"CONTENTdm"@en . "http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1179642"@en . "History of Nursing in Pacific Canada"@en . "Vancouver Medical Association"@en . "1951-01"@en . "2015-01-30"@en . "1951-01"@en . "https://open.library.ubc.ca/collections/vma/items/1.0214632/source.json"@en . "image/jpeg"@en . " BULLETIN\nOF\nThe Vancouver Medical Association\nEDITOR:\nDR. J. H. MacDERMOT\nEDITORIAL BOARD\nDR. D. E. H. CLEVELAND DR. J. H. B. GRANT\nDR. H. A. DesBRISAY DR. D. A. STEELE\nPublisher and Advertising Manager\nW. E. G. MACDONALD\nVOL. XXVII JANUARY, 1951 NUMBER 4\nOFFICERS 1950-51\nDr. Henry Scott Dr. J. C. Grimson Dr. W. J. Dorrance\nPresident Vice-President Past President\nDr. Gordon Burke Dr. E. C. McCoy\nHon. Treasurer Hon. Secretary\nAdditional Members of Executive:\nDr. J. H. Black Dr. D. S. Munroe\nTRUSTEES\nDr. G. H. Clement Dr. A. C. Frost Dr. Murray Blair\nAuditors: Messrs. Plommeb, Whiting & Co.\nSECTIONS\nEye, Ear, Nose and Throat\nDr. N. J. Blair jj Chairman Dr. B. W. Tanton Secretary\nPaediatric\nDr. C. J. Trefry Chairman Dr. Peter Spohn Secretary\nOrthopaedic and Traumatic Surgery\nDr. D. E. Starr Chairman Dr. A. S. McConkey Secretary\n|lpNeurology and Psychiatry\nDr. F. E. McNair ] Chairman Dr. R. Whitman Secretary\nRadiology\nDr. Andrew TuRNBULL\u00E2\u0080\u0094Chairman Dr. W. L. Sloan Secretary\nSTANDING COMMITTEES\nLibrary:\nDr. E. France Word, Chairman; Dr. A. F. Hardyment, Secretary;\nDr. F. S. Hobbs, Dr. J. L. Parnell, Dr. S. E. C. Turvey, Dr. J. E. Walker\nCo-ordination of Medical Meetings Committee:\nDr. R. A. Stanley Chairman Dr. W. E. Austin Secretary\nSummer School:\nDr. E. A. Campbell, Chairman; Dr. Gordon C. Large, Secretary;\nDr. A. C. Gardner Frost; Dr. Peter Lehmann; Dr. J. H. Black;\nDr. B. T. H. Marteinsson.\nMedical Economics:\nDr. F. L. Skinner, Chairman; Dr. E. C. McCoy, Dr. T. R. Sarjeant,\nDr. W. L. Sloan, Dr. J. A. Ganshorn, Dr. E. A. Jones, Dr. G. Clement.\nCredentials:\nDr. G. A. Davidson, Dr. Gordon C. Johnston, Dr. W. J. Dorrance\nSpecial Committee\u00E2\u0080\u0094Public Relations:\nDr. Gordon C. Johnston, Chairman; Dr. J. L. Parnell, Dr. F. L. Skinner\nRepresentative to B. C. Medical Association: Dr. W. J. Dorrance\nRepresentative to V.O.N. Advisory Board: Dr. Isabel Day\nRepresentative to Greater Vancouver Health League: Dr. I>. A. Patterson VANCOUVER MEDICAL ASSOCIATION\nPROGRAMME FOR THE FIFTY-THIRD ANNUAL SESSION\nFounded 1898; Incorporated 1906.\n(Spring Session)\nFEBRUARY 6th\u00E2\u0080\u0094GENERAL MEETING\u00E2\u0080\u0094Devoted to Medical Economics.\nMARCH 6th\u00E2\u0080\u0094OSLER DINNER\u00E2\u0080\u0094Dr. H. A. DesBrisay, Osier Lecturer.\nAPRIL 3rd\u00E2\u0080\u0094GENERAL MEETING (Speaker to be announced).\nMAY 1st\u00E2\u0080\u0094ANNUAL MEETING.\nMAY 28th to JUNE 1st (inclusive)\u00E2\u0080\u0094ANNUAL SUMMER SCHOOL.\nREGULAR MONTHLY MEDICAL MEETINGS\nFIRST TUESDAY\u00E2\u0080\u0094GENERAL MEETING\u00E2\u0080\u0094Vancouver Medical Association\u00E2\u0080\u0094T. B.\nAuditorium.\nClinical Meetings, which members of the Vancouver Medical Association are invited\nto attend, will be held each month as follows:\nSECOND TUESDAY\u00E2\u0080\u0094SHAUGHNESSY HOSPITAL STAFF MEETING.\nTHIRD TUESDAY\u00E2\u0080\u0094ST. PAUL'S HOSPITAL STAFF MEETING.\nFOURTH TUESDAY\u00E2\u0080\u0094VANCOUVER GENERAL HOSPITAL STAFF MEETING.\nFIFTH TUESDAY\u00E2\u0080\u0094(when one occurs)\u00E2\u0080\u0094CHILDREN'S HOSPITAL STAFF MEETING.\nNotice and programme of all meetings will be circularized by the Executive Office\nof the Vancouver Medical Association.\nVANCOUVER GENERAL HOSPITAL\nRefresher Courses for the General Practitioner\nSURGERY\u00E2\u0080\u0094February 12th, 13 th, 14th, 1951.\nEYE, EAR, NOSE and THROAT-^March 5th, 6th, 7th, 1951.\nOBSTETRICS and GYNAECOLOGY\u00E2\u0080\u0094April 9th, 10th, 11th, 1951.\nRegular Weekly Fixtures in the Lecture Hall\nMonday, 12:15 p.m.\u00E2\u0080\u0094Surgical Clinic.\nTuesday\u00E2\u0080\u00949:00 a.m.\u00E2\u0080\u0094Obstetrics and Gynaecology Conference.\nWednesday, 9:00 a.m.\u00E2\u0080\u0094Clinicopathological Conference.\nThursday, 9:00 a.m.\u00E2\u0080\u0094Medical Clinic.\n12:00 noon\u00E2\u0080\u0094Clinicopathological Conference on Newborns.\nFriday, 9:00 a.m.\u00E2\u0080\u0094Paediatric Clinic.\nSaturday, 9:00 a.m.\u00E2\u0080\u0094Neurosurgery Clinic,\nedition, 1950.\nPage 77 ST. PAUL'S HOSPITAL\nRegular Weekly Fixtures\nTuesday, 9:15 a.m.\u00E2\u0080\u0094Paediatric Ward Rounds.\nWednesday, 9:00 a.m.\u00E2\u0080\u0094Medical Ward Rounds.\nSecond and Fourth Wednesday's in month\u00E2\u0080\u0094Obstetrical Clinics.\nFriday, 8:00 a.m.\u00E2\u0080\u0094Surgical Clinic (and alternate weeks) Clinical Pathological Conference.\nSHAUGHNESSY HOSPITAL\nRegular Weekly Fixtures\nTuesday, 8:30 a.m.\u00E2\u0080\u0094Dermatology.\nWednesday, 10:45 a.m.\u00E2\u0080\u0094General Medicine.\nWednesday, 12:30 p.m.\u00E2\u0080\u0094Pataology.\nThursday, 10:30 a.m.\u00E2\u0080\u0094Psychiatry.\nFriday, 8:30 a.m.\u00E2\u0080\u0094Chest Conference*\nFriday, 1:15 p.m.\u00E2\u0080\u0094Surgery.\nBRITISH COLUMBIA CANCER INSTITUTE\nTuesday, 9:00 a.m. to 10:00 a.m. (weekly)\u00E2\u0080\u0094Clinical Meeting.\nB. C. Surgical Society Meeting Dates:\nSpring Meeting, March 30th-31st\u00E2\u0080\u0094Vancouver Hotel (open to all members of the\nprofession).\nTHE BULLETIN\nPublishing and Business Office \u00E2\u0080\u0094 17 - 675 Davie Street, Vancouver, B.C.\nEditorial Office \u00E2\u0080\u0094 203 Medical-Dental Building, Vancouver, B.C.\nThe Bulletin of the Vancouver Medical Association is published on the first of\neach month.\nClosing Date for articles is the 10th of the month preceding date of issue.\nManuscripts must be typewritten, double spaced and the original copy.\nReprints must be ordered within 15 days after the appearance of the article in question, direct from the Publisher. Quotations on request.\nAdvertisements\nClosing Date for advertisements is the 10th of the month preceding date of issue.\nAdvertising Rates on Request.\nPage 78 Return\nhappiness.\nAt the time of life when so\nmany women are distraught by\nmenopausal symptoms, oral\nConestron therapy restores joy of\nliving and brings a feeling of\nwell-being that is a comfort\nto all concerned.\nWELL TOLERATED \u00E2\u0080\u00A2 NON TOXIC \u00E2\u0080\u00A2 ORALLY ACTIVE\nCONESTRON\nT A B L E T S\nCONJUGATED ESTROGENIC SUBSTANCE (EQUINE) WYETH\n.625 mg. and 1.25 mg. tablets\nBottles of 100 and 500\ny/fat/i\nFWqisi\u00C2\u00ABr\u00C2\u00ABd Trad* Mack VANCOUVER HEALTH DEPARTMENT\nCASES OF COMMUNICABLE DISEASE REPORTED IN THE\nCITY\nSTATISTICS\u00E2\u0080\u0094DECEMBER, 1950\nTotal population \u00E2\u0080\u0094 estimated 3 85,500\nChinese population \u00E2\u0080\u0094 estimated\u00E2\u0080\u0094 6,877\nHindu population \u00E2\u0080\u0094 estimated 133\nNumber\nTotal deaths (by occurrence) 394\nChinese deaths 17\nDeaths, residents only 373\nNovember, 1950\nRate per\n1000 Pop.\n12.3\n29.7\n11.6\nBIRTH REGISTRATIONS\u00E2\u0080\u0094RESIDENTS AND NON-RESIDENTS\n(Includes late registrations)\nNovember, 1950\nMale 47 8\nFemale - 472\n950\n29.6\nINFANT MORTALITY\u00E2\u0080\u0094RESIDENTS ONLY\nNovember, 1950\nDeaths under 1 year of age \ 13\nDeath rate per 1000 live births 19.3\nStillbirths (not included in above item) 2\nCASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY\nNovember, 1950\nCases Deaths\nScarlet Fever j 32\nDiphtheria : ililsl\nDiphtheria Carriers \u00E2\u0080\u0094\nChicken Pox 3 8\nMeasles 9\nRubella | 12\nMumps 54\nWhooping Cough 14\nTyphoid Fever -\u00E2\u0080\u0094 \u00E2\u0080\u0094\nTyphoid Fever Carriers -_ \u00E2\u0080\u0094\nUndulant Fever \u00E2\u0080\u0094\n-Poliomyelitis \u00E2\u0096\u00A0 2\nTuberculosis 49\nErysipelas - :\u00E2\u0080\u0094k 2\nMeningitis 3\nInfectious Jaundice \u00E2\u0080\u0094\nSalmonellosis 1\nSalmonellosis Carriers \u00E2\u0080\u0094\nDysentery j 15\nDysentery Carriers \u00E2\u0080\u0094\nTetanus \ \u00E2\u0080\u0094\n, Syphilis - 20\nGonorrhoea 157\nCancer (reportable)\u00E2\u0080\u0094Resident 121\n13\nNovember, 1949\nCases Deaths\n19 \u00E2\u0080\u0094\n11 -CCQMNAUCHT>\nNPH INSULIN\nFollowing an extended period of clinical trial there is now\ngenerally available a modified Insulin preparation known as NPH\nInsulin. The product is distributed as a buffered aqueous suspension\nof a crystalline preparation of Insulin, protamine, and zinc. It is\nsupplied in 10-cc vials containing\neither 40 or 80 units per cc.\n^\n^\nw\n^6\nNPH Insulin exerts a blood-\nsugar-lowering effect extending for\nslightly more than a 24-hour period.\nIn most instances this new preparation has been found to act more\nquickly than Protamine Zinc Insulin\nbut for a shorter period. Probably\nbecause of the fact that NPH\nInsulin is a suspension of crystals,\nits use has been found advantageous\nin cases where it is desired to administer Insulin and a modified form of Insulin in a single injection without\nappreciable alteration of the effect of either of the two preparations.\n\u00E2\u0096\u00A1 . .if \u00E2\u0096\u00A0 '\nCONN AUGHT MEDICAL RESEARCH LABORATORIES\nUniversity of Toronto Toronto 4, Canada\nEstablished in 1914 for Public Service through Medical Research and\nthe development of Products for Prevention or Treatment of Disease.\nCrystals formed of Insulin, protamine and zinc\nin NPH Insulin\nDEPOT FOR BRITISH COLUMBIA\nMACDONALD'S PRESCRIPTIONS LIMITED\nMEDICAL-DENTAL BUILDING, VANCOUVER, B.C. 7<&e \u00C2\u00A3dUv& PatfA\nRecently, as most of us know, the M. S. A. has altered its plan of payment of\naccounts, and is paying 90 % of the account, instead of from 75 to 80 % as formerly.\nThe various approved medical plans, B. C. Telephone, C. U. & C. Vancouver\nand B. C. Schoolteachers' Association and others, have been asked to do the same thing,\nand the whole matter was discussed at a meeting with members of Council and of the\nEconomics Committee of the Council.\nA great deal of frank discussion took place. The representatives of the various\nplans, with one accord, stated that while they were anxious to do all they could to\nmeet the demands of the medical profession, they could not, at present at any rate,\nsee their way to do so without very grave risk of losing their membership. One or two\nof the plans stated bluntly that any attempt on their part to increase fees to meet\nthis extra call would mean that they would have to suspend operations.\nWe feel that these approved plans fill a very important part in our medical economy,\nand that if possible we must help them to survive and prosper. These are some of\nour reasons:\nWe, as a profession, have been declaring for years that we want to see voluntary\nprepaid plans of medical care grow and increase. We have been seeking ways to enlarge\nthe application of M. S. A.\nThese plans, apart from the M.S.A., serve some 32,000 people throughout the\nprovince\u00E2\u0080\u0094not merely in Vancouver or Victoria but in every small town and rural area.\nThey include in their membership people of small income\u00E2\u0080\u0094telephone operators,\nschool teachers, many with families, employees of the government, C. U. & C. members\nand so on.\nThey give to them, not as complete a coverage as does the M. S. A., but nevertheless a very good coverage. They provide in addition to medical and surgical care,\nspecialists' care, X-rays, laboratory tests, etc. These are all things that these people\nshould have, but are also things that most of them could never afford, and would\nnot pay for. Operations of major nature, to these people, are catastrophic. They put\nthem off and avoid them as long as they can.\nThese plans encourage people to go early to their doctor. Thus they are doing\nvaluable preventive work, helping people to avoid the consequences of delay.\nThey are the cause of very many people going to see a doctor, who would otherwise\nnot go\u00E2\u0080\u0094we all know that. If they did have to go, they would be incurring bills which\nthey know they cannot afford. Being honest working people they would in many\ncases rather not go. ||pt\nThese plans, it has been proved again and again, increase our volume of work\nin this wage-level tremendously. We could not hope to apply any but the minimum\nscale to at least 90-95% of them.