History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: March, 1937 Vancouver Medical Association Mar 31, 1937

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 The BULLETIN
OF THE
VANCOUVER MEDICAL
ASSOCIATION
Vol. XIII
MARCH, 1937
No. 6
In This Issue:
PRACTICAL GYNAECOLOGICAL ENDOCRINOLOGY
PROBLEM OF VENEREAL DISEASE
NEWS AND NOTES BULKETTS
(With Cascara and Bile Salts)
. .FOR . .
Chronic Habitual
Constipation
BULKETTS POSSESS ENORMOUS BULK
PRODUCING PROPERTIES AND BEING
PROCESSED WITH CASCARA AND
BILE SALTS PRODUCE BULK WITH
MOTILITY.
WE WILL BE PLEASED TO PROVIDE
ORIGINAL CONTAINERS FOR TRIAL
ON REQUEST.
Western Wholesale Drug
(1928) Limited
45 6 BROADWAY WEST
VANCOUVER   -   BRITISH COLUMBIA
(Or at all Vancouver Drug Co. Stores) THE    VANCOUVER     MEDICAL     ASSOCIATION
BULLETIN
Published ^Monthly under the ^Auspices of the Vancouver ^Medical ^Association in the
interests of the Cftfedical 'Profession.
Offices:
203 Medical Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. H. MacDermot
Dr. M. McC. Baird Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address
Vol. XIII.
MARCH, 1937
No. 6
OFFICERS  1936-1937
Dr. W. T. Ewing Dr. G. H. Clement
President Vice-President
Dr. Lavell H. Leeson
Hon. Secretary
Dr. C. H. Vrooman
Past President
Dr. W. T. Lockhart
Hon. Treasurer
Additional Members of Executive—Dr. A. M. Agnew, Dr. J. R. Neilson
TRUSTEES:
Dr. F. Brodie
Dr. J. A. Gillespie
Dr. F. P. Patterson
Auditors: Messrs. Shaw, Salter & Plommer.
SECTIONS
Clinical Section
Dr. Roy Huggard Chairman     Dr. Russell Palmer Secretary
Eye, Ear, Nose and Throat
Dr. L. H. Leeson Chairmanl     Dr. S. G. Elliot Secretary
Pediatric Section
Dr. G. A. Lamont Chairman     Dr. J. R. Davies. ____ Secretary
Cancer Section
Dr. B. J. Harrison Chairman     Dr. Roy Huggard Secretary
STANDING COMMITTEES
Library
Dr. A. W. Bagnall
Dr. H. A. Rawlings
Dr. W. D. Keith
Dr. S. Paulin
Dr. W. F. Emmons
Dr. Roy Huggard
Publications
Dr. J. H. MacDermot
Dr. Murray Baird
Dr. D. E. H. Cleveland
Dinner
Dr. A. Lowrie
Dr. A. E. Trites
Dr. J. G. McKay
Summer School
Dr. J. W. Arbuckle
Dr. J. E. "Walker
Dr. H. A. DesBrisay
Dr. H. R. Mustard
Dr. A. C. Frost
Dr. J. R. Naden
Credentials
Dr. A. B. Schinbein
Dr. H. A. DesBrisay
Dr. J. R. Naden
V. O. N. Advisory Board
Dr. I. T. Day
Dr. W. A. Dobson
Dr. G. A. Lamont
Sickness and Benevolent Fund—The President—The Trustees
Rep. to B. C. Medical Assn.
Dr. Wallace Wilson Protamine Zinc Insulin
Investigations by Hagedorn and his collaborators in
Denmark, and by Scott, Fisher et al in the laboratories
of the University of Toronto, have shown that preparations of Insulin suitably modified by the addition of
protamine and a small amount of zinc have a prolonged
effect upon being injected subcutaneously. These findings have led to the evolution of a product now designated
Protamine Zinc Insulin, which has been given intensive
clinical trial during the past year.
For a considerable proportion of patients who require the use of Insulin
in addition to the regulation of diet which is essential in all cases of
diabetes mellitus, use of Protamine Zinc Insulin has proved to be
advantageous. In cases where unmodified Insulin provided an inadequate control or required to be adniinistered in several doses daily,
Protamine Zinc Insulin makes satisfactory control practicable. Its
use is often accompanied by a reduction in total number of units as
well as in the number of injections required per diem; and lessening of
fluctuations in blood-sugar levels has a gratifying effect upon patients'
sense of well-being.
In materia medica, Protamine Zinc Insulin supplements rather than
supplants unmodified aqueous solutions of the specific anti-diabetic
principle such as have been in common use since 1922. In some instances the use of unmodified Insulin alone is desirable; in others,
Protamine Zinc Insulin alone is now indicated; while in others, the
use of both preparations gives best results.
Protamine Zinc Insulin (40 units per cc.) is now available in
10-cc. vial packages. Prices and information relating to the
product and its use will be supplied gladly upon request.
CONNAUGHT LABORATORIES
UNIVERSITY OF TORONTO
TORONTO 5      •     CANADA
Depot for British Columbia
Macdonald's Prescriptions Limited
MEDICAL-DENTAL BUILDING, VANCOUVER, B. C. VANCOUVER HEALTH DEPARTMENT
STATISTICS—JANUARY, 1937
Total Population—estimated  253,363
Japanese Population—estimated      8,522
Chinese Population—estimated      7,765
Hindu Population—estimated         352
Rate per 1.000
Number       Population
Total deaths     285 13.3
Japanese deaths          9 12.4
Chinese deaths      12 17.9
Deaths—residents only    256 11.9
BIRTH REGISTRATIONS—
Male, 153 ; Female, 137    290 13.5
January January
INFANTILE MORTALITY— 1937 1936
Deaths under one year of age      16 14
Death rate—per 1,000 births      55.2 43.6
Stillbirths (not included in above) _•__       3 7.
CASES OF COMMUNICABLE DISEASES REPORTED IN CITY
December. 1936
Cases Deaths
Smallpox        0 0
Scarlet Fever I     28 0
Diphtheria         0 0
Chicken Pox       75 0
Measles  1593 5
Rubella         7 0
Mumps   ...     143 0
Whooping Cough .        0 0
Typhoid Fever        0 0
Undulant Fever        0 0
Poliomyelitis         1 0
Tuberculosis        25 13
Meningitis (Epidemic)        1 0
Erysipelas          9 0
Encephalitis Lethargica        0 0
Paratyphoid Fever        0 0
February 1st
January, 1937
to 15
th, 1937
Cases
Deaths
Cases
Deaths
0
0
0
0
25
1
23
0
3
0
3
0
80
0
13
0
1543
2
230
0
0
0
2
0
200
0
105
0
9
0
10
0
3
0
0
0
0
0
1
0
0
0
0
0
19
5
12
■ •
1
0
0
0
7
0
7
1
0
0
0
0
0
0
0
0
EFFECTIVE IRON  MEDICATION!
HEMATINIC  PLASTULES
Three Hematinic Plastules Plain provide the average patient with
an adequate daily dose of iron (ferrous sulphate) to show a marked
increase in hemoglobin.
Hematinic Plastules supply ferrous sulphate and vitamins B and G in
an edible oil in the form of a semi-fluid mass, enclosed in soluble gelatine
capsules which quickly dissolve in the stomach.
Two Types—Plain and with Liver Extract.
SEND FOR SAMPLES AND LITERATURE.
JOHN WYETH & BROTHER, Inc.
WALKERVILLE, ONTARIO
Page 114 OF HYPERTENSIVE
HEADACHES
RELIEVED
FOR rapid, efficient and safe relief of high
blood pressure and its associated symptoms, you can rely on Hypotensyl.
This is a synergistic combination of dependable hypotensive agents—Viscum album (Au-
ropean mistletoe) and hepatic and insulin-free
pancreatic extracts. It hastens recovery and
wins your patient's confidence.
Viscum album has proven remarkably effective for relief of hypertension (O'Hare and
Hoyt 1928, Barrow 1930 and Danzer 1934).
Frequently Hypotensyl effects a reduction of
20 to 30 mm. Hg. in 12 hours. Headaches and
dizziness vanish and reduction is sustained.
Excellent results are obtained in cases of essential hypertension or benign hyperpiesia.
Hypotensyl is also efficacious in treatment of
high blood pressure accompanying pregnancy
or due to fibrotic kidney. The benefit obtained
from careful control of diet, as well as mental
and physical rest, is accentuated by Hypotensyl.
The usual dose is 3 to 6 tablets daily, one-
half hour before meals. Best results are
obtained when treatment is given in courses
lasting two to three weeks, with a week's
interval between, upplied in bottles of 50
and 500 tablets.
HYPOTENSYL
The Anglo-French  Drug  Company
354 St. Catherine Street East               Montreal, Quebec VANCOUVER MEDICAL ASSOCIATION
Founded 1898
Incorporated 1906
Programme of the 39th 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 the Agenda.
General Meetings will conform to the following order:
8:00 p.m.—Business as per Agenda.
9:00 p.m.—Papers of the evening.
1937
February 2nd—GENERAL MEETING.
Dr. T. McPherson and .
Dr. J. D. Balfour: "Obstruction of the Small Bowel."
Discussion opened by Dr. L. H. Appleby.
February 16th—CLINICAL MEETING.
March 2nd—OSLER LECTURE.
March 16th—CLINICAL MEETING.
April 6th—GENERAL MEETING.
Dr. Walter Turnbull and Staff: Symposium on
"Pelvic Conditions."
April 20th—CLINICAL MEETING.
OVOL'S
SPECIALLY DESIGNED
UNMARKED
are UNCOLOURED TABLETS OF
ACETYLS AL. AND COMBINATIONS.
qvol «APCC"
Acetylsalicylic   Acid  3% grs.
Phenacetine    2% grs.
