CONTENTdm
History of Nursing in Pacific Canada
Vancouver Medical Association
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IB BULL of the m e d i g hhh s o <Mm i on VoL XX FEBRUARY»|i^44 With Which f* Incorporated Transaction* of the Victoria Medical Soc the VancoUver^3eneral Hospital and St. Palll'sHospital No^Sk In This Issue: SESSIONAL MATING OFf^ERICA^COi&EGE OfcSlJRGEONS w^APiup^^&--i g^M^^WijilH —'^^^;'-—..^^^ THE INFLUENCE OF PI^TRA^|i|jXl<^i OI^REATMri&ii| -OF I a cm m p.s^^fes|:^fe^: H MBBIl „ jfc_____ 122 TWENTY-FIVE YEARS OF'HEALTH WORK IN THE SOVIET UNION Oli NEWS AND NOTES. 140 53k S0MME^CMQOi§ The Animal funnier School of $ihe Vancouvelll.Medical ^Association will be held j$i£/the ViPLEX E.B.S. Liquid In Pounds—Winchesters^— and Gallons Strength per teaspoonful^^ Thiamine chloride .75 mgm- Riboflavin . ''4|||^p5 mgm. Nicotinic Acid ^.3.0 mgm. Pyridoxine|fll& 453 mcgm. Pantothenic Acid 63 mcgm. VIPLEX: E.B.S. Tablet S.C.T. #745 in bottles of 100, 500 and 1000. Strength per tablet: Thiamine chloride .75 mgm. Riboflavin. .J||? 0.5>3pagm. Nicotinic AcidHjjrlO.O mgm. Pyridoxine-^^3<: 250 mcgm. Pantothenic Acid 250 mcgm. E* 3th E Wmmm Vitamin B deficiency following causes: may result frongltne 1. Malnutrition—There may be a shortage of the components of the B-complex in the dies|| Certain drugs, such as the sulfas, interfere with the action of autotrophic bacteria in the intestines, thus reducing thejnormal "in vivo" synthesis of members of the B-complex. Voluminous water excretion, especially in cha conditions^-may largely remove these water-soluble factors. i.The heavy administration of liquids, as in parenteral feeding, may, by dilution, lower the blood concentration beyond the normal levels of health. Deficiency of B-complex may be suspected if the patient shows: 1. Lesions of the lips, cheeks or tongue. 2r Hypo- or achlorhydria accompanied by a flat, oral dextrose tolerance curve. 3. Acrodynia. 4. Easy fatigue and poor recuperation from fatigue. 5. Undue nausea in pregnancy. 6. The Wernicke Syndrome. 7. Otherwise unaccountable cutaneous disturbaneeiK^ 8. Intestinal hypotonicity. vitamin b symciENdrljaAY be restorelvIh MAINTAINED B^ ADMINISTERING VIPLEX |p.S. EITHERLIQUID OR TABLET FORM In prescribing: follow the name V/p/ex with the letters E.B.S. to indicate your wish for a Shuttleworth product.., H Viplex E.B.S& 'VAT^WTWC THE E/teHUTTtEWOrftHJCHEIKIICAt CO^XIMITEO TORONTO MANUFACTURING CHEMISTS CANADA THE VANCOUVER MEDICAL ASSOCIATION BULLETIN 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. XX FEBRUARY, 1944 No. 5 OFFICERS, 1943-1944 Dr. A. E. Trites Dr. H. H. Pitts Dr. J. R. Neilson President Vice-President 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. SECTIONS Clinical Section Dr. J. W. Miller Chairman Dr. Keith Burwell Secretary Eye, Ear, Nose and Throat Dr. C. E. Davies Chairman Dr. Leith Webster Secretary Pediatric 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 Swtfitcfed DAILY RATIONAL VITAMIN THERAPY NOW MADE POS ONE CAPSULE The OPTIMAL VITAMIK»gMEMENTAT {r«'<ommend#d by the Food and Nutr-jpR No trade namejp rfjjjlrijber ■ Check with the chart Each capsule meets the Recommended Daily Allowances, Food and Nutrition Board, National Research Council. This mum daily U.S. Food] trotion. lsoj%hows the mini. iin requirements, and Drug Adminis- B2 NIC Optimal doily allowance (adult) as recommended by the Food and Nutrition Board of the National Research Council*. = Supplied in ONE SQUIBB SPECIAL VITAMIN FOR. MULA CAPSULE. Minimum daily require-' ments U. S. Food and Drug Administration. "j.A.M.A. 116:2601, June 7, 1941. *Not yet official. and here is something HIW in Ethical Vitamin Therapy TtLSOinBB ."• T 1. Squibb Special Vitamin Formula Capsules are sold to druggists in bulk. The druggist does not have to stock packages of various sizes. In fact, there are none. 2. Prescribe for a patient whatever number of capsules for whatever period you wish. 3. Druggists generally will fill your prescription at the same cost per capsule whether you prescribe 10 capsules or 100—generally about six or seven cents per capsule. 4. Vitamin therapy with Squibb Special Vitamin Formula Capsules is not expensive. The Squibb Laboratories have done everything possible to keep the cost low ... to encourage prescription of a multivitamin preparation ... to keep the control of vitamin therapy where it belongs—under the supervision of the physician with die collaboration of the druggist. VANCOUVER HEALTH DEPARTMENT STATISTICS—DECEMBER, 1943 Total Population—Estimated _ Japanese Population Chinese Population—Estimated Hindu Population Number Total deaths 409 Chinese deaths 20 Deaths—residents only 368 BIRTH REGISTRATIONS: Male, 272; Female, 268 540 INFANT MORTALITY: Dec, 1943 Deaths under one year of age 12 Death rate—per 1,000 births js 22.2 Stillbirths (not included above) 11 288,541 Evacuated 5,541 301 Rate per 1,000 Population 16.7 42.5 15.0 22.0 Dec, 1942 22.6 11 CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY November, 1943 Cases Deaths December, 1943 Cases Deaths Jan. 1-15, 1944 Cases Deaths 65 0 Scarlet Fever i ! Diphtheria , Diphtheria Carrier 2 Chicken Pox 166 Measles 5 Rubella 9 Mumps 5 5 Whooping Cough . 23 0 , i 1 1 3 5 0 'Typhoid Fever Undulant Fever Poliomyelitis Tuberculosis Erysipelas Meningococcus Meningitis Paratyphoid Fever 0 0 0 0 0 0 0 1 0 0 0 19 0 0 0 62 0 0 141 3 2 23 12 0 0 0 22 4 2 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 42 0 0 71 3 2 26 9 0 0 0 0 2 0 V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH DIVISION OF VENEREAL DISEASE CONTROL Syphilis Gonorrhoea Burnaby 0 0 West North Vane. Richmond Vane. l l 2 l l l Vane. Clinic Hospitals & Private Drs. Totals 27 52 83 56 75 134 B 10GLAN-A The most effective therapy for waning mental and physical energy, deficient concentration and memory, reduced resistance to infection, muscular weakness and debility, neurasthenia and premature senility. The efficacy of this very potent endocrine tonic has been confirmed by the clinical evidence of many thousands of cases treated during 1932-1943. Stanley N. Bayne, Representative Phone MA. 4027 1432 MEDICAL-DENTAL BUILDING Vancouver, B. C. Descriptive Literature on Request THE SCIENTIFIC HORMONE TREATMENT Page One Hundred and fifteen SHOULD VITAMIN D BE M GIVEN ONLY TO INFANTS? ITAMIN D has been so successful in preventing* rickets during infancy that there has been little emphasis on continuing its use after the second year. But now a careful histologic study has been made which reveals a startlingly high incidence of rickets in children 2 to 14 years old. Follis, Jackson, Eliot, and Park* report that postmortem examination of 230 children of this age group showed the total prevalence of rickets to be 46.5 %. Rachitic changes were present as late as the fourteenth year, and the incidence was higher among children dying from acute disease than in those dying of chronic disease. The authors conclude, "We doubt if slight degrees of rickets, such as we found in many of our children, interfere with health and development, but our studies as a whole afford reason to prolong administration of vitamin D to the age limit of our study, the fourteenth year, and especially indicate the necessity to suspect and to take the necessary measures to guard against rickets in sick children." *R. H. Follis, D. Jackson, M. M. Eliot, and E. A. Park: Prevalence of rickets in children between two and fourteen years of age, Am. J. Dis. Child. 66:1-11, July 1943. MEAD'S Oleum Percomorphum 50% With Viosterol is a potent source of vitamins A and D, which is well taken by older children because it can be given in small dosage or capsule form. This ease of administration favors continued year-round use, including periods of illness. MEAD'S Oleum Percomorphum 50% With Viosterol furnishes 60,000 vitamin A units and 8,500 vitamin D units per gram. Supplied in 10- and 50-cc. bottles and boxes of 48 and 192 capsules. Ethically marketed. MEAD JOHNSON & CO. OF CANADA, Ltd., Belleville, Ont. VANCOUVER MEDICAL ASSOCIATION FOUNDED 1898 :: INCORPORATED 1906 PROGRAMME OF THE FORTY-SIXTH ANNUAL SESSION I (SPRING SESSION) GENERAL MEETINGS will be held on the first' Tuesday of the month at 8:00 p.m. CLINICAL MEETINGS will be held on the third Tuesday of the month at 8:00 p.m. These meetings are to be amalgamated with the clinical staff meetings of 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. March 7—GENERAL MEETING: OSLER LECTURE—Dr. T. H. Lennie. March 21—COMBINED CLINICAL MEETING and STAFF MEETING at VANCOUVER GENERAL HOSPITAL. April 4—GENERAL MEETING: Dr. J. R. Davies—"Remediable Intra-thoracic Conditions in Childhood." (Illustrated by brief case histories and X-ray films.) April 18—COMBINED CLINICAL MEETING and STAFF MEETING at ST. PAUL'S HOSPITAL. MAY 2—ANNUAL MEETING. 13 th Ave. and Heather St. Exclusive Ambulance Service FAirmont 0080 PRIVATE AMBULANCES AND INVALID COACHES WE SPECIALIZE IN AMBULANCE SERVICE ONLY J. H. CREL.L.IN W. L. BERTRAND Page One Hundred and Sixteen DIPHTHERIA TOXOID and PERTUSSIS VACCINE««-«» The death rate from diphtheria and whooping cough is highest among children of pre-schooi age. It is desirable, therefore, to administer diphtheria toxoid and pertussis vaccine to infants and young children as a routine procedure, preferably in the first six months of life or as soon thereafter as possible. For use in the prevention of both diphtheria and whooping cough the Conm-a/wght Laboratories have prepared a combined vaccine, each cc. of which contains 20 Lfs of diphtheria toxoid and approximately 15,000 million killed bacilli from freshly-isolated strains (strains in Phase 1) of H. pertussis. CONVENIENCE The combined vaccine calls for fewer injections, and, in consequence, the number of visits to the office or clinic may be considerably reduced. It is administered in three doses with an interval of one month between doses. DIPHTHERIA TOXOID & PERTUSSIS VACCINE (COMBINED) is supplied by the Connaught Laboratories in the following packages: Three 2-cc. ampoules—For the inoculation of one child Six 6-cc. ampoules—For the inoculation of a group of six children CONNAUGHT LABORATORIES University of Toronto Toronto, Canada DEPOT FOR BRITISH COLUMBIA MACDONALD'S PRESCRIPTIONS LIMITED MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. THE EDITOR'S PAGE The hospital situation in the Province, and especially in the bigger centres of population, is rapidly becoming an impossible one. It passed the point of being critical, even dangerous, some months ago. When, in the biggest hospital in the Province, every bed is continually full, when patients with cancer requiring operation have to be postponed, and denied admission day after day, and only the gravest emergencies can hope for admission within a few hours, we feel that it is time all of us took an active interest in the matter. We know there are serious, perhaps apparently insurmountable difficulties facing those who administer our hospitals. But nothing is being done—there is, as far as we can make out, no long-range planning: no concerted action: no leadership by any group or individual. Things are just drifting: and this can only end in disaster. We wonder if the time has not come to regard Hospital Administration as Education, our Water Supply, and other like things, are regarded; as provincial problems: to be handled and administered on a large and inclusive scale, say by a Hospitals Commission, or some such body: which could plan ahead, coordinate, and thereby achieve far greater economy and efficiency in hospital administration. As it is, each hospital is a self- contained unit, working for its own hand, unable to cope with the problems of other hospitals, or indeed with the problems of the public at large. One cannot but feel deeply grateful and appreciative of the admirably unselfish work that has been done throughout the province by Hospital Boards. But, notwithstanding all this, we feel that the question of hospitals and hospital care has become too big and too vital a one for us all, to be handled in this way. We need in this Province, more hospital beds. We need some sort of proper planning and allocation of beds: better distribution. Two great reasons for this have newly arisen: health insurance, which will undoubtedly complicate the situation enormously, and which is, in our humble opinion, completely impossible of achievement with our present set-up. The other is the matter of a Medical School in B. C. Our University and Provincial Authorities are not yet fully seized of the necessity for such a school: and it is far from realisation yet: but we all know that it has to come some day: why do we not start now to plan for it? Our point is, simply, that under our present system of hospital administration, nothing can be done in the way of planning or arrangement for future needs, much less to relieve present conditions. Frankly, we do not think that any relief will be given by enlarging our present hospitals to too great an extent. New building, opening of new sites for hospital placement, provision for the medical groups and realignments that will be necessary under health insurance: all these things should be thought of now, and arranged for now. This can only be done through the establishment of some definite organisation, such as we have suggested. Talking of Health Insurance: one can only hope that it will he put into effect slowly, gradually, and with every step carefully taken, and tested as it is taken. We are a little uneasy at the way in which the public has, perhaps without a realisation of the fact, been led to believe that Medical Utopia is just round the corner. The public is told that for $12 a year, health insurance can be given to everyone. It is not told that this is only a small part of the actual cost—and the rest must be made up elsewhere. It does not know whether the medical profession has agreed to anything or not: still less does it know where these medical men are to come from, to do the largely increased amount of work that it will be necessary to do. Only this morning we saw a doctor from the Interior, who has for many years been one of the busiest medical men in the Province. Under the terrible strain of his work, alone and without help, he is breaking Page One Hundred and Seventeen down—had, indeed, partly broken down. It would be worse than absurd to introduce any system into his community which would mean more work for him. And in the larger centres, it is nearly as bad. We have not the personnel now to do the work that we have to do: and it would be folly to add to it. We think, too, of the dearth of hospital accommodation—and see, only too clearly, how impossible it would be to find enough beds for everyone under a free hospitalisation scheme. Nor will things be any better until two questions are faced and settled. The first is the obtaning of adequate medical personnel, more doctors, in fact. To do this, new medical schools are necessary—and we should make a start in B. C. immediately. The Provincial Authorities should give this subject the closest study, and we believe they will be convinced, as we are, of the necessity for such a school. The second is hospital accommodation, of which we have spoken above. Frankly, we cannot see the sense of hospitalisation schemes being put into effect until more beds are available. It will result either in breaches of contracts made with those who come under the scheme, or grave injustice and unfairness to those who do not, but who have just as good a right to hospital accommodation as anyone else, if they are able and willing to pay their bills. The papers have been full, recently, of the injustice perpetrated by the Council of the College of Physicians and Surgeons of British Columbia, against one Dr. Tsai, who has been denied permission to practise in British Columbia. The race cry has been raised, and our press, which could