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History of Nursing in Pacific Canada
Vancouver Medical Association
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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: Dr. J. H. MacDebmot Dr. G. A. Davidson Dr. D. E. H. Cleveland All communications to be addressed to the Editor at the above address. Vol. XXII. JANUARY, 1946 No. 4 OFFICERS, 1945 - 1946 Dr. Frank Turnbull President Dr. H. A. Des Brisat Vice-President Dr. H. H. Pitts Past President Dr. Gordon Burke Hon. Treasurer Dr. G. A. Davidson Hon. Secretary Additional Members of Executive: Dr. R. A. Gilchrist, Dr. W. J. Dorrance TRUSTEES Dr. J. A. Gillespie Dr. A. W. Hunter Dr. G. H. Clement Auditors: Messrs. Plommer, Whiting & Co. SECTIONS if Clinical Section Dr. S. E. C. Turvey Chairman Dr. E. R. Hall Secretary Eye, Ear, Nose and Throat Dr. Grant Lawrence. President Dr. Roy Mustard i Secretary PaediatHc Section Dr. Howard Spohn Chairman Dr. R. P. Kinsman Secretary Orthopaedic and Traumatic Surgery Section Dr. K. J. Haig Chairman Dr. J. R. Naden Secretary Section of Neurology and Psychiatry Dr. A. M. Gee Chairman Dr. J. C. Thomas Secretary STANDING COMMITTEES Library. Dr. W. J. Dorrance, Chairman; Dr. F. J. Buller, Dr. R. P. Kinsman, Dr. J. R. Neilson, Dr. D. E. H. Cleveland, Dr. S. E. C. Turvey. Publications: Dr. J. H. MacDermot, Chairman; Dr. D. E. H. Cleveland, Dr. G. A. Davidson, Dr. J. H. B. Grant, Dr. S. E. C. Turvey, Dr. Grant Lawrence Summer School: Dr. L. G. Wood, Chairman; Dr. J. C. Thomas, Dr. A. M. Agnew, Dr. L. H. Leeson, Dr. A. B. Manson, Dr. A. Y. McNatr. Credentials: Dr. J. R. Netlson, Dr. H. H. Pitts, Dr. A. E. Trites V. O. N. Advisory Board: Dr. Isabel Day, Dr. J. H. B. Grant, Dr. G. F. Strong Representative to B. C. Medical Association: Dr. H. H. Pitts Sickness and Benevolent Fund: The President?—The Trustees EPINEPHRINE. U THE PRESSOR PRINCIPLE OF THE ADRENAL GLAND EPINEPHRINE is prepared by Connaught Laboratories from beef adrenal glands as a pure crystalline compound which is used for three preparations:— EPINEPHRINE HYDROCHLORIDE SOLUTION (1:1000) — a sterile solution in 30-cc. rubber-stoppered vials to be given by intramuscular, intravenous or subcutaneous injection as a heart stimulant and to raise blood pressure. EPINEPHRINE HYDROCHLORIDE INHALANT (1:100) — distributed in special dropper bottles containing 6 cc. to be used in the treatment of bronchial asthma. EPINEPHRINE IN OIL (1:500)—a sterile suspension in oil in 20-cc. rubber-stoppered vials for use intramuscularly when a prolonged effect is desired. >^| Each of these preparations is fully potent, is highly stable and is economical. CONNAUGHT|LABORATORIES University of Toronto Toronto 5, Canada DEPOT FOR BRITISH COLUMBIA MACDONALD'S PRESCRIPTIONS LIMITED MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. Wii \w£t- Si, oXv it for Mg§mL 0n, is Tit tHe tHat it ,0^ given' be EFFECTIVE LOCAL ANALGESIA ^n me tone, imitated tfotoat In the management of sore, irritated throat in children, effectiveness in providing prolonged topical analgesia at the site of irritation, plus ready acceptance, are most advantageously joined in— * sperqum Obviously resistance is negligible when children are given an agreeably flavored tablet of gum to chew. When Aspergum is chewed, a copious flow of acetylsalicylic acid-laden saliva is brought into immediate and prolonged contact with all pharyngeal areas including those seldom reached, even intermittently, by sprays or irrigations. The rhythmic stimulation of muscular action helps greatly to relieve local spasticity and stiffness. Supplied in packages of 16; moisture-proof bottles of 36 and 250 tablets. Ethically promoted—not advertised to the laity. White Laboratories of Canada, Ltd., 64-66 Gerrard Street, East, Toronto, Ontario, Canada. ♦Fantus, B.: The Technic of Medication, Chicago, American Medical Association, 1938, p. 5. ALIKE IN APPEARANCE !^dMw X tiny bodies, externally alike, may differ basically in their requirements af Vitamin ' SJjfhat Iff why Squibb Cod liver Oil comes in two potencies—> Squibb Cod liver OH far normal babies and Squibb Cad Liver Off with Viosterol 10D for premature or rapldM growing infants. sgu'Se • Today, as in 1875, Squibb Cod Liver Oil is helping babies build strong, healthy bodies. They didn't know it then— but now most people realize that it isn't the oil itself—but the vitamin content of the oil that counts. Squibb Cod Liver Oil is twice as rich in vitamins A and D as oils just meeting official pharmacopeia requirements. Therefore your patients have to give their babies one tea- spoonful only of Squibb's daily as against two teaspoonfuls of these less potent oils. The high quality of Squibb Cod Liver Oil is the result of careful rendering and refining of specially selected livers. Excessive heating and exposure to air is avoided and the final oil is carbonated and bottled under carbon dioxide to avoid oxidation of vitamin A. 7 Squibb Cod Liver Oil supplies, per gram, 1800 Int. units of vitamin A and 175 Int. units of vitamin D. It is available in 4 and 12 ounce bottles either plain or mint- flavoured. Premature or rapidly growing infants need extra vitamin D and should therefore receive Squibb Cod Liver Oil with Viosterol 10D, which contains 3000 Int. units of vitamin A and 400 Int. units of vitamin D per gram. *<**% CW Kent 9> S<2U*Si? wmn For literature write E. R. Squibb & Sons of Canada Ltd. 36-48 Caledonia Road, Toronto. 1 *£««»* S/jvcx VANCOUVER HEALTH DEPARTMENT STATISTICS—NOVEMBER, 1945 [tal population—estimated 311 799 panese Population—Estimated . _„ Etacua ted inese population—estimated. . 6,395 ndu population—estimated „ . 335 Rate per 1,000 Number Population Total deaths 356 13.9 Chinese deaths 19 36.1 Deaths—residents only . . 306 11.9 BIRTH REGISTRATIONS: Male, 282; Female, 257 539 21.0 INFANT MORTALITY: November, 1945 November, 1944 Deaths under one year of age I 21 16 Death rate—per 1000 births 39.0 3 0.1 Stillbirths (not included above) 3 15 CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY October, 1945 November, 1945 Dec. 1-15, 1945 Cases Deaths Cases Deaths Cases Deaths jarlet Fever ., 27 0 31 0 27 0 phtheria 10 2 0 4 0 iphtheria Carrier 0 0 0 0 10 0 fiicken Pox 66 0 121 0 87 0 jeasles f 10 0 2 0 6 0 tabella : _ 2 0 7 0 6 0 jumps i 32 0 46 0 48 0 hooping. Cough L... 0 0 0 0 0 0 lyphoid Fever _• 0 0 0 0 ,00 aidulant Fever : 0 0 0 0 10 piliomyelitis 11 0 0 10 iuberculosis ^ 59 13 68 21 pysipelas j 0 1 0 0 0 0 [eningococcus Meningitis 10 0 0 10 jratyphoid Fever 0 1 0 0 0 0 ^fectious Jaundice i 0 0 0 0 0 0 flmonellosis :_ 10 5 0 2 0 llmonellosis (Carrier) 0 0 0 0 0 0 ysentery _-_ 0 0 0 0 0 0 philis I 98 1 128 0 3 0 pnorrhoea 197 0 237 0 ancer (Reportable): Resident _ - 32 0 Non-Resident , .... 7 0 BIOGLAN iif*ll Prepared separately for male and female. Composition: Anti-thyroid principles of the pancreas, duodenum, em- bryonin, suprarenal cortex, tests (or ovary). Each 1 c.c. ampoule contains the equivalent of approximately 29 grams of fresh substance. Indications: Graves's disease, hyperthyroidism, exophthalmic goitre, thyrotoxicosis. The most effective therapy available. Stanley N. Bayne, Representative Phone MA. 4027 1432 MEDICAL-DENTAL BUILDING Vancouver, B. C. Descriptive Literature on Request THE SCIENTIFIC HORMONE TREATMENT Page.68 n u„«i om°t>c miiM Presenting a stable, non-irritating solution of sulfanilamide, urea and chlorobutanol in a glycerin vehicle of unusually high hygroscopic activity. Oto- mide offers these definite clinical advantages: INVIVO ANTIBACTERIAL POTENCY—not inhibited by pus. POTENTIATED ANTIBACTERIAL ACTIVITY—urea-sulfanil- amide mixture more effective than either drug used independently.1 WIDE FIELD—effective in BOTH acute AND chronic otologic infections. Active against sulfonamide- resistant bacteria.2 TOLERANCE—freedom from alkalinity—virtually obviates local irritation. ANALGESIA—effective chlorobutanol analgesia without impaired sulfonamide activity. 1. Tsuchiya, H. M. et al.: Proc. Soc Exp. Biol, and Med., 50:262, 1942. 2. Strakosch, E. A. and Clark, W. G.: Minn. Med. 26:276, 1943. Brown, C. et al.: Am. J. Surg., to be published. Vtf TOM X5 AVAILABLE IN DROPPER BOTTLES OF ONE-HALF FLUID OUNCE (15 cc.) ON PRESCRIPTION ONLY ST '**. S/\) /0% ST WHITE LABORATORIES OF CANADA, LTD., 64-66 GERRARD STREET, EAST, TORONTO, ONTARIO WHITE LABORATORIES OF CANADA, LTD., 64-66 GERRARD STREET, EAST, TORONTO, ONTARIO ANCOUVER MEDICAL ASSOCIATION Founded 1898 :: Incorporated 1906 PROGRAMME OF THE FORTY-EIGHTH ANNUAL SESSION (SPRING SESSION) 111 NERAL MEETINGS will be held on the first Tuesday of the month at 8:00 p.m. [NICAL MEETINGS will be held on the third Tuesday of the month at 8:00 p.m. These meetings will continue to be amalgamated with the clinical staff meetings of the various hospitals for the coming year. Place of meeting will appear on the agenda. ruary 5—GENERAL MEETING. Dr. D. H. Williams: "Recent Advances in Dermatology." ruary 19—COMBINED CLINICAL.MEETING—St. Paul's Hospital. ch 5—OSLER DINNER—Hotel Vancouver. Osier Lecturer: Dr. A. L. Lynch. rch 12—COMBINED CLINICAL MEETING—Shaughnessy Hospital. ril 2—GENERAL MEETING. Dr. Carl G. Heller, University of Oregon Medical School: "Uses and Abuses of the Male Sex Hormone." il 16—COMBINED CLINICAL MEETING—Vancouver General Hospital. j 7—ANNUAL MEETING. Breaks the vicious circle of perverted menstrual function in cases of amenorrhea, tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic relief by stimulating the innervation of the uterus and stabilizing the tone of its musculature. Controls the utero-ovarian circulation and thereby encourages a i \ normal menstrual cycle. j % MARTIN H. SMITH COMPANY &. ' ISO IAEAYETTE STREET. NEW YORK. N. V. 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. Page 69 'I AT THE MENOPAUSE M.i. ^J.* <//*$ s ttfe Sfc ifc V/ .