History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: April, 1925 Vancouver Medical Association Apr 30, 1925

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THE VANCOUVER MEDICAL
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BULLETIN
Published monthly at Vancouver, B. C.
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Inflammatory "Diseases of the Ear
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APRIL, 1925
TuMished fry
eTfrtc^Beath 5pe<&2ing Limited, Uancou^er, <23. (?.
*S Doctors of British Columbia
Do not miss the 56th Annual Meeting
of the Canadian Medical Association to be
held in Regina, Saskatchewan,
June 22'26, next.
A most interesting and important programme is arranged, including eminent men from our own country
and abroad.
We want you to come, not only to hear papers and
addresses, but for a holiday—to meet again the classmates of other days—and to enjoy the entertainment and
hospitality which it will be our pleasure to provide.
Address communications to
Dr. M. R. Bow
care of Regina Qeneral Hospital
Regina, Sask.
Inserted by
Regina
Medical Society
PRESCRIPTIONS
filled exactly as written
Phones: Seymour 1050 -1051
Day and Night Service
Qeorgia Pharmacy Ltd.
Qeorgia and Qranville Sts.
Vancouver, B. C.
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.
APRIL 1st, 1925
No. 7
OFFICERS,  1924-25
President
Dr. H. H. Milburn
Secretary
Dr. o. S. Large
Vice-President
Dr. Stanley Paulin
Treasurer
Dr. A. J. .MacLachlan
Dr. w. F. Coy
Past President
' DR. F. J. BULLER
TRUSTEES
Dr. w. b. Burnett
Delegate to B. C. Medical Association
Dr. J. A. Gillespie
Dr. J. M. Pearson
SECTIONS
Clinical Section
Dr. Lyall Hodgins       ......
dr. \v. l. pfdlow .        .        .
Physiological and Pathological Section
Dr. C. H. Vrooman     -	
Dr. R. E. Coleman ......
Eye, Ear, Nose and Throat
dr. g. c. draeseke      ------
Dr. Colin Graham ....--
Genito- Urinary
Dr. g. S. Gordon -
Dr. J. A. E. Campbell	
COMMITTEES
Chairman
Secretary
Chairman
Secretary
Chairman
Secretary
Chairman
Secretary
Library   Committee
Dr. Wallace Wilson
Dr. R. e. Coleman
Dr. w. a. Bagnall
Dr. w. F. MacKay
Orchestra Committee
Dr. L. Macmillan
Dr. F. N. Robertson
Dr. J. H. MacDermot
Dr. W. d. Patton
Credit Bureau Committee
Dr. L. Macmillan
Dr. J. w. Welch
Dr. G. A. Lamont
Dinner   Committee
Dr. N. E. MacDougall
Dr. A. w. Hunter
Dr. F. N. Robertson
Credentials  Committee
DR.  G.  E.  SELDON
Dr. D. MCLELLAN
Dr. Neil McNeill
Summer   School   Clinics
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.
Programme of the 27th 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.
1925
JANUARY 6 th—
JANUARY 20th—
FEBRUARY 3rd—
FEBRUARY 17 th—
FEBRUARY 25 th—
MARCH 3rd—
MARCH   17th—
APRIL  7 th—
APRIL 21st—
SPRING SESSION
General Meeting.
The OSLER LECTURE by DR. FREDERIC BRODIE.
"Aphasia."
Clinical Meeting.
General Meeting.
Paper:    DR. W. A. DOBSON, "Neuroses in Everyday
Practice."
Clinical Meeting.
Special Clinical Meeting.
DR. C. E. HAGYARD  (Seattle).
Subject:     "Colitis."
General Meeting.
Paper:    DR. R. B. BOUCHER, "Inflammatory Diseases
of  the  Ear."
Clinical Meeting.
General Meeting.
Paper:    Dr. J. L. TURNBULL, "Differential Diagnosis
of Acute Abdominal Conditions."
ANNUAL MEETING.
Page Four <&
Photo by courtesy of Rush Medical Dispensary, Chicago
VICTOR X-RAY CORPORATION, Publication Bureau, 236 So. Robey St., Chicago
Please send me descriptive bulletin on Victor Quartz Lamps.   Also reprints of authoritative papers on Ultraviolet Therapy. I am interested especially in the treatment of
I am also interested in Victor Apparatus for
□ Medical Diathermy   D Phototherapy Name.—— -	
□ Surgical Diathermy   □ Ionic Medication      Street  	
D Sinusuidal Therapy
A-217-A
^#^<^<^#^<^^^^#^^^<^4><t><^<§>^^<^<^#^<§><^<^4>^^<^^4>4>^^<^<@><^4>^>^^^>##^^<^#>^M EDITOR'S PAGE.
We would call the attention of our readers to an article
printed in this issue of the BULLETIN upon the local preparation
of digitalis from the native foxglove. This is the first of a small
series of articles of a similar nature which, through the kindness
of Prof. Clark, of the Department of Chemistry in the University
of British Columbia, we hope to print or reprint from time to
time.
We think that a knowledge of this work should be more
prominently brought to the attention of the medical profession
of the province. It represents original research of a valuable description and of eminently practical worth. In the case of digitalis it is evident that a native drug has been produced which compares favourably with any commercial preparation. The product is both active and reliable, and only too often some of the
preparations we order for our patient are neither the one nor the
other. The way is undoubtedly open for the commercial manufacture of this drug. Whether it can be profitably made here is,
of course, a question to be answered by those who would undertake its production. The common foxglove (digitalis purpurea)
apparently flourishes in diverse climates either in a wild state or
as a cultivated product. Whether the conditions of climate and
soil as found in British Columbia are peculiarly suitable for the
proper development of the active theraupeutic principles of the
plant, is not of course clear as yet. But digitalis is only one of
a number of drugs which are capable of being extracted from plants,
shrubs or trees of native growth. Others have been investigated
by Prof. Clark and his staff. Cascara Sagrada, for example, has
been the subject of considerable research.
