History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: April, 1937 Vancouver Medical Association Apr 30, 1937

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 The BULLETIN
OF THE
VANCOUVER iMEDICAL
ASSOCIATION 1
Vol. XIII.
APRIL, 1937
No. 7
In This Issue:
THE CONTROL OF SYPHILIS
SOME PHYSIOLOGIC CONCEPTS OF THE STOMACH
AND DUODENUM
NEWS AND NOTES BULKETTS
(With Cascara and Bile Salts)
. . FOR . .
Chronic Habitual
Constipation
BULKETTS POSSESS ENORMOUS BULK
PRODUCING PROPERTIES AND BEING
PROCESSED. WITH CASCARA AND
BILE SALTS PRODUCE BULK WITH
MOTILITY.
WE WILL BE PLEASED TO PROVIDE
ORIGINAL CONTAINERS FOR TRIAL
ON REQUEST.   -        '»
Western Wholesale Drug
(1928) Limited
45. BROADWAY WEST
VANCOUVER   -   BRITISH COLUMBIA
(Or at all Vancouver Drag Co. Stores)
-P. THE     VANCOUVER     MEDICAL     ASSOCIATION
BULLETIN
Published ^Monthly under the ^Auspices of the Vancouver ^Medical ^Association in the
interests of the tftledical "Profession.
Offices:
203 Medical Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. H. MacDermot
Dr. M. McC. Baird Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address
Vol. XIII.
APRIL, 1937
No. 7
OFFICERS  1936-1937
Dr. W. T. Ewing Dr. G. H. Clement
President Vice-President
Dr. Lavell H. Leeson
Hon. Secretary
Dr. C. H. Vrooman
Past President
Dr. W. T. Lockhart
Hon. Treasurer
Additional Members of Executive—Dr. A. M. Agne w, Dr. J. R. Neilson
TRUSTEES:
Dr. F. Brodie Dr. J. A. Gillespie Dr. F. P. Patterson
Auditors: Messrs. Shaw, Salter & Plommer.
SECTIONS
Clinical Section
Dr. Roy Huggard Chairman     Dr. Russell Palmer Secretary
Eye, Ear, Ndse and Throat
Dr. L. H. Leeson Chairman     Dr. S. G. Elliot Secretary
Pediatric Section
Dr. G. A. Lamont Chairman     Dr. J. R. Davies . Secretary
Cancer Section
Dr. B. J. Harrison Chairman     Dr. Roy Huggard Secretary
STANDING COMMITTEES
Library
Dr. A. W. Bagnall
Dr. H. A. Rawlings
Dr. W. D. Keith
Dr. S. Paulin
Dr. W. F. Emmons
Dr. Roy Huggard
Publications
Dr. J. H. MacDermot
Dr. Murray Baird
Dr. D. E. H. Cleveland
V. O. N. Advisory Board
Dr. I. T. Day
Dr. W. A. Dobson
Dr. G. A. Lamont
Dinner
Dr. A. Lowrie
Dr. A. E. Trites
Dr. J. G. McKay
Summer School
Dr. J. W. Arbuckle
Dr. J. E. Walker
Dr. H. A. DesBrisay
Dr. H. R. Mustard
Dr. A. C. Frost
Dr. J. R. Naden
Credentials
Dr. A. B. Schinbein
Dr. H. A. DesBrisay
Dr. J. R. Naden
Rep. to B. C. Medical Assn.
Dr. Wallace Wilson
Sickness and Benevolent Fund—The President—The Trustees rena
l-GI
ducts
Adrenal Cortical Extract contains the active principle of the
adrenal cortex and has proved useful in the treatment of
certain cases of Addison's disease. In the course of extensive
research in the Connaught Laboratories on the preparation
of Adrenal Cortical Extract, a highly effective product was
evolved for clinical use.
Adrenal Cortical Extract
Adrenal Cortical Extract is supplied as a sterile solution in 25 cc. vials.
It  is  non-toxic,  is  free  from  pressor  or  depressor  substances  and  is
biologically standardized.
During the preparation of Adrenal Cortical Extract, Epinephrine is obtained as a separate product. This is the active
principle of the adrenal medulla and has long been used for
many purposes, including stimulation of heart action, raising
of blood-pressure and relieving attacks of bronchial asthma.
Two preparations of Epinephrine are available from the
Connaught Laboratories:
Epinephrine Hydrochloride Solution  (1:1000)
Every physician is familiar with the use of epinephrine hydrochloride
(1:1000). It is supplied by the Connaught Laboratories in 30 cc rubber-
capped vials instead of in corked or stoppered bottles. Thus, individual
doses may be readily withdrawn from the vials aseptically without
occasioning any deleterious effects upon the solution left in the vials
for later use.
Epinephrine Hydrochloride Inhalant (1:100)
Recently considerable success has been secured in the alleviation of
attacks of bronchial asthma by spraying into the mouth this more
concentrated solution of epinephrine hydrochloride. This solution is
supplied in bottles containing 1/5 fl. oz. (approx. 6 cc), each bottle being
provided with a dropper fastened into its\ stopper so that small amounts
of the solution may be transferred for inhalation from an all-glass
nebulizer.
Prices and information relating to the use of these adrenal-gland
products will be supplied gladly upon request.
CONNAUGHT LABORATORIES
UNIVERSITY OF TORONTO j
TORONTO 5      •      CANADA j
Depot for British Columbia
MACDONALD'S PRESCRIPTIONS LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B. C. VANCOUVER HEALTH DEPARTMENT
STATISTICS—FEBRUARY, 1937
Total Population—estimated 253,363
Japanese Population—estimated _.      8,522
Chinese Population—estimated      7,765
Hindu Population—estimated         352
Rate per 1,000
Number       Population
Total deaths    342 17.6
Japanese deaths :        8 12.2
Chinese deaths      11 18.5
Deaths—residents  only .    299 15.4
BIRTH REGISTRATIONS—
Male, 151; Female, 131 .    282 14.5
February        February
INFANTILE MORTALITY— 1937 1936
Deaths under one year of age      17 12
Death rate—per 1,000 births      60.3 44.8
Stillbirths (not included in above)        6 8
CASES OF COMMUNICABLE DISEASES REPORTED IN CITY
January, 1937
Cases Deaths
Smallpox          0 0
Scarlet Fever      25 1
Diphtheria         3 0
(jhicken Pox      80 0
Measles  1543 2
Rubella        0 | 0
Mumps     200 0
Whooping Cough        9 0
Typhoid Fever          3 0
Undulant Fever        0 0
Poliomyelitis         0 0
Tuberculosis       19 5
Meningitis (Epidemic) _       1 0
Erysipelas         7 0
Encephalitis Lethargica_        0 0
Paratyphoid Fever        0 0
March 1st
February, 1937
to 15th
,1937
Cases
Deaths
Cases
Deaths
0
0
0
0
37
0
14
0
3
0
0
0
23
0
16
0
253
0
72
0
0
0
1
0
118
0
49
0
5
1
7
0
1
0
0
0
1
0
0
0
0
0
0
0
22
12
20
1
0
0
0
10
1
4
0
0
0
0
0
0
0
0
0
EFFECTIVE IRON  MEDICATION!
HEMATINIC  PLASTULES
Three Hematinic Plastules Plain provide the average patient with
an adequate daily dose of iron (ferrous sulphate) to show a marked
increase in hemoglobin.
Hematinic Plastules supply ferrous sulphate and vitamins B and B in
an edible oil in the form of a semi-fluid mass, enclosed in soluble gelatine
capsules which quickly dissolve in the stomach.
Two Types—Plain, and with Liver Extract.
SEND FOR SAMPLES AJSJD LITERATURE.
JOHN WYETH & BROTHER, Inc.
WALKERVH-I.E,  ONTARIO
Page 135 OF HYPERTENSIVE
j   HEADACHES
RELIEVED
FOR rapid, efficient and safe relief of high
blood pressure and its associated symptoms, you can rely on Hypotensyl.
This is a synergistic combination of dependable hypotensive agents—Viscum album ( Au-
ropean mistletoe) and hepatic and insulin-free
pancreatic extracts. It hastens recovery and
wins your patient's confidence.
Viscum album has proven remarkably effective for relief of hypertension (O'Hare and
Hoyt 1928, Barrow 1930 and Danzer 1934).
Frequently Hypotensyl effects a reduction of
20 to 30 mm. Hg. in 12 hours. Headaches and
dizziness vanish and reduction is sustained.
Excellent results are obtained in cases of essential hypertension or benign hyperpiesia.
Hypotensyl is also efficacious in treatment of
high blood pressure accompanying pregnancy
or due to fibrotic kidney. The benefit obtained
from careful control of diet, as well as mental
and physical rest, is accentuated by Hypotensyl.
The usual dose is 3 to 6 tablets daily', one-
half hour before meals. Best results are
obtained when treatment is given in courses
lasting two to three weeks, with a week's
interval between, upplied in bottles of 50
and 500 tablets.
HYPOTENSYL
The Anglo-French  Drug Company
354 St. Catherine Street East Montreal, Quebec
_PP TENTATIVE PROGRAMME
Summer School Lectures
Tuesday, June 22nd, 1937
9:00 a.m.—Dr. Rowntree: Endocrine Diseases.
