History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: October, 1932 Vancouver Medical Association Oct 31, 1932

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 STORAGE   1TEH
U.B.C. LIBRARY  2I«
s%  ■■^
Bulletin
ji .. OF THE
Vancouver Medical Association
Contents
The Annual Summer School
The Problems of Pregnancy
Library Notes
Medical Economics
Vol. IX.
OCTOBER, 1932.
No. 1.
L
Published monthly at Vancouver, B. C, by
McBeath-Campbell Ltd.,  326 Pender  Street West
Subscription.  $1.50  per year.  THE     VANCOUVER     MEDICAL     ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Association in  the
Interests of the Medical Profession.
Offices:
203 Medical Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. H. MacDermot
Dr.  D. E. H.  Cleveland Dr.  M.  McC.  Baird
All communications to be addressed to the Editor at the above address.
Vol. IX.
OCTOBER,  1932
No.   1
OFFICERS 1932-1933
Dr. Murray Blair Dr. W. L. Pedlow Dr. C. W. Prowd
President Vice-President Past   President
Dr. L. H. Appleby Dr. W. T. Lockhart
Hon.  Secretary Hon. Treasurer
Additional Members of Executives:—Dr.  A.  C.  Frost;  Dr.  C.  H.  Vrooman
TRUSTEES
Dr. W. D. Brydone-Jack. Dr. J. A. Gillespie Dr. J. M. Pearson
Auditors: Messrs. Shaw, Salter 8c Plommer
SECTIONS
Clinical Section
Dr.   A.   M.   Agnew Chairman
Dr. W. H. Hatfield ■: Secretary
Eye, Ear, Nose and Throat
Dr. J. A. Smith .Chairman
Dr. A. O. Brown '. , Secretary
Paediatric Section
Dr.   J.   R.   Davies Chairman
Dr.   J.   H.   B.   Grant Secretary
Cancer Section
Dr. A. Y.  McNair 1 Chairman
Dr. A. B. Schinbein Secretary
STANDING COMMITTEES
Library Orchestra Summer School
Dr. W. H. Hatfield Dr. J. R. Davies Dr- c- e- Br°wn
Dr. H. A. Spohn Dr. F. N. Robertson Dr- T- l- Butters
Dr. D. M. Meekison Dr. J. A. Smith Dr- c- h- Vrooman
Dr.   H.   A.   DesBbisay Dr. J. E. Harrison Dr- J- w- Arbuckle
Dr. G. E. Kidd Dr- H. A. Spohn
Dr. J. E. Harrison Dr- h- r- Mustard
Publications Hospitals
Dinner Dr- J- H. MacDermot Dr. A. W. Bagnall
n»   h   h   p,,.™ Dr* D* E* H- Cleteland Dr. F. J. Buller
ljr. n. n. jtitts dRi Murray Baird Dr   W   C   Walsh
Dr. A. M. Warner "r- cw'     «
Dr. A. T. Henry Dr- S" B* Peele
Credentials V.O.N. Advisory Board
Rep. to B. C. Med. Assn.    £*• F. ?| Patterson Dr. H. H. Caple
JJr.  A.  J.  MacLachlan     Dr.  E. Trapp
Dr. G. F. Strong Dr. S. Paulin Dr. J. W. Shier
Sickness and Benevolent Fund — The President — The Trustees VANCOUVER HEALTH DEPARTMENT
STATISTICS, AUGUST, 1932
Total   Population   (Census   1931)       246,593
Asiatic Population  (Estimated)    15,000
Rate per 1,000 Population
Total   Deaths    ,	
Asiatic Deaths  -	
Deaths—Residents only 	
Birth Registrations   	
Male 176
Female 162
INFANTILE MORTALITY—
Deaths under one year of age  12
Death  rate—Per   1,000  births    35.5
Stillbirths  (not included in above)    5
CASES OF CONTAGIOUS DISEASES REPORTED IN CITY
September, 1st
I
£
'.'
169
8.1
13
10.2
153
7.3
338
16.2
July, 1932
Cases    Deaths
Smallpox   	
Scarlet  Fever  	
Diphtheria   	
Chicken-pox 	
Measles   	
Mumps    i	
Whooping-cough   	
Typhoid Fever	
Paratyphoid   	
Tuberculosis  	
Poliomyelitis	
Meningitis   (Epidemic)
Erysipelas	
Encephalitis Lethargica
0
0
14
1
?f%
0
9
0
2
0
4
0
5
1
1
0
0
0
26
9
0
0
0
0
$■£»
0
0
0
August
, 1932
to 15tl
1,1932
Cases
Deaths
Cases
Deaths
0
0
0
0
13
0
10
0
1
0
0
0
6
0
6
0
0
0
1
0
0
0
7
0
1
0
8
0
4
0
1
1
0
0
0
0
56
11
23
—
1
0
P£"4
0
1
0
0
1
3
0
0
0
0
0
0
0
VANCOUVER MEDICAL ASSOCIATION
Founded 1898 Incorporated 1906
PROGRAMME OF THE 34th ANNUAL SESSION
GENERAL MEETINGS  will be held on the first Tuesday o 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.
1932.
October 4th—GENERAL MEETING.
Paper.
Dr. J.  M.  Pearson:  "Leaves from a Consultant's  Note book."
Research Evening.
October 18th—CLINICAL MEETING.
November 1st—GENERAL MEETING.
Papers:
Dr. W. D. Patton: "Blood Cholesterol in Polycythemia and Pernicious Anaemia."
Dr.   W.   N.   Kemp—"Status   Lymphaticus,   an   adrenal-thyroid
Syndrome."
November ISth—CLINICAL MEETING.
December 6th—GENERAL MEETING.
Symposium.
"The Upper Right Quadrant."
Drs. R. A. Simpson, G. E. Kidd, H. H. Mcintosh.
Papers:
December 20th—CLINICAL MEETING.
Page 1 Milk>Borne Tuberculosis
R. I. Harris, M.C., M.B., Associate Surgeon, Toronto General Hospital, prepared a paper for the Symposium on Milk-borne Diseases,
at the 20 th Annual Meeting of the Canadian Public Health Association
at  Regina,   Saskatchewan,   in   June,   1931.
How great an amount of human tuberculosis is due to infected
milk is even now, not completely known, because of the
time consumed, and expense of making tests. Figures on the extent
of occurrence of bovine tuberculosis in man found by various experiments are given by Dr. Harris as follows:
"ENGLAND. Among 1,294 cases of all types, bovine infection
was found in 24% of the cases. Among 598 cases of bone and
joint tuberculosis the presence of bovine tuberculosis was found
in 20% of the cases, and this percentage was higher in children."
"SCOTLAND. Among 88 cases of all forms of tuberculosis, 55%
were bovine tuberculosis among cases under 16 years of age, and
10% for cases over 16 years of age. In a series of studies of
enlarged glands of the neck in children under 12 years of age,
the bovine germ was found in 90% of the cases. Among 70 cases
of bone and joint tuberculosis in children under 12 years of age,
bovine infection was found in 61 %."
"ONTARIO. Dr. Price, during five years examined strains of
tubercle bacilli fom 340 patients and these for the most part
were children suffering fom all forms of tuberculosis with infection
of bones and joints predominating. Bovine infection was found in
13%. In all cases of bovine infection, it was determined that the
patient was accustomed to consuming raw milk. NO CASE OF
BOVINE INFECTION CAME FROM TORONTO, AND FOR
THIS FACT EFFICIENT PASTEURIZATION OF MILK IS
GIVEN CREDIT. The work done in Ontario brought out the
fact that 4% of the raw milk supplied to Toronto for pasteurization yields tubercle bacilli as tested by guinea-pig inoculation."
