. W. Arbuckle.
1. Dr. H. B. Cushing—The Principles of Artificial Feeding of Infants.
2. Dr. E. P. Scarlett—
Angina Pectoris and Coronary Thrombosis, a clinical study of
100 cases of each condition.
3. Dr. R. Franklin Carter—
The Treatment of Cervical Lymphadenitis in Children.
4. Dr. W. G. Cosbie—Maternal Mortality.
Luncheon—
Luncheon—Mr. Hugh H. Wolfenden—
"The Development of Health Insurance Throughout the World
and Its Bearing on Medical Economics in Canada."
Venereal Disease Demonstration—Place to be announced.
Medical Economics—Round Table Conference, Mr. Hugh H. Wolfenden.
WEDNESDAY, SEPTEMBER 20th
Round Table—Orthopaedics—Dr. Murray Meekison.
1. Dr. Alexander Gibson—Fracture of the Neck of the Femur.
2. Dr. Frank S. Patch—
The Importance of Early Diagnosis in Urinary Tract Tumors.
3. Dr. Roscoe R. Graham—
Cxcostomy, a simple and safe measure in diseases of the colon.
4. Dr. E. P. Scarlett—Peptic Ulcer—New variations on Old Themes.
Luncheon—Meeting of Board of Directors.
Public Health Demonstration—Main lecture room.
1. Dr. Alexander Gibson—Fractures of the Forearm.
2. Dr. R. Franklin Carter—
The Diagnosis of Appendicitis in Children in the Formative
Stage. The Results of Our Attempt to Reduce the Mortality in
Appendicitis.
THURSDAY, SEPTEMBER 21st
8:30 a.m.    Round Table—Nutrition and Gastro-intestinal Diseases—
Dr. H. A. DesBrisay.
9:30 a.m.    1. Dr. Alexander Gibson—Mechanism of the Spine.
2. Dr. R. Franklin Carter—
Selection of Cases with Gall Bladder Disease for Surgery.
3. Dr. F. P. Scarlett—
Common Fallacies in the Diagnosis of Cardiovascular Diseases.
12:30 Luncheon.
Golf.
7:00 p.m.    Annual Dinner—Hon. R. L. Maitland, K.C., M.L.A., will be the guest
speaker.
Distribution of prizes.
Page 347
I SPECIAL FEATURES
Monday, September 18th—2:30 p.m.
Demonstrations of Various Technical Procedures of General Interest.
All of these Demonstrations will be held in the Nurses' Auditorium of the Vancouver
General Hospital (Corner 10th Ave. and Willow St.)   except Artificial Pneumon-
thorax and Pneumo-peritoneum which will be held in the Tuberculosis Centre (adjacent building).
2:30 p.m.    Demonstration of Miller-Abbott tube for Gastro-intestinal Decompression
—Dr. J. R. Neilson (Dept. of Surgery).
2:45 p.m.    Demonstration of Sternal Puncture—Dr. H. H. Pitts and Miss M. Erskine
(Dept. of Pathology).
3:00 p.m.    Friedman Modification of Ascheim-Zondek test—Dr. E. A. Gee and Miss
Dorothy Wylie (Dept. of Pathology).
Sedimentation Test—Mr. W. Pottinger (Dept. of Pathology).
Clinical Demonstration of the Results of Treatment of Cancer—Dr. A.
Maxwell Evans (B. C. Cancer Institute).
4:00 p.m.    Some practical points in the Differential Diagnosis of Intrathoracic Lesions;
Pulmonary and Cardio-vascular—Dr. W. H. Hatfield (Chest Clinic).
4:30 p.m.    Newer Developments in Thoracic Surgery—Dr. W. E. Harrison   (Chest
Clinic).
4:45 p.m.    Demonstrations of Pneumothorax—Dr. W. W. Simpson (Chest Clinic).
To be given in the Tuberculosis Centre.
5:00 p.m.    Demonstrations of Pneumo-peritoneum—Dr. W. A. Coburn (Chest Clinic).
To be given in the Tuberculosis Centre.
Note: These demonstrations will start and finish on time.
Please register for transportation to the Vancouver General Hospital.
:15
:30
p.m.
p.m.
LUNCHEONS
Monday, Sept. 18th, 12:30—Official Luncheon
Tuesday, Sept. 19th, 12:30—Special Luncheon
ROUND   TABLE   CONFERENCES
Main Lecture Room.
Tuesday, Sept. 18th, 8:30-9:30 a.m.—
"Obstetrics," conducted by Dr. J. W. Arbuckle.
Tuesday, Sept. 19th, 8:00 p.m.—
"Medical Economics," conducted by Mr. Hugh R. Wolfenden.
Wednesday, Sept. 20th, 8:30-9:30 a.m.—
"Orthopaedics," conducted by Dr. Murray Meekison.
Thursday, Sept. 21st, 8:30-9:30 a.m.—
"Nutrition and Gastro-intestinal Diseases," conducted by Dr. H. A. DesBrisay.
PUBLIC HEALTH
Lectures and Demonstrations.
Main Lecture Room.
Wednesday, Sept. 20th, 2:00 p.m.—
This session will be presided over by Dr. J. H. MacDermot. Those participating will
present the present programme of Public Health.
MOTION PICTURE
Tuesday, Sept. 19th, 2:30 p.m.—Lecture Room, Hotel Vancouver
Dr. D. H. Williams has secured a special sound-film which will give 90 minutes of
Clinical instruction. This film was prepared by the American Medical Association
and the United States Health Services and is highly commended for the impressive
way in which it presents the whole subject.
Page 348 LADIES'  ENTERTAINMENT
Monday, Sept. 18 th—
9:00 a.m.    Registration. All ladies are requested to register.
Tuesday, Sept. 19th—
9:00 a.m.    Registration.
1:00 p.m.    Scenic drive for visiting ladies. Will the visiting ladies please meet at
the Registration Desk in the Social Suite (1st mezzanine). The local
ladies who are driving will please come to the Registration Desk to meet
their parties.
4:00 p.m.    Tea—Jericho Country Club.
All ladies who are registered are invited to be the guests of the British
Columbia Medical Association.
Wednesday, Sept. 20th—
4:00 p.m. All ladies are invited to Mrs. Cleveland's Tea to be held at the home of
Mrs. G. H. Clement, 1550 West Thirty-fourth avenue (second house
west of Granville street).
Note: Trams No. 6 or No. 7 stop at Thirty-third and Thirty-fifth Aves.
Visiting ladies will please meet at the Registration Desk for transportation.
Thursday, Sept. 21st—
7:30 p.m.    DINNER—to be held in the Social Suite.
All ladies are requested to register. In the case of local ladies, husbands
may secure Invitation Cards for the Tuesday Tea and Dinner Tickets
at the Ladies' Registration Desk.
ANNUAL REPORTS OF STANDING COMMITTEES
BRITISH COLUMBIA MEDICAL ASSOCIATION
Please read before coming to the Annual Meeting.
CONSTITUTION  AND  BY-LAWS
At our Annual Meeting last year in Victoria, our Constitution and By-Laws were
radically amended to provide for our Association becoming a Division of the Canadian
Medical Association. This necessitated a good deal of work on the part of this Committee
during the previous year and left little to be done this year. It is not usual or advisable
to further amend a Constitution and By-laws which has been materially changed, for at
least a year, unless occasion demands. There was no such occasion during the past year.
The new Constitution and By-Laws were printed and mailed to all the members of
our Association after it had been approved by the Canadian Medical Association and sufficient extra copies kept in reserve for future needs.
Following the Annual Meeting last year, your Chairman assisted the College of Physicians and Surgeons in arranging for the collection of the Canadian Medical Association
fee from the members of our Association until a Membership Committee was established.
All of which is respectfully submitted.
H. H. MILBURN, Chairman,
Committee on Constitution and By-Laws.
PROGRAMME AND FINANCE
Programme:
The Annual Meeting for 1939 speaks for itself and no further elaboration on this
subject is required.
Tours have been arranged through the Province in the past year as follows:
1. Sept. 30th-Oct. 12th, 1938.  Doctors Murray McC. Baird and Roy Huggard travelled to the Okanagan and Kootenay Districts where they addressed the Annual
Meetings of No. 4 District Medical Association at Kelowna, the West Kootenay
Page 349 TH
Medical Association at Trail, and the East Kootenay Medical Association at Cranbrook. Other luncheons and meetings were attended en route at Chilliwack, Lytton,
Penticton, Grand Forks, Nelson, Creston and Revelstoke.
2. November 10th, 1938. Doctors D. E. H. Cleveland, Roy Huggard and J. R. Naden
addressed the Annual Meeting of the Upper Island District Medical Association
at Qualicum.
3. June, 1938. Dr. H. A. DesBrisay addressed the Spring Meeting of the Upper Island
District Medical Association at Qualicum.
4. August 1st, 1939. Doctors D. E. H. Cleveland and Roy Huggard travelled to the
Cariboo, Prince George and Prince Rupert. They were the principal speakers at
meetings at Chilliwack, Prince Rupert and Prince George. Most of the profession
were visited en route.
