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History of Nursing in Pacific Canada
Vancouver Medical Association
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SHHlli of the I VANCOUVER MEDICAL ASSOCIATION Vol. XIX MARCH, 1943 No. 6 With Which Is Incorporated Transactions of the Victoria Medical Society the Vancouver General Hospital and StiPaurs Hospital In This Issuer NEWS AND NOTES J|- _^....-^__...^p.. INCOME TAX REGULATIONS ^ WHITHER?—Dr. B. j|' Harriso^:-—^--^^^ -,- DIETETICS—THE SOYA BEAN^-,-j^fe^^^^fe HYPERINSUUNISM—Dr. J. C. Thoma^ .. ^--JS FACTS AND FIGURES (Vancouver General Hospital) SUMMER SCHOOL The Annual Summer School of the Vancouver Medical Association will be held at the HOTEL VANCOliTER, JUNE §2nd to 26th, Inclusive DEHYDROCHOLIN The natural cholagogue The only really effective stimulants of bile secretion are the bile salts, the most active and least toxic of which, is available as Dehydrocholin B.D.H. The use of Dehydrocholin B.D.H., therefore, should be borne in mind for non-surgical biliary drainage in catarrhal cholecystitis, chronic cholecystitis, cholangitis, biliary engorgement, hepatitis, hepatosis, hepatic insufficiency and portal cirrhosis. Subsidiary, though equally valuable, effects of Dehydrocholin B.D. H. administration are the relief of intestinal dysfunction and of atonic constipation due to biliary hyposecretion, also the stimulation of pancreatic function; further, it produces diuresis, also it possesses the power to reduce the toxic reactions to arsphenamine and to gold salts. 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/433 THE VANCOUVER MEDICAL ASSOCIATION BULLETI; Published Monthly under the Auspices of the Vancouver Medical Assoc in the interests of the Medical Profession. Offices: 203 Medical- Dental Building, Georgia Street, Vancouver, B. C. EDITORIAL BOARD: Dr. J. H. MacDermot Dr. G. A. Davidson Dr. D. E. H. Cleveland All communications to be addressed to the Editor at the above address. Vol. XIX. MARCH, 1943 No. 6 OFFICERS, 1942-1943 Dr. J. R. Neilson Dr. H. H. Pitts Dr. C. McDiarmid President Vice-President Past President Dr. Gordon Burke Dr. A. E. Trites Hon. Treasurer Hon. Secretary Additional Members of Executive: Dr. Wilfrid Graham, Dr. J. A. McLean TRUSTEES Dr. F. Brodie Dr. J. A. Gillespie Dr. W. T. Lookhart Auditors: Messrs. Plommer, Whiting & Co. SECTIONS Clinical Section Dr. D. A. Steele Chairman Dr. J. W. Millar —Secretary Eye, Ear, Nose and Throat Dr. A. R. Anthony Chairman Dr. C. E. Davies Secretary Pwdiatric Section Dr. J. H. B. Grant Chairman Dr. John Piters Secretary STANDING COMMITTEES Library: Dr. F. J. Buller, Dr. D. E. H. Cleveland, Dr. J. R. Davies, Dr. A. Bagnall, Dr. A. B. Manson, Dr. B. J. Harrison Publications: Dr. J. H. MacDermot, Dr. D. E. H. Cleveland, Dr. G. A. Davidson. Summer School: Dr. J. E. Harrison, Dr. G. A. Davidson, Dr. R. A. Gilchrist Dr. Howard Spohn, Dr. W. L. Graham, Dr. J. C. Thomas Credentials: Dr. A. W. Hunter, Dr. W. L. Pedlow, Dr. A. T. Henry V. O. N. Advisory Board: Dr. L. W. McNutt, Dr. G. E. Seldon, Dr. Isabel Day. Metropolitan Health Board Advisory Committee: Dr. W. D. Patton, Dr. W. D. Kennedy, Dr. G. A. Lamont. Greater Vancouver Health League Representatives: Dr. R. A. Wilson, Dr. Wallace Coburn. Representative to B. C. Medical Association: Dr. C. McDiarmid. Sickness and Benevolent Fund: The President—The Trustees. S EVEN MORE IMPORTANT TO PRESCRIBE PARGRAN-V W PARGRAN-M (Squibb Multivitamin Pedes) (Squibb Calcium-Iron Capsules) rfi . fcw»Ci ii* SHADED AREAS SHOW PROPORTIONS SUPPLIED BY PARGRAN VITAMIN VITAMIN NICOTINIC VITAMIN ■l *3 AOD C [THIAMINE |ilSO- IASCOIMC KTMO- FLAVIN) *CIW CHIOUDE) CALCIUM IRON =V= 2 tAtGftAN • V ranis t PARGKAN-M Until recently the chances were three to one against the American family getting enough of the foods needed for optimum efficiency and stamina. Now, with many foods rationed and hard to obtain, the odds are even greater. The need for a balanced vitamin-mineral supplement for use where food sources are inadequate becomes increasingly apparent. Pargran-V and Pargran-M save time for the busy physician. Based on the new trend in multivitamin and mineral therapy, these two products, as shown on the chart— • supply in proper balance the vitamins and minerals most generally lacking in the diet; • embody the recommendations of the Food and Nutrition Board of the National Research Council; • afford flexibility of dosage—supplying vitamins or minerals or both—in J£, J^, % or the full recommended daily allowance; • provide the advantages of convenience and economy. Write now for complete information about Pargran-V and Pargran-M and for the new authoritative booklet, "Practical Nutrition." Address 36 Caledonia Rd., Toronto, Ont. MANUFACTURING CHEMISTS TO THE MEDICAL PROFESSION SINCE 1858 VANCOUVER HEALTH DEPARTMENT STATISTICS—JANUARY, 1943 Total population—estimated j 271,597 Japanese population Evacuated Chinese population—estimated ~Z 8,767 Hindu population—estimated 367 Rate per 1,000 Number Population Total deaths ; 350 14.3 Japanese deaths —. —. Population evacuated Chinese deaths : 15 31.9 Deaths—residents only : 1 314 12.8 BIRTH REGISTRATIONS: Male, 302; Female, 283 585 23.9 INFANTILE MORTALITY: Jan., 1943 Jan., 1942 Death rate under one year of age 18 18 Death rate—per 1,000 births 30.8 36.7 Stillbirths (not included in above) 34 14 CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY January, 1943 Cases Deaths Feb. 1-15,1943 Cases Deaths December, 1942 Cases Deaths Scarlet Fever 47 0 64 0 24 0 Diphtheria 0 0 0 0 0 0 Diphtheria Carrier 0 0 0 0 0 0 Chicken Pox 45 0 66 0 70 0 Measles 12 0 11 0 48 0 Rubella 0 0 10 3 0 Mumps 173 0 257 0 132 0 Whooping Cough 6 0 31 0 16 0 Typhoid Fever 0 0 0 0 0 0 Undulant Fever 0 0 0 0 0 0 Poliomyelitis 0 0 0 0 0 0 Tuberculosis 36 17 47 12 15 Erysipelas - 7 0 10 0 0 Meningococcus Meningitis 5 0 3 1 7 0 V D CASES REPORTED TO PROVINCIAL BOARD OF HEALTH DIVISION OF VENEREAL DISEASE CONTROL West North Vane. Hospitals & Burnaby Vane. Richmond Vane. Clinic Private Drs. Totals Syphilis j Figures for January not yet available. Gonorrhoea ) Phone MArine 5411 Res.: MArine 2988 jBeafojce QallofL CANADIAN PHYSIOTHERAPY ASSOCIATION GRADUATE McGILL UNIVERSITY SCHOOL OF MASSAGE AND REMEDIAL GYMNASTICS 417 Vancouver Block Electricity, including Short Wave House Visits Vancouver, B. C. Page 150 ADRENAL CORTICAL EXTRACT FOR THE TREATMENT OF ADDISON'S DISEASE Clinical evidence has established that ADRENAL CORTICAL EXTRACT as supplied by the Connaught Laboratories will provide complete replacement therapy for deficiencies of the adrenal cortex. POTENCY Biological assay of each lot assures a potency of 30 dog-units per cc. PURITY Recent researches in these Laboratories in the method of preparation have made possible a solution of much greater purity. SAFETY Careful tests on each lot ensure its safety for either intravenous or intramuscular injection. ADRENAL CORTICAL EXTRACT Connaught Laboratories as a sterile multiple dose containers. is supplied by the solution in 25 cc. CONNAUGHT LABORATORIES UNIVERSITY OF TORONTO Toronto, Canada DEPOT FOR BRITISH COLUMBIA MACDONALD'S PRESCRIPTIONS LIMITED MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. VANCOUVER MEDICAL ASSOCIATION FOUNDED 1898 :: INCORPORATED 1906 Programme of the Forty-fifth Annual Session (Spring Session) 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 are to be amalgamated with the clinical staff meetings of thf 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. 1943 April 6—GENERAL MEETING. Dr. C. W. Prowd and Dr. C. G. Campbell, Dept. of Radiology, St. Paul's Hospital: "Gastric Mucosal Patterns." (Illustrated by slides.) April 13—COMBINED CLINICAL MEETING at ST. PAUL'S HOSPITAL. May 4—ANNUAL MEETING. •| SUMMER SCHOOL June 22nd to 25 th, incl. The Summer School Committee is happy to announce that the following well-known medical men will be among those participating in the School Session in June: Dr. Foster Kennedy, Professor of Clinical Neurology, Cornell University Medical College, New York, N.Y. Dr. Edwin M. Robertson, Department of Obstetrics and Gynaecology, Faculty of Medicine, Queen's University, Kingston, Ont. Dr. Max M. Cantor, Asst. Professor of Biochemistry, University of Alberta, Edmonton, Alta. MArine 6735 C.S.M.M.G. 805, 718 Granville Street C.P.A. Mite Ada £. McrtJzAam wishes to inform the Medical Profession that she has resumed her Physio-Therapy practice at 805 Birks Building. Short Wave Remedial Exercises Massage HIGH BLOOD PRESSURE BETTER RESULTS OBTAINED WITH B I O G L A N I Another Product of the Bioglan Laboratories, Hertford, England Phone MA. 4027 Stanley N. Bayne, Representative 1432 MEDICAL-DENTAL BUILDING Descriptive Literature on Request THE SCIENTIFIC HORMONE TREATMENT Vancouver, B. C. Page 151 John Wyeth & Brother (Canada) Ltd. WALKERVILLE, ONT. EDITOR'S PAGE The announcement recently made of the Marsh Plan for Social Security, by the Canadian Government, is of intense interest to everyone in Canada. The part dealing with Health Insurance is, of course, of especial interest to us as medical men. It is too early yet, in the absence of fuller detail, to come to any definite conclusions in the matter, but in certain regards, the scheme, as already set out, contains many features entirely new and even revolutionary. The establishment of a basic medical service for everyone, regardless of financial status, or ability to pay, is one of the proposals made. There will be many who will eye this proposal with some doubt—many who will disagree with it altogether. It all depends, of course, on what is meant by "medical service." If it means a real and adequate system of medical care, maintaining the standards we have so often defined and including preventive medicine, with its capacity to prevent and limit disease, we confess to a feeling that such a plan might be an excellent thing: though we see the possibility of utter chaos if the plan is imposed too suddenly, without due prevision, and provision of adequate hospital facilities, etc. If, on the other hand, it means the sort of tripe that is at present being handed out to cases on relief, old-age pensioners, etc., we shall be very much worse off than before, both the "beneficiaries" of the scheme, and the medical men who have to work under it. Speaking for ourselves, we can see in this suggested scheme (the Marsh plan) a possibility of tremendous social good. We feel that health insurance has at last been considered as what it should be, a scheme for lessening disease as well as treating it. We feel that if certain safeguards can be provided, certain safety-valves, and certain guarantees, these proposals may and should win from us, not only our acquiescence, but our active and even enthusiastic support. But these things are necessary. First, safeguards in the provision of adequate hospital and laboratory facilities. We need not labour this point. If health insurance were put into effect tomorrow, without such a safeguard, every hospital superintendent, in the country would want to commit suicide, or resign. Safety-valves. There must be some provision for private practice, specialties, etc., for those who want them—both patients and doctors. Guarantees. We must have guaranteed standards of medical practice, where we shall be able to treat our patients on modern and scientific lines, without the ridiculous limitations of cost, etc., now imposed on us in the treatment, for instance, of the relief patient. All these things, no doubt, will be duly considered. Meantime, we feel that one of the first and most important of the things to receive attention in any post-war reconstruction scheme is the building and equipping of hospitals. Undoubtedly such a project should be one of the "musts" of any such plan. In our last issue, we referred to the climbing rates of hospital charges. We said, rather carelessly, as we admit, that the price of commodities had not gone up much, owing to the imposition of a ceiling. Well, we must acknowledge that we had failed to realize that the price ceiling has not helped the hospitals in any way. We have had an opportunity of seeing comparative prices of food and essential commodities, as they were in 1939, and now are, in 1943. We publish in this issue an extract from such a document. It seems to us that the hospitals have made out an almost unanswerable case for their raised prices, on this ground alone: when one adds the increases in wages, and other operating expenses, one can only thank Heaven humbly that his lot has fallen in pleasanter places than that of the responsible head of a big hospital. But it shews clearly, too, that something will have to be done to make hospital care more readily available to those who need it, and to whom it is rapidly becoming too expensive to afford. In presenting these facts and figures, we are using the material supplied by the Vancouver General Hospital. It goes without saying that these burdens are in no way peculiar to this institution, but must be borne by every hospital in British Columbia: and we are sure their problems are just as grave, in some cases even more so, than in the case of the Vancouver General Hospital. Page 152 NEWS AND NOTES Although Dr. Charles A. Eggert had retired from practice, yet he was well known throughout British Columbia through his many years in Prince Rupert, and a short term in practice in Vancouver. His passing on March 7th came as a shock to the profession. A *S* *Sm *t Sympathy is passed to Major P. S. Tennant, R.C.A.M.C., now stationed at Prince Rupert, in the passing of his father. Major Tennant served for a considerable period in Great Britain before returning to the Pacific Command. *r *S' •«■ *4* Major M. R. Caverhill, R.C.A.M.C, Overseas, and Mrs. Caverhill are receiving congratulations on the birth of a son. sfr We wish to congratulate Major J. Ross Davidson on his recent promotion. He is associated at the Reception Centre, Little Mountain. Major R. C. Hamilton is doing Psychiatry at the Reception Centre, Little Mountain. Capt. R. S. Clarke, Medical Officer, R.C.A.M.C, son of Lieut.-Col. W. A. Clarke, is posted to the Pacific Command. *t *?. »'_ »*• sp *F n? "P Captains J. H. Black, formerly of Wells, A. Herstein of Victoria, R. E. McKechnie II of Vancouver, Paul Phillips of Princeton, W. W. Simpson of Vancouver, E. E. Toma- shewsky, formerly of Alberta, and S. L. Williams of Nanaimo have completed their training and have now returned to the Pacific Command for duty. Capt. W. W. Simpson is posted to Prince George; Capt. Paul Phillips to Victoria Military Hospital; Capt. R.-E. McKechnie to Prince Rupert Military Hospital. * * * * Major R. H. CCallaghan has moved from Victoria Military Hospital to Nanaimo Military Hospital; and Major S. A. Wallace has moved from Nanaimo Military Hospital to Victoria Military Hospital. •<* »r »r *r Capt. S. L. Williams visited his former home in Nanaimo recently. He is now stationed at Chilliwack. *>L *t «JL *t * *C *C *C *C Dr. N. H. Jones of Port Alberni visited Vancouver recently and is applying for appointment as Medical Officer, R.C.A.M.C. * * * * Dr. J. P. Ellis has been in Vancouver. We are pleased to report that Mrs. Ellis is recovering from! her recent operation. Dr. Kenneth Peacock and his wife, Dr. Elaine Peacock, formerly of Manitoba, hive opened offices in West Vancouver. Surg.-Lieut. John W. Frost, R.C.N.V.R., son of Dr. Anson C. Frost, is being married in Great Britain. *"• 3$* 3$* 9fr* We learn with regret of the death at Calgary of the mother of Dr. E. S. Hoare of Trail. Dr. Hoare was called to Calgary. We congratulate Major Kingsley Terry, R.C.A.M.C, on his promotion. Page 153 . ELECTIONS for MEDICAL COUNCIL COLLEGE OF PHYSICIANS AND SURGEONS OF B. C. Please Note: That your vote -will not be valid unless your dues for 1943 are paid before Monday, April 5th, at 10.00 a.m., when the ballots will be opened and counted by the scrutineers. To avoid disappointment you should pay your 1943 dues now. Surgeon-Lieut. A. G. MacKinnon has returned to this area for duty. He was formerly an interne at the Royal Jubilee Hospital, Victoria, and then practised at Duncan, and latterly at Queen Charlotte City before leaving for the East, where he later entered the Services. i£* A A A Lieut.