10:00 a.m.—Dr. Trueblood : Tumours of the Uterus.
11:00 a.m.—Dr. Magnuson : Fracture of the Neck of the Femur.
12:30 p.m.—LUNCHEON.
2:30 p.m.—Clinic—Dr. Brunn : Appendicitis.—St. Paul's Hospital.
3:30 p.m.—Clinic—Dr. Rowntree : Endocrine Disorders.—
St. Paul's Hospital.
8:00p.m.—Dr. Brunn: Lung Abscess.
9:00 p.m.—Dr. Boyd : Tumours of the Neck.
Wednesday, June 23rd, 1937
-Dr. Brunn : Emypema and Interlobar Empyema.
Boyd: Bronchogenic Carcinoma.
9:00 a.m.
10:00 a.m,
11:00 a.m.
3:00 p.m.
Dr.
Dr. Trueblood: Intraoral Tumours.
Clinic—Dr. Boyd : Tumours.—Vancouver General
Hospital.
8:00 p.m.—SYMPOSIUM ON ARTHRITIS.
Dr. Rowntree : Chronic Arthritis and its management.
Dr. Magnuson : Surgical Treatment of Arthritis.
Note.—Following these lectures Dr. Magnuson will show a 1400-
foot reel of moving pictures on research work on the cause of
symptoms in otherwise cured'patients.
Thursday, June 24th, 1937
Trueblood : Tumours of the Neck.
Brunn : Cancer of the Colon.
Magnuson : Fractures of both bones of forearm.
Afternoon—GOLF TOURNAMENT.
8:00 p.m.—Dr. Rowntree : Hypertension and its management.
9:00 p.m.—Dr. Boyd : Nephritis.
9:00 a.m.-
-Dr
10:00 a.m.-
-Dr
11:00 a.m.-
-Dr
9
10
11
9
00 a.m.—Dr.
00 a.m.—Dr.
00 a.m.—Dr.
Friday, June 25th, 1937
Rowntree : Subject yet to be chosen.
Magnuson : Fracture of Elbow in Children.
Brunn : Haemorrhage from Ulcer.
30 p.m.—Clinic—Dr. Trueblood : Lesions of the Skin.
Vancouver General Hospital.
3:30 p.m.—Clinic—Dr. Magnuson : Simple Methods with Fractures.—Vancouver General Hospital.
8:00 p.m.—SYMPOSIUM ON CARCINOMA OF THE BREAST.
Dr. Boyd: Pathology.
Dr. Trueblood : Surgical Treatment.
Dr. Bede J. Harrison: From the Standpoint of the
Radiologist.
Page 136 I EDITOR'S PAGE
In a recent issue of the New England Medical Journal appears an address
by no less a man than J. M. T. Finney, of Baltimore, the well-known American
surgeon, entitled "Religion and Medicine." This is an address he gave at a
special service for Physicians and Medical Students, on St. Luke's Day,
October 18, 1936, in the Cathedral Church of St. Paul, in Boston.
We are not going to quote the letter at all; we prefer rather to recommend
that anyone who is interested in the subject read what Dr. Finney has to say
about it. Our remarks are rather a sort of vocalisation of some reflections on
this topic, of the necessity, in the physician's work, of a spiritual factor.
Not a religious factor, in the sense of creed or dogma or adherence to any
organised group. It is, we think, the false and fatal limiting of the word
religion to fit these artificial and sectarian yardsticks that has made us, as
a profession, so shy of admitting that there is any room at all for religion in
our work. It is a curious fact of history that in the early days of medical
history, the priest and the medicine man were one and the same person. Then,
a little later, as in the days of Hippocrates, the temples and shrines were
centres of medical knowledge, and attached to the religious fane was a species
of health centre, where the sick took baths, and were given therapeutic
exercises and prescribed for by diets and a regimen of life. To this day, in
certain countries, there is a connection still existing between the two things.
For many centuries, of course, the division has been a clear-cut and definite one; and the physician has tended more and more to base his methods
of diagnosis and treatment on definite "scientific" lines, and to eschew as misleading and non-provable all other theories of the causation and treatment
of disease.
Yet the human being is not satisfied, and somehow, somewhere, there is
something lacking to make a complete and coherent system of cure for human
ills. Always, behind the physical sufferings, there is a spiritual pathology,
and our best methods, our most accurate scientific knowledge, our most
rational cures, are thwarted and to a greater or less extent frustrated and
baffled by the fact that, while we have treated the body, we have not cured
the spiritual or mental illness, nor excised the spiritual cancer which, while
it may not have brought on the physical condition, yet is the blacker and
the more tragic part of the whole picture. It is a question whether, till we
find some way of meeting this need, we shall have done our whole duty.
And the trend is even now toward a new alignment of these two great
powers for cure of human ills, the power of the healer of souls, and the power
of the healer of the body—and why should they not be combined in the one
man? Can we not face the issue squarely, and admit what at our heart's
depth we know to be the case, that we must "minister to the mind diseased"
as well as to the body, if we are to render our best service?
A book quoted by Finney, and one that we think every medical man would
do well to read, is "The Return to Religion," by Henry Link, an eminent
psychologist and psychiatrist. This man was for twenty years or so a very
critical and very implacable foe of all things religious. As a boy he had been
surfeited with the pietism and formalism and humbug that men are now
beginning to see is not religion at all, but idolatry merely—till slowly but
surely he came to see that "Religion is not the refuge of the weak, but the
weapon of those who would be strong. I see religion as an aggressive mode
of life, by which the individual becomes the master of his environment, not its
complacent victim." And he found that only by giving his patients some such
weapon, and so re-arming them for the battle of life, could he help them to
health. And Dr. Farrar, who spoke at the Summer School in 1936, said somewhat the same thing.
Physical ills are bad enough—but the real tragedy and torture lie in the
deeper woes of sadness, unhappiness, loneliness, and frustration. Our present
Page 137 day, with its ghastly picture of want and misery, of despair and dumb
acceptance of overwhelming defeat, needs, more than ever, such doctors as
Finney urges us to be.
We would do well to beware of the intolerance and myopia which, because
certain men have misused and mishandled religion, therefore dismiss it all
as useless. "A little philosophy," says Francis Bacon, "inclineth man's mind
to atheism, but depth in philosophy bringeth men's minds about religion."
NEWS AND NOTES
GOLF TOURNAMENT
Vancouver Medical Association
Medical men who play golf and those who simply go to the Association
Golf Tournaments for the fun of an afternoon in God's out-of-doors, followed
by a good dinner under the chairmanship of the one-and-only Ned McDougall,
are urged to attend the first Spring Tournament at Point Grey Golf and
Country Club on Thursday, April 22nd.  For information please telephone
Dr. W. M. Kemp.
* *     *      *
Dr. William Boyd, Professor of Pathology, University of Manitoba Faculty
of Medicine, Winnipeg, has been appointed Professor of Pathology at the
University of Toronto.
* *     *     *
Subscriptions to the John Mawer Pearson Lecture Fund have been
coming in very well since the notices were sent out. To date one hundred and
fifty dollars has been subscribed by members. This amount includes a very
handsome donation of $25.00 from Dr. W. B. McKechnie, who was President
of the Association in 1911-1912.
* *      *      *
Dr. G. A. Davidson and Dr. S. E. Turvey have recently been elected to
membership in the Vancouver Medical Association.
3|C 3|C 3ft 3|t
Dr. W. L. C. Middleton has returned from a month's holiday in California.
Mrs. Middleton, who accompanied the Doctor, will remain in California for
a further visit. Mrs. Middleton has quite recovered from her very severe
illness.
*t* 1* *t* 1*
Cupid has been busy among the medical fraternity—possibly inspired by
the advent of spring. Dr. Russell Palmer was married to Miss Jeanie Davidson on Wednesday, March 3rd. Miss Davidson was formerly employed in the
offices of the Vancouver Properties Ltd., in the Medical-Dental Building.
* *     *     *
The marriage took place on Monday, March 8th, at Turner Valley, Alberta,
of Dr. Henry Scott of this city and Miss E. Ohlson, a former graduate of the
Vancouver General Hospital.
•f* •_* *F *♦*
Miss Mary MacLachlan, daughter of Dr. A. J. MacLachlan, the Registrar
of the College of Physicians and Surgeons of B. C, will be married on Easter
Monday to Mr. W. K. O'Hara.
* *      .      *
Dr. Wallace Wilson has been in California for a few weeks. He will
return about the first of April.
>F * Sp *
We are glad to see that Dr. R. B. Boucher is again at his office, after an
illness of about ten weeks.
.      *     *     *
Dr. C. H. Vrooman was among the 'flu casualties and was ill for some
weeks. We are glad to see that he is now able to be at his office.
Page 138 We extend sympathy to Dr. Leonard B. Wrinch and family, of Hazelton,
in the loss recently of his wife.
* *     *      *
Dr. C. H. Ployart of Lillooet, B. C, has been appointed Medical Health
Officer for Lillooet and District, and School Inspector.
♦ ♦ ♦ 9)C
The Prince Rupert Medical Association, at its Annual Meeting, elected
Dr. C. H. Hankinson as President, Dr. R. Geddes Large as Secretary-Treasurer, and Dr. J. H. Carson as representative to the Hospital Board. As Dr.
