@prefix edm: . @prefix dcterms: . @prefix dc: . @prefix skos: . edm:dataProvider "CONTENTdm"@en ; dcterms:isReferencedBy "http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1179642"@en ; dcterms:isPartOf "History of Nursing in Pacific Canada"@en ; dcterms:creator "Vancouver Medical Association"@en ; dc:date "1943-09"@en ; dcterms:issued "2015-01-29"@en, "1943-09"@en ; edm:aggregatedCHO "https://open.library.ubc.ca/collections/vma/items/1.0214471/source.json"@en ; dc:format "image/jpeg"@en ; skos:note """ Tjhe r|Ul|l|Ei| of the »««■*** 1 WANCOBVER - • ME D IC A Lm S Si) <3»Tfe N Vol* XIX. SEPTEMBER, 1943 No. 12 With Which Is Incorporated Transactions of the Victoria Medical Socieiy the Vancouver General Hospital and St. Paul's Hospital In This Issue: LIBRARY NOTES HEALTH INSURANCE PROVINCIAL BOARD OF HEALTH THE OBESE CHILD. 329 341 342 UNUSUAL CARDIAC DEATH DUE TO TRAUMA -fg^^^^^^^^s "~T THE COMPLETE ANDf BALANCED iVITArVIIN|BlCOIVIPLE)S Most investigators agree that many vitamin B deficiencies do not occur because of the lack of but a single factor of the B complex. They have found that a deficiency of any one component is likely to be associated with a lack of other components of the complex. Therapy with one factor, usually brings to light accompanying deficiencies of other factors. In recent clinical investigations of Vitamin B deficiencies, great success resulted from Vitamin B complex therapy. ViplexE.B.S*^ answers the need for ijvitamin B complex preparation containing all the known ^members of the complex. jThese^ factors are present in balanced amounts in the proportions in which they are needed for normal ^hutrition.3 [The clinical applications for certain components of the^itamin B complex are definite, but in practically all deficiency conditions it has been found that the addition of the otherfxfactors of the complex produces better results^ VIPLEX E.B.S.—Liquid Each teaspoonful contains: Vitamin Bi (Thiamin Chloride) 75 mgm. 260 int. units. Vitamin B* £§*2 {Riboflavin) £5 mgm. Nicotinic Acid . .3.0 mgm. Vitamin B* (Pyridoxine) 63 micrograms Pantothenic Acid (Filtrate Factor) 63 micrograms Suggested Dosage: One to two teaspoonfuls, four times a day. after food. Larger doses may be prescribed, where indicated. VIPLEX E.B.S.—Tablet (S.C.T.i746) Each tablet contains: 11 Vitamin Bi (Thiamin fchlor-. ide).. 75 mgm. 250 int. units; Vitamin Bt 1|§§§1| (Riboflavin) .5 mgm.. Nicotinic Acid . I 10.0 mgm. Vitamin Bt (Pyridoxine) 250 micrograms Pantothenic Acid (FiltraijfZj Factor) 250 micrograms Suggested Dosage: Two to four tablets each day.' after food. VIPLEX E.B.S. Liquid is available in bottles of JJb., also in Winchesters and Gallons. VIPLEX E.B.S. Tablets S.C.t. #746 bj» put 0|> in" bottles of 100,500,1,000. Wh*n Prescribing Specify E.B.S. Preparation ijil;m? Jusi lo to Sun I THE E. B. SHUTTLEWORTH CHEMICAL CO. LIMITED ! Ju«ii< ' **»*a#^s«» TORONTO MANUFACTURING CHEMISTS CANADA [NIYSRSr IRITISH CGLUMBi . T i 1 r> THE VANCOUVER MEDICAL ASSOCIA B UjL LETIN Published Monthly under the Auspices of the Vancouver Medical Asociation 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 SEPTEMBER, 1943 No. 12 OFFICERS, 1943-1944 Dr. A. E. Trites *|#* Dr. H. H. Pitts Dr. J. R. Neilson President Vice-President %{si*9 Past President Dr. Gordon Burke Dr. J. A. McLean Hon. Treasurer Hon. Secretary Additional Members of Executive: Dr. J. R. Davies, Dr. Frank Turnbull TRUSTEES Dr. F. Brodie Dr. J. A. Gillespie Dr. W. T. Lockhart Auditors: Messrs. Plommer, Whiting & Co. -J| ' SECTIONS -. Clinical Section Dr. J. W. Miller Chairman Dr. Keith Burwell Secretary Eye, Ear, Nose und Throat QJM Dr. C. E. Davies Chairman Dr. Leith Webster ^...-Secretary Pwdiatric Section Dr. J. H. B. Grant Chairman Dr. John Piters , Secretary STANDING COMMITTEES Library: Dr. A. Bagnall, Chairman; Dr. F. J. Buller, Dr. D. E. H. Cleveland, Dr. J. R. Davies, Dr. J. R. Neilson, Dr. S. E. C. Turvey Publications: Dr. J. H. MacDermot, Chairman; Dr. D. E. H. Cleveland, Dr. G. A. Davidson Summer School: Dr. J. C. Thomas, Chairman; Dr. J. E. Harrison, Dr. G. A. Davidson, Dr. R. A. Gilchrist, Dr. Howard Spohn, Dr. W. L. Graham Credentials: Dr. D. E. H. Cleveland, Chairman; Dr. E. A. Campbell, Dr. D. D. Freeze V. O. N. Advisory Board: Dr. L. W. MacNutt, Dr. G. E. Seldon, Dr. Isabel Day Metropolitan Health Board Advisory Committee: Dr. W. D. Patton, Dr. W. D. Kennedy, Dr. G. A. Lamont Representative to B. C. Medical Association: Dr. J. R. Neilson Sickness and Benevolent Fund: The President—The Trustees (Squibb Stabilized Aqueous Solution Sulfathiazole Sodium with Desoxyephedrine Hydrochloride) . .Relieves Nasal Congestion .. Helps check the growth of many invading microorganisms •fc Search for a safe and effective preparation for use in relief of nasal congestion and the intranasal treatment of sinusitis has at last resulted in SULMEFRIN—a combination of a soluble sulfonamide and a vasoconstrictor drug in a form agreeable to use. provides these advantages ir QUICK RELIEF OF NASAL CONGESTION * PRACTICALLY NON-IRRITATING * REMARKABLE STABILITY Sulmefrin may be administered by spray or drops, 5 to 10 minims into each nostril, 2 to 4 times daily; or by tamponage, 20 minims on each pack, applied for 15 to 30 minutes once a day. For full particulars write 36 Caledonia Road, Toronto, Ont. E-R: Sqjjibb &Sons of Canada,Ltd.- Manufacturing Chemists to the Medical Profession since 1858. Sulmefrin is available in 1-ounce and 1-pint bottles. Sulmefrin is a trademark of E. R. Squibb & Sons. VANCOUVER HEALTH DEPARTMENT STATISTICS—JULY, 1943 Total Population—Estimated 'fi 288,541 Japanese Population Evacuated Chinese Population—Estimated 5,541 Hindu Population 301 Rate per 1,000 Number Population Total deaths : s 249 10.2 Japanese deaths 1 Population Evacuated Chinese deaths 12 25.5 Deaths—residents only . 208 8.5 BIRTH REGISTRATIONS: Male 331, Female 317 648 26.4 INFANTILE MORTALITY: July, 1943 July, 1942 Deaths under one year of age [ 17 10 Death rate—per 1,000 births 26.2 17.6 Stillbirths (not included above) 9 10 CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY June, 1943 July, 1943 Aug. 1-15,1943 Cases Deaths Cases Deaths Cases Deaths Scarlet Fever ; «__ 31 0 16 0 15 0 Diphtheria 0 0 0 0 0 0 Diphtheria Carrier 0 0 0 0 0 0 Chicken Pox _i i 211 0 28 0 21 0 Measles i 167 0 25 0 7 0 Rubella S __ 11 0 2 0 1 0 Mumps I 64 0 0 0 0 6 Whooping Cough 36 2 13 0 7 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 65 13 42 17 9 0 Erysipelas jj 5 0 10 0 0 Meningococcus Meningitis 3 0 1 0 1 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 Sy philis Gonorrhoea Figures not yet available 1 BIOGLAN-A The most effective therapy for waning mental and physical energy, deficient concentration and memory, reduced resistance tb infection, muscular 'weakness and debility, neurasthenia and premature senility. The efficacy of this very potent endocrine tonic has been confirmed by the clinical evidence of many thousands of cases treated since 1943. Phone MA. 4027 Stanley N. Bayney Representative 1432 MEDICAL-DENTAL BUILDING Descriptive Literature on Request THE SCIENTIFIC HORMONE TREATMENT Vancouver, B. C. Page 324 PITUITARY EXTRACT (posterior lobe) FOR USE IN OBSTETRICS, IN SURGERY AND IN THE TREATMENT OF DIABETES INSIPIDUS A sterile aqueous extract is prepared from the posterior lobe of the pituitary gland, and is supplied as a solution containing ten (10) International Units per cc. ASSURED Each lot is biologically assayed in terms of the International standard. UNIFORM Samples of each lot are tested at definite intervals to ensure that all U I b N C Y extract distributed is fully potent. PITUITARY EXTRACT (POSTERIOR LOBE) is supplied by the Connaught Laboratories in packages of five 1 -cc. rubber-stoppered vials. 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-SIXTH ANNUAL SESSION (WINTER 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 the various hospitals for the coming year. Place of meeting will appear on the agenda. General meetings will conform to the following order: 8:00 p.m. Business as per Agenda. 9:00 p.m. Paper of the evening. 1943 October 5—GENERAL MEETING: Dr. S. E. C Turvey—"Epilepsy as a Problem in the Community" (Illustrated by Slides) October 19—COMBINED CLINICAL MEETING and CLINICAL STAFF MEETING at VANCOUVER GENERAL HOSPITAL. November 2—GENERAL MEETING: Dr. J. C. Thomas—"Civilian Medical Care in Chemical Warfare" (Illustrated by Slides) November 16—COMBINED CLINICAL MEETING and CLINICAL STAFF MEETING at ST. PAUL'S HOSPITAL. COLONIC AND PHYSIOTHERAPY CENTRE Up-to-date Scientific Treatments COLONIC IRRIGATIONS, SHORTWAVE DIATHERMY, SINNEWAVE GALVINISM, IONIZATION, ULTRA VIOLET RAY, STEAM BATHS AND SHOWERS Medical and Swedish Massage Physical Culture Exercises STAFF OF GRADUATE NURSES 1119 Vancouver Block MArine 3723 Superintendent "5 E. M. LEONARD, R.N. '. Post Graduate Mayo Bros. Vancouver, B.C. Page 325 CK UnS0^6' My boss used to be as grumpy as a bear. He'd growl and bang around and his wife said: "Poor George, he's working too hard. It's wearing him down to a frazzle!" So, I told her a few plain facts: ... how I'd discovered the most amazing thing . . . that physicians who prescribe S.M.A. actually have more time for other things'. . . because it isn't necessary to change the formula throughout the entire feeding period. (She sat up at that.) . . . how S.M.A. eliminates many unnecessary questions that mothers usually ask about other modified milk formulae. When I had finished, she said she would certainly speak to George about using S.M.A. as a routine formula. Just because my boss turned over a new leaf . . . he wants everybody to pat him on the back for it. But he's not fooling us . . . we know how he got to be such a nice man. BUSY DOCTORS TO-DAY PRESCRIBE S.M.A. PREPARE. S.M.A. IS EASIER TO S.M. A. Biochemical Division John Wyeth & Brother (Canada) Ltd. Walkerville, Ontario With this issue we close the 18th volume of the Bulletin: and the next will therefore open the 19 th volume. The Bulletin is rapidly approaching its maturity. Whether it grows in stature as it grows in years, is for its readers to say. The Publications Board of the Vancouver Medical Association feels that the time is ripe, perhaps, to make some changes in the Bulletin, which, it is hoped, will make it more useful to our readers. We cannot, in this year of our Lord, do anything very revolutionary or spectacular: we are lucky, we consider, to be in existence at all, to be solvent, to have material to publish. We do not feel that we should do anything very drastic. But perhaps we have not done all we could with what we have, or made the best use of our opportunities. So we are going to try, gradually at first, to explore possibilities. There is good and interesting material going to waste, right here amongst us. We have, in the Association, a Clinical Section, a Pediatric Section, an Eye, Ear, Nose and Throat Section (why can't these fellows find a single word for their specialty?): and we shall one day have other Sections. These Sections, at their meetings, have excellent material presented. Much of it could be of value to every man in the profession, whether he specialises or not. So we have added to our Board, the Chairmen of these Sections, and we hope to get a great deal from them. Then there is another field we can cultivate. Many men, not only in Vancouver, but throughout the Province, have special knowledge and training which they would gladly use to enlighten and help their colleagues in the profession. We shall try to get, from some of these men, special articles of general interest. Then there arise, from time to time, discussions on various topics of current interest. We hope to obtain short articles, perhaps from several men at a time, in the form of a symposium, which would help us all. There are other possibilities which may, and we hope will, prove to be profitable to our publication. What we are aiming at is a monthly publication which will contain something for everyone in every issue. One more word. We are the Bulletin of the Vancouver Medical Association, in name at any rate. But we are really much more. We are a provincial journal at least. Our circulation covers the whole province, and it is right that it should be so. The wider our scope, the higher our aims, the more universal our appeal and usefulness, the better it will be for every one of us in Vancouver, the home and source of die Bulletin. We owe a duty to those in other parts of the Province, especially in those parts which are not as fortunate or as well supplied with resources, clinical and educational, as we are. It is our high privilege, as well as our duty, to give all we have, freely and gladly. It is only the common, daily tradition of our profession, which has no trademarks, no patents, no secrets, no monopolies, but shares everything in common. The B. C. Medical Association's Annual Meeting, recently held, was a very notable success. Its attendance, just over 500, broke all records. A hundred and seventy-five of these were in the uniforms of the three services: even so, the balance of three hundred and twenty-five constituted the largest