"CONTENTdm"@en . "http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1179642"@en . "History of Nursing in Pacific Canada"@en . "Vancouver Medical Association"@en . "1944-11"@en . "2015-01-30"@en . "1944-11"@en . "https://open.library.ubc.ca/collections/vma/items/1.0214549/source.json"@en . "image/jpeg"@en . " The\n\u00E2\u0080\u00A2 \u00E2\u0080\u00A2\nT\"_~>\nBULLETIN\nof the . \u00E2\u0080\u00A2 .\nVANCOUVER\nM E n|l \u00E2\u0082\u00AC A L\nASSOCIATION\nWith Which Is Incorporated\nTransactions of the\n^VICTORIA MEDICAL SOCIETY^\nthe\nVANCOUVER GENERAL HOSPITAL\nand\nST. PAUL'S HOSPITAL\nIn This Issue:\nPSYCHIATRY IN GENERAL PRACTICE\u00E2\u0080\u0094\nG. H. Stevenson, M.D. 37\n\"FRACTURES OF THE OS CALCIS: IMPROVED\nMETHOD OF TREATMENT\u00E2\u0080\u0094Lt.-Col. R. I. Harris 43\nTHE DIAGNOSIS OF A-STEUROSIS\u00E2\u0080\u0094\nGeo. A. Davidson, M.D. ! ___H' 49\nEMOTIONAL PROBLEMS OF DEMOBILIZATION\u00E2\u0080\u0094\nMaj.-Gen. Chisholm 53\nNEWS AND NOTES j| it 55\niVOL. XXI. NO. 2\nNovember. 1944 WITH\nMINEROVITE\nJr. Bm 5.\nESTO.\nVITAMINS PLUS MINERALS\nOnly occasionally does one find clear-cut cases\nshowing deficiency in only one vitamin. Generally,\nvitamin deficiencies are multiple and give rise to\na confused clinical picture very difficult to diagnose. The skin, haemopoietic, digestive, nervous\nand cardiovascular systems may be involved.\nWhen confronted with a diagnosis suggestive of\ndeficiency, but not clear-cut enough to indicate\npositively which vitamin is lacking, a multivitamin preparation is indicated.\nMINEROVITE, E.B.S. Is such a preparation, containing In\neach tablet about half the recommended daily minimum of each of the vitamins known to be essential to\nhuman health. For guidance In prescribing the proper\ndose, the accompanying table, showing the compost-\ntlon of Minerovite/ appears on every bottle*\nINDICATED as a prophylactic vitamin and mineral supple,\nment in cases of diets restricted for reasons of allergy, peptic\nulcer or convalescence and a therapeutic remedy in cases of\nhypovitaminosis.\n\"'TRACE ELEMENTS t Some years ago, agricultural research*\ners began to track down the cause of deficiency diseases that\naffected livestock in some areas. It was found that the lack of\nminute amounts of certain elements ('trace elements' they\nhave been called) was responsible, and several such elements\nhave been found, small quantities of which are essential to\nhealthy mammalian life. Such are the copper and manganese\nincorporated in Minerovite, 100 mgs. of each, per tablet.\n\u00E2\u0080\u00A2Oscar Baudisch, J.A.M.A., VoL 123, Page 959\nWHEN PRESCRIBING\nSpecify E.B.S. Preparations\nJUST TO\nBE SUREI\nSupplied in bottles\nof 100, 500 and\n1,000 tablets.\nC.C.T. Ne. 466\nMinerovite\nCBS.\n\u00C2\u00B0\u00C2\u00B0se: Three or four\ndaily,\nCoMfOl\n^ONTO^]^\nFormula C.C.T. #466 Minerovite E.B.S.\nEach tablet contains:\nVitamin A _KS . . ,\u00E2\u0096\u00A0**\u00C2\u00BB_f 2500 Int. Unit*\nVitamin D . . j||Pf_U#: . 400 Int. Unit*\nVitamin C . . . ._\u00C2\u00BB-.'.. . . 17.5mgms.\n(350 Int. Units)\nVitamin K . . . .^. 008 mgms.\n(200 Dam Units)\nVitamin B\ (Thiamin Chloride)\n.375 mgms. (125 Int. Units)\nVitamin Bt (Riboflavin) . ppi*? \u00E2\u0080\u00A2 .50 mgms.\nVitamin Bt (Pyridoxine\nHydrochloride) .125 mgms.\nPantothentic Acid . $M'&i^\u00C2\u00BB'.125 mgms.\nNiacin, g&^gi;. .^g^. ... 5.0mgms.\nCombined with Salts of the following elements: Iron.Manganese.Copper and Calcium.\nTHE E. B. SHUTTLEWORTH CHEMICAL CO. LIMITED\nTORONTO\nMANUFACTURING CHEMISTS\nCANADA THE VANCOUVER MEDICAL ASSOCIATION\nBULLETIN\nPulished Monthly under the Auspices of the Vancouver Medical Association\nin the interests of the Medical Profession.\nOffices: 203 Medical-Dental Building, Georgia Street, Vancouver, B.C.\nEDITORIAL BOARD:\nDb. J. H. MacDermot\nDb. G. A. Davidson Db. D. E. H. Cleveland\nAll communications to be addressed to the Editor at the above address.\nVol. XXI.\nNOVEMBER, 1944\nNo. 2\nOFFICERS, 1944 - 1945\nDb. H. H. Pitts\nPresident\nDB. FBANK TUBNBULL\nVice-President\nDb. A. E. Tbites\nPast President\nDb. Gobdon Bueke\nHon. Treasurer\nDb. J. A. McLean\nHon. Secretary\nAdditional Members of Executive: Db. G. A. Davidson, Db. J. R. Davies\nTRUSTEES\nDb. P. Bbodie Db. J. A. Gillespie Db. W. T. Lockhabt\nAuditors: Messes. Plommeb, Whiting & Co.\nSECTIONS\nClinical Section\nDb. W. D. Keith Chairman Db. S. E. Tubvey Secretary\nEye, Ear, Nose and Throat\nDb. Letth Websteb Chairman Db. Gbant Lawbence Secretary\nPediatric Section\nDb. John Pitebs Chairman Db. Harry Baker Secretary\nSTANDING COMMITTEES\nLibrary:\nDb. S. E. C. Tubvey, Chairman; Db. F. J. Bulleb, Db. W. J. Dobbance,\nDb. R. P. Kinsman, Db. J. R. Neison, Db. D. E. H. Cleveland\nPublications:\nDb. J. H. MaoDebmot, Chairman; Db. D. E. H. Cleveland,\nDr. G. A. Davidson, Db. J. H. B. Gbant, Db. W. D. Keith, Db. L. H. Websteb\nSummer School:\nDb. G. A. Davidson, Chairman; Db. J. C. Thomas, Db. R. A. Gilchbist,\nDb. A. -M. Agnew, Db. L. H. Leeson, Db. L. G. Wood\nCredentials:\nDr. D. E. H. Cleveland, Chairman; Db. E. A. Campbell, Dr. D. D. Fbeeze.\nV. 0. N. Advisory Board:\nDb. Isabel Day, Db. J. H. B. Gbant, Db. G. F. Stbong\nMetropolitan Health Board Advisory Committee:\nDb. W. D. Patton, Db. W. D. Kennedy, Dr. G. A. Lamont\nRepresentative to B. C. Medical Association: Db. A. E. Tbites\nSickness and Benevolent Fund: The Pbesldent\u00E2\u0080\u0094The Tbustees\n'\n\u00E2\u0080\u00A2 ' Gratifying Relief in \"Sore Throat\"\nwith\nAspergum\nWhen the patient chews Aspergum a soothing flow\nof saliva laden with acetylsalicylic acid is released.\nThus effective analgesia is brought into immediate\nand prolonged contact with all pharyngeal areas,\nincluding those often not reached by gargling or\nirrigations.\nMoreover, chewing provides a gentle stimulation\nof surrounding muscles, helping to relieve local\nspasticity and stiffness, promoting tissue repair.\nThe patient is more comfortable, willingly assumes\na suitable diet earlier: convalescence is hastened.\nIndications for the use of Aspergum:\n1 \u00E2\u0080\u00A2 Post-tonsillectomy care\n2. Acute and chronic tonsillitis,\npharyngitis, \"sore throat\" of\ninfluenza, \"Grippe\", etc.\n3. Acute coryza (with accompanying pharyngeal irritation)\n4. Non-specific upper-respiratory infections\nAspergum is available in packages of 16, moisture-proof bottles\nof 36 and 250 tablets.\nEthically promoted\u00E2\u0080\u0094not advertised to the laity. In boxes of 16\nand moisture-proof bottles of 250\ntablets. Write for samples and\nliterature to W. Lloyd Wood,\nLtd., 64-66 Gerrard Street, East,\nToronto, Ontario.\nIfc/i Aspergum VANCOUVER HEALTH DEPARTMENT\nSTATISTICS\u00E2\u0080\u0094SEPTEMBER, 1944\nTotal Population\u00E2\u0080\u0094Estimated 299)460\nJapanese Population\u00E2\u0080\u0094Estimated Evacuated\nChinese Population\u00E2\u0080\u0094Estimated 5,728\nHindu Population\u00E2\u0080\u0094Estimated 227\nRate per 1,000\nNumber Population\nTotal deaths 266 10.8\nJapanese deaths Population Evacuated\nChinese deaths 14 29.8\nDeaths\u00E2\u0080\u0094residents only 237 9.7\nBIRTH REGISTRATIONS:\nMale, 318; Female, 300 '. 618 25.1\nINFANT MORTALITY: Sept., 1944 Sept., 1943\nDeaths under one year of age : 22 13\nDeath rate\u00E2\u0080\u0094per 1,000 births 3 5.6 22.4\nStillbirths (not included above) 13 9\nCASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY\nScarlet Fever \t\nDiphtheria\t\nDiphtheria Carrier \t\nChicken Pox \t\nMeasles \t\nRubella \t\nMumps \t\nWhooping Cough \t\nTyphoid Fever\t\n. Undulant Fever \t\nPoliomyelitis \t\nTuberculosis \t\nErysipelas\t\nMeningococcus Meningitis _\nParatyphoid Fever (Carrier)\nInfectious Jaundice \t\nTyphi-murium \t\nTyphi-murium (Carrier) \t\nAugust\n, 1944\nSept.\n, 1944\nOct. 1\n-15, 1944\nCases\nDeaths\nCases\nDeaths\nCases\nDeaths\n19\n0\n20\n0\n10\n0\n0\n0\n~*fl* -\n0\n0\n0\n0\n0\n0\n0\n0\n0\n9\n0\n19\n0\n10\n0\n:. 3T\n0\n21\n0\n56\n0\n2\n0\n\u00C2\u00AEfe\n0\n;&\"\n0\n17\n0\n14\n0\nS:\n0\n7\n0\n20\n1\n15\n0\n4\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n46\n8\n87\n7\n25\nJHpsSs\n2\n0\n1\n0\n0\n0\n2\n0\nhJJ^\n0\n0\n0\n1\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n6\n0\n4\n0\n0\n0\n2\n0\n0\n0\nV. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH\nDIVISION OF VENEREAL DISEASE CONTROL\nRich- North\nVancouver mond Vancouver Burnaby\nSyphilis (September) 45\nGonorrhoea (September) 103 2 s.\nWest\nVancouver\n45\n105\nB 10 G LAN-A\nThe most effective therapy for waning mental and physical energy,\ndeficient concentration and memory, reduced resistance to infection,\nmuscular weakness and debility, neurasthenia and premature senility.\nThe efficacy of this very potent endocrine tonic has been confirmed by\nthe clinical evidence of many thousands of cases treated during\n1932-1943.\nStanley N. Bayne, Representative\nPhone MA. 4027 1432 MEDICAL-DENTAL BUILDING Vancouver, B. C.\nDescriptive Literature on Request\nTHE SCIENTIFIC HORMONE TREATMENT\nPage Thirty-two ALIKE\nAPPEARANCE -\n::::;V..:::X:v:--V.'-\n\u00E2\u0080\u00A2 Today, as in 1875, Squibb Cod Liver Oil is helping babies\nbuild strong, healthy bodies. They didn't know it then\u00E2\u0080\u0094\nbut now most people realize that it isn't the oil itself\u00E2\u0080\u0094but\nthe vitamin content of the oil that counts.\nSquibb Cod Liver Oil is twice as rich in vitamins A and\nD as oils just meeting official pharmacopeia requirements.\nTherefore your patients have to give their babies one teaspoonful only of Squibb's daily as against two teaspoonfuls\nof these less potent oils.\nThe high quality of Squibb Cod Liver Oil is the result of\ncareful rendering and refining of specially selected livers.\nExcessive heating and exposure to pir is avoided and the\nfinal oil is carbonated and bottled uhder carbon dioxide to\navoid oxidation of vitamin A.\nSquibb Cod Liver Oil supplies, per gram,\n1800 Int. units of vitamin A and 175 Int.\nunits of vitamin D. It is available in 4 and\n12 ounce bottles either plain or mint-\nflavoured. Premature or rapidly growing\ninfants need extra vitamin D and should\ntherefore receive Squibb Cod Liver Oil\nwith Viosterol 10D, which contains 3000\nInt. units of vitamin A and 400 Int. units\nof vitamin D per gram.\nTiny bodies, externally\nalike, may differ basically In their requirements\nof Vitamin sto: That is\nwhy Squibb Co\nFor literature write\ni. R. Squibb & Sons of Canada Ltd.\n36-48 Caledonia Road, Toronto. VANCOUVER MEDICAL ASSOCIATION\nFOUNDED 1898\nINCORPORATED 1906\nPROGRAMME OF THE FORTY-SEVENTH\n| ANNUAL SESSION |, ff\nGENERAL MEETINGS will be held on the first Tuesday of the month at 8:00 p.m.\nCLINICAL MEETINGS will be held on the third Tuesday of the month at 8:00 p.m.\nThese meetings will continue to be amalgamated with the clinical staff meetings of\nthe various hospitals for the coming year. Place of meeting will appear on the agenda.\nGeneral meetings will conform to the following order:\n8:00 p.m. Business as per agenda.\n9:00 p.m. Paper of the evening.\nJanuary 2\u00E2\u0080\u0094GENERAL MEETING: Cancelled.\nJanuary 1*5\u00E2\u0080\u0094COMBINED CLINICAL MEETING AND STAFF MEETING AT\nVANCOUVER GENERAL HOSPITAL.\nFebruary 6\u00E2\u0080\u0094GENERAL MEETING:\nCarcinoma of the Cervix\u00E2\u0080\u0094Dr. Ethlyn Trapp.\nLate Manifestations\u00E2\u0080\u0094Urological- -Dr. L. R. Williams.\nRectal\u00E2\u0080\u0094Dr. A. T. Henry.\nNeurological\u00E2\u0080\u0094Dr. Frank Turnbull.\nFebruary 20\u00E2\u0080\u0094COMBINED CLINICAL MEETING AND STAFF MEETING AT\nST. PAUL'S HOSPITAL.\nMarch 6\u00E2\u0080\u0094OSLER LECTURE.\nMarch 20\u00E2\u0080\u0094COMBINED CLINICAL MEETING AND STAFF MEETING AT\nVANCOUVER GENERAL HOSPITAL.\nApril 3\u00E2\u0080\u0094GENERAL MEETING: Penicillin Therapy.\nDiscussion to be led by Major W. W. Simpson, R.C.A.M.C.\nApril 17\u00E2\u0080\u0094COMBINED CLINICAL MEETING AND STAFF MEETING AT ST.\nPAUL'S HOSPITAL.\nMay 1\u00E2\u0080\u0094ANNUAL MEETING.\ndimfrr $c i|amta Eft.\nESTABLISHED 1893\nVANCOUVER, B. C.\nNorth Vancouver, B. C.\nPowell River, B. C.\nPega Thirty-three\ni PENICILLIN .\nTo assure that Penicillin would be available for the needs\nof the Armed Services of Canada, the Dominion Government\nmade possible, a year ago, the establishing of two production\nplants, one of which was in the Connaught Laboratories.\nProduction was commenced in the Connaught Laboratories\nwithin seven months and today large quantities of Penicillin\nof high quality are being produced.\nThe entire amount of Penicillin produced in the Connaught\nLaboratories is allocated to the Armed Services.\nAs soon as circumstances permit, Penicillin prepared by\nthe Connaught Laboratories will be available for civilian\ndistribution in Canada.\nCONNAUGHT LABORATORIES\nUniversity of Toronto Toronto 5, Canada\nDEPOT FOR BRITISH COLUMBIA\nMACDONALD'S PRESCRIPTIONS LIMITED\nMEDICAL-DENTAL BUILDING, VANCOUVER, B.C. THE EDITOR'S PAGE\nAt the last Annual Meeting of the British Columbia Medical Association, a most significant report was read by the Chairman of the Committee appointed to consider the\nquestion-of a Medical School for British Columbia. The 1945 Session of the Legislature\nof the Province meets in January or February of next year, and we feel that something\nshould be said about this, so that we may enlist as active workers towards this end, not\nonly those who understand and appreciate the need for it, not only those medical men\nwho live in or near Vancouver, but every medical man in the Province, every member of\nthe Legislature, every educational leader, and last, but by no means least, the public at\nlarge, who will ultimately have to bear the cost\u00E2\u0080\u0094and who must be shown how great the\nneed is, not only from our point of view, but even more from their own.\nThe urgency of the case is beyond question. We hear on every side of the plans\nthat are being drawn up for social betterment, and we welcome and applaud these suggestions\u00E2\u0080\u0094we know, indeed, that they are long overdue. We know that the public is\nright in insisting on more and better medical service\u00E2\u0080\u0094on greater social security, on\nmore efficient prevention of disease, mental hygiene measures ,and a more even distribution of our medical resources. And we know that if all this is to be accomplished\non any reasonably satisfactory scale, the presently available number of doctors is altogether too far below the number that will be needed. Nor is it going to be possible to\nstaff the positions necessary from any source of supply that we now have of medical men.\nThe medical schools now in existence in Canada cannot begin to turn out medical graduates in sufficient number.\nIt takes years to make a doctor, and we cannot get started too soon. Even if several\nmedical schools opened their doors tomorrow, it would be a long time before the effect\nwould be felt. Therefore time is \"of the essence of the contract,\" and we should be\nthinking in terms of speed.\nBritish Columbia is especially in need of a school. We need not at this juncture\nlabour the point so clearly made by our Committee, that Eastern schools are finding it\nimpossible to allot enough vacancies to candidates from British Columbia, that our\nyoung men are losing opportunities that should be theirs. Both Canada and British\nColumbia suffer from this fact. The only remedy is to start one of our own.\nIt would seem, in view of the physical conditions, that Vancouver is the logical\nplace, in fact the only place at present, where a medical school can be built at present,\nwhich would offer facilities of training. This is not to say that only in Vancouver\nshould there ever be a medical school. British Columbia is growing, and there would\nseem to be no reason why ultimately another excellent school should not be built elsewhere\u00E2\u0080\u0094e.g., Victoria, with its good hospitals and its steadily developing medical facilities. When that day comes, we should give it our utmost support.