History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: May, 1929 Vancouver Medical Association May 31, 1929

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 Vol. V.
MAY 1929
No. 8
The Bulle
ofthe^
Vancouver Medical
fen ^S
D^utritional 'Disturbances in Infancy
(Laboratory bulletin
Summer School ^Programme
Tublished monthly atUancouver, ^B.Q., by
McBEATH-CAMPBELL LIMITED
"^Trice^ $ 1.50 per yeav^~ Patient Types:
THE CHILD
Never too young to learn the golden rule of "Habit Time." Much
too young to learn the cathartic habit.
When irregularities of diet or neglect cause constipation, Petrolagar
assists the necessary regimen of bowel education. Children like the taste
—it's just like pudding sauce.
Petrolagar is composed of 65% (by volume) mineral oil with the
indigestible emulsifying agent, agar-agar.
Rtrolagar
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TORONTO, ONTARIO J^^ ZIIIIIIIIZIZ'l 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 above address.
Vol. V.
MAY, 1929
No.  8
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. Davies Chairman
Dr.  S.  H.  Sievenpiper  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 .Chairman
Dr.  G.  O.  Matthews  Secretary
STANDING COMMITTEES
Library Orchestra Summer School
Dr. C. H. Bastin Dr. J. R. Davies Dr. L. H. Appleby
Dr. Wallace Wilson Dr. J. H. McDermot Dr. B. D. Gillies
Dr. S. Paulin Dr. F. N. Robertson Dr. W. T. Ewing
Dr! D. F. Busteed Dr. J. A. Smith Dr. R. P. Kinsman
Dr. W. H. Hatfield Publications Dr. W. L. Graham
Dr. D. M. Meekison Dr. J. M. Pearson Dr. J. Christie
Dinner Dr. J. H. McDermot
Dr. W. T. Ewing Dr. D. E. H. Cleveland Hospitals
Dr! W. A. Gunn Credentials Dr. J. W. Arbuckle
Dr   L. Leeson Dr. A. W. Bagnall Dr. F. Brodie
Rep. to B. C. Med. Assn.    Dr. W. L. Graham Dr. A. S. Monro
Dr. A. Y. McNair Dr.  A. J. MacLachlan Dr. F. P. Patterson
Sickness and Benevolent Fund — The President — The Trustees VANCOUVER HEALTH DEPARTMENT
STATISTICS—MARCH, 1929
Total Population   (Estimated)    ', 228,193
Asiatic  Population   (Estimated)— . 12,300
Rate per 1,000 of Population
Total   Deaths   	
Asiatic   Deaths   	
Deaths—Residents
TOTAL  BIRTHS   .
Male       205
Female    196
INFANTILE MORTALITY—
Deaths under one year of age	
Death  rate per   1,000  Births	
Stillbirths   (not   included  in  above).
only
205
10.58
20
19.14
176
9.08
401
20.69
13
32.14
8
February, 1929
March, 1929
April 1st
to 15th, 1929
Smallpox    „	
Scarlet  Fever
Diphtheria    —
Chicken-pox
Measles   	
Cases
55
22
62
45
19
Mumps        138
Whooping-cough	
Tuberculosis     	
Erysipelas     	
Typhoid   Fever   	
Poliomyelitis    	
Cerebro-Spinal Meningiti:
N.B.—All typhoid cases
Deaths
0
0
0
0
0
0
0
16
0
0
0
2 1
from outside City.
1
11
9
0
0
Cases
67
29
26
158
99
195
8
19
13
3
0
0
Deaths
0
0
4
0
0
0
0
15
1
1
0
0
Cases
20
9
17
17
201
72
0
3
4
1
0
1
Deats
0
0
1
0
0
0
0
0
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.
Page 1 5 X Wi-********
within the tissues
DIATHERMY
According to the definition submitted by the Council on Physical Therapy of the American
Medical Association/'Diathermy
isa term applied to the use of a
nigh frequency current to generate heat within some part of
the body. When such a current
is passed through the body at a
sufficient voltage and amperage,
the resistance offered by the tissues intervening between the
electrodes causes heat to be
generated in such tissues."
WHERE a deep'seated condition exists, indicating the
use of heat as a therapeutic measure, it seems a waste
of time to employ a hot water bottle or electric heating pad,
when an efficient high-frequency apparatus will produce the
desired heat, deep within the tissues, so quickly and thoroughly,
No other means is so conveniently available with which
to introduce, artificially, heat to any internal part of the body.
With the Victor Vario'Frequency Diathermy apparatus you
obtain a quality of current that has the maximum therapeutic
effect, and which at the same time is comfortable and within
the tolerance of the individual patient. This is because the
design of the machine provides a selective range of both volt'
age and frequency, so that a combination of these two factors may be selected as best suited to the treatment in hand.
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ROUGIER FRERES, MONTREAL EDITOR'S PAGE
Our readers must pardon us if the word Education creeps into this
page today, for the topic was so very lately much with us.
A representative and outstanding body of those whose special interest and life work is education have met and discussed the subject for
ten days. Vancouver, sympathetic and interested, has attended the open
meetings in large numbers, anxious and willing to learn. The central
theme has been the disposal of Leisure, the use of such of our time as
is not devoted to the procuring of our daily bread or even more gainful
pursuits. Not that this concerns doctors themselves very much, as yet
we are of those members of the community who first need to obtain
Leisure before we consider how best it should be employed. But then if
'employed' is the right word how is it still 'leisure'? Perhaps under
the prospective scheme of State Medicine we might obtain Leisure and the
time to study how best to use it. Evidently, however, educationists or
educationalists must consider (a) that there is going to be an increased
or increasing amount of leisure and that this business of making ends
meet is, for the bulk of mankind, to become less strenuous and time-
consuming, (b) that the possessor of so much unemployed time is going
to require, on the principle of "mischief" and "idle hands," some sort of
control or direction or persuasion. The radio and movies (and talkies)
of course came in for a good deal of discussion, both as a means of education and as an end. Not we mean by "end" as a finish or obolition or
stultifying of education, but rather an edifying end-result following the
right sort of training, enabling us to exercise taste and discrimination in
the choice of films we will attend. Incidentally we heard too of "Speed"
and "Noise" persumably as possible interferences with Leisure. Dr. Win-
nifred Cullis, Prof, of Physiology in the University of London, England,
came officially to uphold the medical view of things. Dr. Cullis is a
fluent and interesting speaker. We have some notes on her lectures
which we hope to publish later. Meanwhile, we wish these delegates
to the National Conference of Education "God speed" as they start on
their long respective journeys. The local arrangements for the popular
lectures appeared to us to be excellent, allowing for the probability that
even the most sanguine local official could not have anticipated such
capacity audiences. Vancouver showed them many samples of weather,
but not much of anything for long at a time.
Once again we call the attention of our readers to the Summer
School Programme which appears in full on another page. Difficult as it
may seem, every succeeding programme is fuller in anticipation than its
predecessor. We hate to particularize where all are first-class but we
may be pardoned for calling especial attention to our own Canadian, Dr.
