History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: July, 1932 Vancouver Medical Association Jul 31, 1932

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  STflsND aiEAme blds.
yARCISMM&B« CANADA
ANDERS'
ALL GLASS NEBULIZERS
Sprays the finest nebula
of any on the market.
Sells to the patient for $1.50
CHAS. H. ANDERS, Chemist
GORDON M. CLAY, Associate Chemist THE     VANCOUVER     MEDICAL     ASSOCIATION
BULLETIN
Published Monthly under the Auspices of  the Vancouver Medical  Association  in  the
Interests of the Medical Profession.
Offices:
203 Medical Dental Building, Georgia Street, Vancouver, B. C.
Editorial  Board:
Dr. J. H. MacDermot
Dr. D. E. H. Cleveland Dr. H. A. DesBrisay
All communications to be addressed to the Editor at the above address.
Vol. VIII. JULY, 1932. No.  10
OFFICERS 1932-1933
Dr. Murray Blair Dr. W. L. Pedlow Dr. C. W. Prowd
President Vice-President Past   President
Dr. L. H. Appleby Dr. W. T. Lockhart
Hon.  Secretary Hon.  Treasurer
Additional  Members  of  Executives:—Dr.  A.  C.  Frost;  Dr.  C  H.  Vrooman
TRUSTEES
Dr. W. D. Brydone-Jack. Dr. J. A. Gillespie Dr. J. M. Pearson
Auditors: Messrs. Shaw, Salter & Plommer
SECTIONS
Clinical Section
Dr.   A.   M.   Agnew. Chairman
Dr. W. H. Hatfield '- Secretary
Eye, Ear, Nose and Throat
Dr. J. A. Smith I Chairman
Dr. A. O. Brown Secretary
Paediatric Section
Dr.   J.   R.    Davies Chairman
Dr.   J.   H.   B.   Grant   Secretary
Cancer Section
Dr.  A. Y.  McNair . ; Chairman
Dr. A. B. Schinbein Secretary
STANDING COMMITTEES
Library Orchestra Summer School
Dr. W. H. Hatfield Dr. J. R. Davies Dr- B tE- bBrown
Dr. H. A. Spohn Dr. F. N. Robertson Dr- t- l- Butters
Dr. D. M. Meekison Dr. J. A. Smith £r- § **• Vrooman
Dr.   H.   A.   DesBbisay Dr. J. E. Harrison Dr- J- w- Arbuckle
Dr. D. F. Busteed Dr- H- A- Spohn
Dr. J. E. Harrison ,, Dr- H- R- Mustard
Publications „   ... ,
Hospitals
Dinner Dr- J- H- MacDermot Dr. a. v. Bagnall
Dr. D. E. H. Cleveland      £>r   p   j  buller
£R' H> £•  w™ Dr>   H-   A-   DesBbisay Dr!  W.  C.  Walsh
Dr. A. M. Warner Dr   s   b   Peele
Dr. A. T. Henry
Credentials V.O.N. Advisory Board
_.J    !,••» W-'i>'j    a Dr. F. P. Patterson Dr. H. H. Caple
Rep. to B. C. Med. Assn.     t-.attut„ t\     t:   t
K Dr.   A.   J.   MacLachlan      Dr.  E.  Trapp
Dr. G. F. Strong Dr. S. Paulin Dr. J. W. Shier
Sickness and Benevolent Fund — The President — The Trustees
■^58 VANCOUVER HEALTH DEPARTMENT
STATISTICS, MAY,
Total  Population   (Census   1931)    —-
Asiatic   Population    (Estimated)    	
1932.
Total    Deaths    	
Asiatic    Deaths    	
Deaths—Residents   only   	
Birth   Registrations   	
Male      147
Female   141
INFANTILE MORTALITY—
Deaths under  one  year
Death   rate—Per   1,000
Stillbirths   (not  included
Smallpox 	
Scarlet  Fever
Diphtheria   	
Chicken-pox
Measles    	
Mumps
Rate per  1
191
16
177
288
000
246,593
15,000
Population
9.1
12.3
8.5
13.8
Whooping-cough           27
Typhoid Fever 	
Paratyphoid   	
Tuberculosis    	
Poliomyelitis    	
Meningitis   (Epidemic)   	
Erysipelas   	
Encephalitis Lethargica 	
of
age
16
■birr!
is
ab
OL
55.5
10
IN CITY
:d   in
ove)    —
rAGi
S DISEASES
REPORTED
June 1 st
Api
-il,
1932
May,
1932
to  15t
h,  1932
Cases
Deaths
Cases
Deaths
Cases
Deaths
1
0
0
0
0
0
20
0
7
0
7
0
6
0
1
0
2
0
24
0
84
0
34
0
26
0
5
0
2
0
56
0
69
0
33
0
27
0
43
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
56
17
87
21
22
-
0
0
0
0
0
0
0
0
1
0
0
0
1
0
2
0
0
0
0
0
0
0
0
0
REST HAVEN SANITARIUM
On Marine Drive, near Victoria, B. C.
Practising Physicians and Surgeons are invited to send
their chronic or convalescent patients to Resthaven. High
Blood Pressure and Diabetic Diets prepared and administered by competent Dietitian. Your instructions carefully
carried   out.     Qualified   physician   and   nursing   staff   in
attendance.
Write, Telephone or Wire
Manager,  Rest Haven,  Sidney, B.  C.
Telephone Sidney 61L or 95
— Rates are no higher than Hospital Rates ■—
Page 196 Opinions
In Favor of Pasteurization
Dr. Walter M. Simpson, Pathologist of the Miami Valley
Hospital, Dayton, Ohio, in an article entitled "Undulant
Fever (Brucelliasis)" published in Annals of Internal
Medicine, Vol. 4, No. 3, September, 1930, p. 2 56, in
discussing undulant fever contracted from the milk of
aborting cows states:
"Complete, carefully supervised, pasteurization of milk
and dairy products is the logical means of eliminating
milk-borne infection."
In discussing undulant fever, Dr. Simpson in the same
article states:
"American physicians should derive great pride from the
fact that the reawakening of international interest in this
disease has been the direct result of the discoveries of
American workers. The leader among these is Alice C.
Evans."
Miss Evans, herself, in an article on "Undulant Fever,"
published in The American Journal of Nursing, Vol. 30,
November 11th, 1930, observes:
"For the protection of milk consumers the preventive
measure is quite obviously the same as that practiced for
the prevention- of other infectious diseases that are spread
by milk: namely, pasteurization. Those who are able to pay
the price for certified milk may take raw milk with a
reasonable degree of safety, if the certification guarantees
that the milk is from an abortion-free herd. No milk other
than that so certified, or pasteurized milk, can be considered safe, for the cattle disease is wide-spread everywhere in
the United States. It is fortunate that the preventive measure of pasteurization is so easily available."
I ASSOCIATED DAIRIES
Limited
DISTRIBUTING RICH, SAFE, CLEAN MILK
Phones:
Fairmont 1000—North 122—New Westminster 1445
^5HB THE PRICELESS INGREDIENT
The priceless ingredient in any prescription is
the personal integrity of those responsible
for its preparation.
As prescription specialists, we recognize our
duty to the Doctor, to the Public, and to our
own reputation.
SEYMOUR 1050
All Day
Ceovgva
Pharmacy
F
Irt4
777 WEST GEORGIA ST.
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Treatment of Syphilis with Liposoluble Bismuth
CARDYLJ
Campho-Carbonate of Bismuth in oily solution
CARDYL/ is gradually absorbed, thus insuring a steady
and prolonged action, and the patient is not exposed to
cumulative  effect.
