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History of Nursing in Pacific Canada
Vancouver Medical Association
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BULLETIN of .. §■ ; . - The Vancouver Medical Association EDITOR dr. j. h. MacDermot EDITORIAL BOARD DR. D. E. H. CLEVELAND DR. J. H. B. GRANT DR. H. A. DesBRISAY DR. J. L. McMILLAN Publisher and Advertising Manager W. E. G. MACDONALD VOLUME XXX. APRIL, 1954 NUMBER 7 OFFICERS 1953-54 Dr. D. S. Munroe Dr. J. H. Black Dr. E. C. McCoy President Vice-President Past President Dr. George Langley Dr. F. S. Hobbs Hon. Treasurer Hon. Secretary Additional Members of Executive: Dr. R. A. Gilchrist Dr. A. F. Hardyment TRUSTEES Dr. G. H. Clement Dr. Murray Blair Dr. W. J. Dorrance Auditors: R. H. X. Whiting, Chartered Accountant SECTIONS Eye, Ear, Nose and Throat Dr. W. M. G. Wilson Chairman Dr. W. Ronald Taylor .... Secretary Paediatric Dr. E. Stewart James Chairman Dr. George Gayman Secretary Orthopaedic and Traumatic Surgery Dr. W. H. Fahrni Chairman Dr. J. W. Sparkes ||L__-~Secretary |1|| Neurology and Psychiatry Dr. A. .1. Warren Chairman Dr. T. G. B. Caunt.__• Secretary Radiology Dr. W. L. Sloan Chairman Dr. L. W. B. Card Secretary STANDING COMMITTEES Library Dr. D. W. Moffat, Chairman; Dr. R. J. Cowan, Secretary; Dr. W. F. Bie; Dr. C. E. G. Gould ; Dr. W. C. Gibson ; Dr. M. D. Young. Summer School Dr. S. L. Whaiams, Chairman; Db. J. A. Elliot, Secretary; Dr. J. A. Irvine ; Dr. E. A. Jones ; Db. Max Frost ; Dr. E. F. Word Medical Economics Dr. E. A. Jones, Chairman; Dr. W. Fowleb, Db. F. W. Hublbubt, Db. R. Langston, Db. Robert Stanley,'Dr. F. B. Thomson, Dr. W. J. Dorrance Credentials |||| Dr. Henry Scott, Dr. J. C. Grimson, Db. E. C. McCoy. V.O.N. Advisory Committee Dr. D. M. Whitelaw, Dr. R. Whitman, Db. H. A. Hendebson, Db. R. A. Stanley Representative to the Vancouver Board of Trade: Db. J. Howabd Black jgp Representative to the Greater Vancouver Health League: Db. W. H. Cockcboft i ' ~~~~~~~~ Published monthly at Vancouver, Canada. Authorized as second class mail, Post Office Department, Ottawa, Ont. Page 267 £^2i^^v";*:-'- fast accurate diagnosis of moniliasis and trichomonas vaginitis -.-.„-- :V-_. _.^-_^-^:., i A^l:^^__-^__. ^^^^^^ ft^-Ssj J_T] DIAGNOSTIC SIT Contents 1 bottle NICKERSON'S MEDIUM. (Pat. Pend.) 1 ampoule TRICHOMONAS DILUENT 1 glass micro slide 2 sterile cotton*tipped applicators ^^^g____ ORTHO PHARMACEUTICAL CORPORATION ( ONTO Page 268 HOSPITAL CLINICS VANCOUVER GENERAL HOSPITAL Regular Weekly Fixtures in the Lecture Hall Monday, 8:00 a.m.—Orthopaedic Clinic. Monday, 12:15 p.m.—Surgical Clinic. Tuesday—9:00 a.m.—Obstetrics and Gynaecology Conference. Wednesday, 9:00 a.m.—Clinicopathological Conference. Thursday, 9:00 a.m.—Medical Clinic. 12:00 noon—Clinicopathological Conference on Newborns. Friday, 9:00 a.m.—Paediatric Clinic. Saturday, 9:00 a.m.—Neurosurgery Clinic. ST. PAUL'S HOSPITAL Regular Weekly Fixtures 2nd Monday of each month—2 p.m Tumour Clinic Tuesday—9-10 a.m ^ Paediatric Conference Wednesday—9-10 a.m. Medical Clinic Wednesday—11-12 a.m Obstetrics and Gynaecology Clinic Alternate Wednesdays—12 noon Orthopaedic Clinic Alernate Thursdays—11 a.m Pathological Conference (Specimens and Discussion) Friday—8 a.m. Clinico-Pathological Conference (Alternating with Surgery) Alternate Fridays—8 a.m Surgical Conference Friday—9 a.m 1 -Dr. Appleby's Surgery Clinic Friday—11 a.m Interesting Films Shown in X-ray Department SHAUGHNESSY HOSPITAL Regular Weekly Fixtures Tuesday, 8:30 a.m.—Dermatology. Monday, 11:00 a.m.—Psychiatry. Wednesday, 10:45 a.m.—General Medicine. Friday, 8:30 a.m.—Chest Conference. Wednesday, 12:30 p.m.—Pathology. Friday, 1:15 p.m.—Surgery. BRITISH COLUMBIA CANCER INSTITUTE 2656 Heather Street Vancouver 9, B.C. SCHEDULE OF CLINICS—1953 MONDAY—9:00 a.m.-10:00 a.m.—Nose and Throat Clinic. TUESDAY—9:00 a.m.-10:00 a.m.—Clinical Meeting. 10:30-12:00 noon—Lymphoma Clinic. THURSDAY—11:00 a.m.-12:00 noon—Gynaecological Clinic. DAILY—11:45 a.m.-12:45 p.m.—Therapy Conference. Page 271 containing the new vasodilator spasmolytic penetrant Methyl Nicotinate Rubiguent RUBEFACIENT CREAM for pain associated with arthritis, fibrositis, neuritis, stiff muscles, broncho •ptessral disorders, etc. • Faster, more uniform penetrating power • Better sub-epidermal diffusion of the active agents • Marked analgesic, decongestive and spasmolytic properties • Cosmetic superiority • Ease of application TUBES OF 1 OUNCE Contains: Histamine Dmydrochloride. .. 0.1 % Methyl Nicotinate 1.0% Glycol Monosalicylate 10.0% Capsicum Oleorestn 0.1% These are incorporated in a bland, cosmetically pleasant, vehicle. % Page 272 Registered Trod* Mark GREATER VANCOUVER PUBLIC HEALTH Metropolitan Health Committee Dr. Stewart Murray, Sr. Medical Health Officer, City Hall, Vancouver, B.C. Population (Estimated) Vancouver 390,325 Burnaby Municipality 61,000 North Vancouver City. 16,000 North Vancouver District Municipality 16,000 West Vancouver Municipality. 14,2 5 0 Richmond 19,186 University Area 3,800 District Lot 172 1,469 TOTAL 522,030 MEASLES This disease is practically always present in the Greater Vancouver area, and, as in other large urban areas, it Usually shows a peak incidence every second or third year. In the intervening years it recedes considerably but never disappears entirely. As soon as a new crop of susceptibles are available the disease flares up to another peak which may be maintained until the herd immunity again becomes well established. The following figures show the cases reported in the City of Vancouver during the years 1932 to 1953. Year Cases 1940 1296 1941 4709 1942 202 1943 2496 1944 548 1945 1-2138 1946 272 Year 1932 Cases 3532 1933 18 1934 96 1935 1936 759 2818 1937- 1991 1938 91 1939 . _ 39 Year Cases 1947 2746 194 8-- 1580 1949 1169 1950 1373 1951 1211 1952 -1260 1953 643 The five years 1948 to 1952 are notable for their continued fairly uniform incidence. This may be due to a failure in reporting, but probably is a fairly reliable record of the prevalence of the disease. The lack of a high peak of incidence may indicate better cooperation from parents and others in efforts to control the spread of infection. Whatever the reason it will be interesting to see if the pattern changes during succeeding years. The drop to 643 during 1953 may indicate a rise in 1954, and the figures for the first three months of the year make this appear probable (January 10, February 33, March 195). Perhaps some day a satisfactory prophylactic will be developed against measles but that day has not yet arrived. Short term protection usually can be provided by anti-measles serum and this is usually reserved for weekly individuals and children under five. It must be given within five days of exposure if complete prevention is desired. If given from the 5 th to the 8 th days, a modified attack may result and this is probably the most desirable as a more permanent immunity will be set up. Page 273 -j CONNAUGHT > IN PERNICIOUS ANAEMIA LIVER EXTRACT INJECTABLE Liver Extract Injectable provides a thoroughly dependable form of treatment. The preparation of highly purified extracts of liver has been a subject of research studies in laboratories and clinics of the University of Toronto for more than 20 years. An objective of these studies has been to retain in the extract the anti-anaemia factors of beef liver and to eliminate therefrom other material which might be reaction-producing and which is not necessary for remission of the disease. The success of the studies is evidenced by the fact that a dose of Liver Extract Injectable "Connaught", suitable for intramuscular administration once in each three-week period, contains less than seventy milligrams of organic solid. Liver Extract Injectable, 20 micrograms of Vitamin B_ per cc, derived solely from beef liver and tested clinically and by biological assay, is available from the Laboratories in 5-cc. and 10-cc. vials. CONNAUGHT MEDICAL RESEARCH LABORATORIES University of Toronto Toronto, Canada Established in 1914 for Public Service through Medical Research and the development of Products for Prevention or Treatment of Disease. DEPOT FOR BRITISH COLUMBIA MACDONALD'S PRESCRIPTIONS LIMITED MEDICAL-DENTAL BUILDING, VANCOUVER 1, B.C. Page 274 The next month or two will be important ones from the point of view' of medical men in British Columbia. In fact, this year as a whole has many things of interest to us, some of very vital significance. Among the events to come to which we are referring, is the graduation of the first medical men and women to receive their training entirely in a British Columbia University, Medicine '54 of the U.B.C. This marks the successful culmination of a long history of effort and struggle on the part of a great many men, a goodly number of whom have gone from this earthly scene before they had a chance to see their hopes and dreams coming true. One thinks sadly how much this graduation would have meant to our old friend, Dr. J. M. Pearson, who worked and longed for a medical school in British Columbia, and to another old friend, Dr. R. E. McKechnie, who, though he could not count a medical school as one of its faculties, was for so many years a distinguished Chancellor of the University of British Columbia. He, too, if from some rosy cloud he is watching earthly doings, must be feeling happy and proud that so excellent a medical school now exists. The next issue of the Bulletin will be devoted mainly to this epochal event, and we hope to record in permanent form some of the history of this school, with the names of its first graduating class, with pictures and so on. The next great event to which we look forward is the Annual Meeting of the Canadian Medical Association in June when the medical profession of Canada meets in Vancouver: and through its elected delegates to the General Council, transacts our business for us, and renders accounts of its past year's work. It is a great and important meeting, and the preparations for its holding have kept many men very busy for the past year. Our own Dr. G. F. Strong, president-elect, has behind him many men who, like huriself, have worked hard and long to make this year's meeting a success, as we know it will be. Here again there is a somewhat sad note: this will be the last meeting at which Dr. Clarence T. Routley will appear as General Secretary. To those of us who have known and worked with Dr. Routley for many years, this is indeed a melancholy reminder of the inexorable march of time. We shall all miss him personally—but even more we shall all miss him as an able administrator, a wise counsellor and an earnest, devoted servant of his profession. He has done great things for Canadian