History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: September, 1925 Vancouver Medical Association Sep 30, 1925

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 THE VANCOUVER MEDICAL
ASSOCIATION      I
BULLETIN
Published monthly at Vancouver, B. C.
U^iervous breakdown
C. F. Barker
cZAcute Intestinal Obstruction^
Ophthalmic ^Aspects of Qeneral dTXCedicine^
SEPTEMBER, 1925
"Published by
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Address    ,	
Page Two THE   VANCOUVER   MEDICAL   ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Association
in the Interests of the Medical Profession.
Offices:
529-30-31 Birks Building, 718 Granville St., Vancouver, B. C.
Editorial Board:
Dr. J. M. Pearson
Dr. J. H. MacDermot Dr. Stanley Paulin
All communications to be addressed to the Editor at the above address.
VOL. I.
SEPT. 1st, 1925
No. 12
OFFICERS, 1925-26
President • Vice-President
Dr. J. A. Gillespie Dr. a. W. Hunter
Secretary Treasurer
. Dr. G. H. Clement Dr. A. B. Schinbein
Past President
Dr. H. H. Milburn
Dr. W. F. Coy
TRUSTEES
Dr. W. B. Burnett
Representative to B. C. Medical Association
Dr. a. J. MacLachlan
SECTIONS
Dr. J. M. Pearson
Auditor
Dr. A. C. Frost
Clinical Section
DR.   W.   L.   Pedlow       ......
Dr. F. N. Robertson     ......
Physiological and Pathological Section
Dr. G. F. Strong -
Dr. C. H. Bastin -	
Eye, Ear, Nose and Throat Section
Dr. Colin Graham       ......
Dr. E. H. Saunders       ......
Genito-Urinary Section
Dr. g. S. Gordon .--...
Dr. J. A. E. Campbell -       -       -       -
Chairman
Secretary
Chairman
Secretary
Chairman
Secretary
Chairman
Secretary
COMMITTEES
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. N. E. MacDougall
Dr. A. W. Hunter
Dr. F. N. Robertson
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. Alison Cumming
Dr. Howard Spohn
Dr. G. S. Gordon
Dr. Murray Blair
Dr. W. D. Keith
Dr. G. F. Strong
Page Three VANCOUVER MEDICAL ASSOCIATION.
Founded  1898. Incorporated  1906.
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 p.m.—Business as per Agenda.
9 p.m.—Paper of Evening.
The regular work of this Session will commence on Tuesday, Oct. 6, 1925.
Programmes  to  be  announced  later.
%      H5      ^      ^
CITY HEALTH DEPARTMENT
Vancouver, B. C.
STATISTICS — JULY,  1925
Total Population   (estimated)      126,747
Asiatic Population  (estimated)          9,960
Rate per 1000 of
Pop. per Annum
Total Deaths  .    111 10.3
Asiatic Deaths       10 11.8
Deaths—Residents  only        70 6.5
Total Births—Male,       1 61
Female,   127     288 26.8
Stillbirths—not included in above        9
Infantile Mortality—
Deaths under  1  year of age      10
Death Rate per   1000  Births 34.7
Cases of Contagious Diseases Reported.
Aug
June.
1st
to \5th.
Cases. Deaths.  Cases. Deaths.  Cases. Deaths.
July.
Smallpox     10
Scarlet Fever   24
Diphtheria    11
Chicken-pox   12
Measles   3
Mumps     21
Erysipelas     : $gW;.
Tuberculosis      2
Whooping-cough   __,._ 28
Typhoid Fever  ._ 3
Ep. Cerebro-Spinal
Meningitis   0
8
0
9
0
11
1
6
0
0
0
^
0
5
2
9
8
24
1
2
0
0
1
0
0       0
(Cases from Outside City included in above.)
Diphtheria    :      3        1 4       0 1
Smallpox  t.     0       0 0       0 3
Scarlet Fever      3       0 0       0 1
Typhoid Fever       0       0 2       0 0
Page Four Truly mobile. The apparatus proper (upper section) may be removed from the cabinet (lower
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A Diathermy Machine of Major Calibre
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The physician who does only a moderate amount of reading.of medical literature js aware of the present wide and
rapidly increasing use of diathermy in medical practice.
For many years the Victor organization has, studied this
trend, during which one of the outstanding problems was to
design an apparatus which would be of major calibre and at
the same time so compact as to permit its being conveniently
moved about, even to the patient's home when necessary.
Whatever may have been your pafst experience with high
frequency apparatus of the portable type—most of which
have served only as mere introductions to the full possi-
Ifyou would know of the far-reaching possibi,
write our Biophysical Research Publications
bilities of this form of therapy — bear in mind that the
Victor Two-Section Mobile High Frequency Apparatus
stands out as an engineering achievement that is destined
to prove diathermy an important daily factor in the physician's armamentarium.
The machine is held down to compact size without sacrifice
in the quality of currents delivered. In short, this Victor
machine is not a toy—rather it incorporates the honest intent of its designers to place in the physician's hands an
outfit of major calibre with which he may confidently anticipate the best therapeutic results.
ties of high frequency therapy in your practice,.
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(T EDITOR'S PAGE
The wise mariner, when his ship is labouring in a storm,
shortens sail. If she labours still, he sometimes finds it necessary
to lighten ship by jettisoning cargo. One supposes that, in doing
this, he selects that which is least valuable to throw overboard.
So the wise man, when he finds income insufficient to meet outgoings, when his financial ship is labouring, shortens sail and
throws overboard unnecessary things, and luxuries which he can
best spare.
In these days of high.overhead cost of living, all of us occasionally feel the need to retrench. Whether we do this in the
wisest way or not, is another question. The cause of these reflections is the discussion that has been rather frequently heard of
late about membership in the various Medical Associations. To
many it would appear this seems a luxury, a rather superfluous
addition to one's burdens, and they adduce arguments for relinquishing it, if not in all, at least in one or two.
To such, indeed to all who need a little moral support for
their belief that such membership is a necessity and not a luxury,
we would heartily commend a careful reading of a great speech of
Osier's, "On the Educational Value of the Medical Society," found
in the collection of Essays known as "Aequanimitas." While he
gives it this title, the speech points the way, in his inimitable style,
to many other profits that accrue from associations of medical
men. "Unity and friendship . . . are essential to the dignity
and usefulness of the profession." It would be hard to put more
truth into ten times as many words. The removal of misunderstandings—better yet, the prevention of them—encouragement in
the day's work, renewal of enthusiasm and devotion, refreshment
of mind and recreation—these are some of the blessings, apart
from educational advantages, that Osier found in "a well-conducted society." Everyone of us must know this to be true; in
fact, the history of our own Association proves its truth. Surely
in the stress and strain of a busy medical life, perhaps even more
to the men beginning their career, with their long periods, deadly
dull, of waiting, and of discouragement, such boons as these are
beyond price, are more than mere luxuries.
And then the Library—and one can imagine what Osier
would say about this. From a mere dollars and cents point of
view, this one thing alone repays the yearly subscription a dozen
times a year. Especially is this true of such a Library as ours,
with its admirable system of delivery of books, magazines, and
so on.
