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History of Nursing in Pacific Canada
Vancouver Medical Association
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THE ULLETI Published By The Vancouver Medical Association EDITOR: dr. j. h. MacDermot EDITORIAL BOARD DR. D. E. H. CLEVELAND DR. H. A. DesBRISAY Editorial and Business Office 203 Medical-Dental Building Vancouver, B. C. DR. J. H. B. GRANT DR. D. A. STEELE Publisher and Advertising Manager W. E. G. MACDONALD ■' -v.;.-. i&f* VOL. XXIV AUGUST, 1948 No. 11 OFFICERS, 1948-49 De. Gordon C. Johnston President De. Gordon Burke Hon. Treasurer Db. W. J. Doebance Db. G. A. Davidson Vice-President Past President Db. Henby Scott Hon. Secretary Additional Members of Executive: Db. A. S. McConkey, Db. Rocke Robebtson Db. A. M. Agnew TRUSTEES Db. G. H. Clement Db. A. C. Fbost Auditors: Messbs. Plommeb, Whiting & Co. SECTIONS Clinical Dr. E. B. Tbowbbidge Chairman Db. J. A. Ganshobn Secretary Eye. Ear, Nose and Throat Dr. G. H. Fbancis Chairman Db. J. F. Minnes Secretary Paediatric Db. G. O. Mathews Chairman Db. A. F. Habdyment Secretary Orthopaedic and Traumatic Surgery Db. H. H. Boucheb Chairman Db. Bbtjce Reed Secretary Neurology and Psychiatry Db. A. E. Davidson Chairman Db. G. H. Gundby Secretary Radiology Db. Andbew Tubnbull Chairman Db. Maevin R. Dickey.—Secretary STANDING COMMITTEES Library: Db. F. S. Hobbs, Chairman; Db. R. H. Palmer, Secretary; Dr. R. P. Kinsman; Db. S. E. C. Tubvey; Db. J. E. Walkeb and Db. E. F. Wobd. Summer School: Db. A. B. Manson, Chairman; Db. E. A. Campbell, Db. J. A. Ganshobn, Db. D. S. Munboe, Db. D A. Steele, Db. G. C. Large. Credentials: Dr. H. A. DesBrisay, Dr. Frank Tubnbull, Db. G. A. Davidson. Representative to B. C. Medical Association: Db. G. A. Davidson. Representative to V. O. N.: Db. Isabel Day. Representative to Greater Vancouver Health League: Db. J. W. Sheee. kip.sflfc; iff! m Wm wkm Sfc; fif MA mm ft?-* ■ £' i '•':.• ■■■'■.■:■•:■;-■•■'■■•"■ ■•■•■•-•-:-■>-■•■ ••-.:■:■:-•••::::'■■'-'■:-,v':v-;■'• ■•".■;■■'.•:;•'•■,■ ■;-;:-i-:-: S I C C O L A M FOR THE PROMPT RELIEF OF ERYTHEMA and PRURITUS .8 ► Siccolam is a thick creamy paste containing titanium dioxide, zinc oxide and kaolin in a fat-free base which permits its use in both acute and chronic conditions. It possesses to a much greater degree the dehydrating proper-? ties of lotions of the calamine type. Issued in tubes of 2 and 4 oz: and in jars of 16 oz. Is Active in all inflammatory dermatoses. 2. Completely innocuous; no con* tra-indications to its use. 3. Effects immediate absorption of fluid exudate. 4. Causes rapid relief of inflammation and pruritus. 5. Active in both acute and chronic conditions* 6. Can be used in conditions in which the use of fatty preparations is contra-indicated. 7. Simple and cleanly in usei 8. Flesh coloured and can be used as covering for birthmarks and scars. THE BRITISH DRUG HOUSES (CANADA) LIMITED TORONTO CANADA VANCOUVER MEDICAL ASSOCIATION Founded 1898; Incorporated 1906 PROGRAMME FOR THE FIFTY-FIRST ANNUAL SESSION (Fall Session) September 7—SPECIAL GENERAL MEETING—Discussion of Economics and Health Insurance—Auditorium—Shaughnessy Hospital. October 5—GENERAL MEETING—"Cardiac Arrhythmias, Significance and Treatment"—Dr. G. R. Brow, Professor of Medicine, McGill University. October 19—CLINICAL MEETING—Vancouver General Hospital. November 2—GENERAL MEETING—"The Role of Radiotherapy in the Treatment of Malignant Disease"—Dr. A. Maxwell Evans—B.C. Cancer Institute. November 16—CLINICAL MEETING—St. Paul's Hospital. )ecember 7—GENERAL MEETING—PEARSON MEMORIAL LECTURE—"The Response of the Adrenal Cortex to Disease and Injury"—Dr. J. S. L. Browne, Professor of Medicine, McGill University. )ecember 21—CLINICAL MEETING—Shaughnessy Hospital. Breaks the vicious circle of perverted menstrual function in cases of amenorrhea, tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic relief by stimulating the innervation of the- uterus and stabilizing the tone of its musculature. Controls the utero-ovarian k circulation and thereby encourages a J %. normal menstrual cycle. Ik • M v# MARTIN H. SMITH COMPANY l^s. im> untim strut niw yoik. n. t. jSS 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. in mm WM 1 • rJV "*r> 'm $£ ', ' ■ >- Ki'-'. r •■ *C' m'- Page 335 I .X pholonged-action penicillin For Aqueous Injection .. Once Daily Crysticillin 0 J SQUIBB Procaine Penicillin Gfor Aqueous In m Offering all the advantages of prolonged-action penicillin without the disadvantages of the preparations hitherto available. For use in any condition in which penicillin in oil and wax is indicated. ONE DAILY INJECTION MINIMAL PAIN EASILY ADMINISTERED STABLE WITHOUT REFRIGERATION An intramuscular injection of 300,000 units of an aqueous suspension of Crysticillin provides therapeutic blood levels for 24 hours in the majority of patients—and for 36 hours in approximately 50% of patients. Crysticillin contains no oil or wax. Consequently, pain following intramuscular injection is minimal. Crysticillin is easily administered in aqueous suspension with a conventional syringe and needle, neither of which need be dry. Blockage of needle is minimized and cleansing facilitated. Crysticillin is stable in the dry state for 12 months. Sterile aqueous suspension may be kept at room temperature for a period of one week without significant loss of potency. Crysticillin is supplied in diaphragm-capped vials containing dry procaine penicillin G together with a minute quantity of effective and nontoxic dispersing and stabilizing agents—for suspension with sterile aqueous diluent. 1,500,000 unit multiple-dose vials For Literature write E. R. SQUIBB & SONS CANADA LIMITED 2245 VIAU STREET MONTREAL SCfiJIBB A LEAD&R IN PENICILLIN RESEARCH AND MANUFACTURE VANCOUVER HEALTH DEPARTMENT CASES OF COMMUNICABLE DISEASE REPORTED IN THE CITY STATISTICS—MAY, 1948 Total Population—Estimated 3 54,045 Chinese Population—Estimated 7,979 Hindu Populaton—Estimated ; 275 Rate Per 1000 Number Population Total deaths - 349 11.6 Chinese deaths 6 8.9 Deaths, residents only ' 321 10.7 BIRTH REGISTRATIONS: Male 351 Female 3 54 705 23.5 INFANT MORTALITY: May, 1948 May, 1947 Deaths under 1 year of age 9 22 Death raet per 1000 live births 17.0 26.8 Stillbirths (not included above) 5 14 CASES OF COMMUNICABLE DISEASE REPORTED IN THE CITY Number Rate Per June, 1948 Cases Deaths Scarlet Fever 8 Diphtheria —h 0 Diphtheria Carrier 0 Chicken Pox 183 Measles — 94 8 : 5 2 .__ 0 4 3 Rubella Mumps Whooping Cough- Typhoid Fever Undulant Fever— Poliomyelitis. Tuberculosis 41 Erysipelas Meningococcus (Meningitis). Infectious Jaundice Salmonellosis , Salmonellosis ( Carrier ) Dysentery Dysentery (Carrers) Tetanus — Syphilis (not available) Gonorrhoea (not available) — Cancer (Reportable): Resident - Non-Resident 0 0 0 0 0 0 0 0 0-. 0 72 11 0 0 0 0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 0 0 0 0 0 0 1,000 Population May, 1948 Cases Deaths 0 0 9 0 0 186 249 27 4 2 0 6 0 49 2 0 0 1 0 1 0 0 22 151 123 37 0 0 0 0 0 • 0 0 0 0 13 0 0 0 0 0 0 0 0 3 0 0 0 Page 336 i«-f M m t .-'I.''! II4 ii: '■'«'■ Three COMBINED ANTIGENS Now in General Use DIPHTHERIA TOXOID and PERTUSSIS VACCINE (Combined) Diphtheria toxoid of a high degree of potency combined with pertussis vaccine — for the prevention of diphtheria and whooping cough. DIPHTHERIA TOXOID, PERTUSSIS VACCINE and TETANUS TOXOID (Combined) Diphtheria and tetanus toxoids combined with pertussis vaccine — for the prevention of diphtheria, whooping cough and tetanus. _. HTHERIA TOXOID and TETANUS TOXOID (Combined) A combination of diphtheria and tetanus toxoids — indicated for primary immunization of school children or adults, or for administering recall doses to school children previously receiving a full course of injections of combined diphtheria toxoid, pertussis vaccine and tetanus toxoid. DOSAGE ji Three doses of 1 cc. at monthly intervals and a reinforcing dose of 1 cc. after an interval of at least three months. HOW SUPPLIED For tbe inoculation of one child—Package containing Pour 1-cc. Ampoules. For a group of nine children — Package containing Six 6-cc. Ampoules. CONNAUGHT MEDICAL RESEARCH LABORATORIES University of Toronto Toronto 4, Canada DEPOT FOR BRITISH COLUMBIA MACDONALD'S PRESCRIPTIONS LIMITED MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. f*-i\ \-. ft ■-.. *7/te Cditori. Paye The last issue of the Bulletin contained an announcement which affects every doctor practising in Canada; namely, the notice that in future medical men attending national or provincial conventions, and going to the States once in each year for post-graduate work, will be allowed exemption for income tax purposes, if they render a properly audited and certified account of their expenses on all of these. The implications of this are very widespread, and it is a notable concession to have obtained. We fear that the great majority of medical men do not realize just how difficult it was to obtain, and what a great deal of hard work went into the effort to obtain it. We all feel that it is a just concession—that, just as the business man is allowed exemption on travelling expenses necessary to his business, so should we be allowed exemption on expenses incurred in keeping ourselves up to date—expenses necessary to our business. But the struggle to convince the Federal Income Tax Authorities of the justice of our claim has been a long and a hard one. It has been conducted by the Executive of the Council of the Canadian Medical Association and by its very able General Secretary, Dr. T. C. Routley, and only the relentless persistence of these men, to most of whom the time and effort necessary meant a considerable sacrifice of time and money, enabled them finally to succeed in attaining their object. The rest of us are much too apt to take this for granted—to accept it as if xl were only our lawful due. It had to be fought for—and someone had to do the fighting. Naturally, we cannot all take part in the actual procedures that were necessary, but each one of us, nevertheless-, has a clear duty in the matter. That is to become, and remain, members of the Canadian Medical Association—every one of us. Or are we going to sit back and let other men pay all the dues, and do all the work, while we sponge on them? For that is simply what it amounts to. Every one of us benefits constantly by the efforts of the Canadian Medical Association and its divisions—every I one of us is going to owe his future prosperity and well-being as a doctor to their future efforts. Our whole future depends, and we cannot deny it, on how united the medical profession of Canada is in the years to come. And yet there are men, even now, who "cannot afford" to pay the huge sum of eight dollars per annum, which gives them membership in the Canadian Medical Association, not to speak of entitling them to the Journal, which is one of the best medical journals in the world. It is not enough— the subscription should be more, to enable us as a profession to do what has to be done. But whatever the burden, it should be on every man's shoulders, not merely on the shoulders of those who feel their responsibility and are willing to pay their share. We do not want to see medical unions in this country—we believe there is no place for unionism as it is commonly understood, in the medical profession. But we might well take a lesson from the unions, in one regard. A member of a union in Vancouver, apologizing to his doctor for a dilatory payment of his bill, told him that during the \ strike of his union elsewhere, he was assessed thirty dollars a month as his share toward I strike funds. And we find eight dollars hard to pay! This money is not a tax, it is not a gift to anyone—it is not an act of generosity to pay it. It is insurance, and in one way or another must be found and paid, by someone. Even in these days of high cost of living, even with all the other taxes we have to pay, we know that we must keep up our insurance. We pay fire and burglary and accident liability insurance as a matter of course. When it comes to insuring our very \ mode of life, our standards of practice, our freedom to practise medicine as we think we should practise it, some of us hesitate: though we willingly enough accept the benefits obtained for us by the others who do pay, and many of whom pay over and over, I in personal effort and sacrifice. We here in B. C. should have a 100 per cent I membership in the Canadian Medical Association. Let us see to it. Page 337 m r.