The tree Rhamnus Purshiana is indigenous in this part of
the world, and the collection of the bark is, we believe, undertaken here on behalf of manufacturing chemists elsewhere. Experiments in the University of British Columbia seem to indicate
that a considerable degree of the well-known specific properties
of the bark reside also in the wood.
Concerning this and other preparations we hope, later, to
publish articles. Enough has been said to draw the attention of
our readers to the latest possibilities which undoubtedly exist in
the Province of British Columbia in this direction. It is possible
that some members of the profession, of a botanical turn of mind,
may have had their attention drawn to the possible native source
of other drugs, which might repay investigation.
* * *
The Committee on Arrangements for the Annual Summer
School of the Vancouver Medical Association is hard at work.
Already, as has been noted, considerable advance has been made in
the programme. Each year the intellectual promise of the speakers selected seems to excel that of the previous session.    We would
Page Six commend this now annual fixture to our readers. It is not too
early to begin to plan your arrangements so as to enable a considerable proportion of the practitioners outside Vancouver to be
in attendance. This is a co-operative endeavour to bring the wisdom, for the most part of the East, to supplement the practical
knowledge of the West. We expect and usually get a condensed
account of the progress which has recently been made in the department of medicine in which the speaker is particularly interested.
The subjects are diversified and a practical turn is always emphasized.
* * *
NEWS AND NOTES.
A special meeting of the Association was held on the 25 th
ultimo, when Dr. C. E. Hagyard, a prominent gastro-enterologist
of Seattle, Wash., read a very interesting paper on "Chronic Nonspecific Colitis." Dr. Hagyard also held a clinic at the Vancouver General Hospital on the morning of the 25 th, on gastrointestinal disorders. Full reports of Dr. Hagyard's clinic and paper will appear in subsequent issues of this BULLETIN.
The regular monthly meeting of the Association was held
on Tuesday, March 3rd, Dr. H. H. Milburn, President, in the
chair. A letter from Dr. H. A. Barrett was read, and spoken to
by the Doctor, calling attention to the apparent lack of appreciation of the importance of physio-therapy by the profession at
large. It was moved by Dr. Sutherland, and seconded by Dr.
Welch, that Dr. Barrett be given an opportunity of placing his
specialty before the profession.
Dr. G. H. Clement's motion to amend the rule concerning
election of nominees to Hospital staff appointments, was amended
so as to have the election held at the meeting of the Association,
and each nominee to have received a majority vote of the meeting.
The Chairman was also authorized to appoint a Committee
to act in connection with the Victorian Order of Nurses' drive
for funds.
Dr. R. B. Boucher gave a very full and instructive paper on
"Inflammatory Diseases of the Ear," part of which is given in
this issue. The remainder of Dr. Boucher's address will appear in
two subsequent issues.
We are pleased to report that Dr. K. Shimo Takahara, who
was recently operated on for appendicitis, is doing well and has
left the hospital.
Dr. C. H. Vrooman was elected Chairman of the Health
Bureau of the Vancouver Board of Trade, at their annual meeting held recently.
Dr. G. H. Worthington, Chairman of the Health Committee of the City Council, recently appeared in a new role and
Page Seven delivered the
weekly Health Talk
through
the
Pro
oince broad-
casting station,
his subject
being
The
Imp
•ortance
of
Vaccma-
tion Against
Smallpox."
Dr. T.
H.
Lennie has
recently
retu
rned
from a
ho
iday trip
in California
*
*
*
THE PHYSIOLOGICAL VALUE OF B.  C. FOXGLOVES.
By James Arnold Dauphinee.
(Working in the Departments of Chemistry and Botany, University of British Columbia. Abstracted from the American
Journal of Pharmacy, Nov., 1924.)
The following report is an account of an investigation carried
on during the year 1922-23 into the therapeutical value of the
glucosidal content of British Columbia grown foxglove leaves
(Digitalis purpurea, Hinni) ; and also into the effect, if any, of
different fertilizers upon this value.
Five different samples of cultivated leaves have been analyzed
by two different methods: (a) the "cat method" of Hatcher and
Brody; and (b) the "guinea-pig method" of Reed and Vander-
kleed. The plants from which the leaves were taken were originally growing wild in the Burnaby Lake region. They were
transferred to the Botanical Gardens of the University at Point
Grey. Here they were planted in four plots each eight feet wide
and twenty-one feet long. There were on the average one hundred and fifty plants in each plot.
The plants were one and two-year-old specimens before they
were transplanted. They were grown under the influence of fertilizers for a period of one year. The leaves were collected during the last week of June, 1922, just while the plants were flowering. All the leaves were removed from the plants and were dried
in the shade on specially made trays. They were dried in this
manner for four weeks and then made into tight bundles and sent
to the laboratory.
When received at the laboratory they were further dried in
dessicators in a partial vacuum over lime until their petioles would
break with a sharp fracture. The deeply stained brown leaves
were discarded. The remainder of the leaves were crushed and
ground to a No. 60 powder and then placed in air-tight brown
glass containers.
Tinctures were prepared from each specimen of leaves according to the directions given in the U. S. P. IX under the heading
"Type Process P. Percolation," page 444.
The results obtained from the various tinctures are summarized in the following table:
Page Eight TABLE IV.
Particulars
Physiological   Assay
Tinc
(
Cats
Guinea  Pies
ture
No.
No. of
Animals
1 M. L.D.
per Kg.
No. of
Animals
M. L. D.
per
Used
Used
250 gms.