easily have ascertained the actual facts by applying to the Registrar of the College, has, in too many cases, added fuel to the fire. We have discussed this matter with Dr. McLachlan, and find that, as usual, our Council has acted with perfect fairness and impartiality: and there has been no injustice and no persecution of Dr. Tsai. On the contrary, she has been given a great deal of consideration. There are certain other considerations here on which we will not dwell: but which have a very definite bearing on the case. One of our more vocal columnists, Mr. Elmore Philpotts, writing in the Sun, went to considerable lengths in his championship of Dr. Tsai. We feel that if Mr. Philpotts. had been wiser, he would have consulted Dr. McLachlan too. After all, there are always two sides to a question. In these days of scarcity of doctors, it is not very likely that our Council would lightly turn down any legitimate applicant: and they had, as we felt they must have, very weighty reasons for their decision. We should, in this matter, satisfy ourselves of these reasons, and then support our Council by every means in our power. But, too, we feel that a plain statement made by the Council, to the public at large, on this matter, might be a very good thing. After all, the public has only heard one side of the question. The Council is the body appointed by law to safeguard the interests of the public, and their reasons for rejecting Dr. Tsai are not only of interest to the public, but due, we think, to the public. However, this last is a matter for the Council to decide, and we bow to their decision, and accept it without question, whatever it may be. Our list of exchange publications grows steadily. Our latest is "The Antiseptic," a journal published in Madras, India, which has asked us for the privilege of exchange, a request we very gladly grant. It is a well-put-together little journal, with an enormous amount of advertising: but its reading matter is excellent. In this issue we are publishing what we think will be of great interest to our readers, excerpts from articles written for the American Review of Soviet Medicine. In a recent issue of the Bulletin, Dr. Frank Turnbull summarised some of this work—but we believe our readers would derive benefit and added interest from a more direct study of these articles. Page One Hundred and Eighteen Sovite Medicine, i.e. the practice of medicine in Russia, is one of the great miracles of our time, studded as this is with great and epoch-making scientific advances. When one reads of the black chaos from which in some twenty-five years, Medicine in Russia first emerged, to struggle and fight its way, not only unaided by other countries, but against handicaps and obstructions which seemed almost unsurmountable, ultimately to become one of the most efficient and up-to-date systems of medicine in the world, one is again impressed, as one has so often been impressed during this past three years, by the enormous and inexhaustible vitality and virility of this great people. One is lost in admiration of their courage and power: and one feels that perhaps one of the greatest things that may come out of this war, if we are wise and honest enough to embrace the opportunity given us, is an understanding and appreciation of Russia, which will ripen into an abiding friendship and comradeship between our peoples and theirs. Already they have their great names, Burdenko, Bogomoletz, Spasokukotski: names fit to rank with our Mayos and Minots and Moynihans and Bantings. But perhaps among their greatest contributions will be their achievements in organisation and adniinistration, and the public -health work they have done. These numbers of the American Reviw of Soviet Medicine are intensely interesting. They may be seen in our Library. It is with great pleasure, which we know will be shared by very many of our readers, that we print the letter below, from our old friend, Wallie Brewster. Wallie has more friends in B. C. than even he can imagine, and they will be all glad to hear of him;—Ed. Dear Jack: For a long time I have been intending to drop you a line to say how much I appreciate the delivery of the Bulletin. It is very pleasant indeed to learn through the pages of the Bulletin where all the various old acquaintances of Vancouver days are at present. I have been stationed at Yarmouth for the past year and a half but am now leaving for Moncton to take charge of the Station Hospital at No. 31 Personnel Depot in that city and I thought this would be an excellent time to have my forwarding address brought up to date as the Bulletin has. followed me through several stations. I do not get a chance to see many of the western boys down here but was very pleasantly surprised today to receive word that Tommy Matheson of the old Georgia Street Pharmacy would be visiting here in the next day or two. As Tommy is stationed in Ottawa and does considerable travelling, he will no doubt be able to bring me up to date in the gossip. Thanks again and remember me to anyone you might see. Yours sincerely, Wallie. W. R. Brewster, W/C, Senior Medical Officer, No. 31 Personnel Depot, Moncton, N.B. BOOK REVIEWS WHITE BLOOD CELL DIFFERENTIAL TABLES, Theodore R. Waugh, 126 pp., $1.60, D. Appleton-Century Company, New York. This book of tables will prove very useful in laboratories where many blood counts are done daily, and where actual numbers of each white cell present are reported. A glance at the book will show both the clinician and technician just where its usefulness will come in, and most laboratories will find a ready place for it. C. S. McK. Page One Hundred and Nineteen AMERICAN COLLEGE OF SURGEONS The medical profession of British Columbia will be visited by the Sessional Meeting of the American College of Surgeons in April. On the 18 th of that month there will be a meeting in the Hotel Vancouver, lasting one day. During this day, a very busy and most interesting programme will be put on. It will be open to all medical men who wish to attend, and will be absolutely free, except that if anyone wishes to attend the luncheon and/or dinner, he or she will, naturally, have to pay for the tickets. Otherwise, we have been most generously extended an invitation to any or all of the meetings. A synopsis of the very full programme is appended below. As will be readily seen, this is a programme dealing almost entirely with War Medicine, and men in the services will therefore be especially interested, though civilian practitioners will also find it of the greatest value. Though the synopsis below does not state it specifically, there will be also a very full Hospital Programme, and all those interested in Hospital matters will have an opportunity to attend. This will run concurrently with the other. This is a rather unique opportunity, and we appreciate very much this courtesy. Our own colleague, Dr. A. B. Schinbein of Vancouver, will be in charge of the proceedings, and we know he would be glad to see a great many men take advantage of the College's invitation. We hope, too, that men from other centres will regard this as their invitation, too. TUESDAY, APRIL 18, 1944 HOTEL VANCOUVER, Vancouver, British Columbia PROGRAMME MAYFAIR ROOM, 8:30 a.m. MILITARY MOTION PICTURES: Activities of the Medical Department of the United States Army in Theatres of Operation. Produced by the Army Service Forces, War Department. Medical Activities and Installations of the United States Navy in the South Pacific; The Medical Department of the United States Navy in Amphibious Assaut. Produced for the Bureau of Medicine and Surgery, United States Navy. MAYFAIR ROOM, 9:30 a.m. EXPERIENCES IN THE THEATRES OF OPERATION By representatives of the Surgeons General of the United States Army and the United States Navy: Major Clinton L. Compere, Medical Corps, United States Army, Temple, Texas; Mc- Closkey General Hospital. Captain Charles G. McCormack, Medical Corps, United States Navy, Bremerton, Washington; Executive Officer, Puget Sound Naval Hospital. MAYFAIR ROOM, 11:30 a.m. WARTIME PROBLEMS IN COMMUNICABLE DISEASE CONTROL W. P. Dearing, M.D., Senior Surgeon, United States Public Health Service, Washington. SALON A, 12:15 p.m. LUNCHEON FOR PHYSICIANS, SURGEONS AND HOSPITAL REPRESENTATIVES Dr. G. E. Seldon Presiding. Current Problems in Medical Manpower for the Armed Forces, Hospitals, and the Civilian Population. Page One Hundred and Twenty MAYFAIR ROOM, 2:15 p.m. WAR WOUNDS OF THE EXTREMITIES Lieutenant Colonel John B. Flick, Medical Corps, United States Army, Fort Douglas; Surgical Consultant, Ninth Service Command. NAVY WAR SURGERY Captain Charles G. McCormack, Medical Corps, United States Navy, Bremerton, Washington; Executive Officer, Puget Sound Naval Hospital. MEDICAL SERVICE IN INDUSTRY (Horace J. Whitacre, M.D., Tacoma, Washington, has been invited to do this.) EMERGENCY MEDICAL SERVICE IN WARTIME DISASTERS W. P. Dearing, M.D., Senior Surgeon, United States Public Health Service, Washington; Chief Medical Officer, United States Office of Civilian Defense. EXPANSION OF THE PROGRAMME OF GRADUATE TRAINING IN SURGERY AND THE SURGICAL SPECIALTIES BY THE AMERICAN COLLEGE OF SURGEONS Malcolm T. MacEachern, M.D., Chicago; Associate Director, American College of Sur geons. BANQUET ROOM, 6:15 p.m. (A. B. Schinbein, M.D,, Vancouver; Governor, American College of Surgeons, Moderator) DINNER-FORUM SESSION FOR PHYSICIANS, SURGEONS AND HOSPITAL REPRESENTATIVES The Dinner will be followed by a Forum with all speakers on the programmes for the Medical Profession and the Hospital Conferences as the Panel of Experts. There will be discussion of any and all subjects presented during the day, together with related topics of interest to the medical, hospital, and other groups attending the War Sessions. 1 H LIBRARY NOTES RECENT ACCESSIONS TO LIBRARY: Fractures and Joint Injuries, v. II, 1943, by R. Watson-Jones. Year Book of General Medicine for 1943. Edward Tyson, M.D., F.R.S., 1650-1708, and the Rise of Human and Comparative Anatomy in England, 1943, by M. F. Ashley Montague. (Nicholson Fund Donation.) Architectural Principles in Arthrodesis, 1942, by H. A. Brittain. The Hypothalamus—Four Lectures (Morphological, functional, clinical and surgical aspects), 1938, by W. E. LeGros Clark, John Beattie, George Riddoch and Norman Dott. White Blood Cell Differential Tables, 1943, by Theodore R. Waugh. (Donated by Appleton-Century, Publishers.) China's Health Problem, 1943, by Szeming Sze. BOOKS BY^ THE LATE GEORGE W. CRILE, M.D.—DONATED TO THE LIBRARY BY MRS. CRILE: Problems relating to Surgical Operations, 1901. The Kinetic Drive, 1916. A Physical Interpretation of Shock, Exhaustion, and Restoration, 1921. Notes on Military Surgery, 1924. Problems in Surgery, 1928. Diseases Peculiar to Civilized Man, 1934. The Phenomena of Life, 1936. Surgical Treatment of Hypertension, 1938. Intelligence, Power and Personality, 1941. The Cleveland Clinic Foundation, 1938. (By Amy Rowland.) Page One Hundred and Twenty-one SUMMER SCHOOL CLINICS VANCOUVER MEDICAL ASSOCIATION June 20th to 23 rd, 1944, incl. HOTEL VANCOUVER, BALLROOM Speakers: Squadron Leader L. G. Bell, R.C.A.F., Medical Consultant to Command Medical Board of No. 2 Training Command. Surgeon Captain C. H. Best, R.C.N.V.R., Senior Officer of Naval Medical Research Unit. Lieut. Colonel R. I. Harris, R.C.A.M.C, Consultant in Surgery for Eastern Canada. Dr. W. A. Scott, Professor of Obstetrics and Gynaecology, Faculty of Medicine, University of Toronto. Dr. Clifford Sweet, Pediatrician, Oakland, Calif. THE INFLUENCE OF PIN TRANSFIXION ON I TREATMENT OF FRACTURES Donald E. Starr, M.D. (Read at meeting of Vancouver Medical Association, December 7th, 1943) The use of metal fixation in the treatment of fractures is not new. Although the literature is not definite, some form of metal fixation in fractures has been recorded for centuries. There is some reason to believe that the early Egyptians used metal fixation in fractures. They probably did not use steel. In 1894 Arbuthnot Lane and Parkhill in 1897 made two great contributions to bone surgery. The Lane plate, a metallic substance with the use of screws, was revolutionary in internal fixation. Parkhill used the double pin fixation of fractures connected by a metal, adjustable splint. Actually, these pins into bone were a half pin type, and were parallel. They were connected by an adjustable metal splint which could be set after the fracture was reduced. Codivilla, Steinman, Kafer and Von Eiselberg all contributed other methods of using pin fixation of fractures, either incorporating them in plaster, or adjustable turnbuckles, or by direct traction without cast. Following on the principle of the Parkhill plan, other innovations have since been introduced. Roger Anderson was the first man to use oblique pin fixation of the half pin type although by some Lamare is claimed to have used this principle. Schanz and Riedel also used pin fixation, attaching them to adjustable plates outside the cutaneous surfaces to maintain the fragments in position. Page One Hundred and Twenty-two Half pin unit fixation came into vogue about 1931. At that time the oblique pins were fixed in a bar which predetermined the size and direction of the pins and the size of the half pin unit. These half pin units were connected together by plaster. Later, Stader modified the Parkhill principle by securing the half pin metal bars to themselves by adjustable bars with set screws. Haynes also contributed a method of half pin unit fixation that adhered more closely to the Parkhill principle. He used threaded screws which were parallel and then were attached to an adjustable apparatus for extension. He first described this method in 1932 but did not have the instrument marketable until 1938, which was one year after Stader commercialized his adjustable splint. The present Roger Anderson tranfixion incorporates the half pin unit to metal fixation, and requires no plaster. The Haynes, Roger Anderson and Stader principles are all similar in this respect. There are common impressions about the privileges and the efficacy of pin transfixion. Firstly, it is believed that it allows disregard of the fundamental principles of immobilization, by which we mean that any type of fixation above and below the fracture site incorporated to itself should be efficient. Secondly, it is believed that early weight bearing and return to employment is the usual procedure. Thirdly, that it shortens the period of healing. These impressions are, for the most part, inaccurate. One must immobilize a fracture with fixation so that the fixation itself is absolutely immobile in the fracture fragments and these immobilized to themselves. Weight bearing is only possible with any method of fixation where strain is not brought to bear on the fracture site or on the apparatus itself. In other words, an oblique fracture will not stand weight bearing and the pins alone will not stand weight bearing; but a well reduced transverse fracture, well immobilized, will allow early weight bearing. The shortening of the period for healing of bone only occurs in transfixion where the transfixion has caused better immobilization of the fracture. The advantages of pin fixation are obvious. It is indicated, firstly, in fractures previously difficult to immobilize without open reduction, such as the olecranon, very fre- 'quently the- supracondylar region of the humerus in children, and also especially where the fracture was oblique. Secondly, in those requiring prolonged recumbency such as intertrochanteric fractures of the shaft of the femur, and in the mid shaft of the humerus where a spica was not adequate, or where oblique fractures of the long bones did not permit the application of plaster alone but required traction or fixation; and thirdly, in those where the excessive immobilization of the points to obtain fixation was awkward and