« :">i* m tm k * '£. « M ' II tf"^ Some time ago we announced in the Bulletin that Dr. L. H. Appleby, of Vancouver, had been invited to deliver an address before the Sixth International Congress of the International College of Surgeons at their meeting in Rome, Italy. The title of his address was "The Surgical Consideration of the Achlorhydric Stomach." This was a signal honour, and one on which, highly deserved as it was, we all heartily congratulate Dr. Appleby. He has returned to Vancouver, and your Editor asked him for a brief account of his adventures. We found that he had added to his honours by being elected one of the Vice-Presidents of the College, and being appointed to the Editorial Board of the I.C.S. Journal. The September 1949 issue of the Journal will be a wholly Canadian issue, and Dr. Appleby has been appointed guest Editor for the issue. The new President of the College is Dr. Francisco Grana of Lima, Peru, and amongst the Vice-Presidents are Dr. Hamilton Bailey, of London, and Dr. Curtis Lee Hall, of Washington. Dr. Appleby was elected to Honorary Fellowship in the Italian Surgical Society, and has been awarded the Certificate and Medal of the Societa Piemontese di Chirurgia. He found conditions in Italy disturbed and disturbing, as far as the medical profession is concerned, at any rate. He met many old friends, amongst others Dr. Bas- tianelli, the dean of Italian surgery, who at the advanced age of 84 years, is compelled to work for a bare living, though he had retired and had hoped to be able to live the life of dignified leisure to which he had looked forward, and which he had so well earned. But medical conditions in Europe generally are, in Dr. Appleby's opinion, in a very unstable and deplorable state. It is not, he feels, calculated to add to the stature of rnedicine, that it is gradually and rather rapidly becoming socialized and subservient to the state. We must all feel that there is much truth in this point of view. ANNOUNCEMENT It is with pleasure we announce that Dr. Lyon H. Appleby has consented to act as Chairman of a Committee to take charge of financing and building of the new Academy of Medicine. For some time it has been felt that the profession of this Province should have a building worthy of it. A site has been purchased, situated at the corner of Tenth and Burrard Street and the deed to this property is now held in the name of the College of Physicians and Surgeons. Ever since the meeting in Banff in 1945 this idea has been brought up at annual meetings and each time it appeared to be the desire of the profession to proceed, but owing to building restrictions, costs, etc., it had to be postponed. It appears that the time is now ripe to go ahead and with the selection of Dr. Appleby as Chairman, the and the arrangements will be in capable hands. We wish him every success and would hope that the profession as a whole will co-operate fully, financially and otherwise. LIBRARY NOTES HOURS DURING THE SUMMER MONTHS: MONDAY TO FRIDAY 9.00 a.m. to 5.00 p.m. SATURDAY j 1 9.00 a.m. to 1.00 p.m. RECENT ACCESSIONS TO THE LIBRARY: A Study of History, 1947, by A. J. Toynbee (Historical and U/S Fund). Amiable Autocrat—A Biography of Dr. Oliver Wendell Holmes, 1947, by E. M. Tilton (Nicholson Fund). American Association for the Study of the Goiter, Transactions—1947. American College of Surgeons—Year Book for 1947-1949. Page 338 ft American Diabetes Association, Proceedings, Vol. 7, 1947. American Therapeutic Society, Transactions—1945-1946, edited by F. M. Ptotinger. Congenital Malformations of the Heart, 1947, by H. B. Taussig. Gastritis, 1947, by R. Schnidler. Glomerular Nephritis, 1948, by T. Addis. Medical Clinics of North America, Symposium on the Anomalies of the Heart, Mayo Clinic Number, July, 1948. Milk and Food Sanitation Practice, 1947, by H. S. Adams. Neuropathology, 1947, by I. Mark Scheinker. No Retreat from Reason, 1948, by A. E. Cohn (Historical land U/S Fund). Problems of Men, 1946, by J. Dewey. Psychiatric Research, 1947, Various Authors. Successful Marriage, 1947, edited by Fishbein, M., and Burgess, E. W. Surgical Clinics of North America, Symposium on the Liver, Bile Tract, Pancreas, Spleen, Lahey Clinic Number, June, 1948. The Lung, 2nd edition, 1947, by W. S. Miller (Stephen Memorial Fund). The Spleen and Hypersplenism, 1947, by Dameshek, W., and Estren, S. The Treatment of Rheumatism in General Practice, 4th edition, 1946, by W. S. C. Copeman. Trauma in Internal Diseases, 1945, by R. A. Stern. ■4-IB' We publish herewith a letter from Mr. Austin MacDonald, the President of the British Columbia Pharmaceutical -Association. This letter is self-explanatory—and we would urge our readers to read it carefully, and realize that it means just what it says. In this matter, the pharmacists of the Province are compelled to obey the regulations of the Social Service Department—and we cannot expect them to do otherwise. Nor should we expose our patients to the danger of rejection of the prescription that we have given them, because of our own laxity in the matter. This was brought up in the January issue of the Bulletin—and we would emphasize the necessity for care in this regard.—Ed. Dr. J. H. MacDermot, 925 West Georgia Street, Vancouver, B.C. Dear Dr. MacDermot: Physicians and Pharmacists have been advised that only B. C. Formulary prescriptions can be honoured after August 1st. We suggest that the Bulletin co-operate in publicizing this fact and keep harping on it until Physicians realize that it actually is a ruling of the Department. It will save everyone concerned a great deal of annoyance if the Formulary is used, otherwise the patient will have to be sent back to the Physician for a new prescription which complies with the ruling. Yours truly, AUSTIN W. MACDONALD, Pres., Greater Vancouver Druggists Assn. Page 339 ifm. W; >5 W - ■: v. 'M v< t 1? w S 10 ft. < 0) CD c i ° 10 c ^ J2 1 i JC E Q o o ~d o (0 jQ CD 1$ 1 tdO Q 2 (O »-< »H -Q O -w U 0 —1 Q i_" Q c «B E E c g _«o en (U Dr. J. D. Ad osis of Virus al Practice." O I la Q ouis C. Simard, ct to be announc l! .a 4-1 | E.2 S E (O _l CU <L> 1 "5 IB •a Q (D IB L. ri Q 1^ U o in © o O <n *rt oo 6s 6s 0 it i a c ^- . . < ^ ^ IO « ^ J McLachlin: "Some Peripheral Blood 0) Jc X I* ociation 19 J3 o hi It s V 44 Oh ESSIONS- W. Simpson c o T3 (0 E i/) U IO '3 T3 CD U C 3 0 E 0 >_ CQ 10 O O £2 CQ LU '0 E E 0 u 0 Ij <! ^ [ CD ING S n: Dr. W. 4-f eg w O) ffl Dr. A. D. s of the c CD JD O Dr. E. F. ation." JC 4| "lO > O 1 H </5 Z I Q> 10 IS H O 0 "v 4- (O »"'' .2 Ik MOR Chair E o in :00 a.m. Dise Vess E IB a la :30 a.m. Into: O 4- u 0 ■0 0 i?i -9 ^ 00 is 6s 0 a c ") sp "lB 3 M> v' •—< V J O o ^- s 4^ u :^f "| "5 > V) JO "Jo O £ 1 c n: "Fear atment." 0 4- c 4— CQ IB Q 3 c H < Q </3 OS u u c c g s C. Simard, to be announced. IO _^ o o QQ O c E 4— . Adamso n and Tre i i 3 z Q 0) s 44 ll! 4* w <** .2 LL.' ui H3 J- 0 4> c .2 CB a. to r. J. D cognitio w Oh 0> c «0 Qi '3 +- Q O 3 0 G IO C O O Qi :,'r ^ V3 E la *5 U E • •B a.m. t>r. Lo Subjec E •B IB _1 IO E IB o o m 0 m m o *• in ■a • • • • • • .. 00 Os t* 0 1 Page 340 *—"—••—■——'=-=—=——~- • -^* '■l'£.lr€< CD Q ; o IO .!? .*: +- o 1_ o 0> 1- CQ > >+- ll! O 'i u> Ui "5> O %1 c Q en IB Q I J5 IB ■*• o in Q "- Q u © Q 0) Sr* c # a 2 IB c IE e s 5 IE U E u j: IB _J c u e £ U 5 IO C 3 _i k. g Q Q* +- < . .. < iJ ^5 c o U 5 E o o Qi CD at <D Q CO* +~ a ~io <U IO V 3 *- E at E C IO Q> 3 IB 3 •B o m 6. CQ CD m CA w CQ Q M < 5 W T3 CQ z 0 HH i IB c/5 4b CD Cfl c v^ c/3 o E IB O en c k 3 O L. z u ^4— O M— 5 0 1- ~o IB CD 4- .52 z O C CD CD E X 3 CD IO IB CD H d a a. & o m U <u m CO .2 -a _c IB U £ k io o u c <J •B IO U '3 0 _1 E 1. d 0 in 10 JD CD £ 4— 0 TJ c "^ 0 CD 5 CD ■O 3 O CC CC 4- 1 IB C u 3 or J la # c ft. 0 e E 3 IO .2 1- IB CQ c 0 U T> \1 a IB _l 0 CD ^_ 1_ > — IB <D 3 IB 3 x _*! O C e CO cf IB u O c 4- O CD c 4- < 1_ a IB a CQ 4— .2 to > 0 £ 0) "0 0 to *C 4— 10 CD 4- 10 10 a> Q X IO <D 3 0 d h- < E U3 I OI < .2 c jo o CD '<bQQ 10 c 0 CD OI ^ • &- 3 to < 1 "D ei C IB C _g c IO IB 9 £ .2 in 1 0 .2 5 [0 "10 1q £ ^M >. 3 > IB X 0 U 3 3 e Q. O u c »*. C < E d O CD a> X 10 '4— 0Q IB > "3 "0 U O 0 0 <n 00 *8 , i iM •s) • 3Tr Page 341 g* ■ill' tt'l ii -i British Columbia Medical Association President .... President-Elect Vice-President Honorary Secretary-Treasurer Immediate Past President Dr. Lavell H. Leeson Dr. Frank Bryant Dr. W. Laishley Dr. J. C. Thomas Dr. Ethlyn Trapp It' m The British Columbia Medical Association 1948 ANNUAL MEETING CLINICAL SPEAKERS DR. LOUIS C. SIMARD, Montreal Associate Professor of Pathology, University of Montreal. DR. E. F. BROOKS, Toronto Assistant Professor of Medicine, University of Toronto. DR. A. D. McLACHLIN, London Professor of Surgery, University of Western Ontario. DR. WILLIAM MAGNER, Toronto— Assistant Professor of Pathology, University of Toronto. DR. J. D. ADAMSON, Winnipeg Professor of Medicine, University of Manitoba. DR. W. PAUL HOLBROOK, Tucson, Arizona Representing: American Rheumatism Foundation, and American Rheumatism Association. DR. J. W. GRAHAM/Toronto President, Can Arthritis and Rheumatism Society. REPRESENTING CANADIAN MEDICAL ASSOCIATION DR. WILLIAM MAGNER, Toronto. President DR. T. C. ROUTLEY, Toronto General Secretary DR. A. E. ARCHER, Lamont, Alta Consultant on Economics REGISTRATION IMPORTANT: All doctors attending the Convention are requested to register. Members residing in Vancouver are requested to register early on Wednesday. THERE IS NO FEE FOR REGISTRATION. Page 342 ANNUAL REPORTS OF STANDING COMMITTEES CONSTITUTION AND BY-LAWS During the year this Committee has considered amendments to the Constitution and By-laws which would be necessary to incorporate Sections, the setting up of Past Presidents' Advisory Committee, and the proper functioning of the Benevolent Fund. These amendments have been circulated to all members of the profession in accordance with the Constitution. As Chairman of the Committee, it will be my pleasure to move the adoption of amendments referring to each of these subjects. Respectfully submitted, D. F. BUSTEED, M.D., Chairman. COMMITTEE ON PROGRAMME AND FINANCE The Comittee on Programme and Finance was organized early in the year and has been quite active since that time working out the details for the annual meeting to be held September 29th, 30th and October 1st, 1948. The usual speakers' group from the Canadian Medical Association will accompany Doctor Magher, the President, and will be augmented by other speakers selected by the Committee. This year, the B. C. Medical Association is sponsoring a public meeting on Arthritis, and plans for the meeting are being worked out with representation from the arthritis group. The arrangements for lectures, clinics, catering, golf and accommodation have been made, looking forward to a large attendance and a well rounded programme. Respectfully submitted, G. F. KINCADE, M.D., Chairman. fM F;-M :^m X ■-. .• -t COMMITTEE ON LEGISLATION Your Committee reports relatively few activities this year. The Amendment to the Medical Act allowing relief to be given to doctors' dependents was passed without difficulty. Your Committee assisted in the Amendment of the "Chiropodist's Act," insofar as it appeared to infringe on the medical field, with satisfaction to the Chiropodists. The Attorney-General was interviewed some four or five times in regard to individual medical men, details of which are not of interest. Respectfully submitted, THOS. McPHERSON, M.D., Chairman. COMMITTEE ON MEDICAL EDUCATION Last November the Senate of the University of British Columbia, for the first time, resolved that it be the definite policy of the University to start a Faculty of Medicine as soon as adequate clinical facilities were seen to be available. It is true that the Senate also firmly laid down the policy that such a Faculty would be in the nature of a "split school" insofar as the pre-clinical would be done on the present campus and the clinical teaching mainly at the Vancouver General Hospital, in accordance with the proposed hospital additions and alterations, as formulated in Plan "A" of the Hamilton Report. Your Committee was somewhat disappointed in the final University policy of a "split school," but also felt that it was possibly a necessary compromise on both sides if a Faculty of Medicine was to.be started in the near future. Also that it should work out satisfactorily if certain subjects, such as pathology and anatomy, could- be taught in close proximity to the clinical teaching. Page 343 Ml til; >'* PS •.'. SrTUt :?1 Having formulated their policy the University Senate was then able to draw up statements of definite costs and requirements that were presented to the Government this spring, which were largely accepted by the Government, and with the concurrence of the Government the University hopes to be able to accept medical students in the fall term of 1949. A small sub-committee, consisting of Doctors Matthews, Milburn and Strong, has been appointed to keep in close and harmonious contact with the University, in the hope and belief that advantageous interchange of ideas will result and that our present friendly relationship with the University and its President will continue. In the opinion of your Committee, the University now earnestly desires a Faculty of Medicine at the earliest possible date, and it is doing everything in its power to facilitate the promotion of adequate clinical facilities to that end. Respectfully submitted, G. O. MATTHEWS, M.D., Chairman, COMMITTEE ON ARCHIVES In reply to your letter of July 31st regarding the Committee of Archives may I say I am sorry that my continued illness has prevented my doing any work on this Committee during the year and I doubt if I will be able to do any prior to the annual meeting of the Association. I am naturally very sorry for this but it could not be avoided. Respectfully submitted, G. E. KIDD, M.D., Chairman. COMMITTEE ON MATERNAL WELFARE 1. The following members have served on this Committee for the current year: Doctors S. G. Baldwin, Harold Caple, A. C. G. Frost, F. D. Johnson, A. E. Trites and G. F. Amyot, Deputy Minister of Health. 