A course of treatment requires 15 injections of 1 cc.
at the  rate  of  one  every  five  days.
Supplied in boxes of 10 ampoules of 1 cc. each containing 0.05 gm. of metallic Bismuth.
LABORATORY POULENC FRERES
OF CANADA LIMITED
Sample and Literature upon request to
Canadian Distributors:
ROUGIER FRERES,  350 Le Moyne St., MONTREAL EDITOR'S PAGE
It has been suggested by several of our readers that this page in
last month's "Bulletin" should be given to the daily press. They feel
that the public should be aware of our position in the matter of organized
charity and should realize that we are not being fairly treated.
It is rather a tempting idea—while one is still hot under the collar
and filled with a righteous glow of indignation. But fights are won, not
at the first impact, but by cool and dogged persistence, and by adherence
to a carefully worked-out plan of action. The Nelson touch once in a
while works wonders, but it needs a Nelson.
It is cheering, however, to find the dawning of a resentment and indignation which may eventually lead to action. We have been altogether
too complaisant and too 'easy' 'in times of prosperity—and now that
times are bad, we can see whither our complaisance has led. It is not for
us to rail too loudly at the selfishness and unfairness of governmental
bodies and institutions. Let us admit that we ourselves have been weak
and lacking in a proper sense of our own duty to ourselves. If we have
been exploited, whose fault is it, but ours? Is it not that we tend tfo
be indifferent to each other's welfare, or the general good as long as we
ourselves can get by? And is there not an element of distrust and
jealousy, quite unnecessary, but most inimical to progress along economic
lines?
Medical men are still highly individualistic in their view of things.
This is to some extent unavoidable in the nature of our work—but until
we realize that what hurts another medical man hurts us, and come to
some degree of unity, we shall not gain anything from outbursts of
temper or from isolated protests, beyond disappointment and loss of prestige^—for every battle lost is another battle to fight some day.
We are justified in looking to the B. C. Medical Council for guidance in these matters and we are justified in asking that they begin immediately. This whole matter of economics is one that is so vital, that
it is the first, and until some result has been obtained, the only duty of
the Council. It is for every medical man to camp on the doorstep of
the Council until it has grappled seriously with the problem. If properly
devised publicity in the daily press will help, let us have it—but isolated
articles and wailings are of little value—a definite plan should be worked
out and followed, and followed to a conclusion, whatever it costs. We
have so many things that should be remedied, that they cannot be all set
straight at once—but a start should be made, and made immediately.
Only in the last few weeks is there another instance of the attitude
assumed by the public towards that patient ox, the medical profession.
In its wisdom, the Government has assumed charge of some scores or
hundreds of Doukhobour children. All these children are provided for,
and a weekly sum paid for their keep. But they must all be medically
examined. That, however, costs the Government nothing—the doctors
do that free. Specialists in paediatrics, no less, are required for this, and
give their time and the use of their cars, and the gas required, we hope
gladly.
Page   197 We shall not win back to our proper status, to fair treatment, and
to general respect, without a struggle, and it is for our leaders to lead us
in this matter and for us all to get behind them and fight, till we win.
ANNUAL MEETING
The annual convention of the British Columbia Medical Association,
which opened at Kelowna on Thursday, May 26th, and concluded on
Saturday evening with a banquet and ball in the Royal Anne Hotel.
While the attendance at this year's convention was comparatively small,
■ the three-day scientific, business and social programme was carried
through to successful completion, and Kelowna welcomed the opportunity to act as host to the distinguished assemblage, which numbered
about fifty doctors, some of whom were accompanied by their wives.
Dr. W. J. Knox, President-elect last year, was duly elected to the
presidency of the Association at the business session on Friday afternoon.
He succeeds Dr. Thomas McPherson, of Victoria, the retiring chief
executive. The President-elect is Dr. W. S. Turnbull, of Vancouver.
Other officers are: Vice-President, Dr. G. Purvis, of New Westminster;
Honorary Secretary-Treasurer, Dr. D. E. H. Cleveland, Vancouver; and
Mrs. C. J. Fletcher, of Vancouver, continues as Executive Secretary. The
three new members elected to the executive are Dr. W. G. Bissett, Duncan; Dr. J. H. Hamilton, Revelstoke; and Dr. F. Auld, of Nelson.
The convention was featured by post-graduate lectures under the
auspices of the Canadian and B. C. Medical Associations and through
the generosity of the Sun Life Assurance Company, which sponsors the
Extra-Mural Post-Graduate tour throughout the province. The lectures
are designed to bring to the medical men of the smaller centres the latest
in scientific and professional knowledge, and good work is being accomplished in this way.
The convention opened in the I. O. O. F. Temple on Thursday evening with lectures by Dr. A. Gibson, of Winnipeg, and Dr. E. L. Pope,
Director of Medical Services, University of Alberta Hospital, Edmonton.
These eminent physicians also addressed a public meeting in the Junior
High School Auditorium on Friday evening, a report of which appears
elsewhere in this issue.
On Friday morning, Dr. A. W. Hunter, urologist, of Vancouver,
was the first speaker, followed by Dr. C. S. Williams, of Trail. The final
speaker at the morning session was Dr. Gibson.
At noon a luncheon was tendered to members of the Association
Executive and the visiting speakers by Dr. Knox. The ladies enjoyed
golf and tea at the Kelowna Golf Club in the afternoon, and automobile
trips were also arranged for those who wished to make a tour of the
district. A number of visitors attended the dance staged in the Scout
Hall by the Kelowna Boy Scouts on Friday evening.
Speakers at the Saturday morning session included Dr. J. W. Thomson, of Vancouver; Dr. Pope and Dr. Hunter.
Most of the visiting physicians entered the golf tournament on
Saturday afternoon. Dr. Colin Graham, of Vancouver, took premier
honours and the cup donated by the Kelowna medical men. Dr. S. A.
Wallace, of Kamloops, was runner-up.    Of the two hidden-hole  com-
Page  198 petitions staged, Dr. Thomson won the first, Dr. Palmer, of Rossland,
taking the second. Prize for the best score for the first nine holes was
awarded to Dr. Bailey, of Victoria.
The banquet at the Royal Anne Hotel in the evening was featured
by the retiring President's address and the presentation of golf prizes.
This function was followed by a ball in the rotunda.
During their sojourn in the city, several informal functions were
arranged for the visitors.
NEWS AND NOTES
The Vancouver Medical Association was honoured this year by the
attendance of Dr. E. L. Pope, of Edmonton, and Dr. A. Gibson, of
Winnipeg, at a special meeting held in the Medical-Dental Auditorium
on 30th May. The meeting was exceedingly well attended, and great
interest was taken in the papers.
Dr. Pope delivered an address on "Simplified Spinal Neurology,"
which was profusely illustrated by charts, diagrams and lantern slides.
Dr. Gibson's address was on "Injuries to the Spine," detailing several
modern methods of treating compression fractures of the vertebral bodies.
The papers were freely discussed, and much information of an important character was brought out in the discussion.
We extend our sincere sympathy to Dr. and Mrs. W. H. Hatfield
in the loss of their infant daughter, who died on June 7th.
The levity which members of the medical profession sometimes exhibit while referring to sacred subjects has frequently been the subject
of unfavorable lay comment. A recent example which has come to our
attention prompts us to agree with public opinion in this respect at least.
