History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: December, 1937 Vancouver Medical Association 1937

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Vol. XIV.
In This Issue:
(With Cascara and Bile Salts)
. . FOR . .
Chronic  Habitual
Western Wholesale Drug
(1928) Limited
(Or at all Vancouver Drug Co. Stores) THE   VANCOUVER   MEDICAL   ASSOCIATION
Published Monthly under tl\p Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
203 Medical-Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dk. J. H. MacDermot
Db. M. McC. Baibd Db. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address
Vol. XIV.
No. 3
OFFICERS  1937-1938
Db. G. H. Clement Db. Lavell H. Leeson Db. W. T. Ewing
President Vice-President Past President
Db. W. T. Lockhabt Db. A. M. Agnew
Hon. Treasurer Hon. Secretary
Additional Members of Executive—Db. J. R. Neelson, Db. J. P. Bilodeau.
Dr. F. Brodie Db. J. A. Gillespie Db. F. P. Pattebson
Historian: De. W. D. Keith
Auditors: Messbs. Shaw, Salteb & Plommeb.
• ■.'■    — -8ft■    ^        -     SECTIONS W--4§l|§'   "i^i|:
_:H             Clinical Section
Db. R. Palmeb Chairman    De. W. W. Simpson Secretary
Eye, Ear, Nose and Throat
Db. S. G. Elliott Chairman     De. W. M. Paton Secretary
Pediatric Section
Db. G. A. Lamont Chairman"   Db. J. R. Davies Secretary
Cancer Section
Db. B. J. Habbison Chairman    Db. Roy Huggabd Secretary
Db. A. W. Bagnall
Db. S. Paulin
Dr. W. F. Emmons
Dr. R. Huggard
Dr. H. A. Rawlings
Dr. R. Palmer
Dr. G. F. Strong
Db. R. Huggabd
De. D. D. Fbeeze
Db. J. H. MacDebmot
Dr. D. E. H. Cleveland
Dr. Murray Baird
Summer School
De. J. R. Naden
De. A. C. Feost
De. A. B. Schinbein
De. A.Y. McNaie
De. T. H. Lennie    '
De. F. A. Tuenbull
Db. A. B. Schinbein
Db. D. M. Meekison
Db. F. J. Bulleb
Metropolitan Health Board
Advisory Committee
Db. W. T. Ewing
Db. H. A. Spohn
Db. F. J. Bulleb
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 Staphylococcal   Infections!
In treatment and prevention of localized staphylococcal infections such as styes, boils, carbuncles, pustular acne and recurrent
staphylococcal abscesses, Staphylococcus Toxoid has proved to
be distinctly effective. This product is a non-toxic antigen, prepared by treating highly potent staphylococcus toxins with formaldehyde, and cannot induce sensitization to any antitoxin or
Clinical and laboratory evidence strongly suggests that many of
the pathogenic effects of extensive or generalized staphylococcal
infections may be attributed to liberation of staphylococcus toxin
within the body. The use of antitoxin possessing in high degree
the specific power to neutralize staphylococcus toxins is therefore
advocated for treatment of those infections.
As prepared by methods evolved in the Connaught Laboratories,
Staphylococcus Antitoxin has given beneficial results following
its being administered sufficiently early and in adequate dosage
in treatment of acute, extensive or generalized infections, such
as carbuncle, cellulitis, osteomyelitis, meningitis and septicaemia,
where staphylococcus has been the infecting agent.
Prices and information relating to
Staphylococcus Toxoid and Staphylococcus Antitoxin
■will be supplied gladly upon request.
Toronto  5
Depot for British Columbia
Macdonald's Prescriptions Limited
Total population—estimated _  253,363
Japanese population—estimated  8,522
Chinese population—estimated . ,— 7,765
Hindu population—estimated .  352
Total deaths . . „__   214
Japanese deaths £Ljl$      5
Chinese deaths —..       8
Deaths—residents only      181
Male, 173; Female, 153    326
Deaths under one year of age      10
Death rate—per 1,000 births .      30.7
Stillbirths (not included in above)        6
Rate per 1,000
Oct., 1936
November 1st
Sept., 1937 Oct., 1937
to 15th, 1937
Scarlet Fever	
Chicken Pox :	
Mumps     13
Whooping Cough      2
Typhoid Fever      0
Undulant Fever      1
Poliomyelitis        3
Tuberculosis    29
Erysipelas      2
Hospitals        Clinic Clinic     in Province
Syphilis         35 56 4 59
Gonorrhoea   4 82 2 32
ffThe most effective therapy available"
Made in England by
Rep.: S. N. BAYNE |
1432 Medical-Dental Bldg. Phone: Sey. 4239 Vancouver, B. C.
References: "Ask the doctor who is using it."
Up-to-date transportation facilities not only save time for the
traveler, but, in addition, afford
him greater comfort and safety.
This is true also of the up-to-
date treatment of boils with
Stannoxyl. Days of suffering are
fewer and there is greater comfort and safety too.
Stannoxyl is the original preparation of chemically pure tin
and tin oxide for the oral treatment of boils and styes. In 1917
this chemical combination was
shown to be definitely antagonistic to staphylococcus.
Results are gratifying. Use of
the  old-time  lance  is   avoided.
i^ourt(.sy Atchison, TopL ka and Santa Be Ry. Co.
Pain is relieved, inflammation
checked, and there is no draining
wound to spread infection, no
ugly scar.
Soon after treatment is started healing begins and a healthy
base is generally obtained in
eight to ten days.
The only way to find out what
Stannoxyl can accomplish is to
try it in your next case of boils.
Also effective for treating styes,
or in chronic osteomyelitis due
to staphylococcus.
Average dosage is 2 tablets 3
or 4 times daily. Supplied in vials
of 80 tablets. Non-toxic.
Samples On Request
Chemically pure tin and tin oxide
Anglo-French Drug Co., 354 St. Catherine St. East, Montreal, Quebec. EDITOR'S PAGE
With this number of the Bulletin go our sincerest wishes for a very
merry Christmas and happy ending to the year now drawing to its close.
It has been a very eventful year in many ways—in some ways a terrible
year, full of threats and danger, full of agony and ghastly suffering, which,
fortunately or perhaps unfortunately, we cannot in any true sense realise.
Perhaps if we could, we might the sooner do our share towards ending this
state of affairs. But even here there are occasional rifts in the gloom: gleams
of returning sanity, signs of a return to some sort of goodwill and friendship
between nations, and while we can perhaps do little but hope for the best, we
may be able to contribute by our willingness to support any move towards a
better understanding, and a greater measure of generosity and justice
towards those who are not so fortunately placed nationally as ourselves;
since only so can we expect to remove permanently the causes of conflict.
For us as a profession it has been a year of real gains and steady growth ;
we have achieved a greater measure of unity than ever before, and a better
understanding of each other's problems. Here is clear profit in our ledger,
and for this we may be very thankful. We must go further along this road,
however. We must learn to think nationally as well as provincially, and the
leaders of our profession are even now breaking new trail for us to follow.
So as the season of goodwill to all men approaches, we can take courage
and look forward to brighter and happier days to come for the whole world.
.  ,|,   .      OBIT
It is with a real sense of personal loss that we record the death on
October 31st of Dr. Edwin D. Carder, one of the best-known and
most widely beloved of our medical men in Vancouver. His sudden death
came as a definite shock to us all.
Dr. Carder had practised medicine here for about thirty years, and
had no enemies and countless friends. This would be an epitaph that all
might envy—it would be no misstatement about "Eddie" Carder, by
which name everyone knew him. Honest and painstaking in his work,
friendly and cordial to all, always full of quiet but genuine humour,
shot through from time to time with flashes of the keenest wit, he was
an asset to any community, popular with all, welcome in any gathering,
an indispensable part of any merrymaking or celebration. We need only
refer to the part he took for so many years in our Medical Dinners,
which he enlivened so greatly by his positive talent for mimicry and
comedy. He had a gift for friendship with his fellow-men.
We shall all miss him. The enormous crowd that attended to pay the
last honours to him at his funeral is a hint of how widely felt is his loss;
it was also a tribute to him as a man and a friend.
We offer to his bereaved family our sincere condolences and sympathy.
Members of the Vancouver Medical Association are reminded
that the names of those whose dues for the year 1936-37 are unpaid
at the end of December will be posted in the Library.
Dr. R. B. White of Penticton, while in Vancouver, called at the College
♦ aN ♦ H*
Dr. G. A. Lawson has returned from vacation and visited Vancouver
en route to his home in Port Alice.
♦ ♦ ♦ ♦
Dr. Frank S. Macdonald is in practice at McBride and has been appointed
Medical Health Officer and School Health Inspector.
* #      ♦      *
Dr. J. B. Swinden has moved from Whonnock to Ucluelet and is Medical
Health Officer and School Health Inspector for that district on the West
Coast of Vancouver Island.
♦ s|e %z a|c
Dr. D. T. R. McColl of Queen Charlotte City has been appointed Medical
Health Officer and School Health Inspector in addition to his practice and
the post of Superintendent of the Skidegate Inlet Hospital.
♦ ♦ ♦ %
Dr. G. A. Charter, who formerly practised at Queen Charlotte City, is
convalescing satisfactorily following operative treatment late in September.
