History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: September, 1954 Vancouver Medical Association Sep 30, 1954

Item Metadata

Download

Media
vma-1.0214651.pdf
Metadata
JSON: vma-1.0214651.json
JSON-LD: vma-1.0214651-ld.json
RDF/XML (Pretty): vma-1.0214651-rdf.xml
RDF/JSON: vma-1.0214651-rdf.json
Turtle: vma-1.0214651-turtle.txt
N-Triples: vma-1.0214651-rdf-ntriples.txt
Original Record: vma-1.0214651-source.json
Full Text
vma-1.0214651-fulltext.txt
Citation
vma-1.0214651.ris

Full Text

 T H E
BULLETIN
OF
The Vancouver Medical Association
EDITOR
DR. J. H. MacDERMOT
EDITORIAL BOARD
DR.  E.  F. CHRISTOPHERSON DR.   J.   H.   B.   GRANT
DR.  H.  A.  DesBRISAY Dr.   J.   L.   McMILLAN
Publisher and Advertising Manager
W. E. G. MACDONALD
VOLUME XXX.
SEPTEMBER, 1954
NUMBER 12
Dr. J. Howard Black
President
OFFICERS 1954-55
Dr. F. S. Hobbs
Vice-President
Dr. D. S. Munroe
Past President
Dr. R. A. Gilchrist
Hon. Treasurer
Dr. G. E. L.ANGLEY
Hon. Secretary
Additional Members of Executive:
Dr. A. F. Hardyment Dr. Paul Jackson
TRUSTEES
Dr. G. H. Clement Dr. Murray Blair Dr. W. J. Dorrance
Auditor: R. H. N.  Whiting, Chartered Accountant
SECTIONS
Eye, Ear, Nose and Throat
Dr. W. Ronald Taylor Chairman Dr. R. S. Grimmett* —Secretary
Paediatric
Dr. E. S. James  Chairman Dr. G. R. Gayman Secretary
Orthopaedic and Traumatic Surgery
Dr. W. H. Fahrni Chairman Dr. J. W. Sparkes i Secretary
Neurology and Psychiatry
Dr. T. G. B. Caunt Chairman Dr. J. R. Wilson Secretary
Radiology
Dr. H. H. Brooke. I Chairman Dr. S. Miller. Secretary
STANDING COMMITTEES
Library
Dr. R. J. Cowan, Chairman; Dr. W. F. Bib, Secretary; Dr. D. W. Moffat;
Dr. C. E. G. Gould; Dr. W. C. Gibson; Dr. M. D. Young.
Summer School
Dr. Max Frost, Chairman: Dr. E. A. Jones, Secretary; Dr. S. L. Williams;
Dr. J. A. Elliot ; Dr. Robert Goublay ; Dr. G. C. Walsh
Medical Economics
Dr. E. A. Jones, Chairman; Dr. W. Fowler, Dr. F. W. Hurlburt, Dr. R. Langston,
|8||Dr. Robert Stanley, Dr. Charles Battle, Dr, S. Kaplan
Credentials
Dr. J. C. Grimson, Dr. E. O. McCoy, Dr. D. S. Munroe
V.O.N. Advisory Committee
Dr. D. M. Whitelaw, Dr. R. Whitman, Dr. R. A. Stanley
Representative to the Vancouver Board of Trade (Health Committee) : Dr. F. S. Hobbs
Representative to the Greater Vancouver Health League: Dr. F. S. Hobbs
Published  monthly  at  Vancouver,  Canada.     Authorized  as  second  class  mail,  Post  Office  Department,
Ottawa, Ont.
Page 465 Ouabaine Arnaud and
*
Ouabaine Arnaud
has been adopted (1928) at the National Institute f<
Medical Research, London, as the International Standa
against which all concentrates or extracts of ordinal
strophanthins are standardized for biological activity ar
toxicity.
ARMUD
* mm
and only Ouabaine Arnaud
is the strophanthus glycoside which, as a cardiotoni
agent,
jg^    (A) is established as a pure chemical entity
gjg^3    (B) is uniformely reproduced
JBSgjr3    (C) is therapeutically constant on a weight — puritj
basis
03^    (D) is not subject to the error of biological standard
ization
JS1P    (E)   is rapid constant and sure in therapeutic actioi
BS^5    (F)   does not cause or build up habituation
BSEF* (G) is superior to the more ordinary toxic strophan
thins or ouabaines which are often ill-defined
chemically and physically and which vary widel)
due to plant sources and manufacturing methods
ASUr3    (H) is  particularly indicated  in  all  types  of heart
failure with regular rhythm and
(I) in left ventricular failure; left ventricular failure
in myocarditis or accompanying aortic disease or
hypertonia.
*
Ouabaine Arnaud, along with Digitaline Nativelle, are products of which Laboratoire Nativelle
is justifiably proud since both are global standards of purity and uniformity in their respective
fields. HOSPITAL CLINICS
VANCOUVER  GENERAL  HOSPITAL
Regular Weekly Fixtures in the Lecture Hall
Monday, 8:00 a.m.—Orthopaedic Clinic.
Monday, 12:15 p.m.—Surgical Clinic.
Tuesday, 8:30 a.m.—Ophthalmology Clinic (Health Centre for Children)
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.
ST. PAUL'S   HOSPITAL
Regular. Weekly Fixtures
2nd Monday of each month—2 p.m Tumour Clinic
Tuesday—9-10 a.m. - Paediatric Conference
Wednesday—9-10 a.m ? Medical Clinic
Wednesday—11-12 a.m. Obstetrics and Gynaecology Clinic
Alternate Wednesdays—12 noon | Orthopaedic Clinic
Alernate Thursdays—11 a.m Pathological Conference (Specimens and Discussion)
Friday—8  a.m Clinico-Pathological Conference
(Alternating with Surgery)
Alternate Fridays—8 a.m 1 — Surgical Conference
Friday—9 a.m - j Dr. Appleby's Surgery Clinic
Friday—11 a.m Interesting Films Shown in X-ray Department
SHAUGHNESSY  HOSPITAL
Regular Weekly Fixtures
Tuesday, 8:30 a.m.—Dermatology. Monday, 11:00 a.m.—Psychiatry.
Wednesday, 10:45 a.m.—General Medicine. Friday, 8:30 a.m.—Chest Conference.
Wednesday, 12:30 p.m.—Pathology. Friday, 1:15 p.m.—Surgery.
BRITISH  COLUMBIA  CANCER  INSTITUTE
2656 Heather Street
Vancouver 9, B.C.
SCHEDULE OF CLINICS—1953
MONDAY—9:00 a.m.-10:00 a.m.—Nose and Throat Clinic.
TUESDAY—9:00 a.m.-10:00 a.m.—Clinical Meeting.
10:30-12:00 noon—Lymphoma Clinic.
THURSDAY—11:00 a.m.-12:00 noon—Gynaecological Clinic.
DAILY—11:45 a.m.-12:45 p.m.—Therapy Conference.
Page 467 when resistance to other
antibiotics develops...
Chloromycetin*
Current reports1,2 describe the increasing incidence of resistance among many
pathogenic strains of microorganisms to some of the antibiotics commonly in
use. Because this phenomenon is often less marked following administration of
CHLOROMYCETIN (chloramphenicol, Parke-Davis), this notably effective, broad
spectrum antibiotic is frequently effective where other antibiotics fail.
Coliform bacilli—100 strains
up to 43% resistant to other antibiotics;
2% resistant to CHLOROMYCETIN.1
Staphylococcus aureus—500 strains C§j£
up to 73% resistant to other antibiotics;
2.4% resistant to CHLOROMYCETIN.2
CHLOROMYCETIN is a potent therapeutic agent and, because certain blood dyscra-
sias have been associated with its administration, it should not be used indiscriminately
or for minor infections. Furthermore, as with certain other drugs, adequate blood
studies should be made when the patient requires prolonged or intermittent therapy.
References    |||1
(1) Kirby, W. M. M.;. Waddington, W. S., & Doornink, G. M.: Antibiotics Annual, 1953-1954, New
York, Medical Encyclopedia, Inc., 1953, p. 285. (2) Finland, M., & Haight, T H.: Arch. Int. Med.
91:143,1953.
PARKE, DAVIS & CO., LTD.
Page 468
U
H WALKERVIIXE, ONTARIO
_ GREATER   VANCOUVER   PUBLIC    HEALTH
METROPOLITAiN HEALTH COMMITTEE
Dr. Stewart Murray, Sr. Medical Health Officer
Vancouver, B.C.
Population (Est.)
