• • • • • • Alberta • • Medical Bulletin

October, 1950

CAN"ADIA~ :\fEDICIAL ASSOCIATION Alberta Division

- ·--=== PUBLISHED QUARTERLY For Your ...,;;... f inickq Patients )3j/;~~ Prescribe ~ Pleasant Tasting Riki toI EMULSION

n~1,· I r ,, . f) ~,,l AN AQUEOUS f"""llm~..... nlnita. ~mu1s1an r'rOVluBS CONTAINING Greater Absorption Better Storage CLINICAL EVIDENCE J. M. Lewis and co-worken<1) gave eight prema­ ture infants 35,000 units of Vitamin A, flnt as an oil solution and later the same dosage as a water emulsion. They found the average rise In Vitamin A concentration In the blood of these Infants to AYAILABIUTY: be 62 units and 274 units after the oll and the Rlkltol Emulsion E.8.S. Is water emulsion respectfyely. packaged In .. cc., 15 cc., Sobel et al (2) compared the amounts of the and 30 cc. dropper bottles. vitamins stored In the llver of rats after It had It is given by stirring one been given In oll to one group of animals and In or more drops Into milk, aqueous emulsion to another group. They used orange luice, cocoa or Vitamin A from three different sources. The results other beverage. It Is highly of their experiments showed an average of flavoured so that upon 16096 better storage when the aqueous emu&. dilution, it has Cl pleasant lion was used. fruity tan. (1) ~,., llodandry, llnnl...... and Cohi.i. J. realatdcs 31, "'6 (194) (2) Sobel, E. A. et al, J. Nutrition 35, 225 (1NI)

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LEWORTH CHElfCAL CO. LTD., TIRORTO, CAllADA The Alberta Medical Bulletin

Published by

The College of Physicians & Surgeons of Alberta

501 Alexandra Block EDMONTON, ALBERTA

Vol. 15, No. 4 October, 1950

COLLEGE OP PHYSICIANS AND SURGEONS OF ALBERTA

President Vice-President Registrar DR. J. W. RICHARDSON DR. D. N. MacCHARLES DR. W. BRAMLEY-MOORE Calgary Medicine Hat Edmonton

CANADIAN MEDICAi. ASSOCIATION

Alberta Division

President President-Elect Hon. Secretary-Treasurer DR. P. H. ·SPRAGUE DR. H. U. MORGAN DR. W. BRAMLEY-MOORE Edmonton Calgary

EDITORIAL BOARD

DR. W. C. WHITESIDE (Chairman) DR. A. J. ELLIOTT DR. G. G. ELDER DR. G. ELLIOTT DR. B. HALL DR. J . A. L. ALTON .DR. J. S. GARDNER DR. A. M. CARLISLE DR. W. H. KINDRACHUK DR. L. E. JOHNSON DR. A. K. BRADSHAW DR. M. SHULHAN NOTICE: Ollice Address-The address ol the office ol the Registrar is now 501 Alexandra Bldg., Eclmonton. The new office provides better lighting and better Door space.

CONTENTS Page THE PRESIDENTIAL ADDRESS By R. M . Parsons, M .D .. F.R.C.S. CCL, F.A.C.S ...... 7

DISLOCATION OF THE PATELLA By J. P. Moreau, M .D .. F.A .C.S., CC L...... 8

OBSTETRICAL ANAESTHESIA By Maxwell Yates, B.A., M .D ...... 9

CONSTRICTIVE PERICARDITIS By Lloyd M. Davey, B.A .. M .D ...... ········································ ···················· ...... 12

STUDIES ON THE MAMMARY GLAND By H. E. Rawlinson, M.D...... 14

ALBERTA MENTAL HEALTH ACTIVITIES By Randall R. MacLean , M .D...... 16

REPORT ON FROG TESTS IN PREGNANCY By Dora A. Newson, B.A .. M.D...... 19

AN ANALYSIS OF NINETY CONSECUTIVE CASES DISORDERS OF THE BILIARY TRACT Mr. Morris Weinlos, E.D., B.A .. M .D .. F.R.C.S...... 21

MEDICAL ECONOMICS OF 1950 By H. V. Morgan, M .D., F.R.C.S. CE.l .. F.A...... 24

SOME OBSERVATIONS AFTER TWENTY-FIVE YEARS IN THE COMBINED PRACTICE OF RADIOLOGY AND DERMATOLOGY By Walter Morrish, M.D .. C.M ., D.M.R.E...... 26

THE MANAGEMENT OF THE BLADDER-FOLLOWING SPINAL INJURIES • By G. N. Tucker, M.D...... 30

SIMPLIFIED PHYSIOTHERAPY IN RHEUMATOID ARTHRITIS By Dean Robinson, M.D., C.M ...... 32

THE ARCHIVES COLUMN By Dr. G. D. Stanley, Chairman...... 34

EDITORIAL- THE PATIENT AND THE DIAGNOSIS By W. C. Wliiteside, M .D...... 36

NEWS AND SLIGHT PROGRESS...... 37

BUSINESS OF THE COLLEGE AND COUNCIL By Dr. W. Bramley-Moore, Regi strar ... "...... 38

OBITUARY ...... 40

ADVERTISEMENTS ...... 57 I lJ THE ARCHER MEMORIAL WINDOW IN THE ARCHER MEMORIAL HOSPITAL. LAMONT, ALBERTA ( SEPT. 24TH , 1950) ARCHER MEMORIAL WINDOW

In memory of the late Dr. A. E. Archer a memorial window was unveiled in the children's ward of the Lamont Hospital. At the same time the name of the hospital was changed to the Archer Memorial Hospital. Money for the window was donated by the friends of Dr. Archer, mostly residents of the Lamont district. The Window was unveiled by Dr. George Johnson, of Calgary, representing the medical profession of Alberta. Dr. Johnson was an old friend of Dr. Archer's having been associated with him in connection with medical activities over the years. The Dedication of the Window was carried out by the Rev. ·D. J. C . Elson, of St. Stephen's College, former Lamont clergyman. Dr. T. C. Routley, Executive Secretary of the Canadian Medical Association, paid tribute to Dr. Archer in which he called the hospital founder "an outstanding physician, humanitarian, gentleman and Christian." Mr. William Pedruchney, District Agriculturist, com­ mented on Dr. Archer's interest in the new Canadian people who came to .the district as strangers. He called Dr. Archer "a great man" who had given his life to the service of people of a different race, habits and language. It is estimated that between four and five hundred people attended the ceremony and everyone felt that the Window was a fitting token in remembrance of a great life. It is hoped that any members of the Profession or others interested may feel free to visit the Hospital and inspect the Window.

!Unveiling of Memorial Window, September 24th, 1950)

Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 7

PRESIDENTIAL ADDRESS By R. M. PARSONS, M.D., F.R.C.S. (IC) ., F.A.C.S. Red Deer

It is my privilege to welcome you to The cost of seeing a patient and the the forty-fifth annual meeting of the cost of administering to the patient has Alberta Division of the Canadian Medical gradually risen and gives rise to many Association. For the first time we are of the problems that confront us today. having a four-day meeting in order that Health has become a subject of great one whole day of the Convention may · importance to people generally. With the be devoted to business. rising costs of hospital care and treatment Since the formation of the Provincial and in the various ancillary services, pro­ Association there has been a gradual longed illness often becomes a major change in the medical practice and that catastrophe. During the . depression days change was reflected in the lifetime of of the '30's in our district the pressure my father, who graduated from Trinity to establish prepaid medical care schemes Medical College in 190 l. He spent a year was often considerable. It was during under a doctor in rural practice in Ontario, these years that many such schemes were and then a year as an interne in the old established all over the country. During Toronto General Hospital. With this these times of economic stress, health preparation he felt that he was prepared schemes were established at a disad­ to do almost anything, He was a general vantage to the doctor and the premium practitioner who did his own surgery and in such schemes has been increased who qualified after he had been in prac­ several times. tice for fifteen years. He continued as a The pressure for some health security general practitioner who was qualified has continued into good tin;1es and in the in general surgery. last few years prepaid medical care plans His practice was built up on the basis have been set up in every province of of accessibility and service and he went Canada with the exception of Quebec. In anywhere at any time. His office was in Quebe'c the Blue Cross has a large mem­ -· his hous.e and practice for the most part bership. This is in keeping with the very consisted of the doctor going to see the definite trend throughout the world. patient, rather than the patient. coming to see the doctor. Obs'tetrics and often .At the 1949 meeting of the Canadian surgery was done in the home miles from Medical Association in Saskatoon, certain the hospital. Transportation was difficult policies were elaborated and these are and the doctors travelled by team, or later viewed favorably by our governmental by car. authorities. The publication " Oil Call" has issued Diagnosis was based on a painstaking its· sixth bulletin and very clearly ·outlines history and co.mplete physical examina­ the problems that are now confronting tion. The overhead ·was small and the ·us. Doctors in general are said to be doctor kept his own books and sent his scientifically years ahead of their time own accounts. A varying percentage of and socialogically years behind their time. people paid their bills. The accounts of Elsewhere those who have not recognized those w ho could and wouldn't pay were the trend have been caught in the meshes put in. the hands of collectors. The of a political net. We are in a phase of accounts of those who couldn't pay were transition and have come to the cross­ forgotten. roads. On the one hand we have The position of the doctor in the com­ the government sponsored and controlled munity was very similar to that of the scheme, as exists in Britain; and on the minister. He saw his patients in their other hand we have a contributory type homes and often paid long visits. At a of scheme, where the patient-doctor funeral he went with the mourners. relationship is not disturbed. 8 ALBERTA MEDICAL BULLETIN Oct., 1950

I hope we can give more thought cind It i'S to be hoped that at our business time to our economic organization and our meeting we are able lo reach the same public relations and view the general accorq that was experienced al the situation in the same logical and scientific General Council meeting in Halifax. manner we apply to the diagnosis and Note: This address was presented al the treatment of disease. Calgary Convention Sept. 19-22, 1950.l DISLOCATION OF THE PATELLA (Case Report) By J.P. MOREAU, M.D., F.R.C.S. (tC). Edmonton

Dislocations of the patella are classi­ medially, this seldom requires an anaes­ fied as acute and recurrent. Recurrent thetic. The degree of the injury to the dislocations are most often found asso­ medial quadriceps expansion should be ciated with a genu valgum deformity, assessed after aspiration of blood from which accentuates the normal outward the joint and if a rent can be felt it pull of the contracting quadriceps ten­ should be repaired. don on the patella. There also occurs a congenital error of development of the ,Case Report lateral femoral condyle. Rarer causes of We wish to 1'eport an irreducible acute dislo­ recurrent dislocations have been des­ cation of the patella. A young man in his early twenties stated that a few hours previously while cribed, such as trauma alone, external carrying a 100 pound sack of flour up a stair­ way, he missed a step, abducting his left knee. rotation of the tibia and more recently His left knee snapped as he regained his balance the presence of a short fibrous thicken­ and until his admission he felt agonizing pain in his knee. The left knee was slightly flexed ing of the lower tendon of the vastus but could be extended passively. The patella was completely dislocated laterally, and there was lateralis. The classic operation of medial very little swelling of the knee joint and no ap­ transplantation of the tibial tubercle, parent hemarthrosis. The medial collateral liga­ ment was intact. The diagnosis was obvious sectioning of the lateral quadriceps ex­ to the orthopaedic resident who had been called by a perplexed interne. He encouraged the pa­ pansion and plicating the medical prov­ tient, ext>ended the knee fully and pushed the ides a permanent cure; full knee flexion patella medially. The knee was abducted, and another attempt was made to free the patella. and freedom from pain require several Later three attending orthopaedic surgeons and an unbelieving anaesthetist attempted in vain to months. reduce the patella by manipulation with the pa• Acute dislocations are nearly always tient under a general anaesthetic. lateral and maybe complete, or incom­ The kn•ee was then opened through a medial parapatellar incision. There was no rent in the plete, depending on the degree of dis­ medial quadriceps expansion which was drawn very tightly over the femoral condyles. As it placement. In the complete dislocation was sectioned to open the knee joint a wide the patella lies on the outer surface of fold of the lateral quadriceps expansion was found pinched between the patella and the lateral the lateral femoral condyle, its articular condy le. As the taught medial expansion was cut and the tension of the patella relieved, the fold surface facing the condyle. The disloca­ was freed and the patella slipped back into place. tion is usually reduced easily by extend­ There wa·s no gross tear of the medial expansion. but there was a large ecchymotic area in the ing the knee and pushing the patella medial capsular insertion on the tibia.

"I hold every man a debt to his profession". -Frances Bacon (Ethics).

"I prefer to attribute high motive to my friend's acts". -Pasteur (Ethics).

"Live by the old ethics and the classical rules of honesty". -Sir T. Browne (Ethics). Vol. 15, No. 4 ALBERT A ME DICAL BULLETIN 9

OBSTETRICAL ANAESTHESIA By MAXWELL YATES, B.A., M.D. Edmonton In 1853 Sir J ohn Snow administered 1928 Pitkin developed his "controllable chloroform to Queen Victoria for the spinal anesthesia" which was a saddle birth of her eighth child. From that t ype of block done by anesthetizing only time, the popularity of analgesia and the sacral segments of the cord. anei;thrnia for childbirth increased, and Hingston and Edwards in 1940 began rapidly spread throughout the world. the sacral caudal blocks for delivery and There was, hcwever, a great deal of in 1942 developed the continuous caudal criticism from the medical profession, technique. the laity, and especially the ecclesiastics. The work of Grantley Dick Read must The clergy in Edinburgh sent a circular be cited in any review of relief of labor to the local physicians containing these pain. Briefly, his theory is that fear, words: "To all seeming, Satan wishes to acting through the thalmus, brings the help suffering women but the upshot sympathetic nervous system into play will be the collapse of society, for the and causes a tightening of the lower fear of the Lord which depends upon uterine segment, and that if the fear the petitions of the afflicted, will be can be overcome, the pain will cease. destroyed". Certainly it must be agreed that once The ccnflict had raged for six years. f ear is allayed, either by education, but once the Queen had used an anes­ confidence in the doctor, and if neces­ thetic agent, the scale was turned in sary, by drugs, the labour will pr.ogress favor of pain relief during childbirth, more smcothly and effectively with less since in the minds of the laity, there apparent suffering by the patient. was involved loyalty to the throne. All these and many other develop­ For the next 30 years chloroform and ments can really be said to have been ether were used extensively throughout received with variable enthusiasm and the world, with little or no changes in have been used extensively only in local­ techniques. Indeed one could safely say ized centres. In other words, nothing has that at t he present time these two been developed to displace the generally­ agents are mere widely used in obste­ used ether and chloroform as it was in trical anesthesia than any other agent. use in the days of Queen Victoria. In other fields of anesthesia there have Possibly the relatively short history been many improvements in techniques of obstetrical anesthesia is going to re­ and agents and these are in general use; peat itself, for the present Princess but except for nitrous oxide and possibly Elizabeth was reportedly given a new the "low spinal" technique, there has agrnt for analgesia during the birth of been nothing to challenge chloroform Prince Charles. This drug, trichlorethy­ and ether when compared as to ease lene, or trilene as it is commonly called, of administration, availability, potency has been in use in Great Britain for the and safety, and general usefulness. past ten years but has not been reported In the early 1900's nitrous oxide and to have been used in obstetrics on this the so-called "twilight sleep" with mor­ continent until this past year. phine and scropolamine came into use In 1939 when a war in England looked on this continent. The barbiturates then inevitable, the Medical Research Council received a wave of popularity to such an and Anesthetic Section of the Royal So­ extent that in a survey in the United ciety of Medicine began search for an States in the fi}30's, 87 % of obstetricians anesthetic agent which would be non­ were found to be using them in some inflammable and thereby of much practi­ combination for analgesia and hypnosis. cal use in case of war. In 1900, Kreis repcrted the first use Dr. Langston Hewer eventually pub­ of spinal anesthesia in obstetrics, and in lished a series of reports on trilene, a 10 ALBERTA MEDICAL BULLETIN Oct., 1950 drug which had been known to have the stage of surgical anesthesia is potent analgesic properties for years, reached .. On the circulatory system the and had been used for relief of pain in on ly notable effect is the occasional oc­ trigeminal neuralgia. Even in this prov­ currence of extra systoles and clinically ince as early as 1932 the drug was used one sometimes sees a flushed appearance by Dr. H. H. Hepburn in the treatment to the skin. of that condition. The most impressive property is its In the early 1940's the drug began effect on respiration. It is slightly irri­ being used as a general anesthetic and tant, and there is also a notable rise· in it was found that its properties were the rate which may be extreme if one ideally suited for the requirements of tries to "push" the depth of anesthesia. obstetrical analgesia and anesthesia. Therefore in surgery where muscle Widespread popularity has already been relaxation is wanted or where intra­ achieved in Great Britain in the past uterine manipulations are proposed, the ten years and only now is trilene be­ agent is not suitable. ginning to have a trial in this country, despite the enthusiastic reports from The toxicity to the liver and kidneys overseas. is said to be less than that of either The reason for this delay is probably chloroform or ether. There has been due to the early reports of occasional only one case of liver necrosis reported cases of cranial nerve palsies that de­ in Britain, and the influence of trilene veloped following trilene anesthesia. there was doubtful. These were subsequently proven to be Our method of administration has du to an improper method of delivery of been planned for the delivery and re­ the agent, through a carbon dioxide .ab­ pair of the episiotomy only. There are sorption system containing soda lime. several types of self-administered in­ Toxic acetylene products were formed halers on the market which can be used which apparently caused the nerve dam­ in the earlier stages of labour. We use age. It is now never used in such a sys­ a gas machine with a fractional re­ tem and in great Britain safety devices breathing system (no carbon dioxide ab­ have been developed to' prevent the use sorber), and regulate a flow of six lit­ of trilene and a C02 absorber at the res of nitrous oxide and three litres of same time. oxygen. A bottle such as an ether bottle In the Obstetrical Department of the or more preferably a vinesthene bottle University Hospital during the past with a gas flow regulator, is put into eight months, we have used trilene in the system. A few c.c.'s of trilene is put approximately 600 cases. The results in the bottle. There should be no wicks have been so satisfactory to both the irt the bottles to increase vaporization as obstetricians and anesthetists that our the concentration is then too great. The enthusiasm compares with the authors gases are allowed to flow into the bot­ of the British reports. A more detailed tle and over the liquid trilene but never report will be published by one of our bubbled through the liquid. staff in the near future. Analgesia is produced in a matter of Trilene is a clear volatile liquid with a seconds and the patient may state that not unpleasant sweetish smell, and may her lips are numb or that she feels be colored light blue. It is not inflam­ "fuzzy" all over. Anaesthesia is reached mable at ordinary temperatures and pres­ in about one to two minutes at the most sures, in rur. With pure oxygen at over although there may be a short excite­ 25.5 C it may ignite. The dangerous ment period. I have not seen anaesthesia property of reaction with alkalis such carried to the point of having the eye­ as soda lime has already been men­ balls fixed, yet the analgesia provided tioned. is adequate for episiotomy, delivery, a~d About 0.5% in air will rapidly pro­ repair. duce analgesia and as the concentration The advantages of this technique have is increased, after a very short time, been: Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 11

(1) Ease of adminis·tration-Anaes­ edly reduced by an estimated 50% . In thesia is rapidly produced and easily multiparous patients the incidence has maintained by intermittently allowing been reduced from 44 % to 23 %. In the gases to flow over the trilene for a primiparas, the reduction is from 57% few seconds at a time. to 43%. A further reduction is antici­ (2) Quick recovery time-In seconds pated as the obstetrical staff becomes or minutes, depending on the length and more convinced that spontaneous deliver­ amount cf anaesthesia, the patient is ies can more easily be achieved than awake, and well-orientated. previously. (3) Safety-Since a high level of The simplicity and apparent safety oxygen is allowed in this technique there with this technique producing rapid anal­ is no anxiety about hypoxia or anoxia. gesia and anesthesia with a reduced rate If an excess of trilene is given, the res­ of anesthetic complications, has been an piratory rate becomes markedly raised apparent improvement. and thereby acts as a warning sign and The cyanosis, anoxia, and resistance it is a definite one that cannot be over­ by some patients with nitrous oxide, is looked by anyone in the rcom. avoided. The deep anesthesia with (4) Lack of complications-Vomiting ether, necessitating forceps and post­ during induction or throughout the operative complications, is avoided. course or at recovery is a rare occur­ Low spinal anesthesia is of special ad­ rence. This, in itself, distinguishes the vantage in cardiac and respiratory com­ agent from other gaseous or liquid plications, but for general use their agents. r elatively high incidence of post-delivery The incidence of post partem hemorr­ headaches and the slowing of labor with hage has so far not increased, nor has necessitated greater use of low forceps, delay in fetal respirations. However, it would ·seem to be a secondary choice of must be said that the incidence of technique. delayed fetal respirations does not ap­ Any hospital with a gas machine pear to be lowered as much as was could use this agent as I have described. hoped. Possibly other factors in the A New McGill Trilene Inhaler has just labor account for this. been d~scribe~ in the Canadian Medical ___Trilene can apparently slow the pro­ Journal and that inhaler can be gress of labor in some cases, but if ~hi~ adapted to the common types of gas ma­ occurs iti is a simple and quick matter chines in use, at .a low cost. to allow the patient to awaken and· co­ Bibliol'raphy: operate again. 1. Hewer, C. L .. Canadian Medical Association Journal, April 1950. The flexibility of trilene anaesthesia 2. Lull and Hingson, Control of Pain in without vomiting is one of its impres­ Childbir th, November 1944. 3. Ostlere, G., British Medical Journal, sive features, thereby obtaining anal­ January 31st, 1948. · gesia and anaesthesia quickly and yet 4. Asquith, E.. Bourne, W ., Gilbert, R. G., allowing a more natural delivery. The Canadian Medical Journal, June 1950. 5. Reid, Grantley Dick, Childbirth W ithout use of f crceps has thereby been mark- Fear, 1944.

