History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: April, 1931 Vancouver Medical Association Apr 30, 1931

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 The Bullet
|||gHB     OF THE   ^k|^^
Vancouver Medical Association
Vol. VII.
Osler Lecture
Laboratory Bulletin
General—April 7th
Clinical—April 21st
Annual—April 28th
JUNE 22—26, 1931
April, 1931
Published monthly at Vancouver, B. C, by
McBeath-Campbell Ltd., 326 Pender Street West
Subscription, $1.50 per year. I
-    ;      HYPODERMIC   jfjjj
Hydrogen Hydroxide C.P.
(Triple Distilled Water)
In convenient 100 cc.
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your office.
CHAS. H. ANDERS,  Chemist
Published  Monthly  under  the  Auspices  of  the  Vancouver  Medical  Association  in  the
Interests of the Medical Profession.
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 abovs address.
Vol. VII. APRIL, 1931 ~~NoT7
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
Dr. W. B. Burnett Dr. W. F. Coy Dr. J. M. Pearson
Auditors:   Messrs. Shaw, Salter & Plommer
Clinical Section
Dr.  S.  Sievenpiper Chairman
Dr. J. E. Harrison Secretary
Eye, Ear, Nose and Throat
Dr. N. E. MacDougall  Chairman
Dr. J. A. Smith  Secretary
Pediatric Section
Dr. H. A.  Spohn  Chairman
Dr.  R. P.  Kinsman  ! Secretary
Library Orchestra Summer School
r\    r\  ■n  n n     r  -d   r\ Dr. R. P. Kinsman
Dr. D. F. Busteed Dr. J. R. Davies Dr   W   L   Graham
Dr. D. M. Meekison Dr. J. H. MacDermot '   _,' -' B
TA T«77      TT      TT l-.f'-X.TT, L»R.      C      L.     MOWN
Dr. W. H. Hatfield Dr. F. N. Robertson ~    ~  T   t, _
n     „   ..   „ i-,tac Dr. 1. L. Buttars
Dr. C. H. Bastin Dr. J. A. Smith i->    /^  tj-  ir
t-,     ,-,   tt   „ Dr. C. H. Vrooman
dr. c jh. Vrooman t->„   t w   a ,. ~
_.     „  _  „ Dr. J. w. Arbuckle
Dr. C. E. Brown Publications
_. 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. J. E. Harrison Dr. F. W. Lees
Dr. E. E. Day Credentials | Q ^ Aivhory BoarJ
v„4.   *   d  i-  -n j   a        Dr. W. S. Turnbull Dr. Isabel Day
Kep. to B. C. Med. Assn.   ~     «   t ■.#    t t>     tr  t_t  ^
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 HEALTH DEPARTMENT
Total Population   (estimated)            242,629
Asiatic Population   (estimated)    . ,.  14,227
Rate per   1,000   of  Population
Total Deaths          227 12.2
Asiatic Deaths   14 12.8
Deaths—Residents only   -          209 11.2
Birth Registrations   3 36 18.1
Female   171
Male        165
Death under one year of age  9
Death Rate—per 1,000 births  - i  26.8
Stillbirths (not included in above)  ..  8
March 1st
January, 1931 February, 1931 to 15 th, 19 3 1
Cases    Deaths Cases    Deaths Cases    Deaths
Smallpox          0 0 0 0 0 0
Scarlet  Fever       26 0 27 0 10 0
Diphtheria          9 0 15 3 4 0
Chicken-pox       167 0 106 0 59 0
Measles           8 0 4 0 2 0
Mumps -      34 0 65 0 45 0
Whooping-cough        11 0 3 0 3 0
Typhoid Fever  J      2 0 3 0 0 0
Paratyphoid   .-..        0 0 0 0 0 0
Tuberculosis        17 17 19 19 15
Poliomyelitis            0 0 0 0 0 0
Meningitis   (Epidemic)        11 2 2 0 0
Erysipelas    -       7 0 7 0 5 0
Encephalitis Lethargica       0 0 0 0 0 0
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There is an old story that everyone has read, so that the hero of it
is one of our household words: the story of Rip Van Winkle, who fell
asleep for a hundred years, and woke to a new world, strange and portentous—full, no doubt, of things that alarmed him by their unfam-
One need not formally fall asleep to parallel this experience. The
world moves on and changes—old traditions lose their force—new
factors come into play, new conditions arise, so different from the old
ones as to be revolutionary—and we sleep through it all till, awakening
with a start, we find ourselves confronted with a new world, its tempo
different, its whole aspect unfamiliar. This is an alarming and may be
a perilous experience.
All this is to the address of our own profession. It is an old profession, with the slowness of gait, the tendency to praise the "tempores
actos," the unwillingness to change, that are characteristic of honourable
age. Fortunately, it has the power, not vouchsafed to any of its members, to rejuvenate itself, to change its outlook, to re-educate itself to
fitness for grappling with the new problems, and for adjusting itself to
the new conditions.
It is many years since, as a profession, we have shown any signs
of life—we have been peacefully asleep. True, one part of our body,
the British profession, was awakened rather violently and painfully
some years ago, by the National Health Insurance Act. This was the
beginning, and gradually, though slowly, the whole body is beginning
to stir. And there are alarms going off in our ear, and voices calling to
us to get up: so that soon, no doubt, we shall wake from our slumbers,
at first so calm and full of complacency, but of late so disturbed, and
beset by nightmares, of cults, and taxes, and protests from all and
sundry, concerning the high cost of medical care, the hospital deficit,
and all such things.
And when we wake ,it will be to a new world, a world very different from that of forty or fifty years ago. It would be well for us to
realize just how different it is. New economic conditions have arisen,
new adjustments of the social balances made—there are new demands to
be made of us. ' And, while we slept, someone has been through our
pockets to a certain extent, and taken some of our money. Nobody can
deny, if he gives the matter due thought, that for years, there has been
a steadily growing tendency to exploit the medical profession, to sponge
on it, if we may so speak. It has been done gradually and almost pain?
lessly—one might almost say with our consent and counivance—but it
has been done, and when we take stock now, we find that the loss has
been a large one. More, that we are the only ones who have suffered
this loss—and further yet, that we are expected to like it, and to be
good fellows (or silly asses) enough, to make still larger sacrifices pro
bono publico: sacrifices that are not demanded of any other section of
Nor can we blame anyone but ourselves. If we have awakened,
as we see that the profession is awaking, to find a world that is not to
our taste, we are at fault for having over slept ourselves. It is time
for us to wake up, not limb by limb, the British Medical first, then some
other part, but as a body, and take our proper part in the determination
of our own fate.
Page 150 WARNING
The profession in Vancouver is warned of a drug addict who has
adopted a very ingenious method for obtaining prescriptions containing
He consulted a local practitioner about a left sided inguinal hernia.
The hernia is a large one, easily reducible and the internal ring admits
three fingers. He wears working clothes and says he has been cutting
shingle bolts or ties and has a consignment which he is just ready to sell
up the Fraser River. When he gets the money he wants to come in and
have the hernia repaired.
Then he mentions that the dampness of the camp causes his ears to
ache and he further adds that carbolic and glycerine drops do no good,
but a prescription of sweet oil and laudanum, an ounce of each, gives
him great relief. This prescription was given him first by a doctor who
has since left town. The story is plausible and in spite of the fact that
there are no otoscopic findings of importance the prescription is given.
A day or so later he returns saying that when he was going out to the
camp in his car his dunnage bag was stolen and with it the bottle of ear
drops. He asks for another prescription. Then a few days later he
returns and asks if the doctor has found the prescription because when
he went to get it filled he could not find it.
A few days later still he came and asked for another prescription
saying he was an addict. He said he lets the bottle stand and then takes
off the olive oil with an eye dropper. Then he evaporates off as much of
the alcohol as possible getting about one-half ounce from the two-ounce
bottle. He takes this in two hypodermic "shots" and this will last him
a day.
