History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: October, 1924. Vancouver Medical Association 1924-10

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     T  Xi
Published monthly at Vancouver, B. C.
Trogramme for Season ^24-25
^Abstract of ^Address by cDr. IJrooman
GB. Q. eMedical Mews
Tublished by oTKtc^eath Spedding Limited, UancouDer, "SB. M
Published Monthly under the Auspices of the Vancouver Medical Association
in the Interests of the Medical Profession.
5 29-30-31 Birks Building, 718 Granville St., Vancouver, B. C.
Editorial Board:
Dr. J. M: Pearson       Dr. J. H. MacDermot       Dr. Stanley Paulin
All communications to be addressed to the Editor at the above address.
OCTOBER 1st, 1924
No. 1
OFFICERS,  1924-25
DR. H. H. Milburn
Dr. o. S. Large
Dr. Stanley Paulin
DR. A. J. MacLachlan
Past President
Dr. w. b. Burnett
Dr. J. M. Pearson
Delegate to B. C.  Medical Association
Dr. J. A. Gillespie
Clinical Section
Dr. Lyall Hodgins       -
Dr. w. l. Pedlow .--.--
Physiological and Pathological Section
Dr.       -
Dr. R. E. Coleman
Dr. G. C. Draeseke
Dr. Colin Graham
Dr. G. S. Gordon
Dr. J. A. E. Campbell
Eye, Ear, Nose and Throat
Library   Committee
Dr. Wallace Wilson
Dr. R. E. Coleman
Dr. W. A. Bagnall
Dr. W. F. MacKay
Orchestra Committee
DR. L. Macmillan
Dr. f. N. Robertson
Dr. J. H. MacDermot
Dr. W. D. Patton
Credit Bureau Committee
Dr. A. C. Frost
Dr. L. Macmillan
Dr. J. W. Welch
Dinner   Committee
Dr. N. E. MacDougall
Dr. A. w. Hunter
Dr. F. N. Robertson
Credentials  Committee
DR. G. E. Seldon
Dr. D. McLellan
Dr. Neil McNeill
Summer  School  Clinics
Dr. J. M. Pearson
Dr. Alison Cumming
Dr. Howard Spohn
Dr. G. S. Gordon
Dr. R. A. Simpson
Founded 1898. Incorporated 1906.
Programme of the 27th Annual Session
GENERAL MEETINGS will be held on the first Tuesday of the month
at 8 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the month
at 8 p.m.
Place of meeting will appear on Agenda.
GENERAL MEETINGS will conform to the following order:
8 p.m.—Business as per Agenda.
9 p.m.—Paper of Evening.
General Meeting.
Presidential Address:    Dr. H. H. MlLBURN.
Clinical Meeting.
Special Clinical Meeting.
DR. R.  C. COFFEY   (of Portland, Ore.)
Subject:        The  Quarantine Pack in Abdominal  Surgery."
General Meeting.
Paper:    DR. J. J. MASON, "Abdominal Hysterotomy."
Clinical Meeting.
General Meeting.
Paper:     Dr.   G.   A.   LAMONT,   "The  Early  Weaned
DECEMBER  16th—      Clinical Meeting.
JANUARY 20 th—
MARCH 3rd—
MARCH  17 th—
APRIL 7th—
APRIL 21st—
Page Four
General Meeting.
Clinical Meeting.
General Meeting.
Paper:    Dr. W. A. DOBSON, "Neuroses in Everyday
Clinical Meeting.
Special Clinical Meeting.
DR. C. E. HAGYARD  (Seattle).
Subject:     "Colitis."
General Meeting.
Paper:    DR. R. B. BOUCHER, "Inflammatory Diseases
of the Ear."
Clinical Meeting.
General Meeting.
Paper:    Dr. J. L. TURNBULL, "Differential Diagnosis
of Acute Abdominal Conditions."