\nThese plans pay promptly, and with hardly any question. The people who run\nthem do so with no remuneration of any kind, and give largely and generously of their\nown time to make them a success.\nThey charge a discount, which does two things. It pays them operating expenses,\nprovides a small margin, very small, for emergencies, and it enables them to fix a fee\nwhich their membership can afford. That the discount does not provide much of a\nbacklog, if any, is shown by the fact that many of these plans have a provision for\nlevies in case of emergency. Most of them, we understand, are living almost entirely\nup to their income.\nThey are non-profit making, have practically no reserve, and their membership depends upon the ability of members to meet the fee charged. The discount they pay\nmust be regarded not as a discount at all, but as an operating charge.\nPage 80 All of us, every day, have to pay a collection charge on the money we collect,\nafter we have earned it. We must send bills, often a great many times. We often have\nto reduce charges to settle the bill. We often have to send a bill for collection, the\ncharges for which amount to from 3 3 ^3 to 50%. This does not improve our relations\nwith our patients, and frequently means friction and unpleasantness.\nThose of us who have been in practice for twenty to thirty years or more, will,\nwe think, agree that a 20% to 25% cost of collection is not unreasonable, and we\ndoubt if the average medical man can do it for much less even now.\nUnder the operation of these plans, we have received, over the years, many\nhundreds of thousands of dollars\u00E2\u0080\u0094promptly, with little or no bookkeeping\u00E2\u0080\u0094no bad\ndebts, no delay. We have had work which we should not have had otherwise. We\nhave avoided friction, bad feeling, resentment on the part of patients who cannot pay.\nWe believe that to the great majority of medical practitioners, these plans have\nbeen a godsend and most welcome. We believe that they have meant a lot of actual\ncash to us.\nThey are a very good piece of public relations and we should consider this aspect\nof the question very carefully. There should be something more than a mere cash\nrelationship for work done between ourselves and the public we work for. We need to\nshow them our sincere desire to do all that we can, in fairness to ourselves, to mitigate\ntheir burdens and to resolve some of their difficulties. If we support these plans, and\ngive them our whole-hearted backing, we thereby create good feeling and a kindly\nrelationship between them and ourselves.\nFor us to allow these plans to collapse would be. a very bad piece of public relations.\nWe must not put ourselves in a position where it could be said that rather than relinquish our pound of flesh, we are willing to lose all that has been gained in the way\nof tremendous unselfish effort through the years\u00E2\u0080\u0094that all we are considering is our\nown pocket, not the good and the friendship of those whom we claim to serve.\nFor us to allow these plans to collapse would be giving the lie to our own arguments and pretensions in favour of voluntary prepaid plans. It would be forcing\npeople back into the arms of those who advocate compulsory, state-controlled health\ninsurance. Let us make no mistake, this would be the result.\nOn the other hand, if we will do all we can to help these plans to operate, will\ncooperate with them, make necessary adjustments, help them to institute economies,\nand the like, we may perhaps not get all that we should like, but we shall be doing\ngood public service, aiding the cause of early and complete medical care. We believe\nthat those responsible for the administration of these plans, will, if \"they are shown\nthe justice of any request, do all that they can to meet it\u00E2\u0080\u0094they have always shown\ntheir willingness to do so.\nThese plans, too, are of especial value as guides in our negotiations with government in the matter of the care of the indigent. They give us figures of cost which\ncan be of great help to us. If they succeed, we have a standard on which we may\nrely. If they fail, then even the scale on which they are asked to pay is evidently more\nthan a large section of the working population can afford to pay. How then could\nwe expect the indigent and pensioner's scheme to pay as much?\nMedical practice, like all other human enterprise, tends to have elevations and\ndepressions. For some years we have been riding on the wave of general prosperity\nand rising incomes; collections have been good, and we, being human, would like them\nto be even better. But we cannot count on this being always the way\u00E2\u0080\u0094and the time\nmay come, as it has come in the past, when we should be very glad of all these prepaid plans from the M. S. A. down. So let us take good care of our various geese who,\nmonth by month, lay us golden eggs\u00E2\u0080\u0094even if they are not quite as large as we should\nlike.\nAnd let us never forget the immortal words of David Harum: \"Mebbe it ain't a\nbad idee to let the other feller make a dollar oncet in a while.\"\nPage 81 \u00C2\u00AE; I\n\u00C2\u00A3*5>\nHours:\nMonday, Wednesday and Friday 9:00 a.m.-9:30 p.m.\nTuesday and Thursday 9:00 a.m.-5:00 p.m.\nSaturday - 9:00 a.m.-l:00 p.m.\nThe following is a letter of thanks and appreciation sent to the C. S. Williams\nClinic of Trail, B.C., for their recent donation to the Library:\nOctober 30th, 1950.\nDr. M. R. Basted,\nC. S. Williams Clinic,\n901 Helena Street,\nTrail, B.C.\nDear Doctor Basted:\nOn behalf of the Library Committee and members of the Association, I would\nlike you to convey to members of the C. S. Williams Clinic, their sincere thanks for\nthe recent gift to the Library of $100.00.\nAt the recent meeting of the Library Committee we agreed to assign the money\nto the Historical and Ultra-Scientific Fund, which as the name implies is for the purchase\nof books of historical value and on the history of medicine.\nWe are glad to know of the interest shown in the Library by members of the Clinic.\nSincerely yours,\n(sgd) A. F. Hardyment, M.D.,\nSecretary, Library. Committee.\n. Jf JSOOK REVIEW H\nVARICOSE VEINS, by R. Rowden Foote, Buterworth, 1949, pp. 226, illustrated.\nMr. Rowden Foote of London has written a rather remarkable book on a disease\nwhich afflicts 10 % of our population, thrives on our orthograde position and is enhanced\nby a defect in the genes. His historical account of this ugly and disabling condition is\na saga of the failures of great historical figures to find a therapeutic solution for this\ndisorder. Because varicose veins and their complications are not lethal and because their\ntreatment is unspectacular, tedius and unrewarding success has long been delayed.\nThis concise book contains all the current information on varicose veins and their\ncomplications. It includes the pathogenesis, classification, abnormal anatomy and physiology and a detailed account of the investigation and treatment of this condition.\nAlthough the study is thorough and exhaustive one has the impression that the\nbook is brief. This is due, no doubt, to the unusually lucid and pleasing presentation,\nthe generous number of excellent illustrations, the frequent quotations and to some\nextent at least to the brightly handsome binding.\nIt is difficult not to be genuinely enthusiastic about this addition to our library.\n\u00E2\u0080\u0094G.C.J.\nPage 82 IMPORTANT NOTICE\nRe: NEW Physician's Notice of Birth Form\nDear Doctor:\nEffective February 1st, 1951, this province is bringing into use a revised\n\"Physician's Notice of a Live Birth or Stillbirth\", a copy of which is attached. This\nrevision has been made to enable the compilation and analysis of certain facts relative\nto Births in British Columbia. The new report form has been drawn up with the\nhelp and advice of a special committee of medical men headed by Dr. Donald Paterson,\nand each item has been carefully studied for its utility and availability before being\nincluded in the form. As a clarification of the new points that have been added to the\nform an explanatory letter written by Dr. Paterson is enclosed. To assist in completing\nthe form a check-off system has been used wherever possible, the typewriter spacing\nhas been maintained throughout.\nThe revised notification forms are available upon request from the local District\nRegistrar of Births, Deaths and Marriages. Supplies are also being forwarded to all\nhospitals.\n.We trust that you will find the new form entirely satisfactory, and that the\ndata which will become available through its use will prove valuable to the medical\nprofession.\nYours very truly,\nJ. H. Doughty,\nDIRECTOR OF VITAL STATISTICS\nDEPARTMENT OF HEALTH AND WELFARE.\nWhat brought about the alterations in the Physician's Notice of a Live Birth\nor Stillbirth Card?\nThe infant mortality of British Columbia during the last quarter century has\nbeen the most favourable of any of the Provinces of Canada and during the same\nperiod our infant mortality rate has been reduced by over fifty percent. In 1922, 68\nof every 1,000 children born alive failed to survive the first year of life, whereas in\n1949, fewer than 30 of every 1,000 born alive died before reaching the age of one year.\nProud as we may justifiably be of this record, the loss in infancy of 30 of every\n1,000 children born and the crippling of many more still represents a shocking\nwastage and impairment of lives which calls for renewed effort on the part of the\nmedical profession. The recent Survey of Crippling Diseases of Children has brought\nforcibly to our attention the fact that some of the crippling diseases which occurred at\nbirth were not brought to the attention of the medical profession for some months\nor even years. The great improvement noted above has resulted mainly from our attack\non the more glaring and tangible causative factors, but in order to effect further\ngains it now becomes imperative that we discover the additional underlying factors\nwhich continue to take their toll. This can only be done by painstaking study and\nanalysis of the conditions associated with the pre-natal, natal, and post-natal experience\nof all children currently being born in this Province.\nThe Division of Vital Statistics of the Provincial Department of Health and Welfare has agreed to undertake the massive statistical job that is required in this next\nphase of our attack on infant mortality and crippling conditions. To this end the\nPhysician's Notice of Birth Card has been modified to obtain the important data needed,\nwhile still serving its statutory function under the Vital Statistics Act.\nComposition of Advisory Body\nRequests for statistics of the type now proposed have been frequently received\nby the Division of Vital statistics in recent years, and hence in July, 1949, I was\nPage 83 asked as chairman of the Sub-committee on Crippling Diseases of Children to call\nrepresentatives of those Doctors mainly concerned with newborn babies and seek their\nadvice on the nature of the information to be sought.\nThe group consulted consisted of Obstetricians, Pediatricians and representatives\nof Public Health, and were as follows: Dr. Alec Agnew and Dr. Reginald Wilson,\nVancouver General Hospital; Dr. F. S. Hobbs and Dr. A. F. Hardyment, Grace\nHospital: Dr. E. B. Trowbridge and Dr. Peter Spohn, St. Paul's Hospital; Dr. Stewart\nMurray and Dr. A. M. Menzies, Metropolitan Health Committee.\nThe Card and its Description\nYou will note the card which was evolved as a result of long and careful discussion.\nGoing into details, many of the questions asked are self-explanatory but some\nof them may require further elucidation. It was felt that the question \"Was resuscitation necessary\" would give us much information as to the correlation of difficult\nresuscitation with birth injury and with both the anaesthetic and sedation used. The\nquestion \"Name of anaesthetic agent and sedation used\" refers to regional anaesthesia,\ngeneral anaesthesia, as well as sedation such as morphine, hyoscine and barbiturates.