History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: October, 1930 Vancouver Medical Association Oct 31, 1930

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OCTOBER, 1930
No. 1
The Bull
of the^
Vancouver Medical Ass
British oJXledical (^Association Uisit
Ascites
ciHaematuria
Tublished monthly at ^Vancouver, "33. Q., by
McBEATH-CAMPBELL LIMITED
"^Trice^ $1.50 per yeac-^ Patient Types:
THE OBESE PATIENT
is frequently in the chronic constipated class because of the factors of
dietary excesses and lack of exercise.
The general form of treatment calls for a regimen of exercise and
diet. Petrolagar is a very important aid in the management, because, being
unassimilable, it is impossible for it to increase or produce obesity.
Petrolagar, a palatable emulsion of 65% (by volume) pure mineral
oil emulsified with agar-agar, has many advantages over plain mineral
oil. It mixes easily with bowel content, supplyihg unabsorbable moisture
with less tendency to leakage. It does not interfere with digestion.
Petrolagar restores normal peristalsis without causing irritation,
producing a soft-formed consistency and real comfort to bowel movement.
fetrot
agar
Petrolagar Laboratories
of Canada Ltd.
907 Elliott St.,
Dept. V.M.  10
Windsor,  Ont.
Gentlemen:—Send me copy of "HABIT TIME" (of bowel movement) and
specimens of Petrolagar.
Dr	
Address    	 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 and Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. M. Pearson
Dr. J. H. MacDermot Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the abov; address.
Vol. VII.
OCTOBER, 1930
No. 1
OFFICERS 1929-30
Dr. G. F. Strong Dr. C. Wesley Prowd Dr. T. H. Lennie
President Vice-President Past President
Dr. E. M. Blair Dr. W. T. Lockhart
Hon. Secretary Hon. Treasurer
Additional Members of Executive:—Dr. A. C. Frost; Dr. W. L. Pedlow
Trustees
Dr. W. B. Burnett Dr. W. F. Coy Dr. J. M. Pearson
Auditors:   Messrs. Shaw, Salter & Plommer
SECTIONS
Clinical Section
Dr.   S.   Sievenpiper . j Chairman
Dr.  J. E. Harrison Secretary
Eye, Ear, Nose and Throat
Dr.  F.  W.  Brydone-Jack Chairman
Dr. N. E. McDougall ^Secretary
Pediatric Section
Dr.  C. F.  Covernton j Chairman
Dr.  G.  O. Matthews Secretary
STANDING COMMITTEES
Library Orchestra Summer School
t^t-.t-t> t-.tt>t-> Dr. W. T. Ewing
Dr. D. F. Busteed Dr. J. R. Davies „     t>   n   v
t^     t^  *,  -k, t-.     T  u  >t    t~. Dr. R. P. Kinsman
Dr. D. M. Meekison Dr. J. H. MacDermot ~     ™.   T    ~
_     __.  TT  TT t^-cxt-d Dr. W. L. Graham
Dr. W. H. Hatfield Dr. F. N. Robertson ~     T   -,
_,„„„ tatac_ Dr. J- Christie
Dr. C. H. Bastin Dr. J. A. Smith t-\    V-   -n   -d
t^     „   TT  »r Dr. C. E. Brown
Dr. C. H. Vrooman n>     -r   t    r>
Dr. T. L. Buttars
Dr. C. E. Brown Publications
Hospitals
Dr. J. M. Pearson Dr. j. w> Arbuckle
Dinner                   Dr. j. H. MacDermot Dr. j. a. Gillespie
Dr. L. H. Webster                Dr. D. E. H. Cleveland Dr. w# C. Walsh
  Dr. F. W. Lees
Dr. E. E. Day Credentials „nu   i. .        „     j
V.O.N. Advisory Board
T1J.J    r>   •-.   tr j   a Dr. W. S. Turnbull Dr. Isabel Day
Rep. to B. C. Med. Assn.   i-.    a   t n*    t t\    -u  -u  r>    -„
" Dr. A. J. MacLachlan Dr. H. H. Caple
Dr. H. H. Milburn Dr. P. W. Barker Dr. G. O. Matthews
Sickness and Benevolent Fund — The President — The Trustees VANCOUVER MEDICAL ASSOCIATION
Founded 1898 Incorporated 1906
PROGRAMME OF THE 33rd ANNUAL SESSION
GENERAL  MEETINGS  will  be held  on   the first  Tuesday  and
CLINICAL MEETINGS on the third Tuesday of the month at 8 p.m.
Place of meeting will appear on the Agenda.
1930
October       7th—General Meeting:
Speaker—Dr. M. F. Dwyer of Seattle,  "Interpretation  of  Gastric  Symptoms,"  a  clinical  and
roentgenological study of 3000 cases.
October      21st—Clinical Meeting.
November   4th—General Meeting:
Speakers— ^j    "Early       Recognition
Dr. J. G. McKay     >   and treatment of the
Dr. A. L. Crease    J    Psychoses."
November 18 th—Clinical Meeting.
December   2nd—General Meeting:
Speakers—Dr. E. H. Saunders; "Early Recognition of
Acute Mastoiditis."
Dr. N. E. MacDougall;  "Treatment of the
Comon Cold."
December  16th—Clinical Meeting.
VANCOUVER HEALTH DEPARTMENT
1929
_i  240,421
  9,33 5
Rate Per 1,000 of Population
STATISTICS, AUGUST
Total  Population   (estimated)	
Asiatic   Population   (estimated)   	
Total   Deaths	
Asiatic   Deaths	
Deaths—Residents   only   	
Birth  Registrations ,	
Male      155
Female   190
INFANTILE MORTALITY—
Deaths  under  one  year  of  age	
Death Rate—per  1,000 Births	
Stillbirths   (not included in above)
July, 1930
Cases Deaths
Smallpox     0 0
Scarlet  Fever       9 0
Diphtheria    21 1
Chicken-pox 12 0
Measles     0 0
Mumps 1 0
Whooping-cough 3 5 1
Typhoid   Fever     2 0
Paratyphoid 0 0
Tuberculosis     29 17
Poliomyelitis 1 0
Meningococcus   Meningitis     0 0
Erysipelas   _,     7 0
167
8.18
17
21.44
152
7.44
345
16.90
16
46.38
16
August, 193 0
Cases    Deaths
0
13
2
5
1
3
13
3
0
14
0
0
0
0
0
0
0
0
1
0
0
12
0
0
0
September 1
to 15, 1930
Cases    Deaths
0
8
7
2
0
0
1
0
0
13
0
0
3
Pagel Doctors
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412 St. Sulpice St.
Montreal EDITOR'S PAGE
With this number, the Bulletin enters upon its seventh volume.
To those of us who have been associated with its publication, it hardly
seems possible that it is six years since it was launched. For the launching we have one man largely to thank, Dr. H. H. Milburn, in whose
term of office as president, the idea of an Association Journal was first
brought to practical fruition; in fact, it was his personal enthusiasm
that supplied most of the momentum with which this rather fragile bark,
to continue our metaphor of the sea, was started on the ways.
What, we wonder would be the verdict today, if the Bulletin were on
trial for its life? What verdict would our readers give, as to the worth
and usefulness to them of the Bulletin? What would be the verdict of our
contemporaries? And what is our own verdict, as an Editorial Staff?
Stocktaking at intervals is a salutary check on any organization's activities, and perhaps it is time that we effected an audit on those of the
Vancouver Medical Association's Bulletin. It is in the air—City, School
Board, even the Hospital, have all been on trial, and, it is hoped, to the
ultimate betterment of conditions in all three, and why should we not
follow their example? Financially, perhaps, it is not so necessary,—we
have the questionable happiness of the poor man whose accounts are
hardly worth auditing, but there are many angles besides the financial
one, from which we should review our position.
As to our readers—they are, we find, either a very well-satisfied, or a
very inarticulate body of people. We hope the former—but would suggest that even if no criticism occurs to them, a word of commendation,
faute de mieux, would not be amiss. But we feel there must be some
criticisms that should be voiced. We should like to receive from any
of our readers, suggestions, criticisms, expressions of preference, anything
that will show us that we have readers. It is a weary thing to speak
into a great silence.   A few catcalls, even, would be a welcome relief.