\nMeantime, Vancouver must be regarded in this matter, not as the City of Vancouver, but as a suitable site for the British Columbia Medical School. This will, of\ncourse, be best attached to the University of British Columbia, not necessarily entirely\nsituated within the campus of that institution as at present\u00E2\u0080\u0094for obvious reasons of\nclinical teaching\u00E2\u0080\u0094but under the jurisdiction, and within the corporate structure, of the\nUniversity.\nWe shall be told, ad nauseam, of the difficulties that exist, of the needs of other\nfaculties, of the desirability of a law school, of the lack of money to satisfy everybody.\nIn this matter we do not think any of the arguments are sound. Is there a crying\nneed for a Medical School? There is. Have we the facilities and the material and personnel to establish a first class Medical School? We have, as nobody could doubt who\nsees the excellent hospital f acuities and possible material in the way of lecturers, teachers,\nPage Thirty-four which are already available to be drawn on, and which could easily be supplemented\nfrom other sources if the opportunity were given.\nWe are apt to be too much impressed by size. Vancouver is not in the miUion-\npopulation class, but we may do well to remember that Montreal and Toronto were\nturning out excellently trained doctors when they were not nearly as big, and had nothing\nlike the hospital sources of clinical materials that we have\u00E2\u0080\u0094that Winnipeg, which is\nnot as big as we are, has for a generation and more been giving a training in medicine\nsecond to none; that Edmonton, with less than half our population, is doing the same.\nWe should have had a school here twenty years ago.\nThe need is urgent, and the money can and must be found. But we must make\nthe need plain, and the medical men of the province are the ones who can and must do\nthis. Every medical man in British Columbia should be behind this, should preach it in\nand out of season, should importune those in authority, and \"wear out the doorsteps of\ntheir houses\" doing this.\nWe quoted Dr. McPhedran of the Canadian Medical Association in this matter, when\nhe told us that we must ourselves sell this scheme to the public, and be propagandists and\nteachers. We may also quote Dr. Herman L. Kretschmer, President of the American\nMedical Association, who stressed the fact, in addressing the House of Delegates at the\nA.M.A. meeting that \"practising physicians\" (not, mark you, Committees, or the Council of the College, or the Secretaries of the various Associations) \"should devote at least\ntwo hours a day to educating the public. . . .\" \"The physician should serve as his own\npublic relations man within the profession.\"\nDr. Eben J. Carey, Dean of Marquette University School of Medicine, says, \"The\nmedical education of the public is not the responsibility of the politician, but of the\nmembers of the medical profession.\"\nWith all this we thoroughly agree. The Bulletin hopes at an early date to go\nmore deeply into this matter. In the meantime, we urge our readers to read and reread\nthe parable of the Importunate Widow and to remember that homely proverb, \"The\nhinge that squeaks gets the grease.\"\nLIBRARY NOTES\nRECENT ACCESSIONS TO LIBRARY\u00E2\u0080\u0094\nSurgical Clinics of North America, Symposium on Cancer, Barnard Hospital Number,\nSt. Louis, October, 1944.\nManual of Military Neuropsychiatry, 1944, by Harry C. Solomon and Paul I.\nYakovlev.\nTransactions of the Ophthalmological Society of the United Kingdom, Vol. 63,\nSession, 1943.\nAutonomic Regulations, 1943, by Ernest Gellhorn.\nGastro-Enterology, Vols. 1 and 2, 1943, by Henry L. Bockus.\nText-Book of Ophthalmology, Vol. 2, by Sir W. Stewart Duke-Elder.\nIntravenous Anaesthesia, 1944, by Richard C. Adams.\nSPECIAL SUPPLEMENTS\u00E2\u0080\u0094\nSpecial issues of two well-known journals will be received with much interest. The\nBritish Journal of Surgery has published an extra number, devoted to Pemcillin in Warfare. A wide range of cases is reported by members of the British and U. S. Army\nMedical Staffs, and these are taken from experiences in various theatres of war. The\nintroductory articles include one on \"The Principles of Penicillin Therapy,\" by H. W.\nFlorey and M. A. Jennings, and one on \"Bacteriological Methods in Connection with\nPenicillin Treatment,\" by L. P. Garrod and N. G. Heatley. The two concluding\narticles cover penicillin therapy in gonorrhoea and syphilis.\nThe American Journal of Ophthalmology has issued a second section to their October\nnumber, which contains the sixth de Schweinitz Lecture of the College of Physicians of\nPage Thirty-five Philadelphia, Section on Ophthalmology, given by Henry C. Haden. The title is, \"Concerning the Relations of the Developing Optic Nerve to the Recessus Opticus and the\nHypophysis in Young Foetuses: A Study of Seven Human Foetuses 4 M. M. to 40 M. M.,\nInclusive.\" Forty-one illustrations, which compose the major part of the publication,\nwere made from unretouched photographs of sections of human embryos and foetuses in\nDr. Haden's private collection.\nDOCTOR BAGNALL AND THE MEDICAL LIBRARY\nIn 1920 the Library of the Vancouver Medical Association was in its early adolescence\nwhen an event that was to mould its future for twenty-five years occurred. Wallace\nBagnall was elected to the Committee in charge of the Library.\nThe greatest event in the development of the Library prior to this had been the\ndonational benediction of Sir William Osier, with his fervent insistence on the importance of a library in the medical community. Doctor Bagnall believed in this almost to\nthe point of fanaticism and gave of his time, energy and ability more than most physicians realized. It would surprise most of us to know that at least every other book in\nour library had been chosen by Doctor Bagnall; it would amaze us still more to know\nthat he believed our library to be wholly inadequate for the cultural needs of a medical\nfraternity; but it would not astound those of us who worked with him that he envisaged\na scientific library that would give British Columbia an access to all branches of science.\nHis views on the development of our library were such that physicians were wont to\ndismiss him as a visionary. He deplored the inadequate physical accommodation, the\npopular or democratic election of men often little interested in, or qualified to be a\njudge of, the upkeep or growth of a library, and the lack of general appreciation of the'\n'influence of a library on the quality of medical practice. He dreamed of a general\nmedical library serving not only our Association but the University, our medical school\nand the province at large\u00E2\u0080\u0094a physicians' club with lunch and tea rooms, a common\nmeeting place dominated by the intellectual influence of an eclectic library.\nHis help to the library was not only advisory or theoretical. He rarely missed a\nmeeting of the committee, even in the last year when he might well have rested to\nadvantage, he spent evenings in sorting out and discarding the dross and superfluous\nfrom the huge numbers of books that have long been gathering dust in the cellar of the\nlibrary. With a tenacity that at times could become a downright annoyance, he insisted\non buying books in research, in the auxiliary sciences, and in cultural subjects. His\ncutting retort to any objections would be that, even if older ones were not reading\nthese books, younger and better men were coming along and the material must be here\nfor them.\nOsier has said, \"In the continual remembrance of a glorious past, individuals as well\nas nations find their noblest inspiration.\" One of the greatest legacies of our profession\nis the memory of great physicians in each community. For sustained interest, continuity\nof effort, idealism and realism nicely balanced, and avoidance of all personal publicity,\nthis was one of our community's greatest physicians. His \"understanding was keen,\nskeptical, inexhaustibly fertile in distinctions and objections; his taste refined; his temper\nplacid and forgiving, but fastidious, and by no means prone to malevolence or to enthusiastic admiration.\"\nThis is a poor expression of the affection and respect in which the Committee of your\nLibrary held Doctor Bagnall, but in the near future, we shall give you the opportunity\nto participate in a development in your library which will commemorate the Bagnallian\ntradition and hopes in such a manner that, were Doctor Bagnall here, he would say,\n\"Well done.\"\n\u00E2\u0080\u0094The Library Committee.\nPage Thirty-six British Columbia Medical Association\n(Canadian Medical Association, British Columbia Division)\nPresident Dr. G. O. Matthews, Vancouver\nFirst Vice-President Dr. A. H. Meneely, Nanaimo\nSecond Vice-President Dr. Ethlyn Trapp, Vancouver\nHonorary Secretary-Treasurer : I Dr. S. G. Baldwin, Vancouver\nImmediate Past President Dr. P. A. C. Cousland, Victoria\nPSYCHIATRY IN GENERAL PRACTICE\nBy Dr. G. H. Stevenson (Toronto)\nRead at British Columbia Medical Association Annual Meeting.\nPerhaps a slight change of one letter should be made in the title of this paper to\nmake it read\u00E2\u0080\u0094\"Psychiatry Is General Practice\" rather than \"Psychiatry in General\nPractice.\"\nI offer this suggestion seriously because of the growing appreciation that general\npractice is not limited only to the physical abnormalities that afflict us, those caused by\nphysical etiology, bacteria, toxaemias, degeneration, etc. The physical field is no small\nfield and a thorough training in these aspects is no small achievement, but its boundaries have been extended by a new dimension\u00E2\u0080\u0094the emotional factors in disease and\nhealth. True, physicians have perhaps always recognized that there were mental elements\nin physical disease, such as the effect of the attitude of the patient to his disease as\naffecting its outcome. He knew that worry often seemed to have an adverse effect on\nthe well-being of the individual. He remembered that Crile thirty years ago demonstrated that certain hyperthyroid cases recovered without operation when relieved of\ntheir domestic or economic problems. He knew that his own psychological approach to\na patient was important in maintaining the confidence of the patient in hirn and helping\nthe patient toward recovery. It may sometimes have facetiously been referred to by\nothers as \"the bedside manner\" but actually he was including a form of psychotherapy\nin his treatment programme.\nIn 1920 Professor Walter B. Cannon of Harvard published his monumental work\n\"Bodily Changes in Pain, Hunger, Fear and Rage,\" in which he showed how stormy:\nemotions, operating through the sympathetic nervous system, produced in experimental\nanimals the effects of increased blood sugar, rapid hearts, elevation of blood pressure,\ndecreased production of digestive juices, arrested digestion and inhibition of peristalsis.\nValuable as these effects may be to us and to lower animals in times of great danger, to\nenable the animal to fight better or to run faster, tney nevertheless become a handicap\nand an interference to the welfare of the animal if they continue when the need no\nlonger exists. And yet so many of our patients come to us with sleeplessness, digestive\ndisorders, cardiac complaints, which if analyzed thoroughly, may prove to be due to\ncontinued emotional conflicts and disturbances, rather than to any disease of the body\nitself.\nIn 1935 Helen Dunbar brought together in one volume, \"Emotions and Bodily\nChange,\" practically everything that had been published on this subject. It is still the\nbasic reference work in this field.\nIn the intervening years much additional work has been published showing the\ninterplay of the mental and physical, leading to the coining of a new word to express\nthis body-mind relationship, the word \"psychosomatic.\" An organization for research\nin psychosomatic medicine has been formed, the Journal of Psychosomatic Medicine is\nPage Thirty-seven published regularly. Since 1939, Weiss and English have published the first edition of\na textbook on psychosomatic medicine. A new volume by Dunbar entitled \"Psychosomatic Diagnosis\" has been published within the past year.\nThe present war as well as World War I enlarged our knowledge of psychosomatic\nmedicine. World War I emphasized in great numbers of cases what we already knew\nless frequently in civilian life, that conflicting emotions of fear for one's safety and\ndesire to be a brave soldier, produced so-called shell-shock in predisposed individuals.\nThe present war has shown the effect of anxiety, homesickness and discontent in producing peptic ulcer as at least a large part of the etiology. Neurocirculatory asthenia\nwith its multiform physical symptoms is now recognized as a neurosis with somewhat\nsimilar emotional origin. Perhaps psychosomatic medicine is beng overworked, perhaps\ntoo much is being claimed for it, but at least the general practitioner, to be fair to his\npatients and himself, must in many cases weigh the contribution of emotional factors\nin the causation of disease. Even such a general condition as fatigue may well be the\nexpression of discouragement with the problems and responsibilities of life, indefinite\npains, pelvic or elsewhere, may represent a psychic pain, as so commonly expressed in\nsuch phrases as \"he gets under my skin\" or \"he gives me a pain in the neck.\" Nausea\nand vomiting may be the somatic equivalent of psychic repulsion to distasteful life\nsituations. Some of these symptoms, referable to the abdomen, can simulate gall-bladder\nor appendicial disease and lead to unnecessary surgery.\nA good general rule in the neuroses and the psychoses is to avoid surgery unless you\nhave good reason to believe that the morbid condition is causing the mental illness and\nonly then if other means have failed. Neuroses cannot be removed surgically but can\nbe made worse by surgery. While focal infections, readily accessible, should be cleaned\nup by minor surgery, such as infected teeth, tonsils and sinuses, it is often definitely\nhazardous to open an abdomen without clear evidence of definite inflammation or other\ndefinite morbid process. Unless a retroverted uterus is definitely producing physical distress it may be much better to leave it surgically undisturbed; even hernias are best left\nlinoperated, especially in middle, life, unless they are more of a hazard and handicap to\nthe patient than they commonly are. Within the past year I have seen a doctor with a\nhistory of two previous manic attacks develop a third attack immediately after herniotomy, and a bank manager, mildly neurasthenic, enter a deep depression and attempt\nsuicide after the same operation. The mental changes accompanying hyperthyroidism\nmay be rendered still more severe by surgical removal of the thyroid rather than by\nmdical treatment and psychotherapy.\nBefore leaving the matter of surgery in mental medicine I should like to refer to a\nsurgical procedure of fairly recent development known as prefrontal lobotomy or\nkucotomy. Originated in France by Moniz some ten years ago, it was brought to this\ncontinent by Freeman and Watts, who have performed this operation frequently and\npublished a volume concerning it by the title of \"Psychosurgery.\" The operation is of\nspecial value in the agitated depressions of middle or later life which have failed to benefit\nby more conservative treatment. It consists in a trephine bilateral in the line of the\ncoronal suture, and a severance of the tracts between the hypothalamus and the prefrontal areas of the brain. It does not appear to affect the intellectual capacity of the\nindividual, but in selected cases the disappearance of worry and agitation are phenomenal,\nwith good gain in weight and varying degrees of return to a good social and occupational\nadjustment. Dr. K. C. McKenzie of Toronto has operated on approximately 25 cases,\n5 of whom have been patients of the hospital to which I am attached. Only one of our\nfive is unimproved, a case of schizophrenia; four, suffering from involution melancholia,\nwere able to return to their homes immediately after convalescence, in spite of several\nyears of previous mental hospitalization and all four continue at home.