The article closed with this passage, "THE IMPORTANCE OF
BOVINE TUBERCULOSIS IN MAN LIES NOT ONLY IN THE
AMOUNT OF IT WHICH EXISTS, BUT IN THE EASE WITH
WHICH IT CAN BE COMPETELY ERADICATED. PASTEURIZATION OF THE INFECTED MILK, IF EFFICIENTLY AND
CONSISTENTLY CARRIED OUT, COMPLETELY ELIMINATES
ITS ABILITY TO PRODUCE CLINICAL TUBERCULOSIS. IN
COMMUNITIES WHERE PASTEURIZATION OF MILK IS
CARRIED  OUT, BOVINE  TUBERCULOSIS  DOES NOT EXIST."
ASSOCIATED DAIRIES
Limited
DISTRIBUTING RICH, SAFE, CLEAN MILK
Phones:
Fairmont 1000—North 122—New "Westminster 1445 As prescription specialists, we recognize our
duty to the Doctor, to the Public, and to our
own reputation.
Georgia
pharmacy
777 WEST GEORGIA ST.
All Night
If there is any formula you would like to have
put up in soluble Elastic Capsules you can have
it done in twenty-four hours.
Our list of stock formula can be had by a phone
message or post card.
B* C* Pharmacal Co*
329 Railway Street
Vancouver, B. C.
Phone Seymour 597
VI.iHBUW.1IH1 EDITOR'S PAGE
The Summer School has again come and gone and has left behind it
most pleasant memories of an excellent week s work. This year s session
has been most successful. The material presented was uniformly good—the
speakers were all pre-eminent in their own fields, and gave unsparingly
of their substance. One wondered, at the beginning of the week, how on
earth a man might attend all these lectures and yet maintain some sort
of touch with his practice: as the days went by, one found that no matter
what happened to the practice, he could not afford to miss the lectures
and clinics. The stuff was too good to miss.
From a general practitioner's standpoint, the session was particularly
valuable, though the man doing special work would find it equally useful.
But the tone of the whole meeting was the clinical aspect of disease, and
there was a delightful balance between the highly technical and the practical. All the way through, one was conscious of an absence of extremism
or faddism. Conservatism and common sense were the note struck by the
lecturers, and there was no riding of hobbies, or special pleading.
The "depression" seemed to have little or no effect on the School. We
have never had so many out-of town visitors and many were from the
States—very gratifying thing. We feel that they received full value from
their trip and hope to tempt them this way again.
The Summer School has, of course, won its place in our Association
life, and it is a permanent place. We cannot conceive of any attitude towards it but the determination that it is to continue and be made even
stronger and better, though future committees will find it very hard to
surpass this year's session. But we feel that the time has come to adopt a
somewhat different plan, if this is possible, as regards the attendance on
these meetings.
Is it too much to say that it would be a very good thing if the fee
for the Summer School were included in our annual dues? In this way,
it could be reduced considerably from the original $10.00 fee, which is
based on a smaller attendance, and an uncertain attendance. If the fee
were reduced, say to $5.00, and everyone paid it, everyone would attend
and everyone would benefit. Further, the Committee would be able to
budget its expenses exactly, and would be spared many hours of anxiety
and worry. Their task is a big one, in any event: it should be free from the
grave financial responsibility that has hitherto been theirs. We commend
this idea to the Association and would add, that if any such scheme should
be adopted, the fee should be reduced to the lowest sum compatible with
efficiency and safety.
Meantime, we owe a great debt of thanks to our Committee. They
have done us a great service, at great expense of time and work to themselves and while we are sure that their greatest reward is found in the
success they achieved, yet we want them to know that we appreciate the
work they have done and thank them for it.
And lastly, what of our speakers? From first to last, they were a
wonderful team. It was, for them, a hard trying week, for many of them
Page 2 the last of many hard and trying weeks—but they never once let us feel
that they were tired or overtaxed. Their addresses showed clearly, arduous
and long work in their preparation—with an enormous wealth of material
behind them. One would like to hear or read many of them again and have
a chance to study their slides more carefully—but, after all, it is not entirely the facts one learns, or the theories that are expounded to us, which
make the value of such a session. It is the mental stimulation and regulation—it is the "alternative" effect, to use an old word, of the whole
thing, that revives our interest, that tones us up, and refreshes
us, that inspires us to do better work and do it more carefully, and this
tonic we got in generous measure from our most welcome visitors so that
we thank them once more.
That "privie theef, whom men clepeth Death," to quote old Dan
Chaucer, has been busy of late among our ranks and has stolen from us
many of our best and most-liked men. The latest loss is that of Dr. W. D.
Murray, whose passing on September 20th, we mourn. Few men were more
popular or commanded greater respect for his sterling qualities, than did
"Bill" Murray. An honourable, upright man of definite convictions, and
keen loyalty to those convictions: a good sportsman and a genial friend,
he leaves a big gap as he passes. We extend to Mrs. Murray and his family
our warmest sympathy in their loss.
THE ANNUAL SUMMER SCHOOL
The Annual Summer School of the Vancouver Medical Association
opened under the happiest auspices on Tuesday morning the 13 th of September. In many ways this is easily the high-water mark of the Vancouver
Medical Summer School and the Association owes a great debt of gratitude
to Dr. C. E. Brown and his very able committee for preparing a programme which has never been equalled in the history of the Summer
School. The registration of 250 exceeded our most sanguine expectations
and a very gratifying feature was the number of visitors from the United
States, as well as from all parts of British Columbia. Many men came in
for part of the Summer School but were not able to spend the whole week
with us, much to our regret.
The first session was opened by Dr. L. H. Clerf of Jefferson Medical
College, Philadelphia. It was a very happy coincidence that the Committee
was able to secure Dr. Eloesser of San Francisco as a team-mate to Dr.
Clerf whose specialty is Bronchoscopy and Esophagoscopy, as since Dr.
Eloesser's contributions dealt chiefly with lung and chest diseases the two
speakers dovetailed together in a fashion that enabled each of them to
secure the most from his presentation. Dr. Clerf presented an admirable
series of lantern slides on bronchoscopy, and one cannot but feel as a result of listening to these two speakers, that the time has come for a city
of Vancouver's size when an adequate bronchoscopic clinic should be established, and the advantage of bronchoscopy made plain to the general
practitioner. It was a matter of remark that of the listeners to
Dr. Clerf and Dr. Eloesser so few were specialists in eye ear, nose and
Page 3
™'H"!"'1H1«HWWHI1JM throat work but possibly they do not need conversion, while the general
practitioner certainly had the lesson driven home to him of the need and
value of bronchoscopy in the diagnosis and treatment in pulmonary diseases.
Dr. G. C. Hale of London, Ontario then gave an admirable address
on Cardiac Pain, which was all too short. One of our difficulties with regard to this session, speaking as journalists, was that with few exceptions
the speakers used notes rather than papers and we are, therefore, unable
to do more than give a brief resume, in most cases, of the addresses. Several of them however, have been kind enough to promise us abstracts of
their lectures. These will appear as space permits. Their stuff was too valuable by far to lose, and was of such great value to the general practitioner of medicine that it should be made available for his use. We would
suggest to future committees that they ask prospective speakers who do
not propose to use written manuscript if they would prepare a brief abstract of their paper for use in the Bulletin. They would know best the
points they wished emphasized.
The third speaker on the programme was Dr. W. B. Hendry, Professor of Obstetrics and Gynaecology in the University of Toronto. Dr.
Hendry is a clear and forceful speaker and presents his paper in an orderly
and logical fashion. He dealt with some clinical problems of pregnancy
in child birth: a brief summary will be of interest, and is given elsewhere.