medicine— he found the C.M.A. a somewhat rickety, bewildered and ineffective organization—he leaves it a strong, united and purposeful body, truly representative of a strong profession. He would be the first to protest that this was not all his doing by any means— and of course, this is true in one sense—but it was his executive ability, his endless hard work, and his devotion and patience, that did so much to remove misunderstanding, to promote harmony and cooperation, to provide continuity of purpose, and the medical profession of Canada owes a great deal to this man who gladly looked upon himself as our servant, a "good and faithful servant", indeed, as we have found him. And while he leaves this sphere of activity, it is not to "rust unburnished" that he goes. Far from it. He is full of activities yet to come and in a year from now we shall meet him again as the President of the British Medical Association, jointly to hold a meeting with the Canadian Medical Association in Montreal, having been chosen for this honour by the British Medical Association which respects and values him as we do. The meeting of the General Practitioners' Section of the B.C. Division of the C.M.A., held at Harrison last month, is another significant activity of 1954—and it crystallized many hitherto rather vague aspirations and hopes. It was a most successful Page 275 meeting, but that is not all that it means to us. It gave an opportunity to discuss and render operative many plans and ideas which had so far been merely topics for discussion but which will soon bear fruit in definite action. Politically, too, this is an important year for B.C. medicine—but of this we cannot say much now—as the melting-pot is still seething with much, whose shape we. cannot yet see clearly. But there is no doubt that certain changes, some of real significance, are inevitable. We must wait and see. Library Hours: Monday to Friday 9:00 a.m. to 9:00 p.m. Saturday - 9:00 a.m. to 1:00 p.m. Recent Accessions: Medical Clinics of North America for January, 1954. Symposium on Emergencies in General Practice. Progress in Neurology and Psychiatry edited by E. A. Spiegel, volume seven, 1952. Current Therapy, 1954, edited by Howard F. Conn. Culdoscopy by Albert Decker, 1953. lf|| The Anatomy of the Nervous System by S. W. Ranson and S. L. Clark, ninth edition, 1953. Gout and Gouty Arthritis by John H. Talbott, 1953. Transactions of the Association of American Physicians, 1953. Gifford's Textbook of Ophthalmology by Francis H. Adler, fifth edition, 1953. Physiological Basis of Gynecology and Obstetrics by S. R. M. Reynolds, 1952. Nash's Surgical Physiology edited by Brian Blades, 1953. The Thyroid, A Physiological, Pathological, Clinical and Surgical Study by T. Levitt, 1954. Science sans experience N'apporte pas grand' assurance. —Ambrose Pare. Page 276 m VANCOUVER AND MENZIES* or MEDICINE ON THE QUARTER-DECK By DR. FRANK TURNBULL For over thirty years the members of this Association have been accustomed to toregather annually at a meeting which is designed to honor the late Sir William Osier. It is an evening with a special atmosphere, arranged so that everyone in his own way may recall something of the great spirit of Osier. For the speaker who is privileged to deliver the Osier address the invitation has provided a stimulus to recall memories of this remarkable man. Few excursions into biography are more rewarding. It is my hope that the younger members of this audience may feel something of the magical appeal of the Osier story and resolve again to spend a pleasant holiday reading Cushing's Life of Osier, which is one of the greatest biographies of our time. None of the doctors of my age had any professional contact with Sir William. But we have enjoyed countless vignettes of the Osier saga from our fathers, our older colleagues, and our teachers. The magical personality of this man, his unselfishness, and his great capacity for friendship, were sufficient to magnify even a trivial contact into an experience that was always treasured thereafter. One cannot predict to what extent the noble traits of his character will be impressed on a generation that can only learn about them through the printed word. They will not lack opportunity, for no story in modern medicine has been recorded by so many, or so completely. Sir William loved books, and was particularly fond of medical biography. He frequently quoted stories, or wrote at length, about the lives of unusual or illustrious physicians. His zeal to establish the character and motives of historical figures who roused his interest frequently stimulated him to search through archives and old bookshops for incunabula that would supply color and authenticity. j|||| In conformity with the Oslerian method, I have chosen to speak to you about two great men who played the outstanding roles of their careers on the North Pacific coast, during the last decade of the 18 th century. I will tell you about the relationship of Captain George Vancouver and his ship's surgeon, Archibald Menzies. It would be difficult to find two men whose personalities, loyalties, and major interests, were in greater contrast. That they were able to live together as fellow officers in a tiny, mouldy, naval sailing ship for almost five years, through dreadful weather, off a strange and rugged foreign coast, speaks only for the single-minded purpose which drove each, after his fashion, to achieve what he had set out to accomplish. In some ways their reactions to each other seem to typify the universal conflict between science and the state. On the one hand there was Menzies; a botanist by preference, a physician by training, and a scientist at heart. On the other, there was Vancouver; the great navigator, a conscientious commander, but above all a loyal servant of the State. PROLOGUE In June, 1792, the Captain left his ship Discovery at anchor in a pleasant bay while he embarked on the ship's pinnace for a preliminary survey of the unknown coast that lay immediately ahead. His surgeon remained with the ship, living ashore in a tent; while crew members were occupied with 'wooding, watering and fishing', and fellow officers were taking regular observations of sun and stars, the doctor was busily tramping along the shoreline and into the woods. He was 'botanizing', and also speculating about strange burial platforms that indicated some of the customs and beliefs of the native aboriginals. But let him speak for himself: "I landed at the place where the tents were erected and walked from thence around the bottom of the Bay to examine the natural production of the Country, and found that besides the Pines already enumerated the Woods here abounded with the white and trembling Poplars together with black *AnnuaI Osier Lecture delivered to the Vancouver Medical Association on March 2nd, 1954. Page 277 Birch. In consequence of my discovery of the latter, the place afterward obtained the name of Birch Bay". Meanwhile the Captain was exploring to the northward. He entered a broad bay, passing two points which he named Grey and Atkinson. And so he records: "From point Grey we proceeded first up an eastern branch of the sound, where about a league witliin its entrance, we passed to the northward of an island which nearly terminated its extent, forming a passage from ten to seven fathoms deep, not more than a cable's length in width. This island lying exactly across the channel, appeared to form a similar passage to the south of it, with a smaller island lying before it. From these islands, the channel, in width about half a mile, continued its direction about east." And next day he added: "The shores of this channel, which after Sir Harry Burrard of the Navy, I have distinguished by the name of Burrard's Channel, may be considered on the southern side, of a moderate height, and though rocky, well covered with trees of a large growth, principally the pine tribe. On the northern side, the rugged snowy barrier, whose base we had now nearly approached, rose very abruptly. . . ." THE WORLD IN 1792 Seventeen ninety-two was a year of great ferment. The "man-of-the-year" was an anonymous citizen of Paris. He was out on the streets, making life hideous for the aristocrats. For this was the year that ushered in the French Revolution. In the summer of 1792 a young English surgeon named Astley Cooper, having completed his formal training and married, went over to Paris for a honeymoon and post-graduate tour. He was watching an operation by the great Chopart when the first cannon was fired on August 10th. Two months later he writes: "In the evening the gardens of the Tuilleries were full of dead men, and they lay naked, having been stripped of their clothes by the mob. On the next day Ann and I went to the Hotel d'Espagne^and passed through the mob, which was escorting Louis XVI and his queen to the Temple". Across the Channel, England, under George the Third, was prospering. Contact with an expanding world was through the sea. The polite piracy of Sir Francis Drake and other worthies of the 17th century was no longer condoned. In the place of shiploads of plundered gold or silk the new merchant seamen were bringing back the trading- rights and sometimes the sovereignty of great colonies. Their gifts were seldom refused, though sometimes the Mother Country held its nose. The first Governor-General of India, Warren Hastings, was standing trial before the House of Lords in 1792, as scapegoat for the accumulated sins of the East India Company. This was a period of great activity and success for the British Navy. Between wars and alarms of war, the ablest commanders were being sent off on long voyages of discovery. One of the distinguishing features of a great navigator was the ability to bring his ship home with a minimum of scurvy on board. A surgeon of the Royal Navy named James Lind had advocated the use of orange and lemon juice in 1754. It was 40 years before his advice was translated into an Admiralty order. In the meantime, his observations were doubtless being passed around by word of mouth, but only fully appreciated by a few. Good medicine of the day was exemplified in the practice of Benjamin Rush, who was the ablest American clinician of his time. In the year 1792 he was busily engaged with an epidemic of yellow fever in Philadelphia. Dr. Rush was a signer of the American Declaration of Independence and doubtless he had a very good concept of the United States, which at that time did not extend beyond the Mississippi. It is unlikely that he ever thought of the Pacific coast of America. He would have no knowledge that one of his countrymen, Captain Robert Gray, from Boston, master of the saiKngship Columbia, had encountered in