ANNUAL MEETING. <^<^<^<^e^<S^<^b<&^<&^<&^
Mr.' A. T. Morrison has recently taken over the
management of our business. His twenty-five years'
experience in all branches of the Surgical trade will
greatly add to our ability to give you the best service,
which will be our earnest endeavour at all times.
Canadian Surgical Supplies Limited
Cor. Robson and Burrard Streets
Phone Seymour 4802 Vancouver, B. C.
THE first issue of this Bulletin by the Vancouver Medical Association is an
important event, because it represents the first attempt at systematic medical publication in the Canadian West. It is important, also, as evidence
of the continued vitality of the Association, and the progressive spirit of the
officers temporarily  responsible for  its  destinies.
For twenty-seven years the Vancouver Medical Association has laboured
for the good and advancement of the medical profession. By means of this
small monthly publication we hope that its beneficent work will be strengthened
and enlarged. With only this end in view, we take up this work, if not cheerfully, at least with composure. We shall strive for accuracy in our news, for
good-will and consistency in our comment, and where such appears lacking we
request your indulgence in advance. We hope from time to time to publish
certain papers or abstracts and report certain discussions as they may take place
in our Association meetings, thus giving our readers opportunity for further
study and appreciation of these efforts, as well as affording, we hope, additional
incentive to those who prepare these papers. Facilities will be gladly extended
to our sister society, the British Columbia Medical Association, to utilize our
pages for the furtherance of their legitimate aims. It is the intention of the
Executive to distribute this Bulletin to medical men throughout the province,
in order to keep those outside the city in touch with what is going on at the
headquarters of these societies.
In conclusion, we would remind our readers that even minor publications
live by their advertisers, and those advertisers by the sale of their goods.    Verb.
* * *
It is with sincere regret that we chronicle the untimely death of our
esteemed friend and fellow-worker, Dr. R. H. Mullin. As Director of Laboratories at the General Hospital, he had built Hp a large and efficient organization,
which laboured to combine efficiency with economy. Endeavouring on the one
hand to meet the legitimate demands of the profession for installation of new
methods; on the other, recognizing the necessity of keeping within the restricted
financial bounds of an institution in chronic need of funds.
In addition to his work at the General Hospital, Dr. Mullin held the
position of Professor of Bacteriology in the University of British Columbia,
where he also took an active part in the public health work of that institution.
A good fellow, a lover of his fellow men, a loyal member of his profession, a public spirited citizen, a laboratory worker of no mean ability, and
keenly interested in all branches of his chosen calling, Dr. Mullin has been called
aWay.     We  shall see  the  genial  "Bob"   no  more.
Dr. H. H. Milburn was recently called to his home near Peterborough,
Ont., owing to the serious illness of his father.
The sympathy of every member of the Vancouver medical profession is
extended to Dr. A. J. MacLachlan and Mrs. MacLachlan in the sudden death of
their infant son, on August 20th, at Roberts Creek, B. C.
4*      ■   %.        ♦
Dr. Roger S. Countryman, who was an Interne at the Vancouver General
Hospital during 1920, was married on September 3rd, 1924, to Dr. Dorothy
M. Trapp, of New Westminster, B. C. Dr. Countryman is now in medical
practice in St. Paul, Minn.
♦ + ♦
On the evening of August 26th, during the visit to Vancouver of several
members of the British' Association for the Advancement of Science, a dinner
was tendered by members of our Association to Sir David Bruce and the following medical members of the visiting Association: Dr. E. P. Cathcart, Dr. Ivy
MacKenzie, Dr. H. K. Corkhill, Dr. R. E. R. Burn, Dr. F. C. Shrubsall, and
Dr. J. B. Collip of Edmonton. Short addresses were given by all the guests,
and an enjoyable evening was spent by all present.
Page Six Nearly fifty entered for this year's medical golf tournament on August
28 th. The cup donated by Dr. Worthington, to become the property of this
year's winner, stimulated enthusiasm. Medal play and handicaps counted.
