@prefix edm: . @prefix dcterms: . @prefix dc: . @prefix skos: . edm:dataProvider "CONTENTdm"@en ; dcterms:isReferencedBy "http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1179642"@en ; dcterms:isPartOf "History of Nursing in Pacific Canada"@en ; dcterms:creator "Vancouver Medical Association"@en ; dc:date "1947-06"@en ; dcterms:issued "2015-01-30"@en, "1947-06"@en ; edm:aggregatedCHO "https://open.library.ubc.ca/collections/vma/items/1.0214583/source.json"@en ; dc:format "image/jpeg"@en ; skos:note """ The 1 . . lifflfiwKi BWTlfpBJJtt.wuBjII THEElwiAllY of the |p|L I^NCOUVER MfE iitfc AL ASSOCIATION v L*e©5 With Which Is Incorporated Transactions of the VICTORIA MEDICAL SOCIETY the VANCOUVER GENERAL HOSPITAL and ST. PAUL'S HOSPITAL In^This Issue: Page POST OFFICE REGULATIONS AND RATES-lp Applicable to Specimens mailed to the Division of Laboratories jgll ^p^^p^ -'§ll§Ipi|| 1| § ACUTOANTERIOR POLIOMELITIS By Dr. Stewarf^Murray, MJHF.O. ^^g^gj^^^^^^^pj:".?9 i THE DIRECTION IN WHICH WeJ&RE GOING By A. E, Graiier, m^^HHH^^^^Mp • 224 TETANUS—A CASE REPORT By w^yfowier, ^M jjjjjilBPlj HBHBPPH^II? 11 KERNICTERl^ VoL'XXIILNQ.9 June, 1947 H' iMdeieb cence ptRsrsrs; *.*■ R»« || f . i IH (BONE MEAL TABLETS) •rical bJjHch in^alcium/ losphorus and Vitarrjfin D, II necessary for adequate one nutrition. H '; * i - ft ' 'MJt. Kali stages,of bone grc there M ddr^ger^l^^ck 46.5% ,f»'f. children aged 2-14 mm EACH ORlCAyTABLET 1 I g^ Bone ~-^^^M^ ^ i$M phosphorus 1 n VitaminlHStO0%( ORi^^ABLFf%^^< acceple^^MWr^^J are chocolate .favoured. sk Foiiis *Vffli$a&I *l* July '43) iflBi TniSUm THE VANCOUVER MEDICAL ASSOCIATION BULLETIN Published Monthly under the Auspices of the Vancouver Medical Association in the interests of the Medical Profession. Offices: 203 Medical-Dental Building, Georgia Street, Vancouver, B.C. EDITORIAL BOARD: Db. J. H. MacDebmot Db. G. A. Davidson Db. D. E. H. Cleveland. All communications to be addressed to the Editor at the above address. Vol. XXIII JUNE, 1947 No. 9 Db. G. A. Davidson President OFFICERS, 1947-48 Dr. Gordon C. Johnston Vice-President Dr. H. A. DesBrisay Past President Dr. Gordon Burke Hon. Treasurer Dr. W. J. Dorrance Hon. Secretary Additional Members of Executive: Dr. Roy Huggard, Dr. Henry Scott TRUSTEES Dr. A. M. Agnew Dr. G. H. Clement Dr. A. C. Frost " Auditors: Messrs. Plommer, Whiting & Co. SECTIONS Clinical Section Dr. Reg. Wilson Chairman Dr. E. B. Towbridge Secretary Eye, Ear, Nose and Throat Section Dr. Gordon Large Chairman Dr. G. H. Francis Secretary Paediatric Section Dr. J. H. B. Grant Chairman Dr. E. S. James Secretary Orthopaedic and Traumatic Surgery Section Db. J. R. Naden Chairman Db. Claeence Ryan Secretary Neurology and Psychiatry Db. J. C. Thomas Chairman Dr. A. E. Davidson Secretary STANDING COMMITTEES Library: Dr. J. E. Walker, Chairman; Dr. W. J. Dorrance, Dr. D. E. H. Cleveland, Dr. F. S Hobbs, Dr. R .P. Kinman, Db. S. E. C. Tubvey. Publications: Dr. J. H. MacDermot—Chairman; Dr. D. E. H. Cleveland, Dr. H. A. DesBrisay, Dr. J. H. B. Grant, Dr. D. A. Steele. V. O. N. Advisory Board: Dr. Isabel Day, Dr. H. H. Caple, Dr. E. J. Curtis. Summer School: Db. L. H. Leeson, Chairman; Db. E. A. Campbell, Dr. J. A. Ganshorn, Db. D. S. Munbo, Db. D. A. Steele, Db. L. G. Wood. Credentials: Db. H. A. DesBbisay, Db. H. H. Pitts, Db. Frank Turnbull. Representative to B. C. Medical Association : Dr. H. A. DesBrisay. Sickness and Benevolent Fund: The Presidfnt—The Trustees. K ■ I\\ » 1 \\ jv >/ *4 * i .■f f'\\ *v hi 1 l II." if B '4. | • L 1 JL J ?1 1 f i .y 1 m * * ^ k 't 4 1 j ;j. l l l iS 1 9 , j| si ■"• * 1 1 •!?* %\\\\ :t i ' » 1 - '* "I L 1 ii i f ' 1 1 1 H | 4< m i *.♦ "J ' S*H" •tfffl m iv , ■xU if iH •H *k* 1 n 1j 11 \\4 i i 1 ;H '•;*•, IP M'l rtcNfrc PLAGUE DIARRHEA JKJB TO FOOD CONTAMINATION, excessi1^ heat, ^racalioiE^ indulgences or ehangei|>f drinking water is quicklyljlon- trolled by Kaomagtna. AT THE O^^T give 2 lablespoonfuls in a little water HFOLU)l£D BY 1 lablespoonfid after every bowel movement. FOR PROMPT RELIEF FROM DIARRHEA KAOMAGMA Kaolin in Alumina Gel « AND 12 FL OZ. BOTTUS Regi»t«red Trade Mark CLEANSES • COATS • PROTECTS • SOOTHES JOHN WYETH & BROTHER (CANADA) LIMITED WALKERV1LLE, ONTARIO *'X ii m Twncvrm .AT THE MENOPAUSE HIGHLY POTENT ORALLY ACTIVE NATURALLY OCCURRING ESSENTIALLY SAFE WATER SOLUBLE WELL TOLERATED IMPARTS A HEELING OF WELL BEING • conjugated oestrogenic substances (equine) supplied in two strengths: No. 866 — 1.25 mg. per tablet No. 867—0.625 mg. per tablet Both strengths are supplied in bottles of 20 and 100 AYERST, McKENNA & HARRISON LIMITED Biological and Pharmaceutical Chemists MONTREAL CANADA IB iyl (• M in *'A • i j i »'! • ' fi Jt ' . \\ f )' ;?;■ n ?» %l !-' l it ■ .1 i i* ** ' i . p ' | : jStf V fc *'' H ., i L '. ' •f'H k'' 1* dt* !J «# 1 hit V yi Mi ". it I tri 1 w «]| >'.• ' iff- 1 H t M .*< J -I H' a on medical and health matters, is nothing short of a reproach to us as a profession: and the only answer to this problem, in our opinion, is to have some competent authority which could be on the watch, and provide the facts, accurately and dispassionately put, whnever the need arises. LIBRARY NOTES !*.*■ ANNOUNCEMENT OF SUMMER HOURS Evening hours have been discontinued from June 15 th to September 15 th, inclusive. During this period the daily hours will be: Monday to Friday—9:00 a.m. to 5:00 p.m. Saturday—9:00 a.m. to 1:00 p.m. RECENT ACCESSIONS TO LIBRARY: Surgical Clinics of North America, Symposium on Tumours, Lahey Clinic Number, June, 1947. Transactions of the American Association for the Study of Goitre, 1946-46. The Treatment of Diabetes Mellitus, 8 th ed. 1947, by Elliott P. Joslin et al. Principles of Hematology, 3rd ed. 1946, by Russell L. Haden. Diseases of the Chest, 2nd reprint, 1946, by Robert Coope. \\- 1f{ • -J ■ W ki CORRESPONDENCE July 3, 1947 Dr. J. H. MacDermot, Editor—Bulletin, Vancouver Medical Association, 925 W. Georgia St., Vancouver, B.C. Dear Dr. MacDermot: I would appreciate your finding space, if possible, in the forthcoming issue of the Bulletin for the attached notice for physicians regarding Post Office regulations and rates applicable to specimens mailed to the Division of Laboratories.. Your bulletin offers the most effective channel for communicating these facts to the medical profession in the Province. Thanking you, I am, Yours very truly, C. E. DOLMAN, Director. The above letter from Dr. Dolman is self-explanatory, and we are glad of the opportunity to publish his notice below. When one considers the very serious consequences that might follow careless packing of infective material, and the menace that the escape of such material might constitute to the public at large, the necessity for the greatest possible care becomes obvious. Apparently, however, the experience of the Public Health Laboratories shows that such care is not always exercised. We urge our readers to pay special attention to this very timely notice.—Ed. Page Two Hundred and Eighteen ■M' POST OFFICE REGULATIONS AND RATES APPLICABLE TO SPECIMENS MAILED TO THE DIVISION OF LABORATORIES Specimen Containers The attention of physicians is drawn to the regulations governing shipment of specimens by mail to the Provincial Laboratories. Complaints have been received from the District Post Office Inspector that potentially infectious material has been discovered in the mails packed in a single container, although the regulations call for an inner tin and outer carton. Blood specimens for serological tests are also occasionally being sent by mail without replacement of the cotton packing supplied with the outfit, so that if the cork of the test tube is loosely inserted, and the screw cap of the carton improperly fitted, blood may leak into mail bags and stain their contents. Postal Rates The diagnostic facilities of the Provincial Laboratories represent a free service to the public through the medical profession; but no provision is made in the Laboratories' budget for the free shipment of specimens to the Laboratories. Inadequately stamped and even unstamped packages are quite often received. For the information of physicians, the following are the postal rates which now apply to the more commonly used specimen outfits: Diphtheria outfits .03 Kahn outfits | ; .01 Faeces containers .05 Water containers .05 Slides [ .01 Darkfield outfits . .03 Sputum outfits _: .03 th ■> Division of Laboratories, C. E. DOLMAN, Director, Dept. of Health & Welfare. June 17th, 1947. Editor, Vancouver Medical Association Bulletin, 203 Medical-Dental Building, 925 Georgia Street W., Vancouver, B.C. Dear Sir: £$£ Attached is some information rgearding recent appointments at the Vancouver General Hospital namely Dr. Digby Leigh, -Director of the Department of Anaesthesia, and Dr. H. K. Fidler, Director of Laboratories. I would be pleased if you could give publicity to these in the next issue of the Bulletin so that the profession at large in British Columbia would have knowledge of these. It may be of interest to them to know that Dr. Digby Leigh plans on instituting a refresher course for any member of the profession who wishes to take a short course in anaesthesia to assist him in his practice in isolated areas. Also, physicians sending in Page Two Hundred and Nineteen "f It- specimens for pathological examination would like to know who is in charge of that Department now, since Dr. Pitts' resignation. Yours very truly, R. A. SEYMOUR, M.D., Asst. Superintendent. %;| The above letter from Dr. Seymour introduces to our profession in B.C., two men who will undoubtedly be an acquisition to that profession. We publish below a short summary of their qualifications, and the work they have already done.