W. T. Kergin was leaving on a world tour, the members presented him with
a wrist watch, and Dr. Hankinson passed to him the feeling of appreciation
and the well wishes of the group. Dr. 'W. S. Kergin and wife have left
Premier and are accompanying Dr. W. T. Kergin to England.
* *      *      *
Dr. G. G. Ferguson of McBride, B. C, has been appointed Provincial
Medical Health Officer.
* ♦      *      ♦
Dr. J. M. Hershey is reported to have arrived in Pouce Coupe to take over
the duties of Provincial Medical Health Officer. Dr. J. S. Cull was formerly
in charge of the Health Unit in the Peace River Block with headquarters at
Pouce Coupe.
SJ» !|S 3|C 5p
Dr. Cull has recently moved to Vancouver and is now associated with
Dr. J. W. Mcintosh as one of the officers of the Metropolitan Health Board.
Dr. A. M. Menzies, who was for several years serving with Dr. H. E. Young
as Epidemiologist in the Provincial Board of Health, is now in Vancouver
with the Metropolitan Health Board. Other officers of the new Health organization in Vancouver are Dr. A. R. J. Boyd, Dr. K. F. Brandon and Dr. W. G.
Saunders, who has charge of the Unit in North Vancouver,.
Dr. T. W. Sutherland of Wells, B. C, who has been absent from the province during the past eight months. During Dr. Sutherland's absence Dr.
George F. Young carried on as locum tenens.
* *      *      *
Dr. J. C. Thomas and wife have returned to Port Alberni following a
well-earned vacation in Honolulu. During his absence Dr. A. N. Dobry
assisted Dr. R. W. Garner in the practice.
Jft 9)C 3|C 5J.
Dr. G. B. Helem, formerly of Enderby, has moved to Port Alberni and is
now associated in practice with Dr. C. T. Hilton, who has been long-established there.
* *      *     *
Dr. R. Haugen, formerly in practice at Alexis Creek, has moved to
Enderby and has taken over the practice vacated by Dr. G. B. Helem.
* *      *      *
Dr. D. M. King, who has been doing post-graduate work at the Vancouver
General Hospital, has now returned, accompanied by Mrs. King, to his home
and practice in Bralorne. During his absence Dr. C. E. Derkson acted as
locum tenens.
* *      *      *
Dr. G. E. Hollies has entered practice in Pouce Coupe, in the Peace River
Block.
* *      *      .
Dr. F. O. R. Garner has returned from Princeton, where he has been
assisting in the examinations carried on by Dr. R. J. Wride under the new
amendments to the Metalliferous Mines Regulation Act and Workmen's Compensation Act bearing on silicosis.
Page 139 Dr. Hubert Dumont has taken up practice in Victoria.
* *     #      *
Dr. R. S. Woodsworth is now in Kelowna and temporarily associated
in practice with Dr. W. J. Knox.
*•* * jf- -i»
Dr. Gordon E. Stanley is assisting Dr. Leonard B. Wrinch in practice
at Hazelton.
* *     *      *
Dr. Harry Baker has taken up practice at Salmon Arm.
* *     *      *
Dr. J. P. Gussin is at Salmon Arm assisting Dr. A. Beech in practice
during the illness of Dr. S. E. Beech, who, we hope, is rapidly recovering.
9p i|C -ft Sft
Dr. C. E. McRae of Williams Lake, B. C, has been appointed Medical
Health Officer and School Health Inspector for Williams Lake and district.
'P * * V
Dr. L. N. Beckwith has been appointed Medical Health Officer and School
Inspector for Castlegar and district.
* *     *     *
Dr. W. J. Endicott, formerly associated with Doctors G. C. and S. G.
Kenning in Victoria, has now joined the staff of the Trail-Rossland group.
* *      .      *
Dr. L. W. Bassett is now associated with the Doctors Kenning in Victoria.
Sp SfS )(• 3ft
Dr. Hill H. Cheney has joined the staff of the Vancouver General Hospital
and is associated with Dr. Bede J. Harrison in the Department of Radiology.
Dr. Cheney, after graduation from McGill University in 1913, did special
work with Dr. A. H. Pirie at the Royal Victoria Hospital in Montreal. After
returning from overseas service Dr. Cheney became director of the department at Ottawa General Hospital and comes to Vancouver with a recognized
reputation in his specialty. Mrs. Cheney has already been introduced to the
profession as a medical artist, and many men will recall the excellent display
of her art as part of the McGill University Exhibit at the Canadian Medical
Association meeting in Victoria last June.
♦ sj: sfe :Js
Dr. W. R. S. Groves, who has been associated with Dr. R. N. Dick in
practice at Chemainus, proceeded to Smithers via Prince Rupert, where it
will be arranged that he will take on the office and work of the late Dr. F.
V. Agnew.
COLLEGE OF PHYSICIANS AND SURGEONS OF B. C.
INCOME TAX RETURNS j
The following is an extract from the memorandum regarding Dominion
Income Tax returns of members of the medical profession which will be of
assistance to doctors in preparing such returns :
"1. An accurate record of income both from practice and other sources
must be kept.
"2. Under the item of expenses may be included the following: (a) Supplies; (b) new instruments under $50.00 value; (c) telephone; (d) office
rent; (e) postage and stationery; (f) new books and medical journals; (g)
office help; (h) assistants' fees; (i) depreciation on instruments over $50.00
value may be charged at the rate of 15% to 25% per year and on a car used
in professional practice 20% per year until fully depreciated; (j) auto
expenses (restricted to one car) may be charged either as: (1) total cost of
license, oil, gas, grease, insurance, garage and repairs, or in lieu of this, (2)
Page 140 at the rate of eight cents per mile covered in the performance of professional
duties; (k) in the case of a doctor practising from his residence when: (1)
residence is owned by the doctor, a proportionate amount for running the
house not to exceed one-third of total house expense, and (2) in a rented
house, total amount of rent may be allowed but not other expenses such as
heat, light, etc.; (1) annual fees and registration fees not exceeding $100 per
year, business tax, and mal-practice insurance may be charged. No charge
may be made for attending conventions or post graduate work; (m) professional men under salary contract will be taxed without any deduction except
for actual expenses out of salary necessary to maintain the contractual
position, licensing and annual fees may also be charged."
THE LATE DR. FRANCIS VERE AGNEW
Dr. Francis Vere Agnew, who has been in active practice in Smithers,
B. C, since 1930, died while writing at his office desk during the afternoon
hours on March 19th.
The late Doctor Agnew was well and favourably known to the "profession
in this province. He not only had an excellent training, but possessed those
qualities in a marked degree which made him a valued asset to the community and his patients. He was skilful and carried confidence into the home
and hospital.
Having secured his B.A. degree in Dublin'in 1907, he graduated in Medicine in 1912, obtaining certificates of M.B., B.Ch., B.A.O., M.D.
The late Doctor Agnew registered in British Columbia in 1912 and has
been located in Vancouver, Kamloops and Williams Lake, where he spent
several years. Later he took up practice in Telkwa, on the Canadian National
Railway, and when in 1930 Dr. C. H. Hankinson moved to Prince Rupert from
Smithers, Dr. Agnew succeeded to the practice in the latter place.
The sympathy of the whole profession in British Columbia is extended to
his widow and family, and an appreciation of a brother doctor and the loss
sustained by this province is regretfully recorded.
RECENT ADDITIONS TO THE LIBRARY
Diseases of the Eye, by Sir J. H. Parsons; 8th ed., 1936.
Operations of Surgery, 2 vols., by E. P. Rowlands and P. Turner; 8th ed.,
1936.
Principles of Human Physiology, by E. H. Starling; 7th ed., 1936.
Applied Physiology, by Samson Wright; 6th ed., 1936.
Practice of Medicine, by J. C. Meakins; 1937.
Surgical Clinics of N.A., August, 1936. Contains a symposium on Peptic
Ulcer.
Surgical Clinics of N. A., October, 1936. Contains a symposium on Urology.
Surgical Clinics of N. A., December, 1936. Contains a Symposium on Thyroid Diseases.
Nostrums and Quackery, vol. 3, ed. by A. J. Cramp, 1936.
Textbook of Surgery, ed. by Frederick Christopher, 1936.
Heart Disease, 2nd ed., by Paul Dudley White, 1937.
Physiological Basis of Medical Practice, by C. H. Best and N. B. Taylor,
1937.
Diseases of the Nails, by V. Pardo-Costello, 1937_
Yearbook of General Medicine, ed. by G. F. Dick, 1936.
Yearbook of General Therapeutics, ed. by B. Fantus, 1936.
From the Nicholson Fund
American Doctor's Odyssey, by V. Heiser.
William S. Thayer, by Edith G. Reid.
Page 141 ABSTRACT.
THE CONTROL OF SYPHILIS
A Critical Examination of Some of Its Problems,
John H. Stokes, M.D.
