"CONTENTdm"@en . "http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1179642"@en . "History of Nursing in Pacific Canada"@en . "Vancouver Medical Association"@en . "1941-07"@en . "2015-01-30"@en . "1941-07"@en . "https://open.library.ubc.ca/collections/vma/items/1.0214573/source.json"@en . "image/jpeg"@en . " of the\n{VANCOUVER\nMEDICAL ASSOCIATION\n\u00E2\u0080\u00A2Vol. XVII\nJULY, 1941\nNo. 10-\nWith Which li Incorporated\nTransactions of the\nVictoria Medical Society\nthe\nVancouver General Hospital\nand\nSt Paul's Hospital\nIn This Issue:\nNEWS AND NOTES\nNOTES OF ANNUAL MEETING C. M. A. |g -|\u00C2\u00A7g _^;, _^}|293\nBULLETIN WAR RELIEF FUNE^fe; - ~.|||| \u00E2\u0080\u0094 l|ltffS ||||| --^294\nCYSTOMETRY\u00E2\u0080\u0094Dr. L. G. Woo4J\u00C2\u00A3\u00C2\u00A7H\u00C2\u00A3|- _ \u00E2\u0080\u0094 , ^^ffl- - 2\"\nNUTRITIONAL REQUIREMENTS OF THE GROWING CHILD\n\u00E2\u0080\u0094Dr. P. C. Jeans-}^pl. --^\u00E2\u0080\u0094 ^^^H 3\u00C2\u00B04\nPROFESSIONAL INSTITUTE MEDAL :|ill jjliill _ ^\u00E2\u0080\u0094 308\nANNUAL MEETING OF BRITISH COLUMBIA MEDICAL ASSN.,\n1941 \u00E2\u0080\u0094 SEPTEMBER 16, 17, 18.\n\u00E2\u0096\u00A0 t>\nH '\n\u00E2\u0096\u00A0 i\ns\ns\n*K\n4\n* i\nri.\n\u00C2\u00BBA\nMi-\nm\n1/5* \u00C2\u00AB\niaii-J*;,\n51\nAQUAPHEDRIN \u00C2\u00A3.<\u00C2\u00AB\u00C2\u00ABS\nAQUEOUS ISOTONIC\nBACTERIOSTATIC\nAquaphedrin E.B.S. is an aqueous solution of Ephedrine,\nequivalent to a \% solution of Ephedrine Alkaloid. Being\naqueous, Aquaphedrin rapidly diffuses into the natural\nsecretions of the nasal mucosa, without inhibiting ciliary\naction and, being isotonic, it diffuses rapidly and without\nosmosis and, therefore, permits the Ephedrine to exert its\nunique decongestive effect.\nUnlike most Ephedrine solutions, Aquaphedrin E.B.S. is\neffective without stinging and its application is followed\nby grateful relief.\nAquaphedrin is effective in reducing swollen or congested\nturbinates and in relieving congestion of the mucous lining\nin head colds, nasopharyngeal inflammation, sinus blockage,\nhay fever, asthma and other nasal conditions.\nAquaphedrin E.B.S. is packaged in ^ \u00C2\u00B02\u00C2\u00ABana> 1 \u00C2\u00B02- dropper\nbottles, with detachable labels for convenience in dispensing. Also supplied in bulk for use in an atomizer.\nSpecify Aquaphedrin E.BS. on your prescriptions.\ntil L\nTHE E. B. SHOTTLEWORTH CHEMICAL C0.4IMITED\nTORONTO\nMANUFACTURING CHEMISTS\nCANADA\nSPICIPY E. S. S. ON YOUI PIISCIIPTIONS THE VANCOUVER MEDICAL ASSOCIATION\nBULLETIN\nPublished 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\nDr. G. A. Davidson Dr. D. E. H. Cleveland\nAll communications to be addressed to the Editor at the above address.\nVol. XVH\nJuly, 1941\nNo. 10\nOFFICERS, 1940-1941\nDr. W. M. Paton Dr. C. McDiarmid Dr. D. F. Busteed\nPresident Vice-President Past President\nDr. W. T. Lockhart Dr. R. A. Palmer\nHon. Treasurer Hon. Secretary\nAdditional Members of Executive: Dr. Gordon Burke, Dr. Frank Turnbull\nTRUSTEES\nDr. F. Brodie Dr. J. A. Gillespie Dr. G. H. Clement\nAuditors: Messrs. Plommer, Whiting & Co.\nSECTIONS\nClinical Section\nDr. Karl Haig Chairman Dr. Ross Davidson Secretary\nEye, Ear, Nose and Throat\nDr. J. A. McLean Chairman Dr. A. R. Anthonys Secretary\nPediatric Section\nDr. R. P. Kinsman Chairman Dr. G. O. Matthews Secretary\nSTANDING COMMITTEES\nLibrary:\nDr. F. J. Buller, Dr. D. E. H. Cleveland, Dr. J. R. Davies,\nDr. A. Bagnall, Dr. A. B. Manson, Dr. B. J. Harrison\nPublications:\nDr. J. H. MacDermot, Dr. D. E. H. Cleveland, Dr. G. A. Davidson.\nSummer School:\nDr. H. H. Caple, Dr. W. W. Simpson, Dr. Karl Haig, Dr. J. E. Harrison,\nDr. H. H. Hatfield, Dr. Howard Spohn.\nCredentials:\nDr. A. W. Hunter, Dr. W. L. Pedlow, Dr. A. T. Henry\nV. O. N. Advisory Board:\nDr. W. C. Walsh, Dr. R. E. McKechnie II., Dr. L. W. McNutt.\nMetropolitan Health Board Advisory Committee:\nDr. W. D. Patton, Dr. W. D. Kennedy, Dr. G. A. Lamont.\nGreater Vancouver Health League Representatives:\nDr. R. A. Wilson, Dr. Wallace Coburn.\nRepresentative to B. C. Medical Association: Dr. D. F. Busteed.\nSickness and Benevolent Fund: The President\u00E2\u0080\u0094The Trustees. J T\n.\n;.*'\nt\n** \u00E2\u0096\u00A0>,;\nIN\nM\nr\n';\n\u00E2\u0080\u00A2\u00E2\u0080\u00A2\n\u00E2\u0080\u00A2 Ii\nSI\n?tt\n..,; \u00C2\u00BB\n3n&\n'Ibt*\nP^\nThe New Test for\nDiabetic Sugar\nDIABETICS are easily taught to use Galatest, the new micro-\nreagent for detecting diabetic sugar.\nNo test tubes or boiling necessary. One drop of urine deposited on a little Galatest powder, gives an instantaneous reaction.\nCo/or chart accompanies every vial\nTHE DENVER CHEMICAL MFG. CO., 153 Lagauchetiere St. W., Montreal VANCOUVER HEALTH DEPARTMENT\nSTATISTICS\u00E2\u0080\u0094MAY, 1941\nTotal population\u00E2\u0080\u0094estimated 272,352\nJapanese population\u00E2\u0080\u0094estimated 8,769\nChinese population\u00E2\u0080\u0094estimated ; 8,558\nHindu population\u00E2\u0080\u0094estimated _ ; 360\nRate per 1,000\nNumber Population\nTotal deaths 264 11.4\nJapanese deaths 4 5.4\nChinese deaths 16 25.8\nDeaths\u00E2\u0080\u0094residents only 223 9.6\nBIRTH REGISTRATIONS:\nMale, 244; Female, 240-\n484\nINFANTILE MORTALITY\u00E2\u0080\u0094 May, 1941\nDeaths under one year of age 11\nDeath rate\u00E2\u0080\u0094per 1,000 births ! 22.7\nStillbirths (not included in above) 7\n20.9\nMay, 1940\n9\n20.6\n8\nCASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY\nApril, 1941 May, 1941 June 1-15,1941\nCases Deaths\n ; 5\n 0\n 36\n 349\n 132\n 5\n 1\n 0\n 0\nPoliomyelitis . 0\nTuberculosis 21\nErysipelas - 1\nMeningococcus Meingitis 6\nParatyphoid Fever (Carrier) 0\nScarlet Fever\t\nDiphtheria\t\nChicken Pox\t\nMeasles\t\nRubella I\t\nMumps _\nWhooping Cough\t\nTyphoid Fever\t\nUndulant Fever\t\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n16\n0\n0\n0\nCases\n3\n0\n73\n204\n133\n16\n23\n0\n1\n0\n36\n2\n5\n1\nDeaths\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n16\n0\n2\n0\nCases\n3\n0\n62\n20\n32\n1\n3\n0\n0\n0\n10\n1\n1\n0\nDeaths\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\n0\nV. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH,\nDIVISION OF VENEREAL DISEASE CONTROL\nWest North\nBurnaby Vancr. Richmond Vancr.\nSyphilis \t\nGonorrhoea\nVane. Hospitals &\nClinic Private Drs. Totals\n37 30 67\n58 23 81\nA DYNAMIC MENTAL AND PHYSICAL TONIC\nINDICATED IN THESE DAYS OF STRESS\n<< A \"\nBIOGLAN \"A\nAnother Product of the Bioglan Laboratories, Hertford, England\nPhone MA. 4027\nStanley N. Bayne, Representative\n1432 MEDICAL-DENTAL BUILDING\nDescriptive Literature on Request\nTHE SCIENTIFIC HORMONE TREATMENT\nVancouver, B. C.\nPage 285 if\nm\n1\n>,.,\n? t.\nIB\nif\nr\nii *\nSTILBOiSTROL B.D.H.\nProlonged clinical trials have now established the value of\nStiiboestrol B.D.H. in all conditions due to defective ovarian follicular function.\nSuch conditions as delayed puberty, menopausal disorders, pruritus\nvulvae, senile vaginitis, vuIvo-vaginitis in children, secondary amen-\norrhcea and sterility with dysmenorrhea associated with uterine\nhypoplasia will be found to respond to oral administration of\nStiiboestrol B.D.H.\n!n certain patients, however, it is found that stiiboestrol gives rise\nto gastro-intestinal disturbances upon administration, these disturbances being characterised by vomiting and a marked feeling\nof nausea. Such cases should receive continued treatment with\nthe natural cestrogenic hormone, Oestroform, which, being a substance that is normally generated in the body, is incapable of\nprovoking a reaction and is readily tolerated in all cases.\nStocks of Stiiboestrol B.D.H. are held by leading druggists throughout the\nDominion, and full particulars are obtainable from:\nTHE BRITISH DRUG HOUSES (CANADA) LTD.\nTerminal Warehouse\nToronto 2 Ont.\nSti;b/Can/417 BRIEF HISTORICAL NOTES\nON\nMEADS CEREAL AND PABLUM\nJtiAND in hand with pediatric progress, the introduction of Mead's Cereal\nin 1930 marked a new concept in the function of cereals in the child's dietary.\nFor 150 years before that, since the days of \"pap\" and \"panada,\" there had\nbeen no noteworthy improvement in the nutritive quality of cereals for\ninfant feeding. Cereals were fed principally for their carbohydrate content.\nThe formula of Mead's Cereal was\ndesigned to supplement the baby's diet in\nminerals and vitamins, especially iron and\nBj. How well it has succeeded in these\nfunctions may be seen from two examples:\n(l) As little as one-sixth ounce of Mead's\nCereal supplies over half of the iron and\nmore than one-fifth of the vitamin Bt minimum requirements of the 3-months-old\nbotde-fed baby. (2) One-half ounce of\nMead's Cereal furnishes all of the iron and\ntwo-thirds of the vitamin Bt minimum\nrequirements of the 6-months-old breastfed baby.\nThat the medical profession has recognized the importance of this contribution\nis indicated by the fact that cereal is now\nincluded in the baby's diet as early as the\nthird or fourth month instead of at the\nsixth to twelfth month as was the custom\nonly a decade or two ago.\nIn 1933 Mead Johnson & Company went\na step further, improving the Mead's Cereal\nmixture by a special process of cooking,\nwhich rendered it easily tolerated by the\ninfant and at the same time did away with\nthe need for prolonged cereal cooking in\nthe home. The result is Pablum, an original\nproduct which offers all of the nutritional\nqualities of Mead's Cereal, plus the convenience of thorough scientific cooking.\nDuring the last ten years, these products\nhave been used in a great deal of clinical\ninvestigation on various aspects of nutrition, which have been reported in the\nscientific literature.\nMany physicians recognize the pioneer efforts on the part of Mead Johnson\n& Company by specifying Mead's Cereal and PABLUM.\nPablum is a palatable mixed cereal food, vitamin and mineral enriched, composed of wheatmeal (farina), oatmeal,\ncornmeal, wheat embryo, beef bone, brewers' yeast, alfalfa leaf, sodium chloride, and reduced iron. W,l\ni\n;t*\nii\n$ i\nmm m\n\u00E2\u0096\u00A0\n\u00E2\u0096\u00A0 *\u00E2\u0096\u00A0 i '(V.\n?'*\nft\n**\nn\n\u00E2\u0080\u00A21, i\nEffective treatment of Peptic Ulcer...\n\"Because, according to Mutch, the antacid power of Hydrated Magnesium\nTrisilicate is sustained for hours even in the presence of excess acid, because its absorptive power lasts even for a few days, because it has strong\nantipeptic powers, because even in large doses it causes neither constipation\nor diarrhoea, and because it cannot produce alkalosis by absorption of\nunused excess, I consider this an ideal antacid for use in patients with\npeptic ulcer . . . My results have been so gratifying that I am replacing\nother alkalis with this preparation.\"\nKraemer, M.: Am. J. Digest. Dis. 5:422 (Sept.) 1938.\nNo. 937 \"TRICEPIOL\"\u00E2\u0080\u0094a palatable\npreparation containing, in each average\nteaspoonful, 35 grains of hydrated\nmagnesium trisilicate in a base composed of medicinal glucose, sucrose\nand pectin.\nNo. 938 \"TRICEPIOL\" COMPOUND\u00E2\u0080\u0094has a similar basic formula\nto \"Tricepiol\" but contains, in addition,\n1/500 grain of atropine sulphate and\n1 /8 grain of phenobarbital per average\nteaspoonful.\nt S8.93J\niiymdL\nncepio\n$f\u00C2\u00AB\u00C2\u00BBni of fiy&eW\nin 3 o^su cc--\u00C2\u00BBiposom\nncepio\nfilSIiBLiEB\nBUUXTtO&S.\nAY\u00C2\u00A3RST.Mc\u00C2\u00A3\u00C2\u00A3^\npHNMi\ni AY\u00C2\u00A3S5rt McKSNNA & HARBISON\nAvailable in bottles containing 5% and 16 ounces.\nProfessional specimens and literature on request.