—Ed. ;■ j i. ci ♦K H. K. FIDLER, M.D. (Man.) L.M.C.C, B.Sc. (Med.) Dr. Fidler succeeds Dr. H. H. Pitts as Director of Laboratories at the Vancouver General Hospital, following Dr. Pitts' resignation, to become Chief Pathologist at St .Paul's Hospital. Dr. Fidler has had an active and distinguished career for so young a man. He was a demonstrator in pathology in the University of Manitoba, instructor in pathology and bacteriology in the University of Alabama—where he became assistant professior of pathology and bacteriology in the medical school. Following a surgical interneship in the Royal Jubilee Hospital in Montreal, he joined the R.A.M.C., and served as pathologist from 1934-45—subsequently becoming director of laboratories at Shaugh- nessy Hospital. He is certified as Specialist in Pathology and Bacteriology by the Royal College of Surgeons of Canada. He has published various papers dealing with his chosen subject. £ 'Jr, JW DR. M. DIGBY LEIGH, M.D., CM., (McGill) Dr. Digby Leigh is the new Director of the Department of Anaesthesia at the Vancouver General Hospital. This department, so ably run and developed for many years by Dr. David D. Freeze, who, we are glad to note, will still remain on the staff, has lately been reorganized to fit it to deal better with the great increase in volume and complexity of the work it has to do. Modern anaesthesia, with it tremendous devel- iopment along new lines in chest, heart and brain surgery, is now a very complex affair. Dr. Digby Leigh, who comes from Montreal, where he was Assistant Professor of Anaesthesia at McGill, and chief anaesthetist at the Children's Memorial Hospital. Dr. Leigh has had a wide experience in anaesthesia and is particularly well qualified as a teacher. He has served as resident anaesthetist in Wisconsin General Hospital, has been a Research Fellow in Pharmacology at McGill, in addition to his positions detailed above. He is the co-author of a book, "Paediatric Anaesthesia", now on the press, and is a contributing editor of "Anaesthesiology", and a diplomate of the American Board of Anaesthesiology. He certified as "Specialist in Anaesthesia" by the Royal College of Physicians and Surgeons of Canada. Dr. Leigh comes to the Vancouver General Hospital at an especially significant period in its existence. The new developments that are contemplated in the Hospital, the near prospect of the Medical School at the University of British Columbia, and the growth of Vancouver generally, all make it urgently necessary that nothing should be left undone to ensure the optimum development of anaesthetics in our hospitals, along the most up-to-date lines. We welcome very warmly Dr. M. Digby Leigh, who, by his past accomplishments, and by the witness of his colleagues, is so eminently fitted to undertake this task.—Ed. Page Two Hundred and Twenty S ancouver President Vice-President Honorary Treasurer- Honorary Secretary- Editor cal Association Dr. H. A. DesBrisay Dr. G. A. Davidson Dr. Gordon Burke Dr. Gordon C. Johnston Dr. J. H. MacDermot ACUTE ANTERIOR POLIOMELITIS (Contributed by DR. STEWART MURRAY, M.H.O.) . Brief refresher notes: "Poliomyelitis is an acute infectious disease caused by a filtrable virus, occurring in epidemics and sporadically, and characterized by varying degrees of injury and degeneration of the central nervous system, with special localization in the anterior horns and the motor nuclei of the medulla; clinically it shows marked diversity in symptoms from mildest malaise to complete flaccid paralysis of many groups of the skeletal muscles with possible death through involvement of the respiratory centres in the medulla" (Infantile Paralysis 1941). It is a reportable disease to the Health Department. a. The quarantine period for contacts—2 weeks. b. The isolation period for cases—3 weeks. (a and b, see Provincial Communicable Disease Regulations.) Incubation period—3-20 days, usually 6-8 days. Communicability and Transmission It is highly infectious, the patient probably being infectious from the first day at least until 10-20 days after the onset, although the virus has been isolated from the stools of a patient (female 5 years) 125 days after the onset. "Accumulations of epidemiological data in recent years appear to have strengthened the hypothesis that poliomyelitis is spread principally by person to person contact. (U.S. Public Health Report Vol. 62 No. 25 June 20/47.) However, within the last few years the idea that "Polio" may be an "intestinal disease" has come sharply to the fore and spread by means of polluted water and milk or foodstuffs contaminated with human faeces may be quite probable. The virus may be carried by flies feeding on sewage. Evidence is ample to show that there are many healthy carriers and recovery of the virus has been reported from several pools of tonsils removed from children admitted to Los Angeles hospitals in an interepidemic period. Secondary cases may result from contact with primary cases, from two or three days before up to several days after the onset of the disease in the primary case, further indicating the carrier state. Mild gastro-intestinal upsets or a mild pharyngitis or tonsillitis associated with fever, headache and nausea or vomiting should be viewed with suspicion in a family or group from which a frank case arises. Symptoms According to Top's Hand Book of Communicable Diseases the clinical manifestations of poliomyelitis may be divided into three phases; namely the systemic, the central nervous system and the paralytic. The systemic phase differs in no important essential from the onset of a number of acute communicable diseases, and if there be no further manifestations it may be considered an abortive case—this is the type described above as a source. Th central nervous system phase includes those symptoms shown in the first phase, but in addition may become more marked but not necessarily so, and there is hyper- Page Two Hundred and Twenty-one it ,■*# f,r H •*w ♦",! sensitiveness, increased sweating, stiffness of the neck, stiffness of the spine, muscle spasm and usually positive spinal fluid findings. The case may subside and be classified as non-paralytic "polio". The third or paralytic stage may manifest itself as spinal, spino-bulbar, bulbar, encephalitic or meningitic. The signs and symptoms then follow the classical descriptions of the disease. By far the commonest spinal involvement is that affecting the lower extremities. Prognosis The prognosis in general is good. It is generally thought that about 70% of cases have complete recovery, 15% have a slight paralysis and the balance varying types of severe paralysis. Treatment The Polio Committee of the Vancouver General Hospital has adopted the following during the acute stage (see below). After the acute phase treatment is re-education of muscles (physical medicine) and finally special treatment. In all cases the morale of the patient must be reinforced. The folowing is the policy of the Polio Committee, Vancouver General Hospital. Diagnosis: Free consultative service is available for any case staff or private on request through the Supervisor of I.D.H. Consultants include the following who are members of the V.G.H. "Polio" Committee: Dr. J. R. Naden Dr. S. E. C. Turvey Dr. F. Turnbull Dr. E. J. Curtis Dr. J. H. B. Grant Dr. E. E. Day Dr. G. A. Greaves. Special Consultation In any suspect or proven case the attending physician is urged to have the patient seen by Dr. Greaves and to confer with him on the course of treatment. Treatment All patients, suspect or proven cases of polio will receive hot fomentation treatment as soon as possible after admission unless the attending physician specifically request that this treatment be not given. i^ Special Procedures. Before any operative or other major procedure is performed the patient must be seen by two members of the "Polio" Committee who must concur in the procedure to be adapted. This is in accordance with Section 109 of the Hospital By-laws which reads as follows: "The General Superintendent may require a consultation whenever, in his opinion, it will be in the interests of the patient or of the Hospital." In the Vancouver area and lower mainland to date July 15th some 45 cases have occurred. There has been one death, diagnosis having been made on the post mortem micropathological examination. The cases have occurred in the following age groups as shown. These indicate the disease is definitely not confined to the infantile or preschool groups. AGE CLASSIFICATION 0-1 1-5 6-14 15-19 20 over Total — 10 18 4 10 42 Page Two Hundred and Twenty-two M SEX CLASSIFICATION — 7M, 3F 9M, 9F 3M, IF 4M, 6F 24M, 19F Three cases have been reported from outside the Vancouver area. No histories are available as to age and sex. To date there has been no common factor. There is no laboratory test available here aside from spinal fluid findings. There is no specific treatment or method of prevention. The following general advice has been given. (a) avoid over fatigue (b) avoid chilling (c) avoid swimming in polluted water (d) practice a high standard of personal hygiene (e) keep flies away from food (f) avoid crowds (g) regarding tonsillectomies during epidemics, there is a wide difference of opinion. The "Polio" Committee of Vancouver General Hospital feels that if there be any question it is best to delay operation. NOTE: In the June 28, 1947, Vol. 134, No. 9 of the J.A.M., there are two excellent articles on "Polio". (a) P. 749: Epidemiology of Poliomyelitis, by Albert Sabin, M.D. (b) P. 757: Bulbar Form of Poliomyelitis by The Minnesota Poliomyelitis Research Commission. STEWART MURRAY, Senior Medical Health Officer. COLLEGE OF PHYSICIANS AND SURGEONS The medical profession of British Columbia welcomes Dr. F. L. Whitehead, M.D., CM. (Dalhousie) as he takes up his new duties as executive secretary of the College of Physicians and Surgeons. Dr. Whitehead will also act as executive secretary of the British Columbia Medical Association. In these positions he takes the place filled until recently by Dr. M. Caverhill. The new executive secretary has had an active and varied career, and his experiences fit him particularly for the work he will have to do. Graduating in 1935, he very soon joined the R.A.F. (Medical Branch), and served in this organization for ten years, leaving with the rank of Wing-Commander. During this time he saw service in Great Britain, Egypt, Palestine and Germany. He was with the R.A.F. in the Western Desert campaign, in the early days of the war, and shared the grim experiences and severe hardships of those who took part in that terrible campaign. Dr. Whitehead spent two years in the Department of Aviation Medical Research, and travelled a great deal during this time. He also served as Senior Medical Officer of the Queen Elizabeth for six months, at the height of the submarine campaign, but missed any personal contact with torpedoes. Leaving the forces at the end of his ten-year term of service, he practised medicine in Nova Scotia as a general practitioner in a small town. He knows, therefore, at first hand, a good deal about the problems and difficulties that confront a medical man in general practice, and should be able to be of great service in his new position, to the medical men of British Columbia. We wish him all success, and believe that in appointing him, the College made a wise choice. Page Two Hundred and Twenty-three m ' a$! THE DIRECTION IN WHICH WE ARE GOING \\t *' M W. Address-by A. E. Grauer, B.A., Ph.D., President of the B.C. Electric Railway Co. (Delivered at Annual Meeting of V.M.A., May, 1947) Oliver Wendell Holmes once said, "I find the great thing in this world is not so much where we stand as the direction in which we are going". I have taken part of this statement as my title to cover a talk which I hope will not play the role of the politician in the story, will be somewhat rambling in nature but I hope of some interest. The world picture today is a chaotic one. There is no unity in the world, no sense of common purpose. A creed of hate has been built up, stemming from Karl Marx and his doctrines of the class struggle and of the exploitation of the masses by the so-called Capitalists. Karl Marx was a theoretician. He was a brilliant, embittered recluse who, exiled from his native Germany, spent years in the library of the British Museum developing theories that have pretty uniformly been proven wrong by history. Yet the Communists, and to a considerable extent the Socialists, continue to repeat his slogans as if they were gospel truth. Socialism and Communism have the same objectives. They believe that human happiness and welfare can best be furthered by putting total economic as well as total political power into the hands of the State, and thus they are at the opposite poles to free enterprise. However, the Socialists and Communists heartily disagree with each other because they differ radically in their means of achieving their objectives. Marxism is the most complete formulation of a vast counter movement that has risen in western nations against the assertion of the rights and liberties of the individual, which until recently, the English speaking nations took for granted. In all later Socialist, Communist and Fascist phases of this movement we see the same tendency to consider humanity in the lump as classes and not as individuals, the same acceptance of hate and conflict as necessary forces in human society. Through his materialistic interpretation of history, Karl Marx stressed the dominance and inevitably of economic forces over the individual. The great man, for instance, was simply a product of economic forces, the way he looked at it. Now I want to suggest to you that one of the reasons why Communism and Socialism continue to appeal to many people, even in highly developed countries like Canada and the United States, is because of the discontents of people, whatever may be their cause. These causes are many. And free enterprise has been weak in not alertly analyzing them and laying down a positive programme of remedial action. Such a programme would both preach and practise the virtues, inherent in our pioneer background, of "cooperation" and "friendship" as against the creed of class struggle and hatred. Communism and Socialism have been very clever in taking advantage of this weakness by trying to channel all discontents, from whatever cause, into an indictment of the economic set-up of free enterprise. Tactically, both Socialism and Communism continually dwell upon the shortcomings of the Free Enterprise system, and, by implication at least, take the position that these shortomings would not exist under their own systems. In short, they preach, directly or indirectly, a gospel of perfection. This is a tremendous strength, because although philosophers know that there is no greater illusion than that any system run by human beings can be perfect, it is nevertheless a great rallying cry for all those who are in any way discontented with their present lot. My thesis is then that democratic free enterprise, to develop as a healthy system and to offset the erroneous direction which totalitarian systems of all descriptions are trying to give us, must lay down a positive programme of integrating the individual into the social group, of making him feel that he "belongs", and must do this on a broad front. Our present preoccupation with material and economic considerations is not enough. Page Two Hundred and Twenty-four To illustrate this thesis, I shall take examples from three important but quite different fields,—health, community organization, and education. In the field of health, my example is that of mental illnesses of all sorts which I shall group under the term "mental hygiene". The importance and ramifications of mental hygiene have only recently been realized. As Professor His cock of the Yale School of Medicine says, "There is no problem of public health which is more important and at the same time more difficult of solution than that which relates to mental hygiene. In the average family throughout a community it is probable that the handicaps due to mental maladjustments are as great as the handicaps due to all other diseases and defects combined". The dimensions of the problem are enormous. In the first place, there is the problem of major psychoses, commonly referred to as insanity. The number of such cases institutionalized in Canada occupy more beds than exist in all General Hospitals. It has been estimated that 4% of all school children will at some period become patients, which is almost is many as will graduate from our universities. Dementia praecox is responsible for more chronic invalidism than tuberculosis or cancer. In the second place, there are the mental defectives or feeble minded, comprising at least one percent of the population. It is estimated that specail training in public schools is needed for over 40,000 mentally deficient children. There is existing provision in public schools and in residential schools for the specialized training of somewhat over 10,000. There are at least 8,000 adult mental defectives in the Dominion, requiring institutional care, but provision has been made for little over one half this number. This lack of accommodation exacts a heavy price in crime and other social problems. Thirdly, there are the epileptics, a class that, as you know, requires different treatment from that given to the insane. This is the group in which brilliant people are often found. Fourthly, there are psycho-neuroses, including nervous breakdowns, neurasthenia, and severe emotional unbalance—a group of complaints affecting perhaps ten percent of the population. Like marriage, our modern scientific age simplifies lif e but complicates living. Finally, there are emotional factors in connection with physical disabilities, especially of the more chronic types. Where the mental state connected with the physical disability is overlooked, as is not unusual, it simply means that the period of disability is greatly prolonged. As I have said, no adequate survey has ever been made of the size of this problem of mental hygiene in Canada, but it is obvious from the short analysis given, that the numbers involved are very large. Here, then, are a large number of Canadians who, to a greater or less degree, are dissatisfied and groping because of a mental and nervous condition. To a considerable extent their troubles have not even been diagnosed, or properly diagnosed, a situation which, I think it is fair to say, has not been helped by the fact that medical education, until recently, paid little attention to this side of the doctor's training. Even with proper diagnosis, our facilities for dealing with them are in their infancy. Here, then are a large number of people who are not properly oriented, who have a feeling of inferiority, inadequacy, hurt, or dissatisfaction. They don't know what their trouble is. What should be more natural than that many of them would fall for the current left-wing slogans of sexploitation and class struggle, and attribute their troubles to the nature of the economic system under which they are living. Certainly, anyone suffering from a sense of inferiority is excellent material for an aggressive movement that gives him a mission, however wrong that mission may be. In my opinion, the supporters of the system of democratic Free Enterprise are working on far too narrow a front. For instance, if the problem of mental hygiene were properly understood and the correct facilities for treatment worked out, a lot of people who at present attribute their troubles to the naure of economic organization, would see their difficulties in a different light. In this great field, the role of the doctor and of the medical research man is obviously of direct and basic importance. Page Two Hundred and Twenty-five ■ •' ft • . 