attendance in the Association's history. The Board of Directors, under the presidency of Dr. Howard Spohn, worked hard and long to achieve this result. The Programme Committee, under Dr. A. Y. McNair's Page 326 chairmanship, deserves our gratitude and admiration for their admirable work: the list of Speakers was a sure guarantee of an excellent meeting. But all this work depends for ultimate fruition upon smoothly running, smoothly funstioning, machinery. The arrangement of meetings, the ensuring of adequate space, the luncheons and dinners, and golf tournament: the entertainment of guests, especially of ladies who visit us, all this means a vast deal of hard, often unrecognised work: and it turns mainly on the effort of one man. You will easily guess to whom we are referring, our indefatigable Executive Secretary, Dr. M. W. Thomas. He was always on deck, always available, always genial and good-natured and helpful: and we feel that he must have derived an immense satisfaction from the success of this meeting, which he worked so hard over. We should like to pay tribute, too, to his assistants, Mrs. Bender and Miss Smith, who worked with him, and who worked to such excellent purpose. The Ladies' Auxiliary Committees, the Entertainment Committees, and many others, too, contributed very greatly to the enjoyment of the meeting, and a general feeling of happiness and satisfaction. There were so many highlights that it seems invidious to single out any special ones. But the Round Table Discussion on Medical Economics was especially worthy of mention: and we hope to present some of it in the Bulletin at some future occasion. Another feature worthy of especial mention we felt, was the Annual Reports, which reflected a good deal of hard work and thought on behalf of the profession. The one that we felt most worthy of praise, was the report of the Conunittee on Medical Education, presented by Dr. K. D. Panton of Vancouver. This Committee came boldly out with a plea for a Medical Faculty in the University of British Columbia, to be instituted as speedily as possible. We hope sincerely that this suggestion will be adopted, just as soon as can be-arranged. To many, if not most, of us, the most delightful event of the whole meeting was the address given by Dr. W. Boyd of Toronto University, at the Annual Dinner; on the subject of Lawrence of Arabia. We could not say whether the address was long or short (certainly it was much too short in one sense), but it was pure delight. Scholarly, sincere, absorbingly interesting from beginning to end, it was a tribute from the heart, to one of the greatest men of the hundreds of great men that the Mother of the Ejnglish race has produced, with such abounding prodigality, from the beginning of her history. It was given on a note of deepest admiration, rising to this side idolatry: the language of the address was itself a model of English speech, and the voice of the speaker carried in its tones and inflections the love and honour which he has for his "hero," as He called Lawrence. As we listened, bound to silence by his words, we saw, as many of us had never before seen, what a great soul was that of this man Lawrence. Pre-eminent as a soldier, perhaps one of the greatest in English history—certainly the greatest since Marlborough, he was no less great as an English scholar: as a writer of the English language—but he not only had the words, he had the force and the fire and the inspiration of a great thinker and philosopher. And lastly, and mainly, he excelled as a man: and won love and respect, not for bravery alone, not for ability alone, but for a "saintliness," a nobility and grandeur of character, which mark him for ever as one of the greatest: since his claim to greatness was the greatness of the service he gave. All these things Boyd shewed us, and we owe him our thanks and gratitude for a notable evening. The following officers were elected: Dr. P. A. C. Cousland, President; Dr. A. Y. Mc- Nair, First Vice-President; Dr. A. H. Meneely, Second Vice-President; Dr. G. O. Matthews, Honorary Secretary, and Five Directors-at-large: Doctors G. F. Amyot, J. S. Daly, C. H. Hankinson, H. H, Milburn and G. A. C. Roberts, and these members will comprise part of the new Board of Directors. Page 327 LIBRARY NOTES RECENT ACCESSIONS TO LIBRARY— Medical Annual, 1943. Transactions of the Ophthalmological Society of the United Kingdom, 1942. Transactions, Section on Ophthalmology, A.M.A., 1942. Medical Clinics of North America, Symposium on Physical Therapy, July, 1943. The Pharmacology of the Opium Alkaloids—U. S. Public Health Service, 1941. GIFTS TO LIBRARY— The following books have been donated to the Library and have been catalogued recently: Treatment of Tuberculous Diseases in their Surgical Aspects, 1900, by W. Watson Cheyne (donated by Miss Pearson). Memories of the Crimean War, 1911, by Douglas Arthur Reid (donated by Miss Grace Fairley). The following books, among others, in the library of the late Dr. G. S. Gordon, have been catalogued: Dropsy, 1866, by W. R. Basham. Treatment of Pulmonary Consumption, 1871, by James H. Bennet. Treatise on the Venereal Disease, 1791, by John Hunter. Burton's Anatomy of Melancholy, 1837, A New Edition by Democritus Minor. Treatise on Diseases of the Urethra, Vesica Urinaria, Prostate and Rectum, 1922, by Charles Bell. MISSING FROM LIBRARY The following books and journals are missing from the Library, no record having been made by the borrowers: American Journal of Obstetrics and Gynaecology, vol. 43, 1942. Bulletin of the New York Academy of Medicine, April, 1943. It is urgenly requested that they be returned to the Library at once. MICROFILM SERVICE—FREE OF CHARGE The Library Committee is happy to announce that microfilms of short articles may now be obtained without charge. The Army Medical Library has altered its policy in this regard and now considers this a substitute for inter-library loans. Their weekly publication, "Current List of Medical Literature," whicfy is received in the Library, contains a classified list of articles which have been filmed during the week. It is possible, however, to procure a microfilm of any article listed in the Index Medicus, though there might be come delay in obtaining material which has not already been filmed. The Librarian will be glad to give detailed information to any members interested in this Service. Page 328 British Columbia Medical Association (Canadian Medical Association, British Columbia Division) President Dr. P. A. C. Cousland, Victoria First Vice-President ' ! Dr. A. Y. McNair, Vancouver Second Vice-President Dr. A. H. Meneely, Nanaimo Honorary Secretary-Treasurer Dr. G. O. Matthews, Vancouver Immediate Past President Dr. A. H. Spohn, Vancouver Executive Secretary ■_, Dr. M. W. Thomas, Vancouver HEALTH INSURANCE No.1 ABSTRACTS OF DOMINION AND PROVINCIAL ACTS INTRODUCTION This subject has been introduced into the Dominion Parliament and is at present under consideration by a special committee on Social Security. The legislation takes the form of a Dominion Enabling Act providing Grants-in- Aid and a Model Provincial Act. It is important that we keep in mind the fact that many changes may be effected before this suggested legislation becomes law. While the Canadian Medical Association through the Committee of Seven has made two submissions to the Committee on Social Security regarding tins proposed legislation, the Association has never been asked to make an official pronouncement either accepting or rejecting the proposals. Since the reading of the proposed legislation is a laborious task and much of the intent is hidden under necessary legal phraseology the Committee on Economics of the British Columbia Medical Association has prepared the following abstract of that portion of the legislation that is of vital concern to the medical profession. This abstract is not offered as a complete summary but only as a resume of those parts of the draft acts that are of interest to the members of our profession. In some details the acts themselves are very sketchy. An addendum gives briefly certain observations regarding the financial aspects of Health Insurance. Further important information is provided in the excellent abstract of the minutes of the proceedings and evidence submitted to the Committee on Social Security, prepared by Dr. Frank Turnbull, vice-chairman of our committee. G. F. Strong, Chairman, Committee on Medical Economics, B. C. Medical Association. Page 329 I.—DOMINION ACT—CALLED "HEALTH ACT >> 1. Provision for grants to any Province that shall make statutory provision for the economic and efficient use of such grants. (a) The statutory provisions as respects Health Insurance shall be in such terms as to provide benefits, (a) OF THE STANDARDS,^ (b) UNDER THE CONDITIONS, and (c) FOR THE CLASSES OF PERSONS as set forth in the model provincial act. (b) Grants may be paid by the Dominion to the Province (a) FOR THE OBJECT, (b) SUBJECT TO SPECIAL CONDITION, and, (c) IN THE AMOUNTS specified by the Health Act. 2. Health Insurance Grant The suggested amount is $3.60 per capita per annum. 3. Public Health Grants for (a ) Tuberculosis (b) Mental Diseases (c) General Public Health (d) Special Public Health I. Venereal disease II. Professional training HE. Investigational IV. Youth fitness 4. The provisions for Public Health in the Province shall include: 1 Preventive services 2 Consultative services 3 Educational facilities 4 Mental Hygiene 5 Communicable Disease Control 6 Food and Drug Control 7 Nutrition 8 Laboratory 9 Sanitation 10 Vital Statistics 11 Hospitals and Sanatoria 12 Dental Hygiene 13 Child and Maternal Hygiene ' Page 139 14 Industrial Hygiene 15 Quarantine including Air Navigation 16 Public Health Nursing 17 Housing 18 Venereal Disease Control 19 Tuberculosis 20 Cancer 21 Heart 22 School Health Services 2 3 Epidemiology 24 Research 5. These are additional provisions respecting the agreements between Dominion and Provincial governments' reports thereon, and necessary inspection of records. • 6. Administration of Health Act to be under a division of the Department of Pensions and National Health to be known as PUBLIC HEALTH and HEALTH INSURANCE DIVISION. 7. National Council of Health Insurance, consisting of the Director of Health Insurance of the Department of Pensions and National Health as chairman, the Deputy Minister of Health in each Province, the chief administrative officer of Health Insurance of each province which has established Health Insurance and such other persons comprising a representative of the Canadian Medical Association, the Canadian Hospital Council, the pharmaceutical, nursing and dental professions, labour, industry, agriculture, urban women and rural women respectively as may be appointed by the Governor in Council. II. PROVINCIAL ACT—CALLED "HEALTH INSURANCE ACT" Persons Qualified All persons who have their normal place of residence in the Province and in whose cases the requirements of this Act are complied with by them or on their behalf. Sources of Moneys The moneys required shall be derived partly from contributions from employees and employers and partly from grants (Dominion and Provincial) Contributors All employed persons shall contribute, others will be assessed—not only for themselves but for dependents other than children under sixteen. (The care of children under 16 is included in the contributions.) Page 331 Registration There shall be annual registration of all qualified persons and their dependents. (There are then set forth the numerous provisions respecting the contributions of employed and assessed contributors.) Health Insurance Fund There shall be a special account in the Consolidated Revenue Fund of the Province called the Health Insurance Fund, which shall include all moneys received from the sale of HEALTH INSURANCE STAMPS and contributions made otherwise, penalties, grants by Dominion, sums payable by the Province under the Act, and interest. Benefits Shall be such as to provide for the prevention of disease and for the application of all necessary diagnostic and curative procedures and treatment. Shall include: Medical, surgical, obstetrical; Dental; Pharmaceutical Hospital Nursing. Medical, Surgical and Obstetrical Commission shall make arrangements therefore with the organization representative of the practitioners of medicine, surgery and obstetrics, including therein specialists and consultants in medical, surgical and obstetrical diagnosis and treatment who are regularly qualified, duly licensed, and in good standing in the Province. The regulations and arrangements aforesaid shall be such as to secure for each qualified person such adequate measures for the prevention of disease and all necessary and adequate medical, surgical, and obstetrical treatment, attendance, and advice. The regulations shall secure:— 1. Preparation and publication of lists of medical practitioners who have agreed to attend qualified persons and the class or classes of service each such practitioner is qualified and prepared to provide; 2. Right of any medical practitioner to be included; 3. Right of any qualified person of selecting the medical practitioner by whom he wishes himself to be attended; 4. Right of any qualified person to services of specialists and consultants; 5. Services of medical practitioners in prevention of disease and conservation of health; 6. That no medical practitioner be entitled to remuneration for any service in the performance of which-he exceeds his professional competence; 7. That the method of methods of remuneration of medical practitioners and the rate thereof whether by capitation, fee for service, or by salary, or any combination of these, shall be such as are determined by the arrangements made with the organization representative of medical practitioners; 8. The keeping of adequate records. Arrangements may be made with approved clinics. Regulations shall prescribe: Page 332 1. The rules to be followed in detennining the class or classes of professional service which' are within the competence of each practitioner. 