The new offices of the College are open for inspection, just go up several more floors-by elevator-A warm welcome awaits you.

Many are having their Alberta Medical Bulletins bound and improving their index libraries.

All members of the Medical Profession are asked to forward articles for publica­ tion in the Bulletin. Each one can do · his share of enlightenment as he passes along the short road of life. 12 ALBERTA MEDICAL BULLETIN Oct., 1950 CONSTRICTIVE PERICARDITIS By LLOYD M. DA VEY, B.A., M.D. Lamont

It is the purpose of this article to pre'Sent the pericardium . On screening, the right border of the hea rt a1>peared fixed but there was relatively normal an interesting case-history with a few brief pulsation at the apex. NOTE: Fig. 1 and 2. comments on the condition represented. There are two interesting aspects to this Case: Male-aged 52 years. Occupati'on- rarmer. case. The first is that, with such marked There was a history or influenza! illness or severe character as a young man. His present disability started calcification of the pericardium, the patient about one yea r ago when he began to notice pain at the lerel or the left nipple. This pain he described as was so free of symptoms. Actually he came aching in cha.-acter and it bothered him if he walked or primarily to bring his wife for examina­ worked quickly. Attacks were more likely to com e first thing in the morning and in hi s story he connected tion and only saw the doctor for a "check­ them with pain in hi s epigustrium and a reeling or over" continually insisting that it was his nausea. No food intolerance or relationship to meals had been noticed. He complained on questioning of a dry wife who was sick and not he. The second unproductive cough. interesting fact that he is still free of any Physical examination rerealed a small man of medium build who appeared to be in good health. There was no of the other evidences of polyserositis, apparent cyanosis or ab normal venous engorgement. The heart apex was visible four inches from the mid-line adds only confusion to the much debated in the fifth lnterspace. The heart sounds were normal. question as to the relationship between Pulse rate 66 per minute with occasional extra-systoles; B.P. 120/ 76 . The liver wa s not enlarged. There was constrictive pericarditis and polyserositis. no e''idence of ascites. This case would appear to be contrary to X-ray evidence showed slight increase In the transverse diameter or the heart with fairly extensive calcification or the view held by T. Holmes Sellors,

P -A . VIEW SHOWING CALCIFICATION · Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 13

LATERAL VIEW SHOWING CALCIFICATION

F.R.C.S., who writes in the British. Journal The future of the patient with constric­ oJ Surgery, "The relationship of constric­ tive pericarditis depends ·· on the rate of tive pericarditis with polyorrhomenitis development of the condition. The slowly (polyserositis) is probably more intimate developing case may be relatively .symp­ than is commonly supposed. A conne.xion tom free for years and it would appear is recognized, but multiple serqµs effusions that the heart muscle will not suffer are often regarded as being "poflt hoc," the constricting _effects so long. as it ·is whereas their presence may precede con­ not subjected to undue strain. However, striction. few survive to old age and the increasing distress and incapacity of the established As for etiology of thi'S conditi6n current ca"Se is a strong indication for surgical literature submits three possible causes inter_vention w)lich is even more urgent for the origin of constrictive pericarditis: in "quickly devel~ping lesions. tuberculous infection, old pyogenic peri­ carditis and idiopathic factors. This last In summary, a case of constrictive peri­ accounts for the largest group, but it is carditis ha·s been· presented as of interest suggested by several authors that the because· of its striking X-ray picture in reason for this is the limited tissue avail­ sharp contrast to the mildness of the able for microscopic examination in the patient's symptoms and the lack of other patients who receive surgical treatment evidence of polyserositis. A brief note is for this condition, holding that tuberculous made concerning the possible etiology ·of infection is likely the chief- causative the condition and the future for patients agent. suffering from it. 14 ALBERTA MEDICAL BULLETIN Oct., 1950 STUDIES ON THE MA.MMARY-·: GLANU . By '', . .·,~f:-;{iti.~~-~: . H. E. RAWLINSON, M.D. ~--· Dept. of Anatomy Univ~Bft:y . -of Albert~ ·,._, Edm~nt-0n · ;:, \~,: · <. ,;- _., In spite oI almost a century of intensive not .cleai, but, s'ince ·1 is fci.irly well dis- research the enigma of cancer has re- tribu'ted cilong the gland tree, .the oppor. mained essentially a mystery and although !unity has. been taken o'f using it to a major advance in our knowledge may measure the e.xt~nt of the resting mam·- occur at any time ,there is none clearly mary gland. The mammary glands are in sight at present. Ju-st now !he battle analyzed both histologically and chemi- appears to be settling down to a war cally to determine their iron content and of attrition in which persistent and wide- in· this way it 'i-s possible to get very spread efforts are being made to collect precise quantita,five data on gland as much information as possible, not only development. regarding its fully manifested form, but As an example, in a series of mice also in relation lo what are called, the effect .of previous pregnancies on the somewhat indefinitely, its ·"precancerous mammary gland was determined by iron phases." There can be no doubt that, analysis of groups of virgin and breeder sooner or later, some piece of fundamental animals. The latter had an iron content knowledge will turn up that will prove of some two or three times that of the to be the key piece lo the puzzle. virgins, and this agreed with the histo- Of the leads that are at present indi- logical estimation of the stainable iron cated there is one that has some immediate found in the glands. Again; a comparison promise in the well-demonstrated fact that of iron content of the mammary glands endocrine secretions can and do ·have o! three different strains of mice, each an effect on the inception and course of differing in the incidence of mammary at least certain types of tumors. This cancer showed marked and characteristic ·approach has a -special appeal to clinicians differences in iron retention, and hence because endocrine therapy is proststic in gland development, among the different carcinoma, and, to a ·lesser extent, in strains. mammary ':cancer, affoi:ds ... the ..only Attempts are now in progress to intro- . examples BO far demonstrated of biological duce known carcinogenic factors into agents having a definite, even if tem­ animals of low cancer incidence to see if porary, restraining effect on tumor growth. the effect of such agents on the mammary It is clear, however, that we need more gland can be made evident and mea-sured fundamental data on the action of hor­ by iron analysis. This should throw some mones ·on !'issues, both normal and can­ light on the question whether the carci­ cerous, and thi-s is particularly so in the nogenic "milk-factor" in mouse mammary case of mammary ·cancer. Therefore, basic cancer acts directly on the gland or research on problems regarding the mam­ indirectly by means of estrogenic, ot mary gland -has been underway in this estrogenic-like stimulation. department for some time and an outline It ha-s been demonstrated iri this of what is being attempted and what 'has laborator.y that the iron retention can been accomplished may be of interest. be influenced by estrogen stimulation, It has been demonstrated, largely because when castrated male mice are through work in this laboratory, that in given injections of estrogens the rudi­ the .resting mammary gland of adult female mentary male gland is stimulated, not mice, rats, and other rodents, large only to grow, but also to retain iron. deposits of iron occur in the epithelial Following this lead several experiments cells of the gland. These are present in have been set up using spayed female such quantity, and stain so sharply, that mice in which the estrogenic stimulation, the gland tree can be clearly outlined supplied by injection alone, can be rigidly by ·the use of iron stains. The purpose controlled and correlated to breast served by this accumulation of iron is development as measured precisely by Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 15 iron analysis. Similarly castrated males of ordinary breast epithelium undergoing have been grafted with ovaries so that degeneration, and which are prone lo cyst the gland will be stimulated to alveolar formation and often to develop a peculiar development and so to iron retention which type of cancer. The arguments here rest can then be measured and correlated with largely on subjective interpretations of various experimental factors. histological appearances. The first point Altogether, there are strong indications of view has received support from the that the measurement of the state of the finding of scattered fine iron deposits in resting mammary gland by iron analysis the apocrine sweat gland tissue of the may offer a sensitive and accurate tech­ human breast, for iron deposition is a ·nique to replace the older methods which marked feature of the apocrine sweat are ·1argely subjective and relatively crude. glands proper. .However, in an extensive It may thus afford a valuable experi­ study which we carried out on human mental tool to unravel some of the female breast tissue kindly supplied by problems of estrogenic effects on the the Department of Pathology of this mammary glands of appropriate animals. University we could find no massive iron deposits such as occur in the rodent mam­ A question that has always b_een in the mary gland, or in the human apocrine forefront has been the possible application sweat glands proper. The idea occurred, of findings to date to problems of human however, that the iron containing stage breast cancer. Among other things, it is might be passed in the early development probable that the study of stainable iron of the breast from its infantile rudimentary in thE! epithel l~l c~lls of the human mam­ stage to its mature ·condition of specializa­ mary gland may throw light on the 'vexed tion. An effort was made to get tissue question of . the so-called "sweat gland from the breast of adolescent females, cancer" in the human female. These tumors but' so far we have not succeeded in .seem toe · aris~ from islands of peculi~r getting any· such· specimens. In 'the mean­ .tissue in the human brea st that have a time, a somewhat similar approach has .distinctive type of epiihelium. The cells been tried by · iooking for male breast are large in size, . pale in their ~ staln1ng tissue that had been stimulated to develop­ reactions, and· discharge their secretion by II1ent by stilbestrol treatment. Through the means 0£ large cytoplasmic projections splendid co ~ operation of the Pathology that ·break off into the lumen. These Department of the Royal Alexandra Hos­ _c_haracter! stics are similar to those of' the pital in Edmonton, and of some of the iarge sweat glands of the axilla, and :also to a special 'type of ·gland found in clinicians ·· on" ifs staff, a few such specimens have been obtained. · It was the areolae of the breast, both of which encouraging· to find 'in one of these that are collectively referred as "apocrine the mammary gland had not only been sweat glands.'' The · term "apoctine" denotes the mode. of secretion by ;cyto­ ·stimulated to development, but had : also plasmic projections breaking off into the produced massive iron deposits. ducts. The islands. of similar appearing , The ·finding of iron in the stimulated tissue in the human breast have afso male human -breast is undoubtedly of been called apocrine sweat gland tissue, significance. aµd shows that the human and the implication is that they are pretiy giand i~ .clos!liY alli'ad, on the on.e h~nd, much the same; and that the presence lo the rodent mammary gland and, on the of such areas in. the breast is due to other, to the human apocrine sweat glands . _inclusions of apocrine sweat gland tissue .It is. probable that the following-up of in the breast during its development. This :this lead may enable us to clarify some view is strengthened by the fact that both of the. problems regarding the problems the mammary gland and the true apocrine of " sweat gland cancers," and of the sweat glands arise from the promitive endocrine factors in breast development.· milk ridge of the embryo, and also from Human material for these studies is hard the fact that both are influenced by lo come by and we would be most grate­ estrogens. hil for any help in obtaining female b_reast Other pathologists; however, think that tissue in early adolescence, or II1ale breast such tissues in the breast are rather areas tissue after stilbeslrol treatment. Simple 16 ALBERTA MEDICAL BULLETIN Oct., 1950

fixation in 10 °lo formalin is all that · is geons of Alberta during the past seS'Sion required. had a major share in the work. It seems The researches very briefly outlined to me to be apparent that, not only in have been aided in a very 'Substantial this case, but also in regard to all the fashion by the help of others. Dr. H. W. previous awards of this grant, the dual Hankinson ·and Mr. George D. Molnar purpose for which it is intended has been were able to take part by the support served. Not only has it enabled picked of the Medical Research Fund of this medical students to get some idea of University and Mr. E. G. Evans gave research techniques and attitudes of minc:l, valuable assistance. am particularly but it has also furthered that steady and indebted to the help of Mr. G . B. Pierce persistent accumulation of data in the who, as holder of the Fellowship of the fundamental medical sciences which is Alberta College of Physicians and Sur- essential to progress.

ALBERTA MENTAL HEALTH ACTIVITIES By RANDA•LL R. MacLEAN, M.D. Director, Division of Mental Health Ponoka

The ever expanding Health Division Hospital provides the service for the of the Province has now come to Ponoka area, and the Provincial Mental embrace some six Institutions and two Institute assists the Edmonton Clinic in full-time completely staffed Guidance certain areas adjacent to Edmonton. Apart Clinics with itinerant Clinic service to from the value of these Clinics to the some sixty points throughout the Province. community at large, they provide an in­ The Institutions are the Provincial Mental teresting and instructive adjunct to the Hospital, Ponoka; the Provincial Mental otherwise routine duties of the professional Institute, (Oliver) Edmonton; the Provin­ Staff members of the various Institutions. cial Auxiliary Mental Hospital, Clares­ Roughly the populations of the Institu­ holm; the Provincial Auxiliary Mental H.os­ tions are as follows : The Provincial Mental pital, Raymond; the Provincial Training Hospital, Ponoka, 1,450 (mixed); the School, Red Deer; and the Centre known Provincial Mental Institute, Edmonton, as "Rosehaven," which while operating COliverl, 1,300 (mixed); the Provincial under the Department of Public Welfare, Auxiliary Mental Hospital, Clareshol~. is supervised by the Director of the Divi­ 100 (women); the Provincial Auxiliary sion of Mental Health. Soon to join the Mental Hospital, Raymond, 135 (women); ranks of the Hospital Services for the the Provincial Training School, Red Deer, Mentally Ill will be the new Psychiatric 400 (mixed 6 years of age and over); Ward of the University of Alberta, Rosehaven, (Camrose), 210 (mixed). Edmonton, and plans are now being finalized for a similar Unit at the Calgary The Provincial Mental Hospital, Ponoka, General Hospital. The work of these Units and the Provincial Mental Institute, will be integrated into the overall Pro­ Edmonton, are active treatment Mental vincial program. The two full-time Hospitals providing all types of modern Guidance Clinics are located in Edmonton treatment, the amount depending of course and Calgary and serve the surrounding on the availability of medical and other territories. In addition the Edmonton Clinic professional members. Treatment in such has been extending its services to the hospitals consists of Psychotherapy, Occu­ Peace River Country twice annually. The pational Therapy, Recreational Therapy, ·Staffs of the Provincial Training School, Physiotherapy, and Shock Therapy, (which the Provincial Mental Hospital, and the includes Insulin and Electro Shock); Provincial Mental Institute, also participate Psychosurgery, and treatments where in the Guidance program. The Provincial drugs or specific procedures such as the Training School conducts Clinics in and fever treatment for Neurosyphilis are around Red Deer; the Provincial Mental indicated. Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 17

Psychotherapy consists largely of re· Therapy. Despite the contraversies which pealed interviews and discussions with have developed in recent years concerning the patient, with a view to bringing about these treatments, those who have been readjustment of the personality or readjust­ in mental hospital work for several ment to environmental conditions. Psycho­ decades will testily to the revolutionary therapy is very time consuming ii it is changes which Shock Therapy and to be successful and presupposes adequate Psychosurgery have brought about. With medical supporting trained staff for its the introduction of these measures such ;-:>roper application. procedures as prolonged tube-feeding, Physiotherapy, including Hydrotherapy, physical restraint and much seclusion, take'S the form of such procedures as have passed by, it is ·hoped forever. continuous baths, wet packs, massage, Many also appear to have been saved light-cabinet treatments, and is very use­ from the so-called "scrap-heap of mental ful as an adjunct to other forms of treat­ bankruptcy"-not all by any means, . but ment in acute excited or tension and one gets new courage with each conquest. anxiety states. Psychosurgery or Brain Surgery de­ The value of "work" in maintaining signed to remedy or ameliorate mental human morale and sell-esteem is ines­ disorders has now taken i!'S place among timable. So in the realm of treatment in the proven measures which might be mental disorders, Occupational Therapy tried. In selected cases dramatic favorable stands high in the list of effective results might be obtained. Originally rehabilitory measures. Early in the course anxiety, tension and depressive conditions of recovery light, interesting work is most were the popular choice for these opera­ effective in integrating the thought pro­ tions. Such surgery, however, has been cesses and improving cencentration. The used effectively in other type'S of cases benefits of a general physical nature are such as chronic excitements, delusional also quite appreciable. Later in the states and those who may have developed rehabilitation process outside work of an intractable and odious behaviour patterns, industrial character may be more suitable. making their adjustment within or without Coupled with any Occupational Therapy the hospital impossible. The present day program must be a Recreational program. trend seems to favour the transorbital Active treatment mental hospitals, recog­ type of leucotomy in preference to the nizing the value of this, have now engaged classical radical operation of sectioning ; ;J,eciaTly--trained recreational therapists the frontal lobes through "button-holes" to direct such activities. The latter activi­ in the parietal region. ties consists of group games, dances, The modern mental hospital uses bingo, card parties, concerts, sports of specific and nonspecific medical treatment all types and enterprises such as play in the same manner as general hospitals. productions where the patients themselves Antibiotics are in liberal use. The Provin­ do the acting. With proper facilities treat­ cial Mental Hospital, Ponoka, completed 25 ment may be given through the medium years of malarial treatment of Neuro­ of psychodrama where personal conflicts syphilis in 194 9. In more recent years and other mental abnormalities are this treatment has been combined with re-enacted in drama, which procedure Penicillin. The profession might be in­ when carried out under the direction of terested in knowing that at the moment a a psychotherapist may lead to the solution critical study of "25 years of Malarial of the problems involved. Treatment of Neurosyphilis" is being con­ Probably the greatest adjunct to modern ducted in the province by an experienced treatments in Mental Hospital in Shock physician under the direction of the Therapy. While this treatment in crude Divisions of Social Hygiene and Mental form has been popular in the treatment Health. of mental disorders for ages, it remained Guidance Clinics were inaugurated in for Sake! and Meduna to start the train 1929 in Alberta. For . years they were of events which have led to the refine­ conducted by staff members from the ments in the methods of administering mental hospitals. They constitute a com­ Insulin Shock Therapy and Electro Shock munity service for the examination and 18 ALBERTA MEDICAL BULLETIN Oct., 1950

treatment of <:hildren or adults showing patients to mental hospitals, just the same early signs of personality deviations. The as they receive instructions concerning service has proven very helpful, not only other laws. A point often forgotten by the to the medical profession, but to school, laity, medical and otherwise, is that when welfare and many other organizations. a person is placed in a mental hospital To date some 9,000 cases have been with locked doors, his "liberty' is denied seen in these Clinics. The establishment him and there must be a law to <:over of full-time Clinics in Calgary and Edmon- this, odious as it may seem. It is not . ton in 1947 and 1948 re'Spectively, has within the province of a physician or materially enlarged the scope of the employees of an institution to deprive. a activity of this branch of the Mental person of his liberty, without legal Health Division. authority. Much and all as one may dis­ The Psychiatric Ward of the University like it, it seems probable that mental hospitals will always have ·certain locked of Alberta Hospital which will accommo­ wards for the protection of those incom­ date approximately 20 patients, may be petent to exercise their rights of liberty, ready for opening in 1951, and will or likely to interfere with the rights, provide a much needed service in that privileges or even the very "lives" of hospital and community. The ward will be law-abiding citizens. Some province.s or suitably staffed and will function for countries provide (lmbulance service for acute cases. Such a ward would soon lose purposes of going abroad to transport the its effectiveness if allowed to become prospective patient to a mental hospital. glutted with "<:hronic" cases. As intimated While an ideal arrangement, such a earlier in this article, it is expected that service. in a large area like Alberta, which construclion of the Psychiatric Ward in serves as well the adjacent North-West the Calgary General Hospital will com­ Territories, would be so. CO!;tly as to make mence in the near future and will it practically prohibitive'. A conservative eventually function in the same manner estimate of the miles which aml{ukmces as the University of Alberta Hospital Unit. would have to travel in escorting patients A word about Admission Procedures: to the mental hospitals e.ach yeqr at the The clauses of the Mental Diseases' and present rate of admissions, would be one Mental Defectiv,es' Acts governing the hundred and seventy-live thousand miles. admission and discharge of patients Apart from the . initial cost and main­ generally speaking are quite satisfactory tenance and fuelling of the vehicles, there if the proper procedures are adhered to. would be the expenses in connection with No committal laws for the mentally ill providing a chauffeur and at least .two can satisfy all parties concerned. Those trained individuals to accompany the who are mentally incompetent by v.irtue ambulance on each journey. It will be seen of mental illness or mental deficiency at a glance that the expense involved obviously are not capable of exercising might easily be in the neighborhood of "Voluntary" rights; those who are radi­ one-half a million dollars annually. If cally disturbed mentally and are unco­ air-ambulance service were also included operative and unmanageable may require as might be demanded, additional expense assistance of a number of persons in would be incurred. It has occurred to the authority. While it is admittedly undesir­ writer that the same end might be accom­ able to have the uniformed poli<;:e handle plished if all members of the Royal the sick, the fact remains that these Canadian Mounted Police Force were officers of the law are more widely dis­ given a short course in "The Care of the tributed than physicians, nurses or men­ Psychiatric Case," and were given the attendants-furthermore they are in a authority to travel at all times in civilian better position than a health worker to clothes while escorting patients to the commandeer assistance and the required mental hospitals. facilities enroute to a hospital. Another Members of the medical profession at point might be stressed-that is that the large can be quite helpful to the Mental members of the Royal Canadian Mounted Health Division by scrutinizing their Police Force are "itistructed' in respect "nervous' clientele a little more closely. to the laws governing ihe admission of More use might be made of the Guidance Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 19