1 1 f r? • 1 iti-v 1 ."' t. 4'r, 1 « ' ! i- V ft ll' L ii''«", t it H ' |/ it' *■ y< * • :* ■'' u * t g • < '\\,r ■ i t\\ l< $ ti,' * K ^ .if .*' »«?■* ■ ! j ' U ♦' f jf 7 {- ^ v' | 4\\ \\ it : ■ * C • \\ '\\\\ r-J ..* b h ■ ■ u-1,:- In ;?s ■• , p 1 Si ! * . - ' ■ 4 # * I •' k^§~' t' y *' '• lift #■ t/l • tg!<, 1 k *} * ■ \\r& 'i\\Z v" 1 (•'*( IVm *'" rt •i L'.' 1 {f •.'- ■ *P ' ,: |l ^ < 1 f t\\ i, « '■ '' ■'» *!"'■ 'h: >H: w t u >>', r' ' t-a( .• • i j su ♦■ '?;•£ ; l '* •'■: t'i 4' I •?•' '■ r! V l> hi -,i \\ I-? ■ t «£•*■. < 3.'" ' 1 \\:fc : f H «i«* P f ii ••. 111 •. ijO; f. I'i "' IJ ■ <• i'^ i f fa t'. »«J '.- 1 i \\&7 W >■■■ ' W* vV 4 I ; i <** <; I hi •' H > 0 -' k H til ^ I It I II 1 ■ ■t-j ;' ii !'■•, ]» i H I ■I m fcl i Kb I BL DM w WE r ii ljU' KM i Id •W Surveys of Vancouver show serious social disintegration in several areas of our city. They show, for instance, that areas with a high ratio of juvenile delinquency also show a high ratio of other symptoms of social disorganization, and vice versa. We know that we cannot stop industrial and technological development, although we can channel and mould them through intelligent town planning. But we can at least be aware of the social and personal problems that such industrial development raises and take intelligent steps to deal with those problems. One of the most effective ways, as shown by the City of Newburyport, is to retain and make stronger the arts, cultural opportunities, and other types of community organization and activity. Now this is something entirely within our hands as citizens. There are many things over which, as individuals living in Vancouver, we have no control. When the Big Four meets in Moscow, for instance, there is nothing we can do about that situation. But when it comes to community activities, we do not have to wait for agreement between the Nations of the UNO; we do not have to wait for the successful functioning of the Pan-American nion, or of the Dominion-Provincial Conference, or even upon provincial-municipal financial readjustment (although that would help). We can immediately go ahead as individuals or organized groups of individuals to keep our community healthy and make it more healthy. Professional men, in general, have always had the reputation of being little interested in anything outside their own professions. If we really believe_in_democratic free enterprise and the liberties of the individual, we should, each of us, become firmly interested in at least one community interest outside our own business or profession. At the worst, we can follow the words of John Bright who once said, "You should link yourself with a great cause; you may never do the cause much good but the cause will do you a great deal of good." At the best, if each individual businessman or professional man genuinely interested himself in one community activity, there is no doubt that Vancouver would become a great city,—a city with a spirit and a soul; a city where community cooperation took the place of class hatred. Now, I want to turn to an example from my third field, that of Education. To me, perhaps our greatest lack here is the way we have neglected the child before the school entry age of six. Research in the field of educational and child psychology has long shown that the pattern of the adult is largely formed by the time the child reaches the age of six. We know now that the influences begin to work upon the child before he is born. The outstanding lack from the point of view of educational organization, is a nursery school system, taking the child from the age of two on, which would become part of our own general educational system. What the nursery school does is to teach the small child, before non-social habits crystallize, to live in a group and to become a social being. Great Britain took steps a few years back toward making nursery schools part of the public educational system, and there is no doubt that tremendous possibilities lie in this direction. In the first place, from the point of view of having well-adjusted individuals, think of the great advancement that would take place if the child were in a nursery school for at least half the day from the age of two onwards where he would form the habit of adjusting himself to a group. I often speculate as to how many of our unbalanced individuals with a lust for power, like Hitler, Mussolini, and others in various walks of life nearer home, would have been changed had they been put through a proper educational process from early childhood which stressed getting along with other people. The nursery school would also pick up the child with anti-social habits at a time when they could be changed, whether they be the habits learned in the hard school of underprivileged neighbourhood, or the habits learned by the too privileged child of a wealthy home. And from the point of health, think what could be done with the child under the supervision of proper medical and dental people from the age of two! Page Two Hundred and Twenty-eight Here then is another example of the broad front that we must proceed along to realize the possibilities of our system of democratic free enterprise, and, by the same token, to combat the threat of authoritarian forms of government and social organization. To sum "up, democratic free enterprise, while realizing the importance of the individual and his rights and liberties, has so far concentrated upon economic and material factors to the relative exclusion of the more intangible but equally basic considerations that tie the individual into the group and make for a healthy social organization. Socialism and Communism have aggressively advanced their solution to present discontents, but it is based upon a wrong diagnosis. With their stress on material considerations and class antagonisms their proposals would, far from effecting a cure, lead to the dictatorship of the absolute State. Nevertheless, their fighting slogans and their incessant reiteration that the States can plan everything perfectly have a great appeal to those who are discontented for any reason. The direction in which the democratic free enterprise countries of Canada and the United States are going depends upon their ability to analyze socail discontents as effectively as they have scientific and technological problems. In particular, we must work on a broad front, some examples of which I have given, to ensure that the individual has a sense of belonging to his society and a feeling of social fulfillment. This must be done within the factory, within community groups and organizations and through community activities. It is a programme in which every one of us must take part, both in the intelligent handling of his own business or profession, and in an intelligent participation in the affairs of the community. In short, there are various direction in which we can go, but the direction in which we are going to go depends upon each one of us. With individuals as well as societies, a destiny dreaded is a doom. Shall we rise to our Destiny? i' SUMMER SCHOOL — 1947 The twenty-fifth annual Summer School was held early in June this year. The attendance was excellent with a total of 343 registrations. The number of doctors attending from Washington and Oregon was again gratifying. The programme of lectures and clinics was designed to be of particular interest to the general practitioner and all were well attended. Dr. Sturgis' lectures, and his clinic in Medicine at Shaughnessy, were outstanding. Dr. Smith with his Bostonian sincerity brought.us many helpful hints in paediatrics, and because of his special interest and contributions in the pre-natal period, has extended our paediatric outlook. His informal talk at the opening luncheon on the results of his studies in post-war Holland were most interesting and informative. Many of the lectures given during the session will be published during the next few months in the Bulletin. A round table discussion on Diseases of the Thyroid was a definite success, with all speakers participating. A few films on surgical technique were shown for the first time this year and it is believed that at future sessions more use will be made of this excellent means of demonstrating physiological and chemical concepts as well as surgical and other techniques. At the final banquet Rev. Dr. E. D. Braden gave a most entertaining and excellent address to an unfortunately small audience. The golf tournament was held this year at the Vancouver Golf and Country Club at Burquitlam, and the attendance and weather were both excellent. A list of the prizewinners follows: Page Two Hundred and Twentyrtfine ^^ ^^^^^^Tn i llsli f r II i 8''1; H 5{V »f H * j ' I: ' i v f ■ ■ 11 '•» -i r, IIt* Ik j If | j H , .1: ■ *E » 1 v, 1 i < ■•' H ;I*; ■ -1 ■ rtt'-*l !'