2. The Committee submits for approval the following recommendations: (a) That the programme of the next Annual Meting should provide time for practical clinical demonstrations in obstetrics, in accordance with the recommendation brought forward and approved at the last Annual Meeting. (b) That the Provincial Department of Health be requested to work out plans, in conjunction with the Committee on Maternal Welfare of the B. C. Medical Association, for the routine chest x-ray of all pregnant patients. (c) That the profession at large be again reminded to. continue to exert every possible effort and encourage the public to volunteer the donation of their blood to the Canadian Red Cross Blood Transfusion Service, since it is felt that the importance of the ready availability of blood in the prevention of maternal mortality and morbidity cannot be over-emphasized. 3. Although no accurate statistics are available at this time to substantiate a definite statement, it is the impression of your Committee that there is probably in B. C. an unduly high incidence of mortality and morbidity, both maternal and foetal resulting from inexpert obstetrical anaesthesia and it is accordingly suggested that the incoming Committee should undertake a survey of this problem, preferably in conjunction with the B. C. Society of Anaesthetists, with a view particularly to the possibility of ensuring at some time in the future, the availability of professional anaesthetists for parturient women, at least in the larger centres. 4. The Chairman wishes to avail himself of this opportunity to express thanks and appreciation to the members of the Committee for their support and interest. Respectfully submitted, A. B. NASH, M.D., Chairman. Page 344 COMMITTEE ON PUBLIC HEALTH The only problem brought before the Committee was a review of the narcotic situation. However, this is under the consideration of the Dominion Government and the Canadian Medical Association so no action was taken by this Committee. In view of the effects of the present housing shortage on public health, it was decided that The British Columbia Medical Association should join with the Vancouver Housing Association, and the Chairman of this Committee attended the meetings as representative of the B.C.M.A. Respectfully submitted, E. J. CURTIS, M.D., Chairman. (Ml COMMITTEE ON ETHICS AND CREDENTIALS During the year no items were directed to this Committee for consideration. All meetings of the Board of Directors were attended. Respectfully submitted, H. A. L. MOONEY, M.D., Chairman. COMMITTEE ON PHARMACY During the past year no business has arisen for the attention of the Committee on Pharmacy, and the Committee has been inactive. Respectfully submitted, W. W. SIMPSON, M.D., Chairman. COMMITTEE ON HOSPITAL SERVICE No problems or matters have been referred to the Committee during the present year, and therefore, no meetings of this Committee have been called. There is nothing further to report. Respectfully submitted, H. S. STALKER, M.D., Chairman. COMMITTEE ON CANCER 1. The Committee on Cancer of the British Columbia Medical Association held three meetings during the year 1947-48. 2. Local Societies' Meetings—Presentation on "Cancer Control" Complying with the recommendation of the Committee on Cancer of the Canadian Medical Association, approved by General Council at the 48 th Annual Meeting of the CM.A., to the following effect: "That the Chairman of programme Committees in National, Provincial and District Medical Societies be asked to arrange for speakers on the subject of malignant disease." An appropriate letter was sent to all local Medical Societies in the Province, suggesting that one of their meetings during the ensuing year be devoted to cancer and its control. 3. Treatment of Cancer by Unqualified Persons and Publicity Relating Thereto The unfortunate fiasco of the "Braund Cure" which took in persons, at considerable expense, for great distances and the role of the local press in stimulating this affair to the proportions it attained were considered. A second local "Braund" situation was ready to be launched and would have been except for the judicious handling of the situation by the Executive Secretary. Reference is made to an unqualified person in Burnaby who for years has been treating "cancer" by local applications. The concern of the Committee over these recent episodes prompts it to recommend Page 345 i«i .L_- j* 5 pi to the Board of Directors that a policy be adopted by the B. C. Medical Association on all health publicity and that a close liaison be developed with the local press. 4. New Experimental Therapeutic Approaches by Members of the Profession During the year two qualified physicians in the Province have evidenced an interest in developing new approaches in the therapy of cancer. The work of each, which is in the early experimental stage, has been followed with interest by the Committee. Dr. I. C. C. Tchaperoff, of St. Joseph's Hospital in Victoria, is working on the effects of combining the administration of para-aminobenzoic acid with small doses of x-i^ay on malignant neoplasia. Premature publicity on the project appeared at one time during the year. It seemed likely to be too optimistically interpreted by the public until the appearance of Dr. Tchaperoff's statement to the press to the effect that his work was still unproven, though he had hopes for its success. A study on the psychotherapeutic approach to the problem of cancer and to the pain associated with it, is being undertaken by Dr. V. B. Goresky of Castlegar. 5. During the year the Committee continued to maintain a liaison with the B. C. Cancer Foundation, B. C. Cancer Institute and the B. C. Branch, Canadian Cancer Society. Respectfully submitted, D. H. WILLIAMS, M.D., Chairman. EDITORIAL BOARD COMMITTEE This Committee has not a great deal to report, as there has been no important business in the past year in the matter of publicity. The transactions of the B. C. Medical Association have been reported, when this was deemed advisable, through the columns of the Bulletin of the Vancouver Medical Association, which maintains a column at all times headed "B. C. Medical Association," and publishes all material received from the B.C.M.A. The Executive Secretary, Dr. F. L. Whitehead, has rendered most valuable service in preparing this material for publication. In this connection, we feel that due acknowledgment should be made to the Vancouver Medical Association for their courtesy in extending the use of the Bulletin's columns for recording our transactions, and publishing material which we want brought to the attention of the medical profession in general throughout British Columbia. An important method of securing publicity as far as the profession of the province is concerned, is the News Letter put out from time to time by Dr. Whitehead. These letters have been of very great value, and contain a great deal of information, and of very wise counsel. This innovation introduced by Dr. Whitehead, has proved to be very well worth while. A Study Committee on Public Relations was appointed by the President, following a resolution passed at the May meeting of the Board of Directors, to consider and report on the steps necessary to be taken toward the formation of a Public Relations Committee. This Committee consisted of the following: Dr. J. H. MacDermot, Chairman; Dr. D. H. Williams; Dr. G. F. Kincade; Dr. R. A. Gilchrist; Dr. Stewart Murray, M.H.O.; Dr. F. L. Whitehead, Secretary. This Committee will report directly to the Executive of the Association. Respectfully submitted, J. H. MacDERMOT, M.D., Chairman. COMMITTEE ON NUTRITION During the year there has been nothing that occurred in nutritional problems that would warrant a report from the Committee on Nutrition. Respectfully submitted, A. H. SPOHN, M.D., Chairman. Page 346 MEMBERSHIP COMMITTEE Letters have been sent out to the members of the medical profession in British* Columbia, pointing out the value of membership in our national body. The results have been very gratifying and we have, this year, a record percentage of members in the Canadian Medical Association. To date 850 have paid their C.M.A. membership for the year 1948. This number compares favourably with the 1132 members who have paid dues to the College of Physicians and Surgeons. Respectfully submitted, G. D. SAXTON, M.D., Chairman. .'!• COMMITTEE ON INDUSTRIAL MEDICINE Three meetings were held during the year, one of which was a joint meeting with a similar committee of .the Greater Vancouver Health League. The need of a Provincial Division of Industrial Hygiene was again brought to the attention of the Hon. Mr. Pearson, but difficulties, chiefly of finances and suitable trained personnel, make such a move out of-the question at the present time. The local field was prospected and although the same difficulties present themselves there is some hope that an industrial health service may be organized on a local jjasis under the Vancouver Metropolitan Health Committee. Advice and information has been cheerfully given to physicians and others interested in health services in industry. Improved and more uniform standards of pre-employment and periodic physical examinations and records are desirable and your Committee has been pleased to have been of assistance, on occasion, in this direction. Respectfully submitted, A. M. MENZIES, M.D., Chairman. COMMITTEE ON EMERGENT EPIDEMICS During the disruption due to the floods in various parts of British Columbia in the spring of 1948, unexpected demands were made on the Health facilities of the communities, areas, and the province at large. It is gratifying to be able to report that arrangements were quickly made to deal with the health problems involved and that the members of the British Columbia Medical Association distinguished themselves and added new laurels to the profession by the manner in which they undertook any task that presented itself at the time. Such an emergent situation required the closest co-operation from a group of official, professional and non-official agencies to meet the needs of the districts. Provincial Health Services transferred Public Health Nurses and Sanitary Inspectors, from areas in the provinces not involved with the floods into those areas requiring this service, and sent to supervise the activities of this group the Public Health Engineer of the Department, Consultant and Supervising Public Health Nurses, and others so that necessary actions could be taken as quickly as possible. Special supplies were necessary and were soon procured. Most important of all, the closest co-operation between the local part- time and full-time medical health officers and the practising physicians was maintained at all times. In addition to the various technical and professional members from the Provincial Health Department sent to the areas to supplement the local staff, the Armed Forces provided Medical Officers and others along with necessary equipment and supplies to help in the emergency. The manner in which all personnel worked was outstanding, and again, the help and co-operation of the practising physicians throughout the areas was of a high order and played an important part in the final satisfactory health results that were obtained. Page 347 '*ffi >-lVfti Bft :jts*i« ■•ill -.Mi '■•Hi liff This demonstrates the importance of having a flexible programme of action as outlined under the Emergent Epidemic Committee of some years ago which plan formed a guide for the areas concerned. Your Chairman wishes to extend his personal thanks for the help and co-operation of all those taking part in this important work in connection with the floods. Respectfully submitted, G. F. AMYOT, M.D., Chairman. M THE COMMITTEE ON MEDICAL ECONOMICS (The Joint Committee on Medical Economics of the Council of the College of Physicians and Surgeons of British Columbia and the British Columbia Medical Association.) The year 1947'-4 8 has been an extremely active one. Three meetings of the Main Committee have been held and fifteen meetings of the Executive Committee. At the last annual meeting it was decided to set up an Executive Committee to deal expeditiously with day to day events. This has proved to be a very necessary arrangement. It is impossible for thirty doctors from all over the Province to meet at frequent intervals and, in some things which have been brought before us, action was required quickly. The Executive Committee has done a tremendous amount of work and deserves the heartiest thanks of every member of the profession. The Reference Committee of three has dealt with a considerable number of matters referred to them by individual doctors and by Approved Plans. It is worth repeating that the Reference Committee is designed to deal with matters of dispute regarding fees and to set fair fees for unusual procedures. It is not concerned with matters