History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: November, 1951 Vancouver Medical Association Nov 30, 1951

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The Vancouver Medical Association
Publisher and Advertising Manager
OFFICERS 1951-52
Db. J. C. Grimson Dr. E. C. McCoy Dr. Henry Scott
President Vice-President Past President
Dr. Gordon Burke Dr. D. S. Munroe
Hon. Treasurer Hon. Secretary
Additional Members of Executive:
Dr. J. H. Black Dr. George Langley
Dr. G. H. Clement Dr. A. C. Frost Dr. Murray Blair
Auditors: Messrs. Plommer, Whiting & Co.
Eye, Ear, Nose and Throat
Dr. B. W. Tanton Chairman Dr. John A. Irving Secretary
Dr. Peter Spohn____ Chairman Dr. John W. WHiTELAW-Secretary
Orthopaedic and Traumatic Surgery
Dr. A. S. McConkey. Chairman Dr. W. H. Fahrni Secretary
Neurology and Psychiatry
Dr. R. Whitman Chairman Dr. B. Bryson Secretary
Dr. Andrew Turnbull Chairman Dr. W. L. Sloan Secretary
Dr. A. F. Hardyment, Chairman; Dr. J. L. Parnell, Secretary;
Dr. F. S. Hobbs, Db. J. E. Walkeb, Db. E. France Wobd, Db. D. W. Moefatt
Go-ordination of Medical Meetings Committee:
Db. J. W. Fbost Chairman Db. W. M. G. Wilson Secretary
Summer School:
Db. Peteb Lehmann, Chairman; Db. B. T. H. Mabteinsson, Secretary;
Db. A. C. Gabdneb Fbost; Db. J. H. Black; Db. Peteb Spohn;
Db. J. A. Ibving.
Medical Economics:
Db. F. D. Skinneb, Chairman; Db. W. E. Sloan, Db. G. H. Clement,
Db. E. A. Jones, Db. Robebt Stanley, Db. F. B. Thomson, Db. R. Langston
Db. Gobdon C. Johnston, Db. W. J. Doebance, Db. Henby Scott
V.O.N. Advisory Committee
Db. Isabel Day, Db. D. M. Whitelaw, Db. R. Whitman
Representative to the B.C. Medical Association: Db. Henby Scott
Representative to the Vancouver Board of Trade: Db. E. C. McCoy
Representative to Greater Vancouver Health League: Db. J. A. Ganshobn
Published  monthly  at  Vancouver,  Canada.     Authorized  as  second  class  mail,  Post  Office  Department,
Founded 1898; Incorporated 1906
First Tuesday—General Meeting—Vancouver Medical Association—T.B. Auditorium.
Clinical Meetings, which members of the Vancouver Medical Association are invited
to attend, will be held each month as follows:
Second Tuesday—Shaughnessy Hospital Staff Meeting.
Third Tuesday—St. Paul's Hospital Staff Meeting.
Fourth Tuesday—Vancouver General Hospital Staff Meeting.
Fifth Tuesday—(when one occurs)—Children's Hospital Staff Meeting.
Programme of General meetings will be circularized monthly by the Executive
Office of the Vancouver Medical Association Programme of Clinical meetings will be
displayed weekly on bulletin boards prepared for that purpose and placed in the Vancouver General, St. Paul's and Shaughnessy Hospitals.
Regular Weekly Fixtures in the Lecture Hall
Monday, 8:00 a.m.—Orthopaedic Clinic.
Monday, 12:15 p.m.—Surgical Clinic.?^
Tuesday—9,: 00 a.m.—Obstetrics and Gynaecology Conference.
Wednesday, 9:00 a.m.—Clinicopathological Conference.
Thursday, 9:00 a.m.—Medical Clinic.
12:00 noon—Clinicopathological Conference on Newborns.
Friday, 9:00 a.m.—Paediatric Clinic.
Saturday, 9:00 a.m.—Neurosurgery Clinic,
edition, 1950.
Regular Weekly Fixtures
Tuesday—9-10   a.m Paediatric  Conference
2nd Tuesday of each Month—11 a.m l|ii- Tumor Clinic
Wednesday—9 -11  a.m .Jgjp|L  Medical Clinid
2nd and 4th Wednesday—11-12 a.m Obstetrics and Gynaecology
Thursday—11-12   a.m "__, Pathological  Conference
(Specimens and Discussion)
Friday—8  a.m a—\ | | I 1—Clinico-Pathological Conference
(Alternating with Surgery)
Alternate Fridays—8 a.m Surgical Conference
Friday—9 a.m _ Dr. Appleby's Surgery Clinic
Friday—11  a.m Interesting Films Shown in X-ray Department
Regular Weekly Fixtures
Tuesday, 8:30 a.m.—Dermatology.
Wednesday, 10:45 a.m.—General Medicine.
Wednesday, 12:30 p.m.—Pathology.
Thursday, 10:30 a.m.—Psychiatry.
Friday, 8:30 a.m.—Chest Conference.
Friday, 1:15 p.m.—Surgery.
Tuesday, 9:00 a.m. to 10:00 a.m. (weekly)—Clinical Meeting.
Spring meeting—April 25th, 26th, 1952.
RECEPTIONIST with general office experience. Clinical Laboratory training.
Available Immediately.
Box 10, Bulletin Office, 675 Davie Street
Publishing and Business Office — 17 - 675 Davie Street, Vancouver, B.C.
Editorial Office — 203 Medical-Dental  Building, Vancouver, B.C.
The Bulletin of the Vancouver Medical Association is published on the first of
each month.
Closing Date for articles is the 10th of the month preceding date of issue.
Manuscripts must be typewritten, double spaced and the original copy.
Reprints must be ordered within 15 days after the appearance of the article in question, direct from the Publisher. Quotations on request.
Closing Date for advertisements is the  10th of the month preceding date of issue.
Advertising Rates on Request.
Page 23 Vasoconstriction
H combined with
antibiotic therapy in
(brand of phenylephrine)
In upper respiratory tract infections,
topical application of penicillin to the nasal cavity has a decided bacteriostatic action against
typical respiratory pathogenic microorganisms.
To provide clear passage for such therapy,
Neo-Synephrine is combined with penicillin-
shrinking engorged mucous membranes and
allowing free access of the antibiotic.
Neo-Synephrine—a potent vasoconstrictor—
does not lose its effectiveness on repeated application ... is notable for relative freedom from
sting and absence of compensatory congestion.
♦ with
Stable • Full Potency
Supplied in combination package for preparing 15 cc. of a fresh buffered solution
containing Neo-Synephrine hydrochloride
0.25%  and Penicillin  10,000 units per cc.
New York 18, N.Y.      Windsor, Ont.
Neo-Synephrine, trademark rag. U.S. & Canada
Total population  -  estimated '.    397,140
Chinese   population   -   estimated ■ I     6,282
Other   -   estimated : .  640
August,  1951
Rate per
Number 1000 pop.
Total deaths   (by occurrence) 352 10.6
Chinese deaths \  14 26.7
Deaths,   residents   only 308 9.3
Birth Registrations—Residents and Non-Residents:
(includes late registrations)
August,  1951
Female !        - 472
Infant Mortality - residents only
Deaths under  1   year  of  age	
August,  1051
Death rate per 1000 live births 17.9
Stillbirths   (not included in above item) I 10
Scarlet Fever 	
Diphtheria   Carriers
Chicken  Pox	
Whooping Cough 	
Typhoid Fever 	
,1951  *
August, 1950
Cases-       Deal
5            —
15            —
7            —
6            —
5             —
18            —
typhoid Fever Carriers Ui  —
Jndulant Fever j  —
Poliomyelitis   3
I*uberculosis  46
Erysipelas  —
Meningitis j \  —
Infectious Jaundice
Salmonellosis Carriers
pysentery Carriers
4 —
69 —
dancer   (Reportable Resident)
Rapid and Prolonged
For Aqueous Injection
The need for a penicillin preparation which gives initially high blood
levels as well as a prolonged effect is fully met by Penicillin G Procaine and
Penicillin G Sodium for Aqueous Injection.  This product, as supplied by
the Connaught Medical Research Laboratories, provides in each cc. of the
suspended preparation 300,000 I.U. of penicillin G procaine and 100,000
I.U. of penicillin G sodium. The soluble penicillin G sodium permits of the«
rapid attainment (usually within 30 minutes) of a relatively high level of |
penicillin in the blood, followed by the maintenance of lower blood levels
for about 24 hours, due to the effect of the relatively insoluble penicillin j
G procaine.
This new product of the Laboratories is prepared as a stable dryi
powder which requires no refrigeration. By the addition of an appropriatei
volume of sterile water, a free-flowing aqueous suspension is readily andi
quickly obtained. The aqueous suspension is ready for immediate intra-*
muscular injection using a 20-gauge needle.
1-dose vial—  400,000 International Units
5-dose vial—2,000,000 International Units
10-dose vial—4,000,000 International Units
University of Toronto Toronto, Canada
Established In  1914 for Public Service through Medical Research and die development
of Products for Prevention or Treatment of Disease.
