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History of Nursing in Pacific Canada
Vancouver Medical Association
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THE ULL TI OF The Vancouver Medical Association EDITOR dr. j. h. MacDermot EDITORIAL BOARD DR. D. E. H. CLEVELAND DR. J. H. B. GRANT DR. H. A. DesBRISAY DR. J. L. McMILLAN Publisher and Advertising Manager w\ E. G. MACDONALD VOLUME XXVIII JUNE, 1952 NUMBER 9 Dr. D. S. Munroe V ice-Pres ident Dr. J. C Grimson Past President Dr. J. H. Black Hon. Secretary OFFICERS 1952-53 Dr. E. C. McCoy President Dr. George Langley Hon. Treasurer Additional Members of Executive: Dr. G. R. F. Elliot Dr. F. S. Hobbs TRUSTEES Dr. G. H. Clement Dr. A. C. Frost Dr. Murray Blair Auditors: Messrs. Plommer, Whiting & Co. SECTIONS Eye, Ear, Nose and Throat Dr. B. W. Tanton \ Chairman Dr. John A. Irving Secretary Paediatric Dr. Peter Spohn Chairman Dr. John W. WmTELAW-Secretary Orthopaedic and Traumatic Surgery Dr. A. S. McConkey- Chairman Dr. W. H. Fahrni Secretary Neurology and Psychiatry Dr. R. Whitman Chairman Dr. B. Bryson Secretary Radiology Dr. R. G. Moffat Chairman Dr. II. Brooke Secretary STANDING COMMITTEES Library Db. J. L. Parnell, Chairman; Dr. D. W. Moffat, Secretary; Dr. A. F. Hardyment ; Dr. W. F. Bie ; Dr. R. J. Cowan ; Dr. C. E. G. Gould Co-ordination of Medical Meetings Committee Dr. J. W. Frost Chairman Dr. W. M. G. Wilson Secretary Summer School Dr. J. H. Black, Chairman; Dr. J. A. Irving, Secretary; Dr. B. T. H. Marteinsson ; Dr. Peter Spohn ; Dr. S. L. Williams ; Dr. J. A. Elliott Medical Economics Dr. E. A. Jones, Chairman; Dr. G. H. Clement, Dr. W. Fowler, Dr. F. W. Hurlburt, Dr. R. Langston, Dr. Robert Stanley, Dr. F. B. Thomson Credentials Dr. W. J. Dorrance, Dr. Henry Scott, Dr. J. C. Grimson V.O.N. Advisory Committee Dr. Isabel Day, Dr. D. M. Whitelaw, Dr. R. Whitman Representative to the Vancouver Board of Trade: Dr. D. S. Munroe Representative to the Greater Vancouver Health, League: Dr. W. H. Cockcroft Published monthly at Vancouver, Canada. Authorized as second class mail, Post Office Department, Ottawa, Ont. Page 293 IN LIVER DAMAGE Mm W&mMK:3kz. Tssauuprst MEON1NE joss w»snf * aiw««« j Supplementation with Meonine adds flexibility to the dietary regimen MEONINE . . . easy way to give added methionine It is difficult to get a sick person to consume a highly nutritious diet1 . . . and anorexia is a prominent feature of liver disease. MEONINE . . . reduces work required of liver Recent research suggests that excessive dietary protein may impose a burden on critically ill patients.2 MEONINE helps maintain the detoxifying activity of the liver, and is an efficient lipotropic agent. INDICATIONS: Liver damage due to malnutrition, alcoholism, pregnancy, allergy, or chemo-toxins. 1. Delia Pietra, A.: New York State J. Med., 49:263, 1949. 2. Editorial: JAMA., 144:1566 (Dec. 30), 1950. SUPPLIED: TABLETS MEONINE: 0.5 Gm., Bottles of 100 and 500, CRYSTALLINE MEONINE for preparation of parenteral solutions, bottles of 50 Gm. MEONINE dl-METHIONINE WYETH JOHN WYETH & BROTHER (CANADA) LIMITED WALKERVILLE, ONTARIO Registered Trad* Mark Page 294 VANCOUVER MEDICAL ASSOCIATION PROGRAMME FOR THE FIFTY-THIRD ANNUAL SESSION Founded 1898; Incorporated 1906 The Regular Monthly Meetings of the Vancouver Medical Association are discontinued for the summer months, but will be resumed in October. VANCOUVER GENERAL HOSPITAL Regular Weekly Fixtures in the Lecture Hall Monday, 8:00 a.m.—Orthopaedic Clinic. Monday, 12:15 p.m.—Surgical Clinic. Tuesday—9:00 a.m.—Obstetrics and Gynaecology Conference. Wednesday, 9:00 a.m.—Clinicopathological Conference. Thursday, 9:00 a.m.—Medical Clinic. 12:00 noon—Clinicopathological Conference on Newborns. Friday, 9:00 a.m.—Paediatric Clinic. Saturday, 9:00 a.m.—Neurosurgery Clinic. ST. PAUL'S HOSPITAL Regular Weekly Fixtures 2nd Monday of each month—2 p.m Tumour Clinic Tuesday—9-10 a.m. '&M Jl- Paediatric Conference Wednesday—9 -10 a.m mm Medical Clinic Wednesday—11-12 a.m Obstetrics and Gynaecology Clinic Alternate Wednesdays—12 noon J|_ Orthopaedic Clinic Alernate Thursdays—11 a.m Pathological Conference (Specimens and Discussion) Friday—8 a.m. Clinico-Pathological Conference (Alternating with Surgery) Alternate Fridays—8 a.m Surgical Conference Friday—9 a.m . Dr. Appleby's Surgery Clinic Friday—11 a.m Interesting Films Shown in X-ray Department Page 295 lip oc^ope is a complete combination of officially accepted and clinically proven lipotropic factors. 1941 Inositol had its role in accelerating the removal of cholesterol shown, and in 1944 its value in preventing fatty livers was demonstrated. Gavin & McHenry, J. BioL Chem., 739, 485, 1941. Eddy and Dalldorf The Avitaminoses, Williams & Williams, Baltimore 1944. 1946 Cystine was shown to have lipotropic action particularly in combination. A. J. Beams, J.A.M.A., 130.190, Jan. 26, 1946. 1947 Choline was officially accepted for inclusion in the N.N.R. as a lipotropic agent. J.A.M.A., 135:16, 1073, Dec. 30, 1947. 1948 Methionine was officially accepted for its lipotropic activity. J.A.M.A., 139:6, 430, Oct. 6,7948. Through the recent studies of Golfman and others, additional light on the subject of hypercholesterolaemia is be obtained tending towards verification of the assumption that a combination of the lipotropic factors with adequate amounts of essential B complex factor; constitutes the best treatment. Lipotrope is the most potent and most complete combination of these factors available. Bottles of 50 and 250 tablets or capsu Write for further information and Low Cholesterol diet sheets. 1952 marks for Rougier Freres the beginning of their second fifty yea of devotion to medical advance through ethical specialties of therapeut excellence. ougier x rereSy ^ lemoyne street. Montreal i Page 296 SHAUGHNESSY HOSPITAL Regular Weekly Fixtures Tuesday, 8:30 a.m.—Dermatology. Wednesday, 10:45 a.m.—General Medicine. Wednesday, 12:30 p.m.—Pathology. Thursday, 10:30 a.m.—Psychiatry. Friday, 8:30 a.m.—Chest Conference. Friday, 1:15 p.m.—Surgery. BE BRITISH COLUMBIA CANCER INSTITUTE 685 West Eleventh Avenue, Vancouver 9, B.C. SCHEDULE OF WEEKLY CLINICAL MEETINGS Monday—9 a.m. - 10 a.m Ear, Nose and Throat Clinic Tuesday—9 a.m. - 10 a.m Weekly Clinical Meeting of Attending Medical Staff Tuesday—10:30 a.m. - 11:30 a.m Lymphoma Clinic Daily—11:45 a.m. - 12:15 p.m .Therapy Conference B.C. SURGICAL SOCIETY Spring meeting—April 25th, 26th, 1952. EXCLUSIVE AMBULANCE LIMITED EM. 2266 NW. 60 4V j^SSSft!SSS««PS5^St^J«»»K « mm«4* OXYGEN THERAPY SUPPLIED ON YOUR ORDER 24 HR. SERVICE J. H. CRELLIN W. L BERTRAND Page 297 antibiotic decongestive treatment of sinu Neo-Synep Penicillin Since most of the organisms responsible for sinusitis belong to the penicillin-sensitive group,1 this antibiotic is well suited for topical therapy in this condition.2 For penicillin to be effective, however, it should be applied frequently and in adequate concentration to the diseased area. Application of Neo-Synephrine aids in accomplishing penetration of the antibiotic by reducing nasal congestion 3 Neo-Synephrine® Penicillin is supplied in combination package (with diluent) fo make 15 cc. of 0.25% Neo-Synephrine HCI solution containing 10,000 units of penicillin in 1 cc. —■ •— """ 1. Putney, J. F.: Sinus Infection, in Conn, H. J.: Current Therapy 1951. Philadelphia, W. B. Saunders Co., 1951, p. 71. 2. Craig, S. L: New York State Jour, Med., 49:181, Jan. 15,1949. , 3. Woodward, F. D., and Holt, T.: Local Use of Penicillin in Infections of the Ear, Nose and Throat. JAMA., 129:589, Oct. 27,1945. ^/(/A^t^-O^a^e^ or CANADA. LID WINDSOR. ONTARIO For Dual Control of the Common Cold, Allergic Rhinitis, Vasomotor Rhinitis and Sinusitis... Neo-Synephrine Thenfadil* Decongestant Antihistaminic Nasal Solution Bottles of 1 fl. oz. containing Neo-Synephrine hydrochloride 0.25% and Thenfadil hydrochloride 0.1%. Neo-Synephrine, trademark reg. U. S. & Canada, brand of phenylephrine Thenfadil, trademark reg. U. S. & Canada, brand of N,N-dimethyl-N'-(3-thenyl)-N'-(2-pyridylJ ethylenediamine hydrochloride 443 SANDWICH STREET WEST, WINDSOR, ONTARIO Page 298 VANCOUVER HEALTH DEPARTMENT | STATISTICS—APRIL, 1952 Total population—census figure (final) . 