History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: June, 1929 Vancouver Medical Association Jun 30, 1929

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 ^e-^jgYgitirz'
=•«*-•-
Hollywood Sanitarium
LIMITED
<ifor the treatment o}
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference - <U3. Q. cWedical ^Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288.
we*?
r^KSV
_J Vol. V.
JUNE 1929
The Bulle
o/tKo
Vancouver Medical Association
President's ^Address
T^ahn ^est
Qolf
^Published monthly atlJancouver, "B.Q., by
McBEATH-CAMPBELL LIMITED
§*» Trices $1.50 per year*1" Patient Types:
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To avoid bowel complications of pregnancy, Petrolagar is prescribed
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Petrolagar has many advantages in maintaining bowel function. It is
palatable and does not interfere with digestion. It produces normal, soft-
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Petrolagar is an emulsion of 65% (by volume) mineral oil with the
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TORONTO, ONTARIO AAd^ZZZZZZZZZZZZ^Z- THE   VANCOUVER   MEDICAL  ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical  Association  in  the
Interests of the Medical Profession.
Offices:
529-30-31 Birks Building, 718  Granville St., Vancouver, B.C.
Editorial Board:
Dr. J. M. Pearson
Dr. J. H. MacDermot Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the abov? address.
Vol. V.
JUNE, 1929
No. 9
OFFICERS 1929-30
Dr. T. H. Lennie Dr. G. F. Strong Dr. W. S. Turnbull
President Vice-President Past President
Dr. E. M. Blair Dr. W. T. Lockhart
Hon.-Secretary Hon. Treasurer
Additional Members of Executive:—Dr. W. A. Dobson; Dr. A. C. Frost.
Trustees
Dr. W. F. Coy Dr. W. B. Burnett Dr. J. M. Pearson
Auditors:    Messrs. Price, Waterhouse & Co.
SECTIONS
Clinical Section
Dr. J. R. Davees Chairman
Dr.  S.  H.  Sievenpeper -—...Secretary
Physiological and Pathological Section
Dr.  A.  M.  MenzIes Chairman
Dr.  R. E. Coleman Secretary
Eye, Ear, Nose and Throat
Dr. W. E. Ainley Chairman
Dr. F. W. Brydone-Jack Secretary
Physiotherapy Section
Dr. H. R. Ross Chairman
Dr. J.  W. Welch Secretary
Pediatric Section
Dr.  C.  F.   Covernton j Chairman
Dr.  G.  O.  Matthews  Secretary
STANDING COMMITTEES
Summer School
Dr. L. H. Appleby
Dr. B. D. Gillies
Dr. W. T. Ewing
Dr.  R. P. Kinsman
Dr. W. L. Graham
Dr. J. Christie
Hospitals
Dr. J. W. Arbuckle
Dr. F. Brodie
Dr. A. S. Monro
Dr. F. P. Patterson
nt — The Trustees
Library
Orchestra
Dr.
C. H. Bastin
Dr.
J. R. Davees
Dr.
Wallace Wilson
Dr.
J. H. McDermot
Dr.
S. Paulin
Dr.
F. N. Robertson
Dr.
D. F. Busteed
Dr.
J. A. Smith
Dr.
W. H. Hatfield
Publications
Dr.
D. M. Meekison
Da.
J. M. Pearson
Dinner
Dr.
J. H. McDermot
Dr.
W. T, Ewing
Dr.
D. E. H. Cleveland
Dr.
W. A. Gunn
Credentials
Dr.
L. Leeson
Dr.
A. W. Bag nall
Rep. to B. C. Med. Assn.
Dr.
W. L. Graham
Dr.
A. Y. McNair
Dr.
A. J. MacLachlan
Sickness and Benevolent
Fund — The Preside: VANCOUVER HEALTH DEPARTMENT
STATISTICS—APRIL,  1929
Total  Population   (Estimated) — ■ 228,193
Asiatic  Population   (Estimated)—, — 12,300
Rate per 1,000 of Population
Total   Deaths	
Asiatic   Deaths	
Deaths—Residents  only	
TOTAL   BIRTHS	
Female    185
Male       211
INFANTILE MORTALITY—
Deaths under one year of age	
Death rate per 1,000 Births	
Stillbirths  (not included in above)	
Cases of Infectious Diseases Reported in City.
203
18
176
396
24
60.61
11
10.82
17.80
9.34
21.11
March, 1929 April, 1929
Cases Deaths Cases Deaths
Smallpox     :        67 0 42 0
Scarlet  Fever       29 0 14 0
Diphtheria       26 4 37 1
Chicken-pox         158 0 50 0
Measles          99 0 496 0
Mumps        195 0 207 0
Whooping-cough            8 0 9 0
Tuberculosis           19. 15 5 18
Erysipelas       13 1 9 1
Typhoid   Fever         3 1 5 0
Poliomyelitis             0 0 0 0
Cerebro-Spinal Meningitis   —        0 0 i i
N.B.—All typhoid cases from outside City.
May 1st
to 15th, 1929
Cases    Deaths
17
8
15
36
313
85
4
0
4
0
0
0
VANCOUVER MEDICAL ASSOCIATION
Vancouver, B. C.
Ninth Annual Summer School
June 25, 26, 27 and 28, 1929
SPEAKERS
Each of the following speakers will deliver a series of lectures and some clinics will be arranged.
Dr. Ernest Sachs, Professor of Clinical  Neurological Surgery,   Washington   University   School   of    Medicine,'
St. Louis.
Dr. Thomas  Addis,  Professor of Medicine, Stanford University School of Medicine, San Francisco.
Dr. Oswald Swinney Lowsley, Surgeon in Chief, Brady's
Foundation, New York City.
Dr.  Charles  Herbert Best,  Professor of Physiology,  University of Toronto.
Dr.  William   Edward   Gallie,   Surgeon   in   Chief,   Hospital
for Sick Children, Toronto.
Dr. Norman B. Gwyn, of the University of Toronto.
Meetings will be held in the Hotel Georgia, Georgia Street.
Fee #10.00
For Further Information Apply to Secretary.
DR. JOHN CHRISTIE
736 Granville St., Vancouver, B. C.
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This development, the culmination of years of research and engineering efforts, answers the longstanding query of roentgenologists
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Not affected by altitude or
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_j»j EDITOR'S PAGE
The catastrophe at the Cleveland Clinic is still fresh in our minds
and has a particular interest and significance to us as medical men.
Many of our readers have visited the Clinic and have spent profitable time getting information and new ideas. We heard constantly of
the free and hospitable way in which visitors were welcomed and made
free of all the experience accumulated by the master minds of the Institution. Dr. Crile is a personal acquaintance of some of our members
and known to all of us by his force of character, originality and devotion
to his profession.
The moving.event of two weeks ago comes home therefore to us
with peculiar significance. Not only have we this personal and individual acquaintance with the hospital and its staff, not only do we share
with the rest of the world the effect of the shock produced by unexpected tragedy, but because hospitals are our own particular institutions increasingly familiar to us from student days, places of our high
hopes and profound disappointments, centres indeed of our life and our
work, because of all this we feel especially implicated and concerned.
Our hospitals are devoted to the saving of life and to the study of
disease for that end. Individual accidents we understand and are prepared for, but overwhelming and wholesale disaster seems particularly
foreign to the purpose. Fire in hospitals, as in apartment houses, office
buildings, theatres, wherever people congregate, is the enemy always
dreaded by hospital officials. That it is especially dreaded in hospitals
is due to the circumstances that so many of the occupants of a hospital
are of necessity infirm and confined to bed.