6
Digitalis purpurea,  variety  alba.
Fertilizer—cow  manure.
4
|0.0716 gms.
1     H
0.033 gms.
7
Digitalis purpurea   (purple flowers) .       Fertilizer—cow    manure.
3
|0.0634 gms.
10
0,040 gms.
8
Digitalis purpurea   (purple flow-
. ers) .      Fertilizer—superphosphate.
5
|0.0772 gms.
10
0.045 gms.
9
Digitalis purpurea   (purple flowers) .      Fertilizer—ammonium
sulphate.
2
|0.0741 gms.
11
0.036 gms.
10
Commercial   Preparation   No.   1
diluted   to   tincture   strength.
Procured   from   the  pharmacy
of  the  V.   G.  H.
1
|   0.168 gms.
1     17
0.126 gms.
11
Commercial   Preparation   No.   2
diluted   to   tincture   strength.
Procured  from   the  pharmacy
of the V. G. H.
6
|0.0857 gms.
14
0.048 gms.
12
Digitalis purpurea  (purple flowers) .    No fertilizer.
12
0.038 gms.
[Tinctures of Digitalis, as well as powdered Digitalis leaves,
as prepared at the University of British Columbia and referred,
to in this article,  have been used therapeutically in the medical
service of the Vancouver General Hospital.
Definite digitalis' effects have been repeatedly obtained fully
equal in character to any from commercial preparations. In stability, reliability and potency, these preparations have ranked high
on clinical application.—Ed.]
THE IMPORTANCE OF DIAGNOSIS.
The Doctor, the Patient, and the Hospital as Cooperating Factors in Diagnosis.
{A Few Suggestions from M. T. MacEachern, M.D., Chicago,
Director of Hospital Activities, American College of Surgeons, Who Recently Visited Vancouver and Renewed Old
Acquaintances.)
The present trend of medical education is towards a better
background of science and cultural subjects to train the student
to be a more accurate observer and thinker and develop in him an
investigating mind. This is fundamentally essential for diagnosis.
Four questions arise in my mind as I write:
Page Nine (1) Do we as a profession, individually or collectively,
always make the necessary study of each case in arriving at the
diagnosis?
(2) Do we consult with each other as we should?
(3) Does the general practitioner call in the specialist as
frequently as he should?
(4) Does the specialist call in the general practitioner as
frequently as he should in the interests of the patient?
Every patient entering a hospital to-day is entitled to the
following as far as possible:
(1) An early, accurate diagnosis.
(2) An efficient and effective treatment.
(3) The best possible and most permanent end result.
All this can only be accomplished through a careful study of
the patient by the doctor, using natural or human resources for
doing so, and these augmented by such measures as the clinical
laboratory, the X-ray. the metabolator, and many other diagnostic
and therapeutic adjuncts now found in every well regulated hospital. It is sincerely hoped that the day is far distant when the
laboratory, the X-ray and other technical adjuncts will replace
entirely the careful physical examination by the doctor himself.
These adjuncts should always be used in a consulting, assisting
and confirming capacity. Thorough diagnostic and therapeutic
work is best for the patient—for the doctor—and for the establishing and maintaining of public confidence. All this is possible
in Vancouver. The hospital facilities are all that could be desired
and are liberally offered to the entire profession, thus affording
♦them a wonderful opportunity for thorough work.
The following diagnostic proverbs may be of interest:—
"A diagnosis is a decision. Lack of decision has lost some
of the world's greatest battles and has changed the destiny of
nations."
"We cannot build castles in the air—one might as well try
to construct a building without a foundation as to treat a patient
without a diagnosis."
"The diagnosis is not made for its own sake, but rather as a
means of promoting the recovery of the patient."
"A tired physician cannot give his best to his patient."
'The intelligent co-operation of the patient is required."
"A suitable environment is required for careful clinical work
—quietness and good light."
"Uninterrupted concentration is required for reliable examination."
"Forms for recording work and observations should be provided."
"Begin with the symptoms which caused the patient to seek
medical advice. Do not make a hurried diagnosis and then work
backward, trying to make the symptoms fit your preconceived ideas
of the case."
Page Ten "The medical student, the interne, the patient, and his friends
are very apt to be carried away by the grandstand play of the man
who makes a positive snap diagnosis."
"Thoroughness and accuracy are the watchwords of the reliable physician.    Snap diagnoses are dangerous."
"Indefinite signs propounded by enthusiastic observers are
not always reliable."
"Do not ride your scientific hobbies to death. The physician who sees his particular hobby in every patient is apt to
stretch his imagination."
"The patient must not be allowed to lose his best opportunities for recovery while refinements of diagnosis are being investigated and discussed."
"The history is an important factor in every case."
"Findings should be carefully recorded at the time of the
examination."
"More than one examination is required in most cases."
"Examination of one organ or system is only a partial examination of any patient."
"Most patients have defects in more than one organ or system."
'The clinical thermometer, pulse rate, and the scales often
reveal things we can neither see nor hear."
"Properly controlled, prompt, and reliable laboratory and
X-ray service required."
"The laboratory and X-ray are necessary assistants, but cannot replace sound clinical judgment and a thorough physical examination."
"Routine examinations of urine, blood, and sputum should
be made."
"Careful records by nurses and internes are valuable; careless records are dangerous."
"All findings should be carefully reviewed before making a
definite diagnosis."
"The hospital should have a library of reference books available for use of physicians and internes."
'Two heads are better than one.    A careful physician does
not hesitate to seek advice or consultation."
LIBRARY NOTES.
Lewis Stephen Pilchet. A Surgical Pilgrim's Progress, 1845-
1925.    J. B. Lippincott.    1925.    $5.50. j
This is a very readable autobiography, written and brought
up to date by one now in his 80th year, and still actively engaged
in his chosen work.