«L 0/ /. & Ml] ^ MHW< i. ^ » t: fefe / =Tl Line etching inspired by a study of Aristide Maillol These orally-active natural oestrogens have proved effective for all patients, regardless of the severity of their symptoms ... Premarin" (No. 866) for the most severe symptoms; Half-strength "Premarin" (No. 867) when symptoms are moderately severe; "Emmenin'' for mild symptoms. tt PREMARIN" tt EMMENIN tt conjugated oestrogens {equine) Tablets No. 866: Tablets No. 867 GyM* conjugated oestrogens (placental) Tablets No. 701; Liquid No. 927 NATURALLY OCCURRING —WATER SOLUBLE —WELL TOLERATED — ESSENTIALLY SAFE IMPART A FEELING OF WELL-BEING 35 AYERST, McKENNA & HARRISON LIMITED • Biological and Pharmaceutical Chemists • MONTREAL, CANADj 'Ike ZdUwA Paae A very important move has been made by the new Committee on Medical Economics : British Columbia. This is a merging into one of two former Committees, one of |e B. C. Medical Council, and the other of the B. C. Medical Association. The new bmmittee represents both, and its formation will mean economy of time and personnel, id better concentration of effort. Their first move has been to set on foot a plan for a Medical Association Building, ^at will house the B. C. College of Physicians and Surgeons, the B. C. Medical Asso- ation, and the Vancouver Medical Association and Library. This, we think, is a splen- d piece of work, and we hope every medical man in the province will support it. At esent, these three organizations are jammed into a space which is entirely inadequate f-the staff is cramped so badly that it is impossible for them to do their work with any ise or satisfaction—it is a wonder how they get it done at all. There is one Board oom, which is in constant demand—frequently meetings have to be held in the Read- :g Room, which is all wrong. There is no space for filing—no Committee rooms— id if one has to give dictation, one might as well be on the corner of Georgia and ranville. Such a building would be of value not only to Vancouver, but to the whole prov- ce. Men coming here, wanting to discuss matters with the Secretary of the B. C. 'edical Association, would find a place that they could make their medical headquar- rs, with ample room and some comfort. We presume that an adequate auditorium ould be part of the scheme, and this would make for better meetings. Each organiza- Dn would have its own quarters—committees would have plenty of accommodation— ctional meetings could be held, and so on. We even hope that a corner will be reserved >r Editorial offices for the Bulletin—but perhaps we have gone far enough. In any ise, we wish success to this project, and assure its authors of our sincere sympathy and ipport. ■ # * * * We rejoice to see that a hospital survey is planned, to enquire into the whole hospital tuation in B. C. and can only hope it will start work soon. Certainly, we are in a ess, in this regard. The worst of it is, that we cannot blame anybody for it. The >spital authorities have done all that lies in human power to do—they have stretched leir resources to the ultimate cracking-point, they have shewn the greatest considera- mi and courtesy under circumstances of great strain on their staff—and they have :complished wonders. But the limit has been reached, and one can only keep one's agers crossed, and hope prayerfully that no great emergency will strike us until some eans has been found to bring relief. Meantime, there is a good deal that we can do as individuals ourselves. We can torten patients' stay in hospital in a great many cases. A simple hernia or appendix— normal confinement, and so on—all these could go home in a few days, sometimes not itirely willingly—since everyone enjoys a few days' rest, with meals brought to them, at we should, in this case, think strongly and continuously of the great need for beds, id turn a deaf ear to the patient, quite fit to go home, who tells us "Well, Doctor, I link I won't go home Friday, I'll stay another week—the house is cold, and after all ie Blue Cross, or the B. C. Telephone, or the W.C.B., is paying for it." In such cases, we must be firm about the matter. Most people are quite reasonable, id if given a genuine and clear explanation, will see the fairness of what we are telling tern. Incidentally, we are glad that hospital care is not yet entirely free, as our fficulties in such a case would be doubled: it would be much harder to send patients >me. {&? Page 70 One of the great troubles nowadays is the difficulty of obtaining nursing assistaij at home, and this undoubtedly has a very definite bearing on the whole hospital prqj lem. But people can very often obtain some help, if they really try, and we shoii urge them to do so. Also, there is that most excellent organisation, the Victorij Order, which never lets you down—and they can be of the greatest help. We mention these things, since there is sometimes a tendency to blame everythii on the other fellow, namely, the hospital administrations. But we have a distirij responsibility in this matter, and till we have done all we personally can do, even if! means a bit more trouble, and an occasional house call, we have not done our full du and cannot fairly escape this responsibility. It is with pleasure that we enclose in this issue of the Bulletin a copy of a Br prepared by the Premedical Students at the University of British Columbia. Trul young men, who will some day take over the torch from our "failing hands," are be commended for the energy and persistence they are shewing. We should give th^ all the help and support that is in our power—and by any means that we can jusil employ, back up their most praiseworthy effort. The medical school at the U.BJ is not going to come easily or without a great deal of hard sledding—it is going to j a costly undertaking, of great size and involving much planning and adjustment-^-al the first essential is to educate public opinion, first to an appreciation of its urgend and secondly to a demand for its establishment. The Bulletin, we are sure speal for every practising medical man in British Columbia, when it wishes the authors this brief every success in their effort. I MEETING OF THE C. M. A. JUNE 10-12 | It is not too soon to begin making plans for this meeting—in fact, it is vital th all those who wish to go should send in their names at once—as the number of the who can* be accommodated is definitely limited to about 1070 people. After this nur ber of applications has been received, refusals will be regretfully returned to all wl apply too late. Applications should be sent to the Committee on Housing, 203 Medical-Dent Building, Vancouver, B.C., and should contain the following data: Name and address; Number in party—whether Single, accompanied by wife, or daughter. Date of arrival and departure from Banff. There will be practically no single rooms—all rooms will contain two persons, coming singly, men may pair off, and send in the two applications together.' This w: give a choice of room-mate. The rates at the Banff Springs Hotel will be $11 a day, inclusive of room and mea (American plan). All rooms are good, and nobody need fear having a dark or uncon fortable room. All rooms have bathrooms. The rates at the other hotels, which a excellent, modern hotels, are somewhat lower. Applications will be received either as above, or at Banff. All will be referred i the Committee on Housing, which will furnish them in chronological order to the Mai ager of the Banff Springs Hotel. He will assign rooms in this order. Beyond certai reservations which are necessary, there will be-no priorities, and the sooner your applic; tion is in, the more certain you will be of a room. The current number of the CM.A. Medical Journal will contain fuller details tha are here given. Special provision is being made for entertainment, especially for ladies accompan] ■big their husbands, or fathers. Page 71 CORRESPONDENCE The subjoined letter, received from our very good friend, Dr. W. W. Francis, jrarian at the McGill Medical Library, caused an acute capillary suffusion of our facial i. In other words, "is our face red?"! But we are very grateful, all the same, to Dr. bcis—and we appreciate deeply the tact with which he recounts his own experience. I have had few opportunities to be deceived in this way, and so were easily misled. We hasten here to acquit all those concerned with this gift, of any knowledge that i letter was not genuine. We know full well, of course, that the gift by Mrs. Stone Dr. Kidd was made in perfect good faith, and with nothing but the most generous motives: and we value greatly Dr. Kidd's contribution. In any case, even as a facile, the letter is valuable and interesting, and we are glad to have it. But we think alutary discipline to publish Dr. Francis' very kindly and scholarly letter. There is, m what he says, just a remote chance that this is the original letter—and we intend invest in a powerful magnifying glass which will, we hope, render visible the sand ich would prove its authenticity. McGill University Montreal Osler Library, 11 January, 1946. e Editor, lncouver Medical Association Bulletin,. 