In an address delivered before the Annual Meeting of the British Medical
Association at Winnipeg, in 193 0, Sir Farquhar Buzzard, Regius Professor of Medicine, Oxford University, spoke of golf in the following
unseemly manner: "To many, a change from one form of mental work
to another (-italics are ours) is much more recreative than the pursuit of
a ball whose flight and destination are of much less interest than those of
a moth or a bird."
Dr. Isabel Day has returned from a stay of six months in the east,
where she has been engaged in clinical study.
Among those who are going to London for the centenary meeting
of the British Medical Association, after attending the CM.A. meeting
in Toronto are Drs. A. S. Monro and R. B. Boucher.
Dr. Harold Caple is leaving shortly for England for an indefinite
stay.
Miss Firmin, the most frequently consulted reference work in the
V.M.A. library, sailed recently on the "Duchess of Bedford" for England.
Among her fellow-passengers are Dr. H. A. Rawlings and Archbishop
W. M. Duke, both of Vancouver.    It is hoped that before Fastnet is
Page   199 sighted various weighty matters shall have been debated by this trio, and
remains, if any, decently disposed of.
We extend our sincere sympathy to Dr. & Mrs. Williamson Shaw in
the loss of their daughter recently.
STOP PRESS
The engagement of Dr. J. W. Shier is creditably rumoured and herewith reported.    Details later.
We are happy to report the satisfactory convalescence of Miss Mc-
Caul, a popular member of the V. G. H. nursing staff, who has been indulging in an appendectomy.
An interesting milestone in the march of time as affecting the
medical profession in British Columbia was passed at the Annual Meeting
of the Staff of St. Paul's Hospital on Wednesday, June 15th, 1932.
The occasion represented the retirement from the active staff of the
Hospital of the Senior practising Surgeon in British Columbia, Dr. F. X.
McPhillips.
Dr. McPhillips came to Vancouver in 1893, before some of us
were born, and has been in continuous and active practice as a surgeon
in this city ever since. The occasion was commemorated by a dinner
given by the Sisters to the active and consulting Staffs, at which a
memento of appreciation of his long years of faithful and valuable service to the profession, in general, and St. Paul's Hospital in particular,
was presented by Dr. R. E. McKechnie, senior member of the Consulting
Staff. Dr. McKechnie spoke feelingly of the excellent work of Dr.
McPhillips in the early days, working under difficulties with poor and
inadequate equipment, and of his intense loyalty to St. Paul's Hospital.
Dr. R. C. Boyle, himself a pioneer in early surgery in Vancouver and one
of Dr. McPhillips' early confreres, spoke of the many years of sound,
able surgery contributed by Dr. McPhillips to the honour of surgery in
this Province.
Dr. McPhillips stated that he had come here in '93; had seen the
first plank of the first unit of St. Paul's Hospital nailed into place in
November 1894—and had been continuously identified with the institution right down to the present day. Although he is retiring to the consulting staff of the Hospital, he is still remaining in active practice and
it is the hope of his confreres that he may have many more years of
active service. And when the time comes that he must pass his last milestone, the splendid modern institution of St. Paul's Hospital, which he
fathered and nurtured for over a third of a century, will stand as a
monument to the pioneer Dean of Surgery in Vancouver. Dr. McPhillips
—good luck to you, Sir.
SUMMER SCHOOL
Dr. L. Eloesser, Professor of Clinical Surgery, Leland Stanford University, San Francisco, is coming in addition to other speakers already
announced.
Page 200 M
MEDICAL ECONOMICS (5).
R. E. Coleman, M.B.
MEDICAL CAPITAL A BIOLOGICAL PHENOMENON
So fare we have developed to our own satisfaction (except that no
discussion or criticism from our readers has materialized) the reality of
a medical economic problem; the necessity of the medical profession balancing their books; the necessity for the adoption of a unit of measurement; the indications for the use of the pay of a Canadian postal clerk
as a first approximation for this unit of measurement; and that the origin
of the capital which enables the medical student to acept the loss of his
pay is the mental superiors of the community.
The complete absence of any discussion from our readers implies
two things: first, that so far none of the profession here in Vancouver
has seen in the articles any material gain for himself sufficient to rouse
any productive action; second, that so far no one has seen in the discussion anything that threatened his security and so no fears have been
aroused. We predict this attitude will not persist throughout the analysis
because fears will be developed to a considerable degree and it will be
found that it is these very fears that are largely responsible for our present economic situation and, further, that we have no choice but to face
them.
The present paper will deal with the significance of the private
capital that enables the medical student to prepare for the practice of
medicine. We found in the last paper that this capital probably owes its
ultimate origin to those individuals of the community who show general
signs of superior intelligence. In searching for the real significance of
this capital we will again appeal to well established correlations from
other fields of science. In general the physicist of today adopts as his
working hypothesis, that atoms are the products of electrons and protons;
that all of the other elements are the products of the hydrogen atom.
The chemist works on the hypothesis that all chemical compounds are
the product of the various elements; that various compounds of elements
such as water and copper sulphate tend to produce other compounds like
crystalline copper sulphate; that such relatively simple compounds tend
to produce more complicated compounds such as amino acids; that these
in turn produce more complicated compounds such as proteins. The
cytologist works on the hypothesis that cells are made up of electrons,
atoms, chemical compounds. The anatomist works on the hypothesis
that the cells make upe the organs and that the organs make up biological
units, such as man. The biologist works on the hypothesis that biological
groups are made up of the anatomist's biological units. Such a list could
be continued indefinitely, but the above is sufficiently long and sufficently
wide to indicate a common mental trend, and to establish that sufficient
checking in widely different fields of science has eliminated personal bias
to a high degree. These associations instinctively suggest to the individual
that each higher grade in the series is but a special case or special sum of
the manifestations of the next succeeding lower grade. Thus the fact
that a particular chemical compound on analysis yields certain of the
elements, suggests automatically to our minds that the group of phenomena  which  the particular   compound  under  investigation  presents   are but the outcome of special potentialities inherent in the particular
elements present. It is true that we learn more concerning the elements
in question by studing the compounds, but then we infer automatically
that the new phenomena shown by the compounds really originated in
the elements found to be present. Why we make this inference, and why
we feel so secure in the deduction, will be left to a future discussion, but
the fact remains that we have a feeling of security when we make the
inference. Because of the feeling of security engendered by this type of
analogy, and because of the almost infinite series of checkings that it has
been subjected to, it is proposed to avail ourselves of this technique to render the following thesis more readily acceptable both emotionally and intellectually. First place is advisedly given to the emotional appeal because
of its prior importance when seeking acceptance. Though, for some of us,
emotions reach an intellectual (in the ordinary sense) level, nearly all, if
not all, decisions are, in the last analysis, undoubtedly emotional, as will
be shown in a later paper.
For these reasons we feel we are on more or less reasonably acceptable
grounds if we adopt as a working hypothesis that, since man is a biological unit, all of the manifestations that may be observed regarding him
are the outcome of biological potentialities and therefore will tend to
follow the same general drift that other biological phenomena are observed
to follow. It is therefore proposed to assume that the mental, emotional
and instinctive phenomena exhibited by man in his economic responses
tend to follow the same sequence of events as observation has shown to
hold for such biological phenomena as structure, etc. Therefore, since
the science of economics deals with phenomena resulting from man's mental life, the science of economics now becomes the study of a biological
problem. Also since, as previously emphasized, medical economics necessitates detailed consideration of the professional economist's "human factors" (biological factors), it becomes apparent immediately that medical
economics calls for the association of the present science of economics and
the present science of biology. That is, medical economics will be capable
of scientific study only when the present science of economics is quantitatively correlated with the larger science of biological economics.
