History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: June, 1927 Vancouver Medical Association Jun 30, 1927

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THE VANCOUVER MEDICAL
I      ASSOCIATION
BULLETI
Published monthly at Vancouy«,
Subscription $1.50 per yea™ jQ"
'Diphtheria
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Summer School
JUNE, 1927
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Page 266 THE   VANCOUVER   MEDICAL   ASSOCIATION
BULLETIN
Published Monthly  under  the  Auspices  of  the  Vancouver  Medical  Association  in   th.
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. Stanley Paulin
All communications to be addressed to the Editor at the above address.
Vol. 3.
JUNE 1st, 1927
OFFICERS, 1927 - 28
Dr. W. S. Turnbull
Vice-President
Dr. G. F. Strong
Secretary
Dr. A. B. Schinbein
President
TRUSTEES
Dr. A. W. Hunter
Past President
Dr. A. C. Frost
Treasurer
Dr. J. M. Pearson
Auditor
Dr. W. F. Coy Dr. W. B. Burnett
Representative  to  B.C.  Medical  Association
Dr. C. H. Vrooman
SECTIONS
Clinical Section
Dr. Gordon Burke  Chairman
Dr. L. H. Appleby  Secretary
Physiological and Pathological Section
Dr. J. E. Campbell  Chairman
Dr. F. J. Buller __ Secretary
Eye, Ear, Nose and Throat Section
Dr. E. H. Saunders  Chairman
Dr. W. E. Ainley  Secretary
Genito-Urinary Section
Dr. G. S. Gordon  s Chairman
Dr. J. E. Campbell  fe . : Secretary
Physiotherapy Section
Dr. H. R. Ross  Chairman
Dr. J. W. Welch - Secretary
STANDING COMMITTEES
Lib
rary  Committee
Dr. C. H. Bastin
Dr. W. C. Walsh
Dr. W. A. Bagnall
Dr. D. F. Busteed
Orchestra   Committee
Dr. J. A. Smith
Dr. H. A. Barrett
Dr. L. Macmillan
Dr. H. C. Powell
Dinner Committee
Dr. D. D. Freeze
Dr. C. H. C. Bell
Dr. O. Large
Credit Bureau Committee
Dr.  D. McLellan
DR. L. Macmillan
Dr. J. W. Arbuckle
Credentials   Committee
Dr. F. W. Lees
Dr. E. J. Gray
Dr. W. F. McKay
Summer   School   Committee
Dr. G. F. Strong
Dr. W. D. Keith
Dr. H. R. Storrs
Dr. R. Crosby
Dr. B. D. Gillies
Dr. L. H. Appleby VANCOUVER MEDICAL ASSOCIATION
Founded 1898. Incorporated 1906.
THE 30th ANNUAL SESSION
GENERAL MEETINGS will be held on the first Tuesday of the
month at 8 p.m., from October to April.
CLINICAL MEETINGS will be held on the third Tuesday of the
month at 8 p.m., from October to April.
Place of meeting will appear on Agenda.
General Meetings will conform to the following order:—
8:00 p.m.—Business as per Agenda.
9:00 p.m.—Paper of Evening.
CITY HEALTH DEPARTMENT
STATISTICS — APRIL, 1927
Total Population (Estimated)   137,197
Asiatic Population (Estimated)  1__  10,576
Rate per 1000 of Population
Total Deaths '.  :     152 13.5
Asiatic   Deaths      .        18 20.7
Deaths—Residents only      123 10.9
TOTAL BIRTHS     306 27.1
Male      15 3
Female 153
Stillbirths—not included in above       10
INFANTILE MORTALITY—
Deaths under one year of age       12
Death rate per 1000 births       39.2
CASES OF INFECTIOUS DISEASES REPORTED IN CITY
May 1
March, 1927
Cases Deaths
April, 1927
Cases Deaths
to  15,1927
Cases Deaths]
Smallpox 	
Scarlet Fever
Diphtheria
1
17
44
Chickenpox   37
Measles     708
Mumps    5
Whooping Cough  5
Typhoid Fever   3
Tuberculosis    10
Erysipelas  2
Cases from outside city-
Diphtheria     11           0
Scarlet Fever   7           0
Typhoid Fever   3           1
0
0
2
:u?
4
0
0
1
18
0
2
21
27
12
365
11
6
1
8
0
0
0
0
0
0
0
0
19
0
-included in above
7 0
1 0
1 0
1
3
5
13
68
4
7
0
9
2
1
0
0
0
0
1
0
0
0
0
0
Page 26t <di
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*CTO##
StattNdii
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THE Victor X-Ray Corporation has assumed a respon-
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It is a tenet of the Victor code that the operator of a
Victor machine has the right to receive technical aid
Ivhen he needs it.
I So, a nation-wide Victor Service Department was
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Ihe principal cities of the United States and Canada,
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fcen, by drawing on the facilities of the Engineering
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»re equipped to render technical assistance that is appreciated by every user of Victor equipment.
\ Victor alone maintains so comprehensive a Service
Organization.
■Victor X-Ray Corporation of Canada, Ltd.
MOTOR TRANSPORTATION BUILDING
VANCOUVER, B.C.
Many physicians feel that Victor
quality, With Victor service, implies
a price higher than they can afford.
But they are happily surprised when
shown this Victor 5" X-Ray Unit,
complete with Coolidge Tube for
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The same high quality applies here
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I 	
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Page 269 EDITOR'S PAGE
At the April meeting of the Association the recommendation of
the committee appointed to examine the proposal was finally accepted
and a scheme for the inauguration of a Benefit Fund adopted.
By this means, twenty-one years after the incorporation of the Society, the last clause in its articles of incorporation is given effect.
"For the purpose of making provision by means of contribution,
subscription, donation or otherwise, against sickness, unavoidable misfortune or death and relieving the widows and orphan children of members deceased."   So runs the clause.
We are heartily in favour of this new activity. In no more satisfactory way can the uses and influence of this Association be expressed.
The committee in charge has been active in seeking information and in
devising plans for administration. These plans, as we- understand, have
not yet been perfected. They will, indeed, require considerable time to
produce in working shape and much subsequent modification will doubtless be needed.
Those in charge of the establishment and distribution of the fund
will be the Trustees of the Association, whose office is a yearly appointment, and the President. It is, we believe, their intention shortly to issue an invitation to members for a founding subscription in order that
the Fund may be established as soon as possible.
By the October meeting fuller details of the working arrangements
will be forthcoming. We hope that this praiseworthy effort will be a
success; we feel sure that it will. No more fitting way can be found to
commemorate the thirtieth year of the Association and in so doing, of
fulfilling the last of the objects of the founders of this Society.
By the time this number of the Bulletin reaches our readers the time
for the Annual Summer School will be close at hand. The programme
has been completed, details arranged and the full results are presented in
another part of this issue.
Once again we call upon our readers and especially upon the members of the Vancouver Medical Association to make the occasion worthy
of the ancient renown of the Society. City men not infrequently complain of the difficulty of attending meetings held at home on account
of the demands of practice. We acknowledge the difficulty, but our patients are mostly singularly reasonable when they realize that the doctor
is acquiring new information which may later be useful to them personally.   Try it and see.