3 Medical-Dental Building, orgia Street, ncouver, B. C. jar Dr. MacDermot, That Jenner letter! The one and only may still be somewhere, possibly with you in mcouver, but a most deceptive lithographic facsimile was published (without any :ntion in the contents) as frontispiece to the 2nd vol. of the ananymous "Professional ecdotes, or ana of medical literature," London, J. Knight, 1825. Our printed cata- *ue, Bibliotheca Osleriana, is probably in the Association's library. If so, you will find description of the letter in item 1268 on p. 128. I had catalogued our copy as an iginal, but when I came upon some correspondence showing that Osier (knowing its nnection with the "Anecdotes") was doubtful about it, I just had time to alter the scription. I took our letter to an expert, who held it up so that the light would strike at an angle of about 30 degrees. There was no shimmer of the sand which would have en used to blot it if the document had been written with a pen in 1807. If your letter shows particles of sand, it is genuine; otherwise, it is probably a fac- nile, particularly if it shows' signs of having been inserted in a book and folded to a :e less than 7x4 inches. The letter was written to Sir Richard Phillips (1767-1840), publisher of the Monthly Magazine," and the reference to the King of Spain is of Canadian interest, nner had obtained from him the release of the son of Judge Powell of Upper Canada, ho had been condemned as a pirate. See W. R. Riddell, Canad. J. Med. & Surg., 66: )3, 1929, and E. P. Scarlett, Calgary Hist. Bull., Feb., 1940, p. 11. I hate to play iconoclast, so I hope you can produce the sand! Yours sincerely, W. W. Francis. Page 72 LIBRARY NOTES RECENT ACCESSIONS TO THE LIBRARY— Clinical Neurology, 1945, by Bernard J. Alpers. Arthritis, 3rd Ed., 1944, (Review copy), by Bernard I. Comroe. The Canada Year Book, 1945. Surgical Clinics of North America, Symposium on Gynecology and Obstetrics, I cember, 1945, Philadelphia number. Applied Physiology, 1945, 8th ed., by Samson Wright. Surgical Anatomy, 2nd ed. (Reprinted 1945), by C. Latimer Callander. NEW JOURNALS Two new journals are being received in the Library—the Acta Medica Scandinavi and Occupational Medicine. Many of our members are familiar with the "Acta" series which cover a number the specialties. They are published in Stockholm, and the articles appear in Englid French or German, depending on the choice of the author. The Acta Medica conta original articles on research work in the field of Internal Medicine, and are recommend^ to the members as being well worth their attention. An outline of the table of contents of the current issue is given herewith: A chromaffine tumorur simulating Graves' disease—Erik Waaler (Bergen, Norway The effect of nitroglycerine in cardiospasm—Rolf Weyde (Tonsberg, Norway). A new flat epithelial layer covering the gastric and intestinal mucosae—Frederj Duran-Jorda (Manchester, England). An unusual electrocardiographic manifestation of intraauricular dissociation in pair of identical twins—Torsten Lindqvist and Nils Soderstrom (Gothenburg Sweden). Hyperglobulinemia with a unique thermolabile (gamma) component—Greta Hani marsten, Gunnar Lindgren, Borje Olhagen and Rune Ordell (Stockholm). Method for examination of each kidney separately—Kaj Larsen (Copenhagen). VH. Recent studies of tubular functions in normal and deficient kidneys wit] special regard to urea—Gosta Ekehorn (Stockholm). Origin and development of a new therapy for crush injury, transfusion kidney an a certain number of other diseases—Johan T. Peters (New Orleans, U.S.A.). Clinical and pathological findings in myelomatosis and plasma cell leukemia—Jakoi Boe (Bergen, Norway). Occupational Medicine is a new publication of the American Medical Association and takes the place of War Medicine, which has been discontinued. It is felt that th^ material in the new journal is timely, and that it is a necessary addition to the Library! A wide selection of abstracts of related subjects is included. ANNOUNCEMENT RE EVENING HOURS FOR LIBRARY The Library Committee announces that as an additional service to members, the Library will be kept open three evenings each week—Monday, Wednesday and Friday, until 9:30 o'clock, commencing on MARCH 4th. It is hoped that the evening hours will fill the need for further use of the Library by those members who, for one reason or another, are unable to visit it during the day. Page 73 ISTORY OF THE VANCOUVER MEDICAL ASSOCIATION By Dr. G. A. Kidd Continued rrom the December Issue A student of the early histories- of the City of Vancouver and of the Province of itish Columbia will be struck by the large part played in their development by medi- I men practicing their profession within their borders; a part out of all proportion to e numbers involved. Not a few were politically minded and served on the City luncil or in the Provincial Legislature. In earlier years, as the city took form, real ate values increased rapidly, and business opportunities which offered themselves were my. By taking advantage of these, several pioneer doctors laid the foundations of nsiderable fortunes. A few retired altogether from professional work and gave all eir attention to financial affairs. It is remarkable that from such a small group of men originally constituted the Vancouver Medical Association, so many should become tstanding, either in their own professional field, or in those of politics or finance. During its earlier years the Association interested itself more directly, and to a eater extent, in public affairs generally and in civic affairs in particular, than it d later. The attendance at the Society's meetings was not large—averaging less than reive members during the first seven years of its existence. However, the interest ken in these meetings seems to have been in inverse ratio to the numbers in attendee. Discussions were lively, to say the least. We find President Weld urging the mem- rs to show more courtesy and forbearance when discussing matters of a controversial iture, and on many a night the minute book shows that the motion to adjourn came ell after midnight. These men took their citizenship seriously. We find that the gular meeting scheduled to be held on Dec. 6th, 1900, was cancelled on account of a deral election being held on that date. By the end of the fourth year the Association realized that its purely educative mction was being neglected. There was so much business on the agendas that there as never any time left for the presentation of papers. It was accordingly resolved lat there must be a time limit placed on business discussion at regular meetings, and lat at each of these there should be read a paper on some medical subject. Urgent isiness must be attended to at special meetings, and, covering winter and summer asons, there were, for some years, more special meetings held than regular ones. Members interested themselves in a great variety of problems, usually taking the itiative and then pointing the way to a final solution. The following resolution, lopted in 1903, indicates the attitude of the Society towards the welfare of its Muni- pality: "Owing to the fact that there are various matters of civic importance needing le support and action of the Vancouver Medical Association, it is resolved that a per- tanent committee be appointed to deal with these, and to report to the Association "om time to time." These matters comprised such things as the health department, the ty's schools, vital statistics, medical care of the indigent, and many others. Most of lese reforms have long since been implemented, but at that time it required foresight id courage to suggest them. In his presidential address, given in 1903, Dr. Brydone- ack laid down for the Society's consideration a long list of projects which included such lggestions as inspection of the city's milk and meat supply at their sources; medical ispection of schools; notification of tuberculous cases, and appointment of a City Bac- ^riologist. The Association frequently clashed with the Health Committee of the City Council, which it frankly accused of playing politics. Page 74 During its earlier years the Society had so much business of a controversial nat with which to deal that the presentation of papers was largely neglected. There w exceptions, and papers which must have involved long hours of preparation were | before meetings at which not more than half a dozen members were present, and w discussed with spirit and occasionally with considerable heat. Many of these pajj dealt with problems which have since been solved, but were then of vital importancd the profession. We mention a few: Tuberculosis Dr. Brydone-Jack Bacteriology Dr. Underhill Typhoid Fever Dr. Weld Fractures Dr. Monro Abortion -■- Dr. Poole Wounds and Their Treatment Dr. LeFevre Urine Analysis Dr. Pearson Tuberculosis and Milk Supply Dr. Harrison The Intestinal Tract Dr. R. E. McKechnie Tonsils and Adenoids Dr. Farish Foreign Surgeons and Their Work Dr. Boyle Diphtheria Antitoxin and other Sera Dr. Fagan The X-Ray JDr. Riggs The city's first X-ray machine had that year (1900) been installed in the Hospi on Beatty St. One of the high-lights of those meetings of early years was a visit from Sir Laud Brunton. In 1907 he addressed the Association on Blood Pressure. He was at the tiri touring the continent in connection with the formation of an International Council Social Hygiene, which was to have its headquarters in Paris. It was proposed to estai lish branches across Canada, including Vancouver. As mentioned before, the earliest meetings of the Association were held in Dr. JacJ son's office over Atkins' drug store. Later they were held at the homes of various mer bers. Finally at the November meeting of 18999, held at the residence of Dr. LeFevre, was decided to find a permanent home for the Society. Henceforth it met in the Boa: of Trade rooms, at the corner of Hastings and Seymour Streets. The rental was $1.5 a night. Ill formation of the B. C. Medical Association One of the first tasks of the Vancouver Medical Association was to play a leadin part in the organization of a Provincial Medical Society. It might be well to review here the regulations governing the practice of medicine in British Columbia previous t this time. Between 1867 and 1898 three medical acts had been passed by the Provincial Legisj lature with several amendments and additions to existing laws. The first of these w2 passed in April of 1867. It was short: "Whereas it is expedient that persons requirin medical aid be enabled to distinguish between qualified and unqualified persons, there fore be it enacted," etc. The clauses included the appointment of a Registrar, and out lined the qualifications for medical practitioners. These were on the broadest lines— the possession of a diploma from any school in the United Kingdom, or a diploma fror any recognized school in any country which required a compulsory course of stud; extending over three years. If not registered in the Province no practitioner migh assume the title of Doctor of Medicine, nor might he collect fees. Otherwise ther seems to have been little to prevent his practising. Page 75 For several years the law was all but disregarded. Few took the trouble to register, mong the first to do so were Dr. J. S. Helmcken (1869) and Dr. J. C. Davies (1870), 3th of Victoria. A letter dated June 26, 1902, from Dr. G. L. Milne of Victoria to k. R. E. Walker of New Westminster, who was that year President of the B. C. Medical ssociation, describes conditions during the period following the passing of this first [edical Act: "The Act of 1867 admitted almost anyone for registration, and many of le itinerant Medical came this way, to stay in most cases for a short time, and while pre to do any and all kinds of advertising. Many came from San Francisco, and not nly used their own cards, but let it be known that they represented some well-known ractitioner in that city. They would put up at some well-known hotel and probably :ay for two or three months, doing a cash business." Matters remained like this until 1886, in which year the Medical Council of British polumbia was instituted. Victoria men were responsible for this Act. In 1885 they brmed a B. C. Medical Society which had a representative membership from Vancouver nd from Nanaimo. This body appointed a committee to draft an act to regulate the overning of the medical profession in British Columbia. It acted promptly and got gsults. The parent Society held six recorded meetings in the space of three weeks, and hen ceased to exist. Despite its short life, it was instrumental in having the Act of 1886 made law. In 1898 a third medical act instituted the College of Physicians and Surgeons of British Columbia. The study period of medical schools was extended to four years. In the minutes of a meeting held by the Vancouver Medical Association in January, [899, this short item appears: "The Secretary reported a communication from Dr. Fagan, secretary for the New Westminster Medical Association, re amalgamation with them. Consideration was deferred pending definite proposals." Nothing further is heard of his, but at the March meeting, following, a second letter from Dr. Fagan was read. in this the New Westminster Association asked that the Vancouver body combine with % in an effort directed towards the formation of a B. C. Medical Association. A committee formed to confer with the New Westminster men reported that in iheir opinion the formation of a Provincial Association was desirable. Drs. Pearson and ^agan were asked to take the matter in hand, &nd to communicate with the medical nen throughout the Province, asking for their co-operation. During the summer this vas done. Printed circulars—150 in all—were sent out. By autumn only 18 replies had been received. While nothing was heard from Victoria or Rossland, other centers, ncluding Atlin, Dawson, Nelson, Kamloops, Nanaimo and Fernie, had been enthusiastically in favour of the suggestion. In the face of such a discouraging response, the natter, in so far as the Vancouver Society was concerned, was apparently dead. Not so with the New Westminster Society. The men of the Royal City stuck to their guns, and under the date of Oct. 30th, 1899, we have a letter from Dr. Farish, Secretary of their Association. It reads: "Our members, one and all, were disappointed that so few replies have been received to our circular letter, and express their regret and disapproval at the action of the Vancouver Medical Association in abandoning the idea of establishing a Provincial Medical Association. A resolution to this effect has been passed, with the addition that the Vancouver Society be asked to reconsider its decision." Further suggestions being invited by the Vancouver group, the result was that a strong delegation from New Westminster was sent to attend the next regular meeting of the local Society, held in December, 1899. It consisted of Drs. Walker, Boggs, DeWolf Smith and Farish. The plan now outlined by Dr. Walker was something entirely new. He urged the formation of a Lower Mainland Society, to embrace Vancouver, New Westminster, Ladner and Chilliwack. He thought that this might constitute a foundation on which a Provincial Association would ultimately be built. Dr. Boggs supported Dr. Walker, as did Drs. Underhill and Brydone-Jack. It was proposed to hold meetings every three months. Page 76 President Weld of the Vancouver Association thought otherwise. He deprecated th^ suggestion as liable to estrange outsiders, and expressed himself as being very doubtfu] of the possibility of organizing such a Society. In this he was supported on purely medico-legal grounds by Drs. McGuigan, Carrall and Poole. Since a deadlock loomedi the meeting was adjourned to meet again in a month's time. On January 4th, 1900, representatives from the two Societies met in Vancouver Dr. Walker was in the chair. A prolonged discussion resulted in a motion by Dr. Hoops seconded by Dr. Drew: "In the opinion of this meeting it is desirable that a Provincia Medical Association be formed." This was carried. It was also arranged that delegates go to Victoria to discuss the question with the Society there. Henceforth things moved rapidly. On Jan. 18th delegates from New Westminster. Vancouver and Nanaimo attended a dinner given in Victoria by the Medical Association of that city, where the question was discussed. The following day, Jan. 19th, 1900, at the Parliament Buildings, the B. C. Medical Association was inaugurated. Dr. R. Ej McKechnie of Nanaimo was the first President. The first annual meeting was held on August 9th and 10th of the same year. (To Be Continued) ■ || CANADA'S HEALTH AND WELFARE A monthly magazine issued by the Department of National Health and Welfare in Ottawa. The first number of this magazine contains a foreword by the Hon. Brooke Claxton, Minister of National Health and Welfare. The purpose of the magazine, as he sets it forth, is to serve the interests, not only of the federal Department of which he is the head, but of. provincial and municipal health and welfare departments as well. Health Insurance, Old Age Pensions, Family Allowances, Maternal and Child Mortality, the various Welfare Agencies and their work, are all to receive attention. In the October number, Venereal Disease Control in New Brunswick is described; a program of physical fitness in the Saskatchewan jails, Health and Welfare Services in Manitoba are features. The latter is particularly interesting as regards the extension of Health Services: one item of this is the establishment of a Bureau of Diagnostic Services, to make diagnostic facilities available to everyone: another is psychiatric services —child guidance clinics, etc.: like the system we already have in British Columbia. The November number reports on the Quebec Health Units." Every part of this Province, without exception," says the article, "enjoys the advantages of a complete health service. Preventive medicine has been brought within the reach of the whole population." The budget for this work for 1945-6 is $1,108,000. Sixty-eight counties have to serve them fifty-nine complete "Unites Sanitaires," or Health Units. Medical health officers, graduate nurses, sanitary inspectors and public health engineers are attached to each of these. The results of their work are seen in (1) the reduction of general mortality rates, from 14.2 per 1000 in 1926 to 10.1 in 1940; (2) infant mortality from 142 in 1926 to 70.3 per 1000 live births, TB from 125.2 to 76.2 and so on. Some of these are still much too high, but great progress is being made. This number also contains an article on Public Welfare in British Columbia, and a report on the Symposium on Recent Advances in V. D. Control, held at the Annual Meeting of the B. C. Medical Association, where Major W. C. Mooney, Drs. B. Kanee, G. A. Upham and Agnes E. O'Neil spoke. Page 77 OSLER DINNER The Osier Dinner will be held on the evening of Tuesday, March 5 th, at 7:00 o'clock in the Banquet Room of the Hotel Vancouver. DR. A. L. LYNCH, the Lecturer for 1946, will speak on "SIR WILLIAM OSLER AND SOME OF HIS CONTEMPORARIES." | Now that the war is over, it is hoped that the formal character of this function may be resumed. You are therefore urged to wear formal dress if you can possibly do so. Please get your tickets early, from the Library or at the Information Desks of the V. G. H., St. Paul's or Shaughnessy Hospitals. VANCOUVER MEDICAL ASSOCIATION The Vancouver Medical Association is happy to welcome the following new mem- ;rs, who have been elected since October—the beginning of the 1945-46 season: Active Members: Dr. C. H. C. Bell Dr. Rafael de Boyrie Dr. C. G. Campbell Dr. Gordon A. Dowsley Dr. R. J. Elvin Dr. Christina A. Fraser Dr. Margaret Hardie Dr. S. R. Harrison Dr. Ben Kanee Dr. J. W. Laing Dr. Bela Lindenfeld Dr. F. H. Mayhood Associate Members: Dr. Bruce Bryson, Essondale. Dr. L. E. Sauriol, New Westminster. Privileged Member: Dr. M. R. Caverhill Dr. Wm. E. Milbrandt Dr. W. McK. McCallum Dr. H. B. McEwen Dr. Ralph McGregor Dr. J. A. MacMillan Dr. James A. Porter Dr. P. Ragona Dr. Raymond D. Rush Dr. S. H. Sievenpiper Dr. J. A. Street Dr. R. G. Yoerger Dr. L. G. d'Easum, Essondale. I LOST AND FOUND During the past few months the following articles have been left in the Library and are still unclaimed: 1 — Sheaffer's pencil. 1 — Waterman's pencil. 1 — Clasp knife. 