There are several cutaneous abscesses on the left arm. He was told
if he would call the police and would voluntarily go to Essondale for
treatment he would be given a hypodermic of morphine in the presence
of the police.    He refused this and has not returned.
Among other indubitable signs of spring which have made their
appearance is the first exodus to Colwood, which occurred on the weekend of March 14th - 15th. Those implicated in the affair have not seen
fit to make any statements for publication.
Dr. Haywood, superintendent of the Vancouver General Hospital,
has "joined the great majority," "gone west"—in other words, has joined
Quilchena Golf Club. He goes around in about 100, and what is more,
he admits it.
Dr. R. E. McKechnie beams upon the O. R. floors again, albeit
from a somewhat meagre countenance. The Bulletin expresses the sentiments of his colleagues in a warm welcome back to his wonted haunts,
after his severe illness.
The outdoor department of the Vancouver General Hospital has
changed beyond all recognition since the advent of the new superintendent. Its growth can be appreciated by examining the attendance figures:
1929, 7,000;  1930,  15,000.
Page 151
seaas Wrestling has become a major activity among a large number of
the doctors in Vancouver. (Oh no, doctor, we were not thinking of
what you thought, we mean as spectators). Friday_ the thirteenth saw
a majority of the Association at the championship bout at Hastings Park.
There is nothing like exercising the peronei and the gastrocnemn as
a prophylactic for incipient pes planus. (We stand corrected in advance
by the honourable fraternity of orthopedists, but would point out that
the terminology is not copyrighted). This is doubtless the object in
view of the authorities of the Vancouver General Hospital who are building two tennis courts for nurses on the site of the old annex, and of
St. Paul's, where the roof of the new Nurses' Home is to be topped by
tennis courts surrounded by a roof garden with shrubbery, flowers and
gaily coloured umbrellas.
The first meeting of the newly-formed Cancer Committee of the
Vancouver Medical Association, under the able direction of Dr. J. J.
Mason, was held on Tuesday, March 17th in the Medical-Dental Auditorium. Excellent papers on lip and oral cancer were presented by Drs.
B. J. Harrison and C. W. Prowd, which were followed by enthusiastic
and well-directed discussion. The large attendance and the keen interest
shown is a good indication of the timeliness of this movement, and
augurs well for its success.
The sympathy of his colleagues is extended through the Bulletin to
Dr. Washington Wilks in his recent bereavement. Mrs. Wilks died of
pneumonia on March 18 th.
Dermot Davies, only son of Dr. Aubrey H. Davies of Kerrisdale,
died suddenly in Montreal on March 16th. Mr. Davies had already distinguished himself as a graduate of the University of B. C. in winning
a fellowship in economics at. McGill, and was undoubtedly at the beginning of a brilliant career. We beg to tender our sincere sympathy to his
bereaved parents.
The regular monthly General meeting of the Association was held
in the Auditorium of the Medical-Dental Building on Tuesday, March
3rd.    Seventy members were present.
Dr. J. A. Gillespie reported on the present position of negotiations
between the Hospital Committee and the Board of Directors of the Hospital.
Dr. Pedlow reported progress on behalf of the Committee appointed
to consider the necessary changes in the By-laws of the two Associations
with a view to closer co-operation.
Plans for the entertainment of visitors to the Canadian Medical
Association meeting in June next were outlined by Dr. T. H. Lennie,
Chairman of the Entertainment Committee.
Dr. R. E. Coleman moved a resolution asking for the appointment
of a Committee of the Association to make a study of the relationship
between the cost price and selling price of medical service. This Committee to be known as the Medical Economics Committee.    The resolu-
Page 152 tion carried and the Chairman was authorized to nominate the members
of the Committee.
The speakers of the evening were Drs. F. N. Robertson and Wallace
Wilson, whose papers had been held over from the February meeting.
Dr. Robertson spoke on "Some Unusual Uses of Common Drugs" and
Dr. Wilson's subject was "Stenosis of the Mitral Valve." Both papers
were well discussed and much appreciated by the members present. They
will appear in a future issue of the Bulletin.
Through the courtesy of the Staff the February meeting of the
Clinical Section was held at St. Paul's Hospital. Interesting cases were
presented by Dr. D. F. Busteed, Dr. J. Christie and Dr. A. W. Hunter.
The seventeenth of March marked the tenth anniversary of the
Annual Osier dinner held in memory of the late Sir William Osier, the
father of modern medicine. It was particularly fitting that this year's
address was delivered by the father of modern surgery in Vancouver,
almost, one might say, in British Columbia, our much beloved R. E.
McKechnie, who spoke on "Reminiscences of Forty Years' Practice." A
fitting tribute was paid to our Dean by a turn-out numbering no less
than 127 medicos, by far the largest attendance that ever graced a board
for this much anticipated event.
At the head table with the president of the Association were the
previous Osier lecturers, Drs. B. D. Gillies, Brodie, Carder, Keith, Mason
and Vrooman. Drs. Pearson and Seldon were unavoidably absent, while
Dr. G. S. Gordon was detained by illness. A note of sadness was sounded
by the chairman in recalling the fact that the 1929 lecturer, Dr. Cunningham, had passed on, leaving a gap that we can never fill.
Sir William Osier left a mourning medical world on December 29th,
1919. The following year, 1920, Dr. Brodie, then president of the
V. M. A. conceived the idea of an annual address to commemorate the
memory of Canada's most famous physician. On January 10th, 1921,
the first paper was given by Dr. W. D. Keith on "Sir William Osier—
Physician and Teacher." For the next four years this annual memorial
event took the form of a special meeting of the Society. In 1926 the
first dinner was held and such was its success that it has now become a
Dr. Strong, in introducing the speaker, sketched briefly the history
of this special occasion, and remarked on the esteem in which "R. E."
was held by his conferes as exemplified by the splendid aggregation that
faced him. Dr. McKechnie, who appeared a bit thin and tired following his recent rather serious illness, in turn complimented the Executive
on its efficiency in mustering the crowd and indeed it was difficult to
assess the credit between a highly popular speaker and an efficient Executive.
The oration was most interesting. The chancellor touched on his
experiences as a student at McGill, which he entered in 1886, and on his
year as an interne in the old Montreal General Hospital in 1890.
The audience listened with close attention to his account of the birth
of modern surgery at that time, and examined with great curiosity the
old-fashioned instruments which he passed around for inspection. His
anecdotes in connextion with his ten years' practice in Vancouver Island
Page 153 in the mining district brought many a smile, particularly the one in
which he stood up to light his pipe.
At the conclusion of an hour's paper, which must have taxed his
strength in spite of his grit, our senior surgeon took his seat midst applause that was moving in its sincerity. The full story appears elsewhere in the Bulletin.
"Reminiscences of Forty Years' Practice"
By Dr. R. E. McKechnie
I had not the 'honour of being a student of William Osier, nor yet of
having met him. He left McGill for Baltimore in the spring of 18 86,
and I entered McGill in October of the same year.
And still, although we never met, and so did not know one another,
I have had several very kindly letters from him. He seemed to want
to keep in touch with his old school and so must have read the old
Montreal Medical Journal and its successors diligently—for it was in
relation to papers I published at different times that he wrote me, kindly
letters, encouraging, not pointing out how I could do better and so
magnifying himself, but genuinely helpful letters that made you want
to do your best and continue making your observations and drawing your
own deductions. It was this happy, friendly disposition, never seeking
to rise at another's expense, but rather anxious to be helpful to all that
all might rise, that so endeared him to everyone. And his own great
ability could not fail to cause him to reach the levels in medicine that
he attained. So he owed his success not only to the ability of the man
but to the humanity of the man.
My reminiscences of 40 years' practice will soon be 41, for I
graduated in the spring of 1890, and'it is to tell you of the gradual
changes that have taken place in that time in the practice of our profession that this paper was prepared.