Best, who evidently has other matters in his repertoire than diabetes.
We understand that the Committee is indebted to the Canadian Medical
Association for this honour and that Dr. Best is making the long journey
solely to address the Summer School. The Committee had also anticipated the presence of another Torontonian in the person of Dr. K. G.
McKenzie, but as the work which Dr. McKenzie is doing and proposed
Page 159 to lecture on is  much  the same as that of Dr.  Sachs,  Dr.  McKenzie
voluntarily withdrew and will come to us on another occasion.
Now folks! there you are. Come one, come all, and bring your
wives with you. The dates are June 25 th to 28 th, both inclusive.
Tuesday to Friday. The place of meeting is that very satisfactory place,
where we have been the last two or three years, the Hotel Georgia. The
weather will be excellent (we hope), and the Committee will see to it
that the lectures do not interfere with the golf. You may send in your
$10.00 at any time.
NINTH ANNUAL SUMMER SCHOOL
PRELIMINARY PROGRAMME
Dr.  Thomas  Addis,  Professor of  Medicine,  Stanford  University,   San
Francisco.
1. Bright's Disease.
2. Bright's Disease.
3. Toxaemia of Pregnancy.
4. Hypertension and Arteriosclerosis.
Dr. Charles H. Best, Professor of Physiology, University of Toronto.
1. The Action of Insulin.
2. Recent Work on the Vitamins.
3. Muscular Exercise and Physical Training.
4. The Physiological Significance of Histamine.
Dr.   W.  E. • Gallie,  Surgeon  in  Chief,  Hospital   for  Sick   Children,
Toronto.
1. Treatment of Difficult Ventral and Inguinal Herniae.
2. Ununited Fractures.
3. Sprains and Dislocations.
4. Acute Abdominal Emergencies in Childhood.
Dr. Norman B. Gwyn, of the University of Toronto.
1. Rheumatic Fever and present day views as to its aetiology.
2. Anaemia and Blood Diseases.
3. Coronary Thrombosis and Angina.
4. Post operative pulmonary complications.
Dr. Oswald S. Lowsley, Surgeon in Chief, Brady's Foundation, New
York City.
1. Embryology, Anatomy, Pathology and Surgery of the Prostatic
Gland.
2. Tuberculosis of the Kidney and Ureter with a Discussion of
Methods of Diagnosis, Surgical Intervention and After-care.
3. Urinary Calculi, Renal, Ureteral and Vesical.
4. Tumours of the Bladder, Malignant and Non-Malignant, with a
Discussion of Methods of Diagnosis, Treatment and Results.
Dr. Ernest Sachs, Professor of Clinical Neurological Surgery, Washington University School of Medicine, St. Louis.
1. Diagnosis and Treatment of Brain Tumours.
2. Diagnosis and Treatment of Brain Tumours.
3. Trigeminal Neuralgia.
4. Fracture of  the Skull.
Page 160 NEWS AND NOTES
Dr. Lachlan Macmillan has just returned from a four weeks' holiday,
with his wife and family, in California. Dr. Macmillan reports that
road conditions are excellent and weather conditions all that could be
desired, which we assume means golfing was good.
The final examination for the University of Manitoba M.D. degree
is being held in Vancouver for the benefit of the Senior students of
that University who are taking their hospital year here.
* *       *
A Joint Dinner Meeting of the Vancouver and B. C. Mjedical Associations will be held on June 11th, at which Dr. Armand DeLille of Paris,
France, and Dr. G. B. Ruatta, of Florence, Italy, will be the guests.
These gentlemen are in Canada for the purpose of attending the Canadian Medical Association in June and the Association has been able to
arrange for them to come West and address as many medical Societies
as possible en route. Dr. Armand DeLille's subject at the Dinner Meeting on June 11th will be "The Prophylactic Treatment of infants and
children against Tuberculosis with Calmette's vaccine for the newborn
and the Grancher System for older children." Dr. Ruatta will speak on
"The effect of Fasicism on private practice and State Medicine. Both
these gentlemen will speak in English.
*'      *     . *
Dr. L. H. Appleby is leaving on May 9th for Rochester, Minnesota, for a short course in Neurological Surgery with Dr. Adson of the
Mayo Clinic.
* *      *
We have received copy of a Bill shortly to be introduced in the
Dominion House which is entitled "An Act to Incorporate the Royal
College of Physicians and Surgeons of Canada." This Bill provides for
the establishment of a Royal College of Physicians and Surgeons for
Canada on the same lines as the English College, and defines the qualifications which will entitle medical men to membership.
Clinical Meeting
This was held at St. Paul's Hospital on Tuesday, February the 19th,
with an attendance of about sixty members.
Dr. E. J. Gray presented the first case which was one of cervical rib
in a girl aged 10. Always healthy except an occasional sore throat.
Tonsil operation four months ago. The child is normal at school work.
The last four years the patient has had several attacks similar to this.
She will throw the head backwards and rotate chin to the left, at which
time she will drop a cup or anything she has in her right hand. When
these attacks occur she is dazed but not unconscious. X-ray showed a
well developed right cervical rib curving outward and downward. It
is palpable. The rest of the vertebrae are normal. The right arm and
hand show no atrophy of muscle; no sensory or circulatory disturbances.
The pulse is equal on both sides.    Extending or rotating the head tends
Page 161 to  diminish  the  pulse  on   the   right.    Physical   examination   otherwise
negative.
In the discussion which followed Dr. F. P. Patterson drew attention to the fact that while cexvical rib was by no means an uncommon
condition, symptoms indicative of pressure were comparatively uncommon. He pointed out that in the case presented characteristic signs
attributable to this condition were almost totally absent while the symptoms which were complained of were not necessarily attributable to the
anatomy. Dr. Busteed offered a suggestion that the symptoms complained of were due to a tic or torison spasm such as is common in
childhood and that the existence of cervical rib was merely incidental.
A useful suggestion was made by Dr. Lockhart that the arm on the
affected side might be put into a cast in such a position as to relax
the scalenus anticus to which the cervical symptoms are attributed and
see if the symptoms persisted. The case was also discussed by Drs.
Prowd, W. L. Graham and W. T. Ewing, and it was the general opinion
that while of exceeding interest, the case required further study before
a satisfactory answer could be given to the question of the relationship
between anatomy and symptomatology.
Dr. John Christie presented four cases of dermatological interest.
The first was a case of erythema induratum previously shown one year
ago and also two or three years ago. It now showed typical nodules,
deep seated, chronic, painless and in a typical location—the calf of the
leg in a young woman. The case also showed scars of old ulcers which
were typical—deep, irregular, sluggish, with blue ragged border.
The second case was one of lupus erythematosus, commencing in
1923 on both cheeks and gradually spreading until the cheeks and part
of the ears are covered with typical lesions. In January (1929) the
right cheek was treated by C02 snow and shows improvement. Dr.
Christie pointed out that the lesions of lupus erythematosus are never
moist and never ulcerate. The locations of preference are the face,
scalp, hands and mucous membranes. The patient is now getting gold
therapy.