[This lecture, delivered before the St. John's Hospital Dermatological Society,
London, as the Prosser White Oration on June IJ th, 1936, published in the British
Journal of Dermatology and Syphilis, vol. 48, p. 527, Nov., 1936, is an excellent
example of Stokes' vivid and picturesque phraseology, and also of his original
qualities of mind. It furnishes so many arresting and stimulating ideas that we
have printed this abstract for the benefit of our readers, but suggest that those
interested read the article in full. The author's own wording has been given as
much as possible.—Ed.]
In his opening remarks the author expresses his belief that nothing could
be more profitable than to examine some of the exuberant enthusiasms to
which he and perhaps others have yielded in this brief era of extraordinary
expansion in our knowledge of syphilis.
Dealing first with the organism of syphilis we are to be reminded of
its extraordinary fitness for its human habitat, rated by Warthin as the
most exquisite example of symbiosis in the pathogenic field. We have insufficiently realized what is now becoming increasingly apparent—that all our
antisyphilitic drugs act, not alone by poisoning the organism direct, but
also by arousing the defence mechanism of the body. When no such defence
can be effectively aroused by drugs we encounter a treatment-refractory,
infectious or relapsing carrier, and the seriousness of the anergic state is
apparent.
Raiziss' isolation of a strain of S. pallida neurotropic for rabbits from the
brains of asymptomatic mice shows experimentally the persistence of the
infecting agent indefinitely in full virulence. Dark-field examination has
already failed to detect infectiousness in the apparently spirochaete-free but
still highly infective lymph-node. Fruhwald has demonstrated continued
infectiousness of Wassermann-negatfive blood. Perhaps the spirochaete is
merely an end-product of an evolutionary cycle and in itself cannot produce
the disease. It may fail to develop under the conditions prevalent in the
lymph-node, the testicle and elsewhere. A number of the ablest investigators have found the cultivated organism from the experimental animal
avirulent. Is it possible that the immunity to reinfection of the human being
with an acquired syphilitic infection that has once reached full secondary
stage development is an infection-immunity? There is perhaps an ultra-
visible infectious agent, a "virus" accompanying the visible spirochaete, but
also persisting after the latter's disappearance. Perhaps suspected instances
of failure to become infected under known conditions of infective exposure
are examples of virus immunity in individual carriers of an intra-cellular
ultra-microscopic phase.
Turning to treatment and first considering the infectious relapse factor,
it is stated that 91% oi infectious relapse occurs in the first two years; that
half of all relapse lesions are infectious, and two-thirds of them occur on the
external genitalia; the more arsphenamine the less relapse, and much
arsphenamine and much heavy metal gives one-half the relapse that little
arsphenamine and much heavy metal gives. Bismuth is more effective than
mercury—arsphenamine-mercury therapy gives 9.6% muco-cutaneous
relapse as compared with only 3.6% under arsphenarnine-bismuth therapy.
In sero-negative primary syphilis the highest proportion of curative results
is obtained with 10 to 19 arsenical injections with a corresponding propor-
Page 142 tion of heavy metal; in sero-positive primary syphilis, with 25-35 injections;
in secondary syphilis, with 20-29 injections.
The optimum treatment of latent syphilis consists of one year of continuous and a second year of intermittent treatment—a total of 24 arsphenamines and 50-60 doses of bismuth. Continuous treatment the first year is
essential.
The pregnant woman should be given a higher proportion of arsphenamine; at least 10 injections beginning before the fifth month. Treat every
syphilitic woman early and adequately in every pregnancy, whether seropositive or negative. The adequately treated syphilitic woman may not be,
but the untreated syphilitic woman certainly is, a potential carrier of infection for the foetus up to 10 or 11 years after she acquires the disease.
Two yellow powders in identical ampoules, with government toxicity
tests printed on the box-labels—the one is highly spirillocidal in human
syphilis, the other less so or not at all. The failure to suffer some nausea,
headache or other reaction demanding post-treatment precautions may mean
a drug dangerously below effective therapeutic standards, made so by a
manufacturer's response to the practitioner's demand for detoxification.
[Italics ours. Ed.]
The author has candid doubts as to the fitness of either doctor or clinic
to act as the sole, or even the chief, agency in the ideal control of syphilis.
The clinic alone is not enough. It is a fundamental mistake to eliminate the
common doctor, to discourage him, or even fail to encourage him sufficiently,
in the control of syphilis. He should be given his place and taughti to fill it.
One of the major problems of the immediate future'is, then, the education
of the doctor.
There is but one safe stand for a campaign against syphilis based on the
control of infectiousness—treatment from the moment the disease is recognized, and to the point indicated by the "30-0-60-3" formula (30 arsphenamine or neoarsphenamine injections, 0 rest intervals, 60 insoluble bismuth
injections, 3 years of treatment and observation).
Under the heading of prophylaxis, the following sentences are memorable. "Recognizing human frailty, we should bend our efforts unceasingly
toward a better understanding of the disease and its cause, toward a better
prevention based on immunobiology, rather than to rest content with the
present crude proposals to universalize post-contact prophylaxis that is
inevitably against human nature. . . . Over the syringe, and before the
syringe, we and human nature meet. As we deal with the total person of
the patient, as we project ourselves! into his problem, win him, comprehend
him as a facet of the curious jewel of life, we come to command the situation.
Syphilis is conquered in the end, not by a yellow liquid, not by a white
cream, but by the eye, the voice, the understanding, sympathetic mind and
heart. . . . The human beings who tend him are the true instruments of
the syphilitic patient's cure; his first contact with them, the critical moment
of the battle."
SOME PHYSIOLOGIC CONCEPTS OF THE
j   STOMACH AND DUODENUM
Dr. Roy Huggard
Mr. President and fellow members of the Vancouver Medical Association:—I feel that one is greatly honoured in being asked to address this body
upon such a subject. It is, however, with some trepidation that I present the
Page 143 subject matter for discussion this evening, as there may be many points of
controversy raised.
During the last decade, remarkable advances have been made in our
conception of the physiology and biochemistry of the stomach. A few years
ago more stress was laid upon the pathological picture of gastric disease, and
we, as a profession, assessed signs and symptoms in pathological terms. The
gross and histological appearance of morbid changes were the basis of our
conception, and at that time physiology and biochemistry played a very
minor part. However, with the steady advance of surgical procedure we
began to see earlier phases of disease than are seen at the autopsy table, and
increasingly pertinent questions arose that only could be answered by the
physiologist. With increasing regularity the clinician turned to the physiologist for aid, and with such stimulus, marked advances began to occur. Today,
the gastro-enterologist, be he physician or surgeon, is increasingly thinking
of gastric disease in terms of altered physiology and biochemistry. I do not
wish to minimize the marked advances that have also occurred in our
pathological conceptions, but, nevertheless, we cannot deny the tremendous
role that modern physiology is now playing in solving many perplexing
problems met with in gastric disease.
Should one, during the course of this paper, seem to delve too much into
the elementary side of the subject, it is because the subject has been treated
as a whole, and it is difficult to break it up into different parts.
Some of the questions that the gastro-enterologists and surgeons ask the
physiologist in an attempt to assess the symptoms of gastric disease will be
answered—or at least a trial made to do so.
A fundamental fact to remember is that the stomach, physiologically,
consists of two parts, with a common cavity. The upper portion holds the
food nearly motionless while a little starch is digested. Its lining is mucosa
that secretes HCl. and several digestive ferments. This portion is quite
analogous to the crop of a bird. The lower portion is where the food is
ground and mixed with the digestive ferments. It functions as a mill and by
the same token corresponds to the gizzard in a bird.
The cardia is a poor sphincter, both from an anatomical and physiological viewpoint. And upon repeated swallowing it relaxes (according to
the researches of W. B. Cannon). It is further interesting to note that the
stomach, after swallowing, also tends to relax. An interesting clinical application is noted here. Many fast eaters who bolt their food, as is seen at lunch
counters every day, suffer variable distress after their meal, and this, in all
probability, is due to the fact that thq stomach has had insufficient time to
relax—but this is easily remedied by chewing gum and swallowing of saliva,
thus enhancing normal relaxation.
Our knowledge of the mechanics of the stomach has been greatly
advanced by fluoroscopic studies, and the following observations were, for
the most part, made by this method.
In a very irritable stomach, waves of contraction are seen beginning
near the cardia and moving slowly to a point near the pylorus. In some
cases as many as six or seven are seen at one time, but more commonly they
occur in pairs. New ones occur* about three to the minute. However, in most
normal stomachs the fundus is nearly motionless, and only when we study
a series of pictures will there be seen the presence of very shallow waves. In
man, and in many animals, it would appear that these waves are quite different from those of the distal end, inasmuch as their rate of occurrence
is more rapid and they appear to run forwards and backwards much as do
the rhythmic contractions seen in the small bowel. Indeed, in some of the
Page 144 lower animals there appears to be some considerable dissociation between
the contractions of the fundic and pyloric portions: The radiologist usually
sees very shallow waves which seem, to begin in the mid portion of the
stomach, travel downward, and become most pronounced about the incisura,
where they enter the thick red muscle zone of the pylorus. It is here that
they seem to contract with so much power as to divide the stomach into two
portions. However, a small space does exist which allows the escape of food,
which is being pushed! into the pylorus, back into the body of the stomach.
It is here that one sometimes wonders how the food ever gets through the
pylorus, as escape so easily occurs backwards into the body cavity.