Clinic 'Services where it is the wish of the Senile cases also do not fit into the physician to have specific Psychiatric scheme of an active treatment mental advice. The Clinics provide periodic hospital very well. Apart from the actual service to some 60 points in the province dangers involved to the aged in a busy and schedules are ptepared in adance general mental hospital, it is difficult to so that the Director of the Division is keep up the interest of the ward staffs in a position to inform those who inquire if they are called upon to handle any as to when the Clinic may be held in any great number of the'Se irrecoverable types. given vicinity. Such cases are better off in special centres Efforts on the part of the physician to ior the aged. It i'S becoming increasingly differentiate between mental deficiency more obvious that the need for more and mental disease would be appreciated such institutions must be met. as the provincial statutes differ as they apply to these two categories. It is not It is the aim of the Provincial Mental desirable lo have large numbers of mental Health Division to continue to strive for defectives in mental hospitals. The improvement in the facilities for the care problems involved in the handling of the two categories are somewhat different. of the mentally ill and mentally deficient, The Provincial Training School for Defec­ and for preventive work. Although many tives, Red Deer, accepts mentally defective view "Mental Illness" as completely hope­ children between the ages of 6 to 16. Until less in its outlook such is not the case special institutions are developed for except as it affect'S certain categories of children younger than 6, and for adults, these cases will have to be cared for mental illness, and in this respect it is in the home. no different from "physical illness." A REPORT ON FROG TESTS IN PREGNANCY By DORA A. NEWSON, B.A., M.D. Edmonton In the past few years, many articles the male toad, Bufo Americanus were have been published for and against used. No difference was noted in the the use of the male frog as a pregnancy results. Also, contrary to expectation, test. no difference was noted in the breeding The following report is given, to add season, except that the sperms were to the general fund of information. It fewer in number. is the result of 218 consecutive tests, The frogs are received ·by air express, covering eleven months, from Oct. 15th, and placed immediately in refrigeration, 1949, to Sept. 15th, 1950. 3° C at first, for about eight hours, then at 15 °C. for the remainder of their resi­ Bell (!) et al obtained 95.4% accu­ racy, but found that the injection of dence. They ·are also kept in the dark, the urine was frequently fatal to the thus eliminating any effect of light on frogs. Pollack (2) found that during their physiological activity. They .and their boxes are washed daily. Used· the summer months, frogs rendered 20% false negative results. His total number frogs are kept separately, with records of their past performances. A negative of false negatives was 10% . His positive frog may be used in 48 hours. A positive results were accurate. frog, we do not re-use for two weeks. The following figures may be of in­ These are always checked by using a terest because of slightly different fresh frog for the same test. We also technique, and because of some differ­ try to arrange to keep our stock so that ence in results. we do not need to use the newly arrived The male frogs used have been chiefly frogs for several days. By this time we Rana pipiens. During the spring, when hope their gastro intestinal tracts are these were scarce, Rana clamitrans and empty. The intestinal protozoa of frogs, 20 ALBERTA MEDICAL BULLETIN Oct., 1950 though entertaining, are misleading· in there were 4% false negatives, or 96% doubtful specimens. accuracy. The usual morning specimen of urine During the months of June and July, is used, fluids having been restricted there was a preponderance of negative after dinner the previous evening. The results, but only three out of 68 were specific gravity is noted, and the urine false. This was 4.4% of the total, or 6% diluted till the specific gravity is 1.015 of the negative results. or slightly lower, and 4 c.c. of the dil­ The earliest possible tests were ob­ uted urine is injected in the lymph sac of tained four weeks after the last mens­ each of two frogs. This has eliminated trual period. i.e. there was no missed largely the toxic effects of concentrated period. There were two of these. Eight urine, and has not affected the accuracy were positive 3-7 days after the ex­ of the results. The frogs are each put pected period. The latest positive res­ in a glass jar, and are observed first in ults were in patients who were six two hours. If any urine has been pas­ months pregnant. (These were done be­ sed, it is examined for sperms. If nega­ cause of suspected termination of preg­ tive, or if there is no urine, the frogs are nancy). The average overall period at left in their individual jars and observed which results were positive, was four at three and four hours. At this time if weeks after the first missed period. no urine has been passed, frogs are com­ Eliminating those which were done when pressed at the thorax. This usually res­ the patient was three or more months ults in a large amount of urine being pregnant, the average positive result passed. If there is still no urine, 4 c.c. was obtained at two weeks after the of distilled water is injected into the first missed period. lymph sac. This always brings results. Cclllclusions: Insofar as has been possible, the res­ ults have been checked with the phy­ The use of the male frogs, Rana pip­ sician in charge of the case. Some have iens, Rana clamitans, and the toad, Bufo been impossible to· follow and some have americanus for pregnancy tests, in a ser­ been too recent. ies of 218 consecutive cases has been briefly reviewed. The results seem A total of 218 tests have been done. to Of these, 92 were positive and 126 nega­ justify their continued use. tive. Of the positive results, none have (I wish to acknowledge gratefully the been proven to be false. Of the negative patience and co-operation of the many results, five have subsequently proven clinicians who assisted by checking the incorrect. One of these was delivered results of these tests.) three weeks later than the expected References: date, and there is a possibility that the patient became pregnant after the test. 1. Bell, D. M., Macgregor, J. W., However, this has been charted as Vant, J. R.: Can. Med. Asscc. Jour. 62, "false". 68, 1950. This gives an overall accuracy of 2. Pollack, 0. J.: Jour, Lab. and Clin. 97.7% . Taking the negative results only, Med. 36, 127, 1950.

"Let him be tender with the sick, honourable to men of his calling". -Ambrose Pare (Ethics).

"A secret division of fees is condemned. It is detrimental to the public good and degrading to the profession and, therefore unprofessional to give or r eceive a commission". -Code of Ethics. Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 21

AN ANALYSIS OF NINETY CONSECUTIVE CASES OF SURGICAL DISORDERS OF THE BILIARY TRACT By MORRIS WEINLOS, E.D., B.A., M.D., F.R.C.S. (E). Edmontou The present day state of knowledge on CHART I the surgical treatment of the biliary tract Condition is very considerable and I cannot hope Biliary Colic ...... 6 to throw more light upon it in a general Chronic Cholecystitis w ith stones ...... 55 way. There are however, several subjective Chronic Cholecystitis without stones 15 points of view on which there is no general Acute Cholecystitis ...... 8 agreement. It is with special consideration Surgical Jaundic.a ...... 6 of these points that I am presenting this review of ninety consecutively treated It is evident from this chart that, through cases. the years, few patients who have gall­ stones are subject to attacks of biliary Treating the subject in a practical way, colic only. Associated with these attacks it appears best to align the review as or preceding them, sooner or later, dys­ follows : peptic features come into play or an acute Clinical Features: Including laboratory episode develops which assumes a con­ and X-ray findings, associated conditions siderable threat to the patient and in not of heart disease, recent gestation, acute a few cases calculi are arrested in their phases of the disease, age and sex. course in the ampulla of Valer where Method of treatment including pre­ once lodged they will block the passage operative, operative and post-operative of bile into the duodenum and thus lead measures and procedures. to varying degrees of obstructive jaundice, a condition which may or may not be Consideration of the Pathological Find­ relieved spontaneously In the latter ings in relation to the clinical diagnosis. instance, it creates a surgical problem Early and late complications. which will tax the skill of the operator and seriously and materially increase the End res ults. risk of the operation

Clinical Features A special analysis of the laboratory The pattern which we follow generally findings was not made although the enables us to diagnose information is available. We can dismiss 1. Biliary Colic. this part of the analysis by stating that 2. Chronic Cholecystitis with stones. there are no special findings in the blood 3. Chronic Cholecystitis without stones. picture in the chronic states. In the acute 4. Acute Cholecystitis. and gangrenous cholecystitides the degree 5. Surgical Jaundice (post hepatic of leucocytosis is very moderate. Thus obstruction). in only one case of acute Cholecystitis did the white blood count go up to 16,000. An analysis of the symptoms of pain, its In the remaining seven cases the leucocyte character, location and radiation, the count was unaffected. This phenomenon presence of llatuience, fullness alter meqls, is explained by the fact that the acute eructation, intolerance of certain foods, phases are 90 °lo vascular and chemical etc., and of the signs of lever, jaundice, in nature and in only 10 °lo does infection tenderness, rebound tenderness, rigidity, play a role. In this respect diseases of Murphy's sign and the presence of a the gallbladder differ from those of the palpable mass go a very long way in appendix. Here a reverse of the percentage enabling one to reach a leading diagnosis. figures exists. Bilerubin and liver function In this series the diagnosis was aided tests were done when indicated. No com­ by X-rays whenever possible. ment will be made on the efficacy of the On the basis of this analysis, Chart I latter except for quoting one case which was completed. developed three weeks alter confinement 22 ALBERTA MEDICAL BULLETIN Oct., 1950 and in which the prothrombin time went accuracy for the X-ray determination of as low as 15% al a time when the Bili­ gallstones is only around 50%. rubin was about 4.0 mgm. percent. Need­ Cardiac conditions were found in eight less to say this patient passed through cases or · 7.5%. In all these cases the a very crtical time even though she was opinion of an internist was obtained, the then only twenty-one years old. ope~ation was considered necessary and In Chart II are listed the X-ray findings successfully carried out without a single in eighty-five cases. In five cases X-ray death in this group. All of them were examination was not done because there materially benefited in their health by the Were clinical contradictions. The presence operation. of jaundice, acute illness and the presence In seven cases an acute or near acute of a palpable dome shaped movable condition developed shortly after confine­ tender tumor precludes generally the need ment. All of these cases occured in the for a cholecystogram. A scout film of the early thirties. In one case there was abdomen in these cases is not contra jaundice and liver damage. Choledocho­ indicated. tomy had to be added to the cholecys­ CHART II teclomy. In all, recovery was complete. Analysis ol the Findings ol In one case cholecydeclomy was done to cure a paratyphoid carrier unsuccess­ Cholecystograms in 85 Cases fully. Cases 1. Normal function without stones ... :.. 10 An analysis of the age and sex inci­ 2. Normal function with stones ...... 20 dence is contained in charts IV and V. 3. Subnormal function without stones 21 CBABT IV 4. Subnormal function with stones ...... 13 5. Nonfunction without stones ...... 16 Age No. of Cases 6. Nonfunclion with stones ... 5 1-10 0 11 -20 3 8.5 % negative findings. 21-30 10 Stones visualized in 38 cases. 31-40 18 Stones not visualized in 3 7 cases. 41-50 24 The number of examinations made com- 51-60 20 pared to the number that came to opera­ 61-70 13 tion was not determined. 1£ we are to 71 -80 3 include the hospital and the office The youngest case was in a fourteen­ examinations the number of those year-old child who only six months examined would be formidable, I believe. previously was operated on for a gan­ This, however, does not constitute part grenous condition of the appendix. The of this review. oldest case was eighty. Most cases There were ten cases in which the occured between twenty and seventy. The gallbladder visualization was entirely greatest peak was between thirty and negative. A review of these cases is con­ sixty. Hence it is a disease of the middle tained in Chart III because of the special span of life and in this respect bears a interest which this entails. close resemblance to the incidence of cir­ culatory disease of the heart. CHART Ill End Preop. Diag. Op. Findings Path. Report Results CBABT V. 1 O cases chr. 2 chr. with stones 2 chr. with stones Chole 6 chr .. 2 subacute Good Males Age Females 2 subacute 4 chr. 41-50 22 2 neg. 2 There was some X-ray indication of 4 51 -60 16 gallbladder disease in seventy-five cases 2 61-70 11 which is indeed a most satisfactory form l 71-80 2 of examination with a 70% accuracy. Stones were visualized only in thirty­ 9 51 eight cases. In sixty-nine cases gallstones Nine cases or 10% occured in males were found at operation. Hence the all between forty to eighty, most between Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 23

fifty to sixty. The consideration of these Group S includes sub acute figures clearly shows that the three F's Cholecystitis ...... 3 still hold reign. Cholesterolosis ············································-····· 3 Method of Treatment Mucocolle ...... 0 Preoperative measures: Include routine Acute Suppurative ····················-················· 0 preparation plus one day preoperative Group 2 includes one case of carci­ stay in the hospital when feasible during noma of the gallbladder. which a. combination of vitamins C, K. and B are given parenterally. This latter case occured in a female patient, forty-one years old with symptoms Operative Procedure: Right rectus split of biliary disease dating back fifteen muscle incision, exposure, isolation and years. The diagnosis was suspected at illumination of the operative field. Dis­ operation and confirmed by the patho­ section until a clear picture is obtained. logist. This patient is now, six months One must constantly be on guard against later, jaundiced, emaciated and in the normal variations of the anatomical setup last stages of malignant disease. There which is very considerable and of the is a pretty _fair general agreement in the distortions of whatever setup does exist preoperative diagnosis, operative findings by disease both acute and chronic. The and the pathological reports. cystic duct is clamped, cut and ligated. The neck of the gallbladder is retracted Early and Late Complications bringing into view the cystic artery which The most common early complication is similarly dealt with and the gallbladder encountered is that of gaseous distention is then striped by sharp and blunt diosec­ and the concomitant effects that this car­ tion. The field is dried and the abdomen ried with it. It is best relieved by duodenal is closed with a soft rubber dam left to suction and the administration of prostig­ drain the gallbladder bed. The latter is mine. Atelectasis was not encountered not sown over. Only twice in this series ·once. Dehiscence of the wound occured in was it necessary to resort to dissecting two patients, an elderly man and a middle the gallbladder from above down. This aged woman. These -were resutured and method may be used in some acute con­ then went on to healing. Wound infection ditions. occured very rarely and only once did a During the operation the patient re­ sinus form which persisted for several --c~iv(ils- Iiilr avenous ·glucose saline braced months thl'm cleared up. In this case with vitamin B. Spina1 anaesthesia is used oxycel was used to control a little bleed­ nearly exclusively. ing. I always suspected this to have been Post-operative Care: Includes •early the cause of the trouble. ambulation and other routine measures. In two of the cases in which the gall­ The drain is generally removed on the bladder duct was drained, bile failed to fourth day. Retention sutures are left in enter the duodenum freely. In one case for at least twelve days especially in thin it was found to be due to two small elderly patients. calculi missed in the ampulla. Amino­ Consideration of the Pathological Findlngs phyllin suppositories and ether irrigation in Relation to the Clinical Diagnosis gradually resolved the condition satis­ factorily and the patient is now, two and CHART VI. a hall years alter her operation, in per­ 1. Chronic Cholecystitis with stones 60 fect health. In the other case, the block 2. Acute Cholecystitis with stones ...... S was due to the T-Tube. As soon as it was 3. Gangrenous Cholecystitis with accidentally removed, recovery followed. stones ------··················· 4 A late complication is that of incisional 4. Chronic Cholecystitis without hernia. It occured three times in this series stones ...... ------······----·- -························ 9 wh-ich is a high incidence until studied 5. Acute Cholecystitis w ~ thout stones 10 in its relationship to the existing circum­ 6. Negative Gallbladder ...... 2 stances. Ot occured in elderly people with acute conditions. These hernias are Total number of cases ...... 90 generally of little distress and are readily 24 ALBERTA MEDICAL BULLETIN Oct., 1950 enough controlled by the wearing of sup­ the symptoms would disappear. In the few portive garment. cases included in this serie'S in which the End Results gallbladder showed only chronic chole­ The follow-up reveal'S that the majority cystilis or even negative gallbladder, the of cases in which actual pathology was recovery was equally as good as in the present, made a complete recovery other cases. although in some of them, some distress My thanks are due to Dr. M. M. Laskin would persist for months but ultimately for his help with this analysis.