2. The classes of service which shall be deemed to be general practitioners services. Dental Benefit Pharmaceutical Benefit Commission shall make arrangements for the supplying of proper and sufficient drugs, medicines, materials, and appliances to qualified persons. Hospital Benefit Commission shall make arrangements for ALL necessary hospital service for qualified persons in hospitals (including convalescent homes), other than treatment of tuberculosis and mental illness. Regulations shall be such as to secure:— 1. Lists of hospitals showing service each hospital is capable of providing; 2. That arrangements shall be made only with non-profit voluntary, municipal, Provincial Government, and Dominion Government hospitals; 3. That qualified persons be entitled to hospital service only when ordered by medical practitioner; 4. That any person for whom hospitalization is ordered shall have right of selecting hospital;; 5. That governing body of each hospital shall have the right to determine the medical practitioners who shall have the right of treating patients therein; 6. That in any case arrangements shall provide for general ward service only except in emergency; 7. That any qualified person shall have the right to semi-private or private accommodation if available on payment of the difference; 8. That any qualified person shall be available for clinical observation for the instruction of students of MEDICINE AND NURSING. Nursing Benefit When ordered by medical practitioner. Administration 1. This Act snail be administered by a Commission, "THE HEALTH INSURANCE COMMISSION," consisting of the chairman and of such number of other Commissioners as may from time to time be determined by Order-in-Council. 2. The chairman shall be a doctor of medicine regularly qualified, duly licensed and in good standing in the Province, and having practised medicine for at least ten years. 3. The Provincial Health Officer shall, ex-officio, be a member of the Commission. 4. The other Commissioners shall be appointed by the Lieutenant-Governor in Council after consultation with organizations representative of medical practice, dental practice, pharmacists, hospitals, nursing, insured persons, industrial workers, employers, agriculturists, and of such other groups or classes as may from time to time be determined. Administrative Regions For the economic and effective administration of Public Health services and of Health Insurance the Province shall be divided into areas known as Public Health or Health Insurance Regions. Within each such region there shall be established a unified administration of all Public Health services and of Health Insurance. REGIONAL MEDICAL OFFICERS and assistants shall be provided on a full or part-time basis. Page 333 Duties of Regional Medical Officers: 1. To advise practitioner on discharge of their duties; 2. To keep in touch with practitioner with object of raising standards of service; 3. To examine and satisfy himself of the accuracy and sufficiency of the clinical and other records of practitioner; 4. To investigate excessive prescribing. Representative Committees Commission to deal with committee representing Hospitals and Professions re supplying benefits. OTHER PROVISIONS RE: Determination of Questions, Investigation of Complaints and Disputes, Inspection, Offences, Legal Proceedings. Regulations Many subjects are left to settlement by regulations of the Commission. FINANCIAL ASPECTS It is of course of the greatest importance to the medical profession that we satisfy ourselves that this whole scheme is adequately financed. To that end we should secure immdiately the advice of the best actuarial and statistical experts available to us. The method used by the government to determine the costs of the suggested plan is open to some doubt. The costs of medical care in Canada were ascertained and this figure was divided by the number of adults 16 years of age and over. By this method the figure of twenty-six dollars was reached. This then becomes the basic cost per capita per annum and is estimated to cover all adults and their children under 16 years of age. Parenthetically it must be noted that in this method of arriving at medical costs NO ACCOUNT IS TAKEN of the VERY LARGE AMOUNT OF FREE MEDICAL SERVICE RENDERED EVERY YEAR. It is estimated that of the twenty-six dollars, $18.00 is the actual cost of medical care per individual and $8.00 covers the children. The breakdown of the eighteen dollars as between the various benefits has not as yet been clearly set forth. The contribution from the Dominion Government is as noted above to be three dollars and sixty cents for every man, woman and child under the scheme. HEALTH INSURANCE No. 2 RESUME OF THE MINUTES OF THE PROCEEDINGS OF THE COMMITTEE ON SOCIAL SECURITY (Abstract made by Dr. Frank A. Turnbull) A REPORT FOR THE DOCTOR IN PRACTICE INTRODUCTION In March, 1943, at Ottawa, a large parliamentary committee on Social Security was apointed. The purpose of this committee was "to examine and report on a National plan of social insurance which will constitute a Charter of Social Security for the whole of Canada." At their first meeting on March 16th, 1943, Hon. Ian MacKenzie presented a draft copy of a bill respecting Health Insurance. These meetings have gone on during the summer, receiving submissions from all interested bodies. With a few exceptions the discussions so far have been limited to matters relative to Health Insurance rather to the broader aspects of General Security measures. The minutes of proceedings Page 334 and evidences have been published in a series of bulletins that now number 28. The purpose of this paper is to summarize the highlights of these reports in so far as they have a bearing on the present and future practice of medicine. ORIGIN OF THE GOVERNMENT'S PLAN FOR HEALTH INSURANCE The first attempts by a legislature in Canada to formulate a plan of Health Insurance was in the Province of British Columbia, in 1919. A commission was appointed and brought in a report that outlined a plan for a state system. The subject was again discussed at some length in our Provincial legislature in 1928, and in 1929 a Royal Commission published reports dealing with Health Insurance and Maternity Benifits. The Provincial legislature commenced a more determined effort to introduce an effective Health Insurance Act in 1934. This culminated in the abortive statute of 1936, which was passed by the house but never enforced. Meanwhile at Ottawa in 1928 the Department of Pensions and National Health received instructions to undertake a comprehensive survey of public health with special reference to a National Health programme. These studies were guided by Dr. J. J. Heagerty, the Director of Public Health Service. Information was accumulated about foreign Health Insurance plans and about the cost of medical care in Canada. This investigation was continued during the 1930s. In 1942 the Dominion Government directed the formation of an Advisory Committee on Health Insurance. The members of this committee were Civil service experts and were almost all statisticians in various specialized fields. Dr. Heagerty was organizer of the committee and the only medical member. It was by this committee that the Canadian Medical Association was first consulted, along with representatives of other groups, including dentistry, pharmacy, nursing, hospitals, labour, and life insurance. Rapid developments created the need for the unprecedented special meeting of the General council of the Canadian Medical Association in January, 1943. Events were moving swiftly. The parliamentary Committee on Social Security was appointed by the National government in March, 1943, and commenced activities without delay. THE COMMITTEE The special committee on Social Security is composed of 41 members. Their party affiliations are: Liberal 29, Conservative 7, C.C.F. 2, New Democracy 2. The chairman is Hon. Cyrus MacMillan, Dean of the Faculty of Arts and Science, McGill University. The average age of the committee is 55. There are nine doctors on the committee, with an average age of 63. Attendance at the meetings is good, and that of the doctors much above average. Debate on medical issues has been very ably handled by our representatives, notably by Dr. James McCann of Renfrew, Ontario, Dr. John Howden of Norwood Grove, Manitoba, and Hon. Dr. Herbert Bruce of Toronto. HON. MR. IAN MACKENZIE Before introducing the draft for a Health Insurance Bill, Mr. MacKenzie stated that Health Insurance is the greatest present lack in Canada's system of social security. An all-inclusive national plan would be the ideal arrangement, but in Canada this development would involve constitutional problems of the greatest complexity. Mr. MacKenzie wants to do something "practical and useful for the people of Canada quickly and effectively." For this reason the Advisory has drawn up a National Health Insurance bill which avoids the constitutional pitfalls by retaining a high degree of Provincial autonomy. The Dominion Health Insurance Act that Mr. MacKenzie proposes is an enabling act which incorporates a model provincial bill. In order to qualify for grants-in-aid for certain major preventive health measures, each province must maintain wide health services which are all stated in the model bill. The major health measures which will receive Dominion support include such important projects as free treatment for mental Page 33 3 disease, tuberculosis, and venereal disease, research problems and training facilities in public health work, and a program of physical fitness for youth. No province will be able to finance these major aspects of Health Insurance by itself, and thus it is ensured that every province that does adopt the national plan will give a service that will be uniform across Canada. DIRECTOR OF PUBLIC HEALTH SERVICES AND THE CHIEF ACTUARY Dr. J. J. Heagerty has been Mr. MacKenzie's right hand man in the years of planning and he played a major role as witness in the earlier meetings of the Social Security Committee. His personal ideal of Health Insurance, as indicated at various points in his testimony, is that it should cover all the population, that it should be administered by the Department of Health, that the general practitioner should be brought into the preventive field but remain the medical advisor and counselor of the family as a unit, that specialist services should be organized into clinics at least in the urban areas. Dr. Heagerty told the Social Security Committee how he had formed the Advisory Committee on Health Insurance in 1942, and related some of the difficulties that were encountered in planning a model Health Insurance Act. His Advisory Committee initially favored administration of the Provincial Act by the Provincial Health Department but this attitude caused a great deal of dissension. Labour and agriculture insisted that they should be represented on the governing body, chiefly because they were apprehensive of undue medical control. Our medical association argued that direction and administration must be in the hands of those having professional knowledge and understanding of health problems. These conflicting viewpoints were reconciled by the proposal that the provincial administration shall be in the hands of a commission with a salaried chairman, who shall be a qualified medical man. The chairman will be chief executive officer of the Commission. (Note: Dr. Routley's letter of August 5th to members of the C.M.A. has pointed out that at a recent meeting of the Committee on Social Security the words "The Chairman" were deleted from the model Provincial Act and the words "one member" were substituted therefor. No report of the discussion that preceded this motion is included in the proceedings of the committee.) On a number of occasions, Dr. Heagerty was asked by various members of the Social Security Committee to explain how his Advisory Committee arrived at the figure of $26.00 per year as the cost of complete medical care in Canada. His answers were not always consistent. In a general way the figure was calculated by estimating the total cost of medical care in Canada in 1935, adjusting