In the present case the fire has been associated with the production
of a peculiarly lethal gas, the outcome we may take it of the combustion of stored photographic films. The combination gave few people
a chance. Doctors, nurses and attendants as well as patients, fell ready
victims to its attack. Delayed reaction, presumably haemolytic in
character, seems to have claimed its toll of the apparent escapes. Dr.
John Phillips, one of the founders of the Clinic, seems to have met his
end in this way. Our readers will, many of them, remember Dr.
Phillips at last year's Summer School, an earnest, hardworking, capable
physician, whose experience and knowledge were reflected in the addresses
he gave.
Dr. McCullough, at one time Interne at the General Hospital appears
at the time of writing to have escaped serious injury. The doctor has
been in Cleveland some years and was very highly spoken of for his
work there. Many will remember his wife, formerly Miss Mae Gibson, a
graduate of the General, and head nurse on Ward D.
That there were deeds of valour performed that fatal day we may be
sure. Nurses and doctors and helpers generally animated by their common humanity and fortified by their professional responsibility would
acquit themselves valiantly. The worst was that the opportunities were
so few, so instantanious and overwhelming was the visitation.    In the
Page 178 matter of prevention it is probable that throughout the country there
will be a general tightening up of regulations. Where necessary improvements should be made. No institution can afford to take any more
chances than are inherent in any human enterprise.
INVITATION
Through the courtesy of Dr. Alexander Peacock of Seattle, the
American Urological Association extends to the doctors of British Columbia an invitation to be present at their scientific meetings. These
meetings will be held in the Vancouver Hotel on July 5 th in the morning and afternoon. The programme will be posted later. Will anyone
wishing to attend these lectures please notify Dr. A. W. Hunter, 718
Granville St., Vancouver.
IMPORTANT
Will any Doctor who proposes attending the annual meeting of the
Canadian Medical Association at Montreal please communicate with the
Executive Secretary, B.C. Medical Association, 927 Vancouver Block,
Vancouver, B. C.
MEETINGS
The 31st Annual Meeting of the Vancouver Medical Association
was held in the Auditorium on Willow Street on Tuesday, April 23 rd.
At this meeting Dr. T. H. Lennie was unanimously elected President
and Dr. G. F. Strong, who has been secretary of the Association for the
past two years was chosen Vice-president. Dr. E. Murray Blair was
elected Secretary in place of Dr. Strong, and Dr. W. T. Lockhart was
appointed Treasurer in place of Dr. J. W. Arbuckle.
The Auditors' report showed the Association to be in a sound position at the close of the financial year, March 31st, 1929, with an exceedingly satisfactory balance earmarked for the use of the Summer
School representing its credit balances for the past few years. In view of
the pending move to new quarters and the consequent expense entailed
thereby Dr. Appleby moved the following resolution on behalf of the
Summer School Committee: "That two thousand dollars of the funds
in the Association earmarked for the use of the Summer School Committee be transferred to the general funds to assist the Library Committee
in purchasing new equipment." This resolution was seconded by Dr.
Vrooman and carried unanimously.
The various standing committees of the Association and the different
Sections presented reports of the year's work. The Clinical meetings
were exceptionally well attended during the past winter and the average
attendance at the monthly General Meetings of the Association is steadily
improving.
The action of the Sun Life Assurance Company in presenting funds
to the Canadian Medical Association for the furtherance of post-graduate
lectures was mentioned and on motion of Dr. Brodie, seconded by Dr.
Appleby the following resolution was passed:
Page 179 "Whereas the Vancouver Medical Association and the medical profession in Vancouver have benefited and profited by the lecturers
who have been sent from time to time And whereas this Association considers the lectures and clinics given to be of great value
to the profession throughout the country And whereas this has
been made possible through the generosity of the Sun Life Assurance Company.
Therefore be it resolved that this Association go on record as
expressing its heartfelt thanks to the Sun Life Assurance Company
for providing funds for the same And further that this resolution
be sent to Dr. T. C. Routley for submission to the Sun Life
Assurance Company."
Dr. W. S. Turnbull, the retiring President gave a short address on
the responsibilities and privileges of the Association in relation to the
community and to each other.    Dr. Turnbull's address appears in this
issue of the Bulletin.
* *      *
On April 26th Dr. B. R. Kirklin of the X-ray Department of the
Mayo Clinic was in Vancouver and spoke to the members of the Association at a special meeting. Dr. Kirklin's subject was "The Roentgenological Diagnosis of Gastric Lesions."
* *      *
A special meeting of the Association was called for May 7th to
consider a letter from Dr. White re the prophylactic use of iodine in
the schools, and also a letter from the Vancouver General Hospital with
a copy of the proposed amendments to the Hospital by-laws re staff
re-organization.
Dr. White's letter was read and discussed. A motion requesting
the President to investigate the proposal was adopted.
The proposed amendments to the by-laws of the General Hospital
on Staff re-organization came in for a considerable amount of criticism,
especially the withdrawal of nominating privileges from the Association.
There was a substantial preponderance of opinion that such action would
be detrimental to the best interests of the Hospital. It was finally decided that a letter be sent to the Board of Directors of which the following is a draft:
The Medical Association has carefully considered the proposed
By-law amendments on staff re-organization.
"In the past the Association has been glad to assist and co-operate
and assume any possible responsibility. It has valued the privilege of
nominating for staff positions, feeling that the interests of the hospital were of paramount importance to the Association and by making nominations for staff positions the profession, as a whole, through
its Association has assumed a definite responsibility in regard to the
welfare of the patients in hospital.
"It is noted with regret that in the proposed amendments no
mention has been made of continuing the procedure heretofore in
'*«l
Page 180 use whereby the Board received from the Association nominations
for each staff position.
"It is the opinion of this Association that the loss of such cooperation would not be in the best interests of the hospital and we
trust that it is not the intention of the Board of Directors to make
staff appointments without receiving nominations from the Vancouver Medical Association.
"Should the Board wish to consider these amendments further,
the Association, through its Executive or a Committee will be pleased
to meet with them.
NEWS AND NOTES
The sincere sympathy of the members of the Vancouver Medical
Association is extended to Dr. H. W. Coates in the recent death of his
wife. The Association also expresses its sympathy with Dr. K. L. Craig
in the recent death of Mrs. Craig from tuberculosis.
At a joint luncheon meeting of the provincial and local Associations held at the Georgia Hotel on May 14th nominations were made to
fill the positions of Chairmen and Secretaries of the various sections in
the event of the Canadian Medical Association accepting the invitation
of the Vancouver Medical Association to meet in Vancouver in 1931.
Dr. T. C. Routley asked that nominations be forwarded to him immediately so that they could be laid before the Dominion Association at its
Annual Meeting at Montreal in the week of June 17th.
The Bulletin extends its congratulations to Dr. and Mrs. A. M.
Agnew whose marriage took place in Vancouver on May 3rd. Mrs.
Agnew before her marriage was Miss Pauline Creelman, a graduate of the
1926 class of the Vancouver General Hospital Training School.
Congratulations are also offered to Dr. and Mrs. D. A. Tompsett on
the recent birth of a son in the Vancouver General Hospital.