\nAYERST, McKENNA & HARRISON LIMITED \u00E2\u0080\u00A2 Biological and Pharmaceutical Chemists . MONTREAL, CANADA\n934\nPRESCRIBE CANADIAN MADE PRODUCTS\nHELP WIN THE WAR\nBUY WAR SAVINGS CERTIFICATES The natural tendency of humanity is to take good work for granted, and withhold\ncomment, and especially favourable comment: if anything is amiss, we hasten to express\nour unfavourable opinion. This, as Kipling says, is \"wunnerful good for the prophet\"\n\u00E2\u0080\u0094but one sometimes thinks that a prophet who is doing good work might like an\noccasional sign that his work is appreciated, and that it is doing the good he hopes\nit may do.\nDuring the past two or three years there has been some very remarkably good work\ndone in this Province by one particular department of the Provincial Board of Health,\nnamely, the Venereal Disease Division. The moving spirit of this Division is its Director, Dr. D. H. Williams, and while excellent work is being done by all the men on his\nstaff, he is yet the man chiefly responsible for what is a monumental improvement in\nconditions in this Province.\nVenereal disease is slowly, but surely, being mastered, and its terrible power for evil,\nfor economic loss, for loss of health, for moral degradation and injury, is being gradually\ncontrolled and will some day be broken. That this is so is largely due to the indomitable\ncourage and plain speaking of Dr. Williams, backed up as he has been so loyally and\nwell by his Departmental Chief, Dr. G. H. Weir, Minister of Health for B. C. We have\nhad the opportunity of seeing letters, and reading published statements, made by outstanding Public Health authorities, commending and praising the work that is being\ndone in British Columbia, and holding it up as a model for other parts of the continent\n\u00E2\u0080\u0094and the figures of reduction in venereal disease and commercialised vice speak for\nthemselves.\nWe make a point of this for several reasons. We do not do it to exalt Dr. Williams,\nwho would be the last man to want such publicity or praise. But we do not think medical men as a group know enough of the progress being made\u00E2\u0080\u0094and we believe that if\nthey did, and if they realised how very important a piece of work is being done, they\nmight contribute their influence, and often their valuable assistance, towards aiding\nand reinforcing the work of Dr. Williams and his Division. This is a matter of health,\nand is not merely or mainly a moral question. It has, decidedly, moral implications with\nwhich every decent citizen is concerned\u00E2\u0080\u0094but fundamentally, it is a question of health,\nand of economic values. With the latter we are only concerned so far as every citizen\nand taxpayer is concerned: with the former, we are deeply concerned: and we should do\nall in our power to back up Dr. Williams and his co-workers, and the Department of\nPublic Health, which has exerted all its powers for reform so strongly and so efficiently,\nagainst great and growing opposition, against public ignorance and apathy, against influences of a subversive nature, sometimes even in high places.\nA second reason for dealing with this now is by nature of a warning. We tend to\nan inertia which may well be fatal. We see this work being done, we see progress being\nmade, we even applaud, and then we forget. We forget one thing, especially, and that\nis that there are powerful forces working against this reform. The work of Dr. Williams\nand his associates means positive gain for the community. It means added safety for our\nwomen and children, for our soldiers and sailors and airmen in training\u00E2\u0080\u0094it means\neconomic gain to the community, it means better health. But it also means positive loss\nto certain groups in the community, who make money and acquire profit from human\nweakness and folly. And these groups are watching the work of Dr. Williams, and are\nfus sworn foes. They will get him. if they can, because they are losing money through\nnis efforts. They will, we may depend, bring every influence to bear that they can\npossibly do, through political pressure, and in other ways: and unless the community\nas a whole, and its leaders in matters of health, economics, and moral and ethical values,\nawaken to this danger, and take definite steps to avert it, we shall see the undoing of\nPage 286\nMil\n*WJ\u00C2\u00AB M*'\n- 'i. c\n*.'\u00C2\u00AB '\u00E2\u0096\u00A0,!-'\n\"tt\n' \u00C2\u00ABi\nC\n*.;\u00E2\u0096\u00A0\nt\"j.\nI * :s\nmuch of the good that has been done, the loss of much of the progress made, the reversion to a poorer state of health in the community, physical, economic, and moral: and\nwith it the discouragement and disillusionment of men who are giving us of their very\nbest for our own profit, and advantage.\n\"Eternal vigilance is the price of liberty\": and if we are to win and keep our freedom in this matter, if we are going to maintain our gains, consolidate our victories, and\nensure continued advance towards better things, we shall have to be vigilant. As members of a profession on which the public must depend for all its knowledge and security\nin health matters, we owe an especial duty here, to keep watch and ward: to support\nthose who are doing this work\u00E2\u0080\u0094and to keep all with whom we come in contact informed\nas to the necessity for watchfulness.\nThis is not a mere philosophical essay. The remarks we have made here, the warnings we have expressed, are justified by an existing threat to the progress being made by\nthe Venereal Disease Division, one of the departments of the Provincial Health Department. We must do what we can, individually and collectively, to fight reaction: to\nstrengthen the hands of those who are supporting this work, and to resist the subversive\nwork of those who would undermine it. When one reads how'the military authorities\nin Seattle went to the City Council, urging control of prostitution, for the sake of\nmilitary efficiency, one realises that this is only one small argument for the work that is\nbeing done, and there are countless others. This is a time for ruthless eradication of\nanything that wastes money, that threatens physical health, that weakens moral fibre,\nand destroys efficiency, and we, as doctors, as exponents of health, and as good citizens,\nmust do our share.\nCORRESPONDENCE\nDr. J. H. MacDermot,\nEditor, The Vancouver Medical Association Bulletin,\n203 Medical-Dental Building,\nVancouver, B. C.\nJune 16, 1941.\nHi\nDear Doctor MacDermot:\nThe Directors asked rhe to thank the Editorial Board for its support in the promotion\nof the M-S-A and for the valuable space you have given to the Plan. We feel that\nyour help has been of inestimable value in acquainting the Professional Members with\nour progress.\nWe would also like to convey our thanks through you to Mr. Macdonald, the Business Manager, who has always been most helpful.\nThe Provisional Directors retire from office at the Annual General Meeting and in\nturning over the direction of the Plan to their successors they feel confident that they\nwill have your continued co-operation.\nVery truly yours,\nA. L. McLELLAN,\nSecretary-Treasurer.\nPage 287\n.'\ni:ii NEWS AND NOTES\nDr. and Mrs. H. A. MacKechnie are receiving congratulations on the birth on June\n14th of a daughter.\nCongratulations are extended to Dr. and Mrs. G. F. Kincade on the birth of a son\non June 2nd.\nThe profession extends sympathy to Dr. A. J. MacLachlan in his recent bereavement,\nhis mother having passed away.\nDr. and Mrs. W. L. Turnbull are receiving congratulations on the birth on June\n16th of a daughter.\nCongratulotions to Dr. Paul Phillips of Princeton upon his marriage to Miss Edith\nLouise Stewart of New Westminster, on June 5 th.\nPr. and Mrs. John McCaffrey are receiving congratulations on the birth of a daughter, on May 27th.\nDr. B. J. Hallowes of Alexis Creek visited the office while in Vancouver recently.\nDr. and Mrs. Hermann M. Robertson of Victoria are at Harrison Hot Springs for a\nshort period.\nDoctors C. C. Browne and E. D. Emery of Nanaimo and Dr. C. E. Davies of Vancouver spent a week cruising on S.S. Ann, up the Gulf Islands. En route they saw Dr.\nJohn McLean at Bowen Island also on a cruise. Fishing was good and the sun-tan\nexcellent.\nA reception was held recently for Dr. G. A. B. Hall of Nanaimo prior to his leaving\nto reside in Victoria.\nDr. and Mrs. A. H. Meneely of Nanaimo are on vacation. Doctor Meneely attended\nthe Annual Meeting of the Canadian Medical Association at Winnipeg while en route\nto Rochester.\nCapt. J. A. Ireland, R.C.A.M.C., has been transferred from Canadian Infantry Holding Unit in England to be Assistant Radiologist at No. 15 Canadian General Hospital.\nDr. W. H. White of Penticton is attending the C.M.A. Meeting at Winnipeg.\nDr. H. McGregor is holidaying in New Brunswick and Nova Scotia and expects to\nattend the C.M.A. Meeting at Winnipeg.\n* *\nDr. M. J. Swartz, formerly of Cranbrook, has left for Montreal. He will enter the\nRoyal Victoria Hospital, Department of Urology, as an interne.\nDr. F. W. Green of Cranbrook is away on a short holiday at his summer home at\nMirror Lake on Kootenay Lake.\nPage 288\n!\u00E2\u0096\u00A0\u00E2\u0096\u00A0\n.*.'\n.!\nmi\n1\nti\n-Ifl\n\u00C2\u00A711 i\nm\n1\n>#\u00C2\u00A3*\nll\n\ml\nhi\n\W\n* !!\nti if\nDr. W. J. Endicott of Trail is away on a holiday motor trip.\nDoctors F. L. Wilson and E. S. Hoare of Trail had a very successful fishing week-end\nat Watchan Lakes recently.\nDr. L. W. MacNutt of Vancouver was a recent visitor in Trail.\nDoctors A. W. Hunter, R. E. McKechnie and C. W. Prowd of Vancouver, and\nW. J. Knox and L. A. C. Panton of Kelowna have returned from their annual fishing\ntrip to Beaver Lake near Kelowna.\nDr. and Mrs. C. H. Hankinson of Prince Rupert left for Winnipeg to attend the\nC.M.A. Meeting.\n\u00C2\u00ABnp -i* \u00C2\u00BB\u00C2\u00BB\"\u00E2\u0080\u00A2 *i\"\nDr. Karl J. Haig is now with the R.C.A.M.C.\nDr. N. Bathurst Hall of Campbell River has joined the R.C.A.M.C. Arrangements\nhave been made whereby Dr. T. J. Agnew, formerly of Courtenay, where he was associated with Dr. P. L. Straith, will carry on the practice there.\nDr. F. A. Olacke, who has been associated with Dr. J. H. Black at Wells, is now\nlocated at Ashcroft.\nDr. H. E. Hamer is relieving at Revelstoke while Dr. G. L. Watson is on holiday.\nCongratulations are extended to Dr. H. S. Hamilton of Alert Bay upon his marriage\nto Miss Catherine M. Campbell.\nDr. T. W. Walker of Victoria is expected to be \"back on the job\" at the beginning\nof July, after a serious illness.\nDr. W. H. Moore of Victoria has been away for a month's holiday. Dr. V. W.\nSmith, late of St. Joseph's Hospital, has been looking after his practice.\nDoctors L. W. Bassett, E. H. W. Elkington, O. C. Lucas and D. B. Roxburgh of\nVictoria have just returned from two weeks at military camp.\nDr. William Leonard of Trail visited the office while in Vancouver, recently.\nCongratulations to Capt. Brock M. Fahrni, R.C.A.M.C, upon his marriage to Miss\nMargaret Morton of Winnipeg.\nw-\nfn\nLIBRARY NOTES\nRECENT ACCESSIONS TO LIBRARY\nMedical Annual, 1941.\nCollected Papers of the Mayo Clinic and the Mayo Foundation, 1940.\nIndustrial Medicine, by A. J. Lanza and Jacob A. Goldberg.\nThe Library has been the recipient recently of a complete original set of \"Deutsches\nArchiv fur Klinische Medicin.\" This was presented by Dr. B. D. Gillies, and is a\nvaluable addition to our collection.\nA number of reprints from the Lahey Clinic have been received in the Library and\ninclude such articles as:\nPage 289\nM \"Carcinoma of the Thyroid,\" by Frank H. Lahey and Hugh F. Hare.\n\"Esophageal Diverticula,\" by Frank H. Lahey.\n\"The Use of Oxygen in Demonstrating Posterior Herniation of Intervertebral Disks,\"\njby James L. Poppen, Department of Neurosurgery, Lahey Clinic.