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. In one of Osier's addresses, preserved for us in his well-known Aequanimitas, he
writes of "The Educational Value of the Medical Society": and in these days of multiple associations, membership in which is being so temptingly offered to us, it would
be well to pause awhile and ponder the words of this man who contributed so much
help and inspiration to the formation and growth of medical societies. There are
various types of these, the purely medical, dealing chiefly with papers and discussions
of cases—such as clinical, sectional and the like. Then there are the medico-political
societies, to which one belongs for the practical reason of self-protection—and lastly,
there is the medical society in which Osier believed, the association of men together
with a view to achieving the end of which the Psalmist spoke when he said "what a
joyful and pleasant thing it is for brethren to dwell together in unity."
This is the keynote of so many of Osier's talks—unity, peace and concord—in
fact, one of his addresses, his farewell address to the Medical Profession of the United
States, bears this as a title—and it can be found, too, in Aequanimitas. To him the
Medical Society was a prime factor in the securing of this end—harmony between its
members—the opportunity for intercourse with one's fellows for the removal of misunderstandings, for the exchange of ideas—but we urge you to read the original.
Speaking for ourselves, at least, we believe that this should be the prime, if not the
only reason for the existence of such a Society. This includes scientific study and
intercourse, it includes work which will be of benefit to the community in which we
live, it includes social intercourse and so on—but it does not include, and should not
include, controversial matters such as politics, whether medico-economic, legislative, or
what not. This should be left to the organizations which are formed for that purpose.
To include them in the programme of such a body, for instance, as the Vancouver
Medical Association, is to invite discord and wrangling. JTrue, in time past we may
have been forced by circumstances to enter this field, but we should, as soon and as
thoroughly as possible, leave it and return to our own business.
And another fundamental idea of Osier's was the urgent necessity for a good
library. We in Vancouver can never forget how he commended those of us who
started our Library—his words of encouragement and advice, even more precious than
the cheque he so generously included in his letter, that we preserve in our Archives.
To Osier, as booklover, any Library was a mine of wealth, to him, as a doctor it
was an absolute necessity—to the medical society, one of its greatest assets, if not its
greatest. To quote him once more—"In no way can a Society better help in the education of its members than by maintaining a good Library. The self-sacrifice necessary
to establish and maintain such a Library does good to the men who take part in it:
harmony is promoted: the dignity and usefulness of the profession are maintained."
And we in Vancouver know what the Library has meant to us, what a cement
it has been (again to use Osier's phrase). It is our greatest tangible asset, and we must
keep it so, and ever enhance its value.
And this brings us to another point. That evil demon, the high cost of living, has
struck at our Association, as it has at many other institutions. Today the maintenance
of our Library costs twice as much, if not more, than it did some ten years ago. And
the Association cannot provide all that it would like, perhaps even all that it should, to
buy all the books and periodicals that we should have.
Here is an opportunity for each of us to help. Many of our members have given,
and give, generously of books and journals to the Library. Many more of us could do
the same. We are sure that the Library Committee would welcome such help most
heartily. It would be a gift to all of us, it would be a monument to the giver, it would
be a permanent source of benefit to all.
By The Editor
A medical experiment of considerable interest is under way in the Colwood area
adjoining Victoria, and some eight or ten miles from that city's centre.
This is a fairly thickly populated area, with many families living in or near it.
Adjoining it are farming areas, with many small holdings.
For a considerable time there has been a constant complaint from this area that
medical service is very difficult to obtain. It did not appear to be possible to induce
any medical man to settle there permanently—and its distance from town made it
both very difficult and very expensive to secure medical help from Victoria itself.
Accordingly, this present "experiment" has been initiated. As seems to be so
often the case in the question of medical pioneering, a Catholic Sisterhood is responsible
for its inception, and has vigorously sponsored and put into effect a practical and
efficient medical clinic. The Sisterhood referred to is that of the Sisters of the Love of
Jesus, associated with the Order of St. Benedict, better known as the Benedictines,
whose work in all charitable fields is so familiar to us all.
The Sisters acquired part of the property of the Colwood Golf Club, including
the clubhouse. They had hoped to use this as a hospital, but it was found to be
utterly unsuitable for this purpose, and they are now using it to accommodate old
pensioners and crippled old people who require nursing attention.
The Medical Clinic occupies a building on the grounds, and is equipped with
examining rooms, minor surgical rooms, a well-furnished laboratory, consulting rooms,
etc., on the same basis as that of many general medical practitioners. Four medical
men are associated with the Clinic—each one devoting so much time weekly to the
Clinic, and acting precisely as he would in his own office, seeing patients at regular
fees, except, we suppose, where charity patients are concerned, if there be any of these
nowadays. There is a doctor in attendance daily. Provision is made for night calls
and a full office practice is available to the area.
It is estimated that there are some 500 families in this area and this takes no
account of a widely scattered farming population.
The doctors concerned are Drs. J. Tysoe, J. Roe, J. Devlin and V. W. Smith, all
of Victoria.
This is a notable attempt to fill a fairly urgent need, and is ,in our opinion, a most
ingenious solution of a rather difficult problem. It would appear to meet all the requirements—it is fair to everyone concerned, and it suggests a very efficient way of
meeting similar problems in other areas.
As editor of this publication, we visited the Clinic, and were shown through it
by one of the Sisters, whom we suspect we interrupted on her way to tea. She
disclaimed, however, any such interruption, and most kindly spent half to three-
quarters of an hour showing us about. She was, as might be expected, most enthusiastic
about the project—and after listening to her, we too became convinced that this is a
most worthwhile project. We must heartily congratulate the Sisters and their order
on a very good piece of work, and we are sure it will fill a very real need. We
understood from our guide that a hospital is planned of some thirty to fifty beds, to
be erected as soon as is found practicable. This will make the scheme more of a self-
contained unit, and will greatly help residents in the area.
1700 Block West Broadway
Phone CHerry 1331
Page 26 ancouver
Honorary Treasurer-
Honorary Secretary _
JDr. J. C. Grimson
_Dr. E. C. McCoy
-Dr. Gordon Burke
-Dr. D. S. Munroe
-Dr. J. H MacDermot
The twenty-ninth annual Summer School of the Vancouver Medical Association
was held from May 28 th to June 1st inclusive. Once again a diminishing numerical
registration was noticed, there being 199 paid registrations and 33 complimentary,
making a total of 232, which compared with figures of the previous year—namely
250 and 209 represents a slight reduction in registration.
The pattern of the Summer School was varied by the introduction of local speakers
from the Departments of Surgery and Medicine of the University of British Columbia,
Faculty of Medicine. We were fortunate in having visiting speakers from Toronto
and Winnipeg in the persons of Dr. D. E. Cannell, Professor of Obstetrics and Gynaecology, University of Toronto and Dr. C. H. A. Walton, Assistant Professor of
Medicine, University of Manitoba, whose main interest is that of "Allergy." Dr.
Donald Ross, Assistant Professor of Psychiatry, University of Cincinnati—another
Canadian—was a welcome addition to our Summer School, and quite fortunately we were
able to obtain two visiting speakers from the Post Graduate Medical School, University
of London, in the persons of Doctor Sheila Sherlock and Dr. Geraint James.- Dr.
Sherlock spoke on her experiences and concepts of "Cirrhosis of the Liver" and Dr.
James on "Chronic Recurrent Pneumonia." As previously mentioned the pattern of
the Summer School was modified somewhat, in that there were a larger number of
speakers covering a more diversified field. In addition, two successful round table
discussions were held—one on "Peptic Ulcer" and the other on "Asthma." The usual
Clinical conferences were held at the three main hospitals, the Gynaecological Clinic
conducted by Dr. Cannell at St. Paul's, the Surgical Clinic conducted by Dr. Rocke
Robertson at the Vancouver General, and Dr. R. B. Kerr in charge of the Medical
Clinic at Shaughnessy. The guest speaker at the annual luncheon was Senator J. W.
deB. Farris, his subject being "Government." The Golf Tournament was well attended
and followed by a convivial dinner at Quilchena.
In so far as the financial aspects of our Summer School is concerned, total receipts
from sale of 199 tickets at $10 each, brought an income of $1,990 to which may be
added the sale of 75 luncheon tickets at a total of $131.25, making a grand total of
$2,121.25. Total expenditures including travelling and hotel expenses for the guest
speakers amounted to $1,993.70, leaving a credit balance of $127.55.
Although it is apparent that there is a continued decline in the total number of
registrations each successive y~ear, and also that part of the original function of the
Summer School is now being taken over by the Hospital Staffs in the form of teaching
programmes, nevertheless it is the opinion of your Committee that certain members
of the profession consistently appear to register at the Summer School who do not
take part in the various hospital courses, and for this reason we believe that the
Summer School should continue to function in the Vancouver area.