1 — Service button. Page 78 ommittee on cal tconomics Ol British Columbi JOINT COMMITTEE OF Committee on Economics of the Council of the College of Physicians and Surgeons of British Columbia and the British Columbia Medical Association Canadian Medical Association (British Columbia Division) This issue of the Bulletin introduces, under the above heading of the Committ on Medical Economics of British Columbia, a new section. This section will appear eacl month, and will be devoted to current matters in the field of Medical Economics. It is felt that there is need for the widest possible dissemination of information o such matters, to the medical profession in the Province. It is vital that each and ever member of the profession be kept well-informed of the varied and ever-changing picturl that the subject of medical economics presents today. One can only guess at the trend over the succeeding years, but one cannot but be convinced that, in the final analysis! the interests of the public and of the medical professional are identical—not diverse! this despite views which are from time to time expressed by some elements in our gov! ernments, our press, and even the public itself. Therefore the profession must, in thl public interest and in its own, be ready at all times to evaluate a diversity of thought! and trends, to give wise counsel and advice toward all plans seeking the ideal in medical service. This can only be done by thorough knowledge and constructive thought oil the part of each individual member of the profession. Our worst enemy can be tha inertia in these matters to which we are so prone. With these thoughts in mind, your Committee on Medical Economics hopes thai this section of the Bulletin will, in all relevant matters, provide a medium for disJ semination of information, for interchange of ideas and viewpoints, for stimulation oa interest, and one which will assist in clarification and consolidation of thought. An)] suggestions which will assist the attainment of these objectives will be welcomed \A the Committee. Of major interest at this time is the impending implementation by the Department of Veterans' Affairs of its new, "Family Doctor Scheme." • We are awaiting official noti-j fixation from D.V.A. that the plan is in effect, and it is hoped that by the time this i; in print, every doctor will have received notice of the Scheme, together with the ned schedule of fees, and instructions for his guidance. Under this new Scheme the ex-serviceman, with some restrictions as to pensioner; and conditions previously treated while in service, will have the privilege of free choice of doctor in obtaining medical care. The plan now covers in addition to ex-servicemei in their first post-discharge year, all former members of the forces who are unable tc provide hospital and medical services at their own expense. The Department consider; married veterans in receipt of less than $100.00 per month, and single veterans in re-j ceipt of less than $75.00 per month, as eligible for treatment at public expense. The magnitude of the Scheme is evidenced by a quotation from the remarks of the Minister of Veterans' Affairs: "I do not believe that either Parliament or the public have yet appreciated the extent to which the medical services of the Department of Veteransi Affairs have been expanded by these new treatment regulations. We are, in effectj giving a modified health insurance service to more than 650,000, or approximately one-third of Canada's male working population." For this scheme a new schedule of fees was drawn up by a Special Committee of the Canadian Medical Association, at the request of the D.V.A. Dr. Roy Mustard of Vancouver was the representative of the British Columbia Division on the committee. It is understood that the schedule has now been approved by D.V.A. without any Page 79 anges. D.V.A. has also asked for the help of organized medicine to ensure the proper jnctioning of the scheme. A Medical Advisory Committee is to be formed in each (vision to advise the Treatment Branch of D.V.A. on all matters pertaining to the latment of veterans under the scheme. Your Committee is of the opinion that this Lily Doctor Scheme of the D.V.A., embodying as it does the principle of free choice | doctor, and operating under a schedule of fees recommended by the Canadian Medi- l Association, represents a great forward step. Your Committee further feels that it I in a way, a challenge to the profession. We must see that it functions as intended. ly unjustified "loading" of accounts might wreck the scheme. The necessary reports ;ve been made as simple as possible and should be completed conscientiously. *i* »i" 5j" »f It is also announced that the Dependents' Board of Trustees (D.B.T.) have now cepted the new D.V.A: schedule of fees. Under the special circumstances which vera our relationship with the D.B.T., the special committee of the Canadian Medical jsociation agreed to a deduction of 20% on each individual item of the tariff which ceeds $10.00. It is understood that where an account contains a number of items, ch of which is under $10.00, the gross amount will not be affected by the discount, edical Advisory Committees to assist Regional Dependents Advisory Committees in incouver and Victoria are to be set up at once. With the coming into effect of these w arrangements, it would appear that the vexatious difficulties that have arisen over ese accounts in the past, will be obviated. It should be borne in mind that assistance is only given by the D.B.T. to dependents those who are actually in service with the armed forces. Thus as the armed forces e reduced, work under arrangement with D.B.T. will become minimal. SUPPRESSION OF RADIO INTERFERENCE FROM ELECTRO-MEDICAL APPARATUS We would draw the attention of all who use electrical apparatus to the following. MM W$m I. ... 8 I I —(Ed-) A circular recently received from the Radio Division of the Department of Transit emphasizes the following points, and requests that they be brought to the attention members of the medical profession. Radiation from certain types of Electro-Medical apparatus may cause serious interference to practically all types of radio communication. In some instances such as air navigation, such interference is a potential life hazard. Such unwarranted radiation must be suppressed according to various Acts and regulations now in force. All types of Diathermy machines, as well as many other types of electro-medical equipment, come under the provisions of the Acts referred to. The responsibility for (a) finding a means of suppression, and (b) actually suppressing the interference, lies with the user of the apparatus. The Department may, on request and without charge, provide advice and supervise tests to find the most suitable means of suppression. All excessive radiation interference on communication frequencies must be suppressed on or before January 1st, 1948. pi The following is the representative of the Radio Division, Department of Transport, for British Columbia: Mr. W. J. Bowerman, District Superintendent of Radio, 413-418 Belmont Building, Victoria, B. C. Copies of the complete circular are available at the office of the British Columbia edical Association, 203 Medical-Dental Building, Vancouver, B. C. Page 80 EARLY AMBULATION IN SURGERY Lyon H. Appleby, M.D., F.R.C.S. (Eng.) Presented before British Columbia Medical Association Interior Division, Kamloops, B.C., October, 19 Surgeons in continental Europe have, since the turn of the century, been getti post-operative patients out of bed on the second day—to the consternation of less ra( cally minded North Americans. Only within recent years has such a routine come be accepted in this country. Observations upon the post-operative course of young children frequently show th the child heals quite as well standing up and playing in his cubicle as when he is fore to remain recumbent; better, in fact. There is rarely a question of post-operati catheterization; enemata are, as a rule, dispensed with if the child was reasonably norm) beforehand. The uncovered areas of incision so frequently observed in small childrel heal quite as kindly as the covered past, in fact more so. In an editorial in October, 1945, Roy D. McClure1 drew attention to the spread the gospel preached by Leithauser2 in 1943. To the latter must be granted a lar measure of the credit or responsibility for early ambulation following surgery in tl country in recent months. He has been the high priest of ambulation. One can rec uncounted instances of the aged,, the wilful, the insane, who have voluntarily contribut to our growing disbelief of the efficacy of recumbency. Leithauser explains the great bulk of post-operative complications on the basis an inhibition of various reflexes involving such functions as respiratory exchange vit capacity—peristalsis, bladder activity, etc. Our rule during the past two years has simply been this: that if a patient has £ operation of election or one where he is not seriously ill beforehand—this patient shi be made to stand out of bed the evening of his operation and empty his bladder; sha; be ambulatory next day, and thereafter, each within the compass of his strength, ^f have attempted thereby to eliminate as many of the usual post-operative complicatioi and distresses as possible, particularly those of stasis due to reflex inhibition. We are now reporting the post-operative results of approximately 700 case coverir a period of seventeen months, with particular reference to complications. Postoperative thrombophlebitis is an unwelcome complication in the extremities in group variously estimated to be between 4 and 2%. That it is due to reflex inhibitio vascular spasm, and combined minimal infection is well established, and many are tl ways devised to overcome the stasis which is the antecedent of its development. At tl Mayo Clinic, for years postoperatives were given thyroid extract to stimulate the laggir circulation—passive movements and massage have been established bed procedures f< yars. Gamble's3 bed bicycle is a further development of the same idea. Our exper ence has been that we have had two cases of postoperative phlebitis in the extremities i five hundred successive cases—both in cases that could not be made ambulatory—none i those who were up and about. The recent work of Oschner on paravertebral sympathetic block for relief of tl pain, spasm and acute oedema of phlebitis, has gone a long way to help these people, ; has the splendid work done on femoral, saphenous and iliac vein ligations. Neverthele if simple postoperative ambulation can prevent the occurrence of these conditions i large part, then the need for such foregoing procedures is indeed minimal. Post-operative pulmonary complications are variously attributed to anaesthetic irr tations, neurogenic atelectasis, mucus plugs, and, as Leithauser points out, to a refle inhibition of vital capacity with a .tidal air flow greatly reduced, and requiring froa four to six days for normal re-establishment. He clearly has shown that the curve d morbidity follows very closely the curve of vital capacity; he has shown that the moa rapid restoration of normal vital capacity follows, not CO2, not respiratory exercisa with blow bottles, but early post-operative ambulation. Our own position is not yet substantiated by figures, but we are able to say that i 700 successive post-operatives with early ambulation, the number of chest complications their severity and duration, have been clearly and very substantially reduced. Page 81 Inability to