344,833 Chinese population I 7,117 Other—census figure _ 788 April, 1952 Rate per Number 1000 pop. iTotal deaths (by occurrence) 418 14.5 [Chinese deaths __= 19 32.0 Deaths, residents only 362 12.6 Birth Registrations—residents and non-residents (includes late registrations) Male _ : Female April, 1952 Number * 493 462 955 33.2 Infant Mortality—residents only Deaths tinder 1 year of age Death rate per 1000 live births Stillbirths (not included in above item) CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY Scarlet Fever Diphtheria - Diphtheria Carriers Chicken Pox Measles j Rubella Mumps Whooping Cough Typhoid Fever * Typhoid Fever Carriers Undulant Fever Poliomyelitis Tuberculosis Erysipelas Meningitis Infectious Jaundice Salmonellosis Salmonellosis Carriers Dysentery $ * Dysentery Carriers Tetanus Syphilis Gonorrhoea Cancer (Reportable Resident) April, 1952 ses Deaths 11 52 April, 1951 Cases Deaths 82 — 38 1 1 10 1 4 — 2 — 2 — 16 1 170 — 88 37 Page 299 { CONNAUGHT> HEPARIN Clinical experience in the use of Heparin as a blood anticoagulant has extended over many years. The product has been administered intravenously in very dilute solution. Recent experience has shown that intramuscular injection of concentrated solutions is an effective means of prolonging clotting time. This method of treatment provides an increased measure of freedom for the patient and can be extended over a period of months on the basis of two or three daily injections. HOW SUPPLIED Solution of Heparin—Distributed in rubber-stoppered vials as sterile neutral solutions of heparin prepared from purified, dry sodium salt of heparin containing approximately 100 International Units per mg. The product is supplied in the following strengths: 1,000 International Units per cc. 10,000 International Units per cc. Heparin (Amorphous Sodium Salt)—Dispensed in 100-mg. and 1-gm. phials as a dry powder, containing 95 to 100 International Units per mg., for the preparation of solutions for laboratory use. Recent References: Stats, D., and Neuhof, H.: Am. J. Med. Sci., 1947, 214: 159. Walker, J.: Surgery, 1945, 17: 54. Cosgriff, S. W., Cross, R. J., and Habif, D. V.: Surgical Clinics of North America, 1948, 324. De Takats, G.; J.A.M.A., 1950, 142: 527. S + + + CONNAUGHT MEDICAL RESEARCH LABORATORIES University of Toronto Toronto, Canada Established in 1914 for Public Service through Medical Research and the development o£ Products for Prevention or Treatment of Disease. DEPOT FOR BRITISH COLUMBIA MACDONALD'S PRESCRIPTIONS LIMITED MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. Page 300 «7<4e Zditotb Pcufe We have been reading a series of articles, written by Mr. Sam Katz, in the latest Maclean's Magazine, on the "High Cost of Being 111." It is a very ambitious effort, and takes in the Doctors, the Hospitals, and the Health Plans. The articles are readable, and contain much that cannot be gainsaid—but we question very much if they make any contribution to the subject, of any value. They attempt to cover too much ground. A good deal of the article on the doctors is given up to the personal and ethical failings of some of the profession. This really has very little to do with the 1 cost of medical care and is outside the subject discussed. We may assure Mr. Katz that the profession as a whole is well aware of these things, and all over Canada is working j to remedy them, as only it can do. But they make the article readable, we suppose, and are good padding anyway. We do not believe that this sort of article is of much value. It ignores almost | entirely, or passes lightly over, the fundamental causes of increasing costs of medical care—causes the vast majority of which are beyond our control. The fact is, that i the dollar of to-day has only half the purchasing power of the dollar of twenty or thirty years ago—and the medical profession is caught in this net of rising prices and falling dollar values, as is every other profession and industry. A good case might be argued to show that we should really be charging much more than we do. The next thing is that the high cost of medical care works both ways. Medical | care costs the patient more, yes: but it costs the doctor much more to render it than 1 it used to do. His education costs much more—his office expenses are more than i doubled—his equipment costs very much more—and apart from these things, his cost j of living, housing, etc., have risen, as have everyone else's. If he is to live decently, dress suitably, drive a car, raise a family, he must have an adequate income. In the next place the increased cost of medical care is partly due to the great | increase in the quality of medical care available, and this has increased tremendously i in the past two or three decades—with marked results in the saving and prolongation j of life, in vastly better general health conditions. But these things cost money, a I great deal of money, But would those who object to the cost be willing to do without ! these things? We doubt it. We believe that these things above justify, to a great : extent, the increases in the cost of medical care. Good medicine cannot be cheap, and cannot be adequately given on any mass production basis, whose only virtue is its cheapness. Consider Great Britain, where the cost of medical care on a mass basis threatens the national budget—ask New Zealand, where we are told the health insurance plan i absorbs 25 percent of the national income taxes. Lastly, we wonder again why the medical profession is picked on as the arch- criminal in this matter of rising costs. What other profession (except the Church, of course) or business is there where costs have not risen as much or far more than they have in medical care? Is Mr. Katz going to write on the high cost of plumbing or of legal advice, or the high cost of dying? There are scores of articles that might be written in this vein,_and we should like very much to see them. This sort of article tends to create or increase resentment and criticism—and is of very little value, in our humble opinion. Some of the best minds in the community are working on this problem, quietly and objectively, and we think that more can be done in this way than by vague, diffuse writing which, in trying to say everything, ends by saying very little that is of value. Page 301 Library Hours during the Summer Months: Monday to Friday 9:00 a.m. - 5:00 p.m. Saturday 9:00 a.m. - 1:00 p.m. "To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all." —William Osier. Recent Accessions Dejong, R. N., The Neurological Examination, incorporating the fundamentals o Neuroanatomy and Neurophysiology, 1950. Graham, E. A. (editor)—The Yearbook of General Surgery, 1951. Harnett, W. L., A Survey of Cancer in London, British Empire Cancer Campaign, 1952. (gift). Howard, M. E., (editor), Modern Drug Encyclopedia, 5th edition, 1952. Penick, S. B., & Co., (Research Division), Bacitracin, 1952. (gift). Schoenewald, F. S., (compiler), English-German Medical Dictionary, 1951. Surgical Clinics of North America—Symposium on Basic Sciences in Surgical Practice, New York Number, April, 1952. Thornton, J. L., Medical Books, Libraries and Collectors, 1949. Wangensteen, O. H., (chairman)—Proceedings of the Forum Sessions, 37th Clinical Congress, American College of Surgeons, November, 1951. Watson-Jones, R., Fractures and Joint Injuries, Vol. 1, 4th edition, 1952. Symposium on Isotopes in Medicine An excellent symposium on the above subject appears in the latest issue (Vol. 8, number 2-3, 1952) of the British Medical Bulletin which is published by the Medical Department of the British Council in London. The contributors to the symposium are leading authorities in well-known research institutions in Great Britain. The publication may be seen in the Vancouver Medical Association Library. Supplements to the Acta Medica Scandinavica No. 261—Renal Regulations of the Extracellular Fluid II—Renal Physiology in Electrolyte Subtraction by Denton, D. A., Wynn, V., McDonald, I. R. and Simon, S. No. 262—Proceedings of the XXII Scandinavian Congress for Internal Medicine held in Helsinfors, 1950, by E. Adelcruetz. No. 263—Aseptic (nonbacterial— Encephalomeningitides in Gothenburg, 1932- 1950, by L. Afzelius-Alm. No. 264—Studies on Renal Hyperlipemia by Alvar Svanborg. No. 265—Myopthia Distalis Tarda Hereditaria by L. Welander. No. 266—Papers on Medicine and the History of Medicine dedicated to Erik Warburg, M.D., Professor of Internal Medicine, University of Copenhagen. Page 302 Recent Articles Published by Members of the Vancouver Medical Association Appleby, H., The Hush of Retirement. S.G.O. 94:628-629, May, 1952. Fratkin, L. B., Potassium Deficiency in Surgical Patients. West. Jl. S.G.O. 60:168- 174, April, 1952. Gibson, W. C, The Second International Poliomyelitis Conference—a summary C.M.A.J. 66:69-713 January, 1952. Also book review on The Selected Writings of Sir William Osier, Jl. Hist. Med. and Allied Sciences 7:191-192, Spring, 1952. Harrison, Elliott and Cockcroft, W. H., Evaluation of Newer Techniques in the Surgical Scrub. C.M.A.J. 66:110-112, February, 1952. Hebb, F. J., Forgotten Fundamentals. Manitoba Med. Review, 32:247-249, April. 