An account of the recent Golf Tournament between Seattle and
the B. C. medical golfers will be found on another page. The scores
compare very favourably with those published in the May number of the
King County Medical Association's Bulletin.
The Provincial Board of Health is now supplying outfits for the
collection of samples of blood for agglutination tests. These outfits
contain two small glass tubes with data sheet and directions. They may
be obtained at the Vancouver General Hospital Laboratories.
Dr. G. S. Gordon, accompanied by Mrs. Gordon, left at the end of
the month for an extended trip to England and the Continent. The
doctor has stated he does not intend to visit any hospitals, but his
resolution is more than likely to be broken on many occasions. Mrs.
Gordon has, however, stipulated for a holiday trip. On his last trip
abroad Dr. Gordon kindly made some very interesting purchases for the
Library and has promised to look out for further finds on this trip.
Page 181 Lieut.-Col. A. M. Warner has just returned to Vancouver from
Ottawa where he attended the Convention of the Association of Officers
of the Medical Services of Canada as representative of the Vancouver
Branch. At the close of the Convention Dr. Warner went on to New
York and spent some time visiting the various clinics.
GOLF
On Thursday, May 9th, B. C. medical men woke up to a beautiful
morning and a full day of golf ahead. The Seattle team, in the absence
through sickness, of Dr. Houston, was captained by Dr. Shannon. They
had been advised to breakfast on board their boat so that play might start
in good time. The Victoria men, who with New Westminster and
Vancouver medicos form the B. C. team, also arrived in good time, the
Victoria men under Acting Captain A. E. McMicking in the unavoidable
absence of Dr. George Hall.
The Seattle men disembarked in great form, with flags flying and
full of vim ready to battle with the B. C. Giants. The visitors were
rapidly formed up and transported to Shaughnessy Golf Club where
play was arranged to start at 9.30 a.m. With an interval between the
morning and afternoon rounds for luncheon, play was continued until
sunset. Whether it was the weather, or the golf course, or whatnot the
B. C. team "just simply tore things to pieces" and rolled up the score
95—43.
Morning Round
Seattle British Columbia
Speidel-Perry   1-0-0     Boyd-Ewing  0-1-0
Shannon-Hancock     1-0-1     Bilodeau-Seldon  0-0-0
Graham-Nelles   0-1 -1
Whitelaw-Gillies  1-1-1
Boucher-Hodgins   0-1-0
Saunders-Lowrie  0-0-0
Mason-McNichol    0-0-0
-1-1
-1-1
-1-1
-0-0
-0-0
-1-1
-1-1
-0-0
-0-1
-1-0
-1-1
-0-0
-1-1
-1-1
-1-1
-1-1
-0-1
Hepler-Webb  1-0-0
King-Gray  0-0-0
Templeton-Ristine 1-0-1
Wooley-Coffin   0-0-0
Cefalu-Lyons  1-1-1
Standard-Hagyard  0-0-0
Rohrer-Long    0-0-0
McKinney-Wanamaker  0-0-0
Nelson-Manzer    1-0-0
Allen-Dowling 0-1-1
Guthrie-Nicholson    0-0-0
McBride-Dowling    0-0-0
Eaton-Mitchell    . 1-0-1
Davidson-Richards    0-1-0
Turner-Ruge 0-0-0
Bowman-Long 0-0-0
Eikenbary-Dudley 1-1-1
Loer-Holtz    0-0-0
Parker-Rembe 0-0-0
Corson-Cunningham 0-0-0
Anderson-Hall    * - * - *
Kidd-Woodward   0-0-0
Durand-Wheaton    1-1-1
Frost-Kidd * - * - *
Moncrieff-Baillie 	
McEwen-E. Day	
Boak-Thompson  	
Strong-H. Macmillan	
W. Wilson-McLennan 	
J. A. Smith-Webster 	
L. Macmillan-Smith 	
Lennie-Draeseke  	
Keys-McMicking   	
Lockhart-Anthony 	
D. A. Murray-Gillespie _
Bagnall-W. Murray 	
Nay-Griffin 	
Bryant-MacPherson   	
Robertson-Kenning   	
C. McEwen-T. McEwen_
Worthington-Carder   	
Blair-Lees    0-0-0
McAlpine-McLellan    0-0-0
Page 182 Afternoon
Seattle
Speidel-Perry   1-1-0
Shannon-Hancock  0-0-0
Hepler-Webb  0-1 -1
King-Gray  1 -1-1
Templeton-Ristine 0-1-1
Sutherland-Coffin    1 -0-0
Cefalu-Lyons  0-0-0
Rohrer-Long   0-0-0
Mc-Kinney-Wanamaker    0-0-0
Nelson-Manzer 0-1-0
Allan-Do wling    1-1-1
Guthrie-Nicholson    1-0-0
McBride-E. Dowling  0-1-1
Eaton-Mitchell    0-0-0
Davidson-Richards    0-0-0
Bowman-Long 1-0-1
Eikenbary-Dudley  0-1-1
Loer-Holtz 0-0-0
Parker-Rembe    0-0-0
Carson-Cunningham  0-0-0
Anderson-Hall 0-0-0
Kidd-Woodward   0-0-0
Durand-Wheaton    0-0-0
McLellan-Lees   0-0-0
Round
British Columbia
Bilodeau-Mclntosh    0-0-0
Graham-Nelles   1-1-1
Whitelaw-Gillies  1-0-0
Boucher-Hodgins    0-0-0
E. H. McEwen-Day 1-0-0
Mason-McNichol    0-1-1
Moncrieff-Baillie     0-1-1
Brydone-Jack-Thomson   1-1-1
W. Wilson-McLellan  1-1-1
Strong-H. Macmillan  1-0-1
Smith-Webster    0-0-0
L. Macmillan-Day-Smith  0-1-1
Lennie-Draeseke   1-0-0
Keys-McMicking    1-1-1
D. F. Murray-Gillespie 1-0-1
Bagnall-Murray    0-1-0
Nay-Griffin  1-0-0
Bryan t-M'cPherson   1-1-1
Robertson-Kenning    1-1-1
G. Wilson-Freeze  1-1-1
Worthington-Ford  1-1-1
Kidd-Mc Alpine 1 -1 -1
Boyd-Ewing    1-0-1
Blair-Frost    1 -1 -1
The morning score was 42-21 and the afternoon score 53-22 = 95-43.
The afternoon play was followed by a Banquet at the Club House
and a five-piece orchestra was in attendance. Toasts to the King and
the President of the United States were drunk. The Captains of the
opposing teams made spirited addresses. The rest of the evening was
spent in a sing-song and cards. Both Captains conducted themselves
admirably to the end in spite of their very strenuous day. Thanks are
due to the members of the B. C. Team and also to those who had nothing
to do with the team. The success of the affair was really due to the
team work and co-operation which the Captain received from -the members. Especially are thanks due to vice-president Dan McLellan, to
Drs. Lachlan Macmillan and G. F. Strong (the transportation committee)
and to Dr. B. D. Gillies.
MY PRESIDENTIAL YEAR
Being some remarks on retiring from office by Dr. W. S. Turnbull
at the Annual Meeting of the Vancouver Medical Association,
April, 1929.
Gentlemen:
On this the last meeting of our fiscal year, an opportunity is afforded me of talking to you for a few moments, without having to confine
my remarks to any prescribed subject.