April, 1792, a British sloop, the Discovery, under Captain George Vancouver, off Cape Flattery. Perhaps Dr. Rush learned some years later that Gray, after his conversation with Vancouver, sailed South, and at latitude 46°, discovered a mighty river, which Vancouver had missed. i Page 278 The Spanish home country was decaying under the misguidance of one of the stupidest kings of history (Charles IV), while New Spain was enjoying a comparatively enlightened rule under a Viceroy who was a native born Spaniard, or Creole. On the Pacific coast the commandant of the Marine establishment of St. Bias and California was Don Juan Francisco de la Bodega y Quadra. His headquarters were at Monterey, which was almost the northern extremity of New Spain. Like the Viceroy, Quadra was a Creole, of noble Spanish blood, but a native of Lima, Peru. He was a man of courage, gracious manners and high principles, destined by fate to strive for a nation that was decadent and beyond recall as a great power. In 1792, at the age of 52, he was sent to Nootka as the representative of Spain to fulfill the terms of the Nootka convention between Spain and Great Britain. He was told that he would be met at Nootka by a man authorized to represent Great Britain. VOYAGE OF THE 'DISCOVERY' In 1789 the British government planned a scientific expedition to the South Seas and the Northwest coast of America. George Vancouver was to be second in command. A recently launched naval ship, the Discovery, was prepared for the ardors of a long voyage. Before the Discovery was ready for sea a dispute arose between Spain and England about sovereign rights at Nootka on the Pacific. Though Nootka was just a remote settlement on a virtually unknown coast, it was the centre for a great trade in sea otter pelts. The Spanish claim for possession of his port was actually a bid for sovereignty in the whole Northern Pacific. The argument might have been settled without fuss or furore had it not been for the publication of a memorial to Parliament by John Meares, a Pacific fur trader. This fiery sea captain alleged that the Spaniards had seized his ship and property. Matters had now reached an insufferable state, from the British viewpoint. A great fleet was hurriedly assembled off Spithead. Before this show of strength and truculence, Spain capitulated. After playing the part of absentee landlord to the North Pacific for more than a century, all rights were now abandoned. George Vancouver was informed by Admiralty that he had been appointed commander of a new expedition which was to proceed to Nootka, and there 'receive back, in form, a restitution of the territories which the Spaniards had seized, and also to make an accurate survey of the coast . . . and further, to obtain every possible information that could be collected respecting the natural and political state of the country'. It was really an impossible assignment. He was ordered to take over Nootka from the Spaniards and to occupy it; and also to carry out a tremendous survey of the Northwest coast. Vancouver's command comprised the sloop Discovery with a complement of one hundred men, and the armed tender Chatham, under Lt. Broughton, with a crew of forty-five. His officers included Mudge, Puget, Baker, Whitbey and Johnstone. All of these men were subsequently honored in perpetuity when the Captain attached their names to prominent features of his grand chart. They remain on the maps of today— Cape Mudge, Puget Sound, Mount Baker, Whitbey Island, and Johnstone Straits. On April 1, 1791, the two ships set out from England. They rounded Cape Hope, explored for a few months off the Southwest coast of Australia and the coast of New Zealand, then sailed north to the Sandwich Islands, where they wintered. In March, 1792, they sailed to the coast of America and proceeded from latitude 39° toward the north. The Straits of Juan de Fuca were entered. A great island, 250 miles in length, was circumnavigated. The meeting with Quadra at Nootka did not lead to a satisfactory agreement, and Vancouver sent home for further instructions. Meanwhile, he carried on with the work of exploration. Winters were spent at the Sandwich Islands. Through the summer of 1793 and 1794 every inlet on the coast as far north as Cook Inlet in Alaska was carefully explored. There was no argument for a mythical North- West Passage, after Vancouver's charts were published. In December, 1794, the Discovery and the Chatham set off for England, sailing south from Monterey, around Cape Horn, and passing St. Helena. The trip home took ten months. Some of the crew had not yet reached their twentieth birthday. Only two were over forty, and only Page 279 one a married man. They had concluded one of the greatest and most strenuous voyages of history. GEORGE VANCOUVER When Captain James Cook set out from England in 1772, on his long second voyage, one of the "young gentlemen" on the quarter-deck was a fifteen-year-old lad from Norfolk named George Vancouver. This trip was followed shortly by Cook's tragic third voyage. The two expeditions kept Vancouver at sea almost continuously for eight years. James Cook became his ideal. When Vancouver came to write his own 'Voyage of Discovery' respect and loyalty for Cook showed up again and again. He learned from Cook not only lessons of courage and steadfast purpose, but also a keen appreciation of a commander's responsibility for the health of his men. Like Cook, he became one of the great scientific navigators, capable of painstaking labor under the most adverse conditions, to provide charts that would be models of accuracy. During the decade between his voyages with Cook, and the start of his own long voyage to the North West Pacific, there was an interlude of active war service with a British fleet in the West Indies. He served under Rodney, as a lieutenant, in the Battle of the Saints that was fought off Dominica. This fight sealed the fate, on the seas, of the Franco-Spanish alliance. Vancouver's memories of war service are not recorded. Doubtless as he pored over his maps some years later, in the cabin of the Discovery off the North Pacific coast, his mind went back to the West Indies, perhaps in contrast, for the names of two of his senior officers, Hood and Gardner, were attached to his chart. The explorer-navigator-diplomat of the 18th century learned his profession by dangerous and often bitter experience. Some of the hazards were the age-old perils of the sea. There were dangers on land as well. During his first voyage with Cook, Vancouver watched a cannibal boil and eat part of a human head. He was on the beach at Kealakakua Bay on the island of Hawaii when Captain Cook met death at the hands of the natives. Though stories of violent death in this manner were commonplace, Vancouver always went far out of his way to establish friendly relations with natives. His own high respect for authority gave him an intuitive feeling about the ceremony and proper reception that was due to native chieftains. When he met a really great chief, like Maquinna at Nootka, he took care to observe all the amenities that the British Navy could offer, l^jrfj Exploration and charting of a strange coastline by sailingship must have been very tedious. Important points of reference in the chart had to be clearly identified. This involved frequent expeditions by small boat. The Discovery and Chatham would drop anchor in a sheltered bay. Then reconnaissance parties would set out by pinnace or yawl on trips that might occupy several days or even a few weeks. Occasionally the Captain took charge of one of these small boats. At other times he remained on the mother ship, working on his maps, and waiting anxiously for return of the exploiring parties. Meanwhile his skeleton crew were kept busy repairing the ship, gathering wood, washing clothes, and sometimes fishing. When the weather was fine, it was not a bad life. But often it rained for weeks on end. It was raining hard in July, 1792, when they dropped anchor in a Sound about one hundred miles north of Burrard's Channel. The Captain was puzzled. The high mountain range which had been a landmark on the western horizon ever since they had come north from Puget's Sound, was obscured in mists. It seemed to be drawing further away from the mainland, and now, there was a confusing archipelago of islands lying ahead. He sent Johnstone exploring to the North. Mudge was instructed to take a small party out to the West. Puget was given the smallest boat and was old to retrace their route for ten to fifteen miles to the South. While the Captain waited, the clouds simply unloaded. It rained, and rained. He looked around and called what he saw "Desolation Sound" which is the name that remains. One by one the small boats returned. Puget had not accomplished much but loudly praised a beautiful sand beach at a place that the Captain had named, in passing, "Savary's Island". His account of the succulent clams and the profusion of berries greatly interested the ship's surgeon, who duly recorded the details in his diary. The Page 280 Captain was not impressed. He did not have to wait long for a story that was more to his liking. Mudge returned, and said that about twenty miles to the West he had climbed up a mountain top and looked down at a Cape below, and had observed a large volume of water flowing through a narrows that led to the North. Then Johnstone appeared with the best news of all. He had pushed on to the North and had found a wide channel that led out to the Pacific Ocean. That night the Captain added Cape Mudge and Johnstone's Straits to his map. He was puzzled no longer. The Gulf of Georgia was not a large bay, as the Spaniards thought. It was the southern half of a waterway that led to the Northwest and back to the open Pacific. A four year voyage to the North Pacific could not be completed without a quota of misfortunes and accidents. Vancouver and his men had their fair share—a death from dysentery, broken limbs, two men lost overboard. These were the normal hazards. No calamity tests the resourcefulness and metal of a sea captain like the threat of shipwreck. On the first crossing of Queen Charlotte Sound the Discovery ran onto a rocky reef. All the small boat navigators of this Society know how circumspectly the modern sailorman crosses this dangerous stretch of water. Picture a crossing with no hydrographic chart, no tide book. The Discovery stuck fast by the bow. In his subsequent account of the incident the Captain was very brief. He was not an introspective man, and near-failure was an unpleasant subject to recall. Menzies, the surgeon, was doubtless lending a hand with the ropes, tremulous perhaps, but not too concerned because, as he states, "in