\nUnder the heading \"Describe complications of pregnancy or labour\" is meant such\ncomplications as pernicious vomiting of pregnancy, toxemia of pregnancy or acute\nhaemorrhage. Complications particularly of labour would be the use of forceps, version\nor Caesarean Section. Under \"Describe birth injury\" one would note an external\ninjury such as bruising or trauma to any part of the body or fractures or nerve injury.\nWhere internal injury such as cerebral oedema or cerebral haemorrhage was suspected,\nthis would also be noted. Finally, under the description of ''Congenital malformations\"\nwould be noted hare lip, cleft palate, spina bifida, club feet, mongolism and all the\nmany slight or gross malformations detectable at birth.\nStatistical Advance\nIt is anticipated the Medical Profession will realize immediately the value of the\nstatistics compiled and will welcome this step forward. This will place at the disposal\nof the profession in this Province desirable information which cannot now be obtained\nanywhere in Canada.\nDONALD PATERSON, Chairman.\nNOTICE\nAvailable for Locums until July\nDr. G. MARION\n2950 Philips, R.R. No. 8\nNew Westminster, B. C.\nPhone GLenburn 0184-L\nNORTH SHORE ACREAGE-\n10 Y2 acres, 7l/z miles from Medical Dental Building, atop high\nbench where privacy can't be spoiled. Ideal for estate. One\nthird almost clear with only light brush, balance large cedar,\nfir hemlock. On road with light, water. Sell all or half. Buyer\ncould subdivide profitably if desired.\nOwner, Don Tyrell, ALma 3061-L.\nPage 85 LORD LISTER\u00E2\u0080\u0094HIS TIMES AND HIS WORK\nThe Lister Oration\u00E2\u0080\u0094Victoria Medical Society, May Sth, 1950\nGiven by DR. H. H. MURPHY, Victoria\nIn any medical community the establishment of a memorial lecture marks a very\ndefinite advanced plateau in professional thought and development. It signifies, as I\nsee it, a quickened tempo in appreciation of what has been handed on to us through\nthe life and work of the great masters of medicine. Our primary interest is of course\nthe application of scientific medicine to the needs of mankind\u00E2\u0080\u0094to the relief and cure\nof disease\u00E2\u0080\u0094disease which has been defined as \"the shadow of death that clouds the life\nof man.\" When we establish an annual address of this type we are saying at the same\ntime that we are interested in how this knowledge came to us\u00E2\u0080\u0094what manner of men\nthese were who made possible our daily work, and that we have paused in the busy\nround of everyday tasks to pay homage to them.\nThis forward step was taken by the Victoria Medical Society last year and the\nLister Oration was established. When I was invited to address you this year the title\nwas still the same although I was advised that I might choose my own subject. Although\nthe address last year was on Lord Lister I thought that, in the language of the book\nof Ruth, I might still glean some corn after the reapers\u00E2\u0080\u0094and decided to speak to you\nagain this year on the times and on the work of this great man. As you know the title\nhas been broadened and in the current year is simply a memorial address.\nYou will recall how fortunate was the choice of the first speaker, Dr. H. E. Ride-\nwood\u00E2\u0080\u0094the Dean of the profession of Medicine in Victoria. You will readily remember\nhow Dr. Ridewood linked up the life and the work of Lord Lister with the problem\nof education today and with the need of hobbies in the life and training of thoughtful\nmen. Our attention was directed to the careful, painstaking and accurate research that\ncharacterized the active life of Lord Lister and Dr. Ridewood reminded us that money\ncannot purchase successful research unless the mind of the worker has been trained\nand developed by thoughtful study and the power of reflection developed during the\nformative years of childhood. To be invited to give the second of these addresses\u00E2\u0080\u0094to\nbe given the privilege of following Dr. Ridewood\u00E2\u0080\u0094is an honour which I deeply appreciate. I very humbly thank you for the confidence you have shown in me and for the\nopportunity you have placed before me. I am very happy to be one of those who will\ntry to build a superstructure worthy of the foundation laid last year for us by our\nfirst essayist.\nIn her recent delightful biography of Dr. Thomas Cullen of Baltimore, Judith\nRobinson quotes from the second book of Maccabees the 15th chapter and the 38 th\nverse: \"And if I have done well and as is fitting the story, it is that which I have\ndesired: but if slenderly and meanly, it is that which I could attain unto.\"\nAs I speak to you this evening I hope you may remember that verse.\nIf we are to properly appraise a great man we must have some unit of measurement\u00E2\u0080\u0094some yardstick with which we can estimate his worth as against that of mankind in general. It is not easy to find or to formulate such a standard, but for this\nevening I shall go back to the prophet Isaiah\u00E2\u0080\u0094Chapter 32, verse 2\u00E2\u0080\u0094'believed today\nto have been written about 400 B.C. \"And a man shall be as an hiding place from the\nwind, and a covert from the tempest; as rivers of water in a dry place and as the\nshadow of a great rock in a weary land.\" It is all of course cast in the imagery of the\ndesert and each simile used signifies that a man is great as his life is lived in relationship to his people and to his time. Man is here compared with those fundamental\nnecessities which made life in the desert possible\u00E2\u0080\u0094shelter from the storm; water for\nthe irrigation of crops and for the maintenance of life in man and beast and protection\nfrom the desert sun. I would ask you this evening to combine this with the dictum\nof Lord Brougham, \"The true test of a great man\u00E2\u0080\u0094that at least which must secure\nhis place among the highest order of great men\u00E2\u0080\u0094is his having been in advance of\nPage 86 his age.\" In terms of these two definitions we shall consider this evening very briefly\nthe life, the times and the work of that great English surgeon, Lord Lister. I would\nfurther remind you that in the sense in which we shall speak of \"great\" men the old\nadage is incorrect\u00E2\u0080\u0094men are not born great\u00E2\u0080\u0094they become great through devotion to\nan ideal and hard unremitting work\u00E2\u0080\u0094largely forgetting self in their work for mankind.\nThat we may have a1 definite sequence of thought in mind this evening I shall\nsummarize very briefly the important dates in the story. Lord Lister was born on\nApril 5th, 1827, at Upton in the county of Essex, England. This merits emphasis as'\nthere is a current fallacy that he was a Scotchman because as we shall see later he came\nto London from Edinburgh. His father, as Dr. Ridewood told us last year, was a^wine\nmerchant but throughout his life was a student of science, an expert microscopist\nwhose studies won him membership in the Royal Society in 1834 when Joseph was\nseven years old. The special subjects which interested Joseph Jackson Lister were the\nblood and animal tissues\u00E2\u0080\u0094research work which had a very definite bearing on medicine.\nThis is worthy of note because from time to time there has been a tendency for us to\nbelieve that a degree in medicine is a necessity if the worker's findings are to be applied\nto medical problems. Fortunately, today the work of physicists, physiologists and chemists\nis steadily disproving this narrow and false conception. That broadening influence was\nseen in our own society quite recently when the Executive very wisely arranged for\nDr. Newton of the Experimental farm at Sidney to speak to us on plant hormones.\nIt was, I think, quite an important fact, that the Lister family belonged to the Society\nof Friends. The Quaker faith, to use the term more commonly heard today\u00E2\u0080\u0094has been\na very powerful influence for good in the world since its birth in 1647 and perhaps\nmore than any other philosophy in the Western world sets an indelible stamp on its\nfollowers. The Quaker faith is a branch of Christianity differing in many ways from\nthe prevailing type. Adherence to a definite creed is not demanded\u00E2\u0080\u0094there is no. liturgy,\npriesthood or outward sacrament, and women have an equal place with men in the\nchurch organization. It is a way of life rather than a philosophical doctrine. The\nQuakers have always been opposed to war and have refused to take an oath in the\ncourts of law as they believe it creates a double standard of Truth. John Morley in\nhis life of Oliver Cromwell writes as follows: ^Mm\n\"When the Quakers entered history it was indeed high time, for the worst of\nPuritanism was that in so many of its phases it dropped out the Sermon on the Mount.\nQuakerism has undergone many, developments, but in all of them it has been the most\ndevout of all endeavours to turn Christianity into the religion of Christ.\"\nAs you know Friends refused, as a matter of conscience, to accept the thirty-nine\narticles. This debarred them from the older universities and it militated against their\ntaking up law or medicine. They were naturally disqualified from taking orders, and as\nthey had what they termed their \"Christian testimony against war\" they were unable\nto join the army or navy. They protested against what they called \"vain sports and\nplaces of diversion\" so they did not attend theatres, did not dance, did not hunt, had\nno music in their homes and so naturally they studied, very often some branch of\nscience, and combined this quite successfully with business. During the boyhood of\nJoseph Lister the restrictions against Quakers were gradually being relaxed and by\nthe time he had finished private school, University College in London\u00E2\u0080\u0094the Godless\ncollege as it was known for many years\u00E2\u0080\u0094had been opened. It was non-denominational\nand so open to Friends. Lister secured his Bachelor of Arts degree in 1847 and five years\nlater in 1852 graduated in medicine and became a member of the Royal College of\nSurgeons at the age of 25.\nAbout this time James Syme (1799-1870)\u00E2\u0080\u0094his name is current today in association with a special amputation and an operation for external urethrotomy\u00E2\u0080\u0094was at\nthe height of his fame as Professor of Surgery in Edinburgh. Following the death of\nRobert Liston (1794-1847), another Scottish professor at University' Hospital in\nLondon, Syme, had gone there for a few months, but disliking conditions, had returned\nto Edinburgh. During his undergraduate course in medicine, Lister had been influenced\nPage 87 by Graham, professor of chemistry, and Sharpey, professor of physiology, and now\nthese two men advised him to go to Syme's Clinic for six weeks. He went for six weeks\nand remained in Scotland twenty-three years. He went to Edinburgh known as a good\nstudent; he returned a famous man, and he returned with Syme's eldest daughter as\nhis wife\u00E2\u0080\u0094an exceptionally fortunate choice resulting in an unusually happy married\nlife. The years 1854-1860 were the junior years leading to his appointment as Professor\nof Surgery at Glasgow. This post he filled with great distinction until 1869 when he\nreturned to Edinburgh as Professor of Surgery. He continued successful and happy in\nEdinburgh until appointed Professor of Surgery in King's College, London, in 1877.