The Committee wishes to take this opportunity of extending their appreciation to
the Chiefs of Staff of the hospitals for hospital facilities extended and to Doctors
A. S. McConkey, George Langley and A. M. Evans for their untiring efforts in arranging
Page 27 the golf and social entertainment. As usual, your Committee has had a large measure
of their work done by the office and staff of the Vancouver Medical Association, of
which we are greatly appreciative.
Respectfully submitted,
Peter O. Lehmann, M.D.,
Capt. Samuel McClatchie, M.C. 0990991,
Medical Company 27th Infantry Regiment,
A.P.O. 25 c/o Postmaster,
San Francisco, California.
September 23 rd, 1951.
Dr. Lynn Gunn,
College of Physicians and Surgeons of B.C.
Dear Doctor Gunn:
When I received your letter of July 25 th I was with the first battalion of the
Wolfhounds on the Purjin River line and we were rather busy digging in against the
expected Chinese offensive.
Since then we have moved to the Kumwha area where we have been probing at
strong enemy defences for weeks. A few days ago we put in a strong attack to better
our positions and ran into the toughest opposition since last June. Our Collecting
Station evacuated some 160 casualties in about twelve hours but we took the objectives
and counted over 300 Chinese dead lying there..
The problem of evacuation are much simplified this war by the absence of heavy
shelling of rear areas by the enemy, and by the helicopter with which we can evacuate
our most serious cases from our Collecting Stations and on occasions even from
Battalion Aid Stations which are not under fire. But aside from this it is essentially
the same sort of thing we saw in Italy.
There are many unexplained fevers which subsequently have proved to be malaria
(The Benign Tertian) or relapsing fever and sometimes Epidemic Haemorrhagic Disease,
so-called because in not every case could the laboratories find the Leptospira of Weil's
Now the winter is approaching we will likely have our quota of respiratory
disease. Smallpox will reappear in the Korean children in the rear areas (all civilians
are kept out of the fighting zone, with the exception of our labourers and K.P.'s) and
it may be typhus will be found in Chinese prisoners or refugees. However by then I may
once more be back for duty in North America and if so I hope to be able to come to
visit in Vancouver.
Please convey to the members of the Council my sincere thanks for their motion
on my behalf. I have many friends among the physicians in British Columbia and
it is good to know that I can still be considered a member of the College. It may
be many years in these troubled times before a soldier can settle down, but to me
British Columbia is home and some day I hope to be back.
Please keep the $25.00 and if you wish to use it in any worthy medical endeavour
I would be glad to have you do so.
Yours very truly,
"Samuel McClatchie, Capt. M.C."
The Bulletin is honored in publishing the above letter from Capt. McClatchie, and
feel that it will be of great interest to our readers. —Ed.
October,   1951   — September,   1952
 Dr. H. A. L. Mooney, Courtenay, B.C.
 Dr. J. A. Ganshorn, Vancouver, B.C.
 Dr. R. G. Large, Prince Rupert, B.C.
Honorary Secretary-Treasurer Dr. W. R. Brewster, New Westminster, B.C.
Chairman, General Assembly Dr.  F.  A.  Turnbull, Vancouver, B.C.
Constitution and By-Laws; Dr. R. A. Stanley, Vancouver, B.C.
Finance Dr. W. R. Brewster, New Westminster, B.C.
Legislation Dr.  J.  C.  Thomas, Vancouver, B.C.
Medical Economics Dr. R. A. Palmer, Vancouver, B.C.
Medical Education. Dr.  G.  O.  Matthews, Vancouver, B.C.
Nominations Dr. H. A. L. Mooney, Courtenay, B.C.
Programme and Arrangements : Dr. R. C. Newby, Victoria, B.C.
Public Health . Dr.  G.  F.  Kincade, Vancouver, B.C.
Arthritis and Rheumatism ! Dr. A. W. Bagnall, Vancouver, B.C.
Cancer Dr. A. M. Evans, Vancouver, B.C.
Civil Defence—— Dr. L. H A. R. Huggard, Vancouver, B.C.
Emergent Epidemics Dr. G. F. Amyot, Victoria, B.C.
Hospital Service Dr.  J.  C.  Moscovich,  Vancouver, B.C.
Industrial Medicine Dr. E. W. Boalc, Victoria, B.C.
Maternal Welfare Dr. A. M. Agnew, Vancouver, B.C.
Membership Dr. L. H. Leeson, Vancouver, B.C.
Pharmacy Dr. D. M. Whitelaw, Vancouver, B.C.
Dr. Gordon Johnston ^|
The Annual Meeting of the Canadian Medical Association, British Columbia
Division, has marked an epoch in organized medicine in this Province. Since World
War II national and international trends in social affairs have presented our profession
with a series of situations with which it was totally unequipped to deal because of an
inadequate organization. As a result a feeling of hopeless frustration was rapidly
taking possession of our members.
The new constitution which was adopted one year ago has now come into
Ioperation. In it we have an instrument with which to meet our problems. This new
Government of the Division is truly representative of and responsible to the electorate.
It has been designed, as far as possible, to make every member an active member, to
keep them informed and to receive information and opinions from them.
The possibilities of the re-organized association, both for the immediate and more
distant future, are tremendous. It must be remembered, however, that this is a voluntary organization and its success or failure depends entirely on the support it receives
from its members. If it fails, each one of us must accept his share of the responsibility. In the past it was customary to say, "What are they doing about it?" From
now on it will be more proper to say, "What are we doing about it?"
Page 29 Further, if it is to succeed it must have adequate funds. In our society, which
has changed beyond recognition in the last decade, the medical profession is being
examined with a critical eye and open threats of outside control and direction are
prevalent. It is only reasonable, therefore, to give adequate financial support to an
organization of our own which has for its purpose the protection of our rights and
privileges, the care and improvement of our financial status generally and individually
and the preservation of our standards, freedom and prestige throughout the nation.
One might emphasize that for this we should be willing to pay at least as much or
more than a labourer pays to his union for a similar service.
OUR PRESIDENT - 1951-1952
Dr. Harold A. L. Mooney is our new president. As the year passes, he will
become widely known to the profession.
He was born in the small farming community of Elkhorn, Man., on the 5th of
December, 1907. He graduated from its High School with the coveted Governor-
General's Medal in 1924.
At Wesley College, Winnipeg, he obtained his B.Sc. in 1928; and graduated in
Medicine from the University of Manitoba in 1934. He was an outstanding student,
gaining the Medal in Obstetrics. His interest went beyond his studies into student
affairs.   He was a member of the Theta Kappa Psi Fraternity.
His internship was spent at the Misericordia Hospital in Winnipeg, and the
Regina General Hospital. Dr. P. L. Straith induced him to come to Courtenay in
May, 1935. They practiced together until Dr. Straith's untimely death in December,
1946. His strenuous professional life continues in the group of Dr. H. A. L. Mooney
and Associates.
On the 23rd of August, 1937, he married Miss Gladys Carthew of Comox. They
have two children, Joan and John.
He is a member of the Upper Island Medical Society, becoming its president in
1948. He has taken a more than active interest in the B.C. Division of the Canadian
Medical Association.   He is serving on the General Council of the national body.
His life is not confined to the practice and organization of medicine. He is a
charter member of the Kinsmen Club of Courtenay, belongs to the Rotary Club, and
is a valued worker on the Courtenay Board of Trade. When the town band is on
parade, he is a familiar figure with his trombone. Trap shooting and grouse hunting
are his relaxations.    Every phase of the community receives his attention and support.
Dr. Frank Turnbull
Three years ago the British Columbia Medical Association, by majority vote;
decided to change its name to Canadian Medical Association - B.C. Division. This
was done, in conformity with similar action in other Provinces across Canada, to
signify the importance of close identification and liaison with the Canadian Medicaif
Association. Last year another important step was taken when we voted to adopt a
major alteration in our Constitution and By-Laws.
The stronger alignment with the C.M.A., and the reorganization of our provincial
association were necessary developments in a neffort to cope more effectively with the
problems of Medical Economics. In the federal sphere the pressure for a National
Health Insurance scheme, from all the major political parties, is increasing. There is
need for close cooperation between provincial associations and the C.M.A. for the<
solution of many problems that will arise during development of this scheme. Just
as evident is the need for a strong, representative local provincial medical association,
organized on a voluntary basis, to speak for the doctors of B.C. about economic
matters within the Province.
Since 1920 the direction of Medical Economics in B.C. has been passed in succes
Page 30 sion from B.C.M.A. to the College of Physicians and Surgeons, to College and the
B.C.M.A., and finally to the Council of College, where it now rests. Within a month
we shall be asked to vote by mailed ballot whether we wish the business of Medical
Economics to be conducted by the Council of our College or desire this business to
bz transferred to the guidance and control of the reorganized C.M.A. - B.C. Division
(B.C.M.A.). Enclosed with the ballot forms, each doctor will receive a statement
from the C.M.A. - B.C. Division outlining the opinions of your Executive Committee:
1. Why the Council is not a suitable organization to handle our Economic Affairs; and
2. Why the reorganized C.M.A. - B.C. Division is a suitable organization to handle
our Economic Affairs.