\nTo return more closely to general medicine and psychiatry, I should like to caution\npractitioners as to the dangers of bromide administration in the actual causation of\npsychoses. The bromjdes have won a valued place in our pharmaceutical treatment of\nmany conditions, but in addition to the gastric and skin conditions they sometimes\nPage Thirty-eight cause, they may also produce a state of cerebral intoxication. Given to relieve sleeplessness, so-called \"nervousness\" and other psychic disturbances, they may actually increase the symptoms to the degree of marked mental confusion and hallucinosis. Every\nmental hospital admits patients who would not have become admitted or become\npsychotic had the bromide tolerance and blood concentration of bromides been closely\nwatched. Some patients may of their own accord take larger doses than prescribed and\nothers may get their bromides through drug store purchase, but only too frequently the\npatient has taken the drug under medical direction. Commonly the people who develop\na bromide delirium have kidney damage which inhibits the usual excretion rate and\npermits the bromides to accumulate in the bloodstream. Treatment depends on early\ndiagnosis, immediate discontinuance of bromides, and the administration of common\nsalt, 30-grain capsules, thrice daily until the bromide concentration is reduced well\nbelow the toxic level, which is usually 150 milligrams per cent.\nThis might be a good place to interject the suggestion that we drop the old term\ninsanity and replace it, not by mental illness 'or psychosis, but delirium. As long as\nwe think of the term insanity we are apt to think of something outside the field of\ngeneral medicine. These terms all mean that the individual has experienced a mental\nchange, from whatever cause or causes, of such an extent that he is unable to think\nclearly and coherently, he may have delusions and hallucinations and is unable to govern\nhis conduct in a socially satisfactory manner. The common practice has been to think\nof delirium as of short duration and due to toxic or traumatic factors, and insanity as\nof long duration. This is not a very logical differentiation and I suggest no differentiation is indicated. So-called insanity or psychosis is merely a longer than usual delirium,\na still unrecovered delirium, and is still within the province of the general practitioner.\nA case in point might be the so-called puerperal psychoses. These distressing conditions following some confinements are due chiefly to toxic and debilitating factors on\nthe one hand, or to emotional factors on the other, perhaps a combination of the two.\nThe patient is delirious. If toxic she may clear up quickly under treatment, but it may\nnot be a toxic delirium. It may be a manic-depressive delirium, which will last longer\nbut will terminate in recovery, or it will be a schizophrenic delirium, which only too\nfrequently runs a malignantly deteriorative course, to chronic dementia. But even in\nthis last case the patient is still delirious perhaps years after the birth of her child and\nstill a challenge to our research and our best and untiring therapeutic efforts.\nWhile criticizing the use of the words insanity or psychosis, might I also suggest we\ndiscontinue use of the term \"nervous breakdown.\" This is usually applied to the non-\ndelirious mental disorders, the neuroses. But there is no nervous tissue pathology in\nthese cases and certainly it is not broken down. People sometimes like to hide behind\ntheir \"nervous-breakdowns,\" so-called, or take pride in them, aided and abetted at times\nby their medical practitioner. I suggest we call them by their correct name, emotional\ndisturbances or disorders, which immediately puts some responsibility on the patient for\ncontrolling or regulating his emotional reactions to make them less likely to cause\ninvalidism.\nDistturbances of sleep are common in emotional disturbances, often being the early\nsymptoms. While we do have to treat symptoms as they arise, I would suggest we not\npay too much attention to the control of this particular symptom but concern outselves\nmore with the underlying factors which have produced it. The patient doubtless will\nbe greatly worried about his poor sleep and will insist on \"sleeping medicine.\" His\npreoccupation with his sleep difficulty may be screening his real emotional conflict, and\nit is much easier to prescribe a hypnotic than to find the time in these busy days to\nthoroughly analyze his psychological problem. The administration of hypnotics by\nthemselves, however, will not solve the problem, although affording temporary symptomatic relief. The danger of a bromide delirium I have already referred to. The patient\nmay become addicted to hypnotics and we may find we then have an addiction problem\nalso to treat. Some of them lose their ability to produce sleep except in increasing\ndosage with the possibility of damage to kidneys and also interfere with the clarity of\nPage Thirty-nine the patient's thinking. Remember, too, and tell your sleepless patient that nature will\nsee that we get enough sleep, even though it may be light and frequently broken.\nPatients often claim they have not \"slept a wink\" but the observant nurse will record\nthe fact that the patient perhaps did sleep for varying periods of time. The patient is\nnot telling a falsehood, but the sleep being light and broken gives hirn the impression\nthat he has been awake all night. Hypnotics should be exhibited only in the face of\nreal need and if used should be discontinued speedily. A warm bath at bedtime, a light\neasily digested lunch, a quiet comfortable bed, persuasion and perseverance, with more\nattention to the underlying psychopathology might be thought of as a general regime\nin such cases.\nSome of these symptoms of sleeplessness may be a part of the menopausal syndrome.\nI do not propose to enter this field except to refer to those cases of serious menopausal\ndepression commonly known as involution melancholia. Although progress is being\nmade with endocrine therapy we all know its results are none too satisfactory as yet.\nWe still have a lot to learn and many improvements and refinements yet to be made in it.\nI imagine, however, that the symptom of \"depression\" can cause a great deal of\nanxiety to the physician in general practice. Normal depressions can be sufficiently\nworrying, but the patient depressed and on the borderline between normalcy and a\npsychosis, presents a very difficult problem. You will urge constant nursing care, of\ncourse, twenty-four hours a day, the secure locking or removal of poisons, antiseptics,\nguns, sharp-pointed instruments, ropes, etc. But there are always wells and cisterns or\nnearby streams, or a person can jump from a window or rooftop. She can tie belts or\nsheeting around her neck. If you advise immediate removal to a mental hospital the\nrelatives may feel you are too hasty. If you delay, you may have a suicide and be\nblamed for not having taken such action. The welfare of the patient is, of course, the\nonly criterion which should guide us, and removal to a mental hospital should not be\ndelayed if constant skilled supervision is not available or if the patient does not show\ngood response to treatment. A family history of suicidal attempts or of depressive\npsychotic reactions may be a valuable help to us in making our decision.\nI have just spoken as if there was no alternative between home nursing and the\nmental hospital in such cases, but there should be an intermediate facility, namely the\npsychiatric ward in the general hospital. This has been a development of the last twenty\nyears in the United States, more particularly in the last ten, and we are making a slow\nbeginning in Canada. True, you have had the psychopathic division of the Winnipeg\nGeneral under the able direction of Dr. Mathers for many years. Toronto has had the\nPsychiatric Hospital. But every general hospital of fifty beds should have a small well-\nequipped psychiatric section, not only for observation but for protection of the patient\nand for at least preliminary treatment. A general hospital is not doing its full duty to\nthe sick public if it refuses the delirious patient. Even the smallest general hospital\nshould have a room or two (not in the basement or in a corner off the laundry) but\nclose enough to the other wards for good nursing, treatment and availability of consultants. Victoria General Hospital in London has recently opened a 13-bed psycho-\nmedical ward with continuous hydrotherapy, electrotherapy, occupational therapy,\ndietetic facilities and skilled nursing. The ward is under the direction of the Chief in\nMedicine as one of his medical wards, treatment being directed by the psychiatrist on his\nstaff. I cannot urge too strongly the importance of such a ward for the welfare not\nonly of depressed patients but of any other psychiatric or psychosomatic problems occur\nring in general practice.\nI have referred to electrotherapy as one of the facilities on this ward and it is now a\nstandard in most mental hospitals. Time does not permit an extended review of\n\"shock\" therapy, but I think \"shock\" therapy has been the most useful and promising\ntherapy in psychiatric practice in the last twenty years. Beginning with insulin hypoglycemic shock, then metrazol convulsive therapy, we have now come to favour electric\nshock as able to do therapeutically what these others did, and with fewer complications\nand much greater ease of administration. The rationale is still unknown but the effects,\nPage Forty\ni particularly in involution melancholia, at times verge on the miraculous. In those\npatients who may not respond to this therapy, prefrontal lobotomy, referred to earlier\nin this paper, still offers one more valuable therapeutic prospect.\nBefore leaving involutional melancholia it might be noted that men may also go\nthrough an involution, usually later than in women, at fifty to fifty-five, with feelings\nof depression, discouragement, fear of psychosis, sexual impotence or reduced virility,\ninsomnia and gastric disturbances. This may be called neurasthenia, but it might just\nas well be called the male climacteric and treated accordingly.\nThe largest psychiatric field is of courses the neuroses. Freud has said that the\nneurosis is the price we pay for civilization, and as it is a poor sort of civilization we\nhave, it hardly seems worth the price. But the great mass of us have our neurotic tendencies and your offices have many people coming for help for these conditions. They\nare the greatest problem of Army psychiatrists as selection problems, and constitute the\nlargest group of neuropsychiatric casualties. At one time many doctors, after exarnin-\ning a patient who complained of cardiac or gastric -symptoms, and finding no organic\npathology, might say he had nothing wrong with him, or he only imagines he is sick,\nor he is only a neurotic. None of these three statements would be a correct statement.\nIf a person has symptoms which interfere with his adjustment to life he is sick, but the\netiology may be psychic and environmental and not organic or bacterial, or, as indicated\nat the beginning of this paper, it may be a combination of the two. The symptomatology\nmay be variable depending on the type of stress and the make-up of the individual, but\neach case calls for complete study of the family history, the life history of the individual, his problems, conflicts and adjustment difficulties and a careful physical examination. Correction of the psychic and environmental aspects of his life may yield high\ndividends in better health. The general practitioner may well be his own psychiatrist.\nThis presupposes some knowledge of psychotherapy, which means the use of mental\ninfluence in treatment. Although whole textbooks have been written on psychotherapy,\nand although some specialists concentrate on one form of psychotherapy, and scorn\nothers, for those of us who take a middle of the road position, such extremes need not\nalarm us. Billings in his excellent little book \"Elementary Psychobiology and Psychiatry\" has a good outline which might be summarized as follows:\nSymptomatic palliative measures, a building up physically by rest, diet, correction of\nphysical handicaps, cultivation of new interests. In a more direct way an attempt is\nmade to manage both the external environment and correct personality weaknesses.\nCareful analysis of all factors, positive suggestion, direction and re-education of the\npersonality are then attempted. These general principles should also apply to the treatment of alcoholism, a neurosis not uncommon in men. Compulsive drinking (alcoholism) and drug addiction if viewed as psychoneurotic illnesses rather than as moral\nlapses, fall definitely within the scope of the practitioner. There is as yet no pharmacological or surgical treatment for these conditions but careful psychotherapy and adequate after-care yield better results than commonly thought.\nI have suggested that psychiatry is not a specialty but rather a new dimension to\ngeneral practice. Whether or not it is correct to say that psychiatry is general practice,\nat least I believe it is true to say that general practice certainly should include psychiatry.\nPreventive psychiatry or mental hygiene is the positive aspect of health education,\nthe prevention of mental ill health and the preservation of good mental health. Here\nagain the general practitioner has a similar responsibility as he has in the physical field\nfor keeping the child or adult physically fit and warding off smallpox, diphtheria and\ntyphoid by immunization. Perhaps practitioners generally may not feel too confident of\ntheir ability in the mental hygiene field, but I suggest they should familiarize themselves\nwith it, so that they may give leadership to teachers and the general public in building\nup a more mentally healthy public than now exists. Time does not permit a discussion\nof mental hygiene principles here but I am prepared to review them with you if and\nwhen a suitable hour can be found. There are many good texts on the subject, some of\nPage Forty-one them by Canadians. The Canadian National Committee for Mental Hygiene, 111 St.\nGeorge Street, Toronto, is prepared to supply lists of reading material on request.\nThe general practitioner might also engage in research in psychiatry. One remembers that Sir James Mackenzie made his studies in cardiology while in general practice.\nAll the people who enter mental hospitals have been under your care before corning to\nthe mental hospital. Nearly 30% of our admissions are the result of cerebral arteriosclerosis and so-called senility. Why should this be? Why should our brains wear out\nso much sooner than our hearts? You might have some observations over a period of\nyears that would establish another mental hygiene principle and enable many more\npeople to maintain good mental health until their hearts stop beating. Your experience\nwith endocrines and other chemical agents if carefully noted should also be helpful.\nNor should you send your early deliria to the mental hospital (unless too acute to care\nfor safely locally), until you have attempted treatment (perhaps with the consulting\nservice of the Provincial mental health clinic service).\nIt is worth noting that with the exception of senile and cerebral arteriosclerotic\npsychoses, all other psychoses are either declining or maintaining the same level as for\nmany years past. The general practitioner has a large place in the treatment of psychosomatic disorders and the improvement of good mental health.\n\u00E2\u0080\u00A2 v.