1952. H| Hunt, C. L., Syphilitic Cardiovascular Disease. C.M.A.J. 66:324-328, April, 1952. Jackes, H., Fulguration of Malignant Lesions of the Rectum. Treat. Serv. Bull. 7:157-165, AprU, 1952. Mcintosh, H. W. and Phinney, J. I., Further Observations on the Intravenous Use of ACTH. C.M.A.J. 66:569-571, June, 1952 Minnes, J. F., The Therapeutic Evaluation of Cortisone applied topically in Ophthalmic Diseases. C.M.A.J. 66:342-347, April, 1952. Robinson, H. S., Palmer, R. A., Bagnall, A. W. and Mcintosh, H. W., Observations on the Physiological Effects of Cortisone and ACTH. C.M.A.J. 66:347-352, April, 1952. Shea, M. B., and Tanton, B. W., Anaesthesia for Fenestration. C.M.A.J. 66:154- 156, February, 1952. Wilson, R. A., Effect of ACTH on Hair Growth in Alopecia Areata and Universalis—preliminary communication. Lancet 1:646-647, March 29, 1952. Wilson, R. A. and Cockcroft, W. H., The Problem of Penicillin Resistant Staphylococcal Infection. C.M.A.J. 66:548-551, June, 1952. Regarding the opening of the new B.C. Cancer Institute by the B.C. Cancer Foundation—October 6th to 10th, 1952 Plans are being made for a programme of lectures dealing with all aspects of the cancer problem. These lectures will be given mornings and afternoons at the Cancer Institute by a group of distinguished specialists, including Sir Stanford Cade and Professor B. W. Windeyer from London, England. Additional guest speakers will be Dr. S. T. Cantril and Franz Buschke of Seattle and Dr. O. H. Warwick of Toronto. Additional contributions will be given by Dr. Evans and others on the staff of the Cancer Institute as well as some contributions from members of the Attending Staff of the Vancouver General Hospital. The chief speakers are Sir Stanford Cade, Surgeon to Westminster Hospital, London, and Professor B. W. Windeyer, Professor of Radiology, University of London and Director of the Meyerstein Institute of Radiotherapy, Middlesex Hospital. The University is giving honorary degrees to Sir Stanford Cade and Professor Windeyer at a special convocation on Thursday, October 9th. This will be followed by a tour of the Cancer Institute and a tea given by the Women's Auxiliary. That evening, Thursday, October 9th, at 8:15, in the Ballroom of the Vancouver Hotel, the official opening ceremonies will be held. Principal speaker will be the Honorable Paul Martin, Minister of National Health and Welfare. Representatives of the Provincial Government will also be asked to speak and an appropriate programme will be arranged. Page 303 Vancouver Medical Association President . \ Dr. E. C. McCoy Vice-President Dr. D. S. Munroe Honorary Treasurer j Dr. G. E. Langley Honorary Secretary , k Dr. J. H. Black Editor Dr. J. H. MacDermot SUMMER SCHOOL, 1952 - REGISTRATION DOCTORS Agnew, A. M. Armitage, T. F., North Vancouver. Armstrong, W. T., Vernon. Arthur, J. F. Austin, W. E. Balfour, J. Barkman, B. G., Abbotsford. Barner, H. D. Beaudoing, L., New Westminster. Bell, S. A. Black, Howard. |||| Blair, Murray. Blair, N. J. Borden, R. P., Langley. Brown, C. E. Burke, Gordon. Campbell, C. G. Caple, H. H. Chan, G. H. Chipperfield, L. S., New Westminster. Christopherson, E. Clement, George. Cluff, J. W. Cork, J. F. Cowan, R. J. Collison, D. B. Davidson, G. A. Davis, H. R. L. Davies, J. R. Day, E. E. DeMuth, O. DesBrisay, H. A. Dixon, A. E., Mission Doyle, P. J. Dumont, H. Duncan, A. C. DuVernet, E. A. Division of T.B. Control (2) Division of V.D. Control (1) Earl, M. Eaton, C. M. Evans, S. Evans, W. G. Fahrni, B. M. Fleck, Elizabeth. Found, N. P., Kelowna. Fox, M. Francis, G. Frost, A. C. Frost, A. C. G. Frost, J. Page 304 Frost, M. Gale, R. A., Victoria. Ganshorn, J. Garner, M. K. Garner, R. W., Port Alberni. Gilchrist, R. A. Gould, Grant. Grant, J. H. B. Green, K., New Westminster. Greenberg, A. B. Grimson, J. C. Halperin, M. Hardie, Margaret. Harrison, J. E. Heffelfinger, R. M., Coquitlam. Henderson, H. A. Henderson, W. E., Chilliwack. Herstein, A. Hobbs F. S. Hogg, R. J. A., White Rock. Hunt, Leigh. Inglis, H. F., Gibsons Ireland, J. A. J|gg Johnson, A. M. Johnson, E. A. Johnson, F. D. i Kaplan, S. Keith, W. D. Kelly, J. K. Kennedy, H, Cloverdale. Kerr, I. M., New Westminster. Kerr, Robert. Kerster, G. G. King, D. M. Kirkjatrick, G. J. Krivel, H. Lamont, G. A. Lang, J. W. Lawrence, G. Langley, G. E. Lawson, J., New Westminster. Lehmann, Peter. Leeson, Lavell. Levine, M. Levson, H. Lewison, E. Lindenfeld, E. Manson, A. B. Marteinsson, B. T. H. Mason, L. V. Matthews, G. O. Mathias, G., New Westminster. ^Milburn, H. H. Millar, R. D. pfillar, S. M., Whangarei, N.Z. Minorgan, G. A. Morse, P. W. Morrison, M. Moscovich, B. McAfErey, F. McAffrey, J. A. gfcAffrey, R. P. McCoy, E. C. McDonald, D. C. McDonald, R. J. MacKay, B. K., Kamloops. McFetridge, S. "A. McKenna, L. V. "McKenzie, F. D. McLaren, R. McLaughlin, G., North Vancouver. McLean, Keith. McLennan, J. M. McMaster, S. MacMillan, J. L. McMurchy, A. McNab, J. A. McNair, A. Y. ■ McNeill, C. G., North Vancouver. Neufeld, W. P. Nicholson, M. A. Olacke, F. Paige, Bruce. Palmer, R. A. Parnell, J. Paterson, Donald. Patrick, H. L. .Patterson, F. P. Paulin, Stanley. Peacock, Elaine, North Vancouver. Pedlow, A. Porter, J. A. Preston, F. C. Provincial Mental Health Services Essondale (4) Rennie, C. Ritchie, J. B., Regina, Sask. Robertson, C. E. Robinson, G. C. Sadler, Olive. Schom, C. Scott, Henry. Shallard, B. Simpson, W. W. Sinclair, J., New Westminster. Skelhorne, G. P. Skullyfi H. J., New Westminster. Smaill, D. Smith, G. lHy Sochowski, J. Spohn, Peter. Stanley, R. A. Stansfield, H. Steiman, I. Stanwood, D. A. Stevenson, E. M. Stockton, Harold. Stoffman, I. W. Story, J. B. Strohan, R. E. Sylling, M. F. Tanton, B. W. Taylor, W. R. Telford, Lyle. Telford, K. Therrien, E., North Vancouver. Thomas, J. C. Thompson, J. W. Trapp, Ethlyn. Treffrey, C. J. Trites, A. E. Trowbridge, E. B. Turnbull, W. L. Turner, A. S. Verhoeff, D., New Westminster. Wackenroder, H. Waldie, A. Walker, W. Wall, M. D. Wallace, A. W. Walsh, G. Warren, A. J. Watson, Gerald. Whaley, T. R. White, J. V. Whittaker, K. W. Wilks, W. E. Willits, R. E. Williams, S. L. Wilson, G. B., North Vancouver. Winbigler, H. Wynne-, J. R. W. (R.C.A.F.), Sea Island. Workmen's Compensation Board (3 tickets) Young, A. K. Zimmerman, J. The Regular Monthly Medical Meetings of the Vancouver Medical Association are discontinued for the summer months, but will be resumed in October. WANTED A part-time physician is required for the British Columbia Cancer Institute. Salary according to qualifications. Apply to the Medical Director of the British Columbia Cancer Institute, 685 West 11th Avenue, Vancouver 9, B.C. - Page 305 PECTUS EXCAVATUM (FUNNEL CHEST) Peter E. Rees-Davies, F.R.C.S. (Eng.), F.R.C.S. (C) Read before Vancouver Medical Association Summer School, June, 1952. The deformity known as funnel chest is distinguished by a bizarre nomenclature depending upon the language used. Chone koilosternia is the Greek; pectus excavatum, meaning hollow chest, is the Latin; Trichterbrust, German; Thorax en entonnoir, French; pectus infundibuliforme, and several more. The simple English funnel chest seems to describe the condition satisfactorily and is the term which will be used here. Funnel chest is a congenital deformity of the thoracic cage where the sternum and costal cartilages are depressed. The greatest depth of the hollow is at the xiphi-sternal joint and is accompanied by mal-development of the ventral aspect of the diaphram. In extreme cases the sternum may be within two or three centimetres of the vertebral bodies. Modern interest in this condition dates from the end of the last century when a few cases were reported by the Austrian and German schools. The first description of the condition is attributed to Bauhinus1 in 1596, by Ochsner and DeBakey2 in their detailed review of the literature. This physician observed the condition in a seven year old boy. His description of the causative pathology differed in no way from that given today. The sternum or breast bone (sternon - breast) is described in three parts. The manubrium (handle) is the upper triangular part articulating with the clavicles and first and second costal cartilages. It is fixed in position and connected to the gladiolus by a cartilaginous joint which fuses in old age. The gladiolus (sword) or body consists of four segments in cartilage which fuse during youth and articulate with 2-7 costal cartilages. The xiphoid (shaped like a sword) consists of cartilage with a core of bone which becomes ossified late in life and fuses with the gladiolus some time during middle age. A careful study of the anatomy of funnel chest by Brown3 has produced a rational explanation of the cause of the condition. He found that the fascial fibres of the linea alba extend upwards on the posterior aspect of the sternum as a strong band which he has named the substernal ligament. This ligament is intin^ately related to the two strips of diaphragm which originate from the back of the xiphoid process and are inserted into the central tendon of the diaphragm. In addition the diaphragm has fleshy strips arising from the lower six costal cartilages and first three lumbar vertebrae. It has been observed that the apex of the funnel is always at the xiphi-sternal joint. The structures which produce this depression are the two strips of origin from the diaphragm mentioned above. It is found that shortening of these^slips is the cause of the condition. Later a deformity of the costal cartilages and ribs occurs which becomes permanent. The condition occurs in about one in sixteen thousand of the population2 and in the ratio of four males to one female. True funnel chest is a congenital deformity and is frequently familial. Various causes of the deformity have been put forward. 1. Adnormal or deficient development of the sternum and costal cartilages. 2. Intrauterine pressure by a limb upon the sternum. 3. Respiratory obstruction as from enlarged tonsils and adenoids. 4. Nutritional deficiency such as rickets. 5. Trauma, either single severe injury or a series of small ones. 6. Inflammatory disease and adhesions in the mediastinum. 7. Hereditary syphilis. 