History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: November, 1925 Vancouver Medical Association Nov 30, 1925

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 ^^^^^^^^i^^^^^^^^^^S^^^^
THE VANCOUVER MEDICAL
|f ASSOCIATION
BULLETIN
Published monthly at Vancouver, B. C.
^Progress and future of dM^edicine^
^Kead Injuries
Njfws and V\[gtes
NOVEMBER, 1925
Published by
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*(
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Address ".	
Page Two THE   VANCOUVER   MEDICAL   ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Association
in the Interests of the Medical Profession.
Offices:
529-30-31 Birks Building, 718 Granville St., Vancouver, B. C.
Editorial Board:
Dr. 3. M. Pearson
Dr. J. H. MacDermot Dr. Stanley Paulin
All communications to be addressed to the Editor at the above address.
VOL. 2.
NOVEMBER 1st, 1925
No. 2
OFFICERS, 1925 -26
Dr. J. A. Gillespie
President
Dr. A. w. Hunter
Vice-President
Secretary
Dr. g. H. Clement
Past  President
Dr. H. H. Milburn
Treasurer
Dr. A. B. Schinbein
TRUSTEES
Dr. W. F. Coy Dr. W. B. Burnett
Representative to B. C. Medical Association
Dr. A. J. MacLachlan
SECTIONS
Clinical Section
DR.   W.   L.   Pedlow	
Dr. F. N. Robertson     ---...
Physiological and Pathological Section
Dr. G. F. Strong -	
Dr. C. H. Bastin	
Eye, Ear, Nose and Throat Section
Dr. Colin Graham	
Dr. E. H. Saunders      ......
Genito-Urinary Section
Dr. g. s. Gordon -       -       -       -
Dr. J. A. E. Campbell	
Physiotherapy Section
Dr. H. A. Barrett      -       -       -
Dr. H. R. Ross	
COMMITTEES
Library Committee
Dr. Wallace Wilson
Dr. A. W. Bagnall
Dr. w. D. Keith
Dr. W. F. McKay
Orchestra  Committee
Dr. F. N. Robertson
Dr. J. A. Smith
Dr. L. Macmillan
Dr. A. M. Warner
Dinner Committee
Dr. g. F. Strong
Dr. w. A. Dobson
Dr. l. H. Appleby
Dr. J. M. Pearson
Auditor
Dr. A. C. Frost
Chairman
Secretary
Chairman
Secretary
Chairman
Secretary
Chairman
Secretary
Chairman
Secretary
Credit  Bureau   Committee
Dr. Lachlan Macmillan
Dr. J. w. Welch
Dr. G. A. Lamont
Credentials Committee
Dr. Lyall Hodgins
Dr. R. Crosby
Dr. J. A. Sutherland
Summer School Committee
Dr. Alison Cumming
Dr. Howard Spohn
Dr. g. S. Gordon
Dr. Murray Blair
Dr. w. d. Keith
Dr. G. F. Strong VANCOUVER MEDICAL ASSOCIATION.
Founded 1898. Incorporated 1906.
Programme of the 28th Annual Session
GENERAL MEETINGS will be held on the first Tuesday of the month
at 8 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the month
at 8 p.m.
Place of Meeting will appear on Agenda.
General Meetings will conform to the following order:—
8.00  p.m.-—Business as per Agenda.
9.00  p.m.—Paper of Evening.
1925.
OCTOBER   6th-
OCTOBER  20 th-
NOVEMBER  3 rd-
General Meeting.
Presidential Address:     Dr. J. A.  GILLESPIE.
"The Progress and Future of Medicine."
Clinical Meeting.
General Meeting.
Paper:     DR. HlBBERT WlNSLOW HlLL.
"The Part Played by the Laboratory in Clinical
Medicine."
NOVEMBER   17th—     Clinical Meeting.
DECEMBER   1st-
DECEMBER   15 th-
1926.
JANUARY   5 th—
JANUARY  19th—
FEBRUARY 2nd—
FEBRUARY   16 th—
MARCH 2nd—
MARCH  16 th—
APRIL  6 th—
APRIL 20th-
General Meeting.
Paper: DRS. WALLACE WILSON and LYALL HODGINS.
"Intravenous Therapy."
Clinical Meeting.
General Meeting.
Paper:     DR.  G. F. STRONG.
"Cardiac   Pain."
Clinical Meeting.
General Meeting.
Papers:     DR. J. TATE MASON, qf the Mason Clinic,
Seattle.
"Surgical Treatment of Thyroid Diseases."
Dr. Lester J. PALMER, of the Mason Clinic.
"Some Phases of the Diabetic Situation."
DR. MASON will probably give a Clinic at the V.G.H.
on the morning of Feb. 2nd.
Clinical Meeting.
General Meeting.
The OSLER LECTURE.    Dr. E. D. CARDER.
Clinical Meeting.
General Meeting.
Urological Evening.     DRS.  B.  H.  CHAMPION,  G. H
Clement, G. S. Gordon, and A. W. Hunter,
on
"Problems in Urological Diseases."
ANNUAL MEETING.
Page Four I
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—James Harvey
Robinson   in
"The Humanizing
of Knowledge"
Point of View
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This point of view recognizes the fact that
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Hence, while the Victor X'Ray Corporation
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Thus both medical progress and medical con'
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City	
.State. EDITOR'S PAGE.
We have been favoured by Dr. J. W. Mcintosh, M. O. H.
for Burnaby, with a review of the present position of the scheme
for co-operation in health affairs of a Greater Vancouver and
vicinity. A recent meeting of representatives of these municipalities was held under the auspices of the Vancouver Board of Trade,
at which resolutions favouring the establishment of such co-operation were passed.