To my mind one of the outstanding acts of your Executive during
the past years was the revision of the Constitution and Bylaws, and in
Page 183 that revision no greater accomplishment can be observed than the deletion
from the year's programme, of the President's inaugural address and its
replacement by an evening of interest and value to the profession and
of relief to that Officer.
Tonight, however, at the close of my year of office, I welcome this
opportunity. One cannot be unmindful, I trust I never may be unmindful of the honour you have done me in electing me as your President. The time and energy given, the worries and petty annoyances
incident to such a position, have been quite offset by the pleasure it has
afforded me of being able to give a year of service to the members of
this association.
Before giving expression to any of the wandering thoughts which
are apt to come unsolicited when the formality of restraint is removed,
I wish to express to my fellow officers of the Executive Committee, and
to the members of the various committees which have functioned so
acceptably during the year, my very sincere appreciation of their loyal
support and co-operation. To the Summer School and Dinner committees especially, my grateful thanks are tendered. We are much too
prone to accept as our just due all that these two committees accomplish,
without giving a thought to the sacrifice of time and energy of the
members that is entailed.
I would like at this time to say a word about the election, and first
of all, I want to congratulate the Association on the selection of Officers
just completed. Those who are continuing in office from the past
executive, have been tried and found well worthy of your continued
support. To the new officers elected, the good will of the Association
will, I am sure, be at all times extended, and I would like to bespeak on
behalf of the entire directorate, your sincere cooperation and support.
As a matter of fact, and I feel safe in saying this now that my term of
office is over, I think this Association would do well to see that every
office is contested. Nothing creates more enthusiasm than a well contested election for every office, in the same way that any paper delivered
before the Association is of infinitely more value, if thoroughly digested
by means of an active and animated constructive criticism and discussion.
I would not like to go on record as advocating useless dispute, in
fact I hope to point out the folly of that later on, but I do think that
when some matter of vital importance affecting the Association or the
profession is in the offing, a free and wholesome discussion even to the
point of what might be called a row is in the best interest of the
Association. It is an easy matter to pass the buck, if I may be permitted
to use that expression, to the Executive or the Council as the case may
be, but surely we-should be prepared in the more important matters at
least, to offer to that Executive or Council, an indication of what we
desire.
It has been the custom of my predecessors in this office in the past
upon retiring, to leave with the members of this Association some product of their year of observation and experience, and as we look back,
one cannot help but be impressed by the wisdom and importance of the
ideals and objectives which have from time to time been proposed.   But
Page 184 there is a factor which, in our retrospection must be very evident and
which yearly becomes to this Association more and more important
and that is that few, practically none of the suggestions or objectives
that have been offered by the various retiring Presidents, have ever been
acted upon.
Now what does that imply? The inactivity of this Association in
these matters does not in any way detract from the importance of the
various proposals that have been made. To me, after a year of activity
and observation as your President, it brings out very clearly what I have
come to regard as the greatest handicap to this Association and to the
progress of medicine in this Province, the lack of cooperation and concerted action among the profession as a whole.
We have had numerous instances in the past, in what might be
termed the larger affairs of medical practice in this Province in which
failure of the profession to present a united front has reacted unfavourably. We are all familiar with conditions which have arisen locally during the past few years, conditions which affect this Association and at the
same time affect you and me in which the indifference or inactivity of the
profession left us with our difficulties unsolved, with a diminished
amount of self respect and our so-called prestige as a learned profession
more or less submerged.
But you may ask, wherein have we failed, either as an Association or
as a profession? Permit me in rebuttal to ask wherein we have succeeded, and if not, why? Let us come down, for the purposes of self examination, to some of our local problems and analyse our conduct. What
has been our united action for instance on the policy of vaccination,
of quack healing by diet, religion and God knows what all? Can the
profession calmly ignore the situation which has arisen in this city
with regard to hospital accommodation? Why is it possible for any
member or members of a hospital board to imply, as has been done here
recently, that the medical profession has offered no acceptable proposition for the solution of existing difficulties.
It is not the province of this Association or of the profession to
formulate policies for the direction of public utilities or civic departments but when those policies are inimical to the welfare of the profession and of the public, then our duty is clear and we should be prepared to go on record as medical men and as citizens in demanding that
we have at least a recognized voice in seeking what we know to be in
the best interests of the community.
After all the practice of medicine, like any other sphere of activity,
would be dull and sordid were it not for the little flashes of the ridiculous which every now and then break out. When one sees these out-
croppings in the Medical Association, it makes one wonder sometimes
whether the rapid strides that are being made in medical science and the
tension under which all business and all professions are being conducted,
have not robbed us of our proper perspective. In this Association matters which after all are of minor importance, will give rise to endless and
often useless discussion, while too often when something of vital importance not only  to  the Association  but  to   the  whole profession  is
Page 2 85
—/ pending, both the attendance and the discussion are reduced to a minimum.
This might appear as a reflection on the harmony which has characterized the Association in the past. It is certainly not intended as that,
but I do feel that more interest and activity on the part of members
individually as medical men and collectively as an Association, in civic
and Provincial matters, would have a far reaching effect. There is no
reason why the medical profession as a body with its academic training,
its opportunity for contact with the great mass of saner thinking people
and its traditions, should not control and direct policies and legislation
which have to do with the health of the community, which at present
unfortunately jeopardize not only the public welfare, but our own economic position. What but the indifference of the medical profession is
responsible for the national scourge of chiropractors, sanipractors, herbalists, health institutes, cancer fakirs and so on with which this continent
is infected. We hear on every side "the public demands it." Why?
Because we as medical men have become so impressed with our own difficulties that we are unwilling to admit our shortcomings and to seek
within our own ranks and in legitimate fields relief for our patients. In
this connection permit me to refer you to the addresses delivered during
the past year by Dr. Lewis Smith in September last, and by Dr. Cunningham last month. These men have given us, out of their years of
experience and from an entirely different medical environment, the viewpoint of the men interested in the art and science of medicine. Let us
not lose sight of the fact that what they have been trying to drive
home concerns every man in the profession and any reaction must be
favourable, not only to the Association but to the profession.
A splendid opportunity for united action will be afforded the profession in this Province during 1930 when the British Medical Association meets in Winnipeg. An unique yet comprehensive itinerary has
been provided and we have recently had the assurance that in all probability several hundred British medical men will make the trip as far
west as Victoria. Dr. Lewis Smith last year informed us that the development of medicine in Canada is being very closely watched and highly
regarded in England at the present time. We know without any shadow
of doubt, that these visiting British confreres of ours are going home
enthusiastic about Canada. Who wouldn't be? But what impression
are we going to create as a profession. Is that impression to be one of
professional indigestion, or of professional hypertension? Let us see to
it, through our local and Provincial associations that these distinguished
guests of ours carry away with them the vision of a glorious Western
Canada, the destiny of which from a medical standpoint, is in the hands
of an alert united profession.
KAHN TEST AT THE VANCOUVER GENERAL HOSPITAL
LABORATORIES
Mabel M. Malcolm
Bacteriology Division.
In May, 1922, an article appeared in the Archives of Dermatology
and Syphilology, by R. L. Kahn, announcing the technique of a new
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618 Georgia Street West - Vancouver precipitation test for syphilis. According to the above article an antigen
was prepared in the Vancouver General Hospital Laboratories and by the
end of 1922 one thousand of the Kahn precipitation tests had been
done and checked with the routine Wassermann test here.* These tests
showed that the new Kahn test was undoubtedly superior, both as to
results obtained and simplicity of technique, to the Wassermann as
then performed.