8. Faulty posture. While any of these may be contributory factors, they are not in themselves sufficient to produce the condition. Page 306 iffe Brown3 in 1939 showed the condition was caused by congenital shortening of the sternal position of the diaphragm which is intimately connected to the xiphoid cartilage, substernal ligament and linea aspera. He based his surgical correction on this anatomical premise and obtained good results. The diaphragm is developed in four parts; anteriorly from the septum transversum, laterally from the pleuro-peritoneal membranes, posteriorly from the dorsal mesentery. These form the muscular components arising from the periphery of the bony thoracic outlet to be inserted into the central tendon. It is a property of muscle that when it contracts its origin is fixed and the pull is transmitted to its insertion. On inspiration these muscular portions contract, the central tendon is depressed but no tension is exerted on the.bony origin. In funnel chest it is found that there is faulty development of the musculo-sternal portion of the diaphragm, and when inspiration occurs the xiphi-sternum is drawn in causing paradoxical respiration, the degree of retraction being proportional to the degree of muscular deficiency in the anterior diaphragm. As the child grows older the retracted xiphi-sternal point fails tto return to its natural position, the costal cartilages become deformed and the sternum remains depressed. After the age of three the deformity becomes permanent.4 It has ben shown that other deformities of the thorax, pigeon chest, costal asymmetry and Harrison's sulcus can be traced to mal-development of the corresponding portion of diaphram. Symptoms are usually lacking in the early stages. The child is brought to the doctor by the parents because of the obvious deformity. Later, as the deformity increases and becomes fixed, symptoms arise as a result of pressure and distortion of the underlying viscera. Interference with the cardiovascular system produces a variable degree of embarrassment. If the heart is pushed aside, usually to the left, the effects of pressure are small but the great vessels become distorted. If the heart is held in the midline by the sterno-pericardial ligaments, its intake and output is more seriously interfered with and heart failure results. This explains the puny, hyposthenic appearance of some of the children affected. Systolic murmurs may be heard but are of little significance. Arrhythmias and paroxysmal tachycardia occur. Electrocardiograms may show axis deviation from rotation of the heart and inversion of the "T" wave. The symptoms complained of may be undue fatigue, palpitation, shortness of breath on exertion and precordial pain. Compression of the lungs can decrease the respiratory excursion and affect the vital capacity. This may give rise to cyanosis, dyspnoea specially on exertion and predispose to respiratory infection such as tuberculosis and bronchiectasis. There is considerable phychological effect on sufferers when they attain school age. Any unsightly variation from the normal is commented upon and causes misery to the child. Futhermore, in these days of contracting bathing dresses, even inflatable gay deceivers are a poor substitute for the genuine article. In the past this condition has been recognized and dismissed. The sufferers, with a few exceptions, have seemed able to adapt themselves to normal life. Pathological conditions can result and in the same way as he who has never loved does not know what he has missed, so the funnel chested who has never had a normal exercise tolerance does not know what it is- to be normal. The treatment is correction of the deformity, and can only be achieved by surgery. An operation is required which will restore normal function and correct deformity. The restoration of function is of prime importance. Up to two or three years of age the deformity is mobile and has not yet become permanent nor has it caused any symptoms. The indication for operation at this age is to prevent the deformity from becoming permanent. Its correction, therefore, presents a simpler problem than in the older patient whose malformed chest has become permanently ossified. Page 307 The first operation was performed by Meyer in 1911.° He excised part of the second and third right costal cartilages in a sixteen year old boy suffering from tuberculosis. Other procedures followed in which various costaal cartilages and parts of the sternum were incised or removed. These results were not very successful, the deformity was either uncorrected or it recurred. An attempt was then made to obtain elevation by attaching wires to the depressed sternum after freeing its attachments. Later that end was achieved by the insertion of bone grafts. Up to 1938 some thirty- two operative procedures had been employed with various results.2 In 1939 Brown3 described the anatomy of the condition and basing his surgical attack on these anatomical principles laid the foundation for the present day methods. There are two procedures which give good results when properly applied. These are phrenosternolysis and chondrosternoplasty.4 Phrenosternolysis is a procedure applicable to infants up to about two years of age. At this time the deformity is reversible and can be corrected by this comparatively simple procedure. Through <a curved transverse incision over the xiphisternal joint the midpart of the rectus muscles reflected from the lower costal cartilages which are often resected. The xiphoid cartilage is brought to view and excised; the attachment of the diaphragm to the xiphoid, substernal ligament and lower costal cartilage is divided. This is all that is necessary in infants up to two years. A further refinement is to suture the divided diaphragm and rectus muscles together. Chrondrosternoplasty is indicated in older patients where the deformity has become fixed. An incision is made in the midline from the level of the angle of Louis to the distal edge of the xiphoid cartilage. The pectoral muscles are reflected laterally and the rectus abdominis turned down from the lower costal cartilages. Portions of the lower costal cartilages are then removed, the number involved depending on the degree of deformity, usually the third to the seventh inclusive on both sides. About 1 cm. is removed including the maximum curvature. The xiphoid is brought to view and may be removed. The attachment of the diaphragm to the posterior aspect of the xiphisternal region is divided. The sternum can then be raised, keeping in mind the underlying pericardium and pleura. A horizontal wedge of bone is then cut from tie manubrio-gladiolar junction. This is secured by a couple of wire sutures, thus angu- lating the gladiolus into the corrected forward position. A piece of gelfoam is inserted behind the sternum if there is any oozing from intercostal vessels and the pectoral muscles across the midline. In patients with marked deformity a costal cartilage graft may be inserted between the lower costal cartilages to maintain the sternum forward in its corrected position. The post-operative course is usually uneventful and the patient goes home in about eight days. There have been a considerable number of funnel chests treated surgically. Upwards of a hundred are recorded in the literature, and while the results of the earlier methods had their failures the vast majority obtained relief of symptoms. , In order to assess results the patients should be divided into two groups: the older patients with fixed deformity and definite symptoms; and infants without obvious symptoms. In the older group the restoration of function is good even where the correction of deformity has left something to be desired. Perhaps with the newer operative techniques this too will be improved. In the infant group where there are no physical complaints before operation the parents invariably proffer the information that the child now has far more energy. In fact it is usually the parents who now complain. <M Description of four cases operated on by Dr. Appleby now follows. L.W.—Aged 15 months. The mother of this child states that her grandfather and uncle were similarly deformed. Both were great sportsmen, the one was an engineer and the other served in the American Army, neither was inconvenienced by the condition as far as she knows* Page 308 The mother noticed On examination. Fluoroscopy. Electrocardiagram. Operation. January, 1951. Post-operative. Re-examination. May, 1952. Fluoroscopy. Electrocardiogram. nothing abnormal about the child apart from the depressed chest. Moderate degree of funnel chest becoming marked on crying. The heart was compressed at the lower margin, there was paradoxical respiration, the cardiac ratio was greater than the thoracic ratio. Heart enlarged to both right and left. Sternum moderately depressed. Normal. Lower four costal cartilages removed. Substernal ligament divided. Sternum elevated. Osteotomy at manubrio-gladiolar junction was performed and fixed with one silk suture. Gelfoam inserted. Uneventful. Mother states that child has unbounded energy. Well healed scar and practically no depression over chest. Heart and breath sounds are normal. Normal heart. Sternum in good position. Normal. Fluoroscopy. Electrocardiogram. Operation. December, 1951. D.P.