NEWS AND NOTES
Dr. Thornton, who was formerly on the staff of the Vancouver
General Hospital and who has made many voyages as surgeon on the
Empresses, has returned to British Columbia from Europe.   Dr. Thornton
Page 270 was married in the Fall to Miss Flora Mellish, a graduate of the  1925
class of the Training School of the Vancouver General Hospital.
Dr. Robert Crosby and Mrs. Crosby, who left Vancouver at the
beginning of May, have arrived in England en route for the Continent.
They expect to be absent from the city for about four months.
Dr. F. W. Brydone-Jack, who has been doing post-graduate work
in Vienna and England, has returned to Vancouver and resumed practice.
Dr. Brydone-Jack speaks enthusiastically on the abundance of clinical
material available at the centres which he visited.
Four members of the Vancouver Medical Association will be speakers
at the meeting of the Canadian Medical Association in Toronto, June
13 th to 18 th. Dr. D. D. Freeze will give the presidential address to the
Canadian Society of Anaesthetists; Dr. Frederic Brodie will speak on the
"Examination of the Nervous Heart"; Dr. J. W. Thomson will give an
address on "Carcinoma of the Colon with case reports," and Dr. Howard
Spohn will talk to the pediatricians on the "Diagnosis and Treatment of
the Enlarged Thymus Gland."
Da Isabel Day has left on a trip to her home in Toronto.    During
her stay in the East she will do some post-graduate work in obstetrics.
Dr. W. E. Ainley, who left early in March for post-graduate work
in Vienna, has returned to Vancouver and resumed practice. Dr. Spohn
and Dr. Lennie, who travelled to Vienna with Dr. Ainley and Dr. F. W.
Brydone-Jack, will not return till the middle of June.
GOLF
On April 28 th the Victoria and Vancouver Medcial Golf Teams
journeyed to Seattle as guests of the Seattle Medical Golf Team. The
weather was fine, the hospitality lavish, and the "trimming" administered
by our oponents artistic.
A return match was played in Victoria on May 14th. Col wood was
at it's best, and our associates in the Capital City did everything to make
the event most enjoyable. On that occasion the outcome was almost as
satisfactory as could be hoped for, the result at the end of the day being
that the game was all square.
These annual events are becoming more popular, and more enjoyable,
and the time is not far distant when it will require careful judgement
on the part of our golf executive to select the teams.
Page 271 An attempt will be made to arrange matches during the coming
months to be played at the different local courses, so that an accurate
estimate may be made of the different players' capabilities and their
eligibility for the team.
It has been suggested that the Worthington Cup should be competed
for by medal play on handicap. This suggestion will probably be carried
out in the near future.
DIPHTHERIA CULTURES
By H. W. Hill, M.D., D.P.H., L.M.C.C, Professor of Bacteriology; and
of Nursing and Health, the University of British Columbia; Director,
Vancouver General Hospital Laboratories.
[Editor's Note:—This is one of a series of articles intended to indicate the clinical uses, interpretation and applications of various modern
laboratory tests. Each article will be written by a different author, peculiarly familiar with the uses of the test treated of.]
Diphtheria, as it occurs in the human, consists in a variety of tissue
injuries done to the body by the toxins of the diphtheria bacillus. The
latter grow as a rule on the surfaces of mucous membranes; and almost
always those only of the throat, nose or trachea, which are easily reached
by "swabs," from which cultures may be grown.
The cultural laboratory test, whether of a suspected case of diphtheria, a contact or a suspected carrier, seeks to determine one factor only
—the presence or absence of diphtheria bacilli. The further questions of
(a) whether or not toxins are being produced, or (b) whether, being produced, they are or are not doing damage, cannot be determined by the
cultural test. Only the symptoms of the case can determine the presence
of damage; if damage is present, then also toxins of some kind are necessarily present. If damage is absent, toxins may nevertheless be present;
their lack of effect must then be due to the possession of immunity by
the person carrying them.
Positive reports indicate, then, only the presence of the diphtheria
bacillus; whether or not these diphtheria bacilli are damaging the person
in whom they are present must be determined by a consideration of the
clinical symptoms.
If, with a positive report, appropriate clinical symptoms exist, at
once the inference is justifiable that those symptoms are due to the diphtheria bacilli present; and that, therefore, these diphtheria bacilli are producing toxins, i.e., are virulent. The error in making a diagnosis of diphtheria by thus assuming that the clinical symptoms presented are due to
the diphtheria bacilli found is approximately 1%; i.e., of 100 cases so
diagnosed as diphtheria, one will be wrongly so diagnosed, 99 rightly.
The existence of this one per cent, of error is due to the fact that about
1% of the general population carry diphtheria bacilli in their noses or
throats in health.    If in these healthy "carriers" some intercurrent in-
Page 272 fection should produce symptoms lying within the rather wide range
which may properly be assumed to be diphtheritic in character, a diagnosis of diphtheria based on such symptoms plus the diphtheria bacilli would
properly be made; yet in such instances the symptoms are not due in fact
to the toxins of diphtheria at all, but to the intercurrent infection.
The diphtheria bacilli found in such persons may or may not be
virulent. If virulent, the person carrying them obviously must be immune to diphtheria toxin; if non-virulent, of course, the person carrying
them may or may not be immune to diphtheria toxin; but is certainly
not suffering from those diphtheria bacilli present in him, since, being
non-virulent, they are necessarily harmless to anyone.
To diagnose and treat as diphtheria such a case, while technically in
error, is the only rational procedure, because it cannot be distinguished
from true diphtheria without a delay which would be very serious or even
fatal if true diphtheria were in fact present.
Hence the universally accepted rule=Appropriate symptoms-(-diphtheria bacilli indicate both diphtheria diagnosis and diphtheria treatment.
But since delay is so disastrous in diphtheria this is, in practice,
universally amended to read=Appropriate diphtheritic symptoms alone
call for diphtheria treatment; if in addition diphtheria bacilli are also
found, the combination calls for diphtheria diagnosis.
If, then, a patient shows symptoms within the wide range which
are characteristic of diphtheria, he should be at once treated as diphtheria,
and at once receive antitoxin in therapeutic dosage. Then cultures should
be taken to determine the diagnosis, the prognosis and the further treatment.
When well persons (contacts or suspected "carriers") show diphtheria bacilli, any association of these persons with clinical cases of diphtheria makes the inference justifiable that the diphtheria bacilli they show
are virulent; and further that if these persons continue well, they must
be immune to the toxins these diphtheria bacilli are producing. This inference may be confirmed or disproved by making a "guinea-pig virulence
test" of the diphtheria bacilli found, a matter of 24 to 48 hours. The
value of the determining of virulence in such circumstances lies in the
fact that if the diphtheria bacilli prove virulent, the person carrying
them should be isolated, since he is dangerous to others, although not to
himself (since he is immune); while if they prove to be non-virulent, he
is not dangerous to anyone, and need not be further considered.
Negative laboratory reports for diagnosis.—The sources of error,
mechanical and biological, involved in the collection, transmission, incubation, examination and recognition of diphtheria bacilli add up to make
about a 5% error in negative reports, i.e., of 100 negative reports from
persons showing appropriate clinical symptoms, 5 will be in error, 95 correct. Hence, no clinical diagnosis of diphtheria should ever be surrendered because of a single or even two negative reports.
Negative laboratory reports for release from isolation.—The sources
of error above listed in negative cultures for diagnosis have, in release
Page 273 cultures, an important additional one; namely, a relative reduction in the
number and prominence of the diphtheria bacil.i present in the patient.