this alarming and critical situation, Mr. Broughton bore down with the Chatham and came to anchor in very deep water close by us . . . and from his well-known coolness and intrepidity, we derived no small consolation". As the tide fell the ship heeled over. With disaster impending, Vancouver was no man to lay his head on the block with weak prayers for deliverance. Lines were run out to anchors, and an attempt was made to heave her off the way she had run aground, but to no avail. Top gallant masts were taken down, the yard and top masts struck. In Menzies' words "as the water fell from her forward she became deeply immersed abaft, and heeled so considerably that part of her main chains were in water, so that one could scarcely stand on deck without grasping the rigging". At that climactic moment the tide turned, and the Discovery floated off intact. Any admirer of Vancouver feels bound to defend the Captain's reputation against the charge that he was a harsh disciplinarian. This charge would hardly have echoed through history if a certain Thomas Pitt had not accompanied the voyage as midshipman. There seems to have been a streak of psychopath in this young man, and of discipline he would have none. On three occasions Vancouver ordered Pitt to be flogged, and eventually put him ashore on the Sandwich Islands to find his own way back to England. Unknown to both parties, young Pitt had at this time succeeded to the title and estate of has father, Lord Camelford. He made his way back to England on trading ships, and when Vancouver arrived home two years later, commenced a campaign of calumny and occasional threats of violence against his former commander. Eventually, Vancouver was forced to apply to the Lord Chancellor for protection, and Camelford was bound over to keep the peace. A fair consideration of discipline on board the Discovery requires an understanding of the accepted standards of that day. Vancouver was a contemporary of Captain Bligh of the Bounty. The lash was routine punishment in the navy of those days and seems to have been about the equivalent to docking a week's pay today. At any rate, it was commonplace. Consider these excerpts from the ship's log—May 1, 1792, "punished Jno. Muron with 18 lashes for insolence"; May 31, 1792, "punished Wm. Wooderson with 24 lashes for insolence". As the voyage wore on, offences such as violence, drunkenness and fighting, recurred frequently. They probably represented weariness on the lower deck, and perhaps a gradual loss of morale. To be an explorer-captain in 1792 one had to be hard. On the day that Vancouver enjoyed his historic breakfast on board a Spanish ship off Point Grey, his hardy seamen rowed the pinnace all the way from Malaspina Page 281 Channel inside Texada Island to Point Roberts. His men must have welcomed the breakfast interlude, because it was the only break in 18 hours of constant, hard rowing. ARCHIBALD MENZIES When one shifts from a consideration of the stern and austere Captain to a visit in retrospect with his ship's surgeon there is a little sense of relief. Menzies was a gentler character, not a man to be pushed around, but congenial. Prior to entering mediaal school at Edinburgh he had received a very thorough training in botany. A few decades earlier the great Swedish botanist, Linnaeus had originated the binomial nomenclature, and classification had become the vogue in all of the natural sciences. To be attached to a voyage of exploration was sheer delight for a young botanist of that day. The opportunity for botanical exploration was doubtless what attracted the young Scottish doctor to join the British Navy. There were also wars to be fought. While George Vancouver was receiving his first battle experience in the West Indies the assistant surgeon aboard another ship of the line was Archibald Menzies. After peace was declared Menzies was attached to the Halifax station. In 1786 his former teacher of botany at Edinburgh wrote a letter of introduction to Sir Joseph Banks, director of Kew Gardens, telling about this bright young man. "He has been several years on the Halifax station in His Majesty's service as a surgeon, where he paid unremitting attention to his favorite study of botany, and through the indulgence of the Commander-in-Chief had good opportunities afforded him". Through Sir Joseph's influence Menzies was given leave by the Navy to serve as surgeon to an expedition around the world on a private trading ship. This voyage, under Captain Colnett, occupied nearly three years. The ship 'Prince of Wales', sailed around Cape Horn up to the North Pacific, over to China, and eventually home via Cape of Good Hope. Menzies brought back a consignment of plants and seeds for the Kew Gardens, and, moreover, a ship's company who had remained in good health. When the British Government appointed Menzies as a naturalist to accompany Captain Vancouver on the Discovery, he had already attained some fame as a botanist, was experienced in naval medicine, and was no tyro in respect to a long voyage of exploration. Though only 39 years of age when the Discovery set forth, he was four years older than Captain Vancouver, and the oldest, but for one, of all the men on both ships. The combination of his age and experience, with the background of a scientific education, fitted him for a much broader role in the expedition than might have been written into the terms of service of a botanist attached as supernumary officer. Before the Discovery had passed the Cape of Good Hope, the regular surgeon, Cranstoun, took ill, and he never recovered sufficiently to resume his duties. In September, 1792, at Nootka, poor Cranstoun was discharged, and sent home to England on a supply ship. Then, to quote Vancouver: "Mr. Archibald Menzies &. . who had embarked in pursuit of botanical information, having cheerfully rendered his services during Mr. Cranstoun's indisposition, and finding that such attention had not interfered with the other objects of his pursuit, I considered him the most proper person to be appointed in the room of Mr. Cranstoun". History is written by many hands. Let us hear what the appointee records about his new position: "Captain Vancouver . . . solicited me to take charge of the Surgeon's duty . . . and this he urged with a degree of earnestness that I could not well refuse, especially as he requested at the same' time that in case of my not accepting it, to state my having refused it in writing. ... I with considerable hesitation accepted of the appointment, Capt. Vancouver promising me that he would take care it should not interfere with my other pursuits, more .than the real exigences of the service requited. . . ." It is apparent when one studies the available evidence that there was much to be said on both sides regarding the differences that arose from time to time between these two men. Imagine the constraint that had to be continually exercised by the Captain, who was a tidy sailorman, 'through the presence of a messy scientist in his Page 282 officers' quarters. That Menzies made the ship a mess there can be little doubt. He was always dragging specimens on board, and of all the horrible spectacles for a naval man, he had a glass-enclosed greenhouse set up on the quarter-deck. Occasionally Menzies* enthusiasm as a collector bothered other members of the crew. An item from his journal dated May 1, 1792, is illustrative. (They were exploring Puget Sound). "One of the gentlemen shot a small animal which diffused through the air a most disagreeable and offensive smell. I was anxious to take it on board for examination and made it fast to the bow of the cutter, but the stink it emitted was so intolerable that I was obliged to relinquish my prey. I took it to be a Skunk or Polecat". There were no women in the crew of either ship and Indian maidens and matrons usually disappeared into the woods when a foreign ship came into view. One exception to this lack of romantic interest turns up in the Menzies' story. During his earlier voyage to the North Pacific with Colnett, Menzies had visited Nootka. His ship remained in Nootka for about a month and during this time Menzies was tramping the hills and studying the local botany. The wife of the Chief Maquinna's brother took a fancy to him, and apparently accompanied him on some of his walking tours as a self-appointed guardian. His diary does not make clear whether the memory of that comely Indian matron influenced his decision to make a second trip to the North Pacific. It is recorded that he saw her again on the second trip and gave her some presents. VANCOUVER AND MENZIES A ship's doctor is always a special problem for a commander and wise captains usually solve the difficulties of discipline and spheres of influence by becoming fast friends. The rigid, though sometimes fatherly, attitude that Vancouver displayed to his other officers was notably different in most of his relations with Menzies. Between these two there was never much warmth but a great deal of mutual respect. Menzies was always on hand when serious decisions were to be made, and invariably accompanied the Captain on formal visits to native chieftains. He attended all of the difficult negotiations with Senor Quadra. Menzies was a companionable man, and he was able to regale his fellow officers with amusing reminiscences when wretched weather and fatigue dulled their spirits. The Captain appears to have enjoyed these yarns, for he recorded and saved some of them to relate years later in his book. One of the stories that Menzies frequently retold was his account of "Flea Village". The doctor could not resist any opportunity to visit a native settlement. One day in Desolation Sound, when the rain let up for a few hours, he took a small party to explore a nearby Indian village that appeared to be deserted. The reason that the natives had pulled out soon became apparent. The village swarmed with myriads of fleas. Menzies' party retreated in great disorder. When they reached the beach some of them stripped and threw their clothes into the water; others plunged in fully clothed, but, as Menzies said, "to little or no purpose, for after being submersed for some time they (the fleas) leap'd about as frisky as ever". The party arrived back at the Discovery quite naked, towing their clothes in the water behind the boat. In the eighteenth century most of the responsibilities for naval hygiene, such as the control of infections and scurvy, were the direct responsibility of the commander, rather than the doctor. At least, so Vancouver thought, and for Menzies it was just as well. Some of the Captain's sanitary measures were very unpopular, particularly his repeated order that wet pine and fir boughs