Since that time the Kahn test has been adopted by the State Board
of Health of Michigan, and the United States Naval Hospitals, replacing
the Wassermann complement fixation test and is steadily taking precedence throughout the United States and Canada.
Our Laboratory, although following the progress of the Wassermann and the Kahn tests closely and keeping a small stock of the latter
antigen on hand for special requests, has never until lately had the room,
apparatus, or workers to enable us to carry the great technical change
from the Wassermann to the Kahn and the large number of duplicate
tests necessary to establish the superiority of the latter test.
This year, however, we have obtained some slight additional room
and have just received in the laboratory the apparatus necessary for
doing as many as one hundred Kahn tests at a time. It is now our intention, although we are still short of workers, to install the Kahn Precipitation Test, running it for a time parallel with the Wassermann
reaction, then dropping the latter except for special purposes.
A communication from Dr. F. C. Bell indicates that the Hospital
Medical Staff has expressed its approval of our action in adopting the
Kahn test.
The tolerance, as well as the cooperation, of the physician is asked
for any lapses which may occur during the transition period, owing to
the rush of our other laboratory work.
* Malcolm, A Comparison of the Kahn Test with the Wassermann Test, Can. Med.
Jour., March,  1924.
SOME ASPECTS OF THYROID DISEASE
Read before a meeting of the Osier Society by Dr. W. L. Graham.
In choosing the subject of the thyroid gland I am doing so with
the knowledge that it is a most hackneyed subject for medical meetings.
It is an excellent subject for a paper, as we are so ignorant of its pathology, physiology and, even I might venture, of its histology, for we
have great differences of opinion even amongst competent pathologists
as to certain changes that appear in the gland from time to time. I
well remember six years ago, when I left Toronto, at least 90% of the
pathological diagnoses of specimens sent to the laboratory were either
hyperplastic, or adenomatous goitre. When I returned in 1926 at
least 75% of the reports were returned as a mixed type of tumour,
adenomatous with areas of focal hyperplasia or hyperplastic goitre with
adenomatous formation.
Are we to believe that the microscopic appearance of these glands
has changed or was it a change in the mind of the pathologists as to
Page 187
—,N the histology of the thyroid gland or a new interpretation of what was
seen?
This paper is going to be most unorthodox in its construction, with
many by-paths leading to the interesting points. Let me suggest here
that we do not, pathologically speaking, use the terms "hypertrophic"
goitre and "hyperplastic" goitre synonomously; they may be steps in a
definite progression, but we must admit that their microscopic picture
is entirely different and whether a goitre that is only hypertrophied can
show toxic symptoms, I believe is open to question.
It is not only the pathologist who is changing; clinically I have seen
many different reactions to the toxic substance of an over-acting gland.
It can be safely said that the predominating type of goitre differs as to
symptomatology, morphology and histology in different sections of the
country. In Toronto, we see what is to me the normal reaction of a
patient with a hyper-active gland—normal to me, as it was the first reaction I had studied and it proves to me that one cannot be an efficient
observer unless his work has spread over different geographical areas.
In Toronto, we saw the patient with an increased metabolic rate, a
pulse rate that showed some indication of this increase, eye signs that fit
in with the picture, a tremor that is unmistakeable and we say to ourselves—"So this is exophthalmic goitre." And let me mention here that
there is the type of exophthalmos we see with a stare and exophthalmos
without a stare. The latter is the one we most frequently see post- oper-
atively and does not mean an over-acting gland. It is residual. This
clinical point is often of considerable aid in the correct interpretation of
post-operative symptoms, which are not, by any means, always due to
an insufficient removal of the gland.
My first real doubt of this clinical picture of goitre came in New
York City. May I mention my first ward patient in the hospital? A
girl of 26, goitre for six months, basal metabolic rate plus 55, no
exophthalmos, temperature 106, auricular fibrillation, raving mania.
Certainly a different picture from my Toronto conception. In Dr.
Pool's Thyroid Outpatient Clinic, which averages from 70 to 100
patients, I felt I must certainly see all types of hyperactive reactions.
And then to London. Most of the goitre one sees there in the
out-patient departments are of the large colloid type,—harmless and are
not treated except for the three D's as they are called—Dyspnoea, Dysphagia and Deformity. In Mr. Joll's and Mr. Dunhill's clinics most
of the exophthalmic goitre they see comes from, the continent, English
people living in France and Switzerland. They are all fairly mild in
type, though the basal metabolic rates are often high and eye signs
more marked, but there is very little tremor. One rarely saw patients
with gastro-intestinal symptoms or with upper chest suffusion. Why,
I have always asked myself, do we see in parts of England such huge
thyroids, for surely there and in the Highlands of Scotland one sees
the largest colloid goitres in the world and yet exophthalmic goitre is
almost a rarity when one compares it with the incidence on our own
country where we see so few colloid and so many of the toxic type.
Page 188 Si
Marine tells us that the deposition of colloid is the healed stage of
the gland that has once been hyper-active. Are these huge colloids the
result of many previous hyperplastic insults that may have gone unheeded and undiagnosed—I wonder. For these people rarely show any
permanent cardiac damage. Or has temperament more to do with the
development of a exophthalmic goitre than either infection or iodine?
I will leave that question with you, for I cannot help you.
Let us look, for a moment, at the secretion of the thyroid gland.
The cells lining the acini produce two different substances—first, is
thyroxin, which is produced in solution toward the periphery of the
acini and when it is required is absorbed by the blood vascular system.
The other secretion is a colloid containing thyroxin, which is concentrated in the centre of the acini. It is assumed that during times of
greater activity when thyroxin is demanded the solution is produced and
absorbed rapidly by the blood stream. In the resting state, colloid is
formed and when an activity occurs the colloid passes by some means,
either through or around the cells lining the acini and is absorbed into
the lymph system for, as you will remember, the blood vascular system
is impervious to all colloids. So we more readily understand that in the
dual action of the gland, colloid is an indicator of the activity of the
gland.
In the hyper-active gland we have an excess of thyroxin formed.
Of that there can be no doubt and the effect of the hyper-secretion is
an increased metabolic rate. That is a simple hypertrophic goitre, without the patient showing signs of toxicity. That toxicity does occur in
many cases, particularly in the severe ones, cannot be. denied. It is
evidenced by the symptoms seen in associated mental aberrations, in the
symptoms referable to the gastro-intestinal tract and probably in the
exophthalmos.
Plummer has given us an explanation of this. He states that the
hyper-active gland does not only produce an excess of normal thyroxin,
but, as a result of over-activity, also a substance resembling thyroxin,
but deficient in iodine and that this substance, because of this deficiency,
is toxic. For this reason, the administration of Lugol's solution is beneficial in that it supplies the lacking iodine radical to this toxic product
and renders the case one of simple excess production of good thyroxin.
I do not think that anyone can correctly estimate the value of
Lugol's solution; it has changed the whole clinical picture of a disease.
I am quite sure that if, fifteen years ago, we had known of Lugol's
solution, the larger clinics, which have made their reputation in thyroid
surgery, would have been unnecessary—for thyroid surgery today is not
the hazardous procedure for both patient and surgeon that it was then.
The mortality of thyroidectomy should be between 1% and 2% and
that, you will remember, is the mortality of anaesthesia.