Hence the error of negative cultures during convalescence rises to 30%,
i.e., of 100 recent positive clinical cases, the first negative culture will be
obtained while diphtheria bacilli are, in fact, still present in 30; in the
other 70, the first negative diphtheria culture obtained will be correct
in indicating that the diphtheria bacilli have in fact disappeared.
It has been found in a now enormous experience of such cultures
that if two consecutive negative cultures (from both nose and throat)
be required the error is reduced to about 2%, i.e., that with two consecutive negative cultures, only two per cent, of recovered cases will be released while still positive, instead of 30% as would be the case if one
negative culture only were relied upon. Although three consecutive
negative cultures would eliminate this 2% error, it has as yet not been
considered practical to exact them except in release from contagious
hospitals.
Indeterminate laboratory reports.—The sources of error already enumerated result occasionally in "no growth" or its converse, "overgrowth."
The former indicates some error resulting in failure to secure growth of
any organisms in the culture. The latter indicates an excess growth of
certain saprophytes sometimes present in the throat; a growth so great
that the diphtheria bacilli, if present at all, would be completely suppressed or at least lost in the overwhelming mass of other organisms.
In these two instances, fortunately rare, the culture, of course, sheds no
light on the diagnosis and must be repeated.
Very occasionally also, difficulties in the recognition of diphtheria
bacilli may arise in cultures otherwise entirely satisfactory, due to the
wide range of morphology of the diphtheria bacilli; of which some 22
well-recognized types are familiar to bacteriologists. In such instances
the report "non-typical" is made, and another culture asked for; such
second culture often furnishing decisive morphological features lacking
in the first.
SUMMARY
1. Cultures are not of value in securing "early diagnosis" of suspicious
cases. In all such cases, give antitoxin first and then take cultures.
2. Cultures are of immense value in determining at leisure whether or
not the provisional clinical diagnosis of diphtheria was correct;
in the determination of whether or not contacts are dangerous,
to themselves or to others; in the search for "carriers," as
sources of infection; and in ultimate release from isolation of
cases, contacts and "carriers" found to be positive.
3. The guinea-pig virulence test distinguishes, as the culture alone does
not, between harmful and harmless diphtheria bacilli.
Page 274 THE PLACE OF PHYSIOLOGY IN MEDICINE
From  an  address  delivered  before   the  Vancouver  Medical  Association
April 2nd, 1927, by Dr. J. J. R. Macleod.
The subject upon which I am going to speak to you this evening is
one of great interest to all who have to do with medical education and
the development of the men who will be the workers of the future.
Medical education at the present time is in a condition of flux. There is
no really satisfactory medical course in any country. No one knows what
to do. Organizations such as the Rockfeller Foundation have spent
large sums of money in trying to collect data from which they can arrive at some conclusions as to what the most practical, the most rational
medical course shall be. I do not propose to take up these matters here.
You are more interested in general principles which make it quite clear
that physiology must always occupy a very central position in any
scheme for medical education. My idea of physiology—of its importance
in medicine—is best illustrated by taking an example. My example is
the more appropriate since this year we are celebrating the centenary of
Lister's birth. Lister was one of the very greatest men who ever lived in
medical science, and it is very proper that one should take Lister's life
work as an example.
Lister was a student in University College, London. Two of his
professors were very eminent scientists—Thomas Graham, the chemist
and William Sharpey, the physiologist. Lister became interested in the
purely scientific aspects of these two subjects. He did not study them as
a means to an end, but he studied them for the interest they contained
in themselves. He became a physiologist while he was a student. His
interest was such that when the iris was being removed Lister asked if
he might be allowed to take away the tissue to study the action of its
muscle, a purely academic piece of research. This was an example of research work which prepared Lister to make excellent practical use of
his later observations.
Lister became interested in the contractions of involuntary muscle
fibre. He did not complete this work while a student, but shortly after
graduation he completed it and published a paper.
While in the surgical wards of University College Hospital he became interested in gangrene and the processes that preceded gangrene.
This was a very prevalent condition at that time. Later Lister went to
Edinburgh. He was attracted there by the brilliant Syme and carried a
letter of introduction. Syme immediately saw the type of man he had
in Lister—a thorough enthusiast and yet a man. Lister was very active
in his clinical duties in the Edinburgh Infirmary, following always the
search for the causes of gangrene and suppuration and acquiring considerable surgical skill in contact with Syme.
But in spite of these arduous duties he found time to continue his
researches in pure physiology. Those of you who have read his life will
remember how he studied the flow of blood in the capillaries and then
from that went on to the subject of blood clotting. These researches
were of such merit that Lister was made a Fellow of the Royal Society
Page 275 at the early age of 30 as the reward of his brilliant reputation. But the
important point is this—research kept alive in Lister his enthusiasm for
knowledge of the scientific principles underlying the circulation of the
blood.
Lister afterwards went to Glasgow. There gangrene was more rampant even than in Edinburgh. Glasgow Infirmary was built close to the
public burying ground. To this fact and to the overcrowding of the
wards due to the sudden expansion of the city, the terrible conditions in
the surgical wards was largely due. Lister was appalled. He tried to
diminish the incidence of gangrene. At one time he got into difficulties
because he used so many clean towels, etc.
Pasteur, the greatest man that ever lived in medical science had announced his discoveries, and they were very broadly announced, of the
cause of infection. All the world knew of Pasteur's work, but there
was only one man in the medical profession, only one trained mind who
saw that these same micro-organisms must be concerned in the infection
of wounds and living tissue—only one man who saw that gangrene was
due to the action of these same micro-organisms on which Pasteur
worked. Lister was the only member of the medical profession to grasp
the significance of these discoveries. It was because he was thoroughly
trained in the principles of research.
The point I wish to make is this—that doing a piece of research
■work, however elemental, gives the mind a training which is of incomparable value in enabling it to grasp new things, new ideas. I need
not detail the after history of Lister's application of Pasteur's work.
Lister set. to work to try and find a method of preventing the development of micro-organisms in wounds. This seemed impossible and
therefore he did the next best thing—he used an antiseptic method. He
used carbolic acid. He found success, and then think of the splendid
way in which he stood up against the whole medical and surgical world
in his endeavour to convince them of the correctness of his antiseptic
methods.
But men of Lister's type do not stop at one' thing; they go on continually introducing new ideas, if not making more discoveries. Lister
became interested in ligatures. In the old practice the ligature was a
constant source of secondary haemorrhage. All sorts of things were
tried with comparatively little success. No one could discover a method
of ligating wounds without leaving infective material behind in the
wound.
Lister discovered a method and the manner of his discovery was
this: He was treating a case of compound fracture. He used to dress
the wound himself and he noticed in the tibia of this boy a splinter of
bone which was dead, but which he did not think it wise to remove. He
noticed it was getting somewhat frailer, it was becoming honeycombed,
and much to his surprise he found the whole bone had become covered
with a reddish flush. It had become organised. Granulating tissue had
grown into it; Lister, a man of experience in tissue research, immediately
grasped the significance of his observations.    If the dead bone becomes
Page 276
wm granulated and absorbed, why not use ligatures which might also later
become absorbed. He searched around and tried various things until he
tried catgut. It had been used before but not exactly with this idea in
view. Lister then spent a lot of time in finding out how it could be prepared most usefully for this purpose. He could trust no one with this
work, so Lister went to the catgut factory and took part in the preparation of the catgut for the purpose of ligation and finally evolved chromic acid catgut which was antiseptic and quite satisfactory for the purpose for which it was intended.