Dr. Mcintosh points out that the fields where such co-operation could be utilized are numerous. He shows that the interrelationship produced by the situation of Vancouver and neighboring municipalities is very great. Thus a child might live in one
municipality, go to school in another, contract, say, scarlet fever,
in a third, members of the family may work in one or more of
the municipalities, and finally the only available hospital, we may
presume, is in Vancouver. This means that the machinery of the
several municipalities concerned has to be set in motion, work is
increased and duplicated, much time is lost and the possibility of
infection is greater.
Again, left more or less to individual control, health standards may, and probably do, vary in different districts: one municipality may be more careless, another acting with vigour finds its
work reduced in efficiency by the negligence of its neighbour.
Dr. Mcintosh calls attention to the increase in the incidence
of typhoid fever in Vancouver, nearly 80% of which cases during
the last two years, we find on inquiry, were presumed to be in nonresidents of the city. So far as these were contracted in surrounding districts, it is obvious that proper measures of control (whether
the conveyance be by water, milk or other foods, or by carriers)
are difficult, under present conditions, to apply.
Doubtless, also, the tuberculosis problem is one where municipal health co-operation would find a suitable justification, if such
is needed, for its existence.
Dr. Mcintosh provides us with some figures which are of
interest.
The estimated total population of the area in question, which
appears to include everything between West and North Vancouver
on the one hand, and the city of New Westminster on the other,
is given as 237,000, of which Vancouver has 123,000, the remaining 114,000 being divided among the other districts. While
on this estimate Vancouver has 52% of the population, its area
only amounts to 7% of the whole, the remainder with 48% of
the people having 93% of the land.
Page Six In the nine municipalities in question, Dr. Mcintosh gives
us as the figures for total health administration for 1924 (exclusive of hospital costs) $97,740.56, of which Vancouver contributed 77% and the rest 23%. A comparison of serious import
is made between the cost of the other great spending departments
and that for health purposes. Dr. Mcintosh, quoting the report
of the Inspector of Municipalities, shows that from the year 1916
to the year 1924, on streets and roads there has been an increased
expenditure of 61%, on fire protection 61%, on the administration of justice 55% (this sounds like a federal election speech),
on schools 44%, while even the humble councillor has had his
remuneration boosted 84%. But Dr. Mcintosh points out with
all this expansion the expenditure on public health has not only
had no increase, but has actually decreased 22%.
If these figures are correct, it reveals a state of affairs which
calls most urgently for co-operation if this is going to obtain for
a matter of such vital importance as the health of the people, its
proper share in the disbursements from the public purse.
The per capita cost of health administration is very variable
—ranging all the way from 61c in Vancouver and 45c in New
Westminster, through 26c in Burnaby, 14c in North Vancouver
city and Point Grey, to 8c-in the municipality of Richmond.
It seems probable that some adjustment may be necessary
here. While Vancouver will expect to do her share, and a very
liberal share, to contribute 77°/0 of the cost with 52% of the
population, seems to be stretching the interpretation of the word.
Presumably inadequate supervision in health matters in surrounding districts may be partly responsible for Vancouver's excessive
ratio of expense.
We do not gather clearly from Dr. Mcintosh's communication whether it is the intention to combine all phases of health
work under the proposed Union Board, or whether only the more
general aspects of such work would come under its control. Probably at first the latter course might be adopted as a preliminary
measure to accustom the various districts to the apparent sinking
of their individuality.
So far as we have studied the suggestion, it meets with our
approval. As we have said before, Vancouver, and Greater Vancouver, are one and the same in the light of most public questions.
Expediency and common sense should teach us that the sooner
that fact is given practical effect the better.
We might express our regret that the ideas of those interested in the proposed amalgamation had not been voiced in time
to prevent the erection of the new Infectious Hospital on its present
site.    Such a scheme makes the location of the building appear
Page Seven more unsuitable than ever, and greatly strengthens the arguments
put forward by the medical profession in their opposition to it.
* * *
The annual dinner of the Vancouver Medical Association
will be held on Nov. 5th, at 8 p.m., in the Ambassador Cafe.
The committee in charge of arrangements is anxious that every
member of our Association should make a special effort to be
present on this occasion.
* * *
NEWS AND NOTES.
The first meeting of the winter session of the
Medical  Association  was  held  in  the  Auditorium,
Willow Sts., on Tuesday, October 6th.
Vancouver
Tenth  and
The Dinner Committee elected last spring, having resigned,
Dr. G. F. Strong was appointed chairman and authorized to reelect his own committee.
A report was brought in by the Executive concerning the
relations between the Vancouver Medical Association and the B. C.
Medical Association, recommending that an endeavour be made to
effect a working arrangement between these two Associations and
the B. C. Medical Council, with the idea of centralizing the offices
and lessening the overhead. A new committee was appointed by
the Chair, consisting of Dr. J. M. Pearson. Dr. W. D. Brydone-
Jack, Dr. A. W. Hunter and Dr. E. D. Carder, to go further into
the matter and report back to the Association.
The formation of a Physiotherapy Section was authorized
by the meeting.
Dr. D. G. Perry was elected a member of the Committee of
the Credit Bureau, in place of Dr. J. W. Welch, whose term had
expired.
On the question of nominations for election to the Vancouver General Hospital Staff, a discussion arose, which was adjourned
to be dealt with at a special meeting to be called by the Secretary.
The Secretary of the Summer School reported a very successful session, and later the President was authorized to appoint a
committee to bring in nominations to fill two vacancies on the
Committee of the Summer School.
The following were elected to membership in the Association: Dr. D. E. H. Cleveland. Dr. W. W. Bride and Dr. J. A.
Mclver. Applications for membership were received from the following: Dr. J. W. Arbuckle, Dr. A. Y. McNair, Dr. H. R. Ross
and Dr. W. F. Shaw.