of broad policy except to make recommendations to the Executive or the Main Committee. It would be impossible in a brief report to give all the activities of the Committee during the year. A resume of some of the major problems will have to suffice. (a) Fee Schedules: The 1948 Schedule of Fees was distributed and became effective May 1st, 1948. All the Approved Plans have adopted this schedule. The innumerable difficulties encountered by Dr. Mustard's committee in their efforts to produce an agreed schedule were apparently resolved with almost universal satisfaction. Since the new booklet has been issued, the number of complaints has been remarkably few. This is certainly a tribute to the workings of the Committee. Realizing the impracticability of producing a new fee schedule at too frequent intervals the Committee has asked Council to establish a policy regarding the frequency of revision of the fee schedule. The aim in this is to be able to plan for the future and to give the M.S.A. a reasonable chance of anticipating additional expenses. M.S.A.'s contracts are on a yearly basis and constant changing of the schedule would place an intolerable burden on their business administration. The Workmen's Compensation Board scale of fees has also been completed and takes effect as from June 1st. (b) Medical Care of Persons on Relief: The provision of medical care for these people, on a province-wide basis, occupied considerable time and study by the Committee. A brief stating general principles andv our views on the whole matter was sent to the Government on July 6th, 1948. The basic principle contained in the brief is that the profession is willing to negotiate with the Government to set up a province-wide scheme, an estimation of the cost of looking after these people based on payments made by the M.S.A. was arrived at, and the profession now awaits a concrete Government proposal. I think it is generally recognized that the profession will hot receive payment in full for its work and that we shall have to be content with a lesser rate during a period of six months or a year while statistics are amassed to show what the actual cost is. Page 348 (c) At this time last year the Grimmett Report on the Health and Accident Societies had not been acted on. Since then six of these societies have been suspended and the remainder have been placed under the revised Societies Act of British Columbia under which they have to conform pretty well to the requirements of the line insurance companies. The action the Government has taken has removed, to a large extent, one of the most troublesome problems we have had. Much thought has been given to the workings of the prepaid medical care plans as they exist at the moment, to the implications of the Hospital Insurance Act, to the National Health programme recently announced by the Dominion Government, and to health insurance on a voluntary and on a compulsory basis. Most of these subjects are far reaching and to attempt to predict what the results of any of them may be would be folly. It is apparent, however, that the trends towards socialization is increasing in tempo and that the medical profession in this Province cannot dally much longer without formulating some clear policy regarding the future. In day to day contact with these matters one becomes convinced that we must make up our minds what we want and do our best to implement it. If we take no action there will be no one to blame but ourselves. It is for this reason that the Committee has decided to have an Open House on Medical Economics at the annual meeting of the College. The Committee needs to know what the profession wants it to do. The Committee on Medical Economics represents the District Medical Societies and is a body representing the whole profession. It regards its job as one of trying to know what the profession really thinks and to put that into action through the appropriate channels. In policy making it endeavours to express the will of the majority of the profession. An innovation during the past year was the inauguration of the News Letter on Economics. It was recognized that many of the topics we discuss are in a very controversial stage and that they should as nearly as possible be confined to members of our profession. The Bulletin is an open publication, it is distributed to the advertisers and is available to any members of the press association. For these reasons it was decided to adopt the News Letter which you have already received at various times during the year. Suggestions on the manner of making the News Letter more valuable will be welcomed. To date, the number of favourable comments received encourages further work on publicity directed to our own profession. I would like to express my appreciation of the interest and support of the members of the Committee and in particular of the enormous amount of time freely given by the members of the Executive Committee. Respectfully submitted, H. H. MILBURN, Chairman. •:;•& >*%&» M •■■ ■ •. ■-. ";i''■••' Representative of Canadian Medical Association Executive ANNUAL REPORT As your representative on the Executive of the Canadian Medical Association, for die year 1947-48, I beg to report as follows: Four meetings of the Executive Committee and the Annual Meeting of the Canadian Medical Association in Toronto were attended. Publicity has already been given to a large number of items dealt with during the year and I propose to touch on some specific points briefly. 1. The Annual Meeting of the C.M.A. is to be held in Vancouver in 1954. At that time the B.OM.A. will be the host division to our confreres from the rest of the Dominion. 2. Income Tax—After much negotiation it is a pleasure to report that the members of the profession will now be able to deduct, from their earned income, the expenses Page 349 *fi incurred in attending three meetings per year. The full directive from the Department of National Revenue has already been published in the Bulletin. 3. Survey of Physicians' Income in Canada—This survey is available to any doctor who wishes to have it, and it gives some very valuable information to doctors themselves, and also to those persons who are concerned in the planning of the health services of our country. 4. General Practitioners' Section—A well attended meeting of the general practitioners was held in June, at which it was decided to ask the C.M.A. to revise its Constitution so that a General Practitioners' Section could be set up officially within the framework of the C.M.A. This Division has been asked to nominate two general practitioners to serve on a Committee, under the Chairmanship of Dr. Victor Johnson of Lucknow, Ont. The Committee will meet at the Annual Meeting in Saskatoon next year and, by that time, will have a fairly concrete idea of what policy they wish to pursue. 5. C.M.A. Action in regard to recent health grants by the Dominion Government. General Council decided that the C.M.A. should offer to assist the Dominion Government in every way possible, and recommended that the Provincial Divisions should offer to assist in the provincial studios, and action on the latter point has already been initiated, I believe, in this Province. 6. Prepaid Medical Care Plans—After much discussion on this issue it was finally decided that a Charter should be applied for, and that the petitioners for it should represent those plans selected by the various Provincial Associations. A meeting of this group is to be held in Toronto in October, at which time the petition for the charter is to be submitted to the Dominion. 7. Membership in the C.M.A.—There are 8,502 paid-up members of the Canadian Medical Association. B. C. has 850, which is the largest number we have ever had. It would be desirable, at this stage in the development of the practice of medicine, if every doctor in every Province were an active participating member of our National body. 8. Health Insurance—Dr. G. D. W. Cameron, Deputy Minister of Health and Welfare, in the sessions of General Council, gave some very interesting information in regard to the implementation of the health survey grants, and the present position of the Dominion Government in regard to the broad issue of hospital and medical care insurance in general. The C.M.A. re-affirmed its approval of the original eighteen points regarding health insurance. The programme now made possible under the Dominion Government thirty million dollar grant is believed to be the necessary prerequisite in health insurance. No clear cut statement was expressed on whether the health insurance envisaged was to be compulsory or voluntary. 9. Annual Meeting, 1949—The Annual Meeting of the CM.A. of 1949, is to be held in Saskatoon on June 15 th, 16th and 17th. 10. World Medical Association—-The Council of the World Medical Association met in New York on April 26th, 27th, 28th and 29th, with all members present. The following 37 countries, including the Founder Associations, were declared to be now in full membership in the Association. Australia Iceland United States of America Austria India Belgium Canada Italy France Cuba Luxembourg Netherlands Czechoslovakia Norway New Zealand Denmark Palestine (Arab) Poland Page 350 Palestine (Jewish) Portugal Peru Turkey Philippines China South Africa Chili Spain Colombia Sweden Switzerland Dominica Equador Eire Finland Great Britain Greece Hungary The Council of the World Medical Association discussed war crimes, medical education throughout the world, advertising of patent medicines, training of specialists, medical refugees of which there are some 2,000 doctors in camps in Europe, post-graduate medical education, and a number of other matters of importance to the medical profession throughout the world. Dr. T. C Routley, Chairman of the Council of the World Medical Association, and Dr. J. F. C. Anderson of Saskatoon, President-elect of the Canadian Medical Association, are to represent the Canadian Medical Association at the meeting of the World Medical Association in Geneva in September this year. 11. World Health Organization—This is a medical body established as an integral part of the United Nations' Organization. Ratification of the Constitution has been received from 26 nations and the first general assembly of the World Health Organization met in Geneva, Switzerland, in June and July, 1948. The World Health Organization has amongst its functions the following: 1. To act as the directing and co-ordinating authority on international health work. 2. Upon request, to assist Governments in strengthening health services. 3. Upon request, to furnish to Governments appropriate technical assistance. 4. To provide epidemiological and statistical services. 5. To co-operate with other health agencies, Government and non-Governmental, in the advancement of health. 6. To establish and revise international nomenclature of diseases and to perform other services upon request of Governments, which are designed to assist mankind to attain the highest possible level of health. This is a very rapid survey of some of the more important points which have been considered during the past year. Full reports of all the activities of the committees, etc., will be published in due course in the C.M.A. Journal. Respectfully submitted, ETHLYN TRAPP, M.D. :-. •••■ *1«! ■ tI*** w British Columbia Medical Association, 925 Georgia Street West, Vancouver, B. C Dear Sirs: At the Annual Meeting of the Central Council of the Canadian Red Cross Society, the following resolution was unanimously adopted: "This Central Council of the Canadian Red Cross Society hereby expresses its thanks to the medical, dental, nursing and teaching professions for their continued assistance and advice in the work of the Society in its peacetime programme through the year." The Provincial Executive of the British Columbia Division joins in this expression of gratitude for the ever-ready assistance rendered by the medical profession to the Society. It will be appreciated if the respective members of your profession could be made aware herein. Yours sincerely, C. A. SCOTT, Commissioner. Page 351 >I!i m jM INFECTIOUS NEURONITIS By BRUCE SHALLARD, M.B., CH.M., M.D., M.R.A.CP. Read at the Inaugural Meeting of the B. C Society of Internal Medicine, February, 1948. It is customary in Medicine to attach to a disease the name of the original discoverer. This practice continues despite objections on the grounds of its being unscientific and at times confusing. Such is the case in the subject under discussion. In 1895 Landry1 first described a condition characterized by flaccid paralysis, with loss of deep reflexes but with no sensory or sphincter disturbances, commencing in the periphery of the lower limbs and spreading to the arms, trunk, respiratory muscles and head and terminating in death from respiratory failure. No abnormality in the central nervous system was discovered at post mortem examination by the methods available at that time. He called it "Acute Ascending Paralysis" and cases of this type have come to be known as Landry's Paralysis. In 1892 Osier2 described a somewhat similar kind of paralysis under the heading of "Acute Febrile Polyneuritis" which, according to him, was difficult to differentiate from Landry's. During and after the 1914-18 war a group of cases of generalized palsy was recognized in Europe by various observers. Guillain, Barre and Strohl3 (1916) reported a symptom complex of which the chief features were, 1. Motor weakness, 2. Slight sensory disturbances, 3. Loss of tendon jerks, 4. Retention of cutaneous reflexes, 5. Increased protein in the cerebrospinal fluid without a corresponding increase in cells. 