The revised Constitution and By-Laws of our Association were framed so as to
develop as strong and representative an organization as possible. The main strength
of the organization will be derived from a central core of elected personnel, the principal
delegates, vice-delegates, and members of the nominating committee. They will form
the nucleus or the main working parties of our major committees. The Board of
Directors, made up of the officers and the Principal Delegates, will conduct business
of the Association between Annual Meetings. Final decision for the year will be made
by the General Assembly in all matters except finance and change of Constitution
which will be referred to the Annual General Meeting.
If we are to have an effective organization developed along these lines, and if
this organization is to undertake the responsibilities of Medical Economics, the Association must be adequately financed. We have been promised certain grants of money
from Council this year for "educational purposes." These funds alone are not sufficient.
It is necessary within the year to become self-sustaining. That means the collection of
a fee. The services of an experienced and capable full-time Executive-Secretary is an
urgent need. We require additional office and secretarial help. All of this will cost
money (much less than the average doctor spends on tobacco).
By Dr. L. Skinner
The words "State Medicine" usually arouse a violent controversy between the
"Pros" and "Cons". Let us concentrate upon just one aspect—probably the most
important; "How will it affect the freedom of the doctor to treat his patients as he
thinks best?"
The original plan, at least on paper, will guarantee complete freedom in this
respect. However, experience shows that no matter how excellent any concept may
be, unforeseen circumstances and the human element can mar the final product. For
example, with B.C.H.I.S., the marked increase in the cost of living, and the sudden
extra demand for hospitalization, though clearly not the fault of the scheme, have
forced changes—co-insurance, 30 day limits, budget cuts, and many other limitations
not envisaged in the original conception.
The medical care of patients, I fear, will follow this pattern. At the beginning
there will be great scope for the doctor, but demands will rise markedly. At present,
we all have many instances of patients insisting on unnecessary tests, some quite
expensive, even though the cost comes out of their own pocket. With no financial
brake, the number of needless tests will increase sharply; there is no use in saying the
doctors must curb this—the patients will demand, and the doctor will not dare to
refuse, when there is always one chance in a thousand he may be wrong. Costs will
soar, and the total per capita cost for medical care will be doubled or trebled. Many
people feel that if the government is paying, then they must get their share of what is
being given away, and forget the money still comes from all of us. With these rising
costs, restrictions will come into the picture, and soon medicine will be under bureaucratic control. Orders will come down from the administrative hierarchy as to what
and when tests may be done; also that for certain particular conditions, a set line of
have   nosv
^aEN      CIVIL
SftY     »N
LETS        GET
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treatment is to be followed, because there is some evidence that most cases of this type
react best to this treatment. Those who do not adequately respond to these ordained
treatments will be considered neurotic by an impersonal scheme, and either discharged
from treatment or referred to psychiatrists, needlessly, and in overwhelming numbers.
The question of time will be another factor. At present, a high percentage of
our patients receive as much good from the interview with their doctor as from any
remedies that may be prescribed. With the great increase in demands for attention,
often for trivial things, there will.be no time for these helpful chats. Not only willi
the patient be unable to receive any psychological help from the brief consultation,
but the doctor will not have time to do an adequate examination, having to hasten
through a cursory survey, most unsatisfactory to the patient on the one hand, and to
the doctor and his ideals of service on the other. Our general practitioners will become
sorting stations, with no time to treat, but only to pass patients on to the appropriate
Page 32 specialist. The specialists will also be overwhelmed, and unable to do a thorough
examination, so that far more diseases will be missed by default of time than even the
most pessimistic estimates of those now missed for financial reasons. The general standard
of medical care will drop greatly. There will be an especial increase in psychiatric
referrals, of whom most could be better handled in the more intimate relationship with
their own family doctor. All this will lead us toward becoming a nation of neurotics,
with the doctor an automaton and the patient as a number. One author, writing on
state medicine in Sweden, concludes, "If I become ill, I shall go to a quack, for at
least I will then get a measure of human sympathy."
Thus, instead of Patients, Practitioners and Politics, in that order of importance,
there will be a reversal to read—POLITICS, practitioners and patients.
• • • •
The   following   constitute   the  Executive   Committee  of   the   Canadian   Medical
Association, B.C. Division:
President . Dr. H. A. L. Mooney, Courtenay, B.C.
President-Elect Dr. J. A. Ganshorn, Vancouver, B.C.
Vice-President Dr. R. G. Large, Prince Rupert, B.C.
Honorary Secretary-Treasurer Dr. W. R; Brewster, New Westminster, B.C.
Chairman, General Assembly Dr. F. A. Turnbull, Vancouver, B.C.
Additional Directors:
Dr. R. C. Newby, Victoria, B.C.; Dr. R. A. Palmer, Vancouver, B.C.;
Dr. G. C. Johnston, Vancouver, B.C.; Dr. G. H. Grant, Victoria, B.C.;
Dr. A. C. Gardner Frost, Vancouver, B.C.
September 11, 1951.
Dear Sirs:
The above named committee has been very active in arranging programmes for
the coming annual meeting of the Canadian Medical Association, B.C. Division.    To
date there have been six meetings of the committee and the work is all well in hand.
The annual meeting of the Association should be successful and satisfactory.
Trusting this report is satisfactory to you, I am,
Sincerely yours,
Chairman, Programme and
|p| Finance Committee,
Canadian Medical Association,
B.C. Division.
Members of the Committee on Cancer of the British Columbia Medical Association
for the past year were:
Dr. A. M. Evans, Chairman; Drs. J. Balfour, A. C. G. Frost, J. A. Ganshorn,
Roger Wilson, Ethlyn Trapp, W. J. Dorrance, G. R. F. Elliot, H. K. Fidler, H. M.
Edmison, A. B. Nash.
The Committee held one meeting during the year at which the following topics
were discussed:
Plans for the expansion of the British Columbia Cancer Institute.
Proposed establishment of centre for treatment of cancer in Victoria under the
auspices of the British Columbia Cancer Foundation.
Page 33 The question of radiotherapy as a part of the British Columbia Hospital Insurance Service.
Respectfully submitted,
A. M. EVANS, M.D.,
Chairman, Committee on Cancer,
British Columbia  Medical
There is not a great deal of activity to report regarding the Committee on Civil
Defence.    We have had one meeting since authority was created for its formation.
The Sub Committees under the Chairmanship of Dr. Gordon Johnston and Dr.
Roger Wilson have been busy in their respective spheres of activity. The addition
to the Central Committee of the Dean of Medicine will provide the necessary liaison
for the subsequent educational programme that will inevitably ensue. The Association
I am sure, will be aware that there are many difficulties to be ironed out regarding
spheres of activity between the Federal, Provincial and Municipal levels of government.
In addition, one very difficult problem is that of finance and from what source it is
Your Chairman has had an informal discussion with the Provincial Co-ordinator
on Civil Defence and with his Medical Deputy, Dr. George Elliot. There is reason to
believe that the activities of this Committee will increase gradually in the foreseeable
Kindly accept this as an interim report at this time.
Civil Defence Committee.
Canadian Medical Association, British Columbia Division
The Committee on Public Health has been requested for information and advice
by the Association on several matters throughout the year.    However, there have been
no matters of major concern with which to deal.
Correspondence was carried on with the Committee on Public Health of the
Canadian Medical Association in the preparation of the annual report for the annual
meeting of the Canadian Medical Assbciotion. This report stressed the need and pointed
out the opportunities for closer co-operation between the profession at large and the
local health establishments.
Your committee this year were not called together as a Committee as there was
not any definite matter for action until late in August when a sudden demand was
made by the Workmen's Compensation Board of B.C. for a further opinion on the
use of plasma, opiates and oxygen to be presented before the Commissioner holding
the enquiry into the workings of that Board.
The committee were circularized by letter and given a transcript of the evidence
of the Commission so as to obtain their views on this important matter.    Their views
are to be presented as evidence to the Commission shortly.
All of which is respectively presented.
Chairman Comm. Industrial Medicine,
B. C. Division of C.M.A.
The Special Committee on Pharmacy has been occupied during the past year with
the problem of revising the B. C. Formulary. This has proved a difficult, time-consuming work. The detailed revision is now, however, completed and requires only a few
finishing touches before publication. Various other minor problems arising in connection
with the administration of the Food and Drug Act have been dealt with.
Yours truly,
Chairman, Pharmacy Committee,
B. C. Medical Association.
"No activity" reports were made by the following Committees: Legislative Committee; Emergent Epidemic Committee; Hospital Association Committee.      —Editor.
I have the honor of submitting the following report of the Membership Committee of the British Columbia Medical Association.
There are 1713 names on the Medical Register of British Columbia as of June 1951.