These two events in Lister's life illustrate better than anything else
could, what I understand by the place of physiology in medicine. I do
not think physiology has much of a place in teaching men facts. We
must teach students the principles by which these facts have been acquired. Facts get too numerous. Students cannot remember the facts
of physiology, and even if they did remember the facts they are of no
value unless they know how they have been arrived at. The object, the
objective of physiology in medicine should be to train the mind to grasp
the significance of the discoveries of science in their application to the
study of animal function. If I were asked for a definition of physiology
this is the one I should give—an endeavour to apply the principles of science in the study of animal function. It is the junction point in the development of the knowledge of medicine and surgery. It is the junction
point to which converge the principle medical sciences, physics, chemistry, physical chemistry, biology and anatomy. They converge in physiology. The duty of the physiologist is to take the knowledge of these
sciences, the principles, and- work out the application, their application,
in the study of the animal body and in the prevention of disease:
Then, in the training of medical students, the lines diverge again;
they diverge into those arts and sciences of medicine which make up
medical and surgical practice. I may make my point clearer if I take
two or three recent examples in the history of medicine, to illustrate how
the three principal sciences come together and then go apart again in
practice.
Take hydrogen ion concentration and the control of the acid base
equilibrium of the body. Very few of you in your medical course had an
opportunity of understanding what is meant by hydrogen ion concentration. You can now use the fact usefully in your daily practice, but to
understand it you must go back to the rudiments of physics. You must
understand the principles of electro-motive force; you must understand
all that is meant by positive and negative electricity and you must know
how the charges of electricity become changed—that is physical chemistry, the action of buffer substances. Then you see how far they apply
in understanding the reactions of the blood, the ability of the blood to
maintain the nutrition of the tissues, the changes which take place in
hydrogen ion concentration and how to control these changes, and, having learned these things in physiology, you take it to the clinic and learn
what is the application. The work which is being published at the present time in regard to the control of the respiration, dyspnoea rapid
breathing, Cheyne-Stokes breathing, cardiac decompensation, the changes
in the buffer value of the blood, acidosis and alkalosis—these are all com-
Page 277 paratively simple applications of those laws of physical chemistry on which
the hydrogen ion concentration depends. You have to apply these facts
more or less blindly. It is nothing compared with having done the
thing itself in the laboratory. Another example—in connection with
the ductless glands. It takes in the science of biology. Let me take the
subject of insulin. There have been doubts spread about recently as to
whether insulin comes solely from the Islands of Langerhans. It is extremely important to prove this beyond question, because if it comes from
other tissues our whole idea of diabetes becomes false again Without a very
considerable knowledge of biology it would be very difficult to get proof
that insulin comes exclusively from the islets of Langerhans. It has
been found that in certain bony fishes there is no pancreas but the islet
cells are gathered together into groups that have a definite anatomical
position. That was discovered by an Italian anatomist and then a
Frenchman added to our knowledge. Diamare and Laguesse were the
first to state definitely that the antidiabetic function of the pancreas
must be dependent on the internal secretion of the islet cells. But the
point I wish to make is this—that the study of pure biology for itself is
of immense value. I think these two examples will serve for my point,
that physiology is the junction in the medical course where the attempt
is made to apply the facts of physics, biology and chemistry in the study
of animal function.
I have heard it said that physics, biology and chemistry should not
be taught to students by men who have a medical bias. That is utterly
false. Unless the men who teach these subjects teach them as the foundations on which medicine depends, it is useless teaching them at all. The
only object of learning these subjects is to train the mind. How many
of the men working with the roentgen ray understand the physical principles? A student trained in physics grasps these principles immediately
and is better able to understand their physiological action. We must be
prepared to grasp the things of tomorrow. The same with radium, the
ultra violet rays—all becoming increasingly important in medical practice.
If we look back in the history of medicine I think we will find evidence of the importance of the discoveries in the fundamental sciences
in the advancement of medicine and surgery. With the exception of the
work done by Sydenham and his followers in re-introducing the Hippo-
cratic method in the study of disease—that is, the method of criticising,
recording and classifying—apart from Sydenham and his followers, the
work that has meant progress in the advance of medical and surgical
knowledge has depended on discoveries in the fundamental sciences.
The dawn of the modern scientific method is the middle of the sixteenth century when Vesalius published his first anatomy based on the
scientific investigation of structure, the first biology. The whole teachings of Galen were, in general, quite false and inaccurate. They were
based on faulty dissections on the lower animals and on the vivid imagination of a great mind. The old anatomy of Galen used to be taught
by the professor of anatomy, a very great man, seated on a sort of throne
with the book of Galen open before him.    In the centre of the hall be-
Page 278 low, on the table, was the body of some criminal in the process of dissection. The great anatomist could not take part in the dissection. He
simply sat and read from Galen, for the purpose of showing that Galen's
views were the right views. The whole idea was to show that Galen was
the considered authority, the body was dissected merely as an adjunct to
Galen's teaching. Vesalius attended one of these demonstrations as a
post-graduate student and soon sensed a discrepancy between what was
being read and what could be seen in the dissected body. He jumped
over the rails and with very little trouble showed that what Galen said
was wrong and what the body said was right. That was one of the
brightest spots in the evolution of medical knowledge. Vesalius overthrew authority. Galen was no longer an authority, actual observation
was the authority. Harvey also went to Padua and studied diligently
the Galenic doctrine of the circulation of the blood. These men were
not fools and yet they believed the blood ebbed and flowed. How did
they arrive at a new belief? Harvey started doing experiments on living
animals, he started vivisection, and to vivisection the medical profession
owes much. These two sciences, anatomy and physiology, were born at
about the same time, but quite independently. As it were of another
family, there was also born the new science of chemistry—biochemisty,
and the character who is responsible for attending its birth, the ac-
coucher, as it were, was Paracelsus. I think if you take all the bombast
and chicanery and mysticism away from Paracelsus, you will leave behind
a man of very keen intellect, well versed in astrology, even for his day,
and a man who had the sense to see that there was more in animal structure than they knew. He saw that there was something which supplied
energy, and he said this was a chemical. In the animal body, he said,
there are chemical processes going on which supply the energy to drive
the machine—spirits. Very few people have the patience to read Paracelsus' work. It is awfully hard reading. Most of his stuff is absolute
rubbish, but it shows quite clearly that Paracelsus did establish the idea
of physical chemistry. Van Helmont, of Belgium, working a hundred
years after Paracelsus, opened up a new science, the study of the chemistry of living processes. He speaks of the tissues as being little kitchens
for supplying fuel to the blood. He applied the quantitative method in
the study of chemical changes taking place in the animal body. But the
new science of biochemistry did not thrive; the soil was not prepared for
its growth, but the study of the functioning mechanism made great
strides. Hooke, Boyle and Mayow—these men added a great deal to what
Harvey had done. Men began to realise they must become acquainted
with these facts, and schools of anatomy were established for the purpose of studying the then known subjects of medicine and surgery and
to show how things were done.