■' ; U rl' i B'>■' • L* i'' : .*'' > •iff iff; IrVm 1 ri'l » \\v\\lm[ IN !';*",« * 114 j! |.-4l » WW r •*$? Ll 11 ■ r ■ til:- Plift- ; | ,J| il'llli! B ''err ri* £ IK i*' ?iv» f n m ' 1. •$ Ll Lm, • * f ■ ■ 1 SI ■IB 'Jrl ' 'h . v*i! rill '» i' 9 p| ■" •» SUMMER SCHOOL GOLF PRIZES Low Gross—Dr. R. R. M. O'Brien, Spokane, Washington. Second Low Gross—Dr. M. Share, Vancouver. Low Net—Dr. W. Laishley, Nelson, B.C. Second Low Net—Dr. Reg. Wilson, Vancouver. Low Net (18 and over Handicap)—Dr. Ken Peacock, Vancouver. Nearest to the Pin—Dr. W. G. Saunders, Vancouver. Hidden Hole—Dr.'T. A. Johnston, Vancouver. Long Drive—Dr. W. G. Evans, Vancouver. High Gross—Dr. Alfred J. Elliott, Toronto. A complete list of registrants for the Summer School is given below: SUMMER SCHOOL ATTENDANCE, JUNE, 1947 Ainley, W. E. Agnew, A. M. Alton, J. A., Lamont, Alta. Alexander, J. D. F. Anderson, John F., V.G.H. Anderson, W. F., Kelowna, B.C. Anthony, A. Appleby, L. H. Arbuckle, J. W. Armitage, T. F. H. Austin, W. E. Badre, E. J. P., Shaughnessy Bagnall, A. W. Baird, Murray Baker, Harry Baldwin, S. G. Balfour, J. Ball, N. J., Oliver, B.C. Barg, P., Essondale Barner, H. A., Bremerton, Wash. Beach, D. W., West Vancouver, B.C. Becher, J. C. Bell, N. N. Bell-Irving, P., Shaughnessy Bennett, N. T., V.G.H. Benwell, C. C, Essondale Berger, B. Bie, W. F. Black, D., V.G.H. Black, J. H. Blackwelder, G. E., St. Paul's Blair, J. H. Blair, Murray Bogoch, A., Shaughnessy Bonnell, S Boyce, K. C, Shaughnessy Brown, C E. Page Two Hundred and Thirty Brown, Harold Browne, C. C, Nanaimo Buller, F. J. Bryson, B. F., Essondale Burwell, W. Keith Byrne, U. P., Essondale Campbell, Charles, V.G.H. Campbell, E. A. Caple, H. H. Caverhill, M. R. Cawker, C. A. Chase, E. F., Seattle, Wash. Chipperfield, L. S., New Westminster Chisholm, H. A. Christie, John Christopher, H. G, Essondale Christopherson, E. Clark, D. AM New Westminster Clarke, R. S., Shaughnessy Clarke, W. A. Clement, G. H. Cleveland, D. E. H. Coburn, W. A. Collison, D. B. Coltart, G. L. Cooke, E. H. Cooper, H. G. Covernton, C. C, Shaughnessy Covernton, C. F. Croft, P. D., Essondale Crofton, F. D. L., V.G.H. Curtis, E. J. Dalrymple, T. Davies, C. E. Davies, H. R. L. Davies, J. R. Davidson, G. A. J Davidson, J. R. Day, E. E. Day-Smith, F. DesBrisay, H. A. Dickey, M. R. Donnelly, C. W. Drache, V. Dumont, H. Dykes, W. Eaton, C. M. Edgar, Murray Elliot, J. A. Elliot, S. G. Elliott, B. S. Elliott, F. N. Ellis, J. P. Evans, W. G. Ewing, W. T. Farish, J. R., V.G.H. Felsted, Eggert T., V.G.H. Fenwick, J. B., Shaughnessy Fidler, H. K. Finlayson, Wm., V.G.H. Fleck, Elizabeth, V.G.H. Foster, L. E., Bremerton, Wash. Francis, G. H. Fraser, G. A., St. Paul's Fraser, G. D. Fraser, R., St. Paul's Friesen, L. • Frost, A. C. Frost, A. Gardner Frost, J. W. Galbraith, H. B. Ganshorn, J. A. , Gibbings, John S., V.G.H. Gilchrist, R. A. Gillespie, H. S., V.G.H. Glasgow, R. G., Michel, B.C. Gordon, Arthur, V.G.H. Gorkin, M. Gould, G. Graham, H. C, North Vancouver Grant, J. H. B. Grey, E. J. Greene, I. B., Everson, Wash. Grimson, J. C Grisdale, L. C, Langley Prairie Hall, R. G., Portland, Oregon Hallowes, B. J. Halperin, M. L. Hardyment, A. F. Hansen, Eugene, Tacoma, Wash. Harper, R., New Westminster Harry, B. H. Harrison, J. E. Harrison, W. E. Hebb, Frank Henderson, H. A. Henry, A. Taylor Herberts, Ed. D., V.G.H. Herstein, Archie Hicks, E. R., Cumberland Hobbs, F. S. Hoehn, M. R., St. Paul's Hopkins, John A., V.G.H. Huggard, Roy Hunt, Leigh Hutton, G. H. Ireland, I. A. Irish, R. H. JafFe, F. A., Regina Jackson, J. M., Essondale James, E. S. Johnston, D. R., V.G.H. Johnston, F. D. Johnston, Gordon Johnstone, T. A. Katz, Max, Haney Keith, W. D. Kidd, H. M. Kidd, J. M., V.G.H. Kinsman, R. P. Kirby, O. E. Kirkpatrick, G. J. Knott, N. D. Kope, J. H., Enderby Laishley, W., Nelson, B.C. Lamont, G. A. Lamont-Havers, R. W., V.G.H. Lang, J. W. Langley, G. E. Larsen, A. A., St. Paul's Lawrence, Grant Lee, G. H. Leeson, L. H. Leitch, D. B., Edmonton, Alta. Lennie, T. H. Lewison, H. Lockhart, H. B., Port Moody Lockhart, W. T. Lynch, A. L. Mallek, H. Mallek, J. Marshall, R. H. Masterson, T. L., V.GH. Margulius, J., New Westminster Mathias, G., New Westminster Matthews, Charles A., V.G.H. Matthews, G. O. Maxwell, L D«» Shaughnessy May, Susan Melgard, C, Seattle, Wash. Menzies, A. M. Menzies, Albert, V.G.H. Milburn, H. H. Milbrandt, W. E. Millar, R. D. Miller, T., Victoria Milligan, John, Seattle, Wash. Minnes, J. L. Moffatt, C. D. Moffatt, D. W. Mooney, A. W., V.G.H. Moore, W. H., Victoria Morton, W. A. Moscovich, B. B. Moscovich, Jack Mugan, J. McK., Cranbrook, B.C. Mullinger, Margaret Munroe, D. S. Murray, Fraser McAmmond, E. Mc. McCarley, J. S., North Vancouver Page Two Hundred and Thirty-one \\m- :" •;,': I m 4* ' M-r 3 iff! < F-TJf 'is- rfir M V /! m Ik m McConkey, A. S. Shuler, I. J. D., Seattle, Wash. McDonagh, John E., V.G.H. Simpson, R. A. ■ • McDonald, J. R. Simpson, W. W. McGregor, R. Sinclair, J. A., New Westminster MacKay, B. K. Sinclair, F., Cloverdale MacKay, J. H., Shaughnessy Skully, FL J., New Westminster MacKenzie, H. H, New Westminster Sleath, G. E„ V.G.H. McLaughlin, G. A. Smaill, W. D. MacLean, K. Smith, J. A. McLean, J. A. Speelmon, Rex, Spokane, Wash. McLellan, D. Spooner, J. S., Shaughnessy McLeod, E. C. Stanley, Robert McMurtry, T. S., V.G.H. Stan wood, D. H. McNab, J. A. Steele, D. A. McNair, A. Y. Steiman, I. * 5 McNair, F. E. Stephenson, G. H., North Vancouver McNeil, C. G., North Vancouver Stevenson, G. D., Shaughnessy McNeill, Neil . Stevenson, T. K., V.G.H. j McCaffrey, R. P. Stewart, A. J., V.G.H. Neufeld, W. P. Stewart, Neil Nicholson, George, Essondale Stockton, H. S. O'Brien, R. M., Spokane, Wash. Stoffman, I. W. Olacke, Frank Story, Boyd ONeil, Agnes Stranks, G. Osier, T. R., Shaughnessy Strachan, S. A., Shaughnessy Palmer, R. A. Strong, G. F. Paton, W. M. Swanson, A. L., Essondale Peacock, E., West Vancouver Tait, W. M. Peacock, K., West Vancouver Telford, Douglas Pedlow, A. R., V.G.H. Telford, K. M. Perrott, M., Tacoma, Wash. Thomas, J. C. Perveseff, T. Thompson, J. R. Peterson, S. C Thompson, W. J., Shaughnessy Petrie, G. A. Thomson, Frank Perry, W. H., Shaughnessy Townsley, B. R., V.G.H. Phillips, Paul, Princeton, B.C. Trapp, Ethelyn Piters, J. Treffry, C. J. Plecash, M., V.G.H. Trites, A. E. Porter, J. A. Turnbull, Andrew * Pow, C. G., V.G.H. Turnbull, F. A. Pump, K. K. Turnbull, H. L. Raynor, E. F. Upham, G. A. Riedesel, A. W., Aberdeen, Wash. Vanderburgh, A. W., Summerland Roberts, G. A., Chilliwack Vrooman, C. H. L Robertson, Rocke Wall, J. T. -t Robinson, C E. G., Shaughnessy Wall, M. D. Robinson, G. C. Wallace, S. A., Kamloops Rose, A. O., Langley Prairie, B.C. Watson, G. L. Ross, A. C«, New Westminster Weaver, H. G., Sea Island Rothwell, G. S. Webster, L. H. Ruskin, S. G. Rutherford, P. S. Whaley, T. R. Sarvis, E. S., Huntingdon, Wash. Whitelaw, W. A. Saunders, F. E. Whittaker, K. W. Saunders, Leslie, V.G.H. Wilder, E. M., New Westminster Saunders, W. G. Wilks, W. E. Sarjeant, T. R. Williams, D. H. Saxton, George Williams, L. J., Shaughnessy Schori, J. W., Bellevue, Wash. Willits, R. E. Schreiber, M., Coquitlam Williams, S. L., Shaughnessy Schilder, G. Wilson, G. T., New Westminster Schinbein, A. S. Wilson, R. A. Scott, H. Wilson, W. A. > Seldon, G. E. Wood, Everett G., V.G.H. Shallard, B. Wood, L. G. Share, Milton, Shaughnessy Woodsworth, R. S., Kelowna Shier, J. W. Wylde, E. W., New Westminster Shea, M. B. |g. Yak, J. A. Page Two Hundred and Thirty-two HISTORY OF V.M.A. (Continued) SECTIONAL GROUPS The chief function of the Vancouver Medical Association has always been: "To cultivate the Sciences of Medicine and Surgery". Previous to 1908 this had consisted entirely of the reading of papers at the monthly meetings, with subsequent discussions. It was now decided that the members divide themselves into Sections, whereby each group might study that particular branch of Medicine in which he was most interested. Dr. Riggs-was the originator of this new feature of the Society. In April of 1908 he introduced the following motion: "That the Association be divided into sections, each to elect its own chairman and secretary. Sections were to meet Once a month from October until April. The first Section to be so constituted to be called the Clinical Section, embracing clinical Medicine and Surgery." The first meeting of this Section took place in October of 1908, the President of the Association presiding. Several patients were shown and the cases discussed. At first the Section met in the Board of Trade rooms, but after three months the practice of holding the meetings in the various hospitals was instituted, rotating from the Vancouver General