The third case presented by Dr. Christie was one of psoriasis,
unusual in respect of its rapid development.
Dr. Christie's fourth case was one of a pustular dermatitis of the
beard and other hair-bearing areas. The patient had suffered from
asthma for 10 to 11 years. Discharged from the Army as unfit in
1918. Sugar in urine. At that time patient had a rash in right
popliteal space. In 1924 itchy areas in both popliteal spaces. In 1925
similar attacks which included the sacral region. These lesions were
all superficial and itchy. He was treated by the S.C.R. The first
diagnosis at the Vancouver General Hospital was eczema, later the face
became involved and folliculitis barbae was diagnosed. Much routine
treatment was given with more or less success on the body, but never
on the face. Calamine lead, tar, mercury, zinc, etc. were all used. In
February, 1928, patient was given X-ray in small doses, without benefit.
In April, 1928, face was epilated by X-ray with cure.    In August, 1928,
Page 162 there was a recurrence on the face. On account of inflammation,
patient was not again X-rayed. In September last, milk injections
were given, with much improvement and great hopes, but no permanent
benefit resulted. Patient is now getting collosol manganese. Examination of the blood and urine, and skin protein reactions all failed to
help. For six months patient had painful nodules of the ears, a condition
first described by Foerster five years ago.
Dr. Christie's cases were all briefly discussed by Drs. Cleveland and
Lockhart.
Dr. W. L. Graham presented a case of carcinoma of the rectum.
Mrs. H , age 41.    This patient was seen on May 23 rd, 1928,
with Dr. H. H. Milburn. She had complained of loss of weight for the
previous 9 months. For the past six months she complained of tenesmus with a discharge of pus and blood from the rectum. Her usual
weight was 123 pounds; she now weighed 94 pounds!.
She appeared cachectic and was complaining of crampy abdominal
pain, no vomiting.
Physical examination showed peristalsis with no palpable abdominal
tumour. Rectal examination revealed an annular carcinoma of the
lower rectum involving the posterior vaginal wall. The growth was
about 2 inches above the anal margin. The lumen would not admit
the finger and it was impossible to tell how high the growth extended.
There were no glands in the groin.
The following day the patient developed an acute streptococcic
throat and for the next four days her temperature ranged around 103°.
This condition subsided and after a week of normal temperature an
exploratory laparotomy and a colostomy were done as a preliminary to a
perineal excision. There was no pathology in the abdomen. The rectal
growth could not be felt.
The colostomy was opened on the 4th day and the colon irrigated.
Following this the patient seemed to do badly, pulse running around
120 and she commenced to vomit. She did not improve and as her
condition was rapidly becoming worse with a further weight loss of
about 10 pounds we decided that there was no point in delaying the
second stage.
Consequently on April 15 th the patient was transfused and the
following day under sacral anaesthesia and gas oxygen analgesia a Lockhart Mummery type of perineal excision was done. As the posterior
vaginal wall was involved it was necessary to remove it with the growth,
and a plastic operation was done on the vagina. The wound was packed
with iodoform gauze. No sutures; an intravenous was given following
the operation.
The wound was dressed once daily and the patient was out of bed
on May 7th, three weeks after the second stage; she was discharged on
May 20th under the care of the Victorian Order of Nurses. The wound
was healed three months afterwards; a small sinus still persists between
the vagina and rectal incision.    Her colostomy causes her no  trouble
Page 163 beyond a morning irrigation.    She has regained her usual weight of 123
pounds and is looking after her own home and children.
I am not showing this case as a cure, gentlemen, but as a palliative
result.    I do not know when a carcinoma is cured.
A colostomy alone is of no practical value in this type of case as
the patients most frequently die of a toxaemia before complete obstruction occurs; and, as in this case, vomiting is a most persistent symptom,
probably of a toxaemic nature; even if this were not the case the discomfort of rectal tenesmus with its accompanying discharge, over
which the patient has no control, is most distressing. I feel therefore
that any palliative result must necessarily include an excision of the
growth.
One further point I should like to bring out is that distant metastasis of the lower large bowel occurs by the blood stream. 30% of
patients with lower bowel carcinoma die without secondaries in the liver.
In this particular type of case, in which the growth occurs below
the level of the third valve of Houston, which demarcates the portal
and general blood supply of the rectum, the distant metastases occur
in the lungs, then the inferior haemorrhoidal vessels and the lymphatic
metastasis in the groin-inguinal glands.
I also wish to stress the value of the two stage resection of the
large bowel.
In opening the discussion Dr. Sutherland complimented Dr. Graham
on the excellent results obtained. He was of opinion that a great many
such cases originated in a condition of polyposis and that by a more
frequent use of the sigmoidoscope and local destruction of polyps many
might be averted. Dr. McNair stated that the case was of interest
pathologically as it showed malignancy originating in two different
parts of the rectum, one of which had perforated and involved the
recto-vaginal wall. He quoted statistics showing that 12% of cases of
carcinoma arose in the gastro-intestinal tract, of which 70% were in
the rectum and 12% originated in the caecum. Dr. Pearson stated that
he had observed the case both before and after operation and considered
it the most satisfactory he had ever seen. The immediate and present
results were all that could be desired.
In reply Dr. Graham disagreed with Dr. Sutherland as to the frequency of carcinoma of the rectum arising from polyposis. Such cases
as did arise from polyps were usually of the "cauliflower" type which
are rare. He believed that 75% of cases are operable, although operation must generally be very radical.
Dr. Appleby presented a case of solid tumour of the Urachus.
The patient in this case is a girl of 4% years of age, with negative
family and personal history. She has always enjoyed good health. A
few days ago the mother noticed a lump in patient's lower abdomen.
There was no pain and no symptoms of any description.
Examination showed an ovoid swelling, the size of a small grape
fruit apparently in the abdomen and narrowing to a pedicle which seem-
Page 164 ed to go into the right side of the pelvis. The tumour was smooth and
non-adherent and was apparently attached to the umbilicus, which was
normal. No urinary disturbance followed on handling the tumour.
Diagnosis was made of a dermoid cyst in the right ovary. At operation
the tumour was found to be extra-peritoneal in the midline, attached
by a slender stalk to the umbilicus and by a broader base to the bladder.
The peritoneum was opened to verify the position. The tumour was
excised and with it about two square inches of the muscular coat of the
bladder, which was not opened. The wound was closed with a small
drain. Recovery was uneventful. Microscopically the growth proved
to be small round celled sarcoma.
The case is interesting on account of its great rarity, only 22 cases
of solid tumours of the urachus being reported in the literature and the
present case is the youngest of all so far seen or reported. Twenty of
these reported cases were malignant and two were simple fibromyomata.
There are numerous instances of cystic tumours or degeneration of
the urachus but the fact that there are only twenty-two other cases, of
solid tumours reported renders this one unusually interesting.
In the discussion Dr. Hunter recollected doing an autopsy on a
female child 6 to 7 years of age with a previous history of operation on
the urachus. In this case the tumour was so large and the abdominal
organs so intimately involved that they could not be separated.