For our contemporaries. We are evidently read elsewhere for we so
frequently find references to articles, or other of our contents, in journals
scattered all the way from the Atlantic to the Pacific. Even editorial
expressions of opinion have been commented on, and this is all very
cheering.
And our own verdict? Are we satisfied with what we have done?
Heaven forbid that we should ever be, and certainly we are not yet.
Our policy as an Editorial Board has so far been to stress the scientific
side of things, to secure all the material that we can, and, perhaps, to do
this rather to the neglect of the human side. Perhaps this has struck
others too, we do not know—but we have felt that a re-arrangement of
emphasis may in many ways be a good thing. Vancouver is now, medically speaking, a city with a history. The Vancouver Medical Association
shares in this history, and there is much in the past, not only of interest,
but of value and encouragement, that we might do well to recall. Our
Association itself is insufficiently known to its members—and we feel
this a pity, not that we are boastful or self-assertive in the matter—but
that there is much that we should all know, and in which we could all
feel pride. So that in this volume we propose to stress a little more, the
things that are not strictly utilitarian, but which are no less important
for that reason. And, in the immortal, if not original, words of Tiny
Tim "God Bless us All."
Page OBITUARY
On August 31st, the death occurred, in the Vancouver
General Hospital, of Dr. Henry M. Cunningham at the age
of sixty-five.
Dr. Cunningham was a son of the late Thomas Cunningham, well known Government Fruit Inspector of the
Province, and received part of his early education in New
Westminster. Later he attended the University of Toronto,
also Columbia University, New York, graduating in 1895.
He entered private practice at Detour, Michigan, later doing
postgraduate work at the Cleveland Eye Clinic. In 1908 he
spent considerable time in Vienna and Freiburg in special
post-graduate study in Eye, Ear, Nose and Throat work. He
practised his specialty in Marquette, Michigan, until 1917,
when he located in Vancouver.
To the many warm personal friends of Dr. Cunningham
it was known, but hidden from the public by characteristic
modesty, that he was the possessor of musical ability and
a very wonderful voice, and was also a crafstman in the working of fine silver, a maker of silver ornaments and silver
instruments.
The late Dr. Cunningham was a member of the American
Larynological, Rhinological and Otological Society, a Fellow
of the American College of Surgeons and a Past President of
the Pacific Coast Oto-Ophthalmological Society. He was a
contributor to numerous medical journals and delivered the
Osier Lecture in 1928 before the Vancouver Medical Association.
Dr. Cunningham married, in 1908, Miss Bertha Mount-
ford, of Chicago, who survives him. His loss will be felt by
a wide circle of friends both within and without the profession of medicine.
As a man and a physician, Henry Cunningham was beloved by all who came in contact with him. Friendly and
sincere, generous and kindly at heart, he never failed to
respond to any appeal for help in the work in which he was
so highly skilled. He specialized, within his specialty, in
bronchoscopy and oesophagoscopy, and those who do this
work know that more often than not, the patients needing
it are hopelessly crippled and unable to pay, as cancer is so
often the disease present. Yet he gave his time and used his
special and expensive instruments freely and ungrudgingly in
the very best traditions of his profession. The ovation given
him at the close of his Osier Lecture showed in what wide
and true esteem he was held.
Page 3 ANNUAL DUES
The Annual dues for the year 1930-1931 were payable on April 1st
last and, acording to our Bylaws, if not paid before October 31, bank
drafts are issued to each member in arrear. The Treasurer will be glad
if members who have not yet paid up will send in their cheques as soon
as possible, in order that the work of the Association may be carried on
efficiently.
NEWS and NOTES
Dr. H. A. DesBrisay, who was on the Interne Staff of the Vancouver
General Hospital in 1919 has returned to the City and opened an office
in the Medical Dental Building. During his absence from Vancouver
Dr. DesBrisay was for two years at the Mayo Clinic and later for three
years was with the Lockwood Clinic at Toronto, of which he was one of
the original members. Later Dr. DesBrisay was for five years Assistant
Professor of Medicine at Dartmouth Medical School and was also engaged
in private practice. The doctor's intention is to limit his practice to
consulting work in Internal Medicine.
Dr. A. W. Hunter went South for a holiday during the month. He
is Treasurer of the Western Branch of the American Urological Association and read a paper on "Primary Tumours of the Ureter" at a meeting of the Association on September 18 and 20th, at Los Angeles.
We offer our hearty congratulations to Dr. Herbert Stalker and
Mrs. Stalker who were married on September 10th at the Canadian
Memorial Church. Mrs. Stalker, who was Miss Irma Hyland, was a
popular member of the nursing staff of the Eye, Ear, Nose and Throat
Department of the Vancouver General Hospital, and Dr. Stalker has
been acting for some time as Assistant to the Acting Superintendent.
The honeymoon was spent in the South.
Dr. George Seldon, who is quite recovered from his recent illness,
attended the British Medical Association Meeting at Winnipeg. The
doctor then went on to Ottawa and at the meeting of the Medical
Council of Canada on September 3rd, he was elected President of that
body.
Dr. J. G. McKay also went on to Ottawa to attend the Annual
meeting of the Dominion Medical Council as representative of the British
Columbia College of Physicians and Surgeons in place of Dr. Forrest
Leeder, resigned.
Congratulations are in order to Dr. Stanley and Mrs. Sievenpiper on
the birth of a son in Grace Hospital on September 4th.
The names of a few of our members who went to Jasper to enjoy
(inter-alia) the Totem Pole Golf Tournament, follow: Drs. B. D. Gillies,
D. M. Meekison, W. A. Whitelaw, L. H. Appleby, H. H. Milburn, W. l!
Pedlow, E. E. Day, F. Day-Smith, J. A. Milburn, G. H. Clement, N. E.
McDougall and R. B. Boucher.
Page 4 Dr. C. E. Brown and family have left for the East and expect to be
away till the end of October. Dr. Brown will attend the Interstate
Medical Association at Minneapolis on the return trip.
OUR BRITISH MEDICAL VISITORS
Late on the afternoon of September the fifth, the Victoria boat
nosed its way through the fog bearing one hundred and fifty of the
overseas visitors who had attended the splendid convention in Winnipeg.
The fog lacked only the flavour of the London variety and for a brief
moment the delegates fancied themselves back on their own Thames.
This illusion was soon dispelled when they disembarked on the "landing-
stage," by the spectacle of a brass band awaiting their arrival. The
responsibility for this Mid-western touch has not yet been fixed—but a
brass band there was, and, to the strains of something or other the visitors
were escorted to their hotel. The experience was described later, by Mr.
Bishop Harman, as unique.
In the evening a truly excellent civic dinner was tendered to the
Britishers and about one hundred and fifty local guests, in the Hotel
Vancouver ballroom. With the aid of more than the physiological 10c.c.
of spts. vini rect., and some non-vintage wine, the gathering took on
a very sociable character. His Worship the Mayor, Lt.-Col. Malkin, sans
uniform, presided, and in one of those witty speeches for which he is
famous, welcomed the visiting medicos, introducing the principal speakers,
Mr. Bishop Harman, the noted ophthalmological surgeon, and Sir James
Purves-Stewart. Mr. Malkin's remark, that there was no tariff on brains
coming into the country, was particularly well received.
Mr. Harman, with his "hatches,, matches and despatches," and his
subtly expressed, kindly jealousy of the Scottish race, gave a splendid
opening to the well-known neurologist, Sir James Purves-Stewart, himself
a Scot. Sir James, splendidly decked out in Stars and so forth,
somewhat shading the ordinary O. B. E.'s and service medals, informed
the gathering that the Scots descended upon England either for the Sassenach's money or on account of the climate. He himself lived in London for the latter reason, he declared.
