History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: August, 1937 Vancouver Medical Association Aug 31, 1937

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 The BULLETIN
OF THE
VANCOUVER MEDICAL
I   ASSOCIATION
roi.xm.
AUGUST, 1.37
In This Issue:
B. C. MEDICAL ASSOCIATION ANNUAL MEETING
September 13th to 15th, 1937
FRACTURES OF FOREARM AND ELBOW
j      ENDOCRINE DISEASES BULKETTS
(With Cascara and Bile Salts)
. . FOR . .
Chronic Habitual
Constipation
BULKETTS POSSESS ENORMOUS BULK
PRODUCING PROPERTIES AND BEING
PROCESSED WITH CASCARA AND
BILE SALTS PRODUCE BULK WITH
MOTILITY.
WE WILL BE PLEASED TO PROVIDE
ORIGINAL CONTAINERS FOR TRIAL
ON REQUEST.
Western Wholesale Drug
(1928) Limited
456 BROADWAY WEST
VANCOUVER   -   BRITISH COLUMBIA
(Or at all Vancouver Drag Co. Store*) THE   VANCOUVER   MEDICAL   ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
I Offices:
203 Medical-Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. H. MacDermot
Dr. M. McC. Baird Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address
Vol. XIII.
AUGUST, 1937
No 11
OFFICERS  1937-1938
Dr. G. H. Clement Dr. Lavell H. Leeson Dr. W. T. Ewing
President Vice-President Past President
Dr. W. T. Lockhart Dr. A. M. Agnew
Hon. Treasurer Hon. Secretary
Additional Members of Executive—Dr. J. R. Neilson, Dr. J. P. Bilodeau.
TRUSTEES:
Dr. F. Brodie Dr. J. A. Gillespie Dr. F. P. Patterson
Historian: Dr. W. D. Keith
Auditors: Messrs. Shaw, Salter & Plommer.
SECTIONS
Clinical Section
Dr. R. Palmer Chairman    Dr. W. W. Simpson Secretary
Eye, Ear, Nose and Throat
Dr. L. H. Leeson Chairman     Dr. S. G. Elliott Secretary
Pcediatric Section
Db. G. A. Lamont Chairman    Dr. J. R. Davies . Secretary
Cancer Section
Dr. B. J. Harrison ..Chairman    Dr. Roy Huggard Secretary
STANDING COMMITTEES
Horary
Dr. S. Paulin
De. W. F. Emmons
Dr. R. Huggard
Dr. A. W. Bagnall
Dr. H. A. Rawlings
Dr. R. Palmer
Dinner
Dr. G. F. Strong
Dr. R. Huggard
Dr. D. D. Freeze
Publications
Dr. J. H. MacDermot
Dr. D. E. H. Cleveland
Dr. Murray Baird
Summer School
Dr. A. C. Frost
Dr. R. Mustard
Dr. J. R. Naden
Dr. H. A. DesBrisay
Dr. A. B. Schinbein
De. A. Y. McNair
Credentials
Dr. A. B. Schinbein
Dr. D. M. Meekison
Dr. F. J. Buller
Metropolitan Health Board
Advisory Committee
Dr. W. T. Ewing
Dr. H. A. Spohn
Dr. F. J. Buller
Representative to B. C. Medical Association—Dr. Neil McDougall.
Sickness and Benevolent Fund—The President—The Trustees
V. O. N. Advisory Board
Dr. I. Day
Dr. G. A. Lamont
Dr. Keith Burwell
L Protecting Children
NOW that schools are about to reopen, physicians are
again reminding parents to have their children given
the benefit of specific protection against certain communicable diseases. This protection is highly important both for
school children and for younger children and infants.
DIPHTHERIA
The administration of three doses of diphtheria toxoid has
been found to be most effective in affording protection against
diphtheria. Active immunity to this disease is established
in well over ninety per cent, of those receiving the three injections.
| SMALLPOX
Modern technique and vaccine virus of assured potency make
possible a maximum number of "takes" with a minimum of
reactions and scars.
SCARLET FEVER
Protection as evidenced by the Dick Test can be demonstrated
in the case of more than seventy per cent, of children following their receiving five doses of scarlet fever streptococcus
toxin.
WHOOPING COUGH
Injections of a vaccine made from freshly isolated strains of
H. pertussis have given most promising results in prevention
of whooping cough. This disease provides an outstanding
illustration of the importance of immunizing children before
their attaining of school age. Often, as in the case of whooping cough, it is among the younger children and infants that
illness, sequelae and death occasioned by communicable
diseases are most notable.
CONNAUGHT LABORATORIES
I UNIVERSITY OF TORONTO
TORONTO 5      •     CANADA^. ;§ •
Depot for British Columbia
Macdonald's Prescriptions Limited
MEDICAL-DENTAL BUILDING, VANCOUVER, B. C. Smallpox   0
Scarlet Fever j  38
Diphtheria    0
Chicken Pox  119
Measles   5
Rubella    2
Mumps  105
Whooping Cough _  16
Typhoid Fever  0
Undulant Fever  0
Poliomyelitis    0
Tuberculosis  23
Meningitis (Epidemic)  0
Erysipelas  2
VANCOUVER HEALTH DEPARTMENT
STATISTICS—JUNE, 1937
Total Population—estimated  253,363
Japanese Population—estimated      8,522
Chinese Population—estimated      7,765
Hindu Population—estimated  352
Number
Total deaths    218
Japanese deaths        7
Chinese deaths        7
Deaths—Residents only    199
BIRTH REGISTRATIONS—
Male, 182; Female, 170
INFANTILE MORTALITY—
Deaths under one year of age      11
Death rate—per 1,000 births      31.2
Stillbirths (not included in above)      10
CASES OF COMMUNICABLE DISEASES REPORTED 1 i TY
May, 1937
Cases Deaths
0
0
0
0
0
0
0
0
0
0
0
24
0
0
MEMBERS of THE GUILD    f
of PRESCRIPTION OPTICIANS of AMERICA
Always Maintain the
Ethical  Principles   of
the Medical Profession
Guildcraft Opticians
430 Birks Bldg1.       Phone Sey. 9000
Vancouver, Canada.
Page 220 OF HYPERTENSIVE
HEADACHES
RELIEVED
FOR rapid, efficient and safe relief of high
blood pressure and its associated symptoms, you can rely on Hypotensyl.
This is a synergistic combination of dependable hypotensive agents—Viscum album ( Au-
ropean mistletoe) and hepatic and insulin-free
pancreatic extracts. It hastens recovery and
wins your patient's confidence.
Viscum album has proven remarkably effective for relief of hypertension (O'Hare and
Hoyt 1928, Barrow 1930 and Danzer 1934).
Frequently Hypotensyl effects a reduction of
20 to 30 mm. Hg. in 12 hours. Headaches and
dizziness vanish and.reduction is sustained.
Excellent results are obtained in cases of essential hypertension or benign hyperpiesia.
Hypotensyl is also efficacious in treatment of
high blood pressure accompanying pregnancy
or due to fibrotic kidney. The benefit obtained
from careful control of diet, as well as mental
and physical rest, is accentuated by Hypotensyl.
The usual dose is 3 to 6 tablets daily, one-
half hour before meals. Best results are
obtained when treatment is given in courses
lasting two to three weeks, with a week's
interval between, upplied in bottles of 50
and 500 tablets.
HYPOTENSYL
The Anglo-French  Drug  Company
3 54 St. Catherine Street East Montreal, Quebec BRITISH COLUMBIA MEDICAL ASSOCIATION
J PROGRAMME of
Forty-fifth Annual Meeting
%  BALLROOM — HOTEL GEORGIA
Lectures one-half hour with ten minutes for discussion.
MONDAY, SEPTEMBER 13 th
9:00 a.m.—DR. ADAMSON: "Money and Medicine."
DR. MacCHARLES : "Cancer of the Breast."
DR. GORDON: "A Study of 3,000 Cases of Obesity."
DR. OSGOOD: "Therapeutic Thinking."
12:30 p.m.— LUNCHEON—Ball Room, Hotel Georgia.
SPEAKERS : Dr. T. H. Leggett, Ottawa.
Dr. T. C. Routley, Toronto.
Afternoon Session—Demonstrations on Newer Techniques—Vancouver General Hospital.
8:00 p.m.—Evening session—Conference on Public Health.
9:00 a.m,
10:30 a.m.
11:45 a.m,
12:30 p.m.
2 :00 p.m
4:00 p.m.
8:00 p.m
9:00 p.m
9:00 a.m.
1:30 p.m.
7:00 p.m.
TUESDAY, SEPTEMBER 14th
—DR. OS-GOOD : "Recent Advances in Hematology."
DR. ADAMSON: "The Treatment of Chronic Constipation."
—ROUND-TABLE CONFERENCES :
1. Anaemia.
2. Infant feeding.
3. Fractures.
4. Gynaecological endocrinology.
—DR. HENRY: "Surgical Treatment of Intracapsular Fractures
of the Hip."
—NO-HOST LUNCHEON—Hotel Georgia.
—Conference on Contract Group Practice.
—Conference for Coroners.
—Annual Business Session of the British Columbia Medical Association.
Chairman: Dr. G. F. Strong, President.
—Annual Meeting of the College of Physicians and Surgeons of
British Columbia.
Chairman: Dr. S. Cameron MacEwen, President.
WEDNESDAY, SEPTEMBER 15th
-DR. MacCHARLES : "Some Problems of Biliary Surgery."
DR. ADAMSON: "Respiratory Sepsis."
DR. HENRY: "Fusion of Spine with Bone Chips."
DR. OSGOOD: "Hypertensive Cardiovascular Renal Disease."
-GOLF—JERICHO COUNTRY CLUB.
-ANNUAL DINNER—B. C. Medical Association.
This year an innovation is planned in the way of round-table conferences. Four
of these will be held simultaneously at 10:3 0 a.m. on Tuesday, September 14th, in
adjoining rooms at the Georgia Hotel. It is hoped that the men coming to the meeting will indicate in advance which of these round-table conferences they wish to
attend. It is further hoped that these men will send in advance questions to be
discussed at this conference. Experience elsewhere has demonstrated the value of
these round-table conferences for the consideration of troublesome or difficult
aspects of the subject.
Page 221 ^^^, |g!f;;',.";. EDITOR'S PAGE
We have been reading with great interest and pleasure the report of the
Committee on Ethics, made to the Canadian Medical Association at its recent
meeting in Ottawa. The Committee was under the chairmanship of the late
greatly missed Dr. D. A. Stewart of Winnipeg, who died shortly after completing this report, which he virtually wrote. It is, as one would expect from
Dr. Stewart, something of a literary gem. It is adorned and pointed at every
step by quotations from his wide reading in every field, and every Canadian
physician—indeed every physician, for our craft knows no national demarcations—will read this with delight. It is not only a pleasure to read, but it
covers nearly every legitimate question of ethics that may arise, and gives
a positive and categorical statement of conduct, based upon very high ideals.