\nANNALS OF SURGERY\nSymposia on Surgical Preparedness\nIn its May and June issues, Annals of Surgery presents \"Symposia on Surgical Preparedness,\" including a valuable collection of articles on the care of various war injuries\n\u00E2\u0080\u0094plastic surgery, amputations, etc. It also deals with organization for evacuation and\ntreatment of war casualties, and treatment of air raid casualties, cases of shock, etc.\nSymposium on Gastrointestinal Surgery\nThe second part of the June issue is devoted to a Symposium on Gastrointestinal\nSurgery, composed of abstracts of papers presented before the Central Surgical Association, at Ann Arbor, Mich., February 28th to March 2nd, 1941.\nSPECIAL NOTE\nDuring the summer months, the Library will be open from 9:00 a.m. to 5:00 p.m.,\ninstead of the usual hours from 10:00 a.m. to 6:00 p.m.\nSUMMER SCHOOL, VANCOUVER MEDICAL ASSOCIATION\n|. JUNE, 1941 <\u00C2\u00A7 \u00C2\u00A7\nIf the Committee in charge of the Summer School had any doubts or misgivings\nprior to the holding of this year's school, they must have been very pleasantly disappointed by the result. There have been more expressions heard this year, of satisfaction\nand commendation, than usual. The prevailing opinion of this year's Summer School\nis that it is easily one of the best ever held, and we hereby tender to the Summer School\nCommittee our heartiest congratulations and thanks for an adrnirable piece of work.\nThe attendance was excellent. There were 235 registrations, of whom 47 came from\npoints outside Vancouver. This means that 178 Vancouver men attended, which is\ngood, but not quite good enough. Those who failed to attend missed a great deal. After\nall, it is not the attendance that makes a Summer School, it is the quality of the lecturers,\nand there can be no complaint on that score this year. Each one of these men was an\nauthority in his line, and gave of his best. One hesitates to singularize\u00E2\u0080\u0094but there can\nbe no doubt that the work of Dr. Long was the highlight of the meeting. His gift of\nhumour, his friendliness, his amazing versatility, were all incidental to a complete mastery of his subject, and there was never any doubt that we were listening to an authority.\nThe round table panel discussion on the Sulphonamide group of drugs was an\ninnovation, and a most successful one. We were able to secure a stenographic record of\nit, and hope to publish it in the Bulletin later.\nThe actual mechanics of the meeting were all that could be desired. The Hotel\nVancouver provided an ideal meeting place, comfortable, and with excellent acoustics,\nand Mrs. Craig, our librarian, saw that everything ran smoothly. To her, with her\nassistant, Miss Smith, must go a large share of the credit for a well run affair.\nOwing to the reduction of the fee from $7.50 to $5, there will, we are told, be a\nsmall deficit\u00E2\u0080\u0094but we do not think this will distress anyone\u00E2\u0080\u0094this School is well worth\npaying for, and when happier times come back, it will be time to think in terms of\nfinancial profit. Till then, there can be no question that as long as the Summer School\nCommittee maintains these standards, as they have done this year, we must go on holding\nthe Summer School.\nPage 290 f &,\n!SM\n-\u00E2\u0096\u00A0>\u00E2\u0080\u00A2\n\u00E2\u0096\u00A0\nm\n\u00E2\u0080\u00A2i.',\nH\nIi m\n\u00E2\u0096\u00A0 i*!\n\nBritish Columbia Medical Association\n(Canadian Medical Association, British Columbia Division)\nPresident \ Dr. Murray Blair, Vancouver\nFirst Vice-President Dr. C. H. Han&tnson, Prince Rupert\nSecond Vice-President Dr. A. H. Spohn, Vancouver\nHonorary Secretary-Treasurer Dr. Walter M. Paton, Vancouver\nImmediate Past President ' Dr. F. M. Auld, Nelson\nExecutive Secretary l_ Dr. M. W. Thomas, Vancouver\nA MESSAGE FROM THE PRESIDENT\nOnce a year for many years now, the doctors of the province and their wives meet\ntogether for, I believe, a triple purpose. First, to discuss the affairs of organized medicine in general and our immediate problems in particular. Secondly, from a scientific\nstandpoint, to hear outstanding guest speakers in a carefully arranged programme, and\nfinally, to gather together, men and women in a spirit of fellowship in order that we\nmight know each other better.\nThe scientific end of the progremme is well under way, and I know that that committee under the experienced hands of Dr. Strong will supply a well-balanced scientific\nprogramme. A later copy of the Bulletin will carry a detailed programme.\nThe social side will, I sincerely hope ,be up to standard. We are going to really try\nto entertain you, not in any profuse or expensive manner but by the very sincerity of\nour welcome to you and yours.\nThe ladies are already busy with their plans and, I know, will do everything in\ntheir power to make the visit of the ladies a memorable one. So be sure and come along\nyourself and please bring the ladies.\nMURRAY BLAIR.\n1941 ANNUAL MEETING\nVANCOUVER\nHOTEL VANCOUVER\njiinu ' la iaj\nSi \u00C2\u00AB\u00C2\u00BB.\n| Si (B IB\nEE IB\n| BJ CE II\n'\u00E2\u0096\u00A0'mi i\n*nuiiL\ni niiilii\nSeptember 16,17,18\nIS*3 THREE DAYS\u00E2\u0080\u0094TOLL OF\nFINE FEATURES\nMake Your Plans and Reservations Early\nDr. Murray Blair, President, and Mrs. Blair extend an invitation to the members and\nwives to come.\nAgain we are fortunate in having Dr. G. F. Strong as Chairman of the Committt\non Programme. The Committee on Programme is preparing for another splendi\nAnnual Meeting.\nPage 291 The Canadian Medical Association party will consist of Dr. G. S. Fahrni of Winni-\neg, President; Dr. T. C. Routley of Toronto, General Secretary, one speaker under the\nigis of the Department of Cancer Control, and we are glad to announce that Dr. Lennox\nt Bell of Winnipeg, Professor of Medicine, University of Manitoba, and Dr. F. G.\nIcGuinness of Winnipeg, Professor of Obstetrics, University of Manitoba, will be\n{resent.\nDoctor Thomas Addis of San Francisco, who is well known through his outstanding\n>ork on Nephritis, is Professor of Medicine at Stanford University School of Medicine\n\u00E2\u0096\u00A0rill also participate very generously in our programme. His subjects will be: \"Treatment of Medical Diseases of the Kidney\" (1) Practical Methods for Diagnosis and\n[treatment in the Doctor's Office; (2) The Theory of the Treatment of Blight's Disease;\n|3) The Results of Treatment.\nOther speakers are being arranged for and will be announced later.\nLectures - Conferences - Special Features - Clinical Sessions\nDemonstrations - Annual Business Meetings - Luncheons\nAnnual Dinners - Golf - Ladies' Entertainment\nCOMMITTEE ON ARRANGEMENTS\nProgramme\nRegistration and Reception\nPress and Publications\nArrangement and Housing\nClinical Sessions\nEntertainment\nGolf\nTransportation\nCommercial Exhibits\n\u00E2\u0080\u00A2T ^r nr \u00E2\u0080\u00A2\u00C2\u00BB?\nThe Ladies' Committee is already planning for the comfort and entertainment of\ndoctors' wives.\nDrives \u00E2\u0080\u0094 Reception and Tea \u00E2\u0080\u0094 Ladies' Dinner \u00E2\u0080\u0094 are each being arranged by special\ncommittees.\nUPPER ISLAND MEDICAL ASSOCIATION\nThe regular semi-annual meeting of the Upper Island Medical Association was held\nat Qualicum Beach on April 23 rd. After an afternoon of golf a large attendance of\nmembers were entertained at a banquet at the Qualicum Beach Hotel. Following a short\nbusiness meeting, with President Dr. R. W. Garner in the chair, a very instructive index\nof \"Pediatric Diseases and Treatment\" Was given by Dr. E. J. Curtis of Vancouver. Dr.\nJ. R. Naden of Vancouver then gave a comprehensive and interesting lecture on \"Injuries\nof the Knee\" and was unfortunately limited to only a few words on \"Low Back Pain.\"\nDr. M. W. Thomas of the parent association was also a guest. A vote of thanks was\nmoved by Dr. G. K. McNaughton of Cumberland and heartily endorsed by the members\nwith the amendment that while the instructive ability of the visitors was greatly appreciated, they themselves needed some lessons at golf.\n\u00C2\u00A5$ Page 292\n\m\nml Dr. L. H. Appleby | Vancouver\nDr. W. E. Austin Hazelton\nDr. Murray Blair Vancouver\nDr. E. W. Boak ; Victoria\nDr. F. M. Bryant Victoria\nDr. W. A. Coghlin Trail\nDr. G. A. Davidson Vancouver\nDr. W. F. Drysdale Nanaimo\nCapt. Brock M. Fahrni Vancouver\nDr. V. Goresky Castlegar\nDr. E. R. Hall Vancouver\nDr. C. H. Hankinson Prince Rupert\nDr. E. K. Hough New Westminster\nDr. W. S. Huckvale Kimberley\nDr. M. J. Keys Victoria\nDr. D. M. Lineham Vancouver\nDr. Thomas McPherson Victoria\nDr. Herbert McGregor Penticton\nDr. A. J. MacLachlan Vancouver\nDr. G. A. McLaughlin North Vancouver\nDr. Jack Margulius -New Westminster\nwell arranged.\nCANADIAN MEDICAL ASSOCIATION\nANNUAL MEETING \u00E2\u0080\u0094 WINNIPEG\nThe following members of the British Columbia profession attended the meetings of\nthe Canadian Medical Association in Winnipeg:\nDr. A. H. Meneely Nanaimo\nDr. Bernhard Meth ; Britannia Beach\nDr. H. H. Milburn Vancouver\nDr. J. A. Montgomery Vancouver\nDr. G. F. Murphy Vancouver\nDr. J. R. Naden -Vancouver\nDr. A. B. Nash 1 Victoria\nDr. R. A. Palmer Vancouver\nDr. W. M. Paton . Vancouver\nDr. Stanley Paulin Vancouver\nDr. W. L. Pedlow Vancouver\nDr. D. E. Saxton Ocean Falls\nDr. G. D. Saxton Ocean Falls\nDr. J. M. Swartz \u00E2\u0080\u0094. ^\u00E2\u0080\u0094Cranbrook\nDr. M. W. Thomas- Vancouver\nDr. Ethlyn Trapp Vancouver\nDr. S. E. C. Turvey Vancouver\nDr. G. L. Watson Revelstoke\nDr. W. H. White Penticton\nDr. Wallace Wilson Vancouver\nWinnipeg gave the Annual Meeting of the Canadian Medical Association a warm\nwelcome\u00E2\u0080\u0094the meeting was largely attended\u00E2\u0080\u0094the programme of excellent quality and\nThe registration from British Columbia reached 40. Sessions of General Council were\nwell attended, British Columbia being represented by: Doctors Murray Blair, President;\nC. H. Hankinson, First Vice-President; W. M. Paton, Honorary Secretary; E. W. Boak\nand Thomas McPherson of Victoria; A. H. Meneely of Nanaimo; A. J. MacLachlan, H.\nH. Milburn and Wallace Wilson of Vancouver, and M. W. Thomas, Executive Secretary.\nDr. H. H. Milburn attended the meetings of the Executive Committee as representative from British Columbia.\nDr. Murray Blair was elected, as representative of British Columbia on the new\nExecutive Committee of the Canadian Medical Association.\nDr. Wallace Wilson, Chairman of the Committee on Economics of the Canadian\nMedical Association, presided at the session on Medical Economics, which followed the\nstag dinner on Thursday evening, and was attended by 225 members. This session was\nfavourably commented upon and an increasing interest shown.\nAll meetings were well attended, despite the ambitious ascent of the mercury column.\nDr. W. F. Drysdale of Nanaimo Was present to receive Senior Membership, which\nwas conferred upon him at the ceremonial on Wednesday evening.\nDoctors E. W. Boak, F. M. Bryant, Thomas McPherson and A. B. Nash were not\ndisposed by the heat.\nDr. Lyon Appleby thinks that Winnipeg temperatures are not conducive to good\nracing by B. C. horses\u00E2\u0080\u0094however, Harry Milburn was able to replace the lost hat on\nthe last race. We think that Dr. Appleby has very fine ponies in Swift Heels, Little De\nand Build-Up.\nWe saw Lt. C. E. Gould, who is with No. 8 Canadian General Hospital, and also\nCapt. B. M. Fahrni, who contributed an interesting study before the Section on Military Medicine.\nWe saw Bill White of Penticton visiting with W. S. Huckvale of Kimberley.