5. August 28th, 1939. Dr. D. E. H. Cleveland addressed the Annual Meeting of the
West Kootenay Medical Association at Nelson.
In each case our very efficient Executive Secretary, Dr. M. W. Thomas, made the
detailed arrangements for these trips and accompanied the speakers.
Finance:
The Association at present operates on a budget of $2,500. The increasing demands
made on this budget because of increased activity in the central office will shortly mean
that this sum will be inadequate to carry on a service satisfactory to our members.
The tours, which we have long felt were a valuable part of the service rendered to the
medical profession in this Province, should be continued and not restricted by lack of
funds.
It may be necessary, therefore, to appeal to the Council for some increase in the annual
appropriation for the activities of the British Columbia Medical Association.
All of which is respectfully submitted,
G. F. STRONG, Chairman,
Committee on Programme and Finance.
MEDICAL EDUCATION
Mr. President:
Herewith the report of your Committee on Medical Education.
This Committee has been active during the past year. As a result of keeping on file the
calendars and entrance requirements of all Canadian Medical Schools, the Committee has
been in a position to assist prospective medical students to a selection of the proper school
and it is understood that this effort has been successful in certain instances. As a side issue,
one or two residences abroad have been secured for local internes.
Another phase has been the opportunity of introducing, by personal letter, some of
our members to outstanding men in America in certain specialties. It is felt that this
service could very easily be broadened. There are, no doubt, in this Province, specialists
in all branches who, among them, are personally acquainted with all the leading men in
the particular branch of work. It should be simple to establish a central clearing house for
necessary information and personal letters for our members who are desirous of making
post-graduate tours.
So far, an unsuccessful attempt has been made to have in this Committee a central
repository for information concerning residences and interneships, which may be available
throughout America. No doubt, in time, this can be worked out.
The question of exchange of position between local hospital residents and men practising in outlying communities who are desirous of brushing up in our larger hospitals,
has been considered. Here, there are difficulties in the way which, in time, may be circumvented.
The problem of placing British Columbia students in medical schools continues to be
acute, although some progress has recently been made in this respect. This brings forward
the important question of a Faculty of Medicine at the University of British Columbia.
It is felt that there is adequate material in Vancouver for school purposes and an excellent
nucleus for a faculty is available among our members. The supply of internes for our
Page 350 hospitals throughout Canada falls 30% short of the demand. This would suggest that there
is ample room for another "CLASS A" school in Canada, unless our requirements are to
be met by the use of refugee physicians from Europe. Representations should be made
to the Government with respect to the establishment of at least the first two years of a
good medical course, including a Department of Anatomy, at the University of British
Columbia.
Standards of medical schools in Canada are high and, in view of this fact, your Canadian Committee as a whole, holds only a "watching brief" with respect to these standards.
On the other hand, standardization of entrance requirements to these schools would seem
to be desirable. The Canadian Committee is co-operating with other bodies toward the
establishment of boards for the certification of specialists in the not too far distant future.
Such boards are now functioning very successfully in the United States, and constitute
not only a protection to the public but also to the physician.
Finally, this Committee welcomes at all times suggestions for study for the betterment
of medical education standards, or suggestions as to how it may better serve this Association.
All of which is respectfully submitted,
D. M. MEEKISON,
Committee on Medical Education.
ARCHIVES
For a long time it has been felt that some attempt should be made to collect information regarding the history of Medicine in British Columbia, and particularly data regarding the men who engaged in practice here, where they came from, where they worked,
and the conditions under which they worked. It would be very pleasant, also, if the Association were able to establish a kind of Museum of Medical Mementos, where objects of
historic interest could be on display. Your Association, however, unfortunately suffers
from a lack of any permanent home with adequate space to house such exhibits even if they
were available.
It seems, therefore, that the only practicable archives would consist of a book, or a
series of books, in which are recorded facts, not only about the past but about those of our
members who are making history today and have made it in the past, for we must not
forget that some day someone will refer to our times as "the good old days."
With the object of beginning some such storehouse of information, your Committee
has written to a goodly number of members of your Association, men who are in a position
to tell something of themselves, the men and places they have known in British Columbia
and, it may be, medical anecdotes of vast interest. If these men will all co-operate with
your Committee by writing something for inclusion in the first volume, a book of surpassing value will result, for the edification, instruction and inspiration of future generations.
In this way it is hoped that a beginning will be made of the Archives of the British
Columbia Medical Association.
The following is a list of members to whom letters have been written:
Vancouver—Dr. Saul Bonnell, Dr. R. B. Boucher, Dr. F. W. Brydone-Jack, Dr. W. B.
Burnett, Dr. Glen Campbell, Dr. J. S. Conklin, Dr. Newton Drier, Dr. James C. Farish,
Dr. G. M. Foster, Dr. Joseph Gibbs, Dr. G. S. Gordon, Dr. B. D. Gillies, Dr. A. W.
Hunter, Dr. T. M. Jones, Dr. W. D. Keith, Dr. R. E. McKechnie, Dr. W. C. McKechnie,
Dr. P. A. McLennan, Dr. F. J. Nicholson, Dr D. G. Perry, Dr. H. W. Riggs, Dr. A. M.
Robertson, Dr. J. E. Spankie, Dr. A. A. Sutherland, Dr. W. H. Sutherland.
Victoria—Dr. W. A. Fraser, Dr. E. C. Hart, Dr. H. M. Robertson, Dr. H. J. Wasson.
Nanaimo—Dr. W. F. Drysdale, Dr. G. A. B. Hall.
Campbell River—Dr. W. A. Richardson.
Parksville—Dr. Robert Elliot.
Prince Rupert—Dr. W. T. Kergin.
North Vancouver—Dr. Harold Dyer.
New Westminster—Dr. G. H. Manchester, Dr. W. A. deWolfe Smith.
Page 351 Cbillhuack—Dr. R. McCaffrey.
Quesnel—Dr. Gerald Baker.
Kamloops—Dr. M. G. Archibald.
Armstrong—Dr. W. B. McKechnie.
Vernon—Dr. Osborne Morris.
Kelowna—Dr. B. de F. Boyce, Dr. W. J. Knox.
Penticton—Dr. R. B. White.
Grand Forks—Dr. C. M. Kingston.
Cranbrook—Dr. F. W. Green.
Jasper—Dr. T. F. O'Hagan.
Respectfully submitted,
MURRAY McC. BAIRD, Chairman,
Committee on Archives.
MATERNAL  WELFARE
The Committee on Maternal Welfare was organized last October on a Province-wide
basis with a Nucleus Committee of Doctors practising in and around Vancouver. Representatives were appointed from the District Associations, and with five Vancouver Doctors made a Committee of eighteen in all. Whilst it has been impossible to have a full
Committee meeting, several meetings of the Nucleus Committee have been held, including
one with Dr. L. C. Conn of Edmonton, during the Summer School of the Vancouver
Medical Association, his ideas being very helpful, and the rest of the Committee have been
consulted and advised of what was done by letter.
The first question taken up, and the one that was considered most pressing at the time,
was that of improved prenatal care. In this respect the question of greater co-operation
between Public Health Nurses and Doctors was taken up and Dr. H. E. Young of the
Provincial Board of Health was interviewed. He pointed out that it was the policy of the
Public Health Department to have their nurses co-operate with the Doctors in these cases
to the fullest extent and urged that wherever Public Health Nurses were stationed, the
Doctors should make full use of them and work with them, and advised that where there
was no Public Health Nurse stationed that efforts be made to get one.
He also pointed out that his Department issued monthly prenatal and postnatal letters
to patients advising them how to take care of themselves and their babies and when to
consult their Doctors. These letters will be sent on application from patient or doctor and
should be especially useful in outlying districts where it may be difficult for the patients
to see their doctors regularly.
Better prenatal care by the Doctors was also considered and it was realized that
in many cases this could be considerably improved. As a result of a conversation with
Dr. T. C. Routley, General Secretary of the Canadian Medical Association, and correspondence with Dr. McQueen of Winnipeg, Chairman of the Maternal Welfare Committee
of the Canadian Medical Association re the Manitoba survey, the benefits of which are
already beginning to show in their records, it was felt that if all maternity cases were
reported on filing cards which could be sent periodically to the Public Health Department
for abstracting and then returned to the Doctor for his file, that it would result in more
careful work being done.
Such a card has been drawn up and made as simple and concise as is consistent with
adequate prenatal care and record of Delivery. Dr. Young has been interviewed about
these cards and has promised the co-operation of his Department in the printing, sending
out and abstracting of these cards.
It is urged that this card system be endorsed by the members of the British Columbia
Medical Association at this meeting by the adoption of this report so that the cards can
be printed and distributed in time for the institution of the scheme with the New Year.
The Committee on Maternal Welfare would also be glad to receive reports on interesting or exceptional cases occurring in the Province and especially   full   reports   on   any
Page 3 52
. maternity deaths associated with pregnancy, so that they can be reviewed and suitable
treatment advised by a specialist in Obstetrics.