Dr. W. Graham offered the suggestion that Dr. Appleby's case was
not a tumour of the urachus, but a dermoid tumour of the posterior
sheath of the rectus. Dr. Appleby in rebuttal of this pointed out that
the sheath of the rectus was quite distinct from and not involved in
the tumour. As the tumour was found to be a round celled sarcoma,
a question was asked as to the prognosis. Dr. Appleby replied that all
previous cases reported in which the tumour was malignant, the
patients had died within sixteen months. As his case was the earliest
ever reported he would not venture to say in which direction the early
age of the patient might influence the prognosis.
MEDICAL REUNION IN PARIS
9th - 14th June,  1929
The forthcoming Medical Reunion in Paris will extend from the
9th to the 14th of June; it will be organized with the co-operation of
the Revue Medicate Francaise and its contributors, and will be open to
all French and foreign physicians, and also to medical students.
The constitution of the Central Committee is as follows:
President Professor   Delbet
Vice-Presidents Professors Sergent and Desgrez
General Organizer Professor  Balthazard
General Secretary Dr. Leon Tixier
Assistant General Secretary M. Deval, Director of the Laboratory in
the Faculty of Medicine.
Treasurer Dr.  Leon  Giroux,   fermerly Director of  the Clinics
in the Faculty of Medicine.
Page^S^ The meetings will be held in the Palais des Expositions, Paris
(Porte de Vaugirard) where an Exhibition will be organized under the
auspices of the French Exhibition Committee, the arrangements for
which will be superintended by M. Jean Faure, president of the Syndicate of Manufacturers of Pharmaceutical Products.
During the afternoon, various addresses will be given in the new
hall of the Palais des Expositions, by Professor Delbet and Sergent, by
Dr. Lesne, and others.
For the morning, a well considered programme has been drawn up,
which provides for attendance at practical demonstrations with the
assistance of the Directors of the various sections in the Clinics of the
Faculty of Medicine, and in the public and private hospitals, the Poor
Law  Administration,  Pasteur  Institute,   Radium Institute,   etc.
The Entertainment Committee, presided over by Dr. Henri de
Rothschild, has projected a particularly attractive programme:
Sunday, 9th June—Official Reception in the Palais des Expositions;
orchestra, theatrical representation, refreshments.
Tuesday, 11th June—Evening at the Opera.
Thursday, 13th June—Motor excursion to the Vallee de Chevreuse,
lunch at Rambouillet, visit to the Chateaux of Rambouillet and
Dampierre, to the Abbaye of Port-Royal des Champs, collation at
the Abbaye des Vauxe-de-Cernay.
Friday, 14th June—The visitors will be received at the various climatic, thermal, and seaside-health centres, under particularly agreeable and advantageous conditions.
A Ladies' Committee will organize daily visits to the large dressmaking establishments, museums, concerts, tea rooms, etc. It may
already be said with certainty that the success of the Medical Reunion of
1929 will be even greater than that of preceding years as the Committee
has benefited by the experience of the past to introduce every possible
improvement.
Subscription—50 francs for those attending the Reunion; 20
francs for ladies and medical students.    Payment by cheque.
For all particulars, apply to: Monseur Leon Tdcier, 18, rue de
Verneuil, Paris (7e).
B. C MEDICAL ASSOCIATION NEWS
Dr. E. R. Hicks, of Cumberland, has been appointed to the position of Medical Health Officer for the district surrounding Cumberland,
and medical inspector of schools for Minto, Royston, and Union Bay
schools on Vancouver Island.
Jf* *!• ?S*
Dr. L. Ross Lane, of Nanaimo, has left for New York to take postgraduate work. Dr. O. Ingham is taking care of the practice assisted
by Dr. R. Elder.
Page 166 The B. C. Committee on Historical Medicine is now under the
Chairmanship of Dr. A. S. Monro, as Dr. W. D. Keith, who was nominated as Chairman at the last meeting of the Executive, has regretfully
tendered his resignation owing to pressure of work.
The Provincial Legislature Commission to enquire into the desirability of Health Insurance in B. C, will consist of Mr. W. R. Kennedy,
of North Okanagan; Mr. C. F. Davie, Cowichan-Newcastle; Dr. L. E.
Borden, of Nelson, Conservatives; and Dr. J. J. Gillis, of Merritt, and
Mr. G. S. Pearson, of Nanaimo, Liberals. The Commission will commence its meetings shortly, it is announced.
Dr. E. R. Ziegler has returned to his practice at Campbell River,
after three months' post-graduate work at Chicago and Rochester.
*      *       *
The Spring post-graduate tour, made possible by the generosity of
the Sun Life Assurance Co., and arranged by the Canadian Medical and
B. C. Medical Associations will be held in June. Commencing in the
East Kootenay on June 19 th the tour will finish at Prince George on July
10th. Full particulars of towns to be visited, names of speakers and
dates, will be published in the next issue of the Bulletin.
The Annual Meeting of the B. C. Medical Association, this year,
will be held in September, and arrangements are already on the way for
a big clinical, business and social programme. The following men from
the east are expected to be present:
Dr. A. T. Bazin, President C. M A., Montreal.
Dr. T. C. Routley, General Secretary, C. M. A., Toronto.
Dr. K. A. MacKenzie, Associate Professor of Medicine, Dalhousie
University, Halifax.
Dr.  Geo.  H.  Murphy,  Associate Professor of  Surgery,  Dalhousie
University, Halifax.
Dr. G. E. Richards, Professor of Radiology, University of Toronto.
Dr. Geo. S. Young, Associate Professor of Medicine, University of
Toronto.
Dr.   H.   B.   Van   Wyck,   Associate   Professor   of   Obstetrics   and
Gynaecology, University of Toronto.
One need hardly add that this group of speakers will present a
type of programme which will be most acceptable. This team will be
supplied by the Canadian Medical Association, without any cost whatever
to the Provincial Association. Subjects and titles will be published at a
later date.
Congratulations to Dr. and Mrs. R. Gilchrist, of Ladysmith, on the
birth of a daughter, April 3rd, 1929.
Page 167 C|,Our Service is based upon the friendly
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patient .... and it is upon this foundation that our organization is built.
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MACDONALD'S PRESCRIPTIONS LIMITED
618 Georgia Street West - Vancouver British Columbia Laboratory Bulletin
Published irregularly in co-operation with the Vancouver Medical Association Bulletin,
in the interests of the Hospital, Clinical and Public Health Laboratories of B. C.
Edited by
Donna E. Kerr, m.a., of The Vancouver General Hospital Laboratories
Financed by
The British Columbia Provincial Board of Health
COLLABORATORS: The Laboratories of the Jubilee Hospital and St. Joseph's Hospital,
Victoria; St. Paul's Hospital, Vancouver; Royal Columbian Hospital, New Westminster;
Royal Inland Hospital, Kamloops;  Tranquille Sanatorium; Kelowna General Hospital;
and Vancouver General Hospital.
All communications should be addressed to the Editor as above.   Material for publication
should reach the Editor not later than the seventh day of the month of publication.