On Saturday there was much to divert the visitors. Mr. Eric
Hamber displayed most royally the hospitality of the west, by taking
a round hundred of them on a cruise to Britannia and Woodfibre. His
genial entertainment was greatly appreciated both internally and external-
1
Woodfibre was visited first, where the visitors had what must have
been to them the novel experience of sitting down to dinner in the employees' mess-hall. Here they were regaled with the meagre fare that
is served up to the pulp and paper makers, beginning with tomato gumbo
and continuing through to lemon pie and spotted dog. The latter is
entirely unrelated biolgically to hot-dog, as was explained by Dr. Riggs.
The visitors were then divided into small parties and taken through the
plant before returning to the boat. We are very grateful to Mr. A. E.
Brennan, the manager, and Dr. C. G. McLean, the medical officer at
Woodfibre, for making this visit so enjoyable.
At Britannia the visitors were loaded on flatcars and towed by
an electric locomotive up to the top of the mill.    Here they saw the
Page 5 copper ore as it came in from the mine, entering the crushers, and then
descending hundreds of feet of steps; observed the successive processes
on the various levels until the sulphides are floated off on oil-bubbles to
be carried away in scows to the smelters.
A lavish tea was served on the Vencedor after leaving Britannia and
Vancouver was reached at nine o'clock when Mr. Hamber was warmly
thanked for the royal style of his day's entertainment.
After landing the majority of the visitors returned to the hotel, but
a small number were taken to the Medical-Dental Building where they
inspected and marvelled at the comfortable home for books and journals
and their users, as well as the auditorium on the second floor, and the
compact hospital-unit on the third floor.
Some elected a tour of Burrard Inlet as guests of the Harbour Board.
Our port and its potentialities opened the eyes of some of our old country
colleagues just a little wider.
Another party, under the escort of Dr. Lennie, was taken to Fraser
Mills to view the terminal operations upon the remains of the race of
forest giants, for whom tree surgery arrived too late. Others toured the
city while still others pursued the elusive white pill over the beautiful
rolling country-side at Jericho. These latter were mostly from north of
the border and little money changed hands.
Many were greatly surprised at the conspicuous absence of Indians,
bears, cowboys and gambling dens, while astonishingly few of the local
inhabitants carried guns. They were impressed by the fact that almost
the same language was spoken. Indeed, our worthy mayor was almost
more English than they were.
The party left on Sunday morning to return to the murk and
drizzle of the tight little isle. Many of them avowed an early return.
Certainly, if the contingent which paid us the brief but thoroughly enjoyable visit has anything to say about it, the 1940 B. M. A. Convention
will be held in Vancouver.
Although the members of the British Medical Association who visited
Vancouver were only a fraction of the whole, the entertainment furnished them here must rightly have been regarded as a fitting climax to their
Canadian tour, and as illuminating, and characteristic as any local colour
they have seen. Although not the "farthest West," Vancouver was the
last city which they visited before their return across Canada to their port
of embarkation. It is fortunate, therefore, that such an efficient committee
was appointed to arrange for their reception and entertainment here, and
we congratulate and thank this committee for its excellent work and
arrangements.
CORRESPONDENCE
The Editor of the Bulletin,
Vancouver Medical Association,
Vancouver, B. C.
Dear Sir,
In the September number of the Bulletin I notice an adverse comment on the sending of a patient out of the City for a condition which
was diagnosed as brain tumour. The diagnosis was arrived at only after
complete Hospital laboratory tests, checked by private laboratory tests,
Page 6 and consultation with men of outstanding ability in the profession.
Besides this, he was examined independently by other members of the
profession—men of good judgment and long experience, who, I understand, acquiesced in that diagnosis.
It is only fair to state that the clinic to which the case was sent,
does not agree that the case is one of brain tumor, being rather of the
opinion that it is one of multiple sclerosis—a serious condition, and one
which could readily be confused with brain tumour, especially in one
so young—21 years. However, I wish to state here that if another
similar case were to occur in my practice, I would unhesitatingly call
the same men in consultation.
The Bulletin, while commending the newspaper for the charitable
impulse in getting together the funds which enabled the patient to go,
evidently considers the sending of the man as a slight on the profession here.    Not at all—such was never intended.
It is my opinion, often expressed, that the City of Vancouver
is as well, perhaps better, served medically and surgically, than any
city of its size in the world, and there are great men among us, who
in their particular line, could hold their own against the world's best.
May I point out however that "talent and ability in some fields at
least" is an entirely different thing from skill and experience in one
particular field. It may be asked how it is possible to attain or maintain
skill without experience, and how experience can be gained if comparatively rare cases are sent out to some one who already has that
experience. My answer is simply this—that while our patients may
incidently be useful to that end, they are not primarily for that purpose.
I was rather surprised to hear that the profession in Vancouver is
outstanding "in the matter of brain surgery in particular." I have
gone carefully trough the records of the Vancouver General Hospital
to ascertain the facts, and this is what I find. The records of the
Vancouver General Hospital show that during the ten years 1920-1929
inclusive, there were performed all told, 93, 988 operations, of which
number 5,761 were appendectomies. During the same period, although
there were in all 31 deaths from intercranial tumour, and more than
that number discharged from the Hospital with the same diagnosis,
the records do not show one single operation for brain tumour having
been performed. In St. Pauls Hospital, as regards operations for brain
tumour, practically the same situation obtains. I understand that during
the past five years there was one—possibly two specimens of brain
tumour examined in the laboratory, although it is not certain whether
these Were  ante-mortem or post-mortem tumours.
Now, brain tumour is an operable condition. In regard to treatment
"in the matter of brain surgery in particular," it would appear that
we are not in accord with such men as Cushing and Dandy. If your
premises are correct, I quite agree that "it should not be necessary to
send a patient half way across the Continent to obtain proper treatment"
—it should not be necessary to send him half way across the street, for,
if the proper treatment consists in watchful waiting, any of us ought
to be able to do that—in time.
Although I have ' gone into all the available records with the
greatest possible care, and have presented the case as fairly as I know
how, I  am still willing  and  anxious  that  any surgeon who may  feel
Page? that he has been overlooked, may have an opportunity of placing his
position fairly before the profession. I therefore request that any such
surgeon give to the Bulletin for publication, a report of all his operations
for brain tumour—say during the past five years—with laboratory
findings, and end results in each case. For purposes of this discussion
I am not at all interested in cases such as fractures of the skull,
decompressions, and operations such as trephining etc. which are done as
a matter of routine by any surgeon.
A propos of this discussion, you may perhaps remember the circumstances surrounding the death of Floyd Bennett, who died of
pneumonia in the City of Quebec on April 25th, 1928. An eminent
physician was called from the City of New York to assist with the case,
and the Rockefeller Institute sent Lindbergh by air with a quantity
of serum. Two gentlemen in high places, feeling that the fair name of
Canada was in jeopardy, rushed to the defence of Canada in general,
and the doctors of Quebec in particular. Note the similarity of argument to that of the Bulletin. (I quote from the Vancouver Daily
Province of April 28, 1928) "We have physicians and surgeons who
have absorbed the best science of Europe. Here we have everything that
is necessary, and we do not need them to come from the United States
to bring us serum. We can get along without American doctors, be
they the most accomplished specialists in that country." The doctor in
attendance, concerned only with the saving of the life of his patient,
and not with any questions of injured dignity, said not a word, until
he said the last one, and this in part is what he said:- "I think the World
of Medicine has not any borderline or limit and out of charity, in the
face of death or suffering, should be big enough to include the whole
world, if relief can be given or obtained."
The Bulletin is the official organ of the Vancouver Medical Association.   May   I   suggest   that   the   Bulletin,   before  rushing   into  print   in
' criticism of one of its members, be careful to ascertain beforehand all
the  available facts,  and  then  try  to  see  the  end  from  the  beginning
before doing so.
Some things are better ignored than discussed.
Yours very truly,
Daniel McLellan, M.D.
LIBRARY
SECTION
Abstracts
and Reviews
Conducted by
The Osier Society
Discussion on Amputations and their relation to the Artificial
Limb.    C. Max Page et al.    Proc. Ry. Soc. Med., July, 1930.
