History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: November, 1937 Vancouver Medical Association Nov 30, 1937

Item Metadata

Download

Media
vma-1.0214392.pdf
Metadata
JSON: vma-1.0214392.json
JSON-LD: vma-1.0214392-ld.json
RDF/XML (Pretty): vma-1.0214392-rdf.xml
RDF/JSON: vma-1.0214392-rdf.json
Turtle: vma-1.0214392-turtle.txt
N-Triples: vma-1.0214392-rdf-ntriples.txt
Original Record: vma-1.0214392-source.json
Full Text
vma-1.0214392-fulltext.txt
Citation
vma-1.0214392.ris

Full Text

 The BULLETIN
OF THE
VANCOUVER MEDICAL
ASSOCIATION
Vol. XIV.
NOVEMBER, 1937
No. 2
In This Issue:
NEWS AND NOTES
CONDITIONED REFLEXES IN RELATION TO
CLINICAL MEDICINE ||
DEODORANT PADS BULKETTS
(With Cascara and Bile Salts)
. . FOR . .
Chronic  Habitual
Constipation
BULKETTS POSSESS ENORMOUS BULK
PRODUCING PROPERTIES AND BEING
PROCESSED WITH IcASCARAp AND
BILE SALTS PRODUCE BULK WITH
MOTILITY.
WE WILLJjfBE PLEASED TO PROVIDE
ORIGINAL CONTAINERS FOR TRIAL
ON REQUEST.
Western Wholesale Drug
(1928) Limited    §
456 BROADWAY WEST
VANCOUVER   -   BRITISH COLUMBIA
(Or at all Vancouver Drug Co. Stores) r~"i
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:
Db. J. H. MacDermot
Db. M. McC. Baibd Db. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address
Vol. XIV.
NOVEMBER, 1937
No. 2
OFFICERS  1937-1938
Db. G. H. Clement Db. Lavell H. Leeson Db. W. T. Ewing.
President Vice-President Past President
Db. W. T. Lockhabt Dr. A. M. Agnew
Hon. Treasurer Hon. Secretary
Additional Members of Executive—Db. J. R. Neilson, De. J. P. Bilodeau.
Db. F. Brodie
TRUSTEES:
Dr. J. A. Gillespie
Historian: Dr. W. D. Keith
Auditors: Messrs. Shaw, Salter & Plommer
Dr. F. P. Pattebson
'U SECTIONS
Clinical Section
Dr. R. Palmeb  Chairman    Dr. W. W. Simpson Secretary
Eye, Ear, Nose and Throat
Dr. L. H. Leeson Chairman    Dr. S. G. Elliott Secretary
Pwdiatric Section
Dr. G. A. Lamont Chairman    Dr. J. R. Davies Secretary
Cancer Section
Dr. B. J. Harrison .—Chairman    Dr. Roy Huggard Secretary
I STANDING COMMITTEES
Library
Dr. A. W. Bagnall
Dr. S. Paulin
Dr. W. F. Emmons
Dr. R. Huggard
Db. H. A. Rawlings
Dr. R. Palmer
Dinner
Dr. G. F. Strong
Dr. R. Huggard
Dr. D. D. Freeze
Summer School
Dr. A. C. Frost
Dr. R. Mustard
Dr. J. R. Naden
Db. H. A. DesBrisay
Dr. A. B. Schinbein
Dr. A. Y. McNair
Credentials
Dr. A. B. Schinbein
Dr. D. M. Meekison
Dr. F. J. Buller
Metropolitan Health Board
Advisory Committee
Dr. W. T. Ewing
Dr. H. A. Spohn
Dr. F. J. Buller
Representative to B. C. Medical Association—Db. Neil McDougall.
Sickness and Benevolent Fund—The Pbesident—The Tbustees
Publications
De. J
H. MacDebmot
Db. D
. E. H. Cleveland
De. Mubeay Baibd
V. 0.
N. Advisory Board
Db.
I. Day
Db.
G. A. Lamont
Db. Keith Bub well erums, Vaccines, Hormones
.
AND
Related Biological Products
Anti-Anthrax Serum
Anti-Meningococcus Serum
Anti-Pneumococcus Serums
Diphtheria Antitoxin
Diphtheria Toxin for Schick Test
Diphtheria Toxoids
Old Tuberculin
Perfringens Antitoxin
Pertussis Vaccine
Vaccine Virus (
Pneumococcus Typing-Sera
Rabies Vavvine
Scarlet Fever Antitoxin
Scarlet Fever Toxin
Staphylococcus Antitoxin
Staphylococcus Toxoid
Tetanus Antitoxin
Tetanus Toxoid
Typhoid Vaccines
Smallpox Vaccine)
Adrenal Cortical Extract
Epinephrine Hydrochloride Solution (1:1000)
Epinephrine Hydrochloride Inhalant (1:100)
Heparin
Insulin
Protamine Zinc Insulin
Liver Extract (Oral)
Liver Extract (Intramuscular)
Pituitary Extract (posterior lobe)
I
Prices and information relating to these preparations will be
supplied gladly upon request.