A luncheon was held at the Hotel Vancouver where Dr. T. C. Routley, general secretary of the Canadian Medical Association spoke. We are
always glad to see Dr. Routley who never fails to give us a tonic injection of optimism and good cheer. He spoke briefly about the Annual meeting of the Canadian Medical Association and covered many of the reports
given at that meeting.
One of the features of this Summer School has been the excellent
clinics given at the hospitals. Our visitors entered heartily into this work
and these clinics were by no means the least valuable part of the whole
programme. The difficulty was that one could not attend both hospitals
at the same time. When one has Dr. W. E. Gallie at one hospital and Dr.
H. Helmholtz at the other one finds it hard to decide which to attend.
In the evening the speakers were Dr. F. R. Miller of London, Ontario
who gave the first of his lectures on "Recent Advances in Functional
Neurology and Myology.'' Dr. Miller has recently had the degree of F.R.S.
conferred upon him, the greatest honour in the scientific world. Every
Canadian will feel pride in this fact and we all congratulate Dr. Miller.
The other two speakers of the evening were Dr. L. Eloesser and Dr. K.
F. Meyer. One of the things that struck one in this Summer School about
our American visitors was the great range of work that they covered
and the tremendous amount of original research that their work represented. This was perhaps particularly true of Dr. Meyer who in four lectures,
revealed himself as a giant of industry. His range was amazing, and he was
a very keen and forceful speaker, delightful to listen to, and perhaps the
best tribute we can pay to him is to record the fact that he was placed at
the end of the programme on two busy days and kept his audience enthralled and quite willing to listen to him long beyond the time set for
Page 4 his lecture. We hope that Dr. Meyer will come our way again and in separate columns of the Bulletin, brief abstracts of his paper will appear.
Dr. Eloesser was a great find, as we said above: his work fitted so well
with Dr. Clerf's material, that between them they presented a composite
picture of an inestimable value and interest.
Dr. Eloesser brought out some interesting facts with regard to the
incidence of suppurative infection of the lung following operation, especially operations in the respiratory tract such as tonsillectomy, dental extractions and nasal work but reminded us that these conditions may follow
other operations. It occurs in three ways. First, from aspiration of infected
material in which case the condition appears very shortly after the operation with cough, fever, thoracic pain and symptoms resembling the onset
of pneumonia, or there may be blood borne infection shewing symptoms
some days after operation, or again they may be embolic from the seat of
the operation. Here again the symptoms appear some days following operation. The diagnosis is very important. The condition must be differentiated from pneumonia. An X-ray is of great value in diagnosis, but a
point made by Dr. Eloesser as by Dr. Clerf in a later paper was the value
of bronchoscopic examination for diagnosis purposes, and as Dr. Clerf
showed later for therapeutic purposes, where aspiration has been the cause
of the infection. Dr. Eloesser and Dr. Clerf both empasized the advantage of local anaesthetic in tonsillectomy rather than general. We in Vancouver are perhaps surprised to hear of the great number of infections
that appear to follow tonsillectomy under general anaesthesia, in other
places. Probably our routine use of continuous suction and the fact that
anaesthetics given in Vancouver hospitals are so skillfully administered
is responsible for our comparative immunity in this regard, but there can
be no doubt that for adult tonsillectomy the local method of anaethesia
is the safer. This was overwhelmingly shown by the figures quoted by the
speakers. Dr. Eloesser showed many films of radiographs of the lung
showing bronchial abscess and other suppurative conditions notably
bronchiectasis.
Wednesday continued the feast of good things. After Dr. Miller's
second paper on "Recent Advances in Functional Neurology and Myology, ' Dr. Gallie gave an address on "Ununited Fractures—and the Transplantation of Bone" showing many films illustrating his own work in this
regard and some very beautiful results. Dr. Clerf dealt with "Pulmonary
Abscess and Bronchiectasis viewed from a Bronchoscopic Standpoint" and
Dr. Hendry followed him with an admirable address on "Modern Aids to
Labour." The afternoon was taken up with clinics by Dr. Eloesser at the
Vancouver General Hospital and Dr. Hale at St. Paul's Hospital.
In the evening Dr. Clerf dealt with "Diseases of the Esophagus. Their
Diagnosis and Treatment." He emphasized the importance of the early
use of the esophagoscope in diagnosis and showed a long series of films
illustrating various diseased conditions. Dr. Helmholz followed him with
"Disturbances of the Thyroid Gland in Children." He made several very
significant points, the first being the importance of early institution of
treatment in cretinism. The greater part of brain development occurs in
the first two or three years of life and it is precisely at this time that the
Page 5
j.B.mrmTgBizrCB
.■■l.ll.II'H'LI!!UU1'!'H!(,]l!l.',„ diagnosis of cretinism is important if results are to be obtained. He showed
slides illustrating the diagnosis of cretinism in the first few months of life.
During the first six weeks to two months of life, the mother supplies sufficient thyroid extract to conceal the signs, but after this, cretinism is recognized by the slow development of the child, the protruding tongue,
the myxedeatous type of skin, the scanty hair. Thyroid can at this time
literally transform the child, and leads to normal development both of
brain and body. Given in the later part of the second year or later, we will
get physical development but not such good mental development. He dealt
with exophthalmic goitre in older children and emphasized the necessity
again for early recognition and treatment. Dr. Meyer closed the evening's
programme with a delightful talk on "Food Poisoning' upon which he has
done a tremendous amount of work. In his view, a great many cases of so
called ptomaine poisoning are really infection due to staphylococcus aureus which has been recovered from the food causing poisoning and from
the discharges of the body. Ptomaine poisoning is in his opinion a misnomer entirely. It is where food is handled by a great many people before
consumption that this infection is apt to take place.
We cannot go at full length into the entire programme, though it
would be well worth while to do so. We hope to publish abstracts of the
addresses given by Dr. Eloesser and one or two of the other papers are
abstracted in this and other numbers.
DR. W. E. GALLIE
(Abstract)
OBSTETRICAL INJURIES TO NEWBORN
Dr. Gallie referred to many of these—but the outstanding ones were
cranial injuries and brachial plexus injuries  (Erb's palsy).
As regards cranial injuries—the speaker referred to many children
seen in infants' and children's hospitals, showing spastic paralysis as a
result of birth injuries to the skull—chiefly of course, due to the forceps.
They are usually seen when it is too late to do anything. Mental injury
results as well.
The important thing is to anticipate these developments. They follow
intracranial haemorrhage and cell destruction or injury in the brain.
When there has been a hard labour, instrumental and difficult, and
where there is some deformation of the skull, we should think, of course,
of haemorrhage. Usually the child shows signs of difficult respiration, cries
abnormally, may have convulsive seizures or spasmodic twitchings generally, these subside and the child is apparently fairly normal. If they are not
serious enough to cause death spinal puncture should be done; if
blood appears in the spinal fluid we know there has been trauma to the
system.
If the trauma is very severe and we can defiinitely localise it, decompression and evacuation of the haemorrhage may be necessary and may
save life. But the spinal puncture may make this unnecessary. It has two
values.
Page 6 (1) Diagnostic.
(2) Therapeutic—by relieving pressure, it saves damage. It may
be done repeatedly every 5, 6, or 10 hours—will often lead to recovery.
Look out for haemorrhage of the newborn as the underlying cause, and
transfuse if this is .the case.
If operation is necessary, the prognosis is bad, and not much must
be hoped for from the operation.
ERB'S PALSY. Dr. Gallie explained the anatomy and pathology
of this condition. The important features of his remarks on this subject
were his emphasis on, first, the uselessness of interference with the injury
until full trial had been given to the treatment by splint, and time
allowed for function to return. As a rule, the lesion is an overstretching
of the nerves rather than an actual rupture. The main injury resulting
from the condition is the shortening of muscles which oppose the paralyzed ones—leading to hopless contractures. The remedy is obvious, to
put the muscles paralyzed at rest and shorten their bellies, while we put
the opposing muscles on the stretch and lengthen their bellies. A modification of the aeroplane splint, with a flexed and supinated forearm accomplishes this, and as a rule, in several weeks, a cure is effected. Surgery may
be necessary, but as a rule is not needed.
