106 THE CANADiANMEDIcALAssoCIATION JOURNAL
I
a club house and as a home during unemploy-
ment, and should prove a valuable adjunct
to this work.
Just prior to the publication of the report
Dr. J. M. Robb, of Blind River, was ap-
pointed Minister of Health. In the last few
months he has made a very thorough study
of the medical and hospital needs of the
province, and has made considerable effort
to obtain first hand information on the
views and opinions of his colleagues in the
medical profession. Hospitals, formerly un-
der the Provincial Secretary, were trans-
ferred to the Department of Health, and it
was announced early in October that Dr
B. T. McGhie, who had been given oversight
over the mental hospitals, would exercise
jurisdiction over the general hospitals as
well. Both of these medical men have
shown the keenest enthusiasm in their new
fbitorial Conimentt
The Ketogenic Diet in Epilepsy
In a paper presented at the last meeting of
the American Medical Association, Helmholz
and Keith1 of the Mayo clinic, report on the
value of the ketogenic diet in the treatment of
idiopathic epilepsy. Nine years have elapsed
since its introduction at this clinic by Wilder,
in 1921; since then until April 1, 1930, this
treatment has been prescribed for 272 children.
Included in this number were 29 cases of symp-
tomatic epilepsy. In these, although early re-
sults were promising, only two were permanently
freed from attacks. Excluding these 29 and 72
who failed to cooperate and could not be kept
in a condition of ketosis, 171 patients form the
basis of this report.
Of these, 141 have been on the diet for more
than a year, and 30 for less than a year. In the
first group of 141, 43 have remained free from
attacks 1 to 7 years. The writers state that in
their experience, if patients remain free of at-
tacks from 9 months to a year it is exceptional
for attacks to recur when the children gradual-
ly resume a diet not absolutely ketogenic but
still low in carbohydrates and high in fat. If
the attacks do recur, a return to the ketogenic
diet for a short time again checks their develop-
ment.
Thirty-two patients of the 141 showed definite
improvement, both in general demeanour and in
1. J. Ain. M. Ass., 1930, 95: 707.
[Jan. 1931
responsibilities and already, on many oc-
casions, have shown a laudable desire to co-
operate fully with the medical and hospital
organizations.
This report has been received with very
favourable comments. If acted upon, it is
thought that these recommendations should
correct many of the unsatisfactory arrange-
ments existing today. On some points the
report is not as clear as it might be, possibly
because of the indefinite use of certain
terms, but these are details which do not
affect the main text. It is hoped that a
new Hospitals Act will be brought down at
the next session of the legislature, but it is
possible, owing to the change of personnel
in the Cabinet and the need for careful
consideration of so many details that
sufficient time will not be available before
the opening of the House. G. H. AGNEW.
the reduction of the number and severity of the
attacks, but they were not entirely freed from
them. The improvement, however, was so great
that the parents considered that more had been
accomplished by the diet than by any previous
treatment. In the remaining 66 patients, the
treatment failed to effect any improvement. In
the group of 30 patients under observation for
less than a year, 11 were freed from attacks, 13
appear definitely improved, and in 6 the treat-
ment failed. Before the diet was tried, most of
these patients had been on a regimen in which
phenobarbital was used to control the convul-
sions. The writers state. that in a certain per-
centage of cases they found the addition of
phenobarbital to the diet prevented attacks,
when neither the diet alone nor the pheno-
barbital alone controlled them.
Although dehydration may have some value
in the control of convulsions, it proved of little
value in comparison with a ketogenic diet. It
had little if any effect on the seizures of petit
mal, whereas the diet appeared to have a very
definite influence, and some of the most striking
results have been in this type of case. Further-
more, several of the patients, who were entirely
freed from attacks after they were placed on the
diet, drank freely of water without interfering
in any way with the effect of the diet on the
convulsive seizures. Several patients from whom
water was withdrawn to the point of hyper-
thermia were not freed from attacks. One
patient was later placed on the ketogenic diet
Jaul. 1931]
Jan. 19311
EDITORIAL COXMENTS
EDITORIAL
and was entirely free from attacks for a number
of months.
In the discussion which followed the reading
of the paper, Dr. Crothers, of Boston, empha-
sized the importance of considering carefully
the psychological and psychiatric implications
in each individual. Dr. Lucas, of San Firancisco,
emphasized the importance of cooperation in
this treatment by the family, who should have an
intelligent appreciation of the problem. He
corroborated the fact that by adding pheno-
barbital to the ketogenie diet, better results may
be obtained than by either treatm'ent used alone.