CONN AU G H.T LABOR ATO RIES
UNIVERSITY   OF   TORONTO
Toronto 5
Canada
"Depot for British Columbia
Macdonald's Prescriptions Limited
MEDICAL-DENTAL BUILDING, VANCOUVER, B. C. VANCOUVER HEALTH DEPARTMENT
STATISTICS— SEPTEMBER, 1937
Total population—estimated  253,363
Japanese population—estimated .  8,522
Chinese population—estimated  7,765
Hindu population—estimated   352
Number
Total  deaths .    223
Japanese deaths        7
Chinese deaths        9
Dea ths—residents  only . -   191
Rate per 1,000
Population
10.7
10.0
14.1
9.2
BIRTH REGISTRATIONS—
Male, 174: Female, 167.
341
INFANTILE MORTALITY—
Deaths under one year of age _.	
Death rate—per 1,000 births	
Stillbirths (not included in above)
Sept., 1937
9
...     26.4
9
16.4
Sept., 1936
8
23.5
6
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
Aug.
Scarlet Fever  13
Diphtheria    0
Chicken Pox I  12
Measles  .  3
Rubella   0
Mumps    11
Whooping Cough	
Typhoid Fever	
Undulant Fever  0
Poliomyelitis  0
Tuberculosis  37
Erysipelas  ,.  3
2
o
1937
0
0
0
0
0
0
0
0
0
0
8
0
Sept.
8
2
67
4
0
13
2
0
1
3
29
2
1937
0
0
0
0
0
0
0
0
0
0
16
0
October 1st
to 15th, 1937
8
0
99
3
2
11
2
0
0
0
17
0
0
0
0
0
0
0
0
0
0
0
0
VENEREAL CASES REPORTED IN SEPTEMBER
Vancouver Victoria Private Drs.
Clinic Clinic in Province
Syphilis            40 3 98
Gonorrhoea            70 10 40
(Figures for Vancouver will be available next month.)
PETROLAGAR ADAPTABILITY
Every doctor sees a wide variety of patients whose reactions to the
identical treatment differ as much as the patients themselves. To provide
the doctor with a choice of medication most suitable for the individual
case of constipation, Petrolagar is prepared in five types.
The variation of laxative potency of the five types of Petrolagar
affords treatment adaptable to a wide range of cases of constipation.
Samples sent on request.
JOHN WYETH & BROTHER, Inc.
WALKERVILLE, ONTARIO
Page
9.L UP-TO-DATE
TREATMENT for
BOILS
Up-to-date transportation facilities not only save time for the
traveler, but, in addition, afford
him greater comfort and safety.
This is true also of the up-to-
date treatment of boils with
Stannoxyl. Days of suffering are
fewer and there is greater comfort and safety too.
Stannoxyl is the original preparation of chemically pure tin
and tin oxide for the oral treatment of boils and styes. In 1917
this chemical combination was
shown to be definitely antagonistic to staphylococcus.
Results are gratifying. Use of
the  old-time   lance   is   avoided.
/ Santa Fe Ry. Cc
Pain is relieved, inflammation
checked, and there is no draining
wound to spread infection, no
ugly scar.
Soon after treatment is started healing begins and a healthy
base is generally obtained in
eight to ten days.
The only way to find out what
Stannoxyl can accomplish is to
try it in your next case of boils.
Also effective for treating styes,
or in chronic osteomyelitis due
to staphylococcus.
Average dosage is 2 tablets 3
or 4 times daily. Supplied in vials
of 80 tablets. Non-toxic.
Samples On Request
STANNOXYL
Chemically pure tin and tin oxide
Anglo-French Drug Co., 354 St. Catherine St. East, Montreal, Quebec. VANCOUVER  MEDICAL  ASSOCIATION
Founded 1898    ::    Incorporated 1906
Programme of the 40 th Annual Session
GENERAL MEETINGS will be held on the first Tuesday of the month
at 8 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the month
at 8 p.m.
Place of meeting will appear on the Agenda.
General Meetings will conform to the following order:
8:00 p.m.—Business as per Agenda.
9:00 p.m.—Papers of the evening.
1937.
October 5 th—GENERAL MEETING.
Dr. H. A. Spohn: "Conditioned Reflexes and Their Relation to
Medical Practice."
Discussion: Dr. G. A. Davidson.
Dr. Ethlyn Trapp.
October 19th—CLINICAL MEETING.
November 2nd-—GENERAL MEETING.
Dr. W. N. Kemp: "Dietary Sources and Clinical Significance of the
Vitamines."
Discussion: Dr. W. W. Simpson.
Dr. H. H. Pitts.
November 16th—CLINICAL MEETING.
December 7th—GENERAL MEETING.
Dr. A. L. Crease 1
Dr. G. A. Davidson        l.._ . _,      t jj     .. .      ,,
Dr. S. Stewart Murray [  s7mPoslum on Mental Conditions.
Dr. E. J. Ryan j
December 21 st—CLINICAL MEETING.
Page 25 EDITOR'S PAGE
Every now and then, as we pass through this vale of tears, endeavouring
to maintain an equilibrium of complacency and satisfaction with the status
quo, some busybody comes along with a remark or a speech that, in the words
of Stevenson, "stabs our spirit broad awake" and rudely disturbs our peace.
Such, with appropriate apologies, was the Hon. Gordon Wismer, our Attorney-
General, when he spoke in such a friendly way at the Annual Dinner of the
B. C. Medical Association the other night. He raised the question once more
of how far it is the duty of a learned profession, such as law or medicine,
to utilise measures of publicity to acquaint the community which it is trying
to serve with the value of its wares, and the necessity for their use to a
greater extent than is now the case. He said frankly that in his opinion
we were remiss in our duty—that we should engage in reasonable and honestly-conducted publicity; that the public is suffering from lack of knowledge
of what we can give; that other inferior wares are being pushed, sometimes
by unscrupulous people, and that the public is being victimised and exploited
for gain by those whose motives are not worthy, and who have no real merit.