DR. L. H. CLERF
(Abstract)
Bronchial Abscess, may occur in many ways. The first is postoperative. Symptoms may appear within twenty-four hours, with pain
in chest, dry unproductive cough, fever and chills.
These are due to a pneumonitis caused by aspiration of infective
material. Examination under the bronchoscope will usually reveal a
collection of infective material, and aspiration of this through the bronchoscope cures the condition as a rule, with dramatic suddenness. If left,
great trouble may follow—bronchial abscess, and perhaps later bronchiectasis.
These follow, most commonly, tonsillectomies, especially under
general anaesthesia. Of 77 cases following tonsillectomy, only four had
been done under local. They may follow dental extraction—and may
follow any operation where a general anaesthetic has been given, since
infective material may be aspirated (From this Dr. Clerf deduces that
tonsillectomies in the adult are best done under local anaesthetic—Possibly
use of continuous suction may obviate danger and the avoidance of too
deep a degree of anaesthetic, where the swallowing reflex is lost com-
petely.)
Examination of the chest by X-ray will reveal a shadow near the
bifurcation, on one side or the other as a rule. Sometimes this may be found
in one or other lobe nearer periphery. The condition in Dr. Clerf's opinion is a pneumonitis which may end in abscess formation or clear up in
various ways. This may be by the patient coughing up  the infective
Page 7
ffllffU'Ulll'lI'm.'BHWH material or pus; it may be aspirated as spoken of—it may go on to chronic
abscess or may end in bronchiectasis. Of 172 pulmonary abscesses, 70%
followed operation and more than 99% of these followed tonsillectomy.
If they do not follow operation for some days, they may be blood-borne,
though Dr. Clerf thinks this doubtful.
Age Incidence. Commonest between 20 and 40 (66%).
Location. It was previously thought that these were chiefly basal,
but 52% exist in the upper lobe. Physical examination is apt to be deceiving and should be supplemented by X-ray and bronchoscopy. The
former is vital both to diagnosis and prognosis.
Treatment. Adequate drainage is essential and usually to quick
recovery. Many recover spontaneously.
Bronchoscopy should always be done before any surgical measures
are adopted. Usually the abscess can be located and drained by this method.
It may need to be drained many times, sometimes as high as 30 or 40 times
—If this fails, however, surgery is usually necessary.
Bacteriological findings are very important. Spirochaetes are common,
and arsenicals given early give excellent results, but it must be early. Dr.
Clerf gives them as a routine in post-operative pneumonitis, before the
abscess forms.
Bronchiectasis. A very important and very serious lesion of the lung,
May be congenital in origin—may not appear or give symptoms till later
life. May follow aspiration of foreign-body with the effect of bronchial
stenosis, leading to dilatation of bronchial tree.
May follow pneumonitis (post-operative).
May follow repeated infections.
Very frequently associated with sinus infection and Dr. Clerf feels
that in all cases of bronchietasis, infection of the upper respiratory tract,
especially the sinuses, must be sought for and can often be found.
Obstruction and sepsis—bronchiectasis.
Bronchiectasis is most difficult to handle—prognosis is very uncertain, ordinary treatment is useless. The disease is worse than the tuberculosis for which it is so often mistaken—more disabling and more hopeless. Dr. Clerf pointed out that many cases have been treated for years
for tuberculosis which were really bronchiectasis and the diagnosis is very
important.
It is based on history, lack of tubercle bacilli in repeated sputum
examinations, obstructive symptoms (clubbing of nails, cyanosis etc) and
X-ray findings especially after lipiodol injections of the bronchial tree.
Bronchiectasis is almost always in the lower lobe and may be uni- or bilateral. If the former, it is not due to sinus infection, but if bilateral,
sinus infection is the commonest cause. Where a patient has a chronic
cough, over years, with other symptoms suggesting bronchiectasis, it is
most important to treat the sinuses. Nasal sinusitis is particularly prone to
Page 8 lead to further respiratory infection, pneumonitis is apt to follow and may,
if it does not end in resolution, lead to pulmonary abscess, followed by
bronchiectasis.
DR. W. B. HENDRY
(Abstract)
MODERN AIDS TO LABOUR
Chiefly for the following purposes:
(1) Relief of pain.
(2) Shortening of labour.
We must be careful in use of agents to relieve pain, not to prolong
labour unduly by diminishing contractions.
During the first stage we have the following:
(a) Prenatal care. The physician must gain his patient's confidence,
remove fear and mistrust. This is of vital importance.
(b) Drugs. No inhalation anaesthetic during first stage.
Dr. Hendry dealt with various methods that have been in use, notably twilight sleep. This is an amnesia rather than an anaesthesia, is very
difficult to use, unwise in house confinements and dangerous to the baby
if used towards end of the labour. One gathered that he did not care for
it.
Of all drugs used in this stage, heroin is the most valuable. A small
dose (gr. 1/12) is adequate, may be repeated several times, does not depress respiration of either mother or child. Occasionally it exhilarates and
should not then be used.
Synergistically, amytal may be used with heroin. By itself, amytal is
not so good, as we get inhibition of control rather than relief of pain.
Dr. Hendry spoke of avertin, only to condemn its use. It is very
toxic, very depressing, and its use has been attended with a very high
mortality. Rectal use of ether too, he did not endorse.
Second stage of Labour. In this stage we commonly use inhalation
anaesthetics. Chloroform, perhaps the most widely used till recent years,
has, of late, been somewhat frowned on, as it lessens contractions, and is
probably toxic, though the small amount used is generally safe.
Dr. Hendry felt that nitrous oxide and oxygen inhalation is the best
and safest method and in this he is in accord with most observers. (Curiously he did not mention ether though most of us find this exceedingly
satisfactory, at least in Vancouver, and the usual distaste that patients
have for it is not often felt by a woman in labour).
He menioned ethylene and spinal anaesthesia, only to warn against
their use.
(2) Measures for shortening labour.
Page 9
ra'nwiy.un.liiu'i'H.'llLlWJ] (a) Pituitrin. This he considered one of the greatest aids we have, if
used with certain precautions, e.g., when we have made sure that no mechanical obstruction exists, such as bony narrowing or grave disproportion of
head, and that the cervix if fully dilated or dilatable. Its use will frequently shorten labour and avoid exhaustion, and make forceps unnecessary.
(b) Version. This has a great place, and with Potter's technique
(though not his indications), is a far less formidable proceeding than it
used to be.
(c) Eptsiotomy and Mid-forceps. Only when head is not advancing normally and at normal rate.
Lastly, the Forceps. Dr. Hendry's dictum is that forceps should be
used in one of two cases. (1) in transverse arrest or persistent posterior
positions as a rotator and director of head.
(2) To save the mother or child where either one or the other is
showing signs of exhaustion and other dangerous states. His mnemonic
for the use of this instrument is A.B.C.
A    Amnion must be emptied. Attitude of child must be known.
B    Bladder and bowels must be empty.
C    Cervix must be dilated fully.
THE PROBLEMS OF PREGNANCY
Dr. Hendry
"First, as regards the diagnosis of pregnancy. Dr. Hendry made a
plea for the use of the Aschheim Zondek technique for the diagnosis of
pregnancy in the early stages. This is 95 to 96% accurate, and its great
advantage is its simplicity and the fact that it enables us to diagnoses
pregnancy at the most difficult and the most important time, that is,
within the first month. He then took up the problems of the first three
months of pregnancy. First, abortion and ectopic pregnancy, giving the
differential diagnosis. We need not repeat this here but it is of interest
to consider Dr. Hendry's views on the treatment of abortion. In threatened abortion his policy is rest in bed, sedatives and watchful waiting.