Dr. J.  A. Gillespie delivered his Presidential Address,
subject being "The Progress and Future of Medicine."
the
Page Eight A special meeting of the Association was held on Monday,
the 12th October, to consider the question of Staff appointments
to the Vancouver General Hospital. After considerable discussion, a committee consisting of Dr. H. H. Milburn, Dr. D. Freeze,
Dr. A. S. Monro, Dr. Geo. Seldon and Dr. O. S.. Large, was
appointed to go into the matter and report back to the Association
at an early date.
B. C. MEDICAL ASSOCIATION NEWS.
A full Executive meeting of the B. C. Medical Association
was held in Vancouver on October 15th, 1925, when several important matters were discussed.
The first matter taken up was the question of closer cooperation between the various medical bodies now existing in
British Columbia, with a view to increasing efficiency of the work
done, and diminishing cost to the individual practitioner.
Both the B. C. Medical Association and Vancouver Medical
Association have been working on this problem during the past
two or three months, and the Executive authorized the present
Committee of the B. C. Medical Association to continue in office,
add to its numbers, if necessary, and endeavour to develop a concrete plan to be submitted to the Executive, for their future action.
It is felt that a great deal will depend upon any help the B. C.
Medical Council may see fit to give us, in bringing about a solution to this question. In accordance with a previous resolution
of the Executive, it has been decided to publish, herewith, comparative tables of cost of the work done by the Provincial Associations in the various provinces. So far, Alberta is the only
province from which we have obtained a full statement, which
is appended herewith, but other lists will doubtless be obtained
from time to time. It may be noted that in Alberta the College
of Physicians and Surgeons is amalgamated with the Provincial
Association, and the place of our Executive Secretary is filled by
Mr. Hunt, who is known as Assistant to the Registrar of the
Council.
Alberta.
Assistant $3,600.00
Printing and Stationery    1,223.40
*Law Costs   2,507.56
Audit 	
Rent	
Travelling Expenses.
Interest   and   Exchange 	
65.00
240.00
839.04
34.02
British Columbia.
Executive Secretary $3,600.00
Printing and Stationery        118.80
Audit          75.00
Office Rent        240.00
Travelling  Expenses,
Exec. Sec.       880.00
General      503.00
Stenographer          900.00
$8,509.02 $6,316.80
* Largely no doubt debited to Council.
Page Nine A financial report was made by the Secretary - Treasurer,
showing that the Association is solvent, and that membership is
keeping up well.
The Executive then received reports from its committees.
Dr. Lennie, Chairman of the Industrial Service Committee, gave
a report, dealing with various aspects of industrial medicine,
notably, our relations with the Workmen's Compensation Board,
with whose Chairman he reported a very satisfactory interview.
The matter of Physio-Therapy was referred to, and negotiations
are still proceeding with the Board, with a view to putting the
question of who shall be recognized by the Board as doing this
work, on a definite basis.
The question of Lodge Practice was also brought up, and
it was arranged that this matter should be gone into more thoroughly with the local medical societies.
The Publicity and Educational Committee was reported on
bv Dr. McNeill, the Chairman, who has done a great deal of
work in the matter of laying out a plan of campaign for the coming months. A fuller account of the work of this Committee will
be given as soon as a full report is available.
The following gentlemen were elected to membership: Drs.
H. Winslow Hill, Kingsley Terry, C. D. McBride, George F.
Young, R. G. Large.
The Executive had arranged for a luncheon to be held at
which Dr. T. C. Routley, General Secretary of the Canadian Medical Association, was to have addressed us. Unfortunately, the
dislocation of the steamship service, occasioned by the recent dense
fogs, made it impossible for Dr. Routley to reach Vancouver before the evening, and the luncheon had to be cancelled. The
subject of his address was to have been: "Extra Mural Post-
Graduate Work in Canada," and it is greatly to be regretted that
the Association as a whole has not had an opportunity to hear
Dr. Routley on this matter.
We will not give details of the scheme in this number of
THE BULLETIN, but it is intended to publish in the next number a concise account of the whole plan, as outlined by Dr. Routley, and of our share in it.
^^
Page  I en CITY HEALTH DEPARTMENT
Vancouver, B. C.
STATISTICS—SEPTEMBER,   1925
Total Population (estimated)     126,747
Asiatic Population  (estimated)          9,960
Rate per 1000 of
Pop. per Annum
Total Deaths   114 10.9
Asiatic Deaths   13 15.9
Deaths—Residents only  80 7.7
Total Births—Male,    172
Female,  166   338 32.4
Stillbirths—not included in above  8
Infantile Mortality—
Deaths under 1 year of age        9
Death Rate per 1000 Births 26.6
Cases of Contagious Diseases Reported
August.     September.    October 1 to 15
Cases. Deaths. Cases. Deaths. Cases. Deaths
Smallpox     6 1 2         0 0         0
Scarlet Fever   9 0 13         0 7         0
Diphtheria     9 4 2         0 10         2
Chicken-pox   8 0 5          0 16         0
Measles   0 0 10 10
Mumps   8 0 29         0 32         0
Erysipelas   4 0 2         0 2         1
Tuberculosis   10 8 11        11 3         0
Whooping Cough  6 0 9         0 10
Typhoid Fever   7 0 3          1 10
(Cases from outside city included in above.)
Diphtheria    2 0 10 2         0
Smallpox     6 1 0         0 0         0
Scarlet Fever ..-.  10 7 0 10
Typhoid Fever  7 0 3         0 10
Page Eleven "PROGRESS AND FUTURE OF MEDICINE."
Presidential Address of Dr. J. A. Gillespie, before the Vancouver
Medical Association, at the first meeting of the Twenty-eighth
Annual Session, October 6th, 1925.
In his opening remarks Dr. Gillespie gave a brief sketch of
the early days of medicine, touching, as he went, on some of the
peaks which marked the progress of the art during the earlier
part of its existence.
