History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: May, 1933 Vancouver Medical Association May 31, 1933

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 VOL. IX.
MAY. 1933.
NO. 8
o-
THE BULLETIN
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Vancouver Medical Association
Annual Meeting
Subarachnoid Insufflation
Carriers and Puerperal Fever
Chemistry and Metabolism of Cancer
PACIFIC NORTH-WEST MEDICAL ASSOCIATION
Hotel Vancouver.       July 4, 5, 6, 7, 1933.
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Vancouver Drug Company
Limited
Head Office:
456 Broadway West Vancouver, B. C. THE     VANCOUVER     MEDICAL     ASSOCIATION
BULLETIN
Published  Monthly under  the  Auspices  of  the  Vancouver Medical  Association in  the
Interests of the Medical Profession.
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.  IX. . MAY,   1933. .  No.   8
OFFICERS 1933-1934
Dr. W. L. Pedlow Dr. A. C. Frost Dr. Murray Blair
President Vice-President Past President
Dr. W. T. Ewing Dr. W. T. Lockhart
Hon. Secretary Hon. Treasurer
Additional Members of Executive:—Dr. C. H. Vrooman; Dr. H. H. McIntosh
TRUSTEES
Dr. W. D. Brydone-Jack. Dr. J. A. Gillespie Dr. F. Brodie
Auditors:   Messrs.  Shaw,  Salter  &  Plommer
SECTIONS
Clinical Section
Dr. W. H. Hatfield . . Chairman
Dr. W. L. Graham Secretary
Eye, Ear, Nose and Throat
Dr.  R.   Grant   Lawrence    Chairman
Dr.   E.   E.   Day    Secretary
Paediatric Section
Dr.   J.   R.   Davies .  Chairman
Cancer Section
Dr. A. Y.  McNair Chairman
Dr. A. B. Schinbein Secretary
STANDING COMMITTEES
Library Summer School
Dr.   H.   A.   DesBbisay Dr-  J-  W Thomson
Dr. G. E. Kidd , Dr-  C- E- Brown
Dr   1   F   Harrison Publications Dr. C. H. Vrooman
Dr'. W.  D. Keith                   Dr. j. H. MacDermot Pr- £ W/ A^vc^
Dr. C. H. Bastin                     Dr. Murray Baird °R' g' ^ ?f>HN
Dr. A. W. Bagnall                Dr. D. E. H. Cleveland Dr- H' R* Mustard
Hospitals
Dinner Dr. W. C Walsh
Dr   T   G   McKay                                      Credentials Dr- | B.  Peele
£    xr' ^' „n DR- T. H. Lennie
Dr. N. E. MacDougall          Dr.  F.. P.- Patterson rj>R. q p. Covernton
Dr. G. E. Gdilies                     Dr. S. Paulin
Dr. F. W. Brydone-Jack V.O.N. Advisory Board
Rep. to B. C. Med. Assn. D£ j   wJ Shi£r
Dr. G. F. Strong Dr. H. H. Boucher
Sickness and Benevolent Fund — The President — The Trustees VANCOUVER HEALTH DEPARTMENT
STATISTICS, APRIL 193 3.
Total Population  (Estimated) 	
Japanese Population   (Estimated)    1_
Chinese Population  (Estimated)  	
 . -         247,2 51
 ._ 8,429
  7,759
Rate per 1,000 of Population
Total Deaths _          202 9.6
Japanese  Deaths     3 4.2
Chinese Deaths    13 19.7
Deaths—Residents   only     178 8.5
Birth  Registrations .  263 12.5
Male       123
Female 140
INFANTILE MORTALITY—
Deaths under one year of age  8
Death  Rate—Per   1000  births  .  30.4
Stillbirths  (not included in above)   ,  11
CASES OF CONTAGIOUS DISEASES REPORTED IN CITY
April  1st
February,  1933 March,  1933 to 15th, 1933
Cases     Deaths Cases     Deaths Cases     Deaths
Smallpox 	
Scarlet Fever  	
Diphtheria   	
Diphtheria Carrier 	
Chicken-pox 	
Measles   	
Mumps   	
Whooping-cough           2 5
Typhoid Fever   : .	
Paratyphoid    ,	
Tuberculosis       141
Poliomyelitis	
Meningitis    (Epidemic)
Erysipelas   	
Encephalitis  Lethargica  	
25
0
2
0
0
0
87
0
0
0
29
0
25
0
3
0
0
0
41
11
0
0
0
0
4
1
0
0
0
9
0
1
154
3
80
31
4
0
118
1
0
3
0
0
'A1
y]0
0
0
0
0
0
0
0
10
0
0
0
0
3
0
0
62
0
40
19
2
0
35
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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"The Illinois Health Messenger" for April 1, 1933, contains the
following interesting account of an outbreak of scarlet fever traced
to the use of unpasteurized milk at Decatur, Illinois, during September
and October 1932. Like other outbreaks of this disease there was
apparently some difficulty in diagnosing accurately the disease as it
appeared in the patients. It is stated that this outbreak "involved 13
cases of an infection that for the most part was fairly characteristic
of scarlet fever."    The report given is as follows:
Report of the Epidemiologist
"The report of the epidemiologist from the State Department of
Public Healili who investigated the outbreak reads as follows:
'The outbreak began over a month prior to the date of this investigation. A rather sudden increase in the reported prevalence
of scarlet fever in Decatur had attracted attention to and cast
suspicion on a raw milk supply from one particular dairy.'
"This investigation revealed that 13 cases of illness had occured
among the group who had used raw milk from the dairy under
suspicion. Each of the 13 patients had drunk milk from the
supply obtained either directly from the dairy or through a
neighborhood grocer. Two persons of one family with three
members drank pasteurized milk and escaped the disease, while
the third member used the suspected milk and developed symptoms
of illness similar to those characteristic of other cases.
"An unofficial report from the neighborhood stated that prior to
this outbreak there had been scarlet fever on the premises on
which this dairy 'is located. This, however, was denied by residents of these premises. It was officially reported, however, that
an employee at this dairy did have genuine scarlet fever. In one
family where three cases occurred there was a death. The cases
wcAe not at all typical for either scarlet fever or septic sore
throat. In those showing eruption the rash was in most cases
slight and was limited mainly to the chest, although one or two
had well developed rash all over the body. The cases with the
worst throats had scarcely any rash.
"Examination of milk samples from individual animals of this
herd revealed cultures that were positive for hemolytic streptococcus from one cow but so far as we could ascertain there had been
no mastitis in the dairy herd. The cow yielding milk with
positive evidence of hemolytic streptococcus was removed from
the herd and the sale of milk from this dairy was discontinued
temporarily. THE EPIDEMIC PROMPTLY BEGAN TO SUBSIDE. It seems certain that the infection was transmitted through
the milk from this dairy but whether it originated from the in- ■
fected coiv or from the case of scarlet fever on the farm, we are
unable to say."
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Manufacturers: Bilhuber-Knoll Corp., Jersey City, N.J. EDITOR'S PAGE
The annual meeting, held on April 25 th, came as a very pleasant
surprise. Annual meetings are usually dreary affairs, opened with a
handful of conscientious members, present mainly because they have
always made a habit of attending meetings, and this is just another
meeting, and a few chairmen of committees, present because at the last
moment they have collected a few data about the year's work, and
want to get them off their mind. The attendance increases slowly and
fitfully, and then dwindles in the same. manner. The air thickens with
nicotine, and the reports seem as if they will never end. The elections,
all pre-digested as a rule, and therefore tasteless, arouse little or no enthusiasm, while when it comes to appointing the year's committees, a
solution is invariably found by the appointment of men who are not
present. This serves a dual purpose—it provides members for the committees, and it inflicts a punishment on the absentees, which they have
thoroughly deserved by being absent. Of course it leads to a great deal
of trouble later on—but that is a characteristic result of democratic
government in any case which rarely tempers its action of to-day by
a care for what the results may be to-morrow.