\nPAINLESS INTRAVENOUS TECHNIQUE\nTry the use of an intradermal wheel of novo-\ncaine adrninistered with a fine needle, as a prelude\nto removing blood specimens or ao_ninistering\narsenicals. Patients will be grateful. This technique will permit you to prod around for difficult\nveins. Patients won't disappear after the first\n\"shot\"\u00E2\u0080\u0094never to return.\nHlEFS\n;;-\nLATENT SYPHILIS\u00E2\u0080\u0094AN \"EXCLUSION\" DIAGNOSIS\nAll syphilis is latent at some time in its course. Most syphilis is latent at any given\ntime. Diagnosis is established by:\n(1) Repeated positive blood tests.\n(2) No clinical evidence of disease.\n(3) C.S.F. negative.\n(4) X-ray heart and great vessels negative.\n(5) Supportive historical evidence of syphilis.\n(6) Supportive epidemiological evidence of syphilis.\n(7) Exclusion of conditions causing False Positive tests!\n* * * *\nCONTACT INVESTIGATION\nSomewhere in the community there is at least one contact associated with each V.D.\npatient's infection.\nThe physician's most important duty is to arrange for this contact to be examined.\nThe physician and his patient may determine the fate of many.\nWhere possible, the patient should arrange to bring his or her contact in for investigation.\nIf this is not feasible, identifying information concerning the contact should be\npassed to the Health Department for discreet, confidential investigation by specially\nqualified workers.\n\"FIND V.D. CONTACTS \u00E2\u0080\u0094 REPORT V.D. CASES.\"\nPage Forty-two Vancouver Medical Association\n\"FRACTURES OF THE OS CALCIS: IMPROVED METHODS\n| OF TREATMENT\" f **??\nBy Lt.-Col. R. I. Harris\nRead at Vancouver Medical Association Summer School.\nThe management of fractures of the os calcis is difficult. There are several reasons\nfor this. First, the damage to the os calcis varies within the widest limits from an\ninsignificant fissure without displacement to the most extreme degree of comminution\nwith gross deformity. Such variation of injury makes standardization of treatment\nimpossible. Secondly, the technical problems involved in reduction of the fracture are\ncomplex and difficult to solve. Thirdly, involvement of the subastragaloid joint is\nfrequent. When this occurs, late disability from pain is inevitable even though a reasonably good reduction is obtained.\nIn so difficult and complex a problem it is not surprising that much difference of\nopinion exists regarding the best form of treatment, nor is it surprising that the results\nare often unsatisfactory.\nIn civil life, fractures of the os calcis are mostly the result of industrial accidents,\nfalls from a height, from jumping down oh to hard floors or pavements, resulting in\nfractures. But the fracture has become one of great importance in this war. In fact,\nit has become almost the characteristic fracture of this war.\nAt this point I will show you some slides. Here, for instance, is the X-ray of the\nheel of an airman who received this injury to his os calcis. That type of injury; viz.,\na powerful force applied from below, has in this war produced innumerable fractures of\nthe os calcis. Sailors on board ship, whose ship has been torpedoed or mined, sustain the\ninjury by reason of the fact that the deck of the ship is forced up against their heels\nand this produces fractures of the os calcis. Soldiers, driving vehicles over recently\ncaptured fields, run into land mines and the floor of the vehicle is driven against their\nheels, or sailors sliding down the sloping sides of a sinking ship go up hard against the\nbilge of the ship and suffer a fracture of the os calcis.\nNot infrequently in these war casualties, the fracture of the os calcis is combined with\ncompression fractures of the vertebral column, so we have, at this particular moment,\nample reason for devoting a little time to this subject.\nI must say that in war casualties the problem has not been very satisfactory there,\nthe chief reason being that in the forward area the facilities for dealing with this fracture\nin an adequate fashion all too often don't exist. It requires some equipment which is\nnot standard in army hospitals and which will demand the ingenuity of the surgeon to\nimprovise what he can. More important, it requires the interest of someone who knows\nsomething about fractures of the os calcis. By the time the man gets back to the general hospital where we may find instruments and staff capable of handling the problem, it\nis too late because union of some sort has already begun. And all too often this problem\nof organization of treatment for specialized problems, of which fractures of the os calcis\nare one, leads to that kind of imperfect result. The other kind of thing is that in the\nmanagement of fractures, particularly difficult complex problems, there is a moment\nearly in their course when skilled treatment by those who are experienced can do the\nmost for the fracture, but if that moment passes, then the improvement which could\nhave been obtained by skilled treatment cannot be gained even though the patient later\nis placed in the hands of those experienced with it. We must remember that not only\nare there certain problems which -need expert help, but in order to gain the best from\ntheir skill they must be able to deal with them before it is too late.\nPage Forty-three In civil life, the Workmen's Compensation Board knows perhaps as much about this\ninjury as anybody else. Here, for instance, are records supplied me by Dr. Bell of the\nW.C.B. in Ontario of some sixty consecutive cases of fractures of the os calcis, indicating the duration of total disability, which meant the time lost from the moment of\nthe accident until the man returned to work, and you will notice how long is the period\nof disability. It ranged from a month in an insignificant case, to a large group, the\nmajority of which were from 7, 8, 9, 10 to 12 months away from work. The great\nmajority of cases were back to work within 15 months, but that is a long period of disablement for this rather simple fracture. Of these 60 cases, most of them were left\nwith some partial permanent disability, necessitating compensation. Thirty-five were\nplaced on pensions varying from 3% to 50%. The remainder received compensation.\nNot one case reached a finality with no disability at all. The average cost was great\u00E2\u0080\u0094\n$1350 per patient.\nThe most important landmark in our treatment of fractures of the os calcis has been\nBoehler's contribution and his work has done more than anything else to improve our\nmanagement of fractures of the os calcis. ILis emphasis upon the multiplicity of fractures, each of which requires individual treatment, and his emphasis on the need for\nrestoration of the bone to its normal shape, and of the value of traction in securing this,\nhas greatly advanced our knowledge of treatment. Perhaps most important of all has\nbeen the stimulus he has given to the thought and study of this particular problem, but\nin spite of this the problem is too often poorly managed. Many cases are still treated\nwith simple plaster and fixation without any plan of restoration of he bone. His plan\nof treatment falls shrt of perfection, though, and on several points. First, his assumption that fractures of the os calcis can be dealt with by traction alone.\nThe traction is applied by a pin through the crest of the tibia and a pin through the\nposterior-superior corner of the heel, and is applied first in a certain direction and\nwith a certain force and then the direction of the pull is changed and the pull is applied\nagain and again with a certain amount of force, and having pulled in these two directions, a plaster is applied incorporating the bones in the plaster. The assumption is that\nif we apply this traction in two directions and with a predetermined force, that we can\nexpect any fracture of the os calcis to be reduced. The second difficulty in Boehler's\nmanagement is that there is no provision for determining as we go along how we are\ngetting along with the fracture. No X-ray is taken and the fluoroscope is not used.\nLike any other fracture, these fractures need the assistance that we can obtain during\nthe process of reduction. Fractures of the os calcis vary from one another so much\nthat it is impossible to areat them with a rigidly formulated plan without X-ray.\nThe third shortcoming is the assumption that the deformity of the fractured bone\ncan be corrected by traction alone. It has been my experience that while traction,\napplied as Boehler recommends, or better still applied somewhat differently, is a very\nimportant agent in the management of fractures of the os calcis, there are certain\ntypes of fracture in which no amount of traction applied with whatever force you wish\nand in whatever direction you wish, will completely reduce the fracture, and this is\nparticularly true when a large fragment carrying the posterior facet of the subastragaloid\njoint is depressed into the body of the bone. The traction which is applied does not\noften elevate that fragment. It needs something more than this to do it.\nFinally, I think that Boehler has not laid sufficient stress upon the necessity for\nfusion of the subastragaloid joint in certain types of fractures of the os calcis. There\nare important reasons why this fusion should be undertaken. To begin with, the fracture often results in extensive conxminution of the bone, and this frequently involves\nthe articular facet of the os calcis, and when that is so it is seldom that we achieve\nthe perfection of reduction that will restore that and make it perfectly smooth. The\nsecond reason why fusion is important is one which has not been sufficiently stressed.\nNot infrequently the fracture lines of the os calcis are so disposed that a portion of the\nbone which carries the articular surface for the posterior facet of the subastragaloid\njoint is entirely separated from the bone in the fracture line. In other words, not only\nPage Forty-four is the bone fractured but that piece of bone is separated completely from its blood\nsupply, or in a large part from its blood supply. But in a certain proportion of cases\nsuch a fragment is deprived of its blood supply and undergoes aseptic necrosis. It loses\nthe articular cartilage and, though it may become revascularized, its articular surface\nhas been damaged and this results in late osteoarthritis. Such cases are irreparably damaged, and if they have any late disability, it can only be overcome with fusion of the\njoint. Here is another illustration of this point, showing an X-ray of one of these cases.\nThis is a fragment which is likely to undergo aseptic necrosis. It is such facts as these\nwhich make more frequent use of subastragaloid fusion wise and good treatment.\nIn order to provide a more flexible means of treating fractures of the os calcis by\ntraction, we have found it necessary to apply traction in more than two directions and,\nin particular, that there is need for traction in the direction of the long axis of the\nfoot in order to overcome the shortening that so often occurs. There is need for a pin\nthrough the head of the metatarsals which can lengthen the foot when traction is\napplied. It is of advantage that this traction be applied by an instrument which will\nenable one to modify the direction of its pull within as wide limits as possible, and also\nthat it be applied by an instrument which will enable us to modify the force of the\ntraction. This traction ring which you see illustrated here has been devised for that\npurpose. The man's leg is thrust through that ring there and to these hooks are\napplied spreaders on Kirschner's wires through the heads of the first and fifth metatarsals.\nNow, this being a circle, it is possible to shift these tractors around the circle in any\nway you wish, so that the direction of the traction may be modified within wide limits.\nOf course, the force can be modified by the amount of screwing up of this traction which\nis applied. Now, here is an example of what can be accomplished by such tri-radiate\ntraction. We have here two or three sets of X-rays. Here is a very severe fracture of\nthe os calcis. This is the result of the application of tri-radiate traction,\u00E2\u0080\u0094much\nimprovement in the fracture, but this fragment is not yet perfectly reduced. One must\nrealize that when you put traction on that os calcis, it is resisted by the tendo-achillis.\nThis becomes a fulcrum against which it is difficult to tilt up the anterior end of the\nbone. This is a point which I said was overlooked by Boehler in his treatment. I think\nhis point of view is a very good one\u00E2\u0080\u0094if I seem to point out the difficulties of the treatment it is only to emphasize the great strides made in his treatment. That problem is\na very real one and it occurs reasonably often (in about one-third of the cases), and it\nis not overcome by traction of any kind or in any direction or with any force. It can,\nhowever, be overcome if one drives in a stiff pin and uses that pin as a handle, by\nmeans of which this fragment is drawn into position. You can see that pin applied here.\nIf we are going to restore the subastragaloid joint we can rely on traction to add\nmuch more towards that objective, but a certain proportion of cases will need something\nmore than traction, and most commonly they need to have that fragment tilted up at\nthe anterior end. Here is another example of the problem\u00E2\u0080\u0094a severe fracture of the os\ncalcis with gross conuninution and gross compression of the articular surface. The\narticular surface is impacted into the body of the bone. This is the result obtained by\ntri-radiate traction\u00E2\u0080\u0094a very nice reduction of the fracture. Now, this one was one of\nthe early cases in which we were carrying out our method of treatment. We obtained\na good reduction and this is the result three months later. The man went back to work\nand he worked as a moulder and the results have not been perfect because he still has\npain in his subastragaloioV joint and you can see why that is. We would have done\nbetter to have fused that joint, as he now has aseptic necrosis.\nAt this moment I should like to emphasize the problem of subastragaloid fusion. If\nwhat I have told you is right, then we should take fusion as part of our treatment. If\nwe agree that certain cases need fusion, then the sooner we fuse them the better, in\norder to save time for the patient and in order to take advantage of the early period of\nosteogenesis. Now, here is a case in point\u00E2\u0080\u0094a severe fracture to the os calcis\u00E2\u0080\u0094and this\nis the result obtained by traction. It is very easy to apply great force on this tractor.\nActually, the amount of force needed is not very much\u00E2\u0080\u0094there is a tendency to over-pull.\nPage Forty-five At this moment I should like to discuss the aspect of fusion of this subastragaloid\njoint as applied to the particular problem that we have in mind. All of us have been\nfaced with the necessity of fusion because of disability which follows fractures of the\nos calcis and most of us have approached the joint from the lateral side of the foot.\nNow, such lateral exposures are difficult. Subastragaloid fusion in a joint which has not\nbeen damaged is a nice bit of technique and not done easily unless it is done in a very\nprecise fashion, but when the joint has been severely damaged then the exposure of the\njoint is extremely difficult and cannot be accomplished without at the same time exposing the mid-tarsal joint, and that necessitates fusion of the mid-tarsal joint.\nSome time ago Dr. Gallie devised an operation for mid fusions of the subastragaloid\njoint which overcame some of these problems, the chief point being an encroachment\nfrom behind and the insertion of bone grafts between the os calcis and the astragalus.