heavy, namely the Whitman spica and the shoulder spica for the fractures of the femur and the humerous respectively. It was once said that the Whitman mtehod of reduction of the neck of the femur was an excellent means of obtaining non- fusion of the fracture of the neck of the femur and good fusion of the knee. The indications for the use of transfixion: (a) Where mobility is urgent. Only this past week a patient was admitted with a -severe athetoid spasticity. The usual methods of fixation of a fracture in this boy, other than open reduction, a fracture involving the humerus, were impossible; and were it not for transfixion, we should have been in considerable difficulty. (b) Whenever a closed manipulation fails, either open reduction is necessary, or transfixion will avoid open surgery. (c) The necessity of a better and stronger fixation is often necessary in bone grafting. This will be accomplished by pin fixation where a plaster immobilization allows motion during the early stages of the post-operative course due to shrinkage. (d) In a small group, there is definite indication for avoiding open reduction even though it produces better anatomical restoration. This is particularly true of fractures with small fragments involving the joint surfaces. The subsequent fibrosis is sufficient to prevent good joint motion following a good anatomical reduction. Page One Hundred and Twenty-three The types of apparatus have already been briefly described. All currently popular types of apparatus mechanically doubly transfix by metal the major fragments involved. The three best known methods are those of Stader, Haynes and Roger Anderson. The Stader method has been adopted by the Canadian Army. It in essence is a mechanically sound splint. As you will see, it transfixes both fragments well and has a completely flexible method of adjustment. The many set screws and adjusting bolts, as well as the intermediate bar which is also capable of lengthening and fixation, allows complete adjustment of the fracture as well as its fixation by the tightening of the apparatus. The pins are usually one quarter inch in size and placed into the fracture fragments by an electric drill. They can be applied by hand, however, with some difficulty. They transfix both cortices. They may be placed through the block so designed in any two of the four tunnels in the block itself, thereby giving a possibility of four pins for insertion, but in essence only two choices of half pin unit size and position. The method of finer adjustment of the fracture is readily accomplished with this method. There must be a type of splint for each anatomical position, and in order to increase the amount of fixation, extra units, as seen, must be applied, or particularly elaborate attachments are to be used. This is also true of the Haynes' method, the method being rather similar except that the pins are placed parallel in the bone, there also being four choices, two of which must be used. The pins here,- however, are fixed to bone by a threaded end which requires relatively accurate insertion, and which tends to be conducive to early motion of the pins in the bone since they are parallel; and, when transversing thin cortices, would tend to be ineffectual in regards to their thread. The method of adjustment is quite similar to that of Stader, using the centre adjustable bar and the minor adjustment at the fracture site by means of ball and socket attachments in distinction to the set screw method of Stader. The method used in Vancouver, and by the writer, is the Roger Anderson. The reasons for its use are twofold. Firstly, this apparatus was the most available. The method of instruction was also available to us in that the representative of the Tower Instrument Company was able to visit this city for two weeks prior to the use of the apparatus. The Roger Anderson has one feature that the other instruments lack. Its simplicity of construction makes it so that there is no limitation to the direction of the pins, their number or situation, so that any combination or pin unit is possible and attachable to another. The method of adjustment is somewhat similar to the others, although in at least ninety per cent of the cases all adjustment is done by hand. Where further adjustment or extension is necessary, an apparatus is attached to the unit which will accomplish the same extension as the other adjustments but can then be removed and the coupling bar inserted of a simple type. This allows for great flexibility. It does not hamper one from treating any fracture as long as the apparatus is available. One is never confronted with the difficulty of having a humeral splint and a tibia to transfix. Its simplicity is ah economical saving. The principles of application are simple. All major fragments must have at least two oblique pins to transfix it. There should be care taken to insert the half pin unit at the ends of the shaft where at all possible because when -the machine is inserted into the distraction apparatus, the attachment to the. machine should correspond with the joints above and below the fracture site. Exceptions to this rule, however, are in the upper end of the humerus, supracondylar fractures of the humerus, the upper end of the tibia involving the knee joint, the intertrochanteric region of the femur, and in fact most fractures near the end of the bone. The fixed points of anatomy are those points where the centre of the fulcrum of the involved joints above and below the fracture are situated. These must correspond to the mechanical hinges in the distraction machine. In any insertions of pins, thorough technique must be used. One cannot deviate from the bone technique to insert pins, even though they traverse skin and there is no open wound. We are accustomed to use all surgical precautions in their insertion. Page One Hundred and Twenty-four Possible complications of this method are, firstly, as one would suspect, infection. Actually, this situation is rare. When good surgical technique has been maintained, there should be a minimum of infection. Actually, in approximately three hundred cases treated in this city, there have been three frank osteomyelitis results. Two at the present time are relieved, but the other is continuing. The apparatus has been in use about a year and five months. There should be no soft tissue damage and no undue pressure on fascia or muscle. There should be no traction on the skin. Where this occurs, a counter-incision to allow relaxation of the skin about the pin and resuturing on the opposite side are necessary. There is no question about the fact that seepage occurs at the pin sites frequently. This is believed to be due to electrolytic action since the pins and their clamps are of different material. This cannot so far be avoided except in the Stader method where the fixation blocks are made of plastic. Even in this method, however, there is seepage due to electrolysis. The chance of damage to vital structures by pins is also rare. In the insertion of approximately fifteen hundred pins, one peripheral nerve has been damaged. There is no record of injury to arteries although their proximity is often approached. The dangers of over-extension are real. The technical fault involved can be easily avoided. All transfixion should be sadjusted after reduction to allow bone end to contact thoroughly, and also be readjusted as healing occurs to reapproximate bone ends that have been separated due to absorption. If these precautions are taken, the complications of pin fixations are probably less than with the classical methods. Classical illustrations of the efficacy of this method are easily demonstrated. An intertrochanteric fracture of the femur can be easily transfixed as demonstrated. This is done by X-ray control and t^akes but a few minutes. It prevents the prolonged bed rest and the stiffening of the hip and knee and foot due to lack of use and fixation in bed. It allows early ambulatory treatment, three to four days following reduction. It allows early weight bearing, in seven to eight weeks, with good union in all cases without shortening, in ten weeks as a rule. A depressed fracture of the lateral condyle of the tibia, or in fact of both condyles of the tibia, heretofore was considered necessarily an open reduction. It is demonstrated here that pin fixation will reduce the fracture as adequately and prevent an open reduction which is so damaging to joint function in the future. The dangers of complications are much less. The upper end of the humerus, which is inaccessible to manipulation and hard to control, may be easily controlled by the insertion of a half pin unit into the small upper fragment, taking care to avoid the epiphysis in the younger group with which this fracture is frequent. The half pin unit below the fracture site can then be inserted near it, and a "T" fixation of the fracture is possible. In the case illustrated here, you can see it is apparent that early callus formation in poor position has been overcome eighteen days post-fracture in a child ten years of age, something only accompanied otherwise by open reduction. The problem of supracondylar fractures of the humerus in children is a current one. Results have been universally poor where immediate reduction was impossible. The impairment of circulation due to the acute flexion necessary to maintain reduction of the fracture has caused marked ischemia oftener than any other fracture known. By the insertion of the pins so displayed, this fracture can be easily controlled both as to rotation and to forward position of the lower fragment. A fifth pin has been commonly inserted into the fr,acture site and used as a lever in this face. Oblique fractures in general can be well controlled by transfixion as is seen in the view of the tibia shown. |^, There is also the use of the transfixion to modify bone surgery. Heretofore, a sliding bone graft of the tibia was considered precarious because it did not have the strength at the fracture site to maintain itself during the post operative course and immobilization in plaster. It frequently broke and caused further nonunion. The insertion of a bone plate was not the answer, since the absorption due to the grafting caused the plate to become loose if there was any evidence of play at the fracture site. Page One Hundred and Twenty-five However, an inlay bone graft appears to give more stimulus to bone production at the actual fracture site than does an onlay. An onlay graft causes considerable difficulty in closing a wound in the leg over the tibia. It leads to secondary intention healing, if not actual exposure of the fracture site, and prolonged drainage and suppuration. What is more, the inlay graft method prevents the use of the other leg, which would allow early weight bearing on the good leg while fixation of the involved leg is taking place. It, however, is useful in the humerus where an onlay graft is indicated and where no diffi- , culty in closing the soft tissues is encountered. It may be used either as an inlay or an onlay in both bones of the forearm. Osteotomes may be transfixed to avoid plaster fixation postoperatively. In concluding, it is apparent, from the above illustrations, that pin transfixion offers a much more efficient way of controlling difficult fractures and preventing prolonged hospitalization. The technique of application is not without difficulty, but it can soon be mastered and improved with continued use. It can also be said that it is not a substitute for all classical methods of the treatment of fractures, but is bound to simplify and modify our methods of efficient treatment of difficult fractures, especially those which have previously required open reduction. THE BRITISH COLUMBIA CANCER INSTITUTE ANNUAL MEETING OF HONORARY ATTENDING STAFF The Annual Meeting of the Honorary Attending Staff of the British Columbia Cancer Institute was held on Monday, February 21, 1944. The programme of the evening included an election of officers for 1944, the annual report of the Medical Director and a presentation of prepared papers. Dr. T. H. Lennie was re-elected Chairman of the Honorary Attending Staff. Dr. A. Taylor Henry was elected Honorary Secretary. Dr. E. Trapp, the acting Medical Director during Dr. Evans' absence overseas, presented he report of activities of the Institute during 1943. The report showed an increase in the number of patients admitted, 415 as compared with 348 in 1942, which was remarkable only that in the fifth of such reports, there was no indication of expansion of the field of activity, the latter having been curtailed through lack of X-ray equipment and beds. The report contained references to the modest efforts at research which were of necessity entirely clinical—the investigation of pain in relation to cancer —under the direction of Dr. Frank Turnbull; the use of stilboesterol in cancer of the prostate under Dr. L. R. Williams; a clinical trial of perandren obtained by Dr. A. T. Henry, on advanced cases of cancer of breast and cervix; plans for a long-term research investigation on cancer of the breast, under Dr. Olive Sadler's direction. Dr. Trapp reviewed briefly the 1943 annual report of the British Empire Cancer Campaign, with which the B.C.C.I. is affiliated. Their progress has continued uncurtailed by the war, with grants to institutions and private individuals, a substantial proportion of the funds coming from the many copper and silver collections made on behalf of the campaign. In England, plans have been drawn up for the organization and distribution of cancer treatment centres throughout the whole of Great Britain. Plans have also been set in motion to help the occupied countries of Europe with both trained personnel and equipment on the termination of hostilities. Some of the highlights of the report mentioned were as follows: The confirrnation of the American work with diethyl-stilboesterol on cancer of the prostate, the first practical application of chemotherapy in the treatment of cancer. After a detailed analysis of 1023 cases of cancer of the lung, it was found to be four times more common in males than in females, and engineers, mechanics, painters and decorators present a higher incidence than the so-called "white-collar" class. Page One Hundred and Twenty-six The rising incidence of cervical cancer during the menopause and post-menopausal periods gives rise to a plea for intensive propaganda aimed at early diagnosis directed toward the patient and the general practitioner. A study of the incidence of recurrence in breast cancer revealed that the vast majority (84%) recurred during the first and second years following treatment. Following Bittner's work at Bar Harbour, demonstrating that the females of certain strains of mice, which are susceptible to breast cancer, can transmit something in their milk, so that the young which they suckle subsequently develop breast cancer; evidence was sought of a similar phenomenon in the human subject. In the course of the statistical enquiry into breast cancer, this could not be demonstrated. In closing, Dr. Trapp made a plea for a consciousness of the needs of the Institute in serving the public, saying, "After all, we are the British Columbia Cancer Institute and can still offer only diagnosis and radium treatment to any of the estimated five thousand cancer patients in the Province." Dr. Cleveland presented a review of the cancer of the skin of the naso-labial fold. Twenty-two cases of cancer of this region had been admitted and treated radiologically with only two recurrences. He pointed out that lesions of this area are markedly destructive and tend to invade cartilage and bone early. His presentation was illustrated with photographs. Dr. Pitts gave a demonstration of interesting slides, many of which were from lesions and cases seen at clinical meetings throughout the year. Dr. Henry