Vancouver  . _3 90,325
Burnaby  Municipality    1 -  61,000
North Vancouver City   16,000
North Vancouver District Municipality   16,000
West Vancouver Municipality   14,250
Richmond   1 J|  19,186
University Area    1  3,800
District Lot 172   1,469
522,030
SHIGELLOSIS
One hundred years ago (1854) John Snow made his epochal report on an epidemic
of cholera, followed two years later by ¥m. Budd's observations on the spread of
typhoid fever. The subsequent improvement in the protection of water supplies, in safe
milk production and in proper sewage disposal resulted in a tremendous reduction in
gastro-intestinal infections. Yet, with all our modern sanitation and improved personal
hygiene, gastro-intestinal infections, particularly of the Shigella Sonnei type, have
shown an alarming increase in this area during the past few years.
Bacillary Dysentery   (Shigellosis)   Vancouver Metropolitan  Area
Cases Reported
1948 —  5   §§| 1951 — 100       1954 (8 mos.) — 293
1949 — 14
1950 — 129
1952 — 43
1953 — 151
The sudden increase in 1950 was due largely to a widely scattered group of
children who were originally infected at a summer camp. This type of spread has
occurred, to a lesser degree, on some more recent occasions, but the more significant
finding at the present time is the widespread incidence of single family cases wiiich
apparently originate from infections spread within the home.
The presence of such large numbers of cases within a community is fraught with
"considerable danger, lessened fortunately by the short period of infectiousness in most
cases, and by the relatively safe type of water and milk supply in the area. Mild and
missed cases probably constitute our greatest risk and the importance of checking all
suspicious cases with stool examinations should be obvious to all. So-called "stomach
flu" especially in a food-handler should be regarded with extreme suspicion by medical
and lay persons alike.
Page 469 -CCOWMAUCHT>
INSULIN PREPARATIONS
For Short Duration of Action-
For Prolonged Duration of Action—
Insulin-Toronto — an unmodified solution of zinc-Insulin
crystals, highly purified and
carefully assayed to aid in ensuring a uniform effect from
vial to vial.
Protamine   Zinc   Insulin—an
amorphous suspension prepared by modifying a solution
of zinc-Insulin crystals by the
addition of about 1.25 mg. of
the protein-precipitant protamine per one hundred units of
the Insulin. SM
For Intermediate Duration of Action NPH Insulin—a suspension of
crystals containing Insulin
and protamine. Chemical and
biological tests are conducted
to control uniformity of the
preparation.
A Handbook for Diabetic Patients, entitled
"INSULIN", is available to physicians upon
request for distribution to their patients.
CONNAUGHT   MEDICAL    RESEARCH    LABORATORIES
University of Toronto Toronto, Canada
Established in 1914 for Public Service through Medical Research and
the development of Products for Prevention or Treatment of Disease.-
Page 470
DEPOT FOR BRITISH COLUMBIA
MACDONALD'S    PRESCRIPTIONS    LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER § B.C. At the time of writing this we are looking forward to the John Mawer Pearson
lecture to be delivered on Sept. 14th before the Vancouver Medical Association. Our
executive is to be congratulated on its choice of a speaker, as Dr. S. C. Dyke is evidently
a man who would greatly appreciate our old friend Dr. Pearson, and his attitude towards
medicine. We say this because Pearson had a great passion for clinical pathology, and
pathology generally was to him of consuming interest. He had something of Osier's
keenness for post-mortems, and spent all the time he could at autopsies, and he applied
his knowledge continually to his clinical practice. So we feel that he would rejoice
greatly at this selection of a speaker, and we only wish we could be there to hear the
address;. Perhaps if Sir Oliver Lodge and Conan Doyle are to be trusted, he may quite
well, irl some Elipsian field, be Ustening, or viewing, or absorbing by some medium, of
which we as yet know nothing, the lecture named after him.
We are very glad that the Pearson lecture is being" revived. We know that for
some years it was impossible to put it on, and its omission was the result of circumstances,
far more than of indifference. But now it has come back into the realms of acheality,
and from now on we expect it will be a regular event in our medical programmes:
and this is as it should be—A notable authority has told us that "the evil that men do
lives after them, the good is oft interred with their bones", and if this is true, it is a
great pity. Few of us now remember John Mawer Pearson, since few of us now in
Vancouver knew him—but his was a personality too positive and beneficial to be
forgotten easily. He did much for us—we owe to him a great deal of good work—in
our Medical Association itself, he did much in its building and in guiding it along good
lines—our Library is a monument to his keenness, and his devotion to learning. He was
a moving spirit in everything that came up, that might mean more and better education, more interest in the scientific side of medicine, as opposed to the merely practical
side of it; he worked hard for the establishment of a Medical School here, and so on.
These lectureships, established in memory of men we wish to honour, are a great
thing—they are not merely another lecture—but they stimulate us, by making us think,
by reminding us that curiosity, eagerness, devotion, unselfishness are the qualities that
really make men great, and that are at the root of all the progress we make, in medicine
more perhaps than in any other profession^ And John Mawer Pearson had all these in
full measure—So, again, we are happy that we shall hear from him again, by another
voice than his, and that we can give him this need of honour and esteem.
V
V
The Horner Exhibit of Fine Arts, at the annual meetings of the Canadian Medical
Association have developed into a very big affair—and the excellence of the work
exhibited thereat is outstanding.
At the last exhibit in June of this year, Vancouver did itself very proud: in fact,
it made a tremendous showing. No less than three firsts, and one second, came our way—
and we feel that some notice should be taken of this by our Bulletin.
Dr. S. L. Williams won a First in Portraiture—Dr. Goldman a First in Photography—Dr. H. Baker a First in Contemporory Art, while Dr. Gerald Burke won the
Second prize in Traditional Art.
We think this is pretty nearly a record for a city of this size, and when one considers that there were well over 3 50 exhibits to be judged, it is obvious that Vancouver
did very well. Of course, it is the artists who deserve the palm for their excellent
WOrk—but we bask in their reflected glory.
Page 471 CORRESPONDENCE ff' j
Edmonton, Alberta, 26th August, 1954.
Registrar,
College of Physicians & Surgeons
for the Province of British Columbia,
925 Georgia West,
Vancouver, B.C.
Dear Doctor Gunn:
As you are no doubt aware the policy within the R.C.A.F. as regards mercy flights
is that they will be dispatched only at the request of other government services or
departments and then only in the areas where no alternate form of transportation is
available, no commercial air operator is equipped or willing to handle the flight, and no
adequate medical care is within access. However, in spite of every effort to direct the
mercy flights to civilian firms, the task of evacuating civilian emergency cases from
the north has still fallen almost entirely upon the R.C.A.F.
When, after compliance with the existing policy, the R.C.A.F. have been called
upon to carry out mercy flights, it has been the practice that the flight would not be
dispatched until a fair knowledge of the patient's condition was learned. The reason
for this requirement is that far too often in the past cases have been evacuated as dire
emergencies in adverse weather when they could have waited for a short period until
the weather cleared. In addition, Medical Officers have been required to deal with
seriously ill patients in flight without the equipment which they could have taken with
them if they had been forewarned.
Obtaining this essential information on a patient (if such is not in the original
message) means long distance calls which results in needless delay.
It is urged that these problems could be solved if the civilian doctors in the northern
part of your administrative area could be requested to supply information along the
lines suggested below.
1. Cases Unfit For Air Evacuation—These cases stand air evacuation very poorly be^
cause of the rarified air in flight, and the giving of oxygen in flight has little effect.
(a) Patients in shock.
(b) Patients with coronary artery occlusion or angina pectoris.
(c) Patients with less than 50% Haemoglobin or 2.5 million RBC.
(d) Patients in such poor physical condition that the successful completion of the
evacuation is doubtful, unless lifesaving measures are available at Edmonton
which are not available at point of origin.
2. Patient At Edmonton—The civilian doctor in charge of the case at the point of
origin, should attempt to ensure that a bed is awaiting the case on »rrival at Edmonton before calling for a mercy flight.
3. Details Required By The R.C.A.F. Before Dispatching a Mercy Flight—When calling
on the R.C.A.F. Rescue and Co-ordination Centre for a mercy flight, the doctor in
charge of the case should give the following details regarding the patient.
(a) Name.
(b) Age.
(c) Sex.
(d) Disease or injury.
(e) Patient's condition, whether good, fair, serious or dangerous.
(f) Urgency of mercy flight, i.e., immediately or within 24 hours.
(g) Whether medical attendant required in flight, and if required, whether a doctor
or a nurses' aid.
Page 472 (h)   Special equipment that may be required in flight such as artificial respirator,
oxygen, plasma transfusion or the administration of narcotics,
(i)  Name of doctor and hospital in Edmonton to which case is being evacuated.
4.   Special Notes—
(a) Morphine is poorly tolerated by ill patients at altitude.   Demerol is by far the
safer drug.
(b) Patient should have his own blankets as R.C.A.F. blankets are Crown property
and cannot leave the aircraft with the patient to the hospital in Edmonton.
(c) Comprehensive notes of condition and narcotics given to patient with times,
should be available to the flight Medical Officer on arrival.