& ♦ ♦ s|*
Dr. A. N. Hason has recently joined Dr. H. G. Burden of the Resthaven
Sanitarium at Sidney. *      *      *      *
Dr. H. T. Hogan has left for the North and will practise at Tulsequah and
the Polaris Taku Mining Company.
♦ ♦ ♦ ♦
Dr. J. C. Poole and Mrs. Poole (formerly Dr. Lois Stephens) had a vacation in October.
* *      *      *
Dr. William Morris has left to do three months' postgraduate study.
During his absence, Dr. C. E. Derkson will carry on the practice.
*j_ Jj. 3|_ 5j»
Dr. T. W. Sutherland of Wells has been in Vancouver and called at the
office of the College.
* ♦      ♦      ♦
Dr.  Osborne Morris of Vernon visited the office while in Vancouver
* ♦      *      *
Dr. D. Wayne Davis of Kimberley was a recent visitor in Vancouver.
* ♦      *      ♦
Dr. P. A. C. Cousland of Victoria and Dr. S. A. Wallace of Kamloops
attended the meeting of the Board of Directors of the British Columbia
Medical Association on November 12th.
* ♦      *      #
Dr. Norman D. Hall, who was associated with his father, Dr. G. A. B.
Hall, in practice at Nanaimo, is now located at Phoenix, Arizona. It is
announced that his work in the Clinic which he has joined will be limited
to surgery.
♦ sft H* s|s
Dr. F. W. Andrews of Summerland called at the office early in November.
He was returning from an extended tour of Eastern centres, having attended
the meeting of the American College of Surgeons.
* *      *      *
Dr. F. M. Auld of Nelson, the Second Vice-President of the British Columbia Medical Association, attended the meeting of the Board of Directors of
the Association on Friday, November 12th. While in Vancouver he had a long
conference with the Executive Secretary regarding certain contemplated
revisions in contracts.
Page 49 Dr. G. A. B. Hall of Nanaimo is now on vacation.
* *      *      #
Dr. Gordon C. Kenning, President of the British Columbia Medical Association, was in Vancouver on Wednesday and again on Friday attending
meetings. Dr. Kenning and Dr. Auld attended the Annual Dinner of the
Vancouver Medical Association.
■ft .ft 3ft _f(
Dr. W. Allan Fraser of Victoria is doing special work in the East in his
specialty of urology. Dr. Fraser has recently been appointed Director under
the Department of Venereal Disease Control and will have charge of this
work in Victoria.
* *      *      *
We are glad to offer our congratulations to Dr. and Mrs. H. H. Boucher
on the birth of a daughter on November 22nd.
We also offer our best wishes to Dr. and Mrs. George R. Barrett, of
Pioneer Mines, B. C, on the birth of a son on November 21st.
♦ ♦ -I- *
Dr. Arthur B. Nash of Victoria is in Eastern centres doing post-graduate
Dr. Alan B. Hall, who has been practising in Montreal during the past
four years, has returned to Nanaimo and will be associated in practice with
his father, Dr. G. A. B. Hall.
♦      ♦      ♦      ♦
The following Doctors were elected members of the Vancouver Medical
Association at the General Meeting held November 2nd: Dr. J. H. Blair, Dr.
F. H. Bonnell; Dr. A. W. Bowles, Associate member; Dr. L. S. Chipperfield,
Associate member; Dr. C. E. Davies; Dr. G. P. Dunne; Dr. G. W. Knipe;
Dr. R. E. McKechnie II; Dr. S. C. Peterson; Dr. Eleanor Riggs; Dr. J. F.
Sparling, Associate member.
#f_ 3J. 3-jC 5J_
Dr. H. S. B. Galbraith, who has been doing post-graduate work in England,
has returned to Vancouver. Dr. Galbraith will open offices in the Medical-
Dental Building, and will limit his practice to Eye, Ear, Nose and Throat
. . . s.
Dr. D. E. H. Cleveland will be the speaker at the January meeting of the
Vancouver Medical Association.
H8 'H ♦ ♦
The February meeting of the Vancouver Medical Association will take
the form of a dinner meeting, at which the speaker will be Dr. Charles E.
Sears of Portland, Oregon.
♦ *fc % H*
We are glad to hear that Dr. D. M. Meekison, who was in hospital for
some weeks, was well enough to attend the meeting of the American College
of Surgeons in Chicago, and is now attending to his practice.
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 and Surgeons of B. C;
or/and DR. M. W. THOMAS, Executive Secretary,
College of Physicians and Surgeons of B. C.
ABSORPTION FROM THE INTESTINE: By F. Verzar and E. S. McDougall. 1937.
Concerning this book, the following excerpt is taken from an editorial in
the American Journal of Digestive Diseases and Nutrition for July, 1937:
"Until last year anyone who turned to the literature for information as
to the laws underlying the absorptive processes of the small bowel would have
found very little, and that little scattered through highly technical journals.
Today at last we can turn to one well-written monograph, a monument to he
industry and ability of Fritz Verzar, of Basle. . . . This book should be in
the library of every man who practices gastro-enterology, and it should be
read and re-read. For years Verzar and his pupils have been studying the
intestinal mucosa and the ways in which it absorbs and digests, and here we
have a good resume" of their findings, together with a fine review of the literature."—Walter C. Alvarez.
In the November number of the American Journal of Digestive Diseases
and Uutrition there is an article by Prof. Dr. F. Verzar, giving an account of
the recent work done in his laboratory, on "The Adrenal Cortex and Intestinal
■ _JC JjC «(C
ATLAS OF HAEMATOLOGY: By E. E. Osgood and C. Ashworth.
Those men who met Dr. Osgood at the Annual Meeting of the British
Columbia Medical Association in September will be interested to learn that
his book on Hematology has been purchased. But in any event the book is a
valuable addition to the library. There are over three hundred illustrations in
colour. A description of the method of history taking and physical examination of patients with disorders of the haematopoietic system is given in the
first chapter. A system of tables is included, by which definite identification
can be made of any cell.
*     *      *
The Library has received a file of the American Journal of Psychiatry for
the years 1936-37 from Dr. G. A. Davidson. Dr. Davidson has promised to present the current numbers to the Library as they arrive.
Dr. Wallace Wilson has presented to the Library a file of the Bulletin of
the Institute of the History of Medicine, from the Johns Hopkins Hospital,
for the years 1935 and 1936.
The large annual losses of glassware incurred by the Provincial Board of
Health Laboratories under the methods of distribution of specimen outfits
hitherto obtaining, are no longer to be accepted as inevitable.
A depot for Kahn test and throat culture outfits will be maintained in the
Pathology Department of the Vancouver General Hospital for the convenience of practicing physicians, as in the past; but it is requested that supplies
obtained from this source be legibly signed for on the printed requisition forms
All other supplies may be obtained from the Provincial Laboratories at
763 Hornby Street. Supplies will be sent by post upon receipt of a written
requisition, specifying the number and kind of outfits required, or they may
be obtained by the doctor or his accredited representative calling in person
at the Laboratories.
C. E. DOLMAN, Director,
Division of Laboratories, Provincial Board of Health.
The Annual Dinner of the Vancouver Medical Association, which was held
in the Oak Room of the Hotel Vancouver on November 12th, was notable in
a number of ways. The attendance was very nearly a record, 166 sitting down.
The dinner marked a break with some old traditions, and some new departures were introduced. The entertainment offered to eye and ear seems to
have been a success. There was some dubiety in this regard beforehand. For
many years past the burden of furnishing this entertainment has been shouldered manfully and carried off with acclaim by a small group of the members.
It is not criticism of their work to observe that in the course of years the
programme has tended to become stereotyped. The Old Guard's evolutions,
while admirably performed, contained little of the element of surprise. Thus
there was expressed by some a reluctance to attend if the old lines were to
be followed, and by others a failure—technically a "flop"—was predicted if
any change was made.
We believe that the new features introduced, which evidently met with
favor, have not been developed to the extent of their possibilities. The "Movietone News" represented much hard work and expenditure of time, and the
film, the property of the Association, should be regarded as a historical document, the nucleus of a library. The "March of Time" also is a feature containing many opportunities for development: The "Community Singing"
proved almost as potent an agency as cocktails for letting down inhibitions
and enabling everyone to let themselves go.
But we cannot dispense with all of our traditional observances. Two at
least must always hold their place. The standing in silence is a tribute, not
alone to those who have died in the past year, whose names are read, but to
all those gone before who still hold their place in our memories and affections.
The President's recitation of lines from Macbeth :
That struts and frets his hour upon the stage
Life's but a walking shadow, a poor player
And then is heard no more;
followed by an additional line which we suspect was original,
He falls asleep; his memory walks among us.
added to its impressiveness.
The bestowal of the P. G. F. degree upon Dr. Wallace Wilson indicated a
very popular choice. Dr. Wilson had well earned this supreme recognition
from the hands of his colleagues and we offer him our warmest congratulations.
In concluding on a note of appreciation of the way in which the Dinner
Committee accomplished its task, a comment on the menu will not be out of
place. This also was a welcome departure from the older and less palatable
The General Meeting of the Association for December will be held on
Tuesday, December 7th, in the Auditorium of the Medical-Dental Building.
A symposium on Mental Conditions has been arranged as follows:
The Pre-School and School Child—Dr. Stewart Murray.
Psychoneurosis—Dr. A. L. Crease.
General discussion of types of psychoses—Dr. G. A. Davidson.