A fairly exhaustive review of the problems confronting the surgeon:
a dissertation on the ideal stump in both upper and lower extremities; details in technique of various amputations and in general; types of
artificial limbs and a comparative summary and contrast of fashions and
Page   8 ideas in America and on the continent.    At the outset, the general aims
are set forth governing any final major amputation, namely.
1. That the stump should provide a lever of sufficient length and
power for the attachment of an artificial limb suited to the level of the
amputation.
2. That it should be covered closely by healthy, well-nourished
skin or scar, both of which should be mobile on deeper structures.
3. That no part of the stump should be tender on pressure or
abnormally sensitive.
The Symes amputation, is condemned, as invariably giving trouble
after a few years. The six-inch tibia stump is upheld as ideal. The
stokes-Gritti operation is held to be unsatisfactory while that through a
point four inches below the great trochanter is recommended.
A. Rowatt Maxwell's contribution is invaluable by virtue of experience with over 10,000 upper extremity amputation cases in thirty years.
This is a very frank portrayal of the whole subject and should be
thoroughly persued by any surgeon doing amputations.
D. M. Meekison
Malaria Treatment of Paresis.     Freeman,   Walter.     Am.   Jnl.   of
Syphilis, v. 14; p. 326.    July, 1930.
Dr. Freeman in his work on a group of patients that were innocu-
lated with malaria and later followed to necropsy, endeavours to explain
the modus operandi of malaria in the treatment of paresis.
He reached a tentative conclusion, based principally on his findings
in the group that reacted favourably to the treatment, that the malaria
or other febrile illness does not always annihilate the spirachaete, even
though it may suppress its activity in the central nervous system. The
patient is given a better chance to handle his infection elsewhere.
In his paper he gives three possible ways that malaria may operate in
bringing about a remission—By killing the spirochaete by the high temperature—by stimulation of the reticulo-endothelial system in the
cerebral cortex—this hyperpalasia combating and controlling the tre-
ponema and by forced drainage of the nervous parenchyma along the perivascular channels into the sub-arachnoid space.
Treponema are rarely found in the sub-arachnoid space and spinal
fluid. It is thought that the swollen hydrated brain tissue forces a current of fluid along the peri-vascular channels into the parenchyma evicting
the treponema from its haunts and allowing it to be easy prey for the
reticular cells in the meninges.
W. L. C. Middleton.
Injuries Resulting from Irradiation in Beauty Shops.   Hazen, H.
H.    Am.   Jnl.   Roentgenology   and  Radium   Therapy,   v.   XXIIL,
409-412.    April, 1930.
Hazen points out that five years ago there occurred an indiscriminate
installation of X-Ray machines in beauty shops for the purpose of treating superfluous hair. This article includes case reports of ten women so
treated in various shops of this sort in the East. Among these ten the
following conditions have developed: telangiectasia, deep muscular atrophy, atrophy and retraction of the gums, etc., and many suffered, in addition to the disfigurment, much pain.    Dr. Hazen states "In other words,
Page 9 sufficient roentgen radiation to remove hair from the face or body permanently, will, in a high percentage of cases, damage the skin to a visible
extent"—a conclusion with which all will agree although it is just as
certain that hair removal with a slight amount of telangiectasia of the
skin is acceptable to some women on areas other than the face. He concludes "It is amazing that in many communities medical practice Acts
"include only the prescribers of drugs and permit any type of physiotherapist to ply his trade without let or hindrance, with a total disregard for
the potential dangers of the therapeutic procedure." The above applies
equally well to X-Ray examination and treatment of other parts of the
body by those other than qualified medical men or properly trained technicians under adequate medical supervision.
H. A. Rawlings.
Mechanism of Physical Signs in Neoplastic Diseases of Lung"
Chevalier Jackson, J.A.M.A. 95; 639-644. August 30, 1930.
Chevalier Jackson endeavours to point out the importance of understanding the mechanism of physicial signs produced by neoplastic and
other diseases of the lungs in order to interpret better their signs. His
conclusions are drawn from a study of 5,000 bronchoscopies and deals
entirely with bronchial obstruction. He states that for the production
of abnormal physical signs, one or more of four conditions must be
present.
(a) Narrowing or enlargement of the lumen.
(b) Swollen mucosa.
(c) Projecting abnormal tissue.
(d) Foreign  body, or
(e) Secretions.
There are three types of bronchial obstruction comparable to the
: three types of mechanical valves.
1. Stop valve; where there is complete obstruction resulting in
atelectasis and later drowned lung.
2. By-pass valve; air passing in and out but in dimished quantity,
e.g.  asthma.
3. Check valve; air passing only one way, resulting in obstructive
atelectasis or obstructive emphysema.
The following conditions producing valvular obstruction are taken
up in detail. Foreign bodies, benign growths, malignant growths, adenopathy, anomaly, inflammatory, mucosal swelling, granulations and
granuloma, secretions and blood clots.
The author concludes by stating that a full comprehension of the
mechanism of each of the three types of bronchial obstruction is necessary for the proper interpretation of the physical signs and properly
interpreted, the signs in the respective conditions become of the utmost
diagnostic importance. The article is made specially clear by the
schematic illustrations.
W. H. Hatfield.
Early Gastric Cancer.   Wellbrock,  W.  L.  A.    Arch,  of Pathology,
v. 8; 735-743.    November, 1929.
A series of 100 excised and resected small gastric lesions form the
subject matter of this paper.    These were studied by both fresh frozen
Page 10 sections stained by Unna's polych. meth. blue and fixed frozen sections
with haematozylin" and eosin.
The author carefully notes the histology of the chronic gastric
ulcer; touches on a few of the theories of aetiology and then very carefully describes the mucosal cells in various parts of the stomach. He
further states how difficult it is to prove carcinomatous change in a
chronic ulcer unless one could experimentally produce a chronic ulcer and
then carcinoma in the ulcer, and show that all conditions are comparable
to the conditions arising in human beings
The earliest changes must be sought in the lining cells of the tubules,
the typical changes in shape, staining properties, etc., being described.
The author feels the term "malignant or cancerous degeneration" in an
ulcer is a misnomer, as cancer is biologically a defensive constructive
process, though purposeless, functionless and, eventually, fatal.
His conclusion is that differential clinical diagnosis of benign and
malignant gastric ulcers is notoriously defective. All chronic callous
gastric ulcers are suspected of being carcinomatous, and should be treated
as such before and at the time of operation. The use of the microscope
is the only means of mstinguishing simple chronic gastric ulcers from
early gastric carcinoma. The diagnosis cannot be made by clinical means,
roentgenoscopy or the appearance of the gross specimen, that is, in the
small lesions.
H. H. Pitts.
"Read, Mark, Learn and Inwardly Digest"
THE SIGNIFICANCE OF ASCITES, AND
ITS TREATMENT
By Dr. William Fitch Cheney
I.    Significance.
Assuming the diagnosis made, face to face at the bedside with a
case recognized to be Ascites, what does it mean? There are five possibilities of any consequence and only five. All others are rare and remote by
contrast. Of these five possible causes, two are general—disease of heart
and disease of kidneys; and three are local in the abdomen—cirrhosis of
the liver, tuberculous peritonitis and carcinomatous peritonitis.
1. Ascites Due to Heart Disease: It is usually easy to recognize
this form. The history that precedes the ascites points to the heart and
the other signs of disease that are found show faulty action of the heart
itself, of the lungs, of the kidneys as demonstrated by urinary tests, and
of the liver as proved by its increased size and tenderness. Furthermore
dropsy involving the peritoneal cavity rarely occurs first or alone; it is
only a part of a more or less general dropsy. It must be remembered,
however, that in ascites due to cirrhosis of the liver, swelling of the
feet and ankles frequently precedes and frequently follows; and after
ascites from any cause, oedema of the feet results from mechanical pressure. But it is a rule fairly trustworthy that ascites is never the only sign
of dropsy due to cardiac insufficiency, as right hydrothorax may be.