\nThis position he filled until 1893 when he retired from the professorship as Emeritus\nProfessor of Clinical Surgery and consulting surgeon to the hospital. He was made a\nbaronet in 1883 and was elevated to the peerage in 1897. On this occasion, Dr. Weir\nMitchell, of Philadelphia, author, poet and physician, wrote in part as follows:\n\"Surely in all the great story of surgical progress, there has been no one man who\nhas given to his fellows a gift so great as that which came from your hand. It is a little\nthing, a title, but if it represents to you the gratitude of the world, it acquires a larger\nmeaning than if it had been given even for service, however great, to your own country\nalone. It\u00E2\u0080\u0094that which you did\u00E2\u0080\u0094was a thing so past comparison great and far reaching,\nthat, except as to our own gift of anaesthesia, there is nothing in medical annals with\nwhich to compare it.\"\nLady Lister had died in 1893 and he survived, a lonely man, until 1912.\nFrom this brief summary of outstanding dates in his career you will at once notice\nthat Lord Lister's life span covered a very interesting historical period. At his birth\nthe Napoleonic wars had ended with Waterloo only a few years before, and Britain\nwas entering upon her great period of Empire development\u00E2\u0080\u0094the industrial age was\ndawning and changes as great as we are witnessing today were in the making, but\nLister's work for surgery and for mankind was still to be done. His lifetime was to see\ngreat wars\u00E2\u0080\u0094the Crimean, the Franco-Prussian, the American Civil War, the South\nAfrican War, besides many minor ones\u00E2\u0080\u0094and his work was destined to save more lives\nthan were ever sacrificed in territorial conflicts. To bring his period more clearly home\nto us here in. Canada it was to see the Union of Upper and Lower Canada and in 1867\nConfederation was to bring British Columbia into the union. I might mention that\n1867 was a very important year in Lister's life, and we can easily remember it not only\non account of Confederation but also because in this year our national organization\n\u00E2\u0080\u0094The Canadian Medical Association\u00E2\u0080\u0094was founded.\nLister graduated in medicine, as mentioned before, in 1852. Ten years earlier, in\n1842, ether had been first used as an anaesthetic\u00E2\u0080\u0094the microscope was in use but not\n'much employed directly in medicine as yet. The Atlantic cable was not to be laid down\nby the Great Eastern for many years. In 1843 Dr. Oliver Wendell Holmes published\nhis famous paper on the contagiousness of puerperal fever in the New England Quarterly\nJournal of Medicine, and we might pause a moment to survey the state of obstetrics at\nthis time. In proving his point Dr. Holmes refers to a Dr. Gordon, of Aberdeen, who,\nin 1795, published a treatise in which he stated: \"This disease seized such women only\nas were visited or delivered by a practitioner, or taken care of by a nurse who had\npreviously attended patients afflicted with the disease, -|ff . I had evident proofs that\nevery person who had been with a patient in the puerperal fever became charged with\nan atmosphere of infection which was communicated to every pregnant woman who\nhappened to come within its sphere.\" And remember Pasteur and his founding of what\nwe know as Bacteriology was still fifty odd years in the future. Holmes then quotes\nfrom some clinical\" histories which seem pertinent in illustrating certain aspects of\nmedical and surgical practice of the period.\n\"Dr. Campbell, of Edinburgh\"\u00E2\u0080\u0094Holmes writes\u00E2\u0080\u0094\"states that in October, 1821,\nhe assisted at the post-mortem of a patient who had died of puerperal fever. He carried\nthe pelvic viscera in his -pocket to the classroom.. The Same evening he attended a\nwoman in labour without previously changing his clothes\u00E2\u0080\u0094the patient died. The next\nPage 88 morning he delivered a woman with forceps\u00E2\u0080\u0094she died also, and of many others who\nwere seized with the same disease within a few weeks, three shared the same fate in\nsuccession.\" mm\nWhen you have finished his paper\u00E2\u0080\u0094about 30 pages\u00E2\u0080\u0094you feel that further proof\nshould not have been required in any country. I think you will find his conclusions\npertinent even today.\n1. A physician holding himself in readiness to attend cases of midwifery should never\ntake any active part in the post-mortem examination of cases of puerperal fever.\n2. If a physician is present at such autopsies he should use thorough ablution, change\nin every article of dress, and allow twenty-four hours or more to elapse before\nattending to any case of midwifery. It may be well to extend the same caution\nto cases of simple peritonitis.\n3. Similar precautions should be taken after the autopsy or surgical treatment of\n^P^erysipelas^if^the.physician is obliged to unite such offices with his obstetrical duties,\nS^|fcwiiicli:-is\u00C2\u00BBin? the highest degree inexpedient.\n4. On the occurrence of a single case of puerperal fever in his practice the physician\nis bound to consider the next female he attends in labour, unless some weeks have\nelapsed, as in danger of being infected by him, and it is his duty to take every\nprecaution to diminish her risk.\n5. If within a short period two cases of puerperal fever happen close to each other,\nin the practice of the same physician, the disease not existing or prevailing in the\nneighbourhood, he would do well to relinquish his obstetrical practice for at least\na month, and endeavour to free himself by every available means from any noxious\ninfluence he may carry about him.\n6. The occurrence of three or more closely connected cases in the practice of one1\nindividual, no others existing in the neighbourhood, and no other cause being alleged\nfor the coincidence, is prima facie evidence that he is the vehicle of contagion.\n7. It is the duty of the physician to take every precaution that the disease shall not be\nintroduced by nurses or other assistants, by making proper inquiries concerning them,\ngiving timely warning of every suspected source of danger.\n8. Whatever indulgence may be granted to those who have hitherto been the ignorant\ncause of so much misery, the time has come when a private pestilence in the sphere\nof a single physician should be looked upon, not as a misfortune, but as a crime;\nand in the knowledge of such occurrences the duty of the practitioner to his profession should give way to his paramount obligation to society.\nAnd yet so little was known at that time in one country of what happened in\nanother that Ignaz Phillip Semmelweiss (1818-1865) a Hungarian physician practicing\nin the great maternity hospital in Vienna where 7,000 women were delivered annually\u00E2\u0080\u0094\nwas struggling in the dark about puerperal fever. Some thought it was a fever like\nsmallpox\u00E2\u0080\u0094some that it was associated with erysipelas\u00E2\u0080\u0094some attributed it to undue\nmodesty on the part of patients associated with their examination by students. This\nquestion of students brings up another interesting point. In the institution there were\ntwo divisions\u00E2\u0080\u0094one in which the cases were attended by midwives where the mortality\nfrom puerperal fever was 3.8%. The other division was designed for teaching purposes.\nThe labour room adjoined the autopsy room so that if students were engaged in a\npost-mortem they could at once hurry into the case room\u00E2\u0080\u0094should occasion demand.\nHere the mortality was 9.92% and at times as high as 25-30%. Today the conclusion,\neven without bacteriology would seem obvious. However, Sammelweiss wrote at this\ntime: /\ni|i \"All this reduced me to such an unhappy frame of mind as to make life unenviable.\nEverywhere questions arose: everything remained without explanation. All was doubt\nand difficulty. Only the great number of the dead was an undoubted reality.\"\nPage 89 When his friend, Kolletscha, died from a wound received in the course of an\nautopsy on a case of puerperal fever, he recognized that the symptoms were the same\nas those of puerperal fever. His theory was that infection came from some material in\nthe dead body and he reduced the mortality in the students' section by insisting on\ndisinfection of their hands in chlorine water\u00E2\u0080\u0094or chlorinated lime. In spite of the very\nobvious results from his innovations all his ideas were bitterly opposed by the medical\nprofession of Vienna. He had some supporters, however, and their names have come\ndown to us today\u00E2\u0080\u0094Rokitanski (1804-1878), the pathologist, Skoda, the physician\n(1805-1881); Hebra, the dermatologist (1816-1880). Semmelweiss was not the\nprudent, cautious, self-controlled man that Lister was\u00E2\u0080\u0094he had solved the problem\nand knew he had done so, but when his results were not accepted readily he became\ndiscouraged and returned to Budapest where he became insane. He died in Vienna in 1865.\nAnd yet when Lister visited Vienna in 1856 he did not even hear of Semmelweiss or\nof his work. Remember also that in 1861 Semmelweiss published his great book and\nclosed it with these words.\n\"When I, with my present convictions, look back upon the past, I can only dispel\nthe sadness which falls upon me by gazing at the same time into that happy future,\nwhen within the lying-in hospitals, and also outside of them throughout the world,\nonly cases of self-infection will occur. . . . But if it is not vouchsafed to me to look\nupon that happy time with my own eyes, from which misfortune may God preserve\nme\u00E2\u0080\u0094the conviction that such a time must inevitably arrive sooner or later after I\nhave passed away will cheer my dying hour.\"\nIn 1904 a teacher from Budapest stated that Lord Lister had said \"Without Semmelweiss my labour would have been in vain\u00E2\u0080\u0094modern surgery owes much to this\nson of Hungary.\" Later when questioned on this point Lord Lister made the following\nstatement: \"Although it is extremely distasteful to me to speak of the question of my\npriority, I cannot but answer the question you ask in your most kind letter. When in\n1865 I first applied the antiseptic principle to wounds, I had not heard the name of\nSemmelweiss, and knew nothing of his work. Even twenty years later when I visited\nBuda Pesth, where I was received with extraordinary kindness by the medical profession\nand by the students, Semmelweiss' name was never mentioned, having been as it seems,\nentirely forgotten in his native city as in the world at large. It was some time after this\nthat my attention was drawn to Semmelweiss and his work by Dr. Duka, a Hungarian\nphysician practicing in London. I need hardly add that I never pronounced the sentence\nyou quote. But while Semmelweiss had no influence on my work, I greatly admire his\nlabours and rejoice that his memory will at length be duly honoured.\"\nHow this qpuld be forgotten is explained by Sir Watson Cheyne in the following\nwords: \". . . it must be attributed to . . . that self-satisfied inertia of mind which\nmakes men cling to routine, think their own opinions final, and distrust what is novel.\"\nThe well known longevity of error and its perpetuation by restatement is my reason\nfor mentioning this incident this evening. In a fictional biography of Semmelweiss\n\u00E2\u0080\u0094written by Morton Thompson under the title of \"The Cry and the Covenant\" in\n1949\u00E2\u0080\u0094this story is given a new lease of life on the dust cover.\nNow let us pass on briefly to see how Surgery was practiced at the\" time Mr. Lister\nqualified. Some present here this evening may recall the painting of Sir William\nFerguson (who was described as \"the leading operator in London for many years\")\nwhich hung for many years in the Royal College of Surgeons and may still be in existence.