Caffeine  Citrate     % gr.
Codeine   Phosphate     % gr.
qvol «APC"
Acetylsalicylic  Acid  3% grs.
Phenacetine    2% grs.
Caffeine   Citrate     % gr.
qvol «A"
Acetylsalicylic Acid     5 grs.
qvol "APCC2"
Acetylsalicylic  Acid  3% grs.
Phenacetine   2% grs.
Caffeine   Citrate     % gr.
Codeine   Phosphate     % gr.
No packages for laity demand. In bottles of 100 and 500 Tablets only.
Request literature and samples from our Vancouver Branch,
2051 Stephens Street.
MANUFACTURED BY
FRANK W. HORNER LIMITED
MONTREAL, CANADA
Pane 115 EDITOR'S PAGE
A wise man of old, writing an essay on "The Philosophy of Times and
Seasons," said:
"To every thing there is a season, and a time to every purpose under the
heaven ... __ ,
A tune to rend
and a time to sew,
A time to keep silence
and a time to speak."
It will be a very good exercise for any medical man to discover the origin
of these remarks, and we will not spoil the pleasure of the chase by disclosing
their source—but if we were inclined to preach a sermon, no better text
could be found for us at the present juncture of affairs.
It is a difficult time: a time demanding of us cool and deliberate judgment, and sympathy and respectful consideration for those who may not
agree with us, or see eye to eye with us in many regards. It is no time for
destructive criticism only—but constructiveness, honest and sincere helpfulness toward the enhancement of the common good, must be our guiding
motives. Just to rend is not only not enough, it would be unworthy of us;
nor, as we well know, is there any desire to do that, except as preparation for
the reconstruction, the sewing and stitching together of the unfinished
stuff that will make of it a fabric that will endure, and be of real value.
And as regards speech. We are proud of the dignity and forbearance that
have characterized what utterances have been made from our side—and we
applaud the reserve and patience that have been shewn. One is tempted so
often to speak, to explain, to argue, to retaliate—certain things have been
written and said by persons who should know better, which were provocative
and designed to hurt and anger us—but that is not argument, nor does it
advance their cause; and there is a much deeper and more important consideration, that of what will, in the end, prove to be the best and fairest to
all concerned, and will do most to alleviate suffering and hardship, and
promote health and happiness. We are sure that the responsible leaders on
both sides feel this equally, and will together work out a suitable modus
vh/endi. And we feel, too, that when it is time to speak, those who are leading
our side can be trusted, as by their actions hitherto they have shown themselves pre-eminently worthy of our entire trust, to speak reasonably, fairly,
honestly, yet with kindness and generosity, and sympathy for the real difficulties of the position. Till then, we again commend to our readers the little
text with which we began, that they may "read, mark, learn and inwardly
digest it," and continue as they have so well begun.
AMERICAN COLLEGE OF SURGEONS
NORTHWEST SECTIONAL MEETING
The Northwest Sectional meeting of the American College of Surgeons
will be held at the Olympic Hotel, Seattle, Wash., on March 31, April 1 and
2, with Dr. E. Weldon Young, Chairman, and Dr. Edwin A. Nixon, Secretary.
The following speakers are passing through Vancouver on March 28 th
and 29th: Dr. George Crile, Cleveland; Dr. C. L. Scudder, Boston; Dr.
Perry Goldsmith, Toronto; Dr. G. A. B. Addy, Rothesay; Dr. C. C. Higgins,
Page 116 Cleveland; Dr. P. B. Magnuson, Chicago; Dr. M. L. Mason, Chicago; Dr.
G. B. New, Rochester; Dr. B. C. Crowell, Chicago.
A meeting is planned for Vancouver on the evening of March 29th. All
members of the B. C. Medical Association are invited to attend. Further
particulars as to programme later.
A. W. Hunter, Chairman.
ANOTHER "BOOK AGENT" WARNING
Medical men are warned against paying any money to book salesmen
until they are satisfied with their credentials. A certain company seems to
be unfortunate in its representatives, as no less than three men claiming to
represent this company have been found unreliable in the matter of collections in the last three months. Recently a number of doctors in Vancouver
are alleged to have been victimized by a man calling himself "A. J. Shef-
ford," who is taking subscriptions for Mosby journals. In spite of the fact
that a letter was received by the Secretary of the Vancouver Medical
Association from the Circulation Manager of the C. V. Mosby Company
stating that this man was honest and reliable, the Credit Manager of the
same company has now written letters to several doctors in the city stating
that "A. J. Shefford" has no authority to collect subscriptions and that the
company will not be responsible for any payments made to "Mr. Shefford."
The police have been asked to try and locate "Mr. Shefford," but it is feared
that he has left Vancouver.
VANCOUVER MEDICAL ASSOCIATION
SUMMER SCHOOL
The Summer School will be held thisyear in June, from the 22nd to the
25 th inclusive. Lectures will be held as usual in the Hotel Vancouver.
The Committee are happy to announce that the following men have
promised to lecture this year:
Dr. Leonard Rowntree, of the Philadelphia Institute for Medical
Research.
Dr. Wm. Boyd, Pathologist, of Winnipeg.
Dr. Paul B. Magnuson, of Chicago.
Dr. Harold Brunn, of San Francisco.
Dr. Donald V. Trueblood, of Seattle.
Details of the programme are practically complete and a tentative outline will be published in next month's issue.
|    NEWS AND NOTES
The Osier Lecture will be given at a dinner to be held in the Aztec Room
of the Hotel Georgia, on Tuesday, March 2nd. Dinner will commence at 7
p.m. and the lecture at 8 p.m. sharp. Tickets for the dinner at $1.00 each
may be obtained from members of the Executive Committee or at the
Library. Dr. W. A. Whitelaw will be the lecturer this year.
*
.:-
Dr. A. B. Nash of Victoria spent two or three days in Vancouver. He
came over to attend the lectures given by Dr. Walter Schiller.
Page 111 Dr. B. J. Hallows of Parksville came over to Vancouver to hear the
lectures given by Dr. Walter Schiller.
* -_• s> >h
The members of the Eye, Ear, Nose and Throat Section who attended
the mid-winter Clinical Course in Los Angeles have now returned, and all
report a very interesting session and most enjoyable visit in the south.
*■*- *?» *^ »t»
Word has been received in Vancouver that Dr. Howard Caple, who has
been working in hospitals in London, Sheffield and Glasgow for the past two
years, has taken the degree of M.C.G.O. This degree, instituted five years
ago, is held by only three Canadians, as far as can be ascertained. It is
"Master of the College of Obstetricians and Gynaecologists." Dr. Caple is
on the staff of Queen Charlotte Hospital, in London. After the Coronation
he will return to Vancouver with Mrs. Caple.
*** *»• **j* *_*
Dr. W. N. Moray Girling of Vancouver will leave, with his wife and
family, at the end of February to take up residence in the United States.
Dr. Girling will join the Bute Clinic at Bute, Montana. His many friends
will wish him the very best of luck in his new undertaking.
*i* *s* *^ *{•
Dr. A. E. Davidson, of the Provincial Mental Hospital at Essondale,
has returned after spending four months at the Psychopathic Hospital at
Denver, Col.
sS> sj- ;J- sf-
We regret to note the death of Dr. G. A. E. Kelman of Fernie, B. C.
Dr. Kelman came to Fernie in 1923, and was one of Fernie's most popular
citizens. Our sympathy is extended to his wife and family.
THE PROBLEM OF VENEREAL DISEASE AND
THE PROGRAMME FOR ITS CONTROL
Address given ~by Dr. S. 0. Peterson, Director of the Venereal Disease
Department of the Provincial Board of Health.
Mr. Chairman: Members of the B. C. Medical Association:—"In the
beginning God created the Heaven and the earth, man and venereal disease."
In these words Ricord, the famous French venereologist, facetiously
expressed the generally accepted conviction that the venereal diseases
enjoy an antiquity probably as old as Man. There is indisputable evidence
which shows that the Chinese were acquainted with gonorrhoea more than
5,000 years ago. Syphilis, however, as we know it, is a relatively modern
disease. If it was known to the ancients it must have been in some other
form. Syphilis produces highly characteristic lesions and these have not been
described in the older writings. Likewise the bones of those who died in
Europe and Asia previous to the beginning of the sixteenth century do not
seem to show the easily recognized signs of this disease.
Syphilis seems to have been recognized first in Europe late in the fifteenth
century at the siege of Naples, when it broke out in the army of Charles
VIII. Most students believe that it was contracted from the native women
by the sailors who accompanied Columbus when he discovered America.
Spreading rapidly from the army of Charles VIII, it soon became epidemic in Europe, spread like wildfire, and created much havoc. It was variously known as the Spanish Plague or the French Disease. In fact, it was
credited to almost every nation. A friend of mine used to remark, however,
Page 118 that they never accused the Scotch of its origin. The disease, then, is only
about 400 years old, but scientific knowledge of it is even more recent.
Early in the present century progress in the understanding of syphilis became
rapid. In 1903 Metchnikoff and Roux first succeeded in inoculating the
disease into animals, thereby opening the subject to experimental study. In
1906 Schaudinn and Hoffman found and described the germ. In 1907
Wasserman perfected his Mood test for the disease. In 1909, after thirty
years of effort, Ehrlich discovered salvarsan. In 1911 Noguchi cultivated
the germ artificially. Since these fundamental discoveries, enough progress
has been made in the study of the disease to wipe it out entirely in a generation or two if the medical knowledge available could be properly applied.