Coming now to recent medical and surgical research. Every step
in advance in the practical treatment of disease has depended on some
scientific discovery. No one would say that we should train our students
to make scientific discoveries (though we always hope one or two will do
so). The student should be trained so that he can recognize these discoveries at their true value. He can criticize them and he can use the
knowledge in his daily practice. The general practitioner is the very man
who should be doing that.   He has to fight out his battles by himself and
Page 279 it is he particularly who should be trained to fall in with the scientific
progress of his times. Sir James Mackenzie thought along these lines.
He gave up his practice in London and devoted his remaining years to
building up St. Andrew's Institute to show the general practitioner that
he really is a scientific element upon which the progress of medicine and
surgery depends. It is appalling how little we know of the beginnings
of disease—cancer, tuberculosis, metabolic diseases. Why? Because those
who believe themselves to be trained investigators do not see the beginnings and those in general practice who do not consider themselves scientific observers, do. Mackenzie in the early days of his practice used to
note down the exact position of pain and recorded his observations on
cards. In after years he collected these cards and published a book on
the interpretation of pain. Those who followed developed Mackenzie's
method, but he started the thing going. Take the cardiograph. The observations Mackenzie started with were simple and a matter only of record, yet men realized that here was an advance in medical knowledge.
In a class of medical students there will be a certain number who
can never acquire this habit of mind, but I maintain that a very large
number of medical students could. It is no good going after higher entrance standards unless we get men with trained minds, and we should
train these men for the application of medical science to the treatment
of disease.
Finally, let me take up very briefly another phase of the subject.
So far I have been treating "physiology in medicine" in a general manner.
I have been trying to bring out the point that physiology is for the purpose of training the mind to apprehend new things and apply them.    Let
me take the application that has been made in recent years of some physiological discoveries.     The electrocardiograph  is  the  outcome of  Mackenzie's work.    The subject would not have been studied but for Mackenzie's initiative.    Very few men were trained in the procedure of action currents in disease.    Medical students look upon this as a horrid
nightmare.    If we could only get the student to realize what these action
currents are on which so many types of heart disease depend.    It is in-,
evitable that in a very short time we shall be able to use action current
in nerves to study nervous diseases and neuritis and disease in general.
Take another example, the work in metabolic diseases and in the ductless
glands.    The difficulty in dealing with the ductless glands is that a great
many physicians have not been sufficiently trained in the principles of
the method by which the function of these glands was brought to light; .
so they become erudite people who announce discoveries.    There is more
rubbish written at the present time about the ductless glands than about
anything else in medicine and it is appalling that so much of the knowledge of the  ductless  glands should have  been supplied  through  drug
houses.   We often think that the irregular practitioner is the most harmful menace to medicine, but I think these drug manufacturers who produce these  concoctions of the ductless  glands  are  worse  than  the irregular practitioner.    Pluriglandular therapy is useless and yet these drug
houses   have   been   able   to   persuade   trained   medical   men   that   these
drugs do some good.    That could not happen if we could succeed in
training our students during the medical course to be able to criticize
the type of statement these drug vendors use.    In California recently
Page 280
Jj they have been experimenting with extract of the anterior lobe of the
pituitary gland. There was not one preparation of anterior pituitary
lobe on the market that had any effect whatever. Not one of them had
any effect.
Another example in connection with the application of scientific
principles to the treatment of disease. The application of the principles
of calorimetry have, as you know, led to the brilliant researches of du
Bois and others into the treatment of diabetes and other diseases. The
treatment of hyperthyroidism is dependent on the measurement of the
basal metabolism. The physician should know just exactly what a calorie
is, he should understand exactly what its relationship is—what a unit of
electric energy is, and then if he does understand this, it is a matter of 5
minutes to look up the method. Train them in the principles of physics
and chemistry. A great deal of the measurement of basal metabolism at
the present time is not in a very satisfactory condition, due to the fact
that men do not have this training in fundamental principles. It is very
difficult to measure basal metabolism and a man cannot appreciate this
fact unless he has had this fundamental training.
But I am not here for the purpose of telling you of the best scheme
for medical education. What I am trying to do is to let you understand
why it is that at the present time we are going very slowly and very
cautiously in the development of the medical curriculum. We are teaching by old methods, we are teaching old subjects and constantly new
ones. We are not trying to teach the men principles. We are compelled
through tradition, through example, to fill in every month of the student's six years in teaching facts and not giving him time to think for
himself. I hope the student will be compelled to think—that should be
the method, and to go back to my example—Lister was trained in fundamental principles.
B.C. MEDICAL ASSOCIATION NEWS
The sympathy of the medical profession is extended to Dr. A. G.
Elvin of Ladner in the death of his wife on April 8 th.
The annual meeting of the B.C. Medical Association will be held at
the new Georgia Hotel, Georgia Street, Vancouver, on the afternoon and
evening of Wednesday, June 22 nd, concurrently with the Summer School
of the Vancouver Medical Association. The afternoon session will commence at 4 p.m. and the evening session at 8 p.m.    There will be a joint
Page 281 luncheon of the B.C. Medical and the Vancouver Medical Associations
held at 12:30 p.m. in the Georgia Hotel, June 22nd, at which the visiting
speakers to the Summer School will be our guests. The luncheon address
will be given by Dr. B. P. Watson (Professor, Obstetrics and Gynaecology, Sloane Hospital, New York).
The March meeting of the Victoria Medical Society was largely attended and those present were very appreciative of the paper of Dr. B. D.
Gillies of Vancouver. Dr. Gillies dealt with "Some Heart Conditions"
and very lucidly explained the newer knowledge of cardiac conditions
and the more recent developments in examination procedure.
The Victoria Medical Society had as its special visitor and speaker
Dr. J. G. MacKay of Vancouver at its May meeting. Dr. MacKay's subject, "Paranoidal States of Interest to General Practitioners," allowed him
an opportunity to give the members much valuable practical information.
The visit of Professor J. J. R. Macleod of Toronto University to
Victoria was the occasion for two well-attended lectures by this able
teacher. These lectures were held under the Extra Mural post-graduate
scheme of the Canadian Medical Association. At an evening meeting
held in the Library Room Professor Macleod's subject was "Metabolism"
and on the following day at a luncheon held at the Empress Hotel the
members were again given a rare treat when Professor Macleod spoke of
"The Place of Physiology in Medicine." The appreciation of the Victoria profession was evidenced by the vote of thanks and ovation accorded their guest and speaker. We are grateful to Professor Macleod
and also to the Canadian Medical Association for such excellent postgraduate instruction.
An unusually large number of economic problems have been dealt
with during the past few months by the B.C. Medical Association, and
the business office has been kept very busy. Considerable work has been
done in providing "locum tenens" and a number of permanent positions
have been filled.
Numerous enquiries have been received re medical industrial contracts, and advice to both doctors and employers has resulted in improved conditions for the doctors and a better understanding on the part
of employers.
Certain troubles have been taken up with the Indian Department.
In two cases we were able to get the Indian Commissioner, Mr. Ditch-
burn, to recommend a yearly grant and on a general complaint from our
executive secretary, Mr. Ditchburn promised to make a survey of the
province and see personally into the grievances of doctors doing Indian
work with a view to recommending at Ottawa an increase in remuneration where considered desirable. Mr. Ditchburn seems anxious to do the
right thing and has already surveyed part of the province.
Page 282 Provincial government grants in two more cases have been obtained
for "country" doctors who could not, for financial reasons, have stayed
otherwise.