As was previously stated, it is necessary that the medical profession undertake this particular correlation. A further reason for this,
that has a bearing here, is that social customs are by their very nature so
imperative on the individual and the group, that nothing short of disaster,
or threatened disaster, will force the individual or the group to make alterations. The present condition of world economics is an example. It
was only the more or less complete failure of the present methods that
forced the financial world to listen to those who alone were all along in
a position to have any real opinions. Under ordinary conditions, however,
the science of economics takes the social customs as they are and passes
judgment of economic success or failure on the individual or group. In
contrast with the economist, the physician is mainly occupied with at-
temps at repair of the more or less unprofitable human units which constitute the creators of the economic structure. Innumerable personal experiences force the physician, much against his will( for by nature he is
just as refractory to change as is the layman) to materially modify and
often  reverse  his  opinion   of   customs.   His  own   experiences   gradually
Page 202 force him to realize that morals are a matter of time, place and group,
and that the mental and emotional manifestations of the individual are
inseparably linked up with inherited characters, as evidenced by the individual's constitution and as further modified by the accidents of training and disease. The experienced physician does not simply admit these
things, he actually accepts them. He sees that the individual really breaks
down following accepted customs, whether the customer is physical or
mental, whether the custom originated yesterday or in the deepest antiquity. In short the daily life of the physician forces him as an individual
to be much closer to many of the realities of human living than any
other large group. Therefore, the medical profession must take it upon
themselves to correlate the present science of economics with the present
science of biology.
Accordingly from now on financial wealth, with all of its manifestations, will be largely dealt with as a biological product or manifestation.
The phenomena observed regarding wealth will be studied in the same
manner as one would observe the sequence of biological phenomena such
as structure, size, strength, the color of the hair,etc. With regard to
structure, whatever may be the particular mechanism (evolutionary
theory) that one may adopt as producing the sequence of events, there
is general acceptance of a definite relationship between the persistence of
a structure and its biological value to the individual or the group. Therefore, the increased security of life, along with the increased density of
human populations incident to the development of what the economists
call wealth, constitute their own evidence of its biological function and
efficiency.
Having then demonstrated the biological phenomenon of wealth to
be on a par with that of structure, the next question is to observe the
significance of its variations. A conspicuous squirrel structure is its
large bushy tail. One of the advantages of such a tail is that it enables
the squirrel to jump with greater efficiency from limb to limb of a tree.
We accept as a fact that the relative efficiency of such functions tends
to determine the average structure of the individual tails in the group,
those with relatively efficient tails tending to survive better than their
less fortunate fellows. In this case the survival sequence is rigid in that
the resulting greater efficiency can not be borrowed as wealth can. Therefore natural selection rigidly restricts survival to those individuals who
actually possess the survival structure. It is conceivable, though, that
the squirrel's instinct to collect its winter stores might not be so selectively efficient. For example the effort of storage might be relatively
trivial, while the chances of a violent death during the winter might be
very high. Under such conditions squirrels might make multiple stores
in common. The net results would be the sharing of a product that owed
its origin to a selective inherited character; namely, the storage instinct.
If such a group were to be studied over a very long period of time we
would expect to find that the average intensity of the storage instinct in
the group would go in waves. First the death rate would be determined
chiefly by the incidence of violent death in the winter, because deaths
from saturation would be rare, so the unthrifty individuals'would have
as good a chance as the thrifty ones, with the consequent decrease in the
storage instinct.   Then the time would come when the number of thrifty
Page   203 individuals would be inadequate to supply sufficient food for all of the
unthrifty as well as the thrifty which would survive violent death during
the winter. Then only the thrifty ones which knew" the widest range of
stores might survive, until the average incidence of thrifty individuals
rose to the point where adequate stores for all were again available. This
process might then be repeated again and again until some outside factor
developed to alter the nature of the selection.
At this point it may be objected that the squirrel story is a highly
fanciful fairy tale. So it is; but ,like many other imaginative yarns, it
is based upon facts. Since, as you will be shown, it is a true picture of
our own social structure, it can not be assumed that no other biological
group has ever experienced this sequence.
The particular object in developing the above squirrel story was to
contrast two types of inherited characters. On the one hand there are
the structural characters that benefit only the possessor and are therefore
selectively maintained by the beneficiary. On the other hand there are
instinctive characters, the products of which can be passed on to individuals which lack the characters. Such characters would not be
rigidly selective for the maintenance of the individual possessors of the
characters, but on the other hand would still be rigidly selective between
groups. Thus of two groups, that group which contained the largest
number of individuals possessing a group-benefitting instinct would have
better chances of survival than a similar group containing relatively few
or no individuals with the same group-benefitting instinct. It is proposed to develop the thesis that the present social structure actually functions to distribute wealth which owes its origin to certain individuals
who have inherited special mental characters to a high degree, among
individuals who have inherited these same characters to a much less
degree, with the result that the desirable characters tend to be biologically
eliminated.
Having indicated then that wealth is a biological phenomenon, and
having also definitely correlated wealth with mental characters, which
characters every physician is prepared to admit are hereditable, what biological selective relationships should hold between this same wealth and
the group of individuals responsible for its existence? Obviously accepted
biological selection calls for subservience of the interests of the sub-group
to the interests of the main group. Therefore just so much of the wealth
created by the sub-group should be retained by the sub-group as will
maintain them or increase them according to the interests of the main
group. To be particular, the community's needs call for the retaining by
those individuals showing superior intelligence of just enough of the wealth
for which they are responsible to yield a birth rate adequate to the needs
of the main group. That such has not been done is again in part evidenced by the present world depression, since the economists and financiers who foresaw the disaster were too few to stay its course. Such
untoward situations in general are well recognized as being due to three
main causes; complete ignorance of the forces at work, which leaves the
results to p*ure chance; carelessness or lack of foresight, implying that
the ignorance exhibited was great in comparison with what might have
been expected; and lack of control in spite of knowledge.    This last mav
Page 204 be illustrated by an adult in charge of a group of children, who along
with his charges meets with disaster owing to his absolute inability to
control either the children's collectively greater mass or the children's
collectively wider range of experimental ideas. There seems to be no
question but that this illustration is not far from the picture of the
position of many economists and really intelligent financiers since the
war. So much wealth had become subject to the control of childish
minds (not excluding millionaires) that the relatively few adult minds
had to content themeselves with the role of observer. However, it did
not need the recent boom and depression, to demonstrate completely the
fact that civilized communities throughout the world are conspicously
lacking in intelligent adult control. It has been one of the conspicuous
features of human civilization that if one wanted a thing done capital
would effect it if one knew just how to do it, but if one did not know
just how to do it one had to wait for biological processes to produce the
man who could devise a way. This implies that ideas have been the
limiting factors in the economic development of the human race. The
economist of today maintains strongly that neither capital nor workers
constitute limiting factors, but rather that it is the relative scarcity of
individuals with the mental capacity to make efficient use of the material
available. The development of this phase will have to be left for the
future, but sufficient indicaions have been presented to point strongly to
the possibility that the mental superiors have not maintained the control
that their biological importance to the community warrants. Our problem
of medical economics then becomes the biological problem of working out
a mechanism by which the mental superiors will effect that degree of
control that their biological importance to the main group warrants; no
more and no less.