Would you be kind enough to request doctors in isolated areas to follow this procedure when requesting aid from the R.C.A.F.
Yours truly,
HI S. W. COLEMAN,
Air Commodore,
Air Officer Commanding,
1 Tactical Air Command.
WORKMEN'S COMPENSATION BOARD
September 9th, 1954.
To the Members of the College of Physicians
and Surgeons of British Columbia.
Dear Fellow Members:
The summer holiday season is about over, that is, if we have had any summer
at all. We are trying to get our Medical Staff back to full activity and during this
year will send you some further notes by way of the Bulletin.
We are really hoping that the time will come when we do not have to send out
requests for extra information or clearer information or annoying letters for clarification
of discrepancies.
I hope that any and all of you, when you are in Vancouver and this refers to the
doctors from out-of-town, will come up to the Board to pay us a visit. We are most
anxious to be as helpful as we can in the care of compensation cases, to not annoy you
by extraordinary requests or the cutting of accounts, and we are trying very hard to
improve the public relations between yourself and the Board. I know a good many of
you do not think we are making much progress and it is not because we are not trying.
There is a certain percentage of cases and conditions which occur during employment,
which cannot be considered as an accident witbin the meaning of the Act or to come
under the category of Industrial Diseases. In most of these cases, objection is taken
by the workman or the doctor due to the non-acceptance of the claim. It is essential
that any case that is accepted, must fulfill the criteria as laid down by the Act and
Regulations and must be either an accident or an industrial disease within the meaning
of the Act.
In acceptable cases when there is a delay in having the claim adjudicated and an
official notification being sent to the workman and the doctor, there is usually a very
definite cause for such delay. Most often the delay is due to incomplete reports and
inaccuracies in comparing the employer's, the workman's and the attending surgeon's
reports. It is essential that all the information which is received, must agree, otherwise
it is necessary to send out requests for clarification of information or for correction of
information which has been given.
Page 473 In previous letters we have indicated the importance of fulfilling the obligations
in relation to the regulations which are outlined in the booklet "Information for
Physicians and Schedule of Fees". We do not like to annoy you by repeatedly drawing
to your attention the necessity of fulfilling the regulations, but unfortunately it is
necessary.
Except in emergencies it is important that the attending doctor obtains permission
for a consultation and also that permission is obtained for elective operative procedures.
It is important that we receive, as soon as possible, an adequate consultation report on
a letterhead. The consultation reports should not be sent on the form 11 or the form 8
but should be a formal consultation which contains adequate information which substantiates the conclusions. It is also important that we receive adequate operative
reports in relation to all procedures.
We are slowly organizing the review of x-rays as outlined in a letter sent to all
the members of the College in the Spring, but as yet we are only requesting the x-rays
from the Kootenay area. The request to have the x-rays sent in does not in any way
supercede the necessity of sending adequate x-ray reports and is simply a means of
verifying or supervising the care of workmen by a review of the x-ray.
We are still having difficulty in reading some of the writing and it is important
that reports are filled in by typewriter if possible, by pen and ink and not by ordinary
pencil. Some of the writing is almost impossible to read and we would again request
that you have a rubber stmap made with your name and address. If you are going to
have the stamp made anyway, it is almost as easy to have one made with your name,
address and the date, but the forms must have your personal signature. This will, in the
end, save you time and certainly will save a great deal of inconvenience and difficulty
in the interpretation of signatures. W$m
I am still very anxious to hear your.complaints and if you will drop me a personal
note, we will make every possible attempt to correct the causes or cause of your
complaint.
Kindest of personal regards, I remain,
Sincerely yours,
J. R. Naden, M.D.,
CHIEF MEDICAL OFFICER.
MEETING OF SPECIAL INTEREST TO THE PROFESSION
Under the auspices of the Vancouver Medical Association—SIR
JAMES LEARMONTH, Professor of Surgery, University of Edinburgh
will address a general meeting in the TUBERCULOSIS INSTITUTE
AUDITORIUM on TUESDAY, NOVEMBER 9th, 1954, at 8:00 p.m.
The title of his illustrated lecture will be "The Clinical Assessment
of Prognosis in Peripheral Vascular Disease/7 All members of the
medical profession are welcome to attend.
Page 474 THE TREATMENT OF CANCER OF THE BLADDER
BY
B. W. Windeyer, m.d., b.s., f.r.c.s., f.f.r., d.m.r.e.
Paper given at the Refresher Course on Malignant Disease
held at the
British Columbia Cancer Institute
Vancouver, B.C., October, 1952
In cancer of the bladder, as in so many other types of malignant disease, early
diagnosis is of supreme importance. The prognosis in the majority of cases depends
more on the length of time elapsing between the first symptoms and the commencement
of treatment than on any other single factor.
It is a disease which is commoner in men than in womn with its highest incidence
in the sixth and seventh decades, but may occur as early as the twenties. In any case of
haematuria, the presenting symptom in 95% of cases, malignant disease must be suspected and investigation carried out.
The choice of the method of treatment to be used depends on many factors.
Firstly, the general condition of the patient may determine whether any radical treatment can be carried out. Secondly, there are local considerations, such as the size,
extent of spread and the gross appearances of the tumour, its situation, multiplicity and
the histological type. The condition of the renal tract and the renal function must be
considered.
To determine these it is necessary to carry out firstly a general clinical examination, secondly cystoscopy. In addition to an initial cystoscopy which may be done as
an out-patient, it is necessary to perform a careful cystoscopic examination under
anaesthetic.
Cystoscopic appearances generally give a good idea of the malignancy of the
growth. The whole bladder must be studied to refine in detail the position, type and
extent of the growth. The appearances may vary from the delicate fronds of the so-
called "benign" papilloma, through solid nodular growth to frank ulceration. The
tumours may be single or multiple, and infiltrating or non-infiltrating. Papillary growths
are usually of lower malignancy and the ulcerating growths of higher malignancy.
Multiple tumours may not all be of the same gross type. There may be papillomatous
lesions associated with nodular or ulcerating ones and tumours may change in type
with progress of time. There is a tendency for less malignant types to become more
malignant, especially after inefficient and unsuccessful treatment. In addition to the
actual tumour the condition of the rest of the bladder mucosa must be studied for any
signs of alteration from the normal.
Thirdly, biospy of the tumour should be carried out through the cystoscope and,
fourthly, bimanual examination done with full relaxation under anaesthetic. If a tumour
is palpable it usually, but not always, has spread into muscle. Fixation of the growth
is one indication of its inoperability which can be felt on bimanual examination.
Fifthly, intravenous urography should be carried out in all cases. It may give
valuable information of the position, extent and nature of the growth. It is the best
way of showing dilatation of the renal tract and failure of renal function. It may
show a primary growth in the renal pelvis and alter the whole conception of treatment.
Histology
Histological classification is of great importance in determining prognosis, and
also in determining the choice of treatment. My colleague E. W. Riches at the Middlesex Hospital has adopted the method of classification of Dukes and Masinia, which
recognizes grades of malignancy based on cell differentiation.
Grade I is of low malignancy, Grade II is of average or intermediate malignancy,
Grade III is of high malignancy. There is also Grade IV, the undifferentiated carcinoma
simplex.
Page 475 It is of the greatest importance to separate Grade I of low malignancy from those
of higher malignancy in Grades II and III. This is the main differentiation which is of
practical importance, and we do no consider that there is any great advantage in
making a multiplicity of grades. There are subdivisions according to (a) whether they
are papillary or solid growtlis and (b)  whether metaplasia is present or absent.
Stages
The classification also includes a method of staging according to the extent of
spread of the tumour,
Stage I—It is limited to the bladder wall.
Stage IA—It is limited to the mocosa.
Stage IB—It is involving muscle.
Stage II —There is involvement of the paravesical fat.
Stage III—There is involvement of the paravesical lymph glands.
Stage IV—There is a fixation of  the paravesical  lymph  glands  and/or distant
metastases.
In addition, attention is drawn to the importance of associated mucosal changes.
Areas of hyperaemia or cystitis, areas of trabeculation or small nodular elevations may
be evidence of submucosal spread or premalignant areas which will later develop new
malignant tumours. In Masina's words, "The conclusion is that if a tumour is surrounded by diffusely red and apparently inflamed mucosa, these changes are premalignant and malignant till proved otherwise."
Methods of Treatment and Indication for Each
Both surgery and radiotherapy are essential for the proper treatment of cancer
of the bladder. They are complementary and both must be available so that the best
method can be chosen for each individual patient.
Surgery 5^|
Firstly, cystodiathermy may be used for the treatment of the so-called "benign"
papilloma and for papillary tumours of low malignancy. There should be thorough
destruction of the tumour at one sitting and routine follow-up cystoscopy for the
treatment of possible recurrence or new tumour formation. Recurrence may occur
even many years after the bladder has apparently been clear.