My first introduction to a medical life was even four years earlier,
in 1886,- when as a freshman I went down to the Montreal General, in
my first month at College, and secured a post as a dresser in the Out
Patient Department. The whole Hospital smelled of carbolic acid and
iodoform. I learned how to bandage there, but as to the uses of carbolic
and iodoform, of "Red Wash" and "Black Wash," my ideas were very
hazy. Listerism as exemplified in antiseptic surgery was in full swing,
but its practice had so far advanced that the spray was discarded. In
fact the spray was only used in the wards with eucalyptus oil in the
mistaken belief that it was disinfecting the wards. But that did not
last long.
Later on as a junior and then as a senior student I saw the inner
workings of the Hospital. In the medical wards we would find a typhoid
case alongside a case of pulmonary tuberculosis, or one of pneumonia or
erysipelas, and even in the surgical wards there was no attempt to separate the pus cases from the clean.
Coming on to when I had graduated I found myself an interne in
the old Montreal General Hospital with six months under George Ross,
a noted diagnostician, in medicine, and six months under Roddick, in
surgery. Each houseman had about 50 patients to look after and write
up their histories. And these histories had to be written up to date, in a
big book which the houseman carried under his arm on his rounds with
his chief, and if any case were not written up, that, for sure was the
Page 154 one the Professor would ask for while demonstrating a case to the attending students. Even a case admitted the night before had to be written
up and I have written histories as late as two o'clock in the morning so
as not to be caught.
Now bear in mind that the Montreal General Hospital was not behind the times, it was as well equipped as other good hospitals and furnished the clinical material for one of the leading medical schools of the
world at that time, namely McGill. Still it had no pathological laboratory, all that work excepting the actual post-mortem examinations being
done at the College.
In the centre of each ward of 15 to 24 beds was a long table with
a tray of wine glasses on it, the usual testing re-agents, and a student's
microscope—low power of course. And you did your own urine examinations. As for examining tubercular sputum there was not a microscope
with power enough to see a T.B. bacillus and we were expected to know
a T.B. case by physical examination and not to be afraid to give our
opinion. Later in my year an oil immersion, three nose pieced microscope, was purchased for special work, and this was the beginning of the
Laboratory. Koch's serum had just come out and Roddick, through
Osier, had obtained a supply of it so as to beat Toronto to it. I have
a faint suspicion that that first serum was a fake, but it answered its
purpose and we got the publicity. Word had been sent around the profession that it was to be administered for the first time in Canada, at a
certain hour, and at that hour the seats in the surgical theatre were preempted by the Montreal doctors with no room for the stuojents. However, I was Roddick's houseman and prepared the syringe for the first
case. This dose was injected by Roddick. I fixed another syringe for
the next case and Roddick handed it to Jim Bell, and the third syringe
being ready Roddick said, "McKechnie, it is your turn." Well, about
40 cases were selected for treatment. Wilkins had a bunch of pulmonary
cases. Bell some bladder cases. Shepherd five or six lupus cases, and
Roddick some bone and joint cases. I was put in charge of all the cases
and my chief duty was estimating the increase or diminution of T.B.
bacilli in sputum, urine and pus. Shepherd's lupus cases all flared up
and got worse, and he was the first to condemn the treatment, for we
were dealing with dynamite and did not know it. Soon the others found
that not only was no benefit being received, but absolute damage was
being done. But it was for this work of counting T.B. bacilli that the
microscope was purchased and the Laboratory started. This latter was a
vacant place under a stairway which was boxed in and a door hung so
that I could lock up my valuable equipment. One window opening on a
side street gave me my light. Of course at the College our histological
and pathological laboratories were well equipped.
Referring back to Koch's serum—this was the first attempt to combat a disease by the use of an antibody. This leads me to speak of what
we were taught, when I was a student, of the composition of the blood.
Blood consisted of serum and corpuscles. The latter were mainly red and
white cells and a few other kinds the importance of which were not
known. There was also a fibro-ferment which caused clotting—and that
was about all we knew of the blood.
It was recognized that certain infectious diseases were self limiting,
hence must have generated an antibody and the search continued even
Page 155 after Koch's failure. I was practising in Nanaimo when diphtheritic
antitoxin came out, and was in need of it as we had diphtheria with us
all the time, and just then it was of a severe type. I think I secured the
first antitoxin to reach British Columbia for I got it before it was on
the market through friendly influences in Montreal. I got the first dose
—and also such a severe attack of urticaria that in future I preferred
running the risk of an attack of diphtheria to getting another dose of
Both Behring the German and Roux the Frenchman claimed credit
for the discovery, and both are entitled to the credit of it as they discovered it independently. My first antitoxin syringe was a Roux and I
have it still.
Now the profession went wild and antitoxins were sought for the
rest of the infectious family. Doctors dreamed of going about armed
with a syringe and working miracles—but that happy day has not yet
arrived, although progress is recorded.
Up to that time no case of appendicitis had been operated on, but
Shepherd did one and he was joshed by his confreres, as following an
American lead. However, Shepherd was proud of his case, especially
as it did not die. In those days the war was on as to whether perityphlitis caused appendicitis or appendicitis caused perityphlitis.
And in those days the abdominal cavity was almost sacred, not to be
opened except in fear and trembling. No stomach work, excepting an
occasional gastrostomy for oesophageal obstruction, was done, and resection of the bowel was undertaken but rarely. A colostomy for cancer
of the rectum was done extraperitoneally through a loin incision, and
when an introperitoneal resection was done various appliances were
utilized to hold the bowel so that it could be sutured. These included
various forceps, such as I show here, with metal rings over which the
bowel was sewed by rough suturing and the work was completed by
Lembert suturing. Decalcified bone rings and bone plates were similarly
used. I will tell you later of my first bowel operation. At this time the
gallbladder was left severely alone. Ovarian cysts furnished our favourite
operation—and uterine fibroids also had their own technique. The
tumour was drawn through the abdominal wound and its pedicle, which
was often the body of the uterus, transfixed by stout pins which rested
on the abdominal wall. A bronze wire was then passed around and
tightened by an appropriate instrument, which I here show. The tumour
was cut away, leaving a raw stump, and the abdomen closed around it.
Day by day the wire was tightened till the stump sloughed off and the
wound allowed to granulate.
I well remember a fibroid case Dr. Gardiner operated on. The
tumour was as big as an adult head and had a good pedicle. To pull such
a tumour well through the wound an instrument like a corkscrew was
screwed into it and an assistant pulled it up. Dr. Gardiner was very
careful that his wire was properly placed so as not to include anything
else but the pedicle, and finally after repeated examinations, as the doctor
was very careful and visibility was poor, he tightened it up, and cut
away the tumour. Just then Shepherd came into the room and started
to examine the tumour. He uttered two words, "mucous membrane"
and Gardiner blushed to the top of his bald head, for there was a patch
of mucous membrane the size of a 50c piece adhering to the tumour.
With never a word he started to work after releasing his wire and pins
Page 156 and discovered a hole in the caecum. With great pains he closed this
opening and resutured and sutured again, three lines of defence. Of
course we boys thought there was no chance for the patient, but she
never had a rise of temperature and went on to an uneventful recovery.
I never saw a case of goitre operated on when I was at the General
It was looked on as a very dangerous operation, haemorrhage chiefly to
be feared. I only saw one case of Graves' disease, toxic goitre, for the
General did not admit incurable cases, as this was so considered, but this
was a case for class demonstration. Treatment was rest in bed and various cardiac and sedative remedies. The first case I ever saw operated on
was done by myself, as a third year student. Alec Stewart had graduated the year before and was down at Richmond as assistant to old Dr.