Coming to later times, the lecturer proceeded: There is no
more fascinating story in the history of science than the story
of the progress of medicine during the last fifty years, which has
■been greater than in all the previous ages. In making an attempt
to trace this progress, I find there is such a wide field to cover that
it is impossible, in the time at my disposal, to give more than a
short sketch of the principal advances in some of the branches of
medicine. This progress is due to the discovery of the causes of
disease and the use of methods of precision in diagnosis of disease,
clinically and mechanically, due to the development of bacteriology
and pathology, the perfection of the microscope and the invention
of many other scientific instruments, the invention of laboratory
methods and Roentgenology, etc., and the assistance of chemistry
and the allied sciences.
Progress of Bacteriology.
In 1857 Pasteur discovered germ life in lactic acid fermentation, but it was not till 1876 and 1878 that Koch discovered organisms of anthrax and wound infection. From that date (less
than fifty years ago) to the present has followed a series of discoveries, with bewildering rapidity, of the great majority of germ
diseases, including typhoid, tuberculosis, malaria, syphilis, diphtheria, bubonic plague, down to scarlet fever and mumps. These
discoveries have revolutionized the treatment of germ diseases and
lowered the death rate enormously. One of the latest discoveries
is that of Dr. W. E. Gye and Mr. J. E. Barnard, published in the
Lancet, July, 1925, of a filterable virus of cancer, an organism
spheroid in shape, previously non-visible, which they have cultured, and photographed by use of ultra violet light. This virus
is not infective alone unless combined with a chemical "specific
factor" which is present in the tumor and which they have isolated from the growths, but by the combination of virus and
"specific factor" they have produced tumors of the same species.
It would appear that this chemical substance must attack the cells
before the organism can produce the disease. This opens the door
to further research along an enormous front, for if these chemical
"specific factors" can be isolated it offers a wonderful field for
preventative measures, and will explain the causes of lessened resistance to infection in individuals and families' which we have
called "Diathesis."    It also offers a great hope for the discovery
Page Twelve of other filterable viruses in such diseases as small-pox, measles,
etc.
Roentgenology.
Roentgen made his first announcement in 1895, just thirty
years ago, and yet to-day Roentgenology is established as one of
the most valuable aids to diagnosis at our command, as well as
being of great value in treatment and an inseparable helpmate to
medicine and surgery. A radiologist to-day is one of the specialists of whose necessity or value there can be no question. Since
its first adoption, advance has been wonderful, due to improvement in apparatus, tubes, intensifying screens, and in the technique, time of exposure, etc. I remember well the crude machines
and methods in use over twenty years ago, when it was common
to see exposures of five to even thirty minutes for skiagraphs, and
burns were quite frequent. The improvement in fluoroscopy and
use of stereoscopic images marked another advance. Then came
the use of opaque contrast materials, as bismuth and barium, for
the intestinal tract, and the silver salts and iodides for urological
work; also its use for diagnosis of chest conditions, as tuberculosis, lung abscess, hypertrophied thymus, aneurysms, mediastinal
tumors, etc.; in face and head conditions to diagnose obscure
fractures, disease of the sinuses (mastoid, etc.), hypophyseal and
brain tumours. Some recent advances have been: The visualizing
of the gall bladder by intravenous and oral administration of
tetrabrom-phenolphthalein; the method of "Rubin" of injecting
air through the fallopian tubes in diagnosis of sterility and to
render pelvic organs visible; the visualizing of brain ventricles
by injection of air; in obstetrics the diagnosing of the position
of the foetus at term and the presence of twins, monstrosities, etc.'
It seems to me its more general use in obstetrics would be of considerable value in doubtful and difficult cases. There has also
been a marked improvement in the diagnosis of bone disease. The
use of the Roentgen ray and of radium in the treatment of malignant conditions, has marked another step in progress of great
value, although it has not fulfilled all the hopes expected of it
in this line. The use of X-rays in skin diseases and in gynaecological conditions, as fibroids and menstrual disturbances, has been
a distinct gain in treatment.
Anaesthetics.
Morton first used ether in operations in 1846, but it was
only after Lister's principles of antisepsis were accepted in surgery
that anaesthetics came into general use, about 1880. Since that
time the use of anaesthetics—general, spinal, regional, and local—
has become so common for major and minor operations and obstetric work, that this might almost be called "the painless age."
To-day the miracles of modern surgery would be impossible without modern anaesthesia.    The marked advance in anaesthetics has
Page Thirteen been in the greater safety and greater freedom from post-operative
complications. There has been considerable improvement in the
materials used, as well as in the apparatus and in the technique.
The use of pharyngeal anaesthesia and suction apparatus in throat
and head operations has been a distinct gain and a great help to
the surgeon. The improvement in the use of nitrous oxide and
oxygen machines, with the addition of ether or ethylene, has
brought general anaesthesia close to perfection. However, there is
still some room for improvement, and the ideal anaesthetic has
yet to be discovered which will give one hundred per cent, safety
with good relaxation of muscles and absence from nausea and postoperative complications. The enthusiasm which marked the introduction of spinal anaesthesia, which I well remember, over
twenty years ago, has passed away, but with improved technique
the objections to its use are being overcome, and spinal and regional anaesthesia are again coming into use, and are an invaluable addition to our anaesthetic armamentarium, especially in a
certain class of cases.
Internal Medicine.
J
The greatest advance in internal medicine has been in the
improved ability to diagnose disease and the more rational and
more scientific treatment. This has been due to the use of accumulated clinical knowledge, combined with all the extra aids to
diagnosis. To-day the laboratory, with all its equipment, the
X-ray, basal metabolism, electrocardiagraph, blood and spinal fluid
examinations, etc., has made such short and easy cuts to diagnosis
that it is feared by some the art of clinical diagnosis is in danger
of being lost. I do not think there is much danger. If quicker
and more accurate and scientific methods are available, why should
we not take every advantage of them? Clinical methods of diagnosis may even tend to be improved when it is known we are
being checked up by laboratory findings. What must be impressed
on us more and more is that laboratory methods are only aids to
diagnosis which must be tested by clinical findings, and our diagnosis made from all the combined information at our command.
A number of years ago the statement was made by a prominent
man that fifty per cent, of hospital cases were not correctly diagnosed. To-day, with the present methods in well-equipped hospitals, I think I am safe in saying that eighty to ninety per cent,
of cases are being correctly diagnosed after careful study.
The most outstanding discovery in medicine has been that
of the internal secretions and the functions of the ductless glands.
Attention was celled to the action of ductless glands by Claude
Bernard and Addison, but it was not till the latter third of the
nineteenth century that any real progress was made. Since then
the functions of thyroid, parathyroid, pituitary, adrenal, pan-
cieatic and other glands have been discovered and gland extracts
and preparations, as pituitrin, adrenalin, and insulin, made avail-
Page Fourteen able, which have been of wonderful value in treatment. No greater miracles have been performed than those wrought by thyroid
in cretinism, or insulin in diabetes. The proofs of the interaction
of these gland secretions, and their effect on disorders of metabolism, has been a fairly recent advance. It is a source of pride that
one of the greatest of these discoveries (insulin) was made by
Canadians, Drs. McLeod and Banting.
It is also interesting that a recent discovery has been made
by other Canadians, Drs. McDonald, James, and Laughton, in
Ontario, to the effect that there is present in liver extracts a certain chemical substance which has the effect of markedly lowering
blood pressure over long periods of time. This promises to be a
discovery of considerable value. The recent discoveries of the different vitamines, and their effect on nutritional diseases, has also
been a step in advance.
I will only mention another advance in therapeutic measures.
The use of intravenous therapy and blood transfusions. This
will be subject of a paper in the near future. The use of serums
and vaccines may be considered an advance; some of them have
proved of value, but I think they are still somewhat on probation.
In preventive medicine and the treatment of infectious diseases the progress has been simply revolutionary. To do justice
to it would almost require a paper on this subject alone. The
foundation was laid by the discoveries of bacteriology, as already
mentioned, combined with the study of entomology along with
animal experimentation, pathology and laboratory methods. The
wonderful experimental and detective work by the men who discovered that insects were the carriers of disease, when the louse
and the flea, the mosquito and the fly, were traced as the culprits
in the spread of many of these diseases, makes very interesting
reading. Fifty years ago the infectious diseases played havoc in
all countries and among all races, practically uncontrolled with
the exception of small-pox, which was being successfully checked
by vaccination, owing to the work of Jenner. Plague and cholera, malaria and yellow fever, typhus and typhoid, tuberculosis
and diphtheria, venereal diseases and septicaemia, demanded their
fearful toll of millions of the human race, sometimes yearly. Today they are practically all under control, and some of them have
been almost completely eradicated from civilized countries. If the
knowledge which we have of the prevention and cure of these diseases could be properly applied, the results would be even greater.
In our own land, typhoid is now a rare disease compared to what
it was in our student days, when the wards of our hospitals were
full of cases. Tuberculosis is being gradually brought under control and the death rate reduced very materially. That the.nations
of the world are fully aware of the value of preventative medicine
is shown by the fact that there is a health committee of the League
of Nations which keeps itself informed of the prevalance of epi-
Page Fifteen demic diseases in different part of the world, and takes measures
to prevent their spread. A year or so ago they voted two million
dollars to prevent spread of typhus from Russia and Europe.
Probably one of the reasons for the formation of the committee
was the demonstration to the nations of the remarkable results
of preventative medicine during the Great War and during the
building of the Panama Canal.
In the treatment of some of these preventable diseases there
has also been great progress, notably, in malaria and tuberculosis,
diphtheria and syphilis. In syphilis the use of the Wasserman
test in diagnosis, and the use of the arsenical preparations, along
with mercury and- iodides, and quite recently bismuth, has been
a wonderful advance. In diphtheria the result of antitoxin treatment has been almost miraculous. Treatment by antitoxin began
about twenty-five years ago. During these years the death rate
has been lowered from forty per cent, to about seven per cent. The
change in recent years from small to large doses has lowered the
death rate materially, and the statement is made that if large doses
of antitoxin were used when first diagnosed, both intravenously
and subcutaneously, the death rate could be reduced to less than
one per cent.
Surgery.
It is in the realm of surgery that the progress has been so
spectacular, and the "miracles of modern surgery" are largely responsible for bringing the medical profession into greater prominence during the last ten or fifteen years. Surgery, at the time
of Lister, compared to the surgery of to-day, is as a new-born
babe compared to an adult man. Lister's original paper was given
in the Lancet in 1867, but it was some years before his teaching
became generally accepted and his principle of antisepsis acted
upon. It is almost beyond the power of the present generation
to realize that forty-five years ago surgery was only an infant in
swaddling clothes. Few surgeons had ever seen a pathological
organism, as Koch only announced his discovery of organisms of
wound infection in 1878. Previous to this time, although anaesthetics had been used for some years, surgeons were afraid to operate. It was an unusual thing for a wound to heal without pus
formation. Practically all wounds, traumatic and operative, suppurated; and erysipelas, septicaemia, and puerperal fever were
common and often spread through whole hospital wards. The
operative mortality was very high, most operations on the upper
abdomen were fatal, and cerebral surgery and chest surgery, as
well as many other branches of surgery done regularly to-day,
were hardly dreamed of. However, with the adoption of the
principles of antisepsis, with the development of bacteriology and
pathology, and with all the improvements in sterilization and
in diagnosis, and in methods of operating, and in instruments,
the progress has been phenomenal. Asepsis has taken the place of
antisepsis;   technique has been simplified and improved;   modern
Page Sixteen hospitals have been equipped with efficient sterilizing apparatus,
and nurses are specially trained in surgical technique, until to-day
thousands of major operations of all sorts are done daily all over
the civilized world with comparative safety and a great measure
of success. The immense amount of surgical work done can hardly
be appreciated. Last year, in Vancouver hospitals, about ten
thousand operations were performed. If the same per cent, to
population was done in other hospitals on this continent, there
were between nine and ten million operations done last year on
the North American continent alone. To-day any trained surgeon can open the abdomen and do major surgery in our modern
Class "A" hospitals, with little fear of sepsis. Operative wound
infections are rare, and the per cent, mortality in all branches of
major surgery, with good operators, is between one and five per
cent. The realm of surgery to-day is so great and embraces so
many different departments, that it would be impossible to trace
the progress, excepting in a very general way, in a paper of this
sort. I can only briefly mention some of the important advances
that I have noticed during the last twenty to twenty-five years.