\nI may say that it is one of the simplest of procedures and is effective. When you think\na fracture of the os calcis is going to give late trouble and you think it should be fused,\nthen do it early for the best bony union. Having decided that the fracture of the os\ncalcis is of such a nature that late trouble is going to occur, there is no reason at all why\nfusion should not at once be proceeded with, even though the plaster is still on, because\nit is possible to do the operation from behind through a window in the cast and that is\nwhat we have been doing quite satisfactorily.\nThis drawing represents a fracture of the os calcis which has been reduced by tri-\nradiate traction. Ten days after reduction a window was cut in the plaster and a fusion\nwas performed. It is a simple exposure and through that exposure a rectangular tunnel\nis cut in the subastragaloid joint. That is quite easy to do. This tunnel is cut with a\nchisel. This slide illustrates the procedure. A double graft is then thrust into this\ntunnel and we have the joint bridged by these two grafts. This is the type of fracture\nin which we think this aspect of treatment should be considered\u00E2\u0080\u0094a very gross comminution of the fragments. This is the result obtained by traction. You can readily\nsee that there is still tremendous crushing and cornrninution of the central portions of\nthe bone. It was our judgment that it was the best reduction that we could obtain so\nten days afterwards an operation was preformed and a graft was placed in the subastragaloid joint. This is a photograph of the apparatus in use. We use heavy Kirsch-\nner wire instead of Steinman pins. This is another picture of the same patient, showing\nthe tri-radiate traction apparatus. Having reduced the fracture to our satisfaction and\nhaving checked it by X-ray, a plaster is applied incorporating the steel wire and the\npins. Here is another case in which the tractor has been applied.\nNow, this picture illustrates a number of problems. Here is a moderately severe\nfracture of the os calcis with moderate compression of the posterior half of the subastragaloid joint. Here are a series of X-rays which illustrate the steps in the reduction\nof the fracture. Here you see the effect of traction alone and it has lengthened the\nbone and it has improved the position and restored the critical angle but it has not\nreduced that articular portion of the os calcis adequately. An attempt was made to do\nthat with a heavy Kirschner wire but it was not strong enough, so a Steinman pin was\nput in place and this improved the condition considerably though there is still room for\nimprovement.\nNow, here are a number of X-rays of patients, illustrating a number of the problems.\nHere are the X-rays of _ man who had a double fracture to the os calcis and we treated\nboth his fractures in this manner. There was no operative fusion of his joint as his\ntrauma was so great. This series shows a moderately severe fracture. This shows the\nresult of reduction by traction.\nIn conclusion, I would say that it is well to regard fractures of the os calcis as a\nmajor problem in fracture surgery. It is necessary to appreciate that fractures of the\nos calcis vary greatly from one to the other. Therefore, we must individualize each\nproblem. We must study the fracture and the X-ray and decide what is necessary in\nthis particular case. We must make up our minds at the beginning whether a fracture\nof the os calcis presents a major problem or whether it is a simple problem in fracture\nPage Forty-six treatment. If it is a major problem then we must find the means of dealing with it\nadequately right away at the beginning. The procedures which will do most to give a\ngood result are:\n(1) Traction, especially if it is tri-radiate traction and especially if it is sufficiently\nflexible that its direction can be changed and its force can be changed. When traction\nis used we should have some means of checking the result by X-rays during the procedure.\n(2) We should appreciate that some other measure than traction may be necessary\nin certain cases to restore the bone to something like its normal shape, and this is our\nobjective. We should appreciate that in a considerable proportion of our cases, no matter how skillfully we handle the fracture, there will be gross damage to the subastragaloid\njoint and late disability will be inevitable. These should be treated with subastragaloid\nfusion and the sooner the fusion is done the sooner the man will be back at work.\nPosterior fusion has given the most satisfactory results. The freedom of the mid-tarsal\njoint to move has not proved a disability when the subastragaloid joint is fused. On the\ncontrary, it has been an asset.\nDR. A. W. BAGNALL\nObiit Nov. 22, 1944 |\nThe medical profession of Vancouver has sustained many blows lately by\nthe loss of some of its older and most valued members\u00E2\u0080\u0094and the loss of Dr.\nWallace Bagnall is by no means the least of these. He had been in practice in\nVancouver for many years and had reached the top of his profession, as an\ninternist of rare skill and ripened judgment, whose work was regarded as being\nof the best. His integrity of character and his sincerity of mind, gave to his\nopinions a soundness and maturity that made him a valued consultant to his\ncolleagues, and a practitioner of assured worth, to the public at large.\nBagnall was always a student, and had the critical faculty of mind. This\nis a very valuable quality in the man of medicine, and not as commonly possessed as it should be. His bump of credulity was poorly developed, and he\nexamined each new thing with critical care. He was not easily made enthusiastic about new things\u00E2\u0080\u0094and in all his doings, not merely professional, he preserved an open mind, and had to be shown. But when he did become interested\nin a subject he explored it exhaustively\u00E2\u0080\u0094and mastered it thoroughly. He was\nespecially interested in Rheumatism and Arthritis, and made himself one of the\nforemost authorities on these subjects in Canada. His work on the gold\ntherapy of Arthritis was of the pioneer order\u00E2\u0080\u0094and one remembers a most\ncomplete report made by him on the subject many years ago. Even here,\nhowever, enthusiastic as he was on the subject, he did not lose his head or\nbecome fanatic at all, and rather offended some of the ultra-enthusiasts by his\nconservative attitude towards the matter.\nBagnall was a quiet, almost austere man, who made no fuss and did not\napparently go out of his way to assert himself\u00E2\u0080\u0094but he was very warmly\nrespected and liked by all who knew him. It is very pleasant to reflect on the\noccasion at the last Medical Dinner when the Degree of Prince of Good Fellows,\nthe Vancouver Medical Association's cachet of worth and true fellowship, was\nconferred on Wallace Bagnall. It warmed the hearts of all his legion of friends,\nand we rejoice that he knew, before he left us, that we loved him, as well as\nrespecting and liking him.\nThe Vancouver Medical Association owes a special debt to Dr. Bagnall.\nHe served on the Library Committee for many years, and no member of that\nPage Forty-seven *\nConunittee ever gave more generously and freely of his time and energy. It\nis not too much to say that a great deal of the present excellence and efficiency\nof the Library is due to the work that he did year after year, and to his constructive interest and mature experience. His place will be hard to fill.\nWe offer to his family our sincerest sympathy in their loss.\nDR. M. W. THOMAS\nObiit Nov. 11, 1944\nThe grievous and untimely death by drowning of Dr. Morris Thomas,\nExecutive Secretary of the College of Physicians and Surgeons of B. C. and the\nB. C. Medical Association, brought a profound sense of shock to every medical\nman in British Columbia, and to scores outside this province, who had come to\nknow and respect him as one of the leaders in the medical organization of\nCanada. The shock was followed by a deep sense of personal loss, as of a dear\nfriend, whose passing has left a gap in one's more intimate life.\nThomas had, more than most men, a genius for friendship and a great\naffection for his friends. He knew men personally\u00E2\u0080\u0094he took a keen interest in\nall that befell them\u00E2\u0080\u0094in their family relationships and their professional doings\n\u00E2\u0080\u0094he knew what their hobbies and recreations were\u00E2\u0080\u0094he rejoiced with them in\ntheir happier moments\u00E2\u0080\u0094and sorrowed with them in times of trouble. One\nfelt that he knew intimately every man in the Province, and the further the\nman lived from the centres of population, the more anxious was our Secretary\nto do all he could for him. He was always working for the men in practice.\nPerhaps this was his duty\u00E2\u0080\u0094but Thomas brought to this duty a devotion and\na loyalty that made him the friend, as well as the willing servant, of all that\nit was his duty to serve.\nHe was a good fighter, too\u00E2\u0080\u0094and the medical profession owes much to his\ncourageous battling for their interests. Many a man in B. C. will testify to\nthe help and support that he received from our Secretary, in his dealings with\nemployers of labour, and groups of employees seeking medical service. The\nMedical Services Association, so successfully operating in our midst, owes an\nuncountable debt to his work and indomitable support\u00E2\u0080\u0094and his refusal to\nallow inferior schemes to compete unjustly and unfairly with it.\nOrganized medicine in B. C. can never repay its debt to Dr. Thomas. He was\nan almost ideal man for the work he carried on for so many years\u00E2\u0080\u0094and it is\nvery hard to see how he can be replaced. It may be that no man is indispensable: that even the loss of a Moses need not mean irreparable disaster\u00E2\u0080\u0094that the\nthing for us to do is, as Joshua had to do, to get up and go on\u00E2\u0080\u0094but we have\nlost a very valuable and badly-needed guide, counsellor and friend\u00E2\u0080\u0094and it will\nbe long before we shall see his like again.\nWe feel that we speak for every medical man in British Columbia when we\nextend to Mrs. Thomas and his family our deepest sympathy in their bereavement. ^\nPage Forty-eight \u00C2\u00AB\nV\nancouver\nG\nenera\nHospita\nTHE DIAGNOSIS OF A NEUROSIS\nGeo. A. Davidson, M.D.\nPresented at the North Pacific Society of Internal Medicine, Vancouver, B.C., September 16, 1944.\nMore and more it is being stressed that the diagnosis of the Neuroses is ont made\nby excluding organic disease. A neurosis is a definite disorder and the diagnosis calls for\ncertain findings as much as the diagnosis of pneumonia, hyperthyroidism or any such diseases. It is because it is felt that so many neglect this basic fact that it is thought wise\nto discuss the question of the diagnosis. We are told that 30 to 50% of the discharges\nand rejects from our armies are due to mental, emotional and educational faults. It\ntakes but a short time in medical practice to make one realize that he has had little\ntraining to make him feel at ease in dealing with this type of disorder if he comes from\nan average medical school. While this paper will contain little that is new, it is hoped\nthat it will bring those interested in Internal Medicine a better understanding of what\nthe term Neurosis actually means.\nA few months ago a 42-year-old male was referred because of complaints that were\nsuggestive more of a neurosis than of organic disease, e.g., he had spells of feeling faint,\nhis stomach was unsettled and his heart palpitated. He had been off work for one year\nbut had been undergoing examinations for two months prior to that. He had been in\none hospital, had seen two physicians and had gone \"through\" three clinics. He had\nhad X-rays taken of his chest, stomach and colon. He had had three different electrocardiograms and at least three basal metabolic ratings, and had had various blood and\nother tests. This work had cost him more than $300 and he had lost about $3500\nbecause of unearned wages (salary $85 per week). With the exception of one medical\nman all eventually reached the conclusion that it was \"nothing but nerves\" and he was\ntold to \"go ahead and don't worry.\" He stated that one well-known clinic had told\nhim that there was nothing that a physician could do. My suggestion is that had a\nmore careful history been taken with a view to understanding the man rather than his\nindividual organs, he would have been saved much worry, expense, and much of the\ntime spent by the various physicians would have been saved. Another point of great\nimportance is that during the fourteen months on treatment he had developed many bad\nhabits of thought, and had reached a point where it was much more difficult to deal with\nhim than it would have been at first. The easiest time to deal with these cases is when\nthe symptoms are new, when the patient must be studied carefully and given an understanding of the meaning of his symptoms. His problem will be returned to later.\nWho Develop Neuroses?\nI. The Insecure Background.\nIn studying an individual with symptoms the logical method is to deal with the\npatient as a whole and not to think only in terms of how the heart, stomach and other\norgans are behaving. The whole life situation must be seen as clearly as possible so that\nthe various influences that have played on this individual from his childhood can be\nproperly evaluated. It is suggested that the most necessary single point for the diagnosis\nof a neurosis is to decide whether or not the individual had felt secure in his childhood.\nThe child deserves security and the child who is secure is most likely to become a stable\nand confident adult. It has been recognized that home situations have much to do with\nthe development of neurotic states. Death of a parent or divorce of parents are tragedies\nthat reach far into the future of the child's life. This is probably largely due to the\nfact that the child feels so often that he is left in an insecure position. Too often when\nPage Forty-nine the father dies the mother is left with an inadequate income and in addition to having\nto worry over the bodily needs there is no longer the partner to help absorb and modify\nthe emotional situations that develop. Too frequently the mother pours out her grief\non the eldest child so that he must face problems of both economic and emotional\nnatures that he is not yet ready to face. Instead of continuing his life of play and\ngradually accepting adult responsibilities these are suddenly thrust on him so that he\ndevelops a habit of reacting in an anxious way to difficult situations\u00E2\u0080\u0094a habit that often\npersists with him throughout life.\nStrife in the home will also produce a feeling of insecurity and uncertainty in the\nchild and cause him anxieties too early in life.\nAnother point that should be stressed is the effect of the over-anxious, over-solicitous\nmother on the child. There is too much fear expressed that the child will catch a cold,\nget his feet wet or meet with an accident so that often the child looks upon life as a\ndangerous business and full of hazards rather than taking new experiences in his stride\nand with ease.\nIn a group of pension cases suffering from so-called Neurocirculatory Asthenia there\nwere nine cases that had been under observation for 15 years or more. Six of the nine\npatients had lost one parent before he was 15 years of age, ono had lived in an atmosphere of over-protection and one had a father who had been an invalid for years. In\nthis same group where figures were available for 18 of the group, nine who developed\nthe disorder were first children although the group as a whole averaged seven children\nper family.\nThose things in a home situation that make the child feel insecure and afraid have\nbeen discussed at some length as it is felt that the neuroses have their setting well back\nin the life of the individual.\nII. The Necessity for Adjustments in Life.