had prepared a review of 60 cases of cancer of the bowel admitted to the Institute. The ano-rectal cases which had been treated radiologically formed a small encouraging group. Dr. Henry stressed the importance of a proctoscopic examination as an invaluable aid to diagnosis in cancer of the rectum. Diagnostic X-ray pictures of this area are of questionable accuracy, and furthermore, the danger of completing an imminent obstruction, on the introduction of barium, is very real. Nearly all members of the Staff were present at this meeting. Great interest and enthusiasm was shown in the reports and work undertaken. SYMPOSIUM OF WAR MEDICINE IN "THE HEBREW MEDICAL JOURNAL" We have received lately copies of the Harofe Haivri, the Hebrew Medical Journal, edited by Moses Einhorn, M.D. The publication has been in existence for the last sixteen years, and its headquarters are in New York City. It is a semi-annual publication. The two volumes (Vol. i and ii, 1943) are devoted to war medicine, and a most comprehensive list of articles appears in them. This includes among others "The Treatment of Gunshot Wounds of the Head and Brain during the Present War" by Dr. Leo M. Davidoff; "The Early Treatment of War Wounds with Emphasis on Prevention of Deformities" by Dr. J. W. Maliniac; "Some Personal Observations on Military Surgery" by Dr. Ed. Barsky; "Newer Conceptions of the Treatment of Burns" by Dr. Jesse Blo- lowa and Dr. C. L. Fox, Jr.; "The Status of Anaesthesia in Military Surgery" by Dr. S. D. Erlich; "Shock Syndrome and Its Treatment" by Dr. S. Standard; "Ocular Injuries in Chemical Warfare" by Dr. Ed. B. Gresser; "Physical Therapy in War Medicine" by Dr. Wm. Bierman; and "The Importance of the Proper Prosthesis in Post-War Rehabilitation" by Dr. H. M. Wertheim. The sections on Palestine and War contain three authoritative articles which present a vivid picture of the medical contribution by the Palestinian Jews to the war effort: The Red Mogen Dovid (RMD) is a non-sectarian organization in Palestine which fills the same functions in peacetime and war as does the Red Cross in other countries. From a meager beginning in 1930, with only one branch in Tel Aviv, it has, since the outbreak of the war, expanded its activities by establishing twenty-three RMD stations and sixteen fully equipped mobile hospitals throughout Palestine. Page One Hundred and Twenty-seven The Kupat Holim—-Worker's Sick Fund of the Genera Federation of Jewish Labor in Palestine—is the largest institution of its kind in the Near East, having a membership of 96,000. It provides hospitalization, rural dispensaries, nurses' aid and other medical services to its members. It has a country-wide network of 218 dispensaries and a number of well equipped hospitals. During the present emergency it has offered its valuable faculties to the Armed Forces of the United Nations. Under the heading of "Personalia," Dr. Solomon R. Kagan contributes biographical sketches of Adolphus S. Solomons, co-founder of the American Red Cross, and Professor Max Neuburger, the great medico-historian. In the section on Old Medial Manuscripts, Dr. Leo Nemoy brings to light a thirteenth century manuscript entitled "The Arabic Pharmacopoeia of Abu Al-Mina Al- Kuhin Al-Attar." The chapters on drugs and therapy are of great interest both to the pharmacologist and the medical profession. In addition to an English-Hebrew medical dictionary, the original articles are summarized in English. MEMORANDUM REGARDING RETURNS OF MEMBERS | OF MEDICAL PROFESSION As a matter of guidance to the medical profession and to bring about a greater uniformity in the data to be furnished to the Income Tax Division of the Department of National Revenue in the annual Income Tax Returns to be filed, the following matters are set out:— ' Income 1. There should be maintained by the doctor an accurate record of income received, both as fees from his profession and by way of investment income. The record should be clear and capable of being readily checked against the return filed. It may be maintained on cards or in books kept for the purpose. Expenses 2. Under the heading of expenses the following accounts should be maintained and records kept available for checking purposes in support of charges made:— (a) Medical, surgical and like supplies; (b) Office help, nurse, maid and bookkeeper; laundry and malpractice insurance premiums. (It is to be noted that the Income War Tax Act does not allow as a deduction a salary paid by a husband to a wife or vice versa. Such amount, if paid, is to be added back to the income); (c) Telephone expenses; (d) Assistants' fees; The names and addresses of the assistants to whom fees are paid should be furnished. This information is to be given each year on Income Tax form known as Form T.4, obtainable from the Inspector of Income Tax. (e) Rentals paid; The name and address of the owner (preferably) or agent of the rented premises should be furnished (See (j)); (f) Postage and stationery; (g) Depreciation on medical equipment; The following rates will be allowed provided the total depreciation already charged off has not already extinguished the asset value:— Instruments—Instruments costing $50 or under may be taken as an expense and charged off in the year of purchase. Instruments costing over $50 are not to be charged off as an expense in the year of purchase but are to be capitalized and charged off rateably over the estimated life of the instrument at depreciation rates of 15 per cent to 25 per Page One Hundred and Twenty-eight cent, as may be determined between the practitioner and the Division according to the character of the instrument, but whatever rate is determined upon will be consistently adhered to; Office furniture and fixtures—10 per cent per annum. Library—The cost of new books will be allowed as a charge. (h) Depreciation on motor cars on cost:— Twenty per cent 1st year; Twenty per cent 2nd year; Twenty per cent 3rd year; Twenty per cent 4th year; Twenty per cent 5 th year. The allowance is restricted to the car used in professional practice and does not apply to cars for personal use. For 1940 and subsequent years the maximum cost of motor car on which depreciation will be allowed is $1,800. (i) Automobile expense; (one car) This account will include cost of licence, oil, gasoline, grease, insurance, washing, garage charges and repairs; Alternative to (h) and (i) for 1940 and subsequent years— In lieu of all the foregoing expenses, including depreciation, there may be allowed a charge of 4J4c. a mile for mileage covered in the performance of professional duties. Where the car is not used solely for the purpose of earning income the maximum mileage which will be admitted as pertaining to the earning of income will be 75 per cent of the total mileage for the year under consideration. For 1940 and subsequent years where a chauffeur is employed, partly for business purposes and partly for private purposes, only such proportion of the remuneration of the chauffeur shall be allowed as pertains to the earning of income, (j) Proportional expenses of doctors practising from their residence— (a) owned by the doctor; Where a doctor practises from a house which he owns and as well resides in, a proportionate allowance of house expenses will be given for the study, laboratory, office and waiting room space, on the basis that this space bears to the total space.of the residence. The charges cover taxes, light, heat, insurance, repairs, depreciation and interest on mortgage (name and address of mortgagee to be stated) ; (b) rented by the doctor. The rent only will be apportioned inasmuch as the owner of the premises takes care of all other expenses. The above allowances will not exceed one-third of the total house expenses or rental unless it can be shown that a greater allowance should be made for professional purposes, (k) Sundry expenses (not otherwise classified)—The expenses charged to this account should be capable of analysis and supported by records. Claims for donations paid to charitable organizations will be allowed up to 10 per cent of the net income upon submission of receipts to the Inspector of Income Tax. This is provided for in the Act. The annual dues paid to governing bodies under which authority to practice is issued and membership association fees not exceeding $100, to be recorded on the return, will be admitted as a charge. The cost of attending post-graduate courses or medical conventions will not be allowed. (1) Carrying charges; The charges for interest paid on money borrowed against securities pledged as collateral security may only be charged against the income from investments and not against professional income. Page One Hundred and Twenty-nine (m) Business tax will be allowed as an expense, but Dominion, Provincial or Municipal income tax will not be allowed. ~*M Professional Men Under Salary Contract 3. It has been held by the Courts that a salary is "net" for Income Tax purposes. The salary of a Doctor is therefore taxable in full without allowance for automobile expenses, annual medical dues, and other like expenses. If the contract with his employer provides that such expenses are payable by the employer, they will be allowed as an expense to the employer in addition to the salary paid to the assistant. OBIIT DR. OSBORNE MORRIS It is with deep regret that we announce the passing of Dr. Osborne Morris of Vernon, which occurred in the Vernon Jubilee Hospital on February 18 th, 1944. The late Osborne Morris was born in Pembroke, Ontario, seventy-five years ago, and received his early education in that place. After matriculating, he entered medicine in McGill in 18 86, graduating with our beloved friend Dr. R. E. McKechnie in 1890. He first practised his profession at Chapleau and North Bay, where he was appointed C.P.R. surgeon, which appointment he retained continuously until his death. Dr. Morris came west in 1893 and located at Vernon, where he practised until 1941. He married Rosa Armstrong of New Westminster in 1896, and their home in Vernon was for many years a centre of hospitality. Possessed of a large practice scattered over a large district, Dr. Morris led a strenuous and busy life, often working and driving night and day without much rest, and to his honor be it said that he never refused a call throughout his long career. He had a kindly disposition which gained for him many staunch friends, and a personality which made him outstanding. In addition to his private practice, his duties included those of Coroner, Medical Health Officer, and School Health Inspector in which capacities he served for many years. Dr. Morris was a veteran of the first Great War, serving with the C.A.M.C. in England and in France, returning after the war to resume his practice in Vernon. Before going overseas he formed a partnership with Dr. J. W. Arbuckle, Sr., now of Vancouver, and later, in 1936, with Dr. J. E. Harvey, with whom he was associated until his retirement in 1941. A member of the Council of the College of Physicians and Surgeons of B. C. representing District No. 4 for several years, Dr. Morris will be greatly missed on that board. His long eventful career was packed with interesting events which are lost to us, because never recorded. He leaves to mourn his loss, a brother in Toronto, a sister in Pembroke, and his widow in Vernon, to whom we extend our deepest sympathy. J. E. Harvey. Page One Hundred and Thirty TWENTY-FIVE YEARS OF HEALTH WORK IN THE SOVIET UNION Editorial reprinted from American Review of Soviet Medicine. By Henry E. Stgerist The author of this article is well-known in the U.S.A. as a writer on various economic subjects. He is the Editor of the American Review of Soviet Medicine. One is strongly tempted to comment on this very comprehensive editorial. The insistence of the Soviet on health as a primary national consideration, which, above all other departments, must never be starved for funds, sounds to us in this "civilised" country like a wonderful dream. Nothing was allowed to stand in the way of ensuring healthy living conditions, adequate medical care, nurseries for children, maternity beds for women, adequate care for industrial workers by establishment of medical centres. Even the threat of war did not curtail the health budget! Sanatoria were established on a lavish scale—and the best proof of the vision and wisdom of the Soviet leaders lies in their insistence on research.—E*/. Beginnings On July 11, 1943, the Soviet Union celebrated the twenty-fifth anniversary of the foundation of its first People's Commissariat of Public Health. At the time of the October Revolution emergency conditions prevailed, but the Military-Revolution Committee in Petrograd already had its medical division. In February, 1918, a Medical Council was established and then, on July 11, upon Lenin's personal initiative the People's Commissariat of Public Health was founded with N. A. Semashko as its first commissar. This was an event of world significance because it created a totally new type of administrative health agency one which to the present day has not been paralleld in any other country. After the first World War, a number of countries established ministries 6i public health, but their functions are very limited and cannot compare with those of 'the Soviet Commissariat of Public Health as we shall see in a moment. The first years from 1918 to 1922 were extremely difficult. The country was completely disorganized, was torn by civil war, blockade, foreign intervention, famine, and epidemics. The commissariat had to concentrate its efforts on providing medical services to the Red Army and on fighting epidemics, particularly typhus. The louse was a much more formidable enemy than White Guards and foreign troops combined. Soap was rare, and drugs were neither manufactured nor could they be imported. It required superhuman efforts and the mobilization of the entire population to overcome these initial difficulties. But in 1922 the battle was won, and the work of reconstruction along socialist lines began. Reconstruction The Soviet Union was founded on December 30, 1922, as a federation of Soviet socialist republics. The Constitution ratified in 1923 established People's Commissariats of Public Health in every constituent republic. Decentralization seemed advisable considering the vastness of the territory and the uneven development of the various regions. The central government, however, had the power to establish health policies and the Health Commissar of the Russian Federation of Soviet Socialist Republics was chief sanitary inspector of the Union. Once the major epidemics were overcome, the chief task was to provide medical facilities and services to the working population in town and country. This was relatively easy in the cities where existing facilities could be used and new ones could be erected without too much difficulty. Where new industries were created, medical centers were established at the same time, and both grew and developed together. The difficulties were infinitely greater in rural districts. Russia had since 1864 a system of public medical services in rural districts, commonly known as Zemstvo medi- Page One Hundred and Thirty-one cine, but facilities were far too inadequate, particularly among the national minorities where they were almost non-existent. Some definite progress already had been achieved in the 1920's, but rural medicine could not be developed fully before the collectivization of agriculture that took place during the period of the First Five-Year Plan. The fact that all over the vast territory of the Soviet Union women had been liberated from age-old bonds and were taking an increasingly important part in the economic and cultural life of the country, called for special institutions, for maternity homes and nurseries. In tsarist days, the number of physicians and medical institutions had been