\nThe artist was Lehmann and engravings of it hung in the consulting room of many a\nLondon practitioner. Sir William was Professor of Surgery at King's College until\nhis death in 1877 and was succeeded by Lord Lister. In the painting he is depicted\nstanding by a table dressed in a frock coat, the cuffs of which are rolled up, and on the\ntable covered with a glass bowl is a scapula which he had removed\u00E2\u0080\u0094the scapula was a\ntribute to his skill and the turned-back cuffs on the coat showed that he was ready\nto begin operating\u00E2\u0080\u0094no other preparation would be necessary\u00E2\u0080\u0094he would wash his hands\nafter the operation was over. It was, of course, unnecessary before, as surgery was a\nPage 90 dirty business. This type of operative garb was confirmed for me many years ago by my\nchief in surgery in Philadelphia, Dr. Neilson. As a novice in surgery he recalled the\npre-Listerian days and often spoke of the great names, such as Gross and Agnew, of\nPhiladelphia and Sayre of New York. He told me, and I found it difficult to accept\nit all at its face value then, that the surgeon wore the same frock coat at all operations,\nand the greater and more famous the surgeon the more the coat was caked with dried\npus and blood from many surgical baptisms. By the time the surgeon had really arrived\nhis coat bore witness to his prowess\u00E2\u0080\u0094he did not have to hang it up\u00E2\u0080\u0094he stood it in the\ncorner\u00E2\u0080\u0094which at once distinguished it from the coats of younger surgical aspirants. Of,\ncourse, Philadelphia had been the seat of English government and many English customs\nstill prevail there\u00E2\u0080\u0094but all authorities assure us that conditions were much worse on the\ncontinent. Incidentally the assistant also wore a frock coat of more recent vintage and\nfrom a button hole hung the wax whipcord which would be used for ligatures to tie\nthe arteries\u00E2\u0080\u0094James Syme would never tie a vein.\nIn all countries the table and instruments used for an autopsy today on a case\nof puerperal fever or erysipelas would serve equally well tomorrow for an amputation.\nSea sponges were used to mop up pus and were held in a pewter basin which would later\nhold the dressings for use at the completion of the operation. The sponges were rinsed\nout of cold water\u00E2\u0080\u0094perhaps soaked in water for a couple of hours and were ready for use\nagain. Curiously enough we are told that the cataract operations were often successful\nand escaped infection. This is now attributed to the fact that the instrument maker\nwas always present at such operations with a freshly ground knife.\nBefore leaving this aspect of the subject a little story of the time may interest you.\nSir Astley Cooper\u00E2\u0080\u0094the greatest English surgeon of his day (1768-1841) was called\nto remove a wen from the scalp of George Fourth. He was, of course, anxious that\ninfection would not develop, and when suddenly called to see the royal patient the\nnext day he went in fear of what he would find. He thought the king viewed him\nwith disfavour and on his return home he asked his nephew if there was anything\nwrong with his appearance. The nephew replied that he would have put on a clean\nshirt and washed his hands before waiting on the king. Sir Astley looked at his hands\nand shirt all spotted with blood and replied: \"\"God bless me I ought, but I was not\naware of it: and the king is so very particular.\"\nWhen I say as others have said so often before me that septic diseases were \"rife\"\nin all hospitals I must give you some definite idea of what this short word means in\nthis connection. What was known as a \"good old surgical stink\" prevailed \u00E2\u0080\u00A2 in all\nsurgical wards. From time to time surgical wards were closed entirely in the hope that\nthe pestilence might die out. Many in England, Germany and Austria advocated that\ngeneral hospitals should be burned and rebuilt as a means of controlling sepsis. Sir James\nYoung Simpson, of Edinburgh, the great Scottish obstetrician (1811-1870), advocated\nsmall iron huts which would house two surgical cases to be built in the country\nas it was known that infections of this type were much more uncommon there than\nin the large city hospitals. Indeed, it was Sir James who first used the term \"hospital\ndiseases\" to cover the prevalent septic type. Is it to be wondered at that von Helmont\n(1577-1644) ptayed:\n\"O' merciful God, how long wilt Thou be angry with men, that Thou hast not\nrevealed one truth to Thy students in healing? Is this Moloch sacrifice pleasing to\nThee, and wilt Thou that the lives of the poor, of widows and of children, be continually\noffered up unto Thee, in miserable torments of incurable diseases or through the\ncarelessness and ignorance of physicians.\"\nMany believed that the pestilence spread up from one floor of a hospital to that\nabove and hence came the pavilion type of hospital as we still see today in the older\nparts of the Royal Jubilee Hospital. In this connection the following story was told\nto me many years ago and I like to think that it is true. When this idea of a pavilion\ntype of hospital as the preventative of sepsis was accepted the Widal Clinic was built\nin Paris on this plan. Many years later\u00E2\u0080\u0094long after Pasteur and Lister had demonstrated\nPage 91 the fallacy of this theory a new hospital was to be built in San Francisco and the Paris\npavilion type was copied and again from San Francisco the newest idea in hospital\nconstruction was brought to Victoria. So does error continue to influence the world\nlong after its falsity has been known to those who are capable of judgment in the matter.\nTo return to our thesis it is natural when you consider the prevailing conditions\nthat everywhere in Europe physicians and surgeons were groping blindly for an explanation and drifting into a state of depressed fatalism as described by Sir Hector Cameron\n\u00E2\u0080\u0094the surgeon who had done his work well felt when his patients died of sepsis that he\nwas a man \"beset by misfortune\" so that Velpeau (French surgeon, 1795-1867) could\nwrite \"a pin prick is a door open unto death. That door widened before the smallest\noperation; the lancing of an abscess or whitloe had such serious consequences that\nsurgeons hesitated before the slightest use of the bistoury.\" Von Volkman (1830-1839)\nsaid when he closed a wound that he was \"like a husbandman who, having sown his\nfield, waits with resignation for what the harvest may bring, and reaps it, fully conscious\nof his own impotence against the elemental powers which may pour down upon him\nrain, hurricane and hailstorm.\"\nWhen Lister went to Glasgow he found sepsis in control there as elsewhere\u00E2\u0080\u0094even\nin the new surgical hospital. You will be interested in the fact that four feet from\nLister's accident ward in the basement were the cholera pits where those who had died\nin the cholera epidemic of 1849 had been buried. \"The uppermost tier of the multitude\nof coffins reached within a few inches of the surface of the ground and adjoining tne\ngrounds of that Infirmary were the pits where the paupers were buried.\nStatistics available to this day confirm all this. Mr. Erichsen (1816-1896) reported\nmortality in the University Hospital\u00E2\u0080\u0094London\u00E2\u0080\u0094was 25%; in the Edinburgh Infirmary\n43%; Glasgow Infirmary 39.1%; Pennsylvania Hospital, Philadelphia, 24.3%; Massachusetts General, Boston, 26%; Parisian hospitals, 60%; Bilroth, Zurich, 46% (1829-\n1894), and in military practice, 75-90%.\nSpencer Wells (English gynaecologist, 1818-1897) and Keith had been performing\novariotomies with a mortality of 30% at King's College when Lister went there in\n1869\u00E2\u0080\u0094four years after Lister had announced the antiseptic treatment of wounds and\nhad made this type of operation in Edinburgh in his hands practically comparable\nto our results today. The governors at King's had prohibited the operation being done\nby any surgeon on account of the mortality, a degree of outside control of the medical\nprofession which I am sure would gladden the hearts of some of those who would like\nto make over the world more nearly to. their own specifications. That 60% mortality\nfigure which I just mentioned for Parisian hospitals explains the remark of an ancient\nFrench author to the effect that \"A young surgeon who is bred in the Hotel Dieu\nmay learn the various forms of incision, operations, too, and the manner of dressing\nwounds; but the way of curing wounds he cannot learn. Every patient he takes in\nhand\u00E2\u0080\u0094do what you will\u00E2\u0080\u0094must die of gangrene.\"\nErysipelas of a sporadic type we still see from time to time and the occasional case\nof septicaemia is also still an occasional problem, but pyaemia is practically never seen,\nand hospital gangrene is non-existent\u00E2\u0080\u0094at least I have never seen a case. You will be\ninterested in Lister's own description of it, as he knew it and as he banished it from\nthe hospitals of the world:\n\"One variety is where the disease advances with frightful rapidity; hence the\naffected part becomes brown and black but the blackness is not the same as ordinary\ngangrene but brownish black. It may be that the inflammation in the vicinity is so\ngreat as to cause ordinary gangrene when the blackness will be of a purplish color. But\n-hospital gangrene may be extremely languid and then the color instead of being brownish\nblack is pale gray\u00E2\u0080\u0094such a color as is produced by caustics on granulation tissue or as\nis seen in a 'weak' ulcer. There may be no pain and nothing characteristic of hospital\ngangrene except that as you watch it, you find the gray surface steadily increasing in\nsize, and if it be scraped away it is found to consist of a layer of slough one-eighth of\nan inch or more in thickness. Between these two extremes\u00E2\u0080\u0094the weak form with pus\nPage 92 formation but no pain or inflammatory blush and the worst form with pain, redness\nand constitutional disturbances\u00E2\u0080\u0094there are all sorts of degrees. The constitutional\ndisturbance consists of elevation of pulse, loss of appetite and generally the symptoms\nof depression.\"\nIn one of his articles, Sir Hector Cameron recalls Lister's distress over the state of\nsurgery and his inability to accept it with the resignation of contemporary surgeons.\nQuite clearly Lister had that gift which Cicero referred to when he wrote \"Instead\nof striving, as we ought, to render ourselves strange to the familiar, we strive, on the\ncontrary, to render ourselves familiar to the strange.\"\nAt the meeting of The British Medical Association in Dublin in 1867 Lister spoke\nin part as follows:\n\"In the course of an extended investigation into the nature of inflammation and\nthe healthy and morbid conditions of the blood in relation to it, I arrived several years\nago at the conclusion that the essential cause of suppuration in wounds is decomposition\nbrought about by the atmosphere upon blood or serum retained within them; and in\nthe case of contused wounds upon portions of tissue destroyed by the violence of the\ninjury. To prevent the occurrence of suppuration, with all its attendant risks, was an\nobject manifestly desirable but till lately, apparently unattainable, since it seemed\nhopeless to exclude the oxygen which was universally regarded as the agent by which\nputrefaction was affected. But when it had been shown by the researches of Pasteur\nthat the septic properties of the atmosphere depended not on oxygen or any gaseous\nconstituent but on minute organisms suspended in it, which owed their energy to their\nvitality, it occurred to me that decomposition in the injured part might be avoided\nwithout excluding the air by applying as a dressing some material capable of destroying\nthe life of the floating particles.