Excluding those who have residence out of the province, those who have retired, and
an interne group, there are approximately 1400 engaged in the active practise of medicine in this province. Of this number, 918 have paid dues to the Canadian Medical
Association fo rthe current year. This percentage has remained relatively constant in
recent years, a large group still withholding support from the parent organization.
This report is respectfully submitted.
Yours truly,
The Committee on Arthritis and Rheumatism, B.C. Medical Association, would be pleased to arrange a two to five day refresher course
on Rheumatic Diseases if there is sufficient demand. Preferably, this
would be held early in 1952.
In lieu of a course, doctors may arrange to attend the wards and
clinics of the metropolitan hospitals for short-term, special studies.
Anyone interested is invited to contact the undersigned. Please
state your preperence regarding dates. If a course is organized, the
dates will be set according to the wishes of the majority.
C. E. Robinson, M.D.,
Committee on Arthritis and Rheumatism,
B.C. Medical Association,
900 West 27th Avenue,
Vancouver 9, B.C.
Secretary-Treasurer, Canadian Medical Protective Association
It is said everyone likes a story with a Ijappy ending. The story I am going to
tell you comes so close to being a success conceived and managed by the medical
profession, yet growing almost unnoticed in its midst, that I cannot refrain from
beginning it as one would any story with a happy ending.
Once upon a time in the town of Smith Falls, a town near Ottawa which I am
sure some of you know, there was a doctor, a good, ordinary, competent, average
general practitioner, who was called on to treat a rather nasty fracture. The time
was shortly before the turn of the century when facilities were few. With these
facilities and to the best of his ability this doctor treated the fracture and gave the
patient a fairly good functional result, but one apparently that could not be considered
good from an aesthetic point of view. As patients have been known to do since under
circumstances and as, no doubt, patients will continue to do as long as there are
patients, this patient decided to salve his disappointment with a plaster of greenbacks.
Thus, in due course, the doctor was hauled into court to defend himself against a charge
of poor work. His work had not been poor, it had been as good as could be expected
under the circumstances and, happily, the court agreed. But, for those days, the costs
were great and the doctor, like some nations we know after a victorious war, found
himself a beggared winner.
.Fortunately for many doctors since then there was in the profession at that time
a doctor who not only thought something should be done to prevent any future
similar occurrences, but who had the aggressiveness to start doing something. The
late Dr. R. W. Powell, an aggressive personality and a staunch individualist, one who
believed doctors did their own best for their patients, knew that English physicians
had banded themselves together to provide a financial pool from which any one of
them unfortunate enough to need it could get financial help when faced with the
need of defending himself in court. May I here pay tribute to the British Defence
Unions for their help to our Association in its early days and for the advice they still
give so readily and graciously from their long experience whenever we ask for it.
With these British Unions as an example and a guide Dr. Powell and several other
doctors set out to form a Canadian Union which could operate under Canadian Law
much as did the British Unions in Britain. Dr. Powell was elected president in 1901
and until 1935 remained the head of the Association. After a few years, in 1906, he
was joined by Dr. J. Fenton Argue as secretary. The two complemented each other
and to their partnership is due the greatest credit for the Association's activities and
growth. There is no need to remind you that on the death of Dr. Powell in 1935
Dr. Argue became the president of the Association and is still busily engaged; in
maintaining and advancing Dr. Powell's and his own conceptions of how the Association
can serve the medical profession to the greatest advantage.
Several things were in the minds of the founders of the Association. They felt the
Association should be of the profession. It should be owned by it, in as far as
possible it should be run by the profession and be responsible to it. It was hoped
that it would prove, and later it did prove, possible to maintain solvency and yet to
provide necessary help to members at a cost so low that no doctor ever could say
he lacked help because he was unable to afford membership. It is ironical that ever
since some doctors have decided against joining their own defence organization for
the very reason of its cheap membership fee. When the Constitution and By-Laws
were drafted it was felt that doctors should be willing to help other doctors clear
themselves of unjust accusations, to give such help without cost and it yas felt this
*Read  before  the  B.C.  Division  of  the   Canadian   Medical   Association—Oct.,   1951.
Page 36 would accentuate the mutual aspect of the Association's activities. Therefore one of
the By-Laws stated, and states still, that the Associaion may call upon any member to
assist another and no bill may be rendered for the services. Two things have resulted
from this By-Law. There being no necessity to think of costs of expert witnesses,
the fee for membership has been kept much lower than would have been the case
otherwise. The second, and an indirect result, has been a tendency to include help of
this kind in the general category of professional services from one doctor to another,
for which no doctor charges.
Another thing, if more abstract and harder to describe, seemed no less important
to the founders of the Association and they drafted the idea into legal form in the
By-Laws. It seemed that an Association such as they envisioned, an Association that
was a part of the profession and run by the profession, should deal with its business
from the point of view of the profession as well as from the viewpoint of an accused
member. Every opportunity should be taken to decrease the number of actions and
claims brought against members of the profession. In practice, over the years, this
has meant a policy of defending every action that did not seem completely infensible.
Paranthetically it may be said that this is by no means the cheapest way of handling
individual actions. Time after time it would be cheaper to make a small cash settlement, but the effect of such a policy would be to encourage litigious individuals to
claim against doctors. Fewer actions have resulted because of this policy of the
Association and still fewer will be brought if only all doctors insist that the organization
providing them help must defend them in court rather than settle. When, in a district,
it becomes common knowledge that doctors can be blackmailed, the number of claims
against them increases sharply. When it becomes known that no claim against a
doctor will be accepted unless the claimant makes good his claim in court, cases
against doctors drop promptly.
During the discussion of the wisdom of a policy of defending every action is an
appropriate time to mention one piece of contradictory thinking common to most
doctors. The Association has found over the years that, when talking over the problem
as a matter of policy to a man or a group of men, all agree that no case against a
doctor should be settled if defence is possible. The Association finds just as regularly
however that the very doctors who agreed to the policy feel they themselves should
constitute, exceptions when an action is brought against them. It may comfort some
of you some time to be told that a vigorous defence is not more harmful than an
acquiescent settlement. Unless the suit is about something pathognomonic of carelessness or of neglect—in which case no defence is possible anyway—an action against a
doctor stirs up comparatively little reaction among those who do not know him and
among those who do know him two opinions will be held. Among those who know
and dislike him, the small minority in the case of most doctors, the opinion will be
that he has had it coming to him for a long time. Among those who know and like
him the opinion will be completely different. They tend not to desert him but to
rally around and help him all they can on the ground that his service to them has
been good and has been careful and they cannot conceive it would be any less so to
anyone else. Patient loyalty is something most doctors underestimate. So, if any of
you are faced with action, remember that a full, fair defence in court is something that
will not hurt you as much as a settlement in attempted secrecy, and no settlement
ever is a secret even if a doctor feels it has been. When a doctor does not take the
opportunity to defend himself, what other opinion can his patients hold than that he
must have been guilty of the fault charged? Many patients and friends who otherwise
would come to a doctor's support have the ground cut from under their feet and
can only say that they guess he must have been wrong or he would not have paid
without fighting.
Most doctors are quite honest, even if they are mistaken, in their feeling that a
defence for them is not possible. They may be aware that some other course of action
was possible in a given case and they realize after the event that the alternative course
would  have  been  better.     They  feel   the  error   they   think   they   committed,   using
Page 37 hindsight, remember, not foresight, will be evident to everyone and this thinking often
underlies their desire for a settlement. But in medicine foresight is not as accurate
as hindsight and never will be. As long as the doctor was competent, as long as he
brought to bear all knowledge he had and employed it as skilfully as it was in his
own power to do, no court is going to find him guilty of malpractice or negligence
because of some unusual complication, for example, not even if some other doctor
could have got a better result—as long, of course, as the doctor did not claim to be
able to do something for which he was not fitted by training, experience or ability.
The Law recognizes that doctors have different capacities and capabilities, it recognizes
that where one fails another might succeed and it recognizes that some ill results occur
and are unavoidable. So, as long as a doctor can demonstrate adequate training for
the duty he undertook, a fair degree of skill in its performance and conscientious
application of the skill, he will not be penalized for something that, in retrospect, he
knows he might have done better. Thus, when a doctor has done his best, when it
has been an ordinarily competent best, yet he is faced with a claim because of a
result poorer than the patient expected, he helps himself and he helps the profession
by allowing, or better, insisting upon a fair trial in open court.
So we have arrived at the place where we can summarize the answer to "The
Canadian Medical Protective Association—why it is." It is a mutual medical defence
union, formed so that doctors will have their own Association to which they can turn
for help when faced with unjust accusations and frivolous and unjust actions; it exists
only to give them help, to give it in the most helpful manner, first to the member
involved and second to the profession at large. No better summary can be given in
answer to "why is it" than was put in the "Objects'of the Association."