Respectfully submitted.
C. T. HILTON, Chairman,
Committee on Maternal Welfare.
PUBLIC  HEALTH
The opening meeting of the year of the Committee on Public Health was called on
October 19th, 1938, by Dr. A. H. Spohn, Chairman. In his opening remarks he mentioned briefly the function of the Committee, pointing out its importance and the wide
scope of its problems. He urged that physicians play a more active part in shaping policy
regarding public health matters. Lay organizations were showing contrasting activity and
aggressiveness in this field, an example of which had been the Public Hearings in June,
1938, concerning the proposed amendment of the Marriage Act. Numerous briefs from
interested lay organizations had been presented, but none from the medical profession,
every member of which had a vital interest in this question.
Although it is twenty years since the B. C. Medical Association first took official action
advocating compulsory pasteurization of raw milk, the committee undaunted continued
to press for this essential improvement. It was recommended that the following resolution,
addressed to the Honourable Mr. Pattullo, Premier of British Columbia, be presented to
the Board of Directors of the British Columbia Medical Association for approval:
A  Memorandum »
Re Pasteurization of Raw Milk in British Columbia.
"To the Premier of British Columbia:
"The milk question in British Columbia is of such importance to public health that
we beg again to request that immediate action be taken by the Provincial authorities to
remedy the existing unsatisfactory state of affairs.
"The present typhoid fever epidemic at Merritt has been investigated, we understand,
by the Provincial Board of Health and other agencies and has been found to have been
transmitted through raw milk.
"Without effective pasteurization there is no safeguard against similar occurrences
in other parts of our Province. We, therefore, petition your honourable body that some
practical legislative measures be adopted during the coming session of the Legislative
Assembly to further safeguard the public from infected raw milk."
Approval of the Board of Directors was forthcoming and the resolution was forwarded
to the Honourable Premier Pattullo, and copies to the Honourable G. M. Weir, Provincial Secretary, and the Honourable K. C. Macdonald, Minister of Agriculture. Although
receipt of the resolution was acknowledged, the committee has not been informed of any
steps having been taken as yet to put into effect the recommendation embodied in it.
The Committee was informed by the Greater Vancouver Health League that Japanese
midwives were registering the births of Japanese children. The Health League was of the
understanding that according to law, a doctor should be present at each birth and should
register the birth with the Registrar of Births, Deaths and Marriages. Further, it was
pointed out that laxity in regard to strict enforcement of the regulations concerning
registration of births might permit a serious situation to arise regarding the health of the
community. Information received showed that in the City of Vancouver, four Japanese
midwives, who have had two or three months' training in Japan, delivered a very large
percentage of the Japanese births. This matter is still under consideration.
A joint letter from Dr. Dolman, Director of the Division of Laboratories, and Dr.
Williams, Director of the Division of V. D. Control, Provincial Board of Health, to Dr.
D. E. H. Cleveland, President of the B. C. Medical Association, concerning the distribution
of confidential laboratory forms to patients was referred by the Board of Directors to the
committee. This letter pointed out that the confidential report forms issued by the Division of Laboratories of the Provincial Board of Health, which recorded negative findings
relating to Kahn tests on blood specimens, or to microscopic examinations for gonococci
Page 353 were being handed over to prostitutes by physicians in Vancouver and other cities in the
Province. Since physicians are familiar with the facts that a negative reaction may be
present in the earliest and most highly communicable phase of syphilis, and that negative
smears are frequently obtained from persons having gonorrhoea in a communicable state,
the distribution of negative reports to prostitutes, who in turn used them to show prospective clients as a guarantee of freedom from venereal disease, aided and abetted the spread
of venereal disease and endangered the public health.
Dr. Spohn and Dr. H. E. Young, Provincial Health Officer, collaborated on a letter
which was sent to all members of the profession, pointing out the dangers of medical
certification of prostitutes.
As representative of the B. C. Medical Association, Dr. M. W. Thomas attended a
conference in Victoria called by the Honourable A. Wells Gray, Acting Provincial
Secretary, to consider the disposition of 108 single men suffering from V. D. in the City
of Vancouver who were to be cut off from relief assistance. It was pointed out in the discussion by the Director, Division of Venereal Disease Control, that a factor in the concentration of V. D. population in Vancouver was the lack of remuneration of physicians
in outlying parts of the Province where clinics were not available for persons on relief
suffering from V.D. The conference recommended a plan be arrived at to pa yphysicians
in outlying districts of the Province for care given to indigent and low income persons
suffering from V. D.
Dr. Spohn prepared a resume of public health matters in B. C. for the annual report
of the Canadian Medical Association Health Committee.
Respectfully submitted,
D. H. WILLIAMS, Secretary,
for Dr. A. H. Spohn, Chairman,
Committee on Public Health,
PHARMACY
This Committee had several meetings during the year, and on March 14th they met
representatives of the Pharmaceutical Association to discuss the matter of a Provincial
formulary. The representatives of the Pharmaceutical Association were of the opinion
that it would be for the mutual benefit of patient, doctor and pharmacist if the doctors
of the Province could be persuaded to use a Provincial formulary.
It was felt by both the pharmacists and your Committee that if such a formulary were
compiled and made sufficiently comprehensive, it might do away to some extent with the
prescribing of expensive proprietary drugs which are often quite useless. It was suggested
that possibly the formularies that are in use at the Vancouver General Hospital and other
hospitals in the Province might be combined into one Provincial formulary that might
become universally used in the Province.
In order to make a success of such a project it was felt that the formulary would have
to be distributed free by either the British Columbia Medical Association or the College
of Physicians and Surgeons, and this would be a matter of an expenditure of about $500.
The matter was brought to the attention of the executive, but they felt that they could
not authorize such an expenditure of money at the present time.
Your Committee feels that this is a matter that should be discussed by the physicians
and, if there is sufficient demand, would suggest that* further steps be taken during the
coming year for planning such a Provincial formulary.
Respectfully submitted,
C. H. VROOMAN, Chairman,
Committee on Pharmacy.
HOSPITAL SERVICE
This report of your Committee may, in most respects, be somewhat disappointing.
There was some doubt in the minds of the Committee at the outset, as to what constituted the duties or work to be considered. It had been hoped that the visit of Dr. Harvey
Agnew last fall would enable active work to be undertaken.
Page 354 This Committee has met on several occasions and the various phases of the work considered and discussed. Request was made to the outside members in the Province for the
submission of any problems with which it was deemed this Committee might be of service.
In this request your Committee drew a blank.
Later, a sub-committee was appointed in an effort to segregate the work as it was found
that much that was being considered overlapped the work of other committees.
This sub-committee is still at work, co-operating with other committees where possible overlapping occurs, and a sincere attempt is being made to place the Hospital Service
Committee on an active basis.
While little has apparently been accomplished this year it is felt that the foundation
has been laid for active participation in the affairs of the Association next year by the
Committee on Hospital Services.
Respectfully submitted,
W. S. TURNBULL, Chairman,
Committee on Hospital Service.
STUDY  OF  CANCER
I beg to submit to you the report of the Committee on the Study of Cancer for the
past year 1938-39. The work of this Committee has been wide and varied and monthly
meetings have been held throughout the year, a dinner meeting being held in May. At the
beginning of the year the members of this Committee were chosen in such a manner that
all districts of the Province were represented.
Every co-operation was lent through the offices of this Committee to the Central
Executive in their work with the Cancer Foundation in establishing a Medical Staff to
that institution. This work did not properly fall within the scope of the Committee and
will, in all probability, be reported in detail elsewhere.
The Speakers' Bureau, under the Chairmanship of Dr. M. W. Thomas, provided through
the year speakers for addresses which were delivered under the auspices of the Canadian
Society for the Control of Cancer.
It is interesting to note that the medical profession has co-operated widely in the
efforts of this organization and that this organization might well be congratulated upon
the formation of 67 units throughout the length and breadth of the Province.
The work of the Department of Cancer Control was also carried out and some 16
hospitals were invited to set up Cancer Study Groups. To date nine have responded and it
is anticipated that within the passage of time these Cancer Study Groups will increasingly
show results in the efforts being made by the profession to deal with this disease.
The report forms which have been prepared by headquarters at Toronto have been
placed in the hands of all Study Groups in the various institutions and we shall hope that
the coming year will find this work well established. This organization was carried out
under the able chairmanship of Dr. Harold Caple.
During the year the Committee discussed at great detail the advisability of the establishment of a Biopsy Service as an adjunct to the present laboratory services supplied by
the Government. A most comprehensive report was made of the situation by Dr. H. H.
Pitts. The Executive of the Association empowered this Committee to take such steps as
would seem necessary to bring this service to fruition. At the present time negotiations
are proceeding.
We have the most sympathetic support of the Minister, Hon. G. M. Weir, and Dr. C. E.
Dolman, Director of Provincial Laboratories, as well as Dr. H. E. Young, Provincial
Medical Health Officer. It is not unreasonable to suppose that during the coming year
these efforts might well become a reality as the Committee on Cancer believes that this is
a most essential service that should be established as soon as the details may be worked out.