The four best net .scores of the qualifying round competed later by match play
for the Worthington cup. These were Drs. Seldon, Nelles, H. H. Mcintosh,
and with Dr. D. M. McKay tied with Dr. Lyall Hodgins for fourth place. In the
finals Dr. D. M. McKay won the cup in a closely contested match with Dr. H.
H. Mcintosh. The first and second prizes for the best net scores on the qualifying day go to Drs. G. E. Sddon and T. B. Nelles. It is rumoured that the
prizes on the 24 handicap and beginners'' classes were won by Drs. F. P. Patterson and W. D. Patton. A noteworthy feature of the day was the careful way
in which the. four members of the committee studiously avoided winning any
of the prizes. One afternoon in July, at Burquitlam, the medical men lined up
in a friendly battle with the Dentals, resulting in a draw. This ought to be
fought to a finish while the weather is good. The only golf fixture of the
year left is the trip to Vic:oria. If you don't belong to- the "golfers," start
The Annual Dinner of  the Vancouver Medical Association  will be held
in the Ambassador Cafe on the evening of November 7th,  1924.
The attention of members is called to the necessity for prompt payment
of their annual dues. These dues are properly payable at the beginning of the
Association year in April, and early payment makes it very much easier to carry
on Association business during the year.
It is inevitable that there should be, during autumn and winter, a greater
demand for hospital service. Whether or not there is now a real shortage of
hospital beds in Vancouver, may be open to argument; but it does appear (and
is especially applicable to beds for infectious cases) that the population is growing more rapidly than the recognition of the need for more accommodation. If
one also accents it as a fact that the total hospital beds do not provide exactly
flexible accommodation, and that there exists a serious shortage of facilities for
the care of incurable, chronic and convalescent cases, it is evident that hospital
beds for acute medical and surgical cases must be conserved for the winter.
Doctors can assist the hospital staffs greatly by discharging their patients as early
as may be consistent with good treatment. Cases which are apparently not
remediable should not be sent for admission merely to provide shelter for them,
and patients for whom treatment is purely elective might well be held over this
difficult time of the year.— (By Dr. F. C. Bell, Superintendent, Vancouver Gen^
eral Hospital.)
A Memorial Service for the late Dr. R. H. Mullin was held in St. Andrew's
Presbyterian Church on the evening of Sunday, .September 7th. This service,
under the auspices of such public bodies as the Vancouver General Hospital, the
University of British Columbia, the Vancouver Board of Trade, and the Vancouver Medical Association, was largely attended by representatives of these institutions and other friends. The service was conducted by the Rev. W. H. Smith,
and the address was given by the Rev. C. C. Owen, whose duties as Hospital
Host brought him  into close contact  with Dr.  Mullin.
We would call the attention of our readers to the advertising columns of
this issue and urge them to extend their patronage to our advertisers as far as
possible, mentioning the BULLETIN when so doing. We regret that, owing to-
the difficulties attendant on the first issue of a new publication, several prominent
business firms have not been canvassed, but we hope this will be remedied before
the next issue.
"We may make a library, if we do but rightly use it, a Garden of Eden
without its one drawback, for all is open to us, including and especially the fruit
of the tree of knowledge."—Sir John Lubbock.
Through the courtesy of the Executive, the Library Committee has been
allotted space in the Bulletin. This space will be used in an endeavour to
increase the value of the Library to the Association, and to make it of the greatest use to the greatest number. To attain this the Committee needs the active
co-operation of every member of the Association, and it will welcome both
suggestions and constructive criticism. Tell us what. you want to read, and
tell us how you think the routine and regulations could be improved on. Read
over again your copy of the Library Rules and then take this in. Herbert
Spencer once had a Beautiful Theory that was murdered by a Gang of Brutal
Facts. We, too, had a delightful theory—the theory that Library Rules would
be lived up to. Around that theory we built the rules and prided ourselves as
builders, until the Gang, using their keys, broke in, blackjacked our Theory
and left but a shape without a heart. Probably all have sinned in some wa^
against the rules, and none of us is in a position to throw the first stone; but
the fact that members do take out books and journals without signing should
not be. In these cases the property of the Association is permanently missing,
and not only is there involved a loss of money, but the books and journals are
of times difficult to replace. Below is printed a list of "missing articles," and
if the forgetful members who have the same will return them, no questions will
be asked—this time. We give here, also, a list of the purchases made since the
Annual Meeting. From it we plan, from time to time, to specially draw the
attention of the members to important additions to our shelves. The Library
is maintained for you, and we want you to use it to the limit, simply remembering that the rules are made in an attempt to prevent loss and to give the other
fellow an equal opportunity to use the material available.