Secondly, partial cystectomy. This should be limited to the localized single tumour
with no surrounding mucosal change. It is necessary to remove the whole thickness of
the bladder wall and at least 2l/2 cms. of apparently healthy bladder surrounding the
tumour.
Total cystectomy—this has been used for:
(a) Multiple, extensive or widely separated tumours of low malignancy;
(b) Tumours of the base of the bladder;
(c) Single tumours with higher malignancy and evidence of surrounding mucosal
change;
(d) Cases with small bladder'capacity;
(e) As a palliative procedure where other methods have failed or appear likely
to do so. It is used as part of a pelvic clearance in some cases of secondary
involvement of the bladder as from carcinoma of the cervix.
Fourthly, surgery may be used as a palliative ureteric transplant. This may be of
great value to save the patient from a painful bladder death and may give quite
remarkable palliation.
Radiotherapy
1.   Intravesical Implantation.
The implantation of radium needles after suprapubic cystotomy has* been used by
many workers. Jacobs of Glasgow reported 100 cases treated by this method, of whom
37 survived five years or longer. The method has certain disadvantages. There is usually
some degree of cystitis which may be associated with considerable pain and discomfort
and may last for many weeks. With improved distribution and more accurate dosage
Page 476 the degree of cystitis is lessened. It is necessary to open the bladder to remove the
needles. The implantation of radon seeds is now generally preferred to the use of
radium needles. They are placed in a pre-arranged pattern according to the rules of
Parker and Paterson. It is not easy to insert them accurately and the provision of a
perspex jig with holes for the insertion of each seed is a help in accuracy of distribution.
A dose of 6500 to 7000 roentgens at 0.5 cm. from the place of the implant may be
given with seeds of 0.6 or 1.0 millicuries.
The bladder is closed and drained by a urethral catheter and the patient is usually
ready to leave hospital in two weeks as opposed to perhaps six to eight weeks with
radium needles. Results obtained by radon seed implant from the Christie Hospital,
Manchester, in the years 1940-1944 were 21 five year survivals from 38 patients
treated or 55%. As an alternative to radon seeds, seeds made of radioactive gold have
been used lately and a further development which may have technical advantages is
the use of radioactive tantalum wire. The wire made of tantalum is sheathed in
platinum and is similar in flexibility to 10 amp. fuse wire. It is threaded beneath the
tumour with an appropriate distribution and the ends of the wires are tied to a urethral
catheter. The wires are withdrawn with the catheter when the determined dose has
been given.
The type of tumour which is suitable for these implantation techniques is a single
tumour in Stage 1A or IB of average and .high malignancy strictly localized with no
surrounding mucosal changes and not exceeding 5 cms. in diameter. The implantation
should be done by the supra-pubic route. The tumour should be levelled down to the
bladder mucosa with diathermy and the implant done into the tumour base. Poole
Wilson of Manchester has extended this procedure to larger and more infiltrating
tumours after etxensive diathermy coagulation.
Extra vesical implantation of radium needles has been used. It was described by
Ogier Ward to overcome the disadvantages of intravesical radium implantation. We
consider that it may be of value as a palliative in a limited number of patients with
localized extra vesical extension who are not suitable for total cystectomy.
Intra-cavitary Isotope Therapy
The use of various radioactive isotopes in solution to fill up the tumour of the
bladder has been developed in recent years. The first experiments in Great Britain were
started by Frank Ellis with a solution of Thorum X in an attempt to prevent recurrence of superficial papillary tumours after cystodiathermy. Various isotopes have been
used in a bag introduced into the bladder. Muller used a solution of Cobalt 60 and the
Royal Cancer Hospital team starting witri a sodium salt solution now use a solution
of bromine salt. A measured quantity of fluid is used in a bag which is introduced by
perineal urethrostomy. The dose delivered can be accurately measured by filling the
bag in the laboratory prior to the actual treatment. It is necessary to take strict precautions and to be meticulous in technique to avoid contamination by spilling the fluid
and to ensure protection of the operating personnel.
This method is suitable for treatment of growth in Stage 1A when they are
multiple flat and diffuse or have mucosal changes surrounding a single lesion rendering
it unsuitable for radon implant.
Another method of intra-cavitary irradiation is to use a modified Foley catheter
with a source of irradiation suitably placed within the balloon. Both radium and radioactive cobalt have been used, the latter being more appropriate to form a point source
of irradiation. The method has been described by Freedman and Lewis, by William Harris
and Low Beer. In Great Britain it is being used in Manchester and at the Middlesex
Hospital some development has been carried out by Cones and Gregory in association
with Riches. Their apparatus is described in an article which is at present in the press.
For some years radiotherapists and genito-urinary surgeons have sought an adequate
method for the irradiation of the whole mucosal surface of the urinary bladder without
the general local effects, and painful sequelae of external irradiation through multiple
Page 477
IHM—irmni.irnr—ii ports of entry. Supervoltage X-ray therapy, in the 1-4 Mev. range can be used for
radical treatment of carcinoma of the bladder, but even this does not obviate irradiation
of the whole pelvis.
The catheter has a fabric base to prevent stretching and this has a latex covering.
A drainage tube and a tube for inflating the balloon are incorporated in the main stem
of the catheter. The balloon is mounted on the end of the catheter. It was obvious that
any balloon which was distended to its full size was liable to lose its shape, and so these
balloons are designed to reach the required shape and diameter without any stretching
of the rubber. Two latex dippings are all that is required to give the balloon strength
when distended without too much bulk when deflated.
A plastic'container holds the cobalt source, and this is fixed to a nickel rod. The
position of the C0.-6O can be adjusted by a screw thread at the end of the catheter,
and a locking device is used. An introducer is also provided for use when the catheter
is being inserted into the bladder. Two C0.-6O sources are available, of 23 and 46
millicurie strength. Owing to the softness of the metal, and to avoid chipping, they have
been inserted into thin silver cases. Three sizes of balloon have also been made, of five,
six and seven centimeters diameter. The appropriate source is chosen, depending on the
balloon size and time-intensity factor desired for each individual case. The appropriate
ballon is chosen following a cystometrogram so that the bladder wall is as accurately
as possible in contact with the balloon surface.
Before insertion into the bladder, which in the male is through a perineal
urethrostomy or suprapubic route and in the female per urethram, the balloon is inflated
with water to its correct size and left for 18 hours; any fault in the balloons is thus
disclosed. During treatment the balloon is filled with a solution of 5% sodium iodide
tinted by green confectionery colouring (B.D.H.) of 0.01% to which 0.5% sodium
bicarbonate is added to prevent the dye from being decolourized by the sodium iodide.
Should the balloon leak or burst during treatment, the presence of dye in the urine
allows for immediate detection and the active source can be quickly withdrawn.
The sodium iodide in the balloon is radio-opaque and radiographs are taken
immediately after insertion, the position of the cobalt being checked and altered if
necessary. It has been noticed that the bladder may take up to 24 hours to become
adjusted to the shape of the balloon and so a further radiographic check is desirable-
after this interval, and necessary adjustments made. Both antero-posterior and lateral
radiographs are taken and it has been found that the lateral picture is the most important, as it shows occasional distortion of the balloon although the antero-posterior picture
showed an apparent perfect central location of the cobalt source.
Although a central source is desirable on some occasions, it is possible to position
the source to give a high dose rate to a particular area of the mucosa. This may be
desirable in certain cases where the growth is well defined and highly localized. If the
insertion has been made per urethram a longitudinal adjustment of source position can
be made. Alternatively, insertion by a suprapubic route will allow adjustment in the
antero-posterior plane. Previous knowledge of position and extent of growth may,
from dosage considerations, indicate preference for a particular method of insertion, if
both methods are equally suitable surgically.
Dosage estimation is as simple as the inverse square law will allow, and adequate
control of dosage is possible whatever the position and extent of the area being treated.
Depth Dose
The depth doses obtained with a central source depend on the source to mucosa
distance. Table I gives the depth doses for a C0.-6O source centrally situated in
balloons of different size.
Page 478 TABLE I
Distance from Mucosa  (cms.)
0 0.5 1.0 1.5
100 68 50 36 ]
100 72 53 40
100 77 60 50
Wo
Depth Dose
Source to Mucosa
Distance (cms.)
2.5
3.0
3.5
The total dose arrived at has been between 6500r and 7500r delivered at the surface
of the balloon. Varying methods of fratctionation have been tried and finality has not
been reached. It is too early to assess clinical results but the initial response in some
cases has been encouraging.
The first attempts at treatment gave a great deal of pain but with the more
flexible catheter and better provision for drainage this is now much improved.
The types of case suitable for the use of this method are:
(1) Multiple growths of Stage 1A similar to those in which the isotope filled bag
is use_. It has the disadvantage relative to the latter method in superficial growths
that there is a greater depth dose and greater liability to damage the bladder wall. It
is suitable for ulcerated growths on the bladder base which are unfit for surgery, or for
ulcerative growths in any situation. It has been used after ureteric transplant in some
cases. The method is not really suitable for deeply penetrating growths of Stage 2 or 3.