There is another side to the picture—the necessity for organized action, for union, not merely unity.N The medical man
cannot be, at any rate he should not be, only a practitioner of
medicine. He should be an apostle of public health, of sanitation, of good laws—he should be a citizen, and one of the moral
police force of the country—and he can do this most effectually
through association. Again, he has enemies, spoilers, exploiters
of his good-nature and idealism—and for defence against these he
Page Six needs a shell of organization, of companionship en masse with his
fellows. Here comes in the wider type of association, provincial
and federal. Through these we may preserve intact our identity
as a profession, may carry weight in the councils of the nation,
may find insurance against the perils that do so easily beset us.
And as insurance, it is very cheap.
Not to do one's share in this, argues a rather small spirit.-
For the work must be done, and is done, and everyone benefits
by it.    The least each one can do is to pay his share, or he is accepting charity from those of his fellows who have a better appreciation of their responsibilities.
Moreover, it gives one the valuable right of every free-born
citizen, that of finding fault with one's administration. You may
do this justly, if you have paid your tax and cast your vote, but
the man who won't pay his taxes, and neglects to exercise his
franchise, has no right whatever to complain of the government
of his country.
And so with us. If the Association, whichever one it may
be, is not up to your ideas of what an Association should be, you
have your remedy—join it, work in it and for it, and give it the
benefit of your own personality. Both of you will gain immensely, yourself perhaps most of all. The cost is trifling, in
fact it .is an investment, and not an expenditure, but to get the
most out of your investment you must look after it yourself.
NEWS AND NOTES
It is with great regret that we hear that Dr. Alison Cum-
ming is still very seriously ill, and has gone back to Montreal for
treatment. A large section of the public will join us in our wishes
for his speedy recovery.
Dr. R. A. Seymour, of the Vancouver General Hospital,
is being congratulated on the arrival of a daughter. Mrs. Seymour
and the new citizeness are doing well.
Our worthy President, Dr. J. A. Gillespie, has returned from
California, where he has been with his family for a month's holiday, in the form of a motoring trip.
Dr. E. H. Funk is the latest addition to the Benedicts' Association.    He has our congratulations.
The little island of Savary is gradually becoming a very
popular resort for medical men, many of whom have summer cottages there, and whose purest delight it is to introduce their friends
to the charms of the island. Latest converts, we understand, are
Dr. F. N. Robertson, who has built there this summer; Dr. T. H.
Lennie, who reports favourably on the place; Dr. W. D. Keith,
Dr. H. H. Milburn, each of whom have taken cottages there for
the summer, and others, who have made visits of more or less
length. It is an ideal spot from a doctor's standpoint, quiet,
and far from telephones and automobiles. To many of us, the
fact that there is no golf, also gives a feeling of change and rest.
Page Steven It is with great pleasure that we record the return of Dr. A.
S. Monro to his usual occupations. We can assure him that the
corridors of the V. G. H. have seemed unusually quiet and untenanted, without the daily, almost hourly, vision of his white-
sheeted form flitting about them.
Dr. A. W. Bagnall has left for Boston and New York to
do post-graduate work in medicine.
Dr. F. P. Patterson leaves soon for the East to visit orthopaedic clinics.
In view of the ever-growing interest in physiotherapy, members will be glad to hear that Dr. H. A. Barrett (Medical Arts
Bldg.) has offered to give a short course of practical instruction
in this subject to all who care to take it. No charge will be made,
and out-of-town physicians are especially welcome. The course
will be held in the evenings, and any who are interested are requested to communicate with Dr. Barrett at once.
Members are again reminded that fees for the current year
are now due and payable. The work of the Executive is greatly
impeded by the tardiness of a good many of our members in this
respect.
We would again call attention to the obligation we are under
of supporting the firms who advertise in THE BULLETIN. When
doing so, please apprise such advertisers of the fact that you read
their advertisement in THE BULLETIN.
Dr. Geo. Lildon, member of the Dominion Medical Council,
left for the East on the 27th August, and expects to be away about
a month.
^c ^c ={e 5J?
LIBRARY NOTES
(The Library is situated in 529-531, Birks Building, Granville Street, Vancouver. Librarian: Miss Ftrmin. Hours: 10
to 1, 2 to 6.)
REVIEWS OF BOOKS
International Clinics, Vol. 1. Thirty-fifth Series, 1925.
J. B. Lippincott Co.   $2.00. "i
The international character of the work is maintained in this
volume by contributions from Scotland, Switzerland, and France,
though by far the greater part of the material had its origin in
America. Two articles by Prof. L. F. Barker—on Staphylococcus
Septicaemia and Treatment of Neuroses, respectively—will be of
special interest to members of this Association at this time. The
prominence of functional disorders in present day medical thought
is attested by the fact that three other writers discuss some aspect
of the psychoneuroses, the articles by Dr. Alfred Gordon, of Philadelphia, on "Psychoneuroses in Relation to General Medicine,"
being especially interesting and suggestive.
Some of the problems of urological diseases are comprehen-
Page Eight sively dealt with in two articles from the Dorsey Clinic of St.
Louis. Other surgical subjects considered are diseases of Meckel's
diverticulum, mastoid diseases, malformations of the rectum and
anus, acute osteomyelitis and intranasal lesions. Dr. Max Thorek,
of Chicago, describes what he styles "A New and Effective Method
of Treatment of Clinic Suppurations, Especially of Bones," which
consists in the application of an aluminum-potassium nitrate solution in a compress of sterilized rolled oats. The claim of the effectiveness of the method is supported by a tabulated report of
116 cases so treated by the writer and others.
Commencing with a sketch of the regime of Cornaro, a Venetian, born in 1467, who attained the age of 105, Charles Greene
Camston, in his article on Macrobiosis, gives an interesting account of some of the methods that have been advocated for * prolonging life, and makes some deductions applicable to our own
time.
A summary of Medical Progress in 1924 concludes the
volume.
W. F. M.
ADDRESS BY DR. BARKER ON"
"NERVOUS BREAKDOWN"
Dr. Lewellys F. Barker, of Johns Hopkins, addressed a large
audience of members of the Vancouver Medical Association in the
University Auditorium on the evening of Wednesday, July 29th.
Dr. A. W. Hunter, Vice-President of the Association, occupied
the chair and introduced the speaker. Dr. Barker took as the
subject of his address "The Nature, Causes and Prevention of
Nervous Breakdown."
Dr. Barker said that the nervous individual often lacks the
sympathy to which he is entitled. He cannot think right and act
right because he is ill, and it does great harm to tell him that his
symptoms are imaginary. These symptoms are just as real and as
genuine as those produced by definite organic ailments. As to the
varieties of nervous breakdown their name is legion. The neurasthenic and hysterical patient we all recognize. The hypochondriacal patient who tries to interpret his own symptoms in
terms of organic disease: the psychasthenic, who is full of fears
—fears of himself, fears of place, and fears of people—are also
familiar to us.
Of the psychoses proper the manic depressive group is one
of the most important. This cyclic, or circular insanity, is one
which in some form or other is quite widespread. In this condition the patient for a period of time may be greatly depressed,
claims everything appears "blue," and is decidedly melancholic.