empty the bladder in the early post-operative state has been for long jstablished among adult patients as something normal and to be expected; the inhibition lif normal reflexes is nowhere more abundantly demonstrated than here—yet children [arely require catheterization because most of them stand up, in spite of every vigilance [hort of physical restraint. Our own position may be summed up as follows. We have checked the records of bne hundred successive abdominal operations in adults prior to using ambulation and find recorded 397 catheterizations. Another hundred similar cases, since we have com- inenced ambulation, show a record of 27 catheterizations. These figures speak for themselves. Before 100 — 397 catheterizations After 100 — 27 catheterizations s^e believe that, as a consequence, we have practically eliminated post-operative cystitis, Urethritis, and epididymitis as well as an unmeasurable amount of nursing and orderly bare. Post-operative abdominal distension is another example of inhibition of normal reflexes which goes to complicate recumbency. I sincerely believe that in every instance jwhere post-operative distnsion bcomes so severe as to cause concern, something is wrong, •more than just "gas pains." A low grade peritonitis has ensued, a neurogenic atony has developed, or paresis. In no instance has the ingenuity of man been proclaimed superior to that shown in his capacity to devise enemata—most continents have some representative ingredient in the average popular enema. Our position has been just this: In 100 consecutive cases before ambulation there is a record, covering the first four post-operative days, of 274 enemata having been given. In 100 successive similar cases in whom early ambulation was practiced, there were 19 enemata, and most of those were not required for distension. Many people are constipated habitually and ambulation will not cure that, but flatus which is the cause of the discomfort is expelled freely. We frequently give post-operative constipated individuals a rectal instillation of eight ounces of olive oil, or in war time,scarcity, Mazola. For the past two years we have been closing most of our abdominal incisions with a buried, non-absorbable material such as stainless steel wire, braided tantalum, etc. This has proven to be particularly valuable in the varioous nutritional deficiencies which frequently come to surgery and in whom rupture of abdominal incisions has proven to be not infrequent and to the patient a frightening disaster. I do not at all mean to convey the impression that early post-operative ambulation is dependent for its success upon the use of steel wire or tantalum closures. It is equally efficacious after simple catgut closure, as pointed out by Schaefer and Dagstedt.4 The danger period in catgut is about the fifth or sixth day when absorption is well under way. Nevertheless I feel much safer with some such non-absorbable material that remains on duty, such as steel. I have been frightened off nylon after reading Leithauser's report on the development of granulomata at the site of their use. In our own series, in five hundred successive abdominal sections, many of them in severe nutritional states, such as carcinoma, diabetes, obesity, congenital pyloric stenosis, ascites, etc., we have had but one evisceration, and he combined within himself most of the above deficiencies. The ambulatory state in post-operative hernias seems to be viewed with alarm by the unconvinced conservative. The general rate of recurrence of hernia following operation runs between 10 and 12%. Fallis5, studying an unselected group of cases operated on by staff surgeons under the best of conditions, reported a recurrence rate of 7%, which is about the recurrence rate of first-class surgeons. Army statistics of recurrence run up over 20%. A special study is being made of our last two years' hernia cases and is not yet complete; our present recurrence rate is, however, 4.5% with seven recurrences out of one hundred and fifty-three cases. Our routine procedure in hernia, single or bilateral, is closure with steel wire or braided tantalum, and allowing the patient to stand that same evening and void, and to Page 82 be around and about next day. Our recurrence rate has been much less than before and we have avoided practically all complications and sequelae. From time immemorial we have loaded down our incisions with layers of gauze, in turn held down with large pads, the whole securely bound down with adhesive binders, and what not. This is one of those things which we have done in a parrot-like way, without thought, because it seemed the accepted thing to do. Again the experience with children who pull their dressings off—with scalp wounds, to which dressings are seldom applied, has given food for thought. These exposed incisions have always healed kindly. The cost and scarcity of dressings, the poor adhesive that wouldn't stay stuck anyway, has for the past few years caused us to think of newer and more rational ways of handling incisions. We now strip all incisions where drainage has not been instituted on the second postoperative day and dust the incision with Cibazol, a mixture of Sulphathiazole pulv. and Boric Acid. The incision is then left perfectly bare, and in contact with the sheet, pyjamas, etc. The discomfort of dressings is no more. The absence of adhesive, abolishes the usual pimples and adhesive pruritus. The ventilation of the incisions seals it perfectly and movement is quite inhibited. The cost of dressings is cut to the vanishing point. Our experience with over a thousand cases of bared incisions has been that we cannot say we have seen a single instance where trouble or inconvenience could be attributed to that cause. In this changing vista of post-operative care what have we accomplished? First of all we have improved the morale of patients beyond relief. There is something uplifting to a man who can stand up and void and shave, and to a woman who can have on her own nightie, powder, and lipstick,and in whose eyes the magnitude and seriousness of her operation are minimized. There are fewer dressings, more self-care and less nursing, orderly, and barber service. The ambulatory case has a shorter hospitalization, lowered costs, and lessened morbidity. This has resulted in a much earlier rehabilitation of elective surgery cases. Probably the most difficult thing about bared incisions and ambulation is to overcome the ingrained deference to tradition. The surgical post-operative case has in the past few years been removed from the stuffed shirt era and placed in sport togs, and with the change has gone much of the fear, costs, and morbidity. As Leithauser so well said, we hear of people dying a few weeks after operation and have so often heard the remark, "Oh! he got out of bed too soon." Now we know, "He got out of bed too late." 1. Roy D. McClure, American Journal of Surgery, October, 1945. 2.. D. J. Leithauser, Archives of Surgery, 1943, vol. 47, p. 203. D. J. Leithauser, Ibid, 1941, vol. 41, p. 1086. H. A. Gamble, American Journal of Surgery, 1935, vol. 28, p. 93. Shaeflfer and Dragstedt, Surgery, Gynaecology and Obstetrics, 1945, vol. 81, p. 93. L. S. Fallis, Annals of Surgery, 1936, vol. 104, p. 403. i. EQUIPMENT FOR SALE Retired Physician, Eye, Ear, Nose and Throat, wishes to dispose of a large number of instruments, also operating chair and plate glass instrument table. Would prefer to sell the entire lot at a fraction of original cost. Write or phone Dr. Latimer, 1565 West 16th Avenue, phone BAyview 2452. Page 83 NEW FIVE-YEAR HEALTH PLAN OF U.S.S.R. We publish below a report of the new Five Year Plan of the Union of Soviet Republics, for the improvement of the Health of these States. We believe it will prove to be very interesting reading. It certainly is a proof of the immense vitality of this newly-reborn people, and bespeaks their determination to make their country one where health and the prevention of disease will be of paramount importance— where no money or effort will be spared that will make for a healthy, strong population. Of course, they have certain attitudes of mind—certain political principles, that we, with our long tradition of free choice, and our dread of regimentation, hesitate to adopt or endorse—and yet one cannot help wishing that in our country, which has had so many generations in which we might have gone so far, there were more of that passion for health and all that this implies—child welfare, preventive clinics, centres of diagnosis, etc. We have these things, it is true—but they have to struggle for existence, against an apathy, even an active hostility, which should not exist, and which certainly should not be allowed, as they are, to starve research, to handicap public health activities, and which give an equal hearing to the opinions of those who know, and those who are governed chiefly by prejudice that is rooted in ignorance. We read here of the plans for the education and training of doctors, in what seem like astronomical figures. Not only does the State not object to the numbers proposed, they even increase these numbers, when they do not seem adequate, and the suggestions to proceed slowly come, not from Governmental authorities, but from doctors. While here, where we need more doctors everywhere, our governments cannot find the money to build and equip#a medical faculty, though they seem to be able to find it for other faculties. Of course, Russia's need is dire—they have lost so many doctors and hospitals —the figures are staggering—but the point that we are trying to make is that there is a planned scheme on foot, duly discussed by all concerned, and especially by those whose training makes them most fitted to discuss it; this seems to us to come pretty close to a genuinely democratic ways of thinking, and it certainly attains an economy of effort, and a maximum of results in a minimum of time, that we, with all our vaunted advantages seem unable to attain. We are by no means advocating the adoption of the Russian system—there are many things in it that repel us, and that we do not believe would suit our particular theory of life, but there must be a happy mean somewhere between the two methods, and we hope it will someday be found.