Since Last Bulletin, April, 1924.
Ministry of Healing  (Report of Lambeth Committee).
Glycosuria and Diabetes.    Hugh McLean.
Practical Midwifery.    Gibbon Fitzgibbon.
Physiology of the Capillaries.    A. Krogh.
Operative Surgery.    E. S. Taylor.
Medical Annual for  1924.
Scientific Methods.     Ritchie.
Transactions of the American Proctologic Society for 1924.
Transactions of the Amer. Laryn. Rhinol. and Otol. Society for 1923.
Music, Health and Character.    Dr. Agnes Savill.
Master Johann Dietz.    Autobiography.
History of Physiology in 16th, 17th and 18th Centuries.    Sir M. Foster.
Circulatory Disturbances of the Extremities.    Buerger.
Cleft Lip and Palate.    Brophy.
Ophthalmic Surgery.    Josef Meller.
Dislocations and Joint Fractures   (1924).     Frederic  Cotton.
Applied Pathology in Diseases of Nose, Throat and Ear.    Beck.
Mayo Clinic Papers for 1923.
Human Physiology, third edition,  1920.    E. H. Starling.
Diphtheria, Its Bacteriology, Pathology and Immunity.    A. Bulloch et al.
Practice of Medicine.    Osier and McCrae.    Ninth edition,  1923.
Diseases of the Eye  (1923).    Sir J. H. Parsons.
The Leucocyte in Health and Disease.    C. J. Bond.
Medical Clinics of North America for March, May and July,   1924.
Surgical Clinics of North America for February, April and June,  1924.
Lead Poisoning.    R. M. Hutton, Provincial Board of Health, Ontario,   1923.
American History of the War.    Vol. XI.     Surgery.
History of the Great War.    Medical Services.    Two volumes.
Cures.    J. J. Walsh.
Early Symptoms of Circulatory Disease.    Wilson.
Nose and Olfactory Organ.    Schaffer.
Local Anaesthesia.     Hirschel.
Medical Electricity.    Jones.
Diseases of Nose and Throat.    Phillips.
Diagnostic Symptoms in Nervous Diseases.     Hunt.
Surgical Clinics of North America for August,   1921.
Practitioner for February, March, June, August, October and November,
Boston Medical and Surgical Journal,  August  16th,   1923.
American Journal of Physiology, Vol.  5 6.
Canadian Medical Association Journal for May and August,   1924.
Medical Journal of Australia, July 21st,  1923.
American  Journal  Medical   Sciences,   March,   1924.
Surgery, Gynecology and Obstetrics, March,   1923.
The following are the present Library Regulations as recently  revised by
the Library Committee:—
1. JOURNALS are not to be taken from the Library until One Month
following arrival.
2. Unbound Journals, Bound Journals and Books must be returned within
SEVEN days.
3. All members or visitors must register in the book provided near the door,
each visit to the Library, and also make a note there of books or journals
borrowed or  returned.
4. No member shall loan a borrowed book or journal to another member.
5. Members failing to return books or journals within the time limit shown
above will receive a written notice from the Librarian to that effect. If
the member then fails to return the book or journal within three days,
his name will be read out at the next meeting of the Association.
6. The Librarian is authorized to refuse to loan any old book or journal
which is out of print. KEEN'S SURGERY and the OXFORD LOOSE
LEAF MEDICINE are to remain in the Library for reference use there
7. Members borrowing books or journals must produce their membership
cards when requested to do so by the Librarian.