Delivered  before  the  Vancouver  Medical  Association  Summer School,
June,  1930.
Page 11 Gynecologically Correct!
Every gynecologist knows that uterine pain, whether due
to displacement, functional disorders, or inflammation, is, at
times, one of the most intense that the human organism
endures.
Every gynecologist conversant with, the use of
also knows what a larger measure of comfort can be brought
to the patient by the simple insertion of a tampon prepared
with  this  hygroscopic,  thermotherapeutic  agent.
[n cervicitis and endocervicitis,
where there is often considerable sensation of weight and
bearing down in the pelvis,
the ANTIPHLOGISTINE
tampon, by inducing an abundant serous transudation, is
considered by leading practitioners as the depletant and
supportant agent of choice in
the management of these conditions.
Many gynecologists also find
this tampon useful for the purpose of exciting pressure and
giving support in the gradual
replacement of a retroverted
uterus. In such cases, the
tampons should be small and
the string to each one should
be long enough to reach from
the vaginal vault to a point
well  outside  of the  introitus.
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Montreal
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Medical-Dental Building Vancouver 2. Ascites Due to Kidney Disease: Here also there are almost
invariably other symptoms and signs present before ascites develops.
There is a puffy oedema and a waxy pallor about the face, eyes and
hands. There is more or less frequent headache, nausea and vomiting.
There are urinary changes as regards both quantity and quality. Tests
of blood urea show faulty elimination. Phthalein tests show faulty excretion of the dye. The blood pressure is usually high. Finally there is
practically always some other evidence of dropsy and general anasarca.
Rarely or never is the peritoneal cavity alone involved.
3. Ascites Due to Cirrhosis of The Liver: Ascites is a late
manifestation of cirrhosis, therefore a long history usually precedes its
development. This history is one of gastro-intestional disturbances such
as poor appetite, dyspepsia, occasional nausea and vomiting especially on
rising, flatulence, abdominal unrest, heaviness and tenderness in the epigastrium, looseness of the bowels alternating with constipation, weakness,
languor, loss of weight, slight transient jaundice. Hematemesis caused
by cirrhosis is usually a much earlier result than ascites, and the history
frequently includes such a past event when ascites finally appears. With
this background, often of years duration, ascites, when it comes, makes its
onset gradually and painlessly as a rule, but it may appear quite suddenly
The first complaint is of distension by gas, increasing size of the abdomen
and a sense of fulness and stretching.
Physical examination shows wasting of the body in marked contrast
to the enlarged abdomen; sallow colour and dryness of the skin, dilated
vessels on the face, often a number of dilated vessels over the lower thorax,
and the distribution of enlarged veins in the abdominal wall known as
the "Caput Medusae." Another interesting sign, to which Osier used to
call particular attention, is "Spider Angiomata"—small red elevations over
the face, neck and trunk, with radiating small vessels running out from
them like the legs of a spider from its body.
After tapping the abdomen and withdrawing the fluid contents for
better palpation, the liver is usually found smaller than normal, but may
be swollen, the spleen is palpable but not excessively large, and there are
no masses found elsewhere. Frequently there is oedema of the feet and
legs but no general dropsy.
As regards laboratory examinations, (a) the ascitic fluid is clear,
greenish or yellow in colour, its specific gravity is low (usually below
1015), there is a low albumen percentage, and the cells found are 95 per
cent, endothelial (not lymphocytes); rarely is the fluid bloody; (b) the
urine is scanty, highly acid, has a high specific gravity, is dark in colour
and uratic, but contains no albumen, no sugar, no casts and no blood;
(c) the blood shows a moderate secondary anaemia but not the degree
or character shown by splenic anaemia, and there is no leucopenia; not
infrequently the Wassermann reaction is positive, and this is important
because  the  cirrhosis  may   be  luetic   and   yield   to   specific   treatment;
(d) gastric analysis shows a typical chronic gastritis, with abundant
mucus and complete achlorhydria; (e) the stool frequently shows occult
blood; (f) the icterus index may show bilirubinaemia above normal even
where there is no clinical jaundice; and the van den Bergh test may
prove that the cause of this is intra-hepatic; while liver function tests
after the administration of a dye may or may not prove impairment of
the liver's excreting powers.
Page 12 Ascites due to cirrhosis is not always a terminal event, but usually
it makes a bad prognosis, with death probable in three or four months,
after a few tappings. But it may disappear entirely (1) after treatment
for syphilis by mercury and iodides; (2) because it was really due to
some other cause, as a failing heart; (3) because adhesions form after
tapping and permit the blood to return to the heart without passage
through the liver, as after a successful Talma operation; (4) after the
use of ammonium salts and merbaphen, even though the result is not
permanent and ascites recurs slowly a few months later.
4. Ascites Due to Tuberculous Peritonitis: Here the usual
history is one of pain and tenderness over the lower abdomen; but the
onset may be insidious and ascites appear without any preceding symptoms. It occurs most often in young people; but not always. Almost all
patients complain of enlargement of the abdomen and distension by gas
as the first signs of their ascites. There may be a history of previous
tuberculosis elsewhere, in lung, pleura or glands, or the disease may apparently be primary in the abdomen, even though some focus does exist.
In this form of ascites the effusion is moderate, not as large as in
cirrhosis or in carcinomatous peritonitis. After tapping paplable masses
may be found, due to puckered omentum or enlarged mesenteric glands.
Frequently there is a doughy consistency of the abdominal wall and
tenderness on palpation. There is no enlargement of liver or spleen. It
is important to remember, however, that cirrhosis of the liver predisposes to tuberculous peritonitis, which may occur as a complication and
both conditions coincide. In women, pelvic masses may be found, due to
tuberculous disease of the appendages, that act as a focus; and in men
similarly a focus may be found in the testis or epidydimis. Fever usually
acompanies tuberculous peritonitis, but of low grade, variable, and there
may be none.
The ascitic fluid due to this disease is clear as a rule but may be
haemorrhagic. It is of higher specific gravity than in cirrhosis and
shows more albumen. There is a preponderance of lymphocytes in the
cell count. No bacilli can be found in smears from the sediment, but
guinea pig inoculation may prove the nature of the trouble. The urine
is not in any way characteristic unless primary tuberculosis of the
urinary tract has been the focus for the peritoneal infection. The blood
shows a secondary anaemia bu!t no Ieucocytosis. The stool may contain
blood if there is a primary tuberculosis of the bowel and the proctoscope
may demonstrate the presence of ulcers. It is always wise to secure an
X-Ray plate of the chest in the search for primary tuberculosis to explain the ascites as due to tuberculous peritonitis.
5. Ascites Due to Carcinomatous Peritonitis: This form occurs most often in elderly people, because it is metastatic to the peritoneum from primary carcinoma in stomach, bowel, rectum, uterus, etc.
Therfore the age incidence of one is that also of the other; and a history
of the primary disease precedes the development of ascites. The effusion
is large. After tapping, palpable masses are found in the abdomen or
by rectum, or by vagina. The spleen is not enlarged but the liver may
be, and likewise irregular and modular. More emaciation and cachexia
occur than in other types of ascites.    There may be visible and palpable
Page 13 nodules in the abdominal wall or glands may be enlarged in the neck or
the groin; and biopsy on any of these may prove the nature of the
pathology.
The ascitic fluid is haemorrhagic more often in this form than in
any other. It has a comparatively high specific gravity and more albumen
than in cirrhosis. The fluid is otherwise much like that in tuberculous
peritontitis; but the cells at times are more characteristic, multinuclear
and in groups. The blood shows only a secondary anaemia. The blood
Wassermann should be done in every case as a routine. Gastric analysis
may give information proving the existence of primary cancer of the
stomach. X-ray of the gastro-intestinal tract after tapping is always
indicated and may identify the source of the metastatic peritonitis
causing ascites.
