History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: February, 1926 Vancouver Medical Association Feb 28, 1926

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Published monthly at Vancouver, B. C.
cA J\[eU> HDialyzing o^lembrane^
'Workmen's (Compensation Legislation^
Open cfAir School
Qardiac "Tain^
^Published by
cfflc'Beath Spedding Limited, ^Vancouver, eB. Q. ■flip*
A few distinctive features of
PETROLAGAR (Deshell) is a corrective, not a cathartic. It
forms no habit, permitting decreasing instead of increasing
dosage and may be discontinued when regularity is established.
Its oil content is the greatest—65% mineral oil of the highest quality,
means maximum lubricating power and is of paramount importance.
The oil being emulsified, leakage is practically eliminated.
Agar is the sole emulsifying agent used—no fermentative 'gums or soaps.
Petrolagar   (Deshell)   is particularly palatable, more like ice cream thus making
the  physician's  task  easier;   both  children  and  adults  find  it pleasant   to  take.
Three   years   of   satisfactory   results   in   clinical   usage   solely   under   physicians'
prescriptions, prove conclusively the therapeutic value of Petrolagar   (Deshell).
No 1 Blue Label
The palatable emulsion of pure mineral
oil and agaragar is
indicated in the ordinary cases of constipation and as a follow
up in severe cases
when Petrolagar Phe-
nolphthalein has been
previously  used.
Petrolagar        Petrolagar
(Phenol phthalein)
No. 2 Red Label
Phenolphthalein |
to the tablespoonful,
is indicated in severely constipated individuals who have used
drastic purgatives. We
recommend Teducing to
Plain after one or two
No. 3 Green Label
Contains magnesia calcined and is indicated in hyperacidity
and acidosis, and is
extremely useful in
gastric ulcer where
constipation is present.
Useful      in     Pyorrhea
and   acid-mouth.
( Unsweetened")
No. 4 Brown Label
Indicated for those
who do not like
sweets and may be
prescribed safely for
Diabetic patients. It
is bland like the
other numbers and
while unsweetened, is
unusually   palatable.
The principle of lubrication and bulk calls for the  usage of Petrolagar Plain
in all cases untess special considerations indicate one of the other forms.
Deshell Laboratories of Canada. Limited, Dept. V.,
245 Carlaw Avenue, Toronto, Canada.
Please send without obligation, copy of Habit Time and samples of Petrolagar.
^>"  —*sy
Published Monthly under the Auspices of the Vancouver Medical Association
in the Interests of the Medical Profession.
529-30-31 Birks Building. 718 Granville St., Vancouver, B. C.
Editorial Board:
Dr. J. M. Pearson
Dr. J. H. MacDermot Dr. Stanley Paulin
All communications to be addressed to the Editor at the above address.
VOL. 2.
FEBRUARY 1st, 1926
No. 5
OFFICERS, 1925-26
Dr. J. a. Gillespie
a. w. Hunter
DR.  H.  ]
4. Milburn
Dr. G. H.
Clement                   Dr. A. B. Schinbein
W. F. Coy
Dr. W. B. Burnett                Dr. J.
M. Pearson
Representative to B
O Medical Association                       Audi
DR. A. J.
MacLachlan                       Dr. A. C
Clinical Section
. Frost
W.   L.   PEDLOW
■   .
F. N. Robertson
\iological and Pathological Section
G. F. Strong
C. H. Bastin -
, Ear, Nose and Throat Section
Colin Graham
E. H. Saunders
Cenito-Urinary Section
G. S. Gordon
J. A. E. Campbell	
Physiotherapy Section
H. A. Barrett
H. R. Ross
Library Committee
Dr. Wallace Wilson
Dr. A. w. Bagnall
Dr. W. D. Keith
Dr. W. F. McKay
Orchestra  Committee
Dr. f. N. Robertson
Dr. J. A. Smith
Dr. l. Macmillan
Dr. A. M. Warner
Dinner Committee
Dr. G. F. Strong
Dr. W. A. Dobson
Dr. l. H. Appleby
Credit  Bureau  Committee
Dr. Lachlan Macmillan
Dr. J. W. Welch
Dr. G. A. Lamont
Credentials Committee
Dr. Lyall Hodgins
Dr. R. Crosby
Dr. J. A. Sutherland
Summer School Committee
Dr. G. s. Gordon
Dr. Murray Blair
Dr. W. D. Keith
Dr. G. F. Strong
Dr. H. R. Storrs
Founded  1898. Incorporated 1906.
Programme of the 28th Annual Session
GENERAL MEETINGS will be held on the first Tuesday of the month
at 8 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the month
at 8 p.m.
Place of Meeting will appear on Agenda.
General Meetings will conform to the following order:—
8.00  p.m.—Business as per Agenda.
9.00  p.m.—Paper of Evening.
OCTOBER  6 th-
OCTOBER   20th—
General Meeting.
Presidential  Address:     DR.  J.  A.   GILLESPIE.
"The Progress and Future of Medicine."
Clinical Meeting.
General Meeting.
Paper:     DR. HlBBERT WlNSLOW HlLL.
"The Part  Played by  the Laboratory in Clinical
NOVEMBER   17th—     Clinical Meeting.
DECEMBER   15 th-
JANUARY   5 th—
JANUARY   19 th-
FEBRUARY   16 th—
MARCH 2nd—
MARCH   16th—
APRIL  6th—
APRIL 20th-
Page Four
General Meeting.
"Intravenous Therapy."
Clinical Meeting.
General Meeting.
Paper:     DR.  G.  F.  STRONG.
"Cardiac  Pain."
Clinical Meeting.
General Meeting.
Papers:    Dr. J. TATE MASON, of the Mason Clinic,
"Surgical Treatment of Thyroid Diseases."
DR. LESTER J. PALMER, of the Mason Clinic.
"Some Phases of  the Diabetic Situation."
DR. MASON will probably give a Clinic at the V.G.H.
on the morning of Feb. 2nd.
Clinical Meeting.
General Meeting.
Clinical Meeting.
General Meeting.
Urological Evening.     DRS.  B. H.  CHAMPION.  G. H.
Clement, G. S. Gordon, and A. W. Hunter,
"Problems in Urological Diseases."
ANNUAL MEETING. iiiiiiiiiiimtniiitiiiii
Ultra-Violet Technique Simplified
by Victor Quartz Lamps
In developing "Victor quartz; lamps for
ultraviolet therapy the Victor policy of
keeping constantly in mind the technical
needs of the physician has been strictly
followed. The physician is not required to
adapt his technique to the apparatus, be
cause the Victor organization has adapted
Victor quartz lamps to his requirements.