Vol. Ill
MAY, 1929
No. 3
Contents
Dysentery Due to Shiga Bacillus Infection Matheson
Report on Two Cases of Undulant Fever Menzies
DYSENTERY DUE TO SHIGA BACILLUS INFECTION
J. E. Matheson, M.B., Technical Medical Assistant,
Vancouver General Hospital Laboratories.
Dysentery of the bacillary type is an acute infectious disease, tending to become chronic, caused by one or other of two organisms (J5.
Shigae and the Flexner bacillus), closely resembling the typhoid bacillus
group.
Although there exist several strains of these bacilli dysenteriae, differing in their reactions in minor fashion, the main types are those of
Shiga and Flexner.
Bacillary dysentery occurs sporadically in temperate climates, as in
British Columbia, occasionally appearing in epidemic form. One must
not forget, however, that dysentery caused by the Entamoeba histolytica
(amoebic dysentery) is not unknown in British Columbia. There appear
in B. C. odd cases of this infection from time to time in those who have
lived in tropical countries (1922-27, 3 cases V. G. FL Lab. in which
amoebae were found in the stools). The acute flare up of a chronic
condition, of this origin, closely resembles chronic bacillary dysentery.
It is, however, distinguished by the discovery of amoebae in the stools
and by the absence of positive agglutination tests for the Shiga group.
The Pathology is of interest. In amoebic dysentery ulcers occur in
which amoabae may be found. The amoebae are more abundant, however, in the deeper tissues beyond the ulcerated area. The ulcers have
undermined edges.
In bacillary dysentery intense hyperaemia, fibrinous exudate, and
later ulceration, occur, due to the irritant action of the growth and production of toxins by the bacteria in the lumen of the gut. The edges of
Page 168 the ulcers are thickened and granular with, in the more chronic forms, a
tendency to scarring, contraction, and healing. A pseudo-membrane is
often found.
Flexner succeeded in producing identical lesions in the intestine by
intravenous injection of bacteria-free extracts from Shiga cultures, the
toxins apparently being excreted through this route. The toxins seemingly possess a special tissue affinity for the intestinal mucosa.
Gross examination of the feces is important. Fecal stools, fresh
blood, a little mucus with intimately scattered pus, are found in amoebic
dysentery. Bacillary dysentery shows a great deal of clear mucus, some
blood and no fecal matter. Later the mucus becomes opaque and milky
with white blood cells and pus cells.    The blood tends to disappear.
The few cases of bacillary dysentery here were definite infections
of Shiga bacillus as shown by the positive agglutination tests obtained;
other agglutination tests, typhoid, paratyphoid A and B, and B. abortus,
done at the same time and found negative, ruled out the error of massed
or group agglutinations of the organisms by the patients serum.
Since January 1, 1929, 506 sera were examined. Three cases out of
eight Shiga agglutination tests showed positive clumping in dilutions as
high as 1-160.    These were definite clinical cases of dysentery.
Vaccines were made from 24 hour cultures of Shiga bacilli, the
strain of organism used being that which was agglutinated by the
patients serum. In one or two cases, on request, other organisms were
added although no positive agglutination tests had been obtained with
these additional organisms.
Small doses of the vaccine were given in the usual manner. The
clinical course in every case was marked by a definite and immediate
change for the better. After periods of time varying from two to
six weeks the patients were comparatively well of their diarrhoea. Concomitant signs of the disease if present, e.g. anemia, persisted for a
longer period of time. Whether the effect will prove permanent or not,
is not yet definite, but the good results to date are interesting.
The vaccines made from pure culture were, it seems, as efficacious
as the combined type of vaccine. The usual dose given in the beginning was 1 to 3 minims, increasing gradually to 10 minims, this dose
being repeated as the individual case indicates. The injections are given
every 3 or 4 days. This clinical improvement under specific vaccine
therapy is further evidence in favor of B. Shigae as the etiological factor.
I am indebted to Dr. W. A. Whitelaw, Dr. J. W. Thomson, and
Dr. F. H. Trousdale for information concerning the clinical points
mentioned.
There are other points of interest that Dr. Whitelaw kindly mentioned. All cases observed showed, besides the dysentery, some other
condition, acting in such a manner as to greatly modify the defensive
mechanisms of the body to Shiga infection. Such conditions as achlorhydria, with absence of the general sterilizing effects of the gastric juice;
Page 169 operative procedures on the gut with reduced local tissue immunity, etc.,
apparently played a definite part in the setting up of infection.
Conclusions:
1. Bacillary dysentery caused by the Shiga bacillus group
does occur in B. C.
2. Amoebic dysentery is occasionally seen, though rare.
3. Agglutination tests are invaluable aids to diagnosis.
4. Specific vaccines have given excellent clinical results,
with the rapid disappearance of the diarrhoea and general
clinical improvement.
REPORT ON TWO CASES OF UNDULANT FEVER
A. M. Menzies, M.D., Administrative Medical Assistant,
Vancouver General Hospital Laboratories.
Owing to the general interest being taken in Undulant Fever, it
seems well to record some case histories of this disease.
There follow the histories of two cases which have recently been
treated in the Vancouver General Hospital.
Case No.  1.    Mrs.  G.   (Mixed, Abortus and  Shiga  infection).
PERSONAL HISTORY. A white woman, age 43, born on farm in Ontario and
lived on farm till the age of 17, when she married. Cattle and hogs were kept on this
farm but were not handled by the patient, nor did she drink raw milk, as she says she
has always hated milk. After marriage she lived in various Canadian towns, finally coming to Vancouver.    She has had one child who is now a healthy young woman.
PAST ILLNESSES. During the lactation period she developed,.abscesses in both
breasts. These cleared up after incision and drainage. She had measles age 10, but gives
a history of no other infectious diseases. Had some obscure "womb trouble" following
childbirth, but says she cured herself. Apart from a compound fracture of the leg age 5,
and a fractured ankle three years ago, there was nothing of interest.
PRESENT ILLNESS. Began about December 22nd, 1928, with vomiting for three
days, during which time sue was unable to retain anything except water. She had no pain,
but diarrhoea began about the same time as the vomiting. She remained up and about,
and gradually improved till the latter part of January, when the diarrhoea increased and
she consulted a doctor.
She was admitted to Vancouver General Hospital January 30th, 1929, feeling weak,
and having several watery stools daily, some vomiting, and also slight cough. Temperature on admittance was 102, pulse 120, respirations 20. Shortly after admittance, her
feet became swollen, numb and tender. The vomiting soon ceased and the diarrhoea improved. She complained of rather severe chills usually between 3 and 4 a.m. daily, for a
few days.
EXAMINATION. A well nourished white woman of about 40 years of age. She
looked somewhat anaemic, with a dry, muddy skin. Most of the teeth had been removed, but there was bad pyorrhoea alveolaris about the few remaining teeth. Both
feet and ankles were slightly swollen and there was slight pitting on pressure, along the
shins.    There was tenderness on pressure in the torso-metatarsal areas.