MEDICAL ECONOMICS OF 1950 By H. V. MORGAN, M.D., F.R.C.S., F.A.C.S. Calgary

The recent presentation al our annual Moved by Dr. Campbell and seconded Provincial meeting of possible planning on by Dr. Coppock that the resolution be the part of the Provincial Government for accepted by the College, and the Com­ the future plans of universal insurance in mittee on Economics Alberta Division, be this province makes the thinking prac­ empowered to act on behalf of the titioner stop and consider the past, present College. Carried. and future of medicine in its broadest Thus our profe'Ssion alarmed by the and finest sense in Alberta. submission of medical ideals of practice Historically, it can be recalled that the came out strongly in a negative way to Provincial Division of the Canadian Medi­ criticize and object to some of the cal A'Ssociation, alarmed by the sudden principles included in this Act which is passing of the "Alberta Health Insurance still on our statute books and which can Act, 194 6" analyzed its full significance still be enforced .al any time by simple and passed the following resolution: order-in-council. "We agree that we do not endorse the In the Dominion field, the policy of features of: 1942 had been drawn up by the now 1. The form of administration. famous "committee of seven" and proved 2. The method of providing services as the background for our provincial resolu­ tion. This policy was revamped and a result of individual contracts. brought up to date by the Dominion Coun­ 3. The division of the province into cil in 1948 and became known as the Health Insurance districts. Canadian Medical Association Policy. I 4. The penalty clause. feel that it cannot be repeated or read Thus we stood together and refuted too often and that it is worthy of reprint­ basic principles for which we have always ing at this time. adhered to as being essential to the prac­ tice of 'good medicine' which had been Canadian Medical Association Statement contradicted in the Act. This resolution was ol Policy submitted to Council with a preamble as 1. The Canadian Medical Association, follows: recognizing that health is an important element in human happiness, reaffirms its Resolution willingness in the public interest to con­ "Therefore, we recommend the forma­ sider any propO'Sals, ollicial or unollicial, tion of a committee the members of which which are genuinely aimed at the health 'Shall be appointed by the Canadian Medi­ of the people. cal Association Alberta Division and the 2. Among the factors essential to the C .P. & S. of Alberta. This Committee shall people's health are adequate nutrition, have legal authority of both participating good housing and environmental conditions bodies to meet the Government and generally, facilities for education, recrea­ endeavor to obtain the necessary amend­ tion and leisure; and not least, wise and ments to the Act to correct the sections sensible conduct of the individual and disapproved of in this resolution." his acceptance ·of personal responsibility. Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 25

3. It is recognized and accepted that the standards of medicine which will improve community's re·sponsibility in the field of with further scientific advances and bring health includes responsibility not only for increasing service to wider numbers of a high level of environmental conditions our people. The standard of medicine is, and an efficient preventive service, but and can be maintained by the spirit of a responsibility for ensuring that adequate competitive practice-borne on the prin­ medical facilities are available to every ciple of free choice of doctor and all that member of the community, whether or not this implies. This is the true spirit of he can afford the full cost. democracy at its best and brings the 4. Accordingly, the Canadian Medical keenest effort from every practitioner. To Association will gladly co-operate in the pursue this a little further, it also means preparation of detailed schemes which the stimulus of private practice is not have as their object the removal of any underminded, slowed up or destroyed by barriers which exist between the people political interference in its vital adminis­ and the medical services they need and tration. Truly, a man cannot serve two which respect the essential principles of Masters and ii we wholeheartedly serve the profession. at the feet of Hippocrates we cannot be diverted in our humane service by the 5. The Canadian Medical Association need of diversion of our efforts in political hopes that the provincial surveys now acquiescence. being conducted will provide information likely to be of value in the elaboration In June, 1948, the Federal Government of detailed schemes. assigned some thirty-lour million dollars per year for a period not lo exceed five 6. The Canadian Medical Association, years lo be devoted to the study of--and having approved the adoption of the assistance in-expanding existing health principle of health insurance, and having services. This was known as the Health seen demonstrated the practical applica­ Survey and was to initiate an intensive tion of this principle in the establishment study in each province of all existing of voluntary prepaid medical <::are plans, health services and their possible expan­ now proposes: sion. These studies on a provincial plane (al The establishment and/or extension are. now completed and we are pleased of these plans to cover Canada. to report in this province the government

(b) Th~_ _right of every Canadian citizen has seen fit to accept in a large part to insure under these plans. the studied opinions of our profession. The Alberta Health Survey Report, after two (cl The provision by the State of the years of work in its compilation, is now health insurance premium, in whole in the hands of the Provincial Department or in part, for those persons who are of Health for its consideration. Similar adjudged to be unable lo provide reports are being presented from all other these premiums for themselves. provinces to their respective departments. 7. Additional services should come into It was most encouraging to hear the existence by stages, the first and most Rt. Honorable Paul Martin, Minister of urgent stage being the meeting of the Health, make the statement at the Halifax costs of hospitalization for every citizen convention in June that he agrees entirely of Canada. The .basic part of the cost with the Canadian Medical Association should be met by individual contribution, statement of policy layed down in the responsible governmental body bear­ Saskatoon, and whatever the future may ing, in whole or in part, the <::ost for bring in these changing times he intends those persons who are unable lo provide to stand by and implement these prin­ the contribution for themselves. ciples. This is certainly encouraging for Thus, our profession is proving to Mr. our professional future-coming from the John Q . Public that we are not a con­ Minister at the head of the department servative, walled-in, self contained, selfish, who is considering all the Health Survey isolated professional group who think only reports and from whose department will of ourselves, but that we are formulating come further social security and health plans for the continuation of present legislation. 26 ALBERTA MEDICAL BULLETIN Oct., 1950

As has been slated elsewhere there is the British Health Scheme was invoked reason to believe our Minister would view upon them. with favour expansion of our prepaid The work of the last few years is now medical services lo a wider field-to showing signs of bearing fruit and we as include the entire population of Alberta, a profession must keep ourselves informed the cost to be partially borne by the and familiar with the rapidly moving Provincial Government and the fund lo events of medical economiC'S. Let us be admini'Slered by our profession with through familiarity with the whole free choice of doctor and fee for service problem form a united profession, so that basis. This would meet all the points of we can stand together and meet the policy in our Dominion Association state­ problems of tomorrow as a professional ment and our resolution of Ban ff in 194 7. unit without personal and petty prejudice Truly, we have come a long way in the forming a part of our deliberations. If we last few years, and today our co-opera­ attain that state in our thinking, remem­ tion with the developing trend of social bering the Canadian Medical Association security as applied to medicine is helping statement of policy with the Hippocratic to guide and mould governmental plan­ oath of service in our hearts, we can ning of the future. I am sure our confreres unitedly stand for those things which we in the British Medical Anocialion would feel are essential to the practice of good have loved to have occupied our position medicine in this-The Good Canadian on that fateful day a few years ago when Way of Life.

SOME OBSERVATION A~"'TER 25 YEARS IN THE COMBINED PRACTICE OF RADIO.LOGY AND DERMATOLOGY By WALTER MORRISH, M.D., C.M., D.M.R.E. (Canlab.) Edmonton Where to begin and where to end, sole method of treatment, but it must be what to. include and what to exclude in used in conjunction with the other reme­ an article of this nature presents one di es. X-ray treatment alone is not suf­ with a problem which is harder to ~olve ficient and all auxiliary methods are not than it appears. suitable to use with X-ray. Many hundreds of patients pass Some of you will wish to do your own through our hands and several thousand superficial X-ray therapy and some wish X-ray treatments are given in our of­ to refer these cases to a radiologist. In fice every year, so that over the years both cases, I cannot emphasize too much ones ideas begin to jell into a definite the necessity of a proper combination of pattern. True, that for some conditions both methods. If you refer your cases we are on the alert for something better, to a radiologist, then you yourself but as one gets older, the tendency to should be using the complimentary treat­ jump on the pharmaceutical bandwagon ments so that you will obtain the results gets less and one tends to stay with for which you are striving. those methods of treatment that have For those who own their own diagnos­ given satisfactory results. It will not be tic X-ray units, and wish to do1 a limited possible. to give details why we have amount of fractional therapy, the fol­ chosen one method in preference to an­ lowing suggestions may be of assistance. other, but any of you who are particu­ X-ray equipment that is being used for larly interested in some phase of this fluoroscopy may be used to a certain article may get the additional informa­ extent for X-ray therapy. However, be­ tion by writing the author. fore this can be accomplished, the ma­ One should not overlook the fact that chine must be calibrated so that the X-ray treatment for the many skin con­ exact output in Roentgen units is def­ ditions in which it is used, is not the initely known. This calibration may be Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 27 done easily by the serviceman who has Oil of sesame 20 intalled your machine, and once cali­ Oil of almonds 40 brated, unless there is a change in the Oil of olive 60 electrical circuit, remains relatively con­ 3. In a few days, one can usually dis­ stant. continue the compresses for a part of the In addition to knowing the output of day and begin using, your machine, a person· must have an Liquor carbonis detergens drachms accurate understanding of the funda­ one to the ounce of Linamentum mental principles of X-ray. Too much calaminae. stress cannot be given on the matter of 4. Later I stop the compresses and X-ray protecticn. If a physician wishes use the lotion and then when the inflam­ to use X-ray in the various applications, mation has subsided, I start using the he must know definitely what he is following ointment. Very carefully at doing, but this knowledge 'is not hard to first, probably just one small area. acquire. Hyd. ammon. grs. x The quantity of X-ray or number of Liquor carbonis det. drachms one. r units is more important than the varia­ Eucerin ad ounces one. tion of the factors of voltage, filtration, 5. Finally I stop both the compresses 1h value layers, etc. An important fac­ and lotions and use the ointment and tor is to have X-ray settings as 8imple cleansing oil only. It seems very neces­ as possible. For example, for years 95% sary to impress upon the patient, when of superficial X-ray treatments given, using the lotion and compresses that the we have used an arbitrary setting of medicines must be applied continually. kilivoltage 100, filtration lh mm alum­ Not three or four times daily. inum, 12" distance which produces on our equipment 100 r per minute. This 6. X-ray treatment: At the first con­ simplifies matters a great deal and elim­ sultation, if the case is very acute, no inates chances of error. I have not found X-ray treatment is given, but a week through the years, any advantage was later, usually the condition has subsided gained by varying the treatment factors. sufficiently to allow 25 r to be given, 100 Kv., appears to be as efficient as 75 but a week later, usually the condition or 120 Kv., or any intermediate Kv. The has subsided sufficiently to allow 25 r rh-ythm or frequency of course has a to be given, and a week later 50 r, with definite bearing. The standard rule of 75 r the following week. If the case is 50 to 75 r weekly, or lower, 100 to 150 r sub-acute, usually 25 r at the first visit, every two weeks is still a good rule to and if the case is .chronic, usually 50 r follow. to 75 r at the first visit and continued weekly until 750 r has been given. X-ray treatments are used in a large group of skin conditions, but I have 7. Since Benadryl was introduced by chosen only five. Parke Davis, I have given nearly all Eczema or dermatitis conditions 'repre­ the cases Benadryl 50 mg., one with each sent the largest volume of cases that I meal and one at bedtime, increasing by see. Text books usually confuse the in­ one a day, until eight capsules are being experienced. All cases in this group res­ taken each day. To date, a few cases pond to the general measures I am have become sleepy and the dosage was outlining. reduced, but to my knowledge. no severe At the first consultation, I commence reactions ever have taken place. active treatment, as follows: 8. In definite seborrhoeic types indi­ 1. Ice cold compresses made by dis­ cated by dandruff, eczema behind the solving one Domboro Tablet in a tum­ ears, and back of the neck, I prescribe, bler of ice cold water. in addition, a shampoo. 2. A cleansing oil to be used instead Thymol grs. x with of soap and water and to use also when Tincture of green soap one to the changing from one medication to an­ ounce, together with a natural Vita­ other. min B complex. 28 ALBERTA MEDICAL BULLETIN Oct., 1950

Now, having a definite outline . of 6. The scalp has to be kept free from treatment to follow, it is necessary to grease so we advise the use of Thymol decide, if possible, on the cause. In a shampoo, previously mentioned. great many cases, the cause is appar­ 7. Occasionally, if secondary infec­ ent. Varicose veins, varicose eczema: tion is severe, we give Penicillin 300,000 soap opera detergens, hand eczema. units for a few days. Again, the cause may be systemic, and that is why in some cases blood counts, WARTS gastric analysis, basal metabolism tests, All types of warts can be treated suc­ and sometimes others, are necessary. cessfully with X-ray, but in a good many The investigation of possible causes goes cases, electro-fulguration is a much hand in hand with our routine treat­ simpler method. However, planter warts, ments and appropriate additional medi­ warts around the nails, and the condition cation is then given, as indicated. of juvenile warts are treated more ef­ ficiently with X-ray than any other ACNE method. Many new ideas, many new ap­ proaches have been made in the treat­ Plantar Warts ment of this condition. The outline which Here we have been getting consist­ follows gives on the whole, very satis­ ently good results. We give 1500 r to factory results. I do not know of any the wart, using a cone that just covers other methods that will help resolve the wart, after first paring down the the scarring other than X-ray. excess callus, until the small core is 1. X-ray: 75 r weekly to all skin sur­ plainly visible. However, things are not faces involved, either face only or face always what they seem. Callus with a and shoulders, or face, shoulders and painful centre in the region of the head back. The hair, eyebrows, lips, are cov­ of the meta-tarsals particularly the 2nd ered with lead rubber. Both the face and 3rd have almost the same clinical and chest are done at the same sitting. appearance. Treatment with X-ray will It is necessary to advise patients taking remove them, but the condition will X-ray treatments not to over-expose recur, unless the cause has been cor­ themselves to sunlight. Young people rected. Hence, view with suspicion, con­ seem prone to go sun-bathing. The num­ ditions which look like plantar warts in ber of treatments necessary, varies, but the area. Better refer this type of case eight to ten is the usual number. to an orthopaedic surgeon. The condition 2. I usually prescribe, Thyroid grs. 1h is probably one of muscular unbalance. with Vitamin B. Parke Davis and Co., Warts around the Nail Bed taken three times daily, more if the For some time now, warts around the basal metabolism indicates a higher nails have been treated with 1200 r units dose. of X-ray, using 120 Kv, and no filter. 3. Comedones are usually expressed This method appears to be more efficient weekly by a member of the staff, and than coagulation. we advise the generous use of ordinary Juvenile Warts soap and water at normal temperatures, and warn them not to squeeze the This condition is easily recognized by pimples in any way. the fact that the warts are flat and num­ erus. The distribution is usually on the 4. A low fat diet. back of the hands and wrists, or the 5. Locally we have them apply, Lotio face, or on both. calaminae with ppt. sulphur 2 p.c. or Here we give 200 r and repeat the Acnomel ungentum. Sharpe and Dormes. dose in three weeks. As we see them each week, we can watch if the combination of local appli­ Limewater-a wine glass full three cations and X-ray makes the skin too times a day. tender, then we discontinue the ointment Magn. Sulphate-sufficient to cause or lotion. 2 or 3 liquid motions a day. Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 29

Occasionally after a lapse of 3 weeks, CANCBR OF THE SKIN prescribe: In superficial cancer the quantity of Resorcin grs. 60. X-ray administered is the important fac­ tor and within limits the voltage used Solicylic acid grs. 60. has very little bearing on the success of the treatment. Voltages from 10 to Methylated spirits ad to one ounce. 120 K v are used with equal success, and Apply to warts twice daily. filtration is rarely necessary. I usually demonstrate how this should My technique is as follows: be done. 1. Infiltration of the lesion with PRURITUS ANI Novocaine. Our method of treating this condition 2. Fulgurate the growth down to skin is: level. 3. Give 2000 to 3500R. measured in air 1. X-ray treatment, 75 r each week. at 120 Kv, 6 to 20 cm, no filter, at 2. Absolute cleanliness. Wash the one sitting to the area of growth anus with warm water after and 14 · inch beyond. Occasionally if evacuation. the growth is in a suitable place I give 1200 T additional to a wider 3. Avoid wool and tight undercloth­ area of normal tissue. ing. Old fashioned night shirt is As far as I am aware, the above better than pyjamas. method has been successful. There have been a few cases where growth started 4. One course at the beginning of in at the margin of the original treat­ treatment of "crystoids". It is sur­ ment, but on re-treatment, there was no prising how often worms are a recurrence. The face being the common factor. It is much easier to do it area of involvement good cosmetic res­ this way than to bring up the sub­ ults are necessary. It is not recom­ ject of worms in any way with the mended that this type of treatment be patient. given except by specialists in the field. · 5. Benadryl in the usual dose and I al- In the foregoing paragraphs I have ------..W~~ use a lotion, never an oint­ tried to give some practical information ment. 2% Perchloride of Hg. or and tried to keep away from a too Linamentum calaminae. Liquor technical discussion. The article is not carbonis detergens cirachms one to written in the · main for either a spe­ the ounce is as good as any. cialist in Dermatology or one in Radio­ logy but it is written with a hope of Very few cases need surgical treat­ simplyfying the treatment of soine of ment. However, there are some that do, the more common skin "conditions for anal tags, haemorrhoids, and fissures, men iii generii.l practice. The techniques and they should all be treated surgically suggested can be followed without after the eczematous condition has been X-ray therapy and will benefit some of cleaned up. your patients. ' [

If the authors wish reprints kindly request these by order when forwarding the manuscript. The Printers will furnish these at the regular cost.

"He should be modest, sober, patient, prompt to do his whole duty without anxiety. Pious without going so far as superstitions; conducting himself with propriety in his profession and in all the actions of his life". -Hippocrates (Ethics). 30 ALBERTA MEDICAL BULLETIN Oct., 1950

MANAGEMENT OF THE BLADDER FOLLOWING SPINAL INJURIES By G. N. TUCKER, M.D. Edmonton Spinal cord trauma associated with and also upon the status of the bladder back injuries is always complicated by muscle. Thus when a contusion of the alterations in bladder function that pre­ cord results in only temporary abolitio11 dispose to urinary infection and renal of function and no permanent nerve in­ insufficiency, which seriously compro­ jury, the patient enjoys a full return mise the outlook for all patients afflicted of reflex and voluntary muscular con­ with transverse myelitis. During World trol, and the bladder and urinary tract War I. 60 per cent of all patients who resume a normal functioning status sustained spinal cord injuries died of when bladder paralysis disappears. But urinary tract complications. It is obvious if the bladder muscle in such a case has therefore that any improvement in been subjected to anoxia from prolonged handling this relatively common condi­ over-distention and to the damaging ef­ tion will result in the relief of untold fects of severe infection during the per­ suffering and in the saving of human iod of paralysis its functioning pattern lives; in fact modern therapeutic meth­ cannot approach the normal when re­ ods have reduced the mortality of spinal covery of the nerve injury complications cord injuries to around 15 per cent. even though the outlook be favorable Cord injuries regardless of the loca­ from the standpoint of the nerve in­ tion or extent of the lesion results in jury. "spinal shock" below the level of trauma. When permanent cord damage occurs Spinal shock is characterized by the loss the final pattern of bladder function re­ of sensation and of spinal reflexes­ mains abnormal and varies in accordance manifested by flaccidity and elongation with the location and extent of the of the skeletal musculature. The de­ neurological lesion. But here again the trusor however, being composed of efficiency of bladder function, within smooth muscles behaves in a different the limits imposed by altered nerve sup­ manner. Although it is devoid of all ply, is influenced greatly by the status sensation and lacks reflex activity it re­ of the muscle tissue as it emerges from tains its inherent tonicity and does not the hazardous period of bladder paraly­ become flaccid unless permitted to de­ sis. compensate by prolonged distention. The When permanent cord injury occurs paralytic bladder of spinal shock which above the conus, the reflex arc control­ is not catheterized, will constitute a ling bladder function remains intact and three-fold menace to the patient with the patient develops an automatic blad­ transverse myelitis. The constant dribble

ing". This bladder functions like a rub­ outside the confines of a general hospi­ ber balloon whose outlet is compressed tal will surely infect the urinary tract­ by tight rubber bands-it fills under it may kill the patient. tension, overflows by dribbling, and lack­ (2) Institute continuous drainage of ing all reflex connections with the spinal the bladder when the patient is in a cord, it never contracts. The patient, in general hospital. most cases, is able partially to evacuate the bladder by periodic manual com­ (a) Introduce a rubber catheter under pression and to remain tolerably dry. sterile conditions, leave it indwelling, This failing, drainage of the bladder by and connected with a sterile closed irri­ intermittent or inlying catheter or by gating system. A tidal irrigating system suprapubic cystotomy is indicated. allows automatic periodic bladder lavage It is obvious that the critical period with antiseptic solution and provides following cord injury is the period of passive exercise for the musculature. If bladder paralysis. Successful manage­ this type of irrigator is not available a ment of the urinary tract during this sterile intermittent irrigator system is desirable. period depends upon the avoidance of infection and protection of the bladder (b) If facilities for proper manage­ musculature from prolonged overdisten­ ment of catheter and closed drainage tion. If these ends are attained most pa­ system are not available, the patient tients will live, some will recover com­ should have suprapubic cystotomy, or pletely, and many will enjoy a comfort­ drainage by perinea] urethrotomy. Both able existence. methods avoid the danger of periure­ thral abscess while preventing decom­ The following rules of management will avoid most of the pitfalls that en­ pensation of the bladder muscle. danger these patients during the criti­ (c) Administer chemotherapy and ·Cal period: antibiotics to combat infection. (1) Do not catheterize the patient (3) Discontinue drainage of bladder when you find him. His bladder will when the period of paralysis subsides overflow without pain, and it will not and when the pattern of bladder recovery rupture from distention. Catheterization has become fully developed.

CORRECTIONS FOR ERAnA In July issue of Alberta Medical Bulletin page 12 heading should have read "Unusual" instead of "Usual." Page 26 "Prostrate" in heading should read " Prostate." Publishers.

Any Archival material will be greatly appreciated by the Chairman of that committee. The past is quickly disappearing from memory, it is best to record it.