—Ed. Fourth Five Year Plan calls for all-round improvement in country's medical service—outline of programme for Soviet Union's Health Services drawn up by People's Commissariat of Health USSR for incorporation in fourth five year plan and now being discussed by public was described by Vladimir Nikitsky, chief of Commissariat's planning department in interview. "Main lines followed in new five year plan," he said, "are effecting an increase in growth of population—improving general health standards of people and rehabilitation of disabled ex-service men. Data already published give idea of restoration work to be done: Medical institutions destroyed by enemy action include six thousand hospitals, ijpirty-three thousand poly-clinics and dispensaries, 976 sanatoriums, 656 resthomes, and sixty factories producing medicines and medical instruments. In addition to this, the enemy looted and badly damaged or completely razed large number of medical schools. All this must be replaced and re-equipped. '|g| "Five year plan, however, calls for more than this; we have to effect all round improvement in country's medical services." Nikitsky pointed out that during the period covered by previous five-year plans expenditures on Health Services in the USSR increased fifteen-fold on the whole, while in some of the republics expenditures increased twentyfold. During the next five years some of medicine's knottiest problems have to be dealt with—struggle against cancer, Page 84 tuberculosis, malaria, cardiac ailments and diseases connected with metabolism. Important measures to be adopted are the provision of sufficient dispensaries for all people suffering from diseases of the heart and blood vessels, and from cancer and tuberculosis. The experience gained from many years of dispensary work amongst consumptives has proved the great value of this work. There is to be organization on a hitherto unprecedented scale of oncological centres, X-ray and radium stations—the study of the effect of anti-tuberculosis inoculations on children and the development of the same method for adults. Naturally, says Nikitsky, research scientists will have to play their part in studying the microbe and methods of dealing with it. They will also have to study the effect of new anti- I septics, such as penicillin, aspergillum and others. Further research work will be done in the study of typhus parasites and a number of problems of physiology, to develop the legacy left by the great Russian physiologist, Ivan Pavlov. In addition to an extensive engineering project planned to destroy the breeding grounds of the malarial mosquito, it is intended to increase the number of malaria stations, where sufferers can be treated, to increase the number of medical expeditions to malarial infested regions, and the number of malaria specialists in general. Rural medicine will see great improvements in the next five years. It is planned to build a hospital in every rural centre, with twenty-five to thirty beds, and therapeutic, gynaecological and infectious disease sections—also outpatient departments offering facilities for treatment of internal diseases, surgical and obstetric cases, children's diseases, dental cases, tuberculosis and skin diseases. Each of these rural centres is to have a department of hygiene and prophylaxis, and children's nurseries. According to the new plan there will be one and a half times as many beds in urban lying-in hospitals in 1950 as there are to-day, and 2.2 times as many in rural hospitals. This means that every expectant mother in towns, and one in two in villages, will be able to count on a place in a maternity home during childbirth; before the Soviet revolution the village wisewoman was the local midwife—hospitals didn't exist in rural districts. By 1950 there will be a further 115,000 children accommodated in nurseries, which means that twelve percent of all children under three will be able to find accommodation in nurseries, one-third of which will keep children under their care for 24 hours a day "The success of the new five-year plan in various republics", said Nikitsky, "is insured not only by the fact that it is being compiled by the state, which has the means to implement the plan, but also by the fact that people who know what's required, medical workers in town and village, are helping in its compilation, and are discussing every detail." Nikitsky went on to give the reason why two antagonistic ideas of needs and possibilities can be reconciled. On the basis of a norm which is taken from the number of hospital beds, doctors, inoculation, etc., per thousand of populations in 1940, the people's commissariat works out figures of what is required. These figures are then discussed by State Planning Cornmission, and then figures are correlated for the country as a whole. It sometimes happens that needs exceed possibilities and cuts have to be made. "On this occasion," Nikitsky said, "the State Planning Commission was able not only to accede to the demands put forward, but even to give more than we asked for in some cases." This was particularly the case with non-Russian republics, each of whose plans was discussed separately. Here is an example: The Ukraine planned an increase in the number of beds in rural hospitals by fifty thousand before 1950. The People's Commissariat of Health and the State Planning Commission discussed this figure and decided that the increase should be one of sixty thousand. Georgia planned to organize fifty hygiene and epidemic stations—we increased this figure to eighty. Belcrussia wanted to train forty-three hundred doctors during the five-year period, but the Planning Commsision, in view of the condition in which the Germans left the Health Services of this republic, decided that the correct figure for this period would be seven thousand doctors. This is an interesting case, because the Belorussian Page 85 authorities had based their figures on the number of doctors they could train in their own medical schools, whereas the Planning Commission offered the additional twenty- seven hundred doctors from amongst those graduated by schools in Moscow, Leningrad, and other cities. This is not the end of the preparations for the five-year plan, for it is then widely discussed by all concerned. Moscow has displayed initiative in this respect; the Plan was discussed at a joint meeting of medical bodies in the capital. One of the speakers at this meeting warned against "gigantomania' in designing hospitals; the same applies to planning dwarf institutions. Another doctor spoke in favour of raising norms for Moscow, as he said that many hospital beds in that city are now occupied by patients sent from other cities; on the basis of the available data he asked for an increase of eleven thousand beds over that provided by draft plan. Some of the interesting suggestions made at this meeting related to principles underlying the location of new hospitals for infectious diseases and the establishment on the outskirts of Moscow and other big cities of hospitals of a semi-sanatorium type, to which convalescent patients can be sent—also the necessity of establishing in each republic one or more oncological institutions, etc. Basic norms put forward by the People's Commissariat of Health were discussed at a special conference called by the Academy of Medical Sciences. "As far as I know" said Nikitsky, "the plan is already being discussed in all localities, and special local commissions are planning local health resorts, building of hospitals, extension of the network of welfare institutions for mothers and children, training of personnel, etc. These discussions will play a double role; they will help work out details of the five-year plan, and will provide a basis for its implementation in localities." ©hituanj The death of Dr. H. H. Planche removed from our ranks a very good medical man. He had practiced in Vancouver for a good many years, especially in the east end of the city, and in Northern Burnaby, and had the affection and respect of all with whom he came in contact—giving, as he did, always of his best, in devoted service to those who sought his help. Planche was a man of high ideals, and sterling character. He was deeply religious, and had in early life been trained for the Church. When he took up medicine, he carried into it the same high principle and purpose that animated him in his earlier choice of a profession. The writer of this knew him well, and in many years of close contact, can never remember hearing a mean, unkind, or unworthy word pass his lips. He was generous and kindly, and of unswerving honesty. He served for a time as medical officer at Oakalla Prison Farm, and did excellent work there, giving kindly and expert care to the unfortunates who came under his attention, often at a considerable sacrifice of his own time and personal interests. Latterly, he suffered from the effects of a cerebral haemorrhage, and was forced to curtail his activities very greatly—a great loss to a man of his type. To him, at the last, death came as a friend. He was a quiet, rather shy man, and his affliction by deafness intensified this. But to those of us who came to know him intimately, his death meant the loss of a valued friend. !