It was noted above that efficient control was limited; first, absolutely,
by intelligence; second, relatively, by carelessness and lack of foresight;
and third, by the relatively large mass of the number of individuals to be
controlled or the relatively excessive range of ideas. The first or intelligence limits are predetermined biologically by the inherited character
of the intelligence. This type of control can be improved only biologically. The second type of limitation of control implies an adequate biological intellectual equipment secondarily impaired by education and
personal experiences. Such impairments, being essentially educational and
emotional, are capable of considerable improvement by means of
a more efficient training and early environmental control. The third
type deserves special mention because of its particular bearing on medical
economics. It is common knowledge that a given group of individuals
will be controlled physically by one individual and not by another.
Similarly a given group will be controlled mentally by one individual and
not by another. Also we know that some individuals can acquire this
capacity to control while other can not. Thus it is apparent that the
capacity to control is limited primarily and absolutely by inherited characters, and secondarily relatively, by education and experience and
emotions. We have also seen that one of the conspicuous features of the
modern social structure is its lack of adult direction and control; therefore
it is biologically obvious that those individuals capable of adult control
are not functioning efficiently in the biological sense.    Therefore, since
Page   205
mem the biological significance of wealth calls for the better control of untoward economic occurrences, those individuals responsible for the origin
of wealth are biologically responsible for its control in the interest of
the main group. The particular application of this to medical economics
is that since the ultimate origin of the capital that enables the medical
profession to qualify for their professional activities, is the mental superiors
of the community, and since the medical profession itself is largely made
up of superiors, the medical profession is obligated to the mental superiors
of the community for the distribution of the benefits of the capital investment that they represent. In other words the individual physician
has no more biological right to dissipate in riotous medicine the capital investment that he represents, that has a son the right to dissipate in riotous
living, his father's hard-earned savings.
Summary
Wealth is shown to have the attributes of a biological phenomenon.
It is proposed therefore to treat it as such. It is shown that wealth owes
its origin to inherited characters which, while rigidly selective for the
group, are not so for the individual. Indications from common knowledge are given that the number of individuals possessing the inherited
characters which produce wealth is inadequate to the needs of the community. The biological origin of the capital then that enables the medical
student to accept the biological sacrifices incident to his period of training
biologically calls for the fostering of those who possess the characters that
create the capital. That is ,the biological origin of medical capital requires
biological provision for the mental superior of the community.
UROLOGICAL EMERGENCIES
By Dr. A. W. Hunter, (Vancouver)
It is only by comparing our own experience with those of others
that we are able to progress. It is in more frequent emergencies that we
should endeavour to help each other.   Let us start with:
Acute Retention
This   term   usually   applies   to   acute   interference   with   urination.
The obstruction is between the bladder above the urethral meatus.    The
more frequent causes are urethral strictures and prostatic obstructions.
In recent urethral strictures, you are treating patients of early adult
or middle life, while the neglected strictures are often seen in advanced
years. Usually these is a history of a gradual decrease in the size of the
the stream. This narrowed urethra may continue to function for a long
time. Then an acute retention ensues. This retention is often precipitated by some focal infection which in turn causes an inflammation of
the urethra, at the narrow area. This increased vascularity, with its
associated swelling of the mucosa, results in the blocking of the canal.
The engorgement may be precipitated by excessive use of liquor.
First make sure you have a distended bladder, then ascertain the
cause of it. If you rule out causes outside the urethra, you proceed with
your instrumentation. First cleanse the part, attempt to pass a new 18
or 2 OF soft rubber catheter or an olive-tipped rubber catheter.    If this
Page 206 The President and Members of the Vancouver and B. C.
Medical Associations:
Dear Sirs,
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Gymnastics wishes to recall your attention to the salient
features in their constitution, that are of interest to the
Medical  Profession.
(a) The Association is in incorporated by Dominion
Charter, and has members working in all parts of Canada.
(b) The requirements for admission.are rigid, and strictly enforced by the executive.
(c) The members are pledged to work only under
medical supervision.
It is noted, for your information, that the B. C. Workmen's Compensation Board will not recognize or pay for
any massage, unless performed by a member of this
Association.
Signed on behalf of the  C.A.M.R.G.
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Medical-Dental Building Vancouver fails, try to pass a metal catheter of similar size. If you encounter an
obstruction in the pendulous portion or at the bulb, withdraw the instrument. Try passing a small sized gum elastic bougie. If this fails,
do not use force, but resort to filiforms. First fill the urethra with diluted K.Y. or olive oil. See that your filiforms fit your following sounds
or catheters.
The basic principle in engineering where moving parts are
used is to keep them well lubricated. This applies with equal emphasis in
urology.
Next endeavour to pass a filiform guide with the urethra pulled up
taut. If it fails to pass, insert another, and in the majority of cases you
will eventually pass one of them beyond the stricture. Remove the extra
filiforms, attach a small sized catheter to your guide and you will pass
your stricture and enter the bladder. Withdraw only about 15 to 20
ounces, slowly. The least amount necessary to give the patient relief
should be withdrawn, as the withdrawal of large amounts may cause a
troublesome haemorrhage from the bladder.
Now if you remove your small catheter and dilate with larger metal
catheters or sounds, you may dilate the stricture to size 18 or 20 F. Do
not dilate to a large size. If you cannot dilate the stricture, tie in your
filiform carefully and let your patient be content with passing urine
alongside the filiform. Should you be successful in dilating the stricture,
then remove the filiform and tie in a larger sized catheter. This is necessary to ensure a peaceful night's rest to the patient and yourself, for
the instrumentation may be sufficient to cause the patient to have retention at his next attempt at voiding. The subsequent treatment depends
on the dilatability of the stricture.
If the acute retention is caused by prostatic obstruction, the treat
ment is entirely different. In prostatic obstruction you will find no
difficulty in passing your catheter until it is nearly in the bladder. If
a No. 18 soft rubber catheter will not pass, then proceed to fill the
urethra with lubricant and use a No. 18 or No. 20 F. metal catheter.
Pass it down to the membranous urethra and lift up on the penis and
sound, until you feel you are hugging the anterior urethra. Now swing
your catheter butt down toward the perineum, even carry it down between the legs and do this without force. If you are in the urethra,
your catheter will pass over the prostate into the bladder. In my opinion,
most failures are due to attempts to push the catheter in where we think
it should go. We do not depress the butt enough. Withdraw 10 to 15
ounces and wait. Then if the bladder is still very tense withdraw 20
ozs. more. Next remove the metal catheter and insert a No. 18 ort No.
20 soft rubber catheter, and while you are passing the catheter keep
giving it a right hand turn. This helps to elevate it over the sulcus distal
to the neck of the bladder. Tie in your catheter. If the prostatic mass
is neoplastic leave it alone. If is is due to an infected prostate, massage it
and the discharge will pass into the bladder or around the catheter and
can be removed.
Should a young or middle aged person develop an acute retention
following a recent renal colic, it may be due to a stone lodged in the
urethra.   If the patient can void any urine, around the stone, allow him
Page Jt£
to dos so. Then fill the urethra with a good lubricant. Take the largest
sound that you can pass and gradually attempt to force the stone back
into the bladder. Sometimes it will pass easily, other times it is impacted
and requires special instruments to force it back or extract it.