After a year or two he may begin to see daylight again. The
gloominess and depression wear off and things may take on a more
roseate appearance. He feels happy and ecstatic, tends to talk rapidly, and is in a rather exalted state of mind.    The trouble is he is
Page Nine often foo exalted and may become erratic or even maniacal. The
first stage is the depressive and the second the maniacal stage of
this malady. We must recognize, too, that there are incomplete
forms of this disease during which the patient may be only mildly
depressed and correspondingly mildly elated. The depression
grows, and the disease is quite unaffected by treatment, and the
physician in charge of the case may lose or gain credit according
to the time at which he sees the patient. If at the beginning of
his depression it has been said no treatment is of use—if at the
end, the patient will lose his depression with any or no treatment.
In patients with manic depressive psychoses there is no loss of
mental power.
Another variety is the dementia praecox group. These lamentable cases occur in young people. They begin to think their
friends are not treating them rightly, they have grievances, they
are misunderstood, and in general take on the aspect of misfits.
They may get paranoid symptoms. The prognosis in this group
is much worse than in the manic depressive group. Systematized
paranoid delusional cases are rare.
Of the organic psychoses there are many. For example, those
of the toxic infections, as in typhoid fever. Lately a great many
instances have resulted from the infection of encephalitis lethargica,
which produces very characteristic symptoms. While it is probable
that some cases entirely recover, it must be recognized that most
have residual symptoms. About 25% or more of cases will show
that variety of sequela known as Parkinson's syndrome. This
syndrome may occur early in the disease (in which case recovery
seems to be possible), but usually six months or even a year elapses
before its onset, and the outlook is then correspondingly bad.
This syndrome is well recognized, very closely simulating paralysis agitans, except that the tremor is usually absent.
Syphilis may be the cause of another form of organic psychosis, either in the form of definite lesions of the brain or meninges, or as one of the parasyphilitic affections producing general
paresis. Then there are the organic psychoses associated with severe attacks of multiple neuritis, as may occur in arsenical poisoning, known as Korsakoff's syndrome.
Finally we come to the arterio-sclerotic dementia, which in
greater or less degree affects us all if we only live long enough for
it to do so. Unfortunately this condition may at times be presenile in character, that is, the customary arterial changes associated with advancing years occur (possibly for reasons of heredity) in early life, and symptoms, such as unusual forgetfulness,
begin to manifest themselves at this age.
Psychopathic personalities are distorted personalities.
Among them we find a degree of feeblemindedness. These are the
people who are unusually quarrelsome. They are the litigious
variety of persons. They constitute a large element of those who
appear in the divorce courts. Rightly considered the circumstances
leading to divorce mean mal-adjustment, and it is very curious
thatsdivorce proceedings often run in families.     They also con-
Page Ten stitute the derelicts of society, the ne'er-do-wells, tramps, drug
addicts, etc. All these have bad nervous systems and tend to be
antisocial. Rightly regarded all crime and delinquencies are due to
mal-adjustments, and are the result of bad nervous systems. Society is apt in these cases, for its own protection, to take revenge
upon these people when, doubtless, the proper way would be to
try and reclaim them, if possible.
The nervous system is the great organ of integration, and in
all forms of nervous breakdown there is evident a lack of adiust-
ment to surroundings. The laity recognize this in their very
familiar expressions of the condition. They say of such a person
that he is "all gone to pieces," or disintegrated, or is "all broken
up," and, conversely, when he recovers they will say he has "pulled himself together."
The borderline between health and disease is very narrow,
and it is somewhat difficult to give a definition of what one understands by these terms. The best definition, the lecturer said, which
he had been able to arrive at was that health represented an adequacy of response? to environment. What are the conditions leading to inadequacy of response? In these cases we must look for
causes to what has gone before. We must consider, for instance,
the germ cells,.two in number, which contain all the potentialities
of the individual, and these potentialities cannot in any instance
be transcended. Whether they shall be allowed full development
depends upon the environment in which the individual is placed,
and this development is the forerunner of all that comes afterwards.
Heredity and environment constitute two important causes in
the conditions under consideration. Heredity is probably the more
important of the two, and certain conditions, such as longevity
and predisposition to disease, are undoubtedly hereditary in character. Identical twins is the name given to foetuses produced in-
the same egg-cell by a single fertilization in contradistinction to
twins produced from different egg-cells. These latter may be of
different sex, but identical twins are always of the same. They
are exceedingly alike, and it is very hard to tell them apart, especially when young, even their parents may have difficulty in doing
so. Curiously enough, so strong is the part that heredity plays,
twins of this nature are apt to sicken of the same disease in later
life, although they may be living in entirely different parts of the
country.
Dr. Barker went on to illustrate his point by a reference to
the classical case where, as the result of illicit intercourse of an individual with a feebleminded woman, a child was born from whom
there have been a great many descendants also feebleminded and
many of criminal tendencies. Later the man married, and most
of his legitimate descendants have turned out extremely well, many
occupying high positions in various professions and in political
life. Dr. Barker thought that as a result of the work being done
by various societies interested in the problems of eugenics, genealogical histories might some day be available for medical consider-
Page Eleven ation and for use in the treatment of individual patients.
It is probably true that hereditary dispositions may be modified by environment. Nevertheless, hereditary possibilities must be
carefully considered, and especially in the adoption of children the
history of the antecedents should be fully investigated.
It follows, then, that in the prevention of nervous breakdown
there are two prime necessary requirements: (1) the individual
shall be well-born, and (2) his environment shall be of a suitable
character. Dr. Barker's opinion was that in the long run more
will be accomplished by applying eugenic principles than by modification of environment. He considered heredity was extremely
important. As to the best way of introducing and applying the
principles of eugenics, he had grave doubts as to the wisdom of
legislation except so far as such legislation represented the settled
conviction of the majority of the people. The proper way is by
means of education. Especially should this be applied to young
people, who should be taught things concerning the beginnings of
life, biological principles particularly. He considered that Mrs.
Grundy was a very important factor in the case. If young people
realized that it was not the thing to become engaged to an individual because of feeblemindedness or insanity in the family, they
would soon learn to nip early manifestations of love in the bud.
The immigration problem has also to be faced. In the United
States they allowed all and sundry to come in without let or
hindrance until they found that it seemed likely the native Anglo-
Saxon stock would be overwhelmed by the influx of peoples of
less vigorous race, and they had come to the conclusion that in
future more careful selection should be made.
Concerning environment, we must realize that while, as a
rule, the germ cells were well protected, nevertheless they might be
affected by certain poisons. In lead workers, for instance, it has
been found that defects may occur with a good deal of regularity
in the offspring as the result of the toxic effects of this mineral.
Regarding alcoholism, the question was quite open. Dr. Pearl,
of Johns Hopkins, was of the opinion that alcohol tended to kill
off the poor germ cells and leave the good ones. Then there was
the question of pre-natal care and the hygiene of the expectant
mother. The hygiene of infancy was of great importance, care,
food, nursing, and so on. The pre-school age is the important
formative period of life, both from the physical and mental side.
At this age the child is taught obedience, the proper performance
of tasks, the bearing of small annoyances. The habits of parents
and the home surroundings are of immense importance at this
stage in the formation of character, and great differences may result according as to whether such influences are good or bad.