to St. Paul's, and since 1920, to Shaughnessy Hospital. Originally the Clinical Section met the fourth Monday of the month, but after the Regular Meeting night of the Association was changed to the first Tuesday, the Clinical meeting was also changed to the third Tuesday, and has remained so ever since. This Section includes every member of the Association, no matter what his specialty. For a short time the experiment of dividing the Section into two groups, to meet separately, and representing Medicine and Surgery respectively, was tried; but during the first World War, owing to the absence of so many members at the front, the group was reunited, and has remained so ever since. Meanwhile other Sectional Groups were formed, some of which are still in existence while others have been disbanded. The first to be so organized was the Paediatric, followed soon afterwards by the Eye, Ear, Nose and Throat Section. In March of 1920 a Genito-Urinary and Venereal Disease Section was added, and in November of the same year a Section to study Physiology and Pathology came into being. In 1925 a Physiotherapy Section was added, and very recently Sections on Neurology and Psychiatry, and Orthopaedic and Traumatic Surgery have been formed. At present only four, in addition to the original Clinical Section, remain. These are the first two and the last two named above. These groups meet regularly and report annually to the Association. K i- H 4> REGULATION OF THE SALE OF PATENT MEDICINES AND OF NARCOTICS One may wonder why a local Medical Body undertook discussion of such subjects as patent medicines and narcotics—matters which today we consider to be entirely within the province of the Federal Authorities. We forget that forty years ago things were different. There was then no Narcotic Act, and no regulation of the labelling, advertising and sale of patent medicines. It speaks well for the small group of men which then composed the Vancouver Medical Association, that they recognized a dangerous condition and strove to correct it, even to the extent of forcing action on a relcutant Government. In 1905 a woman in Victoria died as a result of taking a patent medicine, and about this time other cases were reported where grave injury had been done by their use. As a result Dr. F. C. McTavish introduced to the Society a recommendation for a more efficient supervision of the sale of secret nostrums,, as well as of narcotics in general. Page Two Hundred and Thirty-three !■ L ,jf 1 fi«*;: i ••■■.. Sodium amytal is a very useful sedative in the control of a case of this nature as its non-cumulative prpoerties allow for better control. Curare was found to be a useful adjunct to the treatment of tetanus. This dose used in this case (units 20) gave immediate relief and is a relatively small dose compared to that used in anaesthesia. One must be on the alert for possible paralysis of the respiratory muscles. Penicillin was used because many authorities think that it has a specific action on B. tetani (3, 4, 5) and because it acts as a preventive against chest and urinary complications. When last seen three weeks after discharge, the patient was eating, sleeping and moving well, and was shortly going back to work. BIBLIOGRAPHY 1. Tulloch, W., Proc Roy. Soc Lond., 529, 1917-19. 2. Wilson, K., Neurology, Arnold, London, Vol. 1, p. 637. 3. Herrell W., Nichols, D. & Heilman, D., J.A.M.A. vbe, 1202, 1944. 4. Buxton, R., & Kurman, R., J.A.M.A., vbg, 26, 1945. 5. Weinstein, L. & Wesselhoeft, C, New Eng. J. Med., 233: 681, 1945. I 4L m™ ,]|j*r- NOTICE LOCUM TENENS, ASSIST AN SHIPS, ETC. All doctors who are available for locum tenens, assistantships, etc., are requested to forward the particulars to the Executive Secretary of the College of Physicians and Surgeons, Room 203, Medical-Dental Building, Vancouver. At present the demand for locums is in excess of the numbers available for such work and the Executive Secretary is anxious to secure the names of all doctors who are available. Every effort will then be made to arrange suitable work in accordance with the individual's wishes and .to provide relief for doctors who are ill or require holidays, and for those who are looking for assistants. F. L. Whitehead, M.D.C.M., Executive Secretary, College of Physicians and Surgeons. Page Two Hundred and Thirty-eight KERNICTERUS By DR. H. BAKER I was rather surprised to find that the single word constituting the title of my paper tonight was so obscure that I could not find it in the 1930 edition of Dorland's Medical Dictionary. The derivation of the word is hybrid. Kern is from the German, meaning nucleus. Icterus needs no explanation. In January of this year I saw a four-year-old female in my office. She was a definite case of cerebral palsy. She was retarded, she was spastic and showed definite and constant athetotic movements. The history was most interesting and revealing. The parents were obviously of healthy, intelligent stock. They had three children. The oldest a boy, 13 years of age, quite Well and doing well in school. The next one a girl, 10 years of age, was in an institution, very markedly retarded and helpless j with marked spasticity and athetosis. This child was born quite easily. At the age of just a few hours she became markedly jaundiced.. The icterus lasted two months. During this time she began to show spacticity and athetosis, and signs of marked retardation, and has remained thus ever since. The third child was the patient whom I saw. Her actual delivery was relatively easy. She, too, at the age of a few hours became extremely jaundiced. The parents described it as copper coloured. The severe jaundice lasted for three weeks and then gradually faded out. She is said to have cried constantly for three to four months. As I stated before she was very retarded. She did not sit up until late and did not walk till three years of age. At four years she had very few words. The father's blood was Rh positive and the mother's Rh negative. Unfortunately I did not have the patient's blood tested for the Rh factor. They have since left town. In my opinion this child and her sibling in the institution represent two cases of kernicterus. What is the condition labelled kernicterus? It was first described in 1875 by Orth. In 1903 Schmorl coined the word kernicterus. Because the condition has been known and recognized for a long time there has been a great deal of conjecture about it. In very recent years considerable light has been thrown upon it. This we will discuss later. Clinically the two cases described are typical cases of kernicterus. Jaundice early in life which persists, going on to signs and symptoms of a degenerative central nervous system. The mortality rate of kernicterus is very high, fortunately. In this way only are these two cases unusual, because they lived. Kernicterus has always been considered almost 100% fatal. These cases show early in life signs of erythroblastosis in their peripheral blood. At post mortem they show other signs of icterus gravis, enlarged spleen and liver with erythroblastotic areas in them. Forty percent of all cases of icterus gravis show signs of kernicterus. The following are the changes in the brain: the C.S.F. and the brain coverings may be yellow. As a. rule the cortex is not stained but microscopically has been found to contain pigment. The major part of the pigmented areas are in the basal ganglia. Intense staining is found in the lenticular and caudate nuclei. There is less often staining of dentate nuclei, mammillary bodies, inferior olives. Sometimes the bulbar nuclei'and spinal gray matter are stained. Petechial and even massive hemorrhages may occur. The ependyma may also be stained. Histologically it is found that the ganglion cells in the pigmented areas are severely injured. Many cells have completely disappeared and others show various degrees of disintegration. These changes seem to be most intense in the basal ganglia. Demyelination of various parts of the white matter has been found even in the spinal cord. If the child lives long enough it has been found that the pigment tends to disappear leaving only the destroyed architecture of the cell layers. The foregoing is a description clinically and pathologically of kernicterus. In the past, aside from mild variation that was the gist of all cases of kernicterus. They were considered rare. In any of the older case reports there was a great deal of theorizing. Page Two Hundred and Thirty-nine "■:*} ? 