Dr. Helmholz in closing the discussion, said that
they did not take any of their patients into the
hospital; they considered it more important for
the patient to remain with the mother or care-
taker, but it was extremely important that who-
ever was to look after the child should master
the technique of the preparation of its food. He
also called attention to the fact that when
children are placed on the diet and ketosis be-
comes evident, they complained for some days of
being sleepy. This appears to be a definite
effect of the ketone bodies.
A. D. B.
New Diplomas in Obstetrics
In view of the regretably high maternal
mortality in connection with childbirth in
Great Britain, Canada, and the United States,
as compared with that in certain European
countries, much study of the matter has been
going on during the last year or two, and it is
evident that determined efforts are being made
to improve the situation. One of the signs of
the times is the institution by various reputable
bodies of diplomas in obstetrics for medical
practitioners. The British College of Obstet-
ricians and Gynecologists, which was founded
last year, has power, either independently or
conjointly with authorized teaching and ex-
amining bodies, to grant to registered practi-
tioners special recognition of advanced know-
ledge in obstetrics and gynaecology. The Royal
Colleges of Physicians and Surgeons (Conjoint
Examining Board) in England this year has
issued regulations for a new diploma in these
subjects, and the Society of Apothecaries of
London has recently instituted a Mastery in
Midwifery. The latest body to take similar
action is the American Board of Obstetrics and
Gynecology, which was formally constituted in
Niagara Falls, N.Y., in September of last year.
It is to be hoped that this official recogni-
tion of advanced standing' in obstetrics and
gynwecology may be an inducement to the prac-
titioner in these various countries to increase
his obstetrical experience and perfect his tech-
nique. This is not to imply that the medical
man is solely, or even mainly, to blame for an
COMMENTS
.107
107
undesirable state of affairs. He is only one
factor in a complicated problem, but it is hoped
that the institution of these new diplomas will
result in the appearance of a large number of
highly trained specialists in obstetrics. We would
respectfully suggest that the establishment of a
similar diploma for Canada might be properly
taken up in due course by the new Royal
College of Physicians and Surgeons of Canada.
We should not be behindhand in this particular.
A. G. N.
The Pursuit 'of Health
The popular address of the distinguished
English physician, Dr. Robert Hutchison, which
he delivered last August at Winnipeg at the
meeting of the British and Canadian Medical
Asociations, entitled "The Pursuit of Health,"
has attracted much attention and some adverse
comment. Dr. Hutchison evidently believes in
the counsel-Audi alteram partem. Whether
one is disposed or not to follow him relentlessly
to his conclusions, it cannot be denied that he
has placed before us some aspects of the subject
of health and its maintenance that are apt to
be overlooked, and has done it in his own char-
acteristic hearable, readable, and arresting
fashion. That many of the statements put for-
ward are exaggerated, to put point on the
arrows, so to speak, Dr. Hutchison would prob-
ably be the first to acknowledge. If reformers,
including those concerned with health pro-
paganda, have gone to extremes, as the lecturer
would seem to imply, it would not be surprising
to find the reactionary doing the same thing.
On this side of the water we are apt, perhaps,
to take our ideas too seriously and drive them
to a too logical conclusion. If so, we have here
the corrective. Our only hesitation would be
whether it was wise to jostle our idols before an
audience so largely lay. The lay press seized
upon the points with avidity, so that perhaps we
are in need of a counter-corrective.
Most medical men will be in accord with Dr.
Hutchison when he scores fads and fancies.
Diet and exercise, in particular, have become
entangled in a web of pseudo-science, and we
have much need here for sanity. Dr. Hutchison
would agree with the dictum of that wise old
thinker, Shakespeare, when he said,-"Let good
digestion wait on appetite and health on both."
With regard to the so-called "diseases of
childhood," and their inevitableness we must
disagree. That such diseases are still prevalent
is a reproach to our profession, but surely they
are not necessary and inescapable; to argue
otherwise implies a reprehensible fatalistic at-
titude. We must do better than this.
Undoubtedly, too, it is true that "health con-
sciousness" may breed "health anxiety," but it
is arguable whether the danger is so great as to