-Col. W. A. Clarke, Assistant Command Medical Officer, and Dr. M. W. Thomas, Executive Secretary of the College of Physicians and Surgeons, visited the North Shore Medical Society at the March meeting. A considerable discussion took place regarding the increased needs of the civilian population owing to the industrial activities. * * * * Major S. G. Kenning, until recently in charge of Medicine at Victoria Military Hospital, has left for Toronto, where he will have a similar post at Chorley Park Military Hospital. Major J. E. Walker, in charge of Medicine at Nanaimo Military Hospital, will replace Major Kenning at Victoria Military Hospital. At Chiljiwack centre, Majors R. L. Borden and G. A. Bird, Captains A. L. Hunt, A. L. Buell, R. A. Stanley and S. L. Williams are stationed. «• * * * The response to the request that all Medical men fifty-nine years of age and under should present themselves to an Army Medical Board in order that they be categorized, has been enthusiastically met by a number of the men. At this date 104 have been so examined and categorized. It is hoped that the remainder of the doctors in that age group will arrange with the Medical Board in their community to be examined. Army Medical Boards are located as listed hereunder: VANCOUVER—Standing Medical Board, Little Mountain. VICTORIA—1. Standing Medical Board, Bay Street Armouries. 2. Officer Commanding, Victoria Military Hospital. NANAIMO—Officer Commanding, Nanaimo Military Hospital. PRINCE RUPERT—Officer Commanding, Prince Rupert Military Hospital. PRINCE GEORGE—Officer Commanding, Prince George Military Hospital. VERNON—Officer Commanding, Vernon Military Hospital. CHILLIWACK—Officer Commanding, Chilliwack Military Hospital. TERRACE—Officer Commanding, No. 1 Field Ambulance. TRAIL—Dr. M. R. Basted, President, Medical Board. KAMLOOPS—Lt.-Col. H. L. Burris, President, Medical Board. # $ Dr. C. C. Browne of Nanaimo visited Vancouver recently. Page 154 Capt. W. E. Austin is serving with the Pacific Command, Vancouver area. Dr. Carl Ewert of Prince George is having a repsite at the Coast from his arduous practice. Dr. W. D. Higgs, formerly of Port Alberni, and more recently serving with the R.CA.M.C, has returned to civil life and is now practising in Victoria. We are happy to report that Dr. H. M. Robertson of Victoria is convalescing following an illness, which came upon him immediately after the meeting of the Medical Council of the Canadian Medical Association in Ottawa. Doctor Robertson is a member of General Council in that he is a past President of the Canadian Medical Association, which office he held during the meeting in Victoria in 1936. Apparently the luck of Dr. E. C Hart extends beyond fishing and bridge. We learn that he won the $1,000.00 diamond ring raffled by the Red Cross in Victoria. Drs. E. W. Boak and F. M. Bryant and Surgeon Commander H. S. Morton, who is stationed at Esquimalt, attended the joint meeting of the Seattle and Puget Sound Surgical Society at Seattle. * * *!- sC- * Surgeon Commander C W. MacCharles, who has been stationed at Esquimalt during the past two years, has been transferred to Vancouver. Major F. H. Stringer has just returned from Ottawa, having taken a special course in administration. He is returning to his former post at Prince George. Major Stringer, while in Toronto, saw Lieut.-Col. Roy Mustard. He reports that he is busy but very well and looks it. *t *t A *?. *T -if *8f 5? Surgeon Lieut.-Commander F. P. McNamee, who has been stationed at Esquimalt since entering the Naval Services, is being moved to an Atlantic Station, and is hopeful that his next address will be Great Britain. Dr. P. L. Straith of Courtenay visited Vancouver. & «5» »5* a Dr. D. W. Beach of McBride was married recently. PRESCRIPTIONS FOR ALCOHOLIC BEVERAGES Doctors are being asked to issue prescriptions for liquor, etc. This is unfortunate and embarrassing to the profession. The Liquor Control Board has arranged that a Doctor may provide on prescription liquor where needed niedicinally for his patient. Page 15 5 LIBRARY NOTES MISCELLANEOUS LITERATURE IN LIBRARY— \British Empire Cancer Campaign. Nineteenth Annual Report, 1942. Diabetic Extracts. Published quarterly for the American Diabetes Association by The Lilly Research Laboratories, containing abstracts of articles in current literature on various aspects of diabetes. Medical Journal Abstracts. Published by the Library Staff of E. R. Squibb & Sons. Contains abstracts of clinical papers and endeavors to report them within a month of their publication. Medical Research Council War Memoranda: Aids to the investigation of peripheral nerve injuries. War Memorandum No. 7. A guide to the preservation of life at sea after shipwreck. War Memorandum No. 8. Monthly Science News. Published by the Science Committee of the British Council. It contains brief reports of recent scientific discoveries. Nutrition Reviews. Published monthly by The Nutrition Foundation Inc. It is intended particularly to be an aid in wartime nutrition problems. Therapeutic Notes. Published monthly by Parke, Davis & Company. Contains short articles and abstracts of various types of therapy. OUT FISHIN3 A feller isn't thinkin' mean, Out fishin'; His thoughts are mostly good an' clean Out fishin'. He doesn't knock his fellow men, Or harbor any grudges then; A feller's at his finest when Out fishin'. The rich are comrades to the poor, Out fishin'; All brothers of a common lure, Out fishin'. The urchin with the pin an' string Can chum with millionaire an' king; Vain pride is a forgotten thing, Out fishin'. A feller gets a chance to dream, Out fishin'; He learns the beauties of a stream, Out fishin'; An' he can wash his soul in air That isn't foul with selfish care, An' relish plain and simple fare, Out fishin'. A feller has no time fer "hate, Out fishin'; He isn't eager to be great, Out fishin'. He isn't ihinkhi? thoughts of pelf, Or goods stacked high upon a shelf, But he is always just himself, Out fishin'. A feller's glad to be a friend, Out fishin'; A helpin' hand he'll always lend, Out fishin?. The brotherhood of rod an' line An' sky an' stream is always fine; Men come real close to God's design, Out fishin'. A feller isn't plotting schemes, Out fishin'; He's only busy with his dreams, Out fishin'. His livery is a coat of tan, His creed—to do the best he can; A feller's always mostly man, Out fishin'. —Guest. Page 156 c o ege o f Ph ysicians an dS urgeons President Dr. W. A. Clarke, New Westminster Vice-President Dr. F. M. Bryant, Victoria Treasurer 1 Dr. H. H. Milburn, Vancouver Members of Council—Dr. F. M. Auld, Nelson (District No. 5); Dr. F. M. Bryant, Victoria (District No. 1); Dr. W. A. Clarke, New Westminster (District No. 2); Dr. Thomas McPherson, Victoria (District No. 1); Dr. H. H. Milburn, Vancouver (District No. 3); Dr. Osborne Morris, Vernon (District No. 4); Dr. Wallace Wilson. Vancouver (District No. 3). Registrar Dr. A. J. McLachlan, Vancouver Executive Secretary— 1 Dr. M. W. Thomas, Vancouver We reproduce an announcement to its employees by Wartime Metals Corporation, a Crown Company engaged in the production of strategic minerals. We are pleased to report that the Employee Welfare Plan described, with our friends, The Travelers, is effective April 1st, 1943. The management, employees and doctors in the area are to be complimented on their co-operation. WARTIME METALS CORPORATION Head Office PLateau 9681» EMERALD TUNGSTEN PROJECT 637 Craig Street West MONTREAL, P.Q. Mine Office: SALMO, B.C. Address Reply to (Munintions & Supply) TO OUR EMPLOYEES: After careful consideration and investigation of plans by "which our employees may budget for the cost of Medical, Surgical and Hospital Care, we have entered into an agreement -with the Medical Services Association to pay doctors' bills and The Travelers Insurance Company to cover Hospital Benefits for yourself and your family. This plan has been selected because it offers the most complete protection of this kind available and is of a character that you cannot purchase as individuals. It provides for early attention and treatment, home, office and hospital visits—consultations —X-ray—services of specialists—surgery or operations and hospital costs. You have free choice of physician and surgeon and hospital. The plan is explained in detail in the following pages and is available to all employees. In addition to the Company's contribution, your monthly contribtuion will be deducted from the payroll as follows: EMPLOYEE'S CONTRIBUTION—1st PAY OF EACH MONTH Single Employee \ $2.25 Employee and Wife 3.50 Employee, Wife and Children from 3 months to 18 years 4.00 The Company in addition to its contribution will pay the initial registration fee of $1.50 per employee. All employees are asked to co-operate. This service is only possible if 7 5 % of the employees are enrolled. The alternative is to retain the present contract for which you are being charged. WARTIME METALS CORPORATION, EMERALD TUNGSTEN PROJECT. The M-S-A has now been in operation over two years and its steady growth is a tribute to the superior and high standard of service provided. We believe the highest commendation of the service that M-S-A has rendered is the fact that we have no knowledge of a single case of dissatisfaction on the part of those who receive the services or those who render the services. Since M-S-A is the only Medical Service Plan in Page 157 America in which all medical men in a Province or State participate, we are na urally gratified that it works, and that this non-profit agency of employees, employers and doctors gives satisfaction and contributes to good employer-employee relations. Our part in the development and underwriting of M-S-A has been amply justified. M-S-A has been ably managed with a minimum of staff and overhead with the use of the International Business Machines Co. Ltd. Service Bureau. Claim procedure is simple and doctors have been paid promptly on the agreed basis. We are proud of the success of M-S-A and of our doctors who have co-operated wholeheartedly and with understanding. The Director of Medical Services tells us hat the taxing of accounts has been a pleasure and that mutual explanations are always on a happy and high level. If M-S-A is the pattern of things to come, we may look forward with confidence to the provision of general medical care by prepaymen . WARTIME METALS CORPORATION Description of Group Medical and Hospital Plan Medical and Surgical Care Provided by Medical Services Association SICKNESS AND NON-OCCUPATIONAL ACCIDENTS: Your doctors' bills will be paid for sickness and non-occupational accidents. The Workmen's Compensation Law provides for accidents at work so that you will now have coverage for 24 hours a day for doctors' bills. FREE CHOICE OF DOCTOR: You may choose any physician and surgeon in the Province at the time of illness or accident. HOME, OFFICE AND HOSPITAL VISITS INCLUDED: Your doctors' bills will be paid for home, office and hospital visits. If able, you are expected to attend the doctor's office. SPECIALISTS' SERVICES, X-RAY AND DIAGNOSTIC AIDS INCLUDED: When your doctor needs help in diagnosing your case, he may call in another doctor or a specialist. You and your doctor choose the consultant. When necessary, your doctor may use X-ray, other diagnostic aids and laboratory examinations. X-ray of teeth is permitted only when the medical doctor finds it necessary in diagnosis. SURGERY OR OPERATIONS INCLUDED: When an operation is necessary, all types of surgery are included. You choose the surgeon. PRE-EXISTING CONDITION TREATED WHEN NECESSARY: Treatment or surgery is provided for acute attacks requiring urgent medical care of chronic disease or surgical conditions whether or not they are pre-existing or when it is possible that recognized treatment may cure the condition. Experimental procedures are not included. EXAMINATION WHEN NECESSARY: When it is felt that there may be something the matter with your health, an examination is provided. A periodic health examination is not included. DIAGNOSIS INCLUDED AND TREATMENT EXCLUDED IN CERTAIN CASES: Your doctor's services necessary to establish diagnosis for pulmonary tuberculosis, venereal diseases, mental disorders, drug addiction, self-inflicted injuries and alcoholism are included. Treatment is excluded for drug addiction, self-inflicted injuries, alcoholism, defects present at birth, injury from war, or riot, or for diseases and conditions for which care is provided without cost or at a nominal charge by public authorities (for example, pulmonary tuberculosis, venereal diseases and mental disorders). REFRACTION EXCLUDED: Examinations for glasses are not included. MATERNITY INCLUDED AFTER 10 MONTHS: $35.00 is paid the doctor for obstetrical services when the mother has been enrolled for 10 months and is acceptable to a general practitioner and includes pre-natal, confinement and post-natal care. MAXIMUM LIABILITY: Bills for services rendered will be paid up to a maximum of $5 00 for any one person in any 12-month period (family of 3 counts as 3 persons, etc.). Liability for an accident (but not for sickness) is limited during the first 6 months to $5 0. After the' service has been in effect for the group for 6 months, the $50 limitation for accident is lifted Page 158 and the $5 00 maximum applies for both sickness and accident for each person irrespective of when they are employed or sign an application. IDENTIFICATION: You will be issued an Identification Card which you present to your doctor when requesting service. - The doctor will then send his report and account to the M-S-A for payment. In order to cut down "paper work" it is important that you notify the doctor at the first attendance that you are a member of the M-S-A- and give him or his nurse the number of your Identification Card. Hospital Care Provided by The Travelers Insurance Company FOR EACH DAY IN THE HOSPITAL: You will be paid $3.00 for each full day you or your dependent is confined in the hospital as a result of a non-occupational accident, or disease for wihch benefits are not provided under any Workmen's Compensation Law. This daily benefit will be paid up to a maximum of 70 days during any one period of disability. FOR SPEICAL HOSPITAL CHARGES: You will also be paid the amount of hospital charges for anaesthetic, laboratory, X-ray and operating room incurred during such hospital confinement up to a maximum of $15.00, during any one period of disability. MATERNITY BENEFIT: If your wife is confined in a hospital as a result of pregnancy, including childbirth or miscarriage, the daily benefit will be paid for each full day of confinement, not to exceed 14 days, for any one pregnancy. In addition thereto you will be paid the amount of hospital charges for anaesthetic, laboratory, X-ray, operating and delivery room incurred during such hospital confinement up to a maximum of $15.00, for any one pregnancy. A single employee must apply for dependent coverage within one month of the date of his marriage. If such application is not made, maternity benefits will not become effective until the insurance on the dependent has been in force for 12 months. These benefits are payable if you or your dependent are confined in a legally constituted hospital, upon the recommendation of a physician, for a continuous period of at least 18 hours and provided such confinement did not commence prior to, or during a period of disability which commenced prior to, the date the insurance became effective. General Information DEFINITION OF DEPENDENT: For the purpose of this insurance the term "Dependent" means an employee's wife, and an employee's unmarried children over 3 months but under 18 years of age. If husband and wife are both eligbile to subscribe for benefits as employees, the husband alone is eligible to apply for the dependent benefits. An employee -who has no dependent will become eligible to subscribe for the dependent benefits on the date he acquires a dependent. The maximum aggregate payment with respect to any one dependent for successive periods of hospital confinement is $600.00. Announcement will be made of the effective date of the plan. No charge will be made to an employee until his insurance goes into effect. WHEN EMPLOYEES ARE INSURED: Each eligible employee who has returned a signed enrollment card will be insured upon the effective date of the plan if he is actually at work. If not at work on such effective date, he will be insured from the date he returns to active employment. NO MEDICAL EXAMINATION: No medical examination will be required if you sign an enrollment card now. It is, therefore, most important that your card be signed promptly, in order to avoid the customary medical examination of the Insurance Company and possible refusal of the insurance. CERTIFICATE OF INSURANCE: A certificate of insurance will be issued by The Travelers Insurance Company for delivery to each employee insured under this Plan. All provisions of the Plan are subject to the terms and conditions of the Group Policy issued by the Insurance Company to the employer. TERMINATION OF INSURANCE: The insurance of an insured employee and that of his dependents, if any, will terminate when the employee's employment terminates. The insurance with respect to a dependent child will terminate on the date the child marries or prior thereto on attaining the age of 18. Page 159 PLEASE READ THIS AND KEEP FOR REFERENCE DOMINION INCOME TAX RETURNS BY MEMBERS OF THE MEDICAL PROFESSION As a matter of guidance to the medical profession and to bring about a greater uniformity in the data to be furnished to the Income Tax Division of the Department of National Revenue in the annual Income Tax Returns to be filed, the following matters are set out'.