Treatment of Mental Disorders—Dr. E. J. Ryan.
From the Office of the Executive Secretary
At the Annual Meeting of the West Kootenay Medical Association, held
at Nelson on September 30th, members gathered from all that large district
extending from Grand Forks and Greenwood, through by Trail and Rossland,
over by way of Nelson to Creston on the east and to Nakusp on the north.
Dr. F. M. Auld of Nelson, the President, welcomed all, and with the help of
their very energetic Secretary, Dr. Wilfrid Laishley of Nelson, a very fine
meeting was arranged. The Programme and dinner were excellent. A report
of this meeting appears in this issue. From the viewpoint of a visitor one
found an active association happily assembled bound by common interest,
imbued with a spirit of friendliness born of confidence and showing a compactness built on neighbourliness which makes unit of thought and action
automatic. The sessions possessed a quality not unusual in the Interior and
your Executive Secretary shared in this wholesome friendliness and cama-
. raderie.
It rained that night as we motored to West Robson with Doctors Thorn,
Gay ton and Endicott, who were returning to Trail. The Executive Secretary
safely embarked on the S.S. Minto, which appeared to be moored half-way
up the Arrow Lakes. We walked along what seemed to be a mile of landing.
The rain must have improved the low-water level.
The evening of October 1st found Dr. H. F. Tyerman at his home in
Nakusp, having just returned from one of those round-up drives of a country
practice. If you have never visited New Denver, Kaslo or Nakusp you have
not sampled the true hospitality of our lake and mountain inland. Dr. Tyerman efficiently serves a wide area and deservedly enjoys the grateful confidence of this scattered community. The Executive Secretary was very
grateful when Dr. Tyerman delivered him safely at shipside.
Revelstoke, via Arrowhead, was reached on Saturday afternoon. On
Sunday, with Johnny Jones, son of Dr. A. L. Jones, as guide and companion,
we were driven by Dr. G. A. Watson to 62-Mile Camp on the Big Bend Highway, the completion of which will link Revelstoke with Golden and provide
a motor road, wide and well built, along the scenic course of the Columbia.
Fresh air, good food in abundance and a bull-cook to build a fire in the tent-
house, made us ready to follow Jones (Junior) over the trail to the Falls,
many miles away. Dr. Hamilton arranged this trip, and when on Monday at
noon the whole party arrived at 58-Mile Camp for luncheon, we gratefully
acknowledged the hospitality of the road builders and the excellent arrangements provided by Doctors Hamilton and Jones.
The Annual Meeting of No. 4 District Medical Association was held on
October 4th, and Dr. A. L. Jones, President, and Dr. J. H. Hamilton, Secretary-Treasurer, set another record—a standard which Dr. J. S. Henderson
and Dr. R. E. Willets will achieve next year at Kelowna.
Dr. Watson is happily located at Revelstoke and his new home was "house-
warmed" by a Saturday evening party. More will be heard of this new home
after the New Year, I learn.
Items of news and notes for publication in the Bulletin are missed occasionally. It is requested that all such news be forwarded to the office. One
important item recently was missed entirely. The office was not warned or
informed of the wedding in September of Dr. F. L. Wilson of Trail. He and
his bride have our best wishes nonetheless.
The meeting at Revelstoke was coloured by the visit of Doctors P. A.
McLennan and Lee Smith of Vancouver, who appeared to enter happily into
the full convention spirit of this district and both contributed largely to the
success of its Annual Meeting.
Back to Vancouver by rail on October 5th and then by motor to the Cari-
Page 53 boo on the 6th, which means that Thanksgiving day was spent on the road.
We found some turkey at Clinton.
We visited Dr. and Mrs. Ellis on the evening of the 6th and you are warned
to brush up on your bridge and be ready for a tough game, especially should
you encounter Dr. A. S. Lamb and Dr. A. L. McQuarrie, as was my good
The next night found us at Quesnel, where we fortuitously found Dr.
Gerald Baker on the eve of his departure for a four-day trip into the wilds
to inspect Indian Reserves ninety miles distant. It being the 7th of October
it seemed propitious that he take along a gun. We enjoyed a visit with Dr.
G. D. Oliver, who is associated with Dr. Baker at Quesnel, and again we
shared these doctors' company with Dr. G. F. Kincade and Dr. F. O. R.
Garner of the Tuberculosis Division, who were conducting a travelling clinic,
the latter doing special silicosis examinations at the mines.
The next morning (October 8th), early, found us in Prince George, and
just here a digression to glimpse at the glorious autumnal colorings. The
view as we dropped down the winding road showed yellows, golds, rusts and
scarlets. These gorgeous effects of early frosts seemed to make us more gladly
buy some anti-freeze. At Prince George we found Dr. Carl Ewert and Dr.
John G. MacArthur busily providing for all medical needs in the absence of
Dr. E. J. Lyon, who was returning that day from his vacation at the Coast.
Conditions in practice in the Northern Interior are affected favourably by
general improvement. Contracts in this area are under revision and we can
report better terms leading to a progressively improved service under the
various schemes.
Returning by way of Quesnel, we went to Wells and Barkerville on
October 9th and there saw Dr. T. W. Sutherland and Dr. George Langley.
Dr. Langley went to Wells in July and has been very busy meeting the
demands of practice in that mining area. His many friends will be glad to
learn that he looks well on that bracing mountain air. He went out to Quesnel
to meet Dr. and Mrs. J. C. Poole, who were passing through for a Thanksgiving week-end away from their practice at Fraser Lake.
On Sunday, October 10th, we passed through Williams Lake and visited
Dr. C. E. McRae, who has a large surrounding countryside under his care.
Mileage is a very real problem in providing for the medical needs of such a
widely-scattered population. Dr. McKenzie, who also practices at Williams
Lake, has shown improvement following a recent illness. These two doctors
working from this point have as nearest neighbours Drs. Baker and Oliver
at Quesnel in the North, Dr. W. A. Drummond at Ashcrof t to the South, and
westerly neighbours at Bella Coola. We visited Dr. Drummond at Ashcroft
on October 11th (Thanksgiving Day) and found him, along with our other
medical friends en route, enjoying the confidence and gratitude of an increasingly profitable clientele—all areas reporting improvement in general
conditions. At this point another digression to tell of the 10-months-old daughter in the Drummond home. Patsy proved to be more interested in the visitors
than in her crib even at a late hour. This reminds us that we did not tell
you about the lively young person—the five-months-old son of Dr. and Mrs.
MacArthur at Prince George. Both babies are vital young persons, reflecting
a large measure of good health in their happy faces and well-nourished bodies.
On October 12th we stopped to see Dr. Ellis at Lytton and learn something of the many-sided features of practice in that centre, where there is a
splendid new hospital and a large Indian School.
Arriving home on the evening of October 12th, it seemed that the time for
a vacation had arrived, and so on October 13th we left for the Island by the
Nanaimo ferry, and that night, having met "the Professor," an ardent angler
and friend at Duncan, we were comfortably lulled to sleep by the rushing
waters of the Cowichan River and safely away from the telephone. As we
extinguished the kerosene lamp we hoped for another day which would bring
the joy of a well-filled creel.
The Board of Directors' second meeting this year, held on November 12th
and continuing in session during the afternoon, was attended by Dr. G. C.
Kenning, Victoria, President; Doctors D. E. H. Cleveland; F. M. Auld, Nelson ; H. Carson Graham, North Vancouver; G. F. Strong, H. H. Milburn;
S. A. Wallace, Kamloops; A. Y. McNair; P. A. C. Cousland, Victoria; N. E.
McDougall; F. R. G. Langston, New Westminster; W. S. Turnbull, A. H.
Spohn, Colin Graham, C. H. Vrooman, Wallace Wilson and M. W. Thomas.
Dr. G. F. Strong, representative from British Columbia on the Executive
Committee of the Canadian Medical Association, reported fully on many
questions dealt with at the recent meeting in Ottawa. Extracts from this
report appear elsewhere in this issue.
The list of the personnel of the Board of Directors is published and all
committees are launched on an active year's work.   .
Board of Directors, 1937-1938
Dr. Gordon C. Kenning, President.
Dr. D. E. H. Cleveland, Vice-President.
Dr. F. M. Auld, Second Vice-President.
Dr. J. R. Naden, Honorary Secretary-Treasurer.
Dr. G. F. Strong, Immediate Past President.
Dr. M. W. Thomas, ex-officio.
Dr. Wallace Wilson; Dr. S. A. Wallace, Kamloops; Dr. P. A. C. Cousland,
Victoria; Dr. G. T. Wilson, New Westminster; Dr. H. H. Milburn—Directors at large.
Dr. W. E. Ainley, Dr. L. H. Appleby—Representatives of College of Physicians
and Surgeons of B. C.
Dr. N. E. MacDougall, Vancouver—Representative Vancouver Medical Association.
Dr. W. Allan Fraser, Victoria—Representative Victoria Medical Society.
Dr. F. R. G. Langston, New Westminster—Representative Fraser Valley Medical Association.
Dr. G. A. B. Hall, Nanaimo—Representative Upper Island Medical Association.
Dr. C. H. Hankinson, Prince Rupert—Representative Prince Rupert Medical
Dr. M. R. Basted, Trail—Representative West Kootenay Medical Association.
Dr. J. S. Henderson, Kelowna—Representative District No. 4 Medical Association.
Dr. H. Carson Graham, North Vancouver—Representative North Vancouver
Medical Association.
Dr. H. H. Milburn—Committee on Constitution and By-Laws.
Dr. G. F. Strong—Committee on Programme and Finance.
Dr. A. Y. McNair—Committee on Study of Cancer.
Dr. A. H. Spohn—Committee on Public Health.
Dr. D. M. Meekison—Committee on Medical Education.
Dr. Wallace Wilson—Committee on Study of Economics.
Dr. W. S. Turnbull—Committee on Maternal Welfare.
Dr. W. J. Knox, Kelowna—Committee on Credentials and Ethics.
Dr. E. Murray Blair—Committee on Pharmacy.
Dr. Colin W. Graham—Committee on Osier Memorial.
Dr. P. A. C. Cousland, Victoria—Committee on Medical History.
Dr. D. E. H. Cleveland—Committee on Editorials.
Dr. C. H. Vrooman—Committee on Nominations.
The Annual Meeting of the Upper Vancouver Island Medical Society was
held at the Sunset Inn, Qualicum Beach, on Thursday evening, November
18th. The meeting was in the form of a banquet, and excellent addresses were
given afterward by Dr. D. Murray Meekison and Dr. G. F. Strong of Vancouver. Dr. Meekison spoke on "Low Back Pain." Dr. Strong gave an account
of the latest treatment of the various forms of heart disease. Following each
address a lively discussion took place—Doctors Higgs, Hilton and Kelly
adding a few of their personal experiences in dealing with such cases. Doctors Strong and Meekison answered numerous questions.
The following doctors were present besides the speakers: Doctors Campbell Davidson, Qualicum; W. F. Drysdale, E. D. Emery, S. L. Williams, Alan
B. Hall, A. H. Meneely, C. C. Browne, Nanaimo; J. McKee, T. A. Briggs,
Courtenay; J. C. Thomas, C. T. Hilton, W. D. Higgs, Port Alberni; E. R.
Hicks, Cumberland; B. J. Hallowes, Casa del Mar; and M. W. Thomas,
the Executive Secretary of the College of Physicians and Surgeons of B. C.
Dr. J. K. Kelly was visiting. Dr. Thomas gave a short but stimulating talk
on Medical Practice.
The following officers were elected for the ensuing year: President, Dr.
A. H. Meneely; Vice-President, Dr. Campbell Davidson; Secretary-Treasurer,
Dr. E. D. Emery; Reporter, Dr. C. C. Browne; Representative on the Board
of Directors, Dr. C. T. Hilton; Member of the Committee on Cancer, Dr. S.
L. Williams.
The Annual Meeting of the West Kootenay Medical Association was held
in Nelson, B. C, on September 30th, 1937.
The following were present: Doctors W. J. Endicott, J. Bain Thorn, M.
R. Basted, D. J. M. Crawford, F. L. Wilson, Wm. Leonard, J. L. Gayton
and L. N. Beckwith of Trail; Dr. H. R. Christie of Rossland; Dr. D. J.
Barclay of Kaslo; Dr. J. V. Murray of Creston; Dr. A. Francis of New
Denver; Dr. N. E. Morrison of Salmo; Doctors F. P. Sparks, H. H. McKenzie,
F. M. Auld, B. L. Dunham, R. B. Shaw, D. W. McKay and Wilfred Laishley
of Nelson; Dr. M. W. Thomas, Executive Secretary of the College of Physicians and Surgeons.
The afternoon was spent in viewing motion pictures presented through
the co-operation of Smith and Nephew, and also a presentation of clinical
In the evening a banquet was held in the Kootenay Lake General Hospital, followed by the business meeting. Dr. Thomas gave a very interesting
talk on the problems of our profession.
The officers for the ensuing year are as follows: Hon. President, Dr. C.
M. Kingston, Grand Forks; President, Dr. M. R. Basted, Trail; Vice-President, Dr. Arnold Francis, New Denver; Secretary-Treasurer, Dr. Wilfrid
Laishley, Nelson; Reporter, Dr. J. Stuart Daly, Trail.
Internists.—Internists' accounts for special examinations, such as x-ray
or metabolic test, will not be allowed, except in emergency cases, unless consent of Committee is first obtained.
X-ray of Teeth.—X-ray of teeth not allowed, as this may be secured at
the Vancouver General Hospital.
Venereal Diseases.—In cases where it is impossible or difficult for the
patient to attend the Government Clinic, salvarsan may be obtained gratis
from the Government Clinic, but payment for medical attention will not be
allowed unless permission of the Relief Committee is previously obtained.
Toxoids.—Administration of toxoids to children under one year of age
will be allowed at the rate of $1.00 per visit. Staphylococcus will be allowed
at the rate of $1.00 per visit, the doctor to provide the staphylococcus toxoid
Serums for Colds.—Payment for injection of serums for colds will not be
Varicose Veins and Ulcers.—Injections for varicose veins will be allowed
the maximum charge: for one leg $15.00, for both legs $25.00. This includes
treatment of varicose ulcers.
Smallpox Vaccination.—Smallpox vaccination to be allowed at the rate of
one office visit.
Glandular Extract.—Charges for the use of glandular extract not allowed
(including amniotic injections) except on the ruling of the Relief Committee.
Actinic Rays.—Actinic rays, light treatment, etc., allowed at the rate of
$1.00 per treatment where considered necessary by the Relief Committee.
Abortions.—For abortions $10.00 will be allowed for the first visit, and
subsequent visits at the regular rate, the total not to exceed $25.00.
Pregnancy.—No charge will be allowed for treatment after the case has
been reported as a maternity cases, maternity cases being looked after by a
separate fund.
Specialists.—A specialist cannot be paid for work outside his own
Circumcision.—The fee for circumcision, when necessary, will be allowed
at the rate of $15.00.
Cauterization.—The fee of $5.00 per treatment will be allowed for electric
cauterization of the cervix.
Examination for Pension.—The fee for physical examination for pensions
is not payable from relief funds.
Post-operative Treatment.—Each case of post-operative treatment must
be judged on its merits, cases in doubt to be referred to the Committee.
Minor Operations.—Minor operations will be paid for with relief funds;
all others should be referred to the hospital.
Peptic Ulcer.—Four visits per month for two months will be allowed for
the treatment of peptic ulcer and two office calls per month thereafter, except
in the case of emergency complications.
Submucous Resections.—No fee will be paid for submucous resections, as
this could be done in the Vancouver General Hospital.
Needling Cataract.—No payment will be made for needling of cataract.
Accounts will not be allowed unless relief number is given, and dates of
visit, also diagnosis and treatment.
Dr. Harold Brunn
(Presented at Vancouver Medical Association Summer School, June, 1937)
I might say that there are two parts to this talk. One is general empyema
of the pleural cavity, which you know all about. In searching for interlobar
empyema I was astounded to find that nobody has written on this subject.
This should be talked about more. I got one fellow to search this subject and
he was very successful. On a wax model of the lungs he produced an interlobar empyema similar to what one would find in humans. So I am going to
take up first the question of this subject.
First, I want to say that in a study of the lobes and of the fissures
we find one interesting thing—the lower lobe on both the right and the left
sides should be divided into two parts: the lower part of the lower lobe and
the upper part of the lower lobe, and the upper part of the lower lobe we
call the superior part or apex of the lower lobe. The lower lobe has three or
four bronchi coming down from the lower bronchus. This bronchus branches
off and goes posteriorly. Pneumonia occurs very frequently in the apex of the
lower lobe. If the fissures are not sometimes made more definitely—and
when you have four lobes on the right side or three lobes on the left side, the
superior lobe makes a fissure and sometimes there is a dimple there and an
adhesion there.
(Slides were then shown.) When a picture is taken in the A.P. view, with
some disease in that lobe it looks like this: a dense area of shadow in
front. If you wanted to puncture this you would be making a great mistake.
If you take the patient in deep inspiration it appears differently in the chest.
You can get atelectasis here. This is an embryo of the fifth week, viewed from
behind. Very often a fissure forms with this bud. Here is a case of a woman
of 53 years. She had a hernia operation for a ventral hernia. The third day
after she developed lung signs. We found dullness—a central pneumonia—
and we had this picture taken. When you take the lateral plate it always
appears as a triangular shadow. Depending on the inspiration or expiration,
this is below or above the diaphragm. Now this woman died and was posted,
and she had an abscess near that area which was overlooked.
Here is another case about midway between inspiration and expiration.
You see the same shadow but it looks a little different although it is the same
thing. Here is a little child that had an area in here and it looked like fluid—
all of this disease of the superior part of the lower lobe. It is an anatomical
lobe very often invaded by inflammatory disease, a central pneumonia, abscess
formation. If you want to drain these patients, you put the patient on his face.
We have never seen a carcinoma of the lung in the upper part of that lobe. I
don't know, why—I would like to ask Dr. Boyd. Here is a woman that was
sent to me and she had pneumonia. She was not improving 25 days after and
her doctor took a picture and you see this shadow. Here we find it again.
Her doctor wanted me to tap this, but I said, "No; that's the superior part
of the lower lobe and I won't tap it"; and I didn't tap it. She cleared up.
It was just a slow process but no fluid. We have many, many plates of the
interlobar fluid in the different fissures.
If you put fluid between the lower and the upper lobes and take a picture,
you get a view in the A.P. position like that—somewhat convex on the top.
When you take the A.P. view they are very diffuse, but in the lateral view they
are more defined. When you go to puncture that, where do you do it? You go
behind, you tap posteriorly near the spine between the fourth and fifth
vertebrae. If you approach that from the axilla you have to go through lung
about 4 inches to get your fluid. These things are very important, both in
Page 58 getting your fluid and in the operation. Here is fluid between the lower and
middle lobe. If more pictures were taken medically of pneumonia and patients
suffering from heart disease, you would find fluid. Medical men don't like to
take pictures. In the A.P. view you have this peculiar triangular shadow.
When you take your picture laterally this fluid is found between the middle
and the lower lobe.
Here is another picture showing that diffuse shadow, very much more
dense. It is very important for you to take a lateral picture. You see the fluid
between the middle and lower lobe. The upper lobe will be alright. Of course,
you have to make modifications. Here we have the whole fissure between the
lower lobe and the middle of the upper. It makes a kidney-shaped shadow. This
next slide was a case of a little child 4^ years old. His brother had pneumonia
and had gone home, and this child began to cough about a week later. They
found he had a temperature every afternoon and he was sent to the Children's
Hospital. They took a picture and were astounded to find this dark shadow
in the A.P. view and they said "interlobar fluid." I know it is not interlobar
fluid. So we had a great discussion as to what it was and I said that I would
put a needle in it. As I drew my needle out, it dropped some pus—perhaps
a broken-down dermoid. It might have been one of those hard neurofibromata,
but we didn't know. So we didn't get anywhere. So we put some air in the
chest and we dropped this tumour down from high up, down almost to the
diaphragm. I sent the patient home, built him up and brought him back.
About four months ago we took out this tumour. Chest surgery in children
is much easier than in adults. It was called a lymphogranuloma, but I am
not so sure. I am going to send it back east for examination. It is a soft
tumour, red and yellow-streaked. However, this child is now well.
This next boy was brought down from the country. He had this shadow
here on this side, and when we took a lateral it was over the heart shadow in
the middle lobe. Whether it was an abscess or whether it was fluid, or whether
it was both, we didn't know. He had been sick for 1% years with cough, expectoration, temperature, rapid pulse, etc. We went in anteriorly and found a
lung abscess and also an interlobar empyema between the middle and lower
lobes. There was no fluid in the pleural cavity. This picture shows how
dense that shadow was. He developed multiple cavities. After the operation
he went right along, but after that his temperature went up and he got an
empyema of his cavity and had to be drained. He improved and was discharged, with this thing all healed up. He came back and was very sick
again, had a temperature, etc., and when we did a lipiodol we found he had
bronchiectatic cavitations. We operated and I took a cautery and burned the
thing out and he is now perfectly well.
This next is an interesting case. This boy had serious trouble with his
kidney; he had a double kidney. He was operated on and half of the kidney
was taken away. Immediately after his temperature went up. He got pneumonia and was very ill. Following the pneumonia there appeared a shadow
in the left axilla. I tried to tap this and I did and got a lot of pus out. We put
a tube in and drained the general pleural cavity. He improved for a while and
then his temperature went up again. We took a needle and two or three times
we tapped this. He had multiple empyema cavities. Here was another interesting case. This woman was very sick following pneumonia. She came in and
said she had had a tumour in 1929 which was right over the heart. She came
in to us and we made a puncture and found a little pus. We also found we had
to drain the general cavity. The woman died and we had a postmortem on her.
She had an old empyema which had been there since 1929, and through that
infection which was there she had these other infections at this late date.
This next is a boy who had a tube in for three years. A tube is only good for
a short time, so don't leave tubes in the chest for any length of time. The
tube continues to make discharge.
Page 59 If you have a picture and you don't know whether it is pus or something
else, look for thickening of the ribs, which means that probably there is
chronic pus.
Here is another picture of a child who was tapped by a fellow who then
put a tube in and pushed it in. In this picture we see that the tube is curled
up^q. the cavity. Here is a tube that went under the diaphragm instead of
above it. This happens fairly often and has been known to cause a liver
We have found that we have not diagnosed fluid in the pleural cavity
because the heart and the mediastinum were not pushed to the other side.
However, they are usually found displaced to the affected side.
One thing about children—don't be afraid about them, for they are wonderful subject!, for chest surgery.
This man had a perinephritic abscess, and when they put a tube in they
put it into the pleural cavity and produced an empyema. In this next case,
a tube was put in for empyema and it was put right into the pericardium.
However, he went in again and put the tube right into the abdomen this
time, and in this picture we see the tube gradually coming out from the
appendiceal fossa. And this little child got well!
Professor Bourgeois is a fine man. Most of these empyemas are postpneumonic. He had a wonderful paper on this subject, and they have cut
down their mortality tremendously. His charts are astounding.
With these cases you must be more definite in your diagnosis. You can't
be too careful. If you have an empyema resulting from an abscess that breaks
from the periphery or into the pleura, you have one thing; if you have an
abscess, that is another thing. Then we have the empyemas that are interlobar, those that fill an entire cavity. And then you have the empyemas
which have air above. And just to say that this method or that method of
treatment is good with empyema, that's no good. The treatment of empyema
is simple. People don's die from empyema; they die from the concurring
infections; they die from the complications; and when the mortality of the
pneumonia is high then the mortality of the empyema is high. In treatment
you don't need a lot of apparatus. What you need is brains, and good brains
at that. Let me talk about treatment for a moment. Bremerton made out
some statistics as to treatment. Many of our cases are bad cases with mixed
infections, etc. Now aspiration with the needle every day or every other
day, taking out as much as you can, will cure a great number of pneumococcic
empyemas in children, but when they get older the very thought of a needle
frightens them. You should make four or five aspirations to see if they get
well. Then you have to put a tube in the chest to close drainage. And don't
leave tube drainage in too long. Don't leave it in for more than three weeks.
We like to get it out in 10 or 12 days, because if they are going to get well
they will do it almost overnight. Sometimes you can't draw all the fluid with
*the tube. We don't persist in that, but we take out a rib; make a little
opening first but take off enough ribs. We put in no stitches, because you
know how rapidly a child will collapse. We go in there with a light and see
that no loculi are left. We then pack the cavity with iodoform gauze usually,
or argyrol gauze. We pack it in very tight, and the child is perfectly well the
next day. You leave that in three to five days, and then they have no discharge any more and you have the cleanest pleura. They close up very rapidly.
The fault we had was that we kept on packing them.
The Annual Meeting of the North Pacific Surgical Association met in
Vancouver November 18-20, at the Hotel Vancouver. The meetings were well
attended, and concluded with a dinner on Saturday evening at which Dr.
Gallie, Professor of Surgery at the University of Toronto, was the speaker.
Dr. Gallie was also the speaker at the meeting on Friday evening, which was
open to all the medical men in the city and which was well attended. Officers
for the coming year are: President, Dr. A. A. Matthews, Spokane; First Vice-
President, Dr. G. Kenning, Victoria; Second Vice-President, Dr. R. Forbes,
Seattle; Secretary, Dr. Martzloff, Portland; Treasurer, Dr. Otis Lamson,
Seattle; Councillor, Dr. F. Brodie, Vancouver.
Extracts from Report of Proceedings of the Executive Committee
of the Canadian Medical Association
Dr. G. F. Strong, the representative from British Columbia on the Executive Committee of the Canadian Medical Association, presented to the Board
of Directors of the British Columbia Medical Association a report covering
the many actviities of the national organization from matters discussed at
the recent Executive Committee meeting in Ottawa, which he attended.
In the matter of the Rowell Royal Commission, a memorandum is being
presented by the Canadian Medical Association which will be prepared after
consultation with the various Provincial medical associations. This will
probably cover such subjects as Public Health Services, medical care of
indigents and fixing responsibility for financial contributions thereto.
The Department of Cancer Control of the Canadian Medical Association
is being developed with a strong Central Committee, with representatives
from each Province and Provincial committees to provide for local organization.
A book is being published and will be the product of the Canadian profession, being written and reviewed by the various Faculties of Medicine in the
Canadian Universities. This Canadian Book on Cancer will be sent to all
members of the profession in Canada. The Canadian Medical Association is
aiding in the organization of the Canadian Society for the Control of Cancer,
a lay-medical organization which will be of great benefit to the Dominion.
Federation, which when accomplished will unify the Canadian profession
in one organization, is in process of development, and in British Columbia
will progress under the guidance of Dr. H. H. Milburn, Chairman of the Committee on Constitution and By-laws of the British Columbia Medical Association. It is hoped that before long it will be possible for all who so desire to
be members of the Canadian Medical Association at the reduced fee of eight
dollars per annum. We have ample proof in B. C. of the value of medical
The matter of pasteurization of milk is being studied by both the National
and Provincial Committees on Public Health, and some action providing for
safer handling, distribution and consumption of milk pressed for.
Already plans for the 1938 meeting of the Canadian Medical Association,
to be held at Halifax, are well under way and the programme is in process
of preparation.
Prepared and Presented by the Director.
The policy of the Division of Venereal Disease Control may be defined
under three headings:
1. What we should like to do.
2. What we have done.
3. What we are doing.
The objectives of an ideal programme would be:
1. To find venereal disease.
2. To treat venereal disease.
3. To teach venereal disease.
Let it be definitely understood that these ideals are not at present capable
of fulfilment by reason of the limited resources of the Division of Laboratories, restricted hospital accommodation and the general inadequacy of
available funds.
To find venereal disease:
1. Routine blood tests: (a) at the first consultation with the doctor;
(b) on every admission to hospital; (c) at every life insurance
2. Contact tracing—examinations of: (a) Husbands, wives, parents
and children of known cases; (b) all other exposures.
3. Routine spinal fluid examinations: (a) At the end of 12 or 18
months treatment in every case of early syphilis; (b) before any
treatment in every case of syphilis of over two years' duration; (c)
in any patient, even without known syphilitic infection, who is suffering from headaches, dizziness, vague symptoms, spasmodic
attacks of pain, character changes, etc.
To treat venereal disease:
1. Adequate facilities for treatment convenient and available to every
2. Universal adoption of recognized modern standards of treatment
in all classifications of syphilis and gonorrhoea.
3. Adequate hospital accommodation for infectious cases, incapacitating complications, specialized therapy.
To teach venereal disease:
1. To graduate and undergraduate physicians.
2. To the general public.
3. To educators, including teachers, preachers, group leaders, etc.
These are the ideals toward which we strive. Hence they represent our
Specifically our policy is:
1. Treatment in clinics: (a) To treat every case that presents itself
to us regardless of his or her social or economic standing, but to
discourage further attendance of all those who can afford treatment by a private physician.
2. Diagnostic services: (a) To offer to the general practitioner the
services of our staff of experts for any special examination of
patients unable to pay private specialist's fees.
Page 62 2.
3. Drugs: (a) To supply anti-luetic drugs free to all doctors where
there are not clinics for all their patients, pay, part-pay and non-
pay, if in return the doctor will agree to administer the drug to
patients who cannot pay and also in special instances in places
where clinic service is available.
4. Social Service (a) The personnel of this section will be glad to
assist any physician in respect to contact tracing, follow-up or
case holding.
5. The Division of Venereal Disease Control is definitely determined
to avoid disturbing in any way the relationship between the physician and his private patient.
What we are doing:
1. The number of active cases under treatment at the Vancouver
Clinic comprises 922 cases of syphilis and 291 cases of gonorrhoea,
making a total of 1213 cases.
New admissions in August, 1937, were as follows: Syphilis, 66,
and gonorrhoea, 72.
Anti-luetic injections given in August, 1937: Arsphenamines, 712;
bismuth, 1449; tryparsamide, 508.
It is estimated that 12,225 ampoules of arsphenamines and 22,500
cc. of bismuth will be distributed gratis to physicians in 1937.
Patients receiving malarial therapy in August, 1937: Adults, 20;
children, 2.
The clinic in Victoria is in the process of reorganization, and other
clinics are proposed in the near future for Trail, Nanaimo and other
focal points.
7.   The central office at 2700 Laurel Street is the headquarters for
provincial records, statistics and drug distribution. A special consultative service is available to any doctor wishing to secure advice
on particular problems which arise from time to time. An average
of 100 consultations monthly is given by correspondence. Advice
by telephone and personal interview is also willingly given to any
The Division has been in existence scarcely a year. We are proud of the
progress to date. We appreciate the co-operation which we have enjoyed from
the medical profession. With their continued support we hope to be able to
accomplish the aims and objectives which we have here briefly outlined.
Maurice H. Rees, M.D.
Dean and Superintendent, University of Colorado School of Medicine
and Hospitals
E. G. Billings, M.D.
Director Psychiatric Liaison Department, Colorado General Hospital,
Denver, Colorado.
(Hospitals, Aug. 1937)
During the last decade through the progress made in that prominent and
promising "advancing edge" of medicine, namely, psychiatry, the non-psychiatric physician and hospital administrator have been brought face to face
with the sane, sensible and scientific consideration of the ever present problem—the care of the neurotic patient in the general hospital.
Page 68 In this discussion we are not in any measure using the term "neurotic
patient" with any of the formal psychiatric connotations. We are using the
term, as do many of the older general physicians, in the incorrect sense of
indicating any person afflicted with any of the many psychogenically determined disorders.
In the days past the so-called "neurotic patient" in the average general
hospital was a clinical case scorned, at times ignored, more often, through
ignorance, mistreated and as frequently subjected to useless, mutilating surgical procedures and discouraging pseudo-medical therapies. The total result
was commonly an individual submerged in a rut of chronic invalidism and
sociologic incompetence, a loss of confidence in the well meaning medical profession, and a financial loss either to the patient, his family, or his community, while, in the case of a charity or semi-private hospital, he became a
monetary and time forfeiture of no little significance.
The psychiatrists, internists and surgeons, working in a co-operative
fashion, have shown us that the days of seeing, examining and treating a
patient merely in terms of his stomach, heart, skin, reproductive organs,
endocrines, etc., are past. We have learned that man is an organism with
organs and structures and individual physiologic functions of those parts
which, working together, give rise to new and higher functions resulting in
so-called mentally integrated activity. Thus worries, remembrances, anticipations, insecure feelings, certain misunderstandings, etc., may affect the
person all over and not merely the abstract mind separated from a body.
Certain trials and strains of life may make for depression with all the body
participations, such as lacrimal gland activity, spasm of the pylorus, disturbed functioning of the bowels, loss of appetite, rapid pulse, etc., which are
common concomitants of such a mood. Competent internists, particularly, tell
us that from one-third to over one-half of the aches, pains and disturbances
in physiology they are called to understand and treat are but body repercussions to the strain of life. We can no longer speak glibly of every patient ill
in such a way as being a "neurotic." Nor can we any longer treat him with
optimism by those still existent, archaic measures arising from focusing on
some one of the many body protests to life strains, making that particular
innocent organ or function the scapegoat for the whole trouble.
During the past two and one-half years the studies of the Psychiatric
Liaison Department of the Colorado General Hospital have shown that out
of every 28 admissions to the ward, at least one patient is suffering with
an illness requiring the services of a physician well trained in psychiatric
procedures. We know that on an average, at least two other patients of the
28 require the aid of a physician with some psychiatric understanding. A
recent survey has shown that in Colorado during 1936, 87,770 patients were
admitted to the general hospitals alone. Using these figures, it becomes
evident that between 3,000 and 9,000 patients (as compared to the 1,580
patients admitted to the tuberculosis institutions of the state) admitted to
the general hospitals of Colorado last year were cases, in part or in whole,
ill as a result of personal difficulties. The significance of these figures if
viewed only from the financial point of view is astounding, and if considered
in more broad medico-sociologic terms, may be considered as indicating that
one of the most pertinent problems of the general hospital staff is the understanding, care, and treatment of the medico-psychiatric case.
It is frequently said that in order to treat adequately the so-called "neurotic patient" many elaborae facilities not common to the average general
hospital are needed. In our experience this is not true. In so far as the
physical aspects of the hospital are concerned, there should be available:
(1) One room per thirty-bed ward, equipped with windows that cannot
be opened wider than six inches top and bottom and preferably made of small
Page 64 1
panes set in steel casements. This simple and inexpensive precaution makes
it possible to protect the delirious, depressed, and possibly suicidal patient
from accidentally or impulsively precipitating himself from the room. In
1934-35 six patients were injured as a result of such falls in the Colorado
General Hospital. During the last two years, with the installation of such
rooms and the additional education of our staff, no accidents have occurred.
(2) Apparatus for giving of continuous neutral baths, though not an
absolute prerequisite, is a necessary adjunct to the treatment of the psychiatric case and is very valuable in the symptomatic therapy in many organic
(3) Opportunities for the patient to have direction in constructive
activity such as craft work, assisting in the upkeep of the hospital ward,
yard, etc., are indispensable. Occupation for the patient of this category is
of paramount importance in aiding the patient to sublimate his more personal difficulties, thus making him more amenable to symptomatic and causal
Besides the few physical aspects of the general hospital necessary for
the adequate treatment of the medico-psychiatric case, by far the most
important requisite is that the nursing and medical staff understand personality functioning in health and disease. To illustrate this point without
indulging in a lengthy discussion, a clinical case admitted to the Colorado
General Hospital will suffice.
R. S. (House No. 28684), aged 30, five years married and the mother of
a 1-year-old child, was admitted 11-30-35, complaining of pain in the abdomen,
discomfort in the neck, and precordium, fatigue, weakness, "chills," and
inability to do her work. This woman, at great expense to her and ultimately
to several physicians and hospitals, was treated over a period of five years
for gastric ulcer, appendicitis, and pelvic disorders that nexer existed. She
was operated on twice, threatened with a thyroidectomy, and as a result
had become an insecure, chronic invalid, unable to care for her child and
home. This woman, for the first two and one-half weeks in the hospital,
because of the traditional methods of history taking, was never given a
chance to explain her symptoms or to elucidate the development of her
illness. A few complaints were taken and then a long and expensive series of
x-ray, laboratory examinations, and special consultations ensued, but revealed no explanation of the problem. Two hours of the time of a physician
willing and able to understand personal difficulties as well as organ dysfunction, revealed that this woman was reacting to some simple problem of
ordinary life, that the symptoms referable to certain body segments were
only manifestations of physiologic participation in emotional tension. Following the historical development of the illness in terms of life situations
she, without any other aid, was capable of understanding her complaints for
the first time. A few simple and non-time-consuming discussions regarding
more healthy means of managing her life, and for the purpose of clearing
up some misunderstandings leading to uneasiness and tension, returned this
woman to a healthy status. She has remained well for two years except for
an occasional cold, accidental or common intercurrent infection. Only one
week and a half was required by the physician last in charge of her to work
out the problem and send her home "under her own power."
This case points to the most important item in the care of the psychiatric
case in the general hospital. This very pertinent integrate is simply that the
nursing and physician staffs of our hospitals have an understanding of human
nature, the physiology of the person as a whole, and not to be too obsessed
with the need to explain everything first or only in terms of diseased organs.
To date, no hearts or stomachs! have applied for admission to our hospital.
Some living,  thinking,  remembering,  anticipating man,  woman or child
Page 65 walked in with those misbehaving viscera. Often the viscera were at fault,
but nearly as frequently they were only participants in a sociologic, economic
and personal drama of everyday life.
It therefore seems imperative that in our medical schools today we teach
the future physician (1) to take a complete history of the complaint in terms
of the setting in which the complaint became apparent, evaluate the personal
and situational factors modifying or amplifying it; and (2) how to treat
the person as a total person with biologic, temperamental and intellectual
attributes capable of modification.
The increase in mental sickness in the United States is resulting in a
dilemma of great significance. If this coming year some plague should incapacitate 3,000 to 9,000 individuals in the State of Colorado, we would do
something about it. Yet next year there will be that number of psychiatrically
incapacitated persons admitted to our general hospitals in the state. To wait
until these individuals are so profoundly invalided that they can never pull
themselves up to an efficient level again, or to wait until ten years hence
they are admitted to our mental hospitals, is not an economcial or common-
sense approach, to say the least. The prevention of the so-called "neurotic"
syndromes is to be found in the general hospital that recognizes the true
nature of the disorder, treats it judiciously, and through these procedures
teaches the people of the community a workable mental hygiene.
"There is much comfort in high hills,
And a great easing of the heart."—Young.
The Cowichan River was in low water when we arrived on the 13th of
October for a few days' respite from duty and the office. The whole picture
changes with the rise of water which usually comes in October. It was rising
on the 20th. The restful fluent mirror with sparkling ripples breaks into a
bouncing whitened stream as it playfully hurries along to the sea. The partly
submerged willow branch tirelessly waves farewell to the sculling leaves
gliding on, as this never-ending river ceaselessly rushes by.
Everything is relentless in the October spate—the salmon are in the river
and, suffering Nature's urge, struggle on to their fate. The Rainbows are
there too, and hence the Angler. The Fisherman wades into the shallows and
surveys the scene—the river, the eddies, the deep silent water, the broken
rushing stretches, the haze and blue on the hills, the whole framed in rusts
and yellows. The Spring brings inspiration, but the Autumnal colourings lure
the Nature-lover and the artist to the river.
The fishing is good and provides an excuse to live by the river, and thus
it is that the Angler casts his fly into the edge of the roughened current and—
splash and a flash (as emphatic as a Lowrie wham or slam)—he is into a
three-pound rainbow; what to do—why a fighting bundle of muscle can be
so stubbornly resistant—stupidly insistent on swimming in rapid water—
fast water and a whirring reel—the rod in a perfect ellipse—the line humming
as the captive strains and sulks, shunts and slacks, spurts and sallies; it
seems to have an idea—to break a too-light leader. The fight is on—the breeze
that strums on the tautened line seems warmer—the sport of kings—the fish
to net—and then again.
A partly filled creel and a fuller day. The days are short in October and
perhaps it is well. One must needs rest and sleep—dream of another day on
the Cowichan—white water and the Rainbow.
"J will life up mine eyes unto the hills, whence cometh my help."
W. N. Kemp, M.D., Vancouver.
(Read before the Vancouver Medical Association, November, 1937)
Before entering on our subject this evening a word of explanation may
be in order. Many of you have wondered or even enquired concerning the
rationale of a paper on vitamins by one specializing in endocrinology. The
truth of the matter is that it is practically impossible to separate endocrine
and vitamin or dietary therapy. Vitamins may well be called "plant hormones" whose clinical importance is second only to the glandular hormones.
In matters of growth, thyroid and parathyroid function, reproductive function, diabetes and other endocrine conditions, a working knowledge of both
vinamin. and mineral requirements is essential.
Since 1911, when Funk coined the word "vitamine" (a word since proven
to be a misnomer except in its application to vitamin B), great progress has
been made in the elucidation of the rdles played by the now well-known and
accepted chemical entities to which the modified term vitamin is still applied.
The classical vitamin-deficiency diseases of xerophthalmia, beri-beri,
pellagra, scurvy and rickets are well known. My purpose in reading this paper
tonight is to direct attention to and discussion of the probable r61e played by
avitaminosis in latent or sub-clinical conditions of vitamin deficiency which
are not sufficiently complete or advanced to give the classical picture of
vitamin deficiency.
. Thanks to the recent clinical and pathological studies of Eddy and Dal-
dorf, whose recent treatise "The Avitaminoses" has been an invaluable vade
mecum in the preparation of this paper, we are now in a position to appreciate the fact that there exists in most "civilized" people many instances of
subclinical or latent forms of deficiency disease. In directing your attention
to a consideration of these newer facts and hypotheses concerning partial or
latent avitaminosis, and in summarizing our present knowledge of the occurrence, stability and other important properties of the vitamins, it is hoped
that some service may be rendered.
That partial vitamin deficiency is a potent factor in the etiology of many
of the "ills that flesh is heir to" is highly probable in the light of the recent
experimental work of McCarrison and Rinehart. The former, a pioneer in
the pathological study of avitaminoses, has recently shown some startling
effects by giving healthy rats diets similar to those followed by humans in
parts of India and England.
His rat colony, fed whole-wheat flour, unleavened bread lightly smeared
with fresh butter, freshly-sprouted "gram," fresh raw carrots and cabbage,
fresh milk, a small ration of raw meat with bones once a week and plenty of
water, showed no illness during a period of two and one-half years. From
this group 1189 animals were examined postmortem without the discovery
of any disease other than an occasional tape worm. In striking contrast are
the postmortem findings of 2243 autopsies of animals fed on diets copied from
those followed by some people in India and England. In these rats disease
was found to be very common. The most frequently appearing lesions were
pulmonary infections, gastric ulcers, enteritis, pyelonephritis and renal calculus. It is probably significant that these lesions are also commonly found
in the humans who follow such experimental diets.
The work of Rinehart is most interesting in this respect also. He observed
changes in experimental scurvy which were suggestive of rheumatic fever.
By superimposing streptococcal infection he produced identical cardiac and
joint lesions to those found in humans following rheumatic fever. If vitamin
C were adequately supplied heinvariably failed to produce any characteristic
lesions, regardless of the kind of bacteria introduced. If, however, the diet
Page 67 was deficient in vitamin C, warty growths could be found on the heart valves,
inflammatory lesions in the myocardium, and degenerative and granulomatous
lesions in the joints.
"The term vitamin connotes a group of substances having a regulatory
action on the utilization of food stuffs, such substances being preventative
of certain pathological consequences of their omission or inadequacy in the
dietary. As such they are closely allied to the hormones produced by our
endocrine glands, but differ from them by the fact that our source of vitamins lies mainly in ingested foodstuffs and not in human manufacture.
Furthermore, the vitamins affect the function of the glands of internal
"The tendency of civilized man to eat less of the natural unrefined food
products and more of the ultra-refined (and hence vitamin-deficient) foods
has led to a condition of dietary habits in which many persons from habit
or necessity are chronically short of some of the essential vitamins. J. B. Orr
has recently published a study of the relation of dietary adequacy to income
in England. His study showed the startling fact that fifty per cent of the
English population follow a diet inadequate in vitamins. Partial group studies
in the United States by the U. S. Bureau of Labor Statistics and the Bureau
of Home Economics show that American diets are also commonly deficient
in vitamins and minerals."
A further aspect of the deficiency diseases which is only recently receiving
recognition is the r61e of abnormal metabolic processes or gastrointestinal
function in making inadequate, either through faulty absorption or excessive
destruction, what might otherwise be an adequate dietary vitamin intake.
We have learned that beri-beri may occur because intestinal lesions prevent
absorption of vitamin B or because the heightened metabolism of fever
increased the requirements of this vitamin. We know that vitamin C may be
destroyed in the body by toxins or in the intestines by bacterial action; that
vitamin D functions best in an acid medium and is ineffectual in the absence
of bile salts.
This fat-soluble vitamin is produced by nature in plant tissues as a pigment called carotene. This pigment is really provitamin A because it serves
as the source of vitamin A to animals, the formation and storage of the latter
taking place in the liver.
Beta-carotene, the best known source of vitamin A, has been selected as
the basis of the International Unit of vitamin A. This unit is the growth-
promoting activity of 0.6 micromilligrams (0.006 mgm.) of pure beta-carotene. Let us note here that one gram (3.6 grams to a teaspoonful) of U.S.P.
standard cod liver oil must contain 600 International Units (I.U.) of vitamin
A. A teaspoonful will therefore contain 2160 I.U. of vitamin A.
The human requirements of vitamin A range from 4000 I.U. in infancy
to 9000 I.U. during pregnancy. Adolescents require 8000 I.U. and adults
approximately 5000 I.U.
The natural dietary sources of provitamin A are the green leafy vegetables and the pigmented vegetables and fruits. The vitamin A content of
milk varies directly with the character of feed that the cow receives, succulent greens increasing the A content of the milk. It is interesting to note that
even the method of curing the hay or alfalfa is important in relation to its
vitamin A content. It has been found that alfalfa artificially dried in a modern
hay drier has about seven times the potency in vitamin A of field-dried alfalfa.
The stability of any vitamin is of prime importance to us. Vitamin A is
stable even at high temperatures if oxygen is excluded. Hence there is little
destruction of A in commercial canning provided soda is not added to the
product for purposes of softening the fibre and the color. All plant and animal
sources of vitamin A show progressive destruction of the vitamin during
storage unless measures are taken to prevent fermentation, oxidation and
rancidity. Frozen products retain vitamin A well.
Page 68 The Equivalence op Vitamin A Sources
Source of vitamin A : Int. Units per oz.:
Beta-carotene .47,000,000
Cod liver oil (U.S.P. standard  6,800
Egg yolk  9,800
Spinach  6,500
Beef liver  3,920
Calf liver  2,860
Apricots (fresh) .  1,500
Sweet Potatoes  1,000
Green lettuce  1,000
Carrots (raw)  1,600
Butter   2,120 to 100
Milk (per pint) 1,200
Cheese  980
Eggs  900
Vitamin A is essential to (1) growth, (2) vision and (3) the health of
specialized (epithelial) tissues.
In vision, vitamin A has a dual part to play; a deficiency produces morbid
changes in the cornea leading to loss of sight or ophthalmitis; secondly, it is
a necessary chemical constituent of the retina. The stimuli that produce the
sensation of vision do so through a chemical change in the retina induced by
the action of light waves on the pigment commonly known as the visual purple
contained in the rods and cones. To produce a nerve impulse in the optic nerve
light must bleach the visual purple to visual yellow. To restore sensitivity
to light visual yellow must be restored to visual purple continuously and
instantly. For this process of sensitivity restoration the presence of vitamin
A is absolutely essential. Retardation of the process results from deficiency
of vitamin A and is called hemeralopia or night-blindness.
It is now possible, with an instrument such as the Birch-Hirschfeld
photometer, to determine the presence and degree of night-blindness. In this
locally made example of the instrument a target with five holes is unequally
illuminated by a light of constant electrical voltage. The inequality of illumination is accurately progressive by means of varying thickness from 1 to 5
of a photographic film of uniform density. The procedure is to determine the
intensity of light required by the patient to enable him to see three of the
holes in the target immediately after coming from a brilliantly illuminated
room and again after ten minutes' rest in the darkness or with the eyes
blindfolded. A modification of this type of instrument is sometimes called the
Since the development and use of such instruments as the photometer
the presence of hemeralopia in sub-acute form has been found to be far more
prevalent than was formerly supposed. Jeans and Zentmire, at the University
of Iowa, located in a rich agricultural district, have announced that by using
this test they had found relative night blindness to be very common among
children entering the University Hospital. Many people with apparently
normal day vision, when exposed to the sudden glare of advancing automobile
headlights, show relative retardation in the restoration of normal vision
because of slow visual purple regeneration due to circulatory deficiency of
vitamin A. It therefore follows that vitamin A deficiency can be an important
factor in the safety of night driving.
Hemeralopia preceeds xerophthalmia and affords warning of vitamin A
deficiency. This early criterion of vitamin A deficiency is obviously of great
importance, since ocular lesions frequently develop so rapidly that, even with
prompt diagnosis, vision may be irreparably damaged.
Although hemeralopia is the first early sign of vitamin A deficiency in
adults, it is of course undetectable in infants, the commonest victims of A
deficiency. Here the deficiency usually manifests itself by a dry scurfy skin
Page 69 frequently showing infections, and sometimes with loss of hair. In Ceylon the
condition is called "mandama" and there the four cardinal signs are xerophthalmia, stunted growth, diarrhoea and a toad-like skin which Nicolls calls
' 'phr y noderma.''
The specific anatomic effect of vitamin A deficiency in the rat, guinea pig,
monkey and other experimental animals is the loss of the ability to maintain
various specialized epithelial surfaces. As a result of lack of vitamin A these
specialized epithelial tissues are replaced by squamous celled epithelium
which is much less adapted to maintain the health of the organism. The
specialized tissues thus adversely affected by avitaminosis A include the
respiratory mucosa, the salivary glands, the eyes, the glands of the intestinal
tract, the pancreas and the parocular glands. In the rat, for instance, all
epithelium undergoes metaplasia, including that of the genito-urinary tract
and the enamel organs of the teeth. In the early stages of the deficiency
"nests" of darkly staining germinal epithelium may be seen to undergo rapid
growth. At is grows, the overlying secretory or duct epithelium degenerates
and sloughs. The aforementioned nests or foci of germinal cells continue to
grow to form islands of stratified squamous epithelium. These first extend
laterally to undermine the adjacent surfaces, and eventually, if the lack of
vitamin A is sufficiently prolonged and severe, they extend to replace the
entire surface of the affected organ. With moderate deficiency, alternating
areas of normal and replacement (squamous) epithelium occur side by side.
What are the consequences of these anatomical changes? The first effect
is loss of function of the affected epithelial surface. In the case of the trachea,
the loss of cilia precludes proper cleansing of that part of the body, and in
the conjunctiva the loss of mucus-secreting cells has an adverse influence on
the health of the eye. In addition to the loss of function of the affected surfaces, two other major sequelae have been repeatedly emphasized. One is
the blockage of gland ducts, leading to stasis of secretions and ipso facto to
infection. The other major consequence of these epithelial retrograde changes
lies in the interference with the function of the glands and organs involved.
The lesions in the teeth are equally striking and characteristic. Wolbach
and Howe consider that they are the most important dental defects resulting
from any of the dietary deficiencies. Here the avitaminosis shows itself in
the atrophy and metaplasia of the enamel organ. Enameloblasts are replaced
by* stratified squamous epithelium. As a result there is loss of enamel and
exposure of dentin which gives the teeth a chalky appearance. Simultaneously
the odontoblasts within the tooth atrophy, thus leading to cessation of tooth
When a considerable lack of vitamin A occurs in pregnant animals,
intrauterine death and resorption of the foetuses occurs. In contradistinction
of avitaminosis E, the maternal decidua becomes necrotic and infected,
leading to foetal death. By increasing the vitamin A intake just sufficiently
to keep animals on the border line of the earliest lesions of deficiency, a
variety of other abnormalities may be produced, including prolonged gestation, difficult labor, with, often, maternal or foetal death and retained and
diseased placentae.
Avitaminosis A causes in man histological tissue changes similar to those
experimentally produced in animals with one notable exception: the skin
lesions of this deficiency are limited to man. They may consist of dryness
and scaliness of the skin and possibly furunculosis. The follicular lesions that
may occur are described as being hard, deeply pigmented and surrounded by
a zone of pigmentation.
In humans, pneumonia has always been a common associate of vitamin A
deficiency. In seven cases in which Blackfan and Wolbach were able to recognize vitamin A deficiency only after autopsy, five had died of broncho-pneumonia. Pneumonia was frequently present in Sweet and King's series of vitamin A deficient cases. It would appear from the experimental and clinical
Page 10
p*a evidence that avitaminosis A predisposes to pulmonary infection, probably
through the regressive changes that it causes in the respiratory epithelium.
It is not impossible that some instances of postoperative pneumonia are due
to a combination of factors, of which avitaminosis A is not the least important.
Experimental studies are, in general, in agreement on the frequent presence of renal and cystic calculi in vitamin A deficient rats. The calculi are
usually of the calcium-magnesium variety and disappear when the diet is
corrected. In some cases in humans, a dietary deficiency may be responsible
for the formation .of kidney stone. It is probable, however, that other dietary
factors are involved in stone formation. In the year 1800 forty-five per cent of
all bladder stones occurred in the young. The almost complete disappearance
of urinary bladder calculi in children in the past hundred years suggests the
beneficial effect of the dietary improvements that have been made during the
past century.
One must agree with Eddy and Daldorf when they state the opinion that
the highly suggestive experimental studies require continued clinical examination of the effects of decreased and increased vitamin A intake. It must
be admitted that many of the discouraging results of vitamin A experimental
clinical therapy are based on very unsatisfactory clinical experiments. Very
few clinical tests have duplicated the experimental laboratory conditions,
and this is particularly important because the effects of avitaminosis A may
often be delayed. For example, there is nothing in the experimental evidence
to indicate that large doses of vitamin A will ward off or modify the course
of a respiratory infection, the early signs of which are already manifest; nor
to indicate that a few days' treatment with the vitamin will have any effect
in a patient with lobar pneumonia.
(Continued in January issue)
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Prescription Department. But we are
ready for your most exacting orders
day or night.
<&mtn $c ijatttta ICiiX
Established 1893
North Vancouver, B. C.   Powell River, B. C.
published Monthly at Vancouver, b. C. by ROY WRIGLKY LTD.. 300 west Pender street ■ 5g£S3j@Sg-_$^^
Hollywood Sanitarium
For the treatment of
Alcoholic, Nervous and Psychopathic Cases
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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