It is hoped that it may be found to be useful to limit some of the indications for total
cystectomy. It may also have a place as a method of pre-operative irradiation to diminish
the likelihood of dissemination. The dose given is the subject of experiment. There is
a tendency to spread out the total time over at least a week during which 6000 to
700Or is delivered. In some cases the dose has been fractionated. With this type of
catheter the cobalt can be withdrawn and replaced without difficulty and there is some
flexibility possible in the arrangement of the dose distribution with regard to time.
X-ray Therapy
(a) Intra-cavitary X-ray therapy through a suprapubic cystotomy has been used
to a limited degree. The cases which appear suitable are single lesions with no mucosal
changes in Stages 1A and IB after removal of the bulk of the tumour by diathermy. It
has been almost entirely superseded by radon seed implantation as there were difficulties
with the apparatus at our disposal in obtaining sufficient access and proper angulation.
In a small series of twelve cases two were rendered tumour free for more than five
years but in others there were recurrences at the edge of the irradiated area, largely
I think through technical difficulties in centering.
(b) External X-ray Therapy—Conventional X-ray therapy in the 250 kilovolt
has not proved effective in the cure of cancer of the bladder. It is not possible to
obtain a suffiicient dose without excessive irradiation of the surrounding tissues. It is,
however, of very great value as a palliative and can in many cases stop haematuria,
relieve pain and discomfort and slow down the progress of the tumour. It may be useful
for the palliative treatment of metastases. It has been used by us for post-operative
irradiation in cases of multiple tumours treated by cysto-diathermy and it appears that
the results have been improved by its use. The use of higher voltage in the one to four
million volt range, or as an alternative the massive cobalt teleradiation apparatus,
appears to have great advantages. The two million volt machines in Great Britain
have produced regression and healing in some cases where this had not appeared possible
with lower voltages, and may materially alter the outlook in some more penetrating
lesions. This work, however, is still very recent. ^g
The sphere of usefulness of external irradiation is in cases of Stage IB which are
numerous or where there are single lesions of this stage with mucosal changes. In
Stages 2 and 3 the development of supervoltage irradiation may provide an alternative
to total cystectomy. In Stage 4 it is the only method of palliation which is available.
Page 479 Complications of Radiotherapy of Cancer of the Bladder
Cystitis is the most frequent early complication occurring as the result of radiotherapy in cancer of the bladder. It may be prolonged, painful and intractable if the
reactions have been intense and particularly in cases of over-dosage.
Other early complications may be proctitis when pentrating radiation has been
used and pyelonephritis which may occur particularly if there has been blockage of
a ureter.
There are also some late complications. There may be calculus formation especially
if there has been prolonged infection. Severe haemorrhage has been known to occur
at a later stage from dilated vessels in a heavily scarred area of mucosa. The only treatment possible in such cases is cystectomy.
Bladder contraction is a more frequent complication as the result of fibrosis after
heavy irradiation. It may proceed to an extereme degree so that the bladder capacity
is reduced to only two or three ounces and ureteric transplant may have to be carried
out. Contracted bladder is more likely to result when heavy irradiation has been given
over a short time and is more likely to be avoided by techniques which injcrease the
overall time of treatment.
To summerize the indications for various methods of treatment in various stages,
according to our present ideas:
Stage 1A
Single lesions of low malignancy
Single lesions of average or higher malignancy
limited in extent
Larger tumours
Multiple lesions
Stage IB
Single—no mucosal change
Multiple or with mucosal change
Stages 2 and 3
Stage 4
Cysto-diathermy
Radon Implant
Total Cystectomy.
Diathermy and Cobalt applicator.
Total Cystectomy.
Isotope bag.
Cobalt applicator.
Partial Cystectomy.
Diathermy and Radon Implant.
Cobalt applicator.
Total Cystectomy.
Cobalt applicator.
X-ray therapy.
Total Cystectomy.
Ureteric Transplant.
X-ray therapy.
Palliative transplant.
X-ray therapy.
SPECIAL NOTICE
DOCTORS attending B.C. Lions Football Games should leave
their names with the Stadium Manager and if called arrangements
will be made to notify them.
Page 480 CANADIAN   MEDICAL   ASSOCIATION
BRITISH   COLUMBIA   DIVISION
1807 West 10th Ave., Vancouver, B.C.      Dr. G. Gordon Ferguson, Exec. Secy
OFFICERS 1953-1954
President—Dr. R. G. Large	
President-Elect—Dr. F. A. Turnbull	
Immediate Past President-*—Dr. J. A. Ganshorn,
 Prince Rupert
 Vancouver
 Vancouver
Chairman of General Assembly—Dr. G. C. Johnston Vancouver
Hon. Secretary-Treasurer—Dr. J. A. Sinclair New Westminster
PRINCIPAL DELEGATES TO THE BOARD OF DIRECTORS
Victoria
Dr. J. F. Tysoe
Dr. E. W. Boak
Nanaimo
Dr. C. C. Browne
Prince Rupert and Cariboo
Dr. J. G. MacArthur
New Westminster
Dr. J. F. Sparling
Dr. D. G. B. Mathias
Kootenay
Dr. S. C. Robinson
Yale
Dr. A. S. Underhill
Vancouver
Dr. Ross Robertson
Dr. R. A. Gilchrist
Dr. J. Ross Davidson
Dr. R. A. Palmer
Dr. A. W. Bagnall
Dr. P. O. Lehmann
Dr. Roger Wilson
Chairmen of Standing Committees
Constitution and By-laws I Dr. Carson Graham, North Vancouver
Finance Dr. J. A. Sinclair,  New Westminster
Legislation —— < Dr. J. C. Thomas, Vancouver
Medical Economics  -Dr. P. O. Lehmann, Vancouver
Medical Education-— —_ Dr. Charles G. Campbell, Vancouver
Nominations Dr. R. G. Large, Prince Rupert
Programme & Arrangements Dr. Myles Plecash, Penticton
Public Health Dr. J. Mather, Vancouver
Chairmen of Special Committees
~Dr. J. H. MacDermot, Vancouver
.Dr. F. W. B. Hurlburt, Vancouver
 Dr.  Roger Wilson, Vancouver
 Dr. John Sturdy, Vancouver
 Dr. Murray Baird, Vancouver
 Dr. F. A. Turnbull, Vancouver
-Dr. W. S.  Huckvale, Trail
Archives	
Arthritis and Rheumatism-
Cancer.
Civil Defence-
Ethics	
Hospitals-
Industrial Medicine-
Maternal Welfare	
Membership	
Nutrition	
Pharmacy-
Public Relations.
 Dr. A. M. Agnew, Vancouver
 Dr. L. Fratkin, Vancouver
 Dr. J. F. McCreary, Vancouver
 Dr. B. T. Shallard, Vancouver
 Dr. A. W. Bagnall, Vancouver
30 WAYS TO KILL AN ORGANIZATION
From the Bulletin of the
Orange County Medical Association, August, 1954.
H Don't come to the meetings.
2. But if you do come, come late.
3. If the weather doesn't suit you, don't think of coming.
4. If you do attend a meeting, find fault with the work of the officers and other
members.
5. Never accept an office or committee appointment, as it is easier to criticize than
to do things.
6. Nevertheless, get sore if you are not appointed on some committee; but if you
are, do not attend committee meetings.
llfef asked by the chairman to give your opinion regarding some important matter,
tell him you have nothing to say. After the meeting tell everyone how things
ought to be done.
8. Do nothing more than is absolutely necessary; but when other members roll up
their sleeves and willingly and unselfishly use their ability to help matters along,
howl that the Association is run by a clique.
Page 481 9.   Don't bother about new members. Let the Secretary do it.
10. When a banquet is given, tell everybody money is being wasted on blow-outs
which make a big noise and accomplish nothing.
11. When no banquets are given, say the Association is dead and needs a can tied
to it.
12. Don't ask for a banquet ticket until all are sold.
13. Then swear you were cheated out of yours.
14. If you do get a ticket, don't pay for it.
15. If asked to sit at the speakers' table, modestly refuse.
16. If you are not asked, resign from the Association.
17. Hold back your dues as long as possible or don't pay at all.
18. If you don't receive a bill for your dues, don't pay.
19. When you do receive a bill for your dues, postpone payments until the Secretary
writes for the money—then get sore because you've been dunned.
20. If you receive a bill after you've paid—resign from the Association or at least
suggest to some of the members that the Treasurer tried to work you or is
manipulating the accounts.
21. Don't tell your Association how it can help you, but if it doesn't help you, resign.
22. If you receive service without joining, don't think of joining.
23. If the Association doesn't correct abuses in your neighbour's business, howl that
nothing is done.