— Income 1. There should be maintained by the doctor an accurate record of income received, both as fees from his profession and by way of investment income. The record should be clear and capable of being readily checked against the return filed. It may be maintained on cards or in books kept for the purpose. Expenses 2. Under the heading of expenses the following accounts should be maintained and records kept available for* checking purposes in support of charges made:— (a) Medical, surgical and like supplies; (b) Office help, nurse, maid and bookkeeper; laundry and malpractice insurance premiums. (It is to be noted that the Income War Tax Act does not allow as a deduction a salary paid by a husband to a wife or vice versa. Such amount, if paid, is to be added back to the income); (c) Telephone expenses; (d) Assistants' fees. The names and addresses of the assistants to whom fees are paid should be furnished. This information is to be given each year on Income Tax form known as Form T.4, obtainable from the Inspector of Income Tax. (e) Rentals paid; The name and address of the owner (preferably) or agent of the rented premises should be furnished (See (j)); (/) Postage and stationery; (g) Depreciation on medical equipment; The following rates will be allowed provided the total depreciation already charged off has not already extinguished the asset value:— Instruments—Instruments costing $50 or under may be taken as an expense and charged off in the year of purchase. Instruments costing over $50 are not to be charged off as an expense in the year of purchase but are to be capitalized and charged off rateably over the estimated life of the instrument at depreciation rates of 15 per cent to 25 per cent, as may be determined between the practitioner and the Division according to the character of the instrument, but whatever rate is detrmined upon will be consistently adhered to; Office furniture and fixtures—10 per cent per annum. Library—The cost of new books will be allowed as a charge. (h) Depreciation on motor cars on cost:— %f^ Twenty per cent 1st year; Twenty per'cent 2nd year; Twenty per cent third year; Twenty per cent 4th year; Twenty per cent 5th year. The allowance is restricted to the car used in professional practice and does not apply to cars for personal use. Page 160 For 1940 and subsequent years the maximum cost of motor car on which depreciation will be allowed is $1,800. (i) Automobile expense; one car) This account will include cost of licence, oil, gasoline, grease, insurance, washing, garage charges and repairs; Alternative to (h) and (?) for 1940 and subsequent years:— In lieu of all the foregoing expenses, including depreciation, there may be allowed a charge of 4^4c a mile for mileage covered in the performance of professional duties. Where the car is not used solely for the purpose of earning income the maximum mileage which will be admitted as pertaining to the earning of income will be 75 per cent of the total mileage for the year under consideration. For 1940 and subsequent years where a chauffeur is employed, partly for business purposes and partly for private purposes, only such proportion of the remuneration of the chauffeur shall be allowed as pertains to the earning of income. (;) Proportional expenses of doctors practising from their residence— (a) owned by the doctor; Where a doctor practises from a house which he owns and as well resides in, a proportionate allowance of house expenses will be given for the study, laboratory, office and waiting room space, on the basis that this space bears to the total space of the residence. The charges cover taxes, light, heat, insurance, repairs, depreciation and interest on mortgage (name and address of mortgagee to be stated); (b) rented by the doctor; The rent only will be apportioned inasmuch as the owner of the premises takes care of all other expenses. The above allowances will not exceed one-third of the total house expenses or rental unless it can be shown that a greater allowance should be made for professional purposes. (k) Sundry expenses (not otherwise classified)—The expenses charged to this account should be capable of analysis and supported by records. Claims for donations paid to charitable organizations will be allowed up to 10 per cent of the net income upon submission of receipts to the Inspector of Income Tax. This is provided for in the Act. The annual dues paid to governing bodies under which authority to practice is issued and membership association fees not exceeding $100, to be recorded on the return, will be admitted as a charge. The cost of attending post-graduate courses or medical conventions will not be allowed. (/) Carrying charges; The charges for interest paid on money borrowed against securities pledged as collateral security may only be charged against the income from investments and not against professional income. (m) Business tax .will be allowed as an expense, but Dominion, Provincial or Municipal income tax will not be allowed. Professional Men Under Salary Contract 3. It has been held by the Courts that a salary is "net" for Income Tax purposes. The salary of a Doctor is therefore taxable in full without allowance for automobile expenses, annual medical dues, and other like expenses. If the contract with his employer provides that such expenses are payable by the employer, they will be allowed as an expense to the employer in addition to the salary paid to the assistant. Page 161 NUMBERS OF RELIEF RECIPIENTS IN ORGANIZED DISTRICTS THROUGHOUT THE PROVINCE FOR JANUARY, 1943 Grand Total Total Cases (exclusive of Municipality (including dependents) Heads Dependents Single dependents ) Alberni 4 4 1 1 2 2 1 3 2 Armstrong . __ 4 Burnaby „ 355 83 117 155 238 Chilliwack City 22 7 8 7 14 Chilliwack District .. __ 45 9 23 13 22 Coldstream . ~ _ .. 1 45 0 9 0 19 1 17 1 Coquitlam _ . __ _ 26 Courtenay __ _ . 8 1 2 5 6 Cranbrook ._ .. _. .. '■■■ __ 37 4 8 25 29 Cumberland .. 7 2 2 3 5 Delta _ 35 9 15 11 20 Duncan ._ __ .. __ _ 12 10 2 4 5 5 5 1 7 Enderby . 5 Esquimalt - 15 2 2 11 13 Fernie . - . 137 42 72 23 65 Glenmore 0 10 0 2 0 8 0 0 0 Grand Forks ... sE 2 Greenwood _. __ _. ._ 1 0 0 1 1 Kamloops . _ . _ 117 16 41 60 76 Kaslo - . 10 2 4 4 6 Kelowna 35 7 14 14 21 Kent - -_ - ..- 28 7 21 0 7 Ladysmith - __ . . .. 32 9 13 10 19 Langley _ . _ . 105 25 40 40 65 Maple Ridge ...... ... . 33 8 12 13 21 Matsqui . _ _ _ .. 44 11 20 13 24 Merritt '■■ . 2 0 0 2 2 Mission District 23 6 6 11 17 Mission Village - 2 0 0 2 2 Nanaimo 96 17 28 51 68 Nelson » 51 7 18 26 33 New Westminster - - 193 38 59 96 134 North Cowichan „ ■' 16 4 6 6 10 North Vancouver City. .. ~ 55 12 18 25 37 North Vancouver District . .. 54 9 8 2 11 3 35 4 43 Oak Bay „_ 6 Peachland _ . - - _ _ 0 0 0 0 0 Penticton _ - _ 78 15 34 29 44 Pitt Meadows - _ 2 17 0 3 0 5 2 9 2 Port Alberni - - - _ - 12 Port Coquitlam . _ ._ _ 13 3 3 7 10 Port Moody . 7 1 1 5 6 Prince George _ - - — _ 29 4 7 18 22 Prince Rupert .. .... ._ 55 6 31 18 24 Revelstoke - . __ 7 51 0 12 0 27 7 12 7 Richmond ._ _ 24 Rossland _ .. . . - 7 1 3 3 4 Saanich - 142 32 43 67 99 Salmon Arm City .. ~ 2 0 0 2 2 Salmon Arm District . ... 14 16 5 5 6 9 3 2 8 Spallumcheen 7 Sumas ._ _ . ■ .. 20 7 9 4 11 Summerland . 1 0 0 1 1 Surrey . . ■"■' . . „ 152 43 59 50 93 Trail ... .... .. .. .. 7 1 3 3 4 Vancouver ... . . 2,602 352 575 1,675 2,027 Vernon ..__._. .. 41 7 13 21 28 Victoria .. ._ .. .. 333 48 66 219 267 Weit Vancouver 20 1 1 18 19 GRAND TOTAL MUNICIPALITIES 5,269 903 1,498 2,868 3,771 Page 162 WHITHER? Dr. Bede J. Harrison Read at the January meeting of the Vancouver Medical Association. trWhat in the beginning are covenants Grow into customs. Custom is lord over covenant; Water proceeds along waterways; Sanction proceeds from covenant. A country grows with its customs." These words are taken from a translation of Jelebu Songs and Sayings and will be found in Journal 78 of the Royal Asiatic Society (Straits Branch). Any attempt to analyze the future of medicine necessitates an examination of the present status of our knowledge and capabilities, and demands that we take heed of our civic as well as our medical functions since our existence as human beings is much more important than our professional activities. In other words, while living up to the limited ideals of the Hippocratic Oath, we must try to go far beyond and to live as rational human beings of the years nineteen hundred and forty-three and onwards. The medical discoveries of the present epoch have brought us great joy. The progress of the sciences of healing and preventing disease, the two great attributes of Aesculapius, quite justifiably makes us proud of belonging to the profession, but there are some conditions associated with our daily lives which so far do not seem to have attracted our attention sufficiently. One of the most important of these is that medical education and medical progress thrive on the continued existence of poverty. Our staff patients are looked upon as a necessity in the undergraduate training of medical students, and as a body we act as though we belWe that poverty and drudgery are a necessary part of existence—for the other fellor.. The gradual elimination of tuberculosis, the reduction in the incidence of and morbidity due to syphilis, the practical disappearance of typhoid fever and diphtheria, the control of yellow fever and malaria, of dengue, and so on, show what can be done to avert disease. But all the time that we have been encouraging mighty onslaughts on individual diseases and their vectors, one condition, more potent for physical evil than all those mentioned put together, has been present everywhere in the world, even in our own midst—the condition of poverty which kills tens of millions; which reduces the efficiency of hundreds of millions, and which prevents the full human development of over a billion people in every generation. We have but to think of our own country in which health is lowered even unto death in some cases by poverty itself; of the number of preventable accidents which would not occur could we but get the money to establish the necessary safeguards; of the infections contracted by the poor in their daily work; of the preventable occupational diseases; of the rapid spread of infection in the homes of the poor; of the diseases due to insufficient and improper nourishment; and of all the degenerations, mental and physical, which follow on the heels of anxiety and poverty. We have but to think of these and we can realize that the most important problem fat preventive medicine at the present day is the abolition of want. We are struggling with much travail in an attempt to establish democracy in Canada, and we hope that when our task is completed, or even pari passu with it, we shall be able to establish democracy throughout the world. Now democracy is not a method of government; it is rather a philosophy which works first in the minds and in the hearts of men, and acting through their will, becomes visibly expressed in a way of life and institutions necessary to that way. So, we can be really democratic and live our lives in Canada, while still objecting that her philosophy is not yet democratic, just as St. Paul, who was a Jew, could cry out proudly that he was a citizen of Rome in the same breath as he inveighed against Rome's .excesses. We cannot make history all black and white. It runs its course, changing with the philosophies of the dominant races, sometimes slowly, sometimes quickly, with colours now of contrasts, now of beautifully blended shades. So, pirates raged in the Straits of Page 163 Malacca from 1914 to 1918, and maybe they will rage again there before this war reaches its close. They may be there even now. That democracy and want cannot live together seems axiomatic. Mr. Vincent Vickers, a director of the Bank of England, said that "our democratic system and our existing financial system can no longer live together; one must give way to the other." Maybe there is some affinity between our existing financial system and our poverty; maybe, like the medical system, the financial system progresses on poverty. It is obvious that if we wish to continue progress on the road towards democracy, want must be abolished. But it must be abolished in such a way that we shall be nearer to our democratic goal than before. As each link in the chain of want is broken, a fresh flower must be added to the garland of freedom; for the two aims are corollary. Freedom must be a philosophy in the minds and hearts of men, which, acting through their will, eliminates poverty. It is a confusion of language to speak of a freedom which does not leave everyone equally free. How do the popular suggestions meet the two aims—personal freedom and abolition of want? The most widely publicized suggestion at the present time is the Social Insurance and Allied Services Report of Sir William Beveridge. This report is, I am inclined to think, being taken too seriously. It would be wiser to regard it as a political kite sent aloft in an endeavour to determine how it will react to the gusts of public criticism. As it stands now it is rather difficult to think otherwise. It seems like an attempt to compromise between the forces of reaction and the normal evolution of man's mode of life and represents a backward step in national economics. I am not attempting to decry the report in so far as it represents what Sir William was expected to produce. The terms of reference from the Ministry of Reconstruction to Sir William's Committee necessitated the drafting of just such a report; and as such, it is a very good report. In fact, had it been published fifty years ago it would have been an excellent report. At the present day, however, the report lacks vision. Its wording suggests that an attempt has been made to find the lowest scale of living which may possibly satisfy the people when the war has been won. It is realized that something must be done to improve the condition of the great majority of the English people. Some sop must be thrown to Cerberus. The whole report sounds quaint at the present time when it has become patent to everyone that there is no limit to the height to which the scale of our material living can ascend except the limit of our facilities for the production of goods and services—a limit at present unknown. Sir William's committee found that three-quarters to five-sixths of the want in England is due to interruption or lack of earning power, and the remainder to lack of adjustment between earning power and family needs. It is noteworthy in this connection that the committee never suggested that there was lack of productive power. The implication is made that because of lack of money, individual citizens cannot buy the goods that have been or can be manufactured or the food that has been or can be produced. According to the report the basic difficulty lies in the manner in which the money is distributed. No mention is made of such facts as the jettisoning of boatloads of oranges from Spain in the Irish Channel because they could not be sold in England. Spreading the money more evenly around does not increase its amount. The margarine of poverty spread more thinly over more of the population does not lessen the total amount of poverty. It simply improves the lot of the very poor while reducing the status of those who are just above the poverty line. But perhaps it is all a question of the definition of want or poverty. Sir William's report speaks of fuel, house rents, food, clothing and health—all in terms of money. One thinks that maybe there is more than these in the life of the ordinary man. Maybe he would like to enjoy some other things in life without having to sacrifice these five, which represent the Beveridge charter. Is not the spirit more than raiment? Maybe the people of England will require also freedom of spirit. Page 164 When the industrial system was entering its hey-day in England, it was considered an economic necessity for national progress, that there should always be a large body of unemployed living in poverty, waiting anxiously for a call to work—a system which has continued in many coal-mining districts even up to the present day. During that same period the slaves of the southern states were also relatively