Professional ethics is to many men something of a mystery, and they honestly
feel at times somewhat befogged as to the path they should take; anxious
and willing-to go the way of honesty and straight-dealing, they may yet be
sincerely puzzled as to the correct behaviour in a given situation. Hence the.
need for a simple, clear, and lofty standard to guide us in our doings with
each other, with our patients, and with the world at large.
. The difficulty seems to.lie in the fact that there are two distinct problems : the first, our own personal standards of conduct and honour; and the
second, the duty we owe to others, and by others, we mean not only the
patient, but our fellow-practitioner. It is in the reconciling and blending of
what are sometimes rather divergent obligations and responsibilities that
the difficulty lies, as we all know. How to attain our primary object, the
welfare of the patient, without injury and wounded feelings as regards our
professional brother, is sometimes a problem exceedingly difficult of solution
—and a general rule cannot be found to cover all situations, though a general
principle may Underlie all solutions. Here a specific formula is an inestimable
aid and comfort to us.
Some people tend to dismiss the need for a code of ethics as largely
unreal, and to take the attitude that such a code is unnecessary for the honest
and sincere physician, and no deterrent from unworthy conduct for him who
will not play the game. Yet all through the ages men have sought for guidance in these things in all sincerity, and have welcomed a simple and direct
code, and it is of real value.
Dr. Stewart and his confreres open their draft with a reference to the
Golden Rule, and perhaps this covers everything; certainly even an approximate observance of this, the ne plus ultra of human conduct, will settle every
conceivable question that may arise, in the right manner. Yet a vague reference to this would have been useless without the details that follow, so
carefully worked out. And a generalisation is not always immediately helpful.
For ourselves, the Gentleman's Psalm, as the 15th Psalm has been called,
has always seemed to contain a perfectly adequate code of ethics, and its
observance to be of quite sufficient difficulty to keep us busy—especially "he
that sweareth unto his neighbour, and disappointeth him not, even though it
were to his own hindrance." We feel that this one item constitutes quite a
code in itself.
The Report embodies that beautiful thing, the Prayer of Maimonides,
which all should read who practise our art of healing. We regret that space
could not have been found for the "Essay on Disease and Physicians" of
Ecclesiasticus the son of Sirach, than which, in our humble opinion, nothing
more beautiful or challenging has ever been written. Perhaps on some future
occasion we might print this in the Bulletin. We are sure the effect could
only be good.
Page 222 NEWS AND NOTES
Mrs. Helen Temple Mursell of Johannesburg, South Africa, widow of
H. Temple Mursell, O.B.E., M.D., F.R.C.S.E., visited the Library with Dr. N.
McNeil, who is her nephew. Mrs. Mursell is a great-great granddaughter of
John Hunter.
Dr. E. J. Gray has recently been awarded the Order of Knight Commander
of St. Gregory, an honorary title awarded by the Holy See, and held by only
two or three men in Canada.
* *      *      *
Dr. and Mrs. L. H. Leeson are receiving congratulations upon the birth
of a daughter on July ii.
Dr. A. C. Frost expects to move into offices at 621 Medical-Dental Building
about the first of August, and will have associated with him his son, Dr.
Gardner Frost. Dr. Gardner Frost has recently completed five years' postgraduate work at Montreal, Johns HOpkins and Gray's Hospital, New York,
specializing in gynaecology and obstetrics.
* *      *      *
Dr. Frederick E. Saunders, son of Dr. E. H. Saunders, has opened offices
in the Medical-Dental Building, and will confine his practice to gynaecology
and obstetrics. Dr. Saunders, who was senior interne at the Vancouver General Hospital last year, did post-graduate work prior to that at the Strong
Memorial Hospital, Rochester, New York.
* *      *      *
We regret to note the passing of Dr. G. H. Woodland, who died on
Wednesday, July 21st. Dr. Woodland came to Vancouver in 1932, from
Medicine Hat. He was a graduate of Dalhousie University. He became a
member of the Vancouver Medical Association in 1933 and since that time,
has been a familiar figure at Association meetings. His kindly disposition
won for him many friends. We extend our deepest sympathy to his widow.
Drs. J. R. Naden, H. H. Boucher and D. M. Meekison attended the meeting
of the Western Orthopaedic Association in Seattle on July 28th, 29th and 30th.
* .      *      *
Dr. J. P. Ellis of Lytton has been on vacation during the month of July.
* *      *      #
Dr. H. O. Smith, who has been an interne at the Vancouver General
Hospital, carried on the practice at Lytton as locum tenens during Dr. Ellis'
absence.
Dr. J. C. M. Willoughby of Kamloops has returned from a two months'
sojourn in Eastern Canada and the United States.
.      *      .      *
Dr. L. G. C. d'Easum, of Atlin, was in Vancouver and called at the office
of the Executive Secretary.
I
Dr. T. W. Sutherland of Wells, while in Vancouver last week, called on
the Executive Secretary and discussed conditions at that centre.
* *      *
Dr. MacKenzie Morrison of Stewart and Miss Cherrie Campbell of Vancouver were married at Stewart on July 16th. This popular young couple has
the best wishes of the profession.
Page 223 BRITISH COLUMBIA MEDICAL ASSOCIATION
Forty-fifth Annual Meeting
Ji SPEAKERS
DR. J. D. ADAMSON, Associate Professor of Medicine, University of Manitoba.
DR. BURGESS GORDON, Associate Professor of Medicine, Jefferson Medical College, Philadelphia, Penn.
DR. MYRON O. HENRY, Orthopaedic Surgeon, Minneapolis.
DR. M. R. MacCHARLES, Department of Clinical Surgery, University of
Manitoba.
DR. EDWIN E. OSGOOD, Faculty of Medicine, University of Oregon.
DR. T. H. LEGGETT, of Ottawa, President, Canadian Medical Association.
DR. T. C. ROUTLEY, of Toronto, General Secretary, Canadian Medical
Association.
SPECIAL NOTICE
LIBRARY HOURS IN JULY AND AUGUST
During the months of July and August the Librarian will be
on duty from 9 a.m. until 5 p.m. instead of from
10 a.m. until 6 p.m.
I   LIBRARY NOTES    j|
RECENT ADDITIONS TO THE LIBRARY
Miller, W. S.—The Lung. 1937.
Holt, L. E., and Howland, J.—Diseases of infancy and childhood. 1936.
Sheldon, W.—Diseases of infancy and childhood. 1936.
Bridges, M. A.—Dietetics for the clinician. 1935.
Levy, R. L.—Diseases of the coronary arteries and cardiac pain. 1936.
St. Clair Thomson—Diseases of the nose and throat. 1937.
Fritsch, E., and Schubart, M.—Short-wave therapy. 1937.
New and non-official remedies. 1937.
ADDITIONS TO THE NICHOLSON COLLECTION:
.    Hartley, P. H. S.—Johannes de Mirfeld. 1936.
Freud, S.—Problem of anxiety. 1936.
Supplements to the OXFORD SYSTEM OF MEDICINE include the following :
A new article, "Tumours of the Cutaneous Glomus," by Dr. O. T. Bailey.
A new article, "Functional Gynaecological Diseases, by Dr. Emil Novak.
A new article, "Sarcoidosis," by Dr. W. T. Longcope.
In addition to the above an entirely new Index has been issued, with
supplementary sheets, in a looseleaf binder, which is a great improvement
on the old one.
THE NELSON LOOSE-LEAF SYSTEM OF MEDICINE has also recently
issued a number of new articles, and revisions of old articles, which include
the following:
"Pituitary Cachexia," by W. W. Herrick.
"Leukaemia," by C. E. Forkner.
Page 224 "Inflammatory diseases of the gastro-intestinal tract," by Stockton Kimball.
A new index has also been issued for the Nelson System, completely
revised, with corrected references to all seven volumes.
Attention is drawn to three volumes of the British Encyclopedia of
Medical Practice, which have been left in the library for inspection through
the courtesy of the agent.
EXECUTIVE  SECRETARY'S  TOUR,  JULY,   1937
In July Dr. Thomas made a hurried trip by car to Revelstoke and down
to Oliver, returning by Princeton and Merritt.
The majority of the doctors visited are planning to attend the Annual
Meeting of the British Columbia Medical Association in Vancouver in September. He reports doctors more optimistic and general conditions improved.
There is no panic regarding conditions in practice. There is need for more
adequate provision for payment for medical care for those who constitute
the doctors' indigent problem. The hospital schemes in operation in many
inland hospitals have been very helpful in providing for hospitalization and
have made it easier for those who contribute to pay other bills incidental to
illness. In several cases it has placed the hospitals' finances in a safer and
sounder condition.
Roads are all passable and much actual road-building is in progress. We
take so much for granted in these days that we fail to appreciate the difficulties encountered and largely overcome in building highways through those
mountainous districts. We should be grateful and less impatient.
A visit to the Okanagan Valley and other points rolled up fourteen hundred miles on the speedometer of the Executive Secretary of the College of
Physicians and Surgeons. He visited Dr. H. O. Smith at Lytton, where the
latter is relieving Dr. J. P. Ellis, who is holidaying at the Coast and enjoying
the Alaska trip. The new hospital at Lytton is worthy of a visit by any doctor
who passes that point on the Cariboo Highway. You are warned not to pick
too hot weather for such a trip.
Doctors J. S. Burris, M. G. Archibald, H. L. Burris, J. C. Willoughby and
F. P. McNamee were all at home at Kamloops, Dr. Willoughby having just
returned by motor from the East and reported an enjoyable trip. Dr. R. W.
Irving was away at his summer bungalow at Celesta on Shuswap Lake, and
had taken a few horses along to preserve a congenial atmosphere in the camp.
Dr. Stewart Wallace, who had been to the Summer School, was carrying on,
and Dr. Ireland, who is always working, was keeping Dr. Bramley-Moore
interestingly busy, while Dr. and Mrs. H. L. Stalker are happily established
at Tranquille. While at the Sanitarium, Dr. P. M. Wilson was seen and his
many friends will be glad to hear of his remarkable progress to recovery.
He admits weighing thirty-five pounds more than at any period of his life.
He mentioned many friends of college days and would be cheered by chatty
notes from any or all of them.
At Chase, Dr. Scatchard was at home and still carried on cheerily and
actively. A visit to Dr. Scatchard and his charming wife takes one back to
England and refreshes both them and you. The Little River fishing camp was
crowded and good catches at this unusually sporting spot were recorded. The
mosquitoes are not the only good biters at the boat camp.
Dr. A. L. Jones, the genial president of the No. 4 District Medical Society,
was affably enjoying the heat and talked things over with the Secretary on
the top of Revelstoke Mountain, where an altitude of 6,200 feet provided a
somewhat cooler atmosphere and a scenic wonderland of floral landscape and
snow-capped peaks. He and the secretary of the District Society, Dr. Hamilton, are already laying plans for the Annual Meeting at Revelstoke. Dr.
Page 225 Strong, who has been associated with Dr. Jones during fourteen years, is
moving to Vernon. His friends will wish him success in his new field.
Salmon Arm afforded a warm welcome and cherries of unrivalled flavour.