School age is important. The school physician of the future should
be able to examine and estimate mental, as well as physical traits,
being thus able to indicate the style of education which is suitable
to the individual child. If a child of inferior nervous or mental
development is placed in a class with more normal children and
its inability to carry on the work in competition with them is
Page Twelve made the subject of remark or scorn, an inferiority complex may
develop which the child may never overcome. As maturity is
reached, vocational guidance is of great importance. Life work
of an interesting character is one of the greatest safeguards we possess against the likelihood of nervous breakdown. Putting people
into a position where all their legitimate needs and requirements,
such as need for healthy parenthood, economic security, and proper social relationships can be satisfied, is another of the defences
against nervous breakdown.
*        *        *
THE IMPORTANCE of OPHTHALMIC ASPECTS of
GENERAL MEDICINE
By Dr. Edward Jackson, Denver, Col.
Abstract of an Address delivered before the Vancouver meeting of
the Pacific Coast Oto Ophthalmological Society, June, 1925.
The situation and constitution of the eye are peculiarly favourable for exact observation of what occurs in it during life.
We can see with the ophthalmoscope the first reaction along the
retinal vessels" to the tubercle bacillus, or we can watch the appearance of a choroidal tubercle and its passage through the different
phases of its progress. Tuberculosis with its lesions now recognized in every tissue of the eye is open to continued microscopic
study throughout its course. Syphilis has been more studied and
is better understood in the eye than in any other organ of the body.
All vascular diseases known by their gross effects or recognized
after death are to be studied in the eye from incipiency to resolution or to functional or organic destruction of the parts inyolved.-
The relations of the eye to the central nervous system are such
that this organ might be termed "the bulletin board for diseases'
of the brain and spinal cord." Of the twelve cerebral nerves six
are distributed in whole or in part to the eye and its appendages.
The four cranial and the sympathetic motor nerves distributed to
the intra and extra ocular muscles bring their controlling impulses
from the cortical motor centres. We can think of this elaborate
division of the nervous system as of a telegraph or telephone system capable of bringing information from all parts through which
it passes, as well as from its more distant terminals. The intelligence thus furnished is published by the symptoms manifest in
the eye. To change the metaphor, the ophthalmic physician from
his point of vantage watching the eye and interpreting the signals
it gives, as the forest observer would interpret a distant column of
smoke, has command of a great territory of disease.
It is time that those who study diseases of the eye should
understand their position of advantage and accept the responsibility it entails in the general struggle of the medical profession with
the forces of disease, disintegration and death. Lesions occurring
in the eye are most favourably situated for the observation and
demonstration of the course of such lesions.    Pathology has a new
Page Thirteen meaning for all physicians when it is demonstrated and studied in
the living body. Its ophthalmic aspects constitute a whole department of modern scientific medicine. In a few directions these are
already somewhat known, but in all directions the boundaries of
our knowledge show unexplored regions to be studied that stretch
out beyond the extending horizon of science.
The common methods of examining the eye offer a field for
the acquirement of a great deal of knowledge, experience and skill.
It is important that all physicians should know something of these
methods of investigation. They should be regarded as part of the
fundamentals of medicine. But the special advances in modern
medicine that enable us to render our most important services to
the community and entitle us to the greater part of the compensation for our services, are only mastered by years of observation,
and study and application of what has been learned in the conscientious management of cases.
,,..,* 'He who would qualify for the function of an ophthalmic
physician or a consultant in the best sense, must have both the
broad outlook on disease in general and the sense of proportion
obtained by thinking on its general problems, and an exact practical acquaintance with modern methods. He should be able to
test visual acuity in different ways and under all sorts of circumstances. He must know that vision of 20/20 may be vision markedly below the normal for a particular person: that visual acuity
above standard and entirely normal for the individual patient, is
possible along with marked papilledema; or great narrowing of
the visual field, hemianopsia or scotomata, of various forms and
locations and significance. He must have in mind the possible
causes of sudden variations in visual acuity; circulatory disturbances with brain tumour, or pituitary disease, toxic amblyopia,
spasm or paresis of accommodation. The effect of floaters in the
Vitreous, the variations due to posture and adaptation in detached
retina; besides the ups and downs of glaucoma; or the changes
in visual acuity with changes in the size of the pupil, in ametropia
or partial opacity of the crystalline lens. He should know the
meaning of each change in the form of the field of vision; the enlargement of the blind spot from disease of parts adjoining the
optic nerve, the toxic causes of central scotoma, the peripheral
boundaries of the field for different test objects, different illuminations, different states of adptation, the significance of ring scotoma, islands of retained vision, relative sensitivity to light and
colors. The changes of field and visual acuity that characterize
tobacco, amblyopia or the effects of methyl alcohol poisoning, or
quinine amaurosis. How the recovering brain cortex may perceive
movement in the visual field, before form or moderate changes of
illumination are able to impress consciousness.
The ophthalmic consultant must be familiar with all the
forms of pain referred to or about the eye, and with the language
in which they are described and referred to by different patients.
He should know that the significance or lack of significance to be
attached to all kinds of pain, depends as much on the psychology,
Page Fourteen physical condition and desires of the patient as upon the organic
conditions with which it is associated. The various forms of
dysthesia, dryness of the eye ball, "stiffness" of the lids, tics that
are not evident to inspection, sensations of heat or cold. All these
occur in an organ most delicately sensitive, the sensations in which
are most sure to be thought about, and talked about, and watched
for, and to furnish supposed cause for alarm, of any portion of
the body.
The visual sensations to be classed as dysthesias are numerous
and important, and the patient's story of them often puzzling.
Scintillating scotoma and the sudden disturbances of the visual
field that belong with it, are always alarming when they first occur, and more often depend on other than .ovular disturbances.
Muscae volitantes cause more annoyance, unjustified disquiet and
alarm, than almost any other symptom we are asked about. The
various interferences with vision, due to after images, usually entirely a mystery to the patient, are often confusing to the physician. He who would interpret their effects must be familiar with
them, in both health and disease: must be on the lookout for
them when testing visual acuity, or mapping fields, or considering
apparent improvement or deterioration in acuteness of vision.
So much for the subjective evidences of general function. But
the ophthalmic aspects of disease are of greater importance because
they are so largely objective. Let us recall the breadth of their
significance by consideration of a very few. The ophthalmoscope
opened the modern era in ophthalmology. The power it gave or
pushing our investigations to the depths of the eye, was not greater
than the power it gave of discrimination as to the character, origin
and outcome of conditions heretofore thought of as identical. We
no longer deal with "inflammation of the uveal tract"; we have
to consider the inflammatory reactions to syphilis, tuberculosis,
focal infections of the uveal tract, or involvement of the uveal
tract by the attacks of pyogenic bacteria, its invasion from adjoining parts or by metastasis through blood channels. The influence
of innervation in the causation and modification of uveal disease
still challenges our ability for original research. Through symptoms of herpes zoster, and acute glaucoma we know it may be extremely important.