There has been a wonderful improvement in technique and
in the practice of the principles of asepsis. Doctors are trained
to-day to have an aseptic conscience. Rubber gloves were just
beginning to be worn as a routine measure then. No operation
is performed without them to-day, and this same principle of
thorough asepsis is carried through all surgical technique. In
recent years a great deal of absolutely new work has been done.
These are only a few of the lines in which progress has been
made. I have not time to mention many other branches, such as:
Diseases of children, neurology, eye, ear, nose and throat work,
etc., psycho-therapy, heliotherapy, and many other therapy's.
I can simply say there has been improvement and much new work
in practically all of these.
Results of our progress on the human race can hardly be
estimated. Osier says: "The average working life of the English
speaking man has been doubled and the age of life expectancy
lengthened ten to fifteen years, while the blessings to the whole
race, but especially to child life, old age, and to the female sex,
have been immeasurable."
What of the future? We have made great progress in the
last fifty years, but we need not pride ourselves that we know it
all. We have much yet to learn. I can hardly say there are many
unexplored fields, but I can say: there is room for much progress
yet in some lines. "Knowledge is proud that she has learned so
much. Wisdom is humble that there is so much yet to know."
There are two' or three lines in which I see hopes of much progress. One is in the realm of blood chemistry and biochemistry.
The progress in the future will, I believe, be largely along that
line of laboratory work, as the study is just in its infancy, al-
Page Seventeen though clinical research is also needed. Another line is that of
psycho-therapy. Although the study of mental processes has
made an advance, and there has been a lot of work done in psychology during and since the Great War, still the medical man's
lack of knowledge of psychology and psycho therapeutics is simply
scandalous.
Our treatment to-day of the neurotic and of the functional
neuroses is neither scientific nor sensible. As a rule 'we examine
him and find no pathology as we know pathology. We say, "O
there is nothing the matter with you. It is only your nerves and
your imagination. Forget it, we can't do much for you," and we
send him off. He goes to the quack, the chiropractor or sano-
practor, or Christian Scientist or unchristian scientist who knows
more practical psychology than we do, and we later hear that he
has been wonderfully cured, of what we said was nothing, but
what he felt was a great ailment. There is nothing more amusing in the history of medicine than the cures (real cures too often)
that have been accomplished from the time of the Egyptians to
the present day, from the days of the oracles to the time of Coue-
ism. Perkins' tractors and animal magnetism, and sympathetic
powders and electric belts, and other faith methods, have all been
equally successful, and the twentieth century shows the same
proneness to be cured by anything that acts on the mind rather
than the body. It is interesting to read of these methods in J.
Walsh's book, "Cures." As we have gone on in practice, we have
found that much of the good we have done has been by our suggestions rather than our drugs. Practically all that we older men
know of psychology and suggestion has been rubbed into us by
observation and hard knocks, and I do not see that the younger
men are getting any more training than we did. I do not think
that as a profession we have made much progress in this line since
the days of the ancients, and I can see a wonderful field for progress by a scientific study of mental processes and practical methods
of treatment. One line which I can only mention to-day is the
lack of progress in the medical education of the public.
The standing of the medical profession to-day with the public is nothing like what it should be, and the fault is largely our
own. Little knowledge of the facts, we know, are in the possession of even the so-called educated public. One of the continuous
surprises of my life is to find the little knowledge, even intelligent
people display, of the body and its functions. One of our great
tasks to-day is to give the public some of this knowledge. They
need it for their own protection against all the quacks and charlatans who prey on the public to-day. It is the duty of medical
men, through public speaking (of which most men seem to be
afraid) and of pur medical societies, to educate the people and get
more medical facts into school education.
With our progress have also come our problems. We have
many which I cannot attempt to solve.    One is the problem of
Page Eighteen the specialist and the general practitioner. Specialism is growing
by leaps and bounds, and it is only rational that it should. One
head cannot hold all the knowledge of medicine to-day, but the
general practitioner is being put in the background. Is he to become the clearing house for the specialist, the carrier of grist to his
mill, content with a laborer's wage, while the specialist operates
with a spectacular flourish and collects a big fee? What is the solution of this problem? In Vancouver to-day there are about
33 per cent, of the profession specialists, some of the Simon pure
variety, and some of the mixed hybrid type, and the number is
increasing daily. There is a widespread desire to practice some
form of specialty. Perhaps the solution is for every general practitioner to also have a specialty of some line. This is done in
some places with success. Another solution is group medicine, and
another is that the general practitioner and men in internal medicine must increase their fees, which, in my opinion, are not adequate for the work done, or it may be that a rational and workable form of health insurance will help the solution of this problem.