Dr. Alan Beech having left on vacation, Dr. S. E. Beech was alone in the
practice but as cheery as ever. Dr. Harry Baker has been at Salmon Arm for
several months and is making a good neighbour, rather than a competitor of
the Doctors Beech. There appears to. be sufficient work attracted to this
centre to keep all three happily engaged.
At Enderby, Dr. Roy Hangen has already settled; himself in the community and has taken-up the good work where Dr. Helem left off when the
latter moved to Port Alberni to be associated with Dr. C. T. Hilton. Dr.
Haugen misses his former friends at Alexis Creek, but both he and his wife
are enjoying the associations in the larger centre.
At Armstrong, Dr. Shotton, in spite of the hot weather, took time out to
conduct a visit to the farm of Dr. W. B. MacKechnie, and it was a delight
to see a once busily successful physician and surgeon applying that same
energy and an acquired knowledge and skill very profitably to animal and
land husbandry, Rows of fine Jersey cattle and Percheron horses were quite
as sleek-looking as the big boar and the wee piglets. Every domestic'animal
may be seen on this farm. The fields of grain, which extended to the horizon
on all fronts, provided a colourful background for the horse show when Dr.
Shotton led a two:year-old Clyde-Percheron before the admiring group. One
could not be just certain which was doing the leading, but there was considerable prancing around the farm-yard and the Armstrong profession was
doing some clever footwork to protect his shoe-leather. A colt of six months
or less forced himself into the fashion parade and seemed very interested in
Dr. Shotton's clothing, which was originally spotless. This colt was almost
as high as the background of corn—the tallest seen along that road. Dr.
MacKechnie looks well and apparently has successfully retired from practice, although he is still pressed into service for advice and assistance, having
lost none of his former acumen.
At Vernon, the departure of Dr. S. G. Baldwin will leave a gap in the
profession there, as also in the hearts of the people. During his eighteen years
at Vernon Dr. Baldwin has seen the population grow markedly—at the rate
of over 200 babies each year during the last few years. Dr. Osborne Morris
is still very hale and active. He and Doctors Harvey, Baldwin and Pettman
joined the group for a chat on medical affairs at the Vernon Club. Dr. Campbell-Brown was absent on a vacation.
Kelowna appeared to be all in the Lake on Sunday—the beach being
black with boys, and girls too. Dr. Boyce enjoys good health and is still very
active, with Dr. Riba Willetts relieving him of the more strenuous demands
of practice. Dr. Knox was holiday-minded and so attired. He took time for
a visit to the Aquatic before the ferry left for Westside.
Peachland, where Dr. Buchanan still provides for the medical needs, produces the most succulent cherries. Later the peach crop in this section is of
remarkably fine quality. The weather gods staged an electric storm but fortunately with no accompanying hail to bruise the young fruit.
Dr. F. W. Andrew of Summerland was at home and keeping cool on the
verandah of his lake-shore residence. One looks across to Naramata, where
Dr. Glen Campbell and his family were spending part of the summer vacation.
Dr. Vanderbergh and family were at their lakeside home. Two happy children, Mary and John, no doubt prove an inspiration to Mrs. Vanderbergh,
who writes successfully for several periodicals.
Penticton was reached that evening and Dr. R. B. White as usual was
at the hotel with the hand of welcome. Dr. George Paine was seen and is
enjoying better health. Dr. McGregor was back in practice, having recently
returned from post-graduate study. Dr. Parmley and Dr. Walker were seen
at the hospital on Monday morning before leaving for Oliver, where Dr. Ball
Page 226
ml reported improved conditions. Everyone appeared optimistic in the cantaloupe section.
Having taken Dr. White back to Penticton, Hedley was next visited.
Dr. Gordon Wride has just taken over a new office in this thriving little
community which is the hub of a very marked mining activity.
At Princeton Dr. "Dan" McCaffrey was visited and is really enjoying
the improved conditions in Princeton. He told of a lake so high on the mountain tops that one could hear the angels whispering. It is cold and affords
good fly-fishing. He thinks doctors should go up there, suggesting that it is
the nearest to heaven some will ever approach. The profession in this province
cannot get along without the Doctors McCaffrey in Princeton, Chilliwack or
Agassiz.
Dr. R. J. Wride, with the help of Dr. Gordon Wride at Hedley and Dr.
Paul Phillips at Princeton, is handling a large mining group practice successfully. Paul is still insistent that it was a heavy patient who wrecked the
examining table.
At Merritt, Doctors J. J. and Austin F. Gillis are serving that centre, and
Dr. J. J. Gillis had just come in from the ranch where these prize cattle are
herded. Dr. Gillis does not always have a bull beside him on his daily rounds,
but it is quite true that one did come into the driver's seat from the truck
last month.
Very considerable interest is being-shown in the Annual Meeting of the
Association and College on the 13th, 14th and 15th of September—and
especially in the newer features of round-table conferences on scientific
subjects, the demonstrations of newer technique and the meetings for Health
and School Officers, for Coroners, and the conference on Contract Practice.
The Committee in charge is warned that several ladies have already signified
their intention to attend the convention.
GOLF—-Annual Tournament
BRITISH COLUMBIA MEDICAL ASSOCIATION
j FORTY-FIFTH ANNUAL MEETING
SEPTEMBER 13 th, 14th, 15 th, 1937
Dr. J. P. Bilodeau, the Chairman of the Committee on Golf,
reports a long list of very excellent prizes in addition to the
TROPHY OF THE B. C. MEDICAL ASSOCIATION
Low Handicap
(Presented by The Mead-Johnson Company)
Other prizes of quality for all classes of golfers open to
all Who register.J
The name of Dr. "Joe" Bilodeau is synonymous with
successful sport.
Golf Tournament—Wednesday, September 15th, 1:30 p.m.
Page 221 FRACTURES OF BOTH BONES OF FOREARM
Db. Paul B. Magnuson
(Given at the Vancouver Medical Association Summer School, June, 1937).
This question of fracture of both bones of the forearm I am beginning to
dread more than any other thing, because we can get up and talk about it
and draw pretty pictures about it and tell just how it should be done, and
the next case comes along and it doesn't work. It is very difficult to handle,
and there are good reasons for it.
In the first place the forearm, with its two bones, one rotating around the
other, should be, I think, considered as two separate bones engaged in two
separate series of movements. The ulna should be considered an extension of
the arm downward and engaged in motions of strength at the elbow; the
radius should be considered an extension of the hand upward and is engaged
in motions of dexterity. And I think that this gives us a pretty good picture
of the bones of the forearm.-Now these two bones are surrounded by muscles
which are extremely active—the most active group of muscles in the body.
Think of the dexterity that the mechanic, the artist, the watchmaker, the
pianist, and so forth, develop in those muscles in the forearm. There are no
muscles that are as sensitive to irritation, that react more promptly to
stimuli, than do these muscles. They are highly sensitive and for their size
are very strong. The tendons which activate the motions of the fingers from
the muscles of the forearm are as sensitive a set of tissues as any in the body
—subject to inflammations, adhesions and other injuries. Then, instead of
having muscles which are parallel to the long axis of the bones, we have
four muscles at a distinct angle; and these muscles don't tend to separate
the fragments. They have a constant tendency to pull the fragments towards
each other.
So there are many mechanical reasons for our inability to reduce fractures of the forearm. There is one other thing, and that is, the fascia that we
spoke of surrounding all the muscles of the forearm starts at the elbow and
runs to the wrist, in general in about that position (diagram). Now, granting
a fracture of these bones somewhere between the elbow and the wrist, what
happens? Haemorrhage. These bones are both well supplied with blood, and
whenever they are broken they bleed freely. Immediately that bleeding starts
it descends within that fascia and the first thing that happens is, instead of
a long sweeping curve, almost a straight line from the elbow to the wrist, we
have a bulging fascia which is ballooned out by haemorrhage. Then we try
to reduce these fractures. What do we have to do to reduce them? We either
have to rupture this fascia or stretch it. The minute that this haemorrhage
occurs there is shortening due, not to the inability of the muscles, but to the
distension of the fascia which now forms two sides of the triangle instead
of the hypotenuse. We all know, who have operated on these fractures, that
even with a lever between the ends of these fragments, one has to be extremely
careful in putting on pressure after the thing is bent, because the traction
is so great, and the force of the stretch puts on so much power, that the ends
of these fragments can be easily broken in pieces, so that pressure must be
put on very easily and very slowly. Here is a diagram of some of these troublesome muscles. The pronator quadratus gives us more trouble than the pronator teres. These two pronators are the two lower pull muscles. The two
supinators are the muscles above. We have been taught to put these muscles
in mid pronation. Bring the fragment which can be controlled into alignment
with the fragment which cannot be controlled.
In fractures of the radius without fracture of the ulna, there is practically always a rotation to deal with. In addition, in a fracture of the radius J
without a fracture of the ulna, there is one thing that always happens that
we have not considered enough and that is that the radius is always shortened
in relation to the ulna (,. and when the radius is shortened in relation to the 1
ulna, the thing that is disarranged, unless that radius is completely reduced
Page 228 to full normal limit, is a disarrangement of the radio-ulna joint. So that in
these fractures it is important to have a complete and accurate reduction.
If it cannot be obtained by closed means, then certainly by open means. In
this type of fracture we have a lot of problems to deal with. The ulna in this
position is probably caught in some way by the interosseous membrane. It
is important that the fragments of both these bones be completely reduced.
We have all had the experience of having good reductions and then in a
week or ten days begun to see them angulate because of those tremendously
active muscles of the forearm, and that happens in spite of open reduction
and fixation. Those muscles work twenty-four hours a day as this picture
shows. This patient's hand is merely a "flapper" now and he came to us four
years after his accident to have it amputated. This simply illustrates to what
extremes muscles will go in their contraction to a point where the strength
of the muscle is balanced by the pull or counter-traction. In this case we
didn't amputate the hand. We shortened the ulna and obtained fairly good
reduction. He came out with a hand that was useful although it wasn't strong.
The muscles were counterbalanced by the radius coming down and impinging
on the carpus and the ulna coming down and impinging on the carpus, and
a satisfactory result was had from operation,
Now, in fractures of this type, where we have a long spike or a little point
of bone, we have to do one of two things. These fragments either have to be
angulated into position, or else one must do an open operation. I have come
to believe that if we cannot succeed promptly with a closed reduction (incidentally, this is the kind of operation where the Roger-Anderson apparatus
is most effective if used correctly), then we should resort to open operation
and fixation. I have always felt that a surgical approach to these things does
no damage and we have.no more danger of infection later than in the application of pins, etc. Here's another type which is physically impossible to
reduce and hold in reduction by any sort of splinting. In the old days, before
the Kirschner wire, I used to use this apparatus (diagram) with much
success.
Immediate reduction is imperative, for you can do much more with reduction in the first hour than in the next twenty-four hours. The steady gradual
traction is the thing that is necessary in all fractures. Traction always
implies counter-traction, and I think most of us provide for the counter-
traction before we start putting on the traction, and I like to use what we
have at hand where we happen to be. In the days when I did a lot of reduction
work, we didn't have Hawley tables, which I think for the most part are
unnecessary for the reduction of fractures, and we got along with a lot of
things that we can pick up anywhere. You can always get a couple of illeys,
a sheet, a clothes line and usually a bed or a long table around any house.