Weber. I was hanging aruond the hospital in the summer months, with
no other students to bother me, and of course getting lots of work,
supplying internes' places while on holiday, etc. Stewart wanted to take
a post-graduate course in New York and offered me $100.00 and board if
I would supply for a month. As this was the biggest money I had ever
seen and I needed it, I accepted. Well, when I got there Alec took a few
days to break me in. He had a couple of surgical cases he wanted to do,
but old Weber would not give the anaesthetic as he did not believe in
operating. So I was selected to give the anaesthetic. With patient ready
for the knife Alec got cold feet and proposed to hold the old leather
ether cone and have me do the operation. Well, I had taken the Anatomy
Prize the year before so thought I knew the anatomy of the neck.
Not without fear and trembling, I operated and the patient got well.
The next day we had a case of obstruction of the bowel from cancer
in the sigmoid. This time he told me to go ahead. The patient had had
obstruction four to five days and today would have been handled differently, but nothing was known then of the deadly toxicity of the bowel
contents. Well, to proceed with the story. We had no bone plates or
other appliances, so I had to extemporize. Our catgut used to come in
glass bottles, three sizes to a bottle, and you pulled the gut out through
the rubber stopper. I utilized the catgut to prepare two rings, and
with four silk sutures equally spaced around each ring, each armed with
a needle, I placed the rings in the ends of the bowel, and transfixing the
walls with the needles, tied the sutures together and thus approximated
the bowel ends, and then went in with my two rows of Lembert suturing. I do not think I ever did a better job, but, successful though the
operation was, yet the patient died. This also was the first resection I
had seen, having gathered my ideas from the medical journals.
At that time urine was considered very poisonous, as witness the
extensive sloughing following a case of ruptured urethra with extravasation. So they did not touch the prostate, and later attacked it through
the perineum, and stone operations were also by the perineal route. I
saw Roddick do one in seven minutes introducing the grooved sound,
incising the urethra perineally, with a long knife thrust upward and
sweeping backward and outward opening the bladder—then the stone
forceps and handing me the stone. It took longer to close the wound
than to do the operation.
During all these years we had no caps or gowns, no rubber gloves,
but were depending on antiseptics, and many a chapped hand or cracked
skiri over a knuckle was seen. I remember one scene in the Gynaecological Clinic with  Gardiner operating.     He would  trust  nobody but
Page 157 himself to set out the instruments, and he brought in a couple of shallow
pans with them in, flooded with 1 in 80 carbolic. He warned us not
to meddle and then retired to scrub up. One bold student jumped the
railing and put a finger in each dish and eventually every student, about
60 or 70, did the same. But the good old carbolic stood the strain as the
patient did not suffer.
In place of gowns we wore rubber aprons. These were sterilized by
leaving in pans of bichloride, and it took courage to put one of those
cold things on. But we learned to keep our hands off everything after
a scrub up and a bath of permanganate and a decolorization with oxalic
acid.   And results were good.
I hope I am not tiring you so will bring my story to British Columbia and a speedy finish.
I first practised as assistant to Dr. D. M. Eberts at Wellington in
1891. This was a flourishing coal mining camp of about 2,500 people.
There was not a trained nurse in the camp as the first Canadian Training
School started only a short time before, so we doctors did the nurse's
work. I got my lesson with my first maternity case. I was supposed to
have the best nurse in camp, the widow of a miner who had been killed,
so I thought I could trust her. After the child was born, and placenta
away, I retired to the next room to give the nurse a chance to clean up.
In a very short time she said all was ready, and I entered. The bed seemed nicely made up, the patient in a clean gown—vulvar pad O.K., binder
in place, etc., but on the third day as soon as I opened the door of the
cabin visions of infection assailed me, and I went on a still hunt to
find where the smell came from, and discovered the bed had been remade
after the confinement by folding a dirty grey blanket to four thicknesses
and putting it over a mattress soaked with blood and faeces. Eberts
only laughed" when I told him. "You are lucky," he said. "You have
learned your lesson with the first case. It took me longer, but now I
do all the nurse's work myself." So long as I was at Wellington, and
later at Nanaimo, ten and a half years in all, in 2,364 maternity cases,
I prepared the bed before, the patient as well, changed the bed afterwards, and cleaned up my patient, and left with a clear conscience.
In these 2,364 cases I lost but one with infection, and that was a self-
induced premature case, that sent for me when she was one day off the
grave with generalized septicaemia. And in all these cases I only lost
three, including the above.
I was called out to a confinement on the far side of Green Lake
one night—was rowed across the Lake and told I would be called for in
the morning. I found a rough log cabin, one main room with a lean-to
at one end for bedroom, and another at the back for kitchen. The old
midwife was the mother of the victim and had been presiding over a
case of inertia for two days till the patient was exhausted. I was put
down on a home-made settee before a big grate fire and presently the
nurse appeared with three hot rum punches. She handed one to me,
which I declined, another to her husband, who did not decline, and
took the third herself, and mine too so as not to waste it. In half an
hour she was back again with the three drinks and the old man got one
and she again got two. The third time she only brought two drinks as
the old man was bawled out, but she got the two. Well, that finished
her, and I was alone without help. However, the old man began to rouse
about midnight, so I got him awake as I had decided I would have to
Page 158 terminate instrumentally. With my patient all prepared and myself
ready I got him to drip on chloroform—but only as I told him. In the
midst of delivery I heard a gurgle and thought the patient was gone. He
had emptied about four ounces on the mask. But beyond chloroform
burns she got through all right.
I had another experience with the same Sarah Gamp in Striketown,
close to Wellington. The child born was an "anencephalous monster."
After the patient was tidied up I started to leave but the nurse called
me back and asked me if I were not going to do my duty. I said I did
not know what else to do, so she jerked her thumb towards the baby
and asked me if I were going to let it live. I told her my duty called
me to do so. "Well," she said, "I had one once and I put it on a pillow
on a chair and another pillow on top and sat on it." But I declined the
procedure. Next morning the baby was dead and did look a bit flattened,
but what was the use of raising a row?
In Nanaimo we had a hospital of about 40 beds with no trained
nurse in the building, and no trained nurses in the town to call on in
case of need. I think the Hospital was the dirtiest building in town.
And still I did some good work there. I furnished my own instruments, basins, ligatures, dressings, sterilizer, towels and later on gowns.
My sterilizer was packed at home in the evening. Next morning early
I went up to the Hospital, taking my own enamel basins and put them
to boil in a wash boiler, put in my Arnold sterilizer and started arranging the operating room. I prepared the patient myself and of course
looked after my sterilized instruments and towels and dressings. And
many a major operation I have done in this manner without an assistant
for I found I could not trust my local confreres, who, from time immemorial were jealous of the colliery surgeons. About half my operating
was done in the miners' houses as it was just as easy to get ready there as
at the hospital. So when I came to Vancouver I thought the old Cambie
Street Hospital, with Miss Elliott in the operating room, and a real
lady superintendent with a staff of trained nurses, was just perfection.
And I have always liked the trained nurses ever since.
But I am forgetting something. Dr. Haywood the other day said
for me to be sure and tell him a panther story. Well, even to this day
panthers are so prevalent on Vancouver Island that a good hunter can
make a living from Government bounty.
One night I had confined a woman in the five acre lots near
Chase River. I heard it mentioned that a panther, or cougar, as it is
commonly called, had made a scatteration in a hen yard the night before,
but I paid no attention. I finished my patient about 2:30 a.m. and
started home, cut through a quarter of a mile of bush to strike the railway about a mile south of the town. As I was walking along the track,
and it was just grey dawn in midsummer, I thought I heard a noise
behind me. But when I stopped so did the noise. This happened a
couple of times, so thinking my trouser legs were causing the noise by
interfering, I walked with feet apart. But the noise persisted. So without stopping I turned my head towards where the noise came from and
here was a cougar just inside the fence in the long grass, sneaking along,
and about 20 feet behind, but out to the side. It squatted so as to be
out of sight in the grass, but the moment I started again it started.
Finally I resolved to bring matters to a crisis and seized a large pebble
and wheeling suddenly fired at it.    All was silent till I started on again when I heard the sound of its pads as they struck the ground on the
other side of the fence.