PARTNERSHIP FOR SALE The Medical Centre of Lacombe, Alberta, presents a splendid opportunity for two medical men who are interested in securing a permanent location with a remunerative practice, in a prosperous town and district. The new modern medical building house'S three medical men, two dentists, an optometrist, a laboratory and X-ray department. This is a partnership proposition and the new man may purchase any share of the building and equipment desired. This opening results from the illness of one of the partners. W. A. HENRY. M.D. LACOMBE ALBERTA 32 ALBERTA MEDICAL BULLETIN Oct., 1950

SIMPLIFIED. PHYSIOTHERAPY IN RHEUMATOID ARTHRITIS By DEAN ROBINSON, M.D., C.M. Banff Contrary to popular belief, it is not After the disease has become quies­ necessary to have a battery of expensive cent it is necessary in some cases to do physiotherapy machines to treat rheu­ a manipulation under anaesthesia to matoid arthritis cases . properly. The correct deformities. This work is most most important thing is that the physi­ satisfactory in the case of knees but cian be fully conversant with modern may also be used for other joints. After ~I treatment including physiotherapy, so manipulation, casts are applied and left that he may intelligently direct the on for 48 hours when they are bivalved work. Desirable equipment will include a and removed for joint movements each bed in a special hospital if possible, a day. good laboratory and a well trained staff Following are some excerpts from acquainted with the problems of arthrit­ articles and books on physiotherapy ics. methods in rheumatoid arthritis. The application of heat, muscle train­ Comroe's Arthritis 1949-"At least ing, movements and rest are in the one or two gentle painless movements physiotherapist's realm of treatment. of the affected joints must be performed The deep warm pool is the best source daily even in the acute stage of the dis­ of heat as it warms the whole body at ease so that dense adhesions are not al­ one time. Besides it is of great help in lowed to form. In acute cases relaxation under water exercises and in re-educa­ motion is advisable. tion of patients to walk. A Balkan As the patient improv~s, the amount, frame is useful but a handyman can con­ and usually the type of exercise is modi­ struct a frame over a bed in a few min­ fied and increased. Attention should be utes which will serve the purpose. A given to underwater exercises, and sling few pulleys and pieces of rope complete - suspension exercise. The Hubbard the equipment. tank may be used for all exercises in the After the diagnosis is made the doc­ early arthritic cases: a simple tank may tor sees the patient daily, gives instruc­ . be made for home use. tions to the physiotherapist and sees Active movements by the patient him­ that they are carried according to pres­ self) are always to be preferred to pas­ cription. All joints in the body are to sive movements (by an assistant). be moved gently each day as far as Never exercise a patient to the point possible without pain. Later muscle set­ of pain or fatigue. Any motion which is ting exercises and quadriceps drill are attended or folio.wed within 24 hours by important. an increase in pain, swelling or stiffness Casts are supplied for swollen joints. in the joints has been excessive; this These casts give considerable relief by must be reduced or modified. Proper resting the joint and doing away with exercise should cause no pain during muscle spasm. In other joints traction their performance. When the acute stage is used to. stretch a contracted capsule, of the disease passes and the patient by use of pulleys and weights. As the moves the affected joints slightly, act­ patient improves and the activity sub­ ive therapeutic exercise is begun. Never sides, more exercise is needed and a force a joint; this may result in a flare­ frame is erected above the bed. Slings up of a smouldering arthritic process". are put under ankles and knees and "Rest in bed should be insisted upon regulated so that the heels just clear in: the mattress. Leg exercises are done for (1) The acute febrile stage of the dis­ one or two hours daily. All exercises are ease with severly inflamed joints. done deliberately and slowly. (2) Patients whose arthritis is pra- Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 33 gressing rapidly, even though there may nutritional and hygienic measures and be no fever and no acute inflammation the prevention of deformity and correc­ of the joints. tion of deformity by the use of plaster (3) Individuals with marked inflam­ casts etc. mation of weight bearing joints. The textbook of the Rheumatic dis­ ( 4) Those with marked constitutional eases, by W. S. C. Copeman. manifestations. "The necessary period "In the early stages of rheumatoid of rest in bed varies with the individual. arthritis treatment is carried out in bed In some a stay of one or two weeks may in order that the general condition may be markedly beneficial, while in a few improve, the deformities, if present are severe cases, four to six months may be ccrrected, and the lower limbs made required to produce any marked res­ strong enough for weight bearing. As ults-If severe arthritis involves weight already pointed out; this period must on bearing structures such as the knees, the i:io account be spent in idleness, for patient should remain off the affected rheumatoid patients left to themselves limbs until the acute stage of the process become steadily weaker. It has been ob­ has passed. Even in the subacute stages limitation of weight bearing will usu­ served that the disease often is asso­ ally produce added improvement". ciated with poor posture, with weak ab­ dominal muscles, obliquity of the ribs, Weight bearing is inadvisable and not and limited chest expansion, and that permitted if: the general health of arthritics improves (1) Weight must be borne on acutely considerably when attention is paid to inflamed or hot joints. the postural abnormalities - (Gold - (2) There is extreme muscular atro~ thwait and others, 1937). Therefore from phy of the legs. the first, postural and breathing exer­ (3) The knees are fixed in flexion, or cises in bed should be instituted. Occu­ the legs are not in good alignment". pational therapy may also be started at From the Primer on the rheumatic an early stage of treatment, provided diseases. (Prepared by a committee of that the fingers and wrists are not too the American Medical Assoc'n.) severly involved. Occupational therapy is an excellent diversion and keeps the Measures of proven value (in the treat­ arms and hands moving. The other exer­ me nt of rheumatoid arthritis). cises which must be instituted from the (a) Rest-Rest is probably the most beginning are static quadriceps contrac­ important single measure in the treat­ t :ons and toe and foot movements. Exer­ ment of the disease-rest for the body cises should be carried out six times a as a whole and rest for the inflamed day for five to ten minutes at a time: joints in particular. However, in pres­ at least one period must be under the cribing rest, intelligence and insight are supervision of the physiotherapist. necessary. The amount of rest varies Regarding plasters-Once the plaster frcm confinement in hospital for six has been removed, assisted active move­ weeks to one year for the patient ·with ments are started. The limb must be severe disease, to breaking the day with supported to counteract gravity; one a two hour rest period when the disease convenient method is to suspend it in a is mild. It is never necessary to pres­ sling hanging from a Balkan frame. If cribe absolute bed rest. Even in the most a Guthrie-Smith bed is available the severe disease, mild muscle setting body as a whole or an individual limb exercises should be prescribed and may be supported. For details of this should be increased as the patient im­ valuable apparatus Guthrie-Smith's book proves. Each case must be considered should be consulted. The line of treat­ on its own merits. For local rest, suit­ ment described, namely, movements, able splints of the gutter type are of exercises and static quadriceps contrac­ great assistance". tions is continued until the patient is Under the same heading are mentioned able to raise the unsupported leg with the other forms of treatment by drugs, the knee straight, at which stage walk- 34 ALBERTA MEDICAL BULLETIN Oct., 1950 ing exercises are begun. As a final b. Late stage-use resisted exer­ measure to strengthen the quadriceps cises with weights and pulleys. stronger forms of exercise can be given, namely, resisted exercises with weights 4. Movement of stiff joints. Assisted and pulleys". The five purposes for active or sling exercises. which exercises are given in rheumatoid 5. Re-education in walking-Re-edu­ arthritis are summarized as follows:- cation exercises. 1. Improvement of posture and gen­ eral health - postural and breathing From Comroe's Arthritis, 1949, under exercises. treatment for rheumatoid arthritis-"in \ 2. Maintenance of movements in arms the acute stage do not employ diathermy, , and hands. ultra short wave therapy or hot baths," Occupational therapy. also "acute stage: no massage". 3. Development of wasted muscles: Francis Bach-"ln general, physical a. Early stage-use static contrac­ treatment has no direct effect on the tions. course of the disease--"

ARCHIVES G. D. STANLEY, M.D. (Chairman) Dr. Arthur Irvine McCalla died on noblest sons. Many a stricken house­ January 16th, 1935. He had come to Cal­ hold has cause to remember with affec­ gary General Hospital as Pathologist in t ionate gratitude the quiet unobtrusive 1914 and in the same year became asso­ doctor whose hand and head and heart ciated with the firm of Drs. Crawford, healed or lightened its affliction. Like McEachern and Merritt. Mr. L. W. another beloved Physician he kept his Brockington K.C., who was resident in vow that he would never enter the tem­ Calgary then paid the following tribute ple of science in the spirit of a money­ to Dr. Mc'Calla in the 1Calgary Herald, changer. His work was to him a labora­ January 19th, 1935, and this column tory, ever opened and furnished for the quotes it with deep appreciation:- careful and persistent search of truth.

"He does not die who can bequeath His profession was but an opportunity Some influence to the land he knows. for service to his fellow-men. Even his Who dares persistent interweath leisure hours were hours of devotion. Love permanent with the wild The creation and continuance of the Cal­ hedgerows. gary Symphony Orchestra were impos­ He does not die but still remains, sible without his determination and Substantiate with his darling plains". steadfast support. The office of presi­ dent which his modesty declined, but "If it be true, as we must believe it to which was his right of service, was ac­ be, that the memory of 'a loyal heart cepted only because his fellow-directors homeward bound' continues as a bene­ resolutely declined to consider his re­ diction and an inspiration to those who fusal and elected him in his absence. outlive his pilgrimage, then the work His lovely garden was a pattern of the and character of Dr. Arthur Irvine Mc­ man himself. Nothing was out of place t Calla will remain in this community as and untended; there were no weeds nor an influence for goodness and mercy untidiness. It was a little miracle of ap­ , and loveliness for many days. plied science, and the tulips, the dahlias, and the sweet-scented stocks which he First as pathologist to the General specially cherished were always the hospital, and then as diagnostician and city's best. surgeon, he paid to his chosen profes­ sion the tribute of skill, patience, hu­ His work, his music, his garden, and, mility and loving kindness that it has not least, his family were his life. None always demanded and received of its of those who were privileged to . share Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 35

the geniality or his hospitable hearth Dr. McCalla claimed for himself no will forget the evenings when his boys virtues. To the strength of others he and himself joined together in playing never denied praise; to their weaknesses the works of the great masters of music. he willingly gave charity and sheltering Those memorable hours seemed to be­ humanity. long to a grand family tradition that is Such was the wistful, kindly, gentle almost lost in the stidency of the modern doctor, and of such is the Kingdom of world. Heaven". \ SCIENTISTS STUDY DANGERS OF RODENT-BORNE , DISEASES Ottawa, Sept. 29th-A thorough study to train members of the survey crew so of the danger from diseases spread by that the study this year will form a small animals and ticks is being carried sound basis for future work. Cost of the out in Saskatchewan this year as part project this year is estimated at $8,000. of the national health program Hon. Paul Martin, minister of National PHYSICIANS' ART SALON Health and Welfare, said here today. It is well known, public health au­ Halifax was the scene of the 6th suc­ thorities state, that the rat population cessful showing of the Physicians' Art is spreading in Canada and has now Salon, an exhibition of photography and reached the Saskatchewan-Alberta bor­ fine art created by Canadian physicians der. Rats are known to be carriers of and under-graduates, and sponsored by plague, pseudotuberculosis, rate bite the Montreal pharmaceutical firm , fever, leptospirosis and other diseases. Frank W. Horner, Ltd. It is also known that ticks capable of Several of our Alberta members were transmitting tularemia and Rocky amongst the prize winners. These in­ Mountain spotted fever to humans have clude, Fine Art, 3rd prize, Dr. T. E. infected small animals such as ground Brown, Lethbridge; Award of Merit, Dt. squirrels and that the infection in these James Calder, Edmonton, and in Mono­ animals is spreading north from the chrome Photography, 3rd prize, Dr. E. - Hni-ted States and eastward in Canada. V. Spackman, Lethbridge. The western branch of the federal La­ This exhibit has in the past attracted boratory of Hygiene at Kamloops, B.C. much attention. The next exhibit will be has been carrying out studies of tick­ held in Montreal again under the spon­ borne and insect-borne diseases for the sorship of Frank W. Horner, Limited. past 10 years, Mr. Martin pointed out, For the first time we have had an but this work has been done mainly in exhibit of doctors' art at our provincial British Columbia and Alberta. The Sas­ convention. No prizes were awarded. Dr. katchewan survey is being carried out R. C. Riley of Calgary arranged the in consultation with the Laboratory of show and is to be congratulated. It is Hygiene and the University of Sas­ hoped that in future years more of our katchewan, and the results will be cor­ members will exhibit some of their work. related with those obtained in Alberta and in the northern United States. t WANTED This type of work is becoming in­ , A full time Medical Director for creasingly important in the western provinces, Mr. Martin emphasized, and a PI"o1vince Wide Medical Services it is hoped that adequate studies and Plan. Application indicating age, control measures now may prevent the experience and salary expected development of a major public health should be submitted to the Regis­ problem. trar, •College of Physicians and Surgeo.ns, Province of Alberta, Special precautions have been taken to 501 Alexandra Bldg., Edmonton. obtain properly designed equipment and 36 ALBERT A MEDICAL BULLETIN Oct., 1950 EDITORIAL THE PATIENT AND THE DIAGNOSIS By W. CARLETON WHITESIDE, M.D. In his delightful memoirs, Marbot says that he has noticed that each profession has it's point of honor. He cites a number of these and finds that the point of honor of the medical man is the safety and welfare of his patient. Now, the safety and welfare of the patient cannot be safeguarded without the correct diagnosis. Clearly it behooves us to use our best en­ deavors to learn that indespensible art. To make a correct diagnosis the patient must be questioned systematically and logically, he must be examined methodically and thoroughly. The patient, who is a human being, with all the psychological factors embodied therein, should be considered as an individual and not as a group, a type or as a class. The very nature of the patient should be studied. The examination of the patient is guided by a few simple rules, namely; "Eyes first and MUCH; hands next and little; tongue not at all". These words of Sir George Humphrey are heavily charged and should command our respect. Through long study and wider experience, a few men in medicine have succeeded in gaining that goal which allows them to summarize the signs and the symptoms, and by logical conclusion arrive readily at a diagnosis which is so frequently correct; while many of us flounder in the slough of despondency, doubt and indecision-the patient meantime lying in hospital at great expense-because we fail to follow the rule for diagnosis: That, every symptom has a biological significance and a physio­ logical interpretation; both of which require logic, thorough evaluation and freedom from intuition and empiricism. A diagnosis by intuition is simply a jump to a conclusion after observ­ ing a symptom or a group of symptoms. It is seldom correct, it may appear "brilliant" but it is a rapid method of reaching a wrong conclusion. Many a seemingly trivial feature about the examination of a patient proves to be the keystone to the correct diagnosis. It is impor'tant for us to examine our patients carefully, missing nothing which the human eye can see if intelligently observed; bearing in mind the anatomy, the physio­ logy and the biochemical aspects associated therewith. If one observes in­ correctly or incompletely a correct diagnosis will not be made, unless one blunders on it or makes a successful guess. By careful examination, observing everything in detail; by verifying every lump, bump or spot; by examining the entrances and the exits of the body with their secretions and excretions; with the aid of the bac­ teriologist, the biochemist and the pathologist; by means of consultations -psychiatric if need be-; or the use of the "extended eye" of the endoscopic instruments or the Roentgen film; by separating the true from the false statements of the patient and summarizing all the foregoing in a logical manner, one should arrive at a correct diagnosis in a high percent­ age of cases. Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 37

NEWS AND SLIGHT PROGRESS

Dr. Douglas M. Cram is associated Dr. N. W. Woywitka has taken up with Dr. Brock Armstrong in the prac­ practice in Edmonton in Ophthalmology tice of Paediatrics in Edmonton. following his Certification and post­ Dr. Louis Beauchamp has opened of­ graduate training in the Toronto Gen­ fices in Edmonton for the practice of eral and Sick Childrens' hospitals. Dr. Diseases of Children. Woywitka served in the R.C.A.F. during Dr. J. J. Lipinski is in general prac­ the Second World War. tice in Edmonton following his Post­ The offices of the College of Phy­ graduate training in the city hospitals. sicians and Surgeons have been moved The "South-North" golf game was to more spacious quarters in the Alex­ andra Building. The number being 501. held in Red Deer in August and the All members of the profession of Al­ highest score was made by one of the berta (and elsewhere) are asked to call most questionable good golfers. The in and maybe pass their opinion of these usual fine aspects of good hosts were fine quarters. Our Registrar and his As­ evident by the Red Deer medical men. sistants are doing a fine job in carry­ Dr. E. H. Duggan won the cup. We are ing on the business of the College. sure that he will not use it for his bariums. Dr. Colin S. Dafoe, recently returned from England, has commenced practice Dr. Edgar M. Gee, formerly from in thoracic surgery in Edmonton. Dr. Manitoba, has taken up offices for Gen­ Dafoe obtained his F.R.C.S. degree eral Practice in Vulcan. Dr. Gee took his whil~ overseas with the British Army post-graduate work at the Montreal Medical Corps. He is a graduate of General hospital and the Toronto Gen­ Queens University and following six eral in Internal Medicine. Dr. Gee spent years as a surgical specialist in Africa one year in surgical pathology at the and Yugoslavia took his training in Presbyterian hospital in New York thoracic surgery in Leicester and Stock­ -Clty. During the war he served with the holm. R.C.N.V.R. Dr. Harold Orr, O.B.E., F.R.C.P. (C). The Cancer Diagnostic Clinic is es­ · has been appointed a member of the Ex­ tablished in Lethbridge and will serve a pert Advisory Panel on Venereal infec­ wide area. The new forms used in these tion on Treponematosis of the United Clinics may be obtained upon request by Nations World Health Organization. the physicians. A fully filled-in form is requested with each patient being sent Dr. Richard Poirier of Edmonton has to the Cancer Clinics. Dr. R. C. Corbett associated with him in Dr. R. H. Horner and Dr. T. R. Clarke hi..; practice on Diseases of Infants and of Edmonton obtained their M.R.C.O.G. Children. degree at the recent examinations held Dr. Walter C. MacKenzie has been in Edmonton by the Ro.ya! College appointed Professor of Surgery at the examiners. Dr. Clarke and Dr. Horner University of Alberta. He will succeed are graduates of the University of Al­ Dr. H. H. Hepburn who will be retiring berta and following their post-graduate from the chair in October but will re­ training in Eastern Canada, and the main head of the N euro-surgical De­ United States have been specializing in partment of the University hospital. Dr. gynaecology and obstetrics. MacKenzie is a graduate of the Univer­ Dr. Roy L. Anderson has re-opened sity of Dalhousie and took his post­ his office in Edmonton following his graduate training at the Mayo 'Clinic. surgical tour of Norway, England and During the war he served with the Royal Scotland during the past summer. Canadian Navy. 38 ALBERTA MEDICAL BULLETIN Oct., 1950

COUNCIL NOTES

Since the last Bulletin, Council met on Medical Services (Alberta) three occasions. The Discipline Commit­ Incorporated: tee met twice. Amongst the problems (a) Full time Medical Director: The dealt with by Council were the follow­ appointment of a full time Medical ing: Director was approved. The Registrar was instructed to place advertisements Standardization of Cancer Therapy: in the various Medical Journals re­ A recommendation has been made to questing applications. the Canadian Medical Association recom­ (b) Recommendations from the vari­ mending that the "Hand Book on Can­ ous District Societies were discussed cer" be revised and republished. The Ca­ and forwarded to Medical Services. nadian Medical Association has indi­ cated that owing to the great cost of (c) Approval was given to the back­ publication that it is not presently ing of a line of credit at the Bank for their intention to do so. The Canadian Medical Services. Medical Association indicates however, (d) Several proposals dealing with the it feels that monographs being sent to rate structure and rate and method of all the members of the Profession by the payment of the professional members National Cancer Society dealing with were discussed. The following were regional Cancer should provide an ex­ approved: cellent substitute. (i ) That Medical Services intro­ Resolutions from Section on duce Experience Rating on all con­ General 'Practice: tract renewals. (This action was taken the 1st of September by Two resolutions from the Section on Medical Services). General Practice, one dealing with the Cancer Clinic and one with the Treat­ (ii ) That a new basic rate will be ment of Rheumatoid Arthritis were set up for all new contracts and con­ dealt with. The question of the Cancer tract renewals. (This action was Clinic regulations are presently under taken the 1st of September). review. Dr. K. Thomson was asked to (iii) That a temporary reduction in speak at the Annual Meeting in connec­ payment of certain medical accounts tion with the Division of Arthritis. be approved. This was agreed to on the following basis. That there be a Public Relations: 10% hold back of professional fees The Canadian Medical Association re­ for services rendered to persons quested that a roster of medical speak­ eligible for service covered by the ers be set up. From this roster speakers following group contracts: would be supplied to address lay audi­ City of Red Deer ences. Some of the topics are: Grp. No. 74- Municipal Group. 110 - Claresholm Health Planning for Personal Health. Association. The Doctor and National Health. 115 - Claresholm Health Community Health. Association. 105 - Dormitory Students, The Business Man and Health. Red Deer. The Teacher and Health. 96 - High River Health Association. Medical Care in Great Britain. 8400 - Lamont Health Ass'n. The various District Medical Societies 1 - Lethbridge Health have been asked to nominate speakers. Association. Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 39