unemployed at certain seasons, but in contrast to the free-born Englishman the slave was housed, clothed, warmed and fed, albeit on a somewhat low standard, by the slave-holder, while the English industrialist took no concern for his workmen in their idleness. The Beveridge report attempts to change the degree of the poverty of the unemployed, but it will tend to ensure the continuance of the system of conjoint unemployment and poverty whereby floating numbers of unemployed will be maintained by the payments made under the report in such a state of health as to be always ready for the industrial market when called upon. An excellent device, in view of the facts that have recently come to light regarding the munitions works on this continent, showing that the time lost in strikes, about one-tenth of one percent, is so small compared to the time lost through industrial sickness and accidents as to be negligible. Incidentally, the maximum amount of time lost in the same industries is found to be due to faults not connected with the workmen at all—either their sickness or their strikes. The greatest loss of time has been found to be due to faults and errors in the management offices of the nation. On this point the Beveridge report is especially weak. It states that the success of the scheme depends upon the absence of any wholesale unemployment and then it hands over the problem of avoiding such a catastrophe to the government as a whole. I suspect that here the report had its metaphorical tongue in its metaphorical cheek. In Paragraph 165, we find the following expression: "Want could have been abolished before the present war by a redistribution of income within the wage-earning classes without touching any of the wealthy classes." This sentence is all that is needed to give anyone who knew England between the two wars an excellent understanding of the meaning of the word "want" as it is used in the Beveridge report. Most Canadians would prefer to replace the term by the expression "dire povtrty." And if the report be read with this alteration in its context, changing the word "want" to "dire poverty," it makes for much better understanding and fixes the report in its proper place in the national economy. That the report aims only at an income security, as Sir William pointed out, renders it still more futile. Under the scheme every person will have sufficient money to pay his rent, if he can get a house at a rental he can afford. The usual experience under such conditions is that rents go up, and the poor individual will still be able to afford only the same type of slum house as he had previously. Those with somewhat higher salaries will be less well able to afford the better type of house, and the tendency will be for them to compete in the lower-priced housing section. In Chile, the social security scheme includes the erection of houses to meet the needs of the people, as well as arranging for the people to have the money to pay the rent. The Chile Social Security Committe builds the houses itself. It is not often I agree with the Gloomy Dean, but when, in reference to Sir William's report, he says, according to the Associated Press dispatch from London on Tanu- ary 29, 1943: "The working man individually is such a good fellow, and so intelligent, I hope he will resist the bribes of politicians," I agree very heartily with him. While praising the report, as about the best that could be expected under the circumstances, I would point out that the most serious objection of all to its acceptance is that it is undemocratic. We must realize that the mere fact that the King will come within its scope does not make it democratic; neither does the fact that every member of the same group pays the same contribution and receives the same benefits. Democracy demands that each shall bear his burden on behalf of the community according to his capacity. It also demiands freedom of action and freedom of movement. The implication of this report is that employment, and work, and the sweat of the brow, are necessary corollaries to the privilege of merely living above the line of dire poverty. Page 165 Can any man be considered free under such circumstances? Of such nature is the freedom of the Germans, the Italians, the Japanese. I submit that the Beveridge report cannot bring about social security because it implies the continuation of a system under which poverty is inevitable. So much for the Beveridge report. It has been considered merely because one or more of its provisions will be found included in similar schemes in many lands. All such plans are basically wrong, even our own proposed Health Insurance plan. They limit the personal freedom of contract, between individual and individual in a mass manner, far beyond the degree that is necessary or permissible under a democratic philosophy. The crux of the whole question is this: Is poverty inevitable? And in this general question, all the minonr questions such as whether poverty is inevitable in any particular part of the world are included. " Let me quote another director of the Bank of England. Sir Basil Blackett, in his book "Planned Economy," page 23, says: "Each member of a community only need work for a few weeks each year to provide the necessaries for western Europe and North America, or only a small number need work at all." Donald Nelson, War Production Chief of the United States of America, has this to say: "Poverty is not inevitable any more. The sum total of the world's possible output of goods divided by the sum! total of the world's inhabitants no longer means a little less than enough for all; it means more than enough." Professor Hansen, of Harvard University, puts the matter thus: "We can afford as high a standard of living as we are able to produce." Note that he speaks about ability to produce, not of how much we can afford to produce. Sir Stephen Demedriadi, President of the London Chamber of Commerce, on the same subject: "The world problem is no longer one of production but merely one of distributing that production." Sir Arthur Salter voices similar views: "Our material resources, technical knowledge, and industrial skill are enough to afford to every man of the world's teeming population, physical comforts, adequate leisure, and access to everything in our rich heritage of civilization that he has the personal quality to enjoy." It has been calculated that there is sufficient power and plant in the United States alone, if fully used, to supply the needs of five times the number of people on the earth. Lord Leverhulme put the matter quite simply: "If every adult worked half a day we could supply more than enough for our needs." King Edward VIII, in The Time's, July 30, 1932, said: "If all the employable labour were employed for a reasonable number of hours per week, the world would have at its disposal a volume of commodities and services that would enable the entire population to live on a higher level of comfort and well-being than has ever been contemplated in the rosiest dreams of the social reformer." According to a recent issue of the London Times, there is "a tendency, especially among industrialists, to question the present system and to insist that some better way must be found to enable would-be consumers to buy what the productive forces of the world are capable of producing," and in the same issue we find the following: "A very cautious report on Reconstruction made by the Federation of British Industry laid it down that this must be a fundamental objective of post-war policy, since without it no political or economic reforms could achieve their purpose." Further, says The Times, "The Association of British Chambers of Commerce took a similar line, expressed somewhat more strongly, while the London Chamber of Commerce roundly denounced the existing system as an anachronism and urged that it must be recast to meet modern economic conditions to facilitate the mass consumption of goods which mass production can provide." The city of Detroit in two days turns out the full requirements of motor-cars in Australia for one year. Professor Soddy says that "four thousand men equipped with the latest machinery could supply the wheat crop of the United States." Page 166 As King Edward said in regard to tuberculosis, so may we say now in regard to poverty: "If preventable, why is it not prevented?" What is it that keeps poverty rampant when in the view of the above mentioned financiers, producers, professors, and statesmen, it is quite unnecessary? Why are there, according to the London Chamber of Commerce, "ninety million destitute people in advanced nations and teeming millions in Africa and Asia half-starved and half-clothed?" Why do thousands of children go to school in England without breakfast and never have a glass of milk to drink, while thousands of gallons of milk are poured down the drain; and at the same time practically every schoolchild in Chile has his glass of milk chocolate every day? Why in 1934 were one hundred and fifty thousand milk cows slaughtered in Holland in time of peace as they are now being slaughtered here in time of war? Did everyone have enough milk and butter? Why were one and a half million oranges dumped in the sea near Liverpool in the hot and rainless month of August, 1933? Had the English people too many vitamins? Why was the destruction of six million suckling pigs and one million sows ordered in the United States? Was it because everyone had all the pork and bacon they needed? Was it because everyone had so much tea that its production was restricted by one hundred and twenty-one million pounds in the peaceful year of 1933? Why were millions of bags of coffee burned, barrels and barrels of herring thrown back into the sea, and wheat used for firing engines? Was it because the people of the world would otherwise have had too much to eat, with a resultant lowering of their standard of well-being? Why were tin and rubber and petroleum restricted and sabotaged in the Indies during the years of peace? Was it so that we might have a dearth of them in time of war? Why was the production of copper, zinc, jute, cotton and sugar deliberately limited? Was there no need of them? Why are the untold millions of ounces of silver, lying in the vaults at West Point, kept there at the present time when the silver could be used to replace thousands of tons of tin—tin which we lack now because we deliberately limited its production when we controlled the Indies? No one can say it is not needed. Why does one child in every six in the British Isles live below the poverty level? It would be very interesting to compute the loss which the "sound money" nations suffered, in terms of actual material wealth, due to deliberate restriction of production, and the sabotage of what had already been produced, in the peaceful years of '31, '32, '33 and '34, and to compare this loss with the actual material costs of supplying armaments for the present war. One might wonder whether war or such peace as we then had is the more expensive. Professor Irving Fisher, Professor of Political Economy at Yale, quotes Sir Montague Norman, Governor of the Bank of England, to this effect: "Real stabilization will come about only when we have taken steps to make our monetary system really the servant, instead of the master, of society." Lord Bryce in his "Modern Democracies" says that "Democracy has no more insidi-| ous foe than the money power." The link between production, which we have already seen can be quite ample, and consumption, which we have seen falls far below what is necessary for health and comfort, is money, according to the report of the Southampton Chamber of Commerce on the Economic Crisis. "We go to work to get the cash to buy the food to get the strength to go to work, and so on, ad infinitum," says Upton Sinclair. In 1933 farmers were "unable to sell their produce and, therefore, were unable to afford the goods produced by the urban worker, because he could not earn enough to buy the farmers' produce." Page 167 These quotations indicate what one might call the local and personal difficulties due to the financial system at present in vogue, but the effects on different classes of society, and on whole nations, are analogous. The Southampton Chamber of Commerce on this point says: "So, the situation develops towards the culmination of the economic struggle among nations—namely, war." While the Rotary International Research Committee puts it thus: "Every intensified competition for foreign markets is one of the most fruitful sources of war. War is the demonstrably inevitable outcome of the present system." President Wilson at St. Louis in 1919 asked this question: "Is there any man who does not know that the seed of war in the modern world is industrial and commercial rivalry?" In the encyclical Quadragesimo Anno His Holiness Pope Piux XI stated: "In our days not only is wealth accumulated, but immense power and despotic domination is concentrated in the hands of a few. This power becomes particularly irresistible when exercised by those who, because they hold and control money, are able also to govern credit and determine its allotment, for that reason supplying, so to speak, the life blood to the entire economic body, and the grasping, as it were, in their hands the very soul of produce so that no one may dare breathe against their will. 'This concentration of power has led to a three-fold struggle for domination. "First, there is the struggle for dictatorship in the economic field. Then the battle to acquire control of the state so that its resources and authority may be abused in the economic struggle. Finally, the clash between nations themselves." Bernard Shaw says that this principle is the "economics of bedlam." The London Times very succintly deprecates what it calls "the nonsense of the old comfortable theory that the process of production automatically distributes enough purchasing power to enable its products to be bought and consumed." And it follows with this pertinent remark: "Widespread confusion as to the nature and function of money, and the working of the existing mechanism, is painfully apparent in speeches made even by highly placed authorities in the War Savings Campaign, and members of Parliament in budget debates." From the foregoing remarks it is obvious that a very real difficulty not mentioned in the Beveridge report lies in the way of the introduction of an ample system of social security. This difficulty lies in the fact that in the process of production, costs are generated at a faster rate than incomes are distributed; and that thus there is an ever- widening gap between the price of the things that are produced and that await purchase and the purchasing power of the nation. The difficulty is evidently due to our present method of handling money, using the word "money" in its fullest sense. Our economic system is fundamentally unable to satisfy the conditions of mass production as we find them. The faults of the system have become more and more apparent as production has increased, but the systems was always unsound, and it is only now that its worst faults have become obvious to all. His Excellency Lord Bledisloe, the Governor-General of New Zealand, stated that "the virtue of money is in its purchasing value, and if this is to be maintained on an equitable basis, the volume in circulation at any one time should be equivalent to the value of goods in the market." Theoretically the basis of all payment, at one period of time, was gold, and money had an intrinsic value in its relation to gold; but a transition occurred in which payments in gold or gold equivalents were gradually replaced by payments in claims on gold, and from then on the value of money began to change from its intrinsic worth to a value which came to depend entirely on its ability to buy goods and services until in these days the word "dollar" conveys to us no idea of gold whatsoever, but just something with which we can buy a certain but ever changing quantity of goods or degree of service. It seems obvious that the nature of money is such that the quantity of is available in a community should be sufficient to allow for the purchase of all the goods that are produced that the consumer wants; as well as to pay for all the services that are available and are needed. Hence, as the total volume of goods produced increases, more money is required in order that the goods may be sold and the markets kept Page 168 stable—for stability of the markets, it must be remembered, is the only safe basis on which a manufacturer can continue to produce. As the country's production is increased, where does the increase in money necessary for smooth economic working come from? It comes from