This is no new thing—but it is a re-statement of the case from a different
angle. It deserves our careful consideration, because it was made by a man
who is himself eminent in a profession. We have been told by newspaper
editors that we should engage in publicity; every now and then some layman,
in all good faith, takes us to task for what seems our oracular attitude, and
our apparent habit of mystery; but it is not often that a man who really
understands the professional feeling in the matter, and who knows why
law and medicine are so slow to "advertise," takes the stand in favour of
publicity and propaganda—and when he does, we may be sure there is something in what he says.
There is an instinctive feeling, and a very sound one, against publicity.
We realise the danger of letting down the bars and allowing the individual
to hawk his wares for public inspecion and sale. There is too much danger
that the unworthy and the merely aggressive and, shall we say acquisitive,
element would win, at the expense, not of other medical men, but ultimately
of the public. Moreover, medicine is not an exact science, nor can it be measured out like sugar or cloth, and its evaluation is very difficult, even by the
trained man; so that there is grave danger of serious misunderstanding.
Again, we are, like law, a profession with very high ideals, and, as someone
has said in a phrase we cannot at present verify, the best law is the least
law: and this also applies to medicine. We do not want more sick people,
we want less; we do not want more people to employ us, we want to lessen
the number.
But, when all this is said and done, there is still a great deal that we
should put before the public, and Mr. Wismer is perfectly right in this
matter. What publicity we do employ is usually, owing to our inexperience
and lack of a publicity sense, put in such a way as to alienate people rather
than to attract them. We urge vaccination—but give no reasons, no figures,
no arguments why the antis are talking through their hat. We embark on
a campaign for lessening tuberculosis or venereal disease—and our success
is exactly in proportion to the wisdom and clearness with which we explain
what we are doing and why we are doing it; and all too frequently we fail
very badly in this particular.
The day is past for the pontifical attitude in medicine, as in religion. The
public, i.e., the ordinary man, must see why he does a thing before he will
agree to do it. He is educated, he reads, he thinks, to a far greater extent
than ever before. He is extraordinarily sensitive to the effect of the written
word—and too often our written words have an allergic effect on him, and
Page 26 bring him out in an eruption. But he is also most amenable to reason, and
after all, the cure for allergy is more of the same more wisely administered.
There is so much that we have to tell the public that is good and desirable and that would help them, and relieve our own burdens. It cannot be
done by the occasional health official, or by half-baked newspaper interviews.
The doing of it by medical men speaking before groups—Y.M.C.A., church,
women's organisations, parent-teacher bodies—while excellent and helpful,
is like trying to empty the sea with a spoon. It should be done as a definite
effort and project by the whole profession through its organised associations.
This will remove any suspicion of personal gain; it will add weight and
authority, and it will enlist our best minds.
We must not be bound, and we think Mr. Wismer meant this, by a
tradition which was very well in its day, when the doctor was sui genesis,
when people "trembled with fear at his frown." Times change, and we with
them, and we must evolve a system of educating the public in health. Where
this has been done by organised medicine, amazing results have followed, as
in Denmark, for example, in the matter of ante- and post-natal care, and,
we understand, in Russia, in general medical matters, where much good has
been the result. We should as a body study this question and deal with it,
and we are grateful to our guest for bringing it to our notice.
NEWS AND NOTES
Dr. J. S. Conklin and Dr. W. D. Keith were unanimously elected to Life
Membership in the Vancouver Medical Association at a recent meeting.
Dr. A. B. Schinbein has left for the east. While he is away Dr. Schinbein
will attend the meeting of the American College of Surgeons, to be held in
Chicago, October 25-29.
__ -I- ♦ ♦
Dr. G. F. Strong has left for Ottawa to attend a meeting of the Executive
Committee of the Canadian Medical Association.
Dr. Roy Mustard has left for a vacation in the east. He will be away for
several weeks.
Dr. L. H. Leeson has left for the Eastern States. He will be away for
three or four weeks.
Dr. J. E. Harrison has left for England and the Continent, where he will
do postgraduate work for several months.
Dr. A. Leigh Hunt, who has recently returned from Montreal, where he
has been doing postgraduate work for the past three years, will take over
Dr. J. E. Harrison's practice while the latter is away in England.
Dr. C. E. Davies, a previous member of the Vancouver Medical Association,
has returned to Vancouver after having been in practice in New York for the
past three years. Dr. Davies spent some time at the Manhattan Eye, Ear and
Throat Hospital, following which he was associated with Dr. R. Tolmie Paton.
Page 27
© Dr. Alice J. McDonald has returned to the city from Toronto, and is now
connected with the Physiotherapy Department at the Vancouver General
Hospital. While in the east Dr. McDonald did postgraduate work in the
Physiotherapy Department of the University of Toronto.
^r "F V I*
We offer our heartiest congratulations to Dr. A. N. Beattie, who was
married on October 16th to Miss Marjorie C. Laidlaw. Dr. and Mrs. Beattie
will reside at loco.
Dr. H. H. Milburn and Dr. A. Y. McNair have returned from a most successful hunting trip up into the Cariboo.
*      *      *      *
Dr. M. W. Thomas, who has been out of the city for some weeks, has been
touring the interior of the Province on business matters pertaining to his
office. He is now enjoying a well-earned holiday on Vancouver Island. We may
expect some good fishing yarns on his return.