Neurological lesions producing retention are easily relieved by the
passing of a catheter, and then combining the local treatment with the
neurological treatment. Just one warning; more damage is done by
trying to get the patient to void without a catheter, than by continuous
catheter drainage, where urinary stasis exists.
Traumatic lesions causing retention are chiefly due to direct violence,
the most frequent being rupture of the membranous urethra in factures
of the pubic bones. These lesions should be investigated promptly. Attempt to pass a catheter and if successful tie it in place, for continuous
drainage. Failing to obtain urine, do not make repeated attempts, but do
a supprapubic cystotomy and tie in a catheter above. Your patient will
usually be suffering from shock, so be content to drain him. See that
you drain also the space of Retzius. This will check spreading of the
infection in the injured parts, and in the blood clot.
Repair your urethra when the patient is stabilized and essentially
well. My clinical and autopsy observations teach me that this is the
simplest way and has the lowest mortality. Moreover, if you are in doubt
as to whether the lesion is in the urethra or the bladder, your next observation of the bladder will settle it and you will act accordingly.
Important points in treatment of traumatic lesions:
Don't do a suprabubic puncture.
Don't do a repair of the urethra unless the patient is free from shock.
Don't forget to drain the prevesical space.
Don't let your suprapubic drain plug with a blood clot. Irrigate it
frequently. (Where you have extravasation of urine, it follows
the facial layers, appearing in the perineum and extending over
front of the abdomen.)
Early diagnosis is imperative so that we may drain by multiple free
incisions. In extravasation the important points are early diagnosis, free
incisions and bladder drainage.
Remember that a harmless looking fractured pubic bone, may have
been compressed into the median line enough to tear off the bladder or
urethra. Ruptures of the bladder are much less frequent than rupture of
the urethra.
Once you have secured drainage in cases with acute retention, the
most important thing is flooding them with water or salines. This keeps
up the kidney function and lessens the onset of uraemia.
What are the outstanding points in acute retention?
1. Early relief.
2. Forcing of fluids.
3. Gentleness.
Renal Colic
Causes:
Impacted stone.
Stricture of ureter.
An aberrant vessel.
Pressure from without, etc.
Page   208 The first thing to do is to make a diagnosis. Loin pain extending
to the anterior abdomen associated with a variable amount of tenderness,
may be all that is complained of. The pain may be severe, intermittent,
or- continuous. The urine will usually show some blood in cases of
stone, while from ureteral stricture the urine may be negative. Positive
findings in the urine of infection are helpful. The white and differential
blood count is usually low. The most accurate method is cystoscopy and
pyelography, the plain plate showing the stone in the great majority of
cases, while the pyelograph reveals obstructions that do not normally show
by X-ray.
The treatment depends on the diagnosis. One is justified in taking
a plain X-ray film at once. If it is positive for stone, you can judge
whether it will pass or otherwise, but if you have a negative film, you
should advocate a complete cystoscopy and pyelography. Intravenous
solutions excreted through the kidneys are very helpful at times but in
my opinion, they are not as valuable as the cystoscopy and pyeography.
If you have a stone 1 cm. or les sin diameter, it will progress down
the ureter, but stones of larger size usually remain impacted.
Benzyl-benzoate capsules (minims 5, 2 capsules every 4 hours) will
act as an antispasmodic, and are preferable to morphia, but when the pain
is severe morphia must be combined in adequate doses to give relief.
Where the stone is large, it will not pass. If the urine is getting by
the stone, one should do a complete cystoscopy and pyelography prior to
starting any operative work, for accidents do happen to all of us.
Manipulation treatment is of doubtful value, for one does not know
how successful he will be. Stones impacted at the bladder orifice are the
easiest to remove by cystoscopic manipulation.
In the operative cases which you may consider an emergency remember what I have said above.
Anuria is a condition in which no urine is voided.    This includes:
(a) suppression, when the secretion of the kidney is suspended.
(b) retention, when the fluid, although secreted, is retained in
in the urinary pasages by mechanical obstruction.
Anuria should be considered obstructive, until proven otherwise.
Severe renal colic on one side will some times give sympathetic suppression on the opposite side. I have seen true suppression of urine in a case
where I had removed a tuberculous kidney. The patient went as long
as 9 days without voiding. In true suppression, I find intravenous salines
and hot wet packs of most use in starting up the secretion.
Where the retention is due to pelvic or ureteral obstruction, the
only method of relief is by overcoming the obstruction instrumentally.
Barely will you require to operate as an emergency.
Uraemia
Uraemia really comes under internal medicine, but so many urological patients are suffering from kidneys which are functionally im-
Page 209 paired by disease or age, that it plays a very important part in emergency treatment. Let an old man down a certain distance and you will
have great difficulty in getting him back. This is especially true of pros-
tatics. I have seen cases die in hospital for lack of water. They have
difficulty in voiding, so they drink less. Their N.P.N, gradually goes up.
Their kidneys become used to functioning with a variable degree of
stasis. Then comes an acute retention, and in many cases uraemia is not
far off. Flood these old men with intravenous or subcutaneous salines
daily and it is a pleasure to see them improve. Catheterize them and
leave them alone, and see what happens.
Lastly, there are a few operative emergencies that are worth considering.
In removing stones, one may accidentally tear off the ureter. While
this is a misfortune, join the torn parts up end to end and you will be
surprised how well they heal, but always drain the area.
Once I tore off the pelvis off the kidney, I removed the stone, and
thought I would have to remove the kidney; however I sewed the pelvis
to the kidney, put in a drain and the patient is quite well now two years
after.
In these cases the golden rule is always to drain the operative area.
In most of my operations on the kidney, nephrotomy, pyelotomy or
nephrectomy, I expect abdominal distension within two days. Anticipate
this by treatment and your patients will have a better convalescence. I
give pituitrin l/z cc. q.4h., starting the morning after the operation.
Keep the bowels open and the stomach free from gas.
THE ETIOLOGY OF STATUS LYMPHATICUS.
W. N. Kemp, B.A., M.D.
(Editor's Note—
Our readers wil remember a short article "The Challenge of Status
Lymphaticus," edited in the April issue of "The Bulletin." This article
carries the argument somewhat further and merits the careful attention
of the reader.)
The first case of -status lymphaticus was reported by Felix Plaster
in  1614 in the following words :-
"Suffocation from a hidden internal struma about the throat.
The son of Marcus Peresius, five months of age, well nourished,
with no previous illnesses, suddenly died from difficult breathing, suffocation. As the father had previously lost two sons from
the same malady, and being desirous of knowing the cause,
we opened the chest at his request. We found the gland in the
region of the throat as a large protruding tumor, one ounce in
weight, spongy, fleshy, pendant, replete with veins, adherent
by membranes to the largest ascending vessel adjacent to the
throat. These being filled with blood and flowing into the
struma, dilated it to such an extent that it compressed the
blood vessels in the locality; in which manner, I concluded, the
child was thus suffocated."
Page   210
mm The thymus became the central figure in etiological discussions and
Kopp's physical explanation (pressure from the thymus gland) was generally accepted until 1858, when Friedleben published his classical experimental and clinical studies on the thymus.
He denied that pressure from an enlarged thymus could explain
Kopp's "Asthma Thymicum" and briefly expressed this view in his
famous dictum "Es gibt kein asthma thymicum."