Such studies as have been made upon gastric rhythmicity suggest two
pace-makers—one near the cardia on the lesser surve, and one at the upper
end of the pyloric portion. However, their presence is not essential, as all
manner of surgical attacks destroying these areas do not seem to alter gastric
function greatly.
Here one might pause to suggest a surgical point. Mechanically, the
stomach does not tolerate a V-shaped excision of the lesser curve well, and
subsequent function is poor as a rule. The reason is quite obvious: as the
wave that sweeps down the stomach travels more rapidly upon the greater
curve, with the lesser curve shortened, the upper portion reaches the pyloric
ring ahead of the lower portion, and sometimes runs back along the greater
curvature, uniting with the down-coming wave and forcing food back into
the stomach, thus retarding and delaying normal emptying.
It is now an established fact that waves travelling from incisura to
pylorus do not all do so the same way. Some physiologists believed that in
the pyloric portion the contractions were systolic; others believed that contraction moved as a wave; actually it would appear that both are correct.
The contractions of the longitudinal muscle travel to the pylorus as a wave,
and those of the circular muscle commonly are systolic, at a variable point
from the pyloric ring. In addition to waves of contraction, there are waves
of relaxation in the pyloric portion that run orad and caudad, and emptying
is probably aided by this mechanism—a wave of relaxation relaxing the
sphincter, and a wave of gastric contents pushing food through.
Waves in the stomach appear to stop at the pyloric line, but from
animal studies recording these waves graphically, we find that there is many
times a relationship between a wave arriving at the pyloric ring, and the
appearance of a tonus wave in the duodenum. The pyloric portion often
appears to be a pace-maker for the tonus waves in the duodenum, one of
these frequently serving as the starting point of a rush wave down the
bowel. Indeed, such a wave is often initiated by a swallowing movement.
The application of this physiological point is obvious. When active peri-
sitaltic activity is desired, the chewing of gum or repeated feedings is a
strong stimulus. Further, it would appear that in cases of mild ileus, following surgery, exclusive of mechanical features, enforced fasting would be a
contributory cause. In such cases, depending on circumstances, the surgeon
might be well advised to give food at an earlier period than is the custom
at present. The contra-indication has been the added stress upon suture-
lines, but it is a matter of debate whether hunger contractions are not as
dangerous as the giving of soft food. In reversed peristalsis, a nausea and
vomiting caused by a reversal of the normal gradient forces of the tract,
the giving of solid food many times promotes a return to normal physiology.
Solid food is much preferred to liquids-, as1 it actually raises the tonus of the
stomach and stimulates gastric contractions. In many instances of functional flatulent dyspepsias, dry feedings are to be preferred to soft liquid
Pane 145 feedings on account of this fact. Fluids favour sudden gastric distention and
the development of abnormal wave responses. It might further be noted
that enemas as a rule stimulate the colon and further enhance the development of reversed peristaltic activity.
Horton has recently demonstrated a thin fibrous barrier between the
pyloric ring and the duodenum, bridged by the occasional bundle of muscle
fibres, but on the whole very similar to the A. V. septum of the heart. Its
function would appear to act as an insulator from the too sudden passage
of powerful antral contractions into the duodenum, and to some extent to
limit antiperistalsis from invading the stomach.
As there are alterations in the pace-maker of the heart, so do such occur
in the gastro-intestinal tract, and they may easily be produced by mechanical stimulus. This readily explains various reversals in the bowel gradient
that occur in emotional upsets, fatigue, infections, etc.
Let us now consider some further studies of the pylorus and its control.
As soon as a patient begins eating, the more liquid portion of the food
begins to enter the duodenum at once. Some investigators have shown that
three to twelve ounces can leave the stomach in 15 minutes. Furthermore,
it is well known today that there is in reality no special pyloric ring with
specialized functions. In fact it is the thickened lower end of the gastric
cylinder, and we are all well aware that its destruction or excision makes
little difference upon the emptying of the stomach. We also now know that
the sphincter does not stay closed, but is open more of the time, and is
relaxed after each wave arrives. We do know, however, that it has a slightly
lower threshold and shorter latent period than the adjacent pyloric muscle,
and thus, upon occasion, may close ahead of an advancing wave. A gastric
ulcer will tend to stimulate it and increase its tendency to contraction.
Studies by Eusterman have shown that even with the sphincter wide
open and a gastric wave approaching, no food contents have entered the
duodenum, suggesting the presence of a higher duodenal pressure.
It would appear that the most important factor of gastric emptying
was to be found in the balance of duodenal and gastric pressures; this has
been amply demonstrated experimentally.
For years we believed that the pylorus was controlled by acidity of
gastric content; gastric acidity opened the spincter, and duodenal acidity
closed it. However, the problem is not so easy. We know the pylorus is open
most of the time. The greatest single factor governing gastric emptying is
fluidity of contents. The stomach empties as rapidly as the duodenum will
receive it; if the material is highly acid or alkaline, or if it irritates the
duodenum by too great osmotic pressure, it will throw the duodenum into
spasm and delay occurs until further dilution.
Ulcers near the pylorus do not influence stomach-emptying through
any change in acidity of the contents, but rather through irritating the
pylorus and so producing spasm, presence of cedema, and the formation of
cicatrix.
We have now concluded a brief resume of some of the more salient
features of gastric mechanics, and will now proceed with the second function of the stomach, namely, secretion. It is not the speaker's intention to
deal at any length withl abnormalities of secretion, as the second paper this
evening will embrace this subject.
As stated in the beginning of the discussion, the stomach has two main
portions. It is the fundic portion that is most concerned in secretion. In this
acid secreting portion one finds thousands of small tubules, each consisting
of a body, neck, and foveola. These tubules are lined with four main types
Page 146 of cell, each cell having a specified secretory function. The chief cells are
found in the body of the tubule and produce gastric enzymes. In the walls
of the tubule usually external to the chief cells are found the oxyntic or
acid-secreting cells, which communicate usually with the lumen by a fine
tract. In the neck of the tubule is found the mucoid type of cell. It produces
an alkaline fluid rich in mucin and sodium chloride. There are further cells
lining the foveola that produce a very thick mucus. In the pars pylorica the
tubules are of much simpler construction and are lined by a mucoid type
of cell. They produce a scanty alkaline secretion rich in mucus.
One of the great puzzles to the physiologist is to suggest how a fluid
one million times more acid than the blood is produced in cells not destroyed
in the process. It is certain that H Cl is formed by a break up of the Na Cl.
Two main theories, however, stand out, and we shall consider them. The
first as advanced by Pavlow, who believed that the acid is secreted at a constant maximal strength, and the second by Roseman, who believed that the
parietal cells form a precursor of acid, rich in chlorine, which later splits
into acid and base. This would seem to explain the fact established by many
that the amount of base in gastric juice varies inversely as to the amount
of acid.
Pavlow does not believe in true hyperacidity. The purest juice of man
obtained with histamine has a concentration of 0.6 per cent H Cl. or a pH of
0.9. The weaker acid found seems to be the product of dilution by the weak
alkaline gastric juices. Hollander has recently confirmed Pavlow's belief in
that he and other workers have secured juices of high purity from man and
animals with the same acid concentration. This is isotonic with blood, and
it would seem that the only way a real hyperacidity could occur would be
to change the composition of the blood. Any objection to this theory of
Pavlow's might be that toward the close of digestion, the concentration of
acid seems to fall with the rate of secretion. Actually, there is no constant
relation between acidity and rate of secretion when experiments are carefully done. Further, Roseman's theory was abolished when Hollander showed
that the purest juice from a fundic pouch contains no fixed base, as it would
have to do if some precursor of acid were split into acid and base components.
It has further been established that the parietal cell secretion is pure hydrochloric acid and water with a concentration of 170 millimolecular equivalents which is, as stated above, isotonic with blood. Now that this is established, one may obtain, by plotting data from analyses of gastric juice and
extrapolating, that the alkaline component must have a chloride concentration of about 100 millimolecular equivalents. Since the total base is about
170 mm., the difference of 70 mm. will represent the combined amount of
bicarb, phosphate and protein anion.
It is not necessarily true that the rate of pepsin secretion follows that of
H Cl. secretion. These vary considerably, although there is some tendency
in a stomach with high acid titre to have a large amount of pepsin.
As stated by Pavlow, when strong acid is secreted an equivalent amount
of base enters the blood, and it has been shown that the blood leaving the
stomach is more alkaline and a slight decrease in chlorides has been observed.
A consequent change in acid base ratio of the blood occurs and resultant
changes in C02 of alveolar air, etc. But as a matter of fact these changes
are rapidly compensated. But when gastric juice is lost in large quantities, as
in a high obstruction, a severe alkalosis is the result. If this is not corrected,
death, as we all know, rapidly ensues.
For some years it has been shown by Pavlow and his pupils that the
quality and quantity of gastric juice varies as to the nature of the stimulus.
Page 147
m It might be of interest here to state the results of the experiments of Hawk
and others relative to this fact. Herein lies some facts underlying diet
therapy and the conclusions are obvious. High acid values occur after ingestion of beef and beef products, chicken, fish, ice cream, lamb, milk, nuts,
pork, turkey, veal, carbonated drinks, cocoa, eggs, salted meats, and bouillon.