Dr. Roy Huggard has left for the east. While away he will attend the
meeting of the American College of Surgeons in Chicago, October 25-29.
NOTICE
Owing to the low percentages paid on Relief Accounts for the months of
January, February and March, 1937, an additional allowance is being made
on accounts rendered during those months.
NORTH PACIFIC SURGICAL ASSOCIATION
The meeting of the North Pacific Surgical Association to be held on
Friday, November 19th, at 8 p.m., in the Oval Room of the Hotel Vancouver,
will be open to all medical men of the city, whether members of the North
Pacific Surgical Association or not. The speaker at this meeting will be
Dr. W. E. Gallie, Professor of Surgery at the University of Toronto. Those
in charge of the meeting trust that as many medical men as possible will
avail themselves of this opportunity to hear Dr. Gallie.
VANCOUVER   MEDICAL   ASSOCIATION
Little Theatre Players Movietone News
March of Time Community Singing
and other attractions.
OAK ROOM, HOTEL VANCOUVER
FRIDAY, NOVEMBER 12 th, 7 P.M.
Tickets $3.50
Page 28 LIBRARY CORNER
SULFANILAMIDE
The following references concerning the use of Sulfanilamide may be of
interest:
Urinary Antisepsis, by H. W. E. Walther, M.D.—J.A.M.A., Sept. 25, 1937,
p. 999.
Acute Haemolytic Anaemia during Treatment with Sulfanilamide, by S. E.
Kohn, M.D.—J.A.M.A.,  Sept. 25,1937, p. 1105.
Toxic Optic Neuritis Resulting from Sulfanilamide, by Paul C. Bucy—
J.A.M.A., Sept. 25, 1937, p. 1007.
Skin Eruptions in Patients Receiving Sulfanilamide, by J. J. Menville and
J. J. Archinards—J.A.M.A., Sept. 25, 1937, p. 1008.
Development of a Cutaneous Eruption: M. H. Goodman, M.D., and Charles
S. Levy, M.D.—J.A.M.A., Sept. 25, 1937, p. 1009.
Dermatitis from Sulfanilamide, by L. J. Frank, M.D.—J.A.M.A., Sept. 25,
1937, p. 1011.
Comparison of Mandelic Acid and Sulfanilamide as Urinary Antiseptics, by
H. F. Helmholtz, M.D.—J.A.M.A., Sept. 25, 1937, p. 1039.
Sulphonamide in Treatment of Bacterium Coli Infections of the Urinary
Tract, by M. Kenny, M.R.C.S., and others—Lancet, July 17, 1937, p. 199.
Agranulocytosis and Para-amino Benzine Sulphonamide, by C. J. Young, M.B.
—Brit. Med. Jl., July 17, 1937, p. 105.
Prontosil in the Treatment of Erysipelas, by A. R. Snodgrass, M.D., and
others—Brit. Med. JL, July 17, 1937, p. 101.
CONDITIONED REFLEXES IN RELATION TO
CLINICAL MEDICINE ■     I
Dr. A. Howard Spohn, Vancouver.
(Read before Vancouver Medical Association, October, 1937)
I appreciate the privilege of again addressing this Society. Tonight I
have the honour of presenting, necessarily in a rather disjointed way, something of the work of a great teacher and scientist, who happens to be one of
my dearest friends. Sojourning as he does in a far distant land, I may be
forgiven for straying from the field of paediatrics into more alluring adjoining
scientific pastures to bring some of his messages from the physiologic laboratory to busy practitioners.
Krasnagorski, from his earliest medical days, was the protege of Pavlov,
that great teacher who followed his own admonitions and so lived physiologically to a ripe and intelligent old age. It might be excusable to say a
word in passing of Pavlov. Shortly after graduation he was stationed at
the large Imperial Medical Naval Academy in St. Petersburg, now Leningrad. After a short time he obtained permission to withdraw to a small
laboratory, very little larger than our Provincial Laboratories on Hornby
Street. Here he passed the remainder of his life, quietly working, thinking,
observing and encouraging a small group of chosen associates. I had the
privilege of visiting his laboratories, containing his original and unchanged
animal hospital, his conditioned reflex apparatus as crude and perfect as
on the day in 1901 that he pronounced it suitable for experimentation. Pavlov
was the first physiologist to see the necessity for asepsis in experimental
surgery in animals. He was a brilliant surgeon, but performed no operation
in humans. He had the unique experience of being honoured both by the
Page 29 Imperial and Soviet Governments, and I visited with Dr. Trapp the beautiful
villa and fine laboratory erected for him by the U.S.S.R. about twenty-five
miles from Leningrad. Here one sees, in brass letters, the motto he left to
medical posterity. It reads: "Observation and Observation."
The object of this paper is to discuss briefly a few of the aspects of the
physiology of the nervous system that have been elucidated through the
conditioned and unconditioned reflex studies of Pavlov and Krasnagorski.
As you know, I am neither a physiologist nor psychiatrist, and I am attempt-
iny only to draw attention to the interesting and important physiologic truths
which these two men have given to medical science, and to suggest some of
the advantages of a more extensive application of teachings which are more
or less familiar to all of us.