This annual meeting was a delightful exception to the general rule
—we feel that the retiring President, Dr. Murray Blair, is greatly to
be congratulated on this—since he took some pains over the programme
ahead of him and kept it well in hand. Reports were really interesting
and to the point—elections were worth coming for—no dirty tricks
were played on absent members—and we got through in decent time.
To two reports in particular we feel that we must pay special
notice. They were those of the Treasurer, and of the committee for the
Provision of Medical Care. To take the Treasurer's report first; one
cannot but be struck, when hearing Dr. W. T. Lockhart give his Annual
Report, by the earnestness and sincerity of our Treasurer. He is not
merely one of the Executive—he is a very hard-working and hard-
worked officer of the association, who brings to his task not only
keenness, but a strong sense of duty. We cannot but feel that in
these times of depression, especially, we are very fortunate indeed to
have such a man as our Treasurer. He has the gift of saying "no"
with a smile—yet it is a firm "no." His) report reveals, as one would
expect, a great deal of work; but it reveals more, in that it shows a
high order of intelligence and financial integrity; and in the use of this
word we do not mean simply honesty of purpose—but that type of
uncompromising honesty which will not accept plausible excuses for
compromise. One is not any longer surprised that banks and financial
houses prefer a Scotchman as treasurer.
Dr. Vrooman's report from the Committee for the Provision of
Medical Care, too, deserves our closest attention; and we print it herewith:
"Last evening at the request of the Medical Board of the Hospital
we met a sub-committee of the Medical Board to discuss matters in
connection with medical men getting payment for attending relief cases.
The Medical Board of the Hospital reported that they had considered the brief and request already made to the City Council for the
Page 13: payment of these relief cases which has already been endorsed by this
Association. Th Executive of the Medical Board endorsed this proposition and would ask the whole medical board to endorse it at their
meeting to-morrow, Wednesday evening.
The Medical Board Committee reported that they were prepared
to ask the Board of Directors of the Hospital to close the Outdoor Department of the Hospital to all cases excepting those referred by a
doctor for special consultation or treatment. They ask that in Vancouver Medical Association endorse their  action in  this regard.
Your Committee request that it be given power to get the signature of all medical men, if they deem it necessary, to an undertaking
that they will not engage in the care of city relief cases on a salaried
basis or otherwise except with the approval of the Committee.
This latter action will not be taken until after the presentation
of the Medical Board's request to the Board of Directors regarding the
Outdoor Department.
Resolution
Resolved that the Vancouver Medical Association approves of the
suggested action of the Medical staff of the Vancouver General
Hospital in requesting that the Board of Directors close the Outdoor Department to all cases except those referred by a doctor for
special consultation or treatment."
The implications of this report are very wide and very important. We
recommend it to the earnest and careful scrutiny of our readers.
If ever there was a time for union and firmness of purpose amongst
the members of our profession, this is the time. One is reminded of a
statement attributed to Miss Ishbel McDonald in New York a few days
ago—when she said that in our efforts toward recovery, we should also
bear it in mind that we must not simply try to get back to where we
were—but must plan a new order of things, and start afresh and better.
This is a saying that we shall do well to ponder over. If and when this
depression ends, are we going back to the same old mess? The same old
incoherence and lack of consideration for each other the same old
scramble and devil take the hindermost attitude? Are we coming out
of the Slough of Despond backwards or on the far side? Those of us
who have read the Pilgrim's Progress will remember that Christian had
to get rid of a great bale of old sins and traditions and habits before
he could "come clean." So with us, we must slough off a lot of false
and even harmful rubbish, in the form of old traditions and old selfishnesses.
We are sure that all our members will get solidly behind this move
for better and fairer things. We take it as said that no sick person
shall suffer, when we can aid them, no man, woman or child, lack all
our care because of poverty—but we feel, too, that the giving must be
our own, and not vicarious, that we must no longer allow ourselves to
be used to enhance some one elses sense of altruism, or to enable people
or governments to evade their just debts.
Dr. E. W. Blair's valedictory remarks, too, will repay cool and
careful thought.    There is a great deal in them of sound constructive
Page 13 8 common sense;   there is nothing in  them  that will  not  be worth our
consideration.
We are with him whole-heartedly in his remarks on our tendency
to isolation. No doubt this has hurt both ourselves and the public we
serve. Neither of us can get at the other—and we believe that Dr.
Blair's suggestions along this line should be followed up and put into
practice.
About the staying out of print, and refusing to give judgments
as a body, on such questions as Daylight Saving, we are not quite so
sure at present that we would go all the way with Dr. Blair. Pronouncements ex cathedra need to be very carefully considered, unless one can
be a dictator or a Pontiff of the Church; otherwise they are at best a
compromise, and rarely represent the unanimous opinion of the profession. Still, there is a question in one's mind whether we may not occasionally have taken a rather cowardly attitude in refusing to face an
issue. It is a question that needs considerable caution, and if one must
err, it is perhaps better to err on the side of caution.
Then there is his suggestion that a Historian be appointed to record
the history of this Association. This is a sound idea. Much of interest
and value must havl been lost already—and more will be lost as the
years go by, if it is not nailed and permanently recorded before it can
escape.
The complete slate of officers elected follows:
President: Dr. W. L. Pedlow.
Vice-President: Dr. Anson C. Frost.
Hon. Treasurer: Dr. W. T. Lockhart.
Hon. Secretary: Dr. W. T. Ewing.
Members of Executive at large: Dr. H. H. Mcintosh,
Dr. C. H. Vrooman.
Editor: Dr. J. H. MacDermot.
Trustees: Dr. W. D. Brydone-Jack, Dr. J. A. Gillespie,
Dr. F. Brodie.
The Bulletin takes this opportunity of commending the Association
for its choice of executive officials. They are all men who have at one
time or another, been tried fully, and shown themselves thoroughly loyal
members of the Association, and good workers. We need such men at
the present time, and our incoming President, Dr. W. L. Pedlow, is to
be congratulated on having such an able staff to work with him
*6
them all  we extend our  best
wisnes  and  assurance 01  our
f
10
most loval
support.
SUBARACHNOID INSUFFLATION IN CHRONIC
POST-TRAUMATIC HEADACHE
By Dr. F. Brodie
In the first half of the last decade Foerster, Wartenburg, Schwab
and Carpenter noted, independently, that certain cerebral symptoms such
as headache, vertigo or mental fatigue, were sometimes abolished or re-
Page 139 muibhwh
lieved by spinal or ventricular injection of air for diagnostic purposes.
Based on these facts and specific observations of his own, Penfield introduced the procedure as a therapeutic measure and in 1927 reported a series
of cases which were materially benefited. Since then Boyd and Reichert
reported ten and six cases respectively and Skinner one.
The purpose of this paper is to report eighteen injections which
were carried out on sixteen patients who had suffered more or less severe
brain injury and were incapacitated by the persistent symptoms of headache, vertigo, mental changes, etc. With one exception the insufflations
were all done as a therapeutic and not a diagnostic measure, although
radiograms in a few cases gave some unexpected information.
Certain preconceived principles were adhered to in the selection of
cases. The presence of headache, preferably of the persistent type, was
considered essential, but failure of localization or localized pain which
became diffused did not exclude: neither did the fact of there being
definite brain lesions. On the other hand all patients shewing a preponderance of neurotic symptoms, or symptoms which were bizarre, erratic
or ill defined, were not included.
The patients were all males and were the victims of industrial
accidents. The ages varied from 19 to 60 years, tUe average being 3 5.5
years. Ten patients were engaged in the lumber industry, two were
miners, while one bricklayer, one lineman, one concrete worker and one
motor-mechanic made up the remainder. Only five were Anglo-Saxons,
one was a Japanese and the rest were natives of Central Europe or Scandinavia. I mention the nationalities merely to remark that the results
appeared to have no relation to race or country. All suffered cerebral
injury: ten had fractured skulls, six being fissured and four depressed.
Of the injuries themselves, estimated at the time of the accident, six
might be considered very severe, four moderately severe and the remaining six, mild. The period of duration of symptoms varied from three
months to six and a half years, the average being slightly over fifteen
months.
The symptoms were remarkably constant; all had headaches, twelve
were dizzy and eleven experienced mental changes. As might be inferred
the headache was the most outstanding complaint, not only on account
of its being present in every case but from its severity and persistence
as well. In the great majority of cases the cephalalgia was almost constantly present, frequently localized, most commonly at the site of the
injury but diffusing during periods of exacerbation, which occurred with
pitiful frequency and lasted for hours or several days. Almost invariably
stooping, straining or excessive physical or mental exertion would institute a mild headache if none existed previously, or increase the severity
of one already present. Another almost constant feature noted in this
connection was that the cerebral discomfort varied with thermal or atmospheric conditions. A warm room, a sultry summer day, or bright sunshine would have adverse effects while changes in the weather, a strong
wind or electrical storms would precipitate or aggravate the condition.
The aggravation was not as a rule restricted to the major symptom but
would extend to minor or less frequent ones until confinement to bed
for a time might become imperative.
Page 140
rmm Dizziness was present in twelve of the patients but was usually
as fleeting as the headache was persistent. Sudden changes of position,
rotation of the head, extreme deviation of the eyes or rapid rising to
the erect posture would cause an immediate severe vertigo, often necessitating adventitious support. Sometimes the symptom would appear without apparent cause and I noted that this was always the source of much
anxiety to the patient. Generally the dizziness lasted only a moment or
two, when it would gradually pass off, only to reappear on the slightest
provocation.
Mental symptoms were present in twelve patients and manifested
themselves in a wide range of variation. In variety and order of frequency
they included: irritability 11, depression 10, impaired cerebration 5, confusion and mental deterioration 3 and delusion 2.
Clinical signs of organic disease were comparatively rare. In five
patients the discs were definitely hazy with engorgement of veins, but
none shewed definite papillitis. Diplopia, hemi-paresis and astereognosis
were present in one case. Paraesthesia of one side of the head obtained in
one case, and one other had vomiting.
The procedure was done in the operating room under strictest aseptic
conditions. In preparation for the operation the patients were deprived
of breakfast and one-half hour prior to being taken to the operating
room were given hypodermically Y^ gr. morphia and 1 1000 gr. scopolamine. They were so placed on the table that where possible, the site
of maximum headache was uppermost. An anaesthetist was always present
to record pulse and blood pressure readings every ten or fifteen minutes
and to note on the chart any changes in the general condition. The skin
at the site of puncture, viz., the mid-line between the fourth and fifth
lumbar spines was desensitized by a 1 % solution of novocaine as well
as the prospective course of the needle down to the theca. This latter I
consider an important factor since after the first needle-prick the patient
is totally unaware of any further instrumentation.
As soon as the tap was successfully made the spinal pressure was
measured. In this series it varied from 3 to 3 8 mm. Hg., the average
being 18. In the one patient with the extremely low pressure of 3 the
reading was fictitious. It appeared that his advent in the operating room
had produced such a "blue-funk," if I may be pardoned a colloquialism,
that he was on the verge of complete syncope with a systolic blood pressure of only 85. After 100 cc. of air had been injected the spinal pressure was 6 mm. Hg. and the blood pressure 140  90.
In conducting the exchange 10 cc. of spinal fluid were removed and
replaced by 50 cc. of filtered air. This was repeated once and subsequently
10 replace 10 until the operation is completed. The amount of air injected varied from 65 cc. to 250 cc, the average being 140. In all cases
except the one previously mentioned, the spinal fluid pressure was reduced in amounts varying from 2 to 26, the average being 10.
A study of the pulse rate and blood pressure readings during the
exchange is very interesting but the many variations are too complicated
for reproduction in a short paper. Suffice it to say that the systolic pressure was higher in nine and lower in eight at the end than at the begin-
Page 141 Mill
ning, while it was equal in one. The rise varied from 2 to 84, the average
being- 28, while the variation in the fall was between 4 and 32, the
average being 14. When it is remembered that in every case, save one,
the spinal pressure was reduced, one is compelled to speculate somewhat
on the variety of circumstances which may influence the relationship
between blood and spinal fluid pressures and question the value of increased blood pressure as an indication of increased intracranial pressure.
The pulse on the other hand was increased in five cases and lowered in
eleven cases at the termination of the exchange, variations in the former
being from 4 to 16, average 10, and the latter from 3 to 62, average 20.
For every patient the operation was a more or less distressing procedure. Headache is the invariable complaint and begins on the removal
of 30 to 50 cc. of spinal fluid and is always worse while the air is in
transit. It is referred to the region of the air's destination, that is, the
uppermost part of the cranial cavity, shifting with changes in position
and tends to increase in severity proportionate to the amount of air
injected. Other signs which usually develop sooner or later are pallor,
or flushing, sometimes alternating, sweating, cough, hiccough, pain down
the legs, nausea and vomiting, the last occurring in 8  of the  18  cases.
Immediately after the termination of the exchange X-ray films of
the head were made. Four patients shewed gross cerebral pathology, six
appeared to have sufficient variation from the normal to be considered
slightly pathological, while in the remaining six no lesion of any sort
could be demonstated.
The ultimate results were not consistently relative to the pathology
observed. Boyd, in discussing results in patients whom he insufflated, asserts that the treatment should not be instituted in patients having definite cerebral damage. This has not been borne out in my experience.
One patient who obtained complete relief shewed the greatest cerebral
lesion while others, where the films were deemed normal, were not improved at all. I will deal more explicitly with this when the slides are
being shewn and individual cases discussed.
The patients in this series were all treated in the twelve months
prior to March, 1932. On account of their leaving Vancouver a few
weeks after discharge from hospital a number of patients have been lost
track of but the majority were under observation for many months and
some up to the present time. Three of the cases shewed no improvement,
seven were slightly improved and four were markedly benefited by the
treatment. The remaining two are difficult to classify. One was entirely
relieved of all symptoms three days after the injection and continued
thus until the tenth day, when he awoke in the early morning with
severe epigastric pain and died in a few moments. Autopsy revealed a
complete occlusion of a progressively sclerosing coronary artery. The other
patient not included among the foregoing had complete recession of all
symptoms for over a month when they began to return with slowly
progressing severity. After five months he anxiously requested that the
treatment be repeated, but the second attempt did not produce any
specially satisfactory result and his final status was but little better than
prior to the first injection.    The four receiving marked benefit were able
Page 142 to resume self-supporting occupations but only one returned to his former
trade. The group classified as slightly improved is difficult to analyze.
Nearly all had partial relief from headache, several had temporary relief
for weeks or months, when the symptoms returned, but not so severely,
some experienced a general improvement in all symptoms while others
lost their mental aberrations. Unfortunately in some of those where distressing symptoms were not entirely abolished there was naturally considerable disappointment which tended to produce anxiety and a fear-of-
the-future complex and they gradually relapsed into a condition but little,
if any, better than before the air was insufflated.
A detailed account of each of these would be too extensive for
the present occasion but I have selected a few shewing radiographic
abnormalities which serve to illustrate the type of case selected, the
peculiar accidents from which they suffered and the results achieved.
J. P., Age 37, Miner.
Complaint: Headache, dizziness and depression.
History: On Aug. 13th, 1930 figured in a mine explosion in which ths
scalp at the vertex was severely lacerated and he was rendered unconscious
for some little time. Subsequently he was dazed and again lapsed into
unconsciousness. He spent three weeks in the hospital, during which time
he suffered constant headache accompanied by vertigo. The pain was
mostly in the forehead and vertex, but there was some gradual improvement until he was thought able to return to work. On Jan. 8 th, that
is, five months after the injury, he attempted to resume his occupation,
but was only able to continue for five days on account of headache and
vertigo, especially on stooping.
On March 3rd, an air injection was done, 100 cc. of cerebro-spinal
fluid under 10 mm. of pressure were removed and replaced by 100 cc.
of air. The exchange produced a severe reaction with headache, coughing
and nausea. Subsequent X-ray examination revealed no abnormality.
A week after the operation the headache had entirely disappeared and he
left the hospital on the tenth day feeling well.
Freedom from symptoms persisted for a little over a month when
they began again in a mild form. There was a good deal of variation in
the severity of these symptoms but by degrees they became nearly as
bad as formerly and at his earnest solicitation the procedure was repeated
on the 11th of Aug. 1931, five months after the preceding one and a year
after the original injury.
On this latter occasion 75 cc. of spinal fluid were removed where
the B. P. which at the beginning was 94 rose to 124 and at the end
was 112. The constitutional reaction was very similar to the preceding one. The next day the headache was much better and there was an
improvement in all his symptoms. On this occasion he did not have;
complete surcease of symptoms, although there was some diminution in
their severity.
Three months later the pain in the head and the dizziness were less
severe but his psychical symptoms of depression, lack of initiative and
anxiety had increased.   He was then lost sight of and, although the actual
Page 143 Mil
physical suffering might have been somewhat relieved, had the feeling that
he would probably have to be committed sooner or later to a mental
hospital.
O. F., Age 26, Logger.
Complaints Dizziness and headache..
History: March 17th, 1930, was struck on the right side of the head
by a swinging timber. His skull and right femur were fractured. He
was unconscious for 10-12 days and mentally deranged for 5 or 6 weeks.
He remained in hospital 10 or 12 weeks, at which time he was able to
walk with the aid of a cane. Since the injury he has had headaches and
dizziness, the former more or less constant but with severe exacerbations
every few days, which may last from several days to 2 weeks. When
severe they are accompanied by vertigo; becomes very ill.
Examination: Mentality: Memory is poor, he is anxious, irritable and
somewhat depressed.
Speech and articulation normal.
Pupils: equal and active to light and accommodation. Ocular movements and fundi normal.
Right ear drum shews a scar from former perforation; Left normal.
There is no change in sensation and movements are powerful, but
he has a tremor of his hands and is unsteady when eyes are closed. The
deep reflexes are slightly increased.
March 16th, 1931: 125 cc. of fluid were replaced by 115 cc. of air. The
procedure was accompanied by intense headache, prostration and finally
projectile vomiting. The X-ray shews extensive dilatation of the posterior
horn of the right ventricle and almost complete absence of convolutional
markings.
As the air was absorbed the headaches became rapidly better. He
left the hospital on the twelfth day and on the fourteenth day took a-
position repairing scientific instruments. He was able to carry on without
recurrence of headache, although he was not so quick as formerly and
prone to be upset by petty annoyances and irritation. After three months
the work was completed and he returned to Switzerland, at which time
he had had no return of headaches and assured me that he could get
along very well at whatever he was doing provided he was not irritated
or worried.
O. W., Age 43, Donkey-engineer.
Complaint: Pain in the left side of the head.
History: Oct. 8th, 1930, while operating a donkey-engine was catapulted by the leverage of a falling log into the roof of the engine which was
made of poles and sheet-iron. He fell backwards headforemost onto the
drums of the engine and was unconscious for a few moments. He had
bleeding from the left ear which lasted about two days. Recovering
consciousness he tried to continue at work for about an hour in spite
of a very severe headache which, becoming gradually worse, necessitated
his laying off. Meeting of Pacific North-West Medical Association
July 4th, 5th, 6th, 7th,
President-
Hotel Vancouver, Vancouver, B. C.
-Dr. B. D. Gillies
Dr.
Dr.
Dr.
Dr.
GUEST SPEAKERS
A. T. Bazin, Professor of Surgery, McGill University, Montreal.
C. H. Best, Professor of Physiology, University of Toronto.
Wm. Boyd, Professor of Pathology, University of Manitoba.
J. G. Fitzgerald, Dean of the Faculty of Medicine, and Director of the
School of Hygiene and Connaught Laboratories, University of Toronto.
Dr. A. H. Gordon, Professor of Medicine, McGill University, Montreal.
Dr. A. T. Mathers, Associate Professor of Medicine, University of Manitoba, Winnipeg.
Dr. S. A. Kinnier Wilson, 14 Harley St., London, England.
Dr. D. E. S. Wishart, Junior Demonstrator of Oto-laryngology, University
of Toronto.
Tuesday, July 4th—
-Registration.
-Dr. A. T. Mathers, "Medico Legal Problems."
-Dr. Wm. Boyd, "Tumours of the Neck."
-Dr. A. H. Gordon, "Migraine."
-Surgical Clinic, Dr. A. T. Bazin.
-Dr. D. E. S. Wishart, "Vertigo."
-Dr. Kinnier Wilson,
-Dr. J. G. Fitzgerald, "Some aspects of the Problem
of   Meningococcic   Meningitis."
-Dr.   C.   H.   Best,   "Recent  Work on   Carbohydrate
Metabolism."
8
00-
9:00 a.m.
9
00-
9:40 a.m.
9
45-
10:25 a.m.-
10
30-
11:10 a.m,
2:00 p.m.
8:00-
8:40 p.m.
8:45-
9:25 p.m.
9
30-
10:10 p.m.
' 10:15-10:55 p.m.-
Wednesday, July 5th
8:30- 9:10 a.m.-
9:15- 9:55 a.m.-
10:00-10:40 a.m.-
10:00-11:00 a.m.-
10:45-11:25 a.m.-
Dr. A. T. Bazin, "Acute Osteomyelitis."
Dr. A. T. Mathers, "Psychoneuroses."
Dr. C. H. Best, "Recent Work on Fat Metabolism."
Dr. D. E. S. Wishart, "Mastoiditis in Children."
Dr. Wm. Boyd, "Why Does a Patient Recover from
Infection?"
Medical Clinic, Dr. A. H. Gordon.
Dr.   A.   T.   Bazin,   "Tumours   of   the   Colon   and
Rectum."
8:00- 9:25 p.m.—Dr. J. G. Fitzgerald, "Acute Respiratory Infection;
a  Problem in  Preventive Medicine."
-Dr. Kinnier Wilson,
A.. H. Gordon, "The Diagnosis of Disease with Coincident Enlargment of the Liver and Spleen."
2:00 p.m.-
8:00- 8:40 p.m.-
9:30-10:10 p.m,
10:15-10:55—Dr.
Thursday, July 6th—
8:30 -9:10 a.m.-
9:15- 9:55 a.m.—
9:00-10:00 a.m-
10:00-10:40 a.m.-
10:45-11:25 a.m.-
2:00 p.m-
7:30 p.m.-
Friday, July 7th—
9:00- 9:40 a.m.-
9:45-10:25 a.m.-
10:30-11:10 a.m.-
2:00 p.m.-
-Dr.   C.  H.  Best,  "Liver  Function  Tests from the
Physiological Point of View."
-Dr. A. H. Gordon,
-Dr. D. E. S. Wishart, "Sinusitis in Children."
-Dr. Kinnier Wilson,
-Dr. A. T. Mathers, "Sleep and its Disorders."
-Golf Tournament, Shaughnessy Golf Course.
-DINNER.
-Dr. T. G. Fitzgerald, "The Nature of Antigens."
-Dr. Wm. Boyd, "The Pathology of the Breast regarded as Disordered Physiology."
-Dr. A. T. Bazin, "Lesions of the Breast."
-Neurological Clinic, Dr. Kinnier Wilson.
Information:
Dr. L. H. Appleby,
.Local Hon. Sec,
925 West Georgia Street,
Vancouver, B. C.
Dr. C. W. Countryman,
Executive Sec,
Paulson Medical-Dental Bldg.
Spokane, Wash. In the Light of Modern
I Knowledge
it has been found that Phlegmonous Processes are
best treated by an appropriate application of Moist
Heat, which not only affords grateful relief, but
often brings about resolution without the necessity
for surgical interference.
Antiphlogistine, due to its osmotic action, to
the antiseptic efforts of its contents, and to its
ability to maintain moist heat for a long time, promotes an active hyperamia, with absence of irritation, thus hastening resolution and relieving pain.
ANTIPHLOGISTINE
in PHLEGMONOUS PROCESSES
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Scarlet Fever Toxin for Dick Test
Scarlet Fever Toxin
Tetanus Antitoxin
Anti-Meningitis Serum
Anti-Pneumococcic Serum (Type 1)
Anti-Anthrax Serum
Normal Horse Serum
Smallpox Vaccine
Typhoid Vaccine
Typhoid-Paratyphoid Vaccine
Pertussis Vaccine
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M Examination six months after the injury revealed slow cerebration
and poor concentration. He had emotional paroxysms in which he became
exceedingly irritable and sometimes violent on the slightest contretemps.
He had periods of depression bordering on lachrymose outbursts. Pupils
were equal and active to light and accommodation. Ocular movements
and fundi normal. Hearing: whispered voice at 1' both ears. There
was a blunting of sensation to pin-prick, more or less general, with
tenderness over the first, second and third dorsal spines. Movements
were generally impaired in power with stiffness of the cervical muscles
and impaired range of movement of the cervical spine. Spinal puncture
shewed a spinal fluid pressure of 10. The fluid was normal except for
a slight increase in protein.
There was very little improvement in his condition and on the 18 th
of November, 1931, the subarachnoid cavity was insufflated with air.
137 cc. of air were injected and a subsequent X-ray examination shewed
a marked separation of the brain from the calvarium. The sulci were
poorly filled. The brain appeared adherent to the inside of the calvarium
on either side of the mid-line. The appearance suggests arachnoiditis along
the longitudinal fissure.
This man was kept under observation for several months in which
there was considerable improvement in his mental powers and some diminution in the severity of his headaches.
R. K., Age 28, Logger.
Complaint: Photophobia, headaches, dizziness.
History: On Aug. 4th, 1931, he was struck on the occiput by a pair
of loading tongs. The scalp was lacerated and he was unconscious for less
than an hour, but subsequently dazed and blind for a few minutes.
There was no bleeding from the ears or nose; no vomiting, but afterwards
had a severe headache which persisted in spite of eight weeks hospitalization.
On examination two months after the injury he was underweight,
pale, weak and looked ill. His mentality was diminished, in that he was
unable to concentrate, had impaired cerebration, some confusion and was
very irritable. There was haziness of the right disc and some diminution
in the fields of vision in the lower quadrant in both eyes. He was quite
unsteady with his eyes closed and any sudden change of position induced
severe vertigo.
No improvement appearing in the symptoms after thirty days observation a subarachnoid injection was done. 100 cc of air were insufflated
and the constitutional disturbance by the procedure was excessive. X-rays
shewed an excess of air in the upper part of the right parietofrontal
region and absence of convolutional markings suggesting brain atrophy.
This patient made a good recovery. The headache disappeared rapidly
and the vertigo also, but more slowly. Six months after the injection
practically all the symptoms disappeared but he never regained the same
physical vigor. He was, however, able to learn the barbering trade, at
which he carried on successfully. In August of this year he had acute
rheumatic fever with endocarditis, from which he recovered very satisfactorily without any return of the cerebral symptoms.
Page 145 BftM
N. C, Age 24, Logger.
Complaint: Headache, dizziness, stiffness of the neck.
History: July 5th, 1931 was thrown from a runaway speeder. Landing
headforemost on a rock he was rendered unconscious for two days and
his scalp being incised along a line extending in a vertical direction from
one mid-zygomatic process to the other was turned down in a flaplike
way over his face. At the same time his nose was severely broken and his
upper incisor teeth damaged. He remained three weeks in hospital, but on
discharge began to develop headache and vertigo, which symptoms have
been getting progressively worse.
Examination Aug. 12 th, revealed no gross abnormality of the nervous system but an X-ray of the neck shewed a fractured sixth cervical
vertebra. At this time he had difficulty in breathing and as his headache
was mostly frontal it was felt that a plastic operation on the nose might
help. This was done successfully and the normal air passages of the nose
re-established. His general condition improved somewhat but the headache and vertigo persisted, as well as general weakness, disclination to
physical activity and fatigue.
In March 1932 the headache was still present more or less constantly
and localized to the frontal region. Subarachnoid insufflation was resorted to on March 9th, 140 cc. of air being injected. The procedure
created very little change in the blood pressure, but the pulse dropped
abruptly. His headache was very severe perspiration profuse, and towards the end of the exchange developed nausea followed by vomiting.
The X-ray shewed dilatation of both ventricles, especially the anterior
horns. The cisterna interchiasmatica was dilated and there appeared to
be some diminution in the size of the sulci. He had a post-operative
temperature of 2 degrees for two days, together with severe headache,
both of which gradually subsided.
This man was kept under observation for four months, during which
time there was only slight improvement in his general condition. The
headache was improved and he gained weight, but never recovered his
normal strength or ambition. Part of his final disability may be due to
the lesion of the vertebra.
I. S., Age 45, Logger.
Complaint: Headache.
History: Six or eight years ago was struck on the right side of the head
by a falling snag. The right frontal bone was severely comminuted and
fragments were depressed. He was unconscious for about two weeks,
during which time a portion of the depressed bone was removed by
operation. Since the injury he has had right sided headache with vertigo,
both of which are worse in dull, cloudy or stormy weather.
Late in 1927 a further fragment of bone was removed which did
not relieve the headache or vertigo. An X-ray examination of the skull
in March 1931 shewed extensive stellate comminuted fragments with
some depressed fragments in the right frontal region. There is an area of
1/6" x YaJ' in which the bone is missing. For diagnostic purposes an
encephalogram was deemed advisable and 225 cc. of fluid were replaced by
Page 146 215 cc. of air in the upright position. The exchange produced a very
mild reaction; headache, but not severe, some nausea and an occasional
cough or hiccough. Examination of the cerebro-spinal fluid, which was
clear and colourless, revealed no cells, positive reduction of Fehling's solution, and a total protein content of 30.4.
The encephalogram shewed air in all cisterns; the ventricles dilated,
the right greater than the left, and the right drawn slightly upwards.
Destruction of brain tissue in the region of the injury with flattening of
the adjacent convolutions was also seen. Ten days after the injection
his headache had entirely disappeared. He was discharged from hospital
and resumed occupation. For six or eight months he had complete freedom from headache and intracranial symptoms, after which time the
headache began to return, mildly at first, but gradually getting worse.
In February of this year, that is, eleven months after his previous
insufflation,  he returned  and  requested  a  repetition  of   the   treatment.
On February 22nd, 165 cc. of air were injected and on this occasion
he shewed considerably more reaction. The spinal fluid pressure was reduced from 22 to 12, the blood pressure from 159/97 to 130/78, and
the pulse from 84 to 80. On this occasion he experienced considerable
headache, copious perspiration and finally vomiting. The X-ray again
shewed dilatation of both ventricles and the bony defects as in the first
films.
The day following the injection he had a very severe headache and
a temperature of 100, both of these subsided rapidly and in ten days he
was discharged without symptoms. He returned to his home on Vancouver Island and I have had no communication from him since.
C. M. Age 53.
Complaints Mental exhaustion, headache, diplopia.
History: February 26th, 1930 was caught by a tightening line, hoisted
into the air and pitching forward landed on the left side of his head
and face, which was severely lacerated. He was unconscious for two or
three days and subsequently exceedingly restless and resistive to interference. His mentality gradually improved, but occasionally he would
be quite irrational. At that time X-ray examination is said to have revealed no fracture of the skull.
Examination on the 11th of March 1930 revealed a drowsy mentality with exceedingly poor memory. At times he became disoriented,
losing himself entirely, and very irritable and depressed. Speech and articulation normal. Pupils equal and active to light and accommodation.
Ocular movements impaired, left external rectus and left superior oblique
were paralysed. Slight nystagmus on extreme deviation of the eyes
in either lateral direction. Tongue protrudes slightly to the left. Fundi:
right normal; left, slight haziness of the discs on the nasal margin.
Sensations: to cotton wool there is diminution of acuity in the right side.
To pin prick analgesia of the right foot up to mid-leg and right hand
and wrist. Astereognosis in the right hand and foot. Joint sense absent
in the right toes. Movements impaired in power in right upper and
lower limbs. Unsteady with eyes closed, having to watch his feet to
put them together. Past-pointing in the right hand. S. J's, equal and
active; K. J's increased; A. J's, active.    No A. C, plantars flexor.
Page 14/ Subarachnoid insufflation May 6th, 1931. 190 cc. of air were injected
As his lesion and headache were at the left vertex this was done in the
upright posture. His reaction to the injection was very severe and he
experienced a mild collapse towards the end of the procedure. X-ray
taken in the upright position shewed unequal dilatation of the ventricles,
a brain defect in the left vertex a half inch from the mid-line, narrowing
of the sulci and diminution of the convolutional markings.
For two or three days after the insufflation he had an elevation of
temperature and pulse rate with a very severe headache. Three days later
the pulse, temperature and respiration were normal, the headache was
practically gone and he felt much better in himself. Five days later
the headache was entirely gone and his feeling of well-being continued.
After eleven days he was discharged from the hospital with no headache,
a much improved mentality and a statement that he felt like his old self
again and better than he had been any time since his injury.
This man was kept under observation for several months during
which time he has been able to make a living on a small farm; had no
return of headache, mental confusion or irritability, except under excessive strain. The paresis and changes in sensation improved markedly, as
did the diplopia, although the latter never entirely disappeared.
Finally we approach the question, what is the value of this procedure
as a therapeutic measure? In this series the cases" were selected with special
care along certain recognized lines. The operation was done with minute
attention to detail and the subsequent hospitalization was nearly always
under the same group of nurses specially instructed in the care of these
patients. I mention these facts because, in trying to appraise the results
with an unbiassed eye, they have not been as good as other published
reports. My own opinion is that entire success can be expected only in
a very limited number of cases, that some relief may be obtained in a
good many, while in others no benefit at all will accrue. It is a fairly
well established fact that no harm will result from the treatment. The
cause of death in the one fatal case in this series, I do not think had
any relationship to the treatment employed. Nothwithstanding the temporary severe reaction from the air-injection and considering the dire
misery and protracted disablement of these sufferers, I feel that one is
justified in adopting such a method even though it may not result in
the outstanding success with which it was first heralded.
CARRIERS AS A CAUSE OF PUERPERAL FEVER
F. E. Coy, M.D.C.M.
Invermere, B. C.
As a contribution to the ever present problem of puerperal fever
I wish to review ten years experience in a small country hospital where
one nurse only is employed. Under these conditions the work of one doctor
and one nurse can be observed over a period of time and the results present
the problem in a different light from that obtained in the larger centres
where greater numbers are involved.
During the first two years four nurses were employed, each staying
six months: nothing abnormal developed among the maternity cases.
Page 148
snxsm The third year a nurse was engaged and remained for three years.
Under her regime trouble started and her maternity cases consistently had
elevated temperatures. The fever was usually only slight, 99° to 101°,
starting as a rule about the eighth day and subsiding in the course of a
week or ten days. Three cases were of a more severe type and were sick
for a period of about two months, one developing a thrombophlebitis
in the leg and a small pulmonary embolism. Fortunately they all eventually recovered.
This nurse was followed by one who had taken a post-graduate course
at the Rotunda Hospital in Dublin and during her stay, which lasted
three years, we did not have a maternity case develop a temperature above
99°.
The nurse who followed stayed one year and her results were equally
good.
When she left we engaged a nurse who, we later discovered, was
suffering from Hodgkin's Disease and had a history of antrum trouble.
At once morbidity among maternity patients developed. Invariably the
temperature on the third day would rise to 101° or 102° and gradually
subside by the tenth or twelth day. Towards the end of this nurse's stay
she contracted a cold followed by acute antrum trouble, first on one side
and then on the other. For two months she was never free of this condition
and had a temperature ranging from 100° to 103°. During this period
she was obliged to assist at three maternity cases,. Each of these, on the
evening of the third day, had a chill and the temperature rose, to 105°
in two, and to 106° in the third. Fortunately they all recovered eventually.
I am well aware that many factors are involved and that no dogmatic conclusions should be drawn from such a small experience. I wish
to suggest the necessity for further investigation of the possibility of
carriers being a cause of puerperal fever. Just as there are innocent carriers of typhoid, diphtheria etc., is it not possible that certain attendants
on maternity cases are innocent carriers of pathogenic organisms which
have a predilection for the tissues of the birth canal and puerperal uterus,
resulting in maternal morbidity and infection, the course and severity
of which depends on the virulence of the organism transmitted?
Are not the following prophylactic measures at least worthy of trial?
No nurse should be allowed on the maternity wards until she has been
examined and found free from foci of infection, especially in the sinuses,
teeth and tonsils. Swabs should be taken and cultures made of the throat
and nasopharynx, to prove the absence of pathogenic organisms.
A close check should be kept on the attendants on each case so that
in the event of the patient's running a temperature, along with all the
other investigations these attendants could be carefully re-examined, in
an effort to find a carrier among the patient's contacts.
SOME POINTS IN THE CHEMISTRY AND
METABOLISM OF CHEMISTRY
H. A. DesBrisay, Vancouver, B. C.
Someone has said that when we find out what cancer is, then
shall we know what life is. This would appear to make the problem of
Page 149 cancer unsolvable. It does seem unsolvable if its solution involves the necessity of knowing everything about cell physiology, cell division, and
repair, and of understanding completely all the obscure forces concerned
in growth and decay.
When we do attempt to delve into the subject of the chemistry
and metabolism of cancer we find that much has been spoken and very
little said.
Taking it for granted that all changes in the body, growth, reproduction and disintegration, are fundamentally biochemical or electrochemical processes, this would suggest that we must make a study of
the normal chemistry of the body before we can hope to approach the
abnormal.    Ay, there's the rub.    We feel very woefully our ignorance.
As students most of us memorized a few facts from text-books
and lectures for examinations, and rejoiced if we passed them, never
again to think of anything so irritating as a chemical formula. The
key to the understanding of cancer must lie in the field of chemistry
The study of the normal is in itself seemingly hopeless. Here we
have the human body, a dynamo built up from twenty-seven different
elements (27 of the 92 elements) ranging from hydrogen the lightest
in the body to iodine the heaviest, (at wt. 53). None of the heavier
metals enter into the constitution of the human machine—because, so
it is said, lead, gold, silver, etc. were not on the surface of the g.obe
when life came into being.
What a maze of chemical reactions may occur with twenty-seven
elements interacting! Then, when we consider each element as a molecule
composed of atoms, each atom in turn composed of proton (central
charge of positive electricity) and electrons (negative charges), the
latter revolving about the central nucleus, as planets revolve about the
sun, how can the human mind hope to picture the interactions, even
dimly?
Suppose one or more atoms of an element such as potassium to be
projected into the constellation of vibrating molecules in a single cell,
each with its atoms—protons and electrons—whirling at tremendous
speed—may this not cause a change in the relative relationship and give
rise to abnormal conditions, slowing up the rate of some, and accelerating the speed of others? From this conception we might build up a
picture of a cell acquiring new and tremendous energy and powers of
overgrowth. At any rate, in the ultimate analysis, some simple electrochemical change must start a cell off on the rampage. Alas, we cannot
see such changes. It is of course possible that one of the elements other
than those in the body, may have to be considered).
In looking into the basic structure matter we find that an atom
of hydrogen is composed of a solitary electron revolving about a positive nucleus, and further that all matter consists of either hydrogen or
combinations of hydrogen atoms. Helium has an atomic weight of four,
with two external electrons. In all atoms, the atomic weights of which are
divisible by four, there are but the atom or atoms of helium, but in
all other elements, in addition there are hydrogen atoms. Nitrogen has
three helium atoms and one molecule   (2 atoms)   of hydrogen.
Rutherford has been able to remove hydrogen atoms from these
compounds  by  bombarding  the  atom  with  helium  atoms.   Aluminium
Page 130 has 6 helium and 3 hydrogen atoms with 13 external electrons, which
represent the number of positive charges in the nucleus. If a hydrogen
atom is knocked off from an atom of aluminum, magnesium may remain, and from other elements on, sodium, phosphorus, etc., corresponding elements probably arise. It is interesting to note that the atomic
weight of calcium is 40, and potassium is next in line with an atomic
weight of 39. This may signify that there has been an inorganic evolution in which the higher elements have been condensed from hydrogen
atoms. Some idea of the tremendous problem that is the chemistry of
cancer may be gathered from this.
Assuming that cancer cells were originally normal cells, what is
the basic electro-chemical disturbance that produces the change, that
causes a new rhythm of growth?
The change is regarded by many writers as fundamentally due to
alterations in surface tension. Now, a cell is not just a bag of fluid.
Living cells contain water, not as a solvent so much as a material dissolved in other materials (colloids), and what appears to be a semipermeable membrane is simply an oily arrangement of oriented molecules,
(producing the phenomenon of surface tension) while in the interior
there is no such order.
This orderly arrangement of surface molecules about cell protoplasm
may be so disturbed-by some irritating or toxic substance, altering the
vibrating rhythm, that there may be great energy release. Magrow observed that under the influence of light of an extremely high frequency
of vibration, cells begin to vibrate, and with suitable vibration rates,
enter into karyokinesis, which, in conditions of abnormal equilibrium,
increase to point of induction of tumour growth. Apparently the irritant
which produces such a vibratory change may be of various types. It
seems necessary that the irritant produce its effect insidiously, being at
no time of too great an intensity. Such irritants may be:
(1) Pfyysical—as X-ray, light, etc.
(2) Chemical—as Coal Tar, etc.
(3) Parasitic—as certain worms.
Now whenever several causes are shown to produce one effect then
we feel that these causes have not been reduced to their simplest terms.
What is the common factor, then, in these irritants? Attempts to determine this and to split up the cell, to extract from it an active pathological agent, have resulted in failure.
Is the disturbing common factor to be found in one of the elements,
potassium, sulphur, etc., or in combinations such as the SH group, or in
toxic by-products, in disordered metabolism or in the realm of enzymes?
From the welter of conflicting reports of the enormous amount of
investigations in cancer certain as yet rather isolated facts emerge. Some
of these points are:
(1) Tumour tissues have a low avidity for oxygen. Sampson Handley
sees in diminished oxygen supply, one of the factors that induce cancer,
along with hypernutrition, and reduction of inhibitory enzymes, all the
result of lymphatic stasis, from multiple and non-specific forms of irritation.
(2) The glycogen content of active tissue cells is high. Warburg
has investigated their carbohydrate metabolism, and it appears that cancer
Page 151 cells live largely by means of fermentation of sugar, and that they have
less need of oxygen than normal cells; that they are essentially anaerobes.
Warburg found that cancer tissue possesses the property of splitting
dextrose into lactic acid to a degree 70 times that of normal tissues.
Insulin hinders the growth of implanted tumours.
(c) Lactic acid then accumulates more in cancer cells than in the
normal, explained by the local oxygen starvation, and the above mentioned property of hydrolysis of sugar. This would lead to hydrolysis of
proteins and possibly to lowering of surface tension, with increase of
cellular nutrition and further suppression of oxidation. If an added element of irritation were present there would be an absence of normal
inflammatory reaction and the products of cellular disintegration might
contribute to the material at hand for the growth of cancer cells. Lactic
acid inhibits phagocytic activity. Injections of lactic acid into mice causes
a marked increase in the virulence of tumours.
(4) Lipoids and Fats: Fat accumulates where there is lessened oxygenation, and lipoids apparently influence proliferative activity. Cholesterol
has been found to be twice as plentiful in a rat tumour as in the whole
body of the animal. The skin of the face where cancer is said to be more
frequent than in any other organ in the body, in many cases examined,
contained six times as much cholesterol as that of the skin of the
abdomen. Sunlight is thought to be the factor that fixes the cholesterol (heliotropism). The blood in a vein leaving a tumour shows less
cholesterol than the arterial blood flowing into the tumour. It is possible
to inhibit or prevent the growth of a tumour by keeping the animals on a
cholesterol free diet and vice versa. Excessive cholesterol feeding does
definitely cause increased growth of malignancy. Cholesterol may be
present up to 3 grams per 1000 cc at the end of pregnancy, and here
a malignant tumour assumes greater malignancy than in the non-pregnant woman.
The normal serum of 110 persons examined showed a gradual increase of cholesterol with age: From .60 gm. per 1000 cc in the first,
months of life, to 2.00 gm. per 1000 cc as the cancer age of 50 to 54
was attained. (Does obesity and a high fat diet, then, predispose to
cancer?)
(5) Enzymes. There is less lipolytic (fat-splitting) co-ferment in
cancer tissue serum than in the normal. The fat-splitting property in
blood tends normally to disappear at about the forty-fifth year, in man.
There is no evidence that there is any specific enzyme concerned in
cancer. So far there have been only three enzymes satisfactorily explained,
chemically. They are:
(a) Thyroxin.
(b) Glutathione—a dipeptide.
(c) Urease—a globulin.
(6) Alkalosis: Uncomplicated, untreated advanced cases of internal
cancer usually have a blood pH above normal (i.e. an alkalosis). This
point has been made use of in treatment. Patients with benign tumours
usually have a blood pH above normal, but lower than in malignancy
(other conditions may show the same alkalosis, however, at times). But
in cancer cases a blood pH which is persistently high in spite of treatment appears to be a bad prognostic sign.
Page 152 (7) By-products of Cellular Activitys. It seems that most by-products
in the body can be made useful to a certain extent, but that excessive
amounts can produce pathological changes. Indol occurs in purulent
tissues and can also be produced by enzyme action, from tryptophan.
Indol causes accelerated cell-division leading to rapid proliferation of
epithelial tissues. Certain amino-acids are of course essential to growth
as lysin. Cystin and arginine stimulate growth.
(8) Vitamines. Vitamine B has apparently a direct relationship to
growth of tumours.
(9) Embryonic Tissues chemically have often the composition of rapidly growing tumour tissue. Recently Hueper and others have reported
on the growth factors of embryo-extract. Fischer and Carrel have previously shown that the active growth factor is bound in the globulin
fraction. The growth factor is apparently not of protein nature, is not
a hormone, nor due to polysaccharides, but Hueper and co-workers did
find a proteolytic enzyme present.
Gye states that chicken embryo extracts are incapable of producing tumours of themselves, and says that primitive embryonic cells do
not have concerous properties. Some others believe, however, that the
Rous agent and the growth-promoting factor are related and similar
in nature.
(10) Inorganic Constituents: Sherk's idea (1904) that cancer may
result from imbalance of the inorganic elements has received much consideration. Bristol in 1913 suggested that cancer develops in three stages:
(1) Cellular degeneration—from local causes: irritations, infections,
etc. (2) Increased affinity of tissues for certain inorganic salts. (3)
Resultant disturbance of chemical equilibrium affecting adjacent cells,
possibly by increased permeability and by stimulating them to excessive
growth.
Inorganic constituents of neoplastic tissues do show a departure from
the normal. Calcium is relatively low in rapidly growing cancer tissue.
Potassium is increased in proliferative processes. Potassium is an antagonist to calcium, and also to sodium. It is transported more rapidly than
any other, except hydrogen. There is a definite modification of K/Ca
ratio in neoplastic tissue as compared to the normal ratio for the organ
affected. With a deficiency of calcium there is an increased permeability of
tissues. Calcium salts show an inhibitory effect on the growth of cancer.
Willy Meyer regards the balance as one of replacement of calcium
by potassium salts, brought about by a variety of mechanisms. There is
then an altered permeability and an alkalosis that is followed by increased
cell division. De Raadt has reported the production of cancer in 4 of 10
mice by means of a diet rich in patassium salts of a highly basic
character.
Magnesium has been shown to be relatively deficient in cancerous
tissue. Magnesium helps to retain calcium—although the two are physiologically antagonistic. (There is more magnesium than calcium in heart
muscle and in voluntary muscle—tissues relatively seldom involved in
neoplastic growth. Is this of any significance, when we consider the soil
on which cancer cells flourish?)
Examination of other elements as iron, manganese, copper, zinc,
etc., in cancer have shown nothing of great interest, except that copper
Page 153 mtm
and also lead apparently inhibit tissue growth. Studies of inorganic changes in the blood itself in malignancy have furnished no significant results.
To sum up briefly then: It has been rather definitely established
that abnormally excessive sugar cleavage is the source of the extensive
energy supply for rapid growth. Along with this there appear to be other
factors: a lowered surface tension, increased permeability, abnormal lipoid
relation, added intracellular water content, and a disturbance of the
inorganic elements.
Now, lest we draw false conclusions, we must remember that the
finding in cancer tissue of various substances differing from those in
normal tissues are end-results and may in themselves have nothing to
do with the production of cancer.
Low calcium, low magnesium, increased potassium and increased
cholesterol, etc., then, do not mean that these alterations are the cause
of cancer, any more than the fact that chlorides are low in the blood
of a pneumonia patient makes this deficiency a cause of pneumonia.
The points thus noted are merely manifestations, whereas what we
all want to know is causation. Nevertheless, the patient compilation of
facts will go on, and some day there will be put together the disorderly
heap of jigsaw fragments that make up at present our knowledge of
cancer.
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Page 154 preventing NUTRITIONAL ANEMIA
in Infants through a Normal
I DIETARY REGIMEN
NtrnuTiONAL anemia was present in 45% of the breast-fed and 51% of the bottle-fed
n a group of more than 1,000 infants studied by Mackay.1 Although this anemia was
pf mild degree, it was sufficient approximately to double the morbidity among the artificially fed.
Anemia Prevalent
\ Commenting on this work,
Ihe British Advisory Com-
jnittee on Nutrition writes,
■ 'This form of anaemia is
prevalent among infants, especially those living under
conditions of city life, and is
attributed to a deficiency of
available iron and possibly
also of copper. Its most important feature is susceptibil-
Cow's Milk, 14 oz.
Dextri-Maltose with
Vitamin B, 1 oz.
Daily Requirement *
IRON
1.01 mg,
2.40
341"
3.11
COPPER
0.166 mg.
°-57°
0.736
traces
IRON
1.44 mg.
Cow's Milk, 20 oz.
Dextri-Maltose with
Vitamin B, V/2 oz. 3.60
Mead's Cereal (dry), V4 oz.   1.70
674
4.18
Daily Requirement*
COPPER
0.24 mg.
0.855
0.09
1.185
"traces"
It is generally agreed that breast milk and particularly
cow's milk are markedly deficient in iron and copper. But
when 1 oz. of Dextri-Maltose with Vitamin B is added to
14 oz. cow's milk, properly diluted (as at 1 month), the above
increase in iron and copper results.
ity to infection, particularly a liability to colds, otorrhoea, bronchitis, and enteritis, and a tendency for infections to become chronic.' '2
Iron, incorporated in powdered milk, should be given as a routine to bottle-fed
[infants, according to the recommendations of this committee in a report to the Ministry of Health. -Kir-ir   r\ r •        •     t
Milk Deficient in Iron
Stored in the liver of the full-term infant is a supply of iron and copper theoretically sufficient for the first six months of life. But actually the reserve is subject to
wide variation,1 probably because of variations in the iron content of the mother's diet
during pregnancy. Hill, for example, says, "If the mother is anemic herself, or if she
has eaten little iron-containing food during the last months of pregnancy, her offspring is born with an insufficient iron deposit. . . ."3
The trend is also toward
the introduction of iron-rich
solid foods at an early age.
The iron content of many
foods is variable, however.
Leichsenring and Flor4 found
that children's diets planned
to contain 5 and 8.5 mg.
iron actually contained only
3.25 and 6.5 mg., respectively. Mead's Cereal, higher
than most foods in iron and
containing standardized amounts of this mineral together with copper, can be administered as early as the third month. Clinical studies by Summerfeldt5 show that
Mead's Cereal is capable of increasing the hemoglobin percentage of growing children.
* The desirable iron intake for children, according to Rose et al, is 0.76 mg. per 100 calories.
Infant of 1 month.(8>£ lb.) and infant of 3 months (llj^lb.), both require 50 calories per lb.s
1-6 Bibliogrdphy on request.
MEAD JOHNSON 8c COMPANY OF CANADA, LTD., Belleville, Ont.
Please enclose professional card when requesting sam pies oi Mead Johnson products to cooperate in preventing their reaching unauthorized persons
When 14 oz.of Mead's Cereal is fed to the 3-months'old infant receiving 20 oz. cow's milk and 1 ^/z °Z. DextruMaltose
with Vitamin B, a significant increase in iron and copper
takes place. (latter & ^arara, ^Jttt
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