Another time I was called to Alberni to look after a shooting accident case. It was a bright moonlight night and taking a team of horses
in a buggy—but no lantern—I started my 56 mile drive.
Crossing the Qualicum on a low level bridge I stopped the team
at a cut bank about 15 feet high and was standing up in the buggy,
lighting my pipe or something, when glancing up I saw the head of a
cougar peering over the edge of the cut bank not 20 feet from me.
The moonlight in its eyes made them look as big as saucers. The next
thing I knew the horses and I were 100 yards down the road. But when
I got into the big timber at the far end of Cameron Lake my trouble
began. I had no lantern and it was so dark the horses kept getting off
the road and I had to get out and find it for them, and all the while I
could hear the timber wolves howling all around me.
Arriving at Alberni—or rather Port Alberni, I found the victim
of the shooting accident in a two story frame house used as a stopping
place for fishermen. I had come prepared with my sterilizer packed,
with my basins and dressings and with half a pound of chloroform and
two pounds of ether. While boiling up things (and I had to skim the
water in the boiler to get the grease off) I was preparing a room downstairs for the operation. A handy man made a couple of trestles and
with two pieces of 12-inch board on top I had an operating table.
For assistants I had two local doctors, one addicted to morphia, the
ohter to morphia and whiskey. The latter was so dirty that I put him
to holding the patient's wrist, for he was bound to help, his job being to
watch the pulse. The other was my anaesthetist. He had never used
ether, but 25 years before as assistant to a colliery surgeon in the North
of England, had given chloroform. So, my basins on chairs with instruments and towels ready at hand, we proceeded to get the patient under.
The patient was a strong buck nigger weighing about 175 pounds—with
a very heavy chest and abdomen. After about a quarter of a pound of
chloroform had been given, the patient never stirring, the anaesthetist
announced that the patient was under. So I proceeded to shave the
abdomen. At the first scrape of the razor the patient said, "My God,
Doctor, you are not going to operate yet"—So that meant I had to put
the patient under myself. And all through the operation I had to keep
on saying, "Give more, give more." At no time was the patient really
under, and when I was through there was not half a tin of ether left.
A probe through the wound, which was immediately above the
pubes, passed directly backwards and when I opened the abdomen I found
where the bullet had embedded itself in the sacrum below the promontory. There was no gas, no feces, no blood, but I had to eviscerate
foot by foot between rigid recti to make sure. However, a miracle had
happened—neither bladder nor bowel had been touched and the patient
got well.
What did I get out of it? I paid $25.00 for the livery team and
was promised a fine bear-skin, but never got it.   But I got the experience.
My most dangerous experience was in Nanaimo at the hands of a
confrere. He was a Toronto Grad., and rather clever, but drink was
his failing. He had had D.T.'s, and this was another attack. The
whole town knew about it, as he had been making an exhibition of himself down town and in his office.    He was known to carry a gun and
Page 160 to be a good shot. His wife phoned me, asking me to go down to his
office and try to get him home. I found him there in a very excited
condition, seeing rats everywhere. The office was a wreck, cupboard
doors kicked in, and while I was there he threw a heavy inkstand at an
imaginary rat. My mission failed and I went to his house to report to
his wife. He must have followed me for while I was talking to her he
came in. I had not yet sat down but was standing a few feet from
her when he burst in, saying I had insulted her and he was not going to
stand for it. I asked for particulars but he drew his revolver, a self-
cocking Colt, and pointed it right between my eyes. I thought this a
good time to apologize or anything to keep him from blowing the top
off my head. So while saying I was sorry if I had said anything that
had been taken amiss, he kept me covered—and three times I saw the
hammer of the revolver rise at the pull of a man crazed with drink—
but three times he let it down. Finally I said I guessed this was no place
for me if he felt that I had insulted him, and he lowered the gun saying
to get the hell out of there—so that is why I am here.
This doctor was an epileptic and I have a rather good story in
connection with that phase of the subject. Old man Stark had sent in
word to Dr. Davis, who delighted to tell the story, that if he wanted a
nice black bear skin, to come out, as there were some bears in a berry
patch in his pasture field. So Davis and his friend the epileptic doctor
rode out on horseback, each armed with a Winchester. Stark directed
them to the scene of operation. Arriving at the field they tied their
horses to the fence and went in. They found the bear all right, for it
gave a big "woof" and rose up on its hind legs. Davis said it was 16
feet high. Both doctors started for the gate, dropping their guns as they
ran, climbed on board their horses and raced for Stark's, Davis in the
lead. Arriving there the other horse came in minus the doctor who had
had a fit and fallen off. And old man Stark had to go down and retrieve
him and the guns.
But my worst scare was one night, my first month in the country,
after having been properly scared by Eberts about the cougars and bears,
coming home one dark night through the bush I stepped on a crooked
stick which turned and hit me in the back. That was the nearest to
death from heart failure I ever reached.
I hope this paper has not been too garrulous, but some of my older
confreres have had similar experiences and to them it will be a welcome
reminder of pioneer days. And to the younger generation, while life
is made easy to you within the area covered by the Vancouver Medical
Association, it will point out to you that you, too, can rise to every
emergency if called on, and it won't hurt you or your professional
dignity, to do what comes to your hand if it is necessary in the interests
of the patient.
By Dr. R. P. Kinsman
The following is a brief review of our present day knowledge concerning this very popular and much discussed subject of vitamins. The
Accessory Food Factors—Vitamins A, Bl, B2, C, D, and E may be
regarded as catalysts which aid in the assimilation of various food substances and the detoxication of various substances which act as poisons.
Water Soluble Vitamin C
The first  discovered  and best known vitamin  is  familiar   for   its
Page 161
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Vancouver,  B.  C. anti-scorbutic qualities. It can be concentrated, is fairly stable, stands
boiling for short periods, but is non-resistant to oxidation and alkalinity.
The most common sources are tomato juice, orange juice, lemon juice,
fresh vegetable, and milk from cows feeding on fresh green food. Scurvy
in infants is fairly common, does not usually develop until the infant is
9 or 10 months of age, but the routine addition of an anti-scorbutic
factor to the diet is an easy matter and now is becoming common practice.
Water Soluble Vitamin B
A tremendous volume of work has been done on this vitamin, but
unfortunately conclusions are somewhat vague. It was first discovered as
a preventative of beri-beri and was called the "anti-neuretic vitamin";
it was also found to have growth producing qualities and later to have
pellagra preventing qualities.
The Medical Research Council of Great Britain suggests that Bl
be adopted for the thermolabile anti-neuritic substance, and that B2 be
applied to the thermostabile pellagra, preventing growth producing substance. In the United States the anti-neuritic substance is designated
"B" and the pellagra-preventing substance vitamin G.
Vitamin B cannot be secured in its pure form, the most prolific
sources are the outer coats of some grains, such as rice polishings, in yeast
and in small quantities in milk and leafy vegetables.
A present there is much work being done on this vitamin and in
the near future we may expect ^ome important discoveries for those interested in nutrition.
Fat Soluble Vitamin A
This is the anti-ophthalmic, anti-infective and growth-producing
vitamin. The best source is in cod liver oil, some fats of animal origin,
milk, butter, yolk of egg, glandular organs of animals; although not
found in animal fat, nor in vegetable fat, certain vegetables contain
moderate quantities.
Vitamin A withstands heat well in the absence of air; the A content
of egg yolk remains constant after being hard boiled; it is, however,
very unstable when subjected to oxidation, especially combined with
A, like other fat soluble vitamins, is contained in the unsaponifiable
fraction of fats, this is obtained by boiling fats with sodium or potassium hydroxide and extracting with ether from the soap. The vitamin
can be obtained in a tremendously concentrated form, but has not
been isolated.
Vitamins are characterized and assayed by means of tests on animals.
This is a very slow and expensive method of measuring vitamin content
and many methods have been sought of determination by colour reactions and measurements of the absorption spectra. As a result of these
investigations, it has been suggested there is a relationship between A
and D, the latter has been identified with a sterol; the former may be
a sterol and intimately related to D.