We must reduce these fractures on the spot, and a local anaesthetic is about
the best I know. Novocain gives a beautiful anaesthesia with no danger of
infection and perfect relaxation of the muscles. In the first place we should
get our patient where we know he is going to stay, and then a hitch for the
forearm (a simple muslin bandage loop). The thing that reduces fractures
is a slow, gradual, steady pull. I put my foot against the side of the table,
with a loop of muslin around my shoulder, and then I have both hands free
to manipulate. I think these simple methods are effective, if for no other
reason, because you can do them on the spot, and, after all, the reduction of
fractures is important on the spot because it becomes increasingly difficult
as time goes on.
This picture was put in to show you what does actually happen with these
muscles. Here is a youngster, and when these x-rays were made she had had
three operations for a fracture of the lower third of the radius. Those operations had been done by men who knew how to do them. There had been no
infection, no trouble, and I believe the doctor when he told me that he had
those fragments in perfect position when that patient left the operating room
table. He had x-rays to show that they were in perfect position. He had done
Page 229 a.bone graft and held it with wire because the bone was so small that had
he drilled a hole big enough to hold anything else, he would have created
another fracture. Notice the angulation and the shortening of the radius in
relation to the ulna. Notice what the pronator quadratus has done. All
because of the pull of those muscles. Now, what are we going to do ? Shorten
that whole arm up, or lengthen the radius? We lengthened the radius by the
use of two Kirschner wires. We held the graft on and these pictures show
the arm after operation. That was done some ten or twelve years ago, and
now she has a perfectly straight arm although she has a good deal of scarring.
The bones, however, are satisfactory. But it would have been perfectly
useless to go into that radius without getting extension first. Here's another
of the same type in an adult. That case, also, was put in traction and
straightened out and subsequently an operation was done where we put in
a wedge-shaped bone graft held by ivory pegs and two pieces of wire. This
one illustrates very well what happens in a fracture of the radius without a
fracture of the ulna. I use a good heavy felt pad around each side of the
wrist to support it and allow those ligaments to heal.
(Several other slides were shown of different types of fractures of both
bones of the forearm.)
Just a word about Colles' fractures. I have always felt that the reason
we didn't see more perfect reductions in simple Colles' is because, as a whole,
we don't like to do damage. We don't like to use too much force on patients,
but with the Colles' I think we ought to reduce them so that they are like a
bag of bones and then they are easy to manipulate. They are very simple but
they have got to be broken up. You can't get extension until the impaction
is broken up, and I think this trick is very helpful: Put a sling around the
carpus and, with the thumbs over each fragment, break that impaction up.
Then straight traction downward and when the fragments come opposite
each other with the hand bent back, then bring the fragments into locking
position, and I don't know of any fracture that is easier to maintain in
position than this Colles', which we see so many of and in which we see so
many bad results. After that, a good tight felt band around the wrist, one
piece on each side of the wrist.
ENDOCRINE DISEASES
Dr. Leonard Rowntree
(Given at the Vancouver Medical Association Summer School, June, 1937).
I have been asked to talk on the subject of "Endocrine Diseases" this
morning. Investigations in the laboratories and in the clinics throughout the
world have tended to make unprecedented progress in this field of medicine
during the last two or three decades. Fancies are being dispelled and facts
established. Now I think that I can discuss this subject (which is a very big
one for an hour's talk) best by resorting to a series of slides. It will conserve time and facilitate the lecture.
I did not intend to speak on the subject of the thymus gland, but two individuals have asked me if I would say something on that subject and express
my viewpoint. I have been tremendously interested in this subject for four
years, and at a little later time in this series of talks we will discuss the
thymus much more in detail. We believe we have succeeded during the last
four years in establishing beyond a question of a doubt one function that
the thymus plays physiologically and biologically. It has to do with the rate
of development of the body, and we find that it is possible to stimulate
growth tremendously or to retard it very remarkably by variations in its
activity. This morning I am just going to touch on the subject very briefly.
This slide shows a very beautiful picture of the thymus and one can see how
important its size may become from a .standpoint of chest substance and
pressure. Now, of course, the clinician's interest has centred mostly on the
Page 280
P. thymus at birth and within the first few days or weeks of life. We know a
good deal about the variations in the size of. the thymus, about its continuous
role to the point of, puberty, but we are uninformed as to its normal size at
birth. Some authorities place it as low as 4 to 5 gms.; others as high as 19
to 20 gms., and it is,absolutely essential for us to establish the true normal
size at birth. I am one of those who, because of four years' work in the subject, believe it is a mistake to overdo the treatment of the thymus. glq.nd with
X-ray at the time of birth or shortly thereafter. I hare seen or have had
called to my attention 20 or 30 children who have bad this treatment. We are
doing one of two things .professionally. We are either unwittingly X-raying
the thyroid, or producing effects which we do not understand, and cannot
control. I am just going.to leave this thought with you. I am one of those
who is very definitely in favour of the use of X-ray where the indications
for its use are clean-rcut aud where it.is well to reduce the size of the thymus
gland, but I believe that many children are given treatment unnecessarily;
I believe that too much treatment is given in many instances and it would
be better to use less X-ray, to use it less frequently, and.in smaller doses.
The reason for these statements will become apparent in another lecture.
Now to turn to the ovary. It took thousands of workers decades to establish the facts revealed in this slide—the maturing of the ovum, the early
corpus luteum. That had to precede mechanical knowledge. Now we have,
so far as the ovary is concerned, at least six hormones fundamentally concerned. We. have folliculin, made by the ovary itself, lutein which reduces
the thickening of the uterus, and we, have from the pituitary prolan A which
has to do with the stimulation of .oestrin production and Prolan B which
brings about changes of the Graafian follicles and causes production of
lutein. Now in pregnancy the .pituitary secretions prolan A and B are formed
in superabundance. They flood the tissues of the mother, and they play their
role in the development of the foetus but drain off as prolan A and B in large
quantities in the urine. So we may have a source of anterior pituitary
secretions derived as products from the urine of pregnant mothers. This is
a piece of work that I think is exceedingly fundamental because it explains
many things. It is possible to show that the ovaries can be tremendously
affected through the implant of a fresh pituitary gland. Here we see the
normal size of ovaries and here hypertrophied ovaries, the result of too much
pituitary. This revolutionises our ideas, because we have never taught in
terms of hormones in relation to atrophy and hypertrophy. The pathologist
must consider both absence, decrease or excess of hormones in many cases
of either atrophy or hypertrophy.
Before leaving this subject I might say that theelin itself is, of course,
of tremendous value in chosen cases of amenorrhcea. Progestin is just coming
up for investigation and is used in habitual abortion. These Other substances
have a very wide interest.
When we come to the male organ we have the presence of two substances.
And we have a substance or hormone known as androtin which is soluble
and has to do with the prostate and seminal vesicles. This substance may
have a very considerable effect in hypertrophy of the prostate, which is
so common in elderly men. Then we have inhibit, which is soluble and,
affects the pituitary and adrenals, and this is also being used now by
probably ten million workers throughout the country to see its effect upon
the enlarged prostate. Dr. Lahr and his workers have felt that it is capable
of control, and if it proves to be the case—it is not yet proven—then it will
become a very important substance in the prevention as well as the control
of hypertrophy. This slide shows a case of hypogonadism and you can see
that in addition to the atrophy of the testicles we have a tremendous increase
in the growth, particularly of the extremities. Now androtin is supposed to
be effective in the development of the gonads, but has not get been proved
to any great extent. There is a peculiar division of nature whereby as the
gonads develop the growth hormone ceases to act or is retarded in this action
Page2Sl but with the absence, of development of the testes we have the continued
growth of the arms and legs.
Now this is a picture so familiar that you have all made the diagnosis.
In my own opinion, a glance—if you know endocrine diseases—often gives
you the diagnosis. But here we have a typical picture of exophthalmic goitre.
There has been tremendous progress in the management of these cases by
iodine, with the improvement in surgery and the management of exophthalmic
goitre itself. This type of disease, where complications exist, would preclude
operation but respond in many instances to the influence of the x-ray. This
is one of the commonest of the endocrine diseases which is missed mostly.
We have a textbook concept of myxcedema and it is missed so frequently
that it is almost unbelievable.
A doctor from Chicago, very prominent, was the patient of a professor in
one of the schools in Chicago and for twelve years was treated for scleroderma, with no thought of myxcedema. He came to the clinic and I said, "Is
it scleroderma or myxcedema?" He was on treatment about a month when
he met a doctor in Chicago. The doctor said, "You'd better go back and let
the boys see how you look." It was unbelievable. He was a doctor and in the
hands of a professor for twelve years. We must keep myxcedema in mind.
In the adult it is extremely important, but it is frequently missed in children.
It just makes the difference between a self-supporting, happy citizen and an
inmate of an institute for feebleminded.
Now, this is cretinism. I have been told that many people do not believe
in the efficacy of treatment. I saw a case 33 years after treatment was
started. She was the sole support of her entire family and had won a prize
in the New York sales contest. She might have spent her life in an institution
for feeble-minded and a little treatment was all she needed to make this
difference. Now, these are very unusual pictures of a group of juvenile
myxcedema and cretinism. The cretins stand out very sharply. This is a
juvenile myxcedema with a very low rate and the feeblemindedness will be
given treatment almost immediately. We have to remember that the brain
does practically all of its development in the first seven years of life, so
treatment must be started at the time when the brain stilLhas a chance to
grow. Myxcedema in the adult and in the child is overlooked repeatedly. A
patient that I saw in California about three weeks ago was brought in, after
having been under the care of an endocrinologist of international fame. I
didn't think there was any pituitary disease in this child. She was dwarfed
immensely. She had been on rather large doses of thyroid and pituitrin. I
made one simple change. I dropped the pituitrin and increased her thyroid
to all she could tolerate. She grew 13 inches in less than a year. It shows
what the thyroid can do in the management of juvenile myxcedema.
The pancreas has brought us great things in our time. Of course we are
familiar with diabetes mellitus. On the laboratory side we know the importance of hyperglycaemia. And then recently we have begun to recognize hyperinsulinism, with marked changes which may go on to a coma, or simulations
of insanity. Most of the cases have mental changes. Dr. Banting, a Canadian,
made the greatest gift to medicine of anyone of our day. Now the requisites
for the adequate treatment of diabetes mellitus include general training and
special knowledge in the field, laboratory equipment, close clinical supervision of the case, diet kitchen, scales for weighing the patient, a thorough
knowledge of insulin, and also a knowledge of when and how much glucose
should be given. Now this (shewing slide) is the ordinary effect on blood
sugar of insulin. This is the protamin preparation which acts much more
slowly. It has a very definite advantage in that it is important from the
standpoint of time. We have always had great difficulty in diabetes at night
because of the changes and sudden fluctuations. These changes may be
equally great but are much slower in onset so that we can control the diabetes
at night. Dr. Scott has recently introduced the zinc preparation and zinc
seems to accelerate greatly the value of insulin. These are all clinical investi-
Page 232 gations and are important contributions to insulin therapy. This chart shows
the fluctuations with ordinary insulin, this with the protamin preparation.