24. If it calls attention to abuses in your own, resign from the Association.
25. Always think and don't fail to talk about the "mote" in the other fellow's eye—
never consider the "beam" in your own.
26. Keep your eyes open for something wrong and when you find it, resign.
27. At every opportunity threaten to resign and then get your friends to resign.
28. When you attend a meeting, vote to do something, then go home arid do the
opposite.
29. Agree to everything said at the meeting and disagree with it outside.
30. Always delay replying to communications from the Association or better, don't
answer at all.
N.Y.S. Association of Chiefs of Police.
•£
#
MEDICAL ASPECTS OF THE PREVENTION
j|t OF AUTOMOBILE ACCIDENTS      IS
(From the Committee on Public Health, B.C. Division)
The recent report by the Subcommittee of the British Medical Association on
medical standards for road, rail, and air transport operators would appear to make
timely a review of such standards as are presently operative in this country with particular reference to the Province of British Columbia. The British Medical Association
Subcommittee which activated at the request of the Minister of Transport had as its
terms of reference—"to examine, in the interests of public safety, the medical standards
required for drivers and others concerned with the operation of all road, rail, and air
transport, and to make recommendations." However, brief consideration was only given
to the first two groups as it was considered that both the railways and civil air lines
had their own medical services, which periodically reviewed their own medical standards,
e.g., in the United Kingdom, as in Canada, medical standards for aircrew call for
annual re-examination (every six months for pilots), and re-examination after accident
or sickness, as laid down by the International Civil Aviation Organization.
The Subcommittee made an extensive review of the medical aspects of motor-
vehicle accidents, although it drew attention to the fact that it is difficult to produce
any conclusive evidence as to the precise relationship between medical conditions and
Page 482 accidents. It was pointed out that so far as automobiles are concerned, while it appears
probable that the major cause of accidents lie more commonly in such factors as
fatigue, inattention and carelessness, than detectable illness, yet it cannot be denied
that the question of medical fitness is an important one. Indeed, in the broadest sense,
if we accept the majority of accidents as due to such factors as impaired concentration,
fatigue, errors of judgment ande motional instability, then most accidents can be
attributed to medical or psychological causes. The question of alcohol in relation to
driving was not considered by the Subcommittee and will not be considered here.
It is true that the above causes may operate in the case of others concerned in
accidents quite apart from the^ drivers although of course primary responsibility for
the avoidance of accidents is placed on the person who drives the automobile. It is also
well recognized that there are certain medical conditions of acute onset which may
render the driver incapable of retaining control of his vehicle, and which might therefore result in the possibility of serious accident, e.g., epilepsy, acute vertigo, uncontrolled
diabetes.
-Bearing this in mind and since under certain conditions candidates for drivers'
licenses are required to produce medical certificates, it is essential that every physician
should be clearly aware of his responsibilities in this regard both for the protection of
the individual and of the public at large.
Thus, in British Columbia every applicant for a Class A or B Chauffeur's License
and for an ordinary Driver's License when the subject is over the age of 70, is required
to submit to medical examination for the purpose of satisfying the Superintendent of
Motor-Vehicles as to his "fitness and capability" to drive. Quite apart from this there
has been set up a screening system whereby the fitness and capability of all applicants
for drivers' licenses, at the time of the initial and repeat drivers' examinations by the
Motor-Vehicle Branch, are checked for gross defects of vision, hearing, coordination,
etc. This screening system however will not pick up latent illness, e.g., diabetes or
epilepsy, which may be potentially dangerous. The medical examinations presently
prescribed for certain classes of drivers do offer at least a partial method of excluding
such cases in the groups partly at risk, e.g., the elderly, or who may present the
greatest danger to the public, e.g., drivers of public service vehicles.
This brings us to a consideration of the responsibilities involved in the prevention
of such accidents. It is clear that a very considerable proportion of the burden of
responsibility for the prevention of accidents rests upon the individual or patient
himself. Unfortunately, the dangers may not be realized by those with limitations,
defects, or latent illness. In this connec_on, increased publicity and encouragement to
seek medical opinion when in doubt should do much to bring such dangers home to
the driving public. Where a patient is already under medical care, it is clearly the
physician's responsibility to make his patient aware of the implications of his illness
insofar as they affect the desirablity of, or his eligibility to, handle an automobile safely.
The physician in his professional capacity, has a two-fold responsibility:—the education
of his patient as outlined above, and in his capacity of issuing a medical certificate
certifying fitness to drive. To satisfy this latter responsibility it is insufficient for the
practitioner to issue a medical certificate based upon his past knowledge of the patient
without examination specifically for the purpose of evaluating the individual's present
status so far as it affects his ability to drive an automobile safely. The physician's
responsibility here can only be met by a careful medical assessment taking into account
past and present medical history, vision and hearing standards, physique, and general
medical condition, including emotional stability. The final decision in any case must
be based on whether the individual suffers from any disease or physical disability likely
to interfere with the efficient discharge of his duties as a driver, or to cause the driving
by him of a public service vehicle to be a source of danger to the public. Since this
latter decision is left at the discretion of the examining physician, the latter must have
his responsibilities clearly and constantly before him at all times.
Page 483 PUBLIC HEALTH AND MENTAL HEALTH NEWS
G. F. AMYOT, M.D., D.P.H.,
Deputy Minister of Health, Province of British Columbia
A. M. GEE, M.D.,
Director, Mental Health Services, Province of British Columbia
HEALTH CENTRE FOR CHILDREN
His Royal Highness the Duke of Edinburgh officially opened the new Health Centre
for Children at 715  West 12th Avenue, Vancouver, on August 7,  1954, with the
diagnostic facilities of the Vancouver General Hospital available to it. The-new Health
Centre provides for the care of acutely ill children and diagnostic problems in childhood
for the entire province.
There are 155 beds in the Centre and these will be increased to 240 within the
next few years. The outpatients department, caring for low-income children, had
18,000 consultations during 1953.
The Centre is an open hospital, but has a staff of 14 Certified Paediatricians who
are responsible for the care of public ward cases and outpatients.
DISTRIBUTION OF GAMMA GLOBULIN
The criteria for the use of gamma globulin for contacts of poliomyelitis cases
have been broadened by increasing the age limit of household contacts to thirty years,
inclusive, and by including household contacts of non-paralytic cases.
Effective immediately, gamma globulin in the prescribed dosage is authorized
for the following:
(1) All household contacts up to 3 0 years of age, inclusive, to either paralytic
or non-paralytic poliomyelitis cases.
(2) Pregnant women of all ages who are household contacts to,either paralytic
or non-paralytic cases.
It is emphasized that the gamma globulin must be administered within three days
following the diagnosis of the original case.
There is no change in the method of distribution; application should be made to
the local health unit office where a supply of gamma globulin is maintained.
Page 484 NEW MENTAL HEALTH CENTER
Construction has commenced on the New Mental Health Services clinical building
in Burnaby on the southwest corner of Willingdon Avenue and the Grandview Highway.
The contract totalling $818,000.00 has been let to the Grimwood Construction
Company of Vancouver.
This new building will provide spacious quarters for the Provincial Child Guidance
Clinics now located in two grossly overcrowded houses on 13 th Avenue.
There will also be a Mental Health Center for Adults, a new development in the
Provincial Mental Health Services. The Mental Health Center will function principally
as an out-patient clinic and day hospital. There is limited accommodation for overnight
care but it is not thought that there will be any great need for this type of service.
It is expected that the new Child Guidance Clinic and Mental Health Center will
be completed in 1955.
^
V
STAFF NOTES
Dr. Ian Kenning, a member of the Crease Clinic staff commenced a year of post
graduate study in psychiatry at the Allan Memorial Institute, Montreal in July. Dr.
Kenning received a bursary from the Mental Health Grant.
Dr. G. A. Nicolson, pathologist, Provincial Mental Health Services, Essondale, B.C.
has received a Mental Health Grant Bursary to enable him to undertake a year of post
graduate study in pathology at the University of Toronto.
Dr. F. G. Tucker of the Crease Clinic attended a short post graduate course on
"Emotional Problems of Children" at the University of Washington in July.
Dr. F. E. McNair, Clinical Director of the Crease Clinic and Provincial Mental
Hospital will be attending the "Laboratory in Group Development" to be held under
the auspices of the University of Washington at Friday Harbor, San Juan Islands early
in September.
Dr. U. P. Byrne, Director, Provincial Child Guidance Clinics attended the Fifth
International Congress on Mental Health together with the International Institute on
Child Psychiatry in Toronto in August.
DOCTOR REQUIRED FOR A B. C. HOSPITAL SHIP
Hospital ship Columbia is in need of a salaried ship's doctor. Would
anyone  interested  please contact The Columbia Coast Mission  in
Vancouver.
Phone MArine 1050
FOR SALE
For Sale, reasonable price, almost new platform scale—no springs—
complete with height measuring rod. Made by Continental Scale
Works Chicago. Can be seen by appointment 508 Hycroft Towers,
phone CEdar 2470.