this figure to the increased population of 193 8 and dividing the total into the population above the age of 16. In one speech Dr. Heagerty claimed that it was a very precise and accurate figure, decided upon by professional statisticians who are acknowledged experts—vol. 4, p. 127. On the other hand, he made such statements as the following: "Broadly speaking, there is perhaps nearly enough money being spent by rich and poor to provide fairly satisfactory service for all"—vol. 3, p. 101; "Insofar as cost is concerned we certainly are not high. There is always some danger one may be low but we just do not think so"—vol. 3, p. 103; "We have not attempted to estimate to the last dollar or to the last cent what Health Insurance is going to cost from the standpoint of treatment"—vol. 2, p. 57. Mr. A. D. Watson, Chief Actuary, Department of Insurance, gave the most scholarly address of the whole session. It was a discussion of the history and philosophy of social security, and the practical measures involved in the application of social security in a constantly changing world. He pointed out the difference between public assistance and social insurance, and stressed that social security measures must be framed to strengthen, not weaken, the responsibility and purpose of the individual. In respect to Health Insurance he stated that the working out of arrangements with the profession and drafting of the necessary regulations by the Provincial Health Insurance Commissions will dwarf into complete insignificance the work involved in the preparation and drafting of the proposed National bill. The whole scheme of operation must be worked out and understood by all concerned before operations can begin at all. He cautions Page 336 against undue haste, and warns that "the risk of error is great in any legislation, but nowhere as great as in social legislation." It was surprising to learn from Mr. Watson's subsequent discussions with the committee that he had played no part in estimating the cost of Health Insurance in Canada. He stated that this was a purely statistical rather than actuarial problem. He did discuss the likelihood of difference of cost in various provinces and gave his opinion that this might be as wide as 35%. (Note: This doubt about probable costs does not distress the theorists and planners. If they are later proven to have been profoundly mistaken it may or may not affect their professional reputations, but almost certainly will not affect their livelihood. On the other hand it is a very vital problem for the doctors in practice. We recall the plight of certain State-hired doctors in Saskatchewan during recent years who went for months working without salary and in some instances were never paid, because municipal coffers were low. The local authorities were able to offer cordwood in lieu of cash, but the doctors just could not live on cordwood Common, sense dictates that we must hire experts to advise us about these figures, particularly for the important negotiations that will precede any Provincial Health Insurance Act.) CANADIAN MEDICAL ASSOCIATION Our initial submission to the Committee was very ably presented by Dr. A. E. Archer and Dr. T. C. Routley. All of this material, dealing chiefly with the principles of Health Insurance, has been published in the Canadian Medical Association Journal. The French-speaking doctors, who are only represented in the C.M.A. by a small minority, authorized the leaders of their associations to express complete accord with the opinions of the C.M.A. Mr. Mclnnis, M.P. for Vancouver East, could not see why cash benefits should be separated from Health Insurance, and expressed the opinion that medical certification would be necessary whether benefits were paid under Unemployment Insurance or not. Dr. Routley answered that if cash benefits were to be included in the scheme we would of necessity have to issue certificates, but reiterated our^stand that the cash benefits should come from a separate fund. At the time of our first presentation there had been no opportunity to study the draft of the proposed Health Insurance Act. At a later date Dr. Archer appeared before the Committee again with more specific suggestions. The need for the support of deserving medical students by government bursaries was indicated. The importance of ensuring that no indigent group could be left out in a Provincial scheme was stressed. Some guarantee was sought that patients insured under the plan would be available for teaching purposes. It was also pointed out that grave difficulties and injustices might result if a Health Insurance measure was introduced while 30% of our men are on Active Service and those remaining in civilian life are carrying an increasingly heavy burden. CANADIAN PUBLIC HEALTH ASSOCIATION The professional leaders of the public health services are naturally more concerned about preventive aspects of Health Insurance than about curative medicine. They emphasize in their brief that the family physician should assume, as a responsibility for those under his care, certain preventive services, some of which are now being furnished through the departments of health. They state that: "The general practitioner is hesitant, under present conditions of private practice, to advocate preventive measures from which he will benefit financially. . . . The patients of the general practitioner are often not sufficiently aware of the value of such supervision to request the physician to render preventive services for which payment would willingly be offered. . . . Payment on a per capita basis would greatly facilitate the rendering of such services by the physician. . . . Payment on a fee basis for each service rendered would be impractical and tend to defeat the fundamental conception of the prevention of sickness and disability." They propose that the local Health Department through its health education programme would inform the public of the essential preventive services which the family Page 337 physician is prepared to render. These preventive activities of the general practitioner will be supervised by the medical officer of health. HOSPITALS Dr. Harvey Agnew, representing the Canadian Hospital Council, outlined the essential principles in any Health Insurance plan that would be necessary to preserve the best in our present system of hospital care. None of these proposals conflict with the attitude of the Canadian Medical Association. It is of interest to us that hospitals insist that they must retain the right to determine their own staffing privileges. They deplore any development that would permit other interests to force them to extend highly technical privileges to doctors whom the trustees, on the advice of their medical staffs, do not feel should be admitted to the staff nor given such privileges. The voluntary hospitals, largely controlled in Canada by Catholic interests, are much concerned about impending developments. Their representatives pointed out that there is a divided opinion regarding the advisability of "regimentation of every department of our life under the auspices of government and the state or the preservation of that freedom which is exemplified by the practice of private charity." Dr. Agnew related that in many European countries where Health Insurance has been adopted the state had gradually taken over voluntary hospitals. TRADES AND LABOUR CONGRESS OF CANADA On the whole, organized Labour favours the government bill, but they are critical of the proposed method of administration because it seems to them to give too much control to the doctors. Mr. P. Bengough, who presented their brief, stated: "We are naturally prepared to concede to the medical profession the right to representation, but we could not possibly agree to their having entire control. In our opinion, those who provide the funds, namely, the government, employees and employers, should control the National Council in the matter of representation." The Labourites stated that they could not possibly agree to the proposed Hospital Benefit, section 31, which reads as follows: "That any qualified person in receipt of treatment as aforesaid . . . shall be available for clinical observation by the teaching staff of medical schools, etc." They argue that there should be no chscrimination between the patient in the public ward and in the private room, and express vague fears about experimentation by medical men on public ward patients. CANADIAN FEDERATION OF AGRICULTURE The Canadian Federation of Agriculture is a national federation of organizations that represent all branches of agriculture across Canada and claims to have an affiliated membership of 350,000. The major point of their brief before the Committee consists of a bulletin entitled "Health on the March," which has been widely circulated in Canada. Mr. H. H. Hannam, president of the Federation, describes their plan as "a modification of state medicine." They are chiefly concerned about medical care of the rural population. It is submitted that Health Insurance must be developed as a national plan, financed from the federal consolidated revenue fund, and that the majority of the Commission at Ottawa should be lay people. They advocate community health centers which shall include all necessary services such as X-ray, laboratory, dental, nursing, and specialists. It is recommended that osteopaths and chiropractors be recognized under a national plan, or that their work should be incorporated into the course of medical training. They are scathing in their criticism of the C.M.A. proposal that the existing schedule of fees in the various provinces should form the basis of discussion with the commission respecting fees under Health Insurance. In criticism of these plans of the Agriculture group Dr. Heagerty stated: "You cannot put into Canada one plan from one end of this country to the other that will be satisfactory . . . the cost of administration of a plan from Ottawa would be financially destructive ... in order to avoid a financial catastrophe, each province should introduce Page 338 this scheme very slowly in certain areas ... we cannot go out and build great health centres, great hospitals, or send masses of doctors into the country areas." OSTEOPATHS One volume of the proceedings is devoted entirely to the presentation of the Canadian Osteopathic Association. It is a puzzling document. The principles and practice of Osteopathy are explained at great length. This reviewer has read the report through several times and must confess to being entirely baffled regarding the fundamental difference between osteopathy and conventional medicine. Judging from their submission, students of osteopathy take practically the same courses as medical students. Osteopaths are trained in drug therapy, including the use of vaccines, insulin, etc., are qualified in midwifery and general surgery, and they claim to train specialists in most of the standard subdivisions that are recognized by regular medicine. They stress manipulative therapy but do not explain their statement that "manipulation without the osteopathic concept becomes sterile". They plead to be included under the Act on an equal basis with Medicine rather than as an ancillary service. CHIROPODISTS There are only 150 accredited members of the Chiropody Association in Canada. Chiropody is defined by their leaders as the medical, mechanical, surgical, and electrical treatment of the ailments of the human foot, and massage in connection therewith. They support the proposed Act but object to the provision which requires the patient to go to a medical practitioner first. They state that all recognized schools of chiropody give a four year course with junior matriculation as the entrance standard, and submit that such intensive specialization in one small section of the medical field equips them to perform their services better than anyone else. OPTOMETRISTS The Canadian Association of Optometrists, with a membership of 1500, requests that Optometry benefits be added as a subsection of the proposed Act along with medical, dental, pharmaceutical, hospital, and nursing benefits. They claim that about 70 per cent of those who require optical attention patronize optometrists. The objection that they take to the proposed Act is the proviso that patients will first have to go to a physician and be referred by the physician to the optometrist. They state that under this plan the doctors will refer all their patients to a medical specialist, but point out that there are not enough medical men trained in refraction to cover the general need. CULTISTS The Christian Scientists requested that on the grounds of religious freedom they be exempted from contributing to the maintenance and sharing in the benefits of the proposed Dominion-wide Health Insurance Act. They foresee that under the proposed Act the integrity of the family as a basic unit of civilized society will be threatened, for by the plan "the individuals of the family are to become members of a semi-military health company, of which the doctor is to be sergeant-major." Various members of the committee