shockingly inadequate. And now there was a crying need for more doctors, nurses, hospital beds, sanatoria, dispensaries, for more of everything. This was at a time when all other fields of Soviet activity were also demanding more personnel and equipment. The new industries needed tens of thousands of engineers. The overcoming of illiteracy called for legions of school teachers. The 13 medical schools of tsarist days, all located in the European sections of the country, obviously could not satisfy the demand. New medical schols had to be founded over the entire Union and particularly among the national minorities where instruction would be given in the native languages. New schools, however, required new scientific teaching personnel that had to be trained first. We can easily realize what a superhuman task the Commissariats of Health were facing. It was so big also because the Soviets were always thinking in terms of the whole country. They always refused to develop one section at the expense of another and, on the contrary, concentrated their efforts on the backward regions. In spite of all difficulties, in 1928, only seven years after the Civil War, the number of physicians had been increased from 19,785 in 1913 to 63,162; the number of general hospital beds from 142,310 to 217,744; of maternity beds from 6,824 to 27,33 8; of rural health stations from 4,367 to 7,531; of women's"and children's consultation bureau fron nine to 2,151. In 1913 free nursery faculties were available for 550 children while in 192 8 the country possessed permanent nursery facilities for 62,054 and seasonal ones for close to 200,000 children.1 In other words, at that time already, in 1928, the groundwork was laid. A universal system of medical services, free and available to all, had been created and the task now was to develop it in quantity and quality. This was done systematically through the Five-Year Plans. The Five-Year Plans During the first Five-Year Plan, fulfilled in four years, from 1929 to 1932, all medical facilities were increased. The health budget jumped from 660.8 million rubles in 1928 to 2,540 million in 193 3. But industry came first, particularly the heavy industries. They had first claim on manpower and materials. It would have been impossible to increase the number of physicians substantially if women had not enrolled in the medical schools in increasingly large numbers. There was a time when close to 75 per cent of all medical students were women, and today women are playing a very distinguished part and are holding leading positions in every medical field. During the years of the Second Five-Year Plan, from 1933 to 1937, the Soviet people began to rep the fruits of their labours. The new plants produced large amounts of consumers' goods. Agriculture had been collectivized and food was plentiful. While industries continude to be developed very rapidly and a formidable, highly mechanized Red Army was being built, more funds, more people, and more equipment were available for health work and for cultural purposes. When the war clouds were darkening on the horizon, the army budget had to be increased tremendously, but it is noteworthy that this never led to a curtailment of public health funds. The health budget grew from 2,540 million rubles in 1933 to 9,433 million in 1938 and was 11,960 million in 1941. The development of health facilities during those years was stupendous. The number 1The figures quoted in this article are from a recent publication of the Commissariat of Health of the U.S.S.R.: Miterev, G. A., The Protection of the People's Health in 25 Years of Soviet Power. Moscow: People's Commissariat of Health, Medgiz, 1942, 96 pp. Page One Hundred andThirty-two of hospital beds was almost doubled, the number of maternity beds trebled. Many lavishly equipped sanatoria were built in the health resorts of the country. New research institu tions were founded and the existing ones were enlarged considerably. The number of physicians increased from 76,027 in 1932 to 112,405 in 1938. The progress was not only one in quantity but also in quality. Standards were raised throughout. Medical education was reorganized, producing not only more but better trained physicians. The new hospitals, dispensaries, and rural health centers had much higher standards than in the pastl The chief impression of the visitor in 1938 was that there was not only more of everything but everything there was greatly improved. The People's Commissariats of Health These developments continued unabated until the country was engulfed in the war. The Constitution fo the Soviet Union which was adopted in 1936 created a new health agency, the All-Union People's Commissariat of Public Health. It is the central, federal health agency and the All-Union Conuhissar of Health is a member of the cabinet, of the Council of People's Commissars. The People's Cornrnissariat of Public Health of the U.S.S.R. is the apex of the administrative pyramid. It establishes health policies, directs and coordinates the work of the health commissariats of the constituent republics, and attends to health problems that concern the Union as a whole. It is an institution that has no parallel in any other country. No ministry of health anywhere has such great responsibility or such vast power. The commissariat, indeed, is responsible for the health and well-being of 170 milhon people and controls all health activities, preventive, diagnostic, and curative. But more than this: it also produces the personnel, equipment, and knowledge required for its work. Like the health departments of other countries, the commissariat is in charge of sanitation and the control of epidemic diseases, and sanitary inspection is one of its important functions. Since all health services are public services, the commissariats— federal and state—are in charge of hospitals, dispensaries, rural health stations, nurseries, • sanatoria, health results, pharmacies, etc., and of the services they render. The standardization of health institutions has greatly accelerated developments, and the setting of standards is one of the important functions of the all-Union commissariat. The commissariats, furthermore, produce the medical personnel they need. In other words, they are in charge of educational institutions. Requirements and curricula are uniform throughout the country. The U.S.S.R. has today 51 medical, 12 dental and 9 pharmaceutical schools training at the moment 120,000 students. Medical students have a five-year course which is supplemented by a period of three years epent in rural practice. All rural physicians have regular post-graduate courses of several months' duration during every three years. At the outbreak of the war, the medical course was accelerated, very much as it is with us; but in 1942 the accelerated program was abandoned because it was found that a competent physician cannot be trained in less than the normal time. The Soviet Union has furthermore 985 schools for the training of so-called middle medical personnel, that is, feldshers (medical assistants), midwives, nurses, dental, and pharmaceutical assistants. The commissariat is also responsible for the equipment required for the health work of the nation. In other words, it controls the medical industries, the pharmaceutical industry, and the industries that produce instruments, apparatuses, appliances, and other medical commodities. This also was a very revolutionary step. Patent medicines and swindle drugs, which in every country cause the waste of millions of dollars quite apart from the harm they often inflict, are inconceivable in the U.S.S.R. Attached to the health commissariat of the U.S.S.R. are 26 All-Union Scientific Research Institutes devoted to the various fields of medicine. They are large well- equipped and well-staffed research centers combining laboratory and clinical divisions. Foremost among them is the All-Union Institute of Experimental Medicine, commonly Page One Hundred and Thirty-three called VIEM in its abbreviated form, one of the world's greatest research centers. From these institutes the commissariat draws inspiration, advice, methods, and to them it refers its scientific problems. The heads of these institutes together with other outstanding researchers constitute the Scientific Council of the commissariat. Other medical research institutes are attached to the commissariats of the constituent republics, to municipal health departments or similar agencies, and the medical schools obviously all take a very active part in the scientific life of the country. In 1941 the Soviet Union had 223 medical research institutes staffed with 19,550 scientists. Thus the commissariats of health have great responsibilities and great power. The administration of health, however, is not carried out in a dictatorial way, but, on the contrary, most democratically. Special committees of the Medical Workers' Union are in constant touch with the commissariats and no decision concerning medical workers is taken without consultation. Every commissariat has a special bureau for the examination of complaints. Whoever thinks that he did not receive the services to which he is entitled or was not satisfied with the service is free to complain and every case is investigated very carefully. Every factory, every farm has its health committee that cooperates very closely with the health agencies. Soviet medicine was born with the slogan that the people's health is the concern of the people themselves. It was recognized from the very start that health cannot be forced upon the people, that it cannot be dispensed to the people, that they must want it, and that the best measures are in vain unless they are carried out under broadest participation of the population. The health commissariats are the leaders of the people in their struggle against disease. The health program of every civilized nation consists of four major tasks: (1) the promotion of health; (2) the prevention of disease; (3) the treatment of the sick, and (4) the rehabilitation of the former patient. Let us discuss briefly how the Soviet Union is handling these problems. Promotion of Health All too often health is taken for granted and the individual becomes aware of it only when it is lost. The promotion of health is one of the most important tasks of medicine. From the first day on, for twenty-five years, the Soviet Union has been carrying on a vigorous campaign of health education. Beginning with the nursery, through kindergarten and school, sound health habits are developed in the children. In youth organizations, in factory and farm, wherever people work, no opportunity is lost to teach health. Hundreds of thousands of men and women are members of health committees in their working places, take an active part in improving the health conditions of their immediate environment and in preparing the health plans of the nation. This is in itself a great educational measure. Mass-feeding in factory kitchens provided an unusual opportunity for improving dietary habits. The radical change in the mode of living effected among backward national minorities had great hygienic consequences. I have often wondered why health education has been much more successful in the Soviet Union than in other countries, and I think the answer is that in the U.S.S.R., health education always went hand in hand with political education. The Soviet citizen, more than anybody else is aware of his responsibilities toward the community. He knows that health and sickness are not a private matter of the individual, that by becoming sick he deprives society of his labor and he feels that it is his duty to remain healthy and fit. This is why health education falls on fertile ground. The development of physical culture .on a mass scale was another measure to promote health. The movement has reached millions of people, students, factory and office workers, and farmers alike. Systematic training under medical supervision has greatly contributed to developing a healthy and sturdy generation of men and women "ready for labor and defense." The energy spent in labor must be restored, and the provision of facilities for rest and recreation is therefore an extremely important public health function. Annual vacations of from two to six weeks, according to occupation, with full pay, are good Page One Hundred and Thirty-four but not enough. Facilities must be created so that the worker can spend his vacation in a way that will give him maximum benefit. In the early days of the revolution abandoned palaces of the nobility were turned into rest-homes. Since then an endless number of vacation camps, rest-homes, and resorts have been built in the country, at the seaside, and in the mountains. A great tourist organization makes it easy for the people to plan and carry out vacation tours. As soon as the Civil War had ended, the famous Caucasian health resorts and spas were thrown open to the people and they have been developed in an unprecedented way. We overhaul our cars every year and have learned that it pays to have minor repairs made before the machine breaks down. Why not do the same with the human organism? Every Soviet rest-home has physicians and medical facilities attached to it so that minor ailments can be treated before serious illness develops. This is undoubtedly a sound programme of human conservation. Prevention of Disease The prevention of disease is in the foreground of all medical activities. It is fair to say that the traditional barrier between preventive and curative medicine has been broken down. There are, of course, physicians who are working as public health officers and surgeons who are primarily therapists, but a new attitude has been created in training and practice. Prevention is emphasized all along the line of medical activities, and every clinical case is a reminder that prevention has broken down somewhere. The fact that preventive and curative services are controlled by the same agencies has, of course, greatly contributed to overcoming age-old barriers. The prevention of infectious diseases is carried out through general epidemiological measures, through sanitation and immunization. The task was gigantic in a country of such magnitude covering vast territories of the Asiatic continent. Tsarist Russia was very backward in sanitation and even Petrograd, the capital, did not possess an adequate water supply in all sections of the city. Smallpox vaccination was far from general in spite of the efforts of Zemstvo physicians. Thus, in many sections of the country, work had to start from scratch. If we wish to realize how much progress has been achieved , in the short period of twenty-five years, we must compare conditions not with those of a small country like England, but rather with those of the British Empire, including the Asiatic and African possessions. Special preventive measures have been developed for the protection of those individuals who physiologically or socially are particularly threatened. Thus from the very beginning great attention was paid to the protection of motherhood, infancy and childhood. Not only was every form of discrimination against married women abolished, but special protection was extended by law to pregnant and nursing women who enjoy many privileges. The country today has 5,803 Women's and Children's Consultation Bureaus where women can get advice for themselves and their children in all their physiological and pathological problems. This is a preventive measure of greatest significance. The protection of labor, the creation of the best possible working conditions is the responsibility of the trade unions, that is of the workers themselves, in which they cooperate very closely with the health authorities. In the U.S.S.R. the All-Union Council of Trade Unions takes the place of our Department of Labor, in other words labor is administered by