various sources, but of these we need consider only one because some ninety percent of our business is done with money which arises in this way. This large proportion of the additional money is created by the banks. The Marquis of Tavistock says: "All money is created by the banks, including the Bank of England," while the Honorable Reginald McKenna, Chairman of the Midland Bank, the largest trading bank in the world, the man who was Chancellor of the Exchequer during the first World War, says: "The Bank of England can create or destroy money." Professor Soddy says: "The cheque system, itself beneficent, has enabled the banks to continuously create and destroy money at will," and Montague Norman, Governor of the Bank of England, speaking before the MacMillan Banking Commission in March, 1930, in reply to questions, agreed that the credit of England was, to a large extent, in his hand, and that he was responsible, between February, 1929, and February, 1930, for reducing the amount of credit in the country by many millions of pounds. Now Montague Norman is a private citizen in whose appointmenp to the Bank of England the people of England have no say. Surely, it is anomalous that the economic life blood of the country should rest in the hands of someone who is not responsible to the country. It is to be noted in passing that in addition to being Governor of the Bank of England, Montague Norman is one of the two British representatives on the Bank of International Settlements, the personnel of which, according to a White paper recently issued by the House of Commons, numbers sixteen and a chairman. Of the sixteen, four come from countries that are quite free, five come from countries under German domination, and seven come from the Axis powers—Germany, Italy and Japan —who own seventy-two percent of the shares. This means that while Montague Norman is practically in control of the issue of credit in Great Britain he is also one of the members of a group who are in control of the issue of international credit, and this all while still a private individual. Is it any wonder that the Bank of England is said to be the only British corporation which can trade with the Axis powers. The experience of Napoleon Bonaparte with the banks of France is rather illuminating. When Nicolas Francois Mollien was appointed to the Ministry of Finance in 1806, he found that the French treasury was being obstructed by the policy of the banks, and he arrived at the conclusion that the banks had been responsible for the financial crisis of 1805-1806. He finally succeeded in freeing the treasury from the interference of the banks, and thereafter no more public loans were floated. Napoleon left no public debt, but England is still paying for the battle of Waterloo. In England, as in Canada, the banks alone have the power of creating money, and we have seen how the industrialists complain about the absence of a sufficient volume of money. If, as the industrialists say, more money is needed to enable mass consumption to keep pace with mass production, it becomes obvious that sufficient money is not being created. Now we know that our banks are very efficient and very sound institutions, and we must conclude, therefore, that our banking system, as at present constituted, is for some reason or other, which we need not discuss here, unable to create the volume of money which is necessary. In other words, our present system is such that we must continue to suffer from a lack of money for consumption. Hence, there exists an urgent necessity of departing from our present system of creating money, and the first and immediate change that is necessary, in view of the opinions which I have quoted, is undoubtedly to take away from private corporations the power of creating money, and to place it in the hands of some body which will be eventually responsible to the people of the country; leaving the banks to carry on their normal business of accepting money on deposit. The control of the total volume of money in circulation, upward or downward, should lie in the hands of some special commission, whose appointment ultimately rests on the will of the people. The appointed authority would have as its function the establishment and operation of a system for the creation and destruc- Page 169 tion of money, together with its distribution and its collection, which would ensure that there would be always available an amount of money sufficient for the complete interchange of goods and services. This commission, working on information which is already available at Ottawa, would have no other function. It would simply have to solve a mathematical problem for the solution of which all the details were in its hands. The problem of how much money would be necessary to suit the conditions of consumption and production as laid out in the returns reaching Ottawa daily could be solved in much the same way as the international rates of exchange are fixed now. The exact manner in which the solution of this equation would be reached, and the exact technical details by which the money would be distributed or collected, as more or less was needed for the community, are essentially matters for the specialist, and just as in recent days at the special meeting here we decided that the Vancouver water supply should be kept pure and that it should be kept pure by chlorination, while at the same time we left the question of the technical methods to be adopted in the hands of the experts, so too we may decide what it is we want in the economic field, as far as it affects the health of the community, and leave it to the statisticians, the actuaries and the bankers to work out the details. "It is the business of government to yield to pressure," says President Roosevelt. It was thus that the Magna Carta was achieved, trial by jury obtained, and in later years the eight-hour day made a fact. It is our business to apply pressure to the government to secure the results we required, instead of allowing the government to impress its wishes on us. We must zealously try to avoid any of the so-called "plans" for our welfare. If we are to remain even as democratic as We are now, we must see that no system is imposed upon us from above which will limit our freedom. Democracy works best with a minimum of interference from the outside. "Plans" are invariably introduced to fit the other fellow, whether he wants to be so fitted or not. Perhaps it would be well at this time to throw overboard much of that peculiar philosophy which sprang from Darwinism and which has militated so strongly against clear thinking in social economic matters ever since. The adoption of the idea of the survival of the fittest, founded on the notion that man has reached his elevated position as the result of a struggle in which he was the victor, was carried from the biological field, in which it was developed, into the industrial field. Manufacturer fought manufacturer on the understanding that the weaker went to the wall; an animalistic mode of behaviour which might have some justification at the present day if the quantity of raw material available were limited, or if the amount of money which could be created was such that when the goods of one manufacturer were purchased those of the other manufacturer must remain on the shelves; but it is immediately obvious that in our time neither of these premises exists. Unlimited amounts of raw material are available, and as much money as is necessary can be created, for Graham Towers, the Governor of the Bank of Canada^says: "Anything which is physically possible is financially possible." The argument of Malthus has been answered quite completely too. He assumed that the population of the world would eventually be too great for the world's production, thus leading to widespread poverty. But apart from the fact that the population of English-speaking people seems likely to be less at the end of the century than it was at the beginning, we find that the increase in the rate of production is even now moving faster than the increase in population, so that it is, at present, quite impossible to foresee the day when there will be more people on the earth than the earth can support. At the present time Canada is supplying food, housing, clothing and heat for over one million five hundred thousand people'who are not producing any of these things for themselves. In addition, she has already given goods—real goods, not money—worth one billion dollars to England, and proposes now to give another billion dollars' worth. The mind can hardly visualize the improvement in the Canadian standard of living which must occur when, after the war is won, these one million, five hundred thousand people commence to work again for Canada, and when there are no more billions of Page 170 dollars' worth of goods to be sent overseas; provided, of course, that the necessary money is created to carry on the business of peace as it has been created to carry on the business of war. Some may object that after the war, the war must be paid for, but if Canada has not borrowed from any nation outside, then she will have paid for the war by the day peace is declared, since payment of the War Loans will simply represent a transference of money from one Canadian to another. Therefore, the total wealth of Canada will remain unchanged; unless, and notice again, the money which has been created by the banks for buying war loans is destroyed immediately the loans are repaid to the banks. In this case we shall be faced with disastrous deflation unless more money is created along the lines indicated above to meet the needs of peaceful production. In keeping with its attitude in the past the medical profession will welcome the abolition of the diseases due to poverty, in the same way as it welcomed the abolition of diphtheria, but the welcome will be only half-hearted if, with the abolition of poverty, there is an equivalent abolition of freedom. I call to mind a not infrequent occurrence in Sumatra where the domesticated pig is visited by the free serpent. Occasionally the serpent enters the cage in which the pig is kept and rapidly waxes fat at the pig's expense only to find that then he cannot get out of the cage; in waxing fat he has lost his freedom and his last state is worse than the first. Let us take care that the serpent of Aesculapius does not enter the cage of state insurance, lest waxing fat therein he may, like the serpent of Sumatra, lose his freedom. The opening lines of the song of Jelebu said "Covenants grow into customs." Let us not, therefore, stand idly by while an undemocratic covenant is drawn up since it will in time become an undemocratic custom. Let us rather make our customs truly democratic so that since "custom is lord over covenant," the covenant may ultimately be drawn in keeping with the democratic philosophy. Summary The medical profession works under the standard of Aesculapius, which implies, among other things, the prevention of disease. Poverty is the most widespread single cause of disease. Poverty in this day is due not to lack of things but to lack of money. Banks alone create money. Industry has expressed its opinion that they do not create sufficient money for the purposes of business. The banks cannot retain their present characters and create sufficient money. The banks are private concerns whereas the creation of money is a public concern. We infer the necessity of a publicly controlled commission, operating without profit, concerned only with the creation and destruction of money, insofar as it is necessary for the free, full and equal interchange of goods and services as between producer and consumer. We think that in this way poverty shall; be abolished, and at the same time more freedom shall come to every man, woman and child in the community. Then we shall know that we have taken another great step in preventive medicine, and, at the same time, have taken a long stride forward on our road towards the ultimate goal—that is Democracy. As water proceeds along waterways, so it is thither that we must go. Let us stand by our faith. Page 171 ancouver enera Hospita THE SOYA BEAN By Miss Marjorie McCullough, B.Sc. Department of Dietetics, The Vancouver General Hospital. The soya bean is indigenous to Eastern Asia and is one of the oldest crops grown by man. It is said to have been grown in China over five thousand years ago and is found mentioned many times in the most ancient books of that country. Today it is still their stable food stuff and is said to appear daily on the table of both Chinese and Japanese, rich and poor alike, in some form or another. Although the bean was introduced into the United States in 1808, scarcely any mention was made of it for one hundred years. Attention was directed to it during the World War when there was an effort to save meat and wheat for the army, but it has been making advancement in the West very slowly, prejudice and custom being among the factors that prevent a people from quickly adopting new food stuffs. In North America the bulk of the soya bean crop is grown in the United States. In Canada the production is limited almost entirely to the Province of Ontario, the total acreage in the Dominion being estimated in 1933 as fifteen thousand acres as compared with one thousand in 1929. The soya bean {Glycine Hispida) is -an annual plant belonging to the family Leguminosae. It has an erect bushy growth varying in height from one to five feet according to variety and season. The branches, instead of growing equally around the stem, as in plants, are developed in one plane like the fingers on a hand. This habit of growth seems to have been fixed through many centuries by the Chinese methods of cultivation. Even though the plants are grown wide apart this flattened habit persists, and if the plant has started from the seed in a way which brings it into a wrong angle with its neighbours it bends itself to get into line, the twist at the junction of the stem and root showing this very plainly when the plant is uprooted. The plant carries heavy foliage and bears auxiliary clusters of very small mauve or white flowers which are self-pollinated. Pods appear in groups of three or four and carry two or three seeds each. They are two to four inches long, following the shape of the Scytho. The leaves are trifoliate and are usually egg-shaped or triangular. Leaves, stems and pods are all covered with fine short hairs, harsh to touch. The leaves turn yellow as the plant approaches maturity and fall off, leaving only the stem and pod. The soya bean has a strong tap root with numerous branching rootlets, a good supply of nodules developing under suitable conditions, these conditions being the presence of bacteria in the soil or direct inoculation of the seed before planting. Its seeds vary in shape and colour according to variety. They may be round or elliptical, and brown, green, black or yellow or combinations of these colours. The soya bean has been found to be adapted to a wide range of soil types but does best on sandy or clay loam, requiring climatic and soil conditions very similar to those of maize—as much sunshine as possible, good drainage, freedom from weeds. The plant is drought-resistant, able to keep alive during the driest weather, and is unaffected by light frosts—factors which should do much to encourage its growth in Western Canada. The value of the soya bean is that it is particularly rich in protein. On analysis it is found to contain approximately (percentages varying with varieties): Protein 44.2 % Phosphorus ~- 1.34% Fat 20.6 % Crude Fibre 4.5 % Carbohydrate 25.0 % Water 8.32% Ash | 3.7 % Page 172 It is because of the high protein content that it is found to be such a valuable substitute for meat, milk and eggs. In the Orient, where these food products are at a premium, especially among the poorer classes, the people have existed on it for centuries. When compared to other food stuffs it has a protein yield of—in the animal kingdom, twice that of meat, three times that of eggs, twelve times that of milk; in the vegetable kingdom, more than three times that of wheat and six times that of bread. It may be expressed as protein in Eggs 3 14.8% Milk , 3.3% Smoked Ham 16.7% Round Steak 20.5% Veal 20.3% Peanuts 25.0-27.0% Walnuts 16.1% Soybeans '. 