Like many in the neighbouring land south of us, while cherishing democratic ideals, he cannot refrain from delving in the
past, and traces his family across the sea to the land which furnished the origin of so many of the ablest men produced in the
Page Eleven United States. And so it is not surprising if a Pilcher coat-of-
arms is found. But pride of birth should be a source of strength
and not of weakness—and so I think it proved in his case.
He has traced his family history among the early settlers in
Virginia, and in their wanderings later on to found new branches
of the family in various States—and this all makes interesting
reading, as shewing the spread of the settlements westward and the
opening up of new country.
Later his story becomes more intimate and takes us within
the family circle. His father was an itinerant "Methodist preacher
of more than ordinary ability. He rapidly became a leader in his
church, and as presiding elder and secretary of conference had
many legal problems to settle. To better understand law he
studied it and later passed the bar examinations of his State of
Michigan. Later, while stationed at Ann Harbor, Michigan, he
was interested in the young University of the State of Michigan,
and was one of its regents for some years.
While thus employed he became interested in the foundation
of its Medical School, and even took a course and graduated as
Doctor of Medicine in his 49th year. Such a father made a deep
impression on his sons. Thus, one brother became a missionary
to China, engaged in educational work, and rose to be the first
president of the Pekin University, which he helped found. Another was a distinguished military surgeon and author, founder
and editor of the "Journal of the Association of Military Sur
geons," and author of a successful standard text-book on "First
Aid in Illness and Injury."
Hs only sister was for twelve years matron of the Seney
Hospital, New York.
And his mother comes in for a very loving pen picture, with
the life in the parsonage, bringing up a family on $400.00 a year,
always loving, cheerful, hopeful and helpful. The chapter on his
mother, their simple life and simple pleasures, is well worth
reading.
As for our hero himself, having faithfully pictured the environment in which he grew up, it was but natural that the thread
of that influence should be traced through his subsequent life. At
the age of 18 he received his M.A. degree, and later that fall entered on his medical studies. Being of age for enlistment, he
joined up that winter as a hospital steward, serving to the end of
the Civil War, and then back to college in 1865. By means of
credits granted for war service and for hospital service in the army,
he was able to graduate the next year, and then his life was before
him. He enlisted in the navy and saw service at the Isthmus and
at Havana, and there got an experience in malaria and yellow
fever, which he did not forget, for later on when the experiments
at Havana proved the source of infection, Dr. Pilcher was among
the first to recognize the discovery and report in his journal its
importance.
Page Twelve It would be tedious minutely to follow his subsequent
career. He left the navy and, recognizing his limitations, due to
his short course at the Medical School, began intensive study to
better himself. Settling in Brooklyn, he founded a school of
anatomy, later incorporated in a medical school, and following
surgery for his life's work, attained high success.
As a teacher his first appointment was as Adjunct Professor
of Anatomy in the Long Island College Hospital. Later for 18
years he was Attending Surgeon to the Seney Hospital.
Following this was a success as a New York surgeon, together with the establishment of a private hospital of his own.
And during all these busy and struggling years he was a
prolific writer, and even as late as 1920, in his 75th year, appeared
in Ochsner's System a chapter by our author on "Surgery of the
Large Intestine."
But long before this he was at work on what constitutes
his greatest plea for the good will of our profession, for his pen
was employed as a journalist in the interest of practising surgeons.
In 1880, he was associated with others in bringing out the
Annals of the Anatomical and Surgical Society, which publication was succeeded next year by the Annals of Anatomy and Surgery—and, in 1885, by the Annals of Surgery. Since that time
for forty years Dr. Pilcher has been the editor of that magnificent
journal. The worth of the man is proved by this work, for no
one but a broad-minded, scientific and practical surgeon could
have made such a success, and through it earned the gratitude of
the profession.
His life's work began before Pasteur and Lister, before
anaesthetics, and thus he lived through the golden age of medicine and surgery, ever keeping abreast of new work, not even
waiting for it to come to America, as his repeated trips to Europe
prove. Great sacrifices had to be endured to make the earlier trips,
and his example should be a source of inspiration to our ambitious
young men to follow along a path which led to success.
Our hero is still with us—still editing the Annals of Surgery—and enjoying the love and respect of the profession as well
as the lesser rewards obtained by a successful career.
Long may our exemplar yet live!
R. E. M.
RECENT ADDITIONS TO THE LIBRARY.
Symptoms of Visceral Disease.    F. M. Pottenger.
St. Andrew's Institute Reports.     Vol. II.
Harvey Lectures for 1922-23.
International Clinics.     Vol. IV.     1924.
Surgical Clinics of N. America.    Oct. and March numbers.
Page Thirteen A Surgical Pilgrim's Progress.     Lewis Stephen Pilcher.
Common Disorders and Diseases of Childhood.     G. F. Still.
4th Ed.    1924.
Crime and Insanity.     Sullivan.
Diseases of the Heart.    Prof. Henri Vaquez.
Goitre,     de Quervain.
Medical Education.    Abraham Flexner.
Principles of Psychotherapy.    Dr. Pierre Janet.
Life of John Hunter.     Stephen Paget.
Works of John Hunter in 4 vols.     1835.
Trans, of Ophthalmological Society of U. K.     1924.
Medical Clinics of N. America.    Nov.,  1924.
G.  U. Diseases.   Compend.     C. S. Hirsch.
Integrative Action of the Nervous System. C. S. Sherrington.
VANCOUVER HEALTH DEPARTMENT.
STATISTICS FOR FEBRUARY, 1925.