7 - Lethbridge Health Dvorkin, Joseph. Association. Ewert, George Winston. 11 - Loyal Order of the Garson, James Ernest. Moose, Medicine Hat. Golding, Thomas Alexander. 103 - Nanton Health Ass'n. Hall, Roger Montague. 120 - Stettler Health Ass'n. Kent, Ian. 125 - Stettler Health Ass'n. Klassen, David. 83 - Women's Ass'n. of Lauerman, Joseph Mathias. Camrose, United Lawrason, Douglas Miller. Church, Camrose. Leach, William Bernard. This agreement is to be reviewed Lynge, Harold Norman. quarterly. McLean, Palmer Mcintyre. McMillan, Donald Woodbury. Standardization of Insurance Reporting Mooney, Marjory Cora. Forms: O'Reilly, Cyril Francis. Standard forms approved by the Peck, Jack Gus. Ontario Medical Association and given Pelletier, Gerard Joseph Leon. approval of the Canadian Life Insurance Rees-Davies, Peter Etheredge. Association were approved. These fo-rms Palmer, Mary Louise McLeay. when brought into use should simplify Smith, Howard Alexander. much of this work. Thorp, Robert Hugh. Waugh, Douglas Oliver William. Vacancies-Cancer Diagnostic Clinics: Applications from 45 medical men The 45th Annual Meeting and Scientific were received for vacancies on the three Convention: Diagnostic Clinics, that is, the clinic in The Committee on Program and Ar­ Edmonton, the clinic in Calgary, and a rangements under the Chairmanship of new clinic being opened in Lethbridge. Dr. D. G. MacQueen, Calgary, is to be Council reviewed the applications and congratulated upon its successful com­ recommended several for each position. pletion of an excellent Convention. The These recommendations together with a scientific papers presented by our visit­ list of all the applications was submitted ors from the East as well as by our own to the Cancer Diagnostic Clinic and the members were excellently prepared and appointments will be made from the well presented. recommended list by the Clinic. The following were the official guests: Alcoholism: Dr. Norman Gosse, Halifax. President, Canadian Medical Association. A resolution from the Annual Gen­ eral Meeting concerning the establish­ Dr. H. B. Atlee. Professor Obstetrics ment of a sanatarium for the treatment & Gynaecology, Dalhousie University. of recurrent alcoholics and drug addicts Dr. J. W. Abbiss. Assistant Professor was discussed and a Committee ap­ Pathology, Dalhousie University. pointed to approach the Minister of Dr. H. Hoyle Campbell, Clinical Health in this regard. Teacher Surgery, University of Toronto. Discipline: Dr. E. C. McCoy, Vancouver. Ten complaints were dealt with. Dr. T. C. Routley, General Secretary, Canadian Medical Association. New Registrants: The Luncheon ·speakers were Dr. E. The following new Registrants were C. McCoy, Vancouver; Dr. Norman approved: Gosse, Halifax, President of the Asso­ Baster, Norman. ciation; Mr. Galbraith, Editor of the Red Boileau, George Rene. Deer paper. Dr. Clarence Routley was Clark, George Clifford. the dinner speaker. Corbet, Richard Crofton Blakely. The Honorary Secretary wishes to Cram, Douglas Martin. thank Mrs. F . J. McCann and the vari­ Dlin, Barney Martin. ous members of the Committee for their 40 ALBERTA MEDICAL BULLETIN Oct., 1950 efforts and the success of the Conyen­ McNeill, A. K.-Empress. tion. McPherson, D. F.-Lethbridge. MacWatt, D. G.-Okotoks. Professional Members--Medical Milner, M.-Edmonton. Services (Alberta) Inc. Morgan, J. E.-Picture Butte. Nelles, S. B.-Calgary. The following doctors have been added Pelletier, G. J.-Evansburg. to the list of professional members Ross, T. R.-Drumheller. Medical Services (Alberta) Inc. Shulhan, M.-St. Paul. Atkinson, H. H.-Calgary. Straughan, G. E.---Jasper. Cram, D. M.-Edmonton. Strilchuk, N. C.-Mundare. Chonko, M. E.-Two Hills. Tompkins, A. D.-Vulcan. Hanson, S.-Edmonton. Watson, J. W.-Calgary. lbberson, J. R.-Calgary. Wilson, R. D.-Edmonton. Johanson, A. N.-Calgary. Wong, George--Lloydminster. Kaye, P. P.-Radway. Worrall, H. C.-Calgary. Lambert, H. J.-Three Hills. Worrall, K. M. F.-Calgary. Lauerman, J. M.-Edmonton. Leith, N.-Edmonton. In the July Bulletin the name of Dr. Lipinski, J . J.-Edmonton. J . M. Adams of Calgary was listed in Malcolm, J. M.-Stettler. error. The name of Dr. L. G. Alexander Mason, L. H.-Bassano. should have been listed. We wish to Mccartan, J·.-Brooks. apologize to Dr. Adams for having in­ McEwen, H.-Calgary. serted his name and to Dr. Alexander MacKinnon, S. J.-Calgary. for having failed to list his.

@bituarp

Dr. T. H. Field of Edmonton, passed away September 11th, 1950 at his resi­ dence, in his 59th year. Dr. Field was a graduate of McGill University in 1922 and following his Interneship came West where he served his fellowman in many capacities. Dr. Field will be remembered because of his active service with the Council, Academy of Medicine and the Provincial Cancer Diagnostic Clinic in Edmonton. He was a member of the Highlands United Church which he served faithfully through the years.

Dr. Sprague Murray Palmer of Alli­ ance died in August, 1950. Dr. Palmer registered in January, 1923. He gradu­ ated from the Trinity Medical College in Toronto in 1900. Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 41

MEDICAL LIBRARY ACCESSIONS JULY-SEPTEMBER, 1950 American Medical Association. American Medical Directory. 18th ed. 1950. American Medical Association. Council on Physical Medicine. Handbook of Physical Medicine. 2d ed. 1950. Baird, Dugald, ed. Combined textbook of obstetrics and gynaecology. 5th ed. 1950. Bernheim, Frederick. Interaction of drugs and cell catalysts. Rev. ed. 1946. Bumke, 0. and Foerster, 0. Handbuch der neurologie, vols. 5 and 6. Burch, G. E. and Winsor, Trevis. Primer of electrocardiography. 2d ed. 1949. Burlington, R. S. comp. Handbook of mathematical tables and formulae. 1933. Cade, Sir Stanford. Malignant disease and .its treatment by radium. 2d ed. 1948. Vol. 1. Castellani, Aldo. Fungi and fungous diseases. 1927-28. Cunningham, D. J. Manual of practical anatomy. 11th rev. and ed. by J. C. Brash. 1949 3v. Curtis, A. H. A textbook of gynecology. 6th ed. by Hoffman. 1950. Delory, G. E. Photoelectric methods in clinical biochemistry. 1949. Devine, Sir Hugh and Devine, John. Surgery of the colon and rectum. 1948. Dixon, Malcolm. Multi-enzyme systems. 1949. Dublin, L. I. and others. Length of life; a study of the life table. rev. ed. 1949. Fowler, H. W. and Fowler, F. G. The concise Oxford dictionary of current English. 3d. ed. rev. 1934. General Medical Council. Introduction to the recommendations of the Council as to the Medical curriculum. Grant, J. C. B. Atlas of anatomy. 2d. ed. 1947. Gregg, D. E. Coronary circulation. 1949. GuggenHeim, Louis. Phylogenesis of the ear. 1948. Gyorgy, Paul. ed. Vitamin methods. 1949. Vol. 1. Harrow, Benjamin. Textbook of biochemistry. 5th ed. 1950. Harvey Society, N.Y. Harvey lectures vol. 43, 1947-48. Hern, K. M. Physical treatment of injuries of the brain and allied nervous disorder:;;, 1949. Huettner, A. F. Fundamentals of comparative embryology of the verterbrates. 1941. Jordan, E. 0. and Burrows, Wm. Textbook of bacteriology. 15th ed. 1949. - London. Nature of disease institute. First Annual report 1948. London. Nature of disease institute. Second Annual report. 1949. Macintosh, R. R. and Mushin, W. W. Physics for the anesthetist. 1947. The Merck manual of diagnosis and therapy. 1950. Mitchell, P. H. TextbooR of biochemistry. 2d ed. 1950. Needham, Joseph and Baldwin, E. J. eds. Hopkins and biochemistry. 1949. Nord, F. F. and Weidenhagen, R. Ergebnisse der enzymforschung. 1949. Vol. 10. Paterson, Ralston. Treatment of malignant disease by radium and X-ray. 1948. Recent progress in hormone research. Vol. 5. 1950. Rockefeller Institute for medical research, N.Y. A study of nerve physiology. Vols. 131 and 132. 1947. Romeis, B. Mikroskopische technik. 1948. Rynearson, E. H. and Gastineau, C. F. Obesity. 1949. Saunders, .J. B. and O'Malley, C. D. Illustrations from the works of Andreas Vesalius. 1950. Selye, Hans. Physiology and pathology of exposure to stress. 1950. Titus, Paul. Management of obstetric difficulties. 4th ed. 1950. U.S. Veterans administration. Technical bulletins. Series 10. Vol. 2, 1948 and Vol. 3, 1949. Vincent memorial laboratory. Cytologic diagnosis of cancer. 1950. Wesson, M. B. Urologic roentgenology. .3 d ed. 1950. Williams, J. W. Obstetrics. 10th ed. by N. J. Eastman. 1950. Zoethout, W. D. and Tuttle, W. W. Textbook of physiology. 10th ed. 1949. 42 ALBERTA MEDICAL BULLETIN Oct., 1950

ANNUAL G~NERAL MEETING COLLEGE OF PHYSICIANS AND SURGEONS Province of Alberta Calgary, 20th September, 1950

The Annual General Meeting of the College of Physicians and Surgeons, Province of Alberta, was held in the Ballroom of the Hotel Palliser, at 11 :00 a .m. Wednesday, the 20th of September, 1950.

The President, Dr. J. W . Richardson, calld the meeting lo order al 11 :00 a .m.

The President asked Dr. D. N. MacCharles lo act as Secretary prolem, in the absence of Dr. Bramley-Moore.

MINUTES OF THE PREVIOUS MEETING: The Aeling Secretary referred lo the Minutes of the Meeting held in Edmonton on the 22nd of September, 194 9, as printed in the Agenda. MOTION: Moved by Dr. Orr, seconded by Dr. Stuart THAT the minutes be accepted as printed. (Carried)

PRESIDENT"S REMARKS: Ladies and Gentlemen: Since our last General Meeting there have been several changes in the personnel of your Council. The present Counc;il consists of Dr. Young, of Lamoni; Dr. Neville, of Camrose; Dr. MacCharle'S, of Medicine Hat; Dr. Dbnald, of Edmonton; Dr. Haig, of Lethbridge; Dr. Coppock, of Eckville, and myself.

I regret lo report the recent death of Dr. T. H. Field, a very hard working and able Councillor who represented the district of Edmonton for several years.

Last January, I was elected President. I accepted this position with great humility for I was following Dr. Morley Young, of whom I had formed the greatest respect. He had filled the chair with outstanding ability. I sincerely solicit your support and co-operation. I am endeavou.ring to follow the good example of my predeceS'Sors. Your Councillors have no easy task carrying out the duties entrusted in them, by you.

The past year has been a strenuous one. We have attempted through the medium of the Alberta Medical Bulletin to give you a short report on Council activities in each quarterly issue. I hope you have carefully read each report. It is extremely important that you should read them and become conversant with the problems which are confronting our profeS'Sion in these rapidly changing limes. We welcome your criticisms and suggestions. Just sit down and drop us a line when you have anything lo offer. We are most anxious to serve you to the best of our ability, so your help will be appreciated.

During the past year there have been seven Council meetings, and numerous Committee meetings. One of the most important as well as disturbing functions of your Council is the disciplining of our members. We have been called upon to investigate several complaints. Some were the result of poor judgment in the treatment of patients, while others, I am sorry lo say, were of rather grave misconducts.

These latter. lour in number, were firmly but I believe fairly disciplined.

I would at this lime like lo make a few remarks regarding Public Relations. This is a subject lo which your Council has given considerable thought. In fact, ii is presently occupying a major place in the minds of medical men all over Canada. It would seem an anomaly that medical men, who individually are held in such high esteem with each of their patients, that these same patients collectively seem lo have such a poor Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 43 opinion of our profession. The Pre'l!s believe it good publicity to take a rap at us occasionally. We must assume that the Press knows what pleases their readers.

I believe that good Public Relations would be greatly improved if each of us would keep "Public Relations" in mind in our remarks and actions.

Your Council forwarded the following resolution to the Canadian Medical As'Sociation: " That the C .M.A. endeavor to secure from the Department of Indian Affairs the Schedule of the D.V.A. Schedule of Fees."

During the year through negotiations with the Minister of Health it was agreed that the Cancer Clinic patients who come under Pensioners' Medical Services would have their treatment paid for by the Cancer Services. This in effect would save the Pension Fund about $25,000. It was also agreed to make an additional grant to the Fund of $20,000 per year. This mean'S that you will receive about $45,000 more for your treatment of pensioners over the $12.50 for each pensioner per year, which we were already receiving. Unfortunately, the doctors accounts against this fund are increasing yearly.

The Fees Committee met several times during the year and had long discussions with different groups and finally revised the Schedule. Copies of which are already in your hand'S.

After Jong negotiations with different Companies an agreement was finally reached with the North American Life and Casualty Company, by which all registered members of the College of Physicians and Surgeons of Alberta could become insured for accident and sickness without · examination. Your Council considers the rates and terms of this agreement very satisfactory.

The Health Survey Commitee report was finally submitted to the Min ister of Health. Doctor Morgan, Chairman of the Liaison Committee, did yeoman service and our thanks go to him and his Councillors for a difficult job well done.

Many new names were placed on the Register during the year making the total registered physicians 754 in this Province as of the 30th of June, 1950.·

For_Jl!!l for submitting resolution'S were forwarded to. you in order that you might have time to carefully consider any resolutions which you would like to submit. I expect some very important matters will come up for discussion. I am .d.esirous that everyone may have a chance for free discussion.

This year for the first time a whole day has been set aside for the discussions of the business of the Profession but we can easily squander this time by unnecessary long orations, so please stick to the points you wish to make, be brief.

REPORT ON GROUP INSURANCE: Dr. Wallace presented the following report concerning Group ln'Surance:

At the Annual General Meeting held in Edmonton on the 22nd of September, 1949, a motion was passed authorizing the formation of a committee to study group insurance for the doctors of Alberta. A committee was chosen consisting of Dr. J. D. Wallace, of Wainwright, as Chairman, and Drs. W. Bramley-Moore, T. H. Field and G. Bell, of Edmonton, as members.

Early in October a questionnaire was sent out to all practising physicians and surgeons in the province asking for opinions on group sickness and accident as well as group life insurance. Several sample sickness and accident policies were pre'Sented and members were requested to choose which on they preferred. The response to this questionnaire was most gratifying probably becau'Se Dr. Bramley-Moore had the fo resight (coupled with his intimate knowledge of the wastepaper basket habits of members of our profession) to enclose a return envelope w ith the questionnaire. 44 ALBERTA MEDICAL BULLETIN Oct., 1950

The results of this questionnaire were interesting in that they showed that a . large majority of doctors were not already protected by a sickness and accident policy. The results were very strongly in favor of such a group policy and also strongly in favor of the one now in force. Very few appeared to be in favor of group life insurance, no doubt an indirect tribute to the integrity and endurance of the numerous in-Surance salesmen who make the rounds of doctor's offices.

During the six weeks following the completion of returns three meetings were held in Edmonton completing final draft's and details on the policy and then the North American Lile and Casualty Company was given the go-ahead signal to recei;ve applications.

A total of 386 policies were taken into force as our group. Of these 382 are still in force. Seven members (six in Edmonton and one in rural Alberta) have not yet paid their renewal premium, and two new applications have recently been received.

The group has been operating less than a year and complete statistics are therefore not yet available. However, ten claims have already been dealt with and $4,577.05 has been paid out to date on these claims.

Your Committee still believes that this is a very worthy venture and invites the continued support of all members to insure the success of our group.

In conclusion we would like to publicly thank our Registrar and fellow commitee member Dr. W . Bramley-Moore for his untiring efforts on behalf of this insurance scheme. He shouldered the bulk of the load and it is mainly due to his work that the plan was inaugurated so quickly. We would also like to thank Mr. W. E. Brunning of the North American Life and Casualty Company, for his co-operation and assistance. MOTION: Moved by Dr. Wallace, seconded by Dr. J. D. Ross THAT this report be accepted. (Carried)

BEPOBT OF THE COMMITTEE ON ECONOMICS: Dr. Young, Chairman of \he Committee on Economics, presented his report as printed in the Agenda and Commitee reports. MOTION: Moved by Dr. Young, seconded by Dr. Neville THAT the report of the Economics Committee be approved. (Carried)

Dr. Hepburn referred to para. 1 of the Economic Committee report concerning pensioners' making use of private or semi-private wards in hospitals. Dr. Hepburn stated that he felt that if pensioners wished to make use of a private or semi-private ward with perhaps the son or daughter paying for the accommodation that it was their business, and that he felt that it would be very unfair to force an extra bill on these people.

Dr. Richardson slated that this recommendation had not been passed by Council.

Dr. Prowse suggested that some scheme for Pensioners should be taken out following the lines of those suggested for M.S.I.

Dr. Richardson slated that another scheme might be considered for the Pensioners' Medical Services if Medical Services (Alberta) Inc., was successful, that is a plan whereby Pensioners' Medical Services would be transferred to a plan covering all the people in the province.

Dr. Tuttle presented a resolution, seconded by Dr. Cameron, concerning doctors being allowed to charge a fee over and above those allowed by the different societies.

(Note: This motion was not submitted in writing, and being later withdrawn, the exact wording of the motion was not available to the secretary.) Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 45

Dr. Pearson stated that in many instances the doctor was not aware of the patient coming under any prepaid plan until he had completed treatment.

Dr. Tuttle stated that he wished to amend his resolution to read that if the doctor realizes the circumstances he should be allowed to charge an extra fee, providing he has that understanding at the beginning of the treatment.

Dr. Young stated that he was a little concerned about Dr. Tuttle's amendment. He stated that there would be no use Council entering into an agreement with organizations such as the T.B. or Cancer Clinics, as this resolution would nullify the whole agreement.

Dr. Orr stated that doctors must not charge separate fees for the treatment of cases under such circumstanc0'S. He stated that this was in the Act.

There was some discussion concerning the doctor's right to accept an extra five or ten dollars from patients if it was given to them by the patient or by the patient's relatives.

Dr. Lewis made the statement that it was probably alright to accept it but that you could not charge it.

Dr. Prowse asked if it was perfectly ethical for him to refuse to treat anyone he wished, and was informed that it was.

MOTION TO ADJOURN: Moved by Dr. Sprague, seconded by Dr. Young THAT the meeting adjourn to reconvene at 2 :00 p .m. (Carried)

MEETING RECONVENED AT 2:15 p.m. The Meeting was called to order by the President. Dr. J. W. Richardson. Dr. Tuttle stated that .he wished to withdraw the motion that he had presented before the meeting adjourned.