There is yet one more type of clinical picture and that is the one
which I have seen in Vancouver. My first thyroid here will illustrate
this type very well. The patient, a Chinaman,—and let me say that in
the Chinese exophthalmic goitre is very rare,  I have only seen  three
Page 1i cases—with a basal metabolic rate of plus 65, very marked exophthalmos,
very large gland which had been present for six months, no tremor,
temperature from 99 to 101 over a period of a month, in which I was
watching him closely. His pulse rate was rarely above 90 and was unaffected by Lugol's solution. Because of the prevalence of tuberculosis
in this race, we checked his chest condition thoroughly, with negative
results. After removal of the gland, he developed a woody induration
in his whole sub-mental region. This opens up the question as to whether
we had an associated thyroiditis.
I wish in this paper to talk of points that are not usually broached
in current papers, probably because we do not completely understand
them, but here in the Osier Club we are living in the realm of problems
to be elucidated and it cannot harm us if we say "I do not know."
Truly, in thyroid disease, I have so many problems I know not where to
start.
Reinhoff and Lewis have produced some interesting views on the
subject of the aetiology of adenomata. We will leave out the question
of foetal adenomata. I believe in them—some pathologists, particularly
Mallory and Robinson, do not admit of their occurrence. We are all
coming to the conclusion that adenomata of the thyroid are not true
new growths, but are the products of involution in a previously hyperactive gland. They are the products of colloid retention in a gland that
has shown areas of lobular hyperplasia. We know that the average
duration of an adenoma before being seen by a surgeon is thirteen years.
Areas of the gland become hyperplastic, recover with the deposition of
colloid, perhaps fuse with an adjoining area of colloid retention, distention occurs, surrounding gland tissue becomes compressed, a pseudo
capsule is formed. The centre of such an area in time may be so far
removed from the capsule, which is the source of its blood supply that it
degenerates and a cyst may form—a haemorrhage might occur in that
cyst at some future time and it may cause pressure symptoms or result
in a calcareous,area.
That, gentlemen, is their conception of the formation of an
adenoma and I cannot see but that it is a reasonable view. It has not
been given wide acceptance as yet, despite the pathological diagnosis
which we do not infrequently see of lobular hyperplasia. This diagnosis
is more frequently seen in such areas as surround Toronto and the Mayo
Clinic.
Let me bring up a few points in regard to the operation. It is a
common operation, done by a great variety of surgeons. Six years ago,
I asked Dr. Eugene Pool what he considered was the percentage of cures
symptomatic and economic following thyroidectomy—you will be surprised when he said about 10%. What is it today? When in New
York a few months ago, I again asked him the same question, wtih no
reference to my previous conversation and his reply was—between 60%
and 70%, perhaps higher. Dr. Pool to those of us who know him is most
conservative in his judgment of results. What is the answer? I did not
need to ask him, nor do I need to tell you that it is Lugol's solution.
We have safely overcome the period of vessel ligation and subsequent multiple stage thyroidectomies, except occasionally in certain cases
Page 190 that have been badly handled, particularly in the administration of
Lugol's solution. We have overcome the 10% to 15% mortality of even
the best clinics. Today even in the hands of the average surgeon the
mortality rate is under 5%, or should be.
There are many ways of removing a thyroid gland. The usual way,
of course, is the mid-line incision of the strap muscles, dividing them in
the larger glands. I am not convinced that this is the best way. The
continental surgeons remove them through a lateral incision, separating
the sterno-hyoid and sterno-thyroid muscles. I have only done a few in
this way—technically it is more difficult and more dangerous also, as
one has not such absolute control of the superior vessels as one has with
the gland exposed. What are its advantages? Probably a greater margin
of safety to the recurrent nerves and in the greater freedom from serum
formation post-operatively. Serum is unavoidable if you are going to
divide the strap muscles or be at all discourteous to the gland in delivering it. Serum draining from a wound means that the scar will not be
perfect.
Personally, I do not drain my thyroids. That improves the appearance of the scar more than any other procedure in the operation. One
must, of course, be meticulous in haemostasis. Quoting Halstead "A
man, to be a good manipulative surgeon requires only three things—a
knowledge of anatomy, gentleness in handling tissues and absolute
haemostasis." True, I often have difficulty with serum—not so much as
previously, because I do not drain the incision and because I have, of
necessity, been more gentle in handling the gland, and am more careful
with my haemostasis, using finer catgut ligatures and not cutting the
strap muscles unless the gland is very large. And one other point I wish
to emphasise most forcibly—that if serum does form, do not remove it
until it is almost breaking through the incision. It should never be removed through a mid-line puncture, always through a lateral one and
better if it be aspirated with a needle and syringe. There is no more uncomfortable result, from the patient's point of view than a scar that
adheres to the trachea and it is not uncommon in cases that are drained
or opened in the midline.
There has been some discussion recently regarding removal of the
gland from within out. By this it is meant that the glanfl, after its
blood supply has been controlled, is removed by an incision extending
from the trachea downwards and outwards, leaving an area of tissue on
the sides of the trachea and oesophagus. The Mayo Clinic probably
deserve the credit for this change in procedure. They found that the
recurrent laryngeal nerve instead of lying under the posterior capsule of
the gland, as is described in most text books, in a large percentage of
cases lies either in the groove between the trachea and oesophagus or
along the side of the trachea.
Regarding the parathyroid glands, a standard text book of anatomy
describes them as "usually four in number, situated at each pole of the
thyroid gland." If that were true, they would always be removed in
doing a sub-total thyroidectomy. As a matter of fact, it has been shown
fairly  conclusively  that  the greater  majority  of   the  parathyroids   are
Page 191 situated as follows: The superior pair lie against the posterior wall of
the oesophagus somewhat above the level of the lower edge of the cricoid.
The inferior pair usually lie against the side of the trachea near the end
of the rings, under cover of the lower border of the thyroid. So we see
an additional reason why it is advantageous to remove the gland, leaving
a portion along the side of the trachea and oesophagus rather than by
the old method of leaving the posterior capsule of the gland. You not
only run less risk in damaging the recurrent laryngeal nerves but also increase the factor of safety as far as the parathyroid glands are concerned.
I would suggest that anyone doing a sub-total thyroidectomy
should inspect the cut surface of the gland for evidence of a parathyroid
gland. It should be transplanted preferably into the remaining thyroid
tissue. It is estimated that over 50% of such glands function when
transplanted.
Let us look for a moment at the post-operative complications with
which one has to deal. Those complications which we so often see in
the other realms of surgery are largely absent in this condition, pneumonia, wound infections, pulmonary embolism—who has ever seen a
pulmonary embolus following thyroidectomy? But if we have escaped
those, we have others in abundance, which cause many an hour's worry.
Of tracheitis let me say that if you will be gentle, if you will not
bare the trachea as in the older type of operation where the posterior
capsule only was left, you will have very little worry with it. Use a
steam kettle with tincture benzoin compound and your patient will be
comfortable. Sometimes a patient who has had difficulty with coughing
during the beginning of the anaesthetic will show some signs postoperatively but these are rare with gas anaesthesia or with local and gas
analgesia.