Besides these five outstanding causes of ascites there remain only a
few other possibilities, much more remote and unlikely. (6) Polyserositis, or Pick's Disease, involves not only the peritoneum but the pericardium and the pleura. It is characterized by ascites of long duration,
recurring persistently after tapping. Its aetiology is unknown. It is
comparatively a rare disease. (7) Solid ovarian tumours may give rise to
ascites in some cases, even when they are not malignant. Pelvic examination ought to identify them. (8) Intestinal obstruction may occasionally
produce ascites as a complication.
II.    Treatment:
1. When Ascites is Due to the Heart: The principles of
management here are those for general dropsy in heart disease:—rest in
bed, Karell diet, limitation of fluids; calomel and soda in broken doses
followed by Epsom salts; paracentesis of the abdomen; then digitalize the
patient by use of the powdered leaves according to the well-known
method, a total of one decigram for each ten pounds of body weight.
Instead of this plan, the longer-used pill of calomel, squills and digitalis,
one grain each, one pill three times a day for four days, may act more
satisfactorily. Diuretics are always indicated following digitalization,
such as euphyllin of which the dose is two-tenths of one gram (3 grains)
by mouth three times a day. Even more efficacious is salygran one-half
cc. intravenously followed next day by one cc. intravenously and 2 cc
every three or four days afterward. Or merbaphen (novasural) may be
used in the same way intravenously, supplemented by ammonium nitrate
by mouth, in dose of 6 to 10 grams (90 to 150 grains) daily, given in
peppermint water.
2. When Ascites is Due to the Kidneys: The indications for
treatment are rest, heat, limitation of fluids, low salt and low protein diet,
tapping of the abdomen, purgation by salines, sweats by external heat,
hot flaxseed poultices to the back over the kidneys. If diuretices are to
be employed, again use ammonium nitrate by mouth and salyrgan by
vein as described. Or the old-fashioned mixture of acetate of potash
with infusion of digitalis sometimes acts even more satisfactorily.
3. When Ascites is Due to Cirrhosis: The plan advised here
is as follows: (a)paracentesis as early as required to give comfort, for
it relieves pressure on the abdominal and thoracic viscera, prevents venous
Page 14 engorgement and possible hematemesis; (b) low salt and low fluid content in the diet; (c) diuretics, particularly merbaphen and ammonium
nitrate given as previously described, constitute the most distinct advance in the therapy of ascites due to cirrhosis and may control it for
long periods, but not indefinitely; (d) purgatives such as the hydro-
gogues (elaterium, Jalap and gamboge) do harm by weakening the
patient, but repeated small doses of calomel followed by Epsom salts are
beneficial. Personal experience with patients subjected to the Talma
operation has never been satisfactory.
4. When Ascites is Due to Tuberculous Peritonitis: The
first thought only a few years ago was surgery. It was believed that by
opening the abdomen and admitting air freely the tuberculosis was arrested. But in recent years it has been found that equally good results can
be obtained without surgery; by keeping the patient at rest in bed for a
long period, weeks or months; and by the use over the abdomen of heliotherapy or the quartz lamp or the X-ray. But any one of these must
be used cautiously, beginning with brief exposure to their influence, because they may cause serious burns if emplayed injudiciously.
5. When Ascites is Due to Carcinomatous Peritonitis: The
only plan to follow is paracentesis and symptomatic treatment to give
relief and comfort. In any case where doubt exists as to the diagnosis,
laparotomy is justifiable to settle the matter. It at least does no harm
and it may reveal a condition that is not malignant after all and therefore
subject to removal or at least improvement by medical treatment.
HAEMATURIA
By Dr. W. L. C. Middleton
There are few, if any, symptoms relative to the genito-urinary tract
than are more important than haematuria, and with but few exceptions
it means organic disease, consequently when met with its source and its
cause should be exhaustively searched for.
It is the cardinal symptom of kidney tumour which is one of the
four important serious conditions giving rise to haematuria—namely,
tumour of the kidney, tumour of the bladder, tuberculosis and urolithiasis
Haematuria may be the only symptom of tumour for a long time
showing as but a few microscopic cells in the urine or as large clots. It
is often intermittent and the intervals may be long. It is well to remember this tendency to intermittency, especially if a haematuria, whose
source and cause is not definitely known, clears up under some treatment
used. It is apt to leave both the patient and the doctor with a false sense
of security in believing the condition cured.
Clinical observation over long periods of time and frequent cystoscopic examinations mey be necessary in patients with a profuse haematuria before a diagnosis can be made, especially if the bleeding is the only
symptom and no apparent cause for it can be demonstrated.
Of ten-times a tuberculosis that evaded diagnosis on previous examinations may be demonstrated.    Haematuria is the second important symp-
Read before the Osier Society of Vancouver, February,  1930.
Page 15 torn in urogenital tuberculosis frequency being the first. Their association is important, especially when they appear out of a clear sky.
These two conditions, tumour and tuberculosis, are the most frequent
causes of haematuria and it is especially in these groups that an early
diagnosis must be made if a satisfactory end result is to be expected.
Young, quoting Clado, Geraghty and Verhoogen, states that in
541 cases of vesical tumour, 404 or 75% gave haematuria as the initial
symptom. Haemorrhage is characteristic of bladder tumours practically
without exception. This is due to the very thin walls of the capillary
type of vessel developing in tumours, making rupture from tranma or
ulceration easy.
Casper found in cystoscoping 142 cases of bladder tumour immediately after the first haematuria, that all but three were small early tumours.
This is a most potent argument in favour of immediate cystoscopic
investigation of all haematurias. It is probable that a good many of the
cases demonstrating haematuria late, when extensive involvement has
occurred, are due to a non-papillary type of tumour.
Kretschmer, in a series of 23 8 cases of haematuria made an accurate
diagnosis in 197. It is interesting to note the incidence of the types of
lesions he found.    In the kidney were found:
3
cases
of
tuberculosis
2    "
' trauma
2
CC
ct
nephritis
2    "
renal carcinoma
8
cc
cc
renal calculus
1    "
I pyonephrosis
8
cc
cc
hypernephroma
1    "
' movable kidney
8
cc
tt
colon bacillus infec
1     "
' pregnancy
tion
1     "
c doubtful stone
2
cc
tt
renal tumour
1    "
■   oxaluria
2
ct
cc
polycystic disease
2
tt
*i diverticula
1
tt
angiomata
1
Ct
" polypi
making a total of 74 cases.
In the bladder were found:
32 cases of carcinoma
26    "       " papilloma
14    I       "  calculus
10 " bladder tuberculosis
making a total of 86 cases.
In the prostate there were 12 cases of carcinoma and 13 cases of
hypertrophy, making a total of 25 cases.
In the ureter were found 10 cases of calculus.
In the female urethra the haematuria was due to prolapse in one case
and tumour in another.
In analysing these cases it is seen that tumours of the bladder were
responsible for bleeding 60 times or 30%. Of the 74 renal lesions tumour
was found in 12 cases.
In the prostate there were 25 lesions, twelve carcinoma tons and 13
benign hypertrophy. If the prostate hypertrophies are included in the
new growths, then the cases of haematuria due to tumour were 99, or
approximately 50% of the positive cases in this series. Tuberculosis is
second in point of frequency.
In the remainder of the cases, in 14 the origin was found but the
cause not definitely established.    In the remaining 25 neither a diagnosis
Page 16 nor the origin of the bleeding could be determined, but the author
stressed the point that though no diagnosis could be made in many of
the latter group, they should not be classed as "essential haematuria,"
but that they are expressions of our present diagnostic limitations.
In reviewing the literature on "essential haematuria" I have noticed
a desire by many authors to get away from this term as it is rather a
poor one and perhaps one that can be too readily used when a definite
diagnosis cannot be made. Later in this paper I will give the opinions of
some of the investigators of this condition.
Though the. cystoscope and urethroscope should always be used to
determine the source and cause of the bleeding some idea of its source
can be gained by the examination of a three glass specimen of urine, and
the constituents, visual or microscopic, of a bladder specimen.
A lesion in the urethra, distal to the external sphincter, producing
bleeding, will show at the meatus, independently of voiding.
If the bleeding is profuse from a lesion in the urethra above the
external sphincter, then the blood will flow back into the bladder and give
one the impression of its having originated from the bladder or kidneys.