\nWith this picture in mind the adjustments that the individual has to make may be\nconsidered. Kraines1 has put this nicely when he says: \"If one disregards all hair-splitting phrases and obscure terminology, it may be generally agreed that all psychologic\nreactions are built up, pyramided on two fundamental drives\u00E2\u0080\u0094the drive for self-preservation (ego-maintenance) and the drive for race preservation (predominantly sexual).\nIn other words, man seeks security and satisfactions.\" Note the term \"security\"! Put\notherwise, if one is happy and contented in his efforts at self-preservation, be they\nsatisfaction in his school work, his office or labours, and if one is satisfied with his relationship to the opposite sex, be it puppy love or a satisfactory marital adjustment, \"all's\nright with the world.\" Probably this might be extended a little to include his relationship to people generally, i.e., the making of a satisfactory social adjustment.\nIf, then, the initial complaints are of a nature that suggest emotional trouble rather\nthan organic disease, it is felt that it is the duty of physicians to enquire into these\nadjustments. Physicians often are timid about asking such personal questions and yet\nthe patient is usually anxious to discuss them and unburden himself.\nIII. The Physical Findings Expected.\nBroadly speaking, psychoneurotic symptoms and signs may be divided into two\ngroups, (a) those expressed by tension, and (b) those expressed by conversion. In the\ntension states one sees the type of case produced by autonomic overactivity, i.e., definite\nphysiological activity is produced.\nAccording to Fulton2, stimulation of the hypothalamus indicates that the posterior\nand lateral hypothalamic nuclei are concerned primarily with the sympathetic outflow,\nthe following responses being seen: (a) Cardiac acceleration, (b) elevation of the blood\npressure, (c) dilatation of the pupil, (d) retraction of the nictitating membrane, (e)\npiloerection, and (f) inhibition of the gut. He says further that these hypothalamic\nnuclei also have connections with the cerebral cortex, generally through secondary\nneurons via the zona incerta, septum pellucidum and mamillo-thalamic tract.\nPage Fifty Bodily changes as a result of emotional reactions have long been recognized although\nthe cortico-hypothalamic connections have only recently been worked out, and these\nnot entirely as yet. The names of Pavlov3, Cannon4, Wolf and Wolff5 at once bring\nto mind some of the important work that has been done and more recently have the\nroles of emotion been stressed in such diseases as peptic ulcer and hyperthyroidism. If\nthe symptoms associated with sympathetic stimulation are kept in mind many of the\nsymptoms and signs seen in the neurosis are evident, e.g., dilated pupils, increased heart\nrate, increased systolic pressure, disturbances in the secretion and motility of the\nstomach and bowel, urinary disturbances, disturbances of sweating, etc. The neurosurgeons with their attacks on the frontal areas have clearly demonstrated that definite\nchange \"can be produced in the personality with a decrease in the general tension.\nKeeping in mind the type of background expected in the neuroses, the difficulties in\nadjusting to certain life situations and the physiological changes resulting from cortical-\nhypothalamic disturbances, the history of the man who was off work for over a year\nbecause of his so-called \"nervous state\" may be reviewed.\nWhen the patient was 12 years of age his father died as a result of an accident. His\nmother had quite a struggle to raise the family after her husband's death and she was\nregarded as nervous, suffered with certain \"spells\" and was said to have overworked.\nThe eldest brother did not accept much responsibility for the family although he was\n20 years of age when the father died. The next two children were girls. Each had\nsuffered from breakdowns and appear to have been badly adjusted. The patient was\nquite aware of all the family troubles. From the age of 12 years he worked after school\nand turned his earnings over to his mother. He left school entirely at 13 years of age\nand has always been sensitive because of his lack of formal education. Although he\nchanged positions fairly frequently he did very well until, due to the war, he was forced\nto change his occupation. He started work in a shipyard, where the pressure was quite\nsustained. At the same time he was doing a certain amount of gambling at cards and\nat horse \"and dog races. The excitement of this probably gave him symptoms referable\nto his autonomic nervous system. He did well in the shipyards but did not like the\nresponsibility, had some fear of his boss and got the idea that this man might welcome\nan opportunity to show his authority. He began to have spells in which he would feel\nfaint, his stomach felt unsettled, his heart palpitated and he was constipated. He was\nadvised to stay off work to see how he felt and from that time on did not return to the\nshipyards and actually did not get back to any kind of work until about July 1, 1944,\nthat is, more than one year from the time he stopped work.\nPhysically he showed fine tremors to the fingers, brisk jerks, moderately enlarged\ntonsils, a coated tongue, a pulse rate that varied between 88-120 and a blood pressure of\n140/88. The hands were decidedly moist and cool.\nThis is regarded as a fairly typical neurosis (tension state) because of the (a) insecure childhood, (b) the difficulty in adjusting to the change of work with the increased\npressure, and (c) because of some of the physical signs which are common in neurosis.\nI am particularly interested in your reactions as to the amount of work that should\nbe done in ruling out organic disease and especially in the laboratory work. In such a\ncase as has been described, would we be justified in reaching the diagnosis of a neurosis\nwithout the extensive laboratory work being done? From the history, would we not be\nreasonably justified in omitting much of this work? Interestingly enough, it was at\none time suggested that the man suffered from hyperthyroidism, and yet when he visited\na man who confines himself largely to the diagnosis and treatment of diseases of the\nthyroid gland this man did not think that it was necessary to do a basal metabolic\nestimation\u00E2\u0080\u0094a test, incidentally, in which I believe we place altogether too much faith,\nas in about 98% of tests it is within our accepted range of normal, and that is a wide\nrange.\nSome internists believe that any man who presents himself with complaints referable\nto the stomach should have a series of stomach and bowel pictures. Should these be\ninsisted upon, and will an injustice be done to a large number of our patients if we do\nPage Fifty-one not demand it? True it is that the trend today appears to be to believe that emotional\ninstability is a forerunner of peptic ulcer. Many men feel that they are running too\ngreat a chance of missing structural change and yet this is doubted.\nI have reached the conclusion, and it is felt that you will agree, that many patients\nare not convinced by negative reports and they believe that the physician must be overlooking something or that his disorder is beyond the knowledge of medical men. How\noften the patient will insist that we do not understand, and whether he says so or not\nthe fact that he drifts from one physician to another is proof that he has not entire\nconfidence in our findings and reports.\nMany physicians believe that a lot of tests impress the patient and make him feel\nmore confident in his physician. This is doubtful. It is felt that care should be taken\nin obtaining the history with an attempt to understand the man and his problems, and\na physical examination should be done to confirm or make you doubt your diagnosis.\nIf the other course is followed, how frequently do we hear patients say, \"Well, Doctor,\nif there is nothing wrong with me but an emotional condition, why did Dr. X make\nall those tests on me and put me to so much expense? Surely he must have felt differently.\"\nThis, of course, is about the same as saying that your patient feels justified in doubting your diagnosis when Dr. X, who undoubtedly was a good man, was not certain of\nthe condition. In other words, he feels that the doctors are in doubt and it is felt that\nthis would not occur if the first man who saw the case treated it with understanding\nand confidence.\nWhile it is not my intention to discuss the treatment of the neurosis, it is felt that it\nis our duty to give the patient some understanding of the physiological responses of the\nbody to emotional factors.\nIt is agreed that not all cases of neuroses are as typical as the one described, and yet\nhe was examined and re-examined and still left in doubt and without relief.\nBriefly, my contention is this: (a) Having in mind the structure of the neurosis\nand (b) being familiar with the \"ring\" of the symptoms described, our attentions should\nbe directed towards a better understanding of the man and his problems and less attention should be paid to the study of his individual organs..\nIt is realized that these suggestions will be received with antagonism and criticism\nby many of the organically-rninded men present, and yet it is felt that as a group we\nare open to criticism for the way in which we deal with this group of patients and for\nthe way in which we go through with our rituals and end up by telling the man to\n\"Forget it. It's nothing but nerves.\"\nSummary\n1. The diagnosis of a neurosis is not made by exclusion but this disorder has a definite\nsymptom complex; a definite background of insecurity, a history of difficulty in\nadjusting to some problems and certain physical findings indicative of (a) tension or\n(b) conversion.\n2. The physiological effects of emotion are discussed especially as they affect the\ncortico-hypothalamic-autonomic system.\n3. It is argued that much unnecessary investigation and laboratory work is done on this\ngroup of patients without value being received.\n4. And finally in having reached our conclusion that the condition is a neurosis it is\nfelt that we owe the patient an explanation as to why he develops his symptoms and\nwhy they persist, rather than leaving him with a diagnosis of \"just nerves.\"\nBIBLIOGRAPHY:\n1. Kraines, S. H., The Therapy of the Neuroses and Psychoses, Lea & Febiger, 1943.\n2. Fulton, J. F., Physiology of the Nervous System, Oxford University Press, 1943.\n3. Pavlov, I. P., Conditioned Reflexes and Psychiatry, trans, by w\". H. Gantt, New York. Internatoinal\nPublishing Co., 1941.\n4. Cannon, \"W. B., Bodily Changes in Pain, Hunger, Fear and Rage, 2nd ed., D. Appleton & Co., 1929.\n5. wolf, S., and Wolff, H. G., Evidence on the Genesis of Peptic Ulcer in Man. J. Amer. Med. Ass.,\n1942, 670-675.\nPage Fifty-tw6 EMOTIONAL PROBLEMS OF DEMOBILIZATION\nMaj.-Gen. Chisholm\nRead before the B. C. Medical Association, September, 1944\nThe process of changing oneself from a soldier to a civilian is in very many cases\nat least just as difficult psychologically as the change from civilian to soldier. In a\ntypically successful soldier the total environment has been oriented towards successfully\nfighting the enemy for a period of anything from one to five years, or more. Every\npressure directly influencing the soldier has been formulated and exerted in this direction. His whole value is judged by his efficiency as a fighter or in giving support to\nother fighters. The whole object of his existence and the focus of all endeavour about\nhim is killing. Effective and wholesale killing has been for years given precedence as\nthe highest moral value and the most admirable of all virtues.\nThe soldier has become accustomed to living in a very close knit community which\nin relation to its main preoccupation is completely reliable and dependable. Its reactions\nin relation to any important question are completely predictable. All its moral values\nare quite clear and all friends and enemies are known.\nThere is little real psychological preparation for the cessation of hostilities during\nthe closing weeks of any campaign. Emotional tension runs very high; there is great\npreoccupation with the events of the moment which are almost invariably new and\nstrange and exciting. Soldiers generally do not allow themselves to count too surely on\nsurviving a war, at least* without severe crippling. In long continued warfare it tends\nto become evident to soldiers that only major wounds leaving permanent crippling are\nlikely to ensure their survival. Even repeated minor wounds keep men away from fighting only short periods and there is a high degree of mathematical likelihood of the soldier being killed if he does not receive major wounds. Very many soldiers, showing a\ndegree of superstition which because of its almost universal presence in our civilization\nmust be regarded as normal, feel that it is dangerous to count on survival, that this is\nin some way a defiance of some Power which may be annoyed at such presumption. It\nis true that soldiers generally indulge in much fantasy about living conditions \"after the\nwar,\" but these are kept clearly in the realm of fantasy and are heavily discounted as a\nprecautionary measure.\nThe cessation of hostilities is experienced as a major emotional shock by soldiers generally. There is a very extensive loss of orientation, a feeling of being lost and bewildered, a groping, turning towards the things of civilian life and all its very different\nvalues. During this period, soldiers tend to be highly labile in mood, unstable and unpredictable. Typically they can hardly be induced to concentrate on anything for very\nlong at a time. The sudden release from the years-old fear of imminent death with the\nrelease of all the consequent tensions, leaves soldiers disorganized and uncertain. These\nstates may be expressed in quarrelling, defiance, drunkenness, even rioting and insurrec-\"\ntion. Aggressive urges which have been carefully nurtured and developed over a period\nof years are supposed to disappear overnight, leaving a peaceful civilian with no such\npressures and consequently no need of outlet. The soldier is expected overnight to give\nup what in very many cases at least is a consuming hatred, and in all cases the object of\naggressive antagonism and to become protective and friendly towards the very people\nwhom he has been hating for years. With the memory of all this, of his friends or rela-\ntimes who have been killed or maimed or even tortured by the enemy, fresh in his\nexperience and kept alive as a spur to his aggressions, this changeover in attitude may\nbe very difficult indeed. It may be successful on the surface but at the expense of extensive repressions and conflict within himself.\nThe cessation of hostilities, in the mind of a soldier, renders his continuing as a\nsoldier completely pointless. He has lost his reason for being a soldier and the period\nduring which he must be kept in the Army with no fighting to do either in the present\nor future feels to him unreasonable and persecutory. All these considerations point to\nthe difficulty in the early stages of the period after the cessation of hostilities.\nIn addition to the disturbed relationship with his immediate environment, he must\nundergo a reorientation towards civilian life, employment, family and friends. In very\nPage Fifty-three many cases the separation between husband and wife has been far more than geographical. Each has been developing along different lines. This is not to indicate that\nthere will necessarily be any loss of love between husband and wife. The tendency is\nrather for each to idealize the other and to maintain a picture of the other which may\nbe too difficult to live up to. On the other hand, suspicion about sexual fidelity is very\ncommon and may cause much trouble, whether justified or not. The relationship of\nthe returning father with his children may also be difficult. The ease of the establishment of such a relationship depends largely on the truth of the picture which the\nmother has presented to the children, of the father. If she has over a period of several\nyears painted a picutre which is rather her idealization of him than himself as he is, the\nchildren and the father will inevitably be in difficulties when he returns. There is a\ntendency in many women to use the absent father as authoritative backing for all their\nown ideas about desirable behaviour in children and to represent the father as having\nattitudes which in fact are their own and not his at all. When the father returns and\npersists in talking and behaving as himself rather than as the idealized picture, the\nchildren may become bewildered, and the mother resentful of her husband's letting down\nher ideal of him.