6. A good prognosis with complete recovery. In 1919 Bradford, Bashford and Wilson4 reported a series of thirty cases of "Acute Infective Polyneuritis" occurring in the troops in France and Flanders. The characteristics were, 1. An initial febrile illness, 2. Motor paralysis of sudden onset and of widespread distribution. 3. Facial paralysis in most cases. 4. Somatic pain and peripheral paresthesia and anaesthesia. 5. Temperature, not usually exceeding 100° F. 6. A high mortality rate (26.6%). They commented on the sudden mode of onset in a number of the patients causing a man to fall down on parade or even on the march. In more than one case death occurred in twenty-four or forty-eight hours. The palsy was practically always progressive and at times conformed to the ascending type. It did not pick out muscle groups, hence the limbs and trunk were affected as a whole. The onset of facial palsy was often distinctly later than that of the limbs and trunk. Viets5 (1927) outlined a similar syndrome under the heading of "Acute Polyneuritis with Facial Diplegia." Forster and others6 (1941 gave a full account of a condition designated "Polyneuritis with Facial Diplegia" occurring in a series of twenty-six patients. In twenty-two cases cranial nerve palsies were present, including facial paralysis. The paralysis was widespread and flaccid with loss of tendon jerks. Hypoaesthesia was present in seven patients. Thirteen needed the use of a respirator. The spinal fluid contained more than 45 mgm. per cent of protein in seventeen cases and the cell count was less than 5 per c.m.m. in fourteen cases. Eleven of the patients (42 per cent) died. Three of the survivors were left with residual symptoms. Sands7 (1931) published a series of four cases under the heading of "Acute Benign Infectious Myelitis." He called attention to Strauss and Rabiner's cases of "Myeloradiculitis" which presented an acute involvement of the posterior nerve roots and the Page 352 spinal cord, manifested by radicular symptoms, paresis of the extremities to fully developed paraplegia, with rapid improvement and complete recovery in an incredibly short time. He also quoted reports of cases of German, French and American workers in which the cord, roots and peripheral nerves were involved and which were regarded by the authors as polyneuritic or myeloradiculoneuritic types of epidemic encephalitis, His own cases were characterized by, 1. A preceding upper respiratory tract infection. 2. Paralysis of legs and back. 3. Loss of deep tendon reflexes. 4. Loss of abdominal reflexes. 5. Retention of urine. 6. Segmental sensory disorders with a band of hyper-assthesia at the thoracic level and hypoaesthesia below that level. 7. Some return of knee and ankle jerks and the occurrence of Babinski's sign later. 8. Raised spinal fluid protein in all four cases but no increase of cells in two. In the remaining two it contained 7 and 110 lymphocytes per c.m.m. respectively. 9. Rapid and complete recovery. A study of the literature makes it apparent that diseases with many similar features have been described under divers names besides those mentioned, viz,., "Infective Neuronitis," "Polyneuronitis," "Motoneuritis," "Polyradiculomyelitis," etc. Although the manifestations are somewhat protean in all these reports a syndrome can be recognized, of widespread flaccid paralysis, with constant but must less prominent sensory changes, with increased spinal fluid protein and normal cells and with complete recovery in the majority of cases. Collier8 believed that the separation of Landry's paralysis and polyneuritis is artificial and that Landry's paralysis is polyneuritis with spinal cord involvement. In fact, he9 considered that Landry's paralysis is one of the most characteristic of all forms of polyneuritis, a destruction of function, rapidly advancing and when not fatal, rapidly and completely recovering, and that every grade of transitional form between the rapidly spreading Landry's paralysis and the slowly advancing types of peripheral neuritis may be encountered. The Guillain Barre syndrome has recently become popular. It appears to be, however, simply one type of polyneuritis. These authors stressed the albumino-cytologic dissociation in the spinal fluid and the uniformly favourable prognosis. Guillain10 (1936) refused to include any case not presenting these features and stated that he and his co-workers had not seen facial palsy with his syndrome and that he had not heard of a single death among patients of his group. He further postulated that the protein content of the spinal fluid in a declared case was one to two grammes per cent and that cases with 300 to 400 mgm. per cent were either abortive or not part of his syndrome. A year later, according to Lewey11, as chairman of a symposium on "Radiculoneuritis" in Brussels, he was compelled to synthesize the result of the discussion and on this occasion withdrew all his previous specifications. He still claimed, however, that epidemics with high mortality could not yet be included in his syndrome until more was known of their aetiology. It would seem therefore that as yet this group of diseases is poorly defined, and that the use of medical eponyms were best avoided in this connection. A conception of the conditions as a whole may be more useful than an attempt to classify them on the basis of the various clinical forms presented. AETIOLOGY Although this form of neuritis is freely qualified by the adjectives "infective" and "infectious," direct evidence of an infective agent is completely lacking. Bashford4 (1919) claimed to have transferred the disease by subdural inoculation of human cord emulsion from man to monkey and from monkey to monkey. These results have not been confirmed by other workers. Sabin and Aring12 inoculated mice, guinea pigs, Page 353 rabbits and rhesus monkeys with a pool of the lungs, liver, spleen, adrenals, kidneys and spinal cord and medulla of one of the cases, with negative results. Nevertheless numerous authors 7, 13, 14, while noting the lack of bacteriologies™ evidence, consider that the disease is an acute infection. The suggestion that it is due to a virus is based on the acute changes, the clinical picture, the epidemiology, its prevalence during the encephalitis epidemic and the prodromal upper respiratory tract infection. PATHOLOGY Pathological reports are few. Those available describe a neuropathy rather than a neuritis as degenerative changes are prominent while inflammatory changes are few or absent. Roseman and Arin15 examined material from three fatal cases. In general they found changes in the central and peripheral nervous tissue. The central changes were shrinkage, vacuolization, chromatolysis and nuclear abnormalities in the nerve cells of the cord, brain stem, cerebrum and cerebellum. Wavy and irregular axones and dendrites of the neurones were observed in the cord and brain stem. Anterior horn cells Were decreased and some were small and shrunken*. Chromatolysis was present. Vacu oles were seen in some cell bodies. The perineuronal spaces were widened. There was slight increase in glial cells and neuronophagia was only seen occasionally. In the whits matter axonal loss was noticed and the myelin sheaths were disorganized. In the peripheral nerves, incluuding the vagus, there was marked oedema ,swelling and fragmen-j tation of myelin sheaths increased neurilemma cells with numerous phagocytes, marked axonal degeneration with swelling, beading, fragmentation and congestion. There were visceral changes characterized by cellular infiltration and focal degeneration of the liver, adrenals and heart. Gilpin et alii1® made pathological studies of three cases and reported degeneratiyaj changes in the peripheral nerves very unevenly distributed and signified by oedema, degeneration of myelin sheaths, beading, swelling and fragmentation of axis cylinders. The femoral, sciatic, intercostals, facial and trigeminal nerves were among those affected. Somewhat similar changes were observed in the dorsal root ganglia. Russell and Moore17 had the singular opportunity of examining the nervous system of a man who died from intussusception nineteen months after an attack of "polyradiculoneuritis." The initial illness was typical and the spinal fluid contained 117 mgm.% of protein and 4 cells. The patient had not recovered completely but showed marked ataxia with loss of tendon reflexes and loss of vibration and position sense in all limbs. At autopsy they found nearly complete loss of myelin in the posterior columns at all levels of the cord. The myelinated fibres of the posterior roots were reduced in some cases and in the peripheral nerves a reduction of axis cylindrs was readily apparent. Nerve cells in the posterior root ganglia showed a moderate decrease. Hatoff18 found only hypercemia and occasional small hcemorrhages on histological examination in a case which terminated fatally but which in other respects was of the Guillain Barre type. Fitzgerald and Wood19, in a man who died after a twenty-four hours' illness with acute ascending paralysis, found only hyperemia and oedema of the brain and cord, most marked in the caudal segments of the spinal cord. Lewey11 examined material from two cases and described his findings as "a hyperacute disintegration of the myelin and axis cylinders of the nerve fibres, without any proliferation of microglial or mesodermal cell elements. There were changes in the cerebral cortex. The anterior hornx cells were decreased. The posterior roots, the splanchnic and the phrenic nerves showed degeneration with demyelination." CLINICAL FEATURES Incidence. The occurrence of "infectious polyneuritis" is not uncommon. Yet it is not well known and undoubtedly many cases are undiagnosed. At the Mayo Clinic16 only thirty-five cases were encountered in the years 1918 to 1936 while Forster et alifi (1941) collected no more than twenty-six cases at the Boston City Hospital in the Page 354 preceding ten years. This is rather surprising in view of the fact that a single observer is able to select five cases seen in the course of three years. Susman and Maddox20 who saw seven cases within a few months made similar observations as to its probable frequency. Mode of Onset. In many cases there is a history of a preceding illness such as sore throat or coryza with general aches and pains occurring a few days to two or three weeks before the appearance of nervous signs. Such an illness was present in forty-nine of the one hundred and twenty-two cases reviewed in the literature by Fox and O'Connor21. The. onset of the disease is acute. The most common initial symptoms are pain and/or paraesthesia. They may be felt in the neck, back, extremities and even the tongue10 but are usually located in the distal parts of the extremities and the lower part of the body. The pain may be very severe and simulate lumbago or acute rheumatism. Motor symptoms soon follow, although in some cases paresis suddenly brings the patient to the ground without any forewarning. On the contrary weakness may develop more insidiously, first in the legs and gradually progressing to reach the arms, neck and head over a period of some days. In the initial stages this combination of paraesthesia and weakness may suggest a functional condition. Clinical Findings. Flaccid paralysis is the outstanding feature of the disease. The lower extremities usually being the first affected, the patient has difficulty in walking. Next he is unable to sit up or to turn in bed. The back and arm muscles may become involved progressively. The extent and degree of the paralysis is variable. In the more severe forms there is total quadriplegia with respiratory paralysis. The cranial nerves are often involved, (the 7th, 10th, 9th, 5th, 11th and 12th in that order)6 and the distribution is characteristically bilateral. Involvement of the 7th nerve gives rise to the term "Facial diplegia," a condition occurring in as many as 85 per cent of cases in one series16. It is of the nuclear or infranuclear type. Dysphagia and dysphonia may als obe found. Choked discs have been reported in three cases16, optic neuritis in two others15 and paralysis of accommodation in four15. The tendon reflexes are absent in the affected extremities. Abdominal reflexes are very frequently absent although the preservation of cutaneous reflexes was on of the cardinal findings of Guillain, Barre and Strohl3. The Babinski reflex is present in a small percentage of cases, where cord involvement is more prominent7 and here a combination of absent knee or ankle jerks and extensor plantar reflexes has been reported. Muscle wasting is minimal, in contrast to poliomyelitis, for