Another problem which we seem to have always with us,
and which does not seem to be much lessened in spite of the progress we have made, is that of the fads and cults, the irregular
practitioner and the quack, who carry on their business generally
contrary to the laws of our land, and continue to fleece the public
often undisturbed by the powers that be. They have appropriated the name of "doctor" because that name has always carried
with it the idea of scientific knowledge and is a name that carries
influence and prestige. At present in our province any old "corn
parer" or "spine jarrer" can tack "doctor" to his name, and the
general public, in many cases, has not sufficient knowledge to differentiate between the irregular and the qualified man, unless it is
impressed on them when they need a death certificate signed or
some evidence in the courts. A very good suggestion, which is
done in some places, and which would be for the protection of the
public, is to have a law passed making it illegal for the name of
"doctor" to be used by anyone who is not a graduate of a recognized medical or dental college, or unless he has had the degree
conferred on him as a recognized university degree. This might
help the public to tell the difference. However, I think that this
problem would solve itself largely if the public were educated to
the necessity of scientific medical diagnosis by the publicity programme, as I have before suggested. I am not afraid of the future
of the medical profession, and as far as I have been able to ascertain from medical history, even from the Greek age down, there
were irregulars, and Sydenham, in the seventeenth century, complains of all the quacks who attempt to treat the public, and I
think it is no worse now than it ever has been. Fads may come
and fads may go, but the regular recognized medical profession
will go on forever, because, more especially due to the progress of
the last fifty years, it is now a definite science founded on the
rock of truth and the solid foundation- of proven facts.
Page Nineteen rfi
Referring again to the question of specialism, I think it will
be a bad day for medicine when the day of the well-trained medical
practitioner is past (if it ever happens). He is the man who has
to meet the public, the man to whom the public look for advice
and guidance in their sickness, and even for his opinion as to the
need of a specialist. The reason for the esteem in which the profession is held to-day is only partly due to our knowledge and
skill, but mostly due to the character of the men in our profession
in the past. The old genial family practitioner with his sterling
character and his human qualities, has done more to make the profession of medcine honored than all our advance in knowledge—
Men of the type of Ian McLaren's old Dr. McClure, or our Canadian poet, Dr. W. H. Drummond's character, "Le Docteur Fiset,"
"De ole fashion kin',"
Who don't mak much monee;
Doin' good was de only ting on hees min',
So he got no use for de politique."
We all know that the practice of medicine to-day is not an
easy life. It is a hard life and the financial returns are not commensurate with the time spent on education and the work we do
(sometimes twenty-four hours' duty along with considerable physical and mental strain, if one takes any interest in one's patients) .
If a young man to-day has not high ideals and cannot look past
the financial side and the desire for wealth, I do not think the profession of medicine offers him a chance of "getting rich quick."
However, it has always been called "a noble profession" and has
•contained men of the highest character, and all our experience tells
us that men without high character in our profession (of which,
fortunately, we have very few) go to the wall sooner or later.
We have all seen examples of this. However, there are compensations in the medical life, and there is no profession that has the
same opportunities for service and for doing a bit of good in the
world. Not even the clerical profession, because medical men are
brought closer into touch with the lives of the people than any
other class, and understand better their weaknesses and their need
of help and sympathy. So if one wishes for an opportunity to
do service to his fellow men, there is still lots of room in the ranks
of the medical profession. Some of us have been a long time in
the profession, many of us twenty-five years or more. I myself
have been nearly twenty-five years, and I notice many grey heads
among Vancouver medical men. We have lived busy lives, and
the day may come to some of us soon when we will have to lay
down our tools, but if we have tried to "play the game" squarely
and to do what good we could in our humble way, we shall go
down at least honored if not rich.    In the words of the poet:
"We shall rest, and faith we shall need it,
Lie down for an aeon or two;
Till the Master of all good workmen
Shall set us to work anew."
Page Twenty HEAD INJURIES.
Dr. H. W. Riggs.
The importance of head injuries lies in the fact that the skull
contents are of such soft, yielding structure. The skull cap itself
may be severely injured; multiple fractures with or without an
open wound, depressed areas of both tables, or of inner table only,
or, only a linear fracture, are evidence of the severity of the force
producing the injury. Yet the degree of skull injury is not necessarily in direct ratio to the vital effect on the skull contents. This
is demonstrated by the X-rays, which show a closed linear fracture
with symptoms of concussion, which are of short duration and
the patient is ready for duty in a few days, while another linear
fracture may result in the death of the patient. A large compound
radiating fracture of the vault may result in recovery, while a linear
radiating fracture of the base causes death. Yet in a large series
of cases it may be said, with certain reservations, that the more
severe the injury to the bone, the greater the damage to the contents. However, from the clinical standpoint, the fracture (excepting the compound or depressed variety) is only the concomitant
circumstance in a case of brain injury. The lines of treatment are
guided by the symptoms resulting from the latter.
In considering these it is interesting to note that such dissimilar diseases as tumours, inflammations, hydrocephalus and concussions, have such similar manifestations, as slowing of pulse,
vomiting, headache, changes in respiration, in B. P., disturbances
of consciousness and pupillary changes. This points to similar
mechanical or chemical effects upon the same portions of the brain.
When we begin to seek the explanation of these similar effects we must go back to the embryological development. The
vital centres which first make their appearance in the neural development are found in what later become the basal ganglia. As
seen in the lower forms of life, these are all that is necessary for the
continuance of life. As the expression of power increases, it is
found that there is a corresponding development of the cerebrum.
So when we consider the parts of the brain involved in any injury
we find that much damage may be done to the cerebrum without
causing damage to the vital centres, which are in the basal ganglia-
pons and medulla. War experiences have substantiated this, in the
number of cases where severe injuries, with even loss of brain tissue, have occurred and the patient has survived—possibly with
loss of power, but still alive. On the other hand, any severe injury to the medulla, or pons, has been followed by death.