\"\nAntiseptics actually date back to the Egyptians, but in that civilization they\nserved the dead rather than the living. In the preparation of the important dead\ncassia, frankincense and myrrh were used. The word as we know it dates back to about\n1750 and- the drugs used were compound tincture of benzoin, alcohol\u00E2\u0080\u0094oiland wine as\nin Biblical times\u00E2\u0080\u0094glycerin, chlorine and its compounds, chloride of zinc and tincture\nof iodine after its discovery in 1811. Lister had watched superficial wounds in the\nhuman heal under a scab and he knew that in animals large wounds may heal in this\nmanner, so in all his earliest efforts he was very conscious of attempting to secure\na satisfactory scab. He turned to one of the newly discovered products of coal tar\u00E2\u0080\u0094\noarbolic acid\u00E2\u0080\u0094first prepared in 1834. Now Pasteur had taught Lister that putrefactive\nchange is similar to fermentation and is due to microscopical organisms. Lister at once\nrealized that to be effective, antiseptics should be applied as a preventative of putrefactive change and not reserved until infection had developed. Lister learned\nof carbolic from his colleague, Dr. Anderson, Professor of Chemistry in Glasgow, and\nhe began his work with a very crude preparation known as German creosote, which had\ncome into use about 1840 as a preservative of wood. Lister had heard of its use in the\npurification of sewerage in Carlisle\u00E2\u0080\u0094that its use there had destroyed the odour from\nthe effluent and that cattle feeding on the pastures treated with this effluent no longer\ndeveloped infection with entozoa. He had tried simple cleanliness and in all his work\nhe continually stressed it\u00E2\u0080\u0094he had seen to proper ventilation of his wards and had tried\nto prevent overcrowding, but still sepsis continued. He knew that simple fractures\nhealed without sepsis, but not so compound fractures. At this time Syme had reached\nthe conclusion that it might be better to amputate all cases having compound fracture\nrather than try to save the leg or arm. Lister also knew (John Hunter knew it, 1728-\n1793) that penetrating wounds of the lung did not necessarily suppurate, so he was\nsceptical of the theory that suppuration was due to the oxygen in the air.\nIn 1865 Lister treated his first successful compound fracture of the femur with\ncarbolic acid and he dressed it in this manner: The wound was swabbed out with\nundiluted crude carbolic acid with a piece of lint held in forceps and a piece of lint\nlarge enough to lap the wound for a least half an inch in every direction was soaked\nPage 93 in undiluted acid and applied. This was covered with a piece of block tin or lead to\nprevent the evaporation of the carbolic. The dressing was held in place with plaster and\nthe whole covered with another dressing to absorb the discharges. From day to day\nfurther coatings were made under the metallic shield. The disadvantages of this\ndressing were soon evident\u00E2\u0080\u0094the inevitable sloughing from the acid. Lister was, however,\nencouraged by his first success and soon secured a purer form of carbolic\u00E2\u0080\u0094soluble 1-20\nin water and to almost any extent in oil, and he found that the acid evaporated more\nslowly from the oily solution. The next development was the carbolic paste or putty\nwhich consisted of ordinary whitening (carbonate of lime) and a solution of carbolic\none-quarter or one-sixth. This putty was spread about one-quarter of an inch thick\non block tin and Sir Rickman Godlee, Lister's nephew, says in the official biography that\nit looked like a poultice. This putty dressing could be as large as desired so that the\ndischarge could be made to travel quite a distance without allowing air to enter and\ncontaminate the wound. From the time of Ambrose Pare (1509-1590) ligatures had\nbeen left long enough to hang out of the wound. They were supposed to provide\ndrainage and later would slough off with, of course, all the attending danger of secondary\nhaemorrhage. To quote further from Lister's address at the Dublin meeting:\n\"If the severest forms of contused and lacerated wounds heal thus kindly under\nthe antiseptic system, it is obvious that its application to simple incised wounds must\nbe merely a matter of detail. I have devoted a great deal of attention to this class, but\nI have not, as yet, pleased myself altogether with any of the methods I have employed.\nI am, however, prepared to go so far as to say that a solution of carbolic acid\u00E2\u0080\u0094one\npart in twenty parts of water\u00E2\u0080\u0094while a mild and cleanly application, may be relied upon\nfor destroying any septic germs that may fall upon the wound during the performance\nof an operation; and also that for preventing the subsequent introduction of others, the\npaste above described, applied as for compound fractures, gives excellent results. . . .\nFurther, I have found that when the antiseptic treatment is efficiently conducted,\nligatures may safely be cut short and left to be disposed of by absorption or otherwise.\"\nThe full details of the fascinating work he did experimentally on animals in\ndeveloping his carbolized silk ligature and later his absorbable catgut ligature you will\nfind in detail in Godlee's life. In 1871 he introduced his carbolic spray\u00E2\u0080\u0094first a hand\nspray, then a complicated spray worked by a lever, and then a steam spray. It was\nthen that the surgeon, as well as the patient, began to show evidence of carbolic acid\npoisoning. After a long operation, the surgeon's fingers would be quite white (rubber\ngloves were not to come until Halstead, of Baltimore, 1852, added his quota to our\nglorious inheritance) and the patients showed carboluria and vomiting from inhalation\nof the spray. From now on, other workers began to contribute. In 1883, Metchnikoff\n(1845-1916), the Russian physiologist, announced his work on phagocytosis. This was\nat once accepted by Lister, and in 1887 Lister abandoned the spray as he was convinced\nof the defensive powers of the body and of the comparative absence of pathogenic\ngerms in the atmosphere. ||||\nI have just referred to the readiness with which Lister accepted new ideas which\nwere adequately documented. Perhaps we might now turn to see how his new system\nof operative surgery was received\u00E2\u0080\u0094for it was a new conception of the cause and prevention of sepsis\u00E2\u0080\u0094it was not just a new type of surgical dressing. The younger men, trained\nunder Lister, were at once impressed with his accuracy, knowledge, sincerity, love of\ntruth, devotion to his work and by the results he obtained. Not so the older men.\nIn Edinburgh, Sir James Young Simpson was his bitter opponent. Sir William Osier\n(1849-1919), in his delightful essay on Captain Thomas Dover, gives a vivid picture\nof this man of the Elizabethan period who combined the roles of physician and\nbuccaneer. As a physician he gave us the powder that bears his name to this day\u00E2\u0080\u0094\nDover's powder\u00E2\u0080\u0094and as a pirate, he discovered Robinson Crusoe on the Island of Juan\nFernandez. Sir William closes his essay with these words: \"A good fighter, a good hater,\nas also so many physicians have been.\" And Lister was to learn the truth of this dictum.\nrfr:| Page 94 Sir James had throughout most of his life carried on a vendetta with James Syme\nand it would seem as if he welcomed the opportunity to carry the war into the second\ngeneration by attacking Lister's antiseptic method. Simpson began by making disparaging remarks at the Dublin meeting and soon an anonymous letter was circulated about\nEdinburgh stating that Lemaire and others on the Continent had used carbolic before\nLister. Of course, Lister never claimed priority in the.use of carbolic as an antiseptic,\nbut nevertheless this anonymous letter was reprinted in the Lancet. This, of course,\nwas not during the active period of the founder of the Lancet, Thomas Wakley (1795-\n1862). His son was now the editor, but certainly something of the founder's editorial\npolicy and principles still influence this journal. Before the appointment to King's\nwas confirmed, the Lancet pontificated as follows:\n\"In many quarters Mr. Lister has acquired a reputation of a thoughtful, painstaking\nsurgeon and has done some service to surgery by insisting on the importance of cleanliness\nin the treatment of wounds, although this has been done by the glorification of an idea\nwhich is neither original nor universally accepted.\"\nLater, however, the Lancet, too, became Lister's enthusiastic supporter. Lister's\nideas and results were attacked by prominent surgeons in medical meetings and in the\njournals, and as we read these effusions today we realize that these men had never really\ngrasped the fundamental basis of Lister's work nor had they perfected themselves in his\ntechnique. Not so, however, on the Continent. In Germany, Richard Volkmann (1830-\n1899) was probably the outstanding surgeon and in the year that Lister announced his\nwork, Volkmann succeeded Blastius (1802-1876) in the chair of surgery at Halle.\nThe hospital there was old and unsanitary; even the minor operative cases died, and\nfor three months in each year the surgical wards were closed in a vain attempt to stay\nthe pestilence. Volkman had served in the Prussian-Austrian War in 1868 and had\nimproved his results with what was known as the open method. Under this technique\n\u00E2\u0080\u0094if you may apply such exact terminology to such a hit-and-miss procedure\u00E2\u0080\u0094the\nwound was left widely open, a piece of lint was placed a little distance off to keep\naway the flies and a pillow beneath to catch the discharge. When Volkmann returned\nhome he found conditions exceptionally bad and considered closing the hospital completely, but before doing so, decided to try the Listerian method. In the winter of\n1871-1872 he went to Edinburgh and personally mastered the details of the treatment\nand then sent one of his assistants to do likewise. He said that his basis for doing so was\n\"with the settled opinion that it was a question of a few weeks only of fruitless experiment and he did it from the point of view of a laborious but unavoidable duty.\" The\nresults seemed like magic\u00E2\u0080\u0094it was as if an evil spirit had been exorcised. Lister had no\nmore enthusiastic follower and disciple, and in 1874 at the Third Congress of German\nSurgeons he said: \"There is no luck in surgery, as Pirogoff (1810-1881) says there is.\nThere are no privileged surgeons, who always hold good cards. Knowledge and ability\nare the only factors that command success. For every case of pyaemia; for every case\nof erysipelas; for every death from diffuse suppuration, the surgeon himself is\nresponsible.\"\nThe next convert was Johann von Nussbaum (1829-1890) who had said of hospital\ngangrene that \"it gnawed at every wound like a wild beast.\" He became one of the\nchampions of the new method, and when deaths due to other causes were blamed on\nLister's method, he made this wise remark: \"Naturally antiseptics do not confer\nimmortality.\" ||||\nErnst von Bergmann (1836-1907) soon accepted Lister's teaching and in addition,\nnoted a suggestion that Lister had made, to the effect that.the antiseptic system might\nbe superseded by the aseptic\u00E2\u0080\u0094as proved to be true. This was the same Professor\nBergmann who was to cross swords with Sir Morell Mackenzie over the malignancy\nof the larnyx of the Crown Prince of Germany in 1886\u00E2\u0080\u0094probably the most internationally discussed medical case in history and one which probably altered the whole\ncourse of European history from that date onwards.\nPage 95 Soon many famous names were added to the growing list\u00E2\u0080\u0094Esmarch, of Kiel\n(1823-1908; Konig of Gottingen (1832-1910); Trendelenburg, of Bonn (1844-1925),\nand then surgeons of St. Petersburg, Copenhagen and Amsterdam. When Kocher\n(1841-1917) was called to Berne he wrote to Lister asking for a full account of the\nantiseptic system, gave it a fair trial and, like other Continental surgeons, soon passed\non to the aseptic method. The irony of the situation was that Lister's methods were\nquickly accepted in England when they came back with a \"made in Germany\" tag\n.attached. Then came the long and unhappy struggle in England between the antiseptic\nsystem and the aseptic\u00E2\u0080\u0094the latter championed by Lawson Tait (1845-1899). As\nyou read the story of that controversy you realize that Sir William was correct\u00E2\u0080\u0094\n\"Physicians have been good fighters.