—Aged 6 years. This boy's mother states that she noticed nothing abnormal about him apart from the depression of the chest. She did, however, think that he was not as well developed as other boys of his age. On examination. This boy was puny, thin and poorly developed. He was below standard for boys of his age. The sternum was depressed; approximately one and a half inches. He had paradoxical^ respiration. B.S. and H.S. are normal. The heart slightly rotated to the left on the long axis and in the left oblique anterior position the apex extended well beyond the spine. Suggested myocardial damage. Probably early intra-venticular block. Left axis deviation. Vertical incision. Excision lower four costal cartilages on each side. Division of the xiphisternal joint and substernal ligament. Cuneiform osteotomy of the manubrio-gladiolar junction. Two wire sutures inserted to hold gladiolus forward. Gelfoam inserted. Uneventful. The mother volunteered the information that she has noticed a tremendous increase in the boy's energy. She thinks that he has benefited considerably in that he is stronger and she thinks he is now the equal of other boys of his age. He has a well formed sternum.. There is no depression. His respiratory movements are normal. The lungs have a full excursion. B.S. normal. H. S. normal. No depression of sternum. Lordosis of mid dorsal spine due to pull from abnormal dorsal diaphram. Mediastinal contents, heart and lungs normal. Pa3e 309 Post-operative. Re-examination. May, 1952. Fluoroscopy. Electrocardiogram. S.E.—Aged 7 years. The father states On examination. Fluoroscopy. Electrocardiogram. Operation. Post-operative. Re-examination. Fluoroscopy. Electrocardiogram. Post-op. Must less left axis deviation. No evidence of myocardial damage now present. ^0& that the child became tired easily after exercise. Marked depression of sternum—maximum at xiphisternal junction. There was limitation of respiratory excursion. B.S. normal. The heart rate is increased, the heart is enlarged towards the mid-axilliary line. There is a systolic murmur. There is no cardiac embarrassment. Some rotation of heart as shown by prominence of left border. Little ossification in lower two segments of gladiolus so it is difficult to judge position of sternum. Normal. Midline incision—lower 4 costal cartilages on either side removed. Xiphisternal joint and substernal ligament divided. Elevation of gladiolus and separation of pleura and pericardium. Cuneiform osteotomy at manubrio-gladiolar junction with two wire sutures. Gelfoam and skin closure. Uneventful. The father states there has been marked improvement in her general health. She can carry out any exercise now without fatigue which would before have made her unduly tired. The xiphisternal depression has been corrected but there is some residual depression of the mid gladiolar region. Respiration is normal with a full excursion. Cardiovascular system is normal. Exercise tolerance is normal. There is a slight depression of lower portion of sternum. Slight widening of cardiac shadow. Some straightening of left border of heart suggesting correction of distortion. Normal. D.B.—Aged 14 years. This boy states that he became short of breath and felt tired more easily than he should. Fluoroscopy. Electrocardiogram. Operation. October, 1951. There is moderate depression of the sternum—mostly between level of sixth rib and xiphoid. Cardiovascular and respiratory systems show no abnormality. Little abnormality of heart seen in antero-posterior, may be slight enlargement. Lateral shows sternum depressed and curved. Right axis deviation. Midline incision. Lower 4 costal cartilages on each side removed. Xiphisternal joint divided. Substernal ligament divided. Gladiolus elevated from anterior mediastinum. This mobilisation was very much more difficult than in the younger patients, the costal cartilages, ligaments and their attachments being much stronger and more adherent. There Page 310 Before operation After operation Post-opera tive. Re-examination. Fluoroscopy. Electrocardiogram was greater adhesion tc the pleura and pericardium. The substernal and pericardial ligaments are stouter and more difficult to dissect. The pleura was opened on the right side. This region was packed with gelfoam. The cuneiform osteotomy was carried out and sutured with wire. Right pneumo and haemothorax with medistinal shift to the left. He now states he is much improved since the operation. He no longer gets short of breath and does not feel tired. He plays all the usual games and does as well as the other boys of his age. Respiration—normal. Cardiovascular system—normal. Depression of sternum; some widening of cardiac shadow with straightening of border of heart. Right axis deviation. No significant change, although function has been improved there is little correction of deformity. This has been a short review of funnel chest with a brief report of four patients treated surgically. In our limited experience operation in the older subjects is more difficult owing tot he inacessibility of the xiphisternal region which has become firmly displaced inwards. The costal cartilages and ligaments which have to be removed or mobilised are very much stronger and more adherent to pleura and pericardium. Page 311 It is suggested the lessons to be learned are, that while surgical correction should be advised, this should be carried out between the ages of on to two years, when the operation is simple, the results are good and the sequelae of the deformity are avoided. BIBLIOGRAPHY 1. Banhinus, Joh. Observationum Medicavim, Francfurts. Liver II, Observ. 264 p. 507. 2. Ochsner and DeBakey. Chone - chondrosternon. J. Thor. surg. 8. p. 469. 1939. 3. Lincoln Brown. Pectus Excavatum (Funnel Chest) J. Thor Surg. 9. p. 164. 1939. 4. Henry Brodkin. Congenital Chondrosternal Depression. Diseases of the Chest. XIX p. 288 1951. 5. Meyer "Ludwig. Zur chirurgischen Beh and luna der angeboren en Trichter brust, Vertraudl d. Berl med. Gesellsch 42. 364. 1911. ATTENTION — EX-SERVICE MEDICAL OFFICERS It is with pleasure that the opening of the 12th Fd. Amb. Officers' Mess at the new R.C.A.M.C. Armoury, 963 West 27th Ave., is announced. We hope that as many ex-service medical officers as possible will become acquainted with this reserve army mess and the units now located in the armoury. Associate mess membership may be granted to: (1) Former unit M.O.'s, officers of R.C.A.M.C. and R.C.A.S.C. (Med); (2) All officers of R.C.A.M.C.—active, supplementary or reserve; (3) All M.O.'s of R.C.N. and R.C.A.F.; (4) Medical officers of all services of allied countries Visiting membership may be extended to reserve M.O.'s of all services, and to internes who are veterans. It is hoped that this mess will fill a long felt need in this area. With your support it is possible that this accommodation will provide a meeting place of the medical fraternity for professional as well as purely military business. You are invited to make an inspection during training hours—Mondays, 8-10 p.m.— or direct enquiries to any member or the undersigned. C. E. Robinson, Major, W. H. Sutherland, Major, Mess President. Officer Commanding, 12 Fd. Amb. DOCTOR'S OFFICES 1 AVAILABLE NOW Well populated area on outskirts of city. Apply Publisher, Bulletin of the Vancouver Medical Association. MArine 7729 675 DAVIE ST., VANCOUVER, B.C. Page 312 RETROLENTAL FIBROPLASIA John A. Irving, M.D., CM/' Retrolental Fibroplasia is a new eye disease of premature infants. It is a disease in which changes take place in the vessels and in the retina, which results in its severe forms, in complete retinal detachment, so that a greyish membrane forms behind the lens, giving the pupil a grey, opaque appearance. It may cause complete loss of sight. The history of this disease is of great interest. In one large medical center in the United States, the earliest case that investigation revealed, from records, questioning of older staff men, etc., occurred in 1937. In 1942 Terry of Boston began reporting on a new bilateral disease of premature infants which he called retrolental fibroplasia because he believed the condition was related to the persistence of the fetal vascular system of the eye, which resulted in a mass of connective tissue behind the lens. This term retrolental fibroplasia is now accepted and used by everyone in speaking of this new disease, but the name, until 1949, implied a variety of pathology to different investigators, mainly various anomalies of the fetal vascular system. In early 1949, two investigators at Baltimore described the onset and course of the disease in 25 cases, and established that it is not present at birth, that it is not congenital and has nothing to do with the fetal vascular system. Their findings were confirmed by other men, and retrolental fibroplasia now means a serious eye disease which develops in premature infants whose birth weight is generally under 4 lbs., and which was largely unknown prior to 193 8. In the 10 years, before 1948, 700 to 1200 cases had been seen in the United States. One half of these were discovered in medical centers in Chicago, New York, Boston and Baltimore. It is estimated that one-half of all pre-school blind children in the United States are cases of retrolental fibroplasia. In this province, the Canadian National Institute for the Blind have the names of 43 pre-school blind children, and 29 of these are listed as retrolental fibroplasia. In Boston the incidence of the condition