In inevitable abortion he feels that it is useless to wait. Here he packs,
gives pituitrin, and in twenty-four hours removes the packing, when the
products of conception almost invariably come away. In incomplete
abortion his treatment varies with the presence or absence of temperatures
and signs of infection. If there is no temperature he treats it as in the
case of inevitable abortion or curettes immediately. If there is temperature
he advises conservative treatment, rest, intravenous salnies and morphia
and waits for the patient to complete the miscarriage, giving ergot and
quinine meanwhile. One point in Dr. Hendry's address is open to considerable argument where he states that he employs a sharp curette in
emptying the uterus. We cannot but. feel that while this instrument may
be safe enought in the hands of Dr. Hendry it is open to grave objection
if used by men less expert.
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Medical-Dental Building Vancouver The speaker then took up the question of pernicious vomiting. He
referred to four points in the treatment of this condition that must
be observed and dealt with. First, the vomiting; second, starvation; third,
dehydration; fourth, toxaemia. He also reminded us of the very marked
nervous element in this condition, which makes it necessary for the doctor
to secure the confidence and co-operation of his patient as a first step
towards success. If this cannot be obtained treatment is usually very difficult. Dr. Hendry's routine treatment consists in first, complete bed rest,
isolation in hospital and the administration of large quantities of glucose
and saline. The glucose has the effect of combatting the starvation and
the dehydration, and large quantities of fluid must be given until the urine
becomes normal in amount and in specific gravity. Signs of toxaemia are
evidenced by a scantiness and high concentration of the urine with the
presence of ketones. Dr. Hendry felt that treatment should produce definite results within a week or must be relinquished and the pregnancy
terminated.
The two important questions of heart disease and tuberculosis were
dealt with. In the early months of pregnancy serious heart disease with
signs of failing compensation mean almost invariably, in Dr. Hendry's
opinion, that we must terminate the pregnancy. This is best done by hysterotomy and section of the tubes, or by simple hysterectomy. Tuberculosis: here we consider the activity of the lesion rather than the extent
of it, and the treatment varies with the period to which the pregnancy has
advanced. In the first trimester we should empty the uterus. In the second
and third trimester this is not so safe: in fact watchful waiting is probably
safer than termination of the pregnancy. The patient should be in a sanatorium and watched carefully throughout. In both heart disease and tuberculosis long labours should not be permitted, and special anaesthesia is the
method of choice in tuberculosis.
As regards the conditions of the second trimester, pyelitis is probably
one of the commonest. Dr. Hendry dwelt on the relation of this to posture and the effect of the pressure by the uterus on the ureter. His treatment was the standard one of varying the reaction of the urine and added
to this his recommendation of catheterization of the ureters.
He then took up the toxaemias of the third trimester and here he
made it very clear that salt was in his opinion the chief contributing factor to the onset of these toxaemias. He quoted his own statistics to shew
that in several hundred cases over the last five years he has had no toxaemia develop in cases in which he has kept the diet salt free, or nearly
so, in the last part of the pregnancy. His plan is to advise the patient
to have one salt free week per month as he finds this better than attempting to diminish the salt in the diet. Where toxaemia develops in spite of
care Dr. Hendry's rules are based upon conservatism but not inertia. They
vary somewhat according to whether the patient is a primipara or multipara. In any case if the child is viable delivery should be as early as possible.
The treatment varies, too, according to whether the patient is actually
in an eclamptic condition or this is merely threatened. When the patient
has acute eclampsia, if the convulsions are continuous, radical treatment
must be instituted, but where there is some margin of safety Dr. Hendry
feels that we should not be in a hurry to do such operations as caesarean
Page 11
""■   ii'n.wa section, which has many risks and is a policy of despair. He valued mainly
the Strogonow method of dealing with these cases and finds it very satisfactory with certain modifications of his own. The central point of this
treatment is to relieve cerebral irritation by every method possible, quiet
surroundings, chloroform before any manipulation, even to giving of
hypodermic or an enema, morphia till respirations are as low as ten, and
other sedatives such as sodium amytal, given in doses of five grains every
four hours intravenously for as long as forty-eight hours. Each case of
course must be judged on his own merits but on the whole a reasonable
intelligent conservatism gives the best results.
Dr. Hendry dealt also with the induction of labour and gave a review
of the methods used. He dealt briefly with antepartum haemorrhage especially that due to placenta praevia. If the patient is a 1-para caesarean sec-
ion is practically always indicated. In multiparae more time may be spared
for more conservative methods. In antepartum accidental haemorrhage due
to separation of the placenta. Dr. Hendry feels that there is a danger of
our being stampeded into caesarean or other drastic methods. The membranes should be ruptured, allowing the uterine wall to contract and so
control haemorrhage, the vagina should be packed if necessary and time
given for the patient to recover from the collapse which accompanies the
condition. In this case we will usually find that the mother will deliver
herself safely.
*        *        *
LIBRARY NOTES
Recent additions to the library include a most useful and valuable
book entitled "Fraud in Medico-Legal Practice" written by Sir John
Collie. The author has had a wide experience in assessing the amount of
disability suffered by compensation, medico-legal and military cases. It
is likely that upwards of 100,000 cases have passed through his hands and
with such a wide experience he is up to all the tricks of the malingerer.
The book makes delightful reading and all our old friends—pain in the
back, hernia, functional nerve disease and a host of others are given in
detail. Many devices for the detection of fraud are suggested and the book
will prove of great value to the practitioner who finds a medico-legal case
on his hands. One might add that the book has also been added to the
library of the Workman's Compensation Board.
Recent issues of the "Journal of Bone and Joint Surgery" contain
many articles of wide interest. The July number has been increased in
size and will repay a perusal. The general make-up of the journal has an
appeal and the material is easily read. The April number gives a
splendid resume of operative treatment of displaced semilunar cartilage
and it is interesting to note how widely the treatment differs in the hands
of widely separated men, apparently all with good results. New work on
the periarticular innervation in sprained joints is reported in the April
number. This may prove to be of considerable interest.
A much neglected journal which finds its way every month to our
shelves is the "Proceedings of the Royal Society of Medicine." The title
is somewhat forbidding and even misleading, but the contents are out-
Page 12 standing in their merit. In the March number one finds a long and interesting discussion of the diagnosis and treatment of acute head injuries
by men whose names are familiar to us all. In the May number a most
illuminating discussion is to be found on fractures in the region of the
ankle joint. Look into this journal once and you will probably come back
for more. (D.E.M.)
POST GRADUATE TOUR (continued)
Dr. A. Gibson's Diary
On returning to the Hospital, I gave a talk on Arthritis, by request.
Pope followed with Disorders of Sensation, and the Chairman announced
that as it was only 10:45 there was some time left and I would talk about
Fractures of the Spine. I did so and was asked about the Treatment of
the old-standing cases, so spoke about Bone-graft and described the Fishtail graft. The discussion was good and the men were all very keen. I
am led to believe that in New Westminster the relations between the various men are unusually good; at Nanaimo it was formerly very bad, although it is now improving. At Nanaimo, Lodge conditions were very
disagreeable, contracts being for the treatment of the men and their
families, at a rate as low as 50c for three months. Good work and pleasant relations cannot exist under such conditions. I ceased speaking about
11:45 p.m. and after Pope had seen a case of diabetic coma, which he had
prescribed for in conformity with the ideas in his talk on Medical Emergencies, and had had the satisfaction of seeing a dramatic recovery, we
drove back to Vancouver. We were accompanied by Robertson and were
met by Mackay; in our rooms we sat talking till about 2 a.m., and then
to bed rather tired.
