In Search of the Anglophone Doctor in Jacques Ferron’s Story “Le petit William”

The story of ‘Le Petit William’ (Contes anglais, 1964) is based on Ferron’s experiences as a general practitioner in the Gaspé in 1946. A medical event, use of the maternal left lateral position by a sage-femme to deliver a baby boy, becomes allegory. The sage-femme had learned the technique from a visiting Anglophone doctor. A simple joke, which superficially appears to be the story’s culmination, takes on a sombre political tone when considered in the light of the Latin epigraph. Trips to the Gaspé, a review of the history of obstetrics and speculation are used in this paper to understand the realities upon which Ferron’s fantastic literature is based. A la recherche du médecin « anglais » dans ‘Le petit William’ de Jacques Ferron L\u27histoire de « Le Petit William » (Contes anglais,1964) est basée sur les expériences de Ferron comme médecin de campagne en Gaspésie en 1946. Un événement médical, l\u27usage de la posture obstétricale « position latérale gauche » par une sage-femme lors de la naissance d’un petit garçon, donne lieu à une allégorie. La sage-femme avait appris la technique d\u27un accoucheur « anglais», de passage dans la région. Une plaisanterie simple, qui semble à première vue être la culmination de l\u27histoire, prend un ton politique plutôt sombre quand on la considère à la lumière de l\u27épigraphe latine. Partant de renseignements recueillis lors de voyages en Gaspésie, d’une revue de l\u27histoire obstétricale, et de la spéculation, nous essaierons de comprendre les réalités sur lesquelles la littérature fantastique de Ferron est basée

Western University (No. 10 Canadian Stationary Hospital and No. 14 Canadian General Hospital): a study of medical volunteerism in the First World War

The Canadian government depended on chaotic civilian volunteerism to staff a huge medical commitment during the First World War. Offers from Canadian universities to raise, staff and equip hospitals for deployment, initially rejected, were incrementally accepted as casualties mounted. When its offer was accepted in 1916, Western University Hospital quickly adopted military decorum and equipped itself using Canadian Red Cross Commission guidelines. Staff of the No. 10 Canadian Stationary Hospital and the No. 14 Canadian General Hospital retained excellent morale throughout the war despite heavy medical demand, poor conditions, aerial bombardment and external medical politics. The overwhelming majority of volunteers were Canadian-born and educated. The story of the hospital’s commanding officer, Edwin Seaborn, is examined to understand the background upon which the urge to volunteer in the First World War was based. Although many Western volunteers came from British stock, they promoted Canadian independence. A classical education and a broad range of interests outside of medicine, including biology, history and native Canadian culture, were features that Seaborn shared with other leaders in Canadian medicine, such as William Osler, who also volunteered quickly in the First World War

Medical response to the declaration of the First World War: The case of Edwin Seaborn

At the turn of the 20th century, Dr Edwin Seaborn was starting his surgical and academic career at Western University in Ontario. When war was declared in 1914, Seaborn prevailed upon the university’s president to offer the Canadian government a fully staffed hospital for deployment overseas. Initially declined by the War Office in Ottawa, the university’s offer was later accepted after mounting casualties stretched the capacity of the Canadian Army Medical Corps, and Seaborn was granted command of the new No. 10 Canadian Stationary Hospital. From 1916 to 1919, Seaborn’s medical, surgical, and administrative practices transformed the humble No. 10 Stationary Hospital into a General Hospital that was indispensable to the war effort and raised the standard for military medical practice. Upon the unit’s return to London, Ontario, Seaborn’s dedication was transferred to his extensive work as an author, historian, academic, and beloved physician. During the centennial of the First World War, this paper explores the impact of an academic medical unit by looking at the career of its Commanding Officer: a man who made an invaluable contribution to the Canadian war effort and set a precedent for exceptional medical care at home and at war

A novel REBOA system: Prototype and proof of concept

Background: Lower torso hemorrhage is a significant cause of death from injuries in combat. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to rescue patients successfully in the hospital setting, but its prehospital use is controversial. We designed a device that would be easy to use, safer in injured vessels, migration-resistant and amenable to a prehospital environment. Methods: We designed a novel, balloon-led device using common commercial materials. Thin latex rubber was reassembled in cylindrical conformation aligned to the shape of the aorta and invaginated into vinyl tubing. The catheter is placed into the femoral vessel, followed by expression of the balloon with CO2 inflation in a proximal direction to navigate and treat damaged pelvic vasculature, occluding the distal aorta. The system was tested on model aortas (both intact and injured cadaveric porcine aorta) with inline fluid flow and pressure monitoring to determine the maximum pressure the balloons could occlude. The device was also tested on a perfused human cadaveric model. Results: Flow was occluded with the balloon up to an average of 561.1 ± 124.3 mm Hg. It always ruptured before causing damage to the porcine aorta and was able to occlude injured iliac vessels and proceed to occlude the distal aorta. The device was effective in occluding the distal aorta of a perfused human cadaver. Conclusion: This novel, high-volume, low-pressure device can occlude the distal aorta in a simulated human aorta model, cadaveric porcine model and perfused human cadaver. It can occlude fluid flow to supraphysiologic pressures. It is easy to use, migration-resistant, able to navigate and treat injured pelvic vessels, and amenable to prehospital care