It is entirely probable that a great step would be taken toward the ultimate solution of the problem of venereal disease control if it were possible
to arrive at some reasonable agreement between health authorities and
specialists on the one hand and the medical profession and the general public
on the other as to the incidence and prevalence of syphilis and gonorrhoea
in the population as a whole. The general acceptance of the extent of its
widespread ravages would compel immediate attention. Those in authority
who have seriously and scientifically studied the situation are of one mind
and in general agreement in respect to these matters. The casual individual,
governed only by general impressions,—and might I say prejudices?—
unsupported by any statistics, is as a rule disinclined to credit the findings
of the first group. Carefully conducted] surveys by responsible health
authorities in connection with other diseases and conditions are accepted
without much controversy, but there seems to be a marked aversion or disinclination to accept the findings in regard to the incidence and prevalence
of syphilis. There is perhaps a very natural and commendable excuse for this
opposition. It is not pleasant to contemplate the statement that such a large
number of people in our midst are the victims of the worst plague in history,
that half of them do not know they are infected, that at least a third of
them are entirely innocent of any wrong-doing, and that the disease ranks
at least fourth among causes of death.
If some agreement between the groups mentioned could be arrived at
by compromise, even at a much lower figure than official estimates demonstrate is the case, a start could be made from that point in a! joint effort
toward better judgment of the situation. If the argument be continued
endlessly no progress will be made. It would be more profitable to discount
every statement in the estimate by half, look at the problem' frankly, and
judge whether it is not even then serious enough to lend every effort towards
its solution.
While we do not have exact statistical knowledge of any disease, accurate
figures on the venereal diseases are even more limited for various reasons.
Half or more of the persons found to have syphilis during routine physical
examination or blood test surveys do not know they are infected. The female
gonococcus-carrier is usually unaware of her condition. Still other persons,
while knowing of their infection, through shame or ignorance attempt self-
treatment or go to "quacks" or drug stores for treatment. But despite these
handicaps a body of useful information has been accumulated as to the size
of the venereal disease problem.
For both syphilis and gonorrhoea the consensus of cases under treatment
on a given day have provided the most comprehensive picture of prevalence.
These studies in the United States have demonstrated that at any time there
may be found at least 683,000 cases of syphilis and 493,000 cases of gonorrhoea under treatment or observation by licensed physicians, including both
Page 119 new and old infections. The incidence-records of fresh infections occurring
annually show 4 per thousand for syphilis and 8 per thousand for gonorrhoea.
Based on these findings it can be said that in the United States approximately
1,5 00,000 persons each year seek treatment for either early syphilis or acute
gonorrhoea. These figures do not include infected persons not under the care
of doctors. Data collected by the American Social Hygiene Association
reveal at least double this number buying remedies in drug stores or going
to unqualified and illegal practitioners. In addition to these, the group of
infected persons not receiving any treatment at all cannot be estimated, but
is admittedly large.
Knowledge of the actual number of syphilis cases in the population is
obtained chiefly through routine blood testing of large numbers of individuals. Many of the supposedly healthy groups have been so tested in connection with obtaining licenses, or routine medical examinations for health
services of one kind or another. These groups have included food handlers,
drivers of public conveyances, barbers, domestic servants, farmers, coal
miners, chemical workers, high school and college students, and applicants
for marriage licenses. The rates recorded have ranged all the way from less
than one per cent to as high as twenty-five per cent. The obvious observation here is, of course, that when one speaks of one in ten or one in twenty
in respect to the prevalence of syphilis, one does not necessarily mean or
imply one in every ten or one in every twenty. The figure naturally is an
average and refers to the mass.
The wide variation in figures are the effect of many social, economic and
other factors. For example, there is nq doubt that a higher disease rate prevails among the class of people who attend clinics; these clinic cases constitute about 40% of all venereal disease cases under known treatment. Among
negroes the incidence of syphilis is said to be four to six times what it is
among the other racial groups' as a whole. There is a higher rate in cities
than in rural communities. About one and a half times as many men as
women are infected. The peak age of infection occurs in young adulthood,
between the ages of 20 and 25 years. Estimates of congenital syphilis in the
population differ according to the experience of the observers. Stokes
believes that from 3 % to 5 % of the whole child population has congenital
syphilis. Jeans and Cooke found in St. Louis that 5 % of the children born
into families of the poor had syphilis, while children of the well-to-do
exhibited a rate of less than 1%. On this basis 2% was estimated as a conservative figure for congenital syphilis in the general population.
Allowing for the relative proportions of these various groups, it is estimated that 5% is a conservative measure of syphilis among men, women
and children in the whole population. Some public health authorities, on a
different basis, have placed the figure considerably higher. Dr. Thomas
Parran, Surgeon General of the United States Public Health Service, recently
made the statement that one adult in ten is infected by syphilis at some time
during his or her lifetime.
In regard to gonorrhoea, our figures are not so satisfactory or definite.
Unlike syphilis with its blood and spinal fluid tests, there are no comparatively simple and positive ways to discover the presence of gonococcal infection in large sample groups of the population. Where opportunity exists
for adequate examinations and follow-up of large bodies of men, gonorrhoea
is found to be far more prevalent than syphilis. In the United States Navy,
for example, there are three cases of gonorrhoea to one of syphilis, and among
the younger men the ratio is over six to one.
It is unfortunate that I am compelled to use figures compiled in the
Page 120 United States, but there are no official estimates available for Canada. I
believe the American estimates are at least approximated here for the following reasons:
1. British Columbia is a seacoast province.
2. It has a large nomadic population.
3. Diagnostic and treatment facilities are unavailable to a large proportion of the population.
4. Even in the cities facilities have been inadequate, and no attempt at
case-finding or follow-up has been made.
5. Only a small fraction of those afflicted with syphilis in the last
twenty or thirty years have received anything approaching modern
standards of treatment requirements.
6. Adequate tests of cure have not been generally carried out in the
past. The number of routine spinal punctures done has been negligible. It is hard to get them done even now, due to lack of hospital
facilities.
Now why do I stress the importance of these estimates of incidence and
prevalence? Simply because the facts are not generally known, even to the
medical profession. The public are quickly becoming aware of them through
wide publicity in the Eastern press, and in popular magazines. The large life
insurance companies also are busy disseminating knowledge as to the prevalence and seriousness of syphilis and gonorrhoea. Recent actuarial studies
show a ratio of approximately 140 to 100 between actual deaths and expected
deaths among syphilitics. February 10th has been designated as Social
Hygiene Day all over the United States, and public education of the facts
in regard to syphilis and gonorrhoea will be carried on by means of the radio,
movies, exhibits and lectures in thousands of communities. A similar campaign of education is contemplated here at a later date as part of the programme of the Provincial Board of Health. It is therefore obvious that the
members of the profession most vitally concerned should have a clear idea
of the extent of the problem.
To stress its importance is but to labour the obvious. Venereal disease is
undoubtedly the community's most urgent public health problem. It is
without question a far greater menace to human life, efficiency and happiness than any other communicable disease. Syphilis is still the killer of the
race, and as a misery producer gonorrhoea remains unrivalled. Parr an states
that automobile accidents in the United States in 1934 resulted in 107,000
cases of permanent disability. Yet in that same year syphilis alone attacked
and disabled more than half a million persons. Fifteen per cent of the blind
have syphilis of the eyes and many more are blind because of gonorrhoea;
10% of admissions to mental hospitals have syphilis of the central nervous
system; 18% of all serious heart and blood vessel conditions are due to
syphilis. Approximately 100,000 deaths annually in the United States are
attributed to syphilis alone.
What can we do about it?
What shall we attempt in British Columbia?
To answer the first question we must know what can be accomplished
by the treatment of the diseases themselves, and in order to estimate what
can be done in this Province we must study what has been done in regard to
their control in other places. We shall study these things particularly in
regard to syphilis, because although progress is being made in the study of
gonorrhoea its treatment is only now in the process of standardization. There
is no disease that offers a more hopeful prognosis than does syphilis. There is
no branch of preventive medicine that offers such promise. Listen to Stokes:
Page 121 "Given a co-operative patient in the sero-negative primary stage of
syphilis, we can promise almost a 100% chance of cure.
"Practically any infectious case can be temporarily sterilized in 3 to 4
days. It can be kept non-infectious by enough arsenicals and by continuous
uninterrupted treatment.
"The number of injections, the preferable drug, the preferable dose, is
now known for every situation involving infectiousness.
"The precise risk of infection for the child is known, for each period of
pregnancy, for each amount of treatment.
"Conditions for stopping, starting and prolongation of treatment are
known.
"Systems for early and latent syphilis, all phases, with proportions of
curative results, exact number of injections, drug, total dose, can be read off
like motor oil charts.
"Nine-tenths of the reactions, complications and troubles of treatment
can be prevented.
"The chief cause, and prevention, of fixed positive blood tests in early
cases is known.
"How to cure 80% or more of previously incurable neuro-syphilis is
now known.
"How to lengthen instead of shorten the life of the heart case is now
known.
"How to cure symptomatic cure in 40 to 100% of stomach and liver
syphilis, 90 to 100% of skin and bone syphilis, is known.
"How to save one eye and prevent involvement of the other in interstitial keratitis, the nemesis of the syphilitic child, is known.
"The superiority of treatment over non-treatment; of modern treatmenc
over old-fashioned treatment, is now established. Modern methods are fully
justified, are superior to the old, second to none, and have negligible disadvantages when properly used. Simplification is bringing them increasingly
within reach of any doctor who can read English, examine a patient, obey
or profit by instructions, clean his hands and tools, use a needle, stop when
he meets a danger sign and seek advice instead of blundering ahead."
Let us now look at what has been accomplished elsewhere. It has been
recognized for a long time that signal success has attended the efforts of
venereal disease control in certain European countries, particularly the
Scandinavian countries and Great Britain. In contrast, it has been evident
that no such diminution in the incidence of venereal disease has occurred
on this continent. In fact it is probable that both gonorrhoea and syphilis
are increasing, not decreasing. It is commonly reported that Denmark has
unusual control of the venereal diseases, especially syphilis, and has practically succeeded in elmiinating this disease from the kingdom.