Fat Soluble Vitamin D
The anti-rachitic,  calcium depositing vitamin, found in cod liver
oil, egg yolk, and animal fats such as milk and butter, is known as fat
soluble D.    In 1918, Mellanby of Sheffield, England, proved that rickets
"is a "deficiency disease," that there was an anti-rachitic  factor which
could be dissolved in fat or oil and was present in the fat of certain
Page 162 animals. In the absence of this factor from the diet, the animals developed rickets, and he established that rickets could be prevented or
cured by the addition of this factor to the diet.
At the termination of the war, Dr. Harriet Chick and her associates working in Vienna confirmed the work of Mellanby. Dr. Chick
also found that only those rachitic children who were fed cod liver oil
improved during the winter but all rachitic children, whether fed cod
liver oil or not, improved during the summer, thus she concluded that
the rays of the sun, in some way, exerted this curative effect. About
the same time some workers in Berlin discovered that when rachitic
children were exposed to quartz mercury vapor lamp, recovery took
The chief constituents of the non-saponifiable fraction of fats are
substances called sterols, that of animal fats is cholesterol and a contami-
nent of most samples of cholesterol is ergosterol. It was now discovered
that this substance ergosterol could be activated by irradiation of ultra
violet light, is then curative for rickets and is apparently the mother substance of Vitamin D.
Cholesterol is present in the skin and this sterol or some fraction of
it when irradiated produces the anti-rachitic factor in the skin which
is set free in the blood stream.
Irradiated ergosterol is extremely potent and possesses 100,000
times the anti-rachitic activity of the same weight of cod liver oil.
It is a powerful agent in the cure of rickets, so powerful, in fact, that
over doses have proven to be harmful and its present indiscriminate
use is to be deplored.
Vitamin D acts in the capacity of a catalyst and as such overdosage is useless as a curative measure. Huge doses of A and D are no
more curative than ordinary doses.
It has been shown that rat units of irradiated ergosterol are not
equivalent in curative powers to the same number of rat units of cod
liver oil.
Three drams daily of cod liver oil (1400 to 1700 Oslo rat units
or 140 to 170 Trenbock rat units V. D.) prevent rickets in 97% of cases,
twice this number of rat units of irradiated ergosterol has very little
effect, if any, in preventing rickets, then one would argue that rickets
may not be due to D deficiency alone. The addition of Calcium salts
to the cod liver oil in the diet is not logical, there is plenty of fixed
lime in the system so what is wanted is not an additional supply, but the
vitamins to set the ions free.
Fat Soluble Vitamin E
The anti-sterility vitamin.
Sources are green leaves and seed germs most plentiful in wheat-
germ oil and lettuce leaf, and is fairly well distributed in common food
E is the most stabile vitamin, is resistant to heat, mild oxidation,
chemical treatment and drying. Like A and D it is found in the unsap-
onfiable fraction but does not seem to be a sterol.
In the male rat absence of E causes degeneration of the testes; the
female's sexual organs are not obviously damaged but gestation is rendered abortive.
Page 16} In conclusion it may be well to add that any method of standardizing vitamin potency in use today is open to question. We must not
be misled into believing that vitamin potency can be measured in exact
numerical units.    There is no official standard in Canada today.
Brief Presented Before the Milk Commitee in Victoria
The Greater Vancouver Health League is a branch of the Canadian
Social Hygiene Council whose purpose is to promote amongst the public
the best scientific thought on health questions. It is a voluntary organization formed under the auspices of the Dominion Government and
working in co-operation with the Provincial Departments of Health of
the whole Dominion. It deals entirely with the preventive aspect of
health matters.
The Vancouver branch consists of representative citizens and whilst
it is a lay organization it operates under the counsel of the medical profession. Amongst its medical representatives is Dr. J. W. Mcintosh,
M.H.O. for the City of Vancouver. During the past few months many
articles have appeared in the press relating to the economic aspect of the
milk supply in the City of Vancouver. We wish to emphasize the fact
that we do not purpose engaging in this controversy; we are concerned
entirely with the health aspects of the question.
Milk Borne Epidemics
Typhoid—Boston 1908—over 1,000 cases from single case of contamination.    Raw Milk.
Typhoid—Montreal—March 1st to June 28—1927—4,755 cases—
453 deaths traced to raw milk. Embargo placed on export to States.
Tourist traffic stopped—business paralyzed. Great financial loss—4,200
potential carriers walking around, meaning as many potential outbreaks.
Compulsory pasteurization was the result.
453   deaths  @   $5,000 $  2,265,000.00
4755  cases @   $180 $      855,900.00
Tourist  loss $50,000,000.00
Other losses inestimable.
Scarlet Fever—Boston 1910, April 25—May 7, 842 cases.
Septic Sore Throat—Boston 1911—several thousand cases—too
many to count—7—8,000. All Boston epidemics mentioned traceable to
raw milk—pasteurization would have prevented all of these.
There have been many thousands of milk borne outbreaks, which
have not been reported, from smaller outlying districts, but upon investigation in some of the districts the condition was found to be traceable to
raw milk.
Typhoid—South Westminster,  13  cases,  1  death,  1930.
Typhoid—West Vancouver, 11 cases, 1 death, 1929.
Kirkland Lake, population 6,500, 500 cases, 6 deaths, about half
way through epidemic.    November, 1930.
District of North Vancouver, November, 1930, 14 or 15 cases, 1
In view of the fact as reported in the Milk Enquiry Commission
Report, 1928, Province of British Columbia, that more than 1,300 out-
P age 164 breaks of disease carried by raw milk were reported between 1895 and
1928 (and these are but a fraction of those which occurred), the importance of this question from the health point of view is undeniable.
It must be remembered that every case of sickness is an economic loss
to the community.
At a meeting called by the Greater Vancouver Health League on
January 26th, 1931, the following resolutions were passed:
Resolved: The Greater Vancouver Health League recommends
that the necessary steps be taken for the establishment of a Union Board
of Health to secure similar uniform control of milk supplies throughout
the whole of the metropolitan area, as has already been done in the case
of water.    Carried.
Resolved: That in addition to the regulations now prescribed with
reference to the production and sale of the class designated as "Preferred
Raw Milk and Preferred Raw Cream," the Greater Vancouver Health
League recommends that pasteurization be required in all cases where
there are 100,000 people or more under the supervision of one M.H.O.
Resolved: The Greater Vancouver Health League recommends that
Regulation 3 of the Regulations under the "Milk Act," approved April
4th, 1928, wherein said regulation deals with "Pasteurized Milk and
Pasteurized Cream," be amended by providing that: During the first
year after the coming into force of this proposed amendment the bacterial count of milk at any time prior to its pasteurization shall not
exceed 1,500,000 per cubic centimetre; during the second year after
the coming into force of this proposed amendment the bacterial count
of milk at any time prior to its pasteurization shall not exceed 1,000,000
per cubic centimetre; and during the third and any subsequent year after
the coming into force of this proposed amendment the bacterial count
of raw milk at any time prior to its pasteurization shall not exceed
500,000 per cubic centimetre.    Carried.
The first resolution explains itself and is strongly recommended in
the Milk Commission Report, page fifty, subject 82, concluding as follows:
"The Commission in accordance with the evidence of M.H.O.'s and
other officers of these districts, suggest that the necessary steps be taken
for the establishment of a Union Board of Health to secure similar uniform control of milk supplies throughout the whole of the metropolitan
area, as has already been done in the case of water."
Regarding Resolution 2, we have already drawn your attention to
a number of epidemics which have been definitely attributed to the use
of raw milk, and resultant loss both of life and economically. For years
the City of Toronto through their M.H.O. has insisted upon pasteurization of all milk with the exception of Certified. A comparison of the
conditions in Toronto under pasteurization, and Montreal where, until
the epidemic, raw milk was permitted provides further conclusive evidence as to what might happen in Greater Vancouver unless proper safeguards are adopted. Up to the present time pasteurization has been the
only successful means adopted to fight the scourge of milk-spread infection and was put into force in the larger places where the above mentioned epidemics occurred. In Canada, Montreal, Toronto, Hamilton
and Saskatoon require pasteurization.