In spite of all the adjuncts to making life more comfortable, the
nervous system of the human race is today subjected to more shocks and.
excitations than ever before in the history of man. While science has blessed
us with the many diversified benefits of electricity and chemistry, yet with
these movements has come an increase in the tempo of life which gives no
thought to physiologic fatigue. Also, inventions of useful and comforting
agents have been accompanied by a myriad other agencies, such as the
diabolical new instruments of warfare, motors capable of producing excessive speeds for ordinary accomplishments, factory machines with monotonously regular but greatly accelerated demands for accuracy and timing, to
say nothing of the tremendous increase in noises of all kinds. In addition, the
colossal upheaval in the business world, the tremendous unrest in the world
through economic and political changes, have completed an array of circumstances which have ravaged the physiologic resources of even the most normal
individual. The time is now overdue when much more attention must be
paid to the physiology of the nervous system and greater knowledge be
gained of the physiologic aspects of certain diseases.
It is an accepted fact that all the processes studied through physiology
and psychopathology are nervous processes occurring in the higher parts of
the central nervous system. It is necessary in modern psychology to endeavour
to understand all the causal factors of normal and pathological behaviour
and the adaptations that may be established or shattered through the
activities of the different mental processes.
However, until fairly recent times the difficulties of studying and accurately recording the mental activities of the central nervous system Were
almost insurmountable because of inadequate methods of estimation.
In 1901 Pavlov started intensive investigation of the nervous system,
and a new interpretation of the psychologic process of the nervous system
was made possible through his conditioned reflex experiment with dogs.
Krasnagorski continued to investigate and elaborate this work in children.
Since 1907 Krasnagorski has untiringly investigated conditioned and unconditioned reflexes in normal and abnormal'children, and in conjunction with
this the effects of certain drugs on the central nervous system. From time to
time, at the International Congress of Science, and through reports in Russia,
England, America, and in Scandinavian countries, etc., he has kept the
scientific world in touch with his experiments, and has made suggestions for
the use of his teachings in the diagnosis and treatment of various nervous
states. The results of his work have been carefully checked and confirmed
by such men as Lillystrand and Bernhardt of Stockholm, Czerny of Germany,
Adrian of Cambridge, England, and Schick and Byrnham of America. The
study of children by Krasnagorski is still being vigorously pursued at his
clinic in Leningrad. The endeavour of these men has been "to carry out the
most complete analyses of the nervous processes of the brain, and so reveal
the fundamental physiologic mechanisms and the dynamics of the cerebrum
and its adjacent parts."
Page 80 Pavlov used the term "conditioned reflexes" to designate the fundamental
nervous phenomenon through which he developed his investigations of the
brain. This phenomenon includes the process of "synthesis" or ability to
connect different cells on the part of the cerebral cortex and was first formulated by physiologists as the "Law of Association." Conditioned reflexes
are reactions which are more or less temporary, but may be permanent. They
are learned by training or induced, or acquired in life. They are also individual, and variable according to external conditions. In these properties or
characteristics they differ from unconditioned reflexes which are permanent,
inborn reactions, belonging to the species and appearing under all conditions.
As unconditioned reflexes there are, for example, such inborn actions as
gastric and salivary secretions, relaxation of the pyloric valve, etc. The
secretion of saliva is an unconditioned function, inborn or innate, and beyond
the power of suppression by the individual. It is through the study and
charting of the salivary and other reflexes that Pavlov and Krasnagorski
were able to arrive at so many of their conclusions.
Early in the investigation experiments showed that the law of formation
of the conditioned reflex remains true for all human beings. External
agencies, such as red light, the metronome, skin stimulation, food reinforcement, can be used to establish conditioning, and these agencies from the
outer world, and also innumerable impulses originating in the organ itself,
acquire the power of eliciting any reflex activity, motor, secretory, emotional,
etc., if they are made to coincide a certain number of times with the reflex
activity. The mechanism of the conditioned reflex enables the child or individual to adapt himself to the surroundings of the outer world. The infant
soon after birth begins, through conditioned reflexes, to suckle, to cry when
hungry or uncomfortable, to snuggle up to his mother for warmth. In other
words, through the establishment of reflexes he gradually adjusts himself
to the outer world and later learns to carry on more or less independently.
The idiot, on the other hand, while his innate or unconditioned reflexes exist,
is unable to adjust himself because reflexes cannot be established in his
defunct cortex. He remains, therefore, a mental bankrupt, dependent for
living on the ministrations of others. The normal child, however, by means
of incessant conditioning through external agencies or situations, establishes
the power of precise and proper adjustments to ever-changing conditions.
The cerebral hemispheres, being the highest part of the central nervous
system, constitute the organ which accomplishes the most complex reflex
activity. Besides positive functions, the cerebral hemispheres develop enormous inhibitory activity which exhibits all the characteristics of conditioned
reflexes. These inhibitory reactions are like positive conditioned reflexes,
temporary, acquired, changeable reactions representing the highest degree of
adaptation. Cortical inhibitions manifest themselves in various forms, e.g.,
extinction, differentiation, and delaying of the conditioned reflexes, and the
formation of conditioned inhibitions such as sleep, hypnotic states, these last
states being manifestations of the same nervous phenomenon. The mechanism
of conditioned inhibition is a powerful regulator of the nervous activity of
the child, and by means of this mechanism every conditioned activity may
be stopped. Life is a series of conditioned activities successfully or unsuccessfully controlled by conditioned inhibitions. Unfortunately the inhibitions may
be so severe as to blot out originality, freedom of self expression, normal
co-ordination or initiative. During infancy and early childhood the parents,
nurse, and others establish or impose endless conditioned inhibitions to regulate the behaviour of the child. Later, school, organized society, the State
and the Church continue the conditioning of the inhibitory systems, and a
personality of perhaps a mere cog in a wheel is created. Happy is the man
whose conditioned inhibitions have been wisely induced, so that while master
of his instincts and emotions he has not, in the process, had his self expression and enthusiasms stunted and warped.