Page 485 DR. E. A. CAMPBELL
The recent tragic death by drowning, of Dr. Ernest Albert Campbell,
came as a profound shock to all his colleagues and friends. It deprived the
medical profession of British Columbia of one of its leading psychiatrists, a
man who was outstanding in his ability and skill in this most difficult and
demanding branch of medicine.
"Ernie" Campbell, as we all knew him, graduated from the University
of Alberta, and came to B.C. in 1927. He was keenly interested in psychiatry
from the outset of his career, and acquired a large and successful practice in
Vancouver. Following the retirement of Dr. James J. McKay, as head of the
Hollywood Sanitarium in New Westminster, Dr. Campbell became Medical
Superintendent of that Institution, and held this position at the time of his
death. He had an office in Vancouver, was much in demand as a consultant,
and in medico-legal cases.
Dr. Campbell had a quiet, rather shy, personality—but was much liked
and respected by all who had any dealings with him. He was friendly and
courteous in his manner, and had a large circle of friends.
Much as we must mourn his death, there was note of courage and self-
sacrifice about it which marked it as a noble ending to a life given to the
service of others. There is no doubt that he met his death trying to bring help
to his two friends, and companions in death, for whom he did everything he
possibly could to secure their safety, before he set out on his long swim, which
proved too much for him. Unfortunately, his efforts were in vain, but this
does not detract from the gallantry he showed.
To his wife and family we extend our most sincere sympathy and
condolences.
V
#
#
DR. FRANK DAY-SMITH
Age 72
It is with a sense of personal loss that we record the recent death of
Frank Day-Smith of coronary heart disease. Frank had known for some time
that he faced a sudden ending to his life—but he had carried on his practice
gallantly, and he died in harness—an end not altogether to be lamented.
Dr. Day-Smith graduated from the University of Toronto in 1909 and
practised in Alberta for some years, coming to Vancouver in 1924, where he
engaged in general practice—and became very busy. He was popular with his
patients, and was a very competent practitioner. Frank enjoyed his life. He
played golf, and played a good game, and it was a pleasure to play with him.
He played a good game of bridge, too, and took a keen interest in sports
generally. His was a friendly and a genial personality, and he had many friends
who will miss him.
He leaves a son and a daughter. One of his sons was killed in the last war.
To his wife and family, we extend our sincerest sympathy and condolences.
Page 486 Dr. Gerde Asche is now practising in Hope.
Dr. Erik Linnolt has opened an office for/general practice in Vancouver.
Dr. Leslie Glass is now an associate with Drs. Toone and Leroux in North
Vancouver.
Dr. Bruce Cates is now studying surgery in the Vancouver General Hospital.
-Dr. Barbara Kraft is now in Kitimat.
Dr. Hugh MacDonald is now practising in Victoria with Dr. F. M. Bryant.
Dr. Dobson is now practising in Westbank, B.C.
Dr. R. W. Lamont-Havers has begun a practise in medicine and rheumatology
in Vancouver.
\ Dr. J. M. Spruenken has opened a practise in Otolaryngology in Vancouver.
Dr. C. B. Bonar Buff am has resumed practice in Victoria after an absence of two
years taking post graduate studies in Philadelphia.
Dr. W. E. Baker has left Victoria for Calgary and Dr. C. /. G. Mackenzie has left
Victoria to take up practice in the Peace River country.
Dr. A. W. Lawler, formerly of Vancouver has joined the staff of the Vancouver
Island Chest Clinic, Victoria. Dr. W. McCulloch of Victoria has also joined the staff.
MARRIAGES
Dr. James Fiddess to Elizabeth Weightman in Victoria.
DEATHS
Dr. Ivan Tchaperoff head of the X-ray department of St. Joseph's Hospital,
Victoria, B.C. died suddenly at his home on August 22, 1954. He was 50 years of age.
Dr. Tchaperoff set up the modern X-ray department at St. Joseph's.
English-born, with his medical degree from Cambridge University, he was at
St. Thomas Hospital of London during his early days as a physician. It was during his
years in England that he published an authoritative work on cancer research and was
named, by the Earl of Athlone, as one of a team to undertake further study on an
international scale. The war interrupted these plans.
Dr. Tchaperoff came to Canada about 17 years ago, while the plans for the cancer
research scheme were still under discussion. He joined the Royal Canadian Army Medical
Corps with the outbreak of the Second World War.
After the war he came to St. Joseph's Hospital and continued his research and
treatment in the field of radiology.
His mother and eight-year-old son survive him.
Page 487 VANCOUVER MEDICAL ASSOCIATION BULLETIN
INDEX—VOLUME XXX (1953-54)
A
ALPHAPRODINE   (SYNTHETIC   NARCOTIC)   WARNING     16
ANTIMICROBIAL AGENTS, THE USE OF IN THE TREATMENT OF
TUBERCULOSIS        84
ARTERIOSCLEROTIC DISEASE,  SURGERY IN OBLITERATIVE}—Musgrove,  J.  E  443
ASTHMA,   EXPERIENCES  WITH  CHILDHOOD—Piters,   John  245
AUTOMOBILE ACCIDENTS—MEDICAL ASPECTS OF THE PREVENTION OF  482
B
BAKER,   H.—On   Doctor-Patient   Relationship , :.... 453
BIOPSY   SERVICE , ;._..-.  148
BIOPSY  SERVICE SPECIMENS  50
BLADDER, THE TREATMENT OF CANCER OF THE:—Windeyer, B. W.  475
BLOOD TRANSFUSION THERAPY, THE PRINCIPAL DANGER OF,
INCOMPATIBLE BLOOD—B. P. L.  Moore  286
BOOK REVIEWS:
Correlative  Cardiology by Carl  Shaffer     13
Golden Jubilee Issue of Antiseptic _  438
Principles and Methods of Physical Diagnosis—S. S. Leopold _. 145
BRITISH COLUMBIA CANCER FOUNDATION  (Its Functions and Activities) 1 241
12, 113, 146, 188, 238, 289, 325, 371,
CANADIAN MEDICAL ASSOCIATION,
B.C. DIVISION 15,
Annual General meeting proceedings	
Annual Meeting,  Impressions of the	
Defense  Associations _	
Elections,   July  29th," 1954 ,	
General Assembly Proceedings	
General Assembly. Meeting Announcement IBM	
General Practitioners   Section Scientific Session . „	
Graduate   Training . I ."
Grievance   Committees	
Knox, Memorial Fund—A. W. D.   (Bill) __ _	
Medical School and Local Medical Societies _.	
Membership—B.C.   Division . :	
Obituary—Major General C. P. Fenwick _„	
Penticton  	
Physicians in Public Service, The Section of (Message from the Executive) '	
Schedule of Fees .^_^.....
Social Assistance Cases, Advice in Prescribing for ; iv^j
Statement of Policy :	
Cade, Sir Stanford—Treatment of Cancer of the Tongue by Radiotherapy and Surgery....
CANCER OF THE BLADDER, TREATMENT OF—Windeyer, B. W. _	
CANCER FOUNDATION—BRITISH  COLUMBIA  (Its  functions and activities)	
CANCER  OF THE  TONGUE,  TREATMENT  OF BY RADIOTHERAPY
AND  SURGERY—Cade,   Sir   Stanford	
CHASE, W. H. AND MOSCOVICH, B. B.—Acute Staphylococcus Enteritis	
CHEST   X-RAY   SURVEY __	
COLITIS,   ULCERATIVE}—Skinner,   F.   L	
COLLEGE OF GENERAL PRACTICE OF CANADA _.-. Ill,
CONGENITAL HAEMOLYTIC JAUNDICE:—Westgate, F. Gordon	
CORRESPONDENCE   ....: —	
CRIPPLED  CHILDREN'S  REGISTRY -	
447
17
15
114
449
28
371
290
146
189
113
325
447
289
448
239
188
82
238
150
475
241-
150
39S
121
366
450
85
76
119
DEAF CHILDREN, EDUCATION OF	
DIAMOX—A NEW DIURETIC—Dick,  John	
DICK, JOHN—Diamox, A New Diuretic	
DIPHTHERIA    I |	
DIVERTICULITIS, SIGMOID—Thomson, Frank B.
DOCTOR-PATIENT   RELATIONSHIP—Baker,   H...
141
440
440
451
199
453
EDITOR'S PAGE ." 11, 75, 109, 143, 183, 229, 275, 311, 353, 395, 437, 471
EDUCATION OF DEAF CHILDREN _  141
ENTERITIS, ACUTE STAPHYLOCOCCUS—Moscovieh, B. B. and Chase, W. H  3*98
FLUORIDATION—A PUBLIC HEALTH NEED	
FOOD POISONING,  SUSPECTED I	
FOULKES, J. G.—The Use of Sympathomimetic Amines in the Treatment of Shock.