\nPage 293 Mrs. Eric Boak was happily surprised when her son, Eric, turned up en route West\non leave. Mrs. Boak thought that he was somewhere on the Atlantic.\nDrs. W. E. Austin of Hazelton, F. M. (Wood) Bryant of Victoria, W. A. Coghlin\nof Trail, G. A. Davidson of Vancouver, V. B. Goresky of Castlegar, G. A. Leroux of\nFernie, H. McGregor of Penticton, G. A. McLaughlin of North Vancouver, Jack Mar-\ngulius of New Westminster, W. L. Pedlow of Vancouver, G. D. and D. E. Saxton of\nOcean Falls, S. E. C. (Ward) Turvey of Vancouver, G. L. (Jerry) Watson of Revelstoke, all graduates of Manitoba, were visiting with old friends.\nDr. C. H. Hankinson of Prince Rupert, First Vice-President of the British Columbia\nMedical Association, was accompanied by Mrs. Hankinson. In that the 1942 Meeting of\nthe Canadian Medical Association will be held at Jasper and the Annual Meeting of the\nBritish Columbia Medical Association will be held at the same time, Dr. Hankinson is\nalready doing some long-range planning on building a large attendance from British\nColumbia at the Jasper meeting. Dr. A. E. Archer of Lamont, Alta., is the new President-Elect of the Canadian Medical Association. He, too, is planning for the 1942\nmeeting at Jasper.\nDr. and Mrs. Gordon Fahrni are to be congratulated upon the excellent arrangements\nfor the Winnipeg meeting, and they should be gratified by the success which crowned\ntheir efforts. Winnipeg did itself very well.\nWAR RELIEF FUND\n* * *\nDominion of Canada\nDEPARTMENT OF NATIONAL WAR SERVICES\nTHE WAR CHARITIES ACT, 1939\nI, the undersigned, Minister of National War Services, the registration authority\nunder the provisions of The War Charities Act, 1939, do certify that\nTHE BULLETIN FUND FOR CONTRIBUTION TO THE WAR RELIEF FUND\nOF THE BRITISH MEDICAL ASSOCIATION OF GREAT BRITAIN\nsituate at 925 West Georgia Street, Vancouver, in the Province of British Columbia, is\na Fund duly registered under said Act.\nDated this 17th day of June, 1941.\nJ. T. Thorson,\nMinister of National War Services.\nS. W. Stapleford,\nDirector of Voluntary Services.\ni;\n41\n**i\nThe setting up of the \"Bulletin War Relief Fund\" has started a similar move\nacross Canada! At the annual meeting in Winnipeg the C.M.A. made arrangements to\nset up \"The Canadian Medical Association War Relief Fund\" for the purpose of collecting funds for the B.M.A. War Relief Fund. Preparations are already being made to set\nup local funds in the other divisions of the C.M.A. and all the funds collected in each\nprovince will be sent forward to the contral C.M.A. fund for transmission from time\n'\"'',: Page 29 4\nfiJIw \u00E2\u0096\u00A0m\ni<\n.\nK*\"*\u00C2\u00BB\u00C2\u00AB i\n!!\nlit\n\u00E2\u0096\u00A0\u00E2\u0080\u00A2'\ni#'\nill\nilS.*\nillii\niifi\niil\n'In\nm\nto time to England. This is a splendid move and will give to many hundreds of doctors\nacross Canada the opportunity they have been looking for\u00E2\u0080\u0094an opportunity of helping\nin a tangible way to lessen the terrific burdens so many of the British medical men have\nto carry in thes edays of their stress and strain. So many of the doctors remaining in\nCanada realize that, under the circumstances, this is the least we could do and the fund\nshould be a great success.\nThis fund has got off to a good start, but has temporarily slowed down. It has been\nauthorized by Ottawa and registered under the name, of The Bulletin Fund for Contribution to the War Relief Fund of the British Medical Association of Great Britain.\nThe need is desperate, and we are sure every medical man in British Columbia, if\nhe realized how desperate it is, would want to help. There are hundreds of medical men\nin Great Britain who have lost everything they had: practice, homes, all their belongings,\nThey need'help and they need it badly, and they need it now. Every dollar we can contribute will help greatly, and we urge all our readers, who have not yet contributed to\nthis fund, to send in what they feel they can afford. The fund is open to every medical\nman in British Columbia, and we shall feel honoured to accept and acknowledge contributions.\nPlease make cheques payable to the Vancouver Medical Association and write on\ncheque, \"For Bulletin War Fund.\" A special account has been opened, and money will\nbe sent forward as fast as possible. Names of contributors, etc., will be published in the\nBulletin, unless a request to the contrary is received.\nLast number of the Bulletin contained the names of those whose subscriptions had\nbeen received up to that point. A fresh list appears in this issue.\nSo please send in your contributions imrnediately, so that we may be able to make a\nworthwhile contribution as soon as we possibly can.\nMartianoff, I. F i $15.00\nI\nAnonymous $20.00\nAnonymous 10.00\nArchibald, M. G 25.00\nDeMuth, O. 25.00\nDunlop, Frederick C 20.00\nLockhart, W\ T 25.00\nNelles, T. R. B.\nSaunders, \u00C2\u00A3. H.\nSeldon, G. E\t\nYip, K. G\t\n10.00\n._ 50.00\n_ 50.00\n_ 10.00\nCOMMITTEE ON THE STUDY OF CANCER\nCancer is a disease that is known to have existed as far back as the Mesozoic penoo.\nDown through the ages it has been recognized and many and varied methods devised i\ncombat its growth. Prayers, incantations and signatures were of no avail. Queer prescriptions were numerous, such as vaginal douches of pig's bile and lime made fro\noyster shells was used in cancer of the uterus. Surgery in varied forms was tried. Fire\nand escharotics were the favourites, but we also find Celsus describing the amputation\nof a malignant breast with removal of the pectorla muscles and dissection of the axillary\nglands, a procedure that sounds strangely modern for those times.\nIn spite of the multiplicity of therapeutic methods used against cancer, we find an\nEgyptian surgeon in 1500 B.C. tesrely stating in reference to cancer of the breast,\n\"There is no treatment.\" Again, a thousand years later, a Hippocratic writer, in writing\nof occult (non-ulcerated) cancers said, \"It is better to omit treatment altogether, for\u00C2\u00BB\ntreated the patients soon die, whereas, if left alone they may live a long time.\"\nThis hopeless attitude was justified until the beginning of the Twentieth Century\nAt that time pathology had developed as a science, owing to the discovery of the micr\nscope; and it was found that cancer originated as a purely local lesion that could t\nreadily removed with complete cure. Add to this discovery the rapid strides in surg<\nand radiotherapy, and for the first time in the history of mankind a cure for cancer\nfound.\nPage 295 Thus, the cancer problem today is not, \"Where is a cure for cancer?\", because we\nhave a cure for cancer. The problem is to overcome the folklore, the old wives' tales,\ntbe myths and the teaching that have fixed cancer in the minds of the laity and the\nphysician down through the ages as a fatal disease consisting of large tumors that had\nto metastasize and cause secondary anemia before the disease could be recognized.\nCANCER CAN BE RECOGNIZED EARLY, BUT IT DOES NOT LOOK LIKE\nLATE CANCER. Thus, let us concentrate our efforts on trying to diagnose cancer\nearly, so early that our present clinical criteria are insufficient and we have to learn new\nones. Then we will save many lives of cancer patients.\nM-S-A ANNUAL MEETING\nThe First Annual General Meeting of the Medical Services Association will be held at 8 p.m. on\nFriday, July 4th, 1941, in the Auditorium of the Medical-Dental Building, 925 West Georgia Street,\nVancouver, B. C. It is requested that all Members attend.\nOrder of Business:\n1. Directors' Report.\n2. Election of Directors.\n3. Appointment of Auditors.\n4. New Business.\nEach Member present in person shall be entitled to vote, provided that when electing the Directors,\neach Member shall vote only for the Director representing the class of members to which he belongs.\nThe Provisional Directors retire from office and of the four Directors to be elected, two shall be\nelected by the Employee Members and one by the Professional Members and one by the Employer\nMembers.\nFIRST ANNUAL REPORT\nMEDICAL SERVICES ASSOCIATION\nTo Our Members:\nDirectors' Report\nYour Provisional Directors submit herewith the Balance Sheet and Financial Statement from\nIncorporation to May 31st, 1941.\nWe are assured by our Members and prospective members that the Plan has been well conceived\n\u00E2\u0080\u0094it fulfils a long felt want\u00E2\u0080\u0094it preserves normal patient-physician relationships. In bringing together\nslong industrial lines those interested\u00E2\u0080\u0094employees, employers and doctors, it is evident that our Plan\nhas the personal interest so necessary in a plan budgeting for medical care which includes early\nattenton and treatment.\nFor the seven months of operation the estimates of cost have been adequate to discharge our\nobligations and to set aside a reserve for contingencies of 12 per cent of the dues. Claims for medical,\nsurgical and hospital care in the amount of $2,177.00 have been paid.\nWe have found the subscribers are pleased with the plan and are happy to report that there has\nteen no cases of dissatisfaction with the services or system of payment. Members have gone freely\nto doctors of their own choice. Doctors from all areas included have given service.\nApart from the 10 per cent for administration expense charged against dues and the registration\nfees, organization expense has been met from advances. As the plant grows this organization expense\nwill be liquidated as is customary from registration fees.\nOur growth has not been rapid but in comparison with similar plans in other cities we have\nmade good progress. Our 500 subscribers compares with the 600 which was the enrolment of the\nAssociated Medical Services Incorporated of Toronto for six months. This plan after three and a\nhalf years of operation now has 24,000 subscribers, and we understand that it is growing at the rate\n~ 325.55\nBalance Deferred, Carried to Balance Sheet $4,311.43\nft\n>:\nfrl* J*\nJ. T. MYERS\nPROVISIONAL DIRECTORS\nA. L. McLELLAN M. W. THOMAS, M.D.\nJOHN YOUNG\nPage 298 I\n'fir\nills!\nII\"\nIS. ir\ni'T\nll\nm\nhs\nIB\ni\n:K\n%l\nmi\nt%i.\nr\nMl\n1;\n%w\,\nI*1\nm.\nancouver\neneral\nHospital\nCYSTOMETRY\nBy L. G. Wood, M.D.\nCystometry was introduced by Rose in 1927 to estimate changes in intravesical\npressure incident to fluid distention of the bladder. It measures the resisting pressure\n(tonus) of the detrusor muscle and is recorded in terms of pressure and capacity.\nDepartures from the normal cystometric curve are due to hypertonia or hypotonia of\nthe bladder-wall. Cystometric data may or may not support clinical findings, or may\ndisclose unsuspected alterations in muscle-resistance and furnish a clue to their causes.\nThey must be interpreted in conjunction with clinical and cystoscopic findings.\nTechnique:\nThe cystometer consists of three parts: An irrigating jar, a Y-connector, and a\nmanometer, these being connected by tubing interrupted by a three-way stopcock. The\nirrigating jar is filled with water. All air must be expelled from the system by manipulating the stopcock. A soft-rubber catheter (No. 22F for adults) is introduced and\nthe urine evacuated, after which the cystometer is connected and the bladder slowly\ndistended. The resisting pressure of the bladder wall is estimated by operating the stopcock. The pressure data are recorded against the amount of fluid in the bladder. Of\nparticular importance are the readings when the first desire to void is noted, when discomfort incident to distention first appears, and when this becomes severe. The final\nrecord is made with the patient straining to void. In the absence of this voluntary\neffort, changes in the intracystic pressure are entirely involuntary, and the recorded\npressure is dependent upon the bladder muscle alone. The voluntary effort to void produces an upper or voluntary pressure line.