We have also in hand with the provincial government the question
of payment of doctors doing work on indigents in hospital. On investigation we find this to be a big question, affecting all parts of the province. It is hoped to find some solution whereby the doctors may be remunerated for this work.
Other matters in hand are treatment of eye conditions of school
children by an irregular practitioner; payment to specialists doing Workmen's Compensation Board work for the "Marine Hospitals Service," and
we also have a committee investigating the new "Provincial Turn-Over
Tax" and its effect on the medical profession.
The executive has in hand the very important matter of a possible
appeal in the case of Seldon vs. Zambuski, the decision in which vitally
affects every medical man. The B.C. Medical Council and the Canadian
Medical Association have both been communicated with in this matter.
We would draw especial attention to the following:
If there are any members of the B.C. Medical Association who have
done examinations for the "Provident Mutual Benefit Association," for
which they have not received payment, please send particulars to the Executive Secretary, B.C. Medical Association, 927 Vancouver Block,
Vancouver.
In April, Dr. Thos. McPherson, President of the Victoria Medical
Society, and Dr. W. E. Scott-Moncrieff of Victoria, visited Alberta to
give post-graduate lectures under the auspices of th# Canadian Medical
Association. The following is copy of letter rceeived from the Secretary
of the Alberta Medical Association dated May 16th:
"Dr. McPherson and Dr. Scott-Moncrieff did us good service
at the following points: Lethbridge, Medicine Hat, Calgary, Red
Deer and Edmonton.
"Owing to the late spring and frequent snowstorms, the roads
did not permit as many outside men to motor to the meetings as
otherwise would be the case, so to that extent fewer men attended.
"The -meetings were well worth while and many favourable
reports have come to this office. An outstanding surgeon of Lethbridge said, 'It was well worth while,' Medicine Hat reported, 'We
appreciate very much the benefits received from these lectures.' The
morning clinics at Calgary were well attended but not so many men
were present at the evening lectures which were reported by those
privileged to hear them as 'most excellent.'
Page 28} "It was a great kindness for the men to take the time from
their private practice to come to the men here. We have thanked
them and we want to further thank you for your trouble in making the arrangements."
THE MECHANISM OF GROWTH
By Dr. J. Ewart Campbell. The basis of a paper read before a meeting
of the Pathological and Physiological Section of the Vancouver Medical
Association.
Growth is limited in amount and time; an animal grows so big and
stops; it grows so old and dies. Why do these events happen? Brails-
ford Robertson assumes the existence of what he calls a catalyst, a body
which is fabricated by the nucleus, acts in a synthetic manner, or literally builds up the structure of the cell, at the same time escaping constantly into the body of the cell and into the surrounding fluids. When
the quantity in the body of the cell or in the tassue fluids balances the
quantity in the nucleus or active part of the cell, growth stops. There
are very definite objections to this theory particularly from the mathematical aspect. The point of interest is that on this basis a cell's growth
is checked by the products of its own activity and apparently any cell or
tissue pursues its own destiny and achieves its equilibrium largely irrespective of external forces, p^j*?^
A suggestion of a method not very dissimilar, may be drawn from
those tissues which are always growing like the epithelium of the skin
and the cambium layer of trees. Here we may assume that the products
of cell activity are passed on from cell to cell and eventually the accumulation of waste products leads to cessation of growth.
A still simpler conception can be deduced from the behaviour of
colonies of microbes grown on artificial media. These colonies attain a
certain definite size depending on the variety of the medium and then die
or at least grow no larger. We can readily attribute this equilibrium to
an accumulation of waste products which bring about a balance of chemical forces.
Let us, however, look at it in another way. There are large animals
and small animals in this world and we might, by surveying the animal
kingdom, get some information which help us to explain growth. Leaving out the analysis and the arguments, two main facts seem to emerge.
The first is that the larger the animal, the longer it lives; the second, the
Page 284 greater its activity, the shorter its life. Activity being defined in a gross
way for our purpose as the number of movements an animal is capable
of making in a unit of time. We therefore make the deduction that the
factors causing activity are the factors which shorten life. On further
analysis activity and smallness seem to be associated with a high degree
of oxidation, or effective respiration, insects and birds exemplifying this
characteristic, and to a lesser degree, bony fishes as compared with cartilaginous fishes.
At various periods in the world's history there have been many
large animals, which have vastly exceeded in size all existing types, with
the single exception of the whale. The culmination of the gigantic
seems to have occurred in the carboniferous period. Up to this era, before there was any great development of land plants (that vegetation
which formed the coal deposits) it is possible that there was a very much
greater quantity of carbon or carbon dioxide in the air. For apart from
coal there have been subsequent huge accumulations of calcium carbonate from the shells of marine animals in sedimentary rocks. The suggestion is, therefore, made that conditions must have been utterly different from what they are today and a further suggestion that the lessened
intensity of oxidation may have favoured growth.
What, then, are the requisites for growth? Food, obviously, and not
only food, but easily available or easily assimilable food; food which can
be secured with the least effort and built up into the animal with the
least expenditure of energy. A warm, humid climate, an abundance of
rapidly- growing and succulent plants as food, subdued sunlight and no
violation or intensive oxidation should furnish a satisfactory hot-house
for forcing almost anything. Generalizing, we may say that anything
which tends to conserve energy will favour growth and that idea may be
extended to all the devices such as skin, hair, feathers and the blubber of
whales, which retain heat.
In a simple theoretical form of growth, which may be illustrated by
a tree, though not very accurately, the growth is growing away from the
source of nourishment, whereas the forces of oxidation and other influences, inimical to growth, may remain the same or even increase. Thus
there is a very different relation between nutrition and oxidation, for
want of a better word. Other factors, too, come into play, one of the
most important being surface. The larger the body or sphere the less
is its surface compared with its volume, hence a smaller cell is very much
more exposed to its environment than a larger one.
The fact remains that growth stops; apparently our clock has just
so many ticks, a series of events following one on another, and time is
our method of measuring whether they are fast or slow. Growth stops
on account of the resistance offered by the totality of the forces acting
against the cell, of which the greatest is oxidation. This term oxidation
is used in a very, loose way, for what appears to happen in the transition
from a state of growth to one of equilibrium is that the cell really loses
water, a change from a more or less homogeneous fluidity and other injuries are the cause. Put in another way, a cell which has attained its
equilibrium has developed some degree of immunity to oxidation.
Page 285 As all cells in the body acquire some degree of modification, we
may feel that that modification is the destiny of the cell. We may make
the concession, to explain the mechanism, that there is a gradual slowing
down of its activity due to the retention of waste products, like the fouling of an engine, and as its vitality, from the point of view of growth, is
lessening it becomes more vulnerable to the forces of its environment and
the cell, which is maturity. This we may presume would check all activity and no further oxygen could be utilized unless there was some opportunity for escape. Apparently that actually happens, or at all events,
many cells at maturity develop a high degree of organized or ordered
permeability, defined in muscle and obvious in gland cells. The mechanism is possibly quite similar in the solidifying of epithelium and the
ripening of seeds where water is plainly lost. By becoming permeable it
loses part of its substance, which is followed, in some tissues, by an intensive oxidation and a reestablishment of the balance.
The next consideration is what happens after a cell has reached its
equilibrium? If the whole organism has attained its equilibrium at the
same time it naturally stops growing. There is no evidence to show that
some modified primitive cell is retained in all tissues, which can commence to grow when adequately stimulated. The equilibrium of any tissue at maturity is so perfectly plain that in order to explain regrowth it
is necessary to explain how this equilibrium is overcome.