Total  population-
Asiatic population-
-estimated     126,747
-estimated       10,000
Rate per 1000 of
Pop. per annum
13.7
Total  Deaths    133
Asiatic Deaths   17
Deaths—residents only   88
Total Births—Male, 155;
Female,  150   305
Stillbirths—not included in above  9
Infantile Mortality.
Deaths under 1 year of age  9
Death rate per 1000 births  29.5
Cases of Infectious Diseases Reported.
22.2
9.0
31.4
February.
Cases.     Deaths.
March to 15.
Cases.     Deaths.
Smallpox            124
Scarlet Fever —.   95
Diphtheria  —•  23
Chicken-pox   55
0
0
1
0
0
0
0
0
0
Measles   3
Mumps 47
Erysipelas . 4
Tuberculosis            28
Whooping Cough I 3
Encephalitis
Lethargica 1               1
Cases from outside City included in above.
Diphtheria 2              0
Smallpox 6              0
Scarlet  Fever    5              0
52
39
8
30
1
25
2
9
2
0
fl'
1
5
0
0
1
0
0
0
0
0
0
0
1
0
0
Page Fourteen B. C. MEDICAL ASSOCIATION NEWS.
The Fraser Valley Medical Society, one of the most active
and progressive in the province, held its monthly meeting on
February 4th. It was attended by all the New Westminster doctors, and also Dr. L. Broe, of Hammond, and Dr. F. D. Sinclair,
of Cloverdale.
Interesting addresses were given by Dr. D. A. Clark on the
"Dick Test and Scarlet Fever," and Drs. Bruce W. Cannon and
G. W. Sinclair (New Westminster) on "Anatomy, Physiology
and Surgery of the Pancreas."
At the next meeting of the Fraser Valley Medical Association, held on March 5th, Dr. W. A. Robertson, of New Westminster, gave an excellent talk on "Fractures About Joints," and
Dr. H. B. McEwen on "Insulin."
Dr. S. E. Beech has relinquished his practice at Ashcroft,
B. C, and is now at Salmon Arm.
Dr. Richard Gibson, who has been in practice in Vancouver
for some years, recently went to Ashcroft to take over the work
of Dr. S. E. Beech at that place. Dr. Gibson has the best wishes
of his many friends in Vancouver.
It is interesting to note that several vacancies in the province
have recently been filled through the business office of the B. C.
Medical Association. This office is gradually becoming a very
busy centre, as it is being more and more used by members of the
profession to help them in their difficulties. Some idea of the
amount of correspondence may be gathered when we say that in
three days, recently, sixty-three letters were sent from our business
office. This is as it should be, and we would urge all those who
feel that we might help them in any way possible, to make the
fullest use of the facilities provided.
A meeting of the Victoria Medical Society was held on Monday, March 9th, at which Mr. R. M. Johnston, Deputy Minister
of Finance of the Provincial Legislature, addressed the members
on "Health Insurance. Dr. Gillespie, of Vancouver, attended the
meeting as a visitor to Victoria. Mr. Johnston's address proved
of deep interest, though he admitted that he did not know all
there was to be known about the subject. In this he finds himself in good company. It is evident that this subject is claiming
the interest of a great many people in different sections of society.
It is hoped that Mr. Johnston may repeat his address in Vancouver at some future date.
The B. C. Medical Association will have the pleasure of
hearing Chief Justice Murphy at a luncheon to be held next
month, when His Honour will speak on "Medical Evidence," or
some allied subject. This address should prove of the greatest
interest to medical men, and a good attendance is hoped for.
The March number of the C. M. A. Journal contains a full
account of the Conference on "Medical Services," held in Ottawa
Page Fifteen last December. A discussion in the case of each paper is by no
means the least interesting or valuable part of the proceedings.
Perusal of these addresses will show the wide range of subjects
touched upon and the keen interest that was taken by those participating.
Dr. R. G. Large, assistant to Dr. H. C. Wrinch, of Hazel-
ton, has been appointed Medical Health Officer and School Medical Inspector for that district, by the Provincial Government.
Dr. D. W. MacKay has left Salmon Arm for Nelson, B. C,
where he will assist Dr. L. E. Borden.
An interesting piece of medical history in British Columbia
is recalled to mind by the retirement, through superannuation, of
Dr. G. L. Milne, Victoria, B. C. A fuller notice of Dr. Milne's
activities appears in the C. M. A. Journal, but it is of
especial interest to B. C. practitioners to refer to the connection
that this well known and well beloved practitioner of medicine
had with the beginning of medical legislation in British Columbia.
In his case history dates back forty years, to a time when B. C. was
a raw province in the making; when the C. P. R., C. N. R. and
P. G. E. were still things of the future, and when everything was
in its beginning. The establishment of a Medical Council; the
enactment of a Medical Act; the defining of Laws and Regulations
governing the practice of Medicine were all to be done, and it is
due to the foresight and statesmanship of men of the type of Dr.
Milne that these things were done, and done as well as they were.
It is surprising to us now that there should ever have been any
difficulty in bringing about this legislation, but it was not without
hard and persistent work that the legislators of those days were
convinced of the necessity for proper regulations of medical practice, and it was not until 1886 that the first Medical Act was
passed. We do well to think occasionally of these men of a day
somewhat behind us, who have retired from active practice, and
are apt to pass more or less into an undeserved obscurity, yet
without whose devotion to the best interests of their community,
and self-sacrifice in serving those interests, we should not now
be in the position of security and dignity that we hold to-day,
and the public would be even worse served than it is at present.
REACTIONS AFTER TRANSFUSIONS.
By Grace A. Wilson, M.A.,
Vancouver General Hospital Laboratory.
Recently a severe reaction followed a transfusion to a baby
from its mother after careful grouping in the laboratory. As
such reactions have been rare in this Hospital, we feel that this case
will be of interest to the profession.