the workers themselves. They collect and spend the vast social insurance funds amounting to about ten billion rubles a year. One of their tasks is the protection of workers against accidents and disease. Labor inspection is very strict and is carried out by sanitary inspectors and specially trained labor inspectors. They are aided in their task by the workers' delegates who in every plant and shop are elected by their fellow- workers. Every case of occupational disease must be reported and is investigated by specialists. The unions support over 40 research institutes for the protection of labor, many of which have budgets of sevreal million rubles and are equipped with laboratories and clinical divisions. Periodic examinations of workers take place regularly and their frequency is prescribed by law. In harmful industries, workers must be examined once every six months, in some even once every four months. Page One Hundred and Thirty-five Periodic examinations are undoubtedly a very important preventive measure, but it is even more important for a nation to have a system of medical care that encourages people to seek medical advice at the slightest symptom before serious illness has broken out. The Soviet Union has realized this by establishing a wide network of what we call medical centres, what they call ambulatoria or polyclinics. This leads us now to a discussion of the treatment of disease, although the distinction is purely artificial since medical centers serve preventive, diagnostic, and therapeutic purposes. Medical Care Through Medical Centers There can be no doubt that group medicine practiced through medical centers is superior to individual medicine. It is the form of medical care that makes the best possible use of the present advanced technology of medicine and is therefore best adapted to it. Group medicine is practiced in every country in the larger hospitals and makes their services superior to those the individual practitioner can render. The people need more than a family doctor today; they need the coordinated services of the general practitioner and of a wide range of specialists. The Soviet Union from the very start adopted the plan of medical care through medical centers and developed it on a nation-wide scale. Large factories or state farms have their own medical centers, staffed sometimes with more than a hundred doctors representing all specialties. Plants that are too small to justify a fully organized medical center share one with other small plants. Since industries usually develop in the same sections of a city, a large medical center can very well handle the workers of several small factories. In addition to the medical center all factories, whether large or small, obviously have first-aid stations staffed with nurses and a few doctors. Other medical centers serve residential districts. In the cities every district has its complete medical center. The organization is never rigid but is adapted to local needs. All doctors are appointed on salaries and the salary is determined by three factors: experience, responsibility, and hazard. They have four weeks' vacation with full pay and frequent post-graduate courses. They see patients at the office and in the homes. In addition to the regular staff, the medical centers have consultants, usually professors of the medical school, who are called for special cases. Private practice has never been for- biddn, but the better the public services became, the less demand there was for private physicians so that the private practice of medicine has practically died out. Some medical centers are directly connected with hospitals, others are not. A rural medical center will usually have its own general hospital and maternity beds, while in the city this may not be advisable. The center should be as easy of access as possible, therefore as close to the working place as possible. The factory grounds, however, are usually not the ideal location for a hospital. Patients are therefore hospitalized in institutions of the neighborhood. Large factories often have their own wards in definite hospitals and maternity homes of the city just as they have their own rest-homes and sanatoria. Rural medical centers are obviously simpler. The medical station of a collective farm with a population of about 800-1000 may have one doctor, one dentist, a few nurses, a couple of midwives, and a dozen beds. This is ample for general medical care and minor surgery. Specialized services are provided by the district hospital, and all health institutions are under the constant supervision of the district health department. The health officer in charge is responsible for all health activities of his district. By 1941 the Soviet Unoin had created 13,461 fully organized medical centers in cities and 13,512 medical stations in rural communities giving free medical services to the people, using all means of medical science to protect and restore the people's health. This truly is a great achievement, the greater when we consider the difficulties that had to be overcome and the shortness of time. From 1918 to 1941 the number of hospital beds was increased almost five times and standards of hospital construction were revised every year. In addition to general hospitals, the country is now well equipped with special hospitals for children, for the treat- Page One Hundred and Thirty-six ment of infectious diseases, chronic diseases, mental diseases, tuberculosis, etc. And treatments are continued in convalescent homes and sanatoria. No country has ever made such wide use of its natural curative forces, of mineral springs and climatic stations, and the results achieved in the treatment of chronic diseases have been very remarkable. Th Soviet Union is today the leading country in the field of balneology and balneotherapy with a central research institute in Moscow and a number of other research institutions in various health resorts. Rehabilitation Physical restoration is not the final goal of the physician's activities. No patient can be considered cured before he has been restored socially, and in this field, the Soviet Union has done pioneer work also. This was to be expected since the rehabilitation of the patient serves the individual's welfare as well as that of society. Every effort is made to reintegrate the former patient into society and to prevent the skilled worker from dropping into the ranks of unskilled labor as the result of physical disability. In every factory one can find highly handicapped workers, blind men, cripples, former tuberculous patients performing skilled labor, and many factories have special workshops for them where the conveyor belt moves more slowly. Most factories have diet kitchens, and the costs involved by such special provisions are met from social insurance funds. Disabled craftsmen join cooperatives where they can continue their work with government aid. And when a man's disability does not permit him to resume his former occupation, he is trained for the work for which he is best fitted at government expense. In war time, every country does a great deal of rehabilitation work, and the U.S.S.R. probably more than any other country. The war veteran, like any other citizen, has a constitutional right to a job, and the government sees to it that he gets it without delay and that he gets good living quarters in addition. But in the Soviet Union, rehabilitation is carried out in peace as in war. It is considered one, and not the least important, aspect of the general health program. From Peace to War Thus from 1919 to 1941, through the heroic years of the Civil War, the period of reconstruction, the years of Stalin's Five-Year Plans, the country subbornly and plan- fully built up its health system, built it along new lines as a public service to which the people, all the people, are entitled. It created the social organization that the modern technology of medicine required if medical progress was not to be wasted. Much had been achieved but the job was by no means completed; it never is. Plans had been made that foresaw more of everything, more personnel and more equipment and still higher standards. The whole nation was busy building, building in every field, peacefully, and had only one wish to be permitted to continue in the construction of a new world. And then, suddenly on June 22, 1941, the Nazi hordes invaded the country and the Soviet people found themselves plunged into the turmoil of the war. As mentioned before, the transition from peace to war medicine was in many ways easier in the U.S.S.R. than in other countries on account of the organization and centralized direction of all medical activities. Over night the entire health system was geared to war. Military medicine had always been a subject of instruction in medical schools, and all physcians, men and women, were prepared to take their place without delay in the armed forces, .in war industries, or wherever their services were needed most urgently. Medical centers had always been an integral part of industrial plants. When industries had to be moved to other sections of the country, the medical centers were moved with them, and where new industries developed industrial faculties were created at the same time . Medical research had always been carried on in a coordinated and planful way, and the Scientific Council could therefore without any delay concentrate on problems of war medicine and mobilize all research institutions of the country for the purpose. The government took a very wise step in appointing the chairman of the Scientific Council, N. N. Burdenko, surgeon general of the Red Army. Page One Hundred and Thirty-seven Periodic examinations are undoubtedly a very important preventive measure, but it is even more important for a nation to have a system of medical care that encourages people to seek medical advice at the slightest symptom before serious illness has broken out. The Soviet Union has realized this by establishing a wide network of what we call medical centres, what they call ambulatoria or polyclinics. This leads us now to a discussion of the treatment of disease, although the distinction is purely artificial since medical centers serve preventive, diagnostic, and therapeutic purposes. Medical Care Through Medical Centers There can be no doubt that group medicine practiced through medical centers is superior to individual medicine. It is the form of medical care that makes the best possible use of the present advanced technology of medicine and is therefore best adapted to it. Group medicine is practiced in every country in the larger hospitals and makes their services superior to those the individual practitioner can render. The people need more than a family doctor today; they need the coordinated services of the general practitioner and of a wide range of specialists. The Soviet Union from the very start adopted the plan of medical care through medical centers and developed it on a nation-wide scale. Large factories or state farms have their own medical centers, staffed sometimes with more than a hundred doctors representing all specialties. Plants that are too small to justify a fully organized medical center share one with other small plants. Since industries usually develop in the same sections of a city, a large medical center can very well handle the workers of several small factories. In addition to the medical center all factories, whether large or small, obviously have first-aid stations staffed with nurses and a few doctors. Other medical centers serve residential districts. In the cities every district has its complete medical center. The organization is never rigid but is adapted to local needs. All doctors are appointed on salaries and the salary is determined by three factors: experience, responsibility, and hazard. They have four weeks' vacation with full pay and frequent post-graduate courses. They see patients at the office and in the homes. In addition to the regular staff, the medical centers have consultants, usually professors of the medical school, who are called for special cases. Private practice has never been for- biddn, but the better the public services became, the less demand there was for private physicians so that the private practice of medicine has practically died out. Some medical centers are directly connected with hospitals, others are not. A rural medical center will usually have its own general hospital and maternity beds, while in the city this may not be advisable. The center should be as easy of access as possible, therefore as close to the working place as possible. The factory grounds, however, are usually not the ideal location for a hospital. Patients are therefore hospitalized in institutions of the neighborhood. Large factories often have their own wards in definite hospitals and maternity homes of the city just as they have their own rest-homes and sanatoria. Rural medical centers are obviously simpler. The medical station of a collective farm with a population of about 800-1000 may have one doctor, one dentist, a few nurses, a couple of midwives, and a dozen beds. This is ample for general medical care and minor surgery. Specialized services are provided by the district hospital, and all health institutions are under the constant supervision of the district health department. The health officer in charge is responsible for all health activities of his district. By 1941 the Soviet Unoin had created 13,461 fully organized medical centers in cities and 13,512 medical stations in rural communities giving free medical services to the people, using all means of medical science to protect and restore the people's health. This truly is a great achievement, the greater when we consider the difficulties that had to be overcome and the shortness of time. From 1918 to 1941 the number of hospital beds was increased almost five times and standards of hospital construction were revised every year. In addition to general hospitals, the country is now well equipped with special hospitals for children, for the treat- Pa^ One Hundred and Thirty-six ment of infectious diseases, chronic diseases, mental diseases, tuberculosis, etc. And treatments are continued in convalescent homes and sanatoria. No country has ever made such wide use of its natural curative forces, of mineral springs and climatic stations, and the results achieved in the treatment of chronic diseases have been very remarkable. Th Soviet Union is today the leading country in the field of balneology and balneotherapy with a central research institute in Moscow and a number of other research institutions in various health resorts. Rehabilitation Physical restoration is not the final goal of the physician's activities. No patient can be considered cured before he has been restored socially, and in this field, the Soviet Union has done pioneer work also. This was to be expected since the rehabilitation of the patient serves the individual's welfare as well as that of society. Every effort is made to reintegrate the former patient into society and to prevent the skilled worker from dropping into the ranks of unskilled labor as the result of physical disability. In every factory one can find highly handicapped workers, blind men, cripples, former tuberculous patients performing skilled labor, and many factories have special workshops for them where the conveyor belt moves more slowly. Most factories have diet kitchens, and the costs involved by such special provisions are met from social insurance funds. Disabled craftsmen join cooperatives where they can continue their work with government aid. And when a man's disability does not permit him to resume his former occupation, he is trained for the work for which he is best fitted at government expense. In war time, every country does a great deal of rehabilitation work, and the U.S.S.R. probably more than any