Page 31 Let us consider a conditioned reflex in relation to the salivary secretion.
As an example: A man has never seen a grapefruit, and when put before him
for the first time it evokes no gustatory sensation, pleasant or otherwise.
It is to him a round, and perhaps uninteresting, yellow fruit. He partakes
of the fruit and the taste is pleasing and very much to his liking. Not only
will the acid taste, but also the pleasantness, increase his salivary flow, and
a new conditioned reflex will be established. Now for years, and perhaps for
life, the mere sight of a grapefruit when he is thirsty and hungry will set up
an active salivary secretion. In other words, the sight of a grapefruit will
make his mouth water. An external object (a grapefruit) has established a
new conditioned reflex through the path of the sub-cortical salivary reflex
tract. And so one might illustrate and analyze many familiar reflexes ad
infinitum. One could, at this point, draw attention to the presence, especially
in children and individuals of a psychic disposition, of a tendency towards
unfortunate and unpleasant conditioned reflexes which may be extremely,
difficult to eradicate, or may even persist through life. Examples are: The
individual who becomes faint and hysterical at the sight of a snake after
being frightened or "conditioned" by his first encounter with such a reptile;
or the uncontrolled attacks which appear with sudden noises in shellshocked
individuals who have been "conditioned" in the war; another striking
example was the case of a famous psychologist who throughout his life
became ill at the sight of a mouse, after being conditioned by a mouse in early
childhood. Frigidity, schizophrenia, hysteria, behaviour problems, inferiority
complexes, etc., are often the result of conditioned reflexes improperly treated.
Children frequently have persistent night terrors following an anaesthetic,
after being conditioned by waiting for operative preparation, with the sight
of instruments, and perhaps the sounds of other children coming out of an
anaesthetic. Many people about to be operated upon are daily subjected to
unnecessary psychic shocks in hospital. By means of the conditioned reflex
the individual is connected with the outer world by innumerable living
threads. How important, then, that in the young and in the physically and
mentally ill, these reflexes should be of the proper character, and how tremendously important are the first educational conditioned reflexes used in
treatment, and how fraught with possibilities when every change in the
external media, even seemingly insignificant ones, are immediately reflected
on a highly sensitive nervous receptor in the brain. Such reactions resemble
the delicate light impressions conveyed through the microscopic lens of a
modern camera to a super-sensitive colour film.
As a motor response Krasnagorski uses the tonic reflex of opening the
mouth, and a grasp reflex, and as a salivary reflex the salivation from all
the salivary glands. By this means he can study the effects of various stimuli
—auditory, visual, thermal, taste, etc. Owing to the high reactivity of the
brain and the extreme sensitiveness of the conditioned reflexes to causal
stimuli, the physiologic investigation of the brain must be carried out under
special conditions. Time will not permit a detailed account of the laboratory
process, but it must meet the following requirements: (1) that the child must
be isolated from all accidental stimuli; (2) complete quietness and comfort of
the patient during the experiment; (3) perfect mechanizing of the experiment; (4) strict definite methods of conducting such an experiment.
Description of Apparatus and Lantern Slides
The methods used in the actual experiments and the apparatus are best
understood by reference to the lantern slides, showing details of the
mechanical devices and tracing charts. The experiments are carried on in
two rooms; the inner room is a small sound-proof enclosure where the child
lies comfortably on a couch, and is observed through a heavy plate-glass
window. About the couch, or connected with the child, are arranged the
various stimuli—skin stimulation, metronome, electrical buzzer, etc. Above
Page 32 the child's mouth is a device with a trapdoor which releases into the mouth,
at the proper moment, such food as candy, citrous fruit balls, cranberries,
etc. On the wall in front of the child are arranged red or other lights for
conditioning, the food being used to reinforce the conditioning reflex. Various
stimuli, metronome, buzzer, etc., can be used either as reinforcements, or
various other stimuli, such as skin stimulators, as inhibiting agents. In the
child's mouth are placed light metal vacuum cups of various shapes, which
can be adjusted comfortably over the orifices of the submaxillary or parotid
glands. The saliva collects in the cups and is led out through rubber tubes,
through the walls of the experimental chamber to the recording apparatus
in the outer room occupied by the operator. The saliva, drop by drop, falls
on a fine, narrow metal leaf, each drop making contact. This make and break
is registered through a tracing needle on the paper roll of a revolving drum.
The time in seconds is also recorded below, so that increase and decrease of
salivary drops is accurately visualized. The jaw reflex is traced by a lead
from the jaws to the revolving tracing sheet. Each application by the operator
of various stimuli is also traced, so that the tracing in an experiment will
show the time in seconds, the mouth and salivary reflex tracings in relation
to the conditioned and unconditioned reflexes, and the application of stimuli
for reinforcement or inhibition of conditioned reflexes. In this way conditioned
and unconditioned reflexes can be charted and studied in all conditions, normal and otherwise, which have to do with the nervous processes of the brain.
The action and dosage of drugs can also be estimated.