Page 165 At a conference held in Ottawa in November, 1930, of Medical
Health Officers of the Dominion including the Provincial Health Officer
of the Province of British Columbia, a resolution was passed unanimously favouring universal pasteurization of all milk supplies. The Vancouver Medical Association in 1922 placed themselves on record in favour of
the pasteurization of all milk. Their views on this subject have not
It should be understood that one who contaminates milk with the
germs of typhoid or scarlet fever is as dangerous as he who poisons
drinking water, meat, or fruit. Even though milk contamination is
through ignorance rather than intent, its effect upon th child who consumes the milk is precisely the same in both instances. The medical profession looks to the milk producers to maintain high standards. The
profession is willing and anxious to co-operate with the milk producers
in every way. Only through co-operation of the Health Authorities,
medical profession, the farmer and the dairy can the public be properly
The safety of any city's milk supply is best measured by its proportion of officially supervised pasteurization. Delay in enforcement of
100 per cent, pasteurization may be advisable in some places in the
interest of its ultimate accomplishment; but compromise on the principle
of pasteurization as the only adequate measure for safeguarding milk
and milk products is certain to involve the health department in an impossible responsibility.
While it is important for infant feeding that the percentage of the
fat should be known, it cannot be emphasized too strongly that the fat
content is of much less importance than the purity of the milk. There
seems to be some misunderstanding on this point, and this leads to confusion of effort. Much greater progress will be made if the various organizations interested in the milk question would unite in demanding
safe pasteurized milk. The public should of course, get a uniform fat
percentage, but a difference of a decimal point in fat content is of very
minor importance compared with the dangers lurking in impure milk.
When we consider that one quarter of all deaths in infancy occur in the
first year and of these deaths 40% are due to disturbances from bad
feeding, (i.e., poor or unclean milk), the importance of the milk question comes home to us. Then we should also remember that the health of
children who do not succumb is impaired, some of them throughout life,
on account of improper food. Milk is responsible for more deaths than
all other food stuffs put together. Early nutrition is inseparably bound
up with the milk question. Poor milk helps to produce malnutrition,
which is associated with what are known as the deficiency diseases. Other
diseases such as dyspepsia, and dysentery are also the direct result of poor
milk. Epidemics of typhoid fever, septic sore throat, scarlet fever, and
infectious diarrhoea with many fatal cases have frequently, as we have
also shown, been traced to milk produced without proper supervision.
When proper supervision is impossible or incomplete, a safe raw milk
cannot be produced and pasteurization must be insisted upon by the
local health authorities.
In view of the foregoing we respectfully request that legislation be
enacted at the present Session of Parliament to put into effect the resolutions as outlined above.
Page 166 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
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 West-minster;
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 fifteenth day of the month of publication.
Vol. V.
APRIL, 1931
No. 4
Leprosy in Canada, and in British Columbia Brown
Bacteriological Examinations of Tuberculosis Cases Hill
By Chester Brown, M.D.
Quarantine Officer, Williams Head, B. C.
Leprosy is a specific infectious disease and is not hereditary. It is
practically speaking the least infectious of all diseases, needing close
intimate contact for its inoculation. The ordinary surgical and nursing
technique is sufficient protection for attendants.
As far as known it is not now endemic among native born Canadians, but is found among immigrants from countries where it is prevalent. Of the thirteen patients treated at Bentinck Island Lazaretto in
recent years, eleven have been Chinese born in China. The other two
were born in the Black Sea area of Russia.
The earliest symptoms are very vague and indefinite, periods of
general ill-health, slight recurring febrile attacks, perhaps unexplained
blisters and ulcers on the skin that soon heal. These early symptoms do
not usually come for medical attention. The usual experience here in
British Columbia is that the Chinese patient conceals it until the disease
is well advanced.
The disease selects skin and nerve tissue, its various forms depending on which of these and in what combination it invades the tissues.
Invasion of the skin is much the commoner, and is probably the initial
lesion in all cases. It causes a thickening of the skin either as isolated
nodules or as a generalized thickening over areas varying up to several
inches in diameter, or a combination of these. Later, as these lesions
resolve, the areas will take on a thin, parchment-like appearance and
feeling, often quite shiny.
The invasion of nerve tissue is peripheral in character following an
early invasion of the skin. This gives rise to a disturbance of sensation
and pigmentation of the skin, and as the process extends to lack of
nutrition and contractures of muscle groups.
In the earlier case the diagnostic symptom is anaesthesia. It is best
searched for by stripping and blindfolding the patient and asking him
to localize with his finger any area lightly stroked with a paper spill.
Page 167 Pigmentated or nodular thickened areas will frequently be found anaesthetic in the centre. Very early there may be hyperaesthesia, later superficial anaesthesia, and still later complete anaesthesia. Complete anaesthesia is commonest in the hands and feet.
Commonly there are combinations of the two types. The patient as
seen first in British Columbia usually shows the advanced stages of these
lesions. That is, he may show the "leonine" expression as the deeply corrugated facial skin is described; numerous areas of nodular thickened
skin with or without ulceration; enlarged nerve trunks, especially the
great auriculars, ulnars and superficial peroneals; areas of discoloration,
pigmentation or depigmentation; wasting of muscle groups especially
the thenar and hypothenar eminences of the hands; contracture of fingers
giving the "main en griffe"; anaesthetic areas, especially of hands and
feet; swelling and shortening of feet.
If a patient shows areas of superficial or entire anaesthesia, and,
usually associated with erythematous, pigmented, nodular or thickened
areas, a bacteriological examination should be made. Material for this
is obtained from the edges of the pigmented areas, or from the nodular
and thickened areas, by nicking the skin with a sharp knife or curretting
it just sufficient to extract the serum, then scraping off the exuded
serous material. Some recommend cutting a small snip out with a
curved scissors. This material should be smeared on a clean glass slide
in the usual way, care being taken to have first flamed the slide and
cleansed the skin area to remove adventitious acidfast bacteria. Smears
should also be taken from both sides of the nasal septum, by gentle
stroking with a small sharp curette. This should be sufficiently forcible
to cause subsequent bleeding. The smears are dried and stained with
carbol-fuchsin, decolorized and counterstained as sputum smears are
stained for tubercle bacilli, the only difference is that perhaps the bacillus
of leprosy is more easily decolorized with alcohol.
Examination with an oil immersion lens shows acid fast bacilli very
similar to those of tuberculosis. The differentiation is in the enormous
numbers and arrangement of the bacilli of leprosy. There will be large
bundles called "cigar bundle and palisade formation." Other so-called
"lepra" cells will be crammed full so it will be impossible to distinguish
the individual bacilli, the whole appearing as masses of granular acid fast
material. Leprosy bacilli are frequently beaded, and if so, more markedly
than is the case with tubercle bacilli.
Probably the commonest cause of mistakes in diagnosis is too great
faith in the ordinary Wassermann reaction. There is a tendency in these
cases to give a falsely positive reaction, especially in the common technique where alcoholic extracts of tissues saturated with cholesterol are
used. If there is any doubt of the clinical diagnosis or the patient does
not reply to antisyphilitic treatment further bacteriological investigation
should be made.
We are informed that the Provincial Board of Health has on file
histories of all present cases at Bentinck Island together with a magnificent collection of photos of these cases.JlThe Provincial Board of Health
also proffers to the medical profession Laboratory facilities in the event
of a case presenting itself which might suggest leprosy.
Further, if any members of the profession are interested, arrangements will be made with Dr. Brown to provide means of transportation
to enable them to visit Bentinck Island and examine the cases there.