LABORATORY FINDINGS. During the first week in February, blood agglutinations were positive for B. abortus and Shiga but negative for Flexner, and the
Typhoid group. Blood culture showed no growth. Examination of the blood for malaria was negative. No parasites were found in the stools. The sputum was negative
for T. B. Her blood count showed 3,880,000 red cells with 51% hemoglobin, color
index 0.7. There was some irregularity in size and staining. The white cells numbered
6,660, with 75% polymorphonuclears, and 24% lymphocytes. Urinalyses showed the
presence of a small amount of albumin, red and white blood cells and bacteria, but no
casts were found.
PROGRESS NOTES. Patient ran a very irregular temperature for about three
weeks, ranging from 99 to 104. The pulse range was from 95 to 130, fluctuating with
the temperature. Respirations 20 to 40. On February 11th, treatment with hypodertnal
injections, of B. abortus vaccine was begun, minims 2, as first dose. On February 15th,
Shiga vaccine, with minims 2, as first dose was added to the treatment, these two vaccines being repeated every three days, in increasing doses, till a maximum of eight minims
was reached.
Page 170 the ■*
much
she has
There was quite a noticeable improvement  in the patient's
vaccine   treatment   was   begun.     She   was   discharged   from
improved,  but still  running  a  slight   temperature.     Since
made favorable progress, except for anaemia which still
Case No.
condition from the time
hospital February 21st,
discharge   from   hospital
persists.
Mrs. H.  (Abortus infection).
PERSONAL   HISTORY.    A
on a farm in Saskatchewan, where
five months ago.    During life on the
Hogs  were also  kept on  the farm.
which died, in three days from some
menstrual history  normal.
PAST  ILLNESSES.    She had
was in bed for about  six weeks at
white woman,  ;
she continued to
ige  &
liv(
??
f Ruthi'iiian
until moving to
cows and drank
parentage, born
British Columbia
raw  milk freely.
farm- she handled
At the age of  21   she married,  and  had  one  child
unknown cause.    Family  history  was negative,  and
what she
the time,
Erysipelas
calls a bad attack of "Flu," age 13, and
but was not treated by a doctor. At the
of  the  right   leg.     Smallpox  age   19,   and
age of   18,  she gives  a history  of
measles age 20.
PRESENT ILLNESS. Began January 26th, 1929, with persistent vomiting, chills,
general malaise, aching back, and frequent watery stools. She remained up and about,
and in about a week, except for the vomiting which disappeared in four days, she became
generally worse—particularly with pain in back and neck, accompanied by slight headache. About the second week of illness she developed a fairly severe sore throat and
cough with .pain in the lower chest, behind the point of the sternum. Pain also appeared
in various joints, knees, ankles, feet, shoulders, elbows, wrists, and hands, with no
swelling noticed, except in the fingers.    These pains lasted about three days.
She was admitted to Vancouver General Hospital on March 18th, 1929, having been
more or less ill for about six weeks. At this time her temperature was 104, pulse 124,
respirations 28, and she complained of cough, with severe pain in lower mid chest,
anteriorly, also a few joint pains; no vomiting or diarrhoea. -
EXAMINATION.    This showed  a well nourished young  woman.     Nothing  unusual
was found, except for coarse rales in the chest and  coated  tongue.    An  odor  similar to
that of typhoid was quite noticeable about the patient,  although  there was no diarrhoea
—enemas being required almost daily.
22nd, were positive for B. abortus,  in dilutions of  1:160,  but were negative for Typhoid
LABORATORY FINDINGS. Agglutination tests March 19th and again on March
and Paratyphoid, as well as for Shiga and Flexner.
Urinalyses have shown albumin constantly present, varying in amount, from plus 1 to
plus 3.    White and red blood cells also granular and hyaline casts were usually found. '
Other laboratory examinations have shown negative blood Wasserman, negative blood
culture (no growth even after 16 days incubation) and nose and throat swabs negative
for Diphtheria.
PROGRESS. On March 25th, a definite pericardial rub was heard, but no enlargement of heart or pericardium could be made out. The joint pains soon ceased, the
cough improved, respirations dropping to 20, and the pain in precordial region slowly
disappeared. Her temperature had been very irregular throughout, dropping at times
almost to normal for two or three days then rising to 101 and 102 each afternoon for
several days. Her pulse remained strong and regular throughout, but usually increased
with the temperature, ranging from 70 to 120.
Symptomatic treatment was used throughout, but on April 5 th, treatment with
B. abortus vaccine was begun, minims 2, being given hypodermically. This was repeated
every third day, increasing the dose by minims 1 till a maximum of 8 or 10 minims was
reached.
At time of writing, this patient is still  in hospital,  but making  satisfactory progress.
In neither of these cases did enquiry reveal any source of infection.
One hated milk of all kinds and consequently had not used it, nor had
she been recently in contact with animals. The other, though living on a
farm where pigs and a goat were kept, says she did not handle the animals and the goat was not milking. Canned milk wasi being used at
the time. In either case could contact with other sick persons, or those
recently recovered, be established.
Peculiarities shown by the above two cases are:
(a) The long prodromal period ushered in  by  an  attack  of
severe vomiting.
(b) The  joint  pains  with   swelling,   symptoms  which  might
lead to a diagnosis of Acute Rheumatism.
(c) The constant presence of albumin,  red and white blood
cells, and sometimes casts in the urine.
I am indebted to Dr. F. H. Trousdale and Dr. W. E. Harrison for
assistance in procuring these details.
Page 171 lows:
FACTORS IN NUTRITIONAL DISTURBANCES OF
INFANCY AND CHILDHOOD
From a paper read before the Osier Society by Dr. E. J. Curtis.
I shall discuss this subject, first, from the food view point; secondly,
the influence of infection harbored by the body.
Requirements for successful nutrition may be ennumerated as fol-
1. The provision for sufficient calories.
2. The food must contain a minimum amount of protein, carbohydrate, salts and water together with vitamines.
3. The food must be free from harmful bacteria.
4. The food must be capable of digestion by the individual.
Failure to fulfill any one of the requirements results in the failure
of the feeding as a whole, which may carry one toward serious consequences.
With regard to the infant no matter how digestible the food it will
be unsuitable unless it supplies a sufficient number of fuel units. A
normal infant rarely thrives unless it gets 45 to 50 calories per pound
of (expectant) body weight per day.
The qualitative factors I will not discuss—it is complex, and in its
complexity one is surprised how well the average child will thrive provided it is filled up. The story of the poorly balanced diet is beyond
the scope of this paper, and so are the enviromental influences upon the
nutrition! faulty habits—excitement—mental and social worries—
physical defects.
The problem of malnutrition is often one involving a vicious
circle of diet and disease. Someone in the Central States has, almost at
will, produced sinus disease in experimental animals while upon a vita-
mine deficient diet.
Hill (1925) of this city publishes a paper in which from school
statistics he concludes, that the infections played no part in malnutrition. This is indeed contrary to the belief generally and widely accepted
today.
In reviewing all my records for the past two years I find 46 per
cent, were malnourished (this figure excludes the newborn). Of these
there were 30 per cent, at least who had parenteral infections limited to
the upper respiratory tract.