Role of persistent processus vaginalis in hydroceles found in a tropical population

Background: Lymphatic obstruction by Wuchereria bancrofti is thought to be the mechanism for development of tropical hydrocele in men and for elephantiasis, mostly in women. Hydrocele prevalence is used to determine the effectiveness of parasite eradication programs. Methods: We maintained a prospective log of operations performed at 1 Canadian Field Hospital during its relief mission to Léogâne, Haiti. Information regarding duration of symptoms, type of previous surgery (if any), surgical approach, associated inguinal hernia and volume and appearance of hydrocele fluid in patients with tropical hydroceles were recorded. Results: From January to March 2010, 4922 patients were seen, none of whom had elephantiasis. Of the 64 patients who collectively underwent 69 inguino-scrotal procedures, 5 patients had inguinal hernia repair several years after hydrocele excision via the scrotum, 19 patients with bilateral hydroceles underwent a scrotum-only approach, and 45 patients had an inguinal approach (33 unilateral and 12 bilateral) to repair 57 hydroceles. A patent processus vaginalis was present in 50 of 57 (88%) hydroceles where the groin was explored. Conclusion: Hydroceles remain common in Léogâne despite successful eradication of filariasis with mass drug administration using diethylcarbamazine-fortified cooking salt. Persistent patent processus vaginalis is a more likely cause than persistent filariasis. There is probably little difference between hydrocele in developed countries and tropical hydrocele other than neglect. Hydrocele prevalence is not a measure of the effectiveness of parasite eradication programs. The recent earthquake in Haiti has highlighted not only the response required for such disasters, but also the ongoing battle against endemic diseases, such as lymphatic filariasis. 1 Canadian Field Hospital was deployed to Léogâne, the epicentre of the earthquake, on Jan. 12, 2010. Wuchereria bancrofti, the most common causative organism of lymphatic filariasis, was endemic in the Léogâne area until eradication by mass drug administration using diethylcarbamazine (DEC) in cooking salt.1 Once the injured were cared for, the surgical needs of the community were addressed. Large numbers of male patients came to our hospital seeking help for disabling hydroceles. Hydroceles in a tropical population, sometimes called tropical hydroceles, are distinguished from those seen in temperate zones by their high prevalence and massive size. Lymphatic obstruction is thought to be the mechanism for development of tropical hydrocele.2 Eradication of the parasite and excision of the hydrocele sac via a scrotal incision is the preferred management.2 In Canada, hydroceles in children are approached through an inguinal incision so that the associated hernia can be controlled, whereas the scrotal approach is primarily used in adults to excise the sac and evert the remnant. Initially, we treated children using the inguinal approach. We then operated on several adults with symptomatic inguinal hernias whose ipsilateral hydroceles had previously been excised via the scrotal approach. We became concerned that adult patients with hydroceles in Haiti had persistence of the processus vaginalis, which had been neglected since childhood. We decided to use the inguinal approach to treat hydroceles in adults if time and resources permitted

After the war is over: the role of General Sir Arthur Currie in the development of academic medicine in Canada

Canadian universities faced a challenge with the return of a large cohort of battle-hardened students and faculty from the First World War. General Sir Arthur Currie, considered one of the few successful generals of the war, returned to a welcome of silence in Canada. McGill University exploited the opportunity to recruit him as its president. Currie oversaw a campaign of building construction and faculty development at McGill that also had a significant effect on the rest of Canada. Through his fostering of the Montreal Neurological Institute and the recruitment of Dr. Wilder Penfield, Currie facilitated the development of multidisciplinary medicine, which integrates clinical care with research — an aspiration still held by specialty medicine in Canada today

Calgary, Edmonton and the University of Alberta: the extraordinary medical mobilization by Canada’s newest province

The Canadian contribution of medical services to the British Empire during the First World War was a national endeavour. Physicians from across the country enlisted in local regiments to join. No other region provided more physicians per capita than the newly formed province of Alberta. Largely org anized through the Medical School of the University of Alberta, the No. 11 Canadian Field Ambulance out of Edmonton and the No. 8 Canadian Field Ambulance out of Calgary ultimately enlisted between one-third and half of the province’s doctors to the war campaign. Many individuals from this region distinguished themselves, including LCol J.N. Gunn from Calgary, who commanded the No. 8 Canadian Field Ambulance; Maj Heber Moshier, one of the founders of the School of Pharmacy at the University of Alberta; and Dr. A.C. Rankin, who would go on to be the first Dean of Medicine at the University of Alberta. These Canadian heroes, and the many others like them who served with the No. 8 and 11 Field Ambulances, personify the sacrifice, strength and resilience of the medical community in Alberta and should not be forgotten

Care of victims of suicide bombing

history of suicide bombingSuicide bombers often target crowds. This commentary discusses the additional features required in a medical response beyond conventional mass casualty care, including forensic documentation, preservation of evidence, suspect tissue identification and viral status, victim counselling and postexposure prophylaxis. We propose a pathway for care of victims of a suicide bomb, adapting elements from protocols for child abuse, sexual assault and needle-stick exposure