In July of last year a commission was appointed in New York to visit
and study conditions in regard to venereal disease in the three Scandinavian
countries and in Great Britain.
Their investigation shows that syphilis has declined markedly since 1920
in each of the four countries studied. In the Scandinavian countries it has
become almost a rare disease. In these three countries, with a total population
of 13,700,000, health authorities were notified of less than 1600 cases in
1933. Careful inquiries and corroborative evidence convinced the Commission of the accuracy and relative completeness of the reports. In Great
Britain the recorded prevalence, as indicated by clinic admissions, is now
one-half of that recorded in 1920. In contrast, the prevalence of gonorrhoea
continues high and has not declined proportionately.
Page 122 In all these countries, in law and practise, the control of venereal disease
is a public responsibility, the cost of which is borne generally by the central
government. In the Scandinavian countries, the system by which health officers are notified of all cases, and the requirement that all infected persons
take treatment, are the chief factors in the control. In Great Britain no
legal control over the patient is exercised, entire dependence being placed
upon free clinic treatment for all. Significant success has attended the
Swedish requirement that all sources of infection be ascertained and brought
under treatment.
In all of the countries studied, generous provisions are made for free
clinic and hospital services, readily available at suitable hours, to all comers,
irrespective of their financial status, by competent, well-paid physicians.
This service is in connection with established poly-clinics and hospitals.
Throughout the Scandinavian countries and Great Britain the relationship between the medical profession and public health authorities is close
and cordial. The Scandinavian system seems particularly conducive toward
stimulating a reciprocal interest on the part of the physician toward public
health. In Great Britain the general physicians' apparent lack of desire to
treat venereal diseases undoubtedly tends toward greater use of the clinics
of that country. This is further increased by the inability of a large part of
the population to pay the relatively high fee of specialists, and the treatment
of syphilis and gonorrhoea, both in the male and female, has been segregated
into one specialty in Great Britain. Special venereal disease clinics have been
established, replacing services formerly in departments of dermatology,
urology and gynaecology. Appointments to positions in venereal disease
clinics are made only from those who are proved to be well qualified.
Adequate laboratory facilities for diagnosis are available in each country,
and some form of government supervision of service is maintained. In Denmark the work of the diagnostic laboratory serving the whole country is
integrated with the system of notification, with outstanding success. Both
a complement fixation and a precipitation test for syphilis are the usual
routine in a given case. In Great Britain much reliance is placed upon the
complement fixation test for gonorrhoea.
The reduction in syphilis prevalence seems to have been due to medical
measures rather than to the exercise of moral restraints, as evidenced by the
continued high prevalence of gonorrhoea. In the Scandinavian countries
public education concerning the venereal diseases is not now an important
phase of the programme, although the public is well informed concerning
treatment facilities. In Great Britain education of the public is still considered important. The venereal diseases are discussed in Denmark with
exceptional frankness.
Prophylaxis by chemical or mechanical means is not officially promoted
in any of the countries. In each country the regulation of commercial prostitution has long been abandoned in favor of repressive measures of varying
degrees of severity.
Among the other factors which have enabled the Scandinavian countries particularly, and, to a lesser degree, Great Britain, to make encouraging
progress toward the conquest of syphilis, the following are especially important:
1. A homogeneous population united to a large degree in language, race,
customs and moral standards.
2. A mature civilization in which respect for law and constituted
authority is almost universal.
3. A general high level of education and almost total absence of illiter-
Page123 acy. Especially high standards of education in medical and other
professions.
4. Quack, cultist, and drug-store diagnosis and treatment of syphilis
and gonorrhoea are at a miiiimum in these countries, and the practice
of the healing arts is limited, at least in the Scandinavian countries,
to regularly licensed physicians. A fully developed social legislation
in the Scandinavian countries supports and supplements the public
health and medical laws.
What is the programme for British Columbia?
I shall merely outline it briefly and tell you what has been done and what
our plans are for future developments. I want to state quite emphatically
here that I fully realize the fact that no comprehensive plan of venereal
disease control can succeed here or elsewhere without the wholehearted
support and the actual co-operation of the medical profession.
We have expanded the facilities and services of this division by the addition of a consulting staff of experts at the local clinic. We have increased
laboratory services through the co-operation of the Provincial Laboratory.
We have modernized treatment methods and technique, and have added a
competent social service department. It is our hope that the profession will
acquaint themselves with and utilize all these services; they are all free and
at their command for both pay and part pay patients.
The programme is a result of a conference on venereal disease held in
Vancouver in May, 1936, composed of representatives of the Government,
the medical profession and Health Officers, including, I believe, your President, and embodied in a report with recommendations to the Department of
the Provincial Secretary.
Specific recommendations for this Province follow, and include:
1. The establishment of a Division of Venereal Disease Control, similar
to the Division of Tuberculosis Control, to develop and integrate
the venereal disease work of the Province.
2. The appointment of a Director to develop, direct, and administer
the programme; to direct the work of the central office and to
render service at the Vancouver Clinic.
3. A central office to be established at Vancouver in connection with
the clinic there. In the central office records of all the work throughout the Province would be kept, and private physicians would
report their cases to this office.
4. It was felt desirable to appoint an advisory council upon which
would sit the Provincial Health Officer, the Director and some
members of his staff, one or two other Departmental officials, some
medical men and social workers. The function of the Council would
be to advise on policy administration.
5. Staff.—Several part-time physicians would be required at the Vancouver Clinic and one at Victoria. Part-time assistants might be
appointed to maintain treatment centres at a few other points in
the Province. Several medical-social workers, nurses, technicians
and office workers would also be required.
6. It would be desirable as soon as possible to obtain new and modern
quarters for the Vancouver Clinic. The problem of the Victoria
Clinic should be canvassed with particular reference to the value
of its being transferred to the Jubilee Hospital.
7. There should be established a central records system, based on
reports from the various clinics, from private physicians, laboratories' reports, and reports of the case-finding programme. With
Page 124 these records statistics could be devised to show the incidence of
venereal disease. Central records would provide an indispensable
basis of knowledge for the development of the work.
8. Outlines the development of the social service and follow-up programme by collaboration with the Welfare Field Service, private
social agencies, public health nurses, police, etc. The follow-up of
patients to induce them to attend regularly for treatment would
be the first part of this programme to be stressed. Arrangements
should be made by means of notification of patients, outside physi-
sicians and outside clinics for treatment of those who move away
from the main centres of Vancouver and Victoria. This work will
lay the basis for the use of compulsory treatment among patients,
and families will be sorted out and referred to collaborating agencies
for attention.
9. The development of the case finding programme includes examination of contacts, school medical examinations, examination of hospital patients, certain industrial or trade groups, etc.
10. It is very desirable that the clinics in Vancouver and Victoria
function as teaching centres. Internes from the hospitals should
gain knowledge and experience in these clinics. The clinics should
be in close touch with the consulting staffs of the general hospitals
in Vancouver and Victoria. Through the clinics, education of the
medical profession in the most modern methods of dealing with
venereal disease would take place. There should be cross reference
of cases between the Vancouver clinic and the Outpatient Department of the Vancouver General Hospital, and close collaboration
between the two. Physicians should be encouraged to report on all
cases drawn to their attention. Close collaboration with various
other agencies, including Municipal Health Departments, the Provincial Laboratory, mental hospitals and other health and welfare
agencies is most important. The Division of Venereal Disease Control should have close relations with the Health Insurance Commission and the Indigent Medical Service, both of which will certainly bring to light many cases of venereal disease. With arrangements for adequate service perfected, the Division of Venereal
Disease Control will be in a position to use the compulsory provisions of the Act. It is urged that careful study of the act be made
by physicians, health agencies, etc.
11. And lastly, that an extensive programme of dignified publicity
and education will probably prove to be essential. It has been proposed that the Vancouver Health League could give great assistance
in this connection.
These, then, are the details of the programme as recommended. I am sure
you will agree that they are quite comprehensive and practical. The Government is determined to carry the programme through. The brilliant results
obtained in other places are a challenge to any progressive community to
lend every effort possible in this campaign to lessen the ravages of the
venereal diseases. Enlightened public opinion will very soon force the issue
if health bodies and the medical profession do not take the initiative in collaborative measures against the world's greatest plague.
Let me close with an extract from an editorial in the Journal of the
American Medical Association of July 18. "The conquest of syphilis is the
next great objective in public health—sufficient reliable information indicates that it is probably the most prevalent of all communicable diseases
Page 125 except measles in epidemic years. The history of medicine shows instance
after instance in which the combined forces of medicine and public health
have conquered disease as far as public co-operation could be procured.
With the combined efforts of physicians, public health officials, educators,
and the public, syphilis can be conquered next."
TWO LECTURES ON PRACTICAL
GYNECOLOGICAL ENDOCRINOLOGY
By Dr. Walter Schiller, Vienna.
The Vancouver Medical Association was very fortunate to have a return
visit from Dr. Schiller, whose lecture on Early Diagnosis of Carcinoma of
the Cervix was abstracted in the December, 1936, number of the Bulletin.
Dr. Schiller's ability as a lecturer is due not only to his monumental knowledge of his subject, but to his clear and logical method of building up a
connected and coherent picture, and his habit of summarizing and digesting
as he goes—so that one can follow him without difficulty, assimilate his
offering, and leave with a feeling of satisfaction rather than the repletion
that leads to indigestion afterwards.
Dr. Schiller dealt with the sex hormones, taking those of woman as the
particular ones of which he wished to treat. He spoke at length, and we
summarize his remarks as follows:
Whenever we prescribe sex hormones, in the treatment of illness or
dyscrasia due to their insufficiency or absence, we are prescribing physiological substances, familiar to the organism. They are not like drugs which
we commonly use, e.g., quinine and digitalis, designed to introduce new factors and new stimulations or actions. We can only, in our use of these hormones, reinforce insufficiency, or supply the lack of substances that should
be in the body.