other country. The war veteran, like any other citizen, has a constitutional right to a job, and the government sees to it that he gets it without delay and that he gets good living quarters in addition. But in the Soviet Union, rehabilitation is carried out in peace as in war. It is considered one, and not the least important, aspect of the general health program. From Pdtace to War Thus from 1919 to 1941, through the heroic years of the Civil War, the period of reconstruction, the years of Stalin's Five-Year Plans, the country subbornly and plan- fully built up its health system, built it along new lines as a public service to which the people, all the people, are entitled. It created the social organization that the modern technology of medicine required if medical progress was not to be wasted. Much had been achieved but the job was by no means completed; it never is. Plans had been made that foresaw more of everything, more personnel and more equipment and still higher standards. The whole nation was busy building, building in every field, peacefully, and had only one wish to be permitted to continue in the construction of a new world. And then, suddenly on June 22, 1941, the Nazi hordes invaded the country and the Soviet people found themselves plunged into the turmoil of the war. As mentioned before, the transition from peace to war medicine was in many ways easier in the U.S.S.R. than in other countries on account of the organization and centralized direction of all medical activities. Over night the entire health system was geared to war. Military medicine had always been a subject of instruction in medical schools, and all physcians, men and women, were prepared to take their place without delay in the armed forces*, in war industries, or wherever their services were needed most urgently. Medical centers had always been an integral part of industrial plants. When industries had to be moved to other sections of the country, the medical centers were moved with them, and where new industries developed industrial faculties were created at the same time . Medical research had always been carried on in a coordinated and planful way, and the Scientific Council could therefore without any delay concentrate on problems of war medicine and mobilize all research institutions of the country for the purpose. The government took a very wise step in appointing the chairman of the Scientific Council, N. N. Burdenko, surgeon general of the Red Army. Page One Hundred and Thirty-seven Even so, the difficulties that had to be overcome were gigantic. The loss of territory deprived the country of essential resources and the systematic dstruction carried out by the Nazis exceeds all imagination. Aware of the significance of health and cultural institutions, the Nazis never evacuate a place without levelling it to the ground, destroying water supplies, sewers, medical centers, hospitals, research institutes, schools, and libraries. And so, the Soviet Union is facing a tremendous task of reconstruction. It is not postponed until after the war but is begun whenever conditions permit. Taking the long view as they always did, the Soviet people are preparing for tomorrow planfully and scientifically. Once before they had to reconstruct their country; they will do it again and in a shorter time, because the pattern is set and the methods have been tested. The day is not far off when the last Nazi will be driven from Soviet soil and the country will come back to life better equipped and more beautiful than ever before. The Soviet Union was justified in celebrating the twenty-fifth anniversary of the foundation of its first People's Commissariat of Public Health. It has opened a new chapter in the history of medicine. The Soviet system of health services and the heroic Soviet medical corps have stood the test in peace and in war. And the medical workers of all civilized countries join in expressing to their Soviet colleagues their deep sympathy and admiration. SPASOKUKOTSKI'S METHOD OF FEEDING ABDOMINAL WOUNDS IJ^fM In an article on this matter, published in the American Review of Soviet Medicine, P. A. Panikov first reviews the question of the treatment of perforating wounds of the abdomen. He dwells on (1) the necessity for exploratory operation in all cases: figures show a 90% mortality in those treated conservatively, and 60% in those operated upon; (2) the necessity for early operation. Figures again show a mortality of 50% in less than 12 hours, up to 80%, over 24 hours. But other factors must be considered: severity of wound, lack of blood, etc. Spasokukotski and others made these important observations: and we quote from the article: "The high mortality rate of those operated on for penetrating abdominal wounds, as is apparent from the foregoing, presents a tremendous problem for our own surgeons. We are constantly striving to lower this mortality rate. Toward this end a number of proposals have recently been made—the reduction of the time-lag in operation (not later than one hour), minimum surgical interference, local infiltrating anaesthesia (the Vish- nevski method), the use of sulfa drugs in the peritoneum, the introduction of anti- gangrenous serums, blood transfusions, etc. Despite all these methods, however, our mortality rate did not fall below 50 per cent. "In making our clinical observations of the post-operative course of the illness and in studying the cause of mortalities, we noticed that the majority of the wounded died on the second or third day after operation when shock had already passed or had decreased, and peritonitis, a fundamental cause of death, had not yet had a chance to set in or was developing with unusual slowness. Death had, however, set in because of the general debility of the patient. We were forced to conclude that the weakened resistance of the organism was the result of the stubborn, unyielding battles of the time, battles which did not permit the organism the required rest or allow the soldier to have sufficient nourishment on time. All this was aggravated by the soldier's prolonged stay on ice and in snow-covered trenches. "In order to raise the resistance of the organism, which in its post-operative state is forced to remain for some time on a starvation and then on a very sparing diet, we decided to adopt Spasokukotski's method of feeding the patient on the operating table. Page One Hundred and Thirty-eight This method had fully justified itself in peacetime abdominal surgery and had won many adherents among the surgical world of the Soviet Union. "The technique of feeding is as follows: After each portion of the intestines of the wounded undergoing the operation has been examined, a trocar is introduced into the initial part of the emptied intestine. If the empty intestine should contain a wound, then the trocar is introduced into this aperture. The trocar is sutured into place with silk thread. Through a rubber tube about 60-70 cm. long, which is attached to the trocar, a high-calorie feed mixture is introduced into the intestine. This food mixture is composed of: 400 c.c. natural milk; 50 c.c. sweet butter; 2 eggs; 50 grams of sugar; 3-5 grams of salt; 50-70 c.c. distilled alcohol. The mixture is prepared in advance and heated to body temperature. After this compound has been introduced, the trocar is removed, the silk withdrawn, and the wound closed. For greater security, a second layer of sutures may be made with catgut. "In our day-to-day work we could not always get enough milk and eggs. We then used canned milk instead of natural milk—700 c.c. of evaporated milk diluted with 300 c.c. of distilled water. In such cases we did not use any eggs in the food mixture. "The satisfactory effects of the Spasokukotski method of feeding were sometimes evident on the operating table itself. Frequently we observed the colour return to the cheeks, the lips become red and warm to the touch. In the majority of cases, the patients fell asleep at the end of the operation. The intestines, instead of being flaccid and pale, generally became dilated, plethoric, and obviously peristaltic. The pulse became rhythmic, the beat much clearer, and the breathing deep and regular. "The injured were able to go through the post-operative period with much less pain. The general appearance of the wounded was satisfactory from the very first days. Peristalsis was normal at the end of the second or the beginning of the third day. From the third to the fifth day, the patient showed a desire to eat. Here are some case histories: "Case 1. Private G., age 31, admitted with a penetrating wound of the right side of the thorax and abdomen. Laparotomy performed. A large liver wound sutured after tamponage. Peritoneum cleansed of a great quantity of blood-. Two wounds of large . intestine near the liver sutured in two layers. Feeding by Spasokukotski method. Condition of patient before operation extremely grave. After operation, patient does not complain of any pain, lips red, breathing deep, sleeps quietly. On the tenth day after removal of stitches, patient evacuated in goocT condition to regimental field hospital. "Case 2. Second Lt. V., age 30, admitted'with many wounds in right thigh and a deep penetrating abdominal wound. Operated. Three wounds sutured in small intestine. Fed by Spasokukotski method. Wounds in thigh excised. After operation, patient did not complain of pain and fell asleep immediately. Sutures removed. On ninth day patient evacuated in good condition to regimental field hospital. "Case 3. Sergeant P., age 33, admitted with deep penetrating bullet wound of abdomen. Operated. Four wounds sutured in small intestine. Haemorrhage at root of mesentery stopped. Peritoneum cleansed of large amount of blood. Fed by Spasokukotski method. Post-operative period satisfactory. Patient evacuated in good condition to regimental field hospital on tenth day after removal of stitches. "Case 4. Private B., age 30, admitted with penetrating bullet wound of right side of abdomen and left buttock. Haemorrhage, shock. Operated on after recovery from shock. Six wounds in small intestine sutured. Excision of 30 cm. made in small intestine. Wound in gall bladder sutured and fistula removed. Fed by Spasokukotski method. Before operation patient was in extremely critical condition; much time and effort was spent to bring him to an operable state. Post-operative condition satisfactory, without complications. Sutures removed on eighth day. On 12th day, in good condition with draining gall bladder, patient removed to regimental field hospital. "Our material shows that, by using the Spasokukotski method of feeding, the mortality rate among this category of seriously wounded was reduced greatly and now does not exceed 40 per cent. These results are still far from ideal, but they are nevertheless a definite improvement. We are convinced that this method should be used more widely in the battle area. Page One Hundred and Thirty-nine NEWS AND NOTES We regretfully record the death of Dr. Osborne Morris of Vernon and Dr. V. E. R. Ardagh recently. Sympathy is extended to Mrs. Morris and to the family of D. Ardagh. Sympathy is extended to Sqdr. Ldr. N. E. Stewart, R.C.A.F., on the loss of his small son by death, and also to Major C. E. G. Gould, R.C.A.M.C., whose mother has recently passed away, and to Major F. S. Hobbs, R.C.A.M.C, in the loss of his infant son. Capt. N. L. Auckland, R.C.A.M.C, who prior to appointment as Medical Officer was •an interne at the Vancouver General Hospital, was married recently. He has the best wishes of his friends. Capt. H. E. Hamer, R.C.A.M.C., is receiving congratulations on the birth of a daughter, and Dr. W. S. Kergin of Prince Rupert, a son. Dr. W. S. Kergin, who for many years was a resident surgeon at Premier and latterly was chief of the medical services at Ocean Falls, has taken up practice in Prince Rupert. The largely increased population at Prince Rupert has created a demand for an-enlarged group of medical practitioners. OFFICERS' MESS A. 22, C.A.M.C., T.C., CAMP BORDEN, ONT. A letter from Captain Cyril M. Robertson, who was formerly in practice at Nelson in association with Dr. F. M. Auld, asks that books or periodicals and other reading matter, "such as fiction, biographies, etc.," be sent to the Library of the Officers' Mess, A.22, C.A.M.C. Training Centre, Camp Borden, Ontario. There are 100 or more Medical Officers there at all times. The Bulletin is sent each month. Any doctors could leave books, etc., at the office, 203 Medical Dental Building, and they would then be forwarded to Captain Robertson. Major R. R. Laird of Oliver will, no doubt, be very happy to have returned to Canada after spending many months in a German Prison Camp, following his capture when seriously wounded at Dieppe. We rejoice with him on his return to Canada and he may be assured of a warm welcome. Major Laird, prior to his appointment early in the war, was an interne in Vancouver and had served as ship surgeon on the Empress of Russia, besides filling other appointments in the Province as locum tenens. Congratulations are extended to the following Officers who have received promotions recently: Lieut.-Col. S. A. Wallace, Major U. P. Byrne. Capt. A. N. Beattie, R.C.A.M.C, who is located in the East, visited in Vancouver recently. Major A. B. Manson, R.C.A.M.C, who has been doing special work in Orthopaedics, has returned to the Pacific Command. Capt. H. Ostry, R.C.A.M.C, has been doing special work in Urology, and is now located at Shaughnessy Hospital. Capt. N. H. Jones, R.C.A.M.C, has been visiting at his home in Port Alberni. Page One Hundred and Forty A meeting of the Prince Rupert Joint Medical Services Association was held in Prince Rupert. Dr. C. H. Hankinson led the discussion on Health Insurance outlining the viewpoint of the Canadian Medical Association, and telling of the negotiations with the Federal Government, and explained the provisions of the proposed bill. Sqdr. Ldr. McKay told of personal experiences with Health Insurance in England, and Dr. R. G. Knipe, Municipal Health Officer, discussed the public health relationships. A question period and general discussion followed, and refreshments were served. The meeting was attended by: Surgeon Lieut.-Commander Grant and Surgeon Lieut. Stark, Novy; Lieut.