3-6-32—Up at 7 a.m. and met Thomson. Was taken by him to his
friend Geddes of the Gregg Importing Co. Spent a few hours in going
over the stock of goods imported from various countries of Europe and
the Orient. Found it very interesting and made a few purchases. Fred
Bell came down to collect me and with Dorothy and the younger boy we
went for a drive around Stanley Park. It was arranged that we have
lunch aboard the Empress of Japan. At the appointed time we arrived
there and met the other guests. Our host was Capt. Aikman, Marine
Supt., for the Pacific Trade of the C. P. R. The lunch was such as old
Lucullus must or rather may have had in his brightest, most expensive
moments. It left us replete to a degree. We then went over the ship
and the magnificence of this boat is something I had hardly believed
possible aboard a sea-going vessel. One inevitably asks oneself if it is
worth while, but I suppose that is something I know nothing about, and
certainly if the opportunity to travel under such luxurious circumstances
presented itself, I am afraid any socialist doctrinaire would seize the
opportunity to acquire practical experience of the life led by the bloated
capitalist. About 4:30 I returned to the Hotel and arranged my things
for stepping out. Fred came back and we went to his home for a quiet
hour of chat. The flowers in some of the residences in Shaughnessy
Heights are remarkably beautiful. The broom is everywhere, and the
roses are just coming into their best.    The vacant lots seem to grow
Page 13
I'U'INIIIII IIII.HI mainly bracken instead of dandelions and sowthistles, and that is not
quite such a ragged growth as to give it the appearance of a mass of weeds.
Having paid our bills, Pope and myself came to the Union Steamship
Dock in search of the Catala. Fletcher met us and introduced us to the
Captain, an old hearty of the name of Dickson who is the doyen of the
skippers on the coast. We were also commended to the care of the Chief
Steward, and then taken to our staterooms. Thomson turned up very
soon, and we sat chatting for a short time, but all were a bit tired and
we turned in rather early.
4-6-32—Up about 7:30 this morning, and to breafast at 8 a.m.
Appetites good, the air keen and a bit nippy. A fair number on board,
of whom a good proportion are Chinese. Being an inside run, there is
practically no motion on the ship and we are as free from rolling or pitching as if we were on land. After a stroll on deck succeeding breakfast
have betaken myself to bring this record up to date.
The day passed pleasantly enough with very little being done. It is
remarkable how rapidly the time goes at sea. The run was smooth for
the greater part of the day and it was interesting enough as we stopped
at small ports such as Englewood and Sointula. The latter is a Russian-
Finn settlement with little sign of activity. Alert Bay however was decidedly more intriguing. We went ashore and inspected the Totem Poles
and other evidences of Indian activity; next to the Hospital (St. George's)
is an Indian burying ground the site of a large number of these memorials,
some of which are of some beauty and great originality of design. Close
by there is a large Indian school, maintained by the Anglican Church.
Our stay here lasted 20 minutes.
Followed by the gulls we fared forth once more and during the
afternoon I sat for my portrait by Pope. The result is flattering and I
can seet that many years have rolled from off my shoulders since I set out
on this trip. Tomorrow Thomson is to have his features immortalized.
We touched at Port Hardy and parted with several other passengers.
Almost immediately we found ourselves in Queen Charlotte Sound with
a strong swell from the West. This was pleasant enough at first, but
speedily developed a force that proved more than enough for the bulk of
the passengers. The public rooms gradually emptied, and strains of the
radio fell upon ears that heard not, or hearing, were not very interested;
the life histories of three diving champions as told from Los Angeles were
insufficiently inspiring to hold passengers from their staterooms. The
spell of discomfort, however, was brief, only an hour or two, and as soon
as we got in the lee of an island all was smooth once more. About midnight we stopped and fastened up to the S. S. Cardena, transferring to
her a good part of our freight; she is to make calls in ports where the
Catala will not touch this trip.
5-6-32—It does not seem like Sunday this morning; it was more so
yesterday; Sunday it is nevertheless, and breakfast is at 8 a.m. We find
ourselves in the Channel known as Graham Reach and the mountains
come down almost to the water's edge. The snow line is lower and
numerous waterfalls course down the hillsides. From either side of the
channel inlets stretch away from the west and east; many of these run
Page 14 for miles into the land and must be of exceeding beauty. About 10:30
we stopped at Butedale, where the waterfall is said to be the highest in
B. C. Most of the inhabitants come down to see the boat come in and
all the dogs without exception. The latter and indeed the former also
are of an eclectic strain, the dogs could be described as Canis Vulgaris,
with the accent on the Vulgaris. The ancestry is undoubtedly mingled;
we have seen signs of collie, bull-terrier, airedale, fox-terrier, scottie, and
this morning at Butedale there was in inquisitive canine vaguely reminiscent of Sealyham.
The passengers are similarly of diverse origin, though the individuals
do not represent such a mingling of races as do the dogs. We have Orientals aplenty; the majority Japanese, with a sprinkling of Chinese. Two
of these commenced to play a game of cards as soon as the boat left Vancouver, and the game is still in progress with increasing seriousness; it
has been interrupted with brief intervals for sleep and meals, and of course
for the undulations of Queen Charlotte Sound. There cards are not the
same as our own and I have no idea of the game they play, but it is accompanied by much slapping down of cards and of writing down in a notebook. A good deal of hilarity appeared at first but this has given place to a
grim seriousness; doubtless the fate of many yen hang in the balance. The
crew are also of mixed extraction, our table steward is an unmistakable
Cockney and the keeper of the "shop" is a derivative of Paisley. We can
always depend on him for a corkscrew. His instincts are not exactly predatory but his sense of values is colored by the conviction that a very
small "meum" is worth a rather large "tuum"; hence 40c a bottle for
soda-water, and 35c for a 25c package of tobacco. No doubt, however,
it becomes us to speak with respect of the grand old principles on which
Scottish greatness has long depended. One can only be thankful that he
comes from Paisley and not from Aberdeen.
Dinner was earlier to-night on account of the fact that we shall not
reach Prince Rupert until 6:30 p.m. The service on the boat has been
very good and we have nothing but praise for the ship and its conduct.
On arrival at Rupert we were met by several of the local doctors and
driven to the Club. Here, arrangements were made to put us up for the
night. At 8 p.m. we went to the Booth Memorial School and were greeted
by six of the Drs. and some 15 nurses headed by Miss Harrison, the Lady
Supt. Pope spoke first on the subject of Disorders of Sensation, Thomson
next on After-treatment of Abdominal Cases, and I followed with Fractures of the Spine. The atmosphere was a bit cold and the seats were not
too comfortable, but all listened manfully to the bitter end. Afterwards
we went to the home of Dr. W. T. Kergin where a company was assembled to bear us company in refreshments. A little after midnight we
dispersed, and found our way to bed.
6-6-32—We rose about 8 a.m. and had breakfast at the Commodore.
From there we were driven to the Cold Storage Plant. This was a sight
worth seeing. At present the chief catch is halibut and the fish were
being brought in and being beheaded in large quantities. The Storage
plant is kept at about 4 above zero and the atmosphere is according. The
fish are frozen and are then dipped thus covering them with a film of ice
which proves very effective in keeping  them  cold.    The halibut  and
Page 15
HH3HHBB2S8SH
HSfflS salmon were stacked like cordwood in large rooms, one of which accommodated some 400,000 lbs. and another about 300,000 lbs. There were
also a number of curiosities which had been brought up from the ocean
in the last 20 years, including a starfish with 17 arms and a number of
Sunfish. Halibut appear to grow very slowly, increasing their weight
about 2 lbs. per year; this has all been worked out and it is apparently
certain that some of the fish which are caught are in the neighborhood of
100 years old. A considerable proportion of the catch, however, are
small and are known on the market as "chicken halibut." This seems to
be a pity for the yearly catch is diminishing; evidently the same wasteful
procedure is at work as in the case of the forests; they are not content
to get the income of the sea but must eat into the capital. There are
also questions of international interest involved; he U. S. as usual is playing a selfish game and has put a duty on fish caught by Canadian boats;
on this account many of the Canadian fishermen are idle. It almost seems
as if the simple principles of fairplay are impossible when big corporations
or governments are in question.