Insulin is good not only in diabeter. It is used in anorexia but recently with
too prolonged use and too much may lead to a serious disturbance of sugar
metabolism. In removal of tumours for hypoglycaemia you may have to administer insulin. We have learned quite recently the value of insulin in the treatment of dementia praecox and this may be an important advance in nervous
disorders, just as the use of insulin was an advance in metabolic diseases.
Now, in hyperinsulinism we must know the symptoms. Patients often have
weak spells, they go to sleep and have convulsions. There is relief by eating
and aggravation by fasting and exercise. We must study it further until its
true nature is defined. I look back to my early days in practice and remember
cases that I thought were hysteria but I now know were nothing but hyperinsulinism. The essential for diagnosis is first the hypoglycaemia and then
the immediate relief with the administration of sugar. Here is an extremely
interesting episode which happened not long ago. I was called out while at
dinner. A patient suddenly had gone crazy, so they said, and they had five
or six people holding him. There was a little girl at the door and I said, "Do
you live here?" and she said "Yes." I said, "Does your mother get this way
often?" She said, "No, but she has been sick. She has got diabetes." I said,
"Did she have any insulin?" She replied, "Yes, she had some half an hour
ago." I said, "Go and buy a cake of chocolate and hurry back." That little old
woman was shaking and trembling, the bed was shaking. We gave her one
five-cent cake of chocolate and in ten minutes she was alert and bright. The
whole case was one of hyperinsulinism induced. We must always bear this
thing in mind, but it is sometimes spontaneous. The relief of that is sometimes
brought about by sugar, but the treatment is much more difficult. A fat diet
is effective to a certain extent. Many patients are subjected to operation and
occasionally tumours are found. This is a chart which shows the sudden
change which.may occur in this connection and in many others in the endocrine section. There is present a tumour. We removed that tumour and in this
particular case, one of hyperinsulinism, we had our patient within a very few
hours in a state of diabetes. Now, that has raised a surgical question of great
importance. Large numbers of patients have died within a day or two of
removal of tumour and surgeons are now removing at the time of operation,
or just before or just after, the very substance for the excess of which they
have operated. The removal of the excess brings an acute deficiency and this
acute deficiency may prove very serious unless it is met by the hormone which
is now lacking.
This is a case of parathyroid disease, tetany, in a child. We have s_en
tremendous progress in the management of tetany and in this field Dr.
Pollock played a very great part, as well as Dr. Hansen. Nowadays, cases of
this type, juvenile tetany, are managed much more readily than they were
years ago through the use of calcium and parathyroid extract. Here is a
patient that I observed at the Mayo Clinic. She said, "Eleven years ago I
came to the Clinic with a diagnosis of enlarged thyroid. I went home. My
local physician removed this tumour. Within three days I felt peculiar. I
had noticed tingling in my hands, I had spasms in my hands and generalized
convulsions." We put her on calcium, all she could take. I told this woman
that if ever we get something better I would get in touch with her. So I wrote
to Dr. Pollock. He sent me on some of his preparation and we administered
this. The blood calcium is back to a normal level. When I came in one morning
she said, "Doctor, this is the first time in thirteen years that I have felt like
myself and I feel perfectly well this morning." Tetany, particularly postoperative tetany, is, unfortunately, more vague. I have seen a great deal of it
in patients who have had their thyroid glands partially or completely
removed. Very rarely does the doctor in charge treat the patient for tetany.
He is usually interested in the B.M.R. Just recently I had in Philadelphia a
very prominent surgeon whose mother had her thyroid removed. It was a
Page 238 case of hypoparathyroidism. Others believe that once it is present it is not
easy to handle. You have to make many adjustments and particularly adjustments in the spring, in March, April and May. Calcium should be given in
full doses by mouth, intramuscularly or into the veins. And usually once you
get calcium back to normal you can cut down your parathormone injections
both as to amount and as to dosage. Now, this parathyroid substance is good
in tetany and in surgical removal of the parathyroid. This is a picture of a
case of hyperparathyroidism in the Philadelphia General Hospital. He was
a young chap, 6 ft. 2 in., a healthy chap. He saw innumerable doctors and
was treated for practically every disease. An interne, when he came on the
service, thought it a most pecular case. He suggested to his chief that this
might be a parathyroid tumour. The boy had lost 27 inches in height. He had
two or three operations on his parathyroid and then he had corrective operations on his arms and legs. Though he is 27 inches shorter, he is relatively
well. The most interesting case in this field was a.doctor. He had much the
same experience as this boy but it was not so rapidly progressive. He was
going upstairs and broke three fingers. He was telling a friend of this and the
latter suggested he might have hyperparathyroidism. He had an operation
and is back in practice and says he is entirely well.
This is a group of cases that we saw at the clinic, showing the various
lesions, and most of these patients do very well, but it is wise to have the
operation, here as in other cases, as early as possible and before permanent
damage is done.
Now, the next group of diseases are those of the suprarenal glands. We
have medullary tumours and here we have neuroblastoma with multiple
metastases. The radiologists make these diagnoses. Then we have paraganglioma, which gives an intermittent paroxysmal hypertension and this
may pass over into a permanent hypertension. Then we may have under-
function of the gland. Then there is a condition called hyperadrenalism or
hypoadrenalism.I don't know if it exists and I never saw it myself. Doctor
Severinghouse reported that there are certain cases of weakness that do
respond to this form of therapy. Now, this is a typical instance, one of the
children in the Clinic, of pubertas praecox, a little chap of thirty months with
tremendous development of the gonads with a large tumour in his abdomen.
He was sent to me for x-ray treatment. Treatment must precede metastases
and should be done early. Here is a case of masculinism. I have seen several
of them. It is due to a tumour of the cortex. It is a lovely young lady. She
has atrophy of the breasts, atrophy of the uterus, enlargement of the clitoris,
a male voice. Treatment is easy if the diagnosis can be made. V-ray is not
vefy effective. However, complete removal by surgery gives a complete cure.
One case which had removal of the tumour has now had nine years' perfect
health. We had a child operated on with this same condition about two
months ago. In making a diagnosis and determining which side the tumour
can be palpated, if you show up the pelvis of the kidney you can see the displacement of the kidney and that points the finger to the tumour site.
Now, this is a case in point, because we have to discuss a diagnosis in
this group of patients. There are five different lesions that present the same
picture. This is a person I saw in consultation, one of tumour of the cortex.
I went up and agreed with him in everything the doctor said. We operated
on the patient and it was a hypernephroma. This case is a typical clinical
picture. She doubled her weight while she was getting ready to die of a
malignant tumour. It causes the patient to eat and put on weight. What else
would produce this tumour? They are not tumours of the cortex but are
adenomas of the pituitary. Now, a renoblastoma of the ovary «an produce a
picture which is almost identical and, in addition, an adenoma gives us a
clinical picture which is hard to differentiate. You have often arterial hypertension. Hypertension is not lacking in this picture and disappeared with
removal of the tumour of the cortex. In addition, Clayton has described some
of these cases which were due to a tumour of the thymus gland. This is one
Page 23k of the peculiar individuals, a child with the body senile, an aged individual,
and with hypertensions. This, also, is due to a cortical adenoma and can be
corrected by removal of the tumour. This is an exceedingly interesting thing.
This is supposed to be the opposite of what we have been looking at; the
very same type, and such cases have been described and from that cause.
I had recently two most interesting cases. One was a boy who had been
accused of rape and was sent to a prison for men. When stripped he was
found to have very beautifully shaped breasts. Trouble started immediately.
They asked if they could send him on and I suggested that the family would
have to decide. Now, of course, we have not infrequently a combination of
Ovary and testis. The results in this boy I cannot tell you yet. We have
another boy who has normal male gonads. He is about 16 and has tremendous
breasts, perfect in formation. We have obtained a large quantity of the male
sex hormones and try to overcome the female sex activity. We believe the
breasts are decreasing in size. This is a patient that was my patient and was
operated on. She was a nun. She was said to have neurasthenia. The doctor
at the clinic said that it was not worth while wasting time on. Her attacks
would last for a half to three hours. I saw her in one of these attacks and
she was desperately sick. We found a blood pressure of 280/180 when she
was in one of these attacks. Dr. Charley Mayo was the third doctor I had
called and he removed a mass that was impinging on the left kidney. There
was a complete and absolute cure of this patient. She is now going on ten
years without a symptom. There have been quite a number of these cases
described before this, but there have been quite a number described with
removal of the tumour with complete cure since this case. This slide shows
the tremendous fluctuations that ihay come in the blood pressure in cases of
this type. This is all due to the work of Swindell. He laid great stress on
the effect of the cortical hormone on the blood volume and on the distribution
of the various elements. Then Dr. Ledd recognized the importance, not only
from the standpoint of the volume of the blood, but the water is also markedly
affected. This is a case of Addison's disease. This patient was 17 years with
Addison's disease and died several months ago. This shows in Addison's
disease the calcification that can be identified in the adrenal glands and
which usually suggests the etiology of tuberculosis. It is possible to increase
the sodium in patients and this brings out an increase in clinical manifestations and an increase in the level of the urea. The clinical manifestations of
Addison's are usually fatigue and pigmentation. A little later comes anorexia
and vomiting, then loss of weight, then dizziness, hypotension, then the crisis.
This usually led to death in the old days. Nowadays in the treatment of Addison's disease we have made very great progress, and taken a tremendous step
everywhere. This recognition of the part sodium played has put another effective weapon into our hands, and now it is possible, by pushing the amount of
sodium given, to keep a patient in much better condition than we could before.
Safety lies in the daily use of small amounts of cortical hormone in Addison's
disease. I think it is a mistake to depend entirely on salt, and many of the
diets are unnecessary. In the crisis we use large doses of cortical hormone:
in the course of the disease, small doses; and then the ordinary form of
treatment, general care. Always we must think of tuberculosis, which is
present in 85 per cent of the cases. The cortical hormone is unquestionably
the most effective of the substances that have been brought up. When we
administer the cortical hormone we get a disappearance of anorexia, an
increase in weight, a decrease in blood pressure. Pigmentation may exist but
it decreases somewhat. We have many patients who have marked increase in
bodily resistance and a desire to go back to work, and I have several patients
who are at work now. This patient is an aviator, an unquestionable case of
Addison's disease. Now this is a patient that went through a double pneumonia. By increasing the cortical hormone, we found no increase in his
pneumonia.
We occasionally run into a case of Addison's disease which resists treat-
Page 285 ment. Here is a typical case that resisted treatment. This is a patient of
so-called hypoadrenia, treated without any effect whatever. I think that some
of these are hypogonads.
Now, there is a new form of hormone, a new form of endocrinology. You
all remember that back in 1925 Whipple used liver in anaemia. They used this
liver in pernicious anaemia with good effects. We have here this beautiful
clinical experiment which brought the pernicious anaemia and achlorhydria
to a state of cure. They brought about a cure. We must not forget that pernicious anaemia is a deficiency disease. This must be an unusual type of
hormone, and I think we are going to have to change our concepts of hormones. A very interesting piece of work has been done by Morse. He suggested that there is an excess of this hormone playing a role in polycythemia.