The patient, a young baby, was typed according to the
usual technique and found to be in Group Four.    The mother
Page Sixteen was also found to be in the same group. A transfusion of blood
was given the baby, and no reaction occurred. Six weeks later
the baby was given a second transfusion, using the same donor.
This time there was a marked reaction, and the child was in a
serious condition for several days.
Re-agglutination confirmed the previous findings, at room
temperature both patient and donor being in Group Four. However, when agglutination was done at ice box temperature, the
baby's cells were weakly agglutinated by Sera 2 and 3, showing
At to be a weak Group One. This agglutination disappeared after
twenty minutes at room temperature, only to re-appear on being
returned to the ice box. A cross-agglutination showed a weak
agglutination of the patient's cells by the donor's serum at ice box
temperature, disappearing again at room temperature, thus confirming the grouping test.
This case illustrates the increasing importance of the careful
selection of donors. Though transfusions have been attempted
since the days of the early Romans, the frequency of severe and.
fatal reactions prevented any general use until some form of selection, such as Moss's method of blood grouping, became available
about twenty years ago.
Until recently all agglutinations were done at 37° C, but in
February of last year the Johns Hopkins' Hospital (1) commenced
publishing some studies indicating agglutination in the ice
box to be more delicate and accurate. These investigations have
also shown that by this method there are more than four groups.
It is therefore possible that the above weak Group One reaction
indicates a serious incompatibility of blood in these two individuals.
Another source of trouble which has been reported from a
number of laboratories (2) is the increasing frequency of reaction
in those patients who have previously received donations of blood.
The frequency would seem to increase in proportion to the number of transfusions the patient has received, and would appear
to be more common when the same donor is used. To account
for this, some authors postulate the development of specific antibodies against the donor in question.
Another possible explanation of some reactions is illustrated
by a case (3) in which a severe reaction occurred in a recipient
who was known to be sensitive to milk. On inquiry it was found
that the donor had consumed large quantities of milk prior to
the transfusion.
References:
(1) C. G. Guthrie 8 J. F. Possel.    Johns Hopkins' Bulletin, Feb.,  1924.
(2) McClure & Dunn.  Annals of Surgery, July, '23, P. 1.
(3) W. W. Duke 8 D. D. Stopper.    Med. CI. of North
Amer., Jan., 1924.
Page Seventeen INFLAMMATORY DISEASES OF THE EAR.
By Dr. R. B. Boucher.
PART ONE—Of the External Ear and External Auditory Meatus.
(Paper read before the Vancouver Medical Association,
March 3,  1925.)
Anatomy.
In presenting this paper on some acute inflammatory conditions of the ear, it seems to me to be proper to briefly recall to
your mind the salient points in the anatomy of the ear.
The external ear consists of the pinna and external auditory
meatus. The pinna is a laminar structure, with a pyriform outline and presents a very uneven surface. It consists of a framework
of elastic or reticular cartilage, which gives it its characteristic
shape. Its skin covering is thin throughout, and is connected to
the perichondrium of the cartilage by a scanty subcutaneous layer.
On the outer aspect of the pinna the skin is tightly bound down,
but on its inner, or cranial aspect, its attachment is much looser.
The ear is very vascular, chiefly from the anterior and posterior auricular arteries.
The auriculo temporal nerve sends branches to the outer
aspect of the pinna. The great auricular nerve sends branches to
the greater part of the skin on the cranial aspect of the pinna. The
small occipital furnishes branches to the summit of the auricle,
and to a limited area of skin on the adjacent portion of its cranial
aspect.
The lymphatics from the outer surface feed into the parotid
glands, and especially to one which is situated in front of the
Tragus. The lymphatics from the cranial aspect of the pinna
make their way, for the most part, to the suboccipital or mastoid
glands, which overlie the mastoid bone and tendinous insertion of
the sterno-mastoid.
The external auditory meatus extends from the concha to the
membrana tympani. It is about 35 m.m. long or U/2 inches in
the adult. It is made up of two parts—the cartilaginous and
bony.
The cartilaginous begins at the concha and runs into the
bony meatus.
By its exterior the lower wall forms the roof of the parotid
recess, and is closely invested by the parotid gland. The outer
extremity of the condyle of the lower jaw forms an important
relationship to the carilage of the meatus.
The bony meatus is formed above by the squamous segment
of the temporal bone which juts outwards at this level, forming
the posterior root of .the Zygoma.    The upper and back part of
the outlet is another projecting ridge—the supra meatal spine	
which is formed by a downward projection of the squamous bone.
It furnishes a valuable landmark in  mastoid operations.     The
Page Eighteen floor is formed by the dense tympanic bone. At the termination
of the meatus there is a narrow sulcus running circumferentially,
called the Sulcus Tympanicus, which surrounds the greater part
of the passage, but it is deficient above and in front. It gives attachment in the recent state to the membrana tympani or drum.
The back part of the meatus is covered by a thin layer of compact
bone which separates it at its inner aspect from the mastoid antrum,
and at its outer part from the anterior mastoid cells. The anterior wall of the meatus is related to the posterior compartment of
the Glenoid fossa, which is occupied normally by some dense connective tissue and usually also by a small extension of the parotid
gland. These structures separate the meatus from the condyle of
the lower jaw and from the temporo-maxillary articulation.
The long axis of the meatus inclines forwards and inwards.
It is not quite straight and shows some slight bony irregularities.
The floor at its commencement ascends slightly, and as it approaches its termination it inclines downwards to its junction with
the membrana tympani, forming with it an angle of 45 deg. This
is a favourite locality for foreign bodies.
The calibre of the meatus is not uniform. It is widest at its
commencement and narrowest at its termination, but between these
two it is somewhat constricted—namely, at the junction of the
bony and cartilaginous.