8. In emergencies, books or journals may be telephoned for and delivered to
members within the city limits at the expense of the Library. These must
be returned within  the specified time by  the borrower.
The B. C. Medical Association Executive desires, in the first place, to
express very cordial thanks to the Vancouver Medical Association, which has
gianted it the privilege of using the columns of this Bulletin. It is intended
that copies of the Bulletin shall be sent to members of the B. C. Medical Association outside the radius of Greater Vancouver.
During the last year the B. C. Medical Association has continued the
policy of furnishing speakers to the meetings held by the District Associations.
The Annual Meeting of No. 6 District Medical Society was held at Nanaimo
on May 20th, at which the following officers were elected: Dr. T. J. McPhee.
President- Dr. W. H. Mclntyre. Secretary-Treasurer. After the business meeting, Dr. Pearson and Dr. Wallace Wilson, of Vancouver, gave addresses—the
former on "Diabetes," with special reference to Insulin; the latter on "Rheumatoid Conditions of Joints and Various Forms of Chronic Arthritis." This
paper represented several months of work at the Shaughnessy Military Hospital,
and was of great interest and value. The evening closed with a supper, and
the whole meeting was a very great success.
The Annual Meeting of the Prince Rupert and District Medical Society
(No. 7 Branch of the B. C. Medical Association) was held in Prince/ Rupert
on August 29th.
Dr. C. H. Vrooman, President of the B. C. Medical Association; Dr. J.
M. Pearson, and Mr. C. J. Fletcher, Executive Secretary of the Association,
attended the meeting from Vancouver.
A dinner was held at the St. Regis Cafe, at which clinical papers were read
by Dr. Vrooman and Dr. Pearson, the event being presided over by Dr. H. E.
Tremayne, President of the No. 7 District Society. In attendance were all the
doctors of Prince Rupert, and Dr. A. E. H. Bennett, of Ocean Falls; Dr. W.
Sager, Port Simpson; and Dr. E. W. Ewart, of Terrace. Dr. Pearson spoke
on "Hypertension," and it is hoped to print his address in an early number of
the Bulletin. Dr. Vrooman's paper appears in this number, and we understand
that both papers were very well received by those present.
The Annual Meeting of the No. 4 District Society (Okanagan) is being
held on Sept. 16th at Kamloops, and, by the time this goes to press, will be
over. We are sending representatives to the meeting, and an account of the proceedings will appear in the next number of the Bulltin.
It is intended to continue the monthly luncheons inaugurated during 1923-
24, and it is hoped that all out-of-town members who can possibly attend will
make an effort to do so. These luncheons have been a very great success and
some interesting, as well as valuable addresses, have been heard at them. Emphasis was laid last year on "Health Insurance," and we had the privilege of
hearing addresses from Mr. Winn, of the Workmen's Compensation Board;
Alderman Pettipiece, representing Labor interests; and Dr. H. E. Young, Provincial Medical Health Officer. President Klinck, of the University of B. C.,
spoke on "University Problems," and we had an excellent address on "Industrial
Surgery," from Dr. Frederick J. Cotton, of Boston, U. S. A. It is hoped to
make these regular monthly events. In connection with these luncheons we
would strongly urge that the District Associations inaugurate something of the
kind for themselves. This practice obtains generally in Ontario, where it has
been productive of very much good. Eminent men, not necessarily medical men,
are invited to address the Association. Members of the Legislature should be
invited, and other men of importance in the community. Our first luncheon
will be held la"e in September or early in October, and will be addressed by the
Hon. A. M. Manson, Attorney-General of the Province. Full notice will be
given, and we urge a full attendance.