The able help and advice at all times of Dr. M. W. Thomas should be mentioned at
this time. He has been most co-operative and a constant attendant at our Committee
meetings. I cannot pass without mentioning the amount of detailed work that our able
Page 3 5 5 Secretary, Dr. Ethlyn Trapp, carried out during the past year. Without her help little
could have been accomplished.
In closing, one desires to thank the members who served throughout the past year
without thought of time, and contributed freely of their advice and counsel in all matters
that were undertaken.
Respectfully submitted,
ROY HUGGARD, Chairman,
Committee on the Study of Cancer.
EDITORIAL  BOARD
During the past year there has not been a great deal for the Committee to do except
at the time of the Annual Meeting. During the year itself the Bulletin of the Vancouver
Medical Association has given space to the British Columbia Medical Association for the
report of its activities throughout the year. An important feature, and one that is greatly
appreciated, we think, by the men at large throughout the Province, is the admirable series
of news and noted supplied by Dr. Thomas, the Executive Secretary of the Association.
He has reporters in various parts of the Province and they supply him each month with
accounts of the doings of various men.
Following the Annual Meeting of the British Columbia Medical Association in September, 1938, the papers read at that meeting were collected, edited and published in a
Supplement to the Bulletin, together with papers read at the Summer School of the Vancouver Medical Association in the same year. This year a different plan will be followed.
The Committee of the Vancouver Medical Association Summer School is publishing its
own papers for the benefit of those only who took part in the Summer School. The papers
read at the forthcoming Annual Meeting, it is hoped, will be collected and published,
after suitable editing, as a supplement to the Vancouver Medical Association Bulletin, for
distribution throughout the Province. The employment of a stenographer and suitable
secretarial help has been authorized by the Executive of the British Columbia Medical
Association and will greatly facilitate this work.
We cannot close this report without expressing to the Vancouver Medical Association
our sincere thanks for their generous co-operation in the matter of publication. There is
no doubt that their action in allowing the doings of the British Columbia Medical Association to be published monthly in the Bulletin is of great value to all the men in the Province
and is tremendously appreciated by them.
Respectfully submitted,
J. H. MacDERMOT, Chairman,
Editorial Board.
ANNUAL MEETING—CENTRAL CARIBOO
£ MEDICAL SOCIETY
{Northern area, including the Cariboo.)
The visit to Prince George on August 9th of Dr. D. E. H. Cleveland, President of the
British Columbia Medical Association, Dr. Roy Huggard and Dr. M. W. Thomas, Executive Secretary, was the occasion for convening a meeting of all the doctors in the Northern
Interior.
Dr. E. J. Lyon of Prince George, the energetic President, presided over the sessions.
Doctors Cleveland and Huggard presented two papers each to the meeting, which was
well attended.
Dr. Thomas attended the business sessions and was able to give much helpful information. The necessity for laboratory services was discussed and it was decided that if a Provincial Laboratory could be established in Prince George it would be very helpful to the
members in that whole area. It was felt that a good technician might be sufficient. A
resolution was unanimously passed by which the Provincial Board of Health would be
Page 356 approached asking that steps be taken to establish a laboratory service in Prince George.
The question of the C.N.R. Employees' Medical Aid Association and its definition of
surgery to dependents was discussed. It was decided that the secretary should write to the
various doctors in the district securing their individual written opinions in this matter.
Those in attendance included Dr. Ross Stone of Vanderhoof, Dr. G. G. Ferguson of
Smithers, Dr. L. M. Greene of McBride, Dr. J. C. Poole of Wells, Dr. Lois Stephens Poole
of Wells, Dr. J. C. Kovach of Quesnel and Drs. E. J. Lyon, Carl Ewert and J. G. Mac-
Arthur of Prince George.
The elections returned Dr. E. J. Lyon as President and Dr. J. G. MacArthur as Secretary.
It was the expressed opinion that these meetings be held annually and that the British
Columbia Medical Association be requested to co-operate by assisting with programme.
POST-GRADUATE TOURS
The visit of the lecture team of Drs. D. E. H. Cleveland and Roy Huggard, together
with Dr. W. M. Thomas, to Prince Rupert was the occasion for the gathering of the men
of the Prince Rupert district to attend the special meetings. Dr. W. E. Austin of Hazelton, Dr. S. G. Mills of Terrace, Dr. C. A. Armstrong of Port Simpson and his assistant, Dr.
Wilson, and Dr. Large, all availed themselves of this opportunity of hearing some very
excellent speakers and enjoying fraternal associations.
THE PHYSICIAN IN RELATION TO THE
I SOLUTION OF CRIME*
Dr. Frank R. Menne
The physician, by virtue of his training, is pre-eminently fitted, to my mind, to take
part in the understanding and interpretation of human behaviour, and so becomes a vital
element in the solution of crime. My activities in recent years have oscillated between the
medical profession and the law enforcement to such an extent that some of my friends
have thought of me as just an ordinary cop, but I have been thrown into this field by
virtue of my position in the University as a director of the Department of Pathology, in
that it became our duty to perform post mortem examinations held on the convicts since
1932, and in that connection we have been thrown into contact with the law enforcement
officer and those conversant with all sorts of crimes, and it has been most interesting
to me to apply some of the knowledge which I have acquired as a physician to the
conditions of human behaviour and to the interpretation and motivation of crime. I do
not think that my profession is so definitely confused as, for instance, the owner of
a certain store who dealt in canaries, among other things, and one day a lady entered his
store and said she was desirous of having a bird in her home and naturally she wanted one
that would really sing. "My husband has agreed to my getting this bird," she said, "and
he says it must be one that will sing."
"Here is a very fine young bird, he has colour, he has the general appearance of a good
singer and he really is a canary. He is young as yet and has not started to sing. If he is a
female he will not sing, but if he is a male, he will sing," said the storekeeper.
"How am I going to tell whether it is a male or female?" enquired the lady.
'Take him home," he told her, "and secure two earth worms, one male earth worm
and one female, and put them before the canary. If the bird takes the male worm, it is a
female, and if it takes the female worm, it is a male."
"And how am I to tell which is the male and which the female earth worm?" enquired
the lady.
"That is your business," replied the storekeeper. "Mine is canaries."
* Address given before the Vancouver Medical Association Summer School, June, 1939.
Page 357 I really do not feel that the line is so sharply drawn here. I think we are aware in all
countries that there is an increasing problem of crime. In the United States it is stated that
the cost of crime is fifteen billion dollars annually, and crimes are being committed in
increased proportion by younger and younger individuals.
In the solution of crime there are certain definite problems. First there is the interpretation of the motivation and character of crime. Among the motivations of crime I think
we can definitely state there is this so-called congenital psychopathy. There is, for instance,
the young boy who grows up nervous, peculiar. He does not know any better, has no sense
of values. The boy's constitutional make-up is such that he may run up against anything.
He is the little boy who starts throwing dirt at the neighbour's washing, goes down to the
store and comes back with the store's oranges, gets into bad company and will end up in
the house of correction, institute for young boys or the penitentiary. He goes on and on,
he comes out into society and then gets thrown back again.
In this main group we think that the physician can come to the fore in the recognition
and classification of such an individual so that he may be properly taken care of by the
State in the right way to begin with, so that he may be saved from becoming a social
problem.
Everyone may know of these individuals, and I think, as physicians, we can assist the
Courts in saving such individuals from the necessity of repeated arrests and charges.
I think too that one cause in the motivation of crime is the instability of the home.
I think that invariably when such individuals come before you there is evidence of separation, the mother and father have been separated and the children allowed to shift for themselves, have not been given any guiding hand or moral persuasion. They too, for another
reason, do not learn the difference between right and wrong, do not have a sense of proportion, a sense of values. They are subjects of heroism, they admire boys of the neighbourhood, relive the history of the race, become Indians, soldiers of warfare and burglars and
anything that appeals to their senses, and away they go and they are embarked on a career
of crime.
Again we know there are criminal individuals who are subjects of sex complexes, who
are victims of organic diseases, who need correction of these diseases. I could name any
number of cases in my experience in which the disposition of men and women, which was
very largely the result of certain endocrine disturbances, could have been corrected. I
think with all of this group physicians could certainly play a real part in helping to identify
and localize and isolate the so-called criminal.
Some motivations of crimes are merely those that occur in the heat of passion, anger
and excitement, the result of some unusual contact and unusual experience. There are
members of society who commit crimes either because of an inherent congenital disposition in that direction and who are, per se, natural habitues of crime and will never be anything else, and there is the so-called casual, accidental criminal, the one who commits a
felony because he is the victim of circumstances. He runs into the complexities of the
law of the land.
I would like to tell the story of a policeman who was given a gun and stick and told
to go down a certain street and start patrolling his beat. He went down about half a block
and saw a motorist come along, stopped him and said, "You are under arrest."
"Why, what have I done wrong?" enquired the motorist. "I did not know I had done
anything."