\nCommonly too the wife has for some years been relatively independent, with the\nfamily's money in her own purse to be spent entirely as she sees fit. This circumstance\nhas produced in most women a much greater sense of financial responsibility. A few\nhave become, of course, more irresponsible. The return of the husband will in almost\nevery case affect the financial independence of the wife, so that the spending of family\nresources becomes at best a matter for consultation between husband and wife, and at\nworst an absolute dominance by the husband or by the wife in this field. Either of\nthese latter situations will complicate the re-establishment of the family and the development of the children.\nA further possible complication is the greatly enhanced group value of many women,\nwho have devoted themselves to canteens, Red Cross, and many other services, including\nwar work of all kinds, whether in factories or in committees. It will require a major\nreadjustment for these women if it becomes necessary for them in effect to retire to\ntheir homes and become again \"only\", housewives. It is to be hoped that at least a\nlarge part of this enormous amount of potentially valuable effort can be redirected into\nchannels which will continue to be useful during peacetime.\nIn relation to civilian employment, there is also a major job of reorientation to be\ndone. There are large numbers of men in the Armed Forces who have never had any\nreally stable civilian employment. Many thousands have come directly out of schools\nand colleges. The transition from a closely knit group whose major virtues have been\nbravery, self-sacrifice and value to the group, to a society whose values are most\nusually measured in monetary terms, may be very difficult indeed. Transition from the\nlong continued state of devotion to one's friends and to a cause, to the self-seeking\nattitude which is so common in civilian life, has always been confusing and difficult for\ndemobilizing soldiers. The emotional need of the soldier after years of conditioning, is\nnot just for monetary reward but for emotional status even more importantly. He\nneeds more to feel valuable and important than he does to feel wealthy. This typical\nneed of the returned soldier to feel important to the group, if appreciated and used,\ncan be of the greatest importance to the future of any country. If it is not satisfied\nthe inevitable tendency will be for the returned soldier to segregate himself with those\nof his kind from the mass of the people and to insist on his rights and privileges.\nThe detailing of all these potential difficulties may indicate a pessimistic atttude\nabout the rehabilitation of the soldier. Actually all these difficulties can be avoided or\novercome by intelligent understanding and determination. It is, however, very important\nthat there should not be a general attitude about rehabilitation like the Victorian novelist's idea of marriage, \"And then they were married and lived happily ever after.\" \"And\nthen he returned from the wars and they lived happily ever after\" can be true but will\nbe so only if the inherent problems in this major adjustment are tackled with wisdom\nPage Fifty-four and forbearance. Much can be done to increase the understanding of both soldier and\ncivilian in this field so that it should be possible to develop general understanding of\nthe problems involved, and a much greater degree of tolerance and helpfulness on the\npart of both.\nIn the Army it is proposed to prepare soldiers for demobilization by courses of lectures and discussions in small groups in an attempt to make the transition to civilian fife\nless uncomfortable and, as so often happens, disillusioning. The newspapers, magazines\nand the radio can do much along the same lines for civilians. It should never be taken\nfor granted that all the adjustment has to be done by the returning soldier. Civilians\nmay well find certain aspects of the philosophy of the good soldier which could with\nvalue be incorporated into their own thinking and feeling patterns.\nNEWS AND NOTES\nWe regret to record the passing of: Dr. M. W. Thomas, Executive Secretary of the\nCollege of Physicians and Surgeons, on November 11th; Dr. A. W. Bagnall, of Vancouver, on November 22nd; Dr. G. A. McCurdy, of Victoria, on November 21st; Dr.\nWm. Buchanan, of Peachland, on December 5 th, and Dr. A. McK. Stewart of Haney.\nOf interest to the profession is the marriage of Major A. Maxwell Evans, R.C.A.\nM.C., Radiologist with No. 1 Canadian General Hospital in Italy, to Miss Eleanor Mionr,\nRed Cross Welfare Officer of Windsor, Ont. The wedding took place in Italy.\nCongratulations on the birth of daughters are being received by Dr. and Mrs. Neil\nA. Stewart of Vancouver, and Surg.-Lieut. F. E. Kinsey and Mrs. Kinsey.\nSons were born to Dr. and Mrs. H. Dumont of Vancouver, Dr. and Mrs. H. Emanuele\nof Penticton, and Dr. and Mrs. John Piters of Vancouver.\nLieut.-Col. A. L. Cornish, Victoria; Lieut.-Col. S. A. Wallace, formerly of Kamloops, and Major J. E. Walker of Vancouver are on the staff of the newly commissioned\nhospital ship Letitia, which has just completed her maiden voyage.\nS/Ldr. J. L. Parnell, formerly of Vancouver, is now with the R.C.A.F. headquarters\nin the Middle East.\nCapt. W. S. Huckvale, R.C.A.M.C.-, who was wounded overseas, is back in Vancouver.\nThe following are the officers of the Fraser Valley Medical Association for the year\n1944-45: President, Dr. H. H. MacKenzie; Vice-President, Dr. G. H. Manchester;\nSecretary-Treasurer, Dr. J. G. Robertson. The representative on the Board of Directors\nof the British Columbia Medical Association is Dr. Bruce Cannon.\nThe Board of Directors of the British Columbia Medical Association held a meeting\non November 29th. Those members present from out of town included: Doctors D. M.\nBaillie and P. A. C. Cousland of Victoria; Dr. F. M. Auld, Nelson; Dr. C. H. Hankinson,\nPrince Rupert; Drs. A. H. Meneely and E. D. Emery of Nanaimo, and Dr. G. S. Purvis,\nNew Westminster.\nDoctors F. M. Bryant and Thomas McPherson of Victoria; F. M. Auld, Nelson;\nG. S. Purvis of New Westminster, and E. J. Lyon of Prince George, attended the meeting of the Council of the College of Physicians and Surgeons held in Vancouver on\nNovember 30th.\nPage Fifty-five NOTICE\nIt has been brought to our attention that some medical men fail to write\nprescriptions for narcotics in INK and also fail to DATE prescriptions as\nrequired by law. Druggists may refuse at any time to fill prescriptions not\nwritten in ink or not dated. Medical men must adhere to the rules.\nA. J. McLachlan,\nRegistrar.\nCapt. W. H. S. Stockton, R.C.A.M.C, has returned to Vancouver. Capt. Stockton\nwas injured in an automobile accident in Italy.\nFlight-Lieut. G. A. Lawson, R.CA.F., who has returned to civilian life, is at present\nin the East taking a post-graduate course.\nDoctors C W. Duck, R. A. Hunter, T. M. Jojnes and R. B. Robertson of Victoria\nwere recently on short hunting trips on the mainland.\nDr. W. E. Baker has opened an office in Victoria, confining his work to Ear, Nose\nand Throat. Dr. Baker served with the R.C.A.M.C.\nFlight-Lieut. H. B. McGregor, R.CA.F., has returned to civilian life, and is resuming\npractice in Penticton.\nDr. F. R. G. Langston and his wife, Dr. Kathleen Woods Langston, have returned to\nthe Province, after several years spent in England.\nCapt. P. S. Tennant, R.CA.M.C, has returned to civilian life, and is practising at\nKamloops. \t\nEAST KOOTENAY MEDICAL ASSOCIATION\nOn October 29th, a meeting of the East Kootenay Medical Society was held in\nCranbrook.\nDuring the afternoon, in the St. Eugene Hospital School of Nursing, the scientific\nsessions were heard. Dr. G. O. Matthews gave a talk on \"Some Paediatric Conditions\nand their Treatment\" and Dr. Murray Meekison spoke on \"Common Problems met\nwith in dealing with Fractures.\" These papers were well received and thoroughly appreciated.\nDuring the short intermission between papers the Sisters of St. Eugene Hospital\nprovided refreshments.\nIn the evening a dinner was held in the Cranbrook Hotel. Following dinner, Dr.\nG. O. Matthews, President of the British Columbia Medical Association, addressed the\nmembers. Among other matters he discussed the formation of a Faculty of Medicine\nin B. C\nDr. M. W. Thomas, Executive Secretary of the College of Physicians and Surgeons,\nspoke briefly on medical economics, and on the subject of a revised schedule of fees.\nDr. F. M. Auld of Nelson, member of the Council of the College for the Kootenays,\ngave a short address on the activities of the Qmncil.\nDr. H. H. Milburn, President of the College of Physicians and Surgeons, described\nvarious health plans, and brought up the subject of a Medical Faculty.\nDr. F. W. Green spoke briefly on medical practice in East Kootenay. As M.L.A. for\nthe District he would be pleased to place before the Provincial Legislature any subjects\nwhich the College of Physicians and Surgeons wished to bring to its attention.\nAfter a short address by Dr. W. O. Green, in which he thanked, the visiting doctors\nfor devoting so much time in attending the meeting in Cranbrook, the officers for the\ncoming year were chosen:\nPage Fifty-six\n\u00E2\u0096\u00A0 President: Dr. J. Vernon Murray, Creston; Vice-President: Dr. T. J. Sullivan, Cranbrook; Secretary: Dr. W. O. Green, Cranbrook.\nThose members present at the meeting included: Drs. G. O. Matthews, D. M.\nMeekison, H. H. Milburn, M. W. Thomas, from Vancouver; Dr. F. M. Auld, Nelson;\nDr. G. W. Leroux, Fernie; Dr. J. Vernon Murray, Creston; Dr. A. E. Kydd, Michel;\nDr. J. M. Tedford, Kimberley; Drs. F. W. Green, W. O. Green and T. J. Sullivan,\nCranbrook.\nDISTRICT No. 4 MEDICAL ASSOCIATION\nANNUAL MEETING\nThe annual meeting of District No. 4 Medical Association was held in Kelowna on\nThursday, October 26th, at the Royal Anne Hotel. Dr. L. A. C. Panton, President,\npresided over the sessions, and was ably assisted by Dr. W. F. Anderson, Secretary.\nDr. Gordon O. Matthews and Dr. D. Murray Meekison, both of Vancouver, gave\nscientific papers, the former dealing with paediatrics and the latter orthopaedic surgery.\nThe election placed the following in office:\nPresident: Dr. R. W. Irving, Kamloops; Vice-President: Dr. J. R. Parmley, Penticton; Secretary-Treasurer: Dr. C J. M. Willoughby, Kamloops; Representative on the\nBoard of Directors of the British Columbia Medical Association: Dr. R. W. Irving.\nIt was decided that the next annual meeting would be held in Kamloops.\nThose present at the meeting included: Dr. G. O. Matthews, Vancouver, President\nof the British Columbia Medical Association; Dr. H. H. Milburn, Vancouver, President\nof the College of Physicians and Surgeons of B. C; Dr. M. W. Thomas, Executive Secretary of the College of Physicians and Surgeons; Dr. E. J. Lyon, Prince George, District\nRepresentative on the Council of the College of Physicians and Surgeons; Dr. D. Murray\nMeekison, Vancouver; Drs. J. S. Burris, R. W. Irving, H. F. P. Grafton of Kamloops;\nDr. A. F. Gillis, Merritt; Drs. R. H. Irish, E. A. Gee, W. G. Trapp Tranquille; Dr. W.\nA. Drununond, Salmon Arm; Dr. J. H. Kope, Enderby; Dr. R. Haugen, Armstrong;\nDrs. J. E. Harvey, A. J. Wright, F. E. Pettman, H. I. Campbell-Brown, J. A. Taylor,\nVernon; Dr. W. H. B. Munn, Flight-Lieut. A. W. Vanderburgh, Summerland; Drs.\nJ. R. Parmley, L. F. Brogden, Penticton; Dr. G. W. Cope, Oliver; Drs. W. J. Knox,\nB. de F. Boyce, L. A. C Panton, W. F. Anderson, A. S. Underhill, D. M. Black, J. A.\nUrquhart, G. McL. Wilson, J. S. Henderson and D. B. Avison of Kelowna.\nWEST KOOTENAY MEDICAL ASSOCIATION\nANNUAL MEETING\nThe West Kootenay Medical Association held its annual meeting in Rossland on\nSaturday, October 28 th, at the Rossland Hospital. The meeting was under the able\nchairmanship of Dr. E. E. Topliff, President.\nThe team from Vancouver included Dr. Gordon O. Matthews, Paediatrician, and\nPresident of the British Columbia Medical Association; Dr. D. Murray Meekison, Orthopaedist; Dr. H, H. Milburn, President of the College of Physicians and Surgeons, and\nDr. M. W. Thomas, Executive Secretary of the College. Dr. Matthews and Dr. Meekison contributed papers of a scientific nature to the meeting, while Dr. Milburn and\nDr. Thomas addressed the gathering at the banquet which followed.\nThe following were elected to office:\nHonorary President: Dr. G. M. Kingston, Grand Forks; President, Dr. G. R. Barrett,\nNelson; Vice-President: Dr. Arnold Francis, New Denver; Secretary-Treasurer: Dr.\nWilfrid Laishley, Nelson; Representative on the Board of Directors of the British Columbia Medical Association: Dr. G. R. Barrett.\nThe meeting was well attended and among those present were: Drs. E. E. Topliff,\nand L. B. Wrinch, Rossland; Drs. W. A. Coghlin, M. R. Basted, D. J. M. Crawford,\nJ. S. Daly, E. S. Hoare, M. E. Krause, Wm. Leonard of Trail; W. H. Ormond, Sloe an;\nDr. Arnold Francis, New Denver; Drs. F. M. Auld, W. Laishley, N. E. Morrison, G. R.\nBarrett, R. B. Brummitt of Nelson; Captain Gordon, and Drs. G. O. Matthews, D. M.\nMeekison, H. H. Milburn and M. W. Thomas, Vancouver.\nPage Fifty-seven REMUNERATION TO PRIVATE PHYSICIANS FOR\nINDIGENT V.D. CASES\nThe Division of Venereal Disease Control of the Provincial Board of Health is\npleased to announce that as from December 1, 1944, there will be an increase in the\nrate of payment to private physicians for treating venereal disease cases who are unable\nto make any payment for such treatment. Payment is made only to private physicians\npractising in areas where no clinic is operated by the Division. The usual reasonable fee\ncharged will be paid for the initial examination, including smear, pelvic examination in\nwomen and blood tests. For the treatment of syphilitic cases, the rate will be $2.00 per\ninjection, and for additional visits for the treatment of gonorrhoea the rate will be\n$2.00 per visit. Physicians practising in those areas where there is a full time health\nunit are asked to submit their accounts to the Director of the Health Unit, otherwise\nthe accounts should be sent to the Division of V.D. Control, 2700 Laurel Street, Vancouver. All accounts must be in triplicate.\nDR. GORDON ALEXANDER McCURDY\n1907: Born Sydney, Nova Scotia. Died: Victoria, British Columbia, 1944.\nIn the death, at the early age of 37, of Dr. Gordon McCurdy, the medical\nprofession and the citizens of British Columbia have suffered a serious loss.\nDr. McCurdy was a graduate of Dalhousie University in both Arts and Medicine. On completion of his University course in 1933, he did post-graduate\nwork in Pathology at Glasgow University and returned to Halifax as Assistant\nto Dr. Ralph Smith, Provincial Pathologist. In 1937 he was appointed Director\nof of the Pathological Department of The Royal Jubilee Hospital in Victoria.\nDuring the next seven years, in spite of impaired health, he was enthusiastic in\nbuilding up his own Department, organizing Pathological Conferences and\nassisting in the scientific work of the Victoria Medical Society. He qualified\nfor membership in the American Board of Pathologists and as a fellow of the\nAmerican Society of Chemical Pathology. His professional work was characterized by a very high degree of intellectual integrity and in demanding a high\nstandard of scientific work from himself he predicated the same in his associates. In addition to his his special training, Dr. McCurdy had an unusual\naptitude in correlating clinical medicine with the Pathological and Bacteriological findings.