37.0-45.0% c/„ Lamb 18.8> The quantity of starch and sucrose present varies chiefly in the manner in which the bean is allowed to riped and the time at which the vine is cut. Seed not thoroughly ripened contains more starch than others. Beans thoroughly ripened contain scarcely any starch. Extensive experiments indicate its value as the basis for persons requiring a low starch diet and for many years food companies have had on the market forms of soybean flour for persons requiring a diet of this kind. The carbohydrate in it is almost entirely galactans, hextases and other non-assimilable carbohydrates, and contain but 8.15% possible source of glucose. For these reasons, it seems especially adapted to the diet of diabetics. The bean contains quite a high percentage of phosphorus in the form of lecithin which makes it valuable in cases of nervous disorders. There is also some iron, magnesium and calcium. It is particularly rich in Vitamin D but contains some A, B and E as well. The soya bean is used as a food stuff in almost every stage of its growth. The dried bean is used after the manner of navy or other beans in making numerous palatable and nutritious dishes—baked beans, souffles, soups, etc. To cook the bean, because of low starch content, the addition of a little flour helps to make them nearly like other beans. The texture and flavour of the bean is improved by slow cooking but soaking for twelve hours decreases the time of cooking. The yellow soya bean is best adapted to baking, while the black and green varieties may be served in the form of soup or as a vegetable. In China and Japan the mature bean is seldom used for boiling or baking, but is an ingredient in numerous fermented products such as "miso" and "natto." These are prepared by mixing with other grains and subjecting to the action of bacteria. The bean properly roasted makes an excellent cereal and has been used as a very satisfactory coffee substitute. During the late war, when Germany found herself on the verge of starvation, glutamic acid, produced from the soya bean, was used in German hospitals to form the basis of beef tea. In China the beans are soaked in salt water and then roasted, the product being eaten in the manner of salted peanuts. The green or vegetable beans are very palatable and nutritious when eaten just before the pod is fully developed. The pods are not eaten because they are tough and undesirable, but they are boiled for five to ten minutes to make shelling easier. The green bean resembles the lima bean in flavour more than any other variety and so is served mostly as a vegetable. Soya bean oil is very versatile and can be used in many ways and for many purposes. In the Orient it is used in the crude state, but among the rich it is boiled and allowed to stand until clarified, giving it better texture and a more pleasing flavour. After being thoroughly refined and deodorized it is a very satisfactory substitute for salad and cooking oils and has proved useful in the manufacture of butter and lard substitutes. Soya bean flour may be made in one of two ways—either by grinding the whole bean, preferably the yellow variety, or the press cake after the oil has been removed from the bean. In invalid and infant dietetics soya bean flour has been used for many years in the United States, although as yet it is not a common commercial product. Extensive Page 173 m tests show that it can be successfully used in the making of bread, muffins, biscuits and crackers. When combined with cereal flours the fat of the soya bean prevents the bread from drying so that it remains fresh for days. Bread made with the addition of soya bean flour has a more attractive appearance and contains more nourishing foods than that made with cereal flour mixed with potatoes and other ingredients of the same type, and it has a more pleasing flavour. The flour should not be used by itself but should be combined with wheat flour, the most satisfactory combination being one part soya bean flour to three parts wheat flour. When a lower starch content is desired, a larger proportion of soya bean flour is mixed with some form of gluten substitute for the wheat flour. Recently a patent process soya bean flour under the name of "Soyolk" has been prepared and placed on the market, and is intended for mixture with ordinary flour. Some of our leading bakeries now make Soyolk bread as one of the regular products. If, as it is claimed, its protein is of high biological value, Soyolk is an admirable addition to our food resources. In the use of soya bean flour, the fat in the recipe is either markedly cut down or is omitted altogether because of the high percentage of fat in the flour itself. The products of the flour are of a finer and closer texture than those made with wheat flour. On account of its high food value as well as the palatable products made from it, soya bean flour is finding increasing favour as a food stuff in North America and Europe. Soy sauce, or Shoyu sauce, is a dark brown spicy liquid prepared from a mixture of cooked and ground soya beans, roasted and pulverized wheat, salt and water. It is then inoculated with a culture known as rice ferment and left from six to eight months to ferment. It is used largely by Orientals for cooking, as a relish or condiment, and resembles to a very great extent our Worcester sauce, It is their "dress-up" accompaniment for less attractive dishes. Not only are beans utilized as food, but young and tender sprouts, the soy sprouts, are used as a green vegetable or as a winter vegetable. They are very tasty and have a mild pleasant flavour. One of the staple foods of the people which cannot be dispensed with is milk. It contains in balanced form all the substances necessary for the proper maintenance of th ehuman body. Unfortunately, however, it is very liable to contamination and a great ,deal can be said in favour of a vegetable milk which is germ-free. It has recently been found that soya beans ground, boiled in water and strained, form a milky emulsion which is very similar in appearance and properties to animal milk. This would to Western palates be nauseating, to say the least, so it is put through further refining processes. The perfected milk, known as "Solac," is as smooth as cows' milk and keeps fresh much longer, often for as long as five days. Milk contains a valuable protein known as milk casein—a complex calcium salt containing phosphorus—which on hydrolysis yields amino acids and phosphorus compounds. Soya bean protein is simple protein and its calcium salts behave quite differently from milk casein. It contains glycinin principally, which contains all the essential amino acids and, like milk casein, is able to sustain life. On hydrolysis it yields only amino acids. Both milk casein and soya bean protein are classed as complete foods. Therefore it is possible to substitute soya bean milk for cows' milk from the nutritive standpoint. It is also true that soya bean proteins can replace proteins derived from other animal sources. This fact has been demonstrated in other Asiatic countries where for centuries the Northern Asiatics have grown up largely on a diet of soya beans, cows' milk and meat being rarely used. Solac is much more easily digested than cows' milk and has been very successfully used in infant feeding and as food for invalids. By evaporation it can be reduced to a powder which keeps indefinitely. Attempts have been made to manufacture it on a commercial scale. The milk can be used successfully in cooking as well—for breads, cakes, creamed vegetables, milk chocolates, and custards. The addition of magnesium or calcium salts, or of rennet or lactic acid, to soya bean milk when it is hot precipitates some of the protein, forming a greyish white curd which settles out, leaving a yellowish watery liquid. This curd, after having been drained and pressed, represents bean curd or "tofu," which is extensively eaten and forms Page 174 the basis of numerous fermented, smoked and dried cheese in China and Japan. Bean curd is made daily and is a staple article of diet among Oriental peoples. Attempts have been made to place canned bean curd on the market, but unfortunately have met with little success. Bean curd is a highly nutritious food and no doubt could be elaborated by the Canadian housewife into a variety of palaatble and nutritious dishes. The soya bean has found an important place in industry as well as in the feeding of livestock and poultry. The most important by-product in the former is the qil, which is removed by hydraulic press and also by oil-solvent methods. The United States The uses of the soya bean may be summed up in the following chart: GREEN MANURE 3 < FORAGE PASTURE f HAY ENSILAGE ] SOILAGE [ STRAW f CELLULOID STOCK FOOD FERTILIZER \ HUMAN FOOD GLUE , VEGETABLE CASEIN [ WATER PAINTS GLYCERIN ENAMEL FOOD PRODUCTS VARNISH WATERPROOF GOODS LINOLEUM PAINTS SOAP STOCK CELLULOID RUBBER SUBSTITUTES PRINTING INKS LIGHTING LUBRICATING CORE BINDING CANDLES LECITHIN I Breakfast foods I Diabetic foods | Flour I Infant foods | Macaroni I Crackers I Soy Milk I Bean curd j Soy sauce [ Bean powder f Bread \ Cakes [ Pastry ) Hard soap ( Soft soap JREEN BEANS. DRIED BEANS f GREEN VEGETABLES | CANNED [SALADS f STOCK FEED I SOY SAUCE j BOILED BEANS \ BAKED BEANS SOUPS COFFEE SUBSTITUTE Sheep Cattle Hogs Poultry I Bean curd I Condensed soy milk VEGETABLE MILK R \ Fresh. «>7 milk BREAKFAST FOODS Confections Soy casein I [ Soy milk powder Fresh Dried Smoked . Fermented I Paper size Paints ■{ Textile dressing Waterproofing [ for textiles Page 175 has been foremost in finding uses for the soya oil and it has become a strong competitor of all other vegetable oils. Although it cannot replace linseed entirely it is frequently used as part of the substitute for it. It belongs to the semi-drying group of oils and stands midway between linseed and cottonseed oil. It is becoming increasingly important in the paint industry and is valuable for use in enamels as it has the particular quality of rendering white permanent, as well as having a smooth flow, and giving an elastic film with a smooth gloss. The largest consumers of soya oil in the United States are the soap making and margarine industries. In the manufacture of soft soap, soybean oil serves as an almost complete substitute for linseed oil; but unless it is hydrogenated it can but partially replace cottonseed oil in the manufacture of hard soaps. It yields about ten percent glycerine as a by-product in the manufacture of soaps. It is also employed in the manufacture of printing ink, candles, waterproof goods, cosmetics, creams, cocoa, fountain drinks, various sweetmeats, chocolates, etc., as well as for lighting and lubricating. In the paper industry, it has been found particularly valuable as sizing, marked improvement being obtained in the characteristics of the paper sheet and in its folding strength, as compared with paper made by the use of milk casein. In the manufacture of glue its use is increasing. The glue has much greater adhesive power and in all probability will be used extensively in the plywood industry for laminated boards and boxes, etc. As a result of work done at the Institute of Paper Chemistry, a new water-proofing process has been developed. This is particularly adapted to waterproofing paper and paper containers, etc. In farming operations the plant provides seed, hay and straw of a particularly high standard for all types of livestock and poultry, and excellent pasture and silage. It may be grown as a soil improver for succeeding crops or as a green manure to restore the fertility of poor thin soils. It has been shown that the acclimatized bean will grow in this country, and if crops can be raised profitably on a commercial basis a service will be rendered both to the farmer and to the country. As the farmer becomes educated to the idea of the cultivation of the soya bean, it will, without doubt, become a staple crop here. Continual experiment is being carried on in order to produce the perfect variety for this climate. At the present time the chief difficulty is that it ripens a little too slowly for our own early falls, but it is merely a matter of time until this will be remedied. It has been said, and it seems the truth, that a country growing the soya bean provides for its people, its cattle and its guns. With the memories of the convoyed food ships of the last war, it would be comforting to know that in the soya bean, which provides a green vegetable, flour for bread, and a substitute for meat and milk, we should have an assurance against starvation. REFERENCES Proceedings of the Second Dearborn Conference of Agriculture, Industry and Science. Bowdidge: The Soya Bean. U. S. Dept. of Agriculture: Soy Bean Utilization. Soy Bean. Soy Bean Hay and Seed Production. Use of Soy Bean Flour. How to Cook Soy Beans. Journal of Home Economics: 1918, Vol. 10. Journal of Home Economics: 1917, Vol. 10. Carter: Nutrition and Clinical Dietetics. Hutchison and Matrom: Food and Dietetics. Page 176 HYPERINSULINISM By J. C. Thomas, M.D. With the discovery of insulin in 1922 and the recognition of insulin shock, there came a realization that oversecretion of insulin might occur and might produce a recognizable clinical syndrome. In 1924 Seale Harris in a report suggested that spontaneous hypoglycemia may depend on an overproduction of insulin. He suggested that the condition represented a disease entity with definite symptoms, i.e. those described as being due to hypoglycemia. His conclusions were based on symptomatology alone. Wilder, Allan, Power and Robertson of the Mayo Clinic, in 1927, described such a casce in which a carcinoma of the pancreas of islet cell type had produced such effects. The patient died a month after operation. Two years later, a case was reported by Howland, Campbell, et al in which "dysin- sulinism" was cured by the surgical removal of an islet eel tumour of the pancreas. In a follow-up report 10 years later this patient was alive and free from symptoms. Since that time the number of cases recognized and successfully treated or identified at autopsy has grown to more than 100. In a splendid review of the pathology of islet cell tumours of the pancreas, Duff has analyzed the reports available up to December, 1941. Incidence: Tumours of this type have been found in 1 in 800 or 1000 autopsies but related symptoms have been described in only 20 per cent of these cases. The incidence is somewhat higher in males than in females. Tumours have been found in patients of every decade from the first to the ninth. However, when the cases with hypoglycemic symptoms are considered alone, it is found that the lower age groups are affected. Pathology: The question of malignancy is extremely important as it is in all cases of tumour. Much more study and follow-up will be necessary before definite conclusions are possible on this aspect of the condition. In his review Duff states that malignant islet cell tumours are rare. He tabulates 12 reported cases with tumour metastases, six of which were accompanied by hypoglycemic symptoms, and in three, this syndrome was absent. In the remainder it was not mentioned. As well as tumour, many cases are described in which an increased number of islets in the pancreas together with an hypertrophy of the individual cells appears to be the cause of severe hyperinsulinism. In such cases some cures have been achieved by resection of a large portion of the pancreas, though many have been unsuccessful. Symptomatology: This is the story of hypoglycemic attacks of varying severity but usually progressive. The past history is one of minor attacks of exhaustion or fatigue followed by isolated episodes of more severe nature up to the stages of acute mania, un- oensciousness, or convulsions. Increasing frequency of attacks, together with the volunteered statement that ingestion of food relieves or totally inhibits an attack and a consequent obesity characterize the later course of the disease. In attacks the blood sugar is invariably low; repeated examinations to confirm this are necessary. There is a greater tendency for attacks to occur a long time after food or after exercise. It may be difficult to raise the blood sugar with glucose or too much glucose may initiate another attack. Differential Diagnosis: In considering hyperinsulinism one must, of necessity, survey the field of hypoglycemia. Today the commonest cause of hypoglycemic syndrome is an excess administration of insulin with inadequate supplies of carbohydrate. Hypoglycemia may be found playing a secondary, even an incidental role, in numerous other conditions. A-mong these, liver disturbances (tumour, atrophy, fatty infiltration and poisoning by chloroform, phosphorus, arsenic or alcohol) and muscular dystrophy are associated with impaired glycogen metabolism. Extreme fatigue and infections with excessive use of the available carbohydrate; lactation, pregnancy and renal glycosuria with abnormal drainage of the blood sugar may be causative factors, while a loss or damage to the normal antagonists, such as occurs in diseases of the thyroid, adrenal cortex and pituitary gland, accounts for another group of