A terminal increase in the amount of blood passed in the urine may
be due to compression of a lesion in the posterior urethra by the muscles
emptying the urethra, the blood of renal origin may have collected in
the base of the bladder or the final contraction of the bladder muscles
may squeeze some additional blood from the tumour or other lesion causing a typical "terminal haematuria," the blood being unmixed with urine
and occasionally considerable in amount. This was demonstrated very well
in a patient seen a short while ago who had been treated for various
complaints and symptoms for some months with nothing referable to
the genito-urinary system until, upon examination of the lower abdomen
by her attending physician, a bladder tumour was palpated—upon catheterization a considerable amount of urine was drawn off at the end of
which appeared about a cupful of blood unmixed with urine. At each
subsequent voiding the urine was blood stained but that passed last was
always much thicker and was often pure blood. Cystoscopy revealed a
fla.t cauliflower-like growth undergoing ulceration, situated at the neck
of the bladder and involving a portion of the sphincter. It is likely,
owing to the position of the tumour, that the bleeding following the first
catheterization was due to trauma, thus revealing a lesion that was totally
unsuspected, for at no time previously had blood been noticed or found
in the urine.
The presence of worm-like ureteral casts are pathognomonic of
bleeding above the bladder, and blood casts of bleeding from the renal
parenchyma.
As the introduction of a ureteral catheter sometimes causes bleeding,
blood in a ureteral catheter specimen does not necessarily indicate the
source of the haematuria. Observation of the jets of urine issuing from
the ureteral orifices is often more valuable in determining whether the
blood is from one or other side, or from both.
Page 17 Microscopic examination of the urine obtained in bleeding above the
vesical orifice may give one an idea as to its cause. If the urine is clear
but for the .blood, the probable cause is either neoplasm, calculus or acute
nephritis. If blood and pus are present, but no bacteria other than tubercle bacilli, then tuberculosis or occasional calculus must be considered.
If blood, pus and bacteria are present then the condition is likely one of
the above secondarily infected or cystitis.
In cases of haemoglobinuria, combining the microscopical and
chemical tests will give the diagnosis, a positive benzidine or guaiac test,
and no red corpuseles in the urinary sediment.
When are we dealing with a case of "essential haematuria?" That
is a case of painless bleeding, in which the kidneys show absolutely no
infectious agent, no organic changes and no clinical evidence of functional insufficiency.
Bumpus, going on the assumption that the haematuria may be the
result of single or multiple diseases not far enough advanced to be
diagnosed at the time of examination, followed a series of 155 such
patients whose haematuria dated back from 5 to 25 years and found that
in only six had there developed any definite renal disease, three of which
were calculi, and in the other three nephrectomy had been performed,
presumably for the persistent bleeding.
He has made an extensive survey of the literature on this condition
and gives the views of some 20 writers, as to the cause, which briefly are
the following:
Chronic passive congestion resulting from scar formation from
pyelonephritis, kidney abscesses which have healed, or infarcts produced
by remote foci of infection. The cicatricial contraction following the
healing of these conditions impedes the circulation of the adjacent vessels
causing them to become varicose and rupture.
Wheeler cites a case of symptomless haematuria with known bleeding from one kidney for 2 years and with negative X-rays. At exploration
of the pelvis at operation no lesion could be found, the pelvis appeared
normal, but upon gross examination a small papilla showed a small
raised granular area about the size of the head of a black pin—this area
upon microscopic examination showed dilated thin-walled capillaries
and veins in large numbers close beneath the epithelium, with numerous
extravasations of blood cells into adjacent tissue and in some places
absence of the endothelium of the capillaries and in one spot rupture of
the pelvic epithelium.
It is likely that all of the above mentioned reasons for this type of
haematuria may be correct to a degree, some more than others, and that
"essential haematuria" may be taken, not as a haematuria due to any
one specific cause, but as a group term embodying any and all causes
that remain after an exhaustive and painstaking search by all means
and methods available, has been made, to find the source and the cause
of the bleedine.
rage
18 In conclusion I would like to give a brief history of 2 cases that
gave as their only symptom blood in the urine.
Mr. age 67.    Complaint:—Blood in the urine.
The bleeding had been present for 2 weeks. Cystoscopy revealed
a tumour growth, ulcerated in one portion, in front of and obscuring the
right ureteral orifice. The prostate was definitely malignant and the
concerous growth could be seen extending into the bladder wall. The
malignancy in the prostate came as a surprise as when felt per rectum it
appeared absolutely normal. X-Ray of the pelvic bones showed marked
involvement with metastases.
Mr.
-Age 45.    Complaint:—Passing of bloody urine.
The haematuria was present off and on for 4 months and once about
8 months previous to that time.
There had been two cystoscopic examinations, once when the urine
was clear and once when only a slight amount of blood was present.
The findings were negative. A final cystoscopy and psyclography
showed bloody urine being ejected from the left ureteral orifice and the
X-Ray showed a marked distortion of the upper two calices.
Nephrectomy revealed a hypernephrome, replacing some two-thirds
of the kidney with some extension into adjacent tissues.
This patient demonstrates the value of examination of the patient's
genito urinary system while he is showing the blood in the urine and of
a complete examination, as no doubt valuable time was lost in making
the diagnosis by not doing a pyelography at the previous examinations.
Miss R* A* Backett, r* n.
Is/lasseuse
Rooms 503-504 Birks Building
Phone Trinity 2004
Sun Ray
with
Quartz Lamp
Cabinet Baths
and Shower
Swedish or
Weir Mitchell
IS/iassage
Specializing in Physio-Therapy
Patients may be visited in homes
(Qualified Physicians invited to visit)
Page 19 British Columbia Laboratory Bulletin
Published irregularly in co-operation with the Vancouver Medical Association Bulletin
in the interests of the Hospital, Clinical and Public Health Laboratories of B. C.
Edited by
A. M. Menzies, M.D., of The Vancouver General Hospital Laboratories
Financed by
The British Columbia Provincial Board of Health
COLLABORATORS: The Laboratories of the Jubilee Hospital and St. Joseph's Hospital,
Victoria; ~St. Paul's Hospital, Vancouver; Royal Columbian Hospital, New Westminster;
Royal Inland Hospital, Kamloops;  Tranquille Sanatorium;  Kelowna General Hospital;
and Vancouver General Hospital.
All communications should be addressed to the Editor as above.    Material for publication
should reach the Editor not later than the seventh day of the month of publication.
Vol. IV.
OCTOBER, 1930
No. 8
CONTENTS
Editor's Notes
Local Facilities for Convalescent Measles Serum
Co-operation Between the Laboratory and Physician
Examination of Feces for Parasites -_	
Harri
rts
MEASLES CONVALESCENT SERUM
Some months ago the V. G. H. Laboratories announced that through
the courtesy of the Provincial Board of Health, measles convalescent
serum would be stocked and distributed gratis to the Profession if suitable donors-could be obtained. It was also announced that the Provincial
Board of Health would pay such donors at the usual rate of $25.00 per
:pint.
The V. G. H. Laboratories can now announce further that at last a
suitable donor has been obtained and a limited supply of measles convalescent serum is now available for use.
From a study of the literature the dosage recommended is 2 to 4cc
for infants under 3 years if given during the first 4 days after exposure,
twice this amount during the next 2 days and 7 to 8cc if given later,
given intramuscularly.
As convalescent serum may entirely prevent an attack, or at least
modify the disease, it is particularly useful in weakly infants or those
recovering from a previous illness, etc.
The passive immunity produced if the disease is entirely prevented
by serum, is probably good for only a few weeks. Those who have the
disease in a modified form following the adminstration of serum, probably
develop a lasting immunity. It would seem, therefore, that the most
ideal results would be obtained by giving the serum the 6th to 8th day
after exposure, thus allowing the disease to develop in a modified form,
thus ensuring the formation of antibodies which would protect the
patient from further attacks probably for life.
MEASLES CONVALESCENT WHOLE BLOOD
In  outlying   districts   where  convalescent   serum   cannot   easily   be
obtained owing to transportation difficulties, it might be well to remember
Page 20 that whole blood or citrated blood, from a person who has had measles
even long before, may be used with success. The usual care would need
to be taken of course, to insure that the blood carry no communicable
disease. The procedure in the use of whole blood is to inject about 20cc.
to 50cc. intramuscularly.
In a circular letter recently sent out by the Provincial Board of
Health to the physicians, instructions are given for collecting and administering convalescent or inmune whole blood for the treatment of poliomyelitis. In the treatment of measles the same instructions would apply,
except that one would need to be certain that the donor had previously
had measles.
A copy of the polio instructions follow:
"Whole blood from Convalescent Patients in Place of Serum for the
treatment of Poliomyelitis cases."
The usual dose of convalescent Polio, blood is 50cc. It, of course,
must be taken strictly aseptically and so handled before and during the
injection.
To prevent coagulation sodium citrate must be added in the proportion of 0.5cc of a 20% solution of sodium citrate to each 50ccs. of
blood. (Of course, if the donor be handy to the patient a direct transfer
of the blood may be done.)
The injection is given intra-muscularly into the gluteus maximus
muscle.
The donor should be previously tested for any specific infection.
(Wassermann and Kahn tests, etc.)
Blood taken as above and citrated may be kept in an efficient icebox
with safety for 24 hours, probably with no material diminution in
therapeutic value.
CO-OPERATION BETWEEN THE LABORATORY AND
PHYSICIAN
The following lines are extracts from an article in the Canadian
Medical Association Journal of August, 1930, quoting Dr. A. C. Rankin,
Dean of the Faculty of Medicine in the University of Alberta.
Material should reach the laboratory at the earliest possible moment
and be accompanied by intelligent and full information as to the nature
of the examination required.
The worth of the laboratory and its value to the hospital and the
public and the patient rests not only with the laboratory staff but upon
the co-operation of others.
It is impossible to make proper distinctions in diagnosis on laboratory
findings alone. While laboratory findings are necessary for accurate
diagnosis and treatment, clinical medicine is still the important factor.
There is a tendency to rely on laboratory findings, instead of upon the
clinical findings in conjunction with laboratory findings.
Dr. Rankin reminds us that the laboratory is adjuvant and can
never take the place of good thorough physical examination and the
investigation of disease in each case as a problem. He also believes that
every physician and nurse should be familiar with the simpler essential
examinations performed in a clinical laboratory and should have a good
understanding of the methods of collecting samples.
Page 21 EXAMINATION OF FECES FOR PARASITES
R.  V.  Harris,  BSc,  V.   G.  H.  Laboratories.
Four main factors contribute to the prevention of the spread of
parasitic infections in the residents of Vancouver, namely the temperate
climate, the modern sanitation, the meat inspection, and the pure water
supply. Nevertheless, owing to its geographic position and its desirable
climate there are many temporary and permanent residents in Vancouver
who have spent part of their lives in places where the incidence of this
type of infection is very high. The Japanese, Chinese, or Finnish immigrant, through his habit of eating raw fish, may harbor Diphyllobothrmm
latum (fish tapeworm), or Fasciola hepatica (liver fluke); the white man
who has lived in India or South America, hookworm or amoebae; and
sailors, black, white, yellow or brown, who have sailed the seven seas,
may in their travels have collected any of the worms which may infest
the human intestine. It happens, therefore, that from time to time we
are asked to examine stools for evidence of parasites, and that once in a
while such evidence is found.
Until about sixteen months ago the method used for the discovery
of ova was the brine-flotation method. In March 1929, however a new
method for concentrating ova and cysts was adopted. This method, of
Damaso de Rivas and Charles A. Fife, is taken from J. Am. Med. Assoc.
February 23, 1929, and is as follows:
"A small portion of material is first softened when necessary and
suspended in an excess of 5% acetic acid solution in a test tube. After
the material is thoroughly shaken it is filtered through a layer of gauze
and the filtrate is collected in an ordinary centrifuge tube, so as to have
the tube about one-third full. To this is added an equal volume of ether,
and after the resulting emulsion has been thoroughly shaken it is centrifuged for from three to five minutes. By this procedure the mixture
is separated into four layers from above down as follows:—the ethereal
extract, which forms the topmost layer; the detritus plug, consisting of
soap and coarser particles, which forms the second layer; the acid solution below this; and finally a scanty sediment at the bottom. The
three upper layers are poured off, leaving the sediment attached to the
bottom of the tube; this is * ■* * examined under the microscope as with fresh cover glass preparations."
The method does not occupy an unduly large amount of time and
does not involve the purchase of any special apparatus.    The superiority of
this new method over the old is indicated by the following records:-
Period      Number Examined      Number Positive % Positive
Year 1926 43 3 7
Year 1927 40 2 5
Latter half 35 6 17
1929
First half 34 5 14
1930
These numbers are gratifying, and indicate that the adoption of the
new method was justifiable.
Although a negative result from a single examination is never conclusive, we feel considerable confidence in the value of this method for
detecting intestinal parasites.
Page 22 'Hold Fast to That
Which is Good"
i
tiMlSmmstm
The Mead Policy
that for years has proved
professionally and economically valuable to physicians who feed infants
also applies to Mead's Viosterol in Oil, 100 D
(originally Acterol). As with Dextri-Maltose,
we feel that Mead's Viosterol is a part of the
physician's armamentarium, to be prescribed
by him alone. Therefore, we refrain from lay
advertising of Mead's Viosterol or any other
Mead Product; furthermore, we do not print
dosage directions on the bottle, on the carton or
in a circular. "Hold fast to that which is
good"—the Mead Policy, Dextri-Maltose and
Mead's Viosterol (originally called Acterol).
Mead Johnson & Co. of Canada, Ltd., Belleville, Ont. Rest Haven Sanitarium and Hospital
MARINE DRIVE, SIDNEY, B. C.
(Near Victoria)
(Visited by Qualified Physicians)
Rest   Haven  is  situated   amid  natural   beauty.    Particularly  convenient   and   desirable  for
Rest—Recuperation   and  Convalescence.
There is boating, salt water fishing,  and golf. <
Private room accommodation $28.00 and $35.00 weekly;
Semi-private   $21.00   and   $25.00  weekly.
Direct  patients   to   Rest   Haven  via   the   Steveston-Sidney  ferry,   MOTOR   PRINCESS.
From   Victoria  by   the   Vancouver   Island   Coach   Lines,   Ltd.,   at   the   Broughton   Street
Station.    Private  car will  meet  boats  if  desired.
FOR  RESERVATION  AND   FURTHER  INFORMATION
WRITE OR TELEPHONE MEDICAL  SUPERINTENDENT  OR  MANAGER-
SIDNEY 95 — 61 L.
Say it with Flowers
Cut Flowers, Potted Plants, Bulbs, Trees, Shrubs,
Roots, Wedding Bouquets.
Florists' Supplies and Funeral Designs a Specialty
Three Stores to Serve You:
48 Hastings St. E.
665 Granville St.
151 Hastings St. W.
One Phone:
Seymour 8033
Connecting all three stores.
Brown Bros* & Co. Ltd.
VANCOUVER, B. C. 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
~    .CENTURY^
B. C. STEVENS CO.
Phone
Seymour 698
730 Richards Street
Vancouver, B. C. -H®e
  «j*[*
•i<33f-»~-
»
Hollywood Sanitarium
LIMITED
"ijor the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference ~ <2B. (p. (^Medical ^Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
*<exe
•xs>» The Bulleti
f      ;rHH   OF THE     >/<|M||
Vancouver Medical Association
£SSt
Contents
Health Insurance
Golf
Pyloric Stenosis
Meetings
General—Nov. 4th
Clinical—Nov. 18 th
Dinner—Nov. 26th
ANNUAL MEETING
CANADIAN MEDICAL ASSOCIATION
JUNE 22—26, 1931
VANCOUVER, B. C
Vol. VII
NOVEMBER,  1930
No.

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