(a) to support, maintain and protect the honour, character and interest of its
(b) to encourage honourable practice of the medical profession;
(c) to give advice and assistance to and defend and assist in the defence of
members of the Association in cases where proceedings of any kind are
unjustly brought or threatened against them;
(d) to promote and support all measures likely to improve the practice of
This then leads to the second part of the title "The Canadian Medical Protective
Association—what it is." was contained in the summary but I am putting the concise
answer to "What it is" in the preamble. The Canadian Medical Protective Association
is a mutual medical defence union. Confusion seems to exist about the meaning of
'mutual medical defence union,' confusion at least about one thing. By definition it is
not an insurance company. This point needs emphasis and re-emphasis. Dozens of
times a year we get requests from doctors wishing to know what the Association
promises to do for them; if the enquiries do not some from the doctors they come
from the doctors' insurance agents ostensibly speaking for the doctors and asking tne
same questions. The Association is not an insurance company and does not enter into
any contract with its members.
If by definition 'mutual medical defence union' does not mean an insurance
company, what does it mean? The words mean exactly what they say. 'Mutual'—
we all have agreed to help each other in two ways whenever such help is necessary
or desirable: financially, by placing a small amount annually into, a central fund;
professionally, by agreeing to assist if we can with our expert advice whenever such
help is necessary or desirable for a fellow practitioner. 'Medical' is self-explanatory,
we do not agree that we will help our fellow practitioners with something that is
non-medical or, to use an expression all of you know, when a member is guilty of
"infamous or disgraceful conduct in a professional sense." The words 'defence' and
'union' do not need any elaboration.
That is all there is to say by way of answer to that question. The Association
is your mutual medical defence union. It is a corporate body whereby you say to all
your friends in the profession: Let us help each other; let us contribute to a fund, a
Page 38 pool, from which any of us can get help if we need it; let us choose someone to manage
the fund, someone who by virtue of experience will be able to use our money most
advantageously. Having said that you have said it all—the Association is yours, it
is you.
With this as a background we are ready to consider "What it does." The answer
to that can be made more informative by a concise statement of how the Association
grew and how its growth allowed more and more responsibility to be assumed and
more help given its members. Some of you may remember^ paying the original
membership fee of two dollars and a half. If you do, you belong to that select group
who had the vision of what the Association might become if it received support in its
early days. These early members were a select group too. At that time the
Association offered to advise its members about medico-legal matters, offered to advise
them how best they might avoid suit when complaints or threats had been made. There
its help ceased. The original members of the Association knew they could get no
financial help if they got into trouble, still they were willing to have their membership
fees used to start a fund which their successors could get the help denied them. That
is why they can be thought of as a select group. The biggest part of the Association's
work then was to save all the money it got. Hoard might be a better word. No
salaries, no honoraria were accepted by the officers; they kept the books; they wrote
the letters of advice, many of them in long hand; I have heard stories of how Dr.
Argue every year during the Christmas holidays conscripted his whole family to open
the mail and enter the receipt of the annual fees from members. That was the kind
of service that gave the Association its start.
Within the next five or six years a small fund accumulated. It was decided to
raise the fee from two dollars and a half to three dollars and the officers then felt
safe enough to assume some responsibility for legal costs. The three dollar membership
fee began in 1906 and five years later, in 1911, legal costs for all the Association's
services from coast to coast were only $565.03. The proportion of income available
for savings dropped, but the officers kept on saving. In 1913 the Association assumed
full responsibility for all court costs. In 1928 the membership fee was raised to five
dollars and the next year responsibility was accepted for payment of damages up to
five thousand dollars for any one member in any one year. In 1932 came an important
advonce. During a trip to the Old Country in that year Dr. Argue was successful in
negotiating a contract for insurance with Lloyd's of London whereby they assumed
the risk for any damages in any one year over and above a variable amount which
depended on the size of the Association's membership. With the certainty that the
catastrophe of an unusually large number of expensive adverse judgments in any one
year could not wipe out the Association's reserve, the privileges of membership were
enlarged so that members were eligible to have all damages assessed against them paid
by the Association.    No other change was made until the end of 1950.
During the year 1950 the Association's General Counsel drew the attention of the
officers to the reasons given by a judge for awarding damages in an amount larger
than had been expected. The judge stated the award was larger than had been
customary for similar charges, but that he had taken into consideration the rise in the
cost of living which necessarily affected the amount of money the plaintiff would need.
He said that not only was the larger-than-usual-amount deemed necessary by him but
that he expected judgments in the future would continue to reflect the changing value
of money. In addition to the probability that, when damages were assessed against
its members, the Association had to expect to pay large amounts, there was another
disconcerting fact. For cases which had arisen in 1948 the Association paid, in 1950,
two claims whose total equalled the total income of the Association for that year.
These two things showed that, if the Association was to pursue its previous policies,
a larger membership fee must be collected. There was a great deal of discussion and
there was the example of one of the British Defence Unions to help in arriving at a
decision. It was decided the fee should be ten dollars instead of five dollars and the
larger fee was collected from members at the beginning of  1951.
Page 39 Another detail that may emphasize what the Association has been doing is the
amount of money it has spent for its members. In the ten year period, 1941 through
1950, the Association paid, out of your money, on behalf of members who were
unfortunate enough to get into trouble, $74,157.39 for legal costs only. In that
same period it paid, in addition, $68,217.27 as damages. Thus the officers of the
Association, acting as your trustees, that is, you who are members, have assisted your
professional brethren to the extent of $143,000.00. How important this has been
to some of them can be judged when you hear that payments for individual doctors
have been as high as $16,000.00. Fortunately not all have been as high—from
there they have dropped to $10,000.00, $7,000.00 and so on down to $100.00 or
$200.00—in one case $12.00.
Actually, the record is good when two other facts are kept in mind. The
Association's membership rose in those same years from 3,402 members to 6,389
members; every member who asked for it and who could be helped was given help;
nor, with three exceptions, did any member receive less than full assistance. Two of
the exceptions had to do with cases where the plaintiffs demanded for settlement amounts
that were completely out of line with any damage they had suffered. The two doctors
concerned, however, were so seized with the feeling that a trial would ruin them that
they asked to be allowed to pay the amount by which the plaintiff's demand exceeded
what all the Association's advice insisted was an adequate settlement. The third
exception was in a different category. Many of you will know that no one can assure
himself in advance of financial assistance in the defence of a criminal suit. A
criminal act is deemed to be a deliberate one. Therefore no organization can offer
in advance to assist an individual defending himself against a criminal charge. Thus
the Association, when one member asked assistance to defend himself against a criminal
charge, was forced to refuse.
Because the Association learnt something from them some comment may be wise
on the first two exceptions. In each case the settlement was too large, more than
the cause justified. The officers of the Association did acquiesce in the members'
requests, but hesitantly. Recently a third case occurred which pointed up the whole
discussion and allowed a policy to be formulated. A patient, after cholecystectomy,
did poorly, and subsequent investigation showed a haemostat in the upper abdomen.
The circumstances of the case were such that the outcome of trial was doubtful. Two
things were learnt very quickly. The patient wanted, as the price of a settlement, more
than was fair. The surgeon was terrified of the publicity that would result if the case
came to trial and was willing to pay, in addition to the amount the Association thought
was ample, whatever extra the patient demanded. It just did not seem good business
to the Association.H No doctor should submit to blackmail for any reason. The
Association therefore instructed its member that the matter must be left in its hands.
The result was a happy one. As soon as it became apparent to the plaintiff there could
be no further bluffing, the Association was able to negotiate a settlement which
reimbursed the patient and which was fair to the doctor. The event crystallized
policy; no doctor, with the approval of the Association, will be allowed to make a
settlement that is unfair to himself. It does harm to the doctor and it harms the
All this perhaps brings us to the final point about which the Association receives
so many enquiries. What can a member expect from the Association when he gets
into trouble? A member can expect that his request for assistance will be dealt with
promptly by Council, the officers of the Association. He can know that all these
men are practicing physicians with all that this means. They know, just as well as
the member knows, more vividly probably, because they are seeing so much more
of it than he is, how liable all doctors are to complaints and threats and actions. They
know that, doctors being human, there is no doctor but might have had one or more
actions brought against him had circumstances, an error not obvious or the goodwill of
the patient, not conspired to save him. Every member of Council therefore approaches
the cases with something of the attitude "there, but for the Grace of God, go I."
Page 40 The member may expect, further, Council to be men of broad and long experience
in medico-legal matters. Council surely fulfils this expectation. The most recent
member has four years experience, two have seven or eight, several have about fifteen
years, one has had more than thirty years and Dr. Argue, of course, has about forty-
five years of experience.