By H. W. Hill, M.D.
Director, Vancouver General Hospital Laboratories
Previous articles have dealt with the diagnosis of diphtheria (February, 1931), and of the various gonorrheal infections (March, 1931).
But it is hardly correct to speak of the bacteriological diagnosis of tuberculosis, as if bacteriological examinations in tuberculosis were parallel
in use to those in diphtheria or gonorrhea.
The distinctions are somewhat as follows: diphtheria and acute
gonorrhea are imminent emergencies, requiring instant and vigorous
treatment. While diagnosable, very often, perhaps always, from clinical
evidence alone, if plenty of time for observation, consideration and review were available, it is exactly this time for such a leisurely clinical
decision from complete clinical evidence which is not available in these
In diphtheria and acute gonorrhea it would be criminal to wait until
an absolutely assured clinical diagnosis could be made. Hence the value
to diagnosis of a bacteriological examination, which often furnishes a
diagnosis almost instantly the patient is seen (from smears), or in diphtheria, within 24 hours by cultures.
But in diphtheria and gonorrhea the germs are doubtless in the
discharges, even before there is any clinical sign of the disease. In
tuberculosis, on the other hand, the appearance of bacilli in the discharges is not an early development. Although, like diphtheria bacilli
and gonococci, tubercle bacilli necessarily are present in the body before
clinical signs develop, unlike diphtheria bacilli and gonococci, they do
not escape in the discharges at this time, or even in the earliest stages of
the attack, but only at some considerably later date. In tuberculosis
and especially in suspected tuberculosis of the kidney, etc., it is decidedly
proper to wait for the laboratory report before undertaking a radical
By the time tubercle bacilli do appear in sputum, etc., the tuberculous case is already well advanced; and the diagnosis should already
have been made, with a very considerable degree of certainty, weeks or
months earlier. This clinical diagnosis far in advance of bacteriological
diagnosis becomes possible in tuberculosis, in contrast with diphtheria and
gonorrhea, because tuberculosis is a disease of slow development affording a long history—because tuberculosis is, for the same reason, a disease
where prolonged clinical observation, consideration and review are possible, as they are not in diphtheria and acute gonorrhea.
Hence the examination of a specimen for tubercle bacilli is made
rather to confirm a diagnosis which should already be fairly firmly
established—to "check up" on a situation already pretty well understood
—rather than, as in the acute infections, to arrive at an.early diagnosis.
In pulmonary tuberculosis the really most important clinical deduction from a positive laboratory finding is this—that the patient showing
"tubercle bacilli positive" is thus definitely shown to be now infective
to others. This is the real bit of new information supplied. The patient
is (or should be) already known to have the disease. A positive bacteriological examination, while confirming this clinical diagnosis, furn-
Page 169 ishes also an important point which no clinical diagnosis could determine
—namely, not the mere presence of the bacilli in the body, but their
escape from the body to the patient's surroundings and associates.
The meaning of a negative result for diagnosis from a suspected
tuberculous specimen differs also from the meaning of a negative for
diagnosis from suspected diphtheria and gonorrhea specimens. In the
latter two diseases, persistent absence of the respective organisms usually
calls for a negative clinical diagnosis. But in suspected pulmonary tuberculosis, persistent absence of the organism does not call for a negative
clinical diagnosis—does not even necessarily impugn a positive clinical
diagnosis. Such negative results are quite compatible with, indeed are
usual in, the earlier stages of tuberculosis.
It is true that a sputum persistently negative in a clinically active
case over a long period makes it imperative to reconsider the clinical
evidence. as to possible focal infections other than tubercle, possible
bronchomycosis, etc. But the point is that such negative sputum is not
incompatible with a diagnosis of tuberculosis—in fact, is to be expected
in all cases in early stages, and in arrested cases.
"Doubtful" or "suspicious" laboratory reports are very rare in
tuebrculosis work. The organism, although recognized only by staining
and morphology, is in these characteristics so distinctive that bacteriological doubt can seldom arise. It is true that if the bacilli are so very
few in number that persistent search of a whole smear reveals but two or
three, the bacteriologist may feel that these might have been introduced
adventitiously, or that the appearance he finds might be due to defects in
staining. In such cases a doubtful report, with a request for another
specimen, might properly be made.
In specimens other than sputum, doubt, otherwise than from a very
scant number of organisms, arises, practically speaking, only in the instance of genito-urinary specimens. Here bacteriologists are haunted by
the fear of confusing the "smegma bacillus" with the tubercle bacillus.
It is therefore the rule that tubercle-like bacilli from genito-urinary
sources shall be reported as tubercle-like, not as tubercle—and that
further tests for differention shall be made, as by inoculation into guinea
Confusion may occasionally arise in purely morphological examinations between tubercle bacilli and lepra bacilli—but such difficulty is
rare in ordinary routine work; and can be solved by further tests (e.g.
guinea pig inoculation, etc.)
Bovine bacilli are seldom encountered in sputum. When present in
glands, etc., special work must be done if differentiation is desired. Tuberculin testing of cattle and, even more, pasteurization of milk, makes
this organism less and less frequent in the human as time goes on.
It should be remembered, concerning negative reports from gland
discharges, pleuritic fluids, etc., that the bacilli are apt to be present in
very small numbers, if at all, at least in their ordinary form and staining. Much work has been done tending to imply the existence of a
filtrable or submicroscopic form of the tubercle bacillus; and also some
careful work to the contrary. Until still more work is done, it would
seem reasonable to assume for the present that such filtrable or sub-
microscopic forms, if they exist, cannot be very demonstrable, nor constitute an overwhelmingly important factor in the examination of tuber- culous discharges. An interesting development of late is the increasing
ease with which workers are securing cultures of tubercle bacilli rather
readily from sputum and other discharges. This is in strong contrast to
earlier days, when the securing of a culture of tubercle bacilli was something of a triumph. Although tubercle cultures are now more readily
obtained, and grow more rapidly than in older days, their growth is still
very slow relative to that of, say, diphtheria or typhoid bacilli, or even
But in tuberculosis there is not the same need for haste as in the
acuter conditions; and it may be possible that the doubtful and even the
negative specimens of today may in the future be submitted to cultural
tests as a routine procedure.
Of course, in all cases of doubt, guinea pig tests are available, and
have been so for a long time.
The field in which examinations of sputum from tuberculosis cases
or suspects is most important is a field in which such examinations should
be far more used than at present, i.e., in incipient and arrested cases, to
determine the development of infectweness.
Here any available sputum should be examined at not greater than
monthly intervals, and particularly if and when "chest colds," bronchitis, etc., appear.
Contacts of open cases should receive special attention; any sputum
available when they are first seen should be examined, but also any sputum available at later dates. In fact, contacts of open cases should be
considered as incipient cases, unless very conclusive evidence to the contrary can be demonstrated. Contacts continuing association with open
cases require frequent "check ups," bacteriological as well as clinical,
during contact and for considerable periods after contact ceases.
1. The usual laboratory test for tubercle bacilli rests on morphology and staining, but is nevertheless very dependable.
2. Positive results from sputum, urine, gland discharges, etc., are
practically almost invariably significant of clinical disease in the patient
yielding the specimen.
3. Negative results, unless frequently obtained over considerable
periods, do not in themselves negative, or even impugn a clinical diagnosis
of tuberculosis, and in early or arrested cases are really part of the classical picture.
4. Negative results in cases the clinical symptoms of which are
such that positive results should be found if tuberculosis be present, suggest that tuberculosis may not be present, and that a search for other
focal infections, blastomyces, etc., should be instituted.
5. Doubtful results are rare, and of course call for further examinations.
6. Incompatibility between clinical symptoms and negative or
doubtful laboratory results may make guinea pig tests or cultural tests
7. Sputum tests should be made systematically on any available
sputum yielded by contacts, incipient cases, or arrested cases, to determine any development or recurrence of infectiveness, as well as to call
attention to clinical developments.
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