\nHowever skill and judgment in his own work, important as they were, would\nnot alone have accounted for his success. He had an exceptional facility in\nmaking lasting friendships. He had early learned to follow the advice of\nPolonius:\n\"Those friends thou hast and their adoption tried,\nGrapple them to thy soul with hooks of steel.\"\nand the friends of college days remained steadfast and loyal in spite of passing\nyears and separation.\nDr. McCurdy had few outside interests but those privileged to know him\nin his own home quickly realized how deep was the satisfaction he found in\nthe world of music opened to him by bis gifted wife.\nWe shall all miss Dr. McCurdy in our daily work and wish for bis guidance\nand enthusiasm.\n\u00E2\u0080\u0094H. H. Murphy.\nPage Fifty-eight MERSALYL B.D\nThe Standard Mercurial Diuretic\nA mercurial preparation is essential for the efficient and rapid\ninduction of diuresis.\nMersalyl (described in the Addendum 1936 to the B.P. 1932)\nis accepted as the standard mercurial diuertic. In common with\nall potent drugs, it has some toxic properties, but these are of\nlittle significance as compared with the benefits associated with\nits controlled use. A few cases of idiosyncrasy have been reported, but, as has been stated in a report upon the use of intravenous\nmercurial diuretics (Lancet, May 8th, 1943, p. 576), 'The occurrence of a few unfortunate reactions is not an indication to withhold the\ndrug but rather to use care in administering it*.\nMersalyl is indicated principally for the treatment of ascites and\noedema of cardiac and cardio-renal origin and ascites due to\nhepatic cirrhosis.\nMersalyl is normally administered by injection for which purpose\nit is available as Mersalyl B.D.H. in ampoules. For supplementary\ntreatment in prolonging the diuresis induced by an injection\nMersalyl B.D.H. is available in tablets for oral administration and\nin suppositories for rectal use.\nStocks of Mersalyl B.D.H. are held by leading druggists throughout\nthe Dominion, and full particulars are obtainable from ....\nTHE BRITISH DRUG HOUSES (CANADA) LTD.\nToronto Canada\nMrsl/Can/4411 \"That's What I Call Rapid Healing!\"\nAFTER TEN DAYS of Amphojel treatment (with,\nof course, an appropriate regime of diet and rest),\nx-ray re-examination often reveals complete disappearance of the peptic ulcer niche.f\nIn addition to promoting rapid healing of the ulcer,\nAmphojel offers:\nPrompt relief from pain\nFewer recurrences\nSuperior weight gain during treatment\nNo alkalosis\nAMPHOJEL\n\"Canada's Original Alumina Gel\"\nA \"Wyethical\"\ntWOLDMAN, EX., and POLAN, C.G.: Th* value of Colloidal Aluminum Hydroxide in the Treatment\nof Peptic Ulcer/ A Review of 407 Consecutive Cases, Am. J. M. Sc. 198:155-164 (Aug.) 1939.\nJOHN WYETH & BROTHER (Canada) LIMITED, Walkerville\n*i; fad\n4M\u00C2\u00BB#**w!\nIt's calls like this, as frequent today as in the\npre-war years, that best serve to explain why\nG-E x-ray and electromedical equipment\ncontinues to efficiently meet the abnormal\nservice demands of wartime civilian practice.\nVerily, G-E customers appreciate today, as never before, the value and\nimportantance of G. E.'s Periodic\nInspection and Adjustment\nService. For in face of the\nunprecedented load imposed on the medical home\nfront, and the difficulty of\nobtaining new and additional\nequipment that would facilitate the\nhandling of this increased amount of\nwork, there was but one alternative: to\nget the most possible service out of existing\nequipment, for the duration.\nMany an investment in G-E equipment has\nbeen based on the assurance that this organi-\nzation would always maintain a nationwide\nfield organization whereby expert technical and\nmaintenance service is conveniently available at all\ntimes. And G. E.'s P. I. and A. Service has been\nconsistently making good that promise\u00E2\u0080\u0094-despite many wartime handicaps\u00E2\u0080\u0094in G-E equipped hospitals, clinics, and physician's offices\nthroughout the United States and Canada.\nSimilarily we are determined to justify your\nfuture investments in G-E products, by supplementing their well-known high quality\nand efficiency with a competentfieldservice.\nWrite for the headquarters address of our\nlocal representative, who stands ready to\nhelp you plan for your present or future\nneeds.\nVICTOR X-RAY CORPORATION of CANADA, Lw.\nDISTRIBUTORS TOR GENERAL ||| ELECTRIC X-RAY CORPORATION\nTORONTO: 30 Hour SUW.-VANCOUVER: Motor Trans. Bldg., 570 Dunsmuir SI\nMONTREAL: 600 Medical Arts Building - WINNIPEG: Medical Arts Building\n.VIK**\nfcOtAttlS\n/Jw_*> 7?eff &*f - Ala SavtMft Chfifieafei ^\nami*OMiH 9mm w: w. n urn i *sr??3\u00C2\u00ABss!S!\u00C2\u00AB9SS\"B\nFor those\nwho eat and run...\nA bite, a gulp and he's off. But that's no meal for an\nactive person. A hurried breakfast or a hurried lunch\ndoes not tend to provide all the food nutrients which\neveryone needs\u00E2\u0080\u0094especially today. \"Alphamin\" taken\ndaily will help to adjust this all too common dietary state.\nCjjeMt\n\"ALPHAMIN\"\nA biologically-standardized product of essential vitamins (A, B, C and D) and minerals (iron and calcium).\n^sp?\nSupplied in boxes of 25 and 50 doses.\n230\nAYERST, McKENNA St HARRISON LIMITED \u00E2\u0080\u00A2 Biological amd Pharmaceutical Chomitts \u00E2\u0080\u00A2 MONTREAL, CANADA '\u00E2\u0096\u00A0.\"\u00E2\u0096\u00A0 \"_--.___\u00E2\u0080\u00A2\n\u00E2\u0096\u00A0*fkt* I \"*T'.\ngS-SiS1-?\nOutlook for the Future\nCALSOL\nA duo-capsule preparation containing\n8 vitamins and 4 minerals.\nIndicated wherever a vitamin-mineral\ncombination is needed and as a dietary\nsupplement in pregnancy.\nFRANK W. HORNER LIMITED\nMontreal Canada\nr^J?\n.^t\u00C2\u00ABOfe\n\u00E2\u0080\u00A24fi^\n\u00C2\u00BB. * ,**__\n\"\"Mil JP6 ..\nt\"_E\ 3\u00C2\u00AB^_-\u00C2\u00BBi\n-___^____\u00C2\u00BB v^__\".\nK^r\n^JP^wS^^^\nE_f9%. _ _ * I t_\n'Xg^T- ^._i_\nJ*\u00C2\u00A3\n:.yX^'\n*\u00C2\u00BB \u00E2\u0080\u00A2 :\n\u00E2\u0080\u00A2*_.\n\u00C2\u00AB*/*g\n\u00E2\u0096\u00A0^\"\n$ 15\ni\u00C2\u00AB\n\u00C2\u00B0* 13\n3 12\nS 11\nz 10\nLU 9\n_*\n< 8\nZ 7\nZ 6\n\u00C2\u00B0 q\not 0\n> 4\nI 3\nQ 2\n1\nIRON\nDURING THE FIRST TWO YEARS\nEGG, LIVER,\nVEGETABLES,\nYEAST, ETC\nPABLUM (OR PABENA)\n\"T^.VftM \u00C2\u00AB\u00C2\u00AE Dl\u00C2\u00AB- WITH YIAST EXTRAO\n\u00E2\u0080\u00A2\u00E2\u0080\u00A2\tf_lttM\ne*'\nVl\u00C2\u00AB*\nEXTRACT\nAND IRON (\"D.M.B.\")\nAGt,Mos. Va 1 2 3 4 5 6 9 12 18 24\nWEIGHT, Lbs. 7 9 10 12 14 15 16 19 22 23 25\nMILK, Oz. 10 16 18 21\n24\n26\n20\n32 32 32\n32\nMD.HiB.rOz. 1 1 VA VA\n1V_\n1%\nVA\n1 Va 0\n0\nPABLUM, Oz. 0 0 0 Vs\nVa\nVa\nV_\nVa 1 1\n1\nIRON DURING\nTHE\nFIRST\n' TWO YEARS\nDuring foetal life iron accumulates (in the form of haemoglobin) in the infant's body.\nAfter birth the haemoglobin frequently drops to 50% by the third month, especially\nin prematures. Neither breast milk nor cow's milk is capable of offsetting this loss,\nas they are deficient in iron. This chart shows that when the carbohydrate and cereal\nsupplements contain iron, a sizeable margin of safety over the requirements can be\nmaintained, not only during the important first six months, but throughout the first\ntwo years of life.\nMore iron than the calculated requirement is needed because some iron is not utilized. In rapidly growing, or poorly nourished infants, and in the presence of infection,\nthe need for iron may be even greater than is indicated in this chart for normal infants.\nMEAD JOHNSON & COMPANY OF CANADA, Ltd., Belleville, Ontario II\n(sodium ethyl sec\nbutyl barbiturate\n\"JtomD\nA SAFE QUICK ACTING SEDATIVE, FREE FROM \"HANG-OVER\"\nFor sedation, hypnosis and to augment the action\nof analgesics.\n\"Noctinal\" is intermediate between the very short\nacting barbiturates, such as Pentobarbital, and the\nlong acting, like Phenobarbital. It is effective in 30\nminutes and lasts 4 to 6 hours. The patient awakes\nrefreshed after a sound, restful sleep, with no\nhang-over\" of depression.\n\"Noctinal\" is safe. Even in excess of full therapeutic doses, it has practically no toxic effect on\nheart, blood pressure, respiration or kidneys. It is\neasily soluble in water and is quickly eliminated.\nThe Canadian Mark of Quality Pharmaceuticals Shut 1899\nDOSAGE\nTABLETS*\nWhen mild continuous sedation is required:\nJ_ to 1 grain two to three times daily.\nIn insomnia: 1^_ grains about one-half hour\nbefore retiring.\nIn excited states: 1 J_ to 3 grains two or three\ntimes daily.\nBest results are obtained if\nfollowed by a warm drink.\nLIQUID >\nAverage dose for adults: Two to three fluid\ndrachms (7 to 11 cc) in a wine glass of water.\nMaximum daily dose for adults: Two fluid\nounces (57 cc).\nMODES OF ISSUE\n\"Noctinal\", J_ gr. CT. No. 352 \"JrowT\n\"Noctinal**, 1*_ gr. CT. No. 353 \"SmuT\nBoth tablets are grooved to\nfacilitate halving the dose.\n\"Noctinal\" Elixir No. 601 _w\u00C2\u00BBf\n\u00C2\u00A7MC66t\nehwikd _ _fto**t &-&\nMONTREAL CANADA\nWHERE QUALITY AND PRICE ARE EQUAL OR BETTER, PRESCRIBE CANADIAN PRODUCTS Colonic and\nPhysiotherapy Centre\nUp-to-date Scientific Treatments\nCOLONIC IRRIGATIONS, SHORTWAVE\nDIATHERMY, SINNEWAVE GALVIN-\nISM, IONIZATION, ULTRA VIOLET\nRAY, STEAM BATHS AND SHOWERS\nMedical and Swedish Massage\nPhysical Culture Exercises\nSTAFF OF GRADUATE NURSES\nSuperintendent:\nE. M. LEONARD, R.N.\nPost Graduate Mayo Bros.\n1119 Vancouver Block\nMArine 3723 Vancouver, B.C.\nIF ARTHRITIS and ECZEMA\nARE ALLERGIC\nETIOLOGICALLY\neffective treatment suggests the use of\nagents to correct mineral deficiency,\nincrease cellular activity, and secure\nadequate elimination of toxic watte.\nLYXANTHINE ASTIER -*{\norally given, supplies calcium, sulphur,\niodine, and lysidin bitartrate \u00E2\u0080\u0094 an\neffective solvent. Amelioration of\nsymptoms and general functional improvement may be expected.\nWrite for Information.\nL-15\nCanadian Distributors\nROUGIER FRERES\n350 Le Moyne Street, Montreal\nJ\nBreaks the vicious circle of perverted\nmenstrual function in cases of amenorrhea,\ntardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic\nrelief by stimulating the innervation of the\nuterus and stabilizing the tone of its\nmusculature. Controls the utero-ovarian*\nk circulation and thereby encourages a ,\n-^ normal menstrual cycle.\n\u00E2\u0096\u00A0W* MARTIN H. SMITH COMPANY jf\nsS&x ISO tAFAYim Sttltl. NIW TOIK. N. T. __\u00E2\u0096\u00A0\nFull formula and descriptive\nliterature on request\nDosage: 1 to 2 capsules\n3 or 4 times dally. Supplied\nin packages of 20.\nEthical protective mark MHS\nembossed on inside of each\ncapsule, visible only when capsule is cut in half at seam. FATHERS OF CAM AD IAN MEDICINE\n\u00E2\u0080\u00A2one of a series\nThis pamphlet, written\nby Badelard, is thought\nto be the first Canadian\npublication of a medical\nnature.\nPHYSICIAN AND SURGEON (1730-1802)\nBORN in 1730, in Picardy, Badelard obtained his medical degree in France and\ncame to Canada as surgeon to the French\ntroops. During the Battle of the Plains of\nAbraham he was made prisoner by a Scot\nnamed Fraser. They became life-long friends.\nAfter the Conquest he settled in Quebec where\nhe won recognition as a skilful surgeon.\nHe enrolled in the Canadian Militia in 1775\nand the following year was commissioned as\nSurgeon to the Quebec Garrison. At the request of Governor Haldimand, he investigated\nan outbreak of disease at Baie St. Paul.\nBadelard continued this investigation until\n1782. He diagnosed the disease as syphilis\nand prescribed various forms of mercury in\ntreating it.\nIn 1785, a pamphlet giving detailed instructions for the treatment of the malady and\nthe dosage of mercurial remedies prescribed\nwas written, by Badelard and circulated by\nthe Government to all parishes for the instruction of the people. (See illustration above.)\nIn 1788, Badelard was conspicuous in supporting a legislative measure to compel any-\nWILLIAM\none wishing to practise Physic, Surgery or\nMidwifery in Quebec to undergo examinations\nand obtain a qualifying Diploma.\nOf a somewhat irascible temperament,\nBadelard seems later to have gained universal\nrespect and affection, for at the time of his\ndeath, in 1802, he was followed to his family\nburial place at Ancienne Lorette \"in spite of\nintense cold\" by a great throng of clergy and\ncitizens of ail classes. He bequeathed 12,000\nlivres (Foundation Badelard) to L'Hopitai\nGeneral for rhe purpose of \"wintering, lodging\nand feeding two poor people\". His obituary\ndescribes him as of \"a nature faithful, zealous,\ncharitable, gay and frank . . . the declared\nenemy of hypocrisy\".\nThe example set by men like Badelard in\nhelping to establish a sound foundation for\nthe practice of medicine\nin Canada inspires this\norganization to maintain\nwith unceasing vigilance\nits policy\u00E2\u0080\u0094Therapeutic\nExactness and Pharmaceutical Excellence.\n& COMPANY LTD.\nTHE SYMBOL OF\nPHARMACEUTICAL\nEXCELLENCE\nManufacturing Pharmaceutists\n727-733 KING STREET WEST, TORONTO\n185*- 1944\nESTABLISHED 1854 LINKS IN THE CHAIN OF TREATMENT\nlORYPHEDRINE\nIICATIONS:\u00E2\u0080\u0094 GRIPPE, CORYZA, RHINITIS, SINUSITIS, TRACHEITIS\nILT DOSE:- ONE TO FOUR TABLETS PER DAY:- IN CONTAINERS OF 20, 100, 500 AND 1000 TABLETS\nOLUSEPTAZINE\nWITH\nEPHEDRINE\ncations:\u00E2\u0080\u0094 Nasal Congestion with Obstruction, Coryza, Acute Rhinitis, Nasopharyngitis\nLIED BY DROFPER TUBE, ATOMIZER OR SWAB:- IN BOTTLES OF 30 C.C. AND 250 C.C.\nGONACRM\nDICATIONS:- ORAL ANTISEPSIS, TONSILLITIS, PHARYNGITIS\nOW PASTILLE TO DISSOLVE SLOWLY IN THE MOUTH:- SUPPLIED IN BOXES OF 20 AND 40 PASTILLES\nASTIUES\nLI MITED\u00E2\u0080\u0094 MONTREAL MILK -\nGonadal Vital\nFOOD FOR VICTORY\nMilk is accepted as the most valuable protective\nfood because it surpasses all others in supplying\nvitamins, minerals, and high quality proteins that\nbuild and maintain sound physical fitness. No\nwonder our fighting forces are among the best fed\nin the world\u00E2\u0080\u0094their milk consumption is exceptionally high\u00E2\u0080\u0094and no wonder Canada's home front,\ntoo, is by far the best fed!\nA quart of milk (4 glasses) gives the following\npercentages of your DAILY FOOR NEEDS.\nIron 16%\nVitamin C*% 16%\nEnergy 22%\nVitamin B 28%\nCalcium\n* Values Variable.\nVitamin A 37%\nProtein ,49%\nVitamin G 79%\nPhosphorus 69%\n 100% MATURITY...\nTHE BULLETIN\nof the Vancouver Medical Association is now in\nits 21st year\u00E2\u0080\u0094strong, vigorous, and efficient.\nIt has been the privilege of Georgia Pharmacy\nto grow beside it, year by yearMWe hope to\ncontinue to share your reflected glory.\nPhone\nMArine 4161\nj\u00C2\u00A3**&L *& Jitmd**\u00C2\u00BB\\nGEORGIA PHARMACY\n13 th Ave. and Heather St.\nExclusive Ambulance Service\nFAirmont 0080\nPRIVATE AMBULANCES AND INVALID COACHES\nWE SPECIALIZE IN AMBULANCE SERVICE ONLY\nJ. H. C___I_LIN\nW. L. BERTRAND \u00E2\u0096\u00A0pi\nHi\n*\nNew Westminster, B. C.\nUor the treatment of\nNEUROPSYCHIATRIC\nDISORDERS\nReference\u00E2\u0080\u0094B. C. Medical Association\nFor information apply to\nMedical Superintendent, New \"Westminster, B. C.\nNew Westminster 288\nor 721 Medical-Pental Building, Vancouver, B. C.\nPAcific 7823 PAciftc 803*\n\u00C2\u00BB_7"@en . "Periodicals"@en . "W1 .VA625"@en . "W1_VA625_1944_11"@en . "10.14288/1.0214549"@en . "English"@en . "Vancouver : University of British Columbia Library"@en . "Vancouver, B.C. : McBeath Spedding Limited"@en . "Images provided for research and reference use only. Permission to publish, copy, or otherwise use these images must be obtained from the Digitization Centre: http://digitize.library.ubc.ca/"@en . "Original Format: University of British Columbia. Library. Woodward Library Memorial Room. W1 .VA625"@en . "Medicine--Periodicals"@en . "The Vancouver Medical Association Bulletin: November, 1944"@en . "Text"@en . ""@en .