In infants the tympanic membrane is flush with the outer
surface of the skull, the tympanic bone is in an undeveloped state,
and the bony meatus is usually complete about the sixth year,
consequently the canal in infants is much shorter.
Blood vessels. The cartilaginous meatus is mainly supplied
by small branches of the superficial temporal and posterior auricular arteries. The bony meatus is supplied by the deep auricular
branch of the Internal maxillary.
Nerves. The auriculo temporal nerve sends two branches to
the meatus, which reach it by piercing the connective tissue which
connects the cartilage with the bone. The deeper part of the passage is supplied by the auricular branch of the vagus nerve.
Acute Inflammatory Conditions of the External Ear.
Only those of the more common type will be considered.
From without in—
1.     Dermatitis of the Auricle.
Traumatic Dermatitis. This occurs as a result of mechanical
influences such as thrusts, blqws, falls upon the ear, insect bites,
scalding, piercing the ears, and irritation of the cutis through wearing too tight ear-rings. The extent, intensity and duration of the
inflammation depends upon the severity of the injury. Such an
inflammatory process may vary from the slightest form of a transient erythema to the development of a circumscribed gangrene of
the skin.
Page Nineteen Treatment is purely antiphlogistic and is regulated according
to the severity of the inflammation.
Dermatitis erysipelatosa. This form arises from erosions,
excoriations and injuries of the auricle and external meatus, and
is due, of course, to the entrance of the streptococcus erysipelatosus.
Its occurrence is facilitated by all forms of moist eczema, by erosions, maceration, and fissure formation of the cutis, due to purulent discharge from the ear. Primary erysipelas of the auricle is
rare. It usually occurs in combination with that of the face and
head, occasionally it extends into the canal of the ear. It is not
necessary to enlarge on this condition, as you are all only too
familiar with it.
Dermatitis Phlegmonosa. Usually follows an injury. It
usually begins as a superficial dermatitis accompanied by high fever.
It closely resembles an erysipelas, but extends into the deeper parts.
The ear, as a rule, becomes extrmely sensitive in 24 to 48 hours,
and a distinct fluctuation can be felt on the third or fourth day.
After incision it heals readily.
Dermatitis congelationis auriculae — commonly called chilblain or frostbite.according to severity.
The skin of the auricle is specially predisposed towards this
form of inflammation. This is explained by the fact that it is
exposed to atmospheric influences, that it has a relatively thin
cutis, and that the subcutaneous tissue, which separates it from
the cartilage, is tense and scanty. All forms of this trouble are
observed on the auricle. The acute hypersthenic forms which
arise from excessive cold, with a simultaneous freezing of the
nose, may lead to partial necrosis, and gangrene of portions of
the skin and cartilage with partial loss of the auricle. This is
specially prevalent in the north. We also meet with the chronic
form associated with moderate swelling and redness, and finally
circumscribed, rather sharply defined dermatitis—the true frostbite.
Tissue changes lead to the formation of nodules and excoriations, especially on the elevations of the auricle—most frequently
on the helix. These show little tendency to heal and are sooner
or later covered by crusts tinged with blood. After these have
been cast off, desquamation of the skin often remains for a long
time. Young chlorotic individuals, especially girls, are most
often affected by this affection. It appears at a fixed time every
year, at the beginning of cold weather. It must be mentioned,
however, that it is not necessary (in those predisposed) for the
temperature to be below the freezing point in order to bring on
the mild type of this trouble. It occurs more frequently in the
low temperature of the autumn, and is especially occasioned if
the patient has been exposed to atmospheric influences for a long
time.    The following subjective symptoms are important:—
Lancinating pains when the auricle is exposed to the air,
especially when it is dry and the wind severe;   itching, burning,
Page Twenty and a feeling of heat, which induce incessant rubbing and scratching, and which become almost unbearable in heated rooms and
in bed.
Treatment in cases due to extreme cold, snow or ice bags.
In the milder types cold applications of Goulard water or Burrows
Solution is servicable.
Goulard water:—Lead aceate, 170 gms.; lead oxide, 100
gms. to a litre of water, and boiled, sip
Burrows' Solution:—Alumin. Crud, 70, dissolved in 280
parts of distilled water.
The ear may be painted with Iodin. Collodion. For the
intolerable itchiness: Collodion, dr. 1; Ol. Ricini, M.XX; Ol.
Terebinth, oz. 1, is useful.
Frequent applications of camphor ointment are also useful.
Inflammation of the External Auditory Canal.
The cutis of the external meatus is always the seat of the
primary forms of inflammation, and the changes produced here
seldom extend to its cartilaginous or osseous walls. The inflammation is either in the cartilaginous meatus, where especially the
glandular elements of the cutis are affected, or in the osseous portion from which the superficial diffuse inflammation often extends
to the cutis of the membrana tympani. The external meatus is
seldom uniformly inflamed in its entire extent.
Otitis Externa presents a number of characteristic forms, the
peculiarity of which depends partly on the situation and partly on
the nature of the exudate. I will only recall to your mind the
commonest types which you will most frequently meet with:—
(1) Acute Eczema. This affection may be localized either
in the auricle or in the external auditory canal, or it may involve
the whole ear. It begins with great redness and swelling of the
skin, which is soon followed by the formation of numerous closely
clustered vesicles containing a serous fluid. This eruption is msotly
found on the posterior surface of the auricle and on the lobule.