\nInterpretation :\nThe normal cystometric curve shows a gradual increase in pressure, and the first\ndesire to void appears when 125 to 175 c.c. of water has been put into the bladder and\nthe intracystic pressure is 5 to 15 mm. of mercury. As more fluid flows in, the pressure\nrises more rapidly until a sensation of discomfort occurs at a pressure of 40 to 65 mm.\nof mercury (amount of fluid 300 to 400 c.c). This denotes that the normal limit of\nstretch of the wall of the bladder has been passed, and at this time the fluid may be\nexpelled around the catheter. By instrucing the patient to void at the conclusion of the\ntest, one may determine the maximum voluntary pressure, which is from 60 to 80 mm.\nof mercury. The normal cystometric curve is constant and departures from it are due\neither to hypertonia or hypotonia of the detrusor muscle. (See Figure 4.) The hypertonic curve is characterized by a shift to the left of the first desire to void, a high intracystic pressure is reached rapidly, and there is a high voluntary pressure. (See Figure 1.)\nThe hypotonic resistance is characterized by flattening of the curve, a shift to the right\nof the first desire to void, a low maximum intracystic pressure, and a low voluntary\npressure. (See Figures 2 and 3.) Irritative and destructive lesions of the filling (sympathetic) and emptying (parasympathetic) mechanisms cause changes in the cystometric\ncurve which in most instances are recognizable as of neurogenic origin. Such changes\nafford comparatively little aid, however, in determining the nature or site of the central\nlesion. Cystometric findings must be interpreted in the light of neurogenic and cystoscopic data. The hypertonic, neurogenic bladder is much rarer and more difficult to\nidentify by cystometric methods than the hypotonic type, and especially so in the\npresence of vesical lesions such as cystitis or stone, giving rise to irritability of the bladder. Nevertheless, one suspects a neurogenic origin of hypertonia when there is no\nPage 299\n\u00E2\u0080\u00A2;<\u00E2\u0096\u00A0'\u00E2\u0096\u00A0 <\u00E2\u0080\u0094\n\"9-\n<\n1\nV*\n<\n. (\n\\n(\n(\n<\nI\n(\n(\no\ne\nS\n1\nft\nX\n1\nA- <\nN\nM\nE\n1\n' 1\n1\n \u00E2\u0080\u00941\nV\nen\n0\na\no\n1:\na\ns\no\nco\no\no\n\no\no\n* o\n\u00C2\u00AB o **\nO N ft)\nm\n\u00E2\u0080\u00A2\nIt.\nf 4* Tl \u00E2\u0096\u00A0'\n\u00E2\u0080\u00A2ill\"'\n1 tat\ndemonstrable disease of the bladder, and the same is true when hypertonia persists despite\nthe subsidence of local vesical irritation. Cystometry is far more important in the\nidentification of neurogenic hypotonia in which the characteristic curve is mimicked only\nby that obtained in vesical diverticulosis, cystocele, marked hydro-ureter with reflux,\nand certain postpartum bladder disturbances. Spinal and sacral anaesthesia produce the\nhypotonic picture. It is said by Muschat that in uncomplicated chronic urinary retention, however marked, the normal cystometric curve is maintained, thus permitting the\nimportant differentiation of uncomplicated obstructive uropathy from that occurring in\nassociation with lesions of the central nervous system.\nThe Neuro-Muscular Mechanism of the Bladder:\nThe innervation of the bladder is derived from three principal sources: (1) sympathetic, (2) parasympathetic, and (3) somatic. The sympathetic fibres arise from the\nfirst, second, third and fourth lumbar segments, and pass by Way of the hypogastric\nplexus to the bladder. The sympathetic impulses contract the internal sphincter, relax\nthe detrusor muscle in the wall of the bladder, and cause retention of urine. The parasympathetic fibres arise from the second, third and fourth sacral segments, and pass to\nthe bladder by way of the pelvic nerves. The parasympathetic impulses relax the internal sphincter and contract the detrusor muscle, producing emptying of the bladder.\nThe parasympathetic innervation is much more active and stronger than the sympathetic\ninnervation as regards bladder function. Somatic impulses to the external sphincter and\nperineum are transmitted by the pudendal nerves and arise from the third and fourth\nsacral segments. Sensory impulses from the bladder are carried by all three systems.\nThe neuro-musclar system governing the function of the bladder in adults functions\nto a large degree under volitional control. It comprises centres in the spinal cord and\ncerebrum, connected by intraspinal association pathways, together with various afferent\nand efferent nerves which serve as connecting links between the vesical musculature and\nthe cord centres. There is in addition to the foregoing a nervous mechanism in the\nbladder walls which when dissociated by injury or disease from central influence may\ncontrol bladder function reflexly.\nBoth filling and emptying of the bladder in infants are automatic, since the brain\nand intraspinal association pathways are structurally immature.\nBladder filling remains in adults an automatic function, but emptying of the viscus\nis partly under voluntary control. That the latter is largely a habit mechanism is indicated by the fact that it functions during sleep.\nFilling and emptying are controlled by inhibitory and excitory impulses to the\nsphincter and detrusor muscles, originating in response to various cerebral and peripheral\nstimuli but emptying is governed by volition. During the filling phase the sphincters\nare contracted, the detrusors relaxed. The reverse occurs in the emptying phase.\nSympathetic (Filling) Mechanism:\nSympathetic fibres collect to form a plexus (the superior hypogastric or inferior\nmesenteric). This plexus continues downwards to the promontory of the sacrum as the\npresacral nerve. The sympathetic plexus is derived from branches originating from the\nfirst four lumbar sympathetic ganglia, which transmit impulses to and from the lower\nthoracic and upper lumbar segments of the cord. The sympathetic mechanism is concerned chiefly with bladder filling, hence the term \"filling nerves\" is used to distinguish\nthem from parasympathetic or \"emptying nerves.'* The function of the presacral nerve\nin relation to the bladder is as follows:\n(1) Excitator to the internal sphincter.\n(2) Inhibitor to the detrusor muscle.\nStimulation of the presacral nerve with Faradic current causes:\n(1) Closure of the ureteral orifices;\n(2) Contracture of the trigonal muscle, and\n(3) Contraction (increased tonus) of the internal sphincter muscle.\nPage 301 Parasympathetic (Emptying) Mechanism:\nThe fibres are derived from the second, third and fourth sacral nerves and join the\nhypogastric ganglia. Efferent fibres from these ganglia carry both filling and emptying\nnerves. Sensory fibres from all coats of the bladder are likewise tributory to these\nganglia. The function of the parasympathetic mechanism, the control of which lies in\na cord centre located in the second, third and fourth sacral segments, is as follows:\n(1) Inhibitor to the internal vesical sphincter muscle,\n(2) Excitator to the detrusor muscle,\n(3) Bearer of sensory impulses concerned especially wiht bladder sensations\nhaving to do with the micturition reflex,\n(4) Possible bearer of impulses from the deep urethra.\nSomatic (Volitional) Nerves:\nSomatic nerves (the internal pudendal nerves) are of spinal origin and furnish motor\ncontrol of the external vesical sphincter muscle and extrinsic urethral muscles (bulbocavernous, levator ani, compressor urethras), and supply sensory fibres to the deep\nurethra.\nIt is well established that either the internal or external sphincter muscle alone, if\nnormal, will serve to retain the urine in the male, so that incontinence does not follow\noperative destruction of the internal sphincter provided the external sphincter and its\nnerve supply are intact.\nNormal Micturition:\nNormal micturition occurs in response to stimuli derived chiefly from rising intracystic pressure incident to increasing accumulation of urine. That it is not solely a\nmechanical problem is evident from the varying amount of urine necessary to inaugurate\nthe desire to void. Whatever may be the source or the type of the initiatory impulses,\nemptying of the bladder is dependent primarily upon inhibitory impulses transmitted to\nthe sphincters coincidently with the transmission of excitator impulses to the detrusor.\nThe internal sphincter muscle is then relaxed. Excitator impulses cause contraction of\nthe detrusor muscles which, aided by increased intra-abdominal pressure incident to\nfixation of the diaphragm and contraction of the abdominal muscles, succeed in emptying the bladder completely in normal individuals.\nThe Neurogenic of Cord Bladder:\nInterference with the normal discharge of impulses controlling the vesical musculature leads to disordered vesical function, and to definite physical changes in the bladder.\nThe condition is usually dependent upon lesions of the spinal cord, but it may occur as\nthe result of diseases of the brain, and in certain systemic diseases, such as diabetes\nmellitus and pernicious anaemia. The term \"cord-bladder\" should therefore not be used\nmdiscriminately. Destructive lesions of the central nervous system lead to vesical hypotonia while irritative ones cause hypertonia of the musculature of the bladder. Certain\nlesions which are primarily irritative end in destruction of tissue, thus altering the\ncystometric as well as the clinical picture.\nThe changing clinical picture is well illustraetd by progressive tabes dorsalis. Its early\nstages may be attended by slight urinary difficulty and moderate retention which increase\nuntil almost complete retention ensues, perhaps to be finally succeeded by true incontinence. In other instances, partial true incontinence is an early symptom of the disease.\nCystoscopic Findings in the Neurogenic Bladder:\nEvery patient presenting himself with symptoms of cord-bladder should be cysto-\nscoped. This was not possible in the series of cases presented here due to the limited use\nof the cystoscopy room for ambulatory patients.\nOn cystoscoping a patient with cord-bladder, some very striking points are noted:\n(1) The bladder may appear normal in all respects.\n(2) The commonest finding, however, is the case in which the cystoscope passes\nthrough the urethral sphincters with little or no resistance. There is retained\nPage 302\n!rT\ni*.\n\u00E2\u0080\u00A2 i. \u00C2\u00BBl\nM ;\nIff\nL v\ni!\n.?! fe\n\u00C2\u00AB(\u00E2\u0080\u00A2\u00E2\u0096\u00A0.'\nMm\ntail\nft\n>L-:\nI III\nl'$ H\nl^ii'-i\n\u00E2\u0080\u00A2\u00C2\u00BB;.\u00E2\u0080\u00A2;\niuL \u00E2\u0080\u00A2\n.,i,\nJIT:\n\u00E2\u0096\u00A0 lili'T \u00E2\u0096\u00A0\nfluid which comes away in a forceless manner. The capacity of the bladder is\nalmost always increased, sometimes the increase being as much as 1000 c.c.\nabove normal. The next thing noted is the appearance of a fine trabeculation\nthroughout the entire bladder excepting the trigonal region. This trabeculation\nis always even throughout, as opposed to the trabeculation noted in long standing cases of obstruction due to prostatism or stricture. In these cases the trabeculation is irregular, and in some cases sacculations appear. Another point of\ndifferentiation is the cystogram. The neurogenic bladder shows a spherical\noutline with a smooth margin, whereas the cystogram of a long-standing\nmechanical obstruction reveals a \"christmas tree\" formation with a jagged\nmargin.