As a result Victor air'Cooled and water'
cooled quartz lamps are so readily installed
and so easily manipulated that the correct
method of applying ultraviolet rays in the
treatment of many cqpditions common to
every practice is quickly acquired.
Main Office and Factory:
2012 Jackson Boulevard, Chicago
33DirectBranches—NOT AGENCIES—Throughout
U. S. and Canada
Victor apparatus for
□ Medical Diathermy
□ Surgical Diathermy
□ Phototherapy
D Ionic Medication
d SinusuidalTherapy EDITOR'S PAGE.
It appears that two medical practitioners in England have
lately been disciplined by the General Medical Council for unprofessional conduct. The conduct complained of in one of these
cases would seem to involve the question of the publication of
matters deemed to be advertising.
This procedure has aroused a good deal of discussion, in and
by the press, and may, it is said, be the subject of questions in the
House of Commons—thus constituting a domestic storm the reverberations of which have been heard in quite distant quarters.
The gist of the comment is that the medical profession is advised to mend its ways, to abjure its mediaeval habit, to live in
the public gaze, and, above all, to change its attitude towards publicity in the form of advertising. In so doing it will get into step
with the remarkable progress which is so noticeable in other
branches of human activity.
We can agree that publicity or advertising (the terms are interchangeable) is the feature of the age. Ordinarily, commercial
advertising has had in view the bringing to public attention of
new inventions or improvements or of a specific article or want.
In this way, also, the public is familiarized by constant repetition
with the name of a firm or its product. To this has gradually
been added a more specious form which seeks to create a want
where none existed. A further development has been utilized by
large institutions and public utility concerns in giving details of
their business with a view to disarming criticism or securing cooperation or acquiescence from their patrons or the public.
We have been puzzled to know into which of these categories
medical advertising would fit. Obviously if one is to advertise, all may do so, and the publication of a long list of doctors,
with or without their qualifications, would mean no more benefit
to the individual doctor or to the public than now results from the
list in the classified section of the telephone directory. Even if
more of a display form of advertisement were used, the same reasoning would apply. Advertising agencies would doubtless profit
and the testimonial bureaux might recapture some of the easy
money with which they were credited during the palmy days of
the patent medicine era. The public indeed would have rather
less means of discriminating than at present.
As matters stand now, the ancient and disreputable attitude
of the medical profession is fairly common knowledge, so that
people may infer that when medical advertisements do appear they
are not of those who follow after the order of Melchizedek. Moreover, we believe that, as most of us are compelled at some time
to entrust our families and ourselves to the care of the medical
profession for want of a better substitute, some degree of reticence is desirable on the part of those who share our secrets and see us
when we are not equipped for the public eye.
As to the more general forms of publicity, we agree that increased knowledge is desirable. Just how far that can be conveyed by lectures, talks or special articles in magazines, is uncertain. In any event we must not forget that the mental perturbation which may be produced by a partial grasp of information is
at times, as we know all too well, very alarming in certain types
of personality. More probably a complete appreciation, if it ever
comes, of disease and its ramifications, will come slowly as the
result of a more complete general education which has as its ultimate purpose the promotion of sound judgment.
At the Clinical Meeting of the Association, held on the 19th
January, Dr. H. White, School Medical Officer, made an announcement with reference to the Open Air School to be opened on the
1st of February, on Clark Drive, near Kingsway. Dr. White
urged the members to make use of this school in the treatment of
under-nourished children, those suffering from anaamia, enlarged
glands, early symptoms of chorea, and those having a history of
exposure to (though not et showing any active symptoms of)
tuberculosis; also children whose home surroundings are so unsatisfactory that a regular regime, with plain, wholesome food, fresh
air and sunshine, would benefit them. No open cases nor any
showing active symptoms of tuberculosis will be accepted. The
usual open air treatment will be given, as well as extra milk morning and evening, and a hot meal will be served at the school at
noon. Parents of children may or need not pay, according to
their financial position.
At the regular monthly meeting of the Association, held on
January 5th, Dr. G. F. Strong gave an interesting paper on "Cardiac Pain," which is published in this issue.
We are very glad to say that Dr. O. S. Large is recovering
satisfactorily from the effects of the accident sustained in a collision between his automobile and a street car, on Granville bridge,
shortly before  Christmas.
We take pleasure in reminding our readers that at the next
General Meeting of the Association, on February 2nd, Dr. J.
Tate Mason and Dr. L. J. Palmer, of Seattle, will be the speakers. Dr. Mason will give a clinic on the morning of that day at
the Vancouver General Hospital. We are hoping for a large attendance both morning and evening.
Page Seven Since our last issue appeared, the Board of Directors of the
Vancouver General Hospital has appointed the Visiting Staff for
the ensuing three years.    The appointments are as follows:—
Medicine—Drs. F. J. Buller, Alison Cumming, B. D. Gillies,
Lyall Hodgins, G. F. Strong and Wallace Wilson.
Surgery—Drs. J. H. MacDermot, P. A. MacLennan, H. W.
Riggs, A. B. Schinbein, G. E. Seldon, and J. W. Thomson.
Dermatology—Drs. J. Christie and T. R. B. Nelles.
Neurology—Drs. F. Brodie and W. F. MacKay.
Orthopaedics—Drs. F. C. McTavish and F. P. Patterson.
Urology— Drs. B. H. Champion and A. W. Hunter.
Psychiatry—Drs. W. A. Dobson and J. G. McKay.
Paediatrics—Drs. E.. D. Carder and C. C. Covernton.
Tuberculosis—Drs. P. W. Barker and C. H. Vrooman.
Gynaecology—Drs. W. B. Burnett and J. J. Mason.
Appointments in the Eye, Ear, Nose and Throat, and Dentistry sections,  were deferred.
In a reprint from the U. S. Public Health Reports, dated
June 26th, 1925, recently received in the Library, the attention of
the medical profession is called to the occurrence during the years
1921 to 1925 of eleven cases of tetanus (nine of which were fatal)
following the use of bunion pads as a dressing after vaccination.
On an investigation of 200 pads of the makes used in these cases,
approximately 25% were found to contain tetanus organisms.
This clearly indicates the danger of using bunion pads or anything except clean surgical dressings following vaccination.
The Summer School Committee has fixed upon the week
of September 13th as the date for this year's meetings. The
Committee is working upon a plan whereby it is hoped to augment the regular session.by speakers obtained through the Canadian Medical Association scheme for postgraduate medical instruction.