The results of injury to the brain tissue are lacerations, haemorrhage, and oedema. The effect of these will vary with the location. For instance, a severe laceration with haemorrhage occurring in the frontal lobe, is quite compatible with consciousness,
while the same lesion at the base of the brain results in unconsciousness and rapid death.
Page  Twenty-one In recent literature much has been written regarding cerebral
pressure in head injuries. In this connection it is interesting to
recall Breslauer's experiments as to consciousness. He found that
pressure on the cortex did not cause loss of consciousness, but that
it did occur with great regularity when there was pressure on the
posterior fossa, particularly around the medulla oblongata. It
was also shown that the disturbances in circulation and respiration
are due to pressure at the part.
If these results are valid, then the amount of pressure on the
cerebrum is not of such immediate importance in dealing with head
injuries. It means that as far as the ultimate outcome of life is
concerned, it is the pressure on the posterior fossa which counts.
Pressure over the cerebrum only becomes dangerous to life when,
through venous congestion or spreading oedema, the centres in the
medulla are interfered with. The pressure on the medulla may be
due to haemorrhage from injury to brain tissue, as the cerebellum,
or, again, the injury may be severe enough to cause more or less
extensive haemorrhages in the medulla and pons. These, of course,
mean not only pressure but destruction of tissue. Even where
there has not been manifest haemorrhage there is a resulting
oedema. This is probably the result of mechanical injury to the
medulla at the time of the blow, caused by being driven against
the border of the foramen magnum, or it may be hydrostatic—
from the sudden changes in the shape of the skull under the force
hitting it. In any case, it seems as if the condition of pons or
medulla were of chief concern following any injury.
Corroborative of the above conclusions are the clinical course
and the pathological findings in head injury cases. As a rule it
will be noted that the cases which have blows to the side of the
head run a more favourable course. True, unconsciousness occurs,
and there is some disturbance of respiration and circulation, but
never of a serious nature unless there is haermorrhage at the base
of the brain, which may involve the posterior fossa. On the other
hand, antero-posterior blows give very serious results, either from
direct injury or by contrecoup to the parts contained in that fossa.
An interesting case, illustrative of this, is the following:
Mrs. H., age 60, brought into hospital with a head injury,
the result of being knocked down by a motor. There were signs
of injury to the right occiput. She was conscious when she arrived at hospital. Pulse was 60, respiration 20. After one hour
she became unconscious with increase of respiration and weak pulse,
and died within five hours. At autopsy there was found a linear
fracture running vertically through the occipital bone on the right
side—to the foramen magnum. There was an extensive laceration and destruction of tissue at the left frontal lobe, with
considerable haemorrhage subdurally over the left hemisphere.
But probably more significant were the small haemorrhages in
the pons and upper part of the medulla.
Page Twenty-two That death in this case was not due to pressure from the
haemorrhage in the cerebrum, may be inferred when we consider
the amount of pressure which exists in an extra dural middle
meningeal haemorrhage, and the patient still lives.
I do not wish to minimize the question of pressure, but to
show that it is primarily not pressure on the cerebrum, but pressure or injury to the medulla and pons which kills, as I believe
this view has some influence on treatment.
However, before dealing with the question of treatment,
I wish to emphasize the necessity of a careful and frequent examination of the patient from the time he first comes under observation. The condition of pulse, respiration, and pupillary changes,
should be recorded at least every hour. The question of blood
pressure is a debatable one. Personally I have never found any
advantage from the taking of it, but still have it done as a matter
of routine. As soon as the symptoms of shock, if such exist,
are over, the spinal fluid pressure should be taken, and if there is
any change later in consciousness, pulse or respiration, it should
be again taken. In the early stages of the case the examination
of the eye fundus does not give any help. In some cases, after
48 hours, or even later, there may be signs of congestion which
are corroborative of other signs of pressure and may indicate the
side most involved.
In regard to treatment, it follows from descriptions of pathology that the main line is to reduce pressure on the posterior
fossa. Daily spinal puncture with withdrawal of 10-15 cc. of
fluid may assist, although from experiments on healthy individuals the withdrawal of fluid is followed in a short time by
reaccumulation. Probably more effectual is the withholding of
fluids by mouth, and the frequent administration of concentrated
magnesium sulphate solution. This will tend to prevent the
accumulation of spinal fluid, and of oedema in the brain tissue.
It may also tend to the absorption of the diffused blood.
If, in spite of the above, the cerebral pressure as indicated by
the spinal manometer, is still high, i. e., above 20 m.m. with definite pressure symptoms, there must be a decompression done. If
the injury has been an antero-posterior one, I believe an occipital
decompression to be more effective than a subtemporal. Possibly
in some cases both forms would be indicated, certainly I believe
much more effective than a bilateral subtemporal.
In spite of all that can be done, many will die, because the
blow has so disturbed the brain cells, or caused haemorrhages and
pressure in the vital centres that no form of treatment will avail,
but in cases where pressure is continuously higher than normal
the above line of treatment is indicated, and will result in an increasing number of patients recovering, because close attention has
been paid to the question of pressure.
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Page  Twenty-live Gillespie & Ault Ltd.
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Page Twenty-nine
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Trusses, Arch Supports
Abdominal Belts,
Sacroiliac Supports and
Artificial Limbs,
manufactured and made
by Experts and guaranteed
by
A, Lundberg Co.
938 Pender Street West
Vancouver, B. C.
Page Thirty Our
^Advertisers
Use this journal for the purpose
of procuring business from the
Medical Profession.
Are you assisting in the
publication of The Bulletin by
patronizing our advertisers?
C^R
S?^>
Page Thirty-one «@^-
Hollywood Sanitarium
^or the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference ~ <\B. Q. cPttedical ^Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
=K3V
Page Thirty-two

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