We would take this opportunity of calling the attention of the medical
profession to the opportunities presented by membership in the Boards of Trade,
in their respective centres of the province. Some three or four years ago the
Vancouver Board of Trade, a large and influential body, including some 1,300
members representing every business in the city, established a Health Bureau, in
Page Ten line with its policy of sub-dividing the work of the Board into departments or
bureaus. The first Chairman of the Health Bureau was Dr. R. H. Mullin, who
held office for two years, and during his term of office excellent progress was
made by the Bureau. The possibilities of this work can hardly be over-estimated. Fortnightly meetings are held at which every aspect of medical work,
as it affects the community, is dealt with in turn. The Health Bureau has now
on hand a scheme to look into the establishment, of a Preventorium for dealing
with incipient tuberculosis in childhood, and if it is able to push this scheme
to completion it will have thoroughly justified its existence.
The meetings of the Bureau arouse the keenest interest amongst all members of the Board. We would urge upon medical men residing within the radius
of the Board of Trade, to make every effort to induce their Board to imitated
this action of the Vancouver Board. We can assure every medical man that it
is well worth his while to belong to the Board of Trade of the city or district
in which he lives.
An obituary of the late Dr. R. H. Mullin appears on another page of the
Bulletin, and we would merely add an expression of our keen regret and sorrow
in his loss. Dr. Mullin was a very loyal and greatly valued member of the;
B. C. Medical Association. He was a man whose friends were legion, and who
touched the community at many points—as Professor of Public Health of the
University of British Columbia; as Director of the Vancouver General Hospital Laboratories; and as an active member of the Board of Trade. He took
keen interest in athletics and sports of all kind—a many-sided man whose place
we shall find it hard to fill.
We would regretfully record the death of Dr. E. H. S. McLean, of Nakusp,
a very highly valued member of the B. C. Medical Association, whose obituary
notice appears in the Canadian Medical Journal. Dr. McLean had been in practice at Nakusp and elsewhere in the province for many years, and had the respect
and affection of all who knew him.
Following the Annual Meeting of the B. C. M. A. in July, the Standing
Committees for the year were appointed by the Executive. The chairmen are as
follows: Industrial Service, Dr. A. B. Schinbein; Legislative, Dr. M. J. Keys;
Publicity and Educational, Dr. Wallace Wilson; Constitutional, Dr. Bagnall;
Ethics and Discipline, Dr. J. A. Gillespie.
These chairmen have appointed their committees, and work has started
for the winter. It is hoped this year to lay special emphasis on educational
work. In connection with this, it may be stated that the Canadian Medical is
planning an extensive campaign of publicity along health lines, to extend all
over Canada.
In conclusion, we would remind members that the officers of the Association are at their disposal for any help or advice that we can give. We have
been able to assist a great many men in various ways—amongst others may be
mentioned the providing of men as locum tenens, of whom we have at all times
a list—-advice as to suitable places in the province to locate, etc. Mr. Fletcher,
our Executive Secretary, is in touch with all parts of the province, and can
supply information on any point.
By Dr. C. H. Vrooman.
After a general review of the scope of the subject, the lecturer proceeded to consider certain specific diagnostic points, particularly in connection
with Pulmonary Tuberculosis.
HISTORY.—Age—Old age is not commonly associated with pulmonary
tuberculosis, but my experience is that positive sputum is much more frequently
found after sixty than before sixteen. During the month of August I had four
men, age 64, 68, 74 and 74, respectively, all of whom had sputum positive to
tubercle bacilli, none of whom had been diagnosed previously because of the
mistaken impression that tuberculosis is not common in the aged. All had
very extensive disease of the lungs, but the clinical symptoms were those commonly associated with chronic bronchitis and  debility of old  age.
OCCUPATION.—A man of 45 or thereabouts, who gives a history of working as quartz miner for several years, and who complains of shortness of breath,
and irritative cough, generally has extensive silicosis and very frequently tuberculosis engrafted upon it. This may be so even though his exposure to quartz
dust was some years previous. The physical signs are frequently slight, while
the X-ray plate will show most extensive mottling. Coal miners, on the other
hand, are not quite as subject to tuberculosis as the average population. They
frequently, though, have emphysematous chests and hypertrophied hearts.