should be burned on the lower decks so that rancid smoke would fill the ship and purify the air. During the fourth year an epidemic of scurvy broke out. Most of the crew and officers were affected to some degree. When the ship's cook broke down and confessed that he had disobeyed orders by serving the prohibited, scurvy-producing skimmings from the boiled salt meat, it was clearly a case for the lash. Whether through his own failing physical strength or not, Vancouver unaccountably forgave the man because of his free confession. Page 283 THE LONG JOURNEY HOME Between winter trips to the Sandwich Islands and explorations of the coastline, negotiations with the Spaniards at Nootka dragged on. During the third year Senor Quadra died, and after his death there was just a long stalemate. History has vindicated Vancouver's stand in the Nootka controversy, but when he finally broke off negotiations and gave the order to sail for home he was far from certain that he would not be charged with diplomatic failure. On the way home disaster almost struck the Discovery for the second time. While they were off the coast of South America it was found that the mainmast was rotten. Contrary to strict Admiralty orders, but with the enthusiastic backing of all his officers, Vancouver directed the ship into the Spanish port of Valparaiso. There were no mainmasts available. It was necessary to turn the mast end for end so that the most defective parts would come below decks. In every way the delay was a most fortunate interlude. Fresh food and rest on shore dissipated the scurvy. The hospitality of the Spaniards left nothing to be desired. On one occasion Vancouver and his officers were entertained at a formal banquet by his Excellency the Captain-General of Chile. Their wan appearance and scarecrow uniforms must have created a strange impression. While they were feasting Menzies noted some curious nuts upon the table and put some in his pocket. He planted these in his frame on the ship. They throve and became young trees before the ship reached England. These were the first monkey-puzzle trees that had ever been seen in Europe, and one of them survived at Kew Gardens for a hundred years. Relations between the Captain and his Surgeon took a turn for the worse after the Discovery had sailed round Cape Horn and was heading north for England. The focal point of their final blowup was that oddly situated greenhouse on the quarter-deck. Many rare and valuable plants were sprouting from seeds that Menzies had diligently collected during the three years on the Pacific. They needed careful attention and with the Equator to cross again, it was necessary to water the plants at frequent intervals. At the same time fair winds made an appearance, and Captain Vancouver was anxious to send every available man up aloft to gain any advantage that the ageing masts would accommodate. It may have afforded the Captain a certain grim satisfaction when he ordered that Menzies' seaman-assistant must henceforth serve his full stint on the deck watch and refused to punish the man for flagrant neglect of the plants. Menzies was furious. There is no verbatim report of what transpired between the two men on the quarter-deck. Doubtless Menzies used some choice Scottish language. In a subsequent letter to Sir Joseph Banks he said: "I, coolly and without either insolence or contempt, complained to Captain Vancouver of being unjustly used in this proceeding. He immediately flew into a rage, and his passionate behaviour and abusive language on the occasion prevented any further explanation, and I was put under arrest because I would not retract my expression while my grievance still remained unredressed". Thus the last few weeks of the voyage wore on, with the ship's Surgeon under open arrest. When the Discovery dropped anchor in the Shannon on the western coast of Ireland, Vancouver resigned his command to Baker and set out for London. A few days after his arrival in London he applied to the Admiralty for a court-martial of Mr. Archibald Menzies for having behaved on the quarter-deck with "great contempt and disrespect". A month later the Discovery reached the Thames and Menzies heard of this application. He immediately sought out Captain Vancouver and expressed a full apology. Vancouver expected this, and withdrew his application for court-martial. So ended an undignified episode. Once ashore both men had many activities of importance to pursue. There was neither time nor inclination to prolong a quarrel, which had been engendered in a state of fatigue and frustration and was only a fading memory now. Vancouver was requested by the Admiralty to prepare a full account of his voyage for publication. Wearily, because he was by now in poor health, he undertook the task. He settled down in Petersham, a beautiful spot up the Thames on the outskirts of London. His older brother John lived with him and acted as secretary. Surrounded by maps, sketches, diaries and notes, he worked steadily at the huge task. After a year's Page> 284 work he had become so feeble that John had to write even his ordinary correspondence for him. In this debilitated state he continued working and died, probably from tuberculosis, before his task was finished, in May, 1798. He left five volumes completed and ready for the press. The sixth and last volume was written from the remaining notes by brother John, with the help of Puget. The first edition of his 'Voyage of Discovery' appeared in 1799. It was recognized at once as a naval classic. Rather overlong and somewhat stilted in style, it is written with a grace of phrase and composed in a well balanced manner that is astonishing from one who had so little formal schooling. He is modest and very generous in tribute to his officers and to the explorers of other nations. Contradictory evidence is sifted with the greatest care. Behind his carefully expressed opinions and conventional style the reader becomes gradually more conscious of a stoical, fine character, an upright man, a professional sailor first and last. EPILOGUE It is the author's privilege to choose the stage effects, and so, for the final scene I have allowed time to roll ahead another forty years. We are on a London street. It is after dark and raining hard. An old gentleman is being driven from his club to rooms on Hanover Square. He is Dr. Archibald Menzies, a lonely widower, now in his eightieth year, retired from thirty years successful practice of medicine. There has been a dinner meeting of the Linnean Society. As an illustrious past-President, Menzies is always certain of an enthusiastic audience of young botanists when he is in the mood for reminiscence. Tonight, he has been chatting about the North West Pacific. Strange that it should be raining so hard. It reminds him of Nootka, and Rivers Inlet, and Desolation Sound. He decides that he will pay off the cabby and walk the last few blocks to Hanover Square, so that he may feel the rain in his face again. As he walks the mood becomes stronger. Memories pour upon him. (Listen to his thoughts): "What days those were—a fine group of officers—all gone now—a credit to the Captain—he chose them all, except me; Baker and Whitbey; yes, and Johnstone— they became Captains too. Mudge and Puget—Admirals, both of them. Those books that Vancouver wrote—strange that he could put so much of himself into the printed page. He was a great Captain". PHYSICIANS' ART SALON OPUS JUNE 14th ' All Canadian physicians and medical undergraduates with art or photography as hobbies are cordially invited to exhibit at the 10th Annual Physicians' Art Salon to be held in conjunction with the Canadian Medical Association Convention at the Hotel Vancouver, June 14-18, sponsored by Frank K. W. Horner Ltd. Entries in the three divisions, Fine Art, Monochrome Photography, and Colour Transparencies will be hung and judged for awards by an outstanding jury of selection. Members of this panel to be announced shortly. TO ENTER Any physician or medical undergraduate interested in submitting work may obtain an entry form with details by writing the sponsor at P.O. Box 959, Montreal. A short note or postcard will do. All expenses, including transportation of exhibits to and from Vancouver, are taken care of by Horner. DEADLINE Completed entry forms must be received before May 28 th to insure proper listing. Exhibitors are also requested to ship entries soon enough to allow for possible delays in express or parcel post. Full shipping instructions appear on the entry form along with addressed labels, Page 285 THE PRINCIPAL DANGER OF BLOOD TRANSFUSION THERAPY — INCOMPATIBLE BLOOD By B. P. L. MOORE, M.B., B.Ch., B.A.O. The main purpose of blood transfusion therapy is to transfuse the recipient with donor erthrocytes which are compatible with the recipient's plasma, and which will survive for a normal length of time in the recipient's circulation. A transfusion of incompatible blood will result in a 'haemolytic reaction' which may vary greatly yn. its severity. Instead of a normal survival time of between 100 to 120 days, complete destruction of the donor erythrocytes may take place, owing to intravascular haemolysis, within a few hours or days. With extra-vascular haemolysis, destruction may not be complete until several weeks have elapsed. The clinical condition of the recipient depends to a great extent upon the rate of erythrocyte elimination. The main purpose of pre-transfusion laboratory investigations is to ensure that compatible blood is transfused. Unfortunately, incompatible transfusions are not entirely preventable. Human error is always present, and may be felt when the specimen, bottle, or patient, is wrongly identified. Technical errors, such as mistakes in grouping the donor or recipient, may occur. However, more haemolytic reactions are caused at ths present time through the use of an inadequate cross-match technique than by any other single means. There are at least nine blood group systems. The ABO, Rh, Kell, Duffy, and MNS systems are of particular clinical importance, but the Kidd, Luther, Lewis, and P systems may be involved on rare occasions. Between them these nine systems permit some 50,000 individual blood group combinations. To group donor and recipient in the ABO system, and classify them as Rh Positive or Rh Negative, means that consideration is only being given to some eight combinations. Probably 80% of cross-matched donor blood is in fact incompatible in some one or more.of these systems. Dependence is placed upon the compatibility test to detect antibodies already formed, but each transfusion is a new stimulus and carries with it the threat of a haemolytic reaction in the future. Fortunately, multiple