A previous attempt was made to show the method of reduction
which takes place in the formation of the sexual cells, and the opinion
was expressed that female and male were simply differences? in degrees,
and now the idea is, that there is an earlier degree of the same kind of
process which the cell must undergo before it is able to grow again. In
other words, growth of a cell proceeds to a certain size and modification
and provided the necessary factors are present a reduction, loss, disintegration in part takes place; at least the equilibrium is overcome and the
new cells resulting from this reduced cell growth until they have achieved
a similar equilibrium, other things being equal.
To be more practical, what causes the reduction? After a cell has
stopped growing the only reason it keeps alive is because some mechanism
has been developed which allows it to exist. This it does by developing
an ordered permeability. Thus the forces which check growth, in the
long run, really keep the growth alive. As the idea of permeability may
be obscure, a better way to express it would be to say that a mechanism
is developed which enables to cell to get rid of the modifications fabricated by oxidation.
It is suggested that growth in a growing tissue may be stimulated
by the products of growth, while in a tissue at equilibrium, the great
stimulating factors are the products from dead and dying cells.
The practical bearing is that there are only two profound changes
a mature cell can suffer, death and growth, and this includes the whole
of pathology.
An abscess is taken as an illustration; its wall or boundary membrane advancing by growth, although disintegration and death keep pace
Page 286 with it. The argument is made that the retained products of cell death,
even more than pressure effects and the pullulating microbes, actually
stimulate or cause the growth and so establish a vicious circle. Consequently, opening an abscess causes it to heal. This may indicate a principle applicable to malignancy and the progressive anaemias.
A common observation in any garden is the fact that many plants
when lavishly manured go to leaf instead of flowering. This implies a
preponderance of growth factors over the forces of resistance, which includes oxidations as possibly the dominating factor. These plants or
their tissues do not seem to reach their final modification as a result of an
excess or defect.
. This is even a commonplace in medicine though the stress is laid on
defeat rather than excess; examples being deficiency of iodine in the
proper development of the thyroid gland and deficient vitamines in rickets. It is presumed that all that is necessary is to supply the defect and
the tissue will take on its final modification. Apparently it does, but
the mechanism seems somewhat complicated. Indications of this mechanism are suggested in the development of bone, which is not cartilage
transformed, but a new growth on top of, as it were and at the expense
of, cartilage. So, too, with the growth of flowers on a plant. It is
growth on a growth and apparently a more modified and less vital growth.
This may be due to a more effective system of oxidation.
The conclusion we may be entitled to draw is that growth occurs
on several planes and there are always two factors to consider, one making for growth, the other checking it; but in checking it frequently a
new growth develops.
A tissue on a lower plane grows more readily and is more vulnerable,
because it is more vital; on the same principle that an epithelial scale is
less vulnerable than one of the underlying succulent cells. It has developed an immunity to the forces forming it.
Still, even a cell on a very low plane comes into some equilibrium
or balance with its environment. We cannot point to any form of
growth which is continuous, and, although we might imagine some profoundly primitive cell growing for eternity, such a cell, apparently, does
not exist. The .nearest approach to it seems a cancer cell, for a cancer
cell grows and never seems to reach finality or equilibrium.
The continuity of a cancerous growth must depend, one would
imagine, on a constantly acting stimulus. Microbic growth, however
ultramicoscopic, is unsatisfactory as an explanation, for while it may be
progressive, its usual termination is an equilibrium. Those states where
microbial infection is progressive, may furnish a clue, as has been suggested in the growth of an abscess.
In cancer, if we rule out microbes, we must supply a mechanism
which will bring about the same result. In the first place, the cells must
be stimulated to grow or rather put into a condition in which they will
grow on an adequate stimulus. Some degree of retention may be necessary, some blocking of the normal excretions of the tissue, which should
Page 287 lead to some cell death. But an atrophying tissue, a tissue which has
lost a large part of its special modification and is reduced to a lower
plane, should be in a very suitable condition to respond by growth provided some body is present to stimulate it. This stimulus could be furnished by dead and dying cells. Once growth occurs it never reaches a
balance. These growing cells are always being stimulated by the casualties following in their wake, the products of the tissue they destroy, the
destruction of the cancer cells themselves, or because no effective means
or mechanism is present to finish, oxidize or dispose of the excretions of
these new cells. They never reach the stage where they develop an outlet or achieve it accidently like an abscess. So a vicious circle is established.
This principle of the vicious circle may be the truth and may also
apply to the anaemias and other constitutional diseases.
Obviously, a normal cell must first be reduced to a lower plane of
growth, but once that lower plane is developed, in a highly complex
organism, that particular tissue may never, or only with great difficulty
or accident, attain its full development and modification again.
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Summer School Clinics
VANCOUVER MEDICAL ASSOCIATION
"Trogramme^
JUNE 21, 22, 23, 24, 1927
All meetings will be held in the GEORGIA HOTEL, opposite the Court House.
Fee, $10.00
Phone: During Sessions — Seymour 5742
Speakers
B. P. Watson, Prof. Obst. and Gyn., Columbia University, N.Y.
H. C. Moffitt, Prof. Clin. Med., University of California.
C. L. Starr, Prof, of Surgery, Toronto University.
J. G. Fitzgerald, Director, Connaught Laboratories, Toronto.
Wm. Boyd, Prof, of Pathology, University of Manitoba.
John Oille, Asst. Prof. Clin. Med., Toronto University.
TUESDAY, JUNE 21st
9-10:00 a.m.—Dr. B. P.  Watson:     The Treatment of Ante-partum  and  Post-partum
Haemorrhage.
10—11:00 a.m.—Dr. J. Oille:    Rheumatic Fever and Endocarditis.
11—12:00 a.m.—Dr. C. L. Starr:    Amputations.
- 1:30 p.m.—Dr. H. C. Moffitt:    Clinic at St. Paul's Hospital.
8— 9:00 p.m.—Dr. J. G. Fitzgerald:     The principles of active and passive Immunization against communicable diseases.
9—10:00 p.m.—Dr. Wm. Boyd:    Glomerulo-nephritis.
WEDNESDAY, JUNE 22nd
8— 9:00 a.m.—Dr. C. L. Starr:    Acute Abdominal Conditions in Childhood.
9—10:00 a.m.—Dr. H. C. Moffitt:    The Clinician's Interest in Bone Pathology.   ■
10—11:00 a.m.—Dr. J. G. Fitzgerald:    Diphtheria Toxoid and Vaccination against Diphtheria;  Scarlet Fever Toxin and Vaccination against Scarlet Fever.
11—12:00 a.m.—Dr. J.  Oille:    High Blood Pressure and- Arterio-sclerosis.
-12:15 p.m.—LUNCHEON;  B.C. MEDICAL AND VANCOUVER MEDICAL ASSOCIATIONS.
- 2:00 p.m.—Dr. B. P. Watson:    Clinic at the Vancouver General Hospital.
- 4:00 p.m.—ANNUAL MEETING B.C. MEDICAL ASSOCIATION;  First Session.
- 8:00 p.m.—ANNUAL MEETING B.C. MEDICAL ASSOCIATION; Second Session
THURSDAY, JUNE 23 rd
-Dr. B. P. Watson:    Puerperal Sepsis.    Aetiology and Pathology.