Our next visit was paid to the Biological station. Here much work
of interest was in progress.   The outlook is mainly commercial.
Doubtless this is as it should be. At present the oils of the halibut
and the pilchard are under investigation. Samples of textures treated
with pilchard oil instead of cottonseed or linseed oil were seen. The fabric
treated with pilchard oil is softer and more pliable than the other, and
does not show the same tendency to crack under changes in temperature
as does the other. Experiments are also being carried out in regard to the
Vitamin content of these oils and rats are being employed for that purpose. We saw the femur under the microscope. It is split and immersed
in a bath of Silver Nitrate. On exposure to a bright light, metallic silver
is deposited and is easily recognized under the microscope. With low
power magnification it is easy to photograph the changes in the epiphyseal line of the animals under different vitamin feeding conditions. The
vitamin appears to act as a simple factor in the deposit of calcium. It
would be interesting to follow the progress of calcification in a healing
fracture by the same method. Another fact of interest we learned, that
canned salmon is a very valuable food regarded from the standpoint of
vitamin content; its cheapness ought to make it more abundantly used.
Again we were told that for all fish at least of the herring and salmon
species the total iodine content is contained in the skin; this forms at
least a justification for eating the sardine in toto.
We visited the Hospital; the operating room is well equipped; the
only drawback is the entrancing view from the window; it must be difficult to keep one's eyes focussed on the subject under discussion. Dr. W.
T. Kergin then took us for a run about the harbour in his launch, it must
be a comfortable boat in which to make little trips during the summer.
A lunch was held at the Commodore Cafe, attended by 14. Immediately after, I spoke on Arthritis, and was followed by Pope and Thomson.
I then spoke again on Colles Fracture and Supra-condylar Fractures. By
this time it was in order to catch the train; no surprise was exhibited on
account of its being an hour late in starting, but that is the C.N.R.    We
Page 16 got our places and discovered that the view from the Observation Car is
obscured by a private car occupied in all probability by some minor nonentity of the System. The route lies up the Skeena. The day is overcast
but the hills are there wreathed in mist, their tops are covered by snow
and in places the snow is still visible down to the level of the railroad
track. Little communities built around canneries are numerous, and the
population seem to be mainly Indians or Asiatics. Our progress is leisurely
in the extreme, but there is plenty of time.    Is this not the C.N.R.?
The time passed slowly, the engine developing one hot box after another. After a journey of 90 miles we were 4^ hours late. Nothing for
it but to go to sleep and hope that things may improve.
7-6-32—We made up some time during the night. Most of the day
Pope and I spent doing cross-word puzzles and otherwise amusing ourselves. About 7 p.m. we arrived at Prince George, and were met by Lyon
and Ewart. After dinner and a wash we went for a drive around the
district. It is rather pretty and interesting. The Fraser is a large river
and close by the town it joins with the Nechako. The remains of South
Fort George are still visible but form a poor relic of the days when it was
a busy and bibulous township.   To bed early and slept very soundly.
8-6-32—A fair number of men have arrived. Unfortunately Holmes
who had driven 160 miles from Burns' Lake had to return at once in
response to an urgent summons but others were present. At no place
have the men come such distances; Brummitt from Smithers, 250 miles;
Baker from Quesnel, 75 miles; and Knipfel from beyond Williams' Lake
about 260 miles. I devoted the whole morning to Fractures with Lantern
slides and after lunch we went at it again. Pope spoke on Disorders of
Sensation, and Thomson on After-treatment of Abdominal operations.
After dinner they wanted more, so I gave them about an hour on
the subject of Joint disorders. We finished about 10 p.m. and there was
a good deal of miscellaneous until 11 p.m. or after. The hotel is good;
the beds have box mattresses and are exceedingly comfortable, much more
so than we had expected.
9-6-32—Another fairly sharp night, but the sun is bright and warm
this morning; the men are still anxious for more information and Pope
and Thomson are to speak this morning. Baker went home last evening,
and Stone also said his farewells, but this morning finds him still here;
these men do not get together very often and are loth to separate as long
as some information is to be picked up.
Pope spoke on Nephritis and also of the use of Pot. Permang. in
Pneumonia. This was received with avidity. Thomson spoke on Abdominal Emergencies, particularly those the result of accidents, he mentioned
the use of blood removed from the abdomen into citrate and re-injected
if sterile. He then gave a short paper dealing with malignant diseases of
the alimentary tract and mentioned the use of a thin solution of Barium
to show up the presence of polyp or other growths.
At the close of the meeting Drs. Stone, Ewert, and Brummitt moved
a vote of thanks to the visitors, and spoke with appreciation of the value
of the post-graduate lectures.   We replied briefly.
Page 17
muuMUMiaiiJimaa The train was on time and we steamed out of Prince George after a
farewell from Lyon and Ewert. We spent a good deal of time that evening on the observation platform passing through scenery of great attraction, along the Fraser. "The Charmed Sunset lingered low a down in the
red West," and we were in no hurry to go indoors.
10-6-32—Early astir this morning, for Pope and Thomson plan to
have a day of golf at Jasper. Our adieus were of the briefest in the matter-of-fact atmosphere of a Pullman car. All decent men have a touch
of sentiment and I am sure that we, all three, hated to break the harmonious trio, the "good companions" of a very happy tour. However, they
to their golf and I to Edmonton and Winnipeg.
11-6-32—From this point on my remarks must reverse the uncomplimentary tone of the early references to the C. N. All that a train
could do, ours did; finishing by steaming into Winnipeg on the dot. The
journey was amid attractive scenery, but one missed the hills. "Who
goes to the Hills, goes to his Mother. I am refreshed all over. The
hakim spoke truly to me this morn when he said that a breath from the
snows blows away twenty years from the life of a man. We will go up
into the hills—the high hills—up to the sound of snow-water and the
sound of the trees—for a little while."
"So and no otherwise—so and no otherwise—hillmen desire their
Hills."
MEDICAL ECONOMICS
Some reflections by The Editor.
A few straws have recently begun to show a wind blowing in the
direction of more just treatment of the medical man. Recently, we
learn, the Vancouver General Hospital authortiies have notified the gov-
erment that on and after January 1st, 193 3, they will no longer fill out
and sign Mothers' Pensions forms and certificates free of charge. We
hope they will some day go even further, and insist that these people
be sent to their own family doctor to have these forms filled out. He
is the logical man. But, if we are to derive any advantage from this, we
must ourselves take the same position: and why should we not? On what
grounds has the Mothers' Pensions Department any right to ask that
this work be done free? No grounds whatever. This is of a piece with
the certificates that are asked of us by the City Relief Department. All
these things, city relief, mothers' pensions Workmen's Compensation,
insurance claims, turn on a doctor's certificate, without which none of
them can be granted or settled. Then why should any of them be done
by us for nothing? We should follow up this lead given by the Hospital
(we should not have waited for it.) The Workmen's Compensation
Board pays us for our reports, and as regards insurance claims, while
we feel that these should be paid for by the Companies concerned, yet
there is something to be said for the point of view taken by an agent
with whom we discussed the question, that very often insurance is the
fund and the only source from which our bills can be paid. We are not
Page IS sure that this argument is sound, unless the insurance companies were
to undertake to protect our claims which they do not. At any rate, it
is enough to satisfy the medical man as a rule, who seems to be able
to live and thrive on hopes, too many of which fail to come to fruition.