\nClinical Features of the Neurogenic Bladder:\nThe various lesions productive of the neurogenic bladder may be grouped into three\nclasses:\n(a) Those causing incomplete dissociation of the voluntary (cerebral) and involuntary (cord) mechanism,\n(b) Those causing complete dissociation of the voluntary (cerebral) and involuntary (cord) mechanism,\n(c) Peripheral lesions.\n1. Lesions causing incomplete dissociation:\n(a) Tabes Dorsalis,\n(b) Neoplasms of the brain,\n(c) Neoplasms of the spinal cord,\n(d) Subacute combined degeneration of the cord.\n2. Lesions causing complete dissociation:\nComplete dissociation of the voluntary (cerebral) and involuntary (cord)\nnervous mechanism occurs suddenly following traumatic section of the cord,\nor it may be somewhat delayed in the case of traumatic injuries which merely\nbruise the cord without sectioning it, the dissociation being completed by progressive myelitis.\n3. Peripheral lesions:\nAcute retention of urine due to spasm of the sphincters occurs reflexly after\noperations upon the rectum and other contiguous organs. It may also be due to\ndetrusor weaknes following neuritis or the hypogastric nerves, to pressure on\nthese structures by pelvic tumours, or to surgical injury or trauma incident to\nchildbith.\nPage 303 NUTRITIONAL REQUIREMENTS OF THE\nGROWING CHILD\nDr. P. C. Jeans\nDelivered at Summer School of Vancouver Medical Association, June, 1940.\nLet us enquire into what controls our choice of foods and then determine after that\nif that choice adequately meets the nutritional needs. There is a large variety of foods\nfrom which we make our choice and a certain amount of selection is not only permitted\nbut is practised by everybody. The diet of the average family is determined in part by\nthe availability of food, personal preference and the cost of food, to some extent at\nleast. To some extent instinct and preference play a very large part.\nThere have been various studies of racial tribes in the world and these are most\ninteresting, for instance, in Africa, where two neighbouring tribes will differ very much\nin their diet customs\u00E2\u0080\u0094one of these lives largely on cereal foods and the other on meat\nand animal foods, and the physique and general health of those on animal foods was\nfar superior to those on the vegetable and cereal diets. There are many other instances\nrecorded of similar observations. When it comes to animal observations, this is on record\nin the classical literature. Dr. Sherman, using rats, kept a colony for many generations\nand these had thrived and the offspring also. The diet was wholly adequate. He supplemented the diet with some milk and there was a very marked difference. They matured\nat a more rapid rate; they matured earlier; they had a longer period of adult life. That\nkind of an experiment shows that your Bible is not a good criterion. The same is true\nfor the human being. Some of this may be illustrated by taking growth as an example,\nwe know that growth is controlled by a number of factors. There is, no doubt, a\nhereditary factor which is concerned with endocrine balance. We can do very little as\nphysicians about this. There is also an environmental angle. It is well known that\nchronic disease of almost any kind can interfere seriously with growth on many occasions. It is well known that nutrition also plays a very prominent role. Of these\nvarious factors it is only the nutritional factor over which we have had any considerable\ncontrol, and it is with that factor that we are dealing tonight.\nOne encounters children who are grossly dwarfed, extremely malnourished, wholly\nbecause of the inadequacy of food. Sometimes we consider these as endocrine disorders,\nwe try to give them pituitary and other products. The food intake is one-third or one-\nquarter what it should be. It is difficult to see how any endocrine preparation can be of\nany use when the food intake is so small. We encounter obesity, also, due entirely to\nerrors in nutrition, and here too at times consider endocrine disturbance as a factor.\nAll of you are acquainted with tables of growth, the height, age and weight tables,\nand there are different authors of these tables. The ones we are most familiar with are\nthose of Baldwin and Wood and there have been some by Hornfelt and in 1933 by\nStewart. The striking thing about these tables is that they show a gradual increase in\nthe stature and size of our children with the passing of time. Hornfelt shows a more\nrapid growth than does Baldwin. I think this is not exclusively due to nutritional\nfactors. More is being learned of what good nutrition is, and better application is being\nmade of this knowledge. These tables give us only an incomplete picture of growth and\ndevelopment and there are so many factors that are not reflected in those tables at all.\nThere is the eruption of the teeth, the rate of eruption of the teeth, the amount of\nmuscle tissue that exists in the body. All of these are nutritional factors, and there are\nseveral more which are important and which are not reflected in any way in growth\ntables.\nNow, these are illustrations of the fact that nutrition is gradually improving but\nwe have not yet reached our objective. The best example of this very important point of\nview, and one with which you may not agree, is the example of dental caries. It is our\nbelief that this is dependent upon nutrition, and if the nutrition is what it should be\nthere would be no dental caries. If it is recognized that 90%, more or less, of our\nchildren have tooth decay, then it becomes obvious that the nutrition of our children is\nfar from what it should be.\nitf\nPage 304 \u00E2\u0096\u00A0 f*>\u00C2\u00A3;\nifti\nfft!\nl\nif \u00E2\u0080\u00A2**\nf *i in*1,\nIV 1\n\u00E2\u0096\u00A0 #ri;\n...\nt;\niff\n'M\n]\u00E2\u0096\u00A0#\nJIT:\nOur knowledge of nutrition is changing very rapidly, particularly in certain fields\n\u00E2\u0080\u0094in some of the vitamin fields\u00E2\u0080\u0094and certain scientists are developing knowledge at a\nslightly greater rate than a good many of us are able to keep up with. There is always\na lag between the development of new knowledge and the practical use of that knowledge. This is shown by several things in the past. There was a time when no one thought\nof giving cod liver oil or orange juice to a baby, but now it is a matter of routine. I\nhave at least hinted that I believe that the average diet is defective and the things in\nwhich it is most likely to be defective are, perhaps, calcium and vitamin A to some\nextent, vitamin Bi to some extent, vitamin D almost certainly to a considerable extent,\nand there is a good deal deal of danger of there being a deficiency of protien. Bread,\nmeat and potatoes form the basis of most of our diets. They are not complete. Those\nwhich supplant this basic diet are spoken of as protective foods\u00E2\u0080\u0094milk, eggs, fruit and\nvegetables\u00E2\u0080\u0094so that most of us are accustomed to the emphasis being placed on the so-\ncalled p;^tective foods in order to supplant the basic diet.\nTo take -\p some of these materials once at a time, let us first consider vitamin A.\nThis perhaps does not belong strictly to this category because an ordinary good diet does\nsupply an ample amount of vitamin A. 'Vitamin A is fairly well distributed so that\neven an average diet will contain a sufficient amount. Because of this fact, the appearance of vitamin insufficiency has been doubted by a number of people. Vitamin A, of\ncourse, speaking broadly, occurs in green vegetables, in the green leaves and in the\nyellow ones, also in milk and butter and eggs. The vitamin A that occurs in our foods\nconsists of the Keratins and, to a very slight extent, to the vitamin A itself. There are\ntimes when a distinction needs to be made for the purpose of discussion. In the fish oils\nwe have vitamin A rather than the keratins. Vitamin A deficiency does occur in spite\nof the fact that even an average diet seems to contain an adequate amount for the human\nneed. The causes of deficiency may be considered as two in general: (1) A deficiency\nof intake, which is not very common. However, it can occur at very low economic\nlevels. It is very difficult to devise a diet that is complete in everything else and deficient\nin vitamin A. We have done this for experimental purposes, and the experiment points\nout that if any individual is deficient in vitamin A, the vitamin A is not the only\nthing he is deficient in. (2) A much more common cause is a utilization defect\u00E2\u0080\u0094\ninability to utilize the vitamin A of the diet. In the first place, vitamin A is one of the\nfat-soluble vitamins and there must be bile in the intestinal tract. There are not many\nwho are lacking in this and this cause is not a very common one. In liver diseases keratin\ncannot be converted into vitamin A. It is known also that mineral oil will dissolve\nkeratin and it is possible to administer mineral oil in such a manner that keratin is\ndrained away in a serious manner. So that one need not fear such a disturbance, but as\nfar as experimental work goes, it may have a very detrimental effect. This has been done\nwith young rats. Even if vitamin A is administered in only such amount as will permit\nresumption of growth, these rate are segregated and one lot given mineral oil; then\nthose rats will die regularly and in a relatively short time of vitamin A insufficiency. If\nto these rats are given valuable amounts of vitamin A, then we don't get these fatal\neffects. The most important cause of vitamin A deficiency is infections of various\nsorts and particularly upper respiratory infections. These have played a frequent and\nhighly important role in most of the children with vitamin A deficiency.\nYou are all familiar with the changes that accompany severe vitamin A deficiency.\nThere are changes in the epithelium and various parts of the body. This has been spoken\nof as an anti-infective vitamin and perhaps erroneously. It is not a good term to apply\nto it. Changes are in the epithelium, in the nose and throat and the eyes, so that vitamin\nA may be considered as an anti-infective material. There has been much discussion as\nto the relation between vitamin A deficiency and the common cold. I don't think it is\ndesirable to review these observations here but to summarize it by giving my own point\nof view. In the case of the common cold, we have a disease which is caused by a virus\nand I doubt if any of you would expect to prevent a specific infectious disease by any\nof the vitamins. What one might expect, however, would be to decrease the secondary\nPage 305 effects, decrease the complications, cut short the period of illness. This is what is accomplished by vitamin A.\nThere has been much discussion as to the relationship between vitamin A and kidney\nstone, and if there is any relationship, vitamin A is only one of many factors responsible\nfor the formation of kidney stone. Night blindness has been considered to be relatively\nrare. Routine ophthalmic examinations can not detect night blindness. Night blindness\nin its relationship to vitamin A depends upon the vitamin A content of the body, and\nthere is a direct relationship between the amount of vitamin A in, the body and in the\nretina and the ability of the person to adapt himself to night vision.