spaced transfusions do not often provoke an antibody response to these 'lesser' blood group antigens. Two factors are involved. First, blood group antigens differ in their potency, and secondly, the percentage distribution in the general population varies, and so limits their opportunities. For example, the antigens D, C. Fya (Duffy), M, and S, all have approximately equal chances of provoking antibody response as judged by their general distribution. From reported cases, however, it is clear that D will immunise the recipient of two spaced incompatible transfusions in some 40% of cases, whereas, C and Fya, act only occasionally, and M and S but rarely. On the other hand, K (Kell) has one hundred times less chance than D of immunising the recipient, yet it would seem to avail itself of much of its opportunity. In other words, K may be as potent an antigen as D. Normally it requires at least one incompatible transfusion, or pregnancy, to 'prime* the recipient. Further transfusions after an interval of at least three months may produce an 'immune' response, and lead to a haemolytic reaction. It is in such cases that the greatest care must be taken in cross-matching. If all antibodies reacted in the same fashion there would be no problem. However, some are best demonstrated at room temperature, others at incubator temperature. Some show up best when cells and serum are diluted in saline, others only when 22% Bovine Albumin is used, while a few can only be detected by the anti-globulin technique. Therefore, a battery of tests is necessary to guarantee a compatible transfusion which is quite impracticable in routine use. A compromise has to be reached. This usually takes the form of a routine test in saline at room temperature, and in bovine albumin at incubator temperature. The onus must rest on the clinician to determine, and record, the previous transfusion and obstetric history of the patient so that the laboratory may add tests such as the indirect Page 286 anti-globulin method, applicable to the individual case. Unless this is done a harvest of haemolytic reactions will be reaped owing to the ever increasing use of blood transfusion therapy. TYPES OF riAEMOLYTIC REACTIONS Diminished survival of donor erythrocytes gives rise to three principal grades of reactions as judged clinically. The point to remember is that the first is invariably unnoticed, the second too often disregarded, and only the third recognized. Because successive incompatible transfusions lead to increasingly severe reactions, awareness of the first two grades, and the cases in which they are prone to occur, will diminish the incidence of the most severe type. (i) The mildest reaction is seen in a recipient 'primed' by one or more previous spaced incompatible transfusions. The cross-match is clear, no symptoms are shown but the haemoglobin shows very little change. Some time after the transfusion, antibody is provoked by the incompatible donor cells and curtails their survival in the circulation. (ii) The commonest form of haemolytic reaction seen at the present time is that occurring in recipients who possess a trace of antibody, as a result of previous transfusions, which is undetected by the cross-match technique. Clinically the patient may show all the signs of a 'pyrogenic' reaction with chill, fever, and nausea, etc., and perhaps a mild transient jaundice in the first week. Haemoglobinuria is usually not present, but methaemalbuminaemia may be demonstrated in some cases. The weak antibody causes immediate although minimal destruction of the donor cells, then, after a 'lag' period, further antibody response accelerates the process. (iii) The transfusion of incompatible blood to a patient who possesses a high titre of albumin anti-Rh is one cause of the most severe form of a haemolytic reaction. Immediate destruction of the donor cells is complete within a few hours, or at the most one or two days. This leads to the reticulo-endothelial system being overloaded, and unable to accept all the products of blood destruction, with consequent haemo- globinaemia, and haemoglobinuria. ABO incompatible blood does not usually lead to such a violent reaction as in the above instance, unless the recipient possesses an immune form of anti-A and an anti-A haemolysin. It appears to be the type of antibody rather than the strength alone which determines the severity of the reaction. Although albumin anti-Rh does not produce haemolysis in vitro, it is powerful enough to produce intra-vascular haemolysis in vivo, and this probably applies to other 'immune' forms of antibody formed against other blood group systems, such as Duffy or Kell. The use of unmatched blood may lead to increased destruction of the recipient's own erythrocytes producing all the signs of a severe haemolytic reaction, or only those of a haemolytic type of anaemia. All group O persons possess saline anti-A and anti-B. In addition, some 20% of normal people possess an 'immune' form of anti-A associated with an anti-A haemolysin. These latter antibodies when present are the cause of haemolytic reactions. Group specific substances readily neutralize the saline antibody, less readily the haemolysin, and only with difficulty the immune antibody. Their use is ^therefore questionable. Antibodies passively transferred to the recipient from the. unmatched blood may react with the donor erythrocytes in subsequent transfusions. It is therefore essential to cross-match or even re-match blood for succeeding transfusions with a specimen taken after the administration of the unmatched blood. The practice of using unmatched blood while waiting for the cross-match to be completed is potentially dangerous. Apart from the risks mentioned above, it should be remembered that to deprive recipients of the safeguard of a compatibility test, especially if they have been transfused in the past, is to leave other potential blood group incompatibilities undetected! The hazards of unmatched blood must therefore be carefully calculated in the individual case. Page 287 A haemorrhagic diathesis has been reported following the transfusion of incompatible blood. Persistent oozing from a surgical wound or from the mucous membranes. is the presenting feature, associated with a definite haemolytic reaction. In some reported examples the only haematological abnormality was increased! protamine titration values indicating the presence of a 'heparin-like' anti-coagulant. In others, increased 'prothrombin times' were found, and on occasion fibrinolysis. Thej cause may be an anaphylactic response in susceptible individuals, possibly to the 'stress'! of an incompatible transfusion, or to some substance in the plasma, for the same findings are seen in the so called "plasma transfusion reactions". SUMMARY If one avoids the pitfalls of human error prior to the administration of blood, one must still face the potential inadequacy of routine cross-match techniques, following the transfusions. The oftener a natient has been transfused, or has been pregnant in the past, the more essential it becomes for the clinician to investigate the patient's previous history to alert the laboratory to potential incompatibility. After the transfusion it is essential that a watch be kept upon the patient both clinically and from a laboratory point of view. Urinalysis for cases transfused under anaesthesia should be routine. Every 'pyrogenic' reaction should be regarded as a suspect haemolytic reaction in the case of recipients of previous transfusions, or women with a significant obstetric history. To justify the ever present risk of blood transfusion, small though it may be, blood must not be regarded as a panacea and should not be ordered until it is certain that, firstly, there is a deficiency in the circulatory fluid, best remedied by human blood and not by some more specific therapy, secondly the minimum volume necessary to accomplish this purpose is known, and thirdly an adequate cross-match technique is available. Friesen, S. R., Harsha, W. N. & McCroskey, C. H. "Massive generalized wound bleeding during operations with clinical and experimental evidence of blood transfusion reactions." Surgery, 1952, 32, 620. Hardaway, R. M., McKay, D. & Williams, J. H. "Lower Nephron Nephrosis." Am. J. Sur., 1954, 87, 41. Mollison, P. L. "Blood Transfusion in Clinical Medicine." Blackwell, Oxford 1951. Moore, B. P. L. "Complication of Blood Transfusion." Can. Med. Assoc. J., 1953, 68, 332. FOR SALE LAKE PROPERTY — PENTICTON %-acre building' site situated beautiful SKAHA LAKE in City Limits, Penticton, just few minutes from shopping centre but secluded, private. Ideal site permanent home or summer cottage. Six hours from Vancouver. Perfect for big city week-end rest cure. A site to buy and hold for retirement. Full price only $10,000. For particulars write to A. F. Cumming Ltd., 210 Main Street, Board of Trade Bldg., Penticton, B.C. Page 288 CANADIAN MEDICAL ASSOCIATION BRITISH COLUMBIA DIVISION 1807 West 10th Ave., Vancouver, B.C. Dr. G. Gordon Ferguson, Exec. Secy OFFICERS 1953-1954 President—Dr. R. G. Large Prince Rupert President-Elect—Dr. F. A. Turnbull : _ Vancouver Immediate Past President—Dr. J. A. Ganshorn __ Vancouver Chairman of General Assembly—Dr. G. C. Johnston Vancouver Hon. Secretary-Treasurer—Dr. J. A. Sinclair HEl New Westminster PRINCIPAL DELEGATES TO THE BOARD OF DIRECTORS , Victoria Dr. J. F. Tysoe Dr. E. W. Boak Nanaimo Dr. C. C. Browne Prince Rupert and Cariboo Dr. J. G. MacArthur New Westminster Dr. J. F. Sparling Dr. D. G. B. Mathias Kootenay Dr. S. C. Robinson Yale Dr. A. S. Underhill Vancouver Dr. Ross Robertson Dr. R. A. Gilchrist Dr. J. Ross Davidson Dr. R. A. Palmer Dr. A. W. Bagnall Dr. P. O. Lehmann Dr. Roger WiJson Chairmen of Standing Committees Constitution and By-laws Dr. Carson Graham, North Vancouver Finance . Dr. J. A. Sinclair^ New Westminster Legislation - , Dr. J. C. Thomas, Vancouver Medical Economics Dr. P. O. Lehmann, Vancouver Medical Education Dr. Charles G. Campbell, Vancouver Nominations Dr. R. G. Large, Prince Rupert Programme & Arrangements—.. j Dr. Myles Plecash, Penticton Public Health Dr. J. Mather, Vancouver Archives- Chairmen of Special Committees .Dr. J. H. MacDermot, Vancouver Arthritis and Rheumatism Dr. F. W. B. Hurlburt, Vancouver Cancer Dr. Roger Wilson, Vancouver Civil Defence— Dr. John Sturdy, Vancouver Ethics - Dr. Murray Baird, Vancouver Hospitals 1 Dr. F. A. Turnbull, Vancouver Industrial Medicine -Dr. W. S. Huckvale, Trail Maternal Welfare I Dr. A. M. Agnew, Vancouver Membership Dr. L. Fratkin, Vancouver Nutrition Dr. J. F. McCreary, Vancouver Pharmacy Dr. B. T. Shallard, Vancouver Public Relations Dr. A. W. Bagnall, Vancouver MAJOR GENERAL