So we must have exact knowledge of the physiological properties of the
glands we are reinforcing or replacing. There is no place for hit-or-miss
therapy; we can only obtain results from accurate application of our
remedy.
With regard to the sex hormones, the first thing we note is that female
sex functions are performed rhythmically, in a definite recurring cycle;
these functions are thus rhythmic or cyclic.
The menstrual cycle is the basis of female sex function—and follows a
definite order.
The second thing that we note is that this female sex function is performed in three different groups of organs, or three stations, as it were, in
three strata. The lowest station is controlled only by the one above, which
in turn is controlled by the highest station. But the top station cannot control the bottom except through the middle station.
We may compare our female system to a house with a basement, a ground
floor and an upper floor.
The basement contains the uterus and is open to inspection and palpation.
Its activities are directed by the ground floor, where the ovaries are.
These control the uterus directly, and govern the menstrual cycle.
In the top floor we have the pituitary gland which controls the ovary.
In a well-regulated administration authority works along defined channels. So the top floor can only influence the basement through the ground
floor.
Page 126
ft 1 Thus we never give anterior pituitary to control the uterus when the
ovary is absent or not functioning.
The menstrual cycle may be defined as the sum of the changes that
take place in the ovaries and uterus (the endometrium of the latter, and to
a lesser but very important extent the myometrium) in cyclic manner,
roughly once a month, the process extending over and being completed in
that time, and ending with the "menstrual flow" unless pregnancy supervenes.
Let us consider the endometrium in the first phase (about 2 weeks) of
the cycle. At first as we examine post-menstruation the glands of the endometrium, we find small glands, straight, short, empty of secretion.
For two weeks these enlarge, but remain straight and empty.
This is the stage of proliferation: the first 2 weeks of the cycle.
During the second phase (third and fourth weeks) the glands become
tortuous, and are seen to be full of a mucin-like secretion.
This is the stage of secretion (in humans) and of transformation in
animals. These two phases are fundamentally different.
So our first conclusion is that there must be at least two different hormones responsible for these two different phases—one directing proliferation, the other directing secretion and transformation.
So there must be two phases of ovarian function to correspond—since
the ovary directs the uterus.
As we examine the ovary, its actions and secretions, we find confirmation
of this double function.
At the beginning of the cycle, the adult ovary shews anywhere from 5
to 15 Graafian follicles, 3 to 5 mm. in diameter. During the first half of
the cycle one of these enlarges to 8 to 10 mm.and bursts. This process takes
roughly two weeks. This bursting is known as ovulation. An ovum is
discharged.
After ovulation (note: only one follicle as a rule ripens and discharges)
the follicle collapses, but in a few hours refills with fluid. There is an enormous increase in granulosa cells, not .only in number but in size. These cells
are filled with thread-like granules ('the lutein hormone or luteo-hormone).
We have the familiar corpus luteum.
Luteinization continues for two to four days; this corpus luteum carries
on the work of preparing the endometrium for the embedding and growth of
the ovum. This is its only function, that of preparing the endometrium for a
fertilised ovum. Fertilisation commonly takes place in this two to four days
after ovulation. If it does, the corpus luteum persists, as we know, for
reasons to be described later. If fertilisation has not taken place, the corpus
luteum lives 8 to 10 days only, then degenerates, ceases the production of
lutein and collapses. The mucosa of the endometrium which was supported
and stimulated by the luteal hormone is suddenly cut off, degenerates, and
we have menstruation.
This is what menstruation is, the sloughing off of a mucosa, engorged,
with large, tortuous glands full of mucin, all of which were prepared with
only one object in view, the provision of a bed for the growing organism,
the fertilised ovum.
But we note certain things. Out of the 5 to 15 follicles apparent in the
ovary at the beginning of the menstrual cycle, one one as a rule (occasionally two) enlarges, ripens and ruptures. Why is this so? (in humans at least
—some animals have litters).
There are two answers probable: (1) This follicle as it grows produces
a depressant substance or hormone, which affects other follicles which might
Pane 127 have grown and inhibits them (an anti-ovulating hormone). This is an
interesting theory—as if we could find and produce this anti-ovulating
hormone in sufficient quantities, we could use it as a contraceptive. This
would be the ideal functional way of contraception. So physiologists have
spent years in its search—so far without any result, probably because the
hormone does not exist.
The second explanation is that this follicle grows and bursts because of
stimulation which it gets from the secretion of the anterior pituitary
(prolan), and that there is only enough secretion for one follicle to ripen.
Today we accept this theory.
In mice we see double uteri, and an ovary attached to each. There are
four maturing follicles in each ovary at a time. If we extirpate one ovary,
we get eight maturing follicles in the other. There is enough prolan A for
eight follicles.
In twin pregnancies (non-identical twins) there is an excess of prolan
A. This has been shewn by certain cases where twin pregnancies occurred
while prolan A was being administered.
So the first phase of ovarian action is the follicular phase, the second
phase the phase of luteinization.
The first phase is preparation for estrus, so the hormone is known as
folliculin or estrogen. It has other names, e.g., theelin. This hormone, folliculin, is isolated from the fluid in the growing follicle: hence the name
folliculin.
The second phase is preparation for the embedding of the ovum; of the
endometrium. This is luteinization, and is effected by luteo-hormone or
lutein. Another name given is progestin or progesterol.
The Pituitary
The anterior lobe of the pituitary produces two gonadotropic hormones:
(1) Prolan A, which stimulates the follicle up to bursting, during which
time the follicle elaborates folliculin; (2) Prolan B, which stimulates the
corpus lutein, to produce lutein, and carry on luteinization.
Antuitrin is the sum of these two prolans, A and B.
They have never been satisfactorily separated, and there is no commercially pure prolan A or prolan B.
Folliculin.—As with all hormones, we follow certain rules in regard to
this substance. We must have (1) qualitative tests of its presence, i.e.,
criteria of its physiological action which shew whether it is present or not;
(2) quantitative tests by which we can measure the amount present. This
latter we estimate by biological means.
What is the test for folliculin (qualitative) ? Its work, we know, is to
prepare for ovulation and estrus, and this is its only function. We cannot
imitate the menstrual cycle by giving folliculin alone in any amount. We
can only produce proliferation of mucosal glands in the endometrium, and
ripening of a follicle; we cannot obtain secretion or lead to menstruation.
So if ovarian function is deficient, folliculin alone will not replace it. Lutein
must also be given. (In humans only, the corpus luteum produces a small
amount of folliculin as well as lutein, its chief product.)
We may give folliculin harmlessly all through the menstrual cycle, but
we must never give progesterol, or lutein, before the second phase (third
and fourth week).
The qualitative test of folliculin is obtained from the fact that it produces estrus, a general hyperaemia of the sex organs. Also in rats the vaginal
mucosa shews definite changes. Examination of this, however, by section,
Page 128 ruins the whole vagina, which is very flimsy and thin and so cannot be
practically used.
Smears from the mucosa shew the changed cells cast off, and this method
is of value. Injection of folliculin into castrated adult female mice will shew
changes in the vaginal smears, squamous cells, instead of columnar.
The quantitative test. Here the unit is the smallest amount which will
produce estrus in a castrated adult rat or mouse (rat-unit, or mouse-unit, as
the case may be—these are by no means identical).
This equals 1 rat-unit of folliculin.
But folliculin has been isolated in the pure form, and now we use as a
standard that 1 mg. pure theelin (folliculin) equals 3,000 rat-units (Dorsy)
or 10,000 international units (I.U.).
Where do we find folliculin?
(1) In liquor f olliculi, and, in lesser amounts, in human corpus luteum
also; (2) in the blood serum of pregnant women in considerable quantities;
(3) in placenta in very large quantities; (4) in the urine of pregnant
women (3,000 to 4,000 units daily); (5) in mares' urine we get as high as
50,000 to 200,000 units per day.
This gives us a cheap, plentiful source, in a watery medium, easy to
isolate.
It has been found that male urine also contains folliculin: hence folliculin. is not a sex hormone. It is also found in the blossoms of trees, even in
the roots and leaves.
So folliculin is not a sex hormone at all, but the proliferation hormone.
It is the hormone of growth and is found even in the oil from oil wells.
In animals it is concentrated in the sex glands, especially in the female;
but wherever the process of proliferation is concerned, we find folliculin.
What is the practical use of folilculin? Why do pregnant women have
so much? Its function is to stimulate and support the growth of the foetus;
and we know that it is essential to this. Babies, otherwise healthy, born at
seven or eight months, will die, because they are cut off from the supply of
folliculin, the growth hormone.
The full-term baby actually excretes folliculin, and gets more from the
mother's milk.
Schiller was able, by giving folliculin to premature babies, to raise the
number of those surviving to three times the usual number.
Where twins have been born, one smaller than the other, by giving
folliculin to the smaller, we can increase its growth to be larger than the
other.
But, if we are going to give folliculin to the premature child to save it,
we must give it within ten hours after birth, or the interruption is fatal.
We give it in small quantities, 80-100 units per diem, divided in two
doses, and given intramuscularly; keep it up for two to three months only.
Then we stop it, and if curve of growth continues, cut it off completely; if
the curve stops we resume its use.
So its first use is in prematurity.
We can give folliculin wherever there is impaired ovarian function, e.g.,
dysmenorrhoea, deficient, insufficient ovarian function.
Thus for dysmenorrhoea it is given.
Also, for sterility, it is given to ensure development of follicle and ripening of ovary, and to prepare the way for lutein (see below). We must give
large doses, for the first two to three weeks of phase, for two to three months.
Page 129 The oral administration is very wasteful, and one unit by hypo equals
about 15 units by mouth.