Strong pepsin stimulants are found in cabbage, beets, turnips, potatoes,
cauliflower and spinach.
Alcohol is a great stimulant to the parietal cells, as is also the smoking
of tobacco. I shall not comment upon the obvious deductions and their
application in peptic ulcer therapy.
Fats and oils lessen gastric activity, but how does this occur? Hydrocarbon oil has no effect upon secretion. A, search of the literature has failed
to suggest how fats reduce secretion; they do not act by coating the mucosa
and interfering with stimuli—but the secret of the reaction is not definitely
known. Upon gastric mechanics, fat slows the emptying time of the stomach
apparently by weaking of gastric waves. According to Quigley and Ivy, it
appears to be the action of some part of the fat upon the intestinal mucosa
and the passage of some substance (not fat) in the blood from intestine to
stomach. Hydro-carbon oil has no effect.
It is now known that there are three phases of gastric secretion: (a)
Cephalic phase, (b) Gastric phase, (c) Intestinal phase.
The cephalic phase was originally referred to as the psychic phase, but
Ivy showed a few years ago that it is present in decerebrate dogs, hence the
term "cephalic."
The smelling, seeing or chewing of savoury food causes a stimulus by
way of the vagus nerves exciting secretion rich in pepsin. This serves to split
off from proteins substances which will maintain a continuous flow of gastric juice. Once digestion has gotten under way it carries on independently,
irrespective of the trials of body or mind. Here one would suggest the use
of the cocktail, soup and hors d'oeuvres as powerful direct gastric stimulants
and capable of substituting for deficient or absent psychic juice.
The gastric phase is that one in which secretion is stimulated by the
presence of food in the stomach. Balkin states that none of the foods and
drinks except alcohol directly stimulate fundic secretion. Ivy and McCarthy,
in 1925, demonstrated, however, that the application of raw meat juice
B-alanine, and histamine to fundic mucosa, stimulated secretion. Also strong
solutions of glucose, sodium chloride and Liebig's meat extract likewise
stimulate secretion to a lesser degree. The subject of gastric secretion producing hormones has been extensively reviewed by Ivy. Many experiments
have been done but nothing definite found until Ivy succeeded in transplanting a gastric pouch into the anterior wall of a bitch. This pouch secreted
when food was placed in the main stomach, thus proving once and for all
the presence of some hormone.
The operative removal of the pyloric portion of the stomach in man
has been done in the hope of lessening secretion—upon the basis that the
pyloric portion was the seat of hormone formation. Actually this does to a
degree occur, but is not consistently true. Actually the lowering of acidity
after subtotal resection operations is probably due to a variety of factors
and not to the removal of the pars pylorica alone.
These factors are: (1) Greater tendency for duodenal regurgitation and
greater dilution and neutralization of gastric juice; (2) Removal of varying amount of secreting fundic mucosa; (3) Food leaving stomach more
rapidly and a shortening of the gastric phase of digestion; (4) Much food
Page 148 is dumped into the bowel in an undigested condition, tending to lessen
gastric secretion as against the greater stimulating effect of normal chyme.
Now let us consider the intestinal phase of gastric secretion. Balkin in
1928 definitely showed that gastric secretion is excited by putting into the
bowel water, meat, or meat juice, meat extract and the products of gastric
digestion such as peptones. Gastric secretion is inhibited by 0.5 per cent
H Cl., fats and oils, gastric juice and concentrated solutions of Na Cl. and
various sugars being introduced into the intestine.
Why some foods introduced into the bowel seem to stimulate gastric
secretion, and then again inhibit, is not known, and more work will have to
be done to answer this point.
It is often assumed that pyloric stenosis increases gastric acidity. That it
does so is no doubt due to prolonging the phase of gastric secretion and it
commonly results in a high total acidity with a low free acidity due to the
accumulation in the stomach of a large amount of food, water, and diluting
fluid.
Experimentally, an obstructed pylorus does not cause much change in
gastric secretion, hence the futility of surgical attack designed to occlude
the pylorus in the presence of ulcer. Owing to this physiological fact the
nature of the operation is unsound and it defeats its own purpose.
Let us now briefly consider what the fall in acidity is due to. This
question is most pertinent, as it raises the point as to what maintains hyperacidity in certain cases of ulcer.
The main cause is cessation of secretion, and it has been demonstrated
histologically that the number of tubules functioning slowly, cease until
all have stopped secretion, and acidity falls.
The second explanation seems to be that as less acid is poured out it is
diluted by the other alkaline secretions and neutralized.
The last factor is found in the fact that towards the end of the secretion
some duodenal content flows back into the stomach, thus causing further
neutralization. While this at one time was regarded as the most important
factor, we now know this is not true.
In 1929 McCann showed that the curve of fall of gastric acidity was
not altered in animals whose duodenal contents had been diverted into the
lower ileum via Mann and Williamson's operation.
Only lately have physicians realized this truth and begun to study the
highly important alkaline constituents of gastric juice.
The secretion of the pars pylorica is usually syrupy and clear and colourless with a few flakes in it. The specific gravity is 1.008 to 1.011; total
nitrogen is 0.054 to 0.095 grams per 100 cc. of .filtered juice; and the total
content of chloride is the same as blood. The pH. is usually from 7.0 to 7.5
and the alkalinity is about 0.04 normal. The amount secreted is small, normally being about .2 to 4 ccs. per hour, and the role it plays in neutralization is a minor one. A constituent is mucus. There are two types: one is
thready, lumpy and visible; the other is a dissolved or invisible mucus. What
protective function this has is little known, but some efforts have been used
to get ulcers to heal by giving mucus by mouth. Physiologically, it is dim-
cult to see how mucus by mouth will adhere to mucosa as does mucus
formed in situ, and as mucus is not a buffer, the rationale of the treatment
does not appear evident. Any buffer action mucus might have is usually
due to the peptones associated with it. The finding of mucus in gastric
contents is not pathognomonic of any disease.
The principal ferments of the stomach are pepsin and rennin.
Pepsin has been isolated in a crystalline form and is a protein. The pH
Page 149 of optimum, peptic activity is 1.7, but Northrop has shown that this is
variable and the exact figure depends on the iso-electric point of the protein
being broken down.
Peptic activity can take place in a neutral solution but proceeds slowly.
Pepsin is killed rapidly when pH. rises above 6.0.
There is some unknown substance in gastric juice that preserves pepsin
as artificial gastric juice deteriorates rapidly—but pure gastric juice of an
animal can be kept for a year without losing any peptic activity. As is well
known, pepsin breaks proteose into the larger fractions, which in turn are
broken further by trypsin and later by erepsin.
Rennin has recently been isolated by Klenier and Hauher practically
devoid of peptic activity. It tends to disappear from the adult stomach
and acts by breaking up the casein membrane of fat droplets and maintains
milk as an emulsion. Its chief function is that by coagulating milk it keeps it
in semi-solid form so that in the stomach it may undergo gastric digestion.
Some of the distress produced by milk in children and adults might be
avoided if it was pre-coagulated in the form of junket or thick buttermilk,
thus insuring the complete function of gastric digestion.
Why does not the stomach digest itself? There are two chief reasons.
The mucosal cells are surrounded by a fatty envelope not subject to protease
attack. The other reason seems to be that mucosa of the stomach and bowel
is protected by absorbed peptone and perhaps by some substances present in
normal gastric juice. These substances can be exhausted by too prolonged
contact with unbuffered dilute hydrochloric acid.
It is well known that there is a bactericidal quality in gastric juice that
bears a direct ratio to the acidity. The stomach is more often sterile in ulcer
patients than normal people.
There is little absorption occurring in the stomach. Alcohol is readily
absorbed, however, and it facilitates the absorption of some other substances
such as glucose.
We have now completed a resume of the primary functions of the
stomach. Although the speaker has emphasized the physiological aspect, it
is done in the hope that some valuable clinical applications may be reached.
There are too many questions that as yet have no satisfactory answers. These
answers will only be found upon persistence and further study. It is with
these few observations in mind that one would suggest we place our therapy
increasingly upon a sound physiological basis. It is only in this way that we
can hope to master the great problems surrounding gastric disease, which
is one of the most common complaints the physician and surgeon hears today.
B. C. MEDICAL ASSOCIATION
Dr. J. H. MacDermot, Secretary of the Health Insurance Committee, and
Dr. M. W. Thomas, Executive Secretary of the College of Physicians and
Surgeons, motored to Bellingham, Washington, on Monday, March 1st, to
attend a meeting of the Whatcom County Medical Society, and were guests
at a dinner at the Hotel Bellingham.
The President, Dr. Orville S. Beebe of Bellingham, was chairman, and
together with Dr. Walter C. Moren, the energetic Honorary Secretary,
greeted the two Canadians and were very successful in assuring your representatives from British Columbia a really enjoyable visit.
After the dinner, which was largely attended, Dr. MacDermot told the
members somewhat of the story of Health Insurance in other countries and
the introduction of such legislation in this province. The members were very
much interested in this subject, as a draft bill will be presented to the State
Page 150 Legislature this year which is, with necessary changes, a replica of the Act
passed in B. C. Dr. MacDermot explained the attitude and action of the
profession of the province with regard to the scheme presented.