Province Wide Prepaid Medical Care:

MOTION: - Moved by Dr. M. A. R. Young, seconded by Dr. S. B. Thorson

WHEREAS our Prepaid Medical Care Plan is at present operating in this Province on the contributary principle,

AND WHEREAS it would seem advisable to include . all the people in the Province under a prepaid "Scheme,

AND WHEREAS we have reason to believe that our Government and the Profession would view with favor further negotiations in this regard along the lines of the synopsis which has already been sent to each and every member of this Association for their consideration and study,

BE IT THEREFORE RESOLVED that this Annual General Meeting of the College of Physicians and Surgeon'S instruct Council and the Committee on Economics to proceed with study and discussions with a view to establishment of a Province Wide Scheme of Prepaid Medical Care after the plan outlined by Sir Earle Page of Australia. (Carried)

Dr. Young stated that after the Annual Meeting in Halifax at which they heard the presentation of Sir Earle Page concerning "A New Conception of a National Health Scheme for Australia" he took the privilege of finding out if the Minister of Health, Province of Alberta, had received a copy of this report. Dr. Young said that the Minister stated that he had received a copy and that he was very impressed with it. Dr. Young stated that he was asked for certain figures as to cost of medical care in the Province, 46 ALBERTA MEDICAL BULLETIN Oct., 1950 etc., was was advised that when he had obtained these figures to return for formal instructions. Dr. Young stated that the circular letter to the profession was the result.

Dr. Young then asked Dr. Routley to say a few words.

Dr. Roadey: Dr. Routley gave a brief outline of the background of Sir Earle Page, staling. that he was Vice-Premier of Australia, a Fellow of the Royal College of Surgeons, England, an outstanding surgeon, and a humanitarian.

He staled further lhai the presentation by Sir Earle Page does not represent the thinking of a few people, but rather the thinking of one of the greatest statesmen that we have in the world today.

Dr. Routley outlined briefly his visit to the ranch of Sir Earle Page, slating that Sir Earle had given 'him the impression that after 30 odd years of medicine he had the answer lo medical care and that they found ii necessary. to take it to the head of the land.

Dr. Routley continued in the words of Sir Earle Page: "Routley, remember this, I am an old man now, I am tired after all the hustle and bustle of politics, but politicians like power and when the medical profession hands it over to the politician then the medical profession may be in danqer. The government has not right to assert a power that is someone else's."

Dr. Routley staled that he was delighted to hear that the Government's thinking was inclined to qo alonq and place this "in your hands." "Politicians come and go, but medical care goes on forever, therefore ii is safer in the hands of those who administer ii, than left to the whims of the politician.'

Dr. Routley slated that Sir Earle Page would be coming lo New York and while in New York he would be visiting Mr. Truman, and then would spend a few days in Ottawa. Dr. Routley stated that should this plan be accepted by Australia, New Zealand, United States and Canada, it would be a pattern for the whole world, the finest things for which medicine stands.

Dr. Routley referred to the segmentation of Public Health Services from the Medical Profession. He also referred to the areas in the Province needing doctors and stated that if this need was known to the profession that the profession should do something about it, and that if no doctor was available and the Government send in public }\ealth nurses they should not be criticised for it as it was the professions own fault.

Dr. Routley staled that the standard of medicine in Canada was second to none in the world and that looking down the road in days of austerity which lie before us, we may have to draw in our horns if not for any other reason than just simply that the mon'.ey will not be there.

In closing Dr. Routley stated that he felt that the Medical Profession should be able to handle the problem of providing adequate care and that in Alberta the profession had the necessary leadership.

Dr. Gosse stated that he was very much heartened by his visits at the meetings across the Dominion and that he also was impressed with the quality of leadership in Alberta. Dr. Parsons slated that as Provincial Representative he felt that ii was his duly to correct an erroneous opinion among the members concerning the present existing deficit in the Health Group operating in the Lethbridge area. He stated that deficits in other groups in the Province paralleled that of the Lethbridge groups. Dr. Morgan outlined briefly the steps taken by the profession in organizing M.S.I. and slated that he felt that the motion put forward by Dr. Young was a golden opportunity lo establish a voluntary province wide plan of medical care with non-political control. Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 47

PUBLIC HEALTH SALARIES:

MOTION: Moved by Dr. Coppock, seconded by Dr. Haig.

WHEREAS four members of the Mental Hygiene Branch of the Public Health Service in this Province have recently or now contemplate leaving the service,

AND WHEREAS two members of the Rural Health Units have recently, and and others now contemplate leaving the service,

AND WHEREAS the reasons for this action are the more attractive conditions and salaries elsewhere, especially in the U.S.A., where the demand for trained Public Health personnel is excessive.

AND WHEREAS salaries in Alberta are not commensurate with the training required, the service given, and the rising cost of living,

AND WHEREAS this rapid loss and change of personnel in the Health Services of this Province is detrimental to the services due to the frequent changes in staff, understaffing, and lack of continuity in service,

AND WHEREAS present salaries and conditions of services are not sufficiently attractive to University of Alberta graduates in medicine to enter these services,

BE IT THEREFORE RESOLVED that the College urge the Provincial Government to take immediate steps to implement the recommendations of the Liaison Committee with 'regard to the provision of adequate salary scales and conditions of service for medical personnel appointed on a full time basis, as set out by the Canadian Public Health Association, and implemented by the report of the Alberta Public Health Association. (Carried)

MEDICAL SERVICES (ALBERTA) INCORPORATED Dr. Galbraith presented the following motion concerning M.S.I. :

_MOTION: Moved by Dr. Waddell, seconded by Dr. Zender.

WHEREAS Medkal Services (Alberta) Incorporated is an effort by the medical profession as a whole in Alberta to meet the public demand and still maintain the control of prepaid medical care,

AND WHEREAS although Medical Services (Alberta) Incorporated is centrally administered, it is not only keeping records of each small group individually for statistical purposes, but actually administering each group separately, rather than as a provincial scheme,

AND WHEREAS premiums collected in one area in the Province may be used for services anywhere in the Province,

BE IT MOVED THAT Medical Services (Alberta) Incorporated be administered as one Provincial scheme, and the setting of premiums( experience rating) and percentage of remuneration to the doctors be based on the figures for the complete operation of the entire scheme in Alberta.

After considerable discussion by the various members of the profession the motion was amended to read:

MOTION: Moved by Dr. Haig, seconded by Dr. Schmaltz.

THAT regional experience rating be -instituted on all contract renewals,

AND THAT a new basic rate apply to new Group Contracts {Carried) 48 ALBERTA MEDICAL BULLETIN Oct., 1950

REPORT OF THE LIAISON COMMITTEE: Dr. H. V. Morgan, presented the report of the Liai-son Committee as printed in the Agenda and Committee Reports:

MOTION: Moved by Dr. Morgan, seconded by Dr. Neville,

THAT the report of the Liaison Committee be approved. (Carried)

REGISTRAR'S REPORT: Dr. MacCharles presented the Registrar's report. Dr. Gorrell moved the adoption of this report and slated that he felt that the <:ongralulations of the meeting should be extended to Mrs F. J. McCann on her appointment as Assistant Registrar. MOTION: Moved by Dr. Gorrell, seconded by Dr. Elder,

THAT the report of the Regi-strar be approved. (Carried)

ECONOMICS COMMITTEE: Appointment of Economics Committee: The following were recommended by the Nominating Committee lo form the Economics Commilee: Dr. J. R. Francis, Calgary -Surgery Dr. K. Thomson, Edmonton -Medicine Dr. E. H. Watts, Edmonton -Anaesthetist Dr. H. E. Duggan, Edmonton -Radiologist Dr. D. S. Gorrell, Calgary -E.E.N.T. Dr. S. Hanson, Edmonton -Pathology Dr. A. H. Maclennan, Edmonton -Obs. and Gyn. Dr. G . N. Ellis, Edmonton -Urology Dr. H. Smith, Camrose -General Practice Members at Large: Dr. F. Coppock, Eckville. Dr. M. A. R. Young, Lamoni. Dr. H. V. Moigan, Calgary. Dr. J. D. Wallace, Wainwright. Dr. W . C. Campbell, Medicine Hal. Dr. S. M. Schmaltz, Lethbridge. Dr. R. M. Par-sons, Red Deer.

MOTION: Moved by Dr. MacCharles, seconded by Dr. Sprague, THAT the report of the Nominating Committee be accepted. (Carried)

DIVISION OF ARTHRITIS: Functions of the above Division were briefly outlined by Dr. K. Thomson.

BENEVOLENT FUND: Dr. Sprague spoke briefly on the inadequacy of the Benevolent Fund, and suggested that some thought be given lo the establishment of a Benevolent Fund

COLLEGE FEES: After some discussion concerning the raising of annual fees of the College the following motion was pre-sented:

MOTION: Moved by Dr. Ingram, seconded by Dr. Neville, THAT due to the increasing cost of carrying on the business of the Alberta Division of the Canadian Medical Association and the College of Physicians and Surgeons Vol. 15, No. 4 ALBERTA MEDICAL BULLETiN 49

THAT the increase in the annual fees for the College of Physicians and Surgeons of Alberta be left lo the decision of Council. . (Carried)

(Registrar's Note: Section 30 of the Medical Profession Act outlines the powers of Council in regard lo the fixing of annual fees.)

ALCOHOLISM: The following motion was presented by Dr. J. D. Ross :

MOTION: Moved by Dr. J. D. Ross, seconded by Dr. P. Rose. WHEREAS the problem of alcoholism is being inadequately handled by the practising profession at the present time,

AND WHEREAS the facilities for the proper treatment of these cases is entirely lacking in this Province,

BE IT T.HEREFORE RESOLVED THAT a Committee of the Council be formed lo meet with the Minister of Health and request that his Government establish in the very near future a sanitarium with adequate trained staff where recurrent alcoholics and drug addicts may be committed for proper treatment in an attempt lo restore these citizens lo a useful position in their communities. (Carried)

MOTION TO ADJOURN : Moved by Dr. Coppock, seconded by Dr. Young,

THAT the meeting adjourn. (Carried)

MINUTES OF THE 45th ANNUAL MEETING CANADIAN MEDICAL ASSOCIATION, ALBERTA DIVISION

The -45th Annual General Meeting of the Alberta Division was held in the Ballroom, Hotel Palliser, Calgary, at 9 :00 a .m., Wednesday, the 20th of September, 1950.

The President. Dr. R. M. Parsons, staled that unfortunately Dr. Bramley-Moore was quite unable to be present due lo illness and that he wished lo appoint Dr. H. P. Sprague as Secretary, prolem.

MINUTES OF THE PREVIOUS MEETING:

Dr. Sprague presented the Minutes of the 44th meeting of the Division which w~s held in Edmonton on the 22nd of September, 1949, as printed in the Committee reports.

MOTION: Moved by Dr. Gorrell, second by Dr. Bradshaw,

THAT the Minutes be accepted as read. (Carried)

BUSINESS ARISING OUT OF THE MINUTES: Defence Medical Association: The Aeling Secretary staled that this Resolution had been carried out. and this year the Association had a speaker on a Defence Medical Problem.

Extension of Annual Convention to Four Days: The Aeling Secretary drew the attention of the members to the fact that this was the first four-day Convention in order that one whole day may be devoted to the Business Meetings. 50 ALBERTA MEDICAL BULLETIN Oct., 1950

COMMITTEE REPORTS: Report of the Committee on Archives: The meeting observed one minute's silence for our deceased members: A. E. Ardiel J. B. Mackay E. A. Braithwaite K. Maclennan T. H. Field J. S. Macleod W. F. Gillespie W . H. McGuffin J. E. C . Henderson E. L. Pope

MOTION: Moved by Dr. Neville, seconded by Dr. Coppock, THAT the Report of the Committee on Archives be approved. !Carried)

Report of the Committee on Maternal Welfare: MOTION: Moved by Dr. Vant, seconded by Dr. Morgan, THAT the report of the Committee on Maternal Welfare be approved. (Carried)

Report of the Committee on Pharmacy and Hospital Service: MOTION: Moved by Dr. Sprague, seconded J;>y Dr. W. B. Parsons, THAT the report of the Committee on Pharmacy and Hospital Service be approved,

AND THAT this Committee be divided into two, namely, a Committee on Pharmacy and a Committee on Hospital Service. (Carried)

Report of the Committee on Public Health: MOTION: Moved by Dr. Pearson, seconded by Dr. More,

THAT the report of the Committee on Public Health be approved. !Carried)

There was considerable discussion by members of the profession concerning Public Health Nurses carrying out. procedures and making calls which should rightfully be carried out by the General Practitioner

Dr. Hepburn stated that instead of blaming the Department of Public Health and Government that he felt that ii was up lo the profession to see that the general practitioners were in the outlying areas lo do the work. He stated that in many of the a,eas where Public Health Nurses were carrying on Public Health work the General Practitioner was just not around. He slated further that as long as the Universities, etc., encourage young graduale'S lo go on and take specialists training one would not get the generai practitioners to go out and serve the public. The main objective of the young graduate s; ems to be to further his study and the general practitioner is just simply not there.

After further discussion the following motion was approved.

MOTION: Moved by Dr. C. L. Pearson, seconded by Dr. C. G . More, WHEREAS the Medical Profession views with concern the increasing utilization of nurses in certain fields of medicine in the more remote areas,

AND WHEREAS the available trained public health personnel is not sufficient to adequately serve the Province,

BE IT THEREFORE RESOLVED THAT the Canadian Medical Association, Alberta Division, request that the Department of Public Health through its trained personnel make adequate use of the general practitioner in the implementation of its public health programs. (Carried) Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 51

Report of the Committee on Cancer: MOTION: Moved by Dr. Hepburn, seconded by Dr. Schmaltz,

THAT the Report of the Committee on Cancer be approved. (Carried)

Report of the Committee on Education: MOTION: Moved by Dr. Vant, seconded by Dr. E. Allin,

THAT the Report of the Committee on Education be approved. (Carried)

Report of the Editorial Board:

MOTION: Moved by Dr. Gorrell, seconded by Dr: Sereda,

THAT the Report of the Library Committee be approved. (Carried)

SECRETARY'S REPORT: Dr. Sprague presented the Secretary's Report as printed in the 1950 Agenda. The Secretary recommended the following members for Life Membership in the

Canadian Medical Association:

J. M. Adams, Calgary. A. H. Baker, Calgary. G . M. Carson, Calgary. J. V. Follett, Calgary. D. W. Whillans, Crossfields. T. W: E. Henry, Fort Saskatchewan. A. G. Scott, Bassano. A. E. Shore, Calgary.

MOTION : Moved by Dr. Sprague, seconded by. Dr: .. J. Wallace, THAT the Secretary's report be approved.

Repo~ of the Chairman of the Medical Lilbrary Committee, University of Alberta: The following report was read by Dr. P. H. Sprague:

The Medical Library al the University of Alberta has shown steady growth since the last report. The nu.mber of volumes has increased and the circulation of books and journals has shown a further increase. This attests to the widening interest of medical students and the medical profession of the Province in medical literature.

The Purchasing Committee of the Medical Faculty has met four times during the year for the consideration and purchase of new items, selecting 212 books out of about 800 presented for their consideration and adding 13 new titles to the Journal subscriptions.

Number of Bound Volumes in Library:

1949-50 1948-49 Added Books ...... : ...... : 5,387 5,175 212 Journals ...... 5,696 5,424 272

Totals ...... ····························· 11,083 10,599 484 52 ALBERTA MEDICAL BULLETIN Oct., 1950

Expenditures: Books ...... $1,186.42 $1,669.04 Periodicals: Old ...... 1,103.61 1,078.14 New ...... ···································································-································· 55.05 8.00 Foreign ...... 172.18 160.51 Binding ...... 1,540.00 1,057.00

Totals ...... $4,057.26 $3,972.69

$ 85.57

The University provided an allowance of $1.000.00 for the purchase of books last year and the College provided an additional $200.00.

It will be noted that the Purchasing Committee kept well within that figure, but did so by selecting only those items which were absolutely essential for student us.

Journals: The Library now receive'S 268 journals. This represents an increase of 13 titles since 1948-49 and an increase of 31 since 1947-48. At the last committee meeting in July, 1950, the purchase of six additional journals was authorized. Circulation ol Books and Journals: During the last year there was another increase in library circulation. The number of items circulated to students, members of the University Staff and members of the College of Physicians and Surgeons was 19,370 as compared with 17,824 during the previous 12 month period. Our records indicate that rural physicians have not been taking full advantage of the service offered by the Library. It might be pointed out that the Medical Library staff is willing and anxiou'S to send out any material in the library which a physician may wish to consult. There is no charge made for the service except for postage.

Comments: The Medical Library in the Medical Building of the University is bursting at the seams. Many of the older bound Journals and seldom used books are housed in variou'S departments in the Medical Building. The new Library Building is nearing completion and will provide more spacious quarters for housing the library. It will al'So provide adequate and comfortable reading rooms and facilities for micro film reading and photostating.

The annual budget for 1950-51 provides $1.200 for the purchase of new boob. It will be noted from the Statistical Report that the Committee managed to stay within that quota last year. The cost of Journals is borne by a special Journal grant. Your Librarian has been advised that the expen.diture for Medical Journals now far exceeds its share, and that no new subscriptions may be started. It is also clear that since library funds are derived from student fees, books selected for the library should be such as to meet the requirements of the students. The purchase of books and journals for use in research or of the medical specialist type will need to be curtailed.

In a Medical Library such as ours is. and which is not supplemented by a Library such as i'S maintained by the Colleges of other Provinces, which must meet the needs of the students as well as those of the researcher and the physician, it is important that no necessary item should be missing. It becomes apparent then that some other source of income must be forthcoming if we are lo meet the requiremenl'S of a modern first-class Medical Library. With this in view I would urgently solicit that the Council of the College g ive some consideration lo implementing such a source of income specifically earmarked for the purchase of specialist items by providing an additional sum of $200.00 annually. A similar request will be made to the Medical Re'Search Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 53

Committee for a fund set aside for the purpose of purchasing material required for medical research. . Dr. Parsons 'Suggested an additional grant of $200.00. Dr. Richardson stated that an additional grant would be given consideration.

MOTION: Moved by Dr. Vant, seconded by Dr. P. Rose,

THAT the report of the Library Committee be approved. (Carried)

NEW BUSINESS: Can11di11n Arthritic: Assoc:illtion: Dr. Rostrup outlined briefly the purpose of the Association which had been set up under the Chairmanship of H. R. Milner. He stated that the organization was primarily concerned with the improvement of facilities to aid the doctors in treating patients with arthritis; in providing fund'S for scholarships for doctors doing arthritic work; model clinics for treatment: supplying of equipment and trained personnel and laboratory and X-ra·y facilities. He stated further that it was not the intention of the Association to take the arthritic patient away from the profession, but rather to pass the patient back to the profession.

REPORT OF THE NOMINATING COMMinEE: President-Elect-Dr. H. V. Morgan.

Coanc:il of the C11nadian Medic:11l Assoc:i11tion: Dr. H. Orr, Edmonton. Dr. F. Coppock, Eckville. Dr. M. A. R. Young, Lamont. Dr. S. Schmaltz, Lethbridge. Dr. R. M. Parsons, Red Deer. Dr. W. C. Campbell, Medicine Hat. Dr. H. V. Morgan, Calgary. Dr. J. B. T. Wood, High Prairie. The following two names were submitted as alternates: Dr. F. H. Sutherland, Peace River. Dr. f Scott, Edmonton. MOTION: Moved by Dr. E. Allin, seconded by Dr. J. D. Ross, THAT the Nominations be approved. (Carried)

Represent11tive on Nominllting Committee C.M.A. Dr. W. Bramley-Moore, Edmonton.

MOTION: Moved by Dr. Schmaltz, seconded by Dr. Lees, THAT this Nomination be approved. {Carried)

Executive Commitee, Can11di11n Medical Association: Dr. H. Orr, Edmonton. Dr. J. Scott, Edmonton {alternate). MOTION: Moved by Dr. P. Rose, seconded by Dr. J. Wallace, THAT these Nominations be approved. (Carried)

Editorial Board: Dr. W. C. Whiteside, Edmonton, and Secretaries of the Districts.

MOTION: Moved by Dr. Coppock, seconded by Dr. W . Parsons, THAT these Nominations be approved. 54 . ALBERTA MEDICAL BULLETIN Oct., 1960

Maternal Welfare: Dr. A. H. Maclennan, Edmonton. Dr. A. J.. Fisher, Calgary. Dr. J. B. T. Wood, High Prairie. Dr. T. E. Brown, Lethbridge. MOTION : Moved by Dr. Vant, seconded by. Dr. Tuttle, THAT these nominations be approved.