\nThere have been a number of instruments devised and by the use of these instruments one can get a very good idea of whether or not the individual is deficient in\nvitamin A. There are several types of these instruments\u00E2\u0080\u0094those which show a bright\nlight into the eye and then measure the time required for recovery, so that the subject\ncan see the test object at a fixed illumination. There is another type in which a bright\nlight is shone into the eyes and a curve is taken. At the very beginning a good deal of\nlight is required, and as time elapses less and less light is required. These various\ntypes of instruments are useful for the small child or baby. By means of these\nprocedures one can determine whether dark adaptation is normal or not. The\ninstrument with which we have been working is one of a type which permits the plotting\nof recovery time after the shining of the bright light. We have been satisfied with\nthis instrument. However, it has received some unfavourable criticism, so that I will\nspeak of that for a moment. There are three criteria which I think we have favoured\nin the use of this instrument. One can get results with the normal individual. The\ncurves all follow within a relatively normal range. When abnormal individuals are\nfound, one can restore them to normal by the administration of vitamin A. One can use\nvolunteer subjects and deplete them of vitamin A and they parallel closely the degree of\ndepletion. All of these points seem to indicate that the test is dependent on the measure\nof vitamin A. There has been shown to be quite a bit of lack of insight in making these\ncriticisms. By means of such a test as this, one can make surveys if one wishes, and\napparently vitamin A deficiency varies greatly in its incidence.\nOne hundred and twenty school children were examined in the fall of the year. We\nfound only one subnormal individual and five who had borderline test results. In the\nwinter in this same group, there were five subnormal individuals and 15 % more of them\nhad borderline results.' The next spring, when the same group was observed, there were\nno subnormals in the group at all and there was only one borderline case. So it makes a\ngreat deal of difference when the group is examined. There is an essential incidence, but\nI don't think this depends upon content of vitamin A. I think it depends upon infection.\nIn one group in which we worked, there were normal results throughout the entire year.\nAs further evidence of the role that infection plays in vitamin A deficiency, I might cite\njust this one type of observation.\nHere is a child who gives an abnormal test result with the instrument and because\nof that abnormal test result this child was given vitamin A in rather generous amounts,\nand about the same time this child developed a cold and instead of giving better tests\nwith the ingestion of vitamin A, the tests became worse, and with the continuance of\nvitamin A and as soon as the cold became better, the results became entirely normal.\nThis illustrates the effect of infection. It also illustrates the false judgment one might\nmake. One might find a child giving poorer and poorer results in spite of the ingestion\nof vitamin A.\nWhat is the need for supplementing the diet of the average child with vitamin A?\nFor the child in good health there is no need. An ordinary good diet would contain\nabout 5,000 units of vitamin A. This is considered ample for the needs of a child. If\none uses this as a criterion, then deficiency is not shown above 1,500 units a day and\nit takes an extremely poor diet to bring the vitamin A content down to that level.\nSupplementing vitamin A for that reason would be unnecessary in the great majority of\ncases. In the case of a child with chronic infection or with repeated respiratory infection,\nPage 306\n\u00C2\u00A3\nif:\nw: 1\u00C2\u00AB'\n!\u00C2\u00AB\u00E2\u0096\u00A0 1 * fc.4\n\u00E2\u0096\u00A0'j\n\"\u00E2\u0096\u00A0f\nIk\nthere is very likely to be vitamin A deficiency and there is much more definite indication\nfor the ingestion of vitamin A. It would be given to these children with colds and\ninfections not because it is an anti-infectious vitamin, but because there is a defect in\nthese children.\nNow we consider vitamin Bj. Here the situation is very much the same as in vitamin\nA. We are much more to the borderline of the ingestion of minimal amounts but much\nthe same factors enter into the vitamin Bi deficiency\u00E2\u0080\u0094illness, infections and various\ndifficulties that lead to poor utilization. In the case of vitamin Bj, however, there is a\nsmaller proportion of the requirement being ingested. This has been brought about by\nthe refined food. Something like 25% of the total calories represents refined cereal. In\nformer times this same type of diet would have supplied 600 untis of vitamin Bj. At\nthe present time the same materials will supply approximately 50 units of vitamin Bj.\nIt puts a rather large burden on the so-called protective foods to bring up the vitamin\nBi to an amount that is needed. This condition has been getting progressively worse.\nAt the present time there has been started a programme of restoration to foods and I\nhope it grows. For example, flour that has been milled to a refinement may now have\nadded to it vitamin Bi and colcium and iron also, back to the content of the original\nwheat, so that we may have a flour that is restored in these details without changing the\nkeeping qualities of the flour, or its taste or its cooking qualities. We hope this programme grows. It is definitely needed.\nIt is difficult to say how much vitamin Bj deficiency there is. There are whole districts in which the disease Pellagra exists. There are large areas in which vitamin Bi\ndeficiency does definitely exist because of low diet intake. Vitamin Bi is known to be\nconcerned with appetite. In the animal, when the animal is deprived of vitamin Bi, the\nappetite is decreased. There is an attempt to transfer this idea to the human being and\nno doubt it holds there, too, but in the case of the child with poor appetite, the chances\nare that we are dealing with multiple factors again. In the majority of instances, at least,\nthe difficulty is one of training a child in feeding habits. There may be a vitamin Bj\ndeficiency. What is needed is re-training of feeding habits.\nWe know in the animal that vitamin B^ is concerned with the tone of the bowel.\nOne encounters the idea that vitamin Bi is a very good thing to give to children with\nconstipation. I am not sure, but I wonder if that fact is due to vitamin Bi, because\nwheat germ and similar materials are laxative even though one has destroyed the vitamin\nBi in them. There is something more than in the effect of bowel tone. It is very definite that clinically there is a laxative effect in most instances from the use of these\npreparations.\nNow the subject of vitamin C. I will restrict my remarks to the application to the\nyoung infant. We know that infants ordinarily will not develop scurvy if they receive\n10 mgs. of vitamin C a day. It is desirable not to restrict the intake to that amount\nand with most of them it seems desirable to give amounts larger than those which will\njust prevent scurvy. If one converts this into terms of orange juice and considers the\naverage orange as containing 50 mgs., then we will see that infants normally get their\nvitamin C. There has been a rather strong tendency to use smaller amounts of orange\njuice than this and to start them somewhat later. It is so often the custom to give a\nteaspoon of orange juice after the baby is one month of age and increase gradually a\nteaspoon at a time and then stop at an ounce as an intake. It seems to me that there\nare no dangers in orange juice and that for nutritional purposes one can consider that\nas our guide. It is our own custom to give an ounce of orange juice each day as soon\nas the baby comes under paediatric care; at 2 or 3 months of age to give 2 or 3 oz. of\norange juice a day. No harm is done and it is more nearly the theoretical nutritional\nrequirements.\nWe don't need to discuss vitamin D. Milk is an excellent source and we hope that\nall our babies and children get an ample supply of milk. It is present also in vegetables\nbut milk is the most important factor. If an abundance of milk is taken and if green\nvegetables and other, fruits are eaten, we don't need to worry about it. There are other\nPage 307\n* J' 1* vitamin D factors about which we know far too little. In most parts of this continent\nwe don't need to worry very much about it.\nThere is another factor that in the rat seems to control the presence or absence of\nhair. Whether this has any application to the human being is not known. We have\noften considered that cirrhosis of the liver may be caused by alcohol. It is now becoming\nsomewhat more evident that these materials are not the direct cause but they are the\ndirect cause of a deprivation of certain numbers of the vitamin D content and it is\nthis which leads to these difficulties in the liver. Alcohol does no damage in these\nrespects, as might be thought.\nAs to the iron intake of the infant\u00E2\u0080\u0094we don't concern ourselves very much with\nthe iron intake of the older child but it is highly desirable with the infant. When the\ninfant is born, he has 22 gms. of haemoglobin for each 100 c.c. of blood. This haemoglobin is broken down to 12 gms. This breakdown leads to the loss of considerable\namounts of iron. Some of this is lost and a considerable amount is stored. It is upon\nthis storage of iron that most of the infants depend for the first 5 or 6 months of\nlife and this storage is adequate if the baby is not ill. So often the baby is not wholly\nwell during that period and the storage is used up more rapidly. Then, a store if iron\nis a normal thing and why should one deplete it at any time? So keep up the iron supply\nafter his first couple of months. There are various ways of doing this. The best way is\nby means of food. Here it is dsirable to give small quantities of iron. The quantity is\nextremely small: 5 mgs. per day is enough in the first 6 months of life\u00E2\u0080\u009410 mgs. for the\nremainder of the first year. This amount of iron would be supplied by a teaspoon of\n1% solution of iron ammonia citrate. In the case of supplying it with foods, one would\nconsider egg yolk and fruits and vegetables as important. This brings about the question\nof feeding cereal as baby's first solid food. This custom goes back a long way. It has\ncome down all through the ages since the Roman Empire. The feeding of cereal as\nbaby's first solid food is founded on custom. It certainly is not through any nutritional\nknowledge. What is it that the baby needs in this early time that he is not getting in\nthe milk formula, in orange juice and in cod liver oil? When even whole grain cereals\nare compared to fruits and vegetables and egg yolk as a source of vitamin Bi, they are\nnot good competitors. Of course, there are cereals which have been fortified with vitamin Bi and this is a good thing, but it is only a custom and not based on sound nutrition.\nIf one is using natural foods, the egg yolk and fruits and vegetables are definitely\nsuperior to the cereals.\nTHE PROFESSIONAL INSTITUTE MEDAL\n[The Bulletin received this news item from the Professional Institute, and while\nadding its congratulations to those already showered on the distinguished medallist, Dr.\nFrederick S. Burke, is glad and honoured to publish the following.\nThis medal is one of the highest laurels a man of science can win in Canada, as is\nevidenced by the fact that it is the fourth presented by the Professional Institute, and\nby the list of those already so honoured, a truly distinguished company. This is not the\nfirst outstanding contribution made by Dr. Burke to the national well being of Canada,\nas our readers will see. Such work, painstaking and conscientious, adds to the sum of\nhuman knowledge and of human happiness, and Dr. Burke has lived up to the highest\nstandards and ideals of his profession, and there are no higher. \u00E2\u0080\u0094Ed.]