from 1938 to 1942, in premature infants under 3 lbs. was 20.4%. In 1943-47 the incidence in the same weight group was 26.3%. In the same city in the 3-4 lb. group, prior to 1943, the incidence was 1.7%, and from 1943-47, it was 20%. In Baltimore, the incidence for premature infants under 3 lbs. before 1944, was 0%, and 1945-47 it was 12.1%. Some cities of the United States have had few if any cases, and very few cases have been reported from Europe. It is known that the incidence in various hospitals in one city may differ greatly, which is true of Vancouver. The earliest observable signs of retrolental fibroplasia occur from 3 to 5 weeks after birth, as early as the second week in some cases. It apparently does not begin to develop in infants older than three months. The early signs are dilatation of the retinal veins, an increased tortuosity of the retinal arteries, and small or large retinal or preretinal hemorrhages. This is followed by oedema of the retina, localized or generalized, and by the formation of new vessels on the surface of the retina or in the vitreous, which becomes cloudy. The retina then becomes detached, and the membrane behind the lens is formed by retina and connective tissue changes in the vitreous. If the membrane behind the lens is complete, all vision is lost. Later changes are adhesions of the iris to the lens, and pressure of the lens and iris into the anterior chamber, which may cause glaucoma. The active phase of the disease, that is up to the formation of the retrolental membrane, stops between the third and fifth month. The later stages are due to contraction of previously formed fibrous tissue. Both eyes are always affected, but not always to the same degree. During the acute phase the process may stop, at least up * Presented at regular Staff Clinical Meeting of V.G.H. September 25th, 1951. * Read before monthly staff Meeting, Vancouver General Hospital, October 23 rd, 1951. Page 313 to the detachment of the retina, and possibly partial retinal detachment will be replaced, leaving varying evidence of the condition. There are many degrees of severity, and affected eyes may be completely blind, or show only localized areas of detachment, or folds of the retina, or be myopic with areas of irregular pigmentation. Various degrees of vision are the result. Retrolental fibroplasia must be differentiated from pseudoglioma, which is the result of an acute inflammation of the interior of the eye often associated with diseases like meningitis, retinoblastoma which is a primary retinal tumor, and congenital anomalies of^the fetal vasulcar system. The latter occur in full term infants, and generally one eye only is affected. Retinal dysplasia is another condition which is bilateral, occurring in small eyes, and malformations are present elsewhere. There is no satisfactory treatment of retrolental fibroplasia. There seems to be no definite proof that ACTH affects the course of the disease, and. Vitamin E has been disappointing in the hands of all investigators except at Johns Hopkins. Retrolental fibroplasia is a disease which is of great interest to the ophthalmologist, the pediatrician, the obstetrician, and the community, and its cause is a complete mystery. At first glance one would think that available statistics concerning increase of incidence in certain places and certain years, which correspond to the adoption of newer techniques, formulas, etc., in the care of premature infants, would lead to discovery of the cause, but apparently investigation along these lines has proved nothing. Concerning the care of the infant, it seems to make no difference if Vitamin A and D are given, or in what medium they are given. Infants getting Vitamin E or alpha-tocopherol acetate from birth have developed severe forms of the disease. Anoxia, asphyxia, hemorrhage, anemia, jaundice, transfusions, Rh. factor, and exposure of the eyes to light have been investigated unsuccessfully. The relationship between retrolental fibroplasia and angiomatous lesions has not been verified, nor has the finding that greater numbers of male infants are affected. In regard to pre-natal influences, there is no association with ancestors, time of conception, health or age of parents, social or economic status, local epidemics, time of birth during the year, diseases of pregnancy, difficulties of labor, drugs or foods used during pregnancy or delivery; and placental diseases. The disease has no relationship to the cause of the prematurity in the mother. One interesting fact is that the disease occurs only once in a family. The increase of incidence of retrolental fibroplasia cannot be explained on the basis of an increased survival rate of premature infants. An interesting line of research now being carried out concerns the electrolyte content of cow's milk in regard to the deficient renal function of premature infants. It is known that the electrolyte content of cow's milk is three times that of human milk and when cow's milk formulas are used, the electrolyte and water imbalance may play some part in the exudative retinitis and retinal detachment of retrolental fibroplasia. It has also been suggested that the disease is caused by a virus. Page 314 PUBLIC HEALTH AND MENTAL HEALTH NEWS G. F. AMYOT, M.D., D.P.H., Deputy Minister of Health, Province of British Columbia A. M. GEE, M.D., Director, Mental Health Services, Province of British Columbia TREATMENT OF CHRONIC ALCOHOLISM Over the past few years the Provincial Mental Health Services have developed a treatment service for selected patients suffering from chronic alcoholism. The treatment in all cases has been carried out at the Provincial Mental Hospital, Essondale. Male patients have predominated and most have been admitted to the Mental Hospital upon voluntary application in accordance with the provisions of Section 13 of the "Mental Hospitals Act". In recent months the subject of the voluntary male patient suffering from chronic alcoholism has been reviewed and as a result certain changes in the admission procedure have been instituted. These new regulations are contained in Order-in-Council 606, dated March 17th, 1952, the text of which is as follows: "(1) The number of male alcoholics without psychosis who have been admitted pursuant to Section 13 (1) of the 'Mental Hospitals Act' and who are receiving care and treatment in the Provincial Mental Hospital, Essondale, shall be restricted to twenty-five (25) at any one time; (2) The senior Medical Superintendent may refuse further admissions of patients in this category until the number under care and treatment is less than twenty-five (25); (3) Requests for admission of this category of patient shall be made in advance and the patient shall not proceed to the Provincial Mental Hospital, Essondale until notification has been given by the Senior Medical Superintendent that he may be admitted; (4) The hours of admission for patients in this category shall be from eight (8) a.m. to ten (10) p.m. daily." With reference to these regulations it should be noted that Section 13 of the "Mental Hospitals Act" deals with voluntary admissions and it should be further noted that these regulations do not apply to alcoholic patients who have been committed in accordance with Section 9 of the Act. Thus the psychotic patient in whom chronic alcoholism is but one symptom should be regularly committed as required by Section 9 of the Act. Further information may be obtained by addressing the Senior Medical Superintendent, Provincial Mental Hospital, Essondale, of by phone call to N.W. 8034. July 4th, 1952. Dr. H. A. L. Mooney, President, B.C. Division, Canadian Medical Association. Dear Dr. Mooney: Re: HEALTH SURVEY REPORT In the Vancouver Daily Province of July 2nd, 1952, a reference was made to the Health Survey Report of the Province of B.C., which was tabled in the House of Page 315 Commons by the Honourable Paul Martin, Minister of National Health and Welfare, on that date. Unfortunately the Press Release which was issued from Ottawa, did not accurately interpret the contents of this Report. The Health Survey Report does not state that the contents had been discussed with the • Health Agencies mentioned in the Daily Province of July 2nd, 1952. The relative portions of the Press Release prepared by the Health Branch, Provincial Department of Health and Welfare, Province of British Columbia, are as follows: "This report contains 125 recommendations for improving the health services of B.C. and represents the viewpoint of various health officials not only in this province, but in other parts of Canada. As such, it does not bind the Provincial Government to action, although many of the recommendations have already been acted upon, or are in the process of being carried out. "The Survey was conducted by Dr. G. R. F. Elliot, assistant provincial health officer. A Health Survey Committee was established at the inception of the National Health Grants programme to advise on matters of general policy. While this committee did not actively participate in the Survey, their advice and assistance were sought, particularly in the early stages." The major recommendations regarding Health Insurance contained in the Report, are as follows: "That comprehensive health insurance be not