Not only has the ophthalmoscope made us acquainted with
atrophy of the optic nerve during life. Not only has it enabled us
to discriminate between inflammation and atrophy, between primary and secondary, beginning and advanced atrophies; it has
placed upon us the burden of correlating the visible changes in appearance of the nerve head, with the nature of the pathogenic
agent, the progress of the disease process, the possibilities for recovery, the influence of therapeutic agents in checking disease and
in bringing about recovery. Not only has the ophthalmoscope
revealed the existence and course of optic nerve oedema and optic
nerve inflammation. Not only have physicians like Allbutt, Hugh-
lings, Jackson, and Gowers, and surgeons like Jonathan Hutchinson and Victor Horsley, demonstrated the flood of light it throws
Page Fifteen on diseases of the central nervous system, making diagnosis certain,
prognosis probable and therapeutics more definite. Swiftly accumulating observations of many workers in ophthalmoscopy show
the very wide range of conditions, ocular and extra-ocular, in
which this method of examination is giving new light on the character and presence of general disease. It is a modest inference, going little, if any, beyond what individuals have already achieved,
to claim that the ophthalmoscopic examination of the optic nerve
will, in the very near future, play as important a part in the observation of general disease as the feeling of the pulse did up to 70
years ago.
With reference to the circulation of the blood, it might be
said in all soberness and restraint of enthusiasm that the use of the
ophthalmoscope has doubled the clinical value of Harvey's great
discovery. The changes in the color of retinal vessels in conditions
of anaemia, polycythemia, altered haemoglobin or lipaemia retin-
alis, should all be recognized by the ophthalmoscopist. The widening of veins by collapse, or by distension; the irregular calibre
of the blood stream due to spasm, or to endarteritis; the change
of color or hiding of veins crossing behind them, due to changes
in the arterial walls, should be familiar ophthalmic aspects of general disease. The exudates and haemorrhages of various forms
have a wide range of significance, in connection with circulatory
conditions. That significance can only be discovered by the skilled ophthalmoscopist. He should have the knowledge of pathology, the interest in different possible causations to interpret their
significance. These are refinements of observation and judgment
that can only be expected of the experienced ophthalmic physician.
The recognition of early departures from health in the small
retinal vessels is more definite, more significant than any observations on the blood pressure. The warning it should convey
would be of the highest value to a large proportion of people who
have reached middle age. If such information were at the disposal
of every patient for whom a physician prescribed correcting lenses,
how many intelligent, well-to-do people would go to the nonmedical optometrist for relief from presbyopia? If members of
the general medical profession understood these things, how many
of them would send their patients to the optometrist for glasses?
Microscopy of the living eye is likely to be as fruitful of important facts as ophthalmoscopy, and it is waiting for students
to explore and map out its most important domain. Koeppe,
Vogt, and their followers, have observed and pointed out many
things, that are to be seen by this means; but their significant relations to general conditions of the body and their clinical value
in diagnosis, prognosis and indications for treatment, are still to
be worked out. It is quite likely that in another generation biomicroscopy will be found more fruitful and more important than
ophthalmoscopy. I
There are other methods of examination that promise results
of great interest in general medicine.     The study of epithelial
Page Sixteen parasitism in the eye by Lindner, Graef, Gifford, McKee, Howard
and others, opens up a field of great promise in bacteriology and
pathology, and for this, as for other things, the eye is the peculiarly favourable portion of the body for clinical experiment and
observation. Here the various anaphylactic reactions are best
studied locally; and such studies must help to fix their general
practical importance.
The staining of living tissue in the eye and the effects of
such staining, are worthy of our most careful attention. In our
search for corneal ulcers and foreign bodies we have been using a
method that can throw light on many questions of cell physiology,
normal and morbid and pharmacology.
*        *        *
ACUTE INTESTINAL OBSTRUCTION
Abstract of Address delivered by Sir Henry M. W. Gray before the
Vancouver Medical Association Summer School.
After referring to the lessening incidence of obstruction- following abdominal operations due to improvements in technique
and to the variation in symptoms produced by obstruction, the
lecturer proceeded to consider the etiology of the condition. In
infants and young children intussusception is by far the most frequent cause. Beginning possibly as the result of excessive peristalsis, as the process develops the bowel becomes more and more
infolded, with the result that congestion, swelling, occlusion of
gut and vessels, traction on nerves, haemorrhage and shock assert
themselves. Needless to say in such cases symptoms are severe and
persistent unless and until their severity is marked by the exhaustion of the bowel and of the patient. Intussusception in older
children and in adults is usually due to some pathological condition, most frequently a polypus, more rarely a stricture. At this
age; however, the most usual causes of intestinal obstruction are
fibrous bands, internal hernia. Meckel's diverticulum, volvulus,
impaction of concretions, sudden blockage of a chronic stenosis
brought on by tubercle, cancer or pressure from a tumour outside
the bowel, and old or recent adhesions causing acute angulation
of the bowel. Finally we must remember the so-called adynamic
or paralytic ileus, which may possibly occur after any abdominal
operation, but especially where the bowel has required much handling or where over-distension has existed previous to operation.
The most frequent and serious form is that caused by peritonitis,
which may affect both small and large bowels. Hence Sampson
Handley's name of "ileus duplex." In this connection one may
mention the acute toxaemia which occurs especially when the obstruction is situated high in the small intestine. It would appear
that the poisons absorbed from the upper jejunum and especially
from the duodenum, exert profound metabolic changes which can
be easily appreciated in the blood. These are evidenced by great
diminution in the chloride content, increase in blood urea, and in
Page Seventeen I
the capacity of the blood for carrying carbon dioxide. In the
later stages this toxaemia exerts an evil effect on the kidneys, producing an acute inflammation with changes in the tubular epithelium or a more diffuse nephritis.
The clinical symptoms of obstruction vary according to the
site and cause, but there are certain phenomena common to all
varieties. In some cases there are premonitory symptoms in the
form of recurrent colicky pains usually in the same part of the
abdomen. If a loop of bowel becomes suddenly strangled, very
severe pain, with manifestations of shock, occurs. After this preliminary storm may come a more or less pronounced calm, though
considerable steady pain usually persists. This, when the small
intestine is the seat of trouble, is usually referred to the umbilical
region, and to the hypogastric area when the lower bowel is affected. In some cases the respite may be so definite that the patient drops off to sleep. Very soon, however, the characteristic
turmoil begins. The persistent pain becomes more intense. It is
accompanied by spasms of colic, more frequent and more intense
when the small intestine is affected. Vomiting soon sets in. At
first remnants of food are evacuated, then bile, followed by more
or less clear watery material as the contents of the small intestine
regurgitate into the stomach. Finally as congestion and decomposition increases, the vomitus becomes brownish; it is described as
being faeculent in character. The higher the obstruction, the
more severe usually is the persistent pain, the more frequent the
colics and the earlier the onset of vomiting. In some cases localized bulging of the abdominal wall, accompanied by the sensation of a tumour mass on palpation, may develop quite early and
before general distension  occurs.
One can frequently make out a succussion splash in the distended coils above the point of strangulation which sometimes give
clear indication of the site of obstruction. This is also at times
indicated by an area of greater tenderness.