The entire auricle is seldom affected. The vesicles are rarely seen
in the canal or on the drum membrane on account of their early
destruction. After rupture of these vesicles, moist surfaces, denuded of epidermis are seen on the auricle and in the meatus. In a few
days these become covered with a light yellow crust (Eczema crus-
tosum), under which the exudation of a serous or viscid fluid still
continues. Pustules of the size of a bean are sometimes formed,
accompanied by marked inflammatory phenomena. When these
burst, thick crusts are formed under which the purulent secretion
is confined (Eczema impetigiosum). According to Rohrer, the
serous secretion contains diplococci, and in the purulent discharge
which arises later, staphylococci.
Etiology. Acute eczema develops either as a primary affec-
tion or as part of an eczema of the face. It may arise without any
known cause, or in consequence of external agencies, such as cold
Page Twenty-one baths and douches, heat (Eczema solare), warm fomentations or
the application of irritating remedies (chloroform, mercurial ointments, mustard poultices and iodoform). One of the artificial
forms of this disease is that circumscribed eczema which occurs on
the superior surface of the crista helicis. It usually appears symmetrically on both ears and in persons who sleep on hard pillows
of horsehair. Occasionally it comes on as a sequela of seborrhoea
and coincident with pediculosis capitis. Acute eczema not infrequently arises in the course of an acute or chronic ear discharge.
This is due to the irritating discharge and is especially observed in
children and those whose skin is delicate and easily irritated. As
a rule, individuals of a scrofulous dyscrasia and those affected with
rickets are especially predisposed to eczema.
Symptoms. The acute form begins with a feeling of heat,
burning and itching, which is followed by severe pain, after the
appearance of the vesicles.
In children (more rarely in adults) the disease is accompanied
by slight pyrexia, restlessness and sleeplessness. The hearing function is normal in those cases confined to the auricle. If the auditory
canal is affected, a mechanical disturbance of hearing, combined
with tinnitus, arises. Such a disturbance is brought about by
the swelling of the lining membrane of the canal and by the accumulation of the desquamated epidermis and crusts. The inter-
currence of middle ear catarrh is seldom observed.
Course. Acute eczema generally runs a typical course. The
milder forms quickly dry up on the second or third day, the epidermis desquamates and recovery ensues.
In the more severe forms the vesicles rupture early, followed
by clear discharge, which abates after several days, -the exposed
parts becoming covered with light or brownish crusts. Under
normal circumstances when the exudation has ceased, a new epidermis is formed beneath the crusts, which, after the latter have
been thrown off, soon assumes its normal appearance. It occasionally takes several weeks for this to occur. The skin of the
affected area remains hyperaemic for a long time.
Furunculosis of the External Meatus.
Furunculosis of the external auditory canal is a circumscribed
inflammation involving either the hair follicles or the sudoriferous
glands. As these organs are limited to the cartilaginous portion of
the canal, the furuncles are not found in the deeper or osseous portion. They may occur without known cause or they may be part
of a general furunculosis. They may occur in the course of a suppurative Otitis Media, from constant irritating discharge or complicating a chronic eczema. Patients with chronic eczema usually
complain of intense itchiness. Anything from a finger to a toothpick, a match or a hairpin is used to relieve this itchiness. Hence
infection. Any* form of traumatism to the external canal is also
a factor. General debilitating diseases predispose. It is seen in all
.ages.
.Page Twenty-two Symptoms. The hearing is but slightly affected in most
cases, as the lumen of the canal is not completely obstructed. The
pain is more or less intense, according to the depth of the inflammation. The furuncle does not always present the appearance of
a boil, as the skin is tense and closely adherent to the cartilaginous
meatus, thus preventing the usual elevated appearance.
The auricle is extremely sensitive to the touch and the movements of the jaw in mastication cause pain. The tension of the
skin becomes so great that the patient is often unable to sleep.
The swelling of the external meatus is more or less diffused on
account of the close adhesion of the skin to the cartilaginous meatus
and, with the inexperienced may be mistaken for the redness and
swelling in the posterior portion of the meatus in mastoid inflammation. It is easily differentiated, however, by remembering that
the swelling due to mastoid disease is limited to the post-superior
wall of the osseous or deeper portion of the meatus, while that due
to furunculosis is in the posterior superior, or inferior wall of the
outer or cartilaginous meatus. In infants the differentiation is
not easy, as the meatus is very shallow and the swelling is near
the drum.
The temperature is irregularly elevated during the first few
days. Deafness and tinnitus may be present if the meatus is occluded, though they may be present without occlusion, and when
this is the case the drumhead and tympanum are probably involved. The more superficial the furuncle the greater the redness
and the more circumscribed its area. Pain is severe if deep involvement. The redness is more diffused if the deeper tissues are involved. In some cases the surrounding tissues become more or
less swollen, as, for instance, when the anterior portion of the
meatus is involved the skin in front of the Tragus is swollen and
purple in colour and the pre-auricular gland is involved; whereas,
if the posterior portion is involved, the mastoid skin may be swollen and simulate mastoiditis. Cervical glandular enlargement is
not commonly present.
Course. The course varies according to depth. It usually
goes on to suppuration, which takes place in from three to six
days. The pain and swelling rapidly subside after the escape of
-pus. Incision should be made early, as if allowed to rupture
spontaneously, granulations may spring from its centre and delay
recovery.
Recurrences are common. After incision, mopping out with
warm boracic or carbolic and insertion of a wick, is about all
that is necessary. The earlier treatment consists of the instillation of Glyc-ac-carb into the meatus and the application of either
heat or cold. My experience leads me to think that heat is the
most gratefully received. When tension increases, early incision.
Any of the coal tar products give considerable relief to pain.
Plain water seems to lead to a relapse, hence should not be used.
Oiher Forms. Bony exostosis—Strictures—Lues and Lupus
and Mycosis, are other forms only to be mentioned in passing in
this paper.
(To be continued)
Page Twenty-ihree  To the Physicians and Surgeons of B* C,
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Page Twenty-nine   

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