With Drs. Matthews and Kinsman I have had the privilege of seeing a group class at the Children's Aid Home, where, as you know,
there once existed fearful conditions. In reviewing the records of 83
of the girls, 51 per cent, were found to be under-nourished, and, of that
number 45 per cent, had chronic or recurring infections of the upper
respiratory tract.
The site of entrance for infection is not considered seriously enough.
In the infant or child the mouth, throat and nose are of permanent
importance, for comparatively, and infrequently at this age, do infectious processes enter by other routes, as the skin, rectum or genitalia.
Page 172 For many years these infections have been regarded as purely secondary but frequently if one is careful* in the history of the case the story of
some respiratory infection is found, slight though it may be, preceding
the original gastro-intestinal upset. A certain number of babies who do
not gain as a result of inadequate food, we find susceptible to infections.
In the former, treatment of the infection exerts a greater influence upon
the nutritional disturbance than any change from an already adequate
diet. In the latter, one may find that the improvement, following the
giving of an adequate diet is only temporary, for the pathologic process
has a firm foothold. Thus a vicious circle exists; and for recovery, that
circle must be cut in two places. In a small proportion of cases the
pharyngitis or other infection does not clear up, the loss of weight or
refusal to gain continues, the gastro-intestinal upset persists, with temperature of varying amount, until collapse and death.
In my three years with Marriott I saw the evolution of the question
of post-auricular drainage in infancy. The ears when examined show
purulent discharge or a red, bulging drum head which on incision reveals
pus or a sero-sanguinous fluid. There may not be any redness or bulging,
the drum presenting only a dirty greyish appearance. It is believed that
the appearance of such a drum head is a manifestation of the general
drying out of the tissues.
Myringotomy alone, in a considerable number of babies is sufficient
to relieve the earlier symptoms, but the age of the infant, the virulence
and type of the organism, the duration of the illness and malnutrition
influence the results of this procedure.
Concerning the anatomy of the baby ear I must mention one or
two points of interest:
The tympanic ring is incomplete in its superior portion.
The aditus and antrum at birth are filled with a thick mesodermal
tissue.
The eustachian tube is short and wide open.
The slightest irritation of the mucosa causes a swelling which readily
separates the antrum from the middle ear. It is for this reason that
suppuration in the mastoid antrum is inadequately drained through the
tympanic membrane when it is opened.
Considerable harm would be done if infant mastoids were opened
promiscuously for treatment of diarrhoea and malnutrition without considering the other causes of infection. More harm has been done and is
being done by permitting unrecognized infection to escape our notice.
The treatment of upper respiratory infection assumes at least as great
an importance as modification of diet.
Some do get well without operation, but at present, clinical observation of the progress of the disease is our best guide. When first such
cases were operated upon the mortality rate was high (85%), and since
has dropped to 20%. The mortality rate on those wards as a whole has
dropped tremendously, easily 50%.
Page 17 i Lemere of Omaha puts the question in an excellent manner. "The
idea is to operate before a child is dying. Operate early, not in the
matter of time, but in regard to the condition of the infant and to the
time of observation of the general condition."
A case may illustrate. W. was four months old and had been admitted to hospital two months previously as a feeding case. Diarrhoea
and vomiting progressively got worse resulting in extreme dehydration
and toxicity. When I saw him first such was the condition. Stimulants
Were being administered in vain hope. A myringotomy revealed only
serum but at the operation on the mastoid, which was performed immediately, a tremendous amount of necrosis was found to be present.
He remained alive for ten days but with a positive blood culture, the
same organism being isolated from the mastoid at operation.
For me to close the subject at this point would be premature without a word concerning procedures which are of utmost importance, before and after operation. Transfusions are given. Intravenous glucose
and normal salt solution parenterally are of paramount importance together with the close co-operation of the otologist, for so often does the
paediatrician make his diagnosis based on general constitutional signs.
Associated with the above condition Lierle, Jeans and others have
found maxillary sinusitis co-existing in many cases. Not infrequently,
however, does paranasal sinus pathology present itself alone in the undernourished infant. A very similar picture to that of mastoid antrum infection is found. It may be the case of an infant developing a sudden
diarrhoea with an acute "head cold" and subsiding with disappearance of
the infection. Another type shows more general constitutional signs and
failure to gain in a pale grey, apathetic infant with a secondary anaemia.
The following case I will give you as an example of such a focus
of infection in an infant.
A male infant 15 months old had a history of repeated upper
respiratory infections. Because of a high fever, cough and loss of weight,
medical advice was sought. Temperature was 103. Some slight nasal
discharge reddened pharnyx and slightly enlarged tonsils. A few coarse
rales were present in the chest. The spleen was palpable. There was a
slight pyuria. X-ray of the chest was essentially negative but plates of
the nasal sinuses showed complete opacity of the maxillary sinuses.
With adequate treatment of the nose he gained three pounds in a month.
In the child of pre-school or school age one is finding more frequently the malnutrition and nasal sinusitis associated. The most common picture is that of the thin, pale and listless child—often mistaken for a tubercular subject because of a cough and the presence of a
few rales in the chest. In cases of chronic bronchitis, as of asthmatic
attacks, of encephalitis lethargica, of a so called epilepsy, one is often
surprised to find an associated paranasal sinus pathology.
We all know the stress Brenneman lays on the upper respiratory
tract as a cause of abdominal pain simulating appendicitis in children.
Here is a case I saw last year: The child (now eight years old) had her
tonsils removed two years ago.    Her colds were not so frequent after
Page 174 tonsillectomy but she did not gain weight. Three weeks before I saw
her she had her appendix removed' because of a few bouts of vomiting,
considerable fever (103°), abdominal pain and a white cell count of
27,000. I saw her three weeks later as I said, she was extremely emaciated, a discharging ear had been present for a week, she had a haemorrhagic nephritis. There was a very granular red throat, the post cervical
glands were considerably enlarged, red mucus membranes of the nose
with strings of mucus and pus. The lungs had a few rales and the
X-ray of the chest showed a bronchitis (this had been taken before I
arrived on the scene and the family refused any further X-ray). The
pathological report on that appendix was not acute nor subacute. Undoubtedly everything was in the upper respiratory tract. Discharge was
soon obtained from the nose after suitable treatment and she improved
thereafter.
It is one of the newer ideas that the aetiology of acute haemorrhagic
nephritis is due to a streptococcus infection generally present in the
tonsils. Preceding the kidney involvement, there has been either an
attack of acute tonsillitis, scarlet fever, sinusitis or otitis media. It
appears that the capillaries of the whole body show marked changes even
before the haematuria appears. It is known that the capillary pressure
rises tremendously in the skin of the scarlet fever patient a few days
before the development of the nephritis. It is debatable whether bacteria or their toxins are responsible for the capillary damage of the skin
or kidneys.
While we are on the subject of the kidney let me say that again the
paranasal sinuses have been regarded as the cause of a nephrosis or parenchymatous nephritis, whatever you like to call it. This was by Clausen
of Rochester, New York, and he has isolated some substance which will
produce the same condition in experimental animals.