Usually we give 5,000 units three times a week, or 10,000 twice or
50,000 once. It may be given in rectal suppositories, but not in vaginal.
There is no danger in overdoses.
A third use is derived from the fact that folliculin makes the vaginal
epithelium thicker, higher, and more resistant to disease, in all mammalia.
Thus a pregnant woman never develops vaginitis, or gonorrhoea.
It can be used thus in g.c. infection, and in the g.c. vaginitis of children.
We must carry on the treatment for months in children; but in the adult,
we can get rid of g.c. in 10 days in a simple vaginitis by raising the resistance.
We give small doses at first, 100-200 units per diem, not massive doses.
Dr. Schiller gave some warnings about the use of folliculin—or rather
about the dangers of its abuse.
In the first place, it must never be given where cancer is present. It
causes rapid growth of cancer—especially cancer of the breast or uterus.
Secondly, there is a danger of addiction. Patients find it gives them
energy and strength, and not only come to rely on it, but become very helpless without it. This is a very serious danger.
It can only be avoided by regular intermissions of the use of the drug, and
these intermissions are essential.
SECOND LECTURE
Folliculin (Continued)
This is a very stable substance: can be boiled for hours without any
chemical disturbance; can be boiled in 5 % acid or alkaline solutions without
damage. Thus it can be sterilised for use by boiling.
Its stability is also shewn by the fact that it is found in oil as it comes
from wells. This means that it must have remained unchanged under very
severe conditions of heat for thousands of centuries—coming originally from
wood.
Progesterol or Progestin
This is the hormone that prepares the uterus for the embedding of the
ovum, for placentation: it does the progravid or progestational preparation,
hence the name. It is the luteo-hormone, derived from the corpus luteum
which remains after ovulation.
Ascheim and Zondek, especially the latter, did the classical work on
folliculin. They worked out the qualitative tests for this substance through
its effect on the sex organs of the mouse and other animals.
But Zondek, who did so much work on folliculin, missed progestin
entirely, because he did his work entirely on mice and rate, examining the
vaginal changes.
The vagina of mice indicates only the estrus phase, i.e., folliculin action,
but it does not in any way reflect the action of progestin.
Progestin affects the uterus: and we find it does this in two ways: (1)
It affects the endometrium, producing tortuous cells, full of secretion, with
hyperaemia and cedema of the whole endometrium (Corner and Clauberg) ;
(2) it affects the myometrium, producing certain effects, to be detailed later.
Our qualitative tests for progestin are derived from the first of these.
Corner and Clauberg worked not on the vagina of mice, but on the uterus
of rabbits, choosing the infantile female rabbit. The endometrium here shews
folds with simple tubules.
As the rabbit grows older the tubules enlarge, but remain straight and
Page 180 are non-secreting. There is simple proliferation, due to the presence of folliculin, developing in the ovaries.
But as lutein appears we see great enlargement and tortuosity of tubules
(pro-gravid phase) serving for the embedding of the ovum.
The three stages of the endometrium are: (1) infantile—pre-menstrua-
tion; (2) proliferation—adult; (3) secretion—pro-gravid.
Clauberg first gave large doses of folliculin to the infantile rabbit and
secured proliferation, but even with such doses as eight to nine hundred
thousand units he did not obtain any secretion phase. But when he gave
progesterol, he obtained a secreting phase, exactly analogous to the changes
in the human.
So we prove the presence of progesterol by giving first folliculin to the
castrated infantile female rabbit (folliculin must be given to prepare the
uterus by proliferation), then the substance we wish to test. If progesterol
is present we get pro-gravid changes.
Quantitatively, the minimum amount necessary to produce pre-gravid
changes in the castrated inf antile*f emale rabbit is one rabbit unit.
Clauberg found further—and this is important clinically—that luteal
hormone has no influence unless folliculin has been first given—luteo-hormone does not act on a pre-prolif erative endometrium.
So we neVer give luteal hormone without having first given a sufficient
dose of folliculin.
Luteal hormone has the function of preparing the uterus for pregnancy
—and nothing else. If the ovum is not fertilised, the corpus luteum collapses suddenly, and this causes menstruation, degeneration of the mucus
membrane.
The corpus luteum does not prepare for menstruation, but for pregnancy.
This is a very important distinction. Menstruation only occurs after its collapse. In 16 cases of laparotomy where a corpus luteum was found to be
present and removed, 14 menstruated in three to four days.
If the corpus luteum remains there will be no menstruation.
So when we given lutein following folliculin, we cannot expect menstruation as long as we keep up the luteo-hormone administration. Stop it
suddenly, and we get menstruation.
As a converse action, we can postpone menstruation by giving daily
doses of luteal hormone. This was done during the Olympic games, where
women athletes whose menstrual period was due to occur on or about the
date on which they were to compete, were treated with luteo-hormone in
large doses during the third and fourth weeks of their cycle, menstruation
was postponed for three or four days, and they were enabled to appear in
their events.
Myometrium
Next we have a test for the effect of luteo-hormone, or progesterol, on
the myometrium. This was discovered by Knaus, who started 15 years ago
a series of studies on the contractibility of the uterine muscle.
He found that the uterus of normal women shews regular contractions
occurring every minute or two; minimual in amount, but definite. The
uterine muscle thus engages in rhythmic contractions as does the heart, but
these are at a different rate and very* slight in comparison with cardiac contractions.
This was in itself a very interesting discovery—but he discovered something else, even more significant. These rhythmic contractions are only found
in the first two weeks of the cycle; after which, in the third and fourth
weeks, they disappear entirely, and the uterus is completely relaxed.
Page 131 Why is this? The answer is not far to seek. The uterus has to get ready
for the embedding of a fertilised ovum. This could not occur in a wrinkled,
contracting mucosa. There must be a smoothed-out, relaxed bed prepared
for the ovum, and there must be peace and quiet for it to grow.
As to the mechanism of this process of relaxation, Knaus discovered that
progesterol paralyses uterine muscle.
Thus we see that progestin has at least two functions: (1) It is responsible for secretion in the glands of the endometrium, for a great increase in
size, and tortuosity; (2) it paralyses the uterine muscle, and so prepares a
quiet, restful bed in which the fertilised ovum may grow in peace.
So from this Knaus developed a quantitative test for progestin: namely,
the minimum quantity necessary to paralyse the uterine muscle within 24
hours against the largest amount of pituitrin (post-pituitary secretion).
This amount is one Knaus unit.
Biochemists have produced crystalline progestin, and we may measure
it quantitatively as follows: 1 mg. progesterol or progestin equals 1 Corner
unit, or 2 Clauberg units, or 6 clinical units.
Generally, British and American firms equate one rabbit unit to one
Corner unit.
Progestin is a neutral white substance, soluble in ether, esterol, or olive
oil, but not to any extent in water, hence "watery" solutions are not reliable,
and are far too weak.
Oily solutions may be given intramuscularly, but are useless by mouth.
It is a fairly stable substance, somewhat affected by light and heat, so
must be kept at a low temperature in the dark. It deteriorates at a fairly
rapid rate, and preparations older than one year should be discarded, as of
uncertain titre.
For what purposes may we use progesterol? A careful consideration of
its action will suggest certain of them, and some of them have been described,
e.g., to postpone menstruation, and in cases of amenorrhcea which are due
to insufficient progesterol. In this latter, if we give progesterol, we must do
so only for a definite time, then stop its use suddenly; this brings on the
flow (the stoppage, remember, not the luteo-hormone, which will postpone
it). Again, we must not forget that folliculin must always be given first,
to prepare the endometrium by proliferation for the action of progesterol.
Sterility.—Where the husband is normal, with normal potent spermatozoa, the uterus and tubes are normal and patent in the wife, but pregnancy
does not occur. Many of these patients are sterile because of insufficient
corpus luteum; the uterus cannot be paralysed—the ovum cannot find a
restful bed in which to grow: it cannot be embedded.
Most of these women have a longer menstrual cycle than usual and it
is painful. We give luteal hormone (first, of course, giving folliculin in first
two weeks) in the third and fourth weeks of the cycle, and they will become
pregnant.
We give folliculin on, say, the 4th, 7th, 11th and 14th day in good-sized
doses. This promotes estrus, ovulation, and gives enlarged glands. Then on
the 18 th, 19th, 20th, 21st, 22nd, 23 rd and 24th day we give luteo-hormone,
then stop. If fertilisation has taken place, there will be no menstruation; but
we must give menstruation a chance to occur, in case fertilisation has not
taken place. So we stop suddenly—and wait three days or so. If no menstruation occurs, we resume progesterol, and give it on the 27th and 30th
days as an extra safeguard.
Dysmenorrhoea'. prolonged and painful menstruations, due to deficient
ovarian function, are remedied to a great extent or entirely by progestin.
Page 132 Habitual abortion.—The function of the corpus luteum of pregnancy is
to ensure perfect rest for the embedded ovum. This is why the corpus
luteum persists after fecundation and embedding of the ovum. But if the
corpus luteum of pregnancy is insufficiently strong or degenerates too soon,
we get casting out of the ovum—abortion.
This may be habitual and occur in consecutive pregnancies. It is probably
due to some insufficiency of support by the B factor of anterior lobe secretion of the pituitary (antuitrin) or prolan B, that the corpus luteum degenerates far too soon.
The posterior lobe secretion, pituitrin, is antagonistic to luteo-hormone,
and if it is in excess, pregnancy terminates, and the corpus luteum extract
will fail if it is not stimulated by prolan B.
So in habitual abortion, 17 or 18 days after menstrual period has been
missed, due to pregnancy, we give progesterol (2 or 3 injections per week
and carry on for 6 or 7 months).
In two years, Schiller has seen 14 such cases of habitual abortion cured
by progesterol.