pointed out that one of the major features of the proposed Act is in the field of preventive medicine, which will benefit all members of the community. If any group, such as the Christian Scientists, are exempted from payments, then those who are contributing to the public health scheme will be paying part of that cost for others who do not contribute. Page 339 The Chiropractors request that they be put on the same footing as medical practitioners in respect to the proposed Act. They warn that "if the government hands over to the medical practitioners control over the life and health of individuals, such steps will react against the government itself." Mr. Mclnnis, M.P. for Vancouver East, stated during discussion that "as far as British Columbia is concerned, a Health Insurance Act which does not include chiropractors on a basis of equality with the medical profession will not be satisfactory." The stone wall that confronts any medical man who argues in public with one of these irregular practitioners was well illustrated in these proceedings: Hon. Mr. Bruce: "I should like to ask you this: Are you aware of the fact that through a treatment developed over the last couple of years, one of the sulpha drugs will cure cerebral spinal meningitis in at least 90% of the cases? Are you aware of that?" Dr. Sturdy: "I have heard that stated, but I would not accept that." Hon. Mr. Bruce: "In the face of that would you still submit these cases to chiropractic treatment?" Dr. Sturdy: "Absolutely, yes." The Committee gave sympathetic attention to every brief that was presented. Their tolerance was sorely tried when the officers of the Anti-Vaccination and Medical Liberty League appeared before them. Reading this presentation is a complete waste of time. One statement, however, is worth quoting: "If any Insurance scheme should be brought into force under the control of the authoritarian medical group, and permitting them to include this concept in 'Preventive Medicine' (prevention of disease by the introduction into the body of products of disease—e.g., vaccines), we fear there will again be riots, fines, sales of chattels, imprisonment, bloodshed." CONCLUSIONS The doctors of Canada have publicly declared themselves in favour of Health Insurance. The Proceedings of the Committee on Social Security indicate what a responsibility was entailed in that declaration. It will soon be necessary to submit more specific and more detailed proposals and to be prepared to have these suggestions exposed to the searching light of public criticism. We have plenty of friends who listen to our plans with sympathy and attention. We also have foes who are bitter and implacable. Some of those who oppose our proposals respecting Health Insurance are jealous of our present status and demand the right to treat the public regardless of what they have to offer. Others are advocates for a cause or for a group, and may plead the tenets of their followers in public, irrespective of their private views. A great number are honest men who just don't know enough about the subject they debate. On our side it is apparent that there must be a common front. "Divide and Conquer" is a principle that is just as effective in political manoeuvering as on the world's battlefronts. Minor disagreements among ourselves need to be ironed out before the important Provincial conferences, or our opponents will use them to our general disadvantage. Page 340 ege ol ysicians a nd Su rgeons President : Dr. F. M. Bryant, Victoria Vice-President . Dr. H. H. Milburn, Vancouver Treasurer— Dr. G. S. Purvis, New Westminster Members of Council Dr. F. M. Bryant, Dr. Thomas McPherson, Victoria (District No. 1); Dr. G. S. Purvis, New Westminster (District No. 2); Dr. H. H. Milburn, Col. Wallace Wilson, Vancouver (District No. 3«); Dr. Osborne Morris, Vernon (District No. 4); Dr. F. M. Auld, Nelson, (District No. 5). Registrar j Dr. A. J. MacLachlan, Vancouver Executive Secretary Dr. M. W. Thomas, Vancouver In view of the fact that the supply of narcotics in Canada is limited it is sincerely hoped that the medical men of the Province will protect the supply by carrying their narcotics on their persons and not tempt the people of the underworld by leaving narcotics in their bags to be stolen from their cars. No PN licenses will be issued in 1944 as it is felt they constitute an invitation to thieves. A. J. MacLachlan, Registrar. (The following letter has been forwarded to all doctors in the Province. Its importance is evident.—Editor.) PROVINCIAL BOARD OF HEALTH Division of Venereal Disease Control Dear Doctor: The importance of prompt diagnosis in primary syphilis, to be followed by early and intensive treatment, cannot be overemphasized. Treatment should not be started until laboratory confirmation, either in the form of a positive report on the darkfield examination of serum obtained from the lesion or a positive blood test has been received. Treatment should not be started when diagnosis rests upon clinical grounds only. Darkfield kits furnishing all that is required for collection and transmission of suspected serum is available and may be obtained by application to the Division of Labora-' tories, Provincial Board of Health, 763 Hornby Street, Vancouver. Every practising physician should keep several of these kits on hand. Those who do not have these should apply for them at once. Unfortunately darkfield examinations can be made only at the laboratories in Vancouver, and in order to remedy the unavoidable delay as far as possible doctors are advised that specimens should be sent by airmail special delivery. The Division of Laboratories will send the report back by telegraph as soon as the examination of the serum has been made. Yours truly, D. E. H Cleveland, M.D., Acting Director, Venereal Disease Control. P.S.—Darkfield examinations are also done in the Royal Jubilee Hospital in Victoria. If it has been your custom in the past to send these to Victoria, it will be quite in order to continue to do so. Page 341 THE OBESE CHILD: A DISCUSSION OF TREATMENT Dr. R. R. Struthers Montreal (Read before the B. C. Medical Association, September, 1943.) In presenting this subject before you, I must plead guilty to having no very scientific viewpoint to present to you, but rather a discussion of the nutritional status of the family of the child who is obese. If one accepts the statement that the ordinary scales of average weight for height and age in children, permits a leeway of 10% plus or minus the average and still remain within the limits of normal nutrition, one may define the obese child as being one who is 20% or more above the average in weight for age and height. This will permit ot the common variations due to family inheritance and physique and is a fairly satisfactory working definition of obesity in children. The subject is of considerable importance, as your Committee has already intimated to me, in that while these obese children may not be great in numbers, they are great in the potentiality of future discomfort and disease, and are, when presented to us, a rather immediate and pressing problem calling for our interest and very specific advice. As with a discussion of adult obesity, these children may be of the group who suffer from endogenous obesity, in whom one may find abnormalities of thyroid or pituitary function, and occasionally mental deficiency. With this group of children I do not intend to dwell, in that ordinary routine physical examination, including X-rays for bone age, estimation of the blood cholesterol level, sugar tolerance and the basal metabolic rate, will usually make the diagnosis apparent, and suitable specific treatment may possibly be advised. In this group may also come occasionally the child who, following an acute infectious illness or after surgical operation, shows sudden accumulation of fat. Similarly infections in these children may be followed by a sudden onset of endogenous obesity which is frequently amenable to the temporary administration of suitable small doses of thyroid extract. My presentation is particularly concerned with the child who presents evidences of exogenous obesity, in which the bald statement is true that the expenditure of energy does not equal the ingestion of calories, that is, that the exercise or activity is not equivalent to the over-eating in which the child indulges, with the resultant production of obesity. From the etiological point of view, cases of this unfortunate condition may be divided into those which are due to individual causes and those due to familial. Of the individual causative factors, I would place fatigue first. Fatigue is a vicious circle in obesity. Actvity because of obesity produces ready fatigue and with it indolence, but the circle can be broken by adequate rest. As with adults, so the obese child suffers from lack of rest in bed, the object of treatment being, of course, to relieve his fatigue, give him a sense of well being and a desire for physical activity, because he has rested, and so increase the expenditure of energy. As an example, a 10-year-old boy, who is in the obese group, should have, if possible, 12 hours rest in bed at night, and 2 hours rest in bed in the afternoon, simply with the idea of improving his sense of physical well- being, so that he is more anxious to partake of athletic activities. Secondly, emotional disturbances in children are unfortunately all too common and are likely, as a source of solace, to result in excessive eating. The insecure, thwarted, frustrated child living in a squabbling household or in an unhappy school situation, is very likely to seek relief and happiness in something which he enjoys, that is, to partake of food and sweets, which he does in excessive amounts. This phase of the subject of obesity in children has been stressed by Dr. Hilde Bruch, working at Johns Hopkins, and while it may be associated with other circumstances, from her point of view, it is unquestionably a common cause of obesity. Finally, the individual etiological factor "gluttony," by which is meant the Page 342 uncontrolled and insatiable desire for food, similar to the alcoholic's desire for liquor, has been suggested. This occasionally is apparently uncontrollable and may be due to some heretofore unrecognized chemical imbalance or deficiency, the etiology of which is obscure. I mention this here only to plead ignorance of its cause. There are, however, more important etiological factors in the family surroundings than in the individual. We speak of children or individuals as being of the linear or lateral type and appreciate that the individual with the short square trunk and wide costal angle is more prone to become obese, if less likely to develop gastric ulcer, than is the narrow linear type of individual. This may be true as a family characteristic with certain families who tend to run to obesity. As I will point out in a further discussion, I fear that this is used as an excuse for obesity, rather than being truly a causative factor. Whether heredity, as such, plays any important role, I sincerely doubt. Most important of the family etiological factors, in my opinion, is the conditioning of the child to certain types and quantities of food by his environment: and this is the main point of my presentation, that obesity in children is in the main not due to faulty social surroundings or inherent or familial characteristics, but is the result of the education of the child in certain dietary habits as a result of his childhood experience; and that the family dietary habits are usually determined by the wife and mother who does the buying and the cooking and the treating. In my experience the majority of obese children in private practice come from family situations where the economic supplies are adequate, where the mother is a good cook and delights in cooking or enjoys seeing her family take pleasure in their food; not to suggest that the joys of the table should be abolished, but rather that there should be temperance in all things, including eating. A statement of the problem may be made that it is not so much a question of specific instructions to the obese child, but re-education of the family habits as regards diet and appetite. Types of therapy may be divided into four groups, firstly drugs, such as codeine which destroys the appetite, and benzadrine which is said to increase activity; but these, in my experience in the average child, have no indication. Secondly, glandular products, such as the use of thyroid or pituitary extracts; these I believe should be used only when there is specific evidence of such glandular deficiency. Truly utilization of food may be increased by the administration of thyroid even in the presence of a normal basal rate, but it is, in my judgment, a dangerous reed on which to teach a child to lean, and until dietary habits are also corrected, the obesity will recur with the cessation of administration of thyroid. Thirdly, dietary restrictions are essential, even though painful, and most children co-operate well, particularly if one sits down and explains the problem to the child, promising