RACE.—The Irish are about five times as liable to tuberculosis as the
Italians, and between three and four times as liable as the average population.
Finns and Scandinavians closely rival the Irish both in infection and lack of
resistance. The prognosis is not good in pulmonary tuberculosis in any of these
races. Jews, on the other hand, are comparatively immune and show good resistance.
FAMILY HISTORY.—A history of tuberculosis in the immediate family
of a patient means that there is six times the liability to tuberculosis as if there
were no such history.
ASTHMA.—About one-half of the cases of asthma give a family history
of asthma or hay fever.
PREVIOUS ILLNESSES.—A history of under-nourishment, poor growth,
and repeated colds, in childhood, is often the indication that there has been
early mediastinal glandular tuberculosis. The importance of the acute infections
such as whooping cough, measles, scarlet fever, etc., are too obvious to dwell on
at length. A history of whooping cough, followed by persistent cough, occasional foul sputum with many basal rales, generally means chronic bronchiectasis.
A history of a chronic otitis media or chronic nasal discharge, or suspicion of
some sinus infection, is often the cause of a persistent bronchitis. Tonsils are
often blamed because they can be looked at, when in reality the infection is in
either the sinuses or the naso-pharynx.
PHYSICAL EXAMINATION.—For a chest examination the patient should
be stripped to the waist. There are still, I fear, those who sometimes try to
make a diagnosis through the shirt. All the various methods of physical examination will at times reveal some evidence leading us to correct our diagnosis,
and all should be carefully used.
INSPECTION in a good light will often reveal some condition that may be
invaluable to our diagnosis.
PALPATION is much neglected in chest cases. Yet it is surprising what
information as to wasting and spasm of muscles, areas of tenderness, etc., systematic feeling will give. Percussion, let me remind you, is a gentle art and
information is not gained by using a bludgeon.
AUSCULTATION is the most important of all our methods. Care, rather
than acuteness of heajring, is necessary for its proper use and interpretation.
Page Twelve The most important and most constant sign of pulmonary tuberculosis
is the presence of persistent moist rales at either apex. They often cannot be
heard on the ordinary deep breath, but by having the patient expire and then
cough and then inspire a deep breath, a shower of fine crepitatious will often
be heard at the end of the cough or at the commencement of the inspiration.
Nine times out of ten this means pulmonary tuberculosis, but it must be remembered that the tenth case comes along occasionally. Chronic influenzal infections
generally attack the base of the lung, but they may attack the apex and be a
cause of persistent apical rales. The X-ray is generally negative in these
After a careful examination and a careful review of the symptoms, write
down the diagnosis. This is a good thing before any laboratory examinations
are made. Do not, though, tell the patient he has no tuberculosis before you
get the sputum report. I would have saved myself some embarrassment on
several occasions if I had not told a patient they had no tuberculosis, only to
find they had tubercle bacilli in the sputum. On the other hand, repeated negative sputums do not necessarily mean no tuberculosis, especially when other
signs and symptoms are definite. Where, though, a patient is expectorating
large quantities of purulent sputum which is repeatedly negative, the case is
probably non-tubercular and diagnosis should be reviewed.
This most valuable method of confirming our clinical findings is too often
abused. The X-ray will give valuable and often unexpected information, but
in most cases it should only confirm what our senses have already told us.   .   .   .
Let me emphasize the point that the X-ray laboratories, the clinical laboratories, etc., should be our servants, not our masters. Or, as one writer puts it:
"The medical profession should not be paralyzed because the laboratory boy has
gone to dinner."
In the diagnosis of empyema, and pleural effusions, we are all too apt to
neglect the use of the aspirating needle. Dullness at either base persisting even
with breath sounds, may mean an encysted fluid, and that fluid may even, in
the most unsuspected case, turn out to be pus. Pus may become encysted and
remain in the chest for over a year, causing very little temperature, and work
its way either into the lung or to the surface. If a case justifies the insertion
of a needle at all, it justifies its insertion half a dozen times at least.