4> >3M 1 ■ml ji ill So* 1-j., iJ.f I Ford in his 1937 edition of Diseases of the Nervous System in Children has this to say: "The familial incidence suggests that a metabolic disorder of constitutional type may be to blame. It has been regarded as an expression of an intoxication due to disfunction of the fetal liver or blood forming organs and by other authors as the result of material toxemia. Zimmerman and Yonnet believe that in the nonfamilial forms generalized infections are often responsible." I might say that there was just as much theorizing about icterus gravis. In 1933 Blackfan and his colleagues showed more or less conclusively that congenital anaemia, hydrops, feotalis and icterus gravis have a common denominator, erythroblastosis. The three conditions were due to whatever it was that caused erythroblastosis. Up to this time the three conditions have been treated as being isolated conditions. It was rathr fortunate that this excellent piece of writing came in 1933 because of what happened in 1941. In that year Levine and his co-workers clearly indicated the importance of Rh iso-immunization in the etiology of erythroblastosis fetalis. Since kernicterus is found primarily in children with erythroblastosis this relationship becomes important in kernicterus. I should like at this moment to review the Rh factor but time does not permit . Many of us here will remember the excellent paper Dr. Turvey gave us some time ago on the Rh factor. It was published in The Bulletin. In the light of our added knowledge since 1940 how does tonight's report appear? To diagnose kernicterus without post mortem evidence we should have: (1) Father Rh positive. (2) Mother Rh negative. (3) Patient Rh positive. (4) Neonatal history of erythroblastosis or persistent jaundice diagnostic of icterus gravis. (5) Evidence of basal ganglion disease. (6) Severe mental deficiency. The only thing we lack is the question of whether our patients were Rh positive. We may reason this way. Since we can in all probability say that they had icterus gravis, then we can say that they had erythroblastosis and if erythroblastotic then they were Rh positive. I will point out the loopholes later. An isolated report of two cases of kernicterus with some discussion is of little value except to remind us of the clinical entity. It should make one stop and think of the relationship of the Rh factor to the whole question of general brain damage and mental deficiency in children. There has appeared in the literature several articles recently along this line. In one report twenty cases of erythroblastosis were analyzed. Of these twenty, thirteen survived. Five of these thirteen showed some manifestation of kernicterus, e.g. neurological manifestations. This is rather a disturbing thought. Erythroblastosis of the new born is quite common. Do 38% of all survivors of erythroblastosis have some brain damage? Yannet in 1944 at the Southbury Training School for Mental Defectives divided his patients into two main groups: (1) The differentiated, i.e. microcephalics, mongols, and so on. (2) The undifferentiated, that is those which did not fit into any clinical picture. In a random sampling of the population at large one would expect to find from 13-15% of individuals Rh negative. In testing the group of mothers of the differentiated group that is exactly what Yannet found. In testing the group of mothers of Page Two Hundred and Forty the undifferentiated one he found 25% of them to be Rh negative. He states that the figures are statistically significant. His conclusion is, "While the demonstration of an Rh negative mother of an Rh positive mental defective does not make the diagnosis of foetal central nervous system due to maternal Rh iso-immunization, it does indicate the group in which this is a distinct possibility. Further clinical study of a large group of this type, may eventually result in a clinical characterization for which blood studies may have confirmatory value." Recently he has analysed another group going to greater detail. Apparently he has been able to prove to his own satisfaction that in the undifferentiated group he could prove statistically that the Rh iso-immunization was a factor in the production of mental deficiency. Of a group of 350 mental defectives with I.Q. less than 30, it was possible to get blood samples from 277 mothers. Of this group of 277, 158 could be placed in well recognized classifications. 119 were placed in the undifferentiated group. 14% of mothers in the control group wer Rh negative. 22% of mothers in the undifferentiated were Rh negative. The random distribution of the Rh factor is such that an Rh negative woman has a 60% chance of giving birth to an Rh positive child. In the control group this is exactly what was found, 12 Rh positive children. In the undifferentiated on the same basis one might have expected to find 15 or 16 Rh positive children. Actually 19 were found. Another group of workers studied 68 undifferentiated institutionalized mental defectives and found almost twice the number of Rh negative mothers and incompatible mother-child relationships than should have been present on the basis of random selection. In any of the dissertations on the Rh factor that I have read it has always been stated that the Rh-anti-Rh reaction takes place late in the pregnancy certainly after the seventh month. This is presumably because the results of the reaction are sought in the peripheral blood namely signs of erythroblastosis. Apparently it goes deeper than that. The Rh factor is present in all the tissues of the body. So the destruction of all the tissues of the body may take place very early in the pregnancy. Because the reparative capacity of the injured neuron is meagre permanent damage may remain. Another theory expressed by Yonnet is that even early in the pregnancy, depending on the titre of the Rh-anti-Rh reaction, red blood cells are destroyed. When the destruction is greater than the blood formation the developing neuron is deficient in oxygen and is damaged. Later when the compensation of the bone marrow catches up further neuronal damage is prevented. Thus, only in those cases in which maternal antibodies were produced in sufficient concentration relatively early in pregnancy would kernicterus be observed. Although we are able to keep children with erythroblastosis alive we cannot repair the damage done to their brain. If we are to believe one report, 38% of a small group of surviving erythroblastotic infants showed signs of brain damage. More patients with kernicterus will survive than in the past. Of that there is no doubt. An isolated fact can be very interesting but when it can be fitted into its place in a larger scheme it is usually enhanced. The original demonstration, that when the blood of rhesus monkeys was injected into rabbits and guinea pigs they produced an antibody, was interesting. Later it was found that most humans had an agglutinogen similar to the rhesus blood. Then it was shown that when blood with this agglutinogen entered the circulation of an individual without it that they in turn had the power to produce an agglutinin against it. Later it was shown that this agglutinogen-agglutinin reaction could be productive of a very serious illness in infancy, i.e. some manifestation of erythroblastosis. Now we are told that this may explain some of the puzzling cases of feeble-mindedness. Starting ,with a relatively simple idea it has come to colour our thinking in a much broader field—that of child development, (or rather the lack of it.) The thought that theoretically the progeny from the mating of people with Rh incompatibility may result in the production of a certain number of feeble-minded chil- Page Two Hundred and Forty-one h' tji »s V.T If dren, no matter what we do, can be rather frightening. Certainly in working with children one must become very conscious of it. This knowledge may become another weapon in our array of weapons to prevent unhappiness. It can be used in the future to explain to unhappy parents the cause for the production of more than one blighted child. But like all weapons it should be used wisely and in the right place. Let ine digress a moment. The knowledge of the Rh factor may solve other riddles. It is even leading us into the ethnological fields. It has been found that among Eskimos, N. A. Indians, Chinese, Japanese, the Rh factor is almost universal. There are no Rh negative individuals. Erythroblastosis fetalis is said to be almost unheard of amongst Chinese infants. Just what this means I do not know. But this much can be said that even among these people when there is mixture with the white race Rh negative individuals begin to appear, with the suggestion that there will be erythroblastosis and all that it connotes. This is a sour note to end upon but I have no more to say Bibliography: 1. JORDAN, Dennis—Survey of Blood Grouping and Rh Factor in the Eskimos of the Eastern Arctic, 1945. CMAJ—54: 1946. 2. LEVINE, Philip—On Human Anti-Rh sera and their Importance in Racial Studies. Science, vol. 96: 452, 1942. 3. LEVINE, Philip and "WONG, Helena—The Incidence of the Rh Factor and Erythroblastosis etalis in Chinese. A. . of Obs. & Gyn., Vol. 45: 832, 1943. 4. STRONG, Robert A. and MARKS, H.P.—Icterus Gravis Neonatorum. J. of Ped. 15: 658, 1939. 5. TURVEY, S. E. C.—The Role of Heredity and the Clinical Significance of the Rh Factor. Bull. V. M. A. 20: 100, 1944. 6. YANNET, Herman and LIEBERMAN, Rose—Central Nervous System Complications Associated with Kernicterus. J. A. M. A. 130: 355, 1946. 7. WALLER, Robert K. and LEVINE, Philip—On the Rh and Other Blood Factors in apanese. Science, 100: 453, 1944. 