The temperature chart can also be related to the tracing made during any
particular period of a disease, such as mumps, scarlet fever, typhoid fever,
measles, etc. All the various connections, mechanical and electrical, make
what appears at first sight a very complicated array of wires, levers and
switches, but the technique has been so perfectly thought out and applied
that each experiment can be exemplified under similar conditions and with
unvarying precision. Besides the studies already indicated, the following
have been investigated: Latent and refractory phases of conditioned reflexes,
degrees of variability of vagus tonus, taste; various forms of epilepsy, endo-
•crinal disturbances.
The discussion in this paper is general rather than particular, but it
might be well to describe briefly the simplest form of conditioning. A child
is selected for experimentation and care taken to explain that no pain or
■discomfort will be part of the test, and that pleasant food will at times be
given through a mechanical device, hanging above the mouth. With the child
resting comfortably the tubes and stimuli are quietly arranged. The child
knows that food will be given during the experiment, but each time before
this occurs a red light is flashed on the wall in front of the child, and a short
time after the red light appears the food of a pleasant taste is dropped in
the mouth. After a repetition of say 10 to 15 times the child associates the
flashing of the red light as a signal that pleasant food is coming, or in other
words, the red light has established a conditioned reflex. After this occurs
the flashing of the red light at once produces an increase in the flow of
saliva and also a jaw reflex—the giving of food reinforces both reflexes as
shown by the acceleration in both saliva flow and jaw movements. With the
reflex established, the red light alone is sufficient to start the conditions, but
.after repetitions without food reinforcement, the brain is taught that the red
light does not now mean food and the reflex which was established is extinguished. Working from this simple conditioning all sorts of conditioning can
be elaborated and studied from various physiologic angles and in various
•states.
The nervous system, then, may be looked upon as an organism in which
reflexes of two kinds occur, namely: (1) conditioned or trained; and (2)
unconditioned or inborn. The conditioned reflex is largely confined to the
Page 33 cortical area but may also exist in the infra-cortical area. The cortical area
is the area of government, the area of sorting out and examining and subdividing reflexes, the area also of radiation of impulse, the area of concentration, the area of inhibition, without which latter power we should be
creatures of impulse and desire. The cortex is an organ of adaptation, and
almost any individual can be damaged by unfavorable surroundings and
impressions, with the establishment of unfavourable conditioned reflexes
which may persist in some cases through many years. Pavlov at first considered conditioned reflexes as only temporary, but his work was only with
dogs. However, Krasnagorski, working with children, has definitely established that the cortex does not forget, that is that conditioned connections
may even be permanent, and if very intense persist for life. They can be, as
in neuroses, inactivated or even eliminated by careful treatment. In normal
individuals they may lie dormant and be re-established after years of dormancy. Consider the. example of a musician whose musical cells have been
properly conditioned by musical training. Through circumstances he may for
years allow his conditioned reflexes to be in a dormant state through not
playing. Howover, even after many years this musical reflex may be quite
quickly re-established. This means that the trained musical cortical cells did
not forget, but the conditioned reflex was only dormant or quiescent. It is
evident that we have many cells which ordinarily are not exercised. Therefore the brain is capable, if protected from disease, of developing many new
complexes or achievements. This power of new achievement exists under
favourable circumstances even to old age. Pavlov until the last two years of
his life continued to make valuable new scientific observations. At 83 he presided at, and read a paper before, the International Congress of Science. We
need not cease to achieve at 50 or 60 years of life, or even at 70, if no gross
pathological change exists.
Individuals may all be classified into the following types: (1) Well-balanced normals. These individuals have normal cortical reactions, that is, they
have a sufficiently strong cortex to regulate their reflexes normally. They have
a suitable balance between the cortex and sub-cortex, with the cortex governing. Such people may not attain the greatest heights in creative genius or in
the arts, such as music and painting, but they do not tend to descend to the
depths of despair and have inhibitory complexes under stress. They have
such good cortical control that they can settle difficulties equitably, and have
the faculties of being contented and able to accommodate themselves quickly
to changing situations.
(2) The sub-cortical type. These individuals are normal but have strong
impulses and instincts, are often hot-tempered, impetuous, usually artistic
and at times very brilliant. They do not, however, regulate their reflexes well.
Pavlov considered that he and Krasnagorski belonged to this class.
(3) The cortical type. These individuals are the potentially hypo-sensitive. They are coldly calculating, unemotional, and the cortex overcomes or
inhibits most of the sub-cortical impulses. They are not artistic and are often
devoid of natural feelings. Emotionally they are cortically inhibited individuals. They may be great organizers and, having few inhibitions, may
become leaders. If their cortical inhibitions have been good they may be great
statesmen, but if their cortical inhibitions have been bad dire results may
follow.
(4) The energetic hysterical type. They have weak cortical control with
an unstable sub-cortical development. In place of artistry they often show
hysteria. These individuals may go gradually or quickly, if improperly conditioned, to pathologic change such as schizophrenia. Unfortunately the
psychopathology of such individuals is sometimes not recognized soon enough.
All these types can be exemplified by conditioned reflex tracings. The
so-called lie determinator is only a modern adaptation of the physiologic
Page 34 teachings of the nervous reflex activity of Pavlov and Krasnagorski. Tt is
necessary for teachers of children to give some consideration to the different
types of their pupils.