Dr. Thomas described the organization under which the members of the
College practised in British Columbia. The members present showed great
interest and inquired regarding the service developed under a full-time
executive medical secretary who had first-hand knowledge based on experience in general practice. Both Dr. MacDermot and Dr. Thomas were delighted
with this opportunity to fraternize with our brothers in the State of Washington.
| TRIGGER-FINGER "
Contributed by Dr. M. W. Thomas
When Dr. W. J. Knox of Kelowna becomes reminiscent and talks of
those earlier days in practice in the Okanagan, he carries you back to 1903
when he joined the now old-timers, who were building Medical History
before that date—Dr. Osborne Morris, who took up practice in Vernon in
1893; Dr. B. de F. Boyce of Kelowna, who came to B. C. in 1894, and Dr.
R. B. White of Penticton, who arrived and commenced his work in 1897.
These men have all remained in the Interior. This reference to the pioneers of the Nineties would not be complete without inclusion of such arrivals as Dr. George M. Foster in 1898, Dr. G. S. Gordon in 1898, Dr. R. B.
Boucher in 1899, all of whom practised in the Boundary country, locating
at Greenwood and Phoenix when Camp McKinney was a real place. Dr.
Knox could write (and he must be encouraged to do it) of some real experiences of thirty-three years ago when these doctors did what one of them is
pleased to describe as a "stud-horse practice",—these were pre-automobile
days.
He did tell a story the other day and it has a moral, so we will repeat it.
Thirty-odd years ago the hills behind Kelowna provided a paradise for
hunters and many men set out for the sport. On one particular day when
the deluge of rain drove a party of hunters (with no umbrellas) into a barn
for shelter these sportsmen proceeded to test their marksmanship on the
bottle-corks—someone had no corkscrew. When they were thoroughly
wetted inside the game became more keen—a friendly rivalry for "best
shot." One of the party enjoyed a reputation and apparently the confidence
of his fellows, for they allowed him to pop corks off their heads with his
.30-.30. Finally he took to knocking the spots off the playing cards. As I say,
he was trusted, and one brave lad held the five-of-diamonds at arm's length
and all went well—the marksman punching out four of the diamonds—
until it came to the last of the five spots. He requested the target-holder to
shift his thumb and finger that the fifth and last spot might be uncovered
and more clearly visible, bu John Barleycorn had set up certain phenomena
within the nervous system of the holder of the card and he moved at the
wrong time, and he incidentally, or shall we say accidentally, lost the distal
phalanges of the thumb and index finger—clumsy beggar the boatswain.
Dr. Knox was summoned, and after galloping over ten miles to the barn in
the hills he saw the unfortunate sitting on a box in the corner, feeling very
groggy, looking stupidly pale, a pool of blood beneath his drooping and
dripping hand.
The others were still carrying on with the sport, by this time mostly
taking rounds of shots at the contents of the bottles. They had given the
victim a large dose of chlorodyne and he was ready to lie down and have his
digits trimmed. These were neat but shorter. The whole crew harangued the
Page 151
B_P stupid card-holder who had so failed their best rifle-shot. He had moved,
they charged, and embarrassed a good marksman—and could expect no
sympathy; rather he had by wabbling inopportunely let down the crowd on
this day of real sport.
CANADIAN MEDICAL ASSOCIATION NOTES
As a member of the Executive of the Canadian Medical Association, I am
taking opportunity at this time of reporting rather briefly on some of the
activities of the C.M.A. in recent months and hope these items will prove of
interest.
First, in reference to Medical Economics, I am pleased to report the
appointment of Dr. T. C. Routley, our general secretary, as Economic Secretary of the Association. No man is more conversant with medical affairs
across Canada than he is and no man should be better fitted for the position.
The Ontario Medical Association has appointed an assistant secretary in the
person of Dr. A. D. Kelly, which will relieve Dr. Routley of a lot of detail
work in the O.M.A. and allow him much more time for C.M.A. affairs. Dr.
Routley is now in England with a busy two months ahead of him. He will
study, first hand, state medicine and health insurance along with other medical activities which may be of special interest to the medical profession of
Canada. "It is my purpose," he also states, "to contact organizations
having as their special object the control of cancer." The British Medical
Association has prepared for him a strenuous programme which takes in the
British Isles, France, Germany, Norway and Sweden. His study of cancer
control activities in European centres has reference largely to another important matter of recent occurrence, namely, the offer by the trustees of the
King George V Jubilee Cancer Fund for Canada of a substantial yearly grant
of money for the carrying out of a programme which was presented by Dr. J.
S. McEachern, Chairman of the Canadian Medical Association Study Committee on Cancer, to the Executive Committee last fall. Dr. McEachern is also
one of the trustees of the fund. Dr. A. Y. McNair, Chairman of the B. C.
Medical Association Cancer Committee, will comment, I hope, on this matter
in this issue of the Bulletin. He will be ex-officio a director of the new
Department of Cancer Control of the C.M.A.
Another matter of considerable importance is the proposed formation of
an Associate Committee on Medical Research under the National Research
Council, for scientific and industrial research, such committee to be comprehensively representative of the leaders in the various divisions in this field
in Canada (universities, public health, etc.). Such a move should stimulate
and assist sound medical research across the Dominion. The Canadian Medical Association would occupy a very important place in this, and rightly so,
as it is the one body that truly represents the medical profession in a national
way.
Dr. Harvey Agnew, our very active and efficient Associate Secretary in
charge of hospital affairs, will attend the International Hospital Association
meeting in Paris during the month of July, on invitation of the American
Hospital Association. It is quite probable that the next meeting of the International Hospital Association, in 1939, will be held in Canada, perhaps in
Toronto. Dr. Agnew and his work are too well known to all medical men in
Canada to require any comment from me.
In the near future a series of articles on the aims, objects and activities
of the C.M.A. will very likely appear in The Canadian Doctor, which reaches
nearly every medical man in Canada. These should be both interesting and
mstruetive. The Canadian Doctor is a very interesting journal, and Dr. James
Stevenson of Quebec, its editor, is to be congratulated on his publication.
As to the interest the C.M.A. has taken in our recent troubles in British
Columbia, particularly over Health Insurance, I here quote from a letter
from our General Secretary on date of February 12, 1937. "We want you all
Page 152 to know that the medical profession of Canada is behind you and waiting to
assist in any way possible." I think I can safely state, as a member of the
Health Insurance Committee of the College of Physicians and Surgeons, that
we did get valuable support from the C.M.A. and Dr. Routley, also from Dr.
Colbeck and the Ontario Medical Association. The editorial comment on
Health Insurance in British Columbia in the last issue of the Journal and
the leading article in the February issue of the 0. M. A. Bulletin clearly shows
that we have their sympathy and support.
The value of strong medical organization is becoming very apparent. I
might say the strongest organization that we can muster is becoming imperative if we are to solve the economic problems that are facing us successfully.
This means strong provincial bodies (where should we have been recently if
we had not had a strong organization?), and a strong, alert, and active
national association which will be able to give the necessary support to any
section that needs it, and will be a co-ordinating influence in medical activities across Canada. Should the British North America Act be modified, and
this seems necessary, and the Federal Government assume greater jurisdiction over health matters, the C.M.A. will have a considerably heavier task
than it has at present. It will be our main standby in Federal health legislation.
This brings up the matter of C.M.A. membership. In numbers there is
strength! The C.M.A. should represent at least 60% of the profession of
Canada; it is now less than 40%. At the Executive meeting last fall, by
reducing the annual fee 20% to allow for a composite fee of $15 for the
provincial and national associations, special inducement was given the Maritime Provinces and Ontario to go out after new members. The General Secretary reports that in Nova Scotia one hundred and sixty new members have
been brought in in that way. Ontario expects to bring its number up to at
least fifteen hundred, which would be an increase of over five hundred. Dr.
Nicholls stated that the cost of publication of the Journal would decrease
considerably if the Association can be brought up to, say, four thousand.
The increased revenue would also increase the services that the C.M.A. can
render the public and the profession.
Lastly, allow me to quote from Dr. Routley's letter of March 9th last:
"Plans for the annual meeting in Ottawa are practically completed, and from
every point of view the meeting should be an outstanding success." This will
be a joint meeting of the Canadian Medical Association and the Ontario
Medical Association and very probably will be a very large one. The men
who were fortunate in being able to attend last year in Victoria were very
enthusiastic about the success of that meeting.
There are perhaps many other activities of the C.M.A. that should be
mentioned here, but my space is limited—the Editor may have to blue-pencil
part of what I have already written. I will therefore conclude by urging
every member of the profession to support organized medicine as fully as he
or she can. Therein lies our strength.
H. H. Milburn, M.D.
"ORGANIZATION FOR CANCER CONTROL"
To the Profession :
During the last year or so the activities of the Committee for the Study oi
Cancer of the Canadian Medical Association have been much in the limelighti
We are indeed fortunate in having Dr. J. S. McEachern as chairman of this
committee. It has been largely through his untiring efforts that there is no^
in the process of formation a Canadian Committee for the Control of Cancer
This will probably be completed and put into effect after the meeting of the
Page 153 General Council of the C.M.A. in June, 1937. This plan is being worked out
with the help of the Board of Trustees of the King George V Silver Jubilee
Cancer Fund for Canada. It promises to be something really worth while
and Dominion wide in its scope. As a beginning, Dr. McEachern has asked
us to try and start the organization of cancer control as soon as possible.