But as regards Mothers' Pensions, and City Relief, we are letting
ourselves be made unfair use of, and while, in these days, we may well
be inclined to concede all we can to a municipality and a province overburdened with financial loads, yet we should not be the only ones to give
everything. No other person concerned with the care of the indigent or
needy, sacrifices any of the payment due him for his goods or services:
but we sacrifice everything. Let us consider whether this is right. We
are paying (or should be, if we got paid ourselves) our full share of the
taxes raised for these purposes. We do not ask anything unreasonable,
but we should not supinely relinquish everything.
In this connection a recent series of discussions by various agencies
within the operation of the Community Chest are of great interest to
the profession, as it is hoped that they will lead to the recognition of the
principle that doctors should be paid for the work they do, even for
so-called charitable work. (It is not charity work, in the accepted sense
of the word—except in so far as the beneficiary pays nothing—the services and the work are all paid for—except—yes, you know the exception) . More will be said of this later.
Frequently, when we urge that we receive payment for our work,
we are met with a sort of threat. It is to the effect that if we don't look
out, the Government or the City will take this out of our hands and
will appoint a paid official to do the work. This scares us so badly that
we creep back to our kennels, with our tail between our legs, and go on
doing the work unpaid.
Now, we need only look at this threat for a minute, to realize how
empty it is. In the first place, there is very little danger of either the
government or the city paying anyone to do this work. (Look at their
refusal to appoint a medical man for night work amongst the indigent
—and why should they, when we will get up and go for nothing?) In
the second place, suppose they did? Then some doctor would get a living
at any rate, where now nobody gets anything, and how would we be
worse off? We lose a tremendous amount by our chronic fear that someone else may get something.
Every time a doctor gets paid for his work every other doctor benefits. If we could get this into our heads! Nobody loses, everyone is the
beter off. And the public benefits, the indigent will benefit. Our own
idea, and in this we are supported by the best opinion, is that it would
give the best results, if the authorities made use of the family practitioner as the chief agent of medical care for the indigent, and paid him:
not in full perhaps, but a reasonable sum. This is the conclusion arrived
at by some of the ablest minds in our profession. It links up the general
practitioner with Health Departments and the prevention of disease, it
ensures that every family have its own medical adviser, and it gives fair
treatment to the medical man. May we have the wisdom and the courage
Page 19 to grasp at these few straws, not as drowning men, but as one tests the
wind and decides to set his course aright, and may we refuse to be frightened by bogies and dreadful forebodings of what may happen to us if
we stand up and insist on what is our rightful due.
NEWS AND NOTES
The contingent that has recently visited Europe is gradually drifting back. Dr. Caple, Dr. Vrooman, Dr. Strong and Dr. J. G. McKay have
returned, and it is rumoured that at the next medical dinner they will
render selections from Vienese Nights, notably the refrain "Then you'll
remember Vienna.'' Dr. Boucher has not yet returned. They will appear
to have had an excellent time and said that they spent most of their
time visiting clinics and hospitals.
We extend our sympathy to Dr. J. R. Davies in his recent loss by
the sudden death of his mother which occurred September 26th,  1932.
We congratulate Dr. Robert Crosby on his success at the recent
exhibition when his high-grade stock received prizes.
Dr. J. A. Gillespie has evidently returned completely to his former
good health, as he is reported to have been seen climbing the fourth
fairway at Quilchena with all his old activity. We are very glad to record this evidence of his recovery.
The recent signs of re-awakening activity in the stock market have
appeared to be of great interest to certain of our members. The names
of various stocks begin to be heard again in the corridors of the hospitals,
and, we hope that some of the lambs will begin to recover from the
severe shearing that they received in the late crash of the stock market.
We understand from a sporting editor of a daily newspaper that
Jimmy McLarnin is seeking for an early match with our good friend
Dr. J. A. MacLachlan, who has recently revealed quite unsuspected talent
in the pugilistic line.
At the recent golf tournament held at Jericho during Summer School
week, Dr. J. Bilodeau was successful in winning the prize for low gross
and low net scores.
Miss Firmin, our Librarian is still away and has been delayed in her
return by the illness of her sister in Ottawa. We hope soon to see her
back.
1|ale ©ptttal €o.
Our Entire Interests are Devoted to
Scientifically Dispensing Your Optical Prescriptions.
18 YEARS EXPERIENCE
Suite 631 Birks Bldg. Seymour 9000
Page 20 A Doctor's Income^
depends upon his presence "on the job"
Accidents or sickness may at any time prevent
this and insurance against these possibilities is a
prime necessity.
C. ALBERT MITCHELL
will take care of this, as well as your
Auto, Fire or Burglary Insurance.
744 West Hastings Street Vancouver, B.  C.
Seymour 3838
wWfflWWWffBii "If one wishes to fortify cod liver oil, it is far more
reasonable and efficacious to increase its potency
by adding a small amount of viosterol, which is a
specific in the prevention and cure of rickets, as it
brings about calcification not only of the bone but
of the proliferating cartilage as well." (Hess,
At/red R, Am. J. Dis. Child. 41:1081; May, 1931.)
MEAD'S 10 D Cod Liver Oil with Viosterol is the choice
of many discriminating physicians because it represents
the long pioneer experience of Mead Johnson & Company in
the fields of both cod liver oil and viosterol.
Mead's 10 D Cod Liver Oil is the only brand that combines
all of the following features:
1. Council-accepted. 2. Made of Newfoundland oil (reported
by Profs. Drummond and Hilditch to be higher in vitamins A
and D than Norwegian, Scottish and Icelandic oils). 3. Supplied in brown bottles and light-proof cartons (these authorities have also demonstrated that vitamin A deteriorates rapidly
when stored in white bottles).
In addition, Mead's 10 D Cod Liver Oil is ethically marketed
without public advertising or dosage directions or clinical information. With Mead's,—you control the progress of the case.
Mead's 10 D Cod Liver Oil is therefore worthy of your personal and unfailing specification.    This -product is supplied
in 3-o%. and 16-o%. brown bottles and light-proof cartons.
The patient appreciates the economy of the large size.
Mead Johnson & Co. of Canada, Ltd., Belleville, Ont.
Vitamin Research Powell River, B. C.
Unequalled  intensity  of action—prolonged  effect—effective
by   injection   and   local   application—advantageous   price
characterize  the  new  non-narcotic  local  anaesthetic
NUPERCAINE "CIBA"
POWDER TABLETS AMPOULES
(A compound Nupercaine Ointment under the name of
PERCAINAIy, "CIBA" has recently been introduced for
the treatment of painful conditions of the skin and mucous
membranes.)
CIBA COMPANY LIMITED
MONTREAL
Messrs.  Macdonalds  Prescriptions, Ltd.      -      Vancouver,  B.   C.
Messrs. McGill & Orme, Ltd.      -      Victoria, B. C.
keep a full range of "CIBA" specialties. 536 13th Avenue West Fairmont 80
Exclusive Ambulance Service
FAIRMONT 80
ALL ATTENDANTS QUALIFIED IN FIRST AID
"St. John's Ambulance Association"
WE SPECIALIZE IN AMBULANCE SERVICE ONLY
R. J. Campbell J. H. Crellin W. L. Bertrand
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
»CENTUPY.«
B. C STEVENS CO.
Phone
Seymour 698
730 Richards Street
Vancouver, B. C Hollywood Sanitarium
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
Westminster 288
n-^^-^-^A-*--*-*--*--*--*-^-
-*--»-■*--*--»--»--*--*--»--*-   ji   ■*--*

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