The ancient bugbear of the surgeon doing thyroid work was postoperative storms. This feared occurrence has largely disappeared or is so
modified by the use of Lugol's solution that it is no longer a factor of
great worry. The efficacy of not closing the wound has always been
open to doubt and now we no longer need decide the issue, because the
adequate pre- and post-operative preparation of your patient with Lugol's
solution has rendered it unnecessary. The preparation of a patient for
operation, I believe, should be in the hands of the surgeon, particularly
the use of Lugol's solution. The day has passed when the surgeon can
neglect the pre- and post-operative care of his patient. The use of
Lugol's solution immediately post-operative has been disappointing to
me. That statement may be open to doubt; I hope it is—but, so far as
my own observation has served, it has not been nearly as efficacious as
intravenous sodium iodide with an abundance of glucose in sufficiently
high concentrations.
The pre- and post-operative psychosis associated with a high temperature, as it must be if it is a true thyroid psychosis, yields very well
to glucose solution if the quantity is sufficient. My own preference being
20 c.c. of a 50% solution repeated every two hours until the mental
disturbance subsides.   That is not a great deal of glucose, only 10 grams
Page 192 per dose, or equal to 1,000 c.c. of a 10% interstitial, but you have the
added advantage of giving the patient abundance of a monosaccharide
to burn. Fluids, of course, are necessary, but in this condition, the
prompt treatment must be directed toward the mental state and fluids
added afterwards.
Regarding auricular fibrillation, particularly when it develops postoperatively during a storm, if it does not subside in a few weeks quini-
dine is indicated. Digitalis does not seem to have the excellent effect that
it does in other heart disturbances. The Mayo Clinic, as a matter of fact,
do not allow any of their thyroid cases to have digitalis. It is quite
apart from my field to discuss this question. I must confess that I
do give digitalis. Quinidine is a drug that I believe should be used only
by a competent internist.
Paralysis of the vocal cords requires consideration. Let me make
myself clear on one point,—I do not think that there is any such clinical
entity as a collapsed trachea. Those cases are practically all recurrent
laryngeal nerve paralysis. Tracheal compression does occur, but it requires a tremendous haemorrhage in a case which, as far as my own
experience goes, has shown some degree of tracheal deviation or compression from a pre-existing adenoma. In these cases of haemorrhage I do
not think the diagnosis could be in doubt if one looks at the wound.
In the hands of an experienced operator, one recurrent laryngeal
nerve is injured in 10% of cases of sub-total thyroidectomy, both sides
in somewhere about 0.5% of cases. Both nerves being caught should be
a very rare occurrence. We should not lose sight of the fact that an
adenoma if advantageously situated can cause a permanent paralysis of
one nerve and, therefore, all cases showing a bilateral recurrent nerve
paralysis may not be due to an operative insult on both nerves.
The nerves, as a matter of fact, are usually not cut but caught
by a ligature or the application of an artery clamp after the gland has
been removed, or owing to haemorrhage which not infrequently occurs
from one of the middle veins, a clamp may be applied boldly, out of
vision, catching the nerve. Before the days in which we realized that
the blood supply of the gland was wholly through the capsule—and
that is only a few years ago—the raw surface was oversewn by a continuous catgut ligature and, no doubt, many of these cases of cord
paralysis were due to this movement.
What is the result of the severance of one nerve? The patient is
hoarse for some months with no interference in breathing. Ultimately
the normal side moves over towards the paralysed side and normal tone
is regained. Usually, however, the patient has difficulty with tones in
the higher register.
If both nerves are severed or caught, one of two things may happen.
What I am telling you, gentlemen, is the subject of the greatest controversy in thyroid surgery. I am giving you the views of Dr. Gordon New
of the Mayo Clinic. They are, as yet, unpublished. They were his
opinions eighteen months ago, and, so far as I am able to ascertain, they
have not changed.    The patient may show a cadaveric position of the
Page 193 cords for a period of, usually, about three months, during which time
he speaks with a low, monotonous voice. There is no dyspnoea. After
this period, the cords assume a mid-line position, when the voice returns
but dyspnoea supervenes during exertion or emotion. These people usually
lead a normal life, with restriction of exercise.
The greatest calamity of all thyroid surgery is the type in which
the cords assume an adducted position as soon as the patient is out of
the anaesthetic with absolute obstruction to breathing. I have seen these
people die in a few moments after the cords have assumed a mid-line
position. The time of their assuming this position seems to depend on
now deep the pre-operative narcosis and how deep the anaesthetic. Sometimes the fenestra is sufficiently large to allow them sufficient air to keep
them alive for hours, as in one case recently, which was diagnosed as
angina pectoris. The only treatment that is of avail in this type is
tracheotomy, but I would like to contradict a statement in a current
medical journal that the only treatment for bilateral nerve paralysis is
immediate tracheotomy.
Personally, I feel that the mid-line position resulting may be due
to a paralysis of only the external laryngeal branch of the internal laryngeal nerve paralysing the crico-arytenoidus posticus, whose function is
abduction, or else in certain cases this muscle may receive its nerve supply through the posterior branch of the recurrent laryngeal nerve. There
is no doubt that all patients should have their vocal cords examined pre-
and post-operatively for, besides an adenoma causing a paralysis, carcinoma almost invariably does. Unfortunately here, where there is so
little ward work done, it is almost impossible.
Regarding tetany, latent tetany is very common. That is shown by
a positive Chvostek or Trudeau sign, pre-operatively. These patients will
have tingling sensations in the arms or mild carpo-pedal spasms if there
has been any gross interference with the parathyroids during the operation. This usually only lasts a short time from one to three months and
can be adequately controlled by calcium lactate in doses of about 140
grains per day. Smaller doses are usually ineffectual. A tetany due to
removal of all parathyroid tissue cannot be controlled by calcium lactate
and any parathyroid extract is ineffectual except the parathormone of
Collip.
In recurring goitre and in symptoms following operation, one should
not urge immediate re-operation. Very often there has been some factor
causing the recurrence of symptoms, such as a return to work or insufficient Lugol's solution post-operatively. Lugol's solution post-operatively,
I have said, has very little effect in controlling toxic symptoms, but I believe in cases in which considerable gland has been left, or the total remaining gland is in one portion Lugol's solution should be given in doses
of 5 minims daily over a period of 4 to 5 months to control the hyperplastic formation which results and may cause an asymmetrical neck. If
these people are put at rest and given small doses of Lugol's solution over
a period of weeks or months, they will return to what is to be their normal for the future. If, under this treatment, they do not get better an
almost complete thyroidectomy should be done.    This carries with it a
m
Page 194 higher mortality, due to difficulties in delivering the gland, to the distorted position that the recurrent nerve occupies following the scarring
of the healing process. Also, to the danger in removal of the remaining
parathyroid tissue.
And now, finally, in regard to anaesthesia, my own feeling is a
preference for local block anaesthesia combined with a gas-oxygen
analgesia. I will not go into the arguments pro and con for infiltration versus block anaesthesia. The answer has been given in other fields
of surgery and no surgeon nowadays would think of doing an infiltration
anaesthesia for a hernia. A block is so simple, so much more efficient as
far as the comfort of the patient is concerned. I realize that here there
is a feeling against block anaesthesia in thyroid surgery. One must know
the superficial nerve supply and unhappy occurrences in its use are
due to carelessness. In infiltration anaesthesia about 200 c.c. are needed;
in block anaesthesia, less than 50 c.c. This must carry a greater margin
of safety, if there is anything in the toxicity of the local anaesthetic. In
regard to the gas-analgesia a 50-50 gas-oxygen mixture should be used,
with no variance from this mixture and it should not be started until
after the local block has been done. A perfect analgesia will result, in
which your patient will answer you when questioned and at other times,
if you are gentle, will appear asleep. The end result is much less bleeding and a co-operative patient when one is dealing in areas adjacent to
the recurrent nerves.