After Friedleben's work, no other contributions to the subject were
made until the time of Arnold Paltauf (1889). Paltauf supported
Friedleben's conclusions that the enlarged thymus was a secondary factor
in thymic asthma. From a study of the vast material available to him
as corner's physician in Vienna, he advanced the theory that "mors
thymica" was due to a lowered resistance dependent on a specific constitutional anomaly of a lymphatic chlorotic type, which so weakened
the influence of the nervous system that persons with this anomaly were
unable to withstand shocks or injuries which would not have seriously
affected normal persons. The anatomic changes observed, he believed,
were only the gross manifestations of the nutritional defect which he
designated "status lymphaticus."
Since Paltauf's time, very little progress has been made in the
solution of this condition of which Durand of Seattle says: " In our
pratice,, cases with thymus symptoms (statxxs lymphaticus), have been
more frequent than cases of mastoiditis, appendicitis and pyloric obstruction."
To H. Spohn of Vancouver, B. C. we owe much of our knowledge
of the clinical symtomatology of the condition. He gives as characteristic and diagnostic, the following symptoms:
1. Dyspnoea  (continuous or intermittent).
2. Cyanotic attacks, not of cardiac origin.
3. Intermittent suffocative spasms, with or without fits of crying
or temper.
4. Stridor   (usually  inspiratory).
5. Paroxysmal coughing or choking attacks.
6. Shock and collapse from seemingly insufficient cause.
On autopsy, the only constant findings are enlarged mesenteric
lymph glands. Usually the thymus is larger than normal for the age, and
nutrition, of the patient.
It is now evident, that the thymic weights hitherto passed as normal,
are nearly twice the normal thymic weight. Obviously, the nearest
approach that we can make to the real normal thymic weight is by autopsies of children dying accidental traumatic deaths.
Anderson and Cameron of Glasgow, in 1927, by the autopsy of
children dying accidental deaths, found the average prepubertal weight
to be 10-15 grms. In the Finklestein Clinci the normal weight is considered to vary from 6.6 to 11.7 grms. In eight consecutive autopsies
by A. W. Hunter, on childen dying suddenly without operation or
anaesthesia or trauma, in Vancouver, post mortem diagnosis being status
lymphaticus, the average thymic weight was 22.2 grms.
Page 211 D. D. Marine emphasized the fact that the thymus is capable of
rapid increase in size and rapid involution, so that an individual child's
thymic weight would vary according to his lymphoid reaction at the rime.
Marine also emphasizes another well-known point, and that is the thymic
involution that accompanies inanition.
I now propose to briefly review some of the clinical and experimental facts that will enable us to build a reasonable theory to account
for the etiology of status lymphaticus.
1. H. D. Rolleston in 1895 in reporting on the supra-renal glands in
one thousand autopsies, stated:
(a) "In foetal life, the suprarenals are relatively much larger than In
adult life—there being o temporary involution in the first year of
extra-uterine fife."
(b) "In cases of Addison's disease (in which there is usually macroscopic damage to the suprarenal gland) the exaggeration of the
lymphoid tissue has been frequently noted and Dr. Greenshaw
considered it as one of the characteristic lesions of the disease.
In some cases, persistence of the  thymus  gland has  been  noted."
Since Rolleston made these observations in 1895, other men have
reported the finding of enlarged mesenteric lymph glands, and persistent thymus, in cases of Addison's disease.
2. D. D. Marine, the well-known American authority, says:
"It has been known for a long time that the suprarenals may be
small in status lymphaticus, but Weisel was the first to point out
that the chromaffin tissue, as well as the cortex, may be strikingly
reduced.  Hedinger has reported similar occurrences."
3. Swale Vincent, the eminent English endocrinologist,  says:
Hypertrophy of the thymus has been recorded in cases of Addison's
Disease, and the association of adrenal hypoplasia and thymic hypertrophy, is said to be common in status lymphaticus."
4. Symmers of New York has said:
"Norris and Weisel have pointed out  the almost constant occurrence  of  hypoplasia  of   the  suprarenal   cortex  in  subjects   with   status
lymphaticus."
5. Anderson and Cameron report one hundred cases of status lymphaticus in which a study of the gross disease was made in all bodies,
and of those histologically demonstrable in fifty. Some disease was frequently present in the thyroid gland and in the suprarenal glands.
Physiological experiments performed within the past decade by
outstanding men like Banting of Toronto, Rogoff and Stewart of Cleveland, F. A. Hartman of Buffalo and Swingle and Pfiffner, are very
informative to the student of status lymphaticus.
Banting and Gearns in 1926 removed the adrenals of 37 dogs in
two stages.   The   dogs  recovered   from   both  operations   but  invariably
Page   212 died within from 4-14 days. At autopsy,  the following were constant
findings:
1. An enlarged thymus. •
2. Enlarged lymphatic glands.
3. Congestion and degeneration of the liver.
4. Congestion and degeneration of the kidneys.
5. Enlargement of the spleen.
6. Congestion and hemorrhage from the stomach and duodenum.
7. Ulcers of the stomach and duodenum.
Rogoff and Stewart emphasize the intense congestion of the pancreas in addition to the above findings.
The explanation of these laboratory findings must be that the
presence of adrenal secretion is necessary to life.
In its absence, there is dyisfunction of both pancreas and liver (with
fatal termination) in which the lymphatic glands and thymus atempt
to play a compensatory role. That it is the cortex of the adrenal gland
that is essential to life, has been shown by many observers before and
since the above quoted experiments.
In passing, it is noteworthy that recently physiologists report that
adrenalectomized dogs can be kept alive indefinitely by the subcutaneous injection of a potent extract of the adrenal cortex. The dogs can
even be revived when in extermis by adequate doses of the extract. It
should also be noted that these treated doge are like children with status
lymphaticus—they are subject to infection and are poor operative risks.
May I, at this point, give the following post-mortem report on a
sudden fatality.
The findings were:
1. A large vascular thymus measuring 14 x 6 x 2.5 cm.
2. Large mesenteric, retroperitoneal, and medstinal lymph glands.
3. The lymph follicles in the lower portions of  the small intestine are large and prominent.
4.
5.
The spleen is slightly larger than normal.
The tonsils are much larger than normal.
These are the findings in cases of unexplained death in children,
the diagnosis being, of course, status lymphaticus.
However, this autopsy was performed by Crowe and Wislocki of
Johns Hopkins, on a dog aged 18 months, in whom a partial adrenal
cortical insufficiency of 4/2 months' duration had been previously established by operatcie precedure.
The frequent association of sudden death and Graves' disease is
well known. The fact that the thymus is unsually enlarged in this form
of thyro-toxicosis is perhaps not,so well known.
Mrs. Scott Williamson, the eminent British surgeon, has recently shown a very close anatomical lymphatic relationship between the
thyroid and thymus. The two glands are connected by a network of
lymphatic channels. He says (in part): "The thymus is essentially in
the nature of a lymph reservoir to the thyroid gland."
Page 213 Briefly, my theory of status lymphaticus is as follows:
The cortical secretion of the adrenal glands is essential to life. In
its absence (either partial or complete) the pancreas, liver and thyroid,
lacking this hormone which is necessary for their essential activities, do
not function properly and there is a severe (or mild) upset in body
chemistry leading to death or, in less severe cases, to a compensated
lymphoid state which we call status lymphaticus. The lymphatic glands
and the thyro-thymic apparatus attempt to compensate for this lack of
adrenal cortical secretion and the subsequent upset in body chemistry
that this lack involves. Hence, the enlarged thymus, far from being the
cause of status lymphaticus, is a compensatory hyperplasia on the part of
the thyroid-thymus defense mechanism.