"Don't give me any of your gab," responded the policeman. "You may tell that to the
judge. I do not know what law it is at present you have violated, but I am sure you have
violated some."
That is the casual, accidental criminal. That is where we might find ourselves on some
occasion, in the clutches of the law, simply as ordinary citizens.
In all of these cases I think the physician can play a very definite part in the identification and segregation of those committing felonies or minor crimes by the appropriate
isolation, or perhaps some new method of procedure will have to be adopted or instituted,
and I think we as physicians can assist law enforcement officers in the recognition of such
deficiencies.
Page 3 58 I know that at the present time we are the victims of the attorneys who solicit our
assistance on one side or the other, and we find ourselves in the Courts, and the cleverness
of the attorney may enable him to practise the tricks of his trade in such a way as to bring
the medical profession into ridicule. Now I hope that some day and in some way this situation may be changed so that the physician may become a real friend of the Court, an
advisor of the Court, and that he may be called by the judge to give his opinion in certain
cases, preferably prior to the trial rather than be induced to come into the Courts of Justice
as a public exhibitionist, as is often the case.
I recall a case in which there was a number of distinguished colleagues in a certain
Court, and I do not think that one or any of them knew really what they were testifying.
They were being tricked in the testifying. Attorneys are very clever in that respect and
say that Doctor So-and-So said so and so and what is your opinion, and before you know
if you are called into Court so that there is that continuous spectacle, and we are all aware
of it, where the physician is called in to give evidence in the height of the trial and becomes
the victim of the attorney. I think it should be the other way round, we should be called
in by the Court, we should be called in to testify as to the mental and physical state of
the prisoner; when there is any scientific evidence it should be obtained before the prisoner
comes into the Court at the so-called pre-trial when evidence and facts should be brought
up before the trial occurs. It makes for courtesy.
I do not mean that only certain members of the community should be called into Court
and that no Doctor should be called into Court. I think that if there is a legitimate differ-
ece of opinion there should be no ill-feeling towards the doctor if he goes into Court.
The opinion must be based upon something more than sentimentalism.
A learned attorney once asked me how it came about that in any trial one could get
physicians into Court and have them perjure themselves on any side. I think what he was
hinting at is that physicians are found on opposite sides of a case in Court and they are
within their rights. The attorney's entire living is made by a difference of opinion. There
would be no trials if there was not a difference of opinion as to innocence or guilt, right
or wrong. So physicians are, of course, entitled to go into Court. I do think, however, and
it has been my experience, that we are victims of interplay on the part of the attorneys.
That should be corrected in some manner.
Now once a criminal has been apprehended and he has been declared guilty by the law,
then I think our work is pretty well over. The real value of the physician in the solution
of crime and his place in the human relationship to crime must come along before the vital
pronouncement of the sentence of the judge, because it is my candid opinion that prisons
and penal institutions do not in any way correct the commission of crimes or interfere
with the commission of crimes, and in reality they constitute institutions of high learning
in the art of crime.
The percentage of those who come back and fall into complete line among those in
society is exceedingly limited. So I hope that some day we may have a sharper differentiation of the types of criminals, certainly with a complete correction of the penal codes, so
that there may be a distinction made between the unfortunate habitues of crime and those
who are criminals to the end, and those who cannot help committing crimes.
There are those who can be put into some useful occupation in society rather than
giving them an opportunity of going out again and murdering another citizen, and that
is a thing to which we must look forward.
Another interesting thing is the relationship of the physician to the coroner's assistant
and the medical examiner's assistant. The Coroner's office is a constitutional office in the
United States and in a number of States. In my own State that constitutional authority
has been shorn of the power first invested in the district attorney. In a number of States
the coroner is out of existence. In certain States a medical examination system has been
established. The system was established in England in 1911 and it has been transmitted
to this country, and, as I have said before, is admirably adapted to a rural civilization, but
it is wholly incompetent to take care of the advance of civilization. There was a survey
made by a learned attorney, a pathologist and a judge in the United States under the
auspices of the National Research Council, and that bulletin we have available in our
Page 3 59 Washington, D.C., quarters, and it was their opinion that the coroner's office is no longer
capable of fulfilling its dual activities. The dual requirements of the coroner's office are,
first, the holding of investigations of unnatural and unusual deaths, suicides, homicides,
etc., the holding of inquests, and the holding of certain individuals suspected or held guilty
for the Grand Jury or other tribunals. There are, therefore, two qualifications, namely,
first, the ability to examine dead bodies, and, secondly, the ability to establish certain legal
relationships by virtue of the commitments- of the coroner's inquest.
It was the opinion of this Committee that in the United States the average coroner did
not possess either of these qualifications. He was not particularly trained for making a
complete and adequate examination, he certainly was not trained for legal work.
In many instances, as is true perhaps of your situation here, and it is true of our situation
in Portland, the coroner has done an excellent job within the limitations of his office, but
it is an inadequate office, and as far as our State is concerned we are looking definitely for
its abolition and we hope to relegate to the medical profession of our State the duties of
examination of bodies under the constructive programme of the unification of procedures.
There may be some disagreements as to the methods of procedure. Through my contact with post-mortem examination I have been led to believe that we are not aware of the
vital relationship of this procedure to the solution of crime . Again and again we have had
opportunities of going back over bodies when some little detail was missed which gave
the key to this solution.
To recall an experience I had recently: I was on a case where an Indian woman had
been in a drunken brawl with her husband. She was found on the following morning dead,
and the Indian was charged with murder. An examination was made of the body, and
there was not anything that showed anything more than that there had been a drunken
brawl. The woman was undoubtedly bruised. Someone said that Indians bruise terrifically
when they are intoxicated. Someone else has said that the way to tell if you are dealing
with an Indian is, if you examine his blood and find it contains 95% alcohol, then he is
an Indian.
We are able to go into such a case, and the physician, using his experience and
knowledge, would examine the body of that woman and determine that while she was
good and drunk, she was not drunk to the point where intoxication would be fatal to her.
In our own laboratory, for example, when we can take an individual, put him in the
next room and give him a certain quantity of whisky and have someone bring us a sample
of his blood every so often, we can tell you just what state he'is in. This can be told by
the quantity of alcohol in the blood.
We are talking about the ability of the individual to exercise his mental functions in
the normal manner, and we can determine that by the alcohol content. We found that
the woman was probably good and drunk, but we also determined that it was the shock
that killed her. In this case there was sufficient evidence to convince the Court that the
Indian was guilty.
In a number of instances we find by the detailed examination that when you make a
mistake in a diagnosis it is because your examination has not been complete—you fail to
start at the top of the head and terminate at the soles of the feet; and so it is, too, in postmortem examination. In the solution of crime, where there are failures, it is because
incomplete and incorrect post-mortem examinations have been made, and so incomplete
and incorrect evidence has been found.
The modern law enforcement officer has been raised to a very high standard and we
have reason to be proud of him. They have precisely the type of training that we as
physicians are accustomed to—the detailed examination with the accumulation of all the
facts, which enables them to make a diagnosis and which enables them to make a right
conclusion as to the determination of a given crime. By the analysis of build, type of
build, grouping, etc., we are able to discern a lot of things about the grouping of individuals.
In the solution of crime through the post-mortem examination we, as physicians, are
able to co-operate with officers to the extent that we can help them piece together the
facts and evidence in such a way that the conclusion may be drawn.
Page 360 Finally, let me say that if we, as physicians, take our place in the determination of the
motivation of crime and do our part in the eradication of those things which make for the
motivation of crime, if we will take our part in the identification and isolation of those
who are criminals by birth, by constitutional make-up, if we will take our part in identifying these criminals before the trial, and if we will further take our part in the appropriate
methods of punishment, in the further training in the art of dealing with crime, then the
former relationship to the solution of crime will become static.
Dr. A. W. Hunter discussed Dr. Menne's address.
Dr. Hunter said he had seen the Medical Examiner System in operation, as well as the
Coroner System; both had political interference. Whatever system was used, the essential
factor was co-operation between the courts, the law enforcement officers and the medical
profession. Today that does not exist. He cited ways whereby with our present system
more help could be given the courts and the police, but the Government must improve the
facilities to the doctors in the less populous areas.
Preventive  Medi
cine
Secti
on
THE IMPORTANCE OF THE EXAMINATION OF THE
CEREBROSPINAL FLUID IN SYPHILIS
S. E. C. Turvey, M.D.
Consultant in Neurology, Vancouver Clinic.
The cerebrospinal fluid was first removed by puncture with a needle through the
lumbar interspaces by Quincke in 1891, and Ravaut in 1903 first applied the technique to
the detection of syphilis. About 1915 it was shown that syphilitic involvement of the
nervous system occurred very early in the course of syphilis, that early neurosyphilis in
the stage before the appearance of secondary lesions could only be recognized by examination of the cerebrospinal fluid, and it is from this date that the test came into its true
perspective in syphilology. The purpose of this note is to emphasize the importance of
repeated examinations and to indicate when these should be done.