These are practically his words: This disease is a general intoxication of the whole body, particularity involving the parenchymatous
organs, and affect the salt and water equilibrium. The cause is a chronic
infection, usually due to the staphylococcus, generally present in the
paranasal sinuses. The causative relationship of the paranasal sinus infection is proved by the fact that proper drainage of the focus is often
the only measure which entirely relieves the oedema and albuminuria,
and that recurrence of the infection again brings on the symptoms.
That the disease is general and not a kidney involvement alone is indicated by several considerations.
1. It is impossible by removal of the kidneys in animals to produce anasarca.
2. Cases presenting anasarca may occur in which there is no kidney
involvement, e.g. after severe burns there is a very marked disturbance in equilibrium between the tissues and the blood, a
disturbance not seen in acute haemorrhagic nephritis.
Salt retention is accompanied by a low blood salt content. If a
tourniquet be placed about the extremity so as to produce stasis, it will
be found  that  in  the  normal  person  and  in  the  acute haemorrhagic
Page 1 "i nephritis the blood becomes more dilute. In the case of the chronic
parenchymatous nephritis under the same condition water passes from
the blood vessels into the tissues.
In this disease a vicious circle exists. Resistance to infection is low,
possibly on account of the general malnutrition. This tends to keep up
the sinus infection which, in turn, leads to further intoxication.
Just how the intoxication brings about the oedema and albuminuria
is unknown. It seems likely that a toxic, alcohol soluble, acid substance, nearly insoluble in water, found in the blood and urine, may be
responsible for the alteration in the permeability of the vessels and of the
kidney.
MEETING AT NANAIMO, B. C.
The Annual Meeting of the District No. 6 Medical Society, Vancouver Island, was held at Nanaimo on Wednesday, April 24th, when
a very excellent attendance of medical men from all parts of the Island
listened to instructive and interesting addresses given by Dr. J. W.
Arbuckle of Vancouver on "Puerperal Infection;" Dr. J. Christie of
Vancouver on "Urticaria and its Allied Conditions;" and Dr. W. L.
Graham of Vancouver on "Intestinal Obstruction." Very interesting
discussions followed each paper. The Executive Secretary of the B. C.
Medical Association was present and gave a lengthy talk on its activities
during the past twelve months, particularly dealing with legislative matters, perhaps the most important of which was the revision of the Coroners' Act, which has greatly improved remuneration of coroners and
medical men doing autopsy work. \.^..
The amendments to the Coroners' Act are as follows:
Where the time spent by a Coroner on any day does not extend
beyond one-half of the day, the fee for that day under the first two
paragraphs of this Schedule shall be reduced to $5 and $7.50 respectively,
but the total fee for any one inquiry shall not be less than $10, nor
less than $15 for any one inquest; and in allowing fees demanded in any
case under this Schedule regard shall be had to the fact whether or not
the time claimed to have been spent was necessarily so spent for the purposes of the inquiry or inquest.
For making post-mortem examination without dissection of the
body or analysis of the contents of the stomach or intestines,
including one day's attendance at inquest $15.00
For making post-mortem examination involving dissection of the
body, without analysis of the contents of the stomach or intestines, including one day's attendance at inquest  25.00
The following officers were elected for the ensuing year:
Dr. G. K. MacNaughton, M.L.A., Cumberland President
Dr. G. A. B. Hall, Nanaimo  Vice-President
Dr. T. J. McPhee, Nanaimo Hon. Sec. Treas.
: Dr. O. G. Ingham, Nanaimo, Rep. to Executive of B. C. Med. Assoc.
Dr. H. B. Rogers, Chemainus; Dr. H. B. Maxwell, Ladysmith; and
Dr. C. T. Hilton, Port Alberni, members of the Executive.
Page 176 #
f    Try It dljtOur Sxpeme.,.
V   p %eturn Coupon for Sample    /
«•
I earn for yourself how promptly 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 Epbedrine Inhalant, No. 66, to
M. D.
Address.
The Value of Colloidal Silver
From the ancient days of the Arabian physicians, Geba and Avicenna, has come
the use of silver as a therapeutic agent. Its best modern exhibition is in the
form of NEO-SILVOL, a silver protein product which is therapeutically
effective without causing irritation, and which leaves no dark tell-tale stains.
Neo-Silvol Contains 20% Silver Iodide in Colloidal Form
Note these facts: Neo-Silvol is fatal to the gonococcus, streptococci, staphylococci,
pneumococci, and Micrococcus catarrhalis. Against streptococci and staphylococci
it is as actively germicidal as pure phenol—and applicable in much more concentrated
soludon. Against the gonococcus it is 20 times as active as pure phenol. Yet Neo-
Silvol does not precipitate tissue chlorides, nor does it coagulate cellular albumin;
weak acids or alkalis or dilute alcohol do not precipitate it.
Neo-Silvol should be at hand for use in treating infectious inflammation of
any mucous membrane—in eye, ear, nose, throat, urethra, or bladder.
HOW SUPPLIED
In 1-oz. and 4-oz. bottles of the granules—In 6-grain capsules, bottles of 50, convenient for making solutions— Asa 5% ointment in 1-drachm tubes—In the form
of Vaginal Suppositories, 5%, boxes of 12
Shall we send you a sample of the capsules?
Parke, Davis & Company Whenever
Depletion is
Paramount
As in Cervical or Inguinal Adenitis, Mammary Complications, Inflammation of the Abdominal Viscera
is indicated.
Applied over the affected area, as hot as can be comfortably borne by the patient, Antiphlogistine, by virtue
of its marked hygroscopic action, serves to deplete the
enlarged glands, relieves the swelling and pain and adds
materially to the comfort of the patient.
This simple treatment, entirely compatible with internal medication, is becoming more and more an everyday procedure with uniformly gratifying results. The
world-wide use of this topical application by the medical
profession is the best evidence of its merits.
Antiphlogistine
THE DENVER CHEMICAL 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.
66 5 Granville St.
151 Hastings St. W.
One Phone:
Seymour 8033
Connecting all three stores.
Brown Bros* & Co* Ltd*
VANCOUVER, B. C.
in cystitis and pyelitis
TRADE
PYRIDIUM
Phenyl-azo-alpha'alpha-diamino-pyridine hydrochloride
(Manufactured by The Pyridium Corp.)
MARK
For oral administration in the specific treatment
of genito-urinary and gynecological affections.
Sole distributors in Canada
MERCK & CO. Limited
412 St. Sulpice St.
Montreal DR.CS. 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 Bayview 5194
Offices:
201, 206 and 214 Vancouver Block
McBeath-
I Campbell
Limited
Trinters 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
B. C. STEVENS CO.
phone 730 Richards Street
Seymour 69Z Vancouver, B. C. •e^stbfsrae
=ia*-t~
Hollywood Sanitarium
LIMITED
tyor the treatment o/
Alcoholic, Nervous and Psychopathic Cases
Exclusively
'Reference ~ 6B. Q- <£M.edica\ ^Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
u&e
5WS>»»
1

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