the possible reason that the motor neurones are not irrecoverably degenerated. Sensory disturbances are mild and apart from subjective paraesthesia and pain consist of hypoaesthesia of variable distribution, for instance, of the upper or lower extremities or the face. Loss of joint and vibration sense is not uncommon. The sphincters are rarely involved. Fever is mild if present. Some authors consider the absence of pyrexia to be typical. Names such as "acute febrile polyneuritis" suggest that it does occur, however, and the presence of a rise in temperature to about 100° is by no means unusual during the first few days. The cerebrospinal fluid characteristics are second in importance only to the motor effects and great significance is attached to an increase in protein content without increase in cells, the "albuminocytologic dissociation" of Guillain and Barre. This dissociation is the rule and some workers regard it as a prerequisite for the diagnosis. Published data, however, indicate that it is not invariable. In Forster and co-workers'6 twenty-six cases the protein was less than 45 mg. per 100 c.c. in seven cases. There are also typical cases in which the cell count is above normal. Gilpin et alii1® in twenty- five cases of polyneuritis found the protein to range from 100 to 800 mg. but the cells varied from 1 to 80, being more than twenty-four in three cases and averaging 12 per c.m.m. in the whole series. Other isolated cases occur in the literature in which the protein and cells are elevated22. The protein content tends to increase during the Page 355 ;.:*? -P-M progress of the disease. Stone and Aldrich23 first demonstrated this in two cases in which the protein increased from 10 to 375 mgms. in 7 days and from 67 to 375 mgms. in 10 days respectively after the onset of the paralysis. Examination of the blood gives normal results in most cases. Leucocytosis is encountered rarely. The Clinical Course. During the first few days the paralysis may spread. Thereafter a stationary period ensues. If the patient survives this, signs of recovery begin to appear during the second and third week. It is slowly progressive and usually complete. The last signs of paralysis to appear are usually the first to abate. The period of disability is variable from a few weeks to several months. In the average case the use of the legs in walking is regained in four to eight weeks. Occasionally patients who recover may have some permanent residual weakness. Persistence of negative tendom reflexes, loss of vibration and deep sense, ataxia and Rhombergism (pseudotabes) was observed by Russell and Moore17. Although there is a remarkable tendency towards complete recovery, in a variable number of cases the course of the disease does not lead to recovery and death may take place quite early in the acute phase or even after a protracted period of several weeks. In the various series of published case reports the mortality rate ranges from nil to forty- two per cent. In Susman and Maddox's series of seven cases of Guillain Barre syndrome one patient died 14%). Differential Diagnosis. In the early stages more than one patient has been thought to be suffering from hysteria and treated accordingly. Acute anterior poliomyelitis is to be excluded. In this condition the paralysis is not bilaterally symmetrical as it is in so-called virus poliomyelitis. Fever, neck rigidity and leucocytosis are much more in evidence. The sphincters are more likely to be disturbed. The presence of an epidemic is of great importance. In most cases spinal fluid examination is confirmatory if carried out in the early stages. A consideration of the cell count together with the protein content is of great value. Meritt and Fremont-Smith found a cell count of less than ten per c.m.m. in only two per cent of cases of poliomyelitis during the first week. An analysis of cases during a recent epidemic showed that during the first week the fluid in five cases out of thirty-eight (13%) contained less than ten cells. But the protein content also in these five cases was low, (12 to 25 mg.). In the later stages of poliomyelitis the protein is higher, the cells are reduced and the test is of less value. Diphtheritic polyneuritis is to be distinguished by the history and by cultures of the throat- swabbings. The onset of paralysis is usually less dramatic. Polyneuritis associated with arenic, lead and syphilis can be excluded by appropriate means. CASE REPORTS The following case histories of patients admitted to hospital have been selected as representative of the different clinical variations of this form of neuritis. Case I. A. W., female, aet forty-seven, was admitted on August 28th, 1942. Three weeks previously she had developed a sore throat and cough wwhih was present for two weeks. Two days before entry, while trying to board a tram, she stumbled and fell to her knees. She got home with diffisulty. On the next day her legs were so weak that she could not walk at all. Her hands "began to tingle" and to lose their power. She complained of pain in the back on movement and a suffocating feeling when lying down. On examination there was no loss of sensation. The abdominal reflexes were present. Power was diminished in the arms and absent in the legs. Knee and ankle jerks were absent. The temperature did not exceed 99 °F. The protein content of the cerebrospinal fluid was 40 mgm.% on the sixth day of the illness, rose to 100 mgm.% on the twelfth and receded to 70 mgm.% on the twenty-second day. There was no increase in leucocytes. Severe burning pain developed in the legs one week after entry and persisted for a few days. Power returned to the arms and by September 24th, 1942, she could raise both legs. She was discharged on October 28th, 1942, the sixty-first Page 3 56 hospital day, with slight residual weakness of the lower extremities, but with brisk reflexes. Full motor power ultimately returned. This is a typical case of "Guillain Barre Syndrome" with a dramatic onset and with albuminocytologic dissociation in which the hyperalbuminosis was not at first present. There was a preceding respiratory tract infection. Case II. E. K., female, aet fifty-four, was admitted on October 30th, 1944, with a history of: 1. Aching across the shoulders and inability to move them for nine days. 2. Increasing numbness and weakness of the legs, hands and forearms for six days. 3. Restlessness and insomnia due to pain for four days. 4. Difficulty in speaking, swallowing and closing the left eye for one day. On the second day she had had nausea, vomiting and diarrhoea. On examination left facial paralysis of infranuclear type was present. All the extremities were almost completely paralyzed and she could barely move her hands. The tendon and abdominal reflexes were absent. Superficial sensation was impaired in the hands, forearms, face, feet and shins. The temperature was normal. The spinal fluid contained 270 mgm.% protein; .there was no increase in cells. The next day the facial paralysis became bilateral. She still complained of dysphagia. From 6th November, 1944, motor improvement was observed in the face, arms and legs in that order. The spinal fluid protein was 250 mgms.%. Recovery was gradual. She was able to walk by January 15th, 1945. On January 27th, 1945, the cerebrospinal fluid protein was 40 mgm.%. There was some residual weakness of arms and legs and the tendon jerks were still absent. She was discharged on the ninetieth hospital day. A follow-up was unsuccessful. This case demonstrates (1) the cerebral diplegia type of Bradford, Forster and others, and (2) an extension of paralysis while under observation. Case III. D. M., a female, aet fifty-one, was admitted on January 18th, 1944, witfy. a history of sudden onset of numbness in the fingers and toes three months previously. She also had had weakness of the hands and difficulty in walking. After four or five days she had gone to bed where she remained for six weeks, getting up only for defaecation. The feeling had returned to her fingers and feet but they were still weak. At the time of admission, physical examination revealed paresis of the hands, arms and legs. The tendon reflexes were depressed in the arms and legs and the ankle jerks were absent. The palntars were flexor. Sensation was not impaired. The cerebrospinal fluid contained 110 mgm.% protein. All other laboratory tests were negative. During a month's stay in hospital she improved considerably but recovery was incomplete. Ten months later, December, 1944, her legs felt strong but her ankles would "go" on unlevel ground and she often fell. Her hands were still "a bit weak" and she could not straighten her fourth and fifth fingers. Examination showed that she had wasting of the interossei of the fourth and fifth digits and of the hypothenar region bilaterally. The Guillain Barre syndrome, according to the original definition, would not be ar^ appropriate diagnosis in this case because of the residual neuromuscular defect. Case IV. E. W., a male munition worker, aet sixty, was admitted on August 12th, 1944. He had been arrested for drunkenness on the previous night and in the morning it was noticed that he could not move his arms or legs. He had no recollection of being "picked up." On examination he was rational. The temperature was normal. Nystagmus was present. The other cranial nerves were intact. Quadriplegia was present but slight power remained in the left leg. All deep reflexes were absent except the left knee jerk which was weak. Abdominal reflexes were present. The leg muscles were tender. The plantar reflexes were flexor. Sensation was impaired in the legs and pinprick could not be distinguished. He had retention of urine and severe constipation. Blood and spinal fluid W. R. and colloidal gold tests were negative. The spinal fluid contained no cells, 80 mgm.% protein and the Queckenstedt was normal. On August 16th, 1944, the right triceps and ankle jerks reappeared weakly. On August 21st, 1944, slight arm and leg movements and positive knee jerks were noted. A positive Page 357 • ■; M bilateral Babinski sign had developed and this was confirmed on repeated occasions. Muscle power returned very slowly but sphincter trouble persisted. On September 19th, the leg reflexes were brisker and the plantars were flexor once more. He could not yet sit up. On October 3rd, 52 days after admission, he walked with assistance but was weak and ataxic. On November 6th, 1944, he walked feebly but without help. Sphincter control had recovered. ,The spinal fluid protein was 25 mgm.%. He was discharged on December 9th, 1944. Motor power was still improving slowly. This was an intermediate type of case with the features of neuromyelitis affecting both lower and upper motor neurones. Case V. W. F., male, aet thirty-three, was admitted to hospital on May 24th, 1945. Six days previously, on May 18 th, he developed "influenza" and went to bed. He had a cough with sputum. Anorexia was present and on taking any food he vomited. After two days he noticed numbness in his legs which gradually extended upwards and reached the mid-thoracic level after four days. At the same time he had urinary incontinence followed by retention which necessitated catheterization. On the day of admission his vision became blurred and for two days he had double vision. He had intermittent asynchronous drooping of the eyelids. On examination it was noted that at intervals of a few minutes one or the other eyelid would drop for a few seconds. This was apparently involuntary. The tongue was furred. There were rhonci and moist rales audible over both lungs. The tendon reflexes were present in the arms and legs. The plantar reflexes were extensor. The lower abdominal muscles and legs were paretic with some spasticity. There was complete anaesthesia to pain, temperature and deep sense up to the level of the nipples. X-rays of the chest and spine were normal. Th spinal fluid pressure was 150 m.m. water and the Queckenstedt test was normal. The fluid contained 25 mgm.% of protein, 120 red cells and 2 white cells per c.m.m. Culture was sterile. The blood and spinal fluid W. R. was negative. On the next day, May 25th, 1945, some weakness was complained of in the arms. He was unable to move his legs or feet. Headache was present and vision was very .blurred. The following day he felt pain in the back and down the legs. On the seventh hospital day slight return of sensation and some movement was noted in the legs. He could pass his urine but heavy pyuria was present. Munro's tidal drainage was instituted. Motor power and sensation gradually improved so that four weeks after admission he had good power in the legs, no impairment of touch and only slight impairment of pain and temperature over the lower half of the left leg. The left plantar reflex was extensor, the right equivocal. The tendon reflexes were increased. The spinal fluid contained 30 mgm.% of protein and 20 lymphocytes per c.m.m. After two months' hospitalization full motor power had returned and he could walk normally. Residual urinary infection was his only disability. This case presents the features of an acute transverse myelitis with rapid onset and rapid and complete recovery. It closely simulates the cases of acute benign myelitis^ reported by Sands and by Strauss and Rabiner. There may be some doubt as to whether it can justifiably be classified in the same group as the previous cases. One of the chief objections that may be raised is the normal spinal fluid protein values and the increased cell content on one occasion. As increased protein is not an invariable finding in the type of polyneuritis hnder discussion this point might be over-ruled. The initial respiratory infection, the subjective sensory symptoms and the favourable outcome would seem to link it with the previous case. Whereas in Case IV the brunt of the attack had fallen in a widespread fashion on the peripheral neurones and to a lesser extent on the upper motor neurone, in this case the cord had been affected transversely at the midthoracic level. This focal distribution alone may suffice to separate it entirely from the previous cases, at least from the clinical viewpoint. Nevertheless, the possibility of an aetiological relationship must be considered and the case will serve to draw attention to a type of acute myelitis with rapid recovery. Page 358 DISCUSSION The foregoing cases illustrate a group of diseases with a fundamental similarity but in which all gradations from peripheral neuritis to transverse myelitis appear. The pathological evidence available indicates that at least in some cases there is a degenerative neuropathy which affects the peripheral nerves, the roots, nerve cells, cord and even the brain. If the weight of the attack falls on the anterior horn cells and peripheral nerves a picture of polyneuritis results. On the contrary if there is acute demyelina- tion of the tracts in the cord an upper motor neurone lesion is produced. Such a hypothesis would explain the protean manifestations of this group and would assist in the recognition of its various forms. Whether this neuropathy is of infective origin, as from a virus, or is a toxic degeneration is not yet known. The negative results of Sabin and Aring's inoculation experiments are against infection. However, further animal experiments and histopathological observations may shed light on this aetiological problem. Certain characteristics stand out, such as acute onset, flaccid paralysis in most cases, tendency to spread, subjective sensory disturbances, spinal fluid albumin—cell dissociation and a striking tendency to complete recovery. Nevertheless, a case should not necessarily be excluded from this group on the grounds of fever, leucocytosis, normal spinal fluid protein, motor sequelae or death. The multiplicity of headings under which this disease has been described signifies that none is entirely satisfactory. Acute polyneuritis, acute neuromyelitis and acute benign myelitis would be descriptive terms. Guillain Barre syndrome, on account of its popularity, might be a better name so long as it is not interpreted in its original strict definition. SUMMARY 1. Landry's Paralysis, Osier's "Acute Febrile Polyneuritis" and other paralytic syndromes described during and since the first World War by many authors, including Guillain, Barre and Strohl, are indistinguishable. 2. The available morbid anatomical studies show widespread degenerative changes in the brain, cord and nerves. 3. A number of typical cases have progressed to a fatal outcome. 4. The causative agent is quite obscure. 5. Cases are recorded which are characterized by acute paralysis of lower and upper motor neurone type (chiefly the former) with recovery. 6. It may be advantageous for the present to recognize these conditions as a group from the aetiological and clinical standpoint rather than attempt to subdivide them. REFERENCES 1. Landry, Octave: Note sure la paralysis ascend ante aigue, Gaz. Lebd. de Med. 6: 472 (July 9), 486 (Aug. 5) 1859. 2. Osier, "William: The Principles and Practice of Medicine, New York, D. Appleton & Co., 1892, p. 836. 3. Guillain, G.; Barre, J. A.; and Strohl, A.; Sur un sundrome de radiculo-neorite avec hyperalbum- L inose du liquide cephalo-rachidien sans reaction cellulaire. Bull, et mem. Soc. Med. d. Hop. de Paris. 40: 1462 (Oct. 13) 1916. 4. Bradford, J. R.; Bashford, E. F., and Wilson, J. A.: Acute Infective Polyneuritis. Quarterly Journal of Medicine. 12 No. 45 & 46. p. 88. January, 1919. 5. Viets, H. R.: Acute Polyneuritis with Facial Diplegia. Arch. Neurol. & Psychiat. 17: 794-803, 1927. 6. Forster, F. M.; Brown, Madelaine, and Merritt, H. H.: Polyneuritis with Facial Diplegia. New England Journal of Medcine. 225, p. 51. July 10th, 1941. 7. Sands, I. J.: Acute Benign Infectious Myelitis. Journal of American Medical Assocation. 96, No. 1. p. 23, January 3, 1931. 8. Collier, James: Landry's Paralysis, In Christian, H. A.: Oxford Medicine, New York, Oxford University Press, 1936, Vol. 6, pt. 1, p. 419. 9. Collier, James: Quoted by De Jong, R. N.: Acute Ascending Paralysis. The ournal of the American Medical Association, 115, 23. p. 1951. December 7th, 1940. 10. Guillain, G.: Archives of Neurology and Psychiatry, 36: 975, 1936. Page 359 w »m ».: -'V '■•Wk m ■-«{•£• 1 ft'P: 1 •II i*M! M m 1 :i-f 1 • $m> "1 •«& 1 M ;<-»..i Lewey, F. H.: What is the Guillain-Barre Syndrome? The Journal of Paediatrics. 26. p. 165. February, 1945. Sabin, A. B., and Aring, C. D.: Visceral Lesions in Infectious Polyneuritis. The American Journal of Pathology XVII, No. 4. p. 469, uly, 1941. Garvey, P. H.; Jones, N., and Warren, S. L.: Polyradiculoneuritis. (Guillain Barre Syndrome). The Journal of the American Medcal Association. 115. No. 23, p. 1955, Dec. 7th, 1940. Cobb, S., and Coggeshall, H. C: Neuritis. The ournal of the American Medical Association. 103, No. 21, p. 1608, November 24th, 1934. Roseman, E.," and Aring, C. D.: Infectious Polyneuritis. Medicine. 20, 463, 1941. Gilpin, S. F.; Moersch, F. P., and Kernohan, J. W.: Ployneuritis. Archives of Neurology and Phy- chiatry. 35. No. 5. p. 937, May, 1936. Russell, W. O., and Moore, W. L.: Permanent Damage to the Nervous System Following an Attack of Polyradiculoneuritis. Archives of Neurology and Psychiatry. 49, p. 895, June, 1943. Hatoff, A.: Polyneuritis of Unknown Etiology in Childhood. The Journal of Paediatrics. 24, p. 393, April, 1944. Fitzgerald, P. J., and Wood, H.: Acute Ascending Paralysis. United States Naval Medical Bulletin. 43. No. ' p. 4. July, 1944. Susman, E., and Maddox, K.: The Medical Journal of Australia. 1. No. 5. p. 158, February 3rd, 1940. Fox, M. J., and O'Connor, R. D.: Infectious Neuronitis. Archives of Internal Medcine. 69, 58. January, 1941. Bassoe, P.: Guillain Barre Syndrome and Related Conditions. Archives of Pathology. 26. 289. July, 1938. ~Stone, T. T., and Aldrich, K.: Acute Polyradiculoneuritis. The Journal of the American Medical^ Association. 114, No. 22. p. 2196. June 1st, 1940. REFRESHER COURSE IN PAEDIATRICS FOR THE GENERAL PRACTITIONER ^ # September 23, 1948, to September 28, 1948, Inclusive Every medical man in British Columbia will have received a copy of the programme of this course. It is an extremely attractive programme, and the list o fspeakers guarantees that every meeting will be well worth attending. The price for the course, Five Dollars, is purely nominal—and will barely cover expenses. This Refresher Course should attract a large number of general practitioners.—Ed. SCHEDULE THURSDAY, SEPTEMBER 23 9-10 a.m. Registration and Welcome—Dr. Lyall Hodgins, Chief of Staff, Vancouver General Hospital. (Introduced by Dr. J. R. Davies) Chairman—Dr. J. R. Neilson 10-11 a.m. Subdural Haematoma—Dr. Frank Turnbull 11-12 a.m. Gait and Posture in Children—Dr. F. P. Patterson 12-2 p.m. Lunch and Film Chairman—Dr. Donald Paterson 2-3 p.m. Round Table Conference on Asthma by the Staff of the Health Centre for Children 3-4 p.m. Pitfalls in Childhood Radiology—Dr. Bede Harrison FRIDAY, SEPTEMBER 24 9-10 a.m. Paediatric Clinic—Vancouver General Hospital Chairman—Dr. Howard Spohn 10-11 a.m. The Backward Child—Dr. Harry Baker 11-12 a.m. Management of the Premature Infant—Dr. A. F. Hardyment 12-2 p.m. Lunch and Film Chairman—Dr. H. K. Fidler Page 360 2-4 p.m. Symposium on Clinical-Pathological Procedures in Children—Dr. J. E. Hill (Haematology), Dr. John Eden (Biochemistry), Dr. W. H. Cockcroft (Bacteriology). SATURDAY, SEPTEMBER 25 9-10 a.m. Neurology and Neurosurgical Clinic—Vancouver General Hospital Chairman—Dr. G. O. Matthews 10-11 a.m. Heart Murmurs in Childhood—Dr. Reginald Wilson 11-12 a.m. Jaundice in Childhood—Dr. Harold Stockton 12-2 p.m. Lunch and Film Chairman—Dr. Donald Paterson 2-4 p.m. Symposium on Feeding in Infancy—Dr. A. F. Hardyment (Breast Feeding), Dr. G. O. Matthews (Artificial Feeding), Dr. R. P. Kinsman (Indigestion) 9- -10 a. m. lO- -11 a. m. ll- -12 a. m. 12- -1 P ,m. 1- -2 P ,m. 2- -3 P- m. 3- -4 P .m. MONDAY, SEPTEMBER 27 Chairman—Dr. J. R. Davies Demonstration of Interesting Paediatric Cases Problem of Cough in Childhood—Dr. J. R. Davies Common Skin Diseases of Childhood—Dr. D. H. Williams Surgery Clinic, Vancouver General Hospital Lunch Chairman—Dr. J. H. B. Grant Tuberculosis in Childhood—Dr. E. Stewart James Anaesthesia in Childhood—Dr. Digby Leigh TUESDAY, SEPTEMBER 28 Chairman—Dr. S. Stewart Murray Behaviour Problems—Dr. H. Gundry Contagious Diseases—Dr. S. Stewart Murray Poliomyelitis—Dr. J. H. B. Grant Lunch and Film Chairman—Dr. George Lamont Demonstration of Intravenous Alimentation and Common Paediatric Techniques—Dr. John Piters with the assistance of Dr. Charles Treffry TUITION: A registration fee of $5.00 will be charged. Sandwich lunch will be provided at a nominal cost. All hospital internes are welcome without fee. §9-10 a.m. 10-11 a.m. 11-12 a.m. 12-2 p.m. 2-4 p.m. I: • !»•! ?§f SPEAKERS John R. Davies, Chief of Paediatrics, Vancouver General Hospital; Harry Baker, W. H. Cockcroft, John Eden, J. H. B. Grant, H. Gundry, A. F. Hardyment, Bede Harrison, H. E. Hill, E. Stewart James, S. Stewart Murray, R. P. Kinsman, Digby Leigh, G. O. Matthews, Donald Paterson, F. P. Patterson, John Piters, Harold Stockton, Charles Treflfry, Frank A. Turnbull, Donald H. Williams, Reginald Wilson. REGISTRATION and enquiries should be addressed to: Dr. Reginald Wilson, Chairman, Refresher Course Committee, Health Centre for Children, 10th and Laurel, Vancouver, B.C.. Page 361 DR. H. F. TYERMAN Obiit August 18, 1948 The death of Dr. H. F. Tyerman of Ashcrof t leaves a big gap in the medical profession of British Columbia. In the words of Dr. R. W. Irving of Kamloops, "He had an awful lot of friends in this country." That is a notable epitaph—and was richly earned by Dr. Tyerman, who practised medicine for forty-one years and more—and much of the time against heavy odds of sickness and personal hardship. "For the past year he has been in bad health and has had to bear with a lot of suffering," to quote Dr. Irving again. He was 65 years old, born and raised on a farm in Ontario—a graduate of Toronto University (1906). He practised in Kindersley, Saskatchewan, and in those days of the horse and buggy, country practice demanded endurance and courage. Dr. Tyerman had both these in ample measure—but gradually the blizzards and rugged weather wore him out—and a chest condition he had developed drove him to British Columbia where he practised at Nakusp on Kootenay Lake, one of the beauty spots of the province. Here he established a splendid reputation as a general practitioner and surgeon. In 1942 he went to Ashcroft, where he remained till his last illness overtook him. Men like Tyerman are not so common, though he probably would never have claimed any special credit. Friendly, capable and devoted to his work, he was one of our best. He leaves his wife, a son, Don Tyerman, well known in the advertising world, to mourn his loss. ARTHUR P. PROCTER, M.D. June 9th, 1948 The tragic death by drowning of Dr. Arthur Procter was reported in the Vancouver press at that time as an accident due to flood conditions. There is a story behind this bald reporting that deserves to be told. It reveals Procter as a very gallant Doctor of Medicine, who died doing his duty, and in an attempt to succour an injured man who needed help. He was practising at Lillooet at the time. A message came to the hospital that a man on the other side of Cayoosh Creek, then swollen by floods, had been injured and needed help. Procter undertook to go, against the advice and urgent appeals of those at the hospital. He set out alone at night, intending to cross by the stepping stones which usually afforded passage of the creek. He never returned. Procter was a badly crippled man. He had lost his right eye, had a limp, and had had many wounds in his arms, chest, head and elsewhere. These were all suffered during this war, and his military record is an amazing one. At the outset of the War he was practising in Vancouver. He crossed the Atlantic from Halifax in 1941, as a stoker in a munitions ship. In England he began his war service as a medical officer in the Forest Gate Hospital in London—but left this in March to enlist as a private soldier in a Commando. Later he was drafted to the Gordon Highlanders. This is one of the crack regiments of Britain, and Procter's record while in it was a magnificent one. In Sicily, he won the M.M. as the result of an exploit in which he was the direct means of taking 180 German prisoners—General Montgomery pinned on the M.M. ribbon in front of the whole regiment. He was made a specialist for scouting and intelligence work, single-handed destroyed an enemy machine-gun post 300 yards inside the enemy lines and was twice wounded. Later in Italy and at the Anzio Beachhead he received other citations. He was wounded at Anzio, and following this was very ill in hospital. Later he returned to Italy, where he was "very badly" wounded, losing his right eye and suffering other very severe injuries. This was the end of his military services, and he returned to Canada—where he spent much time in military hospitals as a patient. On recovery he went to Lillooet. He was a fearless and enterprising soldier, and he played a gallant part to the end. His death became him well. COURSE OF LECTURES AT SHAUGHNESSY HOSPITAL October 6, 1948 — May 10, 1949 We gladly publish the Announcement and Programme of the Shaughnessy Hospital Fall, Winter and Spring Course of Lectures. The announcement should be carefully read. This is a noteworthy contribution by the Shaughnessy Medical and Surgical Staff, and we are sure it will be very greatly appreciated by the medical profession. The reader will be well advised to keep this copy of the Bulletin by him for constant reference.—Ed. To the Medical Profession in Lower British Columbia Mainland Post-graduate lectures in Medicine and Surgery are given during the year at Shaughnessy Hospital. These are given on Wednesday evenings in the Auditorium, beginning October 6, at 6:00 p.m. The timetable for the year is shown below. Medical lectures will be given on the first half of the series and surgical elctures on the last half; some medical and surgical symposia are included. Emphasis is given to recent advances and clinical applications in the subjects presented, and as far as possible, material is illustrated with slides and X-rays. Any medical practitioner in good standing with the British Columbia Medical Association is privileged to attend any or all of these lectures. Please note that these lectures are distinct from the two-week course in March, 1949, to be anounced separately. W. R. L. GUNN, M.D., Superintendent, Shaughnessy Hospital. i V «;" 6 October, '48 6 p. m. 13 October, '48 6 p.m.— 7 p.m. 20 October, '48 6 p.m. 7 p.m. 27 October, '48 6 p.m. 3 November, '48 6 p.m. 7 p.m.— 10 November, '48 6 p.m. 7 p.m. 17 November, '48 6 p.m. A. MEDICINE Discussion of Biliary Tract and Pancreas; Jaudice: Medical aspects Dr. M. M. Baird Surgical aspects Dr. R. Wilson The Dynamic Function of Vitamins in Theory and Practice : Dr. D. M. Whitelaw Aspiration Techniques in the Diagnosis of Cancer Dr. M. V. Rae Disturbances in Calcium and Phosphorus Metabolism _. Dr. J. Parnell Clinical Approach to Lower Motor Neuron Lesions— Dr. C. E. G. Gould Diseases of the Tyroid Gland: Medical aspects Dr. W. W. Simpson Surgical aspects . Dr. T. H. Lennie The Significance of a Pain in the Chest; Differential Diagnoses i Dr. R. A. Palmer Clinical Approach to Diseases of the Spinal Cord i Dr. J. C. Thomas Physical Signs in the Extremities Dr. A. W. Bagnall Psychiatric and Medical Problems of Cerebrology Dr. C. H. Gundry Suppurative Diseases in the Chest: Medical aspects Dr. P. W. Morse Surgical aspects Dr. Ross Robertson Page 363 r* 24 November, '48 6 p.m. 7 p.m. 1 December, '48 6 p.m.— 7 p.m. 8 December, '48 6 p.m. 15 December, '48 6 p.m. 7 p.m. 5 January, '49 6 p.m. 7 p.m. 12 January, '49 6 p.m. 19 January, '49 6 p.m.— 7 p.m. Clinical Evaluation of Splenomegaly Dr. J. E. Walker Recognition and Treatment of Neurodermatitis Dr. D. H. Williams ommon and Uncommon Causes of Lymphadenopathy____ Dr. H. E. Taylor Recent Advances in Virus Diseases Dr. C. E. Dolman Clinical Problems in Cancer of the G.I. Tract: Medical aspects Dr. E. Christopherson Surgical aspects JDr. J. W. Wilson Radiological problems Dr. A. Turnbull Under-nutrition and Over-nutrition Dr. F. L. Skinner Common Small Skin Tumours: Diagnosis and Treatment Dr. D. H. Williams Modern Methods in Congestive Failure—Dr. D. S. Munroe The Use of Drugs in Heart Disease Dr. G. F. Strong Painful Back: Medical aspects 1 Dr. A. W. Bagnall Orthopaedic aspects Dr. F. P. Patterson Psychiatric aspects Dr. G. H. Hutton Compensation aspects Dr. M. R. Caverhill Differential Diagnoses of Dizziness and Syncope . Dr. C. E. G. Gould Diagnosis and Management of a New Case of Diabetes Dr. W. W. Simpson 26 January, '49 6 p.m. 7 p.m. 2 February, '49 6 p.m. 7 p.m. 9 February, '49 6 p.m. 16 February, '49 6 p.m.— 23 February, 2 March 23 March, 30 March, 6 April, 13 April, 7 p.m. '49 6 p.m. 7 p.m. '49 6 p.m. '49 6 p.m. 7 p.m. '49 6 p.m. 7 p.m. '49 6 p.m. '49 6 p.m. 7 p.m.— B. SURGERY Surgical Problems in the Newborn Dr. J. R. Neilson Treatment of Common Conditions Involving the Rectum and Anus .—, Dr. A. Taylor Henry The Acute Abdomen Dr. L. H. Appleby Intestinal Obstruction Dr. J. A. Ganshorn Diseases of Peripheral Circulation: Surgical aspects Dr. Gordon C. Johnston Medical aspects Dr. A. W. Bagnall Surgical Conditions of the Neck (Other Than Thyroid) . Dr. J. W. Frost Surgical Conditions of Veins Dr. L. A. H. R. Huggard Hand Infections Dr. S. T. R. Sarjeant Hernia Dr. H. L. Jackes Peptic Ulcer: Surgical aspects Dr. L. H. A. R. Huggard Medical aspects Dr. E. Christopherson Diseases of Breast Dr. H. Rocke Robertson Bronchiectasis Dr. Ross Robertson Lesions of Skin and Subcutaneous Tissues-Dr. H. E. Taylor Eye, Ear, Nose and Throat Emergencies Dr. E. A. Alexander Ulcerative Colitis and Regional Enteritis: Surgical aspects Dr. J. A. Ganshorn Medical aspects Dr. M. M. Baird Surgical Technique and Materials Dr. H. Rocke Robertson Anaesthesia in General Practice Dr. W. M. Hall Page 364 20 April, '49 6 p.m 7 p.m 27 April, '49 6 p.m 4 May '49 6 p.m 7 p.m 11 May, '49 6 p.m 7 p.m. 18 May, '49 6 p.m • 7 p.m -Head Injuries '. Dr. P. O. Lehmann -Brain Tumours Dr. Frank Turnbull -Pyelonephritis and Recent Advances in G.U. Surgery: Surgical aspects Dr. C. A. Cawker Medical aspects . Dr. R. A. Palmer -G.U. Emergencies Dr. J. A. Balfour -Management of Burns 1 Dr. R. G. Langs ton -Management of Common Fractures Dr. J. R. Naden -Principles of Fracture Treatment Dr. H. H. Boucher -Treatment of Wounds Dr. H. H. Boucher -Skin Grafting for the General Surgeon .Dr. R. G. Langston ARTHRITIS, RHEUMATISM AND THE MEDICAL PROFESSION * fv M' In recent months, the B.C. Medical Association has appointed a Special Committee on Arthritis and Rheumatism. In addition, the subject of the Open Meeting of the B.C. Medical Association Convention on 30th September, 1948, is to be arthritis. It might be justified rhetorically to ask, why all this sudden emphasis on the rheumatic diseases? The answer lies in the demands of the public on the profession. With V.D., T.B. and Cancer at least organized for control, the arthritics have found that by banding together, their voice has now become relatively loud enough to be heard. A sort of challenge is being tossed at the medical profession and the above actions recently taken by the B.C. Medical Association constitute the first steps in reply. It might be interesting to review the recent past in this regard since British Columbia is the first Province to take any action in response to this public demand. Since World. War II, at least in part because of the centres set up by the D.V.A., it became known to civilian sufferers that more could be done in the treatment of rheumatic diseases if only finances and facilities were available. The wheels of propaganda begun to turn and before long Ottawa realised that a considerable group of the voting public wanted definite measures adopted for control of arthritis. In September, 1947, a national conference was convened by the Hon. Paul Martin with representatives from all the Provinces. As a result of these deliberations, there was incorporated, with a national charter, in the Spring of 1948, the Canadian Arthritis and Rheumatism Society. In effect, its purpose is to reduce the illness and death frmo rheumatic diseases, principally by raising funds to supply the facilities needed for research and treatment. Like other matters of public health, this is really a matter for the provinces under the British North America Act, and the real work of the Society therefore depends on the formation of provincial divisions. In British Columbia, the formal indigenous arthritic population has been very considerably augmented by those migrating from other parts of Canada in earch of a more temperate climate. It was thus rather natural that the first provincial division should orginate, as it recently did, in British Columbia. While this B.C. Division is not thoroughly organized as yet, it was able to make arrangements for the Open Meeting of the B.C. Medical Association Meeting and to attract Dr. Wallace Graham of Toronto (Canadian Rheumatism Association) and Dr. W. Paul Holbrook of Tucson, Arizona (American Rheumatism Association) as guest speakers. In line with the broad-minded policy of the B.C. Medical Association, these authorities in rheumatology have also been asked to take part in the general sessions of the annual meeting. Since confusion is apt to arise in nomenclature, the position of the Canadian Rheumatism Association requires clarification. This was formed in 1936 under the aegis of the Canadian Medical Association for medical men with a special interest in the rheumatic diseases. Originally small, its numbers have grown considerably in the past two Page 365 &;p mum years. It now constitutes a sizeable professional group interested solely in the medical aspects of research and treatment of the rheumatic diseases. It has no direct relation to the lay-and-medical Canadian Arthritis and Rheumatism Society other than unanimity of purpose. Locally, the function of guiding the B.C. Division of the lay-and-medical group will be taken over by the new Committee on Arthritis and Rheumatism of the B.C. Medical Association. In this way it is planned that organized medicine will be able not Only to assist but to lead in the programme of arthritis control in this Province and throughout the Dominion. So much for the organizations concerned. While many of the practical details must be cautiously worked out in accordance with the finances made available by the fund- raising groups, the general aim is to make available to the family physician the best of facilities for the diagnosis and treatment of the rheumatic patient, no matter what his financial position may be. It will require more than a little co-operation on the part of every physician in the Province to ensure the success of this new B.C. Division of the Canadian Arthritis and Rheumatism Society. That the general public is in a most receptive mood for any programme of rheumatic control may be seen by their all-too-ready acceptance of each successive "fringe practitioner" who offers "a cure"—no matter what ridiculous price he may charge or how ludicrous his methods. If facilities similar to those now provided for the veteran were available to civilians, the medical profession would be far less likely to be held in at least slight contempt because "the doctor said he could do nothing for me." It is the purpose of the B.C. Division of the Canadian Arthritis and Rheumatism Society to press for ideal facilities for the practitioners of this Province. At first, this must be done in all too small a way and for only the most hopeful cases, but eventually implementation of the programme should exand it sufficiently so that full arthritis control will be adopted as a provincial policy, the rather tremendous costs then being shared by the whole community on the insurance principle. So fare the public has had no announcement of the aims of the B.C. Division of the Canadian Arthritis and Rheumatism Society. Few in the profession are very sure of what is going on. In line with the policy of first obtaining the co-operation of organized medicine, with this foreword, the aims of the B.C. Division will be announced to the public at the Open Meeting of the B.C. Medical Association on Thursday night, the thirtieth of September, properly under the auspices of organized medicine. The presence of a larg number of physicians at that meeting will guarantee to the public the backing of our profession in this programme and will go far towards ensuring its success. A. W. BAGNALL, M.D. This most important undertaking by the B.C. Medical Association, through its Special Committee on Arthritis and Rheumatism, deserves backing by every medical man in B.C. One has only to look at the results obtained by organised T.B. research and treatment, and at the progress being made in cancer treatment and research, to realise that this method of attacking the serious problem of Arthritis and Rheumatism is the right one. We urge our readers to give this project their utmost support. ED. Page 366
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Medicine--Periodicals
The Vancouver Medical Association Bulletin: August, 1948
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