Next we come to the pituitary. There is a great deal of progress but a
great deal of confusion. We have a basophilic cell, an adrenotropic, and many
others have been isolated. I don't know that all of these substances are formed
in the pituitary. The pituitary must have some peculiar function. It seems
unlike nature to duplicate in the pituitary what she has done<in other organs.
Here is a giant and a dwarf. Supposedly the pituitary gland is playing a
part in each case. We have always thought this to be a matter of pituitary
function. We can show just as remarkable changes before puberty from
thymus excess. Here is a normal animal six days old compared with a five-
day-old animal with excessive thyroid; 100 days old and weighs less than
one-fifth of the normal. The most remarkable thing is that the animal of 100
days old is less in weight than the five-day-old one. The thymus and pineal
are concerned in the rate of development and growth, and they will some day
have to be brought into their correct position. Gigantism of this type usually
suggests a tumour of the pituitary. This is familiar to you all. We see very
remarkable changes in the bodies of these infants. We used to wait until
blindness came on; now operation gives much more satisfactory results and
is done at a much earlier date. This one is a case of basophilia. Notice the
distribution of fat and the peculiar stride. These may respond to x-ray or
to surgery. This case is of a girl with the same type of body, also one of basophilia. This is a case of Frederick's disease. This one is not easy to treat but
is easy to recognize. One can produce very definite changes in the gonads and
in the distribution of fat. This is a type in pre-adolescence where treatment
is given. I think most of these children will effect a normal puberty. This is
Simmon's disease, where the whole pituitary has undergone atrophy. She
undergoes bodily and moral disintegration. Large doses of the whole pituitary
over long periods of time have effected almost a cure in one or two instances.
Now, then, anterior pituitary and growth hormones have yet to be related
to the thyroid and thymus, and then we have prolan A and B. Undescended
testes are very common. Some cases are hastened in their descent with
pituitary treatment. They should have medical treatment for six months.
Diabetes insipidus is helped by pressing the posterior lobe hormone. This
shows the tremendous effect of one dose of pituitrin when given subcutaneously. There is no effect when given by mouth, no matter how large a
dose. Here is a group of cases showing how usual it is to get good effects, but
unless you have a very marked diabetes insipidus, the patient would rather
put up with the disease than submit to a prolonged treatment.
This is the last case that I will show. This young lady was sent to me
with the statement that she had put on weight very rapidly and that no
doctor in the world could cure her. The story was that at 11 years she
menstruated and menstruated every two weeks, and when she was nineteen
she put on 40 to 50 pounds. We tried this patient on diet. We tried dehydration. We took off from this girl, through the use of ammonia salts, 50 pounds.
She can't combat her weight except by this. She has had very marked
improvement as the result of dehydration. This was water retention and not
fat, I know. Now, I think that is all that we will show at the present time.
In conclusion, I would like to leave one thought—that there has been
Page 286
m great progress, that we are getting rid of fancies, that we are establishing
facts, but the final proof in endocrinology rests with the clinicians. Only the
clinicians can handle cases. The treatment is specific, which means that if
an endocrinological deficiency is not met by the specific hormone that is
lacking, the patient will not be properly treated. Progress has been so great
to date that I believe it will pay every doctor to familiarize himself with the
present status of endocrinology, that is, for the benefit of the patient.
FRACTURES OF ELBOW IN CHILDREN
Dr. Paul B. Magnuson
(Given at the Vancouver Medical Association Summer School, June, 1937).
The greatest number of fractures in this region are not into the joint. They
are above the joint and probably the commonest fracture of children. They
are so common that I think every one of us who has been in practice for any
length of time has been up against one or more. They are probably the
simplest fracture in any long bone to reduce and there should never be any
disability of the elbow following supracondylar fracture of the elbow in
children.
There are complicating factors in these things as there are in all other
fractures. Probably the greatest of these factors is swelling. They swell
tremendously, and if put up in fixation as they should be, sometimes you
have to be careful to watch and maybe take them down, maybe extend them.
The simplicity of the reduction is quite apparent. We are dealing with a very
small musculature. The mechanics of the thing is simple. This first slide
is a diagram of fractures into the joint. This type of fracture does not occur
always in children. The condylar fractures in children are quite common.
Here the epiphyses are affected and if these are not reduced into their normal
position, the growth of the bones is changed. These condylar fractures always
involve the epiphysis on side or the other and I think a thing we haven't
thought of enough is that the elbow is a wide joint and thin from front to
back, and it has two bones articulating with one bone and those two articulations have the same centre but not the same centre of rotation, not the same
size of diameter or radius of rotation. Now, if one of these condyles is fractured and displaced even slightly forward, one bone rotates around this
circle and the other bone will rotate around another circle, the centres of
which are changed in their relation. Now, one can see that with lateral ligaments holding these two bones in relation to the humerus, if those centres
are off we soon come to a place where the lateral ligaments are thrown into
a twist and those ligaments themselves limit flexion and extension. It isn't
bone necessarily blocking the radius on its course around the lower end of
the humerus or bone blocking the ulna, but it is the fact that when these two
bones come into play they are thrown into a twist and haven't enough elasticity to allow the elbow to come up and, consequently, one or the other bone
is thrown out of line and the ligaments pull tight and prevent motion. Therefore it is important to have absolute anatomical re-position in these fractures that involve the condyle either in adults or children. It is more important
in children. These fractures are so easy to mis-diagnose in the x-ray. That is
the greatest trouble that I have with them—getting the x-ray at an angle
which will give a true picture. It is easy to rotate them so that it may look
in the x-ray perfectly reduced and yet one condyle may be % inch forward
of the other. Well, that may be y± iuch forward at the age of six and a long
way further forward at the age of ten, so that these disabilities constantly
increase and give a rather serious disability in the future. In the adult it
simply acts as a block to complete flexion and extension depending on the
degree of disalignment of these two centres. So that the x-ray after reduction
is extremely important and should be taken, in my opinion, at varying angles,
moving the tube at maybe four angles around the elbow, and see that the
Page 231 condyles are perfectly lined up, and one gets a perfectly transverse lateral
view of the lower end of the humerus. And then one can manipulate to get a
more perfect reduction under the nuoroscope by flexion or extending the
arm, or someone holding the humerus and using the leverage of the forearm
to push or pull one condyle forward. In some of them it is impossible, unless
one gets, them very quickly after injury, to reduce them perfectly. If one gets
them very quickly it is surprising how easy they are in most cases to get back
by slow general traction and manipulation. We have an area here where the
bones are easily felt and if one can get them in the first half hour or hour, one
can feel those bones and manipulate them.
We are all familiar with the carrying angle and of course this is only an
indication of the arc around which these bones rotate. The supracondylar
fracture occurs with the hand outstretched. The lower fragment is carried
backward and usually somewhat upward. The triceps pUll it upward and the
force of the blow carries it backward. Now, if this child falls over with the
fracture already created, serious damage may be done to the blood vessels
or the median nerve. I have never seen the radial nerve injured, but I have
seen the medial nerve injured. The terrific haemorrhage that one usually
finds in these cases is not due to the blow to the lower fragments but to
damage to the blood vessels from some of these sharp fragments. We had a
certain amount of disabilities following these things. This swelling does
cause tremendous distension of the fascia and it is perfectly possible. I have
seen three cases which I am sure would have resulted in serious disability
had not the fascia been opened and the pressure of the blood clot within the
fascia removed, because the hand was pulseless and was beginning to show
the effects of serious pressure even though the arm had not been put in
flexion; and I saw two cases in Boston this winter where it was necessary to
open the fascia and relieve the pressure occurring there. So that the swelling
that occurs in these things is of primary importance and also the care of
the patient immediately after this reduction. These things are not difficult
to reduce if they are allowed to go even a week. Of course they are much more
difficult as time goes on but they can be perfectly reduced. I have never seen a
case where it was necessary to operate on a supracondylar fractur in a
child but got a perfect reduction. Inasmuch as this is a wide joint, very thin
from front to back, it sometimes is very difficult to get apposition which is
completely 100 per cent perfect. There is very frequently a little bit of
rotation so that these wide and thin from front to back surfaces are caught
on each other so that there is a little rotation, but that doesn't affect the
function of the arm. The disalignment is simply a little rotation. Of course,
when one gets 45°, that is something else and would probably interfere with
the function, but not 10° or 15°. As long as the thing is in apposition it is
sufficient. This diagram shows a nice even fracture which I have never seen,
because they are usually jagged. Here is the worst thing that I have ever
seen as a result of a supracondylar fracture in a child. That child was hurt
three blocks from a hospital, taken into the hospital, the arm was supposed
to have been reduced, patient kept in hospital twenty-four hours and then
discharged. She had great pain and was taken back to the hospital three
times on the days following her first discharge and the hand had become
blue and swollen and the doctor said that was alright, and on the third day
the fingers and thumb were gangrenous; the cast was taken off by someone
else and this is what happened—complete amputation of the fingers, a terrific
slough of all the tissues and the contracture. This of course is an extreme
case but is one that shows to what extent interference with the circulation
will progress in these children. There is no excuse for it—not the slightest—
because if this thing begins to show pressure on the circulation as a result
of haemorrhage, then slitting the fascia on each side and allowing that
haemorrhage to escape will be the procedure. Usually these things come as
a result of flexion of the elbow in the presence of swelling, with compression
of the arteries in this region and shutting off the circulation with contraction
Page 238 following. Those are the things which we must guard against. You probably
know how to reduce these things better than I do, but there is a little test
that I have for testing satisfactory reduction which has been very helpful and
useful to me. With the same old bandage, with the bandage around or under
the arm, we put this child on a table or couch or something where you know
he is going to stay put, and of course he has an anaesthetic, usually a general
anaesthetic, but of course children are frightened, and they struggle and make
things very difficult. But I have reduced these things with general traction
without any anaesthetic at all. The child is on the table with the sheath under
her or some individual that the child has confidence in so that he stays put.