Abnormalities of the spinal fluid in syphilis are often present months or even years
before any neurological symptom or sign appears, and it is these "asymptomatic" cases
that respond best to an intensification or modification of routine treatment. This cannot
be overemphasized, that the spinal fluid may be the sole guide to an early and severe
affection of such vital structures as the brain and spinal cord. Therefore, it is an absolute
requirement that the fluid be examined in all early and latent cases at the proper time
during; their course.
The incidence of abnormal findings in the spinal fluid is listed in Table I.
Table 7.
Abnormal Spinal Fluid Changes (Stokes) '
1. In primary syphilis     7—2 5 % of cases
2. In secondary syphilis (untreated)  40—45% of cases
3. In treated syphilis  24—26% of cases
Thus, at the end of three years in the course of syphilitic infections, there will be 25%
involvement of the central nervous system which has not been cleared up by the patient's
resistance or ordinary treatment. If the spinal fluid is not examined routinely as outlined
below, most of these are missed at a stage before fixed damage to the tissue occurs and
when they would respond to treatment.
In the Neurological Section of the Vancouver Clinic of Venereal Disease Control there
are now 628 cases registered.  Of this number of known neurosyphilitics, 103 had a nega-
Page 361 tive blood Kahn on admission.   No more telling indication for the necessity of spinal
punctures need be shown.
The indications for a lumbar puncture may be summarized as follows:
1. Within the first six months after a primary or secondary infection; if positive,
repeat in six months; if negative, repeat in two years or prior to discharge as a "cure."
2. As part of the preliminary or diagnostic examination of all patients with a positive
blood test, other than those with primary or secondary syphilis.
3. Before suspending treatment in an early case. "No rest without a spinal test" in
all early cases.  If positive, no rest is allowed.
4. In all cases of so-called "fixed Wasserman" or "Wasserman-fast" syphilis. Neurosyphilis is a common reason for the "fixed Wasserman."
5. Regularly in neurosyphilitic cases, as an index of progress of treatment. The frequency must be determined by indications in the individual case.
The essential tests of the spinal fluid are four:
1. Cell Count.—An increase of cells is the earliest and simplest form of reaction.
It is an index of meningeal reaction and is therefore non-specific. The normal count should
not be over four lymphocytes per cubic millimetre. Cell counts from five to ten are definitely abnormal and significant. A fluid with a high cell count and positive Kahn has a
better prognosis than one with a low cell count and a positive Kahn.
2. Protein Estimation—An increase of protein above the normal thirty to forty milligrams per one hundred cubic millimetres is an early and non-specific sign of meningeal
reaction. It is of chief aid in prognosis, as it is the last of the four tests to return to normal
under treatment.
3. Kahn Test—This has proven to be as reliable on the cerebrospinal fluid as on blood.
It is the only specific test on the cerebrospinal fluid, but it is well to remember that it may
be, in rare instances, negative throughout an actively progressing neurosyphilis.
4. Colloidal Test—This test is non-specific and it is impossible to confirm or negate a
diagnosis of syphilis by this test alone. Its chief value is as an indicator of the character
and severity of the syphilitic involvement of the nervous system. The "first zone" curve
(5555543210) is invariably of serious prognostic significance, but may occur in tabes,
dementia paralytica, meningovascular syphilis or any other type of neurosyphilis. The
"second zone" curve (0124554100) occurs in forms of neurosyphilis other than dementia
paralytica.  A change in the curve in the absence of a positive Kahn is of no significance.
In their order of value or general significance, they should be placed: Kahn test, cell
count, colloidal reaction, protein estimation. No one test can stand alone as diagnostic or
prognostic, but considered together they are invaluable.
(The technique of spinal puncture will be described in a later paper.)
THE REPORT OF THE GENERAL COUNSEL FOR
THE YEAR 1937-3 8
Secretary, Canadian Medical Protective Association,
Ottawa, Ont.
The attention of the profession is drawn to the following very important opinion given
before the Annual Meeting of the Canadian Medical Association by their General Counsel.
We suggest a careful perusal.—Ed.
Dear Sir:
As General Councel for your Association, I have the honour to submit the following
report.
During the past year all completed actions against your members have been dismissed
and there have been no decisions of the Courts which alter the existing law relating to
our problems.
Page 362 In my report for the year 1936-37, reference was made to an appeal which had been
taken to the Court of King's Bench of the Province of Quebec. This appeal was rejected
by a three to two majority of the Court. After careful consideration, it was felt that the
importance of the case and the chances of success warranted a further appeal being taken
to the Supreme Court of Canada and this will be heard at the October term of the Court.
As various members of the Association have asked for advice as to the circumstances
under which it is legally and ethically justifiable to sterilize a man or woman, it may be
well to deal with it briefly at this time.
It is practically certain that a surgeon may not sterilize a man, and possible that he may
not sterilize a woman, even with their consent, for the sole reason that the patient wishes
to avoid having children. The law considers it to be in the interest of the State that every
citizen shall be able to reproduce, regardless of his or her fitness as a parent, and unless this
axiom is modified, voluntary sterilization will remain illegal. A surgeon who is asked to
perform a sterilization operation in the interests of the patient's health should satisfy himself that health would be seriously endangered if he did not do it, or he will risk a criminal
prosecution. If something goes wrong and the patient dies, he may be tried for manslaughter. If the wife or husband is aggrieved, he is in danger of being prosecuted at their
instance.
Where the operation is decided upon in the interests of the patient's health, the surgeon
should be more careful than usual to explain, in simple language, what the consequences
will be and to obtain a written consent.
Oral consent cannot be really safe. Although a witness, and better still, two witnesses,
may prove that a patient gave consent, yet actions may be brought when memories are
vague and witnesses dead or untraceable. One of the British protective associations has
devised forms which it recommends its members to use:
"I, of   hereby consent to undergo the
operation of and/or such further or alternative operative
measures as may be found to be necessary during the course of such operation."
(The latter may be struck out if it is not clearly applicable).
For sterilizing operations on women it recommends the alternative formula:
"I, of—: hereby consent to undergo the
operation of the effect and nature of which has been explained
to me."
and
"I of the husband of the above named
 hereby consent to such operation."
It is not necessary in law for a husband, to consent to an operation on his wife, provided that the wife herself consents, but the form is used to save dispute afterwards.
All these remarks apply equally to radio-therapy, which, I understand, normally produces considerable discomfort and sometimes actual burning, which is often used to bring
about sterilization, and which when applied to the pelvis often sterilizes the patient incidentally.
All of which is respectfully submitted,
EDMUND F. NEWCOMBE,
Ottawa, June 2nd, 1938. General Counsel.
CHILLIWACK MEDICAL SOCIETY
The Chilliwack Medical Society met Doctors Cleveland, Huggard and Thomas on
August 1st at the commencement of their tour through the northern interior. Following
dinner, presided over by Dr. R. McCaffrey, Dr. Huggard gave a talk on Surgery of the
Gall-Bladder. Dr. Cleveland spoke on the common medicaments in use in the treatment of
diseases of the skin and their indications. Both papers elicited helpful discussion and the
speakers were accorded the warm thanks, of the Chilliwack men.
Page 363 us
V
ancouver
G
enera
Hospita
CHRONIC THYROIDITIS WITH REPORT OF A CASE
C. A. McLaughlin, M.D.
Inflammation of the thyroid gland is a rather rare occurrence, and at the Massachusetts
General Hospital Thyroid Clinic only 1 % of cases are so classed. Chronic thyroiditis is even
yet more rare, the following case being the only one on the pathological records at the Vancouver General Hospital. Thyroiditis may be classed as acute, subacute or chronic, suppurative or non-suppurative. The term strumitis is limited to inflammatory conditions in
a thyroid that has been previously pathological. Chronic thyroiditis seems to be in a separate class of disease entities and one of which the etiology is not known. It is with the latter
type of case that we shall deal.
Chronic thyroiditis is not an end stage of acute thyroiditis; at least, no cases of the
latter have been known to continue on to the chronic stage. Many theories as to its etiology
have been brought forward. Some authors have thought it to be tuberculosis, others luetic,
but the consensus of opinion now seems to be that it is a systemic and generalized infection
possibly originating in the upper respiratory passages, teeth, tonsils. In this respect an
interesting case was reported in which a normally situated thyroid and an anatomically
unconnected aberrant gland were removed from the same patient, the pathological report
being identical, i.e., Riedel's Struma. This was taken to indicate that there was probably
some general etiological factor from the blood stream acting on both glands. Investigators
have injected experimental animals with tubercle bacilli and spirochetes in unsuccessful
attempts to reproduce the disease.
Chronic thyroiditis is generally divided into two types: (a) chronic fibrous, ligneous
or Riedel type, and (2) chronic lymphoid or Hashimoto's type. While these were at first
considered to be two distinct types, latterly some workers have thrown, considerable doubt
on this. Ewing suggests that Hashimoto's type is merely an early form of Riedel's struma.
Graham, after carefully comparing the two types, concludes that they are separate entities,
and points out that the average age of paients with Hashimoto's type is greater than the
average of those with Riedel's thyroiditis, and also that the former is universally bilateral
while 50% of the latter are unilateral.