\"\nWith the firm foundation of antiseptic surgery behind him, Lister went on to\nperfect other aspects of the same problem leading to forty years of continuous experimentation and research on antiseptic dressings. When he began, one. of the commonest\nand most acceptable gifts to any hospital was a bundle of old linen, and in Lister's\nwritings in the earlier period, this accounts for his reference to \"clotjhs\". This work\non dressings deserves much more attention than it has ever received and in this hurried\nreview of the work of a great man I can only mention it. He began with an oakum\ndressing; then a carbolic gauze; then a gauze soaked in blood serum obtained from\nabbatoirs and combined with sublimate of mercury\u00E2\u0080\u0094the so-called sero-sublimate gauze\n\u00E2\u0080\u0094and this was used as far away as Spain and Poland. Today we find it difficult to\nunderstand the Russian point of view\u00E2\u0080\u0094or perhaps I should say when we understand it\nonly too well\u00E2\u0080\u0094it is of interest to find that the idea of an antiseptic dressing was readily\ngrasped by the Russian surgeons of Lister's day. The antiseptic dressing was put in a\nsterile packet by women workers, and while they were not allowed to undertake this\nwork during the menstrual period their pay for this time was not deducted. Then came\nhis sal-alembroth gauze\u00E2\u0080\u0094a double salt of bichloride of mercury and chloride of\nammonium. During this long period of experimental work, Lister drew on his deep\nknowledge of chemistry, physics, biology and physiology, and please remember that no\npaid corps of workers were engaged\u00E2\u0080\u0094the work was all done by Lister himself, always\nlooking for a dressing less irritating to the skin, cheap to manufacture and efficient as\nan antiseptic.\nIn its final form the antiseptic system worked out about as follows for any\noperation. Two basins were filled with solutions of carbolic 1/20 and 1/40. The\ninstruments which had been thoroughly washed after the last operation but not sterilized by heat, were placed in a carbolic solution 1/20 for half an hour and this solution was slightly weakened before the operation commenced. The sponges were placed\nin 1/40 carbolic and his own words may interest you here: \"I put the sponges after\nan operation into a tank of water and let them purify there. The fibrine which clings\namong the pores of the sponges becomes liquified by putrefaction. They can then be\nwashed thoroughly clean of their fibrine and the washing is continued until they no\nlonger give a red colour to the water. They are then put in 1/20 carbolic and kept\nthere.\" The site of the operation was not washed with soap and water but was cleaned\nwith 1/20 carbolic while the chloroform (never ether) was being given. Lister would\nthen take off his coat, roll up his shirt sleeves and fasten an ordinary clean, unsterilized\ntowel across his waistcoat. (He never wore the flowing classical white robe in which\nhe is depicted in the tympanum of the Polyclinico Umberto I in Rome.) He then\nwashed his hands in 1/20 carbolic and towels wrung out of the same kind of solution\nwere placed in position on the patient. He never wore mask or gloves\u00E2\u0080\u0094his hands and\nthose of his assistants were frequently dipped in 1/20 carbolic, sponges wrung out\nof 1/40 and the wound washed with 1/40 before suturing. Vessels were tied with his\nown sulpho-chromic gut brought dry to the house and sterilized in carbolic solution\nand occasionally he used silver wire, catgut or fine silk all sterilized in carbolic 1/20.\nThe dressing was of cyanide gauze covered with salicylic wool. The part of the gauze\nnext to the wound was moistened in the carbolic solution. And lest you might think\nPage 96 this too simple a procedure, remember that this method, with its cruder predecessors,\nwhen properly used, banished sepsis from the hospitals and surgeries of the world.\nLister never abandoned the antiseptic system. He always felt that with great\ncare, expense and many assistants, the aseptic system could be made safe but if there\nshould be one weak link, the patient might suffer. In the antiseptic system, all was\nunder control of the surgeon\u00E2\u0080\u0094nothing was delegated and his method could be used\nin a hospital, a castle or in a cottage. The chemical antiseptic would ever be on the\nalert. What a joy it would have been to Lister could he have lived to see the work\ndone in the first great war with Carrel-Dakin solution, a chemical antiseptic constantly\napplied, and if he came into the operating room of today he would feel quite at home\nwhen he would see the surgeons' hands carefully sterilized with a chemical antiseptic,\nsome chemical antiseptic applied to the operative field and at the conclusion of the\noperation, should occasion call for it, an anti-biotic distributed in the wound.\n\"Who dreams shall live . . . say nevermore\nThat dreams are fragile things. What else endures\nOf all this broken world, save dreams alone.\"\nDana Burnet\nI shall not detain you long with an account of the honours which were showered\nupon Lister not only by his own country but by the whole civilized world. I shall\nmention only a few\u00E2\u0080\u0094Oxford and Cambridge gave him degrees as did Toronto. He\nsucceeded Syme as Surgeon-in-ordinary to the Queen. Foreign decorations of every\nkind came before his baronetcy was bestowed in 1883. He was given the French Boudet\nprize of 6,000 francs for his \"application of M. Pasteur's researches in the art of\nhealing\" to quote the citation. He was awarded the Prussian Ordre pour le Merite\nin 1885 and at that time this was limited to thirty Germans and thirty foreigners and\nup to that time had never been given to a physician or surgeon engaged in actual\npractice.\nWhen Lister entered the surgical stage, Benjamin Bell's leaden drainage tubes had\nbeen forgotten. Cassaignac had introduced rubber drainage tubes but it was Lister\nwho first used them in England or rather, I should say, in Scotland as his first use of\nsuch a drainage was when he operated upon Queen Victoria while at Balmoral for\nan axillary abscess. I might here mention his careful attention to small details\u00E2\u0080\u0094the\ntube was always cut off obliquely and flush with the skin so that the pressure of the\ndressing would not buckle the tube and so prevent proper function\u00E2\u0080\u0094a point not always\nremembered today.\nLest you might think that Lister added to surgical technique in only one way,\nlet me remind you that he developed a new amputation through the femoral condyles\nin 1858; a new plan for excision of the wrist\u00E2\u0080\u0094the whole so-called bloodless system\nof operating; a new amputation of the hip joint; and perhaps most outstanding, the\nfirst operation for removal of the breast for malignancy which could be called radical\nand comparable to the operation of today. He left his mark on the surgery of the\nbladder and urethra; of bones and joints, and did not hesitate to remove a cataract.\nWhat manner of man was this? What were the mainsprings of his being? How\nfar can we, in a few minutes, sum up those qualities of mind and conscience which\nenabled him to mark out for all time his own part in the gradual process of the civilization of mankind.\nAs mentioned earlier, he was born into the Quaker faith and although he \"married\nout\" of the Friends and became a member of the Episcopalian Church, he never lost\nthe Quaker imprint. In a letter to his family even in the later years, he used the simple\nlanguage of thee and thou and as was expressed in the Epistle of the Society of Friends\nthe year before his marriage, he knew that \"True religion stands neither in forms nor\nin the formal absence of forms.\" He was modest without in any way lacking confidence\nin himself. In a letter written to his father in the early days in Edinburgh we find\nthe following: \"It is true it must depend entirely upon myself (under the blessing,\nif I may humbly say so, of Almighty God in Christ Jesus) whether I succeed or not;\nPage 97 but I am encouraged to hope that though I must not expect to be a Liston or Syme,\nstill I shall get on. Certain it is I love surgery more and more and this is one great\npoint; and I believe my judgment is pretty sound, which is another most important\npoint. Also I trust that I am honest and a lover of truth, which is perhaps as important as anything. As to brilliant talent, I know I do not possess it but I must try to make\nup as far as I can by perseverance.\" A little later, Syme wrote of his son-in-law as\nfollows: \"He has a strict regard for accuracy, extremely correct powers of observation and a remarkably sound judgment united to uncommon manual dexterity and a\npractical turn of mind.\"\nIn his opening address to the students, in Glasgow, Lister closed with these words\nas descriptive of the two great requisites of the medical profession: \"First a warm,\nloving heart, and secondly, truth in an earnest spirit.\" When he went to Glasgow he\nwas given a complimentary dinner and in his address, the following interesting sentence\nmerits repetition, perhaps even more today than when the words were spoken:\n\"Scientific truth, as bearing directly on the well being of our fellow creatures\nwill always be a becoming object of our pursuit; and while there is probably no calling\nin which there is greater opportunity for deception than ours, yet when we consider\nthe sacred interests which are committed blindfold by the public to our trust, we\nmust allow that there is no calling in which falsehood is more unbecoming or despicable.\"\nThe following account of an incident associated with Lister's move to London\ntells you much of the character of this great man. I shall give it to you in the worlds of\nMr. Grasset of Toronto, one of Lister's favourite house surgeons:\n\"When Lister left Edinburgh in 1877 there were eight cases in his wards of psoas\nabscess\u00E2\u0080\u0094seven men and one woman. Lister thought they would remain in the hospital\nuntil they got well. Dr. John Stewart tells me that shortly after Lister went to London\nit was decided to turn these patients out. Caird wrote to Stewart and asked if the girl,\na lady's maid from the South of England, would be taken in at King's. *I shall never\nforget,' he says, 'the pained look of surprise in Lister's face when he heard his patients\nwere turned out.' I wired Caird \"yes\" and that night she left for London under the\ncare of a nurse, transported in< one of those long baskets, which in Edinburgh were\nused to carry patients to the operating theatre, manned by dressers of the surgeon.\nShe ultimately got well and the \"Chief\" writing a year or two later said that he had\nseen her walking and looking bright and well. Lister had the men and boys taken from\nthe Infirmary to a Nursing Home where he used to operate in Edinburgh. He put\nthem under the care of his old assistant, John Bishop, and paid all the expenses therewith\nincluding attendance and dressing. In the end, all of them got perfectly well.\"\nMany such stories could be told. I shall mention only one more. A friend of\nLister's told him of a young medical student who, on account of lack of funds, could\nnot finish his course. Lister at once gave the friend a check for fifty pounds to be\ngiven to the student with his best wishes. His gentleness and kindness were proverbial\nand in all things he showed his consciousness of the higher character of his work. He\noften said: \". . . to intrude an unskilled hand to such a piece of divine mechanism as\nthe human body is indeed a fearful responsibility.\" His courtesy was unfailing but he\ncould give a deserved rebuke in no uncertain manner. Once a pompous practitioner\nintroduced himself to Lister as an old college associate some time after the antiseptic\nsystem had been generally accepted. Commenting on the ups and downs of life, the\nvisitor said: \". . . here we are, Sir Joseph\u00E2\u0080\u0094I am unknown and you are famous everywhere for this antiseptic system. Not that there is anything in it. I would not let\nany of my patients have any of these new fangled methods. I would not even try them\non anyone.