him, as one may, relief from his obesity, and sets a time limit on the need for reduction. The aim of dietary restrictions for the obese child is not particularly to lose weight, but to stop the gain in weight until the height becomes more proportional to the weight. Restrictions of pie, pastry, cake, candy and added sugar to food as served, and in tea or coffee if used, and sweetened soft drinks, for a definite period, say of three months, usually produce in the child so satisfactory a response that the patient is of himself quite willing to co-operate from that point on, particularly if, in addition to those, any unsatisfactory emotional or social factors in the background can be adequately rearranged. However, the principal object to be aimed at is not the "selling" of dietary restrictions to the patient, but the re-education of the mother in buying and cooking. She must be taught to provide fewer pastries, pies and cakes, to cook with less butter, fats and shortening, to use less butter on the vegetables for the family and serve fewer rich gravies and steamed puddings, to make desserts of fruit and salads, rather than apple pie, not only for the child who is obese, but for the whole family, for this is so frequently a family situation. For instance, Mrs. W. recently brought her children to me for their annual examination. Mrs. W. is a charming, bright faced, though obese individual of 35, who is a good cook. She stands 5 ft. 4 in. and weighs 160 lbs. Her daughter of 14 is a large child with square shoulders and is 50? Page 343 lbs. overweight. Her son of .12 is 35 lbs. overweight, and her husband, at the age of 38, standing 5 ft. 8 in., weighs 180 lbs. The family is obviously overfed and the correction of the obesity in the family depends upon the re-education of the mother as a housewife. She must learn to be more sparing in the use of fats and carbohydrates in the feeding of her family. I appreciate that it is difficult at the present time to prescribe an appetizing high protein diet because of the moderate form of rationing under which we are living, but I do feel that this is the answer to obesity in many children, and they must be taught to live on a diet moderately restricted in fats and carbohydrates and higher in proteins, particularly those of so-called higher biological Value. Similarly in a family where the father, at the age of 48, standing 5 ft. 9 in. and weighing 225 lbs., died suddenly of coronary thrombosis. His wife, the mother of three children, an excellent cook, obese, the three children all overweight, one being 75% overweight for age and height, all were corrected by the re-education of the mother as regards the dietary requirements of her family. This included the forbidding of cream in the household, removal of butter from the table and restrictions of the other factors which I have mentioned, and the providing of skimmed milk in place of whole milk to drink. As regards the personality difficulty: Jean C, a bright faced, seemingly happy child of 14 weighing some 35 lbs. over average for her age and height, was brought because of her excess weight. A complete metabolic study showed no abnormal findings, but Jean admitted privately to me that she ate because she liked her food, that she got on very badly with her two school teachers, and rather than play with other children of her age a school, she went home and stuffed on bread, butter and jam, so that she would not miss her former playmates. This is not common, but it does occur. The situation was readily corrected by an altered school environment away from home. On the symptoms produced by excess weight I need not dwell, other than to remind you that they are principally subjective. Pains and aches in the feet, which, of course, suffer from the excess load; pains in the legs, occasionally palpitation on exertion and, of course, ready dyspnoea. Occasionally a child is brought for help because of these symptoms, which are usually corrected spontaneously with the cessation of the gain in weight and the return to a normal figure. I would point out that there is a well recognized spurt of growth in both height and weight for a few months or a year preceding maturity, which is commonly spoken of a prematuration spurt in growth. This sudden increase in height and weight, particularly the latter, causes parents considerable needless alarm, as moderate obesity in this particular age group usually requires no therapy. We recognize it as being due to the sudden increase in the growth stimulus associated with maturation and will spontaneously correct itself after a year or two—unless excessive. We must remember, too, that in any diet which is offered to such children, it must be adequate in proteins, calcium, and vitamin "D." On the details of this I need not dwell. Fourthly, we appreciate these obese children suffer very markedly from what may, I think, correctly be called an "inferiority complex," in that they are, because of their ungainly bodies, less able to compete successfully in various sports or aptitudes with their more streamlined playmates. I think the stimulation of the child's desire to excel in some one thing, though minute, should be encouraged. I have on occasion, perhaps foolhardily, advised parents that their medical fees for the treatment of their obese child would be better spent in securing lessons from a professional teacher of some activity, or grace, in which their overweight child may be taught to excel. By this, I mean lessons in swimming, boxing, tennis, athletic dancing and so on. If the child can be taught to become in any sense expert at any game, and his natural desire to excel above his fellows be stimulated, the natural indolence which is associated with excess weight will no longer be a problem. It is very gratifying to one's ego, irrespective of age or social sit - uation, to be aware of one particular faculty in which one does excel. In summary, my suggestions regarding the treatment of the obese child would be to condemn the use of drugs and glandular extracts, unless such deficiency could be satis- Page 344 factorily demonstrated; to warn against the attempt to correct the usual spurt of growth which occurs immediately before adolescence; to draw attention to the fact that obesity in children, while occasionally an individual matter and associated with some unhappy social situation, is much more commonly a "conditioned" situation produced by the parents who are in the habit of satisfying their own unfortunate food habits. To me the most rational approach to the problem of the obese child is in the correction of buying and cooking habits of the mother; and finally, that the added stimulus of adequate teaching, so that the individual may learn to excel in some particular activity, particularly athletic, will help to solve the problem of the imbalance between the intake of food and expenditure of energy, which is, after all, the crux of the situation. V ancouver G eneral Hospital UNUSUAL CARDIAC DEATH DUE TO TRAUMA Pathological Conference—Vancouver General Hospital H. H Pitts, M.D., Pathologist F. P. Sparks, M.D., Assistant Director of Laboratory. This patient was a man aged thirty-six years who, after an injury three years before being admitted to the hospital, died after four months of hospitalization of acute cardiac dilatation due to a rare complication. On his admission on June 29, 1942, he was complaining of pain in the right shoulder, periodic swelling of the right arm, and periodic attacks of dyspnoea for three years, as well as attacks of weakness for two years. He attributed all his complaints to an injury received while at work in a logging camp in 1939, when he fell on his right shoulder while carrying a heavy chain and heard- "something snap," but X-ray examination at the time failed to reveal any fracture. However, he ran an irregular temperature which was attributed to a phlebitis of the veins in the upper arm and shoulder, as there was a definite swelling and tenderness of the shoulder area and upper arm. He was discharged from hospital some forty-five days after his accident, but was unable to carry on his usual work because of these complaints. He was examined on various occasions by several physicians but at no time did he mention injury to the chest or shortness of breath. On February 9, 1940, an examination revealed an engorgement of the superficial veins of the right shoulder and upper thorax. He was given a pension to run for three and one-half years, and he attempted to work at various times, but his right shoulder felt heavy and when he used his right arm he "got weak all over"; he claimed that his arm swelled and became blue and cold when he exercised it. In June, 1942, while splitting wood, his arm became very sore, blue, and swollen, and he became very weak and "passed out." At that time the superficial veins on his shoulder and upper chest "stood out." On June 29, 1942, he was admitted to the Vancouver General Hospital, where he remained for sixteen days. He was tentatively diagnosed subacute bacterial endocarditis though blood cultures were negative. X-ray examination on June 30, 1942, showed "In the left costophrenic sinus is an area of infiltration apparently occupying the extremity of the tenth set of bronchi. The diaphragm moves freely at this site, suggesting there is no pleural involvement. It possibly represents a localized bronchiectasis of a somewhat unusual type. The hilar markings on both sides are grossly increased, due to enlargement of the pulmonary conus and the pulmonary artery on each side." Page 343 He left the hospital entirely unimproved. He was re-admitted September 9, 1942, and stayed in hospital until his death, January 30, 1943. His chief complaints on this last admission were shortness of breath and weak spells. Physical examination revealed a well-nourished and developed restless white male lying in bed. He was dyspnoeic. His right eye was deviated tq the right and the cornea completely opaque. The left eye was normal. Examination of the lungs was negative. His heart was enlarged, the apex beat being eleven centimetres to the left side of the midline, in the fifth interspace. There was a soft blowing systolic murmur present at the apex at the time of his previous admission but this murmur was not present this time. His pulse was 88, soft and regular. His blood pressure was 120/100 and respirations 20. His abdomen revealed no abnormality. Neurological examination was negative. His progress from the time of his first admission on June 29, 1942, was steadily downward, although his heart apparently recovered to some extent after a month of complete bed rest. His temperature varied between 96.1 in th morning to 102.2 in the evenings. He left the hospital against advice in July, only to return on September 9, 1942. At the time of his discharge his temperature was slightly elevated and he complained of some pains in his shoulder. When the patient returned to hospital, on September 9, he was complaining of pain in the upper chest, weakness, difficulty in breathing and a non-productive cough. His temperature was 100, pulse 120, blood pressure 120/100, and respirations 55. An electrocardiogram on September 12, 1942, showed "flattened T waves and some myocardial involvement." Report of X-ray examination on September 14, 1942, was: "Right lateral, 6.0 cm.; left lateral, 12.0 cm.; long axis, 19.5 cm.; transthoracic measurement, 28.0 cm. The heart shows very marked general enlargement, especially in relation to the left ventricle. There is also considerable thickening shown at both the right and left hilus, circumscribed in character." As the patient was thought to be suffering from a chest infection, he was put on sulphadiazine. The temperature and dyspnoea improved but "splinter" haemorrhages were noted under his thumb nail on September 11, 1942. This finding supported the original diagnosis of subacute bacterial endocarditis though blood cultures were still negative. He was not improved by digitalis. In November, 1942, his general condition was improved, probably owing to bed rest. Physical examination revealed, in addition to the previously noted enlarged heart, a soft systolic murmur at the apex. Moreover, there was an anterior to and fro friction rub in the right anterior base of the lung and bronchial breath sounds were present over the lower half of the left chest, posteriorly. The venous pressure of his left arm was 88 mm. water. The circulation times of his right arm were: arm to lung, 8 seconds; arm to tongue, 30 seconds. The patient was allowed up for short periods. However, his pulse remained fast, so he was kept on digitalis, grains 1 l/z daily. An electrocardiogram on November 6, 1942, was reported "similar to September 12, 1942—Tachycardia, some myocardial involvement." X-ray examination on November 7, 1942, revealed "There is no essential change in heart measurements as compared to previous examination. There appears to be a slight amount of enlargement of the ascending aorta but no marked pulsation. There is a slight interlobar thickening of the right side in relation to the third and lower lobe." His condition remained the same until about the middle of December, when his temperature began to rise. His condition became gradually worse. On January 28, 1943, he became greatly nauseated and began to vomit. His cough became very productive, of thin watery sputum; he became very much cyanosed and expired January 30, 1943. Laboratory Findings Blood examinations showed a red blood count as follows: R.B.C. 4,900,000; Hb. 103%; Colour Index 1.06 White blood count varied from W.B.C. 5,000, P. 39, L. 37, M. 5, B. 3, Deg. 4, Page 346 Staph. 