At birth there are no conditioned synapses, all cells being "physiologically
disconnected" in this respect. After birth the stimuli of surroundings, food,
etc., immediately begin to create connections. While not advocating medical
treatment in pyloric stenosis, one can, through an understanding of the conditioned and unconditioned reflex arc, appreciate success which has been
obtained by some physicians with this treatment. The good results can be
explained by the ability of certain drugs such as phenobarbital, acting chiefly
through the sub-cortical areas, to prevent or disassociate conditioned synapses
which occur so early in the course of the disease. With a well established,
conditioned vomiting reflex, the hypertrophy of the muscle at the pyloric
orifice increases very rapidly in a few weeks' time. It was interesting to learn
from such an eminent paediatrician as Professor Ylppo of Helsingfors that
in two large children's hospitals under his guidance there had not been one
operation for pyloric stenosis in two years. Their mortality compares favourably with results in clinics where early operation is performed.
The study of epidemic encephalitis and certain types of idiocy contributed
greatly to the knowledge of the physiologic function of the infra- or subcortical regions. These are the parts of the nervous system where the most
complex co-ordinations of innate or unconditioned reflexes are accomplished.
The facts about conditioned and unconditioned reflexes have been known
for years. Perhaps the accuracy of determination and the wide application of
studies and treatment of many functional and pathologic states is not so
thoroughly appreciated. The reflex reactions in normal states have been thoroughly and definitely established and the reactions in functional and pathologic states have been the subject of much experimentation. Contrast charts
in different conditions can now be carefully compared and deductions as to
treatment, progress and prognosis can be accurately determined. Also, with
the salivary secretion reflex determination, the most accurate deductions as
to effect and dosage can be made with certain drugs acting on the central
nervous system, such as alcohol, adrenalin, pilocarpin, etc. From Krasna-
gorski's work the following statements can be made: With 45% alcohol a
dosage of 2% cc. to 5 cc. is sufficient to produce in children definite reflex
reactions. By this dose inhibiting reactions and depression of the cortical
areas can be demonstrated, that is, there is a decrease of cortical and an
increase of negative or sub-cortical control. The cortical areas are very
susceptible to alcohol in children. As a stimulative drug up to 1.5 cc, after
this it decreases cortical control and causes sub-cortical excitation and depression. The dose for cortical stimulation in infants has been estimated by
Krasnagorski as 0.05 cc. of 45% alcohol per kilo of body weight. With such
definite dosage now known, one can say quite definitely that the stimulative
dose is so small and the depressive phase so quickly reached, that the use
of alcohol as a stimulant in children is practically useless, and in doses
usually employed is positively depressant and should be discontinued. In the
social and therapeutic doses of adults, the cortical inhibition is so marked
and the sub-cortical stimulation so increased, that the individual has the
sensation of a stimulative but confused sub-cortical phase which is, however,
physiologically depressant. While visiting at Pavlov's villa, I heard the story
of the escape from confinement of a male ape. In passing through the laboratory he picked up a small bottle of alcohol, which he proceeded to drink
after taking refuge in a tree. In a short time he began to grimace, gesture
and make a great fellow of himself in. the usual manner of a human inebriate.
Finally, in attempting a balancing act, he toppled to the ground in a drunken
stupor. Thus an ape that could not in a normal state be conditioned to compare cortically with humans, could, under the influence of alcohol, demon-
Page 85 strate the sub-cortical excitations of the human under similar circumstances.
Scientific knowledge, to be of value in medicine, must have clinical applications. What use can one make of the knowledge gained through studies of
conditioned reflexes? The benefits to be gained are startlingly extensive
through a knowledge of the physiology of reflexes, and the weaknesses
and fallacies of certain therapeutic agencies can be explained and understood
in a clearer manner. It will be possible to mention only briefly a few of the
states or conditions in which this physiology may be applied advantageously.
Sleep
Sleep is one of the states of hypo-excitability. Hess of Zurich, after
experimentation, concluded there was a sleep centre, but his theory is not
correct. He introduced fine electrodes into the sub-cortical areas of cats and
with slight electrical currents the animals purred, licked themselves and
went to sleep. If the current was interrupted the cats awoke. He concluded,
therefore, that there was a sub-cortical sleep centre. This thory of sleep does
not, however, explain the phenomenon satisfactorily and indicates that sleep
is the result of stimulation of sub-cortical cells and is therefore a phenomenon of stimulation rather than one of cell relaxation and rest. Pavlov, Krasnagorski and others have proved it to be a cell rest period. Every cell, if
exhausted, tries to defend itself by decreased excitability or activity; that
is, there is a defense hypo-excitability to protect individuals from further
fatigue and exhaustion. As soon as motor cells become tired, then defense
inhibitory reactions begin. For example: closing the eyes stops optical stimuli
and induces sleep. One cannot sleep when standing because immobilization
and the cessation of stimuli is impossible. Quietness causes a decrease of
acoustic stimuli, and with this diminution in stimuli the exhausted cells
begin to decrease their excitability and the pre-sleep state begins. In this
state there may be radiations of potential excitability which spread over the
cortex, producing confused thoughts. For example, after hunting during the
day, one might at night, in the pre-sleep state, think of ducks, game, etc., but
in a muddled fashion, giving a confused jumble with thoughts vaguely or
partially connected with the day's happenings. With approaching sleep, radiations in the sub-cortical areas proceed quickly, but as soon as contacts through
the thalamus opticus are interrupted, sleep occurs; that is, sleep is a state of
interruptions of connections between the brain and other organs and no one
is conscious of the exact moment of sleep. In sleep, isolated, cortical processes occur and produce dreams which are indefