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History of Nursing in Pacific Canada
Vancouver Medical Association
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The . . LETIN _■ w-m. // ^HP T of the • • • VANCOUVER MEDICAL ASSOCIATION ^S-^Ot fl Vi t& fltt*** 1 In This Issue: EDITORIAL 4 LETTERS—THE BULLETIN COMES OF AGE __Ml__ 6 SYMPOSIUM—THE FUTURE OF MEDICAL EDUCATION — G. F. Strong, M.D.; C. E. Dolman, M.D., Stewart Murray, M.D. 9 NEWS AND NOTES 25 M.S.A. ANNUAL REPORT ■ 27 VOL XXI. NO. 1 October, 1944 IOB 11VER OIL PlHIANlUMIDE lillPHATHIAZOLE V7Tsv;'-s;-^s_7..*. ,;:y^"^::-^y:^^y.^^-"r-V"ny^^^-y-Ri:'-: VifozoK.B.S. has three active ingredients blended in a bland ointment base lor treating infection I through the broken skin. Cad L on 0€M WVei* l_/_f_f 1934, first formally demonstrated to the medical profession the value of the age-old burn and abrasion remedy, cold liver oil, it has had extensive and very favorable clinical trials.2 It has been shown to exert a definitely stimulating action on granulation and epithelial regeneration. Moreover, it forms a bland, protective film over the wound, which practically eliroinates the pain of the daily dressings. VITAZOLE E.B.S. is cod liver oil incorporated in an ointment base and fortified to contain in each gram, 1000 International units of Vitamin A and 100 International units of Vitamin D, both of which appear to be closely concerned with regenerative processes in traumatized areas. Snlpha Drugs The marked bactericidal action of the cod liver oil itself3 is strengthened, in Vitazole E.B.S., by the bacteriostatic effect of two sulpha drugs. Sulphanilamide, being rapidly soluble in serum, gets into action quickly; sulphathiazole being less soluble gives a more prolonged action. Vitazole E.B.S. contains 4% of each, combining the well known selective action of sulphanilamide against haemolytic streptococci with that of sulphathiazole against staphylococci. These three agents together can be counted upon to eliminate bacterial flora from any wound. Indications: Wounds, burns, ulcers, abrasions. REFERENCES 1 Lohr, W.: Zentralbl. J. Chir., 61:1686,1934 Chirg. 6:263,1934. 2 An extensive bibliography will be furnished to interested persons upon request. 3 Lichenstein, M.: Lancet 2:1623,1939. Nellis, P. & Thomas, G., Compt. rend. soc. biol. 130:1074,1939. Klazole Ointment E.Bi- «_?""*n<»""i»««»»'lor _• "•aW-' __«ed i*o_„ .ad born« ro-^. ■■— A and D at. odd_ '• ?^ roptd gra aulatioD of —• «• *"*Cod_-«oa Sulpha 50? Sulph, 'on contain, added iooo !»i.„* >— Apply fr«_T *■ 100 I- •""„!•• Composition of Vitazole E.B.S. Cod liver Oil 50% Sulphathiazole 4% Sulphanilamide 4% Ointment base.. .. 42% Each gram contains: Vitamin A 1,000 International units Vitamin D 100 International units VITAZOLE E.B.S. is supplied in 1 oz. tubes 4 oz. jars and 16 oz. jars THE E. B. SHUTTLEWORTH CHEMICAL CO. LIMITED TORONTO MANUFACTURING CHEMISTS CANADA THE VANCOUVER MEDICAL ASSOCIATION BULLETIN Pulished Monthly under the Auspices of the Vancouver Medical Association in the interests of the Medical Profession. Offices: 203 Medical-Dental Building, Georgia Street, Vancouver, B.C. EDITORIAL BOARD: De. J. H. MacDermot Db. G. A. Davidson Dr. D. E. H. Cleveland All communications to be addressed to the Editor at the above address. Vol. XXI. OCTOBER, 1944 No. 1 OFFICERS, 1944 - 1945 Dr. H. H. Pitts President Dr. Frank Turnbull Vice-President Dr. A. E. Tbites Past President Dr. Gordon Burke Hon. Treasurer Dr. J. A. McLean Hon. Secretary Additional Members of Executive: Dr. G. A. Davidson, Dr. J. R. Davies TRUSTEES Dr. F. Bbodie Dr. J. A. Gillespie Dr. W. T. Lockhart Auditors: Messrs. Plommer, Whiting & Co. SECTIONS Dr. E. R. Hall Dr. Leith Websteb. Dr. J. H. B. Grant. Olinical Section >j -Chairman Dr. S. E. Tubvey. Secretary Eye, Ear, Nose and Throat -Chairman Db. Grant Lawrence Secretary Pediatric Section -Chairman Db. John Pitebs Secretary STANDING COMMITTEES Library: Db. S. E. C. Tubvet, Chairman; Dr. A. W. Bagnall, Dr. F. J. Bulleb, Dr. W. J. Dorrance, Db. J. R. Neilson, Db. S. E. C. Tubvey , Publications: Db. J. H. MacDermot, Chairman; Db. D. E. H. Cleveland, Dr. G. A. Davidson, De. J. H. B. Gbant, Db. E. R. Hall, Db. L. H. Webster Summer 'School: Db. G. A. Davidson, Chairman; Db. J. C. Thomas, Db. R. A. Gilchbist, Db. A. M. Agnew, Dr. L. H. Leeson, Dr. L. G. Wood Credentials: Db. D. E. H. Cleveland, Chairman; Dr. E. A. Campbell, Dr. D. D. Fbeeze. V. O. N. Advisory Board: Dr. Isabel Day, Db. J. H. B. Gbant, Db. G. F. Strong Metropolitan Health Board Advisory Committee: Db. W. D. Patton, Db. W. D. Kennedy, Db. G. A. Lamont Representative to B. C. Medical Association: Db. A. E. Tbites Sickness and Benevolent Fund: The President—The Trustees When raw, painful throats X haryrigitis and tonsillitis of the "cold" season—as well as post-tonsillectomy throats—are often so painful as to make the patient, particularly the young child, reluctant to swallow any type of nourishment. A routine relief measure used by thousands of physicians to provide comforting relief^ and to hasten recovery is JLJtJIa/idd A spergum Chewing Aspergum accomplishes these desiderata: 1. The acetylsalicylic acid is carried to the very site of pharyngeal inflammation. A copious salivary flow, laden with this effective analgesic, is brought into immediate and prolonged contact with painful irritated areas—providing prompt and gratifying relief. 2. Local spasticity and stiffness are relieved through the gentle muscular stimulation afforded by chewing. 3. The patient is more comfortable, earlier partakes of a suitable diet; convalescence is hastened. Ethically promoted—not advertised to the laity. In boxes of 16 and moisture-proof bottles of 250 tablets. Write for samples and literature to W. Lloyd Wood, Ltd., 64-66 Gerrard Street, East, Toronto, Ontario. r^ i A PRODUCT OF WHITE LABORATORIES, INC VANCOUVER HEALTH DEPARTMENT STATISTICS—AUGUST, 1944 Total Population—Estimated 299,460 Japanese Population—Estimated s Evacuated Chinese Population—Estimated — 5,728 Hindu Population—Estimated , 227 Number Total deaths 232 Chinese deaths > 7 Deaths—residents only 198 x BIRTH REGISTRATIONS: Male, 308; Female, 317 -25 INFANT MORTALITY: August, 1944 Deaths under one year of age " 17 Death rate—per 1,000 births I 27-2 Stillbirths (not included above) 14 Rate per 1,000 Population 9.1 14.4 7.8 24.6 Augu^, 1943 29.4 10 CASES OF COMMUNICABLE DISEASES REPORTED EN THE CITY Scarlet Fever Diphtheria Diphtheria Carrier Chicken Pox Measles Rubella Mumps Whooping Cough _ Typhoid Fever Undulant Fever Poliomyelitis Tuberculosis Erysipelas May, 1944 Cases Deaths July, 1944 Meningococcus Meningitis Parattyphoid Fever (Carrier). Infectious Jaundice 28 0 0 20 7 6 3 2 1 0 0 77 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16 0 0 0 0 June, 1944 Cases Deaths August, 1944 19 9 9 2 17 7 4 46 2 2 1 July 1-15, 1944 Cases Deaths Sept. 1-15, 1944 10 6 9 1 5 9 44 V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH DIVISION OF VENEREAL DISEASE CONTROL Syphilis (August) Gonorrhoea (August) Vancouver 56 _ 119 Richmond North Vancouver 2 Burnaby 1 West Vancouver BIOGLAN-A §| The most effective therapy for waning mental and physical energy, deficient concentration and memory, reduced resistance to infection, muscular weakness and debility, neurasthenia and premature senility. The efficacy of this very potent endocrine tonic has been confirmed by the clinical evidence of many thousands of cases treated during 1932-1943. Stanley N. Bayne, Representative Phone MA. 4027 1432 MEDICAL-DENTAL BUILDING Vancouver, B. C. Descriptive Literature on Request THE SCIENTIFIC HORMONE TREATMENT Page One DEHYDROCHOLIN For the Treatment of Biliary Insufficiency l(i i - ■ Dehydrocholin B.D.H. is the most satisfactory product for the treatment of biliary insufficiency. Its use constitutes both substitution and stimulation therapy in that Dehydrocholin B.D.H. itself replaces the bile which is being secreted in inadequate amounts, and, >at the same time, it stimulates the bile-secreing activity of the liver. Dehydrocholin B.D.H. is indicated, therefore, whenever bile secretion is deficient or when an increased flow of bile is necessary or desirable. It is indicated also in cholelithiasis, cholecystitis, cholangitis, all forms of jaundice except when there is obstruction of the common or hepatic bile ducts, cirrhosis, congestion of the liver, hepatitis and hepatic insufficiency. Other conditions in which Dehydrocholin B.D.H. is of value include acute alcoholism, metallic intoxications, migraine, urticaria and Weil's disease. Dehydrocholin B.D.H. is administered intravenously. The treatment may be supplemented, and its efficacy enhanced in most instances, by the oral administration of tablets of Dehydrocholin B.D.H. collaterally with the injections. Stocks of Dehydrocholin B.D.H. are held by leading druggists throughout the Dominion, and full particulars are obtainable from THE BRITISH DRUG HOUSES (CANADA) LTD. Toronto Canada -Dhyd/Can/4410 VANCOUVER MEDICAL ASSOCIATION FOUNDED 1898 :: INCORPORATED 1906 * * * * PROGRAMME OF THE FORTY-SEVENTH ANNUAL SESSION 1|| GENERAL MEETINGS will be held on the first Tuesday of the month at 8:00 p.m. CLINICAL MEETINGS will be held on the third Tuesday of the month at 8:00 p.m. These meetings will continue to be amalgamated with the clinical staff meetings of the various hospitals for the coming year. Place of meeting will appear on the agenda. General meetings will conform to the following order: 8:00 p.m. Business as per agenda. 9:00 p.m. Paper of the evening. October 3—GENERAL MEETING: Symposium—Medical Education of the Future, from the standpoint of (a) The Clinician—Dr. G. F. Strong. (b) Preventive Medicine and Laboratory Research—Dr. C. E. Dolman. (c) The Medical Health Officer—Dr. S. S. Murray. October 17—COMBINED CLINICAL MEETING and STAFF MEETING at VANCOUVER GENERAL HOSPITAL. November 7—GENERAL MEETING: Symposium on Industrial Medicine, arranged by Dr. W. G. Saunders, Director of Industrial Medicine, Wartime Merchant Shipping Ltd. November 21—COMBINED CLINICAL and STAFF MEETING at ST. PAUL'S HOSPITAL. December 5—GENERAL MEETING: Report of Work at Crippled Children's Hospital. New Methods of Treatment of Club Feet—Dr. Gerald Burke. December 12—COMBINED CLINICAL MEETING and STAFF MEETING at SHAUGHNESSY HOSPITAL. Nunn & ®I]0mH0n t 2559 Cambie Street Vancouver, B. C Page Two DIPHTHERIA TOXOID and PERTUSSIS VACCINE fep The death rate from diphtheria and whooping cough is highest among children of pre-school age. It is desirable, therefore, to administer diphtheria toxoid and pertussis vaccine to infants and young children as a routine procedure, preferably in the first six months of life or as soon thereafter as possible. For use in the prevention of both diphtheria and whooping cough the Connaught Laboratories have prepared a combined vaccine, each cc. of which contains 20 Lfs of diphtheria toxoid and approximately 15,000 million hilled bacilli from freshly-isolated strains (strains in Phase 1) of H. pertussis. CONVENIENCE The combined vaccine calls for fewer injections, and, in consequence, the number of visits to the office or clinic may be considerably reduced. It is administered in three doses with an interval of one month between doses. DIPHTHERIA TOXOID & PERTUSSIS VACCINE (COMBINED) is supplied by the Connaught Laboratories in the following packages: Three 2-cc. ampoules—For the inoculation of one child Six 6-cc. ampoules—For the inoculation of a group of six children CONNAUGHT LABORATORIES University of Toronto Toronto 5, Canada DEPOT FOR BRITISH COLUMBIA MACDONALD'S PRESCRIPTIONS LIMITED MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. THE EDITOR'S PAGE With this number, dated October, 1944, the Bulletin of the Vancouver Medical* Association has entered its twenty-first year and has "come of age." The Board that directs the publication feels that it will be only fitting to mark this event in some way: and has decided to issue this Anniversary Number in a somewhat more decorative form than usual: and has included several messages from some of our very good friends: the President of the Canadian Medical Association, the Editor of the Journal of that organisation, the General Secretary of the C.M.A., the President of the B.C.M.A., and the Victoria Medical Society. Twenty full years have passed, from 1924, when the then President, Dr. H. H. Milburn, whose picture appears herein, without^any knowledge or consent of his own, conceived the idea of a Bulletin of the Vancouver Medical Association. His suggestion was warmly received by the Association, and it was particularly fortunate that the membership included one Dr. J. M. Pearson, than whom no more suitable man could have been found for Editor. Pearson possessed all the qualifications. He was an excellent organiser and leader, not given to over-emphasis or undue enthusiasms, but intensely loyal to any cause he made his own. So he entered wholeheartedly upon the task, and organized the journal so well that little or no change has ever been found necessary, beyond that necessitated by the natural growth of the journal. Dr. Pearson edited the journal for some ten years—for a year or more before his untimely death in 193 5, he had retired from the active editorship—but was still interested in it in a consultative capacity. Some day the history of the Vancouver Medical Association will be written, and if we can ever prevail on our archivist, Dr. G. E. Kidd, to release some of his material, we will publish it, and it will be of intense interest—but we cannot go into it in any length now. But the perusal of the numbers of the Bulletin for the past twenty years makes for interesting reading. Many things have happened in the time. As for instance, one notes the illness of Dr. Alison Cumming, a very eminent internist in Vancouver in the years from 1910 to 1924: his death occurred in the latter year, from pernicious anaemia. At that time, the work on treatment of pernicious anaemia was still in the embryonic stage, and it is sad to think that so valuable a man could not have shared its benefits, and been preserved to greater usefulness. It is the more ironic, because he was an internist, and had been one of the men selected by Banting to introduce insulin here a few years before—and would have undoubtedly been a leading spirit in the institution of liver treatment for pernicious anaemia. But this is said merely to give a landmark. Great advances have been made in medicine in the past twenty years, and many more loom. Who can say what the next twenty years will shew? What account can the Bulletin render of its stewardship for these twenty years? The answer is, perhaps., not for us to give, who edit and publish it. But its purposes still remain—to preserve and distribute for all our readers' use and benefit, all that is of value in our daily work and intercourse—to help us share with our brethren any bit of knowledge we may gain, any beneficial experience, anything we can give which will help them to help their patients and the community at large. That is its first purpose. Its second is to act as a promoter of unity and solidarity—to keep us aware of each other, and of the bonds between us. In this capacity, as in its first duty detailed above, its influence must go far beyond Vancouver. It must serve the whole province of British Columbia, and it must make its contribution towards national unity among the profession of medicine. Page Three i To this end, the Bulletin has steadfastly striven to be not merely a Vancouver publication but a British Columbia publication, and has worked steadily to this end. We on the Board are all agreed on this point, and have no apologies to offer for our efforts in this direction. We work in close association with Victoria through its Medical Society, we record the doings of other areas, we publish News and Notes which cover the Province, and we act as the unofficial organ of the British Columbia Medical Association. Every medical man in the Province receives the Bulletin, as do all Hospitals, any many other institutions, and all the medical men from B. C. in the Armed Forces, and we are thus able to reach every member of the profession in B. C. Thus through all the long struggles and debatings over Health Insurance, and over Medical Economics generally, we have been able to afford a medium whereby ready and immediate contact could be maintained by the College of Physicians and Surgeons, and by the B. C. Medical Association, with their members. If the Bulletin had done nothing else, we feel that this has fully justified it? existence. Our circulation has risen steadily, from an original two or three hundred copies, to some eleven hundred printed monthly. Our list of exchanges is a long one, and is growing. Our articles are reviewed by the Index Medicus, and we are definitely an established journal. But we did not do all this by ourselves. We have had great help— from the British Columbia Medical Association, from the Victoria Medical Society, from the hospitals of Vancouver, notably from the Vancouver General Hospital, whose Staff has given us most valuable and important contributions, and St. Paul's Hospital, whose Staff has also contributed a great deal to our columns. We look forward to even greater and closer cooperation with all these agencies. We cannot close without saying something about our publishers. We have always been fortunate. Our first publishers, McBeath & Spedding, took a long chance. They agreed to publish without payment, relying on their ability to secure enough advertising to pay the printing bill. We did not even guarantee them against loss. They succeeded, and we have never had any financial difficulties since. Our present publisher, Mr. W. E. G. Macdonald, has been a tower of strength to us. He has succeeded in putting our advertising on a very high plane, and has secured the best of national advertisers. We take this opportunity to express our great appreciation to the latter. We believe, of course, that it is worth their while to advertise in the Bulletin, and we urge all our readers to help us prove it—by reading the advertisements carefully. They are attractive and represent honest products, deserving our use and ^support. And we could go on indefinitely, but will not. But we foresee great things for the Bulletin. B. C. has only begun to grow, and the developments ahead of us will challenge all our brains and goodwill, if we are to play the part our profession should and must play. We know that a Medical School is an urgent necessity for British Columbia, and we must get behind it and support it in every way we can. Rehabilitation, reconstruction, new hospital projects, health insurance properly conceived—many are the tasks ahead of us, and they are going to be stiff ones. The Bulletin pledges itself and its efforts to the support and furtherance of all measures which will elevate the standards of medicine, and contribute to the greater wellbeing and prosperity of British Columbia and Canada. Page Four J. M. Pearson, M.D., (Tor.) Took the chief part in organising the Vancouver Medical Association —was its first Secretary, later President. First Editor of the Bulletin. Henry H. Milburn, M.D., CM. (Queen's) Former President of Vancouver Medical and B. C. Medical Associations; Member and President of Council of B. C. College of Physicians and Surgeons. The Bulletin was founded during his presidency of the V.M.A. and chiefly as a result of his efforts. Page Five LETTERSC THE BULLETIN COMES OF AGE Upon the happy occasion of the coming of age of the Bulletin, it gives me great pleasure to extend to you, Mr. Editor, felicitations on behalf of the Canadian Medical Association. I can do this more gladly as there are still present in my mind the pleasant- est of memories following my visit and all too brief sojourn, among the members of the B. C. Division whose active interest and leadership in all that pertains to the good of Canadian Medicine is due undoubtedly, in good pwt, to the "Bulletin?'. It is through this medium that all the members of the B. C. Division learn what is going on, not only in medical circles in British Columbia but throughout this young nation. This, I take it, is the primary function of the journal and this function the "Bulletin?' has for these 20 years past successfully carried out. Withal, the scientific flavor has not been forgotten. Good scientific articles and case reports which otherwise might not have seen the light of day, appear regularly, all helping to make a newsy readable and useful "Bulletin". The influence of the editorial page cannot be estimated. Through this, medical opinion on various subjects is clearly brmight into focus for the benefit of the profession and more particularly of the public to which it filters through the press. This is especially important in these days of social unrest, in all directions, I can think of no better channel than that afforded by the Bulletin, through which the voice of Canadian Medicine may be heard. For these reasons Mr. Editor I again congratulate you and all associated' with you and wish for all a greater influence from and success for the future in your efforts to keep before the B. C. Division all that is just, fair and true in Canadian Medicine. HARRIS McPHEDRAN, M.D., President, Canadian Medical Association. * To the Editor, The Bulletin of the Vancouver Medical Association. It is indeed a pleasure for me to accept ycur kind invitation to pen a few words for your "Coming of Age" issue. This milestone is always an important one in the life of a person or an institution, and it seems to me that, throughout its existence, the Bulletin of the Vancouver Medical Association has epitomized both the personality and the corporate existence of medicine in British Columbia. A wide variety of magazines and publications come on my desk with unremitting regularity and I must confess that it is not an easy matter to read them all. But it is no exaggeration to say that the pages of your Bulletin are always scanned very shortly after arrival. Now, don't blush when 1 say that 1 always turn first to the Editorial uage —and I am never disappointed. Your articles are timely. Your treatment of them forthright and straight from the shoulder, and the breezy and sometimes caustic comments add the necessary colour. You leave no doubts in the minds of your readers of what you are trying to say. It would be my view that much of the contribution which has been made by organized medicine in British Columbia—and that contribution has been unmistakably advantageous to all concerned—stems from the valuable support which has come from the Bulletin. It has long since been my view that each of the nine Divisions of the Canadian Medical Association should have a "house organ" in the form of a Bulletin, and it is pleasant to note that most of them now have. While our national medical fournal which is received by a very large percentage of the Doctors of Canada does carry a cer- Page Six tain amount of local news, it would be impossible for that Journal to cover the field as adequately as it should be covered in respect to the activities of all the provinces. Over the years, your Bulletin has been constantly out in front with what is news in medicine, not only in British Columbia but in the wide field of medical interest. With zeal and I am sure great sincerity you have seized every opportunity to urge upon your readers the necessity of national unity in medicine. Your scientific and special articles have contributed greatly to the well-balanced character of the publication. Now that the Bulletin has covered the preliminary stage in point of age and embarked upon its adult existence, I am sure that it will continue to merit the confidence and admiration of the profession, winch it no doubt has won during the past twenty-one years, for a job well done. To the Bulletin, its Editor and Staff and the splendid Medical Associations which it serves, may I tender my heartiest greetings and congratulations. T. C. ROUTLEY, General Secretary, Canadian Medical Association. Medical journalism in Canada has been carried on steadily, if in varying degrees, since 1844, except for the one brilliant but abortive attempt on the part of Dr. F. X. Tessier of Quebec in 1826. In this period of exactly one hundred years many medical publications have come and gone, some with long years of existence, others with a life of only a few months; comparatively few have survived. L'Union Medicale holds the place of honour with its unbroken record of publication since 1872, under the one title. Amongst these journalistic endeavours must be included the Bulletins which are produced in some of our Provinces. They are definitely limited in their design, and aim at no national expansion, but even within these limits they are of great value in our medical life. They fulfil not only an essential local but also an historical function, for in them the historian often finds greatly valued material which is not recorded elsewhere. The Bulletin of the Vancouver Medical Association holds high rank amongst these publications. In the present issue it celebrates its twenty-first birthday, and it is with great pleasure that as Editor of the national journal I take the opportunity of expressing my best wishes for the future career of the Bulletin as well as my high regard for the quality of the work it has consistently produced. H. E. MACDERMOT, Editor, Journal of the Canadian Medical Association. The "Bulletin" has come of age. For the past twenty years it has reported medical news and has been the major outlet for the views, opinions and scientific thoughts of not only the members of the Vancouver Medical Association, but also of all the profession in the Province, and during the past five tedious years of war, the "Bulletin" has gone to all those overseas, truly a welcome professional breath from home. To those who do not practise in Vancouver, the arrival of the "Bulletin" is doubly appreciated, as it is the vehicle that keeps every medical man in British Columbia in touch with medical affairs and news, and I may add, without cost. Therefore I wish, on behalf of the British Columbia Medical Association, to congratulate the "Bulletin" on its first twenty years of successful growth and ever-increasing influence and esteem, lt is my conviction that as the years continue to unfold, so too will the "Bulletin" continue to increase in stature and growth and will continue to fill that same vital place in our medical lives that it has so ever increasingly done since its brave inception twenty years ago. GORDON O. MATTHEWS, President, British Columbia Medical Association. October 26, 1944. Page Seven The Editor, Vancouver Medical Bulletin, 203 Medical-Dental Building, Vancouver, B. C. Dear Sir: I feel sure that the members of The Victoria Medical Society are unanimous in offering congratulations to The Vancouver Medical Society at this time at which its "Bulletin" has reached the age of twenty-one years. I gather from your letter that you are requesting expressions of opinion regarding The Bulletin. For anyone in Victoria this would be a very delicate matter for we have come to regard this as our journal in a considerable measure. Consequently, prejudice might play a large part. However, it is no exaggeration to say that the arrival of The Bulletin is always welcomed for its scientific and news value. It is always helpful and of interest and may prove indispensable in these days of changing medical practice and changing medical economics. I would like to add that our congratulations are likewise extended to yourself in your editorship in this significant period. Yours sincerely, G. B. BONAR BUFF AM, Honorary Secretary, Victoria Medical Society. SOME OBSERVATIONS RE VACCINATION By Harold White, M.D. Metropolitan Health Services. In 1925 there was a large number of cases of discrete smallpox in Vancouver and we were doing a great many vaccinations among the pupils of Vancouver schools. It seemed to me to be unfortunate that we had to disfigure a girl's arm with a vaccination scar. Moreover, we found that most cases of severe "reaction" occurred in cases in which the vaccination pustule had been broken, admitting mixed infection. It was observed that by choosing a site on the inner side of the arm about two inches above the internal condyle of the humerus, the resulting scar was hidden from ordinary vision, the pustule was protected by the arm, and so seldom broken, and the site was sufficiently distant from the axilla to escape moisture and consequent maceration of the skin which would otherwise promote the breaking down of the pustule. The enlargement and tenderness of the axillary glands in a successful "take" prevented friction between the arm and the chest wall. The mode of vaccination used is the intradermal method, making several insertions of the needle through a drop of vaccine into a skin cleansed with soap and water. Care is taken to use the vaccine from the end of the tube where it is opaque rather than the end which has the appearance of clear glycerine. No dressing is used unless the pustule has been broken. This system has been used in vaccinating Vancouver school children for the past eighteen years and now is almost exclusively used in the Metropolitan Public Health Services. Since this system has been in vogue the number of severe reactions has been very small. To this, as well as to the absence of disfigurement the reduction of opposition to vaccination in Vancouver is largely attributed. It may be noted here that vaccinations are never performed on the thigh in these services. We find the test of immunity to smallpox in persons previously vaccinated very useful. The usual method is employed of using control intradermal insertions of the needle without vaccine an inch or more above the regular vaccination as described above. A greater reaction at the site of vaccination than at the control site within 48 hours" is an indication of immunity to smallpox even though the vaccination does not take. We also find that vaccine is more potent when kept at refrigerator temperature, and we transport all biological products from refrigerator to clinics in vacuum jars. Page Eight » symposium i th€ futurc of mcoicflL coucnTion FROM THE STANDPOINT OF THE CLINICIAN G. F. Strong, M.D. Vancouver, B. C. In our thinking regarding the future of medical education, we must try to foresee what lies ahead for our profession. Whether we like it or not there is a strong trend toward some form of socialization of medicine which may materially alter the practice of medicine as we know it. There is a rightful demand for a better medical service or, really, a better distribution of present medical service, which demand will undoubtedly necessitate more doctors and a better apportionment of those doctors. The newer forms of medicine may lead to further changes in medical education, but for the present it is fair to assume that the immediate need is for the training of an adequate number of general practitioners to bring the necessary services to all our people, with the addition of sufficient specialists to satisfy the requirements of our ever-expanding medical knowledge. Over the past few decades there has been a general tendency to increase the length ^ of the medical course, and obviously this tendency cannot continue. Each department in our medical schools has claimed that more time should be allowed in order to teach that subject more adequately. This has led to a situation in which valuable additional courses made necessary by changes in social and economic conditions have not been added because the curriculum was already full. There are additions to the medical curricula which would appear to be imperatiye if the profession of medicine is to maintain its rightful place in the community. While this symposium is of three parts, and the present paper deals with the future of medical education from the standpoint of the clinician, it will not be amiss, I am sure, at this point to touch on the relation between prevention and curative services. There is much loose t~_u_kihg and talking regarding preventive medicine by interested laymen and, I am sorry to say, by our own profession. It should be clear that all good medicine is preventive, and as doctors we strive to prevent pain and suffering, prevent, or more accurately, postpone death, as well as prevent disease. It is essential that we bring all possible emphasis to bear on the application of all preventive measures that are available in the light of present-day knowledge. To do this necessitates a program of education of the profession and of the public. It is of little avail to know how to prevent disease unless we can prevail on the public to accept the application of that knowledge. Even in the field of infectious disease, where preventive measures can probably attain their best application, we have not been completely successful. I cannot agree with Sir George Newman when he is quoted as saying "The ideal of medicine is the prevention of disease and the necessity for curative treatment is a tacit admission of its failure," unless that statement is rewritten to read as follows: "One ideal of medicine is the prevention of infectious disease and the necessity for curative treatment of infectious diseases is a tacit admission of failure in that regard." Just now, with all the discussion of health insurance, we are apt to hear too much emphasis on prevention . as if it applied equally to all the ills that human flesh is heir to. There is no evidence that we can prevent arterio-sckrosis, diabetes, or cancer in any way comparable with the measures available to us to control and prevent typhoid fever, smallpox, or diphtheria. While the ravages of the degenerative disorders may be postponed, they cannot be prevented, for we have not yet discovered the secret of perpetual youth. As has been frequently pointed out, as we control and prevent infectious diseases that show their greatest morbidity and mortality among children and young people, we permit more individuals to live to an age when they will inevitably develop either cancer or arterio- Page Nine sclerosis. In fairness to the public, therefore, the real limitations of preventive measures must be made clear. There is no evidence that the need for doctors will grow less, in fact, if we are to apply fully all the preventive measures that are effective to all the people, and then have sufficient doctors to treat them when they develop those illnesses which cannot be prevented, we shall need a great many more doctors than we have today. All of this has a bearing on the future of medical education in that if more doctors are required, immediate steps should be taken to fill that need. If Canada is to achieve better health, Canadian medical schools must produce more graduates, or since that is .said to be impossible, new schools must be established. The doctors that we need will not be of two sorts, one dealing with prevention and the other dealing with treatment of disease, but all should be doctors of medicine trained to prevent disease, suffering, and untimely death. The aim of medical education should be to produce the ideal physician, and the definition of that ideal has varied through the ages. Just now it would seem to me that the ideal physician is one trained to assume that most difficult of roles, that of the general practitioner. The training of specialists through residencies and fellowships entails a phase of post-graduate medical education which time will not permit us to discuss tonight. The ideal graduate should, in my opinion, be prepared to deal with the situations that arise in general practice, in 80% of which he should find himself competent to diagnose and treat the patient without outside assistance, and in the remaining 20% he should recognize the need for diagnostic or therapeutic facilities not available to him. He should be so trained as to be able to diagnose and treat his patients in their homes or in his office with the simple laboratory equipment available to every practitioner. Every effort should be made to train our graduates not to depend too much on elaborate laboratory aids because, for one thing, this is undoubtedly one of the reasons for the concentration of doctors in urban con_uunities. This filling of the cities at the expense ' of rural areas has made our profession vulnerable to some very caustic Criticism from politicians only too ready to criticize. Careful study should be made of the curricula of our medical schools in order to see that as much time as possible is devoted to the training of the practitioner to make him competent to practice medicine without elaborate assistance. Criticism is offered as to the length of pre-clinical laboratory courses, in that too much time is devoted to procedures that would seem of little value in the training of a good general practitioner. It may well be that these courses might be so altered as to leave the more advanced laboratory experiments to those post-graduate students seeking teaching posts or qualifying as specialists. Equal criticism can be levelled at the clinical years where each department tries to graduate a specialist. Fourth and fifth year students have lectures and clinics on some subjects they will never see and certainly will never attempt to treat while in general practice. There is no intention here to suggest a lowering of the standards of medical education, but merely a restriction of the ground that is covered. In any scheme for the future, systematic, periodic, and in my opinion compulsory, post-graduate refresher courses must be envisioned. In the training of the students more attention must be given to the conditions they will see in their first years in general practice, and in the stage in which they will see them. For example, they must be better trained to diagnose the earliest manifestations of arterio-sclerosis, not only the end results as seen in cerebral, coronary, or peripheral vascular failure; they must be trained to handle the mild diabetic as an ambulatory patient and while he is at work, not only in the end stages when he has coma or gangrene. In this connection it is of interest to note that the average text book of medicine devotes a great deal of space to the infections, and relatively little to the degenerative disorders. In one well-known text book, for example, six to seven hundred pages are devoted to the infections, while arterio-sclerosis is covered by forty-five pages, diabetes by twenty-five pages, and chronic arthritis, the commonest cause of disability, by fifty- six pages. This is not to suggest that the study of infectious diseases is not important, but only to emphasize the need for more attention to the degenerative disorders. The Page Ten • infections Can to a large measure be controlled if not entirely prevented, whereas little can be done to prevent the other conditions, and nothing can be done to delay them if we see them only in the terminal stages. The value and the technique of a good periodic health examination should receive more attention. This procedure consists of more than a complete physical examination because, if it is to be of any value to the individual, or society, it must include the social, marital, and industrial relationships involved. The newer subject of geriatrics must be included in the medical courses of the future because of the increasing percentage of our population past middle age. Recent hospital experience in Vancouver emphasizes the preponderance of the aged in our public wards, and while the medical care of these individuals may be void of some of the interest, or shall we say glamour, of the medical treatment of the young, it is essential that our medical graduates of the future be well versed in the conditions common in the older age groups. There is increasing interest in psycho-somatic medicine and our students must have increased training in the earlier detection and control of those nervous conditions that may lead to debilitating disorders. The teaching facilities of our hospitals must be better organized. We have many hospitals in Canada, not at present associated with a medical school, in which the teaching of internes and residents could be greatly improved. The use of apprenticeships might be given further consideration, as there are, without doubt, many well-trained general practitioners who could act as preceptors for recent graduates in order to provide the necessary actual experience in general practice. A "poll" has become a popular device from which to secure information or determine trends. In an effort to secure information as to the character of present-day general practice in British Columbia a poll was taken by securing from each of ten general practitioners a list of one hundred consecutive patients. Thus a sample of one thousand patients was obtained from practitioners in large cities, in small towns, and in rural communities. It is in order for me here to make grateful acknowledgement to the men who have taken the time to return these.lists. For the purposes of our discussion the patients were classified somewhat arbitrarily into the following divisions:— - 1. Medical — (a) Infectious 3. (b) Degenerative 2. Surgical — (a) Minor surgery 4. (b) Major surgery (c) Fractures 5. Table 1. Gynaecological Obstetrical Paediatric. ANALYSIS OF TEN SERIES OF ONE HUNDRED CONSECUTIVE PATIENTS SEEN IN GENERAL PRACTICE Medical: Infectious: A 5 7 6 C. 11 15 27 — 16 — 22 — 33 Degenerative 34 26 63 Surgical: Minor 12 ~ 22 6 Major 2 4 Fractures 6 7 — 20 — 29 Gynaecological 17 5 0 Obstetrical 18 21 0 Paediatric 3 8 0 5 13 9 12 — 22 23 4 55 38 27 23 20 42 30 14 7 4 15 4 5 30 11 26 15 2 7 40 9 12 9 — 21 40 17 2 0 10 14 — 23 37 14 4 5 — 25 — 24 — 67 8 7 9 7 8 0 8 12 24 10 2 3 44 — 19 — 23 2 6 0 11 5 4 7 4 108 111 105 115 100 A.—Acute. C.—Chronic. 128 101 100 100 102 Page Eleven Analysis of these results should not be taken too literally since all the reports were not in quite the same form, making exact comparison impossible, since there was considerable variation in the type of practice concerned, and since the sample is of course ridiculously small. Under infections were listed all acute and chronic infections as well as infestations with parasites. Degenerative conditions included, in addition to the obvious, all arthritis whether infectious or not (the type was usually not specified), and all chronic heart and kidney conditions. Since the latter group was mostly middle-aged the error in not distinguishing those heart and kidney disorders due to infection was probably not great. Cancer was not commonly diagnosed, and no deficiency diseases were noted. Since the age of patients was not always given, there were probably many more children in the series than the figures under paediatrics would indicate. There is, of course, no division of paediatrics in general practice. There would be a considerable seasonal variation in these figures. Most, but not all, of these lists were taken during the recent (summer) months. Table 2. ANALYSIS OF 1000 PATIENTS SEEN IN GENERAL PRACTICE (100 consecutive patients seen by each of 10 general practitioners in B. C. in 1944) Medical: Percentage Infectious—Acute and Chronic 20 Degenerative 36 — 56 Surgical: Minor 17 Major 4 Fractures 6 — 27 Gynaecological 6 Obstetrical — 9 Paediatric ■ 2 The significant part of Table 2 is to be found in the fact that the degenerative conditions represent the largest portion (36%) of general practice. This brings added emphasis to the already expressed need for greater attention to these disorders in clinical taching. One comment that can be made is on the infrequency with which periodic examinations or general "check-ups" were noted, although we must remember that under prevailing war-time conditions most of these practitioners find themselves so overworked as to make it impossible to give time to the examination of the apparently well patient. This only adds force to the argument for more medical men in order to bring an improved medical service to our citizens. There are two important subjects which should be included in medical school curricula, the study of social medicine, and the study of medical economics. Social medicine, which should not be confused with socialized medicine, deals with the relation of poverty, and the resulting malnutrition, inadequate housing, and crime, to disease. Doctors in the past have been prone to take far too little interest in this side of medicine, and unless such a course is included in our medical schools now we may find social workers assuming leadership in this great field of human endeavour. While we recognize the great value of, and need for, the well trained social worker in our present-day social order, there can be no doubt that the medical profession must assume a far greater interest in social conditions. After all, doctors in the broadest sense are social workers and medical education must keep abreast of the developments in this field. Whether we have health insurance, state medicine, or remain as we are, there will continue to be increasing emphasis on the need for medical leadership in the control and prevention of social disorders. The abolition of poverty is, of course, a political rather than a medical question, but when it comes to the application of political ideas to society at large, the doctors should be so trained as to be competent advisors to the state. This whole subject is but another part of the broader aspect of preventive medicine. If there were no poverty and we could educate the people to accept all the known facts regarding preventive measures, a great deal more could be done to lessen the incidence of some diseases. Page Twelve The study of medical economics, also, should be part of every medical course in order to make our graduates aware of the significance of the changes that are taking, place around us. A few years ago the chairman of the Conunittee on Medical Economics of the Canadian Medical Association appealed to each medical school in Canada to include some lectures on economics, only to be met by the unanimous view that the student was already too busy. It is open to serious question if this was a proper attitude. One result of the inadequate attention given to this subject is to be found in the views expressed in a paper given at the session devoted to medical economics at the annual meeting of the Canadian Medical Association in Toronto in May, 1944, by the representative of Camsi, the Canadian Association of Medical Students and Internes. This paper expressed a definite opinion in favor of a salaried system for all doctors; in other words, state medicine. It may be that medical students and internes know best what form medical practice should take in the future, but it is to be regretted that they have reached that opinion without any consideration of the views of the men in practice who have made a careful study of this whole subject. There can be no doubt that, aside from a few dissenters who, like the poor, are always with us, the medical profession is united in opposition to state medicine. In conclusion, therefore, it would seem that from the standpoint of the clinician the medical education of the future must adapt itself to changing conditions. There must be more emphasis on the training of the general practitioner for the type of work he will encounter, and on the broadest aspectives of preventive measures. In addition to this adequate medical training, there must be included instruction in social medicine and medical economics. FROM THE STANDPOINT OF PREVENTIVE MEDICINE AND LABORATORY RESEARCH Dr. C. E. Dolman The University of British Columbia All of us taking part in this symposium face the common difficulty that "the future" covers a period of indeternainate duration. I find myself with the added problem of having to speak from two standpoints which are in some respects opposed. I blame nobody but myself for this dilemma,—for happening to be chiefly interested in both these aspects of medicine—but I ask your indulgence if schizophrenic tendencies should be apparent to the analyticaUy-minded in some of my remarks. You will all agree that the Executive hit on a very timely topic, for there is good reason to hope that "the future" may prove locally quite iinminent, in relation to the setting up of a Faculty of Medicine at our own University. There are also several general reasons why medical education is a highly pertinent topic. First, the growing experience with health insurance in other countries, and the impending adoption of it in Canada, will profoundly affect the attitudes of the' future practitioner towards his profession and his community, as well as towards his potential patient. Secondly, the efforts being made to establish refresher courses for returned men under post-war rehabilitation schemes, will inevitably focus attention upon the need for other postgraduate courses for those in need of "refreshment" not merely after two ot five years of wartime experience, but after ten or more years perhaps completely out of touch with a teaching centre. Thirdly, the growing realization that specialists need to be defined and classified, and that a higher academic qualification must be one of the basic criteria for specialism, may well lead to reconsideration of the content of the undergraduate course. Finally, a combination of external pressures from physical, biological and social sciences ancillary to medicine, and of the slow flux of internal evolutionary trends, is exposing to unusual stresses and ten- Page Thirteen sions a curriculum hitherto always ready to undergo minor modifications, but reluctant to give way on the bigger issues. The only other comment I would make by way of preamble is that since there has deliberately been no collusion between the participants in tonight's symposium, there may be some gaps in our total presentation, and also some overlapping. The gaps may readily be filled in by your assuming that each of us is aware of, and largely sympathetic to, the others' viewpoints; and that the exigencies of the occasion, rather than our own choice of specialty, may entail an exaggerated emphasis here and there. On the other hand, any tendency to repetition between us may be deemed a happy augury that possible differences of viewpoint about medical education are far from irreconcilable. Medical education is, as we all know, a very lengthy affair. In fact, to a greater degree than holds for perhaps any other profession, it never rightly ends. But I am referring to the nujoimum of seven, and frequently ten or more years, which now elapse from the time of passing the University Entrance examination to licensure by the Medical Council of Canada. This long period of initiation gives plenty of time for numerous conflicting educational interests to beset the medical student, and to make of his mind and spirit an unhappy hunting ground. At the very outset, e.g., he finds himself applying for admission to a selection conunittee which realizes that he must be imbued with the importance of a scientific understanding of the principles of prophylaxis, diagnosis, and treatment, and therefore requires him to be well grounded in the basic biological and physical sciences; but which also requires him to be well inducted into the humanities, recognizing that unless he gains an insight into the art of handling mankind he cannot hope to apply his science, and that unless he be a man of character, he cannot be trusted to apply that science ethically. After he passes this preliminary appraisal as both a budding scientist and a potential humanitarian, the medical student remains to some extent the butt of similar conflicting interests. For the original issue between Science and Arts readily merges, with only slight transformation, into one between clinical and laboratory teaching. The final conflict looms for the student when the question arises as to what branch of medicine he should enter—the competitive but possibly lucrative fields of general practice and specialization, or a salaried job as a health officer, a research worker, or a teacher? the market place or the ivory tower? the operating theatre, the executive desk, or the laboratory bench? Speaking then from the standpoints of preventive medicine and laboratory research, I want to suggest a few ways in which medical education might in the near future help to spare the student some of these conflicts. In so doing we might clarify somewhat our thinking and feeling on many professional questions, so that we may close ranks around the fundamental objectives we all strive for—may struggle unitedly - towards the ideals we all share. Let us first consider the important matter of pre-medical education, and the bases for selection of the prospective medical student. I suppose we all agree there is no place for mediocrities in medicine: that no selection conunittee should admit them, and no curriculum conunittee cater to them. I presume we are equally agreed that Medicine can readily absorb all the men (and in my view, all the women) of unusual ability and fine character who may seek entrance. But granted this, how shall we identify the mediocre on the one hand, and those with exceptional talent on the other? A transcript of an academic record makes no allowances for deferred mental development or latent enthusiasms; and gives no clue to possible excuses for a slow crystallization of interests. Moreover, an undiscriminating interviewer may do an injustice to some shy, diffident, uncouth or even ill-favoured applicant, who yet has some capacity for overcoming these defects, and withal carries a great light hid under a bushel. But a combination of these two methods of selection is usually employed in Canadian medical schools, with a success fairly proportionate to the stringency of the standards set, and the conscientiousness with which they are applied. I do not believe there is any satisfactory substitute for the personal interview, conducted by a carefully selected person, or small group of Page Fourteen persons. In the case of distant applicants one should accept nothing less than the word of someone on whose opinion one can rely, whose geese are not all swans, and who is as concerned for the high standards of the school to which he is recommending the candidate, as he is for his own reputation for perspicacity, and for the health and welfare of mankind at large. The detailed questionnaire, covering everything from diet to dreams, which is popular in some United States colleges, often reveals less about a candidate's suitability than does a brief note of sponsorship from a truly reliable quarter. Aptitude tests do not furnish, in my view, suitable criteria for the selection of applicants, since Medicine may call forth, and profitably expend, the most diverse attributes of mind and heart, provided only they be high in quality. Likewise intelligence tests are redundant on persons for whom a record of at least two years' successful college work is available. V This raises the question of what should be required in the type and duration of pre- medical education, As regards duration, my own feeling is that in view of the generally low standards of high school education in North America, and of the fact that many on this continent go to college to procure polish and a cultural sense which in Europe the family more often provides, we should generally insist on a four-year college course, with a Bachelor's degree, as a prerequisite. For the student, once launched upon facts, and the fascinating self-sufficiency of shop-talk ,about disease and death in their manifold forms, leave scant opportunity for the acquisition of culture—especially if we accept any part of J. C. Powys' contention1 when he says: "It is against this newfangled, commercialized motto of 'service' that culture must lift up her beautiful head. Contemplation, not activity of any sort, is the purpose of the universe—or at any rate of that universe which all mystics and artists and lovers and sensualists and saints have substituted for the sterile mirage of objective truth. And every day-dream, begotten of pleasant leisure, by well-side or fire-side or window-sill, is a sort of 'chewing of the cud' of immortal and God-like contemplation, and is worthy of a high place in the order of a good life." Of course I do not imply that an Arts degree can be acquired by day-dreaming, while a medical degree comes only from great effort; but rather that whereas the latter confers both the privilege and the duty of serving one's fellows in some useful and skilful capacity, the former should help to teach the lesson that a man must be as well as do. As Dr. Alan Gregg has put it in a recent article on Medical Education2, "It is not so hard to make students know about disease; it is hard to make them care about it." A well planned Arts course taken under good teachers can do much to make a man care about disease,—may even inspire him to want to contribute, more or less anonymously, to a state of widespread public health. Admittedly, if a man does not have it in him to be that way, neither a Bachelor's nor a Master's degree in Arts will make him so; while some will be aware of, and display, a steadfast sense of vocation from early years. The former type is not suited to Medicine; while the latter, if there is evidence of exceptional intelligence, as well as of good heart, strong will, and sterling character, should not be invariably compelled to mark time by too rigid admission requirements. But in general I feel that more latitude should be allowed in the content of the premedical Arts course than in its duration. The premedical student customarily takes as many science courses as possible: partly to gain exemption from a maximum number of courses in the first and second years of the medical curriculum and partly because a B.A. degree, with a Major or Honours in a science subject, is believed more "useful" than a degree in the Humanities. The first reason for this choice is sound. Medical students must have a good grounding in chemistry, physics and biology, and they may as well get it early, as part of their first two years of a B.A. course. But the second, utilitarian argument for Science subjects is not equally valid. True enough, the biochemist should profit from having majored in chemistry for his B.A.; the radiologist should owe something to his Honours course in physics; and the inununologist or parasitologist should feel able to rejoice that he took courses in bacteriology or entomology. But let us not forget that the courses under Page Fifteen discussion are taken at an Arts undergraduate level, and that years of medical postgraduate work are required to make a well-trained biochemist or bacteriologist. Admittedly, when young men or women show exceptional talent in one or other of these subjects, the situation calls for special consideration. If their level of general education warrants, we should by all means let them concentrate their efforts, set them a research problem, and if they show a real flair in this field, try to arrange a financial grant to maintain them for a year or two of post-graduate research. We should let them learn on their own, with just the right amount of unobtrusive guidance, that research in the field of experimental science, as someone has well written, is "mainly looking for things that are not there, and attempting processes that will not occur. . . . It is subject to innumerable disappointments in following trails that lead out into a boundless desert, or up against barriers that it seems hopeless to try to scale. For the scientist does not make his own landscape, as do the poets, and even many philosophers, nor can he fly hither and thither at will—but he subjects himself to the tyranny of the natural phenomena or processes that he is observing. As Bacon says, he works 'according to his stuff and is limited thereby'." That lesson, if learned before a student enters Medicine, will to some degree Uluminate every aspect of the curriculum. But there seems no good reason why the average pre-medical student, without talent for scientific research, should be refused the right to major or take Honours in Sociology, Mathematics, Psychology, or even Classics if he wishes, and can give sound reasons for his predilection. After all, Medicine, especially in its more preventive aspects, is a branch of Human Biology, a cult of the study of man. We should not then neglect the Humanities in our early education. Far more important, to my mind, than either the content or the duration of the premedical Arts course, is the standard required. Medicine should look for the very best students—an elite. Here we encounter a problem which bedevils us all through our college educational system, and which has been admirably put as follows by Gregg2: "American education has never faced the question of how to foster an elite. Behind the question of whether we have one, or how to create one, stands the equally important query 'Do we want one?' In the 5 th century B.C. the poet Pindar asked the question 'Can excellence be learned?' Our educational philosophy would be in for some extensive reformation if, as a result of the war, we were to ask ourselves: 'Should excellence be pushed?' ... If it should, we have not the system to do it in premedical education. ... As medical schools, we should ask the colleges to allow their premedical students to take a larger proportion of electives than other students, explaining that we attach the greatest importance to the extent to which they excel in the courses they have chosen. More of excellence is revealed by a student in choosing and charting his own course than by being first boat in somebody else's convoy. . . . Medicine offers openings to a wider variety of gifts than any other profession. By what right or wisdom can we narrow the range of abilities to be admitted to so variegated a field of needs and possibilities? What assurance is there in accepting a boy who has been in the upper ranges of a class committed to four slow years of a prescribed curriculum acbninistered with solicitude for the average and with approving neglect of the exceptional? No wonder our medical school deans are asking about the candidate's participation in student activities. Regrettable as it may be, student activities are about the only revealing electives in the convoy colleges. . •. ." I have treated this question of premedical education at some length, because I deem it of paramount importance. For all the many recent surveys of medical education have shown, as Dr. Ray Lyman Wilbur3 has stated, that "the most important factor in determining what comes out of a medical school is what goes into it: i.e+, the educational and personal qualifications of those who are accepted as students. We should now pass on ot the next phase of the student's education—his four to five years of medical sciences and clinical experience. During the first two years of this period, the student is required to absorb, under considerable pressure, masses of factual and largely unrelated information, in the fields Page Sixteen of Anatomy and Physiology, and to a lesser extent Biochemistry and Bacteriology. (In some schools, a little comic relief is afforded by a course in Elementary Psychology, which should have been taken earlier as an Arts subject.) Instruction in these subjects is given by specialists rarely interested in each other's activities, and with little opportunity to teach any group but medical students. To ensure that their Departments should be reputed alive and up-to-date, they struggle for time and appropriations to permit research. But often enough their teaching ability for the ordinary student suffers rather than gains from their research activities, for they discover too much that differs from the text-book account. Still more often, their thirst for research is quenched by overwhelming administrative and teaching duties. To quote Gregg again, in another paper4: "We praise research, we earnestly seek and prayerfully select young investigators of promise; we use productive scholarship and research ability as the cardinal considerations for promotion and even for the selection of professors. We speak warmly of the research career, and after all that build-up we contemplate with almost bovine placidity the professor who cannot do any more research because he is too busy fulfilling the prevalent idea of a professor." One obvious way of attempting to correct this waste of enthusiasm and special talent would be to appoint more research professors and fellows, with due prestige and salary attached to these ranks. Ideally, at least one such appointment should be made to each medical science department. Such a system would not only make for a better balance between teaching, adnunistration and research within the department, but would furnish more opportunity and encouragement to the student with research propensities. However, it is recognized that very few are called, and still fewer chosen, to do research; and the curriculum should be primarily adapted to the needs of the ordinary student, for whom the load of Anatomy and Physiology might well be lightened. There is too much dissection of the preserved cadaver, and too little correlation of surface markings in the live subject with the fluoroscopic picture: too much time spent.on learning by rote the remote relationships of cervical and cranial nerves—which only a neurologist need master—and too little is given to studying the mechanics of the arches of the foot. But this is no place for a detailed consideration of how the teaching of Anatomy should be streamlined and revivified. Dr. Donald Mainland5 has ably discussed this problem. Likewise in Physiology, more time should be given to the study of the whole range of normal human functions, and less to classical demonstrations of what some animal will do under quite unusual circumstances. War-time problems of the Navy, Army and Air Force have given a tremendous stimulus to physiological research, and should provide much new lecture material and laboratory exercises suitable for undergraduate instruction. As for Bacteriology (one of the poorest taught subjects in the whole medical curriculum), this should be released from the bondage of taxonomy, and greater emphasis placed upon those applications of it which have so revolutionized the character and course of the things from which men sicken and die. Schick, Dick and tuberculin tests should be performed on every student; the preparation of the simpler biological products should be demonstrated, or actually carried out by the student; and an introduction given to the main principles of serum, vaccine and toxoid prophylaxis. These changes are advocated as both promoting and fulfilling the prophylactic trend in Medicine. They express, in fact, our realization that while some medical specialties ' must continue to be concerned with the diagnosis and cure of disease, and with the alleviation of suffering—in other words, with problems of human morbidity—the main tendency is" towards disease prevention and health promotion: in other words, towards the widely ramifying problems of human biology. In keeping with this trend, it seems desirable to foster, quite apart from changes in the actual content of the established courses, a closer liaison between the medical and related science departments, e.g., between Biochemistry and Chemistry; between Physiology and Biology; between Anatomy and Anthropology or Zoology; between Bacteriology and any one of these sciences. Not only do research projects benefit from multiple coordinated approaches, but an occa- Page Seventeen h sional interchange of lecturers between such related departments might prove refreshing to all concerned. A short course of lectures could indeed be fittingly given with the help of these and other departments, to emphasize the salient features of man as a biological and sociological entity. The topics touched on might include anthropology, ethnology and eugenics, as well as something of mass psychology, political economy, government and citizenship. Such a course should help to keep the student's feet on the ground he shares with his fellow-man at that crucial period in his career when he grows satiated with the minutiae of medical science, and is about to be initiated into the esoteric mysteries of the professional art. For now he is again liable to become the prey of conflicting interests, the victim of confusion and misunderstanding. How disturbing these conflicting interests may prove, not only at this stage, but sometimes until and beyond the time when the student chooses what field he will plough in the wide estate of Medicine, is epitomized in the following sentences taken from an address given before the Minnesota State Medical Association in 1938 by Dr. Howard Haggard6: "Medical science is not medical practice. The great benefits from the application of preventive medicine that so dominate the public mind today are not those of medical practice. These matters are science, and being science they do not require the participation of the practitioner. Any aspect of medicine that has been reduced to an exact science needs merely medical technicians and not physicians for its accomplishment. So long as the human mind in its full ramifications remains beyond an evaluation with scientific precision, then the practice of medicine must remain an art. So long as medical practice involves the personal contact of physician and patient, then it is the art of the physician which must establish the necessary bond. This is very different from medical research. It is, in many ways, more difficult. It involves not only intelligence and skill, but also qualities of personality unnecessary to the research worker. . . . The emphasis on research has resulted in the development of an aura of sanctity about research. The acquisition of knowledge has received and still receives a cultivated regard amounting almost to a veneration, and one out of all proportion to the regard given to the application of the results of research. . . . The physician, in casting his lot with scientific research, stands and falls with it. And he has chosen an uncertain support. . . .** There is some truth, and much nonsense and sour grapes, in these statements. It is indeed unfortunate if the student should now be too much influenced by some clinician brassily proclaiming, or even smugly emanating such views; for these are perhaps his most formative years at medical school, and he is often unequipped to distinguish profundity from fallacy in arguments about a vocational training upon which he has so recently embarked. Do not misunderstand me. I fully agree that medical research, like any other kind of research, is sterile unless applied; and that its fruitful application depends upon the goodwill, diagnostic acumen, and careful observations, of the clinician. But here Science is supplemented and fortified by Art: not in contest with it. There is no suggestion that clinical medicine (using this term in the broadest sense, to include surgery) should be displaced from its honoured and fundamental position in the professional training of all doctors, even of such as are destined never to use a stethoscope or palpate an abdomen after graduation. I believe there are lessons in deportment, in sympathy, patience, thoroughness, craftsmanship, in the weighing of evidence, and in the understanding of Man, which are to be learned from sound clinical experience, under enlightened teachers, as from no other source. But we are all aware that extraordinary changes have occurred in Medicine in the 100 years or so which have elapsed since the passing of the first Public Health Act in Great Britain in 1948. These changes have led to an increasing realization of the fact that health is largely purchasable, if we are ready, as individuals, and as a community, to pay the price: a belief continually fertilized by new discoveries made chiefly in the laboratory — by salaried men — and giving birth to a lusty, expanding family of practitioners of Preventive Medicine. As Dr. Haven Emerson (7) has put it: "The change of outlook grew in strength with the spreading net of knowledge of the quantity and causes of preventable sickness and death. This Page Eighteen ——__———: took practical form . . . within a score of years in the middle of the last century, by the action of voters and legislators who determined to include within civil government those functions devoted to protection of the general health of the population, so far as this could be achieved by the application of public authority, the employment of appropriate personnel, and the expenditure of tax money. This marriage of the medical sciences to Government has, it would seem, been among the highest achievements of mankind in his ever increasing social ambition to master the safety of his body and soul as well as to build a security for his goods." This theme could be broadly developed, but we must be content to consider briefly some of the curricular adjustments which seem desirable during the final years of the medical course, in view of this changed outlook. Such adjustments should both recognize the rare occurrence and high worth of the research spirit, and be designed to inculcate the prophylactic attitude in every student. Research talent cannot be created by any curriculum. But it can be stifled by stuffiness, and starved by neglect. Likewise it can be provoked to bud by proper stimuli, and encouraged to flower in a favourable environment. The student bent on laboratory research will already have received some stimuli from his contacts with the preclinical medical sciences. However, at that stage he is usually too preoccupied with the absorption of new facts of rather vague import to develop any fixed enthusiasm. By now, he is better orientated to the purpose of each component in his course, and it is important that stimuli should continue to reach him from many directions besides clinical pathology. Such stimuli will be furnished by those modifications in the later curriculum which, from the standpoint of preventive medicine, seem also desirable for the student at large. The Commission on Medical Education organized in 1925 by the Association of American Medical Colleges issued a Final Report in 1932s which emphasized the need to increase and improve the teaching of preventive medicine. That Report points out: "There are two distinct but closely related features of this subject. One concerns itself with the protection of the health of the community through organized public health programs and the other with the prevention of disease and disability in the individual. The former is a well recognized part of the medical curriculum of practically all schools . . ." and in some schools has been quite effectively developed. The latter objective requires that the preventive attitude should infiltrate the teaching in every department of clinical medicine. And in this respect, as the above Report states: "Most courses in preventive medicine do not stimulate the student as much as the importance of the subject warrants. One of the chief causes of this situation is the lack of interest or knowledge on the part of many teachers of the preventive aspects of their own subject. Emphasis on prevention as an integral part of clinical medicine should help greatly to increase the interest of both teacher and student in this matter, so vital to individual as well as to community health." The basic change proposed, namely the establishment and expansion of Departments of Preventive Medicine in the medical schools, is therefore on paper neither drastic nor novel. Yet a survey of undegraduate'instruction in preventive medicine carried out in 1936 by the late Dr. J. G. FitzGerald9 showed that of the 71 medical schools then operating in the United States, only 18 (one-quarter of the total) had full-time Departments of Preventive Medicine, Public Health, or Hygiene. In an additional 25 schools, these subjects were included in, or combined with, Departments of Bacteriology. In 40 per cent of the schools, no formal instruction was given in Preventive Medicine. The situation was only slightly better in the Canadian medical schools, 3 out of 9 giving no place in the curriculum to preventive medicine. Even where whole-time Departments of Preventive Medicine do exist, their contribution to the undergraduate course usually occupies less than 1 per cent of the student's total time table. Such a meagre allotment is in some respects worse than useless. A whole- time department which merely intrudes into the last, or next to last year of the course, a few lectures about sanitation and conununicable disease control, and insulates itself Page Nineteen from all effective relationship with the clinical departments, deserves the unglamorous aura with which it usually becomes invested. The Department of Preventive Medicine should preferably maintain some contact with the student throughout his clinical years. It should be closely linked with the University Health Service, through which observations can be made by the student, and the data analyzed, on that important problem, the limits of the normal. He can be assigned, under these joint auspices, some long-term, but part-time project having to do, for instance, with the respective values of immunization programmes and the isolation of contacts as means of controlling outbreaks of certain communicable diseases; with the effect of diet, sleep and exercise upon growth and general well-being; with the possible relationship between anthropometric findings and "diathesis," racial or national origins, and other factors. By practice on fellow- students, he should become proficient in assessing the psychological traits and conducting thorough physical examinations of the apparently normal. This introduction to preventive medicine through personal study of ostensibly healthy associates should be supplemented by a course of some 40 or more hours of theoretical instruction, and at least one month of field work experience, to be taken preferably in the penultimate undergraduate year. The detailed lecture headings need not concern us here, while the type and scope of the practical exercises Will largely depend upon the facilities locally available. However, a few comments seem relevant on the general content of these courses. The more conventional and classical aspects of sanitation must not be neglected, for too many communities still fail to assure themselves of safe milk and water supplies, or to practise proper sewage and garbage disposal. But due consideration should also be given to the main principles and techniques of physiological and industrial hygiene, with emphasis upon health promotion rather than disease prevention. Again, the basic elements of epidemiology and biometrics should be covered, for the physician of the future must think logically and quqantitatively, must regard himself not merely as adviser to the individual patient, but also as counsellor of the community. The nature, diagnosis and control of the more prevalent communicable diseases might also be reviewed at this time, while public health problems of current or potential national import should be given particular attention. Finally, the student should be well grounded in knowledge of public health legislation, administration and organization. Field exercises should include visits to watersheds and waterworks; to dairy farms and pasteurizing plants; to sewage disposal works, garbage dumps and incinerators; to slums and model townsites; to badly and well constructed .factories. Through planned visits to schools, dental clinics, tuberculosis and venereal disease clinics, prenatal and well-baby clinics, and even to homes, students should be given every opportunity of familiarizing themselves with the social and economic conditions which make for poverty and ill-health. Such visits are best carried out under the auspices of municipal and provincial departments of health and social welfare, whose personnel should readily agree that the medical student requires no less tranning of this kind than the public health nurse or professional social worker. Another major endeavour of the Department of Preventive Medicine should be to give leadership in all matters pertaining to the objectives it stands for—the prevention of disease, the promotion of health, and the prolongation of an abundant life—both within the medical school, and in the community at large. I do not need to dilate on the facts, familiar enough to us all, that the health of the young men of America is such that nearly 50 per cent of them have been found unfit to bear arms; that apart from the _ per cent or so of the population who are leading impaired lives because of cardio-vascular-renal disease, cancer, tuberculosis and syphilis, another 6 per cent is in a state of chronic or incipient invalidism from arthritic, asthmatic, bronchitic, dyspeptic ,oF neurotic disorders; or that as the average age of our community mounts, the burden of these disabilities will also mount. Such facts are compelling arguments favouring permeation of the whole medical curriculum with the preventive and social outlook. This is not the occasion for discussing the mobilization, for this purpose, of Out- Page Twenty patients Departments, and the creation or expansion of Departments of Paediatrics, Geriatrics, and Psychiatry; nor for considering how the laboratory worker, whether in anatomy, physiology, biochemistry, pharmacology, pathology or bacteriology, can best be lured from his workshop for regular visits to the wards. I am only sure that these things are not Utopian, but could and should be done; and in particular, that local circumstances may well afford a unique opportunity for making the attempt. I believe that in proportion to the success of such attempts, made here or elsewhere, the medical profession will rejoice to find itself realizing the hopes expressed in Sir George Newman's poetic definition of the purposes of preventive medicine: "To build a better tabernacle for the soul of man to inhabit." Indeed, we may then find ourselves confidently approaching the day foretold in a little book by E. M. Baker, entitled "The Doctor of the Future," in which the physician, armed with knowledge of every influence of known potency over the human body and spirit, will be able to "look upon his handiwork, like Pygmalion upon Galatea, and see, not disease and death, but the glowing lineaments of life." REFERENCES 1. 2. 3. 4. 5. 6. 7. 8. 9. Powys, J. C, "The Meaning of Culture," w". W". Norton & Co., Inc., New York, 1929. Gregg, A., "Can Excellence Be Learned?" Jour. Ass. Med. Coll., March, 1944. "Wilbur, R. L., "Report of the Council on Medical Education and Hospitals," Jour. Am. Med. Ass., 1938, 110, 1327. Gregg, A., "A Critique of Medical Research," Scientific Monthly, 1944, 53, 365. Mainland, D., "Recent Developments in Anatomy and Its Teaching," Nova Scotia Med. B_J_m 1938, 17, 268. Haggard, H. W"., "The Social Side of Medical Progress," Jour. Am. Med. Ass., 1938, 111, 2065. Emerson, H., "Medicine and Civil Government," Jour. Am. Med. Ass., 1938, 111, 2059. Final Report of the Commission on Medical Education, New York, 1932. FitzGerald, J. G., "Undergraduate Instruction in Preventive Medicine," Jour. Am. Med. Ass., 1938, 110, 1321. FROM THE STANDPOINT OF PUBLIC HEALTH Dr. Stewart Murray May I express my appreciation on being invited to participate in this, to the moment, very excellent discussion of a subject so important to us all. Medical education of the future from the standpoint of the Medical Health Officer is a phase calling for more thought than any of us may presently realize. Indeed, the overall topic of medical education for the future is one well worth our study, as one reads in journals of the widely divergent programmes as carried on in Russia, Mexico, and, undoubtedly, other less publicized countries. In America we have not as yet given very much expression or shown application of the need for revision to meet the changing times, or perhaps we have in a less spectacular fashion, than other countries. To deal specifically with the particular phase assigned to me, let us ask ourselves certain questions. Have our ideas changed regarding Public Health? Unquestionably, yes. Surgeon-General Parran of the U.S. Public Health Service states as follows: "Our social concepts are changing and with them the concept of public health. Today the science of public health extends far beyond its former circumscribed area. It necessarily must be concerned with all factors which make for healthful living—the prevention, alleviation and cure of disease by all methods known to science; the promotion of the physical, emotional and mental status of the people; the provision of decent housing, healthful working conditions, facilities for recreation, food adequate in amount and kind for proper nutrition; a standard of living compatible with normal family "life and the rearing of children. It is the specific responsibility of public health to provide, through conununity effort, those services for the saving of life, the prevention of disease and the restoration to health which the individual or family is unable to provide, or to provide Page Twenty-one as well by individual effort." If this be true, then the curriculum of medical education must be reviewed and the subject matter of the various courses, where applicable, changed to meet this broad need, because every physician, whether specifically engaged in public health practise or otherwise, is doing, or must do, work which affects the public health. Why? you ask. The state of the public health is the sum total of the health of all individuals in a given area. This fact must be impressed upon the minds of our future medicos. We must see society as a whole while treating the individual who is a unit of society. Another question we must ask ourselves, in order to have a better understanding of what is required is: "What is the composition of society?" Society is a group or collection of psychobiological individuals of varying makeups— physically, emotionally, socially and morally, living in varying types of environment and responding to stimuli in keeping with their own intellectual and personality makeup at any given time and their environment. This being the case, our future physician must examine, analyze, diagnose, and treat each individual as such, keeping in mind these different factors and that they apply in health and in disease. With these questions answered, you will realize that the health officer has a different or a broadened viewpoint from which to consider medical education of the future. Moreover, realizing that the human individual is a changing organism, we, the future physicians, must have the patient adopt our programme for him, in keeping with his age level and abilities, and always remember that the future state of health of an individual is influenced by his present state and his degree of enlightenment and awareness of this fact. In other words, may the future physician look upon the patient from a genetic or developmental aspect. If we consider the individual in this manner and train our medicos accordingly, they will guide and direct the patient's programme of living with the proper perspective, and a more wholesome national state of health will occur. Conception and pregnancy are the beginning of man, but, before looking at this phase, let us consider the premarital and preconceptional periods of marriage. The future fathers and mothers—young adults—do not receive sufficient health guidance: here is a field which while not contributing greatly to disease incidence can contribute more to positive healthful living. Too many young people enter marriage or become parents poorly equipped with health knowledge, and unhealthful conditions develop. Our future physician must be prepared to educate this particular group in physical and emotional adjustment programmes. TTiink of the many questions young adults wish answered. Provision for enlightenment of the future doctor should be made in our medical courses. While a good deal will be in the field of psychology, much concerns normal physiology and biology. Obstetrics today is taught as a subject dissociated from other topics and yet, as stated, pregnancy is the beginning. Earlier this year several articles appeared in the Journal of the American Medical Association, pointing out the influence of pregnancy upon the stillbirth and neonatal mortality rates. But pregnancy, as well as affecting the new generation, is a normal biological experience for the mother, with associated morbidities and mortalities, many xstill controllable. Certainly we have advanced, as indicated by statistics, but still toxaemias, psychoses, etc., occur too frequently. In fact, only about 50% of pregnant women enjoy the benefit of a Kahn test. As stated, pregnancy is a normal experience but, because it does place a greater strain on the expectant mother, her programme of living must be adjusted accordingly and the reasons given. Our teaching has emphasized many of the pathological states, while not outlining what is a normal state. More health education is needed here, but the future medical man must be equipped to give it. The future training must be more practical, so that he has a better understanding of pregnancy and its effect upon the mother. Similarly, he must observe and participate in more deliveries in order to have a better understanding of this process. Infancy and childhood still present a field in which the future physician must play a greater part. Progress to date has been tremendous, but while collectively we cannot produce children, collectively we can do more for them in the way of health guidance. Page Twenty-two Then should a future emergency call for men and women, our rejects from the fighting forces—physically, mentally and socially, will be considerably reduced from our present rates. Paediatrics must be broadened in the care phase as well, of course, in progress in treatment. In the care of children, the training of future doctors must be such as to permit them to understand the anatomical and physiological peculiarities of infancy and childhood. Our training has been in the past confined to observing sick children, whereas we should know the well child thoroughly as a starting point. Here one may point out that the examination of well individuals, child or adult, requires greater care than the examination of the sick, in whom our attentions are usually directed to the focal point. Let our future doctors obtain experience in school health and child health centres under supervision, in order to understand the normal. Of course the physical examination without some historical data, in either well or sick, gives an incomplete understanding. Childhood offers the best opportunity of observing the effect of environment. Thus the training should permit observation of children at home, at school, at play. The psychology pertaining must be more effectively taught so that mental hygiene becomes a widely applied policy, rather than as at present. From childhood through adulthood, at the various levels, we know more guidance can be given. How many people complain because when they appear before a doctor for a periodic health examination, they are told little and even questioned as to why they did appear. What I have said about the examination of well children applies, perhaps to a greater degree, to the periodic health examination given adults. Future students could gain experience in what appear to be normal or at least disease-free adults in examinations carried on in industrial hygiene. Here they will have an opportunity of learning how people live when seemingly well. It will give them a better understanding of the behaviour of the sick, (^estioning of candidates at Dominion Council examinations has revealed too great a lack of experience with the well. We are not analyzing the daily programmes of our clients for healthful living, but rather for the absence of disease, whereas both must be included. The narrowness and unsoundness of the regime followed by many contributes to our mentally diseased population. Need we ask ourselves if we are doing sufficient for our citizens in the upper age brackets. Geriatrics certainly must receive greater consideration in the curriculum of the future medico. By this approach, while we may be able to extend the life expectancy, it is more important that we can make the expected span, whatever it may be, a joyous one for work, play and a full life in keeping with the needs of the age level. No progress or very little has been made in reducing the causes of illness and deaths in the age groups over 35. Cardio-vascular-renal diseases and cancer still lead the causes of death. Stressing even the limited knowledge we have from the preventive aspect will, I am certain, lead us to a better understanding and more intensive study of each individual in the "well" state. As stated previously, the state of the public health is influenced by each individual. What of the arthritides, diabetes, cancer, rheumatic fever? We can better train the future doctor and meet the challenge of these than is presently carried out. The whole range of mental diseases remains perhaps our number one problem. Those due to syphilis can be eliminated. Those due to somatic disease can be reduced, as can those of toxic origin. Those of psychogenic origin can be attacked, not when they are in full bloom, but by the application of mental hygienic principles again at all age levels. But these demand a better training in psychology and psychiatry than is presently given in our medical schools. In communicable disease control the health officer looks to the general practitioner for still more effective work. More training in diagnosis is necessary and certainly a greater social consciousness in reporting these diseases must be impressed upon the future medical doctor. In the Armed Services gonorrhoea is reported five times as often as syphilis, whereas in the civilian population the ratio is 1-1 or less, generally speaking. Reporting is not for the sake of figures but for the more effective control in the Page Twenty-three follow up of contacts and the application of preventive measures. The venereal diseases can be eliminated, by the profession as a whole having an awareness of this fact, and then applying this by transmitting their knowledge to their patients and potential patients. Similarly, Tuberculosis control can be more adequately applied when all physicians, present and future, more effectively use even present knowledge. Dr. Dolman has adequately covered the place of biologicals and preventive medicine, but, briefly, a health officer does wish for the -better teaching of immunity and methods of attainment. In the communicable diseases, better histories from the viewpoint of the epidemiologist are obtainable. These can be made possible by the better teaching of epidemiology. May I dwell briefly upon the education for the use of biological products. If every future doctor graduates with the firm conviction of their value, as proven scientifically, we will not, as today, meet people whose doctor advised against them, or was indifferent to them, or did not urge their use during the most effective age level. Only in recent years have we begun to recognize the importance of Nutrition. Give the future doctor a better training in this, in order that he may more effectively guide his clientele and thus change the eating habits of the nation to a dietary contributing more to good health. Man has an environment. Do we presently recognize its importance? Yes, we have done much, but, with more knowledge and better training, we can do more. Our future physician must be aware of these environmental factors. Industrial hygiene is a comparatively new field, and appreciation of its value in improving the public health is not fully recognized. Yet its importance is great in the maintenance and promotion of health and the prevention of disease. Industry is rapidly seeing its value, and to meet the challenge, doctors of the future must receive some training in this field. I have already stressed the importance of the future doctor being expert in the examination (historical and physical) of the apparently well person. Here it is of basic importance. The home and neighborhood environment, in fact all things outside the human body, have their effect upon the individual. Give our future doctors a better knowledge and collectively the profession can exert its weight toward improvements. Housing, as an example, has been analysed as having some sixteen different factors influencing the health of the •people. Make our future doctor aware of these. In short, let us permit our doctor of the future to apply the principles of public health and preventive medicine in all phases of life—well or sick. The specific courses of public health and preventive medicine can emphasize to a greater extent their aspects brought out in each course from the basic sciences to the very refined specialties. In addition, it must teach more impressively the importance of public health procedures, so that tomorrow no well trained man con conscientiously advise raw niilk in a city in preference to that properly pasteurized. All proven public health procedures are vital to the health of the community and thereby the individual. Yet examination, as stated, of only recent graduates has failed to reveal this fact. Let us train our future doctors in the art and science, not only in the alleviation and cure of disease, but also in its prevention and the maintenance and promotion of health. By such a programme the public health will improve and the health officer will experience greater satisfaction in his task. Throughout this expression of what the medical health officer foresees in the training and education of the future physician, I have tried to point out the positive approach to healthful living and disease prevention. To achieve this, may the medical student and therefore future doctor, we trained in careful history taking, history analysing and finally, application. So frequently is the correction of faulty living overlooked, particularly in the psychic field, we must always keep in mind that it is a human being experiencing a disease and not just a case of disease. And, finally, may our teaching be such that the graduate has an open mind, searching always for improvement to humanity. It may come from the great halls of learning but, as a profession, we have learned, as a recent article in the Readers Digest, quoting Page Twenty-four from Oliver Wendell Holmes, states, "From a Jesuit how to cure agues, from a friar, how to cut for a stone, from a soldier, how to treat gout, from a sailor, how to keep off scurvy, from a postmaster, how to sound the Eustachian tube, from a dairy maid, how to prevent smallpox and from an old market woman, how to catch the 'itch insect' "—to which Dr. Wallace H. Cole adds, and from an Australian nurse, how to treat acute infantile paralysis. •••••t••••• mm YES IT DOES."—OSLER. "But I see an incredulous look on some faces and I hear the whispered comment—'tis heard often enough! 'Where is all this syphilis? It does not come my way.' Yes it does. The syphilis we see, but do not recognize, everywhere awaits diagnosis, so protean are its manifestations." Sir William Osier's warning to the Medical Society of London, like any unlearned lesson, bears repeating. POSSIBLE MISCARRIAGE OF JUSTICE! "Syphilis!"—A grim sentence to pass on to a patient—the hazards of the disease and its treatment—its repercussions on the family group—personal heartache!! Only the most convincing evidence merits a diagnosis of syphilis. Never should the diagnosis of syphilis rest on a single positive blood test! FALSE POSITIVE blood tests do occur!!! "TREAT WHEN IN DOUBT"—GONORRHOEA IN WOMEN "With the public health in mind it is far better to treat some women who are not infected, than to neglect to treat women whose infection is not obvious but who may serve as a source of infection to others. Any woman who has recently had intercourse with a man known to have gonorrhoea should herself be given treatment regardless of clinical or laboratory findings. Women who are believed or known to practice incUscriminate sexual intercourse are usually infected and had best be treated if leukor- rhcea is present. Laboratory evidence in such cases is desirable but not essential for the institution of treatment by the foregoing scheme."—"Venereal Disease Information," May, 1943. "FIND V.D. CONTACTS — REPORT V.D. CASES" NEWS AND NOTES The Victoria Medical Society held its Annual Meeting on October 11th, and elected the following officers: President: Dr. J. H. Moore; Vice-President: Dr. T. M. Jones; Honorary Secretary: Dr. G. B. B. Buffam; Honorary Treasurer:JDr. A. B. Nash. •_-__& •5^ "ST "- At the Annual Meeting of the North Shore Medical Society the following officers were elected: President: Dr. D. J. Millar; Vice-President: Dr. K. A. Peacock; Secretary-Treasurer: Dr. Christina A. Fraser. Page Twenty-five MEDICAL SERVICES ASSOCIATION M-S-A ANNUAL MEETING TUESDAY, NOVEMBER 28th, 1944 8:00 p.m. MEDICAL-DENTAL BUILDING AUDITORIUM if VANCOUVER, B. C. Dr. R. R. Laird, who has now retuned to civil practice, has taken over the practice formerly carried on by Dr. Gordon E. Wride at Hedley. Doctor Laird has the best wishes of the profession in establishing himself again in civilian life. Major Laird is well known through his service with the R.C.A.M.C. Dr. H. Roy Mustard is opening an office in the Medical-Dental Building, and as formerly will confine his practice to the Eye, Ear, Nose and Throat. Colonel Mustard has had long service in this war, and he also served during 1914-18, and in the intervening years, having been Commanding Officer of No. 12 Field Ambulance in September, 1939. Colonel Mustard was appointed Commanding Officer of No. 13 Field Ambulance when it was made an overseas unit. •£ 5fr s£ Dr. A. S. Underhill has returned to his former practice in Kelowna. Flight -Lieut. Underhill served with the Air Force in the last war and has had several years of service as a Medical Officer with the R.CA.F. during this war. * * * It is our information that Doctor Walter Bapty is resuming practice in Victoria. Colonel Bapty has had a long service in this war with the R.C.A.M.C. It is interesting to note that Doctor Bapty served in the South African war and also during the whole of 1914-18 war. Lieut.-Col. R. L. Miller is returning to civilian life. During his years of service in the office of the Command Medical Officer it is agreed by common consent that he made an outstanding contribution to the services in the Pacific Command. Lieut.-Col. D. H. Williams of Ottawa was in the West recently and visited the office. Doctor Colin W. Graham, now in practice in Victoria, was in Vancouver recently and called at the Library. «■ Dr. C. A. Armstrong of Ocean Falls called at the office when in Vancouver. # * * Dr. A. L. Jones of Revelstoke was in Vancouver recently and called at the office. Page Twenty-six Fourth Annual Report MEDICAL SERVICES ASSOCIATION DIRECTORS' REPORT To Employee, Employer and Professional Members: Your Directors submit herewith the Balance Sheet and Statement of Income and Expenditure for the twelve-month period ended August 31, 1944, together with the Auditor's Report to the Members. This is the fourth annual report and now completes nearly four years of operation and shows a healthy condition. During the twelve-month period, contributions from employee and employer members amounted to $126,850.40. From these contributions 90% has been spent in providing services or is held for that purpose. Administrative expenses for the period amounted to $11,482.59. Registration fees for the year amounted to $7,866 and enabled the M-S-A to repay with many thanks, the $2,400 advanced by the College of Physicians and Surgeons for preliniinary expenses. The balance of these non-recurring registration fees has been added to the stabilization account. The stabilization account now amounts to $24,707.05, which is not considered excessive. Members will be pleased to learn that there has been a 65% increase in enrolment over last year. The M-S-A has now taken its place in the life of the community. We feel that the excellent service given to members will bring a natural and gradual increase in enrolment. Pleasant relations have been maintained with employees, employers and doctors and we are pleased to report that we have received earnest co-operation from all parties to the Service Contract. During the year, the Board recommended the transfer of the existing hospital care contracts of this Association to the local Blue Cross Plan so that M-S-A now serves its primary purpose in providing a Physicians' and Surgeons' Service Contract. You will find reflected in the Balance Sheet, as a matter of record only, the cost of the preliminary expenses in the development of the M-S-A amounting to $11,708.20 which has been financed out of non-recurring registration fees. These expenditures were written off in prior years against surplus, the name of which has now been changed to stabilization account. We wish to thank the College of Physicians and Surgeons and its Officers for their interest and co-operation which makes possible the smooth operation of the M-S-A. We lost the valued services as Directors in October, 1944, of Mr. H. Springate, Vice- President, through changed employment, and Mr. W. J. Whitney to the armed services. They have been replaced by Mr. J. F. Deane and Mr. F. G. Crompton. The staff of the M-S-A now consists of four persons including Dr. S. Cameron MacEwen, Director of Medical Services, who is engaged part-time and whose efforts, together with other members of the staff, have givn an efficient administration. By order of the Board, H. H. GRANT, 925 West Georgia Street, • Mm President. Vancouver, B. C. November 20, 1944. Page Twenty-seven I MEDICAL SERVICES ASSOCIATION BALANCE SHEET AS AT AUGUST 31, 1944 ASSETS CURRENT ASSETS: Cash in bank .'. $30,721.08 Dominion of Canada Victory Loan Bonds—at cost (quoted market value $11,002.50) 1 ; $11,000.00 Add—Accrued interest 100.30 11,100.30 Dues receivable from members - 1,881.15 FURNITURE AND FIXTURES, less depreciation. DEFERRED CHARGE: Unexpired insurance $43,702.53 753.49 83.10 ORGANIZATION AND DEVELOPMENT EXPENDITURES RECORDED ON BOOKS AS AT AUGUST 31, 1944 AND CREDITED TO CAPITAL RESERVE —per contra 11^08.20 $56,247.32 LIABILITIES CURRENT LIABILITIES: Accounts payable T $10,964.57 DEFERRED CREDIT TO INCOME: Members' contributions unearned 3-7.50 RESERVE FOR CONTINGENCIES, including medical accounts not presented for payment 8,500.00 STABILIZATION ACCOUNT: Balance as at August 31, 1943 $ 7,053.12 Add—Registration fees received (non-recurring) $ 7,866.00 Excess of income over expenditure for the year ended August 31, 1944 (Exhibit A)__ 9,787.93 $17,653.93 24^07.05 CAPITAL RESERVE—per contra 11,708.20 $56,247.32 To the Members, Medical Services Association: We have made an examination of the books and accounts of the Medical Services Association for the year ended August 31, 1944, and have obtained all the information and explanations we have required. In connection therewith, we have examined or tested the accounting records of the Association and other supporting evidence, but the scope of our examination of the detailed transactions was confined to a test thereof. W*e report that, based upon such examination, the above balance sheet is, in oar opinion, properly drawn up so as to exhibit a true and correct view of the state of the Association's affairs as at August 31, 1944, according to the best of our information and the explanations given to us and as shown by the books of the Association. PRICE, WATERHOUSE & CO. Chartered Accountants. Vancouver, B. C, November 1, 1944. Page Twenty-eight MEDICAL SERVICES ASSOCIATION EXHIBIT "A" STATEMENT OF INCOME AND EXPENDITURE FOR THE YEAR ENDED AUGUST 31, 1944 INCOME: Members' contributions $126,850.40 DEDUCT: Medical care accounts paid $100,462.55 Add— Provision for medical care accounts not presented for payment . 5,117.33 $105,579.8 8 Administrative and other expenses: , Salaries $ 6,179.35 Printing, stationery and supplies ■ 1,212.90 Postage , • 320.00 Telephone and telegraph 148.3 5 Travelling 867.40 Insurance 44.17 Legal and audit fees 575.00 Rent ! 594.00 Depreciation !—, 97.28 Interest and bank charges—net {credit) 49.68 Equipment rent and service charges 1,379.59 Miscellaneous i 114.23 11,482.59 117,062.47 Excess of income over expenditure for the year, carried to stabilization account (balance sheet) $ 9,787.93 BOARD OF DIRECTORS H. H. Grant Powell River Company Limited M. W. Thomas, M.D. College of Physicians and Surgeons of British Columbia F. G. Crompton H. R. MacMillan Export Company Limited J. F. Deane The Consolidated Mining and Smelting Company of Canada Limited OFFICERS President A. L. McLellan Secretary-Treasurer Dorothy Myers Assistant Secretary H. H. Grant M. W. Thomas, M.D- _-Vice-President S. Cameron MacEwen, M.D Director of Medical Services ASSISTANT DIRECTORS OF MEDICAL SERVICES F. M. Auld, MX)- | Nelson, B.C. J. S. Daly, M.D Trail, B.C. R. W\ Garner, M.D Port Alberni, B.C. A. B. Haix, M.D Nanaimo, B.C. C H. HANKmsoN, M.D—Prince Rupert, B.C. Gordon James, M.D Britannia Beach, B.C. W. J. Knox, M.D Kelowna, B.C. E. J. Lyon, M.D Prince George, B.C. Thomas McPherson, M.D- . Victoria, B.C. T. J. Sullivan, M.D Cranbrook, B.C. Medical Seryices Association is a service organization operating a non-profit Medical Service Plan by and for its members—employers, employees and doctors, and underwritten by the doctors of British Columbia. Page Twenty-nine MEMBERS A-l STEEL & IRON FOUNDRY, LTD. - ALBERNI PACIFIC LUMBER CO. LTD., Camp No. 1 and Sawmill - ALBERNI PLYWOODS LTD. - ALLARD MACHINE WORKS LTD. ARROW TRANSFER CO. LTD. - BLOEDEL, STEWART & WELCH LTD.—Port Alberni Sawmill; Franklin River; Camp 8, Great Central; Camp 10, Sproat Lake; Great Central Sawmill - BRITISH ROPES CANADIAN FACTORY LTD. - BURRARD RIVET & FORGINGS LTD. CAMPBELL & GRILL LTD. - CANADIAN FOREST PRODUCTS LTD.—Harrison Mills, Logging Division, and Pacific Veneer and Plywood Division - CANADIAN PACIFIC AIR LINES LTD.—Certain Departments - CANADIAN TRANSPORT CO. LTD. - CANADIAN WHITE PINE CO. LTD. - CLARKE BROS. TIMBER CO. LTD. - COAST MILLS EXPORT CO. LTD. - COATES LTD. - CONSOLIDATED MINING AND SMELTING COMPANY OF CANADA LIMITED (THE)—Vancouver - G. H. COTTRELL LTD. - CROSSMAN MACHINERY CO. LTD. - DOMINION BRIDGE CO. LTD.—Burnaby Bridge Plant - DOMINION RUSTPROOFING CO. LTD. - ELECTRIC POWER EQUIPMENT LTD. - ELECTRO-WELD METAL PRODUCTS LTD. - FERGUSON TRUCK & EQUIPMENT CO. LTD. - FINNING TRACTOR & EQUIPMENT CO. LTD. - GALBRAITH & SULLEY LTD. - GRAHAM ELECTRIC CO. LTD. - HAYES MANUFACTURING CO. LTD. - HEAPS ENGINEERING (1940) LTD. - KELLEY LOGGING CO. LTD. - M. B. KING LUMBER CO. (NORTH SHORE) LTD. - KOOTENAY ENGINEERING CO. LTD. - I. F. LAUCKS, LTD. - LAWRENCE MANUFACTURING CO. LTD. - LETSON & BURPEE LTD. - LIONS GATE LUMBER CO. LTD. - LONGLEY ELECTRIC CO. LTD. McKAY & FLANAGAN BROS. LUMBER MILL LTD. - H. R. MacMILLAN EXPORT CO. LTD. - MacMILLAN INDUSTRIES LTD.—Plywood Division - McNAIR BEVEL SIDING LTD. - MERCHANTS CARTAGE CO. LTD. - MOHAWK HANDLE CO. LTD. - MOHAWK LUMBER CO. LTD. - MORRISON STEEL & WIRE CO. LTD. - NORTHWEST BAY LOGGING CO. LTD. - O'BRIEN LOGGING CO. LTD. - PACIFIC COAST SPRUCE (CANADA) LTD. - PACIFIC COAST TERMINALS LTD. - PACIFIC PEAT PRODUCTS LTD. - PACIFIC PINE CO. LTD. - PATTERSON BOILER WORKS LTD. RAT PORTAGE WOOD & COAL YARDS LTD. - SHAWNIGAN LAKE LUMBER CO. LTD.- - SHELL OIL CO. OF B. C. LTD. - SMITH, DAVIDSON & WRIGHT, LTD. - STANDARD OIL CO. OF B. C. LTD. - STEELWELD LTD. - STEWART SHEET METAL WORKS, LTD. - STOREY & CAMPBELL LTD. - TIMBERLAND LUMBER CO. LTD. - TYEE MACHINERY CO. LTD. - VALLEY LUMBER YARDS LTD. - VANCOUVER BREWERIES LTD. - VANCOUVER ENGINEERING WORKS LTD. - WESTERN CHEMICAL INDUSTRIES LTD. - WESTMINSTER CANNERS LTD. - WESTMINSTER HOG FUELS LTD. - YOUNG & GORE TUGBOAT CO. LTD. ASH TEMPLE CO. LTD. - ASSOCIATED DAIRIES LTD.—Office - HENRY BIRKS & SONS (B. C.) LTD. - CANADIAN GENERAL ELECTRIC CO. LTD. - FLECK BROS. LTD. - FRASEA FARMS LIMITED - FRASER VALLEY MILK PRODUCERS' ASSN.— Office - GEORGIA PHARMACY LTD. - INTERNATIONAL BUSINESS MACHINES CO. LTD. - FRED. C. MYERS LTD. - POWELL RIVER CO. LTD.—Vancouver Office - SEABOARD LUMBER SALES CO. LTD. - GEORGE STRAITH LTD. - TURNER'S DAIRY LTD. - VANCOUVER TOBACCO CO. LTD. - VICTOR X-RAY CORPORATION OF CANADA LTD. • BLANE, FULLERTON & WHITE LTD. - CANADA LIFE ASSURANCE CO. (THE) - CONFEDERATION LIFE ASSOCIATION - DALE AND COMPANY LTD. * - GENERAL ACCIDENT ASSURANCE CO. OF CANADA - JOHNSTON & CO. LTD. - A. E. JUKES & CO. LTD. - MANUFACTURERS LIFE INSURANCE CO. (THE) - MARSH & McLENNAN LTD. - MONTREAL LIFE INSURANCE CO. - . J. T. O'BRYAN LIMITED RETAIL CREDIT CO. - H. A. ROBERTS LTD. - SUN LIFE ASSURANCE CO. OF CANADA - THE TRAVELERS INSURANCE CO. - WESTERN CITY COMPANY LTD. (THE) - YORKSHIRE & PACIFIC SECURITIES LTD. AGRICULTURE, FOOD & DRUG DIVISION EMPLOYEES - CAMPBELL & SMITH LTD. CANADIAN ASSOCIATION OF SOCIAL WORKERS—B. C. Mainland Branch - COLUMBIAN CO. LTD. (THE) - COWICHAN DISTRICT TEACHERS' ASSN. - CREHAN, MEREDITH & CO. - CRESTON VALLEY UNITED SCHOOL DISTRICT - DOMINION INCOME TAX EMPLOYEES - MacKENZIE & SON LTD. - METROPOLITAN HEALTH COMMITTEE - NEWS-HERALD LTD. - NORTH VANCOUVER GENERAL HOSPITAL PIONEER ENVELOPES LTD. - PORT COQUITLAM SCHOOL BOARD - ROBERTSON, DOUGLAS & SYMES - ROY WRIGLEY PRINTING & PUBLISHING CO. LTD. - VANCOUVER BOARD OF TRADE - VICTORIA CITY HALL EMPLOYEES - WESTERN SALES BOOK CO. LTD. - YOUNG WOMEN'S CHRISTIAN ASSOCIATION—Vancouver. Page Thirty NOTICE The following numbers of British periodicals are urgently required by the Provincial Board of Health, Victoria, to complete their files: British Medical Journal, March 15 th, 1941. Lancet, March 15th, 1941. Lancet, June 27th, 1942. Anyone possessing these numbers, which are now out of print, is asked to communicate with the Librarian, Vancouver Medical Association Library, or with Dr. G. F. Amyot, Provincial Health Officer, Parliament Buildings, Victoria. LIBRARY NOTES RECENT ACCESSIONS TO THE LIBRARY— Medical Clinics of North America, Symposium on specific methods of treatment, Boston Number, September, 1944. Psychology of Women, A Psychoanalytical Interpretation, 1944, by Helen Deutsch. An Atlas of Anatomy, 1943, by J. C. Boileau Grant. Diseases of the Nervous System, 3rd ed., 1944, by F. M. R. Walshe. Surgical Clinics of North America, Symposium on Cancer, Barnard Free Skin and Hospital Number, October, 1944. Ventures in Science of a Country Surgeon, 1944, by Arthur E. Hertzler (Gift of Author). * A MESSAGE FROM THE LIBRARY For the past twenty-one years the Bulletin, which observes its twenty-first anniversary with the current issue, has served as a medium between the Library and the members of the Association. New accessions have been listed regularly, book reviews published, and "missing" books advertised from time to time under Library Notes. The Library has grown considerably during this period, and it is hoped that its usefulness may increase with each passing year. The.Library Committee has endeavoured to keep abreast of current developments and requirements, and during the war years numerous books and journals on War Medicine have been added, as well as an adequate collection on Industrial Medicine. At present the Conunittee is giving particular attention to psychosomatic and psychiatric publications, as they feel that this section should be expanded. They hope, too, that the Library may have the privilege of giving a fuller service to those returned men and others engaged in post-graduate studies at this centre. To enable us to give this increased service more books than usual should now be added, with perhaps some duplicate copies. Further expansion of the Library is required also because of its increasing out-of-town associate membership and the requirements of members of the Services stationed about Vancouver. This may mean that our appropriation will be somewhat exceeded this year, but we want the Library to be used more, rather than less. The Library lost a valued friend last year in the death of Dr. F. J. Nicholson. As a result of his generosity in founding the Nicholson Fund, an interesting special collection, which included books by and about doctors and history of medicine, was accumulated. It is the hope of the Library Committee that some member of the Asspciation may express a desire to carry on this or some similar contribution to medical education. Page Thirty-one • Diodrast is a highly radiopaque substance. Moreover, it is so constituted that in most instances excretion proceeds in. sufficient concentration to produce quickly dense shadows of the upper urinary tract. This is accomplished with relatively low dosage—only from 20 cc. to 30 cc. of 35 per cent solution. . .. Diodrast has been safely employed in hundreds of thousands of adults as well as in infants and children. However, as with all radiopaque media, a preliminary sensitivity test is advisable. Diodrast sterile solution (35 per cent by weight/volume) is supplied in ampuls of 10 cc, 20 cc. and 30 cc. (boxes of 1, 10 and 25), and in vials of 30 cc. with diaphragm stopper (boxes of 1, 10 and 25). Write for copy of booklet, "Excretion Urography and Retrogtade Pyelography." This contains a comprehensive discussion of the underlying principles, indications, contraindications, 'etc., of excretion urography. D \WltRKA^ I 0 D R A S T jiPffi^gj Reg. U. S. Pat. Off. & Canada Brand of IOPYRACYL {3.5--iiodo-4-pyridone-N-acetic acid diethanoia—line) IWIMTHROPS Pharmaceuticals »/ merit far the -physician WINTHROP CHEMICAL COMPANY, JNC. General Office*: WIND $ 0§g§Mg||| Qsetot PtifctsieMi Stnkt 0fii_: OmMm $?b_* IMf* IMstrof, Qt- wm $$mmm HHH11111HKSI ___- SHOULD VITAMIN D BE GIVEN ONLY TO INFANTS? ITAMIN D has been so successful in preventing* rickets during infancy that there has been little emphasis on continuing its use after the second year. But now a careful histologic study has been made which reveals a startlingly high incidence of rickets in children 2 to 14 years old. Follis, Jackson, Eliot, and Park* report that postmortem examination of 230 children of this age group showed the total prevalence of rickets to be 46.5 %. Rachitic changes were present as late as the fourteenth year, and the incidence was higher among children dying from acute disease than in those dying of chronic disease. The authors conclude, "We doubt if slight degrees of rickets, such as we found in many of our children, interfere with health and development, but our studies as a whole afford reason to prolong administration of vitamin D to the age limit of our study, the fourteenth year, and especially indicate the necessity to suspect and to take the necessary measures to guard against rickets in sick children." *R. H. Follis, D. Jackson, M. M. Eliot, and E. A. Park: Prevalence of rickets in children between two and fourteen years of age. Am. J. Dis. Child. 66:1-11, July 1943. i MEAD'S Oleum Percomorphum 50% With Viosterol is a potent source of vitamins A and D, which is well taken by older children because it can be given in small dosage or capsule form. This ease of administration favors continued year-round use, including periods of illness. MEAD'S Oleum Percomorphum 50% With Viosterol furnishes 60,000 vitamin A units and 8,500 vitamin D units per gram. Supplied in 10- and 50-cc. bottles and boxes of 48 and 192 capsules. Ethically marketed. MEAD JOHNSON & CO. OF CANADA, Ltd., Belleville, Ont. THERE A DIFFEREN ectoAntoen COLD VACCINES IMUVAC IMUVAC offers not merely the immunizing properties of whole killed bacteria ... the usual endo-anfigens . . . but, in addition, the water- soluble, surface ecto-antigens. Utilization of the ecto-antigens, by a distinctive process developed by Parke-Davis, yields a product of greater antigenic potency without proportionate rise in protein content . . . therefore, without appreciable increase in tendency to produce reactions. for Prophylaxis: Imuvac, Oral, enteric-coated tablets, small enough fo swallow easily. Available in bottles of 20, 100, and 500. For Therapy: Imuvac, Parenteral, for subcutaneous or intramuscular injection. Available in 10-c.c. vials. *TRAC--MARK REGj BUY WAR BONDS AND SAVINGS STAMPS PARKE, DAVIS & COMPANY WALKERVILLE, ONTARIO r N! ... IF IT'S AN BABY!" "My Doctor's Made a New Man Outta BOTH of Us!" "All that endless figuring and re-figuring of milk, carbohydrates, water for feeding formulas was getting my doctor down. 'Specially with all he has to do these days. No wonder he looked into S.M.A." "Better yet, my doctor knows that in S.M.A. he's prescribing an infant food that closely resembles breast milk _n digestibility and nutritional completeness!" "Happy am I—and so is Mummy! 'Cause S.M.A. made a new man outta me. And And Doctor? His new disposition matches mine. Believe you me, EVERYBOY'S happy if it's an S.M.A. baby." S.M.A. is derived from tuberculin-tested cows' milk, the fat of which is replaced by animal and vegetable fats, including biologically tested cod liver oil, with milk sugar and potassium chloride added, altogether forming an antirachitic food. When diluted according to directions, S.M.A. is essentially similar to human milk in percentages of vrotein, fat, carbohydrate, ash, in chemical contents of fat and physical properties. JOHN mm & BROTHER «_uii) LIMITED S.M.A. BIOLOGICAL DIVISION WALKERVILLE ONTARIO f Breaks the vicious circle of perverted menstrual function in cases of amenorrhea, tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic relief by stimulating the innervation of the uterus and stabilizing the tone of its musculature. Controls the utero-ovarian k circulation and thereby encourages a _ *L normal menstrual cycle. !___• MARTIN H. SMITH COMPANY ,ji ——^ ISO lAFAYtm STMET. NIW TOUK, N. T. Full formula and descriptive literature on request Dosage: l to 2 capsules 3 or 4 times dally. Supplied in packages of 20. Ethical protective mark MHS embossed on inside of each capsule, visible only when capsule is cut in half at seam. m m^m ___™s8s-si 13 th Ave. and Heather St. Exclusive Ambulance Service FAirmont 0080 PRIVATE AMBULANCES AND INVALID COACHES WE SPECIALIZE IN AMBULANCE SERVICE ONLY J. H. CTRBLIilN W. L. BERTRAND +reama<un/ promptly reduces acidity within the stomach. The antacid effect is persistent. There is no local compensatory reaction, such as commonly occurs with alkalies, and hence no belated oversecretion of hydrochloric acid. Moreover, there is no risk of producing alkalosis. (@rea<ma&n/ promptly relieves pain and heartburn associated with gastric hyperacidity. (gfre&ma&nf. often induces healing of peptic ulcer when employed with an ulcer regimen. aareeawe'</&/arte convenient & cwrrv' ami fa Jane dpcientjn/ aefien mm CIR E AM All N D II C P.I CWf NTHRQP §|£!Slg32S^ra»^3K« U.S. Pat. Off. Brand of ALUMINUM HYDROXIDE GEL TABLETS WINTHROP CHEMICAL COMPANY Pbamaceuticals of merit for the physician GENERAL OFFICES: WINDSOR, ONTARIO Quebec Professional Service Office: Dominion Square Building, Montreal, Quebec Found Beneficial in ingina... Angina pectoris patients can be greatly benefited by the administration of PERANDREN It has been shown that the frequency, duration and severity of anginal attacks are diminished; that patients can markedly increase their physical activity without precipitating attacks and that beneficial effects persist for many months after treatment is discontinued. Write for literature. PERANDREN Trade Mark Reg'd C MB A " Gr HIIKTRl MONTREAL, CANADA .l-ount Peasant ^Undertaking Co. %Xo. KINGSWAY at 11th AVE. Telephone FAirmont 0058 VANCOUVER, B. C. R. F. HARRISON W. E. REYNOLDS w They can take it Cold and blustery weather holds no terror for those whose resistance is high. "AJphamettes" are an excellent means of building adequate reserves of vitenains A and D against the rigours of winter. Each soft gelatin capsule contains at least 5,000 International Units of vitamin A and 1,750 International Units of vitamin D. __ (JyeMt ALPHAMETTES 99 STANDARDIZED CONCENTRATED COD LIVER OIL (Fortified with Irradiated Ergosterol) 226 BOXES OF 25, 50, 100 AND 500 CAPSULES AYERST, McKENNA & HARRISON LIMITED, Biological and Pharmaceutical Chemists, Montreal, Canada. JLW. oon an ci ^Jlded The rise and fall of the tides is controlled by the moon, thus nature, in mysterious ways provides effective control of seasons, growth and other wonders of life. Research has added immeasurably to the knowledge of man, enabling medical science to furnish effective control undreamed of a little over a decade ago. Ortho products are the result of clinical research and laboratory control that assures physicians of products that offer the maximum of effectiveness, tolerability and stability. Available throughout the Empire DUCTS OF CANADA LIMITED - TORONTO ARTHRITIS and ECZEMA of endogenous origin claimed to be allergic, may be favored or induced by calcium and sulphur deficiency, impaired cell action, and imperfect elimination of toxie waste. LYXANTHINE ASTIER administered per os, brings about improved cell nutrition and activity, increased elimination, resulting symptom relief, and general functional improvement. Write for Information L-17 Canadian Distributors R0UGIER FRERES 350 Le Moyne Street, Montreal Colonic and Physiotherapy Centre Up-to-date Scientific Treatments COLONIC IRRIGATIONS, SHORTWAVE DIATHERMY, SIN NEW AVE GALVIN- ISM, IONIZATION, ULTRA VIOLET RAY, STEAM BATHS AND SHOWERS Medical and Swedish Massage Physical Culture Exercises STAFF OF GRADUATE NURSES Superintendent: E. M. LEONARD, R.N. Post Graduate Mayo Bros. 1119 Vancouver Block MArine 3723 Vancouver, B.C. Interesting Facts about laxation and bulk ' I 'WO important facts about all-bran are of much interest. (1) The comparative effectiveness of all-bran's eel lulosic bulk, against that of other bulk-forming foods. (2) The action of all-bran's bulk in the colon compared to other laxatives operating on various bulk principles. COMPARISON WITH BULK EFFECT OF OTHER FOODS. In a University test among chemistry students — on controlled diets containing theoretically equallized amounts of crude fibre — all-bran proved more effective in bulk-forming properties and satisfactory laxative action than most fruits and vegetables. COMPARISON WITH OTHER BULK LAXATTVES.lt is generally known all-bran does not get laxative action by great distension in the colon. It works by preparing wastes, rather than propelling them. For all-bran is one of nature's most effective sources of cellulosic elements which help friendly flora to fluff up and soften colonic wastes for easy, natural elimination. Many doctors, therefore, find it advisable to suggest kellogg's all-bran in cases of constipation due to lack of bulk in the diet. I Fall reports of experiments are available to doctors i and others interested. Please send request to: I KELLOGG CO. OF CANADA LTD., LONDON, ONT, J EniifiiiziiiiiiiiiiiiiriiiiTirriiifiiiririiiiiiiiiiiiiiiiiiiiiifriiiiffiiiiifiiiiiifJiiiiiiTi-iiiiiiii rm jiiiiii riiinriii iriiifririiiiiiiiriJiiifrjiiiiiriiiriiiiirriiiiiiiiriiiirriKiffiifiiiiiiiiijiriffiuiiiiifif "Without loss of protein quality » "Tests on rats have shown that milk with high-quality protein could be ... evaporated, irradiated, canned, and sterilized without loss of protein quality as measured by digestibility or biological value... Concurrent tests on evaporated milk produced at a given plant two weeks, three months, or fourteen months before completion of the test showed no serious loss of digestibility or biological value of milk protein."—Wbitnah, C. H.: Food Research, 1943, Vol. 8, No. 2. convincing evidence that the nutritive value of the protein of raw milk is unimpaired by evaporation, irradiation, and sterili- zation is furnished by the study quoted above. Even storage for considerable periods of time was found to have no significant effect. Frequent examinations and reexaminations of the properties CARNATION COMPANY, IRRADIATED Carnation of irradiated evaporated milk have revealed no shortcomings to detract from its wide usefulness in infant feeding and in special diets for invalids and others. In Irradiated Carnation Milk, the recognized virtues of this form of milk are realized in a product of high quality and controlled uniformity. LIMITED, TORONTO, ONT. 'FROM CONTENTED COWS" yOmRADIATEO latonatUfl \t* Fr»m G»tU*t*4 6** MILK' Milk A Canadian Product t c I KEEPING PACE ... As many of the erstwhile restricted medicinals are becoming more procurable, Georgia Pharmacy is placing them again at your disposal. Trade connections of over 35 years standing is a great help in times like these! Phone MArine 4161 ,jC§4UJL ^.JattooieA&on, GEORGIA PHARMACY LIMITED •IOKMA ammmr w. (Emitter ^IjanttalGti- ESTABLISHED 1893 VANCOUVER, B. C. North Vancouver, B. C. Powell River, B. C. if ^ou $unil (Eo. iCtmilrii * it- New Westminster, B. C. For the treatment of NEUROPSYCHIATRIC DISORDERS Reference—B. C. Medical Association For information apply to Medical Superintendent, New Westminster, B. C. New Westminster 288 or 721 Medical-Dental Building, Vancouver, B. C. Pacific 7823 PAciFic 8036 27
Periodicals
W1 .VA625
English
Vancouver : University of British Columbia Library
Vancouver, B.C. : McBeath Spedding Limited
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Original Format: University of British Columbia. Library. Woodward Library Memorial Room. W1 .VA625
Medicine--Periodicals
The Vancouver Medical Association Bulletin: October, 1944
Text