C. P. FENWICK, C.B., C.B.E., M.C., E.D., M.D. A great number of physicians practicing in B.C. will mourn the passing in Montreal on March 20th, 1954, of Dr. C. P. Fenwick. As A.D.M.S., 2nd Can. Division, then D.D.M.S., 2nd Can. Corps., D.D.M.S., 1st Can. Army, and finally as Director General of Medical Services, 1st Can. Army, he will be remembered as a willing friend to any Junior Officer who sought his advice or help. He was born in St. John's, Newfoundland, on July 10, 1891, the son of the Rev. Mark Fenwick. He was educated there at Methodist College and later went to London University (Eng.) and the University of Toronto where in 1916 he received his M.B. He served with distinction in World War I with the RCAMC, and was awarded the Military Cross in 1917. In the following year he was mentioned in dispatches. Later he was honoured by King George VI: first as Commander of the British Empire (1944) and later as Companion of the Bath (1946). After World War II General Fenwick maintained close contact with the Reserve Army and in addition, helped to reorganize the Defence Medical Organization in 1946. For the following year he served as President of this org inization. Page 289 At the end of World War I, he returned to Toronto to interne at the Toronto General Hospital in 1919 and 1920. After his marriage in 1921 he entered General Practice in Niagara Falls, Ontario, but in 1923 he moved his practice to Toronto and remained in that city until the outbreak of World War II. During the interval he was physician to the Royal York Hotel there, and also served as Associate Coroner for t^ie city. He became Chief of Canadian Pacific Medical Services in 1946 and continued in this capacity until the time of his death. In addition to the exacting work required of this position, he served as Director of the Aero Medical Association and as Medical Director of the U.S. Airline Association. General Fenwick is survived by his wife and by two daughters: to them may we extend our most sincere sympathy. He will be sorely missed by the country which he served so well and the profession which he served so faithfully. Scientific Session of General Practitioners' Section of B.C. Division, Canadian Medical Association The Provincial Section of General Practice held its second annual convention in Harrison Hot Springs in March, and filled the hotel to capacity. Voted the most successful convention of any description ever held in B.C., the scientific program was attended by over 150 doctors during the three-day meeting. Dr. Elinor Black of Winnipeg spoke on cervicitis, praising the topical non-sensitizing antiobiotics in the auxiliary treatment and condemning douches used as sole treatment. In her discussion of pruritus vulvae she stressed allergies both to systemic antibiotics given for unrelated conditions and to direct contact with irritants. A thick lanolin coating to prevent constant scratching while treatment is carried out was also advised. Dr. J. R. Naden of Vancouver discussed wrist injuries, and warned the members always to tell their patients of possible bad results. Later he gave an explanation of the ideal way in which the practitioner and the Workmen's Compensation Board could work to mutual advantage. Dr. L. H. Appleby in an appraisal of the acute abdomen advocated exploration of the abdomen after acute pancreatitis to ascertain the cause if possible. He also decried excessive transfusions in severe bleeding before hemorrhage had been controlled as this often causes fresh bleeding. Dr. S. H. Kaufman of Seattle outlined psychotherapy in practice and differentiated between Empathy, in which we can understand the patients' problems; and Sympathy in which we become involved in the problems and lose our effectiveness. The competent doctor manoeuvres the patient into suggesting psychiatric help himself, rather than ^sending" him for psychotherapy. In a second presentation he discussed the emotional problems of children and this talk was broadcast to the doctors' wives in the lobby of the hotel. Dr. A. W. Bagnall of Vancouver discussed arthritic diseases in which he pointed out that aspirin and gold therapy were still useful therapeutic weapons. He also discussed heart disease and pointed out that congestive failure is often the result of infection which is missed in a quick examination. Luncheon speaker for the ladies was Dr. Elinor Black who discussed women in early medicine, and banquet speaker for the convention was Dr. Appleby who gave a history of the development of the medical staff and serpent symbol. Dean M. Weaver of U.B.C. outlined the new preceptorship course for students in the final year of medicine, who will spend one month with general practitioners prior to interneship. Twelve Washington State practitioners attended the convention. Page 290 WORKMEN'S COMPENSATION BOARD To The Members, College of Physicians and Surgeons of British Columbia. Dear Fellow Members: The Medical staff at the Workmen's Compensation Board are constantly endeavoring to improve the public relations with the practicing physicians throughout the Province. We deeply appreciate your suggestions and criticisms and hope that you will continue to help, with hoped for improvement in our mutual problems. We have endeavored to improve our telephone service and would request your cooperation when 'phoning about a workman's claim to please give the name of the workman, his number and the problem involved to the secretary. By this means it is hoped when the doctor at the Board who is involved in the care of the claim gets the file and 'phones you he will be in a position to discuss the file intelligently, and if possible give you an immediate decision with the facts in front of him. If you so desire you could have your secretary put in the first 'phone call and there will then be only one telephone conversation between yourself and the involved doctor at the Board. We are hoping this will save your time and will make the handling of telephone calls much more efficient as far as your office, and also as far as the Medical Department at the Board is concerned. As indicated in our letter in the February Bulletin we are still proceeding with some new plans in relation to the submission of x-rays. We are hoping by the 1st of July to have inaugurated a system whereby all x-rays will be submitted to the head office of the Board within seven days after they have been taken. This procedure has been carried out successfully in at least one other Compensation Board in Canada and it has been found to be of mutual benefit to the workman and the attending doctor, and we earnestly hope that you will cooperate with us in this plan to improve the medical care of the workman. Space does not allow of an adequate explanation of all the problems that are involved in relation to Compensation Board cases. Files at the head office are often complicated by factors unknown to the doctors outside and necessitates correspondence between the attending doctor and the Board. We have had under review for some time the problem of a workman receiving time loss payments simply because he is attending the Rehabilitation Clinic. After great consideration it has been felt that workmen who are living in the Vancouver area and have an attending physician and are going to the Clinic for physiotherapy should receive their compensation cheques on submission by the attending physician of a progress report. It is the feeling of the Board that the attending physician should assume the full responsibility for the care of the workman and should not pass on this responsibility to the doctors at our Clinic. It is our sincere hope that the doctors will cooperate with us in this respect and starting on the 1st of July doctors will submit to us progress reports on workmen under their care in the Vancouver area at intervals of every two weeks so that a workman will get his time loss payments without delay. At the same time a sincere request is made that the doctors submit in these reports some information in relation to the workman's progress and a definite prognosis if possible as to the possibility of the workman returning to employment. At times difficulty is encountered in relation to attending physicians telling workmen about permanent disability awards and also in respect to what the Board should do in relation to retraining. It is important to emphasize that only upon complete review of the file and decision by the Board can certain problems be finalized. It is requested that the attending doctors refer the workman to the head office of the Board Page 291 or communicate with the Board by letter in relation to these problems without discussing them too specifically with the workman so that he will not get a distorted idea of what it is possible for the Board to do for him in any specific instance. We hope you will continue to bear with our attempt to improve the situation in relation to workmen under your care and our care. Again, with the very kindest of personal regards from the Medical Department of the Compensation Board, I remain Sincerely yours, J. R. NADEN, M.D., Chief Medical Officer. NEW REGISTRANTS March 8, 1954.. LONGLEY, James Donald, The Children's Memorial Hospital, 1615 Cedar Avenue, Montreal, P.Q. March 11, 1954 BLAIR, William Harvie, Royal Columbian Hospital, New Westminster, B.C. March 11, 1954 GOODMAN, Benjamin, 2400 Auto Court, Kingsway, Vancouver, B.C. March 11, 1954 KEDDIS, Erna, c/o West Coast Hospital, Port Alberni, B.C. March 11, 1954 MacGUIRE, Gerald Francis (F/L), Dept. of National Defence, R.C.A.F., Holberg, B.C. March 26, 1954 WOOD, William S., Vancouver General Hospital, Vancouver, B.C. DOCTOR'S OFFICE SPACE AVAILABLE Location 100 miles from Vancouver in growing community on main highway. Suitable office for rent in new building, available June 1. For further particulars apply the Publisher, 675 Davie St., Vancouver, B.C. MArine 7729. For further particulars apply the Publisher, 675 Davie St., Vancouver, B.C. - MArine 7729 Page 292 PUBLIC HEALTH AND MENTAL HEALTH NEWS G. F. AMYOT, M.D., D.P.H., Deputy Minister of Health, Province of British Columbia A. M. GEE, M.D., Director, Mental Health Services, Province of British Columbia THE POLIOMYELITIS PROGRAM IN BRITISH COLUMBIA The present program for the care of poliomyelitis patients in British Columbia has been developed during the past three or four years through the cooperation of the private physicians, the provincial and local health services, the Vancouver General Hospital and Royal Jubilee Hospital, Victoria, the R.C.A.F. Air-Sea Rescue Unit and the British Columbia Poliomyelitis Foundation. The need for a province-wide program arose from the fact that the specialized services were located