The member can expect that Council will approach his problem thinking only of
how best the assistance may be given to help the member and the profession in the
member's district. Nothing else enters into the problem. This statement is not only
true, to members it is the most important fact about the organization. The Association
is the members' own, there are no stockholders, there is no governing body with an
overriding influence. The Association's only reason for existence to to provide the
best service possible. Granted that the members expect its officers to maintain the
solvency of the Organization, the question of expense does not enter into a decision
about the kind of assistance that will be provided a member. It would surprise you
if you could see how often a few hundred dollars would settle a claim which will
require an amount rurining into thousands to be defended successfully. But, again
granting the continued solvency of the Organization, if the Association allows the
financial aspect of a case to determine the action to be taken it fails in its duty to
the member and to the profession. For every claim that is settled in a district, one or
two others can be expected because it was settled. When all claims are resisted
claimants think twice before making nuisance claims. The Association would be
failing lamentably in its duties if it allowed the fact that a few hundred dollars instead
of a few thousand would dispose of a claim to influence its thinking and determine
its course of action. By the same token, the doctor who is so negligent that his case
must be settled or whose case Can not be defended successfully does an equal amount
of harm to the profession in his own district. Right now, there is one city in Canada
that illustrates this. Two men were guilty of gross negligence, substantial damages
were awarded against the mand there was the expected amount of publicity. More
claims have arisen in that one city since those two judgements than in all the rest of
the Dominion of Canada put together.
The member can expect that the best counsel in his district will be retained to
look after bis interests. The Association uses its money as carefully and as wisely and
as savingly as it can, but it does not attempt to save money by retaining any but the
most experienced and best counsel. gjSp
The member can expect the legal costs to be paid.
If the member is unfortunate enough to lose his case and must pay damages he
should know that he is eligible to have those damages paid for him by the Association.
This fact has been printed in the inside cover of the annual statements for years.
Yet there still are enquiries, and there are more written from British Columbia than
from anywhere else, about whether or not the Association pays damages for its
members and if so, what part of them. An occasional enquirer wonders if the
Association pays anything. The Association recently had a British Columbia doctor
say he had decided to remove the conduct of his case from the Association because,
and this is a quotation, "From my point of view I must have financial protection
as well as moral protection . . ."
Now let us turn to one or two things that seem of importance to the Association
but cannot be written into the Constitution or into By-Laws. Where else should
any doctor expect to receive more help than he would from a group of his own
profession? No contract the Association could issue, specifying every benefit the doctor
will receive as well as all the exclusions that will be enforced, no promise to stick to
the letter of the law, can ensure the kind of service that sticking to the spirit of the
law means to a member. The Association is not a financial organization-—once again
granting that enough business acumen must be used to keep the organization solvent—
it is an association of doctors banded together to provide themselves with the best
assistance in medico-legal matters.
Page 41 The second point about which the Association feels strongly is the great advantage
that would accrue to individual doctors and to the profession as a whole if the whole
of the profession belonged to the Association. If it be granted, for example, that
unnecessary settlement of a case reacts to the profession's disadvantage and that
defending every action where defence is possible reacts to the profession's advantage,
the only organization whose policy that is surely is one which, when the need arises,
can provide you with more help and assistance than any other. The Canadian Medical
Protective Association is not interested in the question o*f size for size's sake, it does
not care whether the membership is six hundred or seven thousand, except for one
thing. The higher the proportion of doctors belonging to the Association, the less
trouble those doctors and the rest of the profession may expect form unnecessary,
frivolous and nuisance suits. This is the reason the Association has entrusted to me this
duty of explaining its activities to you, purely because the more of you belonging
to and using the Association, the better the service it can render all of you.
Since this booklet was printed a decision has been handed down by the "Tax
Appeal Board" affecting liability for tax upon income received from property the
subject of a gift between husband and wife.
In that case the husband had made a gift of cash to his wife who purchased shares,
later sold the shares and purchased other securities. The income from these latter
securities was added to the husband's 1948 taxable income by the department. On
appeal the Board held that the section of the act which taxes the husband for income
received by the wife on property transferred to her by him, or property substituted
therefore, does not include income from the property substituted for the substitution.
The provisions of the Act regarding gifts to children under 19 years of age are
similar so it should follow that this decision will also apply to gifts to minors.
This case may be appealed and this decision may be reversed by a higher court
or amending legislation may be passed by parliament to counteract the effect of this
Offered for sale by Doctor's widow, set of TICE in good condition.
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Page 42 66
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By Frank Turnbull
From the Dept. of Surgery, section of Neurosurgery, Vancouver General Hospital
Discussion at Staff Clinical Meeting, October 23,  1951.
Craniostenosis means premature closure of one or more of the sutures in the
cranial vault. Sutures of the skull are anatomical features that have long been well
known. Hippocrates wrote about them. Even the Egyptian surgeons three thousand
years earlier described how injury of the skull was modified by the presence of sutures.
But there was no adequate description about the relation of premature fusion of sutures
to cranial deformity until Virchow's observations in  1851.
To appreciate the clinical aspects of craniostenosis it is helpful to understand the
normal state of the cranial sutures. At birth there is no bony union between the
membranous bones that form the vault of the skull, a fact that can be readily confirmed
by palpation. Between six and twelve months of age the sutures become closed. They
are not fused—just interlocked by their serrated margins. During the early years of
childhood this interlocking of serrated margins is not very firm. If there is increase
of intracranial pressure the sutures open up. By the age of ten years the sutures have
become interlocked so firmly that increased intracranial pressure causes little or no
enlargement of the head. Actual bony fusion of the sutures usually commences in
middle age, and is not complete until old age.
The sutures that are involved in craniostenosis are like the fused sutures of old
age. There has been bony union. The cause of this anomalous development is unknown.
The extent of harm to the brain that may result from craniostenosis, as well as the
character of the deformity, depends upon the number and the location of sutures that
are involved. For the purpose of this discussion I will employ a very simplified
When all of the sutures of the vault are closed before birth the skull presents a
tower-shape (oxycephaly). The suture lines stand up as ridges like the poles that
support an Indian tepee. The roofs of the orbits are depressed and the eyeballs protrude. The intracranial pressure may become very high. Frequently the discs are
choked and this may go on to optic atrophy and blindness. Most of the children
are mentally retarded. In later years they are apt to be epileptic. When the condition
is well advanced, with a grossly deformed head and protruding eyes, the diagnosis is
easy.    But in the early months it is apt to be confused with microcephaly.
In microcephaly the baby has been born with a mal-developed little brain. There
is no premature union of the sutures. The bones of the vault just fall together because
there is nothing to push them out and there are no fontanelles. The tiny vault is in
striking disproportion to a normal face and base of skull and to the normal or slightly
large ears—truly a state of 'nothing much above the ears'. The diagnosis is confirmed
by x-ray films which demonstrate the normal sutures.
Incomplete craniostenosis may involve the sagittal suture alone, or only the coronal
suture, or coronal and lambdoid sutures, or any combination of these. When the
sagittal suture along the crest of the skull is prematurely closed the head remains
narrow but the coronal and lanbdoid sutures spread apart widely—resulting in a long
boat-shaped head (scaphocephaly). If the coronal and/or lambdoid sutures are closed
prematurely there is no fore and aft development, but the sagittal suture spreads
widely and thus a short, wide head results   (brachycephaly).    Infants with partial
Page 43 craniostenosis may grow up into adult life with normal intellect and vision, handicapped
only by the social effect of their deformed heads. Many of these children suffer from
a significant degree of increased intracranial pressure with potential if not actual
harm to their brain.
Early attempts to relieve craniostenosis by surgery were not very successful. This
was only partly due to inadequate technical facilities. In 1894 Jacobi collected the
reports of thirty-three patients upon whom operation had been performed.1 Apart
from a depressing mortality rate of almost 50%, Jacobi pointed out that most of the
thirty-three operations had proven useless because the diagnosis was wrong. Microcephaly
had been mistaken for oxycephaly. Providing more room for a microcephalic brain
is obviously wasted effort.
The pessimism that was engendered by Jacobi's report seems to have echoed
through several succeeding generations of doctors. But scattered reports that were
encouraging began to appear. One record stands well in front of all the others. This was
a case that was reported by Faber and Towne.2 He was operated upon in 1923 for
premature fusion of the sagittal and part of both coronal sutures. At the time of
operation he was aged seven months and showing cranial deformity, some proptosis,
and signs of increased intracranial pressure. The operation was a linear craniectomy
(i.e. establishing a 1 cm. trough in the skull just beside and parallel to the sagittal
suture and a similar trough across the whole length of the coronal suture from ear to
ear). This case was followed closely for 18 years. There was considerable early
improvement in the shape of the skull, which was maintained, and there was also
relief from the increased intracranial pressure.
The trouble with linear craniectomy was that the bones soon fused across the
gutter. There was a natural reluctance to re-operate even if temporary benefit had
been obtained initially. Furthermore, if the diagnosis was made relatively late, when
the skull had become thickened, the increased pressure might not be satisfactorily
relieved. So there were devised a succession of procedures, including bitemporal
decompression, circular craniectomy to allow the whole 'roof of the skull to lift up,
and large 'hinged' bone flaps.
In 1940, when Martha K., age iy2, appeared as a patient at the Vancouver
General Hospital, the operation a la mode was called morcellation. This procedure
consisted in making an incision from one temple to the other, peeling the scalp back
to the occiput and forward to the eyebrows, and then, making many criss-cross gouge
cuts through the skull, so that the vault was converted into a checkerboard of isolated
pieces of skull, each clinging to underlying dura, but separated from its neighbor.