This plan has been approved by your committee.
The plan is one of study, and making full use of information available
from complete cancer records. It is fully realized that the obtaining of records
in any hospital is a difficult one. To do this, there must be full co-operation of
the profession, supporting these committees in the various hospitals; the
co-operation and help of hospital superintendents and the Department of
Health.
A definite history form has not been decided on, but this will soon be done
and, we hope, distributed for record purposes. It is desirable that this form
be uniform throughout Canada.
To start the organization for cancer control we wish to establish a Cancer
Study Committee in all hospitals of 100 beds or over.
The purpose of establishing these committees is:
(1) To secure complete and carefully recorded histories of all cancer
cases admitted to hospital.
(2) To have available for future study records of treatment and reports
of subsequent progress in follow-up notes on every cancer case.
(3) To pool the experience of the staff, and give to every member an
opportunity to become familiar with early signs and symptoms of
cancer in various sites.
(4) To enlist each member of the staff in a campaign to instruct his own
clientele in the early signs and symptoms of cancer whenever opportunity offers.
(5) To give to every hospital the opportunity to contribute its quota to
the building up of reliable statistics regarding the number of living
cancer cases in Canada in a given year. At present this can only be
estimated.
The proposed committee to undertake:
(a) To scrutinize, soon after admission, the history of each cancer case,
and if the history is incomplete, point out to the attending physician
wherein it is incomplete and ask that the data be secured and recorded.
(b) During the patient's hospitalization, to require of each person responsible, that a description of laboratory investigation, treatment
given, and any other relevant data be filed with the history.
(c) After a patient's discharge from hospital, that follow-up notes be
entered at intervals at six months.
(d) To arrange that the hospital authorities provide that all cancer records be kept in a special file.
(e) To provide, at each monthly meeting of the staff, a speaker who will
give a brief talk on the early signs and symptoms of cancer of some
specific site.
(f) To urge constantly upon the members of the staff that each one
undertake to inform his clientele regarding early signs and symp-.
toms of cancer, whenever the opportunity presents itself.
Page 154 (g) To refrain from interfering with the patient, but at all times to hold
themselves in readiness to give the attending physician any aid in
their power if he should ask for it.
In the near future the various district secretaries will receive direct communications regarding this plan. It is our sincere wish that this be given due
consideration. A start, however small, is still a start. I feel that before we
can do anything we must organize. This is the nucleus for cancer study. Any
future developments can very easily be woven into this provincial and dominion-wide set up. I trust you will receive this favourably. The need of a plan
has long been felt; now we have one. Even at a sacrifice of time and effort,
let us make a definite start.
A. Y. McNair,
Chairman, Committee on Cancer,
B. C. Medical Association.
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MONTREAL Pediatric Acceptance of Dextri.
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1934 I
Continued down from 1911
1934
"The question of carbohydrate is one of individual
tolerance. Personally, I like Dextri-Maltose."—L.
Fischer: Pediatric progress during the last jjfly years.
Arch. Pediat. 51:807-218, April 1934.
1934
"Cow's milk has a caloric value of 20 calories per
ounce. Dextri-Maltose, commonly used, has 120 calories
per ounce. As an example let us say that we have a well
baby four months of age weighing 14 pounds. According
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or 630 calories. Sugar requirements will be 1 J_ ounces—
that is, 180 calories. Then deduct this from the 630
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12 J^ ounces of water
1M ounces of Dextri-Maltose
Divide into five feedings of 7 ounces each and feed every
four hours."—B. F. Thomas: Infant cars and feeding, J.
M. A. Alabama 8:848-851, April 1984.
1934
- Within a week it became necessary to place the baby
entirely on a TnilV formula. This was a mixture of milk,
water, and dextrinialtose, and he thrived on it."—J. M.
Higgins: Acute lymphatic aleukemic leukemia, Pennsylvania M. J. 87:818-819, July 1984.
1934
"The dietetic treatment of pylorospasm yields gratifying results, the use of a thick farina formula usually
proving successful. This is prepared as follows:
Skimmed milk ; 10 ounces
Water. 12 ounces
Farina 5 level tablespoonfuls
Dextri-maltose No. 1 3 level tablespoonfuls
"Mix the milk and water together and bring to a boil.
Then sprinkle in slowly 5 level tablespoonfuls of farina
and boil over a direct flame for five minutes, stirring
continually. Transfer to a double boiler and cook for one
hour. After the mixture is cooked add the dextri-maltose."
—C. S. Raue: The dietetic treatment of nutritional disorders in infancy, Hahneman. Monthly 69:522-528, July
1984.
1934
For pyloric stenosis, "He was given atropine>sulphate
grains 1/1000 before each feeding and this was increased
to grains 1/600 before vomiting was controlled. The
formula consisted of cow's milk 16 ounces, water 16
ounces, dextri-maltose 2 level tablespoonfuls and uncooked farina 6 tablespoonfuls. He was fed 6 tablespoonfuls every 4 hours, 6 feedings a day. ... In 5 days time
there was a gain of 25 ounces. He was under treatment
for a period of 5 months and 26 days during which time
there was a gain of 14 pounds and 7 ounces."—R. D.
Hostetter: Pyloric stenosis, Ohio State M. J. 80:606-608,
Aug. 1984.
"The mother's breast feedings were complemenl
a mixture of three quarters milk, water and c
maltose. After a loss of 5 ounces (l75.1 Gm.) duri
first three days, the child gained steadily, weig
pounds and 5 ounces (3,316.9 Gm.) by the eighth
—5. 5. Brown, M. Morrison and D. A. Meyer: /
of the new-born without erythroblastosis: Observation
autopsy, Am. J. Dis. Child. 48:886-845, Aug. 1934.
1934
"A formula of cow's milk, water, and dextri-n
was given. The feedings were well taken, and the
were normal."—J. L. Rothstein: Low calcium tela
the newborn, J. Pediat. 6:341-851, Sept. 1934,
I     1934
"Dextri-Maltose is, of course, the best sugar b
pensive.* Cane sugar gives fairly satisfactory resull
cept in very advanced cases, when dextrimaltose mu
given."—K. C. Chaudhuri: Marasmus and its treat
M. Digest 2:246-249, Oct. 1934.
1934
"Meads Dextri Maltose is preferred, as it is not
Used to the laity. It contains dextrins and maltos
almost equal amounts, and in the three varieties van
only in the amount of sodium chloride and potassr
bicarbonate they carry."—G. WisweU: Proprietary ft
in infant feeding, Nova Scotia M. Bull. 18:483-486, '
1984.
1934
"To be sure, one can still raise well infants,!
commercial granulated sugar, but one has a disti
safer feeling, in the presence of disease, when a CO)
tion of sugars, such as dextrins and maltose, can t
ployed."—L. C. Schroeder: The treatment of pneui
in infants and children, M. Clin. North America 18:81
826, Nov. 1934.
1934
In pyloric stenosis, "Finally, if the stools are incl
to be hard and dry and the fluid intake falls below 2,
3 oz. per pound body-weight, additional fluids, pre!
ably in the form of a solution of one of# the d
maltose preparations, between feedings, will usu
sufficient."—C. C. Fischer: Constipation in infanc
childhood, Hahneman. Monthly 69:918-918, Dec. Wi
1934
"A sugar of the dextri:maltose type seems to t>
most consistently and universally satisfactory.
Lynch: Fundamentals of infant feeding, J. Indiana 1
27:571-574, Dec. 1934.
(to be continued)
When More Physicians Specify MEAD'S, More Babies
Will Be Fed By Medical Men
*It is interesting to note that a fair average of the length of time that an infant receives Dextri
Maltose is five months: That these five months are the most critical of the baby's life
the difference in cost to the mother between Dextri-Maltose and the very cheapest carb
drate at most is only $6 for this entire period—a few cents a day* That, in the end, it CO*
mother less to employ regular medical attendance for her baby than to attempt to doner,
feeding, which in numerous cases leads to a seriously sick baby eventually requiring the i
costly medical attendance*   -r
MEAD JOHNSON & CO. of CANADA, Ltd.? Belleville* Ont
Please enclose professional card when requesting: samples of Mead Johnson products to cooperate in preventing- their reaching unautho "Seymour 2263
A new telephone number is a nuisance
—but it's also a challenge to our
minds. Test your memory on this
number—and call it when you need
dependable service.
Of-NAU.
MIGHT
OPEN
ALL
NIGHT
GEORGIA PHARMACY
L. I M  I TED
W.OEOR-IA
STRUT
(timttv $c Hf muta Eft.
Established 1993
VANCOUVER, B. C.
North Vancouver, B. C.    Powell River, B. C.
Published Monthly at Vancouver, b. c. by ROY vvrioley LTD., soo weet Pender street Hollywood ISanitarium
Limited
For the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference—B. C, Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
__3___5___.

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