The monthly Clinical Meeting of the Association was held
on January 19th. Dr. A. J. MacLachlan presented a case of a
man, aet. 64, with good personal and family history, with negative Wasserman, in which a condition of myocarditis with heart
block was obvious. The ventricular rate was 22 per minute, and
the auricular rate about 70. Patient gave a history of having suffered from transient attacks of faintness without loss of consciousness and with attacks of blindness. B. P., 220/64. Dr. MacLachlan showed the electrocardiograph tracings and X-rays. There
was a loss of weight from 180 to 135 pounds in a period of 18
months.    The blood vessels were much thickened.
Dr. W. D. Patton presented an interesting case, thought by
him to be polycythaemia. The patient was a woman of 50, with
good personal and family history. She had recently noticed that
her hands and face became flushed while working, and in July,
1925, had a sudden protrusion of painful haemorrhoids.    Haemor-
Page Eight
^— inoidectomy was done on July 14th by clamp, and cautery method
under general anaesthetic, followed by marked and prolonged nausea with fullness in the head, congestion of conjunctivae commencing three days after operation, sore eyeballs, generalized abdominal distress, irritation while passing urine, with a distinct red
flush,    with    tenderness   over   each    shin. Thirty - six    days
after operation, nausea and vomiting were still present,
with pulse of 100, irregular temperature and marked acetone reaction in urine, but no sugar or albumen. B.P. 165. W.B.C.
7,000. Polys 70%. R.B.C. 4,200,000. Hg. 61% (although
Talquist scale showed 90%). Blood sugar normal, blood culture
negative. Glucose with insulin rapidly removed the acetone, but
nausea continued. Patient regained strength and weight, but
oedema of the feet became more marked and the eyelids were swollen. Examination of the fundi by Dr. E. H. Saunders showed
marked venous engorgement. In the discussion which followed
the question was raised as to this being a true polycythaeemia or
erythraemia, in the presence of the low red cell count and Hg. index, with absence of palpable enlargement of liver and spleen. Dr.
Patton quoted exhaustively from the literature to prove his contention. In discussing treatment, it was generally accepted that
benzol and X-rays were no longer considered of special benefit,
but that phenylhydrazin hydrochloride and blood letting are the
most satisfactory therapeutic agents.
Dr. F. P. Patterson presented three cases of paralysis which
had become noticeable at varying periods after fracture or dislocation, although no nerve lesion had been noticed by either patient
or doctor at the time of the accident. One case was a dislocation
of the head of the femur with crushing of the acetabulum, with
subsequent foot-drop owing to the dislocation not having been reduced and pressure on the peroneal part of the great sciatic nerve
in the sciatic notch.
Another case was a fracture of the bones of the forearm
through being caught by a belt, with subsequent wrist-drop, which
upon investigation disclosed a neurofibroma in the musculo-spiral
nerve between the nerves of supply of the supinatus longus and external head of the triceps, although no evidence of tissue injury
was noticed at the operation.
The third case was somewhat similar. The man had been
caught by a belt, with outward dislocation of the elbow joint and
a large cut across the pectoral muscles, exposing the axillary vessels. He developed wrist-drop and anaesthesia to near the elbow
joint. The musculo spiral nerve was exposed and about three
inches were found to be considerably compressed by fibrous tissue
which was dissected away from the nerve, the latter being embedded in muscle. Up to date nothing has been done in the region
of the axillary wound, but improvement is now quite noticeable
both in the region of the musculo spiral and ulnar distribution.
Page Nine Dr. Patterson called special attention to the necessity for immediate investigation of the possibility of nerve lesions in all cases
of fracture and dislocation.
A Sterilizable Dialyzing Membrane. H. W. Hill, M.D.,
D.P.H., L.M.C.C., Director Vancouver General Hospital Laboratories; Professor of Bacteriology, and
of Nursing and Public Health, University of B. C.
In searching for a sterilizable dialyzing membrane, a suggestion came from the Christmas festivities of 1925, which presented
much candy and many candy-boxes enclosed in transparent glistening sheets of "paper." The resemblance of this "paper" to thin
sheets of collodion induced me to try its dialyzing powers, which
for silver nitrate, sodium chloride (Donna E. Kerr and H. W.
Hill, independently), and glucose (Donna E. Kerr), proved perfect. The next step was to test its resistance to sterilization. Fifteen pounds steam pressure for twenty minutes in the ordinary
laboratory autoclave left it unchanged in appearance, feel, etc.;
and its dialyzing qualities were unaffected  (Donna E. Kerr).
The various uses of such a membrane in physics, chemistry,
and especially in biology and bacteriology, both scientific and applied, are obvious, and need not be enlarged upon here. With
Duponts Household Cement, probably collodion dissolved in acetone (R. E. Coleman), the sheets may be made up into tubes,
into flat, square or round bags, etc., etc. Diaphragms may be
cemented across bowls or beakers, or glass tubes, etc. It would
appear to make practicable a whole field of bacteriology as yet
hardly explored.
The material is said to be named "cellorhane," and to be
made in France (now made by the Dupont Company of U. S. A.).
It sells wholesale at about 25 cents a square yard. So far as we
have been able to discover, this substance has not been previously
advocated as a sterilizable dialyzing membrane, for the above purpose.
* * *
From the V'. G. H. Laboratories.
It has been reported that a certain young lady, who has been
under very close observation for diabetes mellitus, was completely
cured by drinking "radioactive" water from a well-advertised jar.
The truth is that, after four months' consumption of six to eight
glasses of the water per diem, no change has been demonstrable.
A possible reason for the apparent failure is suggested in the 21st
November issue of the Journal of American Medical Association,
where it is stated that to obtain the very minimum of demon-
Page Ten strable therapeutic effect one would have to consume at least 120
gallons, or sixty jars, of the water each twenty-four hours. One
hundred and twenty gallons is twenty-four hundred glasses, or
almost two glasses every minute of the day and night. As the
young lady has to earn her living, suppose she were to devote two
hours of the morning and four hours of the evening to the "good
of her health" (?) she would have to drink a glass every nine
Summary of Cases Discharged from the Vancouver General
Hospital in 1924.
Report Made to the Staff of the Hospital by the
Department of Tuberculosis.
Total discharges     123
Conditions on Admission—
Far advanced   103, or 84.   %
Moderately advanced   18, or 14.5%
Incipient   |  2, or 1.5%
Number with positive sputum  110, or 89    %
Number with negative sputum  13, or 11    %
Note.—About six with "negative sputum" had no sputum
examined or only one sample.