In the first year of life there is always a temporary involution of
the adrenal cortex. This may be carried too far or be too sudden in its
progress, and the child suffers from a suprarenal insufficiency with the
resulting metabolic upset which leads to the well-known symptoms and
signs of status lymphaticus.
LIBRARY SECTION
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present time there hangs on the wall of the reading room a letter from
the late Sir William Osier, complimenting the Association on this new
endeavour; it was accompanied by a donation of one" hundred dollars.
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mature stage of existence. All have felt the help and friendship of the
books on the shelves, the mental intercourse with the spirits behind the
written page, for, as has been said, books are the sepulchres of thought;
but how many have ever paused in their rush to procure some needed
information, to think of what the library really means, how valuable it
really is, from either a personal, historical or monetary viewpoint. It has
many facilities, some of which are used only too infrequently.
On the shelves of our Vancouver library are approximately 7000
volumes, which compares favourably with most of the medical libraries
in Canada. There is no piece of medical literature which is not available
in the library or through its facilities. The would-be author has the whole
medical world at his beck and call.    In the late years from $1200.00 to
Page   214
■ ' '» ■fkUilU $1500.00 has been spent annually on the purchase of new books and
journals and the binding of the journals. The purchase of new books
has always been a problem, for medical books are only of value when they
are new, or old enough to be of historical value. Over 100 new books
are added to the library annually, many of which are donated. New
editions of widely used books are constantly replacing old ones on the
shelves. If at any time a particular book is wanted and is not to be
found, the library committee welcomes suggestions. These have been all
too infrequent in the past. The overflow from the library—yes, even our
present spacious quarters are crowded—is housed in a basement room;
there can be found many old books, and duplicate journals, which are
of untold value for trading purposes through the library exchange. It
is by this means that many of our most valuable files have been completed.
When next in the library, spare a few moments to browse around
and note some of the older books. Books, like proverbs, can be said to
receive much of their value from the stamp and esteem of ages through
which they have passed.   They are the monument of vanished minds.
"Golden volumes! richest treasures,
Objects of delicious pleasures.
One whole section containing many old and valuable books would
take volumes to describe. Picking up one we find it to be "The Whole
Works of that excellent Practical Physician, Dr. Thomas Sydenham."
There are two volumes lying side by side; one printed in Latin in 1695,
the other in English in 1697. Here on an upper shelf lies "Medicorum
Omnium Facile Principis Opera Omnia Quae Extant" of Hippocrates,
printed in 1657 in both Greek and Latin text. This is the Geneva edition
dedicated to Cardinal Carlo Lotharingio. Nearby is another fine old book
by Albinus of Frankfort-on-the-Oder, on of the greatest anatomic illustrators of all time. It is bound with old brass clasps, and contains many
fine engravings. It is a large folio entitled "Tabulae Sceleti et Musculorum Corporis Humanis." There are several books by John Hunter
published about 1818. One rather interesting volume, published in 1872,
was written by Sir Charles Bell, who was a leading anatomist of his
period. The work was a result of his lectures to artists and is entitled
"The Anatomy and Philosophy of Expression as connected with the Fine
Arts." Several early American books are to be found, such as the first
book to be printed in America on the subject of X-ray, and "Observations and Enquiries into Yellow Fevers," by Benjamin Rush, printed in
1794. These are but a few of the many interesting books of bygone
days.
"Leaving us heirs to amplest heritages
Of all best thoughts the greatest sages
And giving tongues unto the silent dead." "
The section of the library devoted to biographies and history bears
a fair proportion to the rest, and is well worthy of perusal.
As we look around the library, we will find that the bulk of the
stacks hold files of old journals and rightly so, for it is these that really
make a library of value. 71 current journals are to be found on the
rack in the reading room, which in itself is a formidable array of medical
Page 215 literature. The Lancet, which was first published in 1823, shews a complete file; every volume from the beginning reposing on the shelves. The
British Medical Journal is complete since 1862. With very few exceptions, The American Journal of Medical Sciences is complete since it was
first published in 1827. It is hoped that this series will soon be completed.
There are many of the Guy's Hospital Reports^ including the first few
issues, wherein may be found Bright's original discription of Bright's
Disease. The collected papers of the Mayo Clinic, which began as "The
Collected Papers of St. Mary's Hospital," in 1909, are complete. A valuable set of volumes is the complete "Index Catalogue of the Library of
the Surgeon General of the United States. All the volumes of the Surgical
Clinics of North America, which originally started as Murphy's Clinics
and then became "The Surgical Clinics of Chicago," are to be found in
the library. Some of the other complete files are, "The Transactions of the
Ophthalmogical Society of the United Kingdom," "The John Hopkins
Bulletin," and "The Archives of Internal Medicine."
It is encouraging to note the increasing number of donations to the
library, both books and journals. Some members subscribing to journals,
turn each issue regularly over to the library; thus enabling the purchase
of a greater number of journals. What a commendable habit! Duplicate journals are always of value for exchange purposes through the library exchange.
And so, as time rolls on, the library continues to grow, forever increasing in value. Let us continue to take pride in our library, to use
all its facilities, and to improve it constantly.
" 'Tis well to borrow from the good and great,
'Tis well to learn; 'tis God-like to create."
BOOK REVIEWS
The Cause of Cancer—by W. E. Gye and W. J. Purdy, members of
the National Scientific Institute, London.
The Genesis of Cancer—by Sampson Handley.
These two volumes, by writers who speak with authority, have recently been added to the library. The work of Gye and Purdy is based
on experiments made by Rouse, of the Rockefeller Institute, of New York,
by which he demonstrates the transmissibility of fowl saromata, by the
injection of cell free filtrates made from the tumour, showing that the
agent which causes them is separable from the malignant cells. Gye believes that "This agent is a virus, very wide spread jn nature, which is
the common cause of all varieties of cancer, and that it acts in connection
with a chemical factor which differs in each species of animal being
specific to that species." The criticism of those who differ from him is
that while he seems to have demonstrated the existence of a filter—passing
virus specific to this particular growth, he has failed to produce any
evidence which connects hman malignant growths with the virus of fowl
sarcoma.
The "Genesis of Cancer" is the result of 25 years clinical experience
and histological work on cancer, by Handley, who draws the following
conclusions:
Page   216
mm* Local lymph stasis is a constant precursory factor of malignant disease, and may therefore be spoken of as its cause.
All cancers are preceded in epithelial tissues by papillomata, and in
glandular tissues by adenomata.
A papilloma is a hypertrophy of epithelial cells resulting from proliferative changes having been brought about by lymph stasis, caused by
an obliterative lymphangitis, particularly of the terminal lymphatics in
the dermal papillae.
Chronic obliterative lymphangitis may be either infective, from
bacterial or viral invasion; irritative, from light, heat, chemicals, etc., or
mechanical, due to lymphatic blockage by parasites, such as filaria.
How does lymph stasis produce malignancy? Handley admits that
the answer "is a task belonging to the future," but he offers the following hypothesis—Lymphatic obliteration results in the cutting off from
the cell of its oxygen supply. This induces a new metabolic habit by
which the cell energy is sustained without oxygen by hydrolyzing sugar
into lactic acid (glycolysis). This metabolic change is attended by an
intense stimulus to cell proliferation, and once established, it becomes
permanent.
Handley claims that while his theory denies the existence of any
one specific cancer organism or parasite, it denies neither the irritative
nor infective theories, but reduces them in rank, and absorbs them in a
larger generalization.—G. E. K.
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