8. YANNET, Herman—The Importance of the Rh Factor in Mental Deficiency. Bull. N. Y. Acad, of Med. 20: 512, 1944. a. »CT Page Two Hundred and Forty-two OBITUARIES DR. S. C. MacEWEN Obiit IS June 1947. The recent death of Dr. S. C. MacEwen, better known as Cam MacEwen, means a very great loss to the profession of British Columbia, to whom he. was very well known in the later years of his life, as the medical director of the M.S.A. of this Province. ' Cam MacEwen was a very good fellow—and we think it is true to say that every medical man who knew him, and came in contact with him officially, not only respected him, but liked him personally, and trusted him completely. He tried always to be fair and generous, and succeeded admirably in a very difficult position. His work on the M.S.A. was outstanding, and he did much to bring it to its present very high position in the life of B.C. He was approachable and friendly, and his loss will be very keenly felt by this great organization. Dr. MacEwen was one of the three MacEwen brothers of New Westminster, where he practised for many years, and was well known, and very much liked. His medical work was of a high order, and he sacrificed much to take up the M.S.A. work. To those who mourn him as one of their own family, we extend our condolences and sympathy. DR. BERTIE BLACKWOOD Vl > Obiit 7 July 1947. Very few of the medical men now practising in Vancouver will have known Dr. Blackwood, whose ill health forced him into virtual retirement some years, ago—but many of the older men will remember him well, and will mourn his passing. Dr. Blackwood resided and practised in Kerrisdale for many years, and had a large practice. He was very highly esteemed by his fellows, and very successful as a practitioner. He met his very tragic fate courageously and philosophically. % ♦' h' *i iW if Page Two hundred and Foryt-three :! We were sorry to learn of the passing of Dr. Bertie Blackwood, a well known doctor in Vancouver. During the first World War he served with the Canadian Army and later with the British Army Medical Corps. Following the war he was Medical Health Officer and Police Surgeon in Vancouver for a number of years before returning to private practise. Deepest sympathy is extended to Mrs. Blackwood and family. The profession extends sincere sympathy to Dr. J. G. McMurchy of Nelson in the loss of his wife. We regret to record the death of Dr. George Edward Duncan. Dr. Duncan registered in British Columbia in 1900 and retired from active practise several years ago. We extend our sympathy to Mrs. Duncan in her bereavement. Doctors attending the Canadian Medical Association Annual Meeting, held in Winnipeg during May, report that it was most successful. The British Columbia Division was well represented, a large number of doctors found it possible to attend the sessions. i'j»r The profession extends to Dr. Honor M. Kidd congratulations on winning the Osier medal from the American Association of Historical Medicine. Dr. Kidd is the first woman and the first Canadian to win this award. ;'* i* Congratulations to Dr. and Mrs. W. F. Bie on the birth of a daughter, and to Dr. and Mrs. C. C. Covernton on the birth of a son. Among those doctors taking vacations at the present time is Dr. W. H. White holidaying at Christina Lake and Dr. G. S. Purvis who is spending a month at Gunn Lake. Dr. and Mrs. E. S. Hoare and family, of Trail, are vacationing at the coast. Dr. and Mrs. G. F. Enns motored to Winnipeg, where Dr. Enns attended the C.M.A. Meeting, and where they will spend some time visiting relatives and friends. '* Congratulations and best wishes extended to the following doctors on their recent marriages: Dr. and Mrs. William R. MacEwan, who will reside at South Shalalth. Dr. and Mrs. W. H. Sutherland who will make their home in Vancouver. Dr. and Mrs. T. W. Tysoe will live at Britannia Beach where Dr. Tysoe is the resident doctor. Page Two Hundred and Forty-four Dr. and Mrs. L. A. Patten are holidaying at Jasper. We are glad to hear that Dr. Patten's health is much improved. * I Dr. J. H. Sturdy has left the Vancouver General Hospital to join the Department of Pathology at the Banting Institute in Toronto. Dr. A. A. Gordon who has been doing post-graduate work at the Vancouver General Hospital has now joined the Montreal Pathological Institute at McGill University. Dr. Chas. G. Patten has left Hope to join in the practice at Chilliwack with Dr. R. W. Patten. • Dr. J. H. Stapleton has left Vancouver to take up practise in Penticton. Dr. R. D. Morrison, formerly of Vancouver, has taken up practice at Hope. Dr. J. G. MacArthur of Prince George made a rush visit to Saskatoon to see his father. We are glad to know Mr. MacArthur is now progressing favourably. At the annual meeting of the Central Interior Medical Association, recently held in Prince George, the following officers were elected: Dr. J. G. MacArthur, President. Dr. Larry Maxwell, Secretary. The annual dinner and election of officers of the Westminster Medical Association was held. The following officers were elected: Dr. Bruce Cannon, President. Dr. J. F. Sparling, Vice-President. Dr. A. C. Ross, Secretary-Treasurer. Doctors W. A. Clarke and H. B. Lockhart, Directors. 4> Dr. T. R. Whaley has added four new Kentucky thoroughbred fillies to his string at Beverley Place near Chilliwack. Some excellent stock is expected from this choice line. '.t V.\\ Page Two Hundred and Forty-five B.D.H. 1 OESTROGENS »•( ► For broadest therapeutic application, the range of B.D.H. Oestrogens includes both natural and synthetic substances for oral and parenteral use for the treatment of all conditions attributable to hyposecretion of the ovarian follicular hormone. i .71 DIENOESTROL B.D.H. The new synthetic hormone ► Being non-toxic and available at low cost, Dienoestrol B.D.H. possesses all the advantages of both the natural and synthetic oestrogens and none of the disadvantages. FOR ORAL USE—Tablets of 0.1 mgm., 0.3 mgm. and 1.0 mgm. DIENOESTROL COMPOUND B.D.H. Each tablet presents Dienoestrol B.D.H. 0.1 mgm. combined with Phenobarbitone }/£ grain. J >VI :;»! OESTROFORM ^ Preparations of the natural oestro- genic hormone are issued in various forms and standardised biologically. FOR ORAL USE—Tablets containing 1,000, 5,000 and 10,000 inter- national units. FOR INJECTION — Ampoules of 1 cc. containing 2,000, 10,000, 20,000 and 50,000 international benzoate units. FOR VAGINAL USE — Pessaries each containing 1,000 international units. STILBOESTROL B.D.H. ^ The original synthetic oestrogen prepared for oral and parenteral use. FOR mgm. FOR 1 cc. ORAL 0.25 USE- mgm., and 5.0 mgm. -Tablets of 0.1 0.5 mgm., 1.0 INJECTION — Ampoules of containing 1.0 mgm. and 5.0 STILBOESTROL COMPOUND B.D.H. Each tablet presents Stilboestrol B.D.H. 0.25 mgm. combined with Phenobarbitone ^ grain. IT' STILBOESTROL DIPROPIONATE B.D.H. and HEXOESTROL B.D.H. are also available in tablets of 1.0 mgm. THE BRITISH DRUG HOUSES TORONTO (CANADA) LIMITED CANADA 79-47 Breaks the vicious circle of perverted f menstrual function in cases of amenorrhea, tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic relief by stimulating the innervation of the I uterus and stabilizing the tone of its II musculature. Controls the utero-ovarian Ilk circulation and thereby encourages a L i^ normal menstrual cycle. f%^ % MARTIN H. SMITH COMPANY Jk St. ISO L»f ATIITI STMR. NIW TO«K. N. V. (^ p Full formula and descriptive literature oft 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. AUTOGENOUS VACCINES For the treatment of chronic infections, such as recurrent boils, pustular acne, chronic sinusitis, rhinitis, etc. All vaccines are tested for sterility. Telephone PAcific 4839 mEDICPL LABORATORY OF Dr. P. 5. RUTHERFORD 312 Vancouver Block, Vancouver, B.C. u v w :* B ft £ H l V '*•! I . j i i 1 EM Wk* H I V If k;T] 2/ 41 p'J w HI Z'^M v^J| A New Synthetic Antihistamine] Agent for the treatment of INDICATIONS Hay Fever - Urticaria - Pruritus - Urticarial Dermatitis - Anaphylactic Reactions Serum Sickness - Vasomotor Rhinitis PRESENTATION I Neo-Antergan is presented in tubes of m 50 coated tablets each containing 0.1 iGm. of acid maleate of N-dimethyl amino-ethyl-N para-methoxy- benzyl-amino-pyridine. SS ^idiWf.-:^-- Iff In the near future: Neo-Antergan Tablets 0-05 Gm. Neo-Antergan Ampoules 0.05 Gm. JxLuvxaJjcruj I aiUenx: jxe/i&4 OF CANADA U M I T I D - M O A/ 7 fl f 4 I ^^it^&K£$3M life.. "Gastro-Intestinal . 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SUPPLIED in 6 ounce bottles for prescription use, 32 ounce bottles for dispensing. ** WINDSOR, ONT. NEW YORK KANSAS CITY SAN FRANCISCO DETROIT SYDNEY, AUSTRALIA AUCKLAND, NEW ZEALAND H *Kopelowitz, J. O.: J. Missouri St. M. A. 38:55,1941 Gastron Trade-Mark Reg. S-107A V • ,-y *.tt' I* w. 4*\\i U ORTHO-CREME Vaginal Cream is soft, white and pleasandy scented, and has been formulated especially for those patients who prefer a cream to a jelly. Clinical evidence indicates that one out of three patients has this preference.* It is effective, tolerable to the vaginal mucosa, and possesses marked stability. ORTHO-CREME has received the A.M.A. seal of approval. I? ft: *REFERENCE: Marie Wessels, M.D. Human Fertility, Vol. 5. No. 6, December, 1940 ORTHO PHARMACEUTICAL CORPORATION (CANADA) LIMITED — TORONTO ► ff Calcium-Sandoz [calcium-glucono-galacto-gluconate) often gives dramatic relief in the treatment of estival ills INSECT BITES • CONTACT DERMATITIS - HAY FEVER Wasp, Hornet and Bee Stings Dermatitis venenata — Poison Ivy Granules — Chocolate and Effervescent Tablets — Ampoules. V tt Calcibronat-Sandoz ff (calcium-bromide-lactobionate) is most effective in Itching Dermatoses URTICARIA - PRURIGO - DERMATITIS - ECZEMA Penicillin Reaction and Allergic Reactions Granules — Effervescent Tablets — Ampoules LITERATURE AND SAMPLES ON REQUEST. SANDOZ Sandoz Pharmaceutical Dept. The WINGATE CHEMICAL CO. LTD 378 St. Paul Street West Montreal 47-1 Y. 'A * • ' Em l ' ri 'V *!*i t \\ 4 • 1 V 1, I t ,,jr u * < * if' ' ' '. 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