-Col. F. E. Coy, Officer Commanding Prince Rupert Military Hospital; Captains Moscovich, Wallace, and Semenchuk, Army; Squadron Leader McKay and Flight-Lieut. Hogg, Air Force; Drs. C H. Hankinson, R. G. Knipe, R. G. Large, J. A. McDonald. The meeting was held in the Navy Wardroom and the Navy were hosts for the evening. We learn that Dr. F. R. G. Langston is now working with Sir Harold Gillies at the plastic unit at Basingstoke, England. Mrs. Langston (Dr. Kathleen Woods) is at the same hospital. m*;= Sqdr. Ldr. B. T. H. Marteinsson has been visiting in Port Alberni, prior to his transfer East and possibly farther afield. Dr. A. P. Miller of Port Alberni is now fully recovered from a recent illness. Dr. and Mrs. Miller were visiting in Vancouver. Dr. Arnold Francis of New Denver has been in Vancouver and was very busy attending hospital rounds. * * ::- * Capt. W. J. Endicott, R.C.A.M.C, returned to his home in Trail for a short visit. Dr. W. H. B. Munn, who is carrying on the practice of the late Dr. Herbert McGregor at Penticton, visited the coast recently. Dr. A. H. Meneely of Nanaimo attended the Seattle and Puget Sound Surgical Meeting recently. Dr. D. A. Hewitt, who was formerly at Port Alice, is now in the practice at Campbell River. •&■ *£ %r S£" Dr. W. A. Richardson of Campbell River, who has been working very strenuously during the winter, having been left alone in the practice there since Dr. T. J. Agnew left to take *up practice in Vancouver, has gone ot Victoria for a deserved rest. Dr. Richardson is a graduate of fifty-eight years' standing and has been registered in British Columbia fifty-six years. In spite of his years he has done an outstandingly fine job at Campbell River, responding to calls night and day when he himself on occasions should have been the patient. Dr. J. L. Coltart of Kamloops, who is associated with Dr. R. W. Irving, has been in Vancouver, and visiting the hospitals. The last meeting of the British Columbia Medical Association was attended by the following out-of-town members: Dr. P. A. C. Cousland, President; Drs. G. F. Amyot, F. M. Bryant and Thomas McPherson of Victoria; G. A. McLaughlin from the North Shore; D. J. Millar, North Vancouver; T. A. Briggs, Courtenay; F. M. Auld, Nelson; G. A. C. Roberts, Chilliwack; L. A. C. Panton, Kelowna; J. S. Daly, Trail. Page One Hundred and Porty-one The New Ortho Essential Set is packed in a plain box with a sleeve type label that can be readily removed to make a convenient prescription package. The Set contains . . . Rx package Ortho-Gynol with removable label . . . Ortho Diaphragm . . . Universal type Introducer. ORTHO PRODUCTS OF CANADA, LTD. RADIOSTOLEUM Trade Mark (Standardized Solution of Vitamins A and D) There is no more effective and generally acceptable means of administering Vitamins A and D than through the medium of Radiostoleum. Radiostoleum liquid contains 15,000 international units of Vitamin A and 3000 international units of Vitamin D in each gramme. Each capsule contains 6000 international units of Vitamin A and 1200 international units of Vitamin D. Thus effective prophylactic or therapeutic doses of Radiostoleum can be administered in a small volume of a readily assimilable and acceptable vegetable oil. Radiostoleum is particularly recommended for routine administration throughout the winter months when requirements are perhaps highest and dietary intakes of Vitamins A and D are perhaps lowest and during the spring when reserves have probably been depleted during the winter months. For therapeutic use, when a larger proportion of Vitamin D is required, Radiostoleum-D is available. Each gramme of this preparation contains 15,000 international units of Vitamin A and 10,000 international units of Vitamin D. Stocks of Radiostoleum are held by leading druggists throughout the Dominion, and full particulars are obtainable from THE BRITISH Toronto DRUG HOUSES (CANADA) LTD. Canada Adding SOMETHING GOOD f to . SOMETHING GOOD The extra vitamin content of Ayerst "10-D'' Cod Liver Oil makes it a particularly valuable supplement during the winter months. A special process of carbonation preserves the high vitamin content from deterioration and imparts to the oil a flavour which appeals to all who take it. COD LIVER OIL Richer in vitamins A & D Available in 4 & 16 oz. bottles CyeMt I93A AYERST, McKENNA & HARRISON LIMITED, Biological and Pharmaceutical Chemists, Montreal, Canada. ■M Bawled out... who me ? The doctor I work for is one of the busiest pedicrtricians in town. When I started working for him, I noticed that he was prescribing plain cow's milk modified—almost as routine. Once in a while when he had a problem case—he would look to S:M.A. as his trouble- shooter. Well, that made me wonder. If S.M.A. worked so well in tough cases ... wouldn't it work even better on normal infants? I mentioned this to the doctor. For a minute, he looked as if he was going to bawl me out. But instead, he said it sounded like a good idea. He decided to try S.M.A. on all of his patients . . . for a while. The results were so successful me a raise last week! * * * he gave ""s Why don't you try S.M.A. in your own practice, doctor? See if it doesn't work better. Busy Doctors To-day Prescribe S.M.A. .. . S.M.A. is Easier to Prepare The infant food that is nutritionally complete Trade Mark Reg. in Canada $MA S.M.A.-BiochemicaI Division John Wyeth & Brother (Canada) Limited WALKERVILLE, ONTARIO Breaks the vicious circle of perverted menstrual function in cases of amenorrhea, tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic relief by stimulating the innervation of the uterus and stabilizing the tone of its musculature. Controls the utero-ovarian circulation and thereby encourages a normal menstrual cycle. • MARTIN H. SMITH COMPANY k. im lAtAYtm sratft. niw toK. n. t. w Full formula and descriptive literature on request Dosage: l to 2 capsules 3 or 4 times daily. Supplied in packages of 20* Ethical protective mark MHS embossed on inside of each capsule, visible only when capsule is cut in half at seam. Nmtn & Slfomaott 2559 Cambie Street t ancouver ,B.C echve — rinhng CAMPBELL & SMITH LIMITED 820 Richards Street • Vancouver, B.C. • PAcific 3053 Tfoto rfvtUlc&U There has long been a reed need for a potent, mercurial diuretic compound which would be effective by mouth. Such a preparation serves not only as an adjunct to parenteral therapy but is very useful when injections can not be given. After the oral adrninistration of Salyrgan-Theophylline tablets a satisfactory diuretic response is obtained in a high percentage of cases. However, the results after intravenous or intramuscular injection of Salyrgan-Theophylline solution are more consistent. Scdyrgcm-Theophylline is supplied in two forms: ^iJLh^A (enteric coated) in bottles of 25. 100 and 500. Each tablet ' contains 0.08 Gm. Salyrgan and 0.04 Gm. theophylline. ^ ltft£A& *n amPlus °f 1 cc- boxes of 5, 25 and 100; ampuls of 2 cc, 5°*^ boxes of 10, 25 and 100. Wiite for literature "Salytgcm," trademark Reg^ffe-S. Pat. OIL & Canada Brand at MERSALYL with THEOPHYLLINE WINTHROP CHEMICAL COMPANY, INC. Pharmaceuticals of merit for the physician GENERAL OFFICES: WINDSOR, ONTARIO Quebec Professional Service Office: Dominion Square Building, Montreal, Quebec WINTHROP WINTHROP New quick, simplified URINE-SUGAR TEST CLINITEST A TABLET COPPER REDUCTION METHOD NO FLAME NO WATER BATH A test can be made in less than 1 minute. No complicated equipment. No heating. No liquids or powder to spill. Small, compact, portable in pocket or bag. And Clinitest is Reliable The chemistry underlying the Clinitest Tablet Method is essentially the same as that involved in the well- known copper reduction methods of Fehling and Benedict. It retains the familiar progression of colors from blue through green to orange, and indicating sugar (glucose) at 0%, }£%, Yzfo, Ya%, 1% and 2% plus. Economical . . . Note Reduction in Price Complete set (with tablets for 50 tests) costs patient only |1.75. Tablet Refill (for 75 tests) $1.75. Write for full descriptive literature. Available through your surgical house or prescription pharmacy. 5 drops urine plus 10 drops water. Drop in tablet. © Allow for reaction and compare with color scale. EFFERVESCENT PRODUCTS INC. —-----1 Sale Canadian Distributors FRED. J. WHITLOW & CO., LTD., 187 DUFFERIN STREET, TORONTO Zephiran Chloride is a germicide of high bactericidal and bacteriostatic potency. In proper dilutions it is nonirritating and relatively nontoxic to tissue cells* Zephiran Chloride possesses detergent, keratolytic and emulsifying properties, which favor penetration of tissue surfaces, hence removing dirt, skin fats.and desquamating skin. INDICATIONS Zephiran Chloride is widely employed for skin and mucous mem.' biane antisepsis—for preoperative disinfection of skin, denuded skin and mucous membranes, for vaginal instillation and irrigation, for vesical and urethral irrigation, for wet dressings, for irrigation in eye. ear, nose and throat infections, etc. HOW SUPPLIED Zephiran Chloride is available in TINCTURE 1:1000 Tinted TINCTURE 1:1000 Stainless AQUEOUS SOLUTION 1:1000 in 8 ounce and 1 gallon bottles. Write far Informative booklet ZEPHIRAN Trademark Reg. U. S. Pat. OH. 5 Canada CHLORIDE Brand of BENZALKONIUM CHLORIDE REFINED WINTHROP CHEMICAL COMPANY, INC. Pharmaceuticals of merit for the physician WINTHROP General Offices: WINDSOR, ONTARIO Quebec Professional Service Office: Dominion Square Building, Montreal, Que. WINTHROP flDount pleasant TflnbertakirtG Co. %tb. KINGS WAY at 11th AVE. Telephone FAirmont 0058 VANCOUVER, B. C. R. F. HARRISON W. E. REYNOLDS Jfead GoUi Checked WITH 3 DROPS IN EACH NOSTRIL . . . PRIVINE"Ciba Ff (1:1000 solution of 2— (naphthyl—1—methyl)-imidazoline hydrochloride) I 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 Vi ounce with dropper, and bottles of 4 ounces. CIBA COMPANY LTD. Montreal CASE HISTORY Patient: B.M., age 60, Journalist. Blood Wassermann: ++++ Cerebrospinal: Plus 4. Colloidal gold: 5554432211. PAST HISTORY In the last war the patient received a shot in the buttocks and during treatment in the rear he showed signs of mental instability. 1916. For sex perversion and offences against law and decency, he was later confined to jail, resulting in a pronounced claustrophobia. Early sexual life was most irregular, and inadequately treated syphilis may have been contracted from one of a succession of venereal mistresses to which the patient, admits. He has three legitimate children but no other to speak of. Definite mental aberrations were established at this time, some illusory extravagances astonishing friends and relatives (e.g. during a train ride he believed himself making a military assault upon the capital of his country). The patient lived in enormous rooms to satisfy his expansive moods and to accommodate his exaggerated thoracic enlargement and acute lordosis. HISTORY OF PRESENT ILLNESS Mentally and physically the patient's health has deteriorated since 1930. In 1935 the patient took a darker outlook on life during a trip to Ethiopia. In 1940 while in France the patient perpetrated a back-stabbing crime and other acts of violence, showing unbalanced mental reactions. In 1942, while watching cross-country races in Tunisia, he suffered a complete mental and physical breakdown. Although the patient seeks refuge in a his ultimate fate seems inescapable. DIAGNOSTIC IMPRESSION General paresis of the insane. TREATMENT Heavy Metals (Eisenhower). Seclusion and rest (Gestapo). Lead .303. NOTE: Patient refused castor oil treatment, claiming recommended it to others with poor results. home for incurables he IRON PLUS . . . FERONOL TABLETS contain 2Vi grains iron sulphate, combined with vitamin B complex, liver extract and copper. FERONOL TABLETS are indicated for the treatment of the anemias (except pernicious), in pregnancy and in convalescence. FERONOL TABLETS may be prescribed—two tablets three times daily before meals—they are packaged in bottles of 60. FRANK W. HORNER LIMITED MONTREAL CANADA JOB - Hemorrhoids rank comparatively high among the causes of lost "man hours." Today, more than ever, this should be a matter of concern to physicians. Whenever non-surgical treatment is indicated, Anusol may he used with the knowledge that it will afford the kind of relief likely to keep the patient on his job. By their emollient properties Anusol Suppositories reduce inflammation, alleviate pain and check the bleeding. They contain no narcotic or anesthetic to give the patient a false sense of security. "We suggest that you give Anusol a trial in one of your ambulant cases; we shall be glad to send you a supply for that purpose. WILLIAM R. WARNER & CO. LIMITED 727 KING STREET WEST, TORONTO, ONTARIO ANUSOL HEMORRHOIDAL SUPPOSITORIES M* IF ARTHRITIS and ECZEMA ARE ALLERGIC ETIOLOGICALLY effective treatment suggests the use of agents to correct mineral deficiency, increase cellular activity, and secure adequate elimination of toxic wane. LYXANTHINE ASTIER -( orally giveri, supplies calcium, sulphur, iodine, and lysidln bi tartrate — an effective solvent. Amelioration of symptoms and general functional improvement may be expected. Write for Information. L-15 J Canadian Distributors ROUGIER FRERES 350 Le Moyne Street, Montreal Colonic and Physiotherapy Centre Up-to-date Scientific Treatments COLONIC IRRIGATIONS, SHORTWAVE DIATHERMY, SIN NEW AVE GALVIN- ISM, IONIZATION, ULTRA VIOLET RAY, STEAM BATHS AND SHOWERS Medical and Swedish Massage Physical Culture Exercises STAFF OF GRADUATE NURSES Superintendent: E. M. LEONARD, R.N. Post Graduate Mayo Bros. 1119 Vancouver Block MArine 3723 Vancouver, B.C. Cereal Found to Be a Reliable Source of Crude Fibre Content! Wide variations found in the digestibility of fibre from other nutritional sources! ■ O test whether theoretically equalized amounts of fibre from various food sources would produce equal laxative results, experiments were conducted in a Midwestern U.S. university using a group of advanced chemistry students.* These subjects were put on a control diet from which crude fibre had been removed. Foods, containing "equalized" amounts of crude fibre, measured according to tables in nutrition textbooks, were then added, and laxative effects compared. Slight variations were noted from individual to individual, as was expected. But wide variations appeared in the relative digestibility of crude fibre from the various nutritional sources. The fibre sources shown to be most effective in their action were cabbage and KELLOGG'S ALL-BRAN. These showed pronounced "bulk-forming" properties and satisfactory laxative action. The fruits and other vegetables studied gave variable and less pronounced effects. It can thus be seen that KELLOGG'S ALL-BRAN, a uniformly prepared cereal, with a practically constant crude fibre content, will be reliable in its desirable laxative "bulk-forming" effect. I ~ *Full reports of experiments available to doctors and others interested on request to: I KELLOGG COMPANY OF CANADA LIMITED, London, Onl ] I fiiiuiiiiiiiiiiiiiiiiiiiiMiiitiiiiiiiiiiiiiiiiiiiiiiiiitiiiiiiiifiiiiiiitiiiiiiiiititiiiiiiiiiiiiiiiiiiiiiiiiiiiiitiiiiiiiiiiiniinnitiiiiftiiiiitiiiiiiiiiiiiiiiiiiiniiiiiiiiiitiiiiiiiiiiniiiiiiftiiuiiiiniiiH What's oufo&tfuutta abou t IRRiDIITED carnatiJn milk EasHEssMS /ill brands of evaporated milk must conform to the same government standards of butterfat and total milk solids. Yet many physicians are convinced that their best results are obtained with infant-feeding formulas constructed with one brand of evaporated milk—Carnation. What, then, is the reason for this preference? For one thing, Carnation is irradiated, making it a dependable automatic source of vitamin D. Also, there are intangible factors. There's the indirect influence of our great experimental dairy farm on the herds and methods of dairymen who supply us. 'There's the supervision exercised by our field men, who regularly visit the farms all over the country from which our milk is obtained. There's the strict testing of the raw milk at our modern evaporating plants. There's the scientific control of processing, checked by each plant's own laboratory—and the double-check, at a central laboratory, of daily samples from every plant. 111 It may be impossible to analyze for intangibles like these. But they can't be eliminated from any consideration of the quality of a food product. IRRADIATED Carnation JTJ IRMDIA1ED ia/imatlott 'FROM CONTENTED COWS* Milk A Canadian Product A iULL STOdK - If thejBfedicinatsyou require are to be had, we have them. There _ are ^iany modem discoveries?||and preparations that are replacing some of those not now available. The Medical professioncan depend on Georgia Pha rmaey-—a Iways.1 Phone MArine 4f6 \ <4^t *fe JhmdeAAim \ GEORGIA PHARMACY Ml -T.K D- •■•*•* A &t$xi Sc l|anttii lib. ESTABLISHED 1893 VANCOUVER, B. C. North Vancouver, B. C. Powell River, B. C. pi m k ffiriiSttrotrJi V I New Westminster, B. l|§ For the treatment of NEUIU^PSHlX^IATBIC DISORDERS For information apply to Medical Superintended^ ;New Westminster, B. C. or 721 Medical-Dental Building, Vancouver, B. C. PAcific 7823 Westminster 28
Periodicals
W1 .VA625
English
Vancouver : University of British Columbia Library
Vancouver, B.C. : McBeath Spedding Limited
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Original Format: University of British Columbia. Library. Woodward Library Memorial Room. W1 .VA625
Medicine--Periodicals
The Vancouver Medical Association Bulletin: February, 1944
Text