introduced at present, but receive further study. "That consideration be given to the introduction of plans which would cover some medical services and/or certain groups of the population. "That consideration be given to the introduction of a comprehensive health insurance plan to cover children." With reference to the last two recommendations, it will be noted that it is stated "THAT CONSIDERATION BE GIVEN". This may be interpreted as meaning the B.C. Division, Canadian Medical Association, and other allied professional organizations, would be interested in active participation to explore the possibility of such recommendations. I would also like to call your attention to two pertinent points: (1) The Health Survey Report is a departmental report to the Government, but contents of this Report and recommendations have not been discussed with the B.C. Division, Canadian Medical Association, and other health agencies mentioned in the Daily Province, July 2nd, 1952. (2) The Health Survey Report should not be interpreted as Government policy. I am deeply appreciative of the excellent relationships that have always existed between the medical profession and this department. I feel that an official statement regarding the Health Survey Report should be placed before the members of the B.C. Division of the Canadian Medical Association as soon as possible to prevent any misunderstanding that might develop as a result of the Ottawa Press Release of July 2nd, 1952, in the Daily Province. Finally, copies of this Report have not been published in sufficient quantity to allow distribution to interested parties. When printing is completed in the very near future, a copy will be forwarded to you. Yours sincerely, G. F. AMYOT, M.D., D.P.H., Deputy Minister of Health. Page 316 CANADIAN MEDICAL ASSOCIATION-B. C. DIVISION October, 1951 — September, 1952 OFFICERS —Dr. H. A. L. Mooney, Courtenay, B.C _Dr. J. A. Ganshorn, Vancouver, B.C President _ President-Elect Vice-President Dr. R. G. Large, Prince Rupert, B.C. Honorary Secretary-Treasurer Dr. W. R. Brewster, New Westminster, B.C Chairman, General Assembly i Dr. F. A. Turnbull, Vancouver, B.C. STANDING COMMITTEES Constitution and By-Laws CHAIRMEN .Dr. R. A. Stanley, Vancouver, B.C Finance Dr. W. R. Brewster, New "Westminster, B.C. Legislation Dr. J. C Thomas, Vancouver, B.C. Medical Economics Dr. R. A. Palmer, Vancouver, B.C. Medical Education Dr. G. O. Matthews, Vancouver, B.C. Nominations Dr. H. A. L. Mooney, Courtenay, B.C. Programme and Arrangements Dr. R. C Newby, Victoria, B.C. Public Health Dr. G. F. Kincade, Vancouver, B.C. SPECIAL COMMITTEES CHAIRMEN Arthritis and Rheumatism ^ Dr. A. W. Bagnall, Vancouver, B.C. Cancer . \ Dr. A. M. Evans, Vancouver, B.C. Civil Defence . Dr. L. H. A. R. Huggard, Vancouver, B.C. Emergent Epidemics Dr. G. F. Amyot, Victoria, B.C. Hospital Service Dr. J. C Moscovich, Vancouver, B.C. Industrial Medicine Dr. E. W. Boak, Victoria, B.C. Maternal Welfare j : Dr. A. M. Agnew, Vancouver, B.C. Membership Dr. L. H. Leeson, Vancouver, B.C. Pharmacy Dr. D. M. Whitelaw, Vancouver, B.C. THE ANNUAL CONVENTION Victoria—Empress Hotel—September 15-18 inclusive ACCOMMODATION—Each member is asked to make his own accommodation by writing to the hotel directly. Please do it early. When the Empress is fully committed, the Convention Committee will find a place for you. PROGRAMME—The General Assembly will meet on Monday the 15th. Registration will begin at 8:30 a.m. and the meeting will get under way at 9:00 a.m. It is expected that a full day will be required for this very important work. The Nominating Committee will breakfast together at 8:00 a.m. on Monday and then proceed to a sitting room to complete their task. Their report will be received by the General Assembly in the afternoon. The New Board of Directors will assemble for luncheon on Thursday the 18th. This will be their first meeting to plan the professional activities for the coming year. The Scientific Programme is still in the process of completion, but it is known that Drs. Hamilton, Richards and Orr will present papers on the Page 317 branches of medicine, surgery and dermatology. This team is from Edmonton. Contacts are now in progress for speakers from the Pacific Northwest to add to a full programme. As is customary, the programme will take the form of Round Table Conferences as well as formal papers with discussion periods. ENTERTAINMENT j 1 The Annual Luncheon will be on Tuesday and the President of the C.M.A., Dr. Harold Orr of Edmonton, will be the guest speaker. The Annual Dinner will be in the Ballroom on Thursday the 18th. Golf and fishing will be arranged for the Wednesday afternoon. A Buffet Supper and Dance will be held at the Victoria Golf Club, at 6:00 p.m. EXHIBITS If The commercial firms have supported the Convention very well indeed and there will be more than thirty exhibits. We should be grateful to them for this attendance. \A Hobby Show is being arranged and interested members should contact Dr. Janowsky of Victoria about their exhibits. A Commissionaire will be engaged to protect them. LADIES COMMITTEE Registration will begin for the ladies on Tuesday the 16th, in the Library of the hotel. There will be a sherry party, luncheon and fashion show on Tuesday. The fashion show will be sponsored by The T. Eaton Co. Ltd. For Wednesday afternoon His Honour the Lieut. Governor and Mrs Wallace have graciously offered a Garden Party at Government House. On Thursday afternoon there will be opportunities to be shown around Victoria to see some of the gardens or places of local industry. The evening will be fully occupied with the reception and dinner. The Committee on Arrangements in Victoria has worked hard to make this meeting a pleasure and inspiration for you. The important work of the profession requires your support. Make your plans and reservations early. The General Assembly of the Association held a Special Meeting in Vancouver on Saturday, May 17th. It was well attended and serious thought given to many of the problems. Although the number of doctors in British Columbia who have actively supported the Association and enrolled as members is very encouraging, we shall need, to fulfill our obligations as professional men, the active participation of all doctors. Since so many of the problems involve every doctor in practice and institution, the Assembly instructed that a News Letter be sent out, not only to members who have joined, but to all doctors, so that they may be informed on what is being done on their behalf. This News Letter was mailed in June and entitled "A Six Month Report". We hope you enjoyed reading it, and if not already a member, will enroll now. The Association is the place where every doctor has the opportunity of guiding his own future and developing his profession. GORDON FERGUSON Page 318 COMMENTS ON THE B.C. DIVISION The B.C. Division has been conducting the multitudinous affairs of the profession in this Province for the past few months since these heavy, responsibilities were relinquished by the College of Physicians and Surgeons. The difficulties that had to be faced and the urgent problems that required immediate solution were many and great. The office staff was inadequate; there was no Executive Secretary; paid membership was nil; the Executive was feeling its way through the maze of a new and unfamiliar constitution. The horizon was dark indeed. In these few months the picture has changed and the skies have cleared. Much has been learned and much has been accomplished. Of the more tangible achievements one may mention that the office staff has been increased, an Executive Secretary has been employed, there are 952 paid-up members and over 200 founders, a well instructed and determined delegation are on their way to the C.M.A. Convention in Banff, a new fee schedule containing substantial increases has gone to press, a much more equitable schedule of fees has been obtained from the Workmen's Compensation Board and is now in the hands of the profession, the Government has agreed to pay 2 5 % more per annum for S.A.M.S. cases as of April 1st, 1952, and the relations of the Division with the Workmen's Compensation Board, the Press, the Radio and the Government are good. On the debit side there has been some criticism of appointments and policies but this is a good thing. One can only say that the officers are those that were elected by the membership, and in this respect it is pertinent to remark that the B.C. Division is a very representative organization, having over 100 elected representatives in the (legislative) Assembly. At the present level of membership this means that there is about one representative for every seven doctors. These men are elected for one year and if they are not satisfactory—put them out at the annual meeting in September. It is also a responsible organization and you are entitled to know what is going on and if you don't like it—tell them so. Again, to date there are only about 952 members paid up. This is not satisfactory. The Division must have 100% membership and everyone must do his share to carry the burden. When one considers that the accomplishments so far will mean over one million dollars extra each year in the pockets of the profession, it is hard to see how