My pre-operative preparation is a repeated morphine—hyoscine injection given one and one half hours and three-quarters of an hour before
operation.
B. C. MEDICAL ASSOCIATION NEWS
We regret exceedingly to record the death of Dr. U. Jeffery, of this
Province, on May 2nd, 1929. Dr. Jeffery, during the last few months,
had been an assistant medical officer at the Essondale Mental Institution
but resigned recently on account of ill health. He will be remembered
as an interne at the Vancouver General Hospital in 1926. Dr. Jeffery
was having a short vacation with his brother in Seattle when he was
taken suddenly ill and died from pneumonia. For some time he practiced
at Sumas, Washington.   He was a graduate of Manitoba, 1925.
Dr. Douglas Corsan of Fernie, and Dr. R. B. White of Penticton,
were recent visitors to Vancouver when they attended a meeting of the
College of Physicians and Surgeons, and also visited the office of the
B. C. Medical Association where many matters were discussed.
Dr. George A. Minorgan is at present acting as assistant at the Essondale Mental Institution.
Page 195 The Spring post-graduate tour will include the following towns:
June 19    Cranbrook
July
21
22
29
30
2
6
9
Nelson
Penticton
Victoria
Nanaimo
New Westminster
Prince Rupert
Speakers:
Dr. Norman Gwyn of Toronto
Dr. T. McPherson of Victoria
Dr. H. E. Ridewood of Victoria
Dr. D. E. H. Cleveland, of Vancouver
Prince George
Dr. Norman Gwyn will also speak at the Vancouver Summer School,
June 25th to 28th.
S£ 3fr 5fr
Dr. Ed. Sheffield has voluntarily resigned his position at Coalmont
after practising there nine years. After taking post-graduate work in the
East and Europe Dr. Sheffield will probably return to this Province to
practise.
We regret to announce that Dr. L. T. Davis of Parksville has been
very ill for the past two months.    His many friends will wish him a
speedy recovery.    Dr. Davis is one of the oldest practitioners in  the
Province, having registered here in 1886.    He is a graduate of Queen's
University, Kingston, 1883.
*      *      *
Dr. W. O. Rose of Nelson has left for an extended holiday, leaving
his practice in the care of Dr. H. H. MacKenzie and Dr. F. M. Auld.
Dr. J. H. Hamilton of Revelstoke has taken a holiday in California.
Dr. L. E. C. d'Easum, who has been assistant to Dr. A. E. H.
Bennett of Ocean Falls for some time past, has resigned his position to
enter private practice in partnership with Dr. R. McCaffrey of Chilli-
wack. Dr. d'Easum's place has been taken by Dr. P. P. Smyth, who
has recently returned to the Province after some years' absence. Dr.
Smyth was formerly in practice at Swanson Bay, and also in Nanaimo.
There have been two meetings of the local members of the Executive of the B. C. Medical Association held this month, the last of these
being specially called to discuss the important question of Health Insurance.
Dr. J. H. MacDermot has been chosen as Delegate of the B. C.
Medical Association to the National Council of Education.
Four applications for membership in the B. C. Medical Association
were approved by the Executive this month, these being:
Dr. Stanley G. Mills Rock Bay, B. C.
Dr. Robert Elder Nanaimo, B. C.
Dr. Edmund Lewis Reid Nelson, B. C.
Dr. P. S. McCaffrey Agassiz, B. C.
m
Page 196 SI   In ^    "p
ENDOMETRITIS
VULVITIS
CYSTITIS
SALPINGITIS
OVARITIS
Is of special service by causing, on account of its
marked hygroscopic property, an abundant serous
transudation.
Antiphlogistine with its 45% c.p. glycerine is also
ideally adapted for the vaginal tampon, combining the
much needed mechanical support with the prolonged
glycerine action. Leading obstetricians and gynecologists
know of its practical value in all those cases where prompt
depletion is a paramount consideration. Antiphlogistine
is antiseptic, non-irritating and by virtue of its thermo-
genetic potency can be relied upon to generate and maintain moist heat longer than any similar preparation now
available to the medical profession.'
Our Booklet: "Pregnancy—Its Signs and Complications"
together with sample gladly mailed to the
physician upon request.
THE DENVER  CHEMICAL MFG. COMPANY
153 W. Lagauchetiere St.
Montreal Say it with Flowers
Cut Flowers, Potted Plants, Bulbs, Trees, Shrubs,
Roots, Wedding Bouquets.
Florists' Supplies and Funeral Designs a Specialty
Three Stores to Serve You:
48 Hastings St. E.
665 Granville St.
151 Hastings St. W.
One Phone:
Seymour 8033
Connecting all three stores.
Brown Bros. & Co. Ltd.
VANCOUVER, B. C.
♦»
Try It at Our Expense .,.
wan
Jiphedrine   lip
«~
%eturn Coupon for Sample
I earn for yourself howpromptly out the irritation of inhalants
j and effectively Swan-Myers containing menthol, thymol,
Ephedrine Inhalant, 1%, No. 66, eucalyptus, or other aromatics...
relieves the nasal congestion of Stocked by dealers in 1-ounce
colds, coryzas and hay-fever with- and 1-pint bottles.
THE WINGATE CHEMICAL CO., Ltd., 468 St. Paul St., West, Montreal
Send physician's sample Swan-Myers Ephedrine Inhalant, No. 66, to
VMA
.M. D.
Address. DR.C. S.McKEE
AND
DR. R. E. COLEMAN
announce that in future their Clinical Laboratory
Services will be combined and a twenty-four hour
service maintained.
Telephones
Seymour 2996, Bayview 268 and Bay view 5194
Offices:
201, 206 and 214 Vancouver Block
McBeath-
Campbell
Limited
^Printers and
Publishers
Vancouver, B. C.
The Owl Drug
Co*, Ltd*
All prescriptions
dispensed by qualified
Druggists.
You can depend on the
Owl for Accuracy
and despatch.
We deliver free of
charge.
5    Stores,   centrally   located.
We would appreciate a call
while in our territory. 536 13th Avenue West Fairmont 80
Exclusive Ambulance Service
FAIRMONT 80
ALL ATTENDANTS QUALIFIED IN FIRST AID
"St. John's Ambulance Association"
WE SPECIALIZE IN AMBULANCE SERVICE ONLY
R. J. Campbell J. H. Crellin W. L. Bertrand
STEVENS'
SAFETY PACKAGE
STERILE GAUZE
is a handy, convenient, clean commodity
for the bag or the office.
Supplied in one yard, five yards and
twenty-five yard packages.
ESTABLISHED   NEARLY A
.CENTURY.   ~
B.C. STEVENS CO.
Phone
Seymour 698
730 Richards Street
Vancouver, B. C. ■—wag
se-^lprs*
5K3aH—
Hollywood Sanitarium
LIMITED
tyor the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference ~ *iJB. Q. <&tf.edica\ ^Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
v®«?
3KSV Vol. V.
JULY,  1929
/
The Bullets
of the^
Vancouver Medical Association
Qanglionectomy
dfttalarial therapy in V^eurosyphilis
(Convalescent Swum in Poliomyelitis
^Published monthly atlJancouver, ^B.Q., by
McBEATH-CAMPBELL LIMITED
"^Trice^ $1.50 per year-^

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