While general distension occurs fairly regularly if the lower
part of the small intestine is affected, it may not occur in strangulation of the upper part. It is stated that distension occurs much
later in obstruction of the lower part of the colon or rectum.
Obstruction in the small intestine has been shown to render
the bowel more permeable so that imperfectly digested proteins,
etc., gain entrance to the blood, which may explain the excess urea
found therein. Constipation is a very prominent feature in these
cases, and should always be impressive, because when colic occurs
without obstruction it is always accompanied, sooner or later, by
the passage of gas or faeces. But here, after the bowel has become
emptied of its contents below the site of obstruction, constipation becomes absolute, neither flatus nor faeces being passed.
If the obstruction is not relieved the muscular coats of the
bowel become exhausted, and on that account pain may be relieved
to some extent. At this stage the nervous mechanism of the bowel
is liable to become poisoned by toxins manufactured in the stagnating contents.    This may result in paralysis or at least paresis
Page Eighteen of the bowel. Very soon one finds that organisms penetrate the
walls of the bowel at or above the obstruction, and cause peritonitis.
The picture presented by the patient at this time is a very
miserable one. Some describe it as a condition of secondary shock.
In large part the symptoms are due to loss of fluid, from persistent
vomiting and sweating, but it is really also a condition of profound toxaemia. The face is drawn and pale, often dusky, the
eyes are sunken, the skin is cold with clammy sweat. The nose,
ears and fingers may be mottled and blue, with stagnating capillary
circulation. The pulse is feeble, thready, rapid; respiration is
rapid, often sighing, and temperature is subnormal. There is persistent, insatiable thirst. There is only occasional colicky pain.
Vomiting becomes of an overflow character. The patient may be
unusually alert mentally. He often does not realize the seriousness of his condition.    The end may come quite rapidly.
Treatment
There is usually so great urgency in many of these cases that
1 think one does the patient an injustice if one waits for results of
special laboratory examinations. Please do not think that I do
not appreciate the value of these findings. The abnormal conditions of the urine and blood may give most valuable indications
for both operative and post-operative treatment. But the questions, whether blood urea is or is not present in large excess, and
whether chlorides have or have not largely disappeared from the
blood, does not, or ought not, to influence the operative procedure.
There are certain necessary procedures which are accessory to
operation, and which become increasingly important as the case
develops in intensity.
First, it is necessary, if the patient has been vomiting at all,
to wash out the stomach, especially before giving a general anaesthetic, otherwise he runs the risk of being drowned by his own
vomit, or of inhaling vomited material and bringing on septic
pneumonia. Spinal or even local anaesthesia does not entirely
obviate these risks. I remember many years ago being called to a
remote village to find the patient, a large, heavy man, in a very
pitiable and distressed state owing to neglected chronic obstruction which had suddenly become acute. In my innocence of those
days I thought that while he would not stand a general anesthetic,
he would be able to control his vomiting so that it would not
choke him, if we gave him a spinal anaesthetic. I wanted to avoid
for him the further distress of having his stomach washed out.
He was very nervous and had a bad heart. I neglected to tell him
that his legs might become paralyzed temporarily. When the
spinal anaesthetic took effect, he suddenly realized that he could
not move his legs. He took fright, became greatly excited, fainted, vomited profusely and really drowned himself, although his
enfeebled heart failed him also.
In some cases where vomiting had persisted and was tending
to become overflow in character, I have left the stomach tube in
Page Nineteen situ during the operation, or if the stomach and upper intestine
were found distended when the abdomen was opened, have had
it passed again.
"The next big indication is to restore as far as possible the
depleted body fluids which have been extracted from the tissues
everywhere. Recent investigations have shown that, as the case
develops, the chlorides of the blood become increasingly diminished, and this fact has apparently a great deal to do with the recuperative powers of the patient. We must make up for the loss of
these chlorides by supplying him with more, but not in overwhelming amounts. Therefore give, according to the size of the
patient, the state of his heart, and the effect on his pulse and general condition, intravenous, subcutaneous and rectal infusions of
saline solution. His tissues will tend to drink it up rapidly, so
encourage absorption by making the solution isotonic.
I think it is better not to give active aperients after operation
until the bowel has had time to recover its tone. Such a stimulus
may, I believe, have the opposite effect to what is desired and
make the debilitated bowel "throw up the sponge." I prefer to
give enemata to empty the bowel from below so that less strain is
required to push on what may come along from above, and at the
same time I try to coax back vitality and vigour and co-ordinate
movements in the injured part by such simple remedies as belladonna by the mouth, or, if sickness threatens, atropine or eserine
hypodermically in small doses. The first enema is usually given
on the day after operation. When evidence of activity becomes
manifest, by spontaneous passage of flatus or faeces or even by
desire to go to stool, then I give, for example, small repeated doses
of cascara or even a dose of castor oil and laudanum. As soon as
the patient feels desire for it, I give him ordinary food so as to
stimulate peristalsis .and prevent noxious adhesions. The part of
the bowel which has been strangled tends to form adhesions. On
more than one occasion I have had to open the abdomen again on
account of fresh obstruction from this cause. Sometimes, if the
bowel has been severely congested and dilated, although it may
recover its colour quickly at operation it may require several weeks
before ft works properly. In these cases one finds the pulse remains abnormally rapid. In such cases both feeding and the exhibition of medicinal intestinal stimulants may have to be carefully  regulated.
In discussing actual operative measures I wish first to lay
stress upon the situation and manner of the incision. I almost
invariably make a long, at least 6-inch paracentral incision on the
right side a good inch from the midline, and displace the rectus
outwards. I like to infiltrate the area of incision with J4 % novo-
caine solution so. that I may, if necessary, carry the making of the
incision under local anaesthesia alone, at least as far as the peritoneum and at the end of the operation be able to close the abdomen without more general anaesthetic than may have been required for intra-abdominal manipulation. This reduces the length
and strain of general anaesthesia very greatly, and it is a much
Page Twenty more simple business than making, for example, paravertebral injections. A short gas and oxygen anaesthesia will not harm the
patient unless his condition is absolutely desperate. I think that
the long incision, by permitting easier examination and handling,
more than makes up for the extra time expended on it. When
sutured in layers, post operative hernia is avoided more by this
than by any other method of making a long incision.
Having opened the abdomen, the hand is inserted into the
lowest part of the pelvis and pulls up any collapsed coils there.
The bowel is then followed upwards until the point of obstruction is reached. If no collapsed bowel is found in the pelvis, the
caecum is examined. If the caecum is collapsed the obstruction
must be above it, if distended, then the obstruction is below it,
so the sigmoid is next inspected. If it is collapsed the obstruction
lies between caecum and sigmoid. If there is much difficulty in
arriving at a diagnosis of the site of obstruction, I do not scruple.
to allow the distended coils of bowel to come out of the abdomen.
I cover them carefully with warm dry towels and gauze strips to
prevent undue cooling. I prefer dry material to moist material.
The latter by its evaporation fosters the cooling process of the
bowel. If warm lotion is continuously poured over it, in order
obviate cooling, there results a sloppy mess, besides introduction
of extra risk otherwise. I do not think that evil results follow the use of dry material so much as when moistened packs are
used.