anyone can afford not to be a member. Furthermore, there are less than 200 founders and this is a sad state of affairs. Everyone must be a founder if we are to have a reserve to meet unknown, but not unheard of, political manoeuvers. It is fantastic and unthinkable to say we can't afford it. Most of us spend this much on tobacco and spirits per month and the founders' fee is for life. THE QUESTION OF EXTRA BILLING Extra billing occurs where a patient who is covered under a prepaid plan is rendered a separate account by the doctor for an amount in excess of that paid by the plan. The practice has become an increasing problem to all of our prepaid plans in recent years, most particularly in the urban areas of Vancouver and Victoria. As regards those prepaid plans which are either sponsored by or approved by the B.C. Medical Association, it is incumbent upon us to deal with the problem in the interests of providing good medical service to the community. There is no doubt that we are experiencing extensive world-wide changes in the realm of medical economics and one of the manifestations is the rapid development and expansion of prepaid plans. To negate their function and need is an unrealistic approach. They are with us and their destruction would entail cataclysmic distress on our own way of life. That extra billing embarrasses the schemes cannot be denied, but alternatively we must not allow the plans to determine our pattern of practice. To function at all the schemes must adhere to a fixed standard of fees, and in many instances the practice of extra billing has been an expression of our schedule of fees Page 319 not being up to date. Our new schedule should help to rectify this aspect of the problem. There remains however a number of instances where exceptionally difficult problems have been undertaken or where patients have demanded more service or have insisted upon luxury service. Here there would seem to be times for a basis for extra billing, as the schedule of fees paid by the schemes is based on average cases with average demand upon the doctor. Another frequent cause for extra billing occurs where patients consult specialists without referral. Here the specialist must devote time and skill in excess of that established for under the prepaid plan. To be maintained prepaid medical care must be mutually fair and equitable to both doctor and patient. If there is a real basis for extra billing, then we must recognize the practice and establish a place for it. If on the other hand there is no basis for the practice then similarly we must face the problem and attempt a measure of control. To ignore the present situation is inviting criticism from the public bodies and the condoning of inequalities of remuneration. P.L. THE NEW MEDICAL ARMOURIES, B.C. AREA The recent creation of a Reserve Force Medical Armouries near Shaughnessy Hospital has elicited considerable interest among members of the profession. The manner of its inception is a tribute to the foresight of the Medical Planning Staff in Ottawa, and to the ability and energy of Colonel R. J. Nodwell in his former capacity as Area Medical Officer. Somewhat more than a year ago Colonel Nodwell became aware of the fact that a large proportion of the Medical Officers retiring from active duty with the R.C.A.M.C. in 1945 took up residence and opened practice in the Vancouver Area. Many of these doctors were, and are, on Supplementary Reserve strength, and many have been serving in a more active role with one of the Reserve Force Medical Units. It followed ~that the available officer personnel for the training of other-rank medical specialties was proportionately high in Vancouver, and that, given adequate facilities, these officers could help to relieve the current shortage in the Corps, of trained operating- room assistants, laboratory and x-ray technicians, orderlies and first-aid instructors. Accordingly, application was made to Defence Headquarters for the establishment of a Medical Armouries at Oak and 27th, to house 12 Cdn. Field Ambulance and 66 Cdn. General Hospital, along with proposed Hygiene and Dental Corps units. Complete remodelling of the interior of the attractive building began almost immediately, and is now virtually completed. Full equipment for the operating theatre has been received. The field x-ray unit is in process of installation, and the laboratory has been well-furnished. Beds and other ward equipment, both tropical and temperate, have been made available. Pharmaceutical supplies have been delivered and the dispensary is functioning. The various offices and messes have been furnished adequately and unit quartermaster scales have been filled. In May of this year the General Hospital was transferred from the Supplementary to the Reserve force, and at the time of writing, has the unique distinction that it is the only hospital unit with this status in Canada. It has been established on a 400-bed basis and is under the command of Lt. Col. Roy Huggard. His staff will consist of approximately 20 Reserve Force Officers, 30 Nursing Sisters and 150 Orderlies and Tradesmen. No attempt will be made to fully recruit the unit until this fall. No. 12 Cdn. Field Ambulance is commanded by Major W. H. Sutherland and has been in active operation in the new Armouries for approximately six months. The training program has been thorough, and prosecuted with vigour by a well-organized unit. During the winter months parades were conducted weekly, and in addition, the various messes have been made available for unit social functions from time to time. Insofar as Reserve and Supplementary Reserve Force Medical Officers are concerned, an invitation to enjoy all mess facilities will be extended to them this fall. Page 320 There will be no obligation, implied or otherwise, to participate in unit activities, but those who wish to assist in other-rank specialist training will be encouraged to do so, and may be paid for such services. The hope expressed by those who have been most concerned in the development of this centre, is that the Armouries will provide a common and casual meeting-place for Active, Reserve and Supplementary Reserve Force Medical Officers, and that it will in addition provide dining facilities for military and non-military medical societies. The invitation will, of course, encompass all ex- service officers in the Province. —J.S. A Dinner Meeting of the Victoria Medical Society was held on May 16, at which Dr. David M. Baillie delivered the Annual Memorial Oration on "The Life and Work of Sir James Mackenzie". Out-of-town visitors were Sir Phillip Livingston, Cowichan Bay, and Dr. G. Blott, Nanaimo. Dr. L. Ranta, formerly of U.B.C., is now on the Medical Administrative Staff of the Vancouver General Hospital. Dr. Jack Ross of the Vancouver General will be obstetrics resident at the Royal Victoria Hospital next year. Dr. L. E. Wood has opened a private practice in otolaryngology in Vancouver. Dr. Jack Fenwick of Vancouver is now assistant medical director of CARS in B.C. Dr. Dave Robertson of Vancouver has begun practice in Courtenay with Dr. A. L. Mooney. Dr. D. Leemy is entering practice with Dr. Kay Graham of Vancouver. Dr. Sid Segal of Vancouver has received a research fellowship in the department of physiology at U.B.C. Dr. W. Stevens of St. Paul's Hospital is returning to Kingston to assist in gynecology at Queen's University. Dr. Bruce Morgan of St. Pauls has enlisted in the Canadian Medical Corps. Dr. W. Phelps will be resident in surgery at the Vancouver General Hospital next year. Dr. Ian Rose of London, England, has lately joined the Irving Clinic of Kamloops. Dr. H. P. Grafton of Kamloops has recently been elected a Fellow of the Royal College of Obstetricians and Gynecologists of London, England. Dr. William E. French formerly of Vernon, B.C., has lately joined the Burris Clinic of Kamloops. Dr. W. Tait, of Vancouver, has become a radiology assistant at the Vancouver General Hospital. BIRTHS To Dr. and Mrs. /. Edmison of Victoria, a son. To Dr. and Mrs. JR.. E. Burns of Victoria, a daughter. To Dr. and Mrs. /. R. Boyd of Vancouver, a daughter. To Dr. and Mrs. T. W. Acheson of Vancouver, a daughter. To Dr. and Mrs. F. W. Hurlburt of Vancouver, a daughter. Page 321 *vs tea al ^ %*. I-SO-GEL GRANULES Stimulus to Intestinal Peristalsis I-SO-GEL, a granular preparation of certain dried mucilaginous seeds has the property of reproducing the normal stimulus to intestinal peristalsis by increasing the intestinal bulk through absorption of water in the alimentary canal. I-SO-GEL contains no purgatives and is a purely natural laxative with a smooth, mechanical action, especially suitable for the constipation of diabetes. It is valuable also in mucous colitis, dysentery, haemorrhoids, and intestinal flatulence. After the performance of colostomy, I-SO-GEL gives excellent results by solidifying the faeces. Available in 6 oz., 12 oz., 24 oz. and 3% lb. containers. Complete literature supplied upon request. THE ALLEN AND HANBURYS COMPANY LIMITED • TORONTO, ONT LONDON, ENG A-652B Page 322
Periodicals
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Medicine--Periodicals
The Vancouver Medical Association Bulletin: June, 1952
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