hypoglycemias. Page 177 Si Functional hyperinsulinism has been described in children and in adults. The patient is, as a rule, emotionally untable. He complains of hunger and weakness, before meals. He will recover without treatment and can fast for twenty or more hours, without symptoms, and maintain a reasonably satisfactory level of blood sugar. His attacks are controlled by diet. In many such cases there is an associated vagotonia. While in mild diffuse hyperinsulinism, dietary treatment may suffice and the patient return to normal, the process in tumour cases is progressive and nothing short of excision of the tumour, will give the patient relief from his symptoms. The following is a summary of a recent case investigated at the Vancouver General Hospital in whom hyperinsulinism is suspected to be due to pancreatic tumour or hyperplasia of islet tissue. A search of the hospital records revealed three previous case histories in which investigation appeared to have substantiated this diagnosis. One of these left hospital requiring three cupfuls of sugar daily to control her reactions. One wonders how the ration board would deal with this problem. Male age 40; occupation, elevator weighman. Height 5 ft. Sl/2 ins. Weight, 169. He was first seen on September 27, 1942. His doctor wrote that he had been under his care since May 31, 1940, when he complained of straining himself playing football. This he described as a twitching in the calves of both legs and a tingling sensation. He was seen again in September, 1940, and from then on at frequent intervals. He has had four or five different collapses or severe attacks. He has noticed that he has had them more often lately, and they are getting more severe. They may now occur as often as twice a day. He has had, one or two, at night. He has noticed that1 he can ward them off with sugar and carries chocolate bars with him, all the time. They are more likely to come on after exercise. He describes a typical attack, as follows: (1) Clumsy with his hands. (2) Convulsions—hands and feet affected—may last for 30 minutes. (3) Relieved or shortened by sugar. (4) Mental confusion—he does not believe he goes unconscious. He believes most of his attacks have been in the afternoon and he changed his supper hour from 6 to 5 p.m. as he found this helped. He had received several types of anticonvulsive drugs with little change in his attacks. He was admitted to hospital for investigation. He was put on a measured diet with 250 gms. of carbohydrate to establish an intake of known value. His fasting blood sugar was 70 mgms. per 100 c.c. He was exercised for an hour without producing a convulsion and his blood sugar was 95 mgms. per 100 c.c. He was given a light meal at 11 a.m. and more exercise at 3 p.m. At this time he showed mental confusion and inco-ordination. At 3.30 p.m. his blood sugar was 40 mgms. per 100 c.c. His symptoms were relieved by glucose. A glucose tolerance test was done at a later date and the blood sugar followed, for six hours. Time Blood Sugar Mgms. Per Cent Fasting 70 Y4 hours - 170 2 hours 1 . 160 3 hours 120 4 hours 50 5 hours 42 6 hours 40 X-rays of the pituitary region were taken and no anomaly was found. Liver function was tested by means of intravenous bromsulphalein: 80% was found in the 5-minute specimen. 5% was found in the 30-minute specimen. Spinal puncture showed no increase in pressure; cell count 5, globulin test negative. Kahn—negative. Page 17% Urinalysis was negative. Physical examination was negative. Blood pressure was 130/90. Pulse 75. Cranial nerves were normal. Reflexes were easily obtained and equal. No disturbances of sensation were found. He returned home with a diet high in fats and protein and 125 gms. of carbohydrate with six feedings. He was advised to use sugar or orange juice if he felt an attack coming on. On November 6th he had a series of four consecutive attacks. The last one was a severe epileptic type of seizure and was witnessed by his doctor: "The muscular contractions knocked over some of the furniture and broke the picture frame on the table. I kept feeding hint sugar and candy and made him drink water. I suppose inside of 15 minutes these had all subsided." Again on November 20th, at about 2.30 p.m., he felt his arms jerk. He took 10 lumps of sugar and a glass of orange juice and the attack passed off. Since the above case was reported the patient was operated on by Dr. Roscoe Graham in February, 1942. He found an adenoma about 1.5 cms. in diameter, lying behind the tail of the pancreas. His convalescence since operation has been happy. His blood sugar has remained normal since he returned to bed following his operation. On March 2, 1942, a glucose tolerance test was done by Dr. Walter Campbell, using 100 gms. glucose. The following are the results: Blood Sugar Time Mgsm. Per Cent Urine Fasting " 95 Negative Half Hour 157 One Hour 13 5 Negative Two Hours 99 Negative Three Hours 80 Negative Summary: A case of hyperinsulinism due to pancreatic adenoma of islet cell type is reported with operative findings. FACTS AND FIGURES Supplied by Dr. A. K. Haywood, Medical Superintendent of the Vancouver General Hospital. We raised our rates by 50c per diem at the start of the War in September, 1939, to cover our increased costs due to increased wages occasioned by Board of Arbitration, Order No. 52 of the Board of Industrial Relations, 8-hour day and 6 -day week requirements of the Government. In this same connection we had losses in revenue of many thousands of dollars per annum due to orders of the Provincial Government respecting per capita grants. The above mentioned increase of 50c per diem did not cover all of our increased costs by a considerable amount, but our deficit at that time was not too far out of line with previous years and with no more increased costs we could* have carried on. However, since that time we find salaries and commodity prices have increased to an extent that we can no longer carry on our operation at the present rates. Payrolls since the time of the last increase in Ward rates are as follows: 1939 $ 1,212,625.97 1940 1,233,53 0.43 1941 _ . 1,278,13 2.64 1942 1,351,664.20 This shows an increase of $140,000 per annum, which is due to two salary increases resulting from arbitration with the employees and increased staff due to the adoption of the eight-hour day. Page 179 Our salaries for the year 1943 are to be increased by a further $100,000.00 due to a new Cost of Living Bonus, an introduction of a system' of meal tickets for nurses and certain other increases for student nurses. Thus our salaries have, in effect, increased by $240,000 between the start of the War and our Budget for 1943. So much for salaries and wages. Now let us examine our budget loss for these years under review: Our operating loss in 1939 was $218,023.44; in 1940, $213,761.16; in 1*941, $174,551.30; in 1942, $211,368.20. Our budgete loss for 1943, $379,000.00. The foregoing figures show that our increased revenues from the greater number of pay patients have taken care of the increased expenses up to a certain point, but now we have reached a stage where our charges, if paid in full, do not meet our operating costs. The increase in rates which has just been announced will increase our revenue by approximately $120,000.00 and we shall still be showing a greater loss than in previous years. Increased commodity prices have also added to our burden and a few items are shown herewith. Comparative Prices of Some Largely-Used Commodities in 1939 and 1943—Vancouver General Hospital Commodity Consumption Price Price Per Year 1939 1943 Beef * 120,000 lb. $ .08 $ .17% lb. Bacon 12,000 | .19 .36 " Table Butter 48,000 " .21'/2- .37 " Milk 96,000 gal. .14 .39 gal. Ice Cream 1,200 " .80 1.20 " Eggs, large 25,000 doz. .21 .49 doz. Coffee 12,000 lb. .15 .26 lb. Tea 10,000 " .30 .66 | Bread 132,000 " .04 .05'/2 " Potatoes 180 tons 26.00 52.00 ton Grapefruit 50 cs. 2.90 4.10 cs. Lemons 100 " 5.00 7.35 " Oranges 400 " 3.00 5.65 " Codfish 24,000 lb. .05 .12 lb. Chicken _ 3,200 " .23 .28 " Paste Wax 1,200 | .21% .25 " Coal, washed pea 9,000 tons 5.90 6.47 ton Fuel Oil 800 bbl. 1.61 2.06 bbl. Soap, 400's, 1 oz 225 cs. 3.20 3.70 cs. Green Band Roch. Jugs, 30s _ 30 doz. 5.76 8.80 doz. Green Band Creamers, 2 oz 10 " 1.18 2.23 " Green Band Worcester Cups —. 60 " 1.50 2.82 " Adhesive Tape, 12x1 .... 15 " 1.75 2.10 spl. Gauze Bandage, 3 in 800 rls. .45 .68 rls. Brunswick Gauze _ 60 M yd. 2.20 3.95 C yd. Mop Cloths 12 doz. 1.10 1.45 doz. Sheets, bleached, 72x104, 1-in. hem, 60 " 14.00 18.98 " Covers, hot water bottle, 12x18 \ 40 " 1.50 1.65 | Gowns, child's 15 | 5.20 5.70 | Pads, bed, 36x36 30 " 10.50 12.75 " Sheets, unbleached, 72x99 .....*..... 800 " 10.80 12.65 " Patients' Gowns 200 " 13.25 15.00 " Doctors' Gowns 200 " 13.45 17.30 " Artery Forceps S.S. B/Xk 36 " 42.00 72.00 " London Lner Syringe, 2 cc. 50 " 5.40 9.60 Cotton, New Era, No. 1 150 lb. .32 .41 lb. Water Bottles 20 doz. 9.50 13.O0 doz. Ice Caps 2 1 12.75 15.95 " White Bond Paper, 17x22x32 200 M 3.84 4.40 M Page 180 GENERAL PRINCIPLES FOR GYNECOLOGICAL SURGERY Paper presented to the Internes of St. Paul's Hospital by A. C. Frost, M.D. 1. Operating Room Requirements for a good operating room—especially arranged and prepared for the purpose. a. Dust free and light from the North. Clean cases kept separate from infected cases. b. Illumination—good—either daylight or artificial. c. Warmth—well heated—72 to 77° F. d. Good air—Instruments boiled outside in a separate room—for preparing patients and for the dressing of doctors. e. Sterilizing technique—is known to you all. f. Technique of Hand Disinfection—10 minutes, Furbinger technique. 2. Preparation of Patient for gynaecological operation. Better to have patient in hospi tal for 48 hours or more. a. Voiding—It is wise to have woman patients practise voiding lying down—in bed pan—because this is a post-operative nuisance, owing to the incision, trauma of the bladder. b. Older Patients—One of the dangers to elderly patients after operation is hypostatic pneumonia. This danger is greatly decreased if the body is used to bed rest for several days previous to operation. c. Bath—Skin irritation and shaving. 1. Bath tub if possible. 2. Never apply compresses of disinfectant solution over the operative site as this may cause skin irritation. 3. Evening before poeration shave the pubic and perineal area. d. Mucous Membranes—Teeth should be kept clean to avoid danger of pneumonia following anaesthesia. e. Vaginal Discharge—if any, daily douches of permanganate or weak formaldehyde or acriflavine to reduce the number of pathogenic micro-organisms. Contraindications for gynaecological surgery—Acute Gonorrhoea—Leukorrhcea, Ulcers of Vulva—Menstruation. f. Evening before operation: Enema to evacuate the bowel. This is imperative. The food the day before should have little residue—meat is best for this purpose. Avoid vegetables, potatoes, and even milk. g. Immediately before operation: All gynaecological cases should be catheterized to make sure the bladder is empty. 3. Doctor's part in Preparation of Patient: 1. The Respiratory System: The lungs should be examined carefully. If bronchitis, operation should be postponed owing to aspiration of infection followed with broncho-pneumonia: as you know, this is a dangerous post-operative complication. If they have bronchitis, treat with saline inhalations with 10 gtts. of adrenalin chloride to the litre. By mouth—expectorants—with a little digitalis, helps. If one has to operate in the presence of bronchitis, local or spinal anaesthesia should be used. T.B. may progress very rapidly after operation. 2. Mouth, Nose, Throat and Sinuses: Mouth—(oralsepsis); Throat (tonsillitis)—avoid operation—owing to danger of pneumonia and its consequences. Page 181 ■Ml 3. Veins of the Patient: Must be inspected for varicosities in the extremities. Owing to the slowing of blood flow, thrombosis may easily develop in the varices. Thrombosis is also increased by operative injury. The great danger of thrombosis is the sequel of embolism which often results in death. Great care must be taken to avoid post-operative thrombosis. Women with varicosities may be given digitalis the day before operation to stimulate cardiac action. During the operation—avoid the compression of legs with the knee and leg holders—must be well padded. Keep the patient elevated as short a period as possible. Watch that the second assistant does not rest his arms on the patient's thighs. This may produce compression of the veins in the popliteal space. It is sometimes wise to continue cardiac stimulants after operatoin and the legs kept slightly elevated from the start. Sponge rubber also for arms to prevent ulnar nerve injury. Loss of Blood—Women who have lost much blood either before or after operation have the same tendency to the development of thrombosis as those who have varicosities of the legs. There is no sure preventative measure. 5. Skin Lesions—Furunculosis, etc., are poor risks. If chronic lesions—no contra-indication (psoriasis, etc.). 6. Shock—Prepare with gum acacia and blood transfusions before operation.— Plasma. Be sure that systolic blood pressure is above 100 before operation.— Blood protein and haematocrits. 7. Heart.—Young patients with compensated valvular lesions usually do well under anaesthesia. If there are evidences of decompensation, they should be rested in bed and well digitalized. Decompensation following mitral stenosis makes the patient a poor risk. To test the cardiac reaction—either Valvular or Myocardial: After sitting up and lying down in bed several times, cardiac insufficiency will be indicated by an increase in respiration and pulse rate and a fall in blood pressure: Whereass A normal heart will show a slight change in respiration and pulse rate with an early increase in blood pressure. 8. The Urinary Tract:" The urine must be carefully examined for the presence of renal or bladder disease. Nephritis, if acute, is contra-indication. Hypertensive cardio-renal disease—even the simplest operation is serious. Must be carefully prepared by internist before operation. Essential hypertension—a high systolic blood pressure in the absence of cardiac or renal disease is no contra-indication. Cystitis must be treated before operation, owing to the fact that oil gynaecological operations are carried out in close proximity to the bladder. The compli- catins from cystitis may be ascending infection in the renal pelvis, pyelitis. If the test shows renal insufficiency, a renal function test should be made. Operative trauma and anaesthetics must be reduced to a minimum to be conducive to early and comfortable recovery—Force intravenous glucose post-oper- atively in large amounts in young people—more sparingly in aged and obese. 9. Nervous System: Common in gynaecological patients. These are overcome with adequate doses of luminol or nembutal or sod. amytol—eveningn before and repeat at 6 a.m. the morning of the operation. Epilepsy is no contra-indication. One must give sufficient hypnotics post- operation. Page 182 10. Patient's General Condition must be checked: The following must be carefully watched: a. Elevated temperature is contra-indication—Force fluids, ice caps to abdomen; Sulphathiazole—and wait.—I.V. glucose. b. Watch for high-grade anaemia, pernicious ancemia, leukemia, diabetes, Addison's disease, enlarged thymus, sedimentation rate—these are all poor risks. All ancemias are prepared by saline and blood transfusions. Leucocytosis—if leucopenia—is a poor risk. All pernicious anaemias—by liver therapy. c. Diarrhoea patients are poor risks—this should be controlled before operation. d. Obesity—poor risk—more p.o. complications—heart p.o. complication or embolism. e. Diabetics—Control of blood sugar by insulin injections. f. Syphilis—if positive—should have pre-operative treatment, if possible. g. Hyperthyroidism—Lodge doses of sedative and oidine before and after operation. De-hydration must be corrected before operation. 4. Preparation of Patients: Trendelenberg is the usual gynaecological position. It is ideal because: a. It allows abdominal viscera to fall away from the lower abdomen against the diaphragm, leaving the pelvis empty. b. It allows the secretion from the nose, mouth and trachea to flow toward the pharynx, and kept from being aspirated into the lungs. c. Also prevents anoemia of the brain; which sometimes occurs during anaesthesia. Disadvantages of this position: 1. Kroske and Duhrssen state that in fat people they have observed cases of acute cardiac dilatation in patients with chronic myocarditis, apoplexy and ileus, by the pulling and twisting of the colon. For this reason, put the patient up in Trendelenberg position gradually and keep up as short a time as possible. The table should be brought back to horizontal position before closing the wound, so that the operatr may cntrol visually the return of the intestines to their norma position. 