Fourthly.—We often see, especially in young girls, a condition in which
the ovary does not produce enough progesterol to give a thorough progravid
phase. We do not see the whole endometrium half transformed; we see half
the endometrium shewing increase of tortuosity, cedema, secretion, etc.—the
characteristic progravid changes—and the other half resting. It occurs in
patches, and we have a jagged surface, as part of the surface degenerates and
is cast off—and severe juvenile menorrhagias. These are accompanying
signs of hypoplasia and sexual infantilism—scant pubic hair, small breasts,
etc.
In these cases marvellous results are obtained by giving progesterol in
heavy doses, following some doses of folliculin.
Schiller has seen cases where haemoglobin has dropped to 25%; where
hysterectomy or vaginal extirpation appeared the only hope for saving life,
saved by giving progesterol, which stopped the menorrhagia completely.
Progestin is the characteristic fejmale sexual hormone, found only in
females. Folliculin cannot replace the deficient function of the ovary—it is
merely a proliferating hormone.
Frigidity, neurasthenia, any condition of insufficient function, must be
treated by progestin (following folliculin).
Progestin is found mainly in the corpus luteum. Commercially, the corpora lutea of pigs are used; but these are small, and the preparation is very
expensive, so that in Europe an ampoule of 20 units strength costs $10.00,
and 20 units is not a large dose.
We are now at the stage with progestin at which we were with folliculin
some years ago; folliculin is now produced much more cheaply, and no
doubt ways will be found in the case of progesterol also.
There are two ways in which it may be more cheaply produced: (1) A
synthetic progestin may be obtained—and its production is claimed by certain German and American firms; (2) we may find a source of larger corpora lutea, e.g., the whale, where the corpus luteum is the size of a football.
In sterility and habitual abortion we must give as large doses as possible,
at least 20 units to the dose. When one remembers that in habitual abortion
two to three doses a week must be given for months, one can readily see that
cost may be prohibitive. We shall see later, in discussing anterior lobe secretion of the pituitary, that in many cases the use of the latter, which is much
cheaper, may obviate the necessity for using progesterol.
Why does the onset of labour occur when it does? The answer to this
Page 133 is found in the relative amounts present in the blood of progestin on the one
hand, and pituitrin, or posterior lobe of pituitary extract, at any given time.
Making quantitative tests during pregnancy, we find that the amount of
progestin in the blood is maximal at the time of conception, and declines
steadily; while the amount of pituitrin is at a minimum at the beginning of
pregnancy, and steadily increases during pregnancy; when it overtakes the
declining progestin, and the lines cross, labour occurs. The placenta contributes a small amount of progestin, but not much. The reason for this onset
at this point is obvious: as long as progesterol predominates, the uterus is at
rest, and the ovum is also at rest; but a powerful stimulant of contractions,
namely pituitrin, is gradually increasing in quantity, till it overtakes and
neutralises the depressant progestin; then it is present in many times its
usual amount, and induces powerful contractions of the uterus.
Pituitary Hormones
We are dealing now with those of the anterior lobe, which control the
ovary in its two phases of activity.
The secretion of the anterior lobe was discovered first by Zondek, who
called it prolan. It is also called antuitrin. It has only one effect, it stimulates
ovarian function.
Thus : (1) it is responsible for the waking-up of the ovary at puberty—it
is the puberty hormone, the gonado-tropic hormone. (2) It stimulates the
follicle, its growth, and so the production of folliculin. Only part of the
antuitrin does this, the fraction known as prolan A. (3) It stimulates the
luteinizing function of the ovary. It stimulates and supports the corpus
luteum, and is so indirectly responsible for the growth of the foetus, for its
continuance at peace, and so on. This action of antuitrin is due to its other
fraction, known as prolan B.
So we use antuitrin A in sexual infantilism, late developments, deficient
puberty, undescended testicle, etc.
We give injections of antuitrin for these purposes, but we must not expect
immediate results; we must expect to have to go on giving it for three or
four months before we get a response. The amount of hormone in the
preparation is small.
B.—We use it to stimulate the development of the corpus luteum. In
women who are sterile, the lack of progestin may be due to lack of prolan B;
and so antuitrin should be given first, before we give progestin. It is much
cheaper, and the pituitary lack is the cause in the majority of sterilities.
Prolan is neither readily soluble nor stable; it is prepared in slightly
alkaline solutions, and deteriorates very rapidly; so it is generally dispensed
in two ampoules, one containing progestin crystals, the other solvent. This
is the best method. Some firms sell a solution, guaranteeing that it will be
at least half the recorded strength at the end of six months.
It is standardised in mice and rat units—the rat unit equals one-eighth
one mouse unit.
Prolan is found in both male and female pituitary glands, not in pregnant
women, but in large quantities in placenta. In hydatidiform mole or chorion
epithelioma we find it in amounts 30 to 40 times normal, and this is a diagnostic sign.
Urine of normal women contains traces of prolan; of pregnant women
8 to 10 or 15 units per day; in hydatidiform mole or chorion epithelioma 30
to 50 times as much, i.e., 300 to 500 or more units per diem.
This to summarise the four hormones:
1. Prolan, produced by anterior pituitary, influencing ovary only; has no
effect on castrated individual; contains two fractions: prolan A, controlling follicle, and production of folliculin and stimulating ovulation,
and prolan B, controlling corpus luteum, production of luteo-hormone, and
supporting the corpus luteum of pregnancy.
2. Folliculin, produced by ovary {inter alia) in follicle growth, controlling
oestrus, stimulating proliferation and ovulation.
3. Progestin, produced by ovary (corpus luteum) ; influences myometrium,
causing paralysis and allowing embedding of ovum at rest, and endometrium, causing secretion, cedema, tortuosity, and preparing for embedding
of ovum—later ensuring rest for ovum growth, till overtaken and neutralised by
4. Pituitrin (post-pituitary lobe secretion), stimulates myometrium, causing
contractions; opposed by lutein or progestin.
Page 134 S.U.P.
In inflammatory and septic conditions
THE value of the injection of S.U.P. 36 in many inflammatory and septic
conditions was established in exhaustive investigations many years
ago, and subsequent clinical experience covering more than a decade has
provided confirmatory evidence. The accompanying clinical report demonstrates that from the first injection of S.U.P. 36 the temperature falls and
distress is diminished; the final result is a considerable reduction in the
period of infection, with a shortened and uncomplicated convalescence.
,iuie u,i-'vi-'- —  <--   x-_a   ,  u_i3 __.'_~e.   was  itsscncu tiiiu   luc  yctuciii, Slept P-
fully. On the third day, morning temperature was 103°. S.U.P. 36 was repeated
again and the evening- temperature came down to 100°. On the fourth day the
morning temperature was 99° . . . the evening temperature came down to
normal and the lungs were quite clear. . . ." •
Stocks are held by leading druggists throughout
the Dominion, and full particulars are
obtainable from
The BRITISH DRUG HOUSES (Canada) Ltd.
Terminal Warehouse Toronto 2, Ont.
SUP/Can/37
Cocomalt...
Cocomalt is a delicious, easily digested and nourishing
food in powder form, designed to be mixed with milk.
By laboratory analysis Cocomalt contains:
Moisture, loss in vacuo at 6 5 ° C. 0.88%
Fat  3.68
Protein (N x 6.25) 13.06
Crude Fibre __  0.74
Mineral Matter-Ash 3.33
Carbohydrates (by difference) 78.31
Calcium  0.30
Phosphorus    0.33
Iron, Fe  0.02
(SAMPLES SENT TO ANYONE ON REQUEST)
WESTERN CANADA AGENTS:
SCOTT-BATHGATE CO., LTD.
WINNIPEG      ::     VANCOUVER
Qcomalt
Aoe-icious food drink
CHOCOLATE FLAVOR 'ELSIE'S CRAMMING FOR
HER EXAMS-
BORDEN'S REQUIREMENTS
ARE SO TERRIBLY STRICT,
YOU KNOW"
Bpillli
_____
IB&i
_-__HHl
H»«n__-_l
iSSfl
i^P^Hi
0 L l\l v./ U v L / • i . a cow has to pass some pretty stern
tests on a Borden-approved farm. But otherwise her life is rosy—
fed on selected grasses, housed in a clean and airy barn, visited
often by Borden farm inspectors and veterinarians.
All she must do in return is give an extra-good, pure milk—the
kind from which Borden's St. Charles Irradiated Evaporated Milk
is made.
Thousands of doctors write
"BORDEN'S" . . .
when prescribing" irradiated evaporated milk for infants. Doctors
know, as many mothers do not,
the extra safeguards that protect
ALL Borden products.
If you are not familiar with Borden's St. Charles Evaporated Milk
write The Borden Company Limited, Yardley House, Toronto,
Ont., for professional literature
and samples.
Gordetti:
13o^e*oi .
ib 1
3
SHAFFER'S FOOT
Because   of   the   clawlike
position of the toes in many
of these cases, the defect
is popularly termed trclaw-
foot."  This  condition can
be  completely  rectified
and, with corrective, scientifically built shoes, the
foot made absolutely nor-
^^^^^^m                             mal   -with   my   system   of
Nil H^ii                           manipulation.
___p111P^ ^l^i^i^Hi^^^B
•
Doctors...
We can fit your patients 'with
Made-to-Measure and
Corrective  Shoes
Subject to your Prescription and
Recommendation
•
>4 YEARS' EXPERIENCE IN LAST MAKING AND
CUSTOM SHOE-BUILDING
•
51 WEST HASTINGS ST., VANCOUVER, B. C. Two Products of Outstanding Merit (or Treating . ..
RHEUMATOID ARTHRITIS
PULMONARY TUBERCULOSIS
rsr—-ii —tj —it* —__■ —_j _.__f —JtJt—.nr _=___-
,_J .IJ M >IJ -T __JT
.IJ ___
For intravenous administration
Gold Sodium Thiosulphate—In ampoules of 0.05 Gm.,
0.10 Gm., 0.20 Gm., 0.25 Gm. and 0.50 Gm.
In Rheumatoid Arthritis—'First inject 0.05 Gm. every five days,
then 0.10 Gm. to 0.20 Gm. per week till the total dose of 2 Grams
is obtained (Forestier).