••••••» »••*••■ fcft/fFS EXAMINATION OF CEREBROSPINAL FLUID IN SYPHILIS EVERY CASE OF SYPHILIS MUST HAVE AN EXAMINATION OF THE CEREBROSPINAL FLUID. - ft, :||M|I If 'W&- Cases of early syphilis, treated according to a schedule requiring six months or longer, should have a lumbar puncture at the conclusion of treatment. Cases of early syphilis, treated with a rapid form of treatment, should have a lumbar puncture six to nine months from the time treatment was begun. Cases of latent syphilis, or of late forms of syphilis, should have a lumbar puncture immediately, before beginning treatment. CO-OPERATION OF PATIENT— ; ' A lumbar puncture is to be considered as a minor surgical intervention and, like aH surgical interventions, should not be performed without the consent of the patient. As a rule, by exercising a certain amount of tact, and by giving appropriate explanation to the patient, there is no difficulty in obtaining his consent. When, in spite of all explanations given, the patient refuses to submit to a lumbar puncture, the physician cannot consider himself as released of further responsibility in this regard. He should inform the patient that his treatment cannot be considered as complete unless the examination of the cerebrospinal fluid is negative, that the cerebrospinal fluid which has not been examined cannot be presumed to be negative, and that, therefore, further treatment will have to be given. At each subsequent treatment, the physician should try to gain the confidence of the patient. After a time, may explain more fully to him the necessity for a cerebrospinal fluid examination. It is very rare that after a few weeks of such additional treatment and discussion of his problem the patient does not give his consent to a lumbar puncture. ANNOUNCEMENT The Canadian Anaesthetists Society (B. C. Division) which has recently been organized in this Province, with headquarters in Vancouver, plans to hold regular monthly meetings. These meetings will be largely scientific in character and are scheduled for the second Monday of each month. All members of the medical profession who are interested in Anaesthesia, and especially members of the Vancouver Medical Association, are invited to attend. Dr. H. Bruce MacEwen is Secretary of the B. C. Division of this Society. Page 87 It is with the deepest regret that we learn of the death of Dr. W. Ross Stone of Vanderhoof, and Dr. Wesley Patterson Walsh of Beattie Anchorage, on January 28th. The profession extends sympathy to the families of these two doctors. Sympathy is extended to Dr. D. M. Lineham of Vancouver in the loss of his son, Donald Harvey Lineham, and to Dr. A. B. Schinbein of Vancouver in the loss of his father, John M. Schinbein of Listowell, Ont. Dr. and Mrs. J. A. Ireland are receiving congratulations on the birth of a son on January 21st. Lieut.-Col. J. L. M. Anderson of Victoria has returned from service overseas, and is now out of the R.C.A.M.C. Wing Commander B. T. H Marteinsson, formerly of Port Alberni, has received his discharge from the Air Force, and is now in practice in Vancouver. Major J. E. Walker, R.C.A.M.C, has returned to civilian life, and is practising in Vancouver. Major F. S. Hobbs has received his discharge from the R.C.A.M.C. and has resumed practice in Vancouver. Major A. L. Hunt of Vancouver has returned to civilian practice following his discharge from the R.C.A.M.C. Major Gordon Kirkpatrick, R.C.A.M.C, is now out of the Army, and is attached to the staff of the Child Guidance Clinic in Vancouver. Major A. N. Beattie of Vancouver has returned to civilian life following service with the R.C.A.M.C. Dr. Beattie is new on the staff of the Division of Venereal Disease Control in Vancouver. , Squadron Leader H. R. Christie is now out of the Air Force, and in practice at Rossland. »». *», *». *». Lieut.-Colonel S. G. Kenning, following service overseas, has* returned to Victoria and resumed practice there. Major D. B. Roxburgh has returned to Victoria and is now out of the Services. Dr. Roxburgh is pathologist at St. Joseph's Hospital. Capt. L. L. Ptak of Victoria has returned to practice in that city, following his discharge from the R.C.A.M.C. Surgeon Lieut.-Commander Gavin Chisholm is now located in Victoria, following his discharge from the Naval Medical Services. * * sT- sj- Major K. L. Craig has received his discharge from the R.C.A.M.C, and is in practice at Campbell River. Page 88 Major W. M. Toone, R.C.A.M.C, has returned to civilian life, and is practising in West Vancouver. Major H. Beecher Galbraith, who recently received his discharge from the R.C A.M.C, is now in practice in Vancouver. h * «• § • Squadron Leader J. L. Parnell of Vancouver, who served with the Air Force in the Middle East, has received his discharge. Major G. L. Stoker, who returned recently from service overseas, has received his discharge from the Army, and is in practice at Dawson Creek. Squadron Leader E. B. Trowbridge is out of the Air Force, and has resumed practice in Vancouver. Flight-Lieut. H. V. Hughes of Victoria has received his discharge from the R.C.A.F* A A *t A »C *r *P *v Flight -Lieut. George MacKay is practising in Vancouver, following his discharge from the Air Force. 1- **• 5> Sj- Flight-Lieut. H. M. Ross of Vancouver is now out of the Air Force and in practice in that city. * * * % Flight-Lieut. H. Cantor has returned to civilian life, and is in practice at Vanderhoof. * * * * Flight -Lieut. M. R. Earle of Vancouver has received his discharge from the Air Force, and is at present taking a post-graduate course. ij- ^- ij- if- Flight-Lieut. T. R. Blades is in practice at White Rock, following his discharge from the Air Force. Flight-Lieut. Ian Balmer has received his discharge from the Air Force, and is in practice in Vancouver again. Flight-Lieut. B. F. Bryson of New Westminster is now on the staff at the Provincial Mental Hospital, Essondale, following service with the R.C.A.F. A A A ' A Capt. A. C. Ross has returned to civilian practice in New Westminster. * * * * Surgeon Lieut. H. G. Farish of Vancouver is out of the Naval Medical Services. Capt. E. Lewison, formerly of Zeballos, has received his discharge from the R.C. A.M.C. and is now in practice in Vancouver. Following his discharge from the Army, Dr. C. S. Rennie has commenced practice in Vancouver. * 55. Dr. Wm. B. McKechnie of Armstrong was a recent visitor to Vancouver. While in the city he attended the general meeting of the Vancouver Medical Association. A ' A A A Dr. J. A. MacMillan of Vancouver has been appointed medical director of the British Columbia Telephone Company. Dr. MacMillan will advise the company on industrial hygiene and public health matters. Page 89 Dr. T. C Routley, General Secretary of the Canadian Medical Association, and Dr. A. E. Archer, Consultant in Medical Economics for the C.M.A., were in Vancouver during the latter part of January, Matters relating to the annual meeting of the Canadian Medical Association next June were discussed, also, economic problems, when they attended the meeting of the Committee on Medical Economics of British Columbia. Dr. Archer travelled to Victoria with Dr. M. R. Caverhill, Executive Secretary, to attend the meeting of the Victoria Medical Society, before returning to the East. *r *{* *(* *»* Dr. R. W. Irving of Kamloops spent the Christmas season with his son, Roden, in Los Angeles. A A %t %*!. ■SaK^ **• -v *P *? Major W. M. G. Wilson, who returned from overseas some time ago, visited Kamloops renewing old acquaintances. *J» *?, *t, »<!. Dr. W. Bramley-Moore of Edmonton has been appointed Registrar of the College of Physicians and Surgeons of Alberta. Dr. Bramley-Moore practised at Blue River, B.C., from 1935-1938, and served overseas in the Far East. I NOTICE Word has been received from the Greek Red Cross that the physicians and hospitals in Greece are badly in need of instruments and equipment, and this appeal for assistance has been endorsed by this Division. Any instruments which can be donated to this worthy cause may be shipped express collect directly to the following address: The Greek War Relief Fund, 245 Notre Dame Street West, Montreal, Que. Each parcel or box should be accompanied by a statement indicating the articles which are enclosed. At the meeting of the Prince Rupert Medical Society held recently, the following were elected to office: Dr. W. S. Kergin, President; Dr. J. A. Mkcdonald, Secretary; Dr. R. G. Large, Representative to Board of Directors of the British Columbia Medical Association. * We extend sincere congratulations to Dr. Frank Day-Smith on the occasion of his recent marriage. CANADIAN CANCER SOCIETY Notice is hereby given that the Annual Provincial Meeting of the British Columbia Branch of the Canadian Cancer Society will be held in the Auditorium of the Medical- Dental Building, 925 West Georgia Street, Vancouver, on Thursday, February 28, 1946, at 4.30 p.m., to receive the report of the Board of Directors, and of the Auditors, to elect Officers and two members of the Grand Council of the Society, as provided by the by-laws of the Society, and to transact such other business as may properly come before the meeting. ' By order of the Board, mm$ A.'Y. McNair, M.D., President, British Columbia Branch. Mrs. A. S. Conrad, Acting Secretary, British Columbia Branch. Wm Page 90 NUTRITION SURVEY A nutrition survey, designed to help find those sections of the population needing improved nutrition, will be undertaken in British Columbia during the next six weeks, Dr. L. B. Pett, chief of the nutrition division of the Department of National Health and Welfare, revealed recently. This is the first survey of its kind to be carried out anywhere in the world and is being made under the joint auspices of the Provincial Board of Health and the Federal Department, with the active participation of the Metropolitan Health Unit of Vancouver and of the nutrition services of the B. C Red Cross Society. The survey team, headed by Dr. F. W. Hanley, medical officer of the nutrition division, Ottawa, includes Miss Ruby White, nutritionist, and two graduate nurses, Misses Edith Perkins and Patricia Macphee. The survey, Dr. Pett explained, combines the newest clinical approach with dietary knowledge and laboratory skills to the study of such medical problems as anaemia. The procedures to be used are based on over two years' study of the best methods employed in Great Britain and the United States and have already been given several preliminary tests in Canada. Surveys of nutrition, Dr. Pett pointed out, are services provided on request by the federal department in support of work by provincial public health personnel and by medical practitioners. The British Columbia survey will be followed by others in various parts of the Dominion. CAMPBELL & SMITH LIMITED 820 Richards Street ; : Vancouver, B.C. : : PAcific 3053 echve C/ rinhng Page 91
Periodicals
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Medicine--Periodicals
The Vancouver Medical Association Bulletin: January, 1946
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