Condition on Discharge—
Died   58, or 47%
Unimproved   32,  or 26%
Improved    33,  or 27%
Longest stay in Hospital of those who died   710  days
Shortest stay in Hospital of those who died        2
Died within 60 days or less of admission     35
Discharged unimproved within 60 days or less of admission —. 26
Total terminal cases      61
Number who had a chance of improvement.. 62
Results in 62 cases admitted in adequate time for some
effective treatment—
Died  1     23
Discharged unimproved        6
Improved 33
62 Classification according to symptoms—
Severe   7 9
Moderate     3 8
Slight  — 5
Conclusions :
1. Fifty per cent, of cases admitted have no chance of even
improvement. They either do not seek medical aid until
too late, or are not diagnosed early enough.
2. Of those who live longer than 60 days, over 50% show
improvement and qualify for sanatorium treatment.
3. The means of isolating dying cases from those who have
a chance, are inadequate.
4. The total accommodation for tuberculosis is most inadequate—eight and nine patients frequently have to be
accommodated in other wards of the Hospital waiting
for room in Ward "O." It is also well known that
patients have to be kept at home for weeks because of
lack of accommodation.
5. The accommodation that would be provided in the
building formerly occupied by the University should not
be alienated for any other purpose. It is all needed at
once for tuberculosis patients. The health of the community is suffering now because of the lack of this accommodation.
6. Histories for the tuberculosis patients are not being written, and there is not an adequate interne service on
Ward "O."
7. Ward "O" does not protect the community from a number of advanced and infectious cases.
8. Ward "O" does give a chance for life to a number of
cases who otherwise would have no chance. Thirty-
three were discharged improved.
A number of those under sanatorium or home supervision have had their disease arrested and have been able
to return to work.
*        *        *
By E. S. H. Winn, Esq., K.C., Chairman Workmen's
Compensation Board of B. C.
The principle of systematic compensation for losses due to
industrial accident has been known in Europe for over a century,
the earliest examples being found in the mining industries. As
these industries were the first to be operated on a large scale with
large numbers of employees whose lives and safety depended on
the care and skill of the manager and of their fellow workmen,
and, in addition, at a high danger rate, it was but natural that attempts should be made to provide in a definite manner for the
relief of the distress of employees caused by accidental injury or
other physical disability.
Page Twelve Compensation to workmen injured by accident arising out
of and in the course of their employment, like many other ideas
involving the progress of civilization, was a slow growth. Emerging from the hard soil of economic study in the books of the German scholar Schaeffle, the idea gained the power and force of
official recognition by being embodied in the social insurance system of Germany promulgated by William I and Bismarck.
The emperor's famous message to the Reichstag on November 17, 1871, said in part: "We consider it our imperial duty
to impress upon the Reichstag the necessity of furthering the welfare of the working people .... a bill for insurance of workmen
against industrial accident will first of all be laid before you;
after which a supplementary measure will be submitted providing for a general organization of industrial sick relief insurance.
Likewise, those who are disabled in consequence of old age or
invalidity, possess a well-founded claim to more ample relief on
the part of the state than they have hitherto enjoyed. To devise
the fittest ways and means for making such provision, however
difficult, is one of the highest obligations of every community,
based on the moral principles of Christianity."
A brief outline of what led up to this legislation might be
interesting, as a proper conception of the circumstances that formerly prevailed is necessary to a thorough understanding of the
theory of workmen's compensation. In discussing the subject
it is assumed that you are familiar with the principles applicable
to those sustaining the relationship to each other of employer and
workman, and therefore only such reference to common and statutory law on the subject of employers' liability will be made as
seems to be imperative.
At the time of the adoption of the common-law rules of
liability, industrial conditions radically differed from those which
prevail to-day. The employer employed comparatively few workmen, with whom in the performance of their work he was brought
into intimate association and was able to exercise a supervising
care and control. He was acquainted with the habits and characteristics of each of his employees; the employees knew the employer personally in the same way, and, moreover, were brought
into such close relationship with one another that their habits and
peculiarities were mutually known and understood. The business
carried on was small in extent; the appliances which were used in
the work consisted in the main of hand-tools; the power, when
any was used, was simple in character, afforded by the utilization
of horses or of water-power applied directly to the machinery,
which was neither complicated nor particularly dangerous in character. Under these conditions the rules of the common law originated.
The injured workman could recover at common law from
the employer only by showing that he was guilty of negligence:
that is, that in the given case he had failed to exercise a proper
Page  Thirteen degree of care, and that the injury had resulted therefrom. From
time to time in the development of the law, qualifications to the
liability of the employer for negligence were introduced. It was
held that, notwithstanding the fault of the employer, if the employee himself had likewise been guilty of negligence contributing
proximately to his injury, he could not recover; that he assumed
the natural and ordinary risks and perils incident to the performance of his services, and he was denied the right of recovery whenever the injury was occasioned by defects in appliances or premises
with or upon which he worked with knowledge thereof, actual
or imputed. It was further held that where the injury was occasioned by the negligence of a fellow-servant, he could not recover. These various substantive rules and defences were not
unjust or unreasonable when applied to the conditions prevailing
at the time of their adoption, but they have come to be recognized,
not only in this country, but all over the civilized world, as no
longer justly applicable to modern industrial conditions.
In the industries to-day, often thousands of men are employed in the service of a single employer; the appliances with
which they do their work consist in the main of more or less complex machinery, kept in motion, and often in highly rapid motion,
by the elemental forces of steam and electricity. This machinery
so propelled is not always under the immediate control of the
workman who uses it, but its operation is governed by other workmen at more or less remote points. These and other changed conditions have so impressed intelligent observers in this country that
attempts have been made to modify the rules of the common law
to meet them, and from time to time legislation has been adopted,
sometimes abrogating an existing rule and sometimes altering it,
in accordance with the opinions of the various legislative bodies
which have dealt with the question. Thus the doctrine of contributory negligence has in some Provinces and States been so
changed as to allow recovery where the negligence of the workman is slight as compared with that of the employer. The doctrine of assumption of risk has been so altered as to permit recovery where the defects, although known to the workman, consist
in the absence of safety appliances, etc., prescribed by law. The
doctrine of fellow-servant negligence has been modified by the
introduction of the separate department and the superior-servant
rule. Statutes have been passed imposing specific duties upon the
employer, having for their object the promotion of the safety of
his workmen and making him liable to workmen sustaining injury
because of their non-performance. These attempts and others
which might be enumerated, all indicate a clear recognition on the
part of legislatures and courts that the common-law system of
employers' liability for negligence, with its various controlling
defences, can no longer be justly applied to modern industrial
Not only has this been the case in our own country, but the
same tendency is manifest in the legislation of nearly every civil-
Page Fourteen ized country in the world. Most of these countries have gone
far beyond Canada and the United States in the direction of remedial legislation. England and her colonies and the various
countries in Europe, with few exceptions, have adopted laws which
either expressly or in effect abrogate the laws of liability for fault,
and substitute the law of compensation, under which the injured
workman, or, in the case of his death as the result of accident
in the course of his employment, his dependents, receive certain
definite compensation proportioned in various ways to the wages
paid at the time of or during a prescribed period before the accident.