Committee on Public Health: Dr. G. M. Little, Edmonton. Dr. J. A. Gillett, Edmonton. Dr. C . .L. Pearson, Galahad. Dr. W. A. Henry, Lacombe. Dr. W. H. Hill, Calgary. Dr. S. Argue,. Hanna. Dr. M. O'Meara, Lethbridge. Dr. C. G. More, .Red Deer. MOTION: Moved by Dr. Orr, seconded by Dr. Rostrup, THAT the nominations be approved. (Carried)

Committee on Finance: Dr. W. Bramley-Moore, Edmonton. Dr. Harry Gibson, Calgary. Dr. S. Schmaltz, Lethbridge. Dr. N. B. Maclean, Blairmore. MOTION : Moved by Dr. MacCharles, seconded by Dr. Stuart, THAT these nominations be approved. (Carried)

Committee on Archives: Dr. G. D. Stanley, Calgary. Dr. P. Campbell, Lethbridge. Dr. J. 0. Baker, Edmonton. Dr. G. R. Johnson, Calgary. Dr. A. F. Anderson, Edmonton. MOTION : Moved by Dr. P. Rose, seconded by Dr: N.eville, ' THAT these Nominations be approved. (Carried)

Committee on Cancer: Dr. W. E. Ingram, Calgary. Dr. P. Malcolmson, Edmonton. Dr. E. F. Donald, Edmont.on. Dr. J. W . .MacG~egor, .Edmonton. Dr. H. A. Stuart, Calgary. Dr. w. s.· Andersof., Edmonton. Dr. S. M. Rose, Lethbridge. Dr. E. D. MacCharles, Medicine Hat. Dr. T. R. Clarke, Edmonton. Dr. L. McLatchie, Calgary. Dr. G. N. Ellis, Edmonton. Dr. H. N . .Jennings, Calgary. Dr. D. G. Florendine, Calgary. MOTION : Moved by Dr. Campbell, seconded by Dr. A. A. Haig, THAT these Nominations be approved. (Carried)

Committee on Legislation: President: Dr. P. H. Sprague, Edmonton. President-Elect: Dr. H. V. Morgan, Calgary. Hon. Sec.-Treas.: Dr. W. Bramley-Moore, Edmonton. Dr. H. Orr, Edmonton. Dr. J. D. Neville, Camrose. Dr. M. A. R. Young, Lamont. Dr. L. M. Fairbairn, Calgary.

MOTION: Moved by Dr. Stuart, seconded by Dr. Bunn, THAT these Nominations be approved. (Carried) Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 55

Committee on Hospitalization: Dr. D. R. Easton (Chairman) Edmonton. Dr. A. G. Ross, Elkpoint. Dr. C. R. Bunn, Red Deer. Dr. F. Coppock, Eckville. Dr. J. K. Mulloy, Calgary. MOTION: Moved by Dr. Morgan, second.ad by Dr. Neville, THAT these Nominations be ·Qpproved. (Carried) Committee on Pharmacy: ,·· Dr. D. R. Wilson, Edmo.nton (Chairman) Dr. A. H. Baker, Calgary. Dr. J. D. Heaslip, Calgary. Dr. T. C. Michie, Ponoka. Dr. P. H. Sprague, Edmonton. Dr. H. Soby, High River. Dr. A. C. McGugan, Edmonton. MOTION : Moved by Dr. ,Sereda, seconded by Dr. Schmaltz/ THAT these Nominations be approved.

Committee on Educatio~: Dr. J. MacGregor, Edmonton. Dr. J. J. Ower, Edmonton. Dr. J. Scott, Edmonton. Dr. E. . P. Scarlett, Calgary. Dr. W. MacKenzie, ·Edmonton. Dr. J. E. McAllister, Calgary. Dr. M. A. R. Young, Lamont. Dr. W. S. Anderson, Edmonton. Dr. S. M. Rose, Lethbridge. Dr. Bunn asked who ;eonstituted the Nominating Committee. Dr. Parsons replied MOTION: Moved by Dr. Pearson, seconded by Dr. Lees, THAT these Noil).inations ·be approved. (Carried) that it seemed in the past "the Nominating ·Committee had been appointed in various ways. He stated that his Nom1nating Committee had consisted of the President of the Association, the immediate Past Pre11ident, .the President-Elect · and the Commitee on Arrangements for the Convention in Calgary. Alter some discussion the following motion was approved. MOTION: Moved by Dr. Orr, seconded by Dr. C. R. 'R. Bunn, THAT the matter of a change in the Constitution providing for the appointment of a Nominating Committee be referred to the Committee on Legislation. (Carried)

Dr. R. M. Parsons, retiring president, thanked the members of the profession for such an excellent turnout and · for their co-operation during the past year. MOTION TO .ADJOURN: MOTION: Moved by .Dr. Morqc~m. seconded by Dr. Schmaltz, THAT the meeting adjourn. (Carried)

FOB SALE ALL IN "STILLE STAINLESS" STEEL General Abdominal Surgical Instruments, practically new, pre-war quality, consisting .of : I I) Box-locked artery forceps, straight and curved-various lengths. (2) Halstead mosquito forceps, straight and curved, box-locked. (3) Allis tissue forceps. 14) Backhaus towel forceps. with stops. (5) Other forceps. For particulars apply to DB. C. A. BERNER 221 Birks Building EDMONTON 56 ALBERTA MEDICAL BULLETIN . Oct., 1950

FROM TiiE CRADLE TO THE TEENS . this multi-vitamin for moderns provides protection against hidden or unexpected vitamin deficiencies. lnfantol insures optimum metabolic activity during the years of rapid growth. 4 lnfantol, the water-miscible six-vitamin DIETARY SUrPLEft\Elolf combination, may be given from spoon or FQR CHILDREN Allll> added to formula. Either way, pleasant­ Do, ADULTS tasting lnfantol solves the dietary supple­ •· 0,,. .,..,ttlf 10 ment problem for patient and physician $ C<.; . teaspoonful (apP " ' simply, completely, and economically. dQoly.... .,i .. FRANK W. HORNER LIMITED MONTREAL CANADA Vol. 15, No. ' ALBERTA MEDICAL BULLETiN 57

worth noting

Potent therapeutic agents may be two-edged swords-clinical efficacy coupled with varying degrees of toxicity. CHLOROMYCETIN is a powerful sword with a single edge. It exerts a remarkable antibiotic effect on a wide range of infections (including many unaffected by penicillin, streptomycin or the sulfonamides). At the same time, it is unusually well tolerated. Published reports emphasize its relative innocuousness.

"NO significant untoward effects in patients who received chlora~- .phenicol under our care." Smadel. J . E.: J .A.M.A. 1u:a15, 1950 (discussion).

"NO evidence of renal irritation ... No impairment of renal function • • • . No changes in the red-cell or white cell series of the blood ... nor did jaundice occur• • . . .Drug fever was not observed ... side effects were slight and infrequent." Hewitt, W. L., and Williams, B., Jr.: New England J. Med. ! 4%:119, 1950

"NO toxic reactions or signs of intolerance were observed." Payne, E. H.; Knaudt, J. A., and Palacios, S.: J. Trop. Med. & Hyg. 61:68, 1948

"NO symptoms or signs of toxic effeels attributable to the drug were observed." Ley, H. L .. Jr. ; ·smadel, J. E•. and Crocker, T.: Proc. Soc. Exper. Biol. & Med. 68:9, 1948 CHLOROMYCETIN CHLORAMPHENICOL, PARKE-DAVIS

CHLOROMYCETIN is effective orally in urinary tract infections, PACKAGING! bacterial and atypical primary pneumonias, acute undulant fever, CHLOROMYCETIN is supplied in Kapseals typhoid fever, other enteric fevers due to salmonellae, dysentery of 0.25 Gm. (250 mg.) (shigella), Rocky Mountain spotted fever, typhus fever, scrub typhus, and in capsules of 50 mg. granuloma inguinale, and lymphogranuloma venereum. 58 ALBERTA MEDICAL BULLETIN Oct., 1950

in alcoholism . • •

7:40 P.M. Handwriting of same patient, twenty-five minutes after the oral administration of Tolserol. Tolserol Squibb Mephene.rin (3-o-tolosy, 1-l-propanedlol)

• ' to 1,xm~rol .tremor aniquiet the. patient , •for the relief of withdrawal symptoms • to reduce or eliminate the use of paral• dehyde and barbiturates • administered orally and intravenously

Elixir, Capsules, Tablets, Solution

t•TOL~EROL ·~ IS A TRADEMARK OF E. R. SQUlllll 811 SONS E- R. SQUIBB &. SONS OF CANADA, LIMITED, z:z+s· VIAU STREET, MONTREAL

SQJJIBB MANUFACTURING CHEMISTS TO THE MEDICAL PROFESSION SINCE 1858 Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 59

EXTRA POTENCY: WYCHOL is made with Tricholine Citrate. Each fluid ounce provides 6 Gm. choline base •• , . plus an effective amount of in08itol-900 mg. TASTE APPEAL: WYCHOL has a pleasant fruity taste and is only mildly acid (pH 5.4.5.5). Gastric distress or harm to teeth is minimized. ECONOMY: Lowest in co8t on the basis of content of. lipotropic factors. Your patients will co-operate to get the m08t out of the therapeutic regimen when you prescribe WYCHOL SYRUP OF CHOLINE AND INOSITOL WYETH 60 ALBERTA MEDICAL BULLETIN Oct., 1950 • •

"Tmth never grows old" Thomas Fuller, 1639

With passing years, ideas, theories and conceptions may change with new discoveries and growing knowledge. But truth never grows old. No matter how widely the pendulum may swing, truth remains the center of its path. Because of its inherent soundness, Dextri-Maltose* is the carbohydrate of choice in more hospitals than ever before. It enjoys the confidence of ever-growing thousands of physicians. And the physician who prescribes Dextri-Maltose in infant feeding follows a course confirmed by a great mass of evidence, for no other carbohydrate enjoys so rich and enduring a background of authoritative clinical experience. However the pendulum may swing, facts remain facts, and truth never grows old.

MEAD JOHNSON & CO. OF CANADA, LIMITED BELLEVILLE, 9NTARIO *Registered Trademark Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 61

'Bellafoline Total laevorotatory alkaloids of belladonnaa Powerful parasympatholytic. HYPERSECRETION - VAGOTONIA INTESTINAL SPASMS, ETC. 'Belladenal Bellafoline +phenobarbitone. Antispasmodic for the relief of physical · and mental tension. --

CORONARY SPASMS ~ PYLOROSPASMS - BILIARY CHOLIC - SPASTIC CHOLITIS - DYSMENORRHOEA PEPTIC ULCERS - NOCTURNAL ENURESIS THALAMO-MOTOR DISTURBANCES, ETC.

Literature and samples upon request SANDOZ PHARMACEUTICALS LIMITED 391 ST. JAMES STREET WEST SANDOZ. MONTREAL, P. Q . 62 ALBERTA MEDICAL BULLETIN Oct., 1950

Vasoconstriction combined with antibiotic therapy in NEO-SYNEPHRINE (brand_of phenylephrine) with CRYSTALLINE PENICILLIN

In upper respiratory tract infections, topical application o·f penicillin to the nasal cav· ity has a decided bacteriostatic action against typical respiratory pathogenic microorganisms.

To provide clear passage for such therapy, Neo -Synephrine is combined with penicillin'­ shrinking engorged mucou.s membranes and allowing free access of the antibiotic.

Neo- Synephrin_e.,.. a potent vasoconstrictor - does not lose its effectiveness on repeated ap­ plication ... is notable for relative freedom from sting and absence of compensatory congestion.

® NEO-SYN EPHRIN E with CRYSTALLINE PENICILLIN ~~s~INC . ; NEW YORK 13, N. Y. . WINDSOR, ONT. Stobie • Full Potency Supplied in combination package for preparing 10 cc. of a fresh buffered solution containing Neo-Synephrine hydro­ chloride 0.253 and Penicillin 5000 units per cc.

Neo·Synephrine. trademark reg. U. S. & Canada 443 Sandwich Street. West Windsor, Ontario Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 63

...

Proper care and maintenance is the surest way of retaining peak efficiency in the units you operate. But by their very complexity, x-ray and electro­ medical equipment must be serviced.

The X-Ray and Radium Serviceman who calls on you is thoroughly trained in the factory-his function is to assure that routine inspection and adjustment prevent avoidable mishaps. When unforeseen failures in equipment do occur, he responds to your call promptly, to put your equipment back in perfect working condition. So, whether it's routine inspection and adjustment, accessory· installation or repair, rely on X-Ray and Radium Service. As distributors for Keleket, Sanborn and Raytheon equipment we feel that our servicemen are able to give you the finest service in Canada. Radium, Ac:c:essories and Radiation Instruments Medical Radium in needles, cells, tubes and plaques of all sizes, with a complete line of accessories and applicators. Also, radiation measuring instruments for dosage calculations and traced equipment for use in research.

261 Davenport Rel., Toronto 5. Exclusive distributors for Keleket x-ray,fSanborn diagnostic and Raytheon diathermy evuipment. Moncion· Ouebec •Montreal• Winnipeg· Regina· Edmonton· Calgary· Vancouver 64 ALBERTA MEDICAL BULLETIN Oct., 1950

IT'SFROM !t BIRKS

Because of the traditional fine quality of Birks diamonds and the beauty of their mountings, Birks diamond engagement rings are treasured and admired through the years. BIRKS REGISTERED JEWELLERS I AGS I AMERICAN GEM SOCIETY Vol. 15, No. 4 ALBERT A MEDICAL BULLETIN 65

MORE CALCIUM, IRON and TRACE ELEMENTS

have been added to DIETARY SUPPLEMENT B.D.H.

When the 'ordinary mixed diet' supplies 'less than enough' essential nutrients during any period of increased need, the daily administration of Dietary Supplement B.D.H. will provide a wide margin of safety.

NEW Each capsule contains: Each tablet contains IMPROVED Vitamin A 1500 I.U. the equi1Jalent of: FORMULA Pro Vitamin A Ferrous Sulphate B.P. (5 grs. ) 330.0 mgm. (beta carotene) 1500 I.U. Copper 1.5 mgm. Thiamine Hydro­ Manganese 2.0 mgm. chloride 1.2 mgm. Riboflavin 1.0 mgm. Nicotinamide 10.0 mgm. One capsule and one tablet Ascorbic Acid 25.0 mgm. constitute a single dose. Vitamin D 600 I.U. Calcium Phos- phate Dibasic ( 2 Yi grains) 165.0 mgm. Iodine 0 .2 mgm.

THE BRITISH DRUG HOUSES (CANADA) LIMITED TORONTO CANADA 66 ALBERTA MEDICAL BULLETIN Oct., 1950

Current Clinical Meat Feeding Studies

REPORT No. 3

UTILIZATION OF NUTRIENTS BY PREMATURE INFANTS These studies were designed to compare the utilization by premature infants of the nutrients in milk, meat-sup­ plemented milk and milk­ substitutediets. The balance method is being used to de­ termine the utilization of calcium, phosphorus, iron, PIONEER fat and nitrogen. This study is part of an extensive clinical research MEAT EATER program now being con­ ducted through grants-in­ (5 years later) Jennifer Oberg at 5?{ aid made by Swift's. months was a partici­ pant in Swift's original meatfeeding tests.

Although J ennifer had been a "collicky original test feeding group started at six baby," she thrived on Swift's Strained weeks.) Swift's Meats for Babies provide Meats from the first. According to her essential complete proteins and food iron. mother, "She put on weight, seemed to gain Six different Swift's Mea ts for Babies vary strength. And I could tell she liked the meats. infants' diets-help form sound eating hab­ She'd kick her feet and laugh when I fed its. Beef, lamb, pork, veal, liver and heart. them to her." Each 100% meat-soft and smooth, slightly salted. Expert preparation assures minimum "Today she's a fine, healthy child" fat content and maximum nutrient retention. Jennifer's picture above bears out her Swift's Meats for Babies are ready to serve mother's statement. Today J ennifer is a at about half the cost of home-prepared meats. "good eater" and her favorite food is meat! These days any ba by can enjoy the bene­ fits of earlier meat feeding. Doctors recom­ mend Swift's Meats for Babies in the early weeks of life. (A number of infants in the All nutritional state­ ment1 made in this advertisement are ac­ cepted by the Council on Foods and Nutri­ tion of the American Medical Association. Vol. 15, No. 4 ALBERTA MEDICAL BULLETIN 67

1 A new, bulk-producing, colloidal treatment for chronic constipation . 2 A mixture of methylcellulose and car­ boxy-methylcellulose which produces a C .T: No. 756 voluminous gel, promoting normal peri­ stalsis and natural bowel evacuation. VOLUGEL E.11.S. 3 A non-antigenic, non-toxic, non-irritat­ E•ch l•bld conl•hu: ing gel which is not absorbed by the CarboJ:ymethylc•llulose • 0 .375 Gm. W·i ·lu'• M•thylc•llulose • • 0 .125 Gm. intestinal tract.* IDdic&ted in chronic constip&tion. C.T. No. 756 Volugel E. B.S. l>OSAGE: Four to •iJ:teen l&bl•I• daily until 0.5 Gm. in bottles of 100, r•9ularity is e1 tabli1hed. Then the dos.e YI 9udually teduced until n one are req\lited. 500, 1000. Tablets should be wa1hed down witb plenty ol watet. C.T. No. 757 Volugel Control Stronger E.B.S. 0.5 Gm. plus 0.7 mg. of the synthetic purgative, Diocetylpheno­ Tainter (1) found that, with methylcel· THE E.B.SHUTTLEWORTH lisatin, in bottles of 100, lulose, stools were easy of passage. No CHEMICAL COMPANY. LIMITEP 500 and 1000. colicy or griping pains were experienced ...,,,,.,, J<"l>(. "'"NG C tfMoS!O:. as a result of the drug administration. TO~ ~ Schweig (2) evaluating the effectiveness -...... ·.·.·.·.·.·.·.·.·.·.·.·.·.·.·.·."··· of methylcellulose in 37 patients, found that in 62% a normal, soft, bulky stool • • • was passed at least once a day without griping, cramping or tenesmus. In 30o/o (1) Tainter, M. L. : Proc. Soc. Exper. Biol. & Med., of cases results were good, the patient 54:77 (1943) passing five or more stools a week. (2) Schweig, K. : N.Y. State J. Med., 4B, 1822 (1948)

Descriptive folder on request.

LEWORTH CHEMICAL* CO. LTD., TORONTO, CANADA

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Prof ssional Pharmacy

Tegler Bldg. Edmonton

PRESCRIPTIONS

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Greyhound Building Calgary. Alberta .----we Invite You lo Give Our Service a Trial·---. Many doctors of Alberta have been using our services regularly for many years. with complete satisfaction to themselves and their patients. It is our desire to co-operate with the medical men of the province, and i you have not as yet given our service a trial, we invite you to take advantage of it when in need of Made-to-Order WALKING CALIPERS. LEG BRACES, SPINAL BRACES. CELLULOID CORSETS, ABDOMINAL SUPPORTS, CERVICAL SPLINTS. EXTENSION BOOTS, ARCH SUPPORTS, TRUSSES, ETC. Over twenty years of practical experience in the manufacture and fitting of Prosthetic Appliances enables us to give expert attention to your requirements.

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Calgary Artificial Legs Are Widely Recognized as the Best COMFORT and CONTROL· Giving Limbs on the Market Today BECAUSE

Our PELVIC BELT leg, for above-the-knee amputatlona, offers a new and vastly superior method of BUspension and control. Eliminates cumbersome shoulder straps, gives free­ dom to shoulders, rhest and diaphragm, thus aiding wrrect posture and health, and allows transfer of "muscle control" to limb, thus affording a measure or CO~IFORT and CONTROL Impossible to achieve with the old style of limb.

Our CUSHION SOCKET leg, for below-the-knee amputations, provides a unique CUSHION for the bearing surface of the stump, over which the weight ls EVENLY distributed, thus ellmlnating undue pressure on protruding bones, preventing sore<, with their dangers or infection and FURTHER AMPUTATIONS and prorldlng COMFORT such as the old gtylo or •ocket CANNOT give. Of particular advantage In new ampufatlon cases where the stump must become accustomed to bcarlni t~e weight.

Calgary Artificiaf Limb Factory 605 FIRST ST. EAST, CALGARY

~ DOUGLAS. EDMONTON