Martha was a happy baby but she had a grotesque deformity. She had a dished-in
face, the typical tower skull of oxycephaly, and gross exophthalmos. (This general
syndrome is called Creuzon's deformity). Her optic discs were choked and she appeared
to be almost blind. X-ray films showed absence of cranial sutures and gross markings
of chronically increased intracranial pressure. The morcellation operation was performed. All of the gouge cuts of the skull spread open widely and it was difficult
to keep the islands of bone from dropping off the dura. After an uneventful convalescence we lost track of Martha for about five years and then heard that she was
attending the School for the Blind. When last examined at age eleven she was doing
reasonably well in school. X-ray films of the skull showed no evidence of our morcellation. The operation probably accomplished something in respect to relief of
For obvious reasons there was not much enthusiasm for that operation. During
another decade, craniostenosis, in most centres, was just a descriptive term that did
not lead to any action. For a recent revival of interest we are chiefly indebted to Dr.
Ingraham and colleagues of Boston.3 Their methods are based on two principles: 1.
The most logical of the old operations was linear craniectomy along the fused suture
line, but a method must be employed that will prevent bony re-union, and 2. Operation
should be done early, preferably before six months. They used strips of polyethylene
to cover the bony margins.    Polyethylene is remarkably non-irritating and  can be
Page 44 left buried in tissues for indefinite periods. (Tantalum foil, likewise non-irritating, has
been used for the same purpose).4
Our first opportunity to try out this method was on Baby E., who was recognized
at birth by Dr. J. Whitelaw, as a case of scaphocephaly. There was the typical long,
narrow head with a bony ridge in place of a sagittal suture. Operation was performed
at age of one month. Channels about 2 cm. wide were cut from the skull on either
side of the crest of the skull, extending from coronal to lambdoid sutures. Polyethylene
strips were tied along the bony margins. Recovery was uneventful. At six months
the baby's head was completely normal in shape. It is fortunate that this is so, for
the baby is a foundling. The foster mother is so pleased with the appearance and general
development that she is applying to adopt the baby.
The next two cases presented the same type of craniostenosis but with a complication. Jimmy M. was age 2J4, and Diane A. almost 3. Their long, narrow heads
had been accepted by the parents as just an unfortunate trick of nature, and both
children were regarded as showing a normal mentality. We asked ourselves two
questions: 1. Is there any chance of lessening the deformity? and 2. Is the brain liable
to suffer any further harm which could be prevented by operation? By age three a
child's brain has achieved 80% of its growth. Most of the remaining 20% increase
in bulk occurs between age 3 and 10. It therefore was reasonable to expect that there
would be a further relative increase of the deformity if nothing were done, and vice-
versa. The answer to the second question was supplied to me by Drs. Ingraham and
Matson. Their experience indicated that operation, even though delayed to this age,
was of definite benefit to the child's mentality. At their suggestion X-ray films of the
skull were reviewed. There was no doubt, in both instances, about the evidence of
chronic increased intracranial pressure. In Jimmy M. the skull was bulging out like
a thin blister in both parietal areas. It is now four months since operation was performed on both children in the same manner as for Baby E. There has been a definite,
though minor improvement in the shape of their heads. The parents are pleased. It
is too soon to access the effect of operation on the children's mentality.
There is a reasonably satisfactory surgical technique for contral of the complications
that result from craniostenosis. Recognition of the condition and apropriate surgical
treatment during the first few months of life is a necessity for optimum results.
Deformity of the skull, and the baneful results of chronically increased intracranial
pressure, may be averted. Gross abnormality in the shape of the infant's skull is no
longer a matter for complacency.    It sometimes can be remedied.
1. Jacobi, A., quoted by Faber and Towne.
2. Faber, H. K., & Towne, E.M., J. Pediat., 1943, 22, 286.
3. Ingraham, F. D., Alexander, E., Jr., & Matson, D. D., Surgery, 1948 ,24, 518.
4. Simmons, D. R. & Peyton, W". T., J. Pediat., 1947, 31, 528.
Available soon, in most thickly populated area of the city.
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For information, Phone or Call
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Page 45 'eu/3  an
d   IIloted
Dr. G. E. Evans is now practising in Mission.
Dr. D. Forbes is now in North Vancouver.
Dr. A. K. Young is the new director of the University of B.C. Health Services.
Dr. Colin Ibbotson has joined the Radiology department of the Jubilee Hospital
in Victoria.
Dr. Stephen Wigby is now on the staff of Shaughnessy Hospital.
Dr. K. D. Fleming is now practising ophthalmology in Vancouver.
Dr. H. L. Burris of Kamloops has retired from active practice.    We wish him a *
long and happy life of leisure.
Dr. E. K. Cunningham and his wife Dr. G. V. S. Cunningham have opened a joint
practice in Vancouver after many years in Chengtu, China.
Dr. S. W. Jackson, Dr. Ian Kent and Dr. W. R. Laidlaw have joined the staff of
the Provincial Mental hospital as Essondale.
Dr. J. F. McCreary of Toronto is now head of the Department of Pediatrics at
the University of B.C.
Dr. K. S. Burton has opened a practice in New Westminster.
Dr.  F.  C.   Preston  has   begun  an  orthopaedic   practice   in   Vancouver   on   his *
return from England.
Dr. C. D. Holmes of Victoria has retired.
Dr. W. H. Fahrni has opened a new office in Vancouver. He is specializing in
Dr. M. B. Walters has opened an office in Vancouver for the practice of internal
Dr.  David  daman  has  opened  an   office  in  Vancouver   and   will  specialize  in ij
Dr. L. W. Card is specializing in radiology in Vancouver.
Dr. G. Sleath of Haney is now studying in Toronto.
Dr. Eric Smith of Vancouver is now studying in New York.
Dr. D. M. Baillie and Dr. George Hall of Victoria have retired.
At the Annual Meeting of the Victoria Medical Society held on October 15th,
1951, the following officers were elected for the ensuing year: President, Dr. W..H.
Moore; Vice-President, Dr. J. D. Stenstrom; Honorary Secretary, Dr. D. A. Hewitt;
Honorary Treasurer, Dr. W. A. Trenholme.
Dr. W. M. Gilmore, formely on the radiology staff of the Royal Jubilee Hospital,
is now Radiologist to the Us-Island Hospital Group at Duncan, Nanaimo, Port Alberni
and Comox.
The Eleventh Annual Meeting of the Medical Services Association will be
held at 8:00 p.m., Monday, December 10th, 1951, in the Christmas Seal
Auditorium, 10th and Willow Streets, Vancouver, B.C.
Page 46 West Kooteriay Medical Association meeting was held October 27th, 1951, in
Trail, B.C. Afternoon clinical meeting programme: Dr. L. Anderson, "Civil Defence";
Dr. E. Christopherson, "Dyspepsias," and Dr. France Word, "Injuries to the G.U.
To Dr. and Mrs. M. A. Nicholson, of Vancouver, a son.
To Dr. and Mrs. L. C. Kindress, of Squamish, a son.
To Dr. and Mrs. R. A. Stanley, of Vancouver, a daughter.
To Dr. and Mrs. P. M. Wolfe, of Victoria, a son.
Dr. W. D. McKinley and Miss June Lawrence, daughter of Dr. and Mrs. Grant
Lawrence of Vancouver.
Dr. J. P. Ellis of Vancouver and Mary Asthorpe, daughter of the late Dr. and
Mrs. J. S. McLeod.
Dr. Donald MacKay and Catharine MacLeod of Stewart, B.C.
The Workmen's Compensation Board, through its Chief Medical
Director, Dr. G. B. Murphy, has asked us to acquaint the medical profession with its change in policy as regards referral of patients for
phsysiotherapy. The following notice was printed in the October
Bulletin and we reprint it herewith.
Please take note also of the new address of the board: 707 West
37th Avenue, Vancouver, B.C.
OBIT SEPT. 13, 1951
George Kerr MacNaughton, of Cumberland, B.C., passed away September
13, 1951. He was born in Black River, New Brunswick. He graduated in
Arts from the University of New Brunswick. He became principal of Harkins
Academy in New Brunswick. He graduated in Medicine from McGill
University in 1906, interned at the Montreal General Hospital, and came to
Cumberland late in 1906. This was his field of labour until his passing. In
1917 he was made a Fellow of the American College of Surgeons.
From 1928 to 1933 he was M.P.P. for Comox. He was a high official in
the Masonic Lodge, was interested in many local organizations, and was
appointed by His Majesty the King as Serving Brother of the Order of St.
John Ambulance. The day of his funeral the town was hushed. The church,
though large, was inadequate. The people went with him to his resting place.
It seemed as if everyone said—there lies a kind friend, an honourable statesman, a Doctor who gave his best for the medical care of his patients in his
He: is survived by his wife, a daughter, Mrs. J. E. Elliot, Toronto, and a
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