When the obstruction has been located the character of the
causative factor and the condition of the bowel decides further
proceedings. These vary from the mere snipping of a band to
difficult and tedious separation of adhesions or actual excision of
a gangrenous loop, followed by entero-anastomosis. In the last
case I prefer to make end to end anastomosis whenever possible.
If the patient is in very bad shape, it may be compulsory, after
dealing with the cause of the obstruction, simply' to bring the
gangrenous loop well out of the abdomen, fix the viable proximal
and distal parts of the bowel to the edges of the wound and open
the loop. One or more enterostomies should be made above the
affected loop through separate small wounds. Multiple enterostomies, reserved for the worst cases procure the advantage of
draining different parts of the bowel and at the same time permitting the introduction of saline solution. Every surgeon of
experience knows how inert the bowel may become, and though
drainage effectively empties one loop, adjacent loops may remain
distended. The bowel kinks very readily in such circumstances.
The saline solution must be introduced at very low pressure—
over-distension prevents recovery of tone, besides tending to cause
kinking. I believe that the performance1 of enterostomy gives
better results than emptying the proximal bowel during operation.
The latter procedure demands too much handling of the bowel
and tends to increase shock. The same remark applies of course
to wide excision of bowel.
It is sometimes difficult to decide when to make enterostomy
Page Twenty-one I
as already indicated. I feel that if strong, colicky pains have persisted right up time of operation, and if, at operation, the bowel
responds by local contraction to local stimulation, e. g., by pinching, it will likely recover without enterostomy. If, however, the
colicky pains have become feebler, if general distension of the
abdomen is present, and if, at operation, the coils are found to be
flaccid and floppy, and do not respond to local stimulus, enterostomy is compulsory. In cases of doubt, rather make an enterostomy than not. If the obstruction has been in the large intestine,
I like to make a caecostomy as well as an enterostomy.
I think a Pezzier's catheter is quite a suitable tube to use,
and of a medium size, but an ordinary catheter does equally well,
and is easier to remove. The latter has to be fixed by suture.
Only exceptionally are there solid particles in the small intestine,
so that the contents drain through comparatively small tubes. I
like, when multiple enterostomy is done, to remove one tube at a
time, the upper before the lower, so as to try to obviate distension
which is liable to occur from adhesive kinking. I have an impression that the higher the enterostomy the longer it takes to heal.
The tubes may be removed and the stomata allowed to close, as
soon as the patient is established in convalescence, that is, really,
when vomiting has stopped and the bowels have "moved' satisfactorily. A simple application for preventing excoriation of
the skin round an enterostomy is ethereal rubber cement solution
(1 in 4). This is applied several times a day. The ether evaporates and leaves a thin film of rubber over the skin.
It is sometimes almost impossible to tell, from the appearance of the bowel alone, whether the colour and swelling is due
to intense congestion and subperitoneal or interstitial haemorrhage
alone, or whether gangrene has actually occurred. The presence
of the haemorrhagic effusion constitutes the difficulty. The purple
colour of mere congestion soon gives way to more normal appearance when strangulation is relieved, but effused dark blood does
not dissipate and there may be no change of colour, or only in
patches. Of course, the flaccid, inert and often brittle state of the
really gangrenous bowel is easy enough to distinguish—but there
are all gradations. One must remember also that interstitial extravasation of blood has probably taken place before gangrene occurred. I have never found the following test to fail, and I have
used it for very many years. I incise, with a sharp knife, the
peritoneum and very superficial fibres of the muscular coat of the
suspected part of intestine. If circulation be intact, definite bleeding, although possibly in small amount, will occur. One finds
then that each time a clean piece of gauze is pressed lightly on the
incised part, it will be stained with fresh blood. Still more certain can one be of the viability of the bowel if blood can be seen
oozing out steadily from the cut. If gangrene has occurred the
first or second piece of gauze may be definitely stained, but not
more. There is practically never any doubt in actual experience.
If the gut is viable, the small incision is closed by a mattress suture
of fine linen or catgut.
Page Twenty-two B. C. MEDICAL ASSOCIATION NEWS
Dr. Wm. T. Kergin, of Prince Rupert, has returned home
from his European trip, having been away three months.
Dr. Graydon Hume, of London, England, was a visitor in
Vancouver for a few days, in the early part of July. He was
greatly impressed with our wonderful scenery, well equipped hospitals, and last, but not least, the work of the B. C. Medical
Association.
The holiday season is in full swing, weather perfect, and
many doctors, being very human, are taking advantage of the
business office of the B. C. Medical Association to obtain locum
tenens, so that they may get away for a well earned rest.
Dr. J. W. Lang, late of Hutton, B. C, and Mrs. Lang are
to be congratulated on the birth of a daughter.
Dr. D. J. Barclay, who quickly recovered from his recent
automobile accident, was able to resume his holiday, which, with
Mrs. Barclay, was spent on the coast, where they renewed many
old friendships.
At a recent meeting of the B. C. Medical Association, the
following doctors were appointed Chairmen of Standing Committees for the coming year:—
Legislative—Dr. M. J. Keys, Victoria.
Industrial Service—Dr. T. H. Lennie, Vancouver.
Publicity and Educational—Dr. Neil M. McNeill, Vancouver.
Ethics and Discipline—Dr. I. Glen Campbell, Vancouver.
Credentials  and  Constitution—Dr.   A.   W.   Bagnall,   Vancouver.
Dr. A. A. King, of Ladner, returned to his practice on
August 1st, after doing six weeks' strenuous post-graduate work
in eastern cities.
Dr. D. G. Morse, of Port Haney, is taking a month's holiday
from August 8th. His practice will be taken care of by Dr. H.
C MacKenzie.
Dr. E. W. Ewart has relinquished his practice at Terrace,
B. C, and is now acting as assistant to Dr. Moffat, of Vancouver.
Interesting communications are received from time to time
by the B. C. Medical Association, from Dr. Carl M. Eaton, of
Atlin, B. C, who has now been isolated in this most northern
town in the province, for nearly three years. His many friends
in Vancouver will be glad to see Dr. Eaton, when he passes through
this city in the fall, on his way east to take post-graduate work.
Dr. Lewellys F. Barker passed through Vancouver towards
the end of July, and the members of the Vancouver Medical Association turned  out in force to hear an address by him on the
Page Twenty-three "Nature, Causes and Prevention of Nervous Breakdown." In his
address Dr. Barker touched on some of the burning topics of the
day, such as the community's responsibility to criminals and delinquents, the teaching and application of the principles of Eugenics, and the need for departments of mental hygiene in the public
schools and colleges.
Miss Johns, Professor of Nursing at the University of British
Columbia, has resigned that position to take up work for the
Rockefeller Institute in the organization of nursing in Czechoslovakia. Miss Johns will be very much missed in nursing circles
in Vancouver.
The University of British Columbia, at the close of the holidays, will open its doors in the new (temporary) buildings at
Point Grey. The only permanent building completed at present
is the Science Building, which will house the Library. The temporary buildings erected are of stucco and will probably be in use
for some years. The old University buildings, in Fairview, will
be taken over by the Vancouver General Hospital to meet the
need for increased accommodation.