\nThe Professional Institute Medal, awarded annually for outstanding contribution in\n\"research, administration, or industrial organization by any member of the professional\nservices of the Provincial or Dominion Governments,\" was recently presented to Dr.\nFrederick S. Burke, of the Department of Pensions and National Health. The presentation was made at the annual luncheon of the Professional Institute of the Civil Service\nwhich precedes the business meetings of the organization opening here. The award was\nmade to Dr. Burke for his outstanding study, over a number of years, of the mortality\namong war pensioners, particularly those suffering from tuberculosis, and the valuable\nPage 308 B\n.!<<+\nin\nw\nHi\nIV* feit i\n'JS\n1%\nI\n'fft\nM\u00C2\u00BBj *\nN:\n?<'\ni*:\ntil it*\ni% H\nHlf\n,\u00C2\u00ABi\nla\nfindings and suggestions made by him which have had far-reaching influence on the\nmedical conduct of the present war.\nThe study of the subject of deaths among war pensioners was an entirely new\ndeparture not previously attempted in Canada or elsewhere. It was not undertaken\nbecause of the present war but was finished before its declaration, so that the conclusions\nreached were the result of cold reasoning. Its timeliness is obvious.\nDr. Burke is a native of Fergus, Ontario, graduated in medicine in 1911 from the\nUniversity of Toronto, and saw extended service overseas during the first Great War.\nHe was twice mentioned in despatches. He was Director of Medical Services in the\nToronto Health Department, prior to joining the Department of Pensions and National\nHealth. Dr. Burke has three hobbies: the Professional Institute, mechanics and fishing.\nHis connection with the Institute has been extensive, having served as second vice-\npresident in 1938, and having been chairman of a number of important committees.\nDr. Burke has an inventive streak in his make-up and the government has adopted an\nimproved type of mechanical ankle joint for artificial limbs, perfected by him. Among\nother things he has invented a folding- trailer for automobiles.\nThis is the fourth medal presented by the Professional Institute for outstanding\ncontributions. Former awards were made to Dr. J. H. Craigie of Winnipeg for his\nwork in solving the grain rust problem, to Mr. H. L. Seamans of Lethbridge for his\ndiscovering a method of controlling the Pale Western Cutworm, and Mr. Herbert Marshall of Ottawa, for his study of the Canadian Balance of International Payments. The\njudges of this year's submissions, which were more numerous and of a higher calibre than\never before, consisted of Dean C. L. Mackenzie, Acting President of the National\nResearch Council; Dr. Augustin Frigon, Assistant General Manager of the Canadian\nBroadcasting Corporation, and Mr. Vernon Knowles, prominent journalist and Publicity\nDirector of the Canadian Bankers' Association.\nAcknowledgement of the importance of Dr. Burke's findings and suggestions have\nbeen received from outstanding members of the medical profession in Canada, the United\nStates, the United Kingdom and even Australia. It has also been praised by life assur-\nPage 309\n;\ni** ance companies and the Actuarial Society of America. An article appearing in the\nJournal of the Canadian Medical Association, based on Dr. Burke's findings, estimates\nthe eventual total cost of pensions for conditions that could have been diagnosed by\nX-ray, \"and much of it eliminated from the pension budget,\" at the astonishing total of\n$500,000,000.\nAs a result of the lessons learned from this study undertaken by Dr. Burke, the\nNational Defence Medical Services have put into effect, along the lines suggested,\nmeasures which have already saved vast sums, and will continue to save even greater\namounts. From the humanitarian or public health point of view the gain is equally\ngreat. Tuberculosis is detected very early, when chances of cure are good. Cases are\nremoved from contact with others, thus protecting the army and the public. Furthermore, early detection followed by early treatment gives the sufferer an almost normal\nexpectancy of life and efficiency.\nFurther, if the lessons learned from the study are followed, and steps in that direction\nhave already been taken, Canadian boys under twenty will not be subject to the rigours\nof front line service, and the enhanced diet or rations will greatly aid the efficiency of\nthe young soldier and prevent the breaking down of many through deficiency diseases.\nIn his study of deaths among war pensioners, Dr. Burke had revealed the fact that\n\"the death rate from disease indicated that the after-effects of war service had a less\nadverse influence on the seasoned men of 30 years and over than on those of 24 years\nand younger.\" Dr. Burke further revealed that \"it therefore seems reasonable to assume,\nin the absence of other proof, that with the country on a war footing, the army ration\nas provided during the Great War, while otherwise adequate, may have been deficient\nin the protective elements, and as a result contributed to the loss of man power by permitting the physical breaking down of many in the younger age groups, and by increasing the difficulty of all ages to ward off infections.\"\nIn his survey of mortality of war pensioners, Dr. Burke discovered that those surviving the immediate post-war period and as a result of \"excellent medical care and\nanother element of greater importance, partial if not total freedom from financial worry\n... are thrown into ages in which their mortality is more favourable in comparison with\nthe mortality of Canadian males.\"\nIt is the belief of the Medical Group of the Professional Institute of the Civil Service\nof Canada, expressed in a summary of Dr. Burke's presentation, \"that the revealing facts,\nas demonstrated in Dr. Burke's paper, have been the means of giving us a better army\nfor this present war, as well as saving the Canadian taxpayer staggering sums of money.\nThus work of this nature reflects directly on the financial and the health aspect of every\nCanadian citizen, and, as a result, is worthy of encouragement.\"\nThe Medical Group feels that in all fairness to Dr. Burke it should draw the attention of the judges to the Standard Morbidity Code for Canada, which Dr. Burke originated and developed during the course of his work as chief of the Division of Medical\nInvestigation of the Department of Pensions and National Health. Without such a\nCode, says the Medical Group in its summary, \"medical studies of this nature would\nhave been well nigh impossible. The chief and most important feature, however, was\nthat he had the Code, together with an Appendix for war illnesses and injuries, in such\na complete form that the Army Medical Services were able to adopt it for use within a\nfew days of the outbreak of war and as a result of its timely preparation it has been\naccepted as both Morbidity Code and Standard Nomenclature for the Army Medical\nServices.\nThis was immediately followed by its adoption by the Canadian Pension Commission\nand the Treatment Branch of the Department of Pensions and National Health. This\nmeans that the same Code numbers indicating illness or injury are carried through from\nthe Army to Pensions to Treatment, and we believe that this constitutes the greatest\nadvance yet made towards uniformity of Army Medical Records.\"\nPage 310\nr n hi:.\n\" (i*\nw\nSi t\nm\nWt;\nm\nK If:\nII\njm\nJl\nti\nSi\nI\n\u00E2\u0096\u00A0a,\n1\nSt. Paul s Hosplta\nCASE REPORT\nR. C. Weldon, M.D.\nBy E. Chambers, M.D.\nIn the following paragraphs, we are submitting a case report, which we think mail\nbe of interest to some of your readers:\nAbout February 25, 1940, a white, married female of 23 years of age, contracted a\ncommon cold, which was followed by general aching, malaise, and extreme prostration**\nSymptoms were those of influenza. Temperature of the patient was around 102\u00C2\u00B0 F. She\nstates that she had nausea and vomiting and also some epistaxis. At this time, she also\nsuffered diarrhoea of three days' duration. Since that time, she has had a general feeling\nof malaise, loss of appetite, and some abdominal tenderness. Past history reveals the\nfact that the patient had had a boarder who had had typhoid fever and recovered.\nPatient was admitted to the hospital March 17, complaining of general weakness ami-\ngeneral prostration. Temperature was 99 when she entered, and went up to 1033 that\nevening. She continued with cough, feeling of general malaise and prostration, and a\nspiked temperature, varying from 99 to 104 until March 23, when she was given a blood\ntransfusion, 500 c.c, after which time her temperature came down to normal and\nremained same. The donor of the blood had been immunized for typhoid fever with\nthree shots in 1940, and with one shot in 1941. Patient had some clay-coloured stools\nthe first four or five days. Spleen was enlarged three fingers below the costal margin and\nthere was evidence of slight abdominal tenderness. Remaining physical examination was\nnegative.\nLABORATORY EXAMINATIONS:\nMarch 19, 1941\u00E2\u0080\u0094\nB. typhosus Flagellar \"H\" antigen\u00E2\u0080\u0094agglutination to dilution 1:160\nSomatic \"O\" antigen\u00E2\u0080\u0094Titre to follow\nB. paratyphosus A .Negative\nB. paratyphosus B Some agglutination to dilution 1:160\nBr. abortus Negative\nMarch 20, 1941\u00E2\u0080\u0094\nB. typhosus Flagellar \"H\" antigen (titre) Agglutination to dilution 1:1280\nSomatic \"O\" antigen (titre) Agglutination to dilution 1:2560\nApril 3, 1941\u00E2\u0080\u0094\nB. typhosus j Flagellar \"H\" antigen\u00E2\u0080\u0094agglutination to dilution 1:640\nSomatic \"O\" antigen\u00E2\u0080\u0094agglutination to dilution 1:2560\nB. paratyphosus A Agglutination to dilution 1:80\nB. paratyphosus B_ Agglutination to dilution 1:80\nBr. abortus No agglutination in 24 hours. If after further incubation\nagglutination occurs, a subsequent report will be sent.\nUrinalysis\u00E2\u0080\u0094Sp. Gr. 1015; Reaction\u00E2\u0080\u0094acid; Albumin\u00E2\u0080\u0094plus 1; Sugar\u00E2\u0080\u0094negative;\nMicroscopical\u00E2\u0080\u0094Pus cells\u00E2\u0080\u0094plus 1; Pus in clumps\u00E2\u0080\u0094plus 1; Few epithelial cells.\nBlood Count\u00E2\u0080\u0094 Haemoglobin\n15.36 gms. 100% R.B.C. \"W.B.C. P.M.N. Eosin L. Lymphs\nMar. 17\u00E2\u0080\u0094 54% 2,800,000 3,000 36 64\nMar. 24\u00E2\u0080\u0094 73%\nApr. 9\u00E2\u0080\u0094 80%\nMar. 17\u00E2\u0080\u0094Anisocytosis plus 1; Poikilocytosis plus 1\nMar. 19\u00E2\u0080\u0094Icterus Index 4.5\nMar. 19\u00E2\u0080\u00942 specimens sputum: No T. B. found\nMar. 22\u00E2\u0080\u0094Bl. Culture: (4 p.m.) 72 hours no growth\nMar. 24\u00E2\u0080\u0094Culture stool rec'd 19/3/41: No B. typhosus, B paratyphosus A or B found\nMar. 26\u00E2\u0080\u0094Stool culture: No. B typhosus found\nApr. 3\u00E2\u0080\u0094Stool: No B. typhosus found\nApr. 12\u00E2\u0080\u0094Stool: No. B typhosus found\nMar. 17\u00E2\u0080\u0094Sedimentation rate: 11/55\nMar. 22\u00E2\u0080\u0094Mr. J. D Jones\u00E2\u0080\u0094matched and compat.\nPatient group A4.\nLungs were x-rayed and found negative.\nPatient was given Phenobarbital grs. iss to sleep, Blands compound gr x one t.i.d and haliver\noil capsule b.i.d.\nPage 311"@en . "Periodicals"@en . "W1 .VA625"@en . "W1_VA625_1941_07"@en . "10.14288/1.0214573"@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: July, 1941"@en . "Text"@en . ""@en .