Riedel's Struma or Chronic Ligneous Thyroiditis.
Riedel first reported his three cases in 1896. Clinically and at operation he thought these
to be malignant, but their subsequent course did not bear out this diagnosis. Search of the
literature reveals 90 cases reported with this diagnosis.
Symptoms and Course.—The clinical course is gradual and progressive and may lead
to death from pressure symptoms if not relieved. The patient, however, usually consults
her doctor relatively early because of the enlarged, tender swelling and pressure symptoms.
In Graham's series the average duration of symptoms was 7.3 months.
Besides the tender swelling, dysphagia, dyspnoea, hoarseness and aphonia are common
complaints, as well as accepted headaches dure to involvement of the upper cervical nerves.
Later on in the disease myxcedema or other signs of hypothyroidism may appear and this
is a distinguishing point in that malignancies do not produce hypof unction of the thyroid.
Means states that hyperfunction is never found. Patients often show evidence of thyroid
deficiency postoperatively and require thyroid therapy. Riedel's type is unilateral in 50%
of cases.
Pathology.—The thyroid becomes enlarged, tender and stony hard in consistency and
gradually becomes changed into hard fibrous tissue. The process may be briefly described
as an active sclerosing with extension into the neighbouring structures of the neck (except
the skin) which may thus make subtotal thyroidectomy very difficult if not impossible.
One case is reported where extension up to the base of the skull occurred. The parenchyma
Page 364 may be almost completely replaced by fibrosis and varying degrees of hypothyroidism is
not uncommon.
Diagnosis.—The chief difficulty in diagnosis, of course, is from malignancy. The age
of the patient often aids here. Lymph glands are never involfed in chronic thyroiditis, but
they are not necessarily involfed in carcinoma either. The Glasgow clinicians (see below)
suggest biopsy, if in doubt, before a clinical trial with X-radiation or radium therapy.
Chronic Lymphoid or Hashimoto Type of Thyroiditis.—In 1912 Hashimoto published
a report on four cases of chronic thyroiditis that varied in a number of ways, both pathologically and clinically, from Riedel's type. In 1936 Lee collected 36 cases from the
literature that he classified as Hashimoto's type. Thus it would appear that this is a rarer
type that Riedel's. However, in Means' series of 12 cases of chronic thyroiditis he classifies them all as Hashimoto's type.
In the largest series of 38 cases, 37 of these were females with ages varying between 15
and 75, but with an average aye slightly higher than in Riedel's type, i.e., 45-55 years.
Symptoms and Course.—This is very similar to the preceding type, with the following
exceptions: The disease is insidious and progressive but of slightly longer duration. The
average period of symptoms before consulting a doctor was 14.4 months. Besides this,
there is usually a temperature, a leucocytosis, present, which is rare in Riedel's type.
Pathology.—Here both the gross and microscopic differ from Riedel's struma. There
is an enlarged tender gland but it does not have the stony hardness of the previous type.
While there is infiltration of the capsule it does not involve the surrounding structures of
the neck and thus presents an easier surgical problem.
The microscopic picture is one of very extensive lymphoid infiltration with lymph
follicles present, many of which may have active germ centres. Along with this process
there is atrophy of the parenchyma of the gland.
Diagnosis.—The diagnosis here is not so apt to be confused with carcinoma, because
of the difference in relative hardness. Temperature and leucocytosis are also aids, but a
final diagnosis is not justifiable without microscopic examination.
Treatment.—The treatment of both types is the same and most authorities recommend
subtotal thyroidectomy where this is possible. Although results with this type of treatment
are good and a permanent cure is usually obtained, cases have been reported of recurrences
necessitating further surgical procedures. Dr. G. Fahrni states that lately he has been
removing only the isthmus of the gland with good results. Renton, Charteris and Heggie
of Glasgow report a series of five cases treated with radium, with good results in all cases.
Three of these cases were diagnosed by biopsy and two on clinical evidence only. They
suggest that a therapeutic trial of radium will establish a diagnosis in 10-14 days with
regression in size of the gland and clinical symptoms. Crile states that "when a clinical
diagnosis can be made, roentgen therapy is the preferred treatment.
Report of a Case.
The following case is reported as interesting in that the clinical symptoms probably
resemble most closely Hashimoto's type, whereas the pathological picture is of Riedel's
struma. It also shows some of the difficulties and complications of surgery in these cases.
History: Miss P. S., Canadian, age 23. Admitted Feb. 22, 1939.
Entrance Complaints: (1) Nervousness, (2) loss of weght, (3) palpitation, (4) headaches, all over a period of 7-8 months; (5) tender lump in throat and neck, 2 months.
History of Present Illness: At 6 years of age patient had "a goitre" for which her physician prescribed rest and "iodine tablets." Since then has had no related trouble until last
summer, when her friends noticed a change in her. She became nervous, restless, and began
to lose weight in spite of the fact that she has always been of the "thin type," never weighing more than 100 pounds (Height 5 ft. 4 in.) She was also troubled with a "pounding
heart" and a peculiar type of headache beginning in the back of the neck and radiating into
the occipital and at times the temporal regions. These were of short duration and occurred
usually just after rising in the morning. Chiropractic adjustments failed to relieve these.
Seven to eight weeks previous to admission she first noticed a tender swelling in the
Page 365 neck. After some procrastination she consulted her physician. Because of the inflammatory
characteristics heat was applied without much effect. A B.M.R. was taken, which showed
a rate of —j—2 8 and patient was admitted to hospital for preoperative preparation.
Functional Inquiry:
Head and neck—Headaches as above. Eyes and ears, negative; no exophthalmos. Goitre
at 6 years of age regressed under treatment and she had no further trouble until present
illness.
Respiratory—Negative, with exception of slight dyspnoea.
Alimentary—No particular dysphagia except "slight constant pressure" on neck.
Appetite good. No indigestion, but lately has complained of pain in epigastrium after
meals.  Bowels tend to be constipated.
Cardiovascular—Has noticed "pounding of heart" for past few months and also that
she tires very easily after minor exertion.  Slight dyspnoea.  No oedema.
G.U.—Menses began at 13. Twenty-eight-day cycle usually lasting 5 days, with mild
dysmenorrhcea lasting first few hours only. For past two months cycle has been only 21
days. No nocturia or dysuria.
Neurological—Patient says she is much more nervous than usual, tires easily and often
gets "crying spells."
Examination:
T., P., R., 99°, 115, 20. A thin, fair-haired, excitable young girl, quite restless in bed;
appears to have lost some weight.
Head and neck—Eyes: Pupils equal, react to L. and A.; no exophthalmos or lid lag.
Ears, nose and throat: Negative. Neck: There is a diffuse firm rubbery enlargement of the
thyroid which is quite tender on palpation, particularly the right lobe. No bruit detected.
Skin freely moveable over it.
Respiratory—Lungs clear throughout.
Cardiovascular—Heart: Normal in shape and position; no murmur; no irregularities.
B.P., 130/80.  Pulse: Rapid but regular, good volume and tension, rate 115.
Abdomen—Negative.
Skin and Extremities—Skin moist and elastic; slight tremor to extended hand.
Laboratory—B.M.R., +28. Urinalysis, negative. R.B.C. 3,080,000, Hb. 60%. Unfortunately there is no record of white cell count. X-ray: Chest. Heart, slightly enlarged
to right. Lungs: A few calcified nodules in right and left second zones; "slight increased
density shown at apices in relation to thoracic inlet possibly due to enlarged thyroid."
Progress.—Patient was put on high carbohydrate diet, sedatives, digitalis grs. I b.i.d.
and Lugols m X ti.d. For two weeks she showed very little improvement, pulse running
95-120 and temperature ranging between 99-100. However, during the third week temperature and pulse dropped to practically normal and thyroidectomy was performed on
March 17, 1939.
Operation.—Dr. G. E. Sheldon performed a subtotal thyroidectomy under avertin
gas anaesthesia. Moderate difficulty was experienced in freeing the gland, although it did
not appear to grossly involve the surrounding tissues. It was firm in consistency, pale in
color and gave a rubbery sensation on incision. Penrose drain inserted and wound closed
in layers.
Pathological report—
Macroscopic: "Specimen consists of 3 pieces of thyroid tissue weighing in aggregate
20 grams. They are very pale, extremely firm, and on section present a compact, rather
fibrotic, homogenous cut surface; the firmness and pallor suggesting a possible thyroiditis."
Microscopic: "A great many sections were taken through various portions of the
thyroid gland and they show, as the most outstanding feature, a massive diffuse lymphocytic infiltration and accompanying fibrosis, which has markedly compressed the acinar
structures, practically none of which contain colloid material, and their lining epithelium
appears definitely but moderately hyperplastic. Scattered throughout are moderately frequent tubercle-like formations, fairly well circumscribed and consisting of generally quite
large, irregular giant cell formations and epithelial cells.  There is no caseation in any of
Page 366 the sections examined and these are probably so-called 'pseudo' tubercles that are occasionally seen in this condition, i.e., Riedel's struma or chronic ligneous thyroiditis."