\" Lister answered, \"Sir, if your patients know what I know they would\nnot let you enjoy the honoured name of physician.\"\nAddresses made on the occasion of complimentary dinners given to distinguished\npeople or comments made in connection with the confering of honourary degrees never\nlack superlatives but even allowing for this, we can read again some of those made\n111 Page 98 regarding Sir Joseph on such occasions\u00E2\u0080\u0094two or three samples suffice this evening.\nIn his essay entitled \"Pasteur and Lister\", Mr. Stephen Paget writes: \"There never\nwas, there never will be, a surgeon more careful over each case, more open-minded\nin his criticism of his own method.\" In 1900 a dinner was given in Paris to Lord\nLister. Dr. Lucas Champonniere closed with these words: \"We can remember the\nmiserable condition of surgery and how great was the mortality. Nelaton said that\na statue of gold should be raised to the person who was able to prevent what we know\nas sepsis. You, Sir, have deserved that statue.\" At the same banquet, Dr. Pinard said\nin part: \"Lord Lister when we are asked why you are illustrious we reply\u00E2\u0080\u0094because you\nhave driven back death itself; because in all you have done you have caused only tears\nof gratitude.\" In 1902, the Royal Society gave Lord Lister a banquet and Mr. Bayard,\nthe American Ambassador, said: \"My Lord, it is not a profession, it is not a nation,\nit is humanity itself which with uncovered head salutes you.\"\nAt a time when physicians and surgeons seldom, if ever, took holidays, a common\nremark during the hunting season was \"My moors are in Harley Street\" or wherever\nthe office of the individual might be located. John Abernethy spoke of chasing the\n\"damned guinea\" but Lister took regular vacations. Before his lectures he always tried\nto find time to sit down and quietly think over the subjects he intended to present.\nIn Glasgow, Edinburgh and in London, his choice of a home was largely dictated by the\nclose proximity of a park where he could walk quietly as he thought out his problems.\nIt is always interesting and perhaps profitable, if too much time is not spent on it,\nto try to fit a great man from one period into the problems of a later one. When we\npause to consider the very rapid progress our profession is making along so many fronts,\nit is not surprising that many problems beset us. Perhaps two stand out over and\nabove all others\u00E2\u0080\u0094the problem of specialization\u00E2\u0080\u0094and I am a specialist\u00E2\u0080\u0094and that of the,\neconomic relationship of our profession to the population as a whole.\nAmongst his many firsts, Lister was the first to practise surgery as a specialist\nin the strictest modern sense of the word in Glasgow\u00E2\u0080\u0094that is his practice was entirely\nreferred. When we use the term specialist or think of the problem of specialization\nwe are apt to think of it in terms of our own work or our own profession. Dr. Richard\nAsher in a recent article in the Lancet (August 27\u00E2\u0080\u00941949 page 358) says in part: \"I\nhave known an eye surgeon after seeing a case of Retinitis Pigmentosa write in the notes\n'This might be part of the Lawrence-Moon-Biedl syndrome; is there any evidence of\nPolydactyly?' For an opthalmologist to feel himself incapable of counting fingers is\nsurely the limit of over specialization.\" However, the whole problem has a much\ngreater significance than to our profession alone. It is one of the outstanding earmarks s\nof our civilization today. Pioneer specialist that he was, I think Lord Lister would have\nrecognized the dangers inherent in it today. I know of no better analysis than is given\nby A. G. Gardiner in his essay on Professor Geddes:\n\"You remember the man at the Breakfast Table whom Holmes called Scarabee?\nHe sat absorbed and silent over his meals. Nothing that was said reached the remote\nfastness of his being until one day somebody mentioned beetles. To the amazement\nof everybody, he awoke to the world around him. The key had been found that unlocked his prison and he came out into the daylight only to return to his solitude and\nabstraction when the subject that was his one contact with life ceased to hold the\ntable. In that quaint figure Holmes satirizes the specialist\u00E2\u0080\u0094the men who, in pursuit\nof one microscopic phase of being, becomes divorced from the splendid pageant of life.\nIn some degree, most of us are victims of this myopy of the mind. It is one of the\ndiseases of civilization. It is the price we pay for that wonderful subdivision of labour,\nthat intricacy of relationship which moves each of us farther and farther from the\ncentre of the wheeling universe of things. As the artificial structure we create becomes^\nmore vast, more complex, a more cunning contrivance of machinery, the individual\nman diminishes in stature and authority. The primitive shepherd shearing his sheep,\nspinning his wool, weaving his cloth to make his crude coat was nearer to the heart of\nthings than the multitude of clever mechanics, salesmen, labourers and clerks who each\nPage 99 carry out some detail of modern industry. We are like Frankenstein in his laboratory\u00E2\u0080\u0094\nwe have constructed a monster who makes us his slaves; a monster so enormous, so\namorphous that we can neither measure nor control him. All that we know is that\nwe are caught in his intangible toils.\nThe remedy for this tragedy of civilization, which exalts the machine and belittles\nthe man is in education. Since we cannot have the joy of creation, which the old craftsmen had, we must learn to let the mind expand outside the scope of our daily work.\nAnd alas, when we come to education, we find the Scarabee. The same principle of\nspecialization which reduces the artisan and the clerk to a tiny function in a structure\nhe does not see or understand, reduces scholarship to water-tight compartments, mechanics\n'divorced from art, economics from ethics, medicine from education. Yet all are only\nphases of one theme that is universal\u00E2\u0080\u0094the art and practice of life. It is the full light\nof the sun we want; not the broken fragments of the spectroscope. We should use\npigeons, not live in them.\"\nThe relationship of economics to the practice of medicine would undoubtedly have\nserved as a challenge to Lord Lister just as the problem of sepsis did. Like the problem\nof sepsis, this concerns mankind first and the profession of medicine in the second place\n\u00E2\u0080\u0094So it would have appealed to him on both counts. He did not look towards the Government to solve the problem of sepsis nor did he try, as so many of his associates did,\nto make himself believe that no such problem existed. He believed that the problem\nof sepsis was one for the medical profession to solve and as far as my study of the man\nand his work goes, I believe he would have felt the same way about our economic problem\ntoday. We cannot act as if the problem does not exist\u00E2\u0080\u0094it is ours to solve.\nLord Lister's marriage was an exceptionally happy one and the years of his life\nfollowing Lady Lister's death, while filled with honours and distinctions, found him\na very lonely man. She died from pneumonia in 1893 while they were on a visit to the\ncontinent, the year he gave up his appointment at King's when he was sixty-six. A\nserious illness in 1903 seriously impaired his health and the end came nine years later\u00E2\u0080\u0094\nalso from pneumonia. He was buried beside his wife in Hampstead Cemetery but there\nwas a memorial service for him in Westminster Abbey attended by the King and Queen\nand the representatives from every civilized country. The anthem used at that service\nwas Handel's and the. juxtaposition of texts from the Old Testament and the New\nseemed to have been composed especially for that occasion:\n\"When the ear heard him, then it blessed him; when the eye saw him, it gave witness to him; he delivered the poor that cried, the fatherless and of him that had none\nto help him. Kindness, meekness and comfort were his tongue. If there was any virtue\nand if there was any praise, he thought on those things. His body is buried in peace\nbut his name liveth for evermore.\"\nBIBLIOGRAPHY\n1\u00E2\u0080\u0094Lord Lister, by Sir Rickman Godlee. MacMillan & o. Ltd., London, 1917.\n2\u00E2\u0080\u0094Lord Lister, by G. T. Wrench, M.D. (London). T. Fisher Unwin, London, 1913.\n3\u00E2\u0080\u0094Joseph Lister, by Rhoda Truax. The Bobbs-Merrill Co., New York, 1944.\n4\u00E2\u0080\u0094Pasteur and After Pasteur, by Stephen Paget, F.R.C.S. Adam 6h Cjharles Black, London, 1914.\n5\u00E2\u0080\u0094Reminisciences of a Specialist, by Greville Macdonald, M.D. George Allen & Unwin, Ltd., London,\n1932.\n6\u00E2\u0080\u0094Surgical Memoirs, by James G. Mumford, M.D., 1908. Moffat, Yard & Co., New York.\n7\u00E2\u0080\u0094Fifty Years of Medicine Surgery, by Dr. Franklin H. Martin. The Surgical Publishing Co., Chicago,\n1934.\n8\u00E2\u0080\u0094The Lancet, Richard Asher, M.D., London M.R.C.P., August 27, 1949, Page 358.\n9\u00E2\u0080\u0094An Alabama Student & Other Essays, by Sir William Osier. Oxford University Press, 1908.\n10\u00E2\u0080\u0094Articles by Lord Lister\u00E2\u0080\u0094The Lancet, September 19th, 1896. Page 797.\n11\u00E2\u0080\u0094Never Dies The Dream, by Margaret Landon. Doubleday & Co., Garden ity, N.Y., 1949.\n12\u00E2\u0080\u0094British Medical Journal, 1893\u00E2\u0080\u0094Pages 161, 272 and 337.\n13\u00E2\u0080\u0094British Medical Journal, Dec. 13th, 1902. Articles by John Chiene; B. W. Watson Cheyne, F.R.C.S.-\nF.R.S.; Dr. Lucas Championiere; Alexander Ogston, M.D., Aberdeen; D. Berry Hart; Thomas Annan-\ndaye, F.R.C.S.; Sir Hector C. Cameron.\n14\u00E2\u0080\u0094The Encyclopaedia Brittanica.\nPage 100 J. C. McPhee, J. S. Madill and H. H. Brooke, in radiology; Drs. David Mowatt, C. J.\nReich, Henry Scott, C. G. Campbell, B. F. Paige and W. Simpson, in medicine; Drs.\nLloyd W. Warcup, R. D. Coddington, H. A. Chisholm and Frank Paulson, in surgery;\nDr. Ben Schuman in pediatrics; Dr. H. O. Cooper in urology; Dr. William P. Fisher in\nTwo Vancouver orthopedic surgeons have returned from the U.K. with degrees in\nDr. R. J. Paine, Dr. H. S. Hamilton and Dr. R. S. Crimmett in Ophthalmology; Drs.\nneurology; Dr. Malcolm Allan in thoracic surgery and Dr. Frank McNair in psychiatry.\nAmong B. C. doctors who have gained additional degrees in their special fields are:\ntheir field. They are Dr. Palmer McLean and Dr. Hector Gillespie.\nDr. Anthony Larsen, of Nanaimo, is spending a short time at the Vancouver\nVenereal Disease Control Unit preparatory to entering Public Health Work in the\nFraser Valley.\nDr. G. Marion, former pediatrics resident at the Vancouver General, is doing\nlocums in B.C. with a view to eventual practice here. |\nDr. D. Tompsett, of Vancouver, is on a five-week vacation in California.\nBIRTHS\nTo Dr. and Mrs. R. W. Boyd, a son.\nTo Dr. and Mrs. Hal Spiro, a son.\nTo Dr. and Mrs. B. F. Paige, a daughter.\nTo Dr. and Mrs. J. D. F. Alexander, a son.\nTo Dr. and Mrs. C. A. Cawker, a daughter.\nHOBBY SHOW\nDuring the meeting of the B. C. Medical Association to be held next\nOctober in Vancouver, there will again be a Hobby Show.\nAll exhibits -will be insured and there will at all times be a man\nto care for the exhibits.\nLet's make this a bigger and better show and begin now to prepare\nyour exhibits.\nDr. A. C. G. Frost,\nChairman, Hobby Show\",\nB. C. Medical Association.\nAvailable at once, attractive office, 1645 Marine Drive, North\nVancouver, near Norgate Park. New, modern building. Apply:\nA. E. AUSTIN\n629 Hornby Street Telephone: MArine 2431\nPage 101"@en . "Periodicals"@en . "W1 .VA625"@en . "W1_VA625_1951_01"@en . "10.14288/1.0214632"@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: January, 1951"@en . "Text"@en . ""@en .