On July 27th the Victoria Medical Society met in the Library
room to hear a most interesting and instructive address by Dr.
David McKenzie, of McGill University and the Royal Victoria
Hospital, Montreal. Dr. McKenzie dealt with "Tumours of the
Bladder." Again the Victoria profession found itself enjoying
instruction from a teacher from one of the educational centres,
even though it was necessary to encroach on Dr. McKenzie's well
earned vacation, from which he so graciously spared an evening.
The Victoria members are pleased indeed to note that arrangements are being made for a programme ofN post-graduate courses
under the Canadian Medical Association.
At the meeting of the Victoria Medical Society, held on July
27th, Dr. Raynor gave a short but interesting resume of the proceedings of the Canadian Medical Association annual meeting at
Regina. This was well received, as the members of the Victoria
profession feel that they must be fully informed of the exact
nature of the details to which they must attend, to ensure the comfort and success of the meeting at Victoria next year. Dr. Forrest
Leeder, President-elect of the Canadian Medical Association, was
present, and a meeting will be held in the near future to commence
active planning for the 1926 meeting. If Victoria can duplicate
the weather of this and past years, we can safely promise those
who attend a very busy time enjoying a full programme under
temperate weather conditions.
Dr. Gordon C. Kenning is holidaying with his family at
Chemainus, where the big salmon have been running.
Dr. J. W. Lennox and family are again at Parksville, on
Vancouver Island.^ Dr. Lennox, who is the popular Vice-President of the Victoria Medical Society, returned to Victoria with
his complexion ruined by sunburn.    He reports the bathing as
good.
Page Twenty-four THE UNIVERSAL CAR
H c/housands of Medical men
from coast to coast are finding
in the FORD closed car the
solution of their transportation
problem from the standpoints of
ECONOMY, COMFORT and
SERVICE.   WHY NOT YOU?
We   offer  you a 24 hour  shop
service. Leave your car at night
and it will be ready in
the morning.
STONEHOUSE MOTORS LTD.
tyord IDealers
418 GEORGIA STREET WEST
VANCOUVER, B.C.
c^c
sopra
Page Twenty-five PHONE SEYMOUR 2487
McBeath Spedding Ltd*
Vancouver, B.C.
PRESCRIPTIONS
filled exactly as written
Phones: Seymour 1050 -1051
Day and Night Service
Qeorgia Pharmacy Ltd.
Qeorgia and Qranville Sts.
Vancouver, B. C.
Page Twenty-six B. Q Pharmacal Co. Ltd.
329 Railway Street,
VANCOUVER.
Manufacturers of Hand'-made Filled Soluble
Elastic Capsules.
Specimen  Formulae:
No. 20a—
Cascara Liq. Ext., 30m
Euonymin,  1 gr.
Podophyllin, \ gr.
No, 29—
Cod Liver Oil, 25m.
Quinine, 1 gr.
Creosote, Beechwood,
2m.
Guaiacol, Pur., 2m.
Special Formulae Made on a Few Hours' Notice.
Price Lists and Formulae on
Application.
Say it with Flowers
Cut Flowers, Potted Plants,  Bulbs,  Trees,  Shrubs,
Roots,   Wedding   Bouquets.
Florists'  Supplies and Funeral Designs a specialty.
Three Stores to Serve You:
48 Hastings St. E.
665 Granville St.
151 Hastings St. W.
Phones Sey. 988 and 672
Phones Sey. 9513 and 1391
Phone Sey.  1370
Brown Bros, & Co. Ltd*
VANCOUVER, B. C.
Page Twenty-seven Free Delivery Service anywhere in the city
from 8 a. m. to 11 p. m.
Distributors:
Mulford's Biologicals       Fraisse Serum
Capitola Pharmacy Ltd*
(FRED G. BROWN)
Seymour 158       New Address: Davie and Bute Sts.
Nearly
A CENTURY OF  SERVICE
The STEVENS Companies have supplied four generations with
HIGHEST GRADE SURGICAL INSTRUMENTS
STEVENS
English Hand-Made
OPERATING KNIVES
of finely tempered surgical steel are warranted to give long
and satisfactory service.
Special prices during run of this advertisement.   Write for quotations
B. C. STEVENS CO., LTD., 730 Richards Street
Page Twenty-eight To the ]
MEDICAL PROFESSION
The Frost Pharmacy Ltd.
Desire to announce to the Medical Profession that they have
opened for business at
Qranville Street and 12th Avenue
and vuill specialize in Prescription Service.    Our Prescriptions
are filled as ordered, without deviation and our delivery
service is decidedly prompt.
Our Prescription Department
will at all times be in charge of a graduate.
GORDON FROST   jf
(Formerly of the V. Q. H.)
Phones: Bay. 540 and 1720 Granville at Twelfth
The Ou?l Drug
Co., Ltd'
JWl prescriptions dispensed
bu. qualified Druggists.
Ijou can depend on the Ou?l
for Jlccuracy and despatch.
VJe deliuer free of charge.
5 Stores, centrally located.    We
would appreciate a call while
in our lemlory.
Ambulance
Service
TELEPHONE
Fair. 58 & 59
IS/Lount Pleasant
Undertaking  Co.   Ltd.
R. F. Harrison    W. E. Reynolds
Cor. Kingsuiay and Main
Page Twenty-nine 110,000 Policyholders in the
Mutual Life of Canada
HTHE MUTUAL LIFE OF CANADA is a Company
of approximately 110.000 policyholders bonded
together for mutual protection and support in time of
trouble. They obtain the insurance practically at cost.
Surplus profits over and above provision of necessary
reserves are divided  among  participating  policyholders.
Last  year,   the  sum  of   $2,689,000   was   thus  distributed to Mutual policyholders as dividends.
Mutual Annual Dividend policyholders have three options:—■
1. To reduce the second and future premiums, or,
2. Left with the Company to accumulate at compound interest and applied to shorten the premium  paying  period.
M     To Purchase Bonus Additions.
The Mutual Book tells  you  the whole story.     Write
or call on
402 Pender St. W.
WILLIAM J. TWISS
Phone Sey. 1610.
Vancouver. B. C.
Nurses* Central
Directory
Phone Fairmont 5170
Day and Night
Hourly, Institutional and Private Nurses
Supplied
Registrar—Miss Archibald, R. N.
601 13 th Ave. West, Vancouver
Patronize the
BULLETIN
advertisers.
Orthopedic
Appliances
Extensions for short limbs,
Trusses, Arch Supports
Abdominal Belts,
SacrO'Iliac Supports and
Artificial Limbs,
manufactured and made
by Experts and guaranteed
by
A.LundbergCo.
938 Pender Street West
Vancouver, B. C.
Page Thirty Bn
Our
^Advertisers
^\,
Use this journal for the purpose
of procuring business from the
Medical Profession.
Are you assisting in the
publication of The Bulletin by
patronizing our advertisers?
<rsyc
=)?CS
Page Thirty-one ~Hs©e
aap
I
Hollywood Sanitarium
LIMITED
tyor the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
"Reference ~ <tB. Q: cMedical ^Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183 Westminster 288
V<e)(!
?»©*>
Page Thirty-two  

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