12 on June 30, 1942, to W.B.C. 10,050, P. 46, L. 22, M. 1, E. 4, Deg. 6, Staph 21 on Janu6ar 7, 1943. His sedimentation rate increased from 2/7, September 9, 1942, to 2/29, November 10, 1942, and 18/686, January 7, 1943. Kahn—negative. Agglutination tests—negative on two occasions. Numerous examinations of the urine were normal. Sputum examinations on five occasions were negative for Bacillus Tuberculosis. A post-mortem was done on this man on January 31, 1943. The body was that of a poorly nourished white male, which presented nothing of note on external examination. Lungs: The right pleural cavity was entirely obliterated by old pleuritic adhesions; the left cavity contained about 200 c.c. of straw-coloured fluid. The right lung weighed 1650 gm., the left 720 gm. Both lungs were cedematous but on cross-section there were small areas of consolidation scattered from apex to base, in both lungs. They were white, and in many areas showed small abscesses. They did not present a typical caseous appearance but suggested rather a miliary tuberculosis. The lesions were more numerous at the apices and bases of both lungs. Smears from the lesions were positive for Bacillus Tuberculosis. Heart: The pericardial sac was found to contain about 150 c.c. of clear straw- coloured fluid. The heart was definitely enlarged and weighed 500 gm. Both right and left ventricles were dilated, but the right side was larger than the left. The myocardium was fairly firm; that of the right ventricle measuring 0.8 cm. in thickness; that of the left, 1.3 cm. There was no evidence of thrombus formation in any chamber of the heart. The valve circumferences were as follows: P.V. 9.5 cm.; T.V. 14.5 'cm.; M.V. 10.5 cm.; A.V. 9 cm. All the circumferences were larger than normal but the tricuspid valve was definitely dilated and incompetent. There was a slight thickening of the mitral leaflets and aortic cusps. The coronary arteries and the aorta were free from sclerotic thickening. Pulmonary Arteries: A large old, well-organized thrombus was found almost entirely occluding the lumen of both right and left pulmonary arteries. The proximal ends of the thrombi were smooth, whitish-yellow and well-rounded off, indicating that they had been present for a relatively long period of time. These thrombi could be traced distally into all the large branches of the pulmonary arteries of both lungs. It should be noted that neither the main arteries or their branches were completely occluded at any one point. The liver weighed 1770 grams. It was a dark purplish-red colour and on cross- section showed the typical nutmeg appearance of chronic passive congestion. The spleen weighed 160 gm. The capsule was slate-grey. Running across the spleen was a very fibrous area which was yellow in colour and nearly cut the spleen in two. On cross-section it had the typical appearance of an old infarct. The splenic pulp was greatly congested. The gastro-intestinal tract, pancreas and adrenals were normal. The right kidney weighed 130 gm.; the left, 110 gm. The cortex of both was distorted by old scarring. The capsules stripped with difficulty, showing an irregular cortical surface. Both cortex and medulla were markedly congested and showed evidence of old infarcts. Examination of the ureters, bladder and prostate was negative. Page 347 Thus the findings were as follows: 1. Almost complete bilateral pulmonary thrombosis. 2. Acute dilatation of right and left heart. 3. Pleurisy (old), right side. 4. Consolidation and abscess formations, both lungs, due to tuberculosis. 5. Pulmonary oedema, right side. 6. Chronic passive congestion of liver, spleen, kidney6s. 7. Old infarcts of spleen and kidneys. Summary and Discussion Ante-mortem pulmonary thrombosis is a rare condition. According to Scovacole and Charr1 who have reviewed the literature, one hundred cases of pulmonary thrombosis have been reported, and in forty-nine it was on the right side, in six on the left, and in forty-five cases both arteries were thrombosed. In this case, both pulmonary vessels were thrombosed. Brenner2 states that symptoms may be present from one month to several years. He gives dyspnoea, exertion, cyanosis, chest pain, an enlarged heart and a dense shadow over the pulmonary artery, as the findings in his cases. Pou and Charr3 report rapid increase in dyspnoea, cyanosis, engorgement of cervical veins, pain in the chest or epigastrium, restlessness, mental confusion, exophthalmos, blurred vision, low pulse pressure with thin thready pulse and oedema of the ankles in the terminal stages, as outstanding clinical features of their six cases. This patient had some of these symptoms. He had attacks of dyspnoea and weakness, and an engorgement of the veins of the upper chest. The cervical veins were not engorged but cyanosis was present before his death. Pain in the chest was a feature from his last admission till his death. His pulse pressure was low (120/100 and 100/ 95). Bogaert and Scherer4, McGinn and White5, and Brenner2 found prominent Q waves in the first lead and late invasion of T wave with a high origin in lead 3. In some there was a tendency to right axis deviation. The electrocardiographic findings in this case showed a pronounced- S wave in the first lead and a slight depression of S and T in lead 2. There is a tendency to right axis deviation. These changes are suggestive of Cor pulmonale. X-ray and physical examination are of questionable aid in the diagnosis of pulmonary thrombosis. Pou and Charr3 conclude that a differential diagnosis of thrombosis of the pulmonary artery from myocardial insufficiency, coronary artery occlusion, spontaneous pneumothorax, intrathoracic new growths and pulmonary embolism may be possible by a close observation of the clinical course of this condition. As to the cause of pulmonary thrombosis, many different views are held by different investigators. Brenner2 considers that most thrombi are embolic in origin. He states that there is nearly always some pre-existing disease such as syphilis, rheumatism, tuberculosis; or there may be a patent ductus arteriosus in cases of true pulmonary thrombosis. Scovacole and Charr1 in their analysis of the hundred cases reported in the literature, conclude that pulmonary disease is not the only determining factory in the production of pulmonary thrombosis. In forty-six of them there was definite evidence of parenchymal pulmonary diseases, not including those with arterial pulmonary changes associated with cardiovascular disease. In this series of forty-six cases, twenty-two had thrombus on the right side, ten bilaterally and five on the left side. In the remainder of the hundred there was no pulmonary disease, but twenty-seven had thrombus on the right side, twenty-six bilaterally and one on the left side. This suggests that the right side predominance of thrombosis does not depend entirely upon the pulmonary disease being more marked on that side, but rather upon some other factor. These workers, in Page 348 attempting to explain the predominance of right-sided thrombosis, refer to Seinor6, who draws attention to the anatomical surroundings and greater length of the right pulmonary artery, which *lies horizontally under the arch of the aorta. In its course to the hilum, the right pulmonary artery has certain structures close to it which the right artery does not possess. In front there is the ascending aorta and the superior vena cava as well as the phrenic nerve, the anterior pulmonary plexus and the reflection of pleura. Lying close to the artery posteriorly is the right bronchus and azygos vein. Above the artery is the arch of the aorta; below the artery is the right atrium and the right pulmonary vein (upper). At the root of the lung the right bronchus is above and beyond it, and the pulmonary veins are below and in front of it. These surrounding pulsating vessels would undoubtedly compress the right pulmonary artery and tend to cause a slowing-down of the blood stream. In the case under discussion, the thrombosis was bilateral and so the above anatomical factor can be eliminated as a cause. Thus we are left with the other two causes: embolus and pulmonary disease. An embolus could have broken free from the site of the old phlebitis in the right arm and lodged in the pulmonary arteries with a subsequent building-up of thrombus to present the picture seen at post-mortem. On the other hand there was widespread pulmonary disease present in both lungs, although the immediate vicinity of the thrombi was free from disease. It is very difficult to assess the value of each of these factors in assigning the cause of the thrombosis. Summary 1. The clinico-pathological findings of a case of a bilateral pulmonary thrombosis following trauma are described. 2. The outstanding clinical features of this case are described and compared with the findings described in the. literature. 3. The conclusions of other writers are given as to the factors causing pulmonary thrombosis, i.e.: Embolus, pulmonary disease, systemic diseases, inflammations, congenital defects and anatomical factors causing a slowing-down of the blood in the right pulmonary artery. (Our sincere thanks are due to Dr. George F. Strong for permission to publish this case from his medical service.) REFERENCES , 1. Scovacole, J. W., and Charr, R.: American Review of Tuberculosis, 27, 1941. 2. Brenner, O.: Archives of Internal Medicine, 1935, 56, 1189. 3. Pou, J. F., and Charr, R.: American Review of Tuberculosis, 193 8, 37, 394. 4. Bogaert, A., and Scherer, H. J.: quoted by Pou and Charr (3). 5. McGinn, S., and White, P.: quoted by Pou and Charr (3). 6. Seinor: quoted by Scovacole and Charr (1). Page 349 vr J«w 1943 corpora*10* Chicago. X1 S *« iafo^Jproduc ttf.C«> _-ad *° u.«« t1"^ front a* ***&??* ~* «»?j£ Robert J- ary of Under Sec ^ 6-E STANDARDS ARE SET UP TO BE MAINTAINED- IN WAR AND IN PEACE VICTOR X-RAY CORPORATION of CANADA, Ltd. DISTRIBUTORS FOR GENERAL ^ ELECTRIC X-RAY CORPORATION TORCWTO: 30 Bloor SL, W.-VANCQUVER: MotorTrans. Bldg, 570 Durauir St MffliMAL: 600 Medical Arts BuJding ' ''' *"- %<&* Zest *?«*- JV*tS*>^G*fifiatim While abbreviations may save time, physicians who say "an ampoule of Pit" are never sure of getting pituitrin*. When PITUITRIN is specified by its full' name medical men receive the original prep* aration of its kind, first offered to the profession by Parke, Davis & Company in 1909. PITUITRIN contains an unusually low per* centage of inert or irritating matter and will not deteriorate over long periods of time. Since an excess of acid is not required as a preservative, injection is practically painless. Clinical results, based on millions of injections, have made PITUITRIN (brand of posterior pituitary extract—C. F.) specific for all prepartum and postpartum USeS. •TRADE-MARKRE& PITUITRIN PARKE, DAVIS & COMPANY WALKERVILLE • ONTARIO cfOX \\6\\^^ in the Treatment of TRICHOMONAL VAGINITIS Stovaginal is especially indicated in pathological conditions of the vaginal mucosa resulting from or associated with the Trichomonas Vaginalis, as well as in mixed and non-specific infections of the vagina. STOVAGINAL POWDER constitutes a practical means of office or hospital treatments by the physician. STOVAGINAL TABLETS provide a convenient and effective means of uninterrupted home treatments by the patient. Stovaginal is supplied in containers of 20, 100 and 500 vaginal tablets and in bottles of 30 and 200 grams of vaginal powder. OF CANADA LIMITED — MONTREAL >h 7' rv—» CJ\\ r&Sr K<4S, 5ni A COMPLETE VITAMIN AND MINERAL TONIC :|| "NEOCHEMICAL'FOOD The most complete, effective and economical preparation, of its kind available anywhere at the present time, N.C.F. Tonic is a true chemical food, supplying adequate amounts of those chemical and bio-chemical factors which tend to be deficient in unsupplemented diets. Extensively prescribed for school children to offset the effect of long hours spent indoors. PRINCIPAL INGREDIENTS IN DAILY DOSE IRON (as ferrous salt) COPPER (as salt) VITAMIN A Her. 1/30 gr. 2000 Int. units VITAMIN D (Ostogen) 2000 Int. units PHOSPHORUS (as salt) % gr. CALCIUM (as salt) 1 gr. VITAMIN Bi 200 Int. units (Thiamin chloride) ) Aids in the prevention of NU« ) TRITIONAL ANAEMIA Helps keep the EPITHELIAL TISSUE healthy; specific to prevent and treat NlGHT BLINDNESS of dietary origin ) Promotes normal development \\ of BONES and TEETH, and \\ prevents and cures RICKETS Protects against and aids in the treatment of symptoms of Bi deficiency including NEURITIS of Bi deficiency Aids in prevention of IODINE DEFICIENCY IODINE (as salt) 1/192 gr. MALT EXTRACT q.s. Protein 3-5%; fat 0.6%; carbohydrate 54% by weight; 85.4 calories per fluid ounce. Biologically standardized in our own laboratories.