2. Danger of thrombosis—important—the entire body weight should not be borne by the leg holders, owingn to pressure on popliteal veins and the development of thrombosis. Trendelenberg position is used in Vaginal Operations. The legs flexed at hips and kneed abducted. Horizontal position—Appendectomy and hernia. 5. Preparation of the Field of Operation: 1. Cleaned as thoroughly as hands of operator. 2. Skin, after washing with soap solution and with ether, is painted- with iodine benzine mixture, which consists of tr. iod. 5 cc, liz. petrolatum 50 cc, and benzine q.s. to make 500 cc for a 5 min. period. Page 183 Watch red-headed women for sensitive skins. These are often followed with marked inflammation and may affect healing of perineal wound. Danger—it may be wise to use tr. iod. '5% instead of 10%. Be careful that solutions do not run down back. 3. Be sure to catheterize the patient before all gynaecological operations. 4. Drape a patient for vaginal operation—in Trendelenberg. Sterile covers over abdomen and under buttock. Then a sterile linen sheet with slit 60 cm. in the middle of its longitudinal axis. This is spread out so that it covers between the knees and legs, patient's body, lower abdomen and pelvic outlet, so that the slit exposed the external genitals only. The Gynecological Wound: 1. Must be handled with care and gentle manipulation to avoid lowering the healing resistance to the tissues. It has been demonstrated that the injection of 1 cc of a culture of staphylococcus into normal tissues was absorbed rapidly, while the same injection caused an abscess if a disturbance of the circulation was produced in the area of injection by the introduction of a mass ligature. 2. Too many sutures lower the vitality of the ligated tissues. By shutting off the blood supply, they are deprived of the protective elements of the blood. Often the origin of a wound infection may be traced to a ligature stump. 3. Every cut which is not essential to the operation, unnecessarily injures the tissues. 4. Anatomic Orientation: The better one knows his anatomy, the easier and the quicker will be be able to recognize the anatomic structures and thus produce less injury and disturbance in wound healing. 5. Technique: Is an important factor in all gynaecological operations as in all operations, because the healing of the wound will depend upon the technique of the operator. Sponges should not be used to mop the wound more often than necessary. No more retractors than are needed should be used to pull and bruise the tissues. The operator should not use his hands for the dissection. It is done much neater and in a more elegant fashion with instruments. Never leave large stumps in the operative region. Vessels should be isolated before tying to avoid this. All bleeding vessels should be ligated or twisted. All dead spaces to be avoided, because these are sure to cause serum collections. If the wound is not dry, if dead space cannot be obliterated, then drainage is better. The operator must operate with great care and certainty. Good wound healing may be produced by good operative technique. Page 184 Standardized LIVER EXTRACT HEPAROL eIs HEPAROL E.P.S. is standardized according to the method of the Anti-anaemia Advisory Board of the U.S.P. to contain 4 U.S.P. injectable units in each ampoule. A Standardized Liver Extract for Intramuscular Injection, containing 4 U.S.P. units in each 2 cc. ampoule (2 units in each cc). REGENERATIVE TREATMENT This Standardized Liver Extract enables the physician to treat nutritional types of macrocytic anaemia, Addisonian pernicious anaemia and the anaemia of pregnancy with fore-knowledge of the result to be expected. As the patient receives a specific amount of the anti-anaemia fraction of liver in each Heparol ampoule, it is unnecessary for him to consume large amounts of liver in his diet and the advantages of administering a highly active material in sufficient amounts by a single route at regular intervals, are obvious.- I I MAINTENANCE 1 | I I After regeneration has been accomplished, the normal blood picture may be maintained by less frequent injections of Heparol, which render the ingestion of large quantities of liver, for maintenance, unnecessary. HYPOCHROMIC ANAEMIA Many patients suffering from hypochromic anaemia respond to a combined treatment with liver and iron. In these cases, in addition to the intramuscular injection of Heparol E.B.S., it is advisable to prescribe Ferrochlor with Vitamin JBi, a preparation which exhibits iron in the form in which it is most readily assimi lated by the system, without gastric disturbance. HEPAROL AMPOULES E.B.S. are supplied in convenient boxes of 6's and 12's. FERROCHLOR with Vitamin Bi is supplied in two convenient forms: Liquid; and Tablet (S.C.T. #338A). Identify these products on your prescriptions by inserting the letters E.B.S following the product name. THE E. B. SHUTTLEWORTH CHEMICAL CO. LIMITED TORONTO MANUFACTURING CHEMISTS CANADA Ntttm $c 5ty0m0fltt 2559 Cambie Street Vancouver, B.C. HUM 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 toxic waste. LYXANTHIME ASTIER administered per os, brings about improved cell nutrition and activity, increased elimination, resulting symptom relief, and general functional improvement. Since the best evidence is clinical evidence, write for literature and sample. Canadian Distributors ROUGIER FRERES 350 Le Moyne Street, Montreal COLONIC AND PHYSIOTHERAPY CENTRE Up-to-date Scientific Treatments COLONIC IRRIGATIONS, SHORTWAVE DIATHERMY, SINNEWAYE GALVINISM, IONIZATION, ULTRA VIOLET RAY, STEAM BATHS AND SHOWERS Medical and Swedish Massage Physical Culture Exercises STAFF OF GRADUATE NURSES 1119 Vancouver Block Superintendent E. M. LEONARD, R.N. Post Graduate Mayo Bros. MArine 3723 Vancouver, B.C. echve rtn CAMPBELL & SMITH LIMITED 820 Richards Street • Vancouver, B.C. • PAcific 3053 uccessful management of high blood pressure calls for a regimen which is adjusted to individual requirements. Physical activity is generally curtailed and overwork is avoided. In certain circumstances special diets are prescribed and the use of stimulants is restricted. These measures are often supplemented with the administration of Theominal. This combined vasodilator and sedative aids in reducing blood pressure to a more normal level. As a consequence hypertensive symptoms are relieved and the risk of complications is reduced. DOSAGE: The customary dose of Theominal is 1 tablet two or three times daily; when improvement sets in the dose may be reduced. Each tablet contains theobromine 5 grains and Luminal* Vfc grain. ^^ , •Luminal (trademark), Winthrop Chemical Company, Inc., brand of phenobarbital. Supplied in bottles of 25,100 and 500 tablets. CHEMICAL COMPANY INC. Pharmaceuticals of merit for the physician General Offices: WINDSOR, ONT. Professional Service Office: Dominion Square Building, Montreal, Que s*~ ■£> r J A LIFT NOW ■/r M* \ mm 7 Today when the work of all Canadians is contributing in some measure to Canada's war effort, the health-building role of the physician in his community has become increasingly important. The government's nutrition campaign is a forward step but such a programme of mass education is invariably a slow process. Meanwhile a "lift" is needed now to reduce absenteeism and to overcome fatigue. When a deficient diet is a causative factor,. "Alphamin" will prove an ideal supplement. One capsule and one "comprill" daily is the recommended dosage. 127 A balanced preparation of essential vitamins and minerals. THERAPEUTICALLY SOUND • PHARMACEUTICALLY CORRECT AYERST, McKENNA & HARRISON LIMITED, Biological and Pharmaceutical Chemists, MONTREAL, Canada Personalized G-E Field Service Is Not Only For The Duration # To users of G-E x-ray and electromedical apparatus, the maintenance service rendered by factory-trained men in G-E's local branches and regional service depots is increasingly important these days. And they are getting it despite many of the handicaps which war restrictions impose. For many years this personalized field service has been available to G-E customers everywhere, who have come to recognize it as a prime requisite to the continued satisfactory operation of all high-grade technical equipment. That's why G-E Field Service functioned before the war and will continue, on a still larger scale, in the peace years to come. Perhaps you've heard about "P.I. and A"—G-E's Periodic Inspection and Adjustment Service—which, incidentally, was not inspired by the exigencies of war, but for thirteen years has helped physicians, hospitals, and clinics to keep their x-ray and electromedical apparatus in tip-top operating condition. To become better acquainted with these service facilities provided for your immediate vicinity, you need only to get in touch with one of the following G-E headquarters offices or regional service depots. You'll find the G-E representative who calls on you a reliable source of helpful suggestions. VICTOR X-RAY CORPORATION of CANADA, Ltd. DISTRIBUTORS FOR GENERAL #1 ELECTRIC X-RAY CORPORATION /;/ Canada this competent maintenance and technical service is extended through the following Victor offices and service depots: MONTREAL, QUE. 600 Medical Arts Bldg. QUEBEC CITY, QUE, P. O. Box 84 HALIFAX, N. S. 37 Deacon St. TORONTO, ONT. 30 B/oor St., West OTTAWA, ONT. 454 Holland Ave. WINNIPEG, MAN. Medical Arts Bldg. REGINA, SASK. 82 Angus Crescent CALGARY, ALBERTA 43? 14th Ave., N. E. EDMONTON, ALBERTA 11511 97th St. VANCOUVER, B. C Motor Transp. Bldg. 570 Dunsmuir St. %&e* t&tt 3u* - ft?** Savutft Cktificet* S^S^^BSSS JUST 3 SIMPLE STEPS INVOLVED IN CLINITEST THE NEW TABLET URINE-SUGAR TEST 5 drops urine phis 10 drops water. That is all • Q Drop in tablet. Compare with color scale. TIME—Less Than One Minute I DEPENDABLE—The Clinitest Tablet Method employs a modification of Benedict's copper reduction method, retaining the familiar progression of colors from blue through green to orange, indicating sugar at 0%, K%, 3^%, %%, 1% and 2% plus. ECONOMICAL—Complete set (with tablets for 50 tests) retails to the patient for $2.00. Tablet refill (for 75 tests) —$2.00. Clinitest Urine-Sugar Test and Clinitest Tablet Refill are available through your surgical supply house or prescription pharmacy. Write for full descriptive literature. EFFERVESCENT PRODUCTS INC. Sole Canadian Distributors 1-$*- FRED. J. WHITLOW & CO., LTD., 187 DUFFERIN STREET, TORONTO 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 A k normal menstrual cycle. • MARTIN H. SMITH COMPANY 8&k ISO LAfATITTI STCEET. NIW TOM. N. T. W Full formula and descriptive literature on request Dosage: l to 2 capsules 3 or 4 times daily. 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. Jlecd Calck Checked WITH 3 DROPS IN EACH NOSTRIL . . . PRIVINE"Ciba" (1:1000 solution of 2—(naphthyl—l^methyl)-hnidazoline hydrochloride) MASAL DROPS U Clinical investigations on Privine Nasal Drops have proved that they are excellently suited for the treatment of all forms of nasopharyngeal affections. In head colds, a few moments after the instillation of 3 drops of Privine in each nostril, the headache and sensation of heaviness in the head disappear, while the nasal respiration becomes easier, the watering of the eyes stops, the voice regains its normal tone and the sense of smell is restored. ISSUED: In bottles of Vz ounce with dropper, and bottles of 4 ounces. CIBA COMPANY LTD. Montreal 4 <&„ ,4 ^fe. m$0^ ^ m ^fSSSHP ^pteienti ■fl Complete Su.tt5tltu.te FOR THE THERAPEUTIC EFFECTS OF COD LIVER OIL ewoaat NO OBJECTIONABLE TASTE OR ODOUR As a nutritional supplement Ostogen-A has many advantages over fish liver oils. It has no disagreeable taste or odour; does not cause gastric disturbances; is easily administered in drop doses; and is very economical—costing your patient but a cent a day if prescribed in the larger size. OSTOGEN-A: 500 VITAMIN D Units per drop. 1000 VITAMIN A Units per drop. DOSAGE: One to three drops daily from precision dropper. MODES OF ISSUE: 6 cc. bottle—78 days' supply. 15 cc. bottle —195 days' supply. THE CANADIAN MARK OF QUALITY PHARMACEUTICALS SINCE 1899 Ovade* &§&ooot&(Sb. MONTREAL CANADA WHERE QUALITY AND PRICE ARE EQUAL OR BETTER PRESCRIBE CANADIAN PRODUCTS flDount {pleasant TilnbertaMng Co. !lLtb. KINGSWAY at 11th AVE. Telephone FAirmont 0058 VANCOUVER, B. C R. F. HARRISON W. E. REYNOLDS 13 th Ave. and Heather St. Exclusive Ambulance Service FAirmont 0080 PRIVATE AMBULANCES AND INVALID COACHES WE SPECIALIZE IN AMBULANCE SERVICE ONLY J. H. CREL.LIN W. L. BERTRAND Sxifenof o£ Titan, Oleum percomorphum 50% is now known as Oleum Percomorphum 50% with Viosterol. This product consists of the liver oils of percomorph fishes, viosterol, and fish liver oils, a source of vitamins A and D in which not less than 50% of the vitamin content is derived from the liver oils of percomorph fishes (principally Xiphias gladius, Pneumato- phorus diego, Thunnus thynnus, Stereolepis gigas and closely allied species). To conserve vitamin A supplies during wartime, capsules of Mead s Oleum Percomorphum 50% With Viosterol now contain 83 mg. of oil, equivalent to 5,000 vitamin A units and 700 vitamin D units per capsule. The new size capsule is now supplied in boxes containing 48 and 192 capsules—about twice the number of capsules without increase in price to the patient. Contrary to rumors, the potency remains the same; namely 60,000 vitamin A units and 8,500 vitamin D units per gram* MEAD JOHNSON & CO. OF CANADA, LTD, BELLEVILLE, ONT. For Complications As Old As Time IF NEED for stimulation of tabor ■ arises in delivery rooms, obstetricians often rely upon Pitocin*, an oxytocic of many'advantages and de* pendable performance. Pitocin consists of the oxytocic principle of the posterior pituitary gland with practically none of the pressor hormone. Its extremely low protein content so minimizes possibility of systemic reaction that many physicians prefer Pitocin for routine management of obstetric patients. Pitocin is indicated for stimulation of uterine musculature in uncomplicated obstetrics, increasing tone of the uterus by direct action. It is widely used in uterine inertia during the second stage and to check uterine hemorrhage* a product of modern research offered to the medical profession by <ca^ &\ PARKE, DAVIS & COMPANY WALKERVILLE, ONTARIO * Trade-mark Reg. Neutral pH Non* Irritating Stable Solution Indications Coryza Rhinitis Sinusitis Nasal Congestion with obstruction Naso-Pharyngitis, etc. wrm FPMFDPINF offers special advantages as a local application in infections of the nose, throat and ear. The solution is neutral in reaction, a great advantage over solutions of sodium salts of the sulphonamide derivatives, which are generally of high alkalinity and unsuitable for local application. In the combination of Soluseptazine with Ephedrine, the vasoconstrictor action of the latter drug tends to delay the dispersal of the active agent into the general circulation, thereby inducing a more prolonged local anti-infective action of the Soluseptazine. Soluseptazine with Ephedrine may be applied by dropper tube, by atomizer or by means of swab or tampon. Presented in bottles of 30 c.c. and 250 c.c. JLaJ/Trixdtxnjj I aujuutjc j%£/LeA OF CANADA LIMITED — AfO/Vr/?£4£ For Healthy Bodies The medical profession today unhesitatingly recommends pure whole milk as the complete food for all ages. From a midmorning snack to a midnight bite, it's "Just what the Doctor ordered." Keep an ample supply on hand at all times and laugh at Father Time's futile effort to mark you. Be sure your milk and cream is from carefully selected, tested herds, and reaches you with a minimum of delay—pasteurized, of course. MILK CREAM BUTTERMILK aSBSSSi Victory on the j|p|. but war news is not half so important as any one of the hundreds of Doctors' prescriptions that are continually handled by our Pharmacists. The war has made so many ingredients harder to obtain, but you can depend on us to dispense every prescription as you want it. Phone MArine 4161 yr^M^c &Jh*d**A»*\ GEORGIA PHARMACY t_ t V« I T C D (E? nter $c if anna ICti ESTABLISHED 1893 VANCOUVER, B. C. North Vancouver, B. C. Powell River, B. C. ^2. t^jN/rfr <Eo. CimttFH New Westminster, B. C. For the treatment of NEUROPSYCHIATRY DISORDERS Reference—B. C. Medical Association For information apply to Medical Superintendent, New Westminster, B. C. or 721 Medical-Dental Building, Vancouver, B. C. PAcific 7823 Westminster 288 >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: March, 1943
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