Diagnosis: Riedel's struma (chronic ligneous or woody thyroiditis.)
Post-operative Course—The temperature and pulse returned to normal on 5-6 day.
Patient complained of considerable headache and aching pain in the back of neck. She also
complained of periodic tingling sensations in extremities, particularly right arm and leg,
and on one occasion complained of a brief crampy spasm of the right hand. She was discharged on the 15 th post-operative day, feeling quite well.
After discharge patient developed typical attacks of tetany with positive Chrostek's
sign and carpopedal spasms (Trousseau's sign) which were particularly aggravated by menstruation. High calcium and low phosphorus diet, calcium gluconate by mouth and parathormone therapy was instituted. While considerable improvement occurred to date there
are still some signs of parathyroid deficiency.
Summary.
The literature on chronic thyroiditis is briefly reviewed. Reports were found on 138
cases, 90 of which were Riedel's type.
An interesting case is reported that shows clinical features of both types, i.e., Riedel's
and Hashimoto's.
Recent claims for roentgen and radium therapy may offer some advantages over surgery in view of technical difficulties in the latter procedure.
REFERENCES:
Means, J. H.—Thyroid and its diseases.
Renton, J. M., Charteris, A. A., and Heggie, J. F.—B. J. S., July, 1938.
Ewing—Neoplastic Diseases.
Fahrni, Gordon S.—Personal communication.
Boyd, Wm.—Surgical Pathology.   1933.
Christopher F.—Textbook of Surgery.   1936.
Joll, C. A.—Diseases of Thyroid Gland.   1932.
Jaffe, R. H.—Chronic Thyroiditis.  J. A. M. A., vol. 108, Jan., 1937.
Bremzier, A. G.—Thyroiditis accompanied by Hyperthyroidism. Annals of Surg., Jan., 1927.
A CASE OF ADENOCARCINOMA OF THE OVARY
EXHIBITING RETROGRESSIVE CHANGES IN
PERITONEAL IMPLANTS FOLLOWING LAPAROTOMY
Dr. H. A. Robertson
The patient, a housewife, aged 44 years old, nullipara, of English birth and parentage,
was admitted to St. Paul's Hospital in June, 1938, with a tentative diagnosis of cyst of
right ovary and fibromyomata uteri.
Complaints and Present Illness: On admission patient complained of: (1) Burning,
dragging pain in right iliac fossa and lower back, three months' duration; (2) enlargement
of abdomen, more especially for three months and to a lesser extent for one year; (3)
menorrhagia and metrorrhagia, three months; (4) general weakness and malaise. Menstrual irregularity became more and more marked just before admission, the period averaging two weeks' duration after an interval of only two weeks.
Past history was essentially negative, except for usual childhood diseases. There was
no previous hospitalization.
Physical examination revealed a somewhat emaciated, pale brunette, appearing more
than stated age owing to a definitely cyanotic tint of the complexion, apparently due to
abdominal compression. The temperature was 99.4; pulse 102; respirations 20. Heart and
Page 367 lungs were negative. B.P. 122/70. Hgb. 89%; R.B.C. 4,640,000; W.B.C. 15,900; Pmn.
85%; L. Lymphs. 13%; Monos. 2%. Bleeding time 2% mins.; coagulation time 3 mins.
Abdominally a firm mass could be palpated, extending from the pelvis prominently into
the mid-epigastrium, rather more to the right side. Vaginally this large mass found to be
differentiated from the uterus, which, however, was also enlarged and knobby and extremely fixed low down in the pelvis. X-rays: A flat plate of abdomen demonstrated increased density in right lower abdomen with gas displacement to left but no evidence of
calcification or sharply circumscribed mass. Urinalysis was essentially negative, although
considerable urgency from pressure had been complained of.
Operation—June 11th, 193 8. Under avertin and ether anaesthesia abdomen was opened
through a low right paramedian incision, subsequently extended upwards to the xiphoid
cartilage on account of the extreme size and solidity of the ovarian tumour encountered.
A considerable amount of clear, straw-coloured fluid was aspirated from the peritoneal
cavity. The tumour was freed from numerous adhesions to the parietal peritoneum,
omentum and transverse colon and removed with double ligation of the pedicle. The
anterior parietal peritoneum was extremely thickened, congested and nodular in places
where it had been in apposition with the tumour. In addition to the primary tumour there
were three smaller parovarian cysts on the right side, one of which the size of a tennis ball,
lay between the folds of the broad ligament. The uterus was found enlarged to the size
of a two and one-half months' pregnancy, and studded with several very firm intramural
fibroids. The left ovary, size of a small orange, contained many small cystic nodules, which
grossly resembled the exterior of the primary tumour. All of these structures were left
undisturbed in situ as, following removal of tumour, patient showed signs of collapse, the
pulse rising to over 160. The long abdominal wound was hurriedly closed after ligation of
numerous points of adhesion.
Pathological Report.—Gross: Mass about the size of a football, which has a nodular,
irregular appearance. On section contains a large amount of mucinous material. Remainder of the tissue is very soft and apparently degenerating. Other sections which are more
solid have a somewhat fatty appearance, of the nature of fatty degeneration. There are
several cavities filled with clear, mucinous material. Walls of these cavities are very
haemorrhagic.
Microscopic: Sections taken from various portions of this tumour show it to be almost
a solid mass of carcinoma. There is a considerable amount of mucoid secretion filling
pseudo acini, lined by columnar and very irregularly shaped epithelial cells, and in many
places formation of definite papillary projections into the lumen, in other places solid epithelial proliferation. There is a very marked anaplasia of the cells, many mitotic figures,
and the tumour is exceedingly vascular. This is a papillary adeno-carcinoma of the ovary
which has arisen from a papillary cyst adenoma. There are extensive areas of necrosis
present.—Dr. A .Y. McNair.
Course.—Following blood transfusion 500 cc. on the day of operation patient made
uneventful recovery, being afebrile after third post-operative day, and quickly losing the
cyanotic or cachetic appearance previously noted. Roentgen therapy was advised after
completion of wound healing but refused. Menstruation resumed a 28/5 cycle, being
very moderate in amount, but some backache persisted owing to the weight and size of
the uterus which still tightly packed the pelvis. Ten months later, April, 1939, patient
presented herself again for operation and was readmitted to St. Paul's Hospital.
Operation—April 24th, 1939. Under ether anaesthesia a left paramedian incision was
made and on exploring the pelvis and upper abdomen no visible or palpable trace of recurrence of malignancy was found and the areas where adhesions had existed were entirely
clear. The left ovary had retrogressed to a normal size and consistency. The smaller cysts
previously noted on the right side had completely disappeared. The uterus, which was now
the size of a three-months' pregnancy, was removed supra-vaginally with coring out of
the cervix. Pathologically uterus showed large intramural fibromyomata with no evidence
of malignancy. The post-operative course was again uneventful and afebrile from the
fourth day, and patient now appears and feels perfectly well.
Page 368 Comment.—The apparent retrogression of peritoneal and other implants in cases similar to the above following laparotomy has been described by several writers1, occurring as
inexplicably as the improvement that follows laparotomy in tuberculous peritonitis.
Ewing2 states that: "This favorable outcome occurs almost exclusively with structures
which are of a comparatively low degree of malignancy.'* The usual reference3 is to
pheudomyxoma peritonei, serous cystadenoma, or pseudomucinous cystadenoma. The
present case would appear to be unusual in presenting on the contrary large proportions
of solid adeno-carcinoma of considerable vascularity and apparent activity.
REFERENCES:
1. Curtis, Bumm, Troschel, T. Freund, E. Fraenkel, Pfannenstiel, Olshausen.
2. Ewing: Neoplastic Diseases.   W~. B. Saunders Company, Philadelphia, 1928.  Ed. 3.
3. James Robert Goodall, Nelson Surgery, VoL 7.  Cysts and Tumours of the Ovary.
s.
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Detailed information on request.
FAT-SOLUBLE VITAMINS PRESENTED
IN SOFT GELATIN CAPSULES
Vitamin A.... 10,000 International Units
Vitamin D.... 1,750 International Units
Vitamin E....As contained in 2% oz.
of whole wheat
WATER-SOLUBLE VITAMINS AND
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Vitamin Bi (Thiamin Chloride)
222 International Units (.67 mg.)
Vitamin C (Ascorbic Acid)
300 International Units (15 mg.)
Ferrous Sulphate Exsiccated
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Acid Calcium Phosphate
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also traces of copper, manganese
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AYERST, McKENNA & HARRISON LIMITED
882
Biological and Pharmaceutical Chemists
MONTREAL, CANADA Prevention of the Common Cold
Reports in medical literature indicate that an urgent need is felt by the medical
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D.B.H. Common Cold Vaccine is now issued in tablet form for oral administration. :
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B. D. H. COMMON COLD VACCINE TABLETS
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Stocks of B.D.M. Common Cold Vaccine Tablets (For oral use) are held by leading
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