Pulmonary tuberculosis is the most difficult condition to diagnose, and in
the exclusion of it practically all other conditions are considered. To review its
symptoms would carry us through the whole realm of clinical medicine. I would
like to present to you, as the most concise standard for the diagnosis of active
pulmonary tuberculosis, the five criteria laid down by Brown and Heise in a
recent number of the Review of Tuberculosis:—
1. History of  an  haemoptysis  of  a   teaspoonful  or more,   without  obvious
cause, e. g., Mitral Stenosis.
2. The occurrence of pleurisy with effusion.
3. The presence of persistent moderately  coarse  rales  in  the  upper half  of
the chest.
4. A definite parenchymatous X-ray lesion of a tuberculosis character in the
upper half of the chest.
5. Tubercle Bacilli in the sputum.
The occurrence of any one of the above conditions should cause you to
treat the case as pulmonary tuberculosis until proven otherwise.
In a later article. Brown and Heise examined carefully a large number of
cases and compared the X-ray findings with the other four standards. Their
conclusions  were  as  follows:—
"A definite parenchymatous lesion was demonstrated in the X-ray plate,
"1.     Almost all who had a positive sputum, 97.4%.
"2.     Nine out of ten cases with rales.
"3.     Nine out of ten cases who had haemoptysis.
"4. Eight out of ten cases having early a history of dry pleurisy or pain
in the chest.
"5.     Six out of ten cases with pleurisy with effusion."
Page Thirteen Orthopedic Appliances
Extensions for short limbs, Trusses, Arch
Supports, Abdominal Belts, Sacroiliac
Supports, and Artificial Limbs, manu'
factured and guaranteed by Experts in
each line.
938 Pender Street West
Vancouver, B. C.
The Ovx>l Drug
Co., Ltd.
uAU prescriptions dispensed
bu qualified Druggists.
l]ou can depend on the Ou?l
for ^Accuracy and despatch.
IDe deliver free of charge.
5 Stores, centrally located.    We
would appreciate a call while
in our territory.
Fair. 58 & 59
M.ount Pleasant
Undertaking  Co.   Ltd.
R. F. Harrison    W. E. Reynolds
Cor. Kingsway and Main
Page   Fourteen The Medical Profession is United
in recognition of the fact that the MOST IMPORTANT
FACTOR IN THE LIFE OF A CHILD is the Milk supply.
MILK is the first and only food the new-born child receives, and when—as is frequently the case—cow's milk has
to be substituted for the natural mother's milk, too much care
cannot be taken to secure the best and purest milk obtainable.
THE BEST'AND PUREST MILK can come only from
the MOST SANITARY AND EFFICIENT DAIRY. Therefore, when recommending a supply of Milk, for either BABY,
"The Children's Friend"
15 69 Sixth Avenue West.
Bay view 5 5 3.
Burns Drug Company
The Dispensing Department is an entirely separate
unit of our business.
We stock all  the  leading   manufacturers'   lines.
Don't forget — Dispensary  Phone,   Seymour   606
Page   Fifteen Rest Haven Sanitarium
Medical and Surgical
No Tubercular or Mental Cases
Strictly Ethical
C~7 _ ^E  cordially  invite  the  medical  profession  to  visit  Rest
IVJ Haven.    Here, beautiful surroundings, kind and cheerful
attendants, with liberal but carefully prepared diet, furnish an environment favorable to recovery.
Hydrotherapy, massage and other physio-therapy treatments
are provided under careful medical supervision.
Your own program for patient carried out, including special
diet for diabetics, etc. Reports and laboratory tests' sent to physicians referring patients to us.
Don't miss an opportunity, Doctor, to see our place, and if
possible enjoy a day or two here with your family as our guest.
O. S. PARRETT, M.D.,   •
Medical Superintendent.
SIDNEY, B.C., near Victoria
Phone 95-0
Page  Sixteen


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