- MODES OF ISSUE In Liquid form, 7 % oz. bottles (24 day size), 23J< oz. (72 day size), 461$ oz. (economy size, 144 days)—recommended for children. 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PRIVINE"Ciba" (1:1000 solution of 2-(naphthyU-1—methyl)-imidazoline hydrochloride) NASAL DROPS 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 Vt. ounce with dropper, and bottles of 4 ounces. CIBA COMPANY LTD. Montreal •II/. X \\ ^, pp co Postprandial distress Having to listen to a prosy after-dinner oration may be a painful experience, but more real, in the physical sense, is the distress that awaits him who has dined well but none too wisely. Gourmandism is difficult to cure, as is the habit of hurried dining, and so it becomes a matter of alleviating the gastric distress caused by hyperacidity. Physicians for many years have found in Cal-Bis-Ma the kind of preparation that will help provide this relief. A palatable powder composed of substances recognized as effective for gastric neutralization, Cal-Bis-Ma may be prescribed with assurance that it will act promptly and safely. A trial supply will be gladly sent to physicians. Please write to the Dept. of Professional Service. j CAL-BIS-MA WILLIAM R. WARNER & CO., LTD., 727 King St, West, Toronto, Ontario n b n u ^w The United States Bureau of Dairy Industry in its research has discovered a new growth-stimulating factor in milk. This factor—now called "X" until further identification is possible—is different from all of the now-known nutrients of milk. Dr. C. A. Cary and his associates at the Bureau of Dairy Industry, United States Department of Agriculture, have been conducting research on milk over a period of yea rs.^| These studies have led them to the conclusion that milk definitely has more value than has yet been discovered. These research workers fed experimental animals a synthetic mixture of all of the known nutrients of milk. They fed other experimental animals the complete food—milk. The ani- male which were fed milk—as such—grew better and were in better general physical condition than the animals which received all of the various known components of milk. Although many nutritionists have indicated that there might be further nutritive substances in milk than have been discovered, this is the most recent proof of that fact. Good nutrition is a basis to stamina and endurance—each a "must" in the war effort. INDEX TO VOLUME XIX, V.M.A. BULLETIN, 1942-43 A ACTINOMYCOSIS, PROBABLE CASE—W. Keith Burwell 77 ARGBNTAFFTNOMATA, REVIEW OF CASES, V.G.H.—L. B. Harville 17 ARTHRITIS, CHRONIC—John W. Scott 57 B BOOK REVIEWS— Advances in Internal Medicine, v. 1—J. Murray Steele, Ed 34 Advances in Paediatrics, v. 1—A. G. DeSanctis, Ed 99 Blood Grouping- Technic—Fritz Schifi! and Wm. C. Boyd 6 Manual of Industrial Hygiene and Medical Services in War Industries 219 War Gases—Morris B. Jacobs 6 War Medicine—Winfield Scott Pugh, Ed — 7 BRITISH COLUMBIA CANCER INSTITUTE— Annual Meeting of Honorary Attending Staff 192 Review of Cases of Carcinoma of the Body of the Uterus—Margaret Hardie 192 BRITISH COLUMBIA MEDICAL ASSOCIATION 13, 40, 75 Annual Meeting _ _ 273, 299 Canadian Medical Association—Special Meeting of General Council 104 —Meeting, Montreal =- 275 Committee on Economics—"Health Insurance—How Soon?"—T. C. Routley 228 Committee on Industrial Medicine 68 Committee on Study of Cancer—^Cancer of the Stomach 38, 75 Communication—Dept. of Munitions and Supply, Controller of Chemicals—Quinine 250 Health Insurance—No. 1—Abstracts of Dominion and Provincial Acts 329 —No. 2—Resume of the Minutes of the Proceedings of the Committee on Social Security—A Report for the Doctor in Practice _ 334 Upper Island Medical Association Meeting _ 39 BRITISH COLUMBIA PHARMACEUTICAL ASSOCIATION—Health Insurance Committee 118, 233 BROMIDE POISONING, REVIEW OF 12 CASES—Phillip E. Pemberton 106 BURWELL, W. KEITH—Probable case of actinomycosis 77 C CAESAREAN SECTIONS IN V.G.H., 1941—George H. McKee 206 CAMPBELL, C. G., and PROWD, C. W.—Gastric mucosal patterns.... 226 CAMPBELL, E. A.—Classification of the neuroses 134 CANTOR, MAX M.—Evaluation of hepatic function 316 Evaluation of renal function 309 CARCINOMA OF BODY OF UTERUS—Margaret Hardie 192 CARDIAC DEATH DUE TO TRAUMA—H. H. Pitts and F. P. Sparks 345 CATARRHAL JAUNDICE, EPIDEMIC—J. S. Kitching 114 CECOSTOMY—INDICATIONS AND TECHNIQUE—Roscoe R. Graham 22 CHRISTIE, JOHN—Congenital pachyonychia and keratoderma, Case 113 CLEVELAND, D. E. H.—Osier Lecture—The fear of the skin 196 COLLEGE OF PHYSICIANS AND SURGEONS 11, 12, 157, 191, 249 Election of Members of Council 70 Medical Services Association 306 Annual Report 70 Information for Doctors 101 B DAVIDSON, GEORGE A.—The treatment of neuroses 144 DESBRISAY, H. A.—Medicine and war 276 DIVISION OF VENEREAL DISEASE CONTROL | 116, 341 Reporting cases*—Notification form N.l _ 232 D\\)BSON, W. A.—Early psychotic manifestations resembling neuroses 140 DOLMAN, C. E.—Laboratory diagnosis of venereal disease 131 Sero-diagnostic tests for syphilis 131 DUNN, EILEEN M.—Diet in disease of the gall-bladder 14 E ERYTHROBLASTOSIS FOETALIS AND ITS RELATIONSHIP TO THE Rh FACTOR— A. H. Spohn and Peter H. Spohn. 211 P FROST, A. C.—General principles of gynaecological surgery 181 FRACTURES, TREATMENT—MODERN TREND—H. S. Morton 79 G GALL BLADDER DISEASE, DIET—Eileen M. Dunn 14 GASTRIC MUCOSAL PATTERNS—C. W. Prowd and C. G. Campbell 226 GRAHAM, ROSCOE R.—Indications and technique for cecostomy 22 GYNAECOLOGICAL SURGERY—GENERAL PRINCIPLES—A. C. Frost 181 HAEMATOMA, SUBDURAL, IN INFANCY—J. W. Cluff 289 HAEMORRHAGIC BLOOD DISEASES—John W. Scott k 86 HARDIE, MARGARET—Carcinoma of the body of the uterus 192 HARRISON, BEDE J.—Whither? 163 HARVILLE, L. B.—Argentaffinomata, review of cases 17 HASKINS, JOHN L.—Psychological warfare ! 48 HEART ATTACK IN YOUTH—H. G. "Weaver 307 HENRY, C. M.—Review of roentgen therapy in acute infections 43 HEPATIC FUNCTION, EVALUATION—Max M. Cantor 316 HYPERINSULINISM—J. C. Thomas - 177 HODGINS, G. L.—Staff medical work in the Vancouver General Hospital 288 X INCOME TAX RETURNS—INFORMATION - - 160 IRON DEFICIENCY ANAEMIAS—John W. Scott »2 J JOHNSON, A. M.—Plasma proteins in modern medicine 20 JOHNSTONE, ALAN—The law and social hygiene 304 K KITCHING, J. S.—Epidemic catarrhal jaundice H4 B LABORATORY DIAGNOSIS OF VENEREAL DISEASE—C. E. Dolman 131 LAW AND SOCIAL HYGIENE—Alan Johnstone. 304 LEE, G. H., and PITTS, H. H.—Retroperitoneal lymphangioma, case 41 M MEDICINE AND WAR—H. A. DesBrisay _ 276 MEMORIES—P. A. McLennan 251 MORTON, H. S.^-Modern trend in the treatment of fractures i 79 Mc McCULLOUGH, MARJORIE—The soya bean 172 McKEE, GEORGE H.—Caesarean sections in V.G.H. in 1941 206 McLENNAN, P. A.—Memories 251 N NEUROSES, CLASSIFICATION—E. A. Campbell , 134 NEUROSES, EARLY PSYCHOTIC MANIFESTATIONS RESEMBLING—W. A. Dobson 140 NEUROSES, SIGNIFICANCE OF SYMPTOMS—S. E. C. Turvey 142 NEUROSES IN WAR TIME—J. C. Thomas 136 NEUROSIS, COMPENSATION—Frank Turnbull - 139 NEUROSIS, TREATMENT—George A. Davidson -^ 144 NEUROTIC—BACKGROUND AND PERSONALITY—Gordon H. Hutton 133 O OBESE CHILD—DISCUSSION OF TREATMENT—R. R. Struthers 342 OBITUARIES— Anderson, Lt.-Col. W. H. K 244 Lamb, A. S j - 100 Lees, Lt.-Col. Frederick W. 245 McDiarmid, Capt. J. M 127 McGregor, Herbert 127 Oliver, Capt. G. D , .1. 244 Perry, H. H : . 100 OSLER LECTURE—THE FEAR OF THE SKIN—D. E. H. Cleveland 196 F PACHYONYCHIA AND KERATODERMA, CONGENITAL, CASE—John Christie 113 PEMBERTON, PHILLIP E.—Review of 12 cases of bromide poisoning 105 PHARMACISTS—RELATION TO PUBLIC HEALTH AND HEALTH INSURANCE— Hugh Wolfenden 119, 147 PITTS,, H. H., and LEE, G. H.—Retroperitoneal lymphangioma, case 41 and SPARKS, F. P.—Cardiac death due to trauma . 345 PLASMA PROTEINS IN MODERN MEDICINE—A. M. Johnson 20 PROWD, C. W., and CAMPBELL, C. G.—Gastric mucosal patterns B26 PSYCHOLOGICAL WARFARE]—John L. Haskins 48 r RENAL FUNCTION, EVALUATION—Max M. Cantor 309 RETROPERITONEAL LYMPHANGIOMA, CASE—G. H. Lee and H. H. Pitts 41 ROENTGEN THERAPY IN ACUTE INFECTIONS, A REVIEW—C. M. Henry 43 S ST. PAUL'S HOSPITAL— Case reports 77, 113 General principles of gynaecological surgery—A. C. Frost 181 Erythroblastosis foetalis and is relationship to the Rh factor—A. H. Spohn and Peter H. Spohn 211 SCOTT, JOHN W.—Chronic arthritis 57 Haemorrhagic blood diseases 86 Iron deficiency anaemias 52 SKIN, THE FEAR OF—D. E. H. Cleveland _ 196 SOYA BEAN—Marjorie McCullough 172 SPARKS, F. P., and PITTS, H. H.—Unusual cardiac death due to trauma 345" SPOHN, A. H., and SPOHN, PETER H.—Erythroblastosis foetalis and its relationship to the Rh factor 211 STRUTHERS, R. R.—The obese child: a discussion of treatment 342 SYPHILIS—Serological test for : 116 Sero-diagnostic tests 131 T THOMAS, J. C.—Hyperinsulinism 177 Neuroses in war-time : 136 TURNBULL, FRANK—Compensation neurosis 139 TURVEY, S. E. C.—The significance of symptoms in the neuroses ,..„..,„ 142 VANCOUVER GENERAL HOSPITAL— Case reports 17, 41, 106, 307, 345 Chinese diets—H. S. D. Garven 210 Department of Dietetics—Diet in disease of the gall-bladder 14 The soya bean .". 172 Facts and figures * 179 Report by Dr. F. N. Robertson to Medical Board 286 Review of Caesarean Sections, 1941—Geo. H. McKee 206 Staff medical work in V.G.H.—G. L. Hodgkins 288 Subdural haematoma in infancy—J. W. Cluff .'. 289 VANCOUVER MEDICAL ASSOCIATION— Annual reports, 1942-43 220 Library notes 6, 34, 69, 98, 127, 156, 219, 272, 298, 328 . Microfilm service 128, 138 Notes on B. C. Formulary—No. 1 Analgesics „ 133 Summer School, 1942 ■ 8 Summer School, 1943 216, 246, 270 VICTORIA MEDICAL SOCIETY 43, 79 W WEAVER ,H. G.—A heart attack in youth 307 WHITHER?—Bede J. Harrison 163 WOLFENDEN, HUGH—Relation of pharmacists of Canada to public health and health Insurance 119, 147 Breaks the vicious circle of perverted 1 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 j Ik normal menstrual cycle. * MARTIN H. SMITH COMPANY ^ ~ iso iAF»Yim suiti. Ntw vonc n. v. *m 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. Telephone MArine 2015 Residence: B Ay view 8116-M Moth} C. Jlaboey A.P.A., A.R.P.T.T. CANADIAN PHYSIOTHERAPY ASSOCIATION MASSAGE — REMEDIAL EXERCISES ELECTRICITY, Including Short Wave House Visits 704 Birks Building, 718 Granville Street Vancouver, B. C. IN PREGNANCY suggested |or;trea^eht of threatened |r habitual abortion que to f vitamin e deficiency FOR INCREASED Ialcium REQUIREMENTS % Each capsule contains 50 milligrams of mixed tocopherols, equivalent in vitamin E activity to 30 milligrams of a-tocopherol. Tocopherex contains vitamin E derived from vegetable oils by molecular distillation, in a form more concentrated, more stable and more economical than wheat germ oil. For experimental use in prevention of habitual abortion (when due to Vitamin E Deficiency): 1 to 3 capsules daily for 8% months. In threatened abortion: 5 capsules within 24 hours, possibly continued for 1 or 2 weeks and 1 to 3 capsules daily thereafter. Tocopherex capsules are supplied in bottles of 25 and 100. 0 Each capsule of Viophate—D contains 4.5 grains Dicalcium Phosphate, 3 grains Calcium Gluconate and 330 units of Vitamin D. The capsules are tasteless, and contain no sugar or flavouring. Where wafers are preferred, Viophate—D Tablets are available, pleasantly flavoured with winter- green. One tablet is equivalent to two capsules. How supplied: Capsules-—Bottles of 100 and 1,000. Tablets —Boxes of 51 and 250. For literature, write 36 Caledonia Road, Toronto E-R:Squibb&.Sons of Canada. Ltd. MANUFACTURING CHEMISTS TO THE MEDICAL PROFESSION SINCE 1858 I SO LC^|i!^»!;'§IE WASSr-^»L/lT cJuce Jhe poss|bif^^^p|Bies^^feifjng Phone MArine 416 ,jbdU*^.J&*d**0*\\ GEORGIA PHARMACY LIM1TCO MWUMA (Sntpr &; l| t^i|I&. ESTABLISHED 1893 VANCOUVER, Wm North Vancouver, B.Cl Powell River, B. (B^ DHHH| wm mm #*& %## ft New Westminster, B. C. For the treatment of NEUROPSYCHIATRIC DISORDERS Reference—B. C. Medical Association For information apply to Medical Superintendent, New Westminster, B. C or 721 Medical-Dental Building, Vancouver, B. C PAcific 7823 Westminster 288 87 University of British Columbia Library DUE DATE S SERIALS JAN ° 0 n/ \\ VHIV a. b CV «g FEB 10 1966 J A jy 9 7 f?P7] FORM 310S &70%/2^ m m WOODWARD LIBRARY """@en ; edm:hasType "Periodicals"@en ; dcterms:identifier "W1 .VA625"@en, "W1_VA625_1943_09"@en ; edm:isShownAt "10.14288/1.0214471"@en ; dcterms:language "English"@en ; edm:provider "Vancouver : University of British Columbia Library"@en ; dcterms:publisher "Vancouver, B.C. : McBeath Spedding Limited"@en ; dcterms:rights "Images provided for research and reference use only. Permission to publish, copy, or otherwise use these images must be obtained from the Digitization Centre: http://digitize.library.ubc.ca/"@en ; dcterms:source "Original Format: University of British Columbia. Library. Woodward Library Memorial Room. W1 .VA625"@en ; dcterms:subject "Medicine--Periodicals"@en ; dcterms:title "The Vancouver Medical Association Bulletin: September, 1943"@en ; dcterms:type "Text"@en ; dcterms:description ""@en .