The general theory of workmen's compensation is that industry should bear the loss of life and limb incurred in the production of its finished product, just as it bears the expense of
replacing worn-out and broken machinery; and that for every
injury incurred in the course of employment some fixed amount
should be provided in the way of compensation to the person
incurring the injury, or to his dependents in case of his death;
and this without regard to the question of fault or negligence of
the employee, because many injuries or deaths are bound to occur
under modern conditions, even when the utmost care is exercised
by both the employer and the employee. The practical application of the doctrine involves a virtual abandonment of the common-law principles of employers' liability and the many statutory
enactments commonly known as "Employers' Liability Acts,"
thus giving every employee injured in the course of employment
the. right to secure something in the way of compensation for his
injury, and as soon as possible after he sustains his injury, and
at a minimum of expense.
Following the above referred-to German legislation, practically all of the European governments abolished the negligence
litigation system for that of compensation, irrespective of fault.
The first Acts passed in the United States were passed by the States
of Washington and Kansas, on March 14th, 1911. Up to
June 30th of this year there are forty-six States with collective liability systems, and in Canada eight of our Provinces
have workmen's compensation legislation, with six of them based
on that of collective liability. The first Canadian compensation
Act of any kind was passed in British Columbia in 1902, followed
by Alberta in 1908, Quebec in 1909, and Manitoba and Nova
Scotia in 1910. These were all administered by the courts. In
1914, Ontario adopted the collective liability system, followed
by Nova Scotia in 1915, British Columbia in 1916, Alberta and
New Brunswick in 1917, and Manitoba in 1921. The last six
referred-to Canadian systems are based upon the mutual liability
system of Germany and upon the exclusive State fund of Washington. CITY HEALTH DEPARTMENT.
Vancouver, B. C.
Total Population   (estimated)
Asiatic Population   (estimated)
Total   Deaths     142
Asiatic  Deaths    20
Deaths   (Residents only)     108
Total Births—Male, .   157
Female,   146   303
Stillbirths—not included  in above   11
Deaths under one  year of  age  _ 1 3
Death  Rate  per   100   Births     42.6
Rate per 1000 of
Population per Annum
January  1st to
Scarlet   Fever   	
Diphtheria            31
Chicken-pox          20
Whooping Cough    	
Typhoid Fever 	
Cases from Outside City
Scarlet Fever   	
Typhoid Fever 	
>r,   1925
.   1926
uded in
Members of the profession in Vancouver will be interested
to hear of the arrangement that has recently been made by
Woodward's, Limited, with its employees. Under this agreement, there is no regular medical man appointed to deal with sick
members of their association, but each member is free to choose
his or her own doctor. The association will pay the first call or
consultation in each case. This agreement was entered into after
the company had consulted the B. C. Medical Association, and is,
in our opinion, a good one for all those concerned.
Recently, in Vancouver, a large committee of prominent men
has been formed to devise schemes for ameliorating the lot of certain ex-service men who are handicapped in their search for employment by physical disabilities of various kinds,  due to their
Page Sixteen service. Such committees in other parts of Canada have been very
successful, and have accomplished great good. Several well known
business and professional men have allied themselves with the project, amongst them Dr. R. E. McKechnie. -The B. C. Medical
Association was asked to appoint a representative, and Dr. A. M.
Warner, of this city, has consented to act. As an overseas man
himself, with an enviable record, and as one who has kept in close
touch with returned men through his appointment as Vocational
Medical Officer at Shaughnessy Hospital, Dr. Warner is peculiarly
fitted for this work, and will, we are sure, have the hearty endorsement of all medical men.
Arrangements for the forthcoming Annual Meeting of the
Canadian Medical Association are well under way in Victoria. All
members of the profession are asked to plan their arrangements for
the summer with this meeting in mind.
Copies of a booklet issued by the London Life Assurance
Co. of Ontario, on the work of Child Welfare Clinics, are being
obtained for circulation through the province to medical men.
These are full of valuable and interesting information, and will
be found useful.
The books of the B. C. Medical Association to the end of
December, 1925, shew a credit balance of about $1200, with some
more cheques to come in. The records of the office shew a busy
year in various ways. For instance, 22 permanent positions were
secured for B. C. men, 34 locum tenens were supplied, 46 men in
the province applied for help in finding locations or assistants, and
so on.
The Medical Board of the W. C. B., whose talk to the Vancouver Medical Association was reported in the last number of
the BULLETIN, paid a similar visit to the Fraser Valley Medical
Society on January 7th. These meetings are an extremely wise
innovation, as well as being very welcome to the profession at
large. The experience of our Industrial Committee, which deals
with a great many cases.where there is dispute, shews that in the
vast majority of cases the trouble is due to misunderstanding on
the part of the doctor, much more than to any deliberate carelessness or neglect. The frank and friendly words of these gentlemen of the Medical Board have done a tremendous amount to
help us in doing our share towards the carrying out of the W. C.
Act, and we hope this visiting of theirs will extend to all the centres in the province.    It cannot but help them as well as us.
*        *        *
G. F. Strong, M.D.
(Read before the January meeting of the Vancouver
Medical Association.)
The various clinical conditions in which cardiac pain occurs,
omitting that due to aortitis or to pericarditis, may be discussed
under four headings: \>.m
1. Pain due to fatigue;
2. Pain of irritable heart;
3. Paroxysmal pain—angina pectoris;
4. Pain of coronary thrombosis.
The idea that pain may arise from fatigued heart muscle is
strengthened by the fact that pain occurs in voluntary muscle that
is overstrained. Fatigue is more easily produced, less effort is required to overstrain the muscle, in the presence of disease or any
diminution of the blood supply. When a muscle contracts actively, it requires more blood than when quiet; therefore, when the
heart is called upon to meet increased demands, its blood supply
must be increased. The reserve power of a healthy heart is considerable, and it is only severe overstrain that will produce pain.
This sort of pain commonly occurs in hypertrophied hearts, the
result of long standing hypertension or any other cause, in hearts
with chronic valvular disease (possibly more particularly aortic)
those types of cardiac arrythmia characterized by excessively rapid
rates, and may also be seen in untreated cases of permanent fibrillation.
This type of pain, simple fatigue pain, occurs usually around
the apex in the sub - mammary region, and radiates, if at all,
around the chest to the back. The pain is generally of a dull
aching character, though at times it may be sharp and stabbing,
even to being confused with a mild angina. It is a continuous
ache rather than a paroxysm of severe pain. It may present features that make its distinction from the more ominous types of
cardiac pain difficult. In that case a therapeutic test will frequently
be of assistance. Fatigue pain is invariably benefited by rest and
digitalis, and is not relieved by the nitrites, whereas the pain of
angina, with which it is most likely to be confused, is usually immediately relieved by one of the nitrites.
The pain occurring in irritable heart or effort syndrome is
probably an expression of hyperexcitability of the nervous system.
In this discussion we must bear in mind that in the production
of pain there are always two important factors—first, the stimulus,
and second, the nervous mechanism. We know that people vary
considerably in their interpretation of pain. A stimulus sufficient
to produce severe pain in one, may produce a mild pain in another,
and no sensation at all in a third. The pain of irritable heart is
felt because of the individual's lowered threshold for pain. An
amount of strain borne with ease by a person with normal nervous mechanism will produce pain in these patients with the so-
called effort syndrome.
The pain in irritable heart, unlike other forms of cardiac
pain, arises as a result of excitement as often as a result of effort.
Like simple fatigue pain, this is a continuous precordial ache ra-
Page Eighteen diating, if at all, around the chest to the back. There is no doubt
that many cases present combinations of these two types of pain—
simple fatigue and irritable heart pain.
Angina pectoris is notably an English disease. From the
time the name and first description were given by Heberden, in
1768, practically all of the important views have come from English physicians, though it must be admitted that, except for theories as to its cause, little of importance had been added to the clinical conception of the disease until the monumental work by the
late Sir James Mackenzie. When we come to study angina pectoris, or cardiac pain in general, we realize what a tremendous influence Mackenzie has left on our ideas in this regard. Of the
various theories as to the cause of angina—and there have been
many, Huchard at one time collected eighty—there seem to me
to be only two that warrant careful consideration at the present
1. The theory that the pain arises from the muscle of the
2. Allbutt's theory  that angina  is due to disease of the
first part of the aorta.
The idea that the muscle may, under certain conditions, give
rise to severe paroxysmal pain, is by no means new, although it
is an idea that Mackenzie has done much to clarify. Any of the
older theories that angina depended on coronary vessel disease,
presumed that the way in which this vascular damage brought
about angina was by the alteration, always diminution, in the
blood supply to the heart muscle. Mackenzie has broadened this
conception by the idea that pain is due to exhaustion of the heart
muscle. This exhaustion is brought on by overstrain in the healthy
heart and by lesser strain in the diseased heart, in which ischemia
to some degree is usually present. Ischemia in these diseased hearts
may be produced (1) as a result of arterio sclerosis of the coronary arteries (2) as a result of diminution in the size of the
orifices of these arteries due to disease of the aorta or aortic valves,
and (3), as a result of a regional vascular crisis affecting the coro-
.nary vessels, a temporary constriction or spasm causing ischemia
of the heart muscle. Arterio sclerosis of the coronary arteries may
occur as a part of generalized arterio sclerosis, in which case the
cause of the angina will usually be clear, but arterio sclerosis of
the coronary arteries may also occur as a circumscribed patch' of
arterial disease, with perfectly normal systemic vessels. In either
case the disease of the coronaries may be of sufficient extent to produce a relative ischemia of the heart muscle with resulting paroxysms of pain. On the other hand, it is not unusual at all to see
cases at post mortem with extensive coronary disease, that have had
no history of anginal attacks. This only emphasizes the wide
variation in individual response, not only as to the reserve power
of the heart, but also in the individual's interpretation of pain.
Diminution of the orifices of the coronary arteries is quite likely
Page Nineteen to produce angina, but it does not often occur as an isolated lesion,
that is to say, there is usually some additional involvement of the
coronary vessels. That angina may be due to arterial spesm in
the coronary circulation is based on the following evidence:
1. Many clinically well-defined cases of angina pectoris
show at autopsy normal hearts, aortae and coronary
2. Regional vascular crises do occur in the vessels of the
brain, retina, and various systemic arteries.
3. The coronary vessels are under the influence of vasomotor nerves, and so are as susceptible to spasm as any
other arteries.
Certain European critics of Mackenzie's views of angina
claim that the pain is due to fatigue of the muscle, not exhaustion.
This seems a distinction without a difference, a mere quibbling
over words, because in either case the actual stimulus for the production of the pain is probably a chemical one, resulting from the
improper elimination of the end productions of muscular activity.
Allbutt's theory that in angina the pain arises as a result of
disease of the first part of the aorta with resulting stimulation of
the sensory nerve endings found there, seems to me a far less comprehensive view than that of Mackenzie's. There are, no doubt,
cases of aortitis in which pain and even paroxysmal attacks of pain
may be produced by this mechanism, but I cannot believe that we
can explain all cases of angina by this theory. Cases are recorded
in which pathological examination failed to reveal any evidence
of aortic disease. Allbutt answers by saying that the pathological
examination in such cases is not extensive enough to demonstrate
the causal lesions in the wall of the aorta. The opinion on this
continent and in England favors, I believe, Mackenzie's idea.
Allbutt's theory is not without support, however, for recently two
prominent European cardiologists, Vaquez in Paris and Wenke-
bach in Vienna, have lent the weight of their prestige to his beliefs.
The pain resultii. g from coronary thrombosis differs from
any other form of cardiac pain in the degree of its severity. It
is a long, continued, very severe, substernal pain, not relieved by
rest, digitalis, or nitrites, but demanding large doses of morphine
for its alleviation. There is no doubt that many of the cases of
status anginosus of the older writers were instances of coronary
thrombosis. Coronary thrombosis frequently occurs in an artery
already diseased, and may therefore occur in a patient suffering
from angina, although it may also occur as a bolt from the blue
in a patient apparently in perfect health. The onset of the attack
is constant, a sudden prostrating pain occurs usually following
some exertion, the pain substernal as in angina, not apical as in
simple fatigue or irritable heart. The pain may occasionally be
epigastric or right or left hypochrondrial, in which case a difficulty
Page Twenty may arise in the differential diagnosis between coronary thrombosis and gall stone colic or perforated gastric ulcer. A fair number of cases have been reported recently from well-equipped surgical clinics where the abdomen has been opened for an upper abdominal lesion, only t© find that the patient is suffering from
coronary thrombosis. It is important to remember that recovery
may, and frequently does, occur in these cases, and the fact that a
patient recovers and leads a moderately active life after one of
these attacks is not evidence of a mistake in diagnosis. The diagnosis of coronary thrombosis can usually be made from the character of the pain. The electrocardiograph may be of use in diagnosis, as most of these thrombosis cases will show a very definite
deviation from the normal tracing.
Before leaving this part of the discussion, I want to discuss
the pathology of these four conditions—fatigue, irritable heart,
angina, and coronary thrombosis. We must remember that these
conditions (except coronary thrombosis) are functional. The
pain arises as a result of exhaustion of the heart muscle, and there
will be, therefore, no constant pathologic picture. I am not at all
sure to what extent the infarct itself gives rise to the pain in
thrombosis; the resulting strain on the unaffected portions of the
heart would undoubtedly be sufficient to cause some, if not all, of
the agonizing pain these patients suffer.
Much has been written regarding visceral pain, but when we
come to look for an explanation of cardiac pain we find very little.
Most theories as to the cause of the pain in angina, for instance,
carry us only so far. Beyond that to the actual origin of the sensation, little had been done until Mackenzie's work. Exhaustion
in muscular tissue is brought about by muscle contraction. That
muscle contraction under certain conditions may produce pain, has
been shown in different ways. In involuntary muscle excessive
contraction, or spasm, with some resulting muscle exhaustion, is
capable of causing pain. Mackenzie says: "The severe pains
which go by the name of colic—bowel, renal, gall-stone—are all
associated with hollow muscular organs, and it is a justifiable inference that pain in 'colic' is a result of violent contraction of the
hollow muscle." Another type of pain arising as a result of
fatigue, that is excessive contraction, in involuntary muscle, is that
occurring in the ciliary muscle of the eye as a result of errors in
refraction. Pain also arises from voluntary muscles under suitable
conditions. We all have experienced the painful muscles resulting
from violent and unusual exertion, as after the first tennis of the
season. To quote from Mackenzie again: "Voluntary muscles
can give rise to pain. The pain in all these cases only arises when
the muscles have been exercised by a considerable and long continued effort. If in an elderly person the arm be emptied of blood
and a tourniquet be applied so tightly as to prevent any blood
reaching the forearm, opening and shutting the hand is followed
speedily by loss of power, then by severe pain if persisted in."
Pain may arise from any muscle tissue, but such a sensation is only
produced  under certain circumstances,  severe prolonged contrac-
y tion. It seems a reasonable conclusion that it is not the contraction per se that produces pain, but only the exhaustion produced
by the excessive activity. Exhaustion is relative. A diseased muscle or one with a diminished blood supply will become exhausted
more readily than a healthy one.
The heart is a hollow muscular organ, but its activities are
modified because of the nature of its work. The pain of various
kinds of colic is due to spasm of certain muscular organs. Spasm
of the heart is incompatible with life. Pain arising from the heart
is not due to spasm. The heart may produce pain when it is
called upon for greater effort than is normally expected of it, or,
with slowly progressive disease of the heart muscle or the arteries
supplying it, pain may arise as the first evidence of the heart's
inability to carry on its customary activities. If the immediate
cause of the pain is exhaustion, then the pain should occur at the
time the heart is strained. In certain patients this is not the case.
The pain may come on at a period of bodily quiet, as at night
when the patient is asleep, or during the day when he is resting.
This pain may be explained as a summation effect of many small
stimuli. In a nerve muscle preparation when a sub-minimal
stimulus is applied to the nerve, there is no response from the
muscle, if this stimulus be repeated frequently enough a contraction eventually occurs. This same summation effect may be responsible for the pain in cardiac conditions. The exhaustion of
the muscle may produce stimuli sub-minimal in character which
can only cause pain by a summation effect. In this connection it
is of interest to note that most angina cases have their first attacks
as a direct result of exertion, subsequently they attempt to avoid
the exertion sufficient to bring on an attack, and it is then that
these rather atypical attacks occur at a time when the body is at
rest. Whether the pain be due to simple fatigue, irritable heart,
coronary disease, or spasm, the immediate cause of that pain is
always exhaustion of the heart muscle. The tremendous influence
left on the medicine of our day by Sir James Mackenzie will be
ascribed in the future, I am sure, to his insistence on the importance of the factor of muscle exhaustion in the whole field of the
study of cardiac disease.
The stimulus, I have said, to the production of cardiac pain
is a chemical one resulting from exhaustion. When a muscle contracts, a definite chemical change occurs. There is an oxidation
of glucose with a resulting production of lactic acid, carbon dioxide, and water. In a relative deficiency of the oxygen supply
to a contracting muscle, as would occur either in excessive strain
or in conditions where there was a diminution in the blood supply, the production of lactic acid is increased. The actual cause of
pain arising from a contracting muscle may be lactic acid or some
similar metabolite present because of deficient oxidation. Other
factors than muscle exhaustion may be present in cases of coronary
thrombosis where a cardiac infarct occurs with the usual pathologic results.
Page Twenty-two The nerve supply to the heart was then considered, both
afferent and efferent nerves being described.
Following this the lecturer took .up the question of the
surgical relief of pain in  angina.
The first clinical experimental study on the afferent cardiac
nerves was the operation performed by Jonnesco, in 1916, for
the relief of pain in angina pectoris. Jonnesco has been doing
his operation of sympathectomy, which consists of a complete,
usually bilateral, cervical sympathectomy, including the stellate
ganglion, since 1896, during which time he has done over 200
for the relief of such conditions as exophthalmic goitre, epilepsy,
migraine and glaucoma. It is of some interest, that in 1923, he
reported that in those 200 cases he had never seen any bad effects
produced by this operation, and yet three out of the first six cases
of angina operated on by him died very soon after operation, and
died a cardiac death. Apparently a normal heart may get along
with its sympathetic supply practically removed, whereas a diseased heart may be considerably embarrassed. Since Jonnesco's
first operation, in 1916, there have been a number of attempts at
the surgical treatment of angina which throw light on the afferent
nerve supply of the heart. Jonnesco removed all three cervical
ganglia and the first thoracic ganglion, and advised that this be
done on both sides. Coffey and Brown, of San Francisco, were
the first to attempt the operation on this continent. In their first
case they decided to do the operation in two steps in order to do
only what was actually necessary, and as a first step they cut the
sympathetic trunk below the superior cervical ganglion and the
superior cervical cardiac sympathetic nerve. The patient had such
relief from this that they dropped the idea of any more extensive
operative procedure. They have reported six cases with one death,
the other five patients much relieved.
Other surgeons, using some modification of the Jonnesco
operation, have also reported successful results. The surprising
thing has been the success achieved with the very different surgical
procedures adopted. The superior cervical ganglion alone has been
removed, the superior and middle ganglia have been taken out,
and all three ganglia have been removed, and these procedures carried out on one or both sides with apparently a certain amount of
success in any of these methods. The success of the operation following such varying technique makes one suspect that in some of
these patients the element of suggestion and the enforced rest during the post operative period are partly responsible for the alleviation of the pain. Langley has pointed out the physiological error
in these operations, and suggests the section of the major and
minor accelerator nerves, which he admits would cut most of the
efferent as well as the afferent sympathetic fibers. In cases so operated no bad effects were noted. The other operation in angina
cases is to cut the afferent cardiac fibers associated with the vagus.
Wenkebach has urged this procedure, and he reports five cases from
his clinic, in which Hofer has isolated and cut the depressor nerve
Page  Twenty-three with some relief. Just why Wenkebach, who has committed himself to Allbutt's theory of angina, should advocate cutting the
nerve from the aorta that is supposed to reflexly lower the blood
pressure when the first part of the aorta is distended, is hard to
understand. This nerve would seem to perform a Valuable protective function in angina cases. The only objection Wenkebach
raises to this procedure is the difficulty, in fact the impossibility,
of recorgnizing the depressor nerve.
Mackenzie, in an article written not long before his death
from angina, criticized all these operations on the ground that, in
the first place, the surgeon didn't know exactly what he was cutting, and in the second place, the pain in angina is in itself a danger
signal that may be most valuable to the patient.
To summarize: there are four conditions in which pain arises
from the heart itself—simple fatigue, irritable heart, angina pectoris, and coronary thrombosis. The important factor in the production of this pain is exhaustion of the heart muscle. The afferent pathways by which the impulses are transmitted to the central
nervous system are not yet clearly defined, though afferent fibers
undoubtedly accompany both the vagus and sympathetic efferent
Minor Surgery:   By LIONEL FlFIELD, F.R.C.S.  (Eng.), London.
Pp. 425; 273 illustrations.    H. K. Lewis, Ltd., London.
A book such as this is particularly opportune, as there is really no modern text book on minor surgery at present in print. Mr.
Fifield has launched his first work at a time when it is badly
needed. As demonstrator of minor surgery in the London Hospital, with its thousands of outpatients, he has had an unrivalled
opportunity for collecting relevant data. That he has done this
well will be at once obvious to readers of his little classic.
Almost every phase of minor surgery has been covered—
personal opinions and methods, based on routine experiences at
his great hospital, predominate. Such conditions as cellulitis,
abscess, infections of the hand, etc., receive careful and detailed
treatment. About half the book is devoted to that most important field of minor surgery, fractures, and each of the more common fractures is carefully explained and the best types of splint
shown in the accompanying illustrations. Such minor operations
as tracheotony, tonsillectony, reduction of dislocations, cystoscopy
and urethroscopy, urethrotony, minor amputations, hydroceles,
and operative and non-operative treatment of herniae, are fully
and well dealt with. Teeth extraction is fully covered. The
final chapter deals with anaesthesia and the suitable choice of
anaesthetic for the various minor operations.
Page Twenty-four Profusely illustrated, well bound, clearly printed on good
paper, and carefully indexed, this little volume ought to fill a place
in every practitioner's library. L. H. A.
International Clinics, Vols. 2 and 3.   Thirty-fifth Series.    1925.
J. B. Lippincott Co., Montreal.    $3 a volume.
These two volumes are in accord with the usual excellence of
these publications, and contain many short articles of generally
useful medical and surgical information.
Particularly interesting is the article on removal of angiomata
with carbon dioxide snow by McLean and Cannon, of the Babies'
Hospital of New York City. A discussion on right-sided pain in
relation to abnormality of the proximal half of the colon, by Dr.
Emanual Lipschutz, tends to explain the many failures of appendectomies and other abdominal operations to afford symptomatic
relief to the patients.
Deaver presents the differential diagnosis in the acute abdomen, while articles on "The Present Status of Affections of the
Kidney," "Dysentery, Its Diagnosis and Management Through
the Microscope," "Infectious Arthritis," by Lewellys Barker, and
"Reconstruction Surgery," by Fred Albee, make the volume well
worth while. H. R. S.
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Practice limited  to  Physiotherapy.
Quartz   Lamps,   water   and   air-cooled;   High   Frequency,
Galvanic Static and Wave Currents; Massage, etc.
Special   facilities   for   surgical   diathermy   (electro-coagulation) .
Hydrosine  bath  for  weight  reduction—by  artificial  exercise of muscular tissue—not a dehydrating process.
Electrolysis for hyertrichosis, e'tc.
Ionization for otorrhoea.     A. R. Friel's method.
Authorized   by   the   Workmen's   Compensation   Board   to
treat their cases.
Trained assistants only.
Hours  9  a.m.  to  6  p.m.,  including Saturday.     Evenings
by appointment.
Address:    Court House Block, 812 ROBSON STREET
SCHALL 8 SON made the first Diathermy Machine used
in England for St. Bartholomew's Hospital in  1909.
Since then they have equipped more Institutions in all parts
of the world with Electro-Medical and X-Ray Apparatus than
any other single organization.
Their long and wide experience has made them recognized as
the oldest firm manufacturing the most perfect apparatus for
Electro-Medical and X-Ray work.
Most failures in Electro-therapy are due to faulty apparatus. Schall's Instruments will do all and exactly what is
claimed for them.
We shall be pleased to supply any information possible,
either regarding apparatus or technique to any doctor on request.
Canadian  Representatives:
Empire Agencies Ltd*
Phone Sey. 7106 VANCOUVER, B. C.
Page Thirty-one -»-^>c
Hollywood Sanitarium
tyor the treatment of
Alcoholic, Nervous and Psychopathic Cases
Inference W&M($. dMe&ical <5\ssociation
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
Page Thirty-two


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