Then we just lean back gently, massaging around the posterior surface of the
humerus with our fingers. While we are doing that we are gently pulling,.and
the muscles in a child's humerus are very easy to tire out. These muscles do
not have the tendency to contract that these forearm muscles do. So we lean
back gently, pull back slowly, and ease these muscles gently to where they
belong. Then the thumbs can be placed on the lower end of the upper fragment in front and with the fingers behind this lower fragment has been
pulled down far enough so that you can, with that motion, push the lower
fragment forward and then, with one hand around here, with the thumb
just above the olecranon and the fingers over the other fragment, the arm
is brought up this way, pulling on the lower fragment, and we pull it slowly
up and slip out of the bandage loop. Now they will come to right angles without being reduced. Now my test for this is as follows: With the thumb—if
the arm comes up with that much pressure—the thumb simply presses the
elbow into flexion and if the arm comes up, allowing for the swelling, 105°
(15° above a right angle), I consider that that is satisfactorily reduced. If
the lower end of the humerus comes down to its lower curve, those elbows
will always come up to 105° without any pressure. Now an x-ray is made
and we will find, maybe, that the fragment lies in that position and this
fragment crosses it a little bit like that. What's the difference ? That amount
of rotation here will be convexed by the rotation in the shoulder and they
hold better if they are just a little bit crosswise. You take an A.P. view in
that position and, of course, the bones are all overlapping. I never put a
cast on these things. I put on a splint up here and one up there and bind them
together with the arm in 105° to 110° of flexion and leave the hand entirely
out because a plaster cast around the thing obscures the elbow and one
cannot examine it from time to time. It is nice to keep a little powder in
between these skin surfaces and be able to feel the fragments. If the child
is up and around, if you don't have a splint on, the upper end of the humerus
cuts in. Anything that holds the arm up in flexion will maintain this fracture,
because the lower end of the triceps moulds around the posterior surface of
the lower end of the humerus and acts as a posterior splint, and as long as
that triceps is pulled tight and the lower end of the humerus is pulled forward, they will stay that way.
Now this is an extremely common form of injury in children (slide shown)
—a fracture of the condyles which changes the position and direction of the
epiphysis. The reading of the x-ray in children is quite a chore sometimes
because at various ages they look quite different. In old cases we have occasionally done this. It is a gamble. I would never take an epiphysis out if there
was any way of preventing it. You can always do an arthroplasty or something when the patient grows up but I would never take that epiphysis out.
In the last six months I had a case come in which was sent from a city a
little distance from home, in which there had been advice to have that
epiphysis removed because it was blocking the elbow. We felt that there
ought to be some rearrangement of the elbow made, and the parents consented to have this operated on. So we took this fragment completely off and
had an x-ray taken immediately to see where it should be put back on. We
Page 289 then screwed it in place with an ivory screw and the lateral x-ray picture
showed good position.
Now, about fractures into joints. This boy had a comminuted fracture—
a "Y" fracture; here is the case on admission about one hour after the accident. And I can?t impress too much upon you that the time to reduce fractures
is right now. Fractures are emergency. This other x-ray was made the next
morning. I reduced that fracture with traction. Now there is a little stunt
that we do in these cases of fracture into joints. A piece of felt which is
stiff enough can be cut as is shown on the diagram. Then it is used as shown.
That piece of felt holds the thing down where one wants it. The arm is suspended and held at right angles. Now, if you get these fractures early enough
and use this apparatus, they mould right into place. And in these fractures
you don't need over ten pounds of traction.
IMPORTANT NOTICE
APPOINTMENTS and CONTRACTS
Members of the College of Physicians and Surgeons of British
Columbia ARE REQUESTED NOT TO APPLY for any APPOINTMENT or enter into negotiation with reference to any CONTRACT
without having first communicated with either or both:—
DR. A. J. MACLACHLAN, Registrar,
COLLEGE OF PHYSICIANS & SURGEONS OF B. C.
or/and DR. M. W. THOMAS, "Executive Secretarys
COLLEGE OF PHYSICIANS & SURGEONS OF B. C.
NOTES ON C. M. A. MEETING AT OTTAWA
To say the least, the meeting was in every particular a success. Registration was in the neighborhood of 1,600, with nearly every Province well
represented, particularly Ontario. British Columbia's delegation included
Dr. Herman Robertson, retiring president of the Association. Let me here
remark that Herman performed the duties of his high office with distinction,
doing credit to the profession here, but we must not forget the capable
assistance of a very charming hostess in the person of Mrs. Robertson. Others
from British Columbia present were: Drs. Howard Spohn, Neil McDougall,
Wallace Wilson, G. F. Strong, Don Cleveland, W. D. Kennedy; Eric Boak,
Victoria; Wallace Bagnall and Arthur Bagnall, a recent graduate from
Toronto; Ethlyn Trapp, just back from Europe; Dr. Barrett, Victoria; W.
S. Kergin, Prince Rupert; Otto DeMuth, and the writer. Dr. H. E. Young
was in Ottawa at the time attending the Canadian Public Health Convention,
which immediately preceded the C.M.A. meeting.
Weather was fine in the main—just a little warm in spots—and Ottawa
looked its best. One can readily appreciate why "The Fathers" chose the
former "Bytown" for the capital of Canada. One rather warm evening during
convention week, Dr. Bazin, Dr. Neil McDougall and the writer chose to miss
some of the doings at the Chateau for some much-needed exercise and fresh
air. We selected the park behind the hotel for our wanderings and eventually
found a comfortable spot to rest at its farther end just above the entrance
to the bridge across the river. What a sunset! The broad expanse of the
Page 2^0 Ottawa immediately in front of us, with Chaudier Falls and the Gatineau
in the distance, Capitol Hill and its imposing buildings on our left, and the
Laurentians away on Our right. With two such companions and in such
surroundings I'll gladly play hookey anytime.
The entertainment, for everyone, including the kiddies, was all that could
be desired. Garden parties, dinners, luncheons, golf, drives around Ottawa
and district, were delightful to say the least. The Governor-General came
especially to Ottawa from Quebec to address us at luncheon on Wednesday
and to grace the ceremonial that evening with his presence. Altogether it was
wonderfully arranged, and Drs. Leggett and Patterson and confreres from
Ottawa are to be highly complimented on the success of the whole undertaking. Dr. Leggett, new president of the C.M.A., and Dr. Routley will be with
us at our B. C. meeting in September. Before passing to other items, let me
here note that the Ford Motor Co. of Canada placed at the disposal of visiting
doctors and their wives both cars and drivers for their convenience while in
the city. I hope Dr. Patch has occasion to read this.
Commercial exhibits were arranged on the main floor of the Chateau
Laurier in very convenient locations and were very attractive. There were
78 booths in all; only lack of cash prevented my coming back with a trunk-
load of new instruments, books, etc. On warm afternoons one could quench
one's thirst with a cold drink of orange juice with vitamin W, Coca-Cola,.
Heinz tomato juice or Vi-Tone—there was really no occasion at any time
during the convention for drinking just plain ice-water.
The scientific exhibits, some 50 all told, occupied one large room, and
they were certainly worth while. There were two. from the Mayo Clinic, one
from the Lahey Clinic of Boston, several from the Connaught Laboratories
and the University of Toronto, and several from the Montreal General Hospital and McGill University, and many more excellent ones that space does
not allow mention of here. Suffice it to say that if one did nothing else but
study the material presented in these scientific exhibits, one's time would
have been well spent.
The scientific sessions were excellent. In the main there were twenty-
minute papers, the curtain dropping sharp on time. With so many sectional
meetings on at the one time, one was able to take in about a tenth of what
one actually wanted to hear, but that is the fault of large conventions and
there is not much can be done about it. One has the consolation of knowing
that the main papers will be published in the Journal later. With a fairly
comprehensive programme available on the start in which a brief outline of
the substance of each paper is given, one can budget his time well enough to
get in what one most wants to hear, and a little private chat with the speaker
afterwards helps too. At this point I would like to mention that excellent
contributions were made by the visiting speakers from Great Britain, France
and United States. Drs. Spohn, Cleveland and Wallace Bagnall were amongst
those who gave papers.
In the September issue of the C. M. A. Journal the proceedings of Council
and the two executive meetings will be published in detail, so my comments
on these must necessarily be brief. The General Secretary's report on his
trip abroad, where he made first-hand study of National Health Insurance
schemes, particularly that in Great Britain, was most interesting and instructive. We are assured that he will tell us more about it from time to time in
the pages of the Journal. He also visited other European countries on this
study, notably Germany and Denmark. In view of the new activities to be
inaugurated by the C.M.A. in the matter of Cancer Control he also investigated methods of cancer control in the various countries in Europe which he
visited. In a short experience on the executive one is struck by the enormous
amount of work done for the C.M.A. and the profession of Canada by such
Page 241 men as Dr. Geo. Young, chairman of the Executive and Council, Dr. Bazin,
Dr. Patch and others, and their great interest in the work. The Executive session before the Council meeting was one continuous grind, on account of the
volume of work to be covered. Few of us saw the outside of the hotel from
Thursday night until Sunday morning. The suggestion was brought up in
Council, and previously in the Executive session, that regional subexecutives
be established, where a lot of detail, particularly that of local importance,
could be thrashed out, in order to lessen the enormous amount of work of the
Executive sessions. The regions suggested were: Western, to include the four
western provinces; Central, to include Ontario and Quebec; and Eastern, to
comprise the three Maritime provinces. It was also suggested that Associate
Secretaries of the C.M.A. be established in each region with a sub-office of
the Association. The matter was passed to the new executive for study and
report. Other matters I can merely mention here, but which are particularly
important, were Dr. Harvey Agnew's report on interneship; Dr. Wallace
Wilson's report of the Committee on Economics, in which the principles laid
down in the report of the Economic Committee of the C.M.A. at Calgary in
1934, so often quoted, were considerably modified, and Dr. Strong's motion
re pasteurization of milk; also Dr. McEachern's report of the Study Committee on Cancer. The discussion on Federation was particularly interesting,
and I think Federation was advanced to some extent at the meeting. The
Executive and Council again affirmed its attitude of full support to the profession of British Columbia in its struggle over Health Insurance. I am sure
all will find the reports in the September issue of the Journal most interesting.
Next year the meeting will be in Halifax, and with Dr. K. A. McKenzie,
our new President-elect, and his confreres in Halifax in charge of arrangements, I have no doubt that anyone who decides to make the journey there
will be well rewarded. How about motoring down and taking in the eastern
coast of Nova Scotia and the GaspS afterward, and following the Trans-.
Canada Highway back to Old Quebec? It is certainly worth thinking about.
Altogether the convention at Ottawa was a delightful experience; to
meet many old acquaintances that I had not seen for nearly thirty years was
more than worth while, and to have participated in the discussions that face
medicine in Canada was a privilege I have greatly appreciated; and I take
this opportunity of thanking the profession of this Province for the privilege
accorded me this year of being their representative on the Executive. Dr.
Strong, British Columbia's new member on the Executive Council, will
represent us this year we know, just as well as his name implies, but I hope
he stays out of that aeroplane.
Harry Milburn.
RE PASTEURIZATION OF MILK
The resolution passed at the Annual Meeting of the Canadian Medical
Association in Ottawa, June, 1937, is published for your information:
Whereas raw milk may be the means of transmitting various'types of
serious infectious diseases such as bovine tuberculosis, typhoid fever, undulant fever, scarlet fever, diphtheria, septic sore throat, etc., and is a major
factor in higli infant mortality; and
Whereas it has come to our attention that there are many areas in
Canada where raw milk is still distributed and sold:       *±.\   >,w
Be it resolved that this Association go on record as endorsing the compulsory pasteurization of all milk offered for sale.   ..j$$
Page 242 TTT1
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L.1BVMA
Dr. P. ASTIER LABORATORIES
36-48 Caledonia Road, Toronto 111111111111111 r ■ 111111 ■ 11 ■ ■ i
i ii in 11 in iiiiiiii mill tiiiiiiin ill iiirniiin inn iiiiiniiiiii i
S'r.
•Vs.
"It is increasingly evident, from a communal
standpoint, that the best method of preventing
rickets involves the use of some form of antirachitic milk, and furthermore that we must
draw a distinction between measures which
are most suitable for the prevention of rickets
and those most suitable for the cure of
rickets."—Hess, Alfred F.: Am. J. Pub.
Health, 22-1215, Dec, 1932.
factor of safety
&?&.  ^Mr^p THF.TM    ft*f>r\trtcr    -fnrmTiliic    drp    rnnctriir.tM
w
HEN feeding formulas are constructed
with Irradiated Carnation Milk, neglect
on the part of the mother will not deprive the
infant of an intake of vitamin D which, while
not to be considered curative, has been shown
by clinical research to constitute an important
factor of protection in the average normal case.
The carefully controlled potency of this milk
makes it, under all conditions and wherever purchased, a dependable source of vitamin D. The
Dionne Quintuplets have been using Carnation
Milk since November, 1934.
Carnation  Company, Limited
88 Abbott Street, Vancouver, B. C.
I R R A D I A  TED
(^arnation
J-V J.UJK,
WRITE for "Simplified
Infant Feeding," an
authoritative publication   for   physicians.
A CARNATION PRODUCT
"From Contented Cows" . U M M E R !
Summer days show a marked increase in accidental injuries. The
vacationist, the farmer, the child at play.may all suffer wounds
contaminated with spores of tetanus and gas gangrene-producing bacteria.
Treatment of all dirt-contaminated, contused and penetrating
wounds should include combined prophylaxis against tetanus and
gas gangrene.
A CCI D E NT SI
We suggest Parke-Davis Tetanus-Gas Gangrene Antitoxin
(Combined),   Refined  and  Concentrated.   The   customary
prophylactic dose—7500 units tetanus antitoxin and 2000
mits each perfringens and vibrion septique antitoxin—is
vailable in syringe packages and in rubber-diaphragm-
bpped vials.
PROPHYLAXIS!
MRKE,   DAVIS   &   COMPANY   •   Walkerville,   Ontario
*• World's Largest Makers of Pharmaceutical and Biological Products A PRESCRIPTION SERVICE . . .
Conducted in accord with the'ethics of the Medical
Profession and maintained to the standard suggested by
our slogan:
Pharmaceutical Excellence
AAcGiII 6 Ormo '/
l_ 1 is* ITE D ^S
FORT STREET (opp. Times)      Phone Garden 1196      VICTORIA, B. C.
Nannie ®tj0m00tt
2559 Cambie Street
ancouver
/B.C.
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 An Efficient Antacid
H YD ROX YL
Each fluid ounce represents:
Magnesium Hydroxide (freshly precipitated)
equivalent to Magnesium Carbonate 100 grains
Bismuth Hydroxide (freshly precipitated)
equivalent to Bismuth Salicylate (Normal)     4 grains
Combined with Papain, Pancreatin and Sodium Phenolsulphonate
in a palatable vehicle.
DOSE—One to four fluid drachms well diluted with water or mill-
half an hour before meals, or in cases of hyperchlorhydria
give two hours after meals.
Neutralizes acidity without the liberation of Carbon Dioxide gas and
thus does not cause additional distress to patients already suffering'
from distention.
Available in special eight and sixteen ounce wide-mouth bottles for
your patients' convenience.
TKe J. F. HARTZ CO., Limited
Pharmaceutical Manufacturers
TORONTO W     i     e  MONTREAL
flfcount pleasant TUnbertaking Co. Xto.
INGSWAY at 11th AVE. Telephone Fairmont 58 VANCOUVER, B. C
R. P. HARRISON W. R. REYNOLDS II
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 Seymour 698
73 0 Richards St., Vancouver, B. C.
S. BOWELL & SON
DISTINCTIVE FUNERAL
| SERVICE
Phone 993
66 SIXTH STREET
NEW WESTMINSTER, B. C.
Breaks the vicious circle of perverted
menstrual function in cases of amenorrhea,
tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic
relief by stimulating the innervation of the
uterus and stabilizing the tone of its
musculature. Controls the utero-ovarian
circulation and thereby encourages a
normal menstrual cycle.
W
» MARTIN H. SMITH COMPANY
b_ ISO lA.AWTI STRUT. NIW TO» K. N. V.
Full formula and descriptive
literature on request
Dosage: 1 to 2 capsules
3 or 4 times daily. Supplied
in packages of 20.
Ethical protective mark MHS
embossed on inside of each
capsule, visible only when capsule  is cut in half at seam.
mmmmsmmmmmmmmmBm THE WORLD OVER!
Us*.    *S«
iH__mM
LABORATORIES AND AGENCIES IN
181 Countries for       % ■
Antiphlogistine
— THE —
Denver Chemical Manufacturing Co.
| 153 LAGAUCHETIERE ST. W., MONTREAL.        ?
^ Made in Canada. DIARRHEA
"the commonest ailment of
infants in the summer months"
(HOLT AND McINTOSH: HOLT'S DISEASES OP INFANCY AND CHILDHOOD. 1933)
One of the outstanding features of DEXTRI-MALTOSE
its low fermentability and consequent preference in the
management of infantile diarrhea.
In summer diarrhea, "The best food to use is
boiled skimmed milk, acid skimmed milk, or dried
protein milk. Carbohydrates are added in the
form of dextri-maltose."—G. Wiswell: Infant mortality and its prevention, Nova Scotia M. Bull.,
15:504-509, Oct. 19S6.
Concerning the treatment of diarrhea, "If the
■weight remains stationary,
it is an indication that
loss of substance is occurring through the stools,
mostly in the form of alkaline salts. To equalize this
loss of substance, the diet
must be increased, but in
such a way as to avoid
causing fermentation. This
may be done by adding
dextri-maltose and preparations of protein to the food,
increasing the calories until the infant is taking 160
calories per kilo, of body
weight."—H. L. Ratnoff, Nutritional disturbances 3 Arch.
Pediat., 41:111, Nov. 1924.
"The suggestion of Dr.
Alan Brown of Toronto,
Canada, that Dextri-Maltose be added to protein
milk, was of great value.
Too many practitioners still
use protein milk for prolonged periods without adding carbohydrate; it must
be emphasized that regardless of the condition of the stools, carbohydrate
must be added to protein milk within a reasonable
time in order to avoid collapse."—G. J. Feldstein:
Underfeed/big of infants and children, Arch. Pediat., 50:297-306, May 1988.
Regarding the treatment of diarrhea, "In our
experience, the most satisfactory carbohydrate
for routine use is Mead's dextrimaltose No. 1."—
F. R. Taylor: "Summer Complaints," Southern
Med. & Burg., pp. 555-559, Aug. 1927.
"Again, following the teaching of the originator of protein milk, the carbohydrate added
should be the one that is most easily assimilated.
Dextri-maltose is the carbohydrate of choice."—
R. A. Strong: The diarrheas of early life, Mississippi Doctor, 14:9-15, Sept. 1986.
"If the stools are acid, green, and excoriating,
a food high in protein and low in fat, and carbohydrate is indicated. Dried powdered protein milk
is very ideal here—one to ten dilution. On t
other hand, if the evacuations are brown, watei
and stinking with putrefactive odors, a proteoly
diarrhea, it will be of advantage to add a sm|
amount of carbohydrate, a dextri-maltose prepai
tion  being very efficacious."—A.  Q. Dow: Du
rheas in infants, Xcbraa
M. J., 20:22-24, Jan. 19i
SERIOUSNESS
OF DIARRHEA
There is a widespread opinion that,
thanks to improved sanitation, infantile diarrhea is no longer of serious aspect. But Holt and Mcintosh declare that diarrhea "is still
a problem of the foremost importance, producing a number of
deaths each year...." Because dehydration is so often an insidious
development even in mild cases,
prompt and effective treatment is
vital. Little states (Canad. Med.
A. J. 13:803, 1923), "There are
cases on record where death has
taken place within 24 hours of the
time of onset of the first symptoms."
"After the prelimina
short period of starvati.
protein milk should be ua
When the diarrho
has been sufficiently check^
dextri-maltose may be add
and gradually increased!
til from 4 to 6 tablespoa
are being used."—Tvl
Denney: Acute nutritiot
disturbances of infarn
Univ. West. Ontario M.
2:132-187, April, 1982
In diarrhea, "Carbo!
drates, in the form of dext
maltose, well cooked c
eals or rice, usually c
be handled without tn
ble."—B. B. Jones: A c\
cussion of some of the co
moner types of infant
diarrhea, and the principl
underlying the diets tM
in their treatment, V
ginia M. Monthly, 55:4\
415, Sept. 1928.
In cases of diarrhea, **■
the first day or so no suf
should be added to the milk. If the bowel mo
ments improve carbohydrates may be added. T
should be the one that is most easily assi
ilated, so dextri-maltose is the carbohydrate
choice."—W. H. McCaslan: Summer diarrhea*
infants and young children, J. M. A. Alabat
1:278-282, Jan. 1982.
"In the preparations commonly used, Mea
Dextri-maltose Nos. 1 and 2, the maltose is o;
slightly in excess of the dextrins, and theref<
they are advantageous if there is a tendencyi
excessive fermentation."—W. J. Pearson fl
W. G. WylUe: Recent Advances in Diseases
Children, P. Blakiston's Son & Co., Phila., 19
pp. 74,116. __.__
"During the periods of severe diarrhea and f(
Iting the diet may have to be limited to skimp
milk, glucose, dextrimaltose and fruit juices.'
D. C. Darrow: Steatorrhea, in The Practitioni
Library of Medicine & Surgery, D. Appleton-C
tury Co., Inc., New York, 19SS, vol. 7, p. 390.
Just as DEXTRI-MALTOSE is a carbohydrate modifier of choice, so is CASEG  (calcium caseina
an accepted protein modifier.  Casec is of special value for (1) colic and loose green stools in breast-'
infants, (2) fermentative diarrhea in bottle-fed infants, (3) prematures, (4) marasmus, (5) celiac disea •
MEAD JOHNSON & CO. OF CANADA, LTD., BELLEVILLE, ONT.
When requesting samples of Dextri-Maltose,   please enclose professional card  to cooperate in preventing their reaching unauthorized p*n
^1 That Invaluable Sense
—Confidence!
Just as a patient places his life in a
Doctor's hands with implicit confidence
—so Doctors have placed their prescriptions with us in the same way, these
many decades. The telephone number is
Seymour 2263.
Of-M_tt
HtOHT
GEORGIA PHARMACY
LIMITED
W.OIOROIA
STRUT
&mttx $c Hf amta Utix
Established 1S9)
VANCOUVER, B. C.
North Vancouver, B. C.    Powell River, B. C.
published Monthly at Vancouver, b. C. by ROY WRIOUCY LTD.. soo west Pender street fsxsxsxsxsxiEX&ssxGmte
Hollywood Sanitarium
Limited
For the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference—B. G. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C. ,
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
^^^^^^^^^^^^^^^^^

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