451
153
GAMMA GLOBULIN _     49
GAMMA GLOBULIN, DISTRIBUTION OF H&1P?&I  4^4
GENERAL PRACTICE,  COLLEGE  OF CANADA  ......:... Ill, 450
GENERAL PRACTITIONERS  SCIENTIFIC  SESSION 1  200
GREATER VANCOUVER PUBLIC HEALTH STATISTICS 7, 107, 141. 181, 227, 273,  469
GREEN,   F.   W.—Obit  210
Page 488 HEALTH CENTRE FOR CHILDREN   (opening)  484
HEALTH OF THE PEOPLE ,  327
HEART DISEASE, A CASE OF IATROGENIC—Mirabel, L  412
HEBB, FRANK—Some Reflections Upon Theory and Practice     79
HYPOPARATHYROIDISM IN CHILDREN—Whitelaw,  J. W  115
I
IATROGENIC HEART DISEASE, A CASE OF—Mirabel, L  412
INDEX TO THE VANCOUVER MEDICAL ASSOCIATION BULLETIN
VOLUME  XXEX   (1952-53) _ .. .     51
VOLUME  XXX   (1953-54)  488
JAUNDICE,   CONGENITAL   HAEMOLYTIC—Westgate,   F.   Gordon.
85
KNOX MEMORIAL FUND—A. W. D. (Bill) ~   113
p
LIBRARY NOTES .. 13, 77,  110, 144, 186, 230, 276,  396, 438
LIBRARY RULES—Vancouver Medical Association    397
BE
MEASLES       273
MEDICAL BALL—FOURTH ANNUAL  (University of British Columbia)  187
MEDICAL  COLOUR   TELEVISION.. J&  330
MEDICAL AND LEGAL PROBLEMS AND RESPONSIBILITIES
(Mutual)—Murphy,   H.   H  231
MEDICAL STUDENTS EMPLOYED IN HEALTH UNITS     50
MENTAL  HEALTH   CENTRE   (New)  485
MENTAL   HYGIENE   PROBLEMS   181
MERCY  FLIGHTS—DEPARTMENT OF  NATIONAL  DEFENCE  472
MIRABEL, L.—A Case of Iatrogenic Heart Disease  412
MOORE, B. P. L.—The Principal Danger of Blood Transfusion Therapy—
Incompatible Blood „  286
MOSCOVlCH,  B. B. and CHASE, W. H.—Acute  Staphylococcus Enteritis  398
MOTOR VEHICLE DRIVERS, PHYSICAL CONDITION OF  240
MURPHY, H. H.—Mutual Medical and Legal Problems and Responsibilities  231
MUSGROVE,  J. E.—Surgery in Obliterative Arteriosclerotic Disease...-  443
XT
NEWS AND NOTES 89, 123, 161, 209, 250, 295,
NEW REGISTRANTS _.. 78, 123,
376, 419, 455, 487
147,  195, 250, 292
OBITUARIES:
Campbell,   Ernest   A  486
Davies,  John  Reford    159
Day-Smith, Frank.  486
Fenwick,  Major General C. P.. ...._  289
Firmin, Miss _ — - -  411
Green, F. W - -  210
OBLITERATIVE ARTERIOSCLEROTIC DISEASE,  SURGERY  IN—Musgrove,  J.  E  443
OSLER LECTURE—"Vancouver and Medicine or Medicine on the Quarter-deck"—
Turnbull,  Frank. - | __  277
P
PHYSICAL CONDITION OF MOTOR VEHICLE DRIVERS  240
PHYSICIAN'S REFERENCE MANUAL  REVISED - -  452
PITERS, JOHN—Experiences with Childhood Asthma.  245
POLIO  _ _ 1 p 1
POLIOMYELITIS—Alterations  in Procedure for Handling  Patients  375
POLIOMYELITIS—Approach to the Control of Paralytic—2  373
POLIOMYELITIS  PROGRAM  IN  BRITISH COLUMBIA  293
POST GRADUATE EDUCATION ANNOUNCEMENT AND SCHEDULE  196
PROVINCIAL HEALTH BUILDING  (Vancouver)  119
PUBLIC HEALTH—GREATER VANCOUVER Metropolitan Health Committee 7, 273, 351
PUBLIC HEALTH AND MENTAL ^    jnA
HEALTH NEWS 49, 81, 84, 119, 148, 190, 240, 293, 327, 373, 416, 4al, 484
PUBLIC HEALTH STAFF NOTES -    485
REHABILITATION,  WESTERN  SOCIETY
(Rehabilitation Centre).
145
S
SCHOOL   HEALTH   SERVICES — gjj  107
SHOCK, THE USE OF SYMPATHOMIMETIC AMINES
IN THE TREATMENT OF—Foulkes,  J. G - .!_  153
SIGMOID DIVERTICULITES—Thomson,  Frank  B  199
SKINNER,   F.   L.—Ulcerative   Colitis  366
STAPHYLOCOCCUS EJNTERITIS, ACUTE—Moscovich, B. B. and Chase, W. H.... ._..... 398
STROKES, THE CAUSE OF—Turvey S. E. C » 406
SYMPATHOMIMETIC AMINES IN THE TREATMENT OF SHOCK,
THE USE OF—Foulkes,  J.  G  153
SYPHILIS TODAY (From Division of V. D. Control)  416
Page 489 THEORY AND PRACTICE, SOME REFLECTIONS UPON—Hebb, Frank.     79
THIRTY WAYS TO KILL AN ORGANIZATION.-     481
THOMSON,   FRANK  B.—Sigmoid   Diverticulitis       199
TONGUE, TREATMENT OF CANCER OF BY RADIOTHERAPY
AND   SURGERY—Cade,   Sir   Stanford    150
TUBERCULOSIS, THE" USE OF ANTIMICROBIAL AGENTS
IN   THE   TREATMENT   OF _„_     84
TURNBULL,  FRANK—Vancouver and Menzies or Medicine on the Quarter-deck
(Osier   Lecture)    .. 277
TURVEY, S. E. C.—The Cause of Strokes _..  406
U
ULCERATIVE COLITIS—Skinner, F. L  366
UNIVERSITY OF BRITISH COLUMBIA MEDICAL SCHOOL
GRADUATING CLASS—Letters of Congratulations:
Burns, C. W  316
Canadian Schools, Good Wishes from _  318
Graduating Class in Medicine (First Class from University of British Columbia)  324
Huggard, Roy (C. P. & S.)  317
Large,  R G.   (C.M.A.,  B.C. Div.) _ .§__..-  317
Martin,    Eric _ ..._...._ ___   313
Martin,   Paul : ."...-  312
MacKenzie,  N.  A.   M  314
UNIVERSITY OF BRITISH COLUMBIA,  FACULTY OF MEDICINE   319
V
VANCOUVER MEDICAL ASSOCIATION—
Annual   Reports   1953-54 :  355
Library   Rules _ ._  397
Summer School Annual Report 1953 — 1     14
VANCOUVER AND MENZIES OR MEDICINE ON THE QUARTER-DECK—
Turnbull, Frank \    277
VERNON  CONVALESCENT  HOME  CARE   SERVICE   190
W
WESTERN  SOCIETY  FOR  REHABILITATION Ill   145, 193
WESTGATE,  F.   GORDON—Congenital   Haemolytic   Jaundice     85
WHITELAW J- W.—Hypoparathyroidism in Children  115
WHOOPING   COUGH :  227
WINDEYER, B. W.—The Treatment of Cancer of the Bladder \ \  475
WORKMEN'S COMPENSATION BOARD—Correspondence 12,  184,  249,  291, '372, 473
INVESTORS
Syndicate
^"__S
You will find the ideal answer to your savings and investment problems through Investors Syndicate and its affiliate
Company, Investors Mutual — Canada's fastest growing
mutual fund.
^rnvedtord S^unaicate of L^anada oLtd.
^rnvedtord   rrlutual of Canada oLtd.
NEVILLE ASTl£Y2__w«R
anaqer
aqt
313 — 744 West Hastings Street — Vancouver
Telephone MArine 5283
FRED G.HITCHENS 3__** %
3220 Wetherby Road, Victoria. B.C
Telephone Garden—9556
anaatr
aat
Page 490 ^   University _ British Columbia Library
DATE DUE
SERIALS _
AUJLii
.— Vg/cD_ /^-^ *
ma.
-tm^%
wtt
FORM   NO.   310 B £?£>£2-2-
WOODWARD
LIBRARY
v
_l
-J
3
CO
•
z
CO
co-
<
<
__?
-
_r=
<_-
ai-H
>~
_F
O —
u
z
<—
>
0
S
_a
_a
_a
-5
-MNjvers/ty of b§®#t
VANCOUVER 8
MB/A
i\
II
a
it'll _■ _s *a
M_„ ¥
W_ 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/cdm.vma.1-0214651/manifest

Comment

Related Items