-Dr. Wm. Boyd:    Endocarditis.
-Dr. Fitzgerald:     Serum Treatment of Diphtheria and Scarlet Fever.
-Dr. C. L. Starr:    Classification of the Arthritides.
-Dr. H. C. Moffitt: Clinical vagaries of Hodgkins' Disease and Lymphosarcoma.
-Dr. B. P. Watson:    Puerperal Sepsis:    Treatment.
-Dr. J. Oille:     Chest Pain.
-Dr. H. C. Moffitt:    Diagnosis of Abdominal Tumours.
-Dr. Wm. Boyd:    Lobar Pneumonia.
FRIDAY, JUNE 24th
-Dr. B. P. Watson:    Aetiology and surgical treatment of Cystocele and
Rectocele.
-Dr. J. Oille:    The Heart in relation to Pregnancy.
-Dr. Fitzgerald:     Skin   tests   for   the  Determination   of   Immunity
Susceptibility;   their   application   in   the  prevention   of   Diphtheria
Scarlet Fever.
11-12:00 a.m.—Dr. Wm. Boyd:    The Cells of the Blood.
- 1:30 p.m.—Dr. C. L. Starr:    Clinic; Vancouver General Hospital.
8- 9:00 p.m.—Dr. H. C. Moffitt:    Tumours of the Lung and Mediastinum.
9—10:00 p.m.—Dr. C. L. Starr:    Acute Osteomyelitis.
Page 289
8- 9:00
a.m.-
9-10:00
a.m.-
10-11:00
a.m.-
11-12:00
a.m.-
- 2:00
p.m.-
3- 4:00
p.m.
4- 5:00
p.m.
8- 9:00
p.m.
9-10:00
p.m.
8- 9:00
a.m.-
9-10:00
a.m.
10-11:00
a.m.
and
and ^Headquarters for
VANCOUVER MEDICAL SUMMER CLINIC
Hotel Georgia
Vancouver's Newest and Most Modern
Corner Georgia and Howe Streets
320 Rooms
320 Baths
RATES:
Single, from $3.00 and up
Double, from $4.50 and up
Out-of-town doctors should write, or wire, for
reservations without delay
All medical meetings will be held at this
New and Palatial Hotel
DINING ROOMS
COFFEE SHOP
BALL ROOM
BARBER AND BEAUTY SHOPS
etc., in connection
TELEPHONE
Seymour 5742
J. A. WELDON,
Manager
Page 290 The Owl Drug
Co., Ltd.
Jill prescriptions dispensed
bu qualified Druggists.
l|ou can depend on the Ou?l
for Jlccuracrj and despatch.
H?e deliver free of charge.
5 Stores, centrally located.    We
would appreciate a call while .
in our territory.
Ambulance
Service
TELEPHONE
Fair. 58 & 59
M.ount Pleasant
Undertaking Co.   Ltd.
R. F. Harrison    W. E. Reynolds
Cor. Kingsuiay and Main
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.
Phones Sey. 98 8 and 672
Phones Sey. 9513 and 1391
Phone Sey. 1370
Brown Bros. & Co. Ltd.
VANCOUVER, B. C.
Page 291 -
Telephone Your
Prescriptions
SEYMOUR 112
Pays instant attention to all telephone calls . . . gives you quickest possible service in filling prescriptions . . . despatches them
either to your office or to the
home of the patient ... a careful system of checking and re-
checking every prescription received obviates the possibility of
error. Delivery by motor cycle
completes our effort to render
you assistance in the urgent requirements of your profession.
Our telephone number is
SEYMOUR  112
Thac3oi\^U^ ]||[ Prescriptions
Strand Theatre Building
618 Georgia Street West
Page 292
u Tetanus Antitoxin
<^> p. d. & CO. <™>
c^==r
Potent—Refined—Concentrated
[( HROUGH years of biological research we have developed certain refinements in
f the manufacture of Tetanus Antitoxin that enable us to offer to the medical pro-
ission a product which, we feel confident, stands alone in point of quality.
[Tetanus Antitoxin, P. D. & Co., is supreme in these important particulars:   small-
|ss of volume, rapidity of absorption, water-white clearness, and fluidity.
[And still another point,—on account of the small content of protein and total
flids, the risk of producing serum sickness or other form of protein disturbance
bm its use is slight.
[Tetanus Antitoxin, P. D. & Co., is supplied in a dose of 1500 units in bulb and
binge containers for prophylaxis, and in doses of 3000, 5000, 10,000 and 20,000
[tits in syringe containers for treatment.
Parke, Davis & Company
\United States License No. 1 for the Manufacture of Biological Products^
TETANUS ANTITOXIN, P. D. & CO., HAS BEEN ACCEPTED JOR INCLUSION IN N. N. R. BY THE
COUNCIL ON PHARMACY AND CHEMISTRY OF THE AMERICAN MEDICAL ASSOCIATION.
Page 293 The University of Washington
invites the physicians and surgeons of British Columbia to attend the
Eleventh Qraduate o^YCedical /Lectures
Five Days of Lectures, Clinics and Social Events
JULY 18-22 INCLUSIVE
The Committee has  secured  a  Faculty  of Outstanding  Scholarship:
Dr. GEORGE CRILE, of Cleveland, on "surgery"
Dr. CHARLES L. MIX, of Chicago, on "medicine"
Dr. CHARLES L. SCUDDER, of Boston, on
"fractures and allied injuries to bones and joints"
The lectures this year will doubtless be crowded; hence we ask you to secure
your ticket well in advance for fear you may be disappointed. Every effort
will be made to accommodate all out of Seattle applicants. Precedence will
be given in order of application. The fee of $ 15 covers all social events managed by the Committee as well as the lectures. Make cheque payable to
University of Washington.
Address:—
University Extension Service, Room 121, Education Hall
University of Washington, Seattle, Washington
B. Q Pharmacal Co. Ltd.
329 Railway Street,
VANCOUVER.
Manufacturers of Hand-made Filled Soluble
Elastic Capsules.
Specimen  Formulae:
No. 60—
Blaud Pill, 10 gr.
Arsenious Acid, 1/50 gr.
Ext. Nux Vomica, \ gr.
Phenolpthallin, \ gr.
No. 61 —
Blaud Pill, 10 gr.
Arsenious Acid 1/50 gr.
Ext. Nux Vomica, \ gr.
Phenolpthallin, \ gr.
Special Formulae Made on a Few Hours' Notice.
Price Lists and Formulae on
Application.
Page 294 STEVENS' 1
Safety Package
STERILE GAUZE
Soft Pure Absorbent
STERILIZED BY 20 lbs. STEAM PRESSURE
The Stevens Safety Package is designed to enable the gauze
to be withdrawn from the carton without removing the
whole roll.
READY FOR USE IN THE OFFICE
HANDY FOR THE BAG
B.C. STEVENS CO. LTD.,
730 Richard Street,
Vancouver, B.C.
PRESCRIPTIONS
filled exactly as written
Phones: Seymour 1050 -1051
Day and Night Service
Qeorgia Pharmacy Ltd.
Qeorgia and Qranville Sts. Vancouver, B. C.
Page 295 •~^e»
E*3s{^-.
Hollywood Sanitarium
LIMITED
tyor the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
"Reference | <23. Q. <£M.edica\ Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
!1<9S*»
Page 296

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