In Pulmonary Tuberculosis—Results recently published show
that gold salts are more effective in the recent exudative type.
Myochrysine
For intramuscular administration
Sodium Aurothiomalate.—In aqueous  solution or in
oily suspension in the following dosages:  0.01 Gm.,
0.05 Gm., 0.10 Gm., 0.20 Gm. and 0.30 Gm.
In Rheumatoid Arthritis—Specially adapted for this purpose;
weekly injections of 0.1 to 0.2 Gm.; the total amount for one
series should be between 1.5 Gm. and 2 Gms.
In Pulmonary Tuberculosis—Recommended in cases where
patients appear to be particularly sensitive to gold and where
intravenous injection seems to complicate treatment unnecessarily.
JLaJurtxiJt^ jyjEAjeA
OF       CANADA       L  I H   I   T  E  D
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Distributors:  ROUGIER FRERES, 3 50 Le Moyne Street, Montreal. COMPLETE X-RAY SERVICE IN YOUR OFFICE
New High-Powered G-E X-Ray Unit is a Boon to Modern Practice
_>W it becomes feasible for you to install in your office a major-calibre
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e G-E Model R-36 Shockproof X-Ray
though it occupies a very small floor
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ire you find the refinement of a control
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Moderately priced, the R-36 represents the
greatest value ever offered in complete diagnostic equipment—probably the big opportunity you
have long awaited.
Address Dept. A53 for the illustrated catalog,
without obligation.
__liii_®e6RPoikAT--ON
2 01 r JACKSON   BLVD.
CHICAGO,   ILLINOIS ALL-BRAN cleanses like a
water-softened SPONG
Kellogg's ALL-BRAN is the
natural laxative food that
corrects common constipation due to meals low in "bulk."
This simple test shows how ALL-
BrAN functions: fill a glass 4/5 full
of ALL-BRAN. Pour water up to the
brim of the glass. Soak 15 minutes,
and drain off excess water. Feel the
water-softened mass. It's much like
a soft sponge. In fact, laboratory
tests show that ALL-BRAN absorbs
at least twice its weight in water.
Within the body, this water-
softened "bulk" gently "sponges"
out the system. ALL-BRAN also provides vitamin B to tone up the intestinal tract, and iron for the blood.
ABSORBS    TWICE
WEIGHT IN WATER
The "bulk" in Kellogg's ALL-BRAJ
is much like that in leafy vegetable!
But with many people, the "bulkl
in fruits and vegetables is large!
broken down in the system . . . an
intestinal muscles get too little e:
ercise. Gentle-acting ALL-BRAN filw
does not break down. So it is muc
more satisfactory.
ALL-BRAN may be served as
cereal,  or   cooked  into  appetizin
muffins, breads, etc.   It is sold b
all grocers. Made
by Kellogg in London, Ontario.        / _ 7****9fctf
Eat tfdloftfff ALL-BRAN
regularly for regularity COLONIC
IRRIGATION
INSTITUTE
Superintendent:
E. M. LEONARD, R.N.
Post Graduate, Mayo Bros.
REALIZING the need for a properly equipped centre where those
suffering from constipation, worms,
indigestion, etc., could be assured of
modern scientific colonic irrigation
and internal medication, E. M. Leonard, R.N., has fitted out operating
rooms with the most up-to-date scientific equipment. Here the patient will
receive every attention, and proper
thorough treatment under the care
of a fully trained nursing staff, at a
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Individual Treatment $ 2.50
Entire Course  10.00
Medication (if necessary) $1 to $3 extra
This treatment is beneficial in cases
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worms, diverticulosis, colitis, acne,
and any condition which may have
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ensure comfort, convenience and
thoroughness in these treatments,
call at the Colonic Irrigation Institute, either in Vancouver or Victoria,
B.C. Registered nurses always at
your service.
631 BIRKS BUILDING
VANCOUVER, B. C.
Phone Sey. 2443
•
506-7 CAMPBELL BUILDING
VICTORIA, B. C.
Phone Empire 2721
For
Arthritis
and Chronic
Rheumatism
Prescribe
Lyxan thine
Astier
• Its formula — iodo-
propanol-sodium sul-
phonate, lysidin bitar-
trate, calcium gluconate,
sodium bicarb, tartaric
and citric acids—supplies calcium, iodine and
sulphur, with a powerful   uric   acid   solvent.
LYXANTHINE
I ASTIER
GRANULAR
EFFERVESCENT
clinically effects rapid
disappearance of tissue
infiltration, relieves
pain, promotes protein-
waste elimination, exerts
cholagogue action.
DOSAGE, 1 teaspoonful well
dissolved in a glass of water
every morning, on an empty
stomach, for 20 days. Rest 10
days.    Repeat   if   necessary.
Please send Sample and
literature of Lyxanthine Astier
Dr.	
Address.
City	
Provxnoe..
I_1BVMA
Dr. P. ASTIER LABORATORIES
36-48 Caledonia Road, Toronto A PRESCRIPTION SERVICE . . .
Conducted in accord with the ethics of the Medical
Profession and maintained to the standard suggested by
our slogan:
Pharmaceutical Excellence
AAcGiII 6 Ormo
FORT STREET (opp. Times)      Phone Garden 1196     VICTORIA, B. C.
Nmtn $c 5. if0mB0tt
2559 Cambie Street
ancouver
•; B. C
>c««<jo»-W-^
l^vXvIsjX^^.^jJ
536 13th Avenue West
Fairmont 80
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xclusive
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s
ervice
i
FAIRMONT 80
ALL ATTENDANTS QUALIFIED IN FIRST
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WE SPECIALIZE IN AMBULANCE SERVICE
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R.J.
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J. H. CrELLIN
W. L. Bertrand Dial "Ciba"
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requirements of a good hypnotic.
Cibalgine "Ciba"
Cibalgine represents a non-narcotic analgesic and antipyretic worthy of the physician's confidence. It is indicated in the treatment of pain of every description, febrile
manifestations, nervous excitement, insomnia due to
pain, dysmenorrhoea, etc.
CIBA COMPANY LIMITED
MONTREAL    I     *
flfoount Peasant XDUibertakinQ Co. %tb.
KINGSWAY at 11th AVE. Telephone Fairmont 58 VANCOUVER, B. C
R. F. HARRISON W. R. REYNOLDS STEVENS' SAFETY PACKAGE
STERILE GAUZE
is a handy, convenient, clean commodity for the bag or the office. Supplied
in one yard, five yards and twenty-five yard packages.
ESTABLISHED  NEARLY A
.CENTURY/*
B. C. STEVENS CO.
Phone Seymour 698
73 0 Richards St., Vancouver, B. C.
BO WELL & SON
DISTINCTIVE  FUNERAL
SERVICE
Phone 993
66 SIXTH STREET
NEW WESTMINSTER, B. C.
Breaks the^icibus circle of pervcIJed
menstrual functiqjl in cases oj^mcri^rhea,
tardy periods ||on-p|hysiological)'"and dysmenorrhea. Affords remarkable symptomatic
relief by stimulating the innervation of the
uterus arid  stabilizing the tone of it-
musculature. Controls the utero-ovarian
\   circulation and thereby encourages a
normal menstrual cycle, fp.
_k A
• MARTIN H. SMITH COMPANY
150 lAfAYITTI STRUT. NIW YORK, N. Y.
IS.IW.PSS**"''
Full formula and descriptive
literature on request
Dosage: 1 to 2 capsules
3 or 4 times daily. Supplied
in packages of 20.
Ethical protective mark MHS
embossed on inside of each
capsule, visible only when capsule is cut in half at seam*
K;%>W.<^s*ftR^^A>V^>w_x«<^ COUGH
A PAINFUL and troublesome cough,
whether associated with Tracheitis,
Laryngitis, Pharyngitis, with Bronchitis,
Pleurisy or Pneumonia, when treated with
Antiphlogistine, applied as hot as the
patient can comfortably bear, is usually
attended with the happiest results.
Following its use, the congestion tends to
decrease and the respiration to ease, while
the cough becomes looser and less painful.
mKKMKKKMKU^
MADE   IN   CANADA
Sample on Request
The Denver Chemical Mfg. Co.
153 Lagauchetiere St. W.,
MONTREAL We are hopeful that by the medical profession's continued whole-hearted acceptance of Ow
Percomorphum, liquid and capsules (also Mead's Cod Liver Oil Fortified With Perconaoi
Liver Oil), it will be possible for us to make the patient's "vitamin nickel" stretch still fiuw
Mead Johnson & Company of Canada, Ltd*, Belleville, OnU, does not advertise to the publ
. Thank you,
nr
Doctor!
JUL HE tremendous rush of last month has come
and gone. We appreciate the confidence you
placed in us. We were able to cope with every
demand, only because our organization is planned
to meet emergencies and give accuracy and speed.
We've been doing it for twenty-five or thirty
years—and hope to continue.
.SEYI050
OMNAU,
MIOHT
OPEN
ALL
NIGHT
GEORGIA PHARMACY
W.OIOROIA
STRUT
SEYMOUR
1050
t&mtn $c Uf mttta £&
Established 1893
VANCOUVER, B. C.
North Vancouver, B. C.    Powell River, B. C.
Published Monthly at Vancouver, b. c, by ROY YVRIGLEY LTD.. 300 West Pender street S-_3g_-3S-_3£-g^^
Hollywood Sanitarium
Limited
for the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
s_._>V

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