almost entirely in the Infectious Diseases Unit of the Vancouver General Hospital, and to a lesser degree in the Royal Jubilee Hospital, Victoria. Up until 1951 these two hospitals were able to meet the requests for admission of patients from outside the metropolitan areas of Vancouver and Victoria. However, in 1952 the incidence of poliomyelitis in this province was high, 594 cases being reported, and it became evident that it would be necessary to establish a province-wide policy in order to ensure that the highest level of care would be available without delay to patients in any area of the province and that facilities would be used to the best advantage. The plan was originally drafted by the Poliomyelitis Committee of the Vancouver General Hospital in conjunction with representatives of the Provincial Health Branch. It was then discussed and concurred in by the full time medical health officers throughout the province. The Poliomyelitis Committee was set up in 1949 by the Medical Board of the Vancouver General Hospital with the Senior Medical Health Officer of Vancouver as chairman. It is composed of 14 highly trained medical men, including two representatives each of medicine, paediatrics, orthopaedics and hospital administration, and one each from public health, ear, nose and throat, neurology, physiotherapy, psychiatry and oxygen therapy. The purpose of the Committee is to accept for treatment cases of poliomyelitis referred to it who are being treated in the Infectious Diseases Unit of the Vancouver General Hospital, which admissions are under the direct jurisdiction of the Senior Medical Health Officer of Vancouver and to serve as consultants to the private physician for the proper care and rehabilitation of their patients. The recommended treatment, if accepted by the private physician, is carried out at the Vancouver General Hospital, or the Western Society for Rehabilitation, Vancouver. Patients referred to the Poliomyelitis Committee for care are admitted or transferred to the service of the chief representative of the Department of Medicine in the case of an adult, or if a child, to the service of the chief representative of the Department of Paediatrics on the Poliomyelitis Committee. A similar committee is now functioning in the Royal Jubilee Hospital, Victoria, and patients admitted to the Vancouver General or Royal Jubilee Hospitals from outside Vancouver or Victoria now come under the jurisdiction of the Poliomyelitis Committee upon referral. The members of the Poliomyelitis Transportation Screening Committee are, in Vancouver, the Assistant Provincial Health Officer, the Senior Medical Health Officer of Vancouver and the Assistant Director, Medical, of the Vancouver General Hospital. The corresponding committee on Vancouver Island is composed of the Deputy Provincial Health Officer and the Senior Medical Health Officer, Victoria Esquimalt Board of Health. The cooperation of the Air-Sea Rescue Unit of the Royal Canadian Air Force stationed in Vancouver has been outstanding. As soon as a request for transportation Page 293 1/ is cleared through the necessary channels, every effort has been made to complete the* evacuation, despite hazardous flying conditions in some cases. A medical officer and a nurse of the R.C.A.F. are included in the crew of the plane which carries a portable respirator, and other necessary equipment. The specialized equipment required for the care of poliomyelitis patients is located! almost entirely in the Vancouver General Hospital and the Royal Jubilee Hospital, withj the larger share being in the former. A number of the hospitals in other parts of thei province do have respirator equipment but this is not all up-to-date or of the typej which can be used for any length of time. Because of the high cost of such equipment it is considered more economical to concentrate it in the two larger centres of population. It was necessary in 1953 to purchase 26 respirators of the tank type, in addition to other equipment such as rocking beds, positive pressure breathing therapy unit, etc. Approximately $75,000 has been expended on equipment, just over one-half the expenditure has been made from the National Health Grant for Crippled Children, and] the remainder has been made by the British Columbia Foundation for Poliomyelitis. The British Columbia Foundation for Poliomyelitis is a voluntary agency supported largely through the efforts of the Kinsmen's Clubs throughout the province. In addition to the provision of equipment already noted, funds have been given towards the purchase of equipment for one or two other institutions, the provision of additional physiotherapists and research. Because of the greater flexibility in the use of voluntary funds it has also been possible for this organization to assume certain extraordinary expenses. The liaison between the Poliomyelitis Foundation, the office of which is located in Vancouver, and the Provincial Health Branch through the Assistant Provincial Health Officer, is exceptionally close, and has made it possible to work out effective coordination between the services of this voluntary agency and the various governmental agencies. The cost of hospitalization is covered by the British Columbia Hospital Insurance Service as long as the patient is in the acute stage of the disease. After this stage is passed, the cost of hospital care becomes the responsibility of the individual. The more specialized rehabilitation services are given at the Western Society for Rehabilitation, Vancouver; some services are available at the Royal Jubilee and the Vancouver General Hospitals, and in addition, through the cooperation of the Canadian Arthritis and Rheumatism Society (British Columbia Division), physiotherapists on their staff in the various areas throughout the province are giving treatments to post- poliomyelitis patients at the request of the private physician. In general, patients are expected to pay for rehabilitation services. Such services are requested by the private physician on Poliomyelitis Form C which is referred by the Assistant Provincial Health Officer to the Medical Director, Western Society for Rehabilitation, for assessment and recommendations. Clinical assessment of patients is normally carried out by arranging for short-term admission to the Vancouver General Hospital. Here, preliminary retraining is commenced. When the patient has progressed to a self-maintenance level, admission to the Western Society for Rehabilitation is arranged. A supply of gamma globulin was made available to this province in September of past year and was distributed through the local health units. Provision for research in poliomyelitis is quite recent in this province and has been due to the support of the Kinsmen's Clubs and the British Columbia Foundation for Poliomyelitis. Prior to this year an amount of $12,500 was given to the University of British Columbia for the purchase of research equipment. In 1953 the Kinsmen Chair of Neurological Research was established in the Faculty of Medicine, University of British Columbia, through the contribution of $5,000 a year for five years. Additional research into the epidemiologic aspects of poliomyelitis is being carried on under the direction of the Consultant in Epidemiology to the Health Branch, Department of Health and Welfare. With the cooperation of health units in the field, and the Provincial Division of Laboratories in Vancouver, a number of studies into the spread pattern of epidemic poliomyelitis, identification of virus strains in epidemic areas, and field evaluation of gamma globulin are under way. Page 294 Dr. G. B. Buffam of Victoria is now studying in Edinburgh. Dr. J. M. Layng is now practising in the West Broadway Medical district. Dr. C. J. Reich has opened an office in Port Coquitlam. Dr. J. R. Siddall, former resident in Ophthalmology at the Vancouver General, is now practising in Illinois. Dr. D. G. Elphich has returned to practise in London, England. Dr. Ronald Taylor of Vancouver has been nominated for a Fellowship in the American Laryngological, Rhinological and Otological Society Incorporated (Trilogical Society). He will receive his Fellowship at the National Meeting in Boston on the 25th of May, 1954. This is the leading organization of its kind on the North American Continent and there are only seven Fellows in Canada. Dr. J. D. Stenstrom of Victoria attended the Annual Meeting of the Pacific Coast Surgical Association in California at which he delivered a paper on "Carcinoma of the Colon". MARRIED Dr. George Hector Thompson to Joyce Evelynne Stewart of Victoria. BIRTHS To Dr. and Mrs. J. B. Cupples of Victoria a daughter. To Dr. and Mrs. Michael J. W. Penn of Victoria, a son. g|£| DEATHS Dr. Clarence Henry of Victoria on March 9 at Shaughnessy Veterans' Hospital, Vancouver. Born in Norwich, Ontario, in 1874, Dr. Henry practiced in Victoria from 1940 until his retirement seven years later. He was a McGill graduate in 1902, and went to Yorkton, Saskatchewan, where he remained until 1923. From 1916 to 1919 he served overseas with the No. 8 Saskatchewan Hospital Unit. From 1923 to 1940 he was a practicing radiologist in Regina. During his time on the Prairies, Dr. Henry was medical officer of health in Yorkton, and was active in originating milk pasteurization. He was a member of Victoria Rotary Club until he retired, and attended Oak Bay United Church. He is survived by his wife, one son and three daughters. Dr. C. Denton Holmes, 86, Saanich medical officer for a number of years, died on March 16 at Mount St. Mary, Victoria. He was a veteran of the First World War, and was appointed superintendent of Soldiers' Re-establishment for the Island in 1915. While serving this role he was sent to England for study. Four years ago he retired from active practice. He is survived by his wife and four children. Page 295 A PAGE FROM THE "Iftoddt" ALBUM w Ostogen-A with C // VITAMINS A, D AND C • Aqueous vehicle enhances absorption and utilization • Mixes readily with milk or other liquids • Pleasant flavour — accepted by all children 6hwdu> &9*o6at&©>. MONTREAL CANADA OSTOGEN-A with C" Each 5 drop dose (0.25 cc.) contains: Vitamin A palmitate 2000 Int. units Vitamin D 1000 Int. units Vitamin C 30 mg. DOSE: Five drops daily. MODES OF ISSUE: Bottles of 8,15 and 30 cc, with calibrated dropper. Page 296
Periodicals
W1 .VA625
English
Vancouver : University of British Columbia Library
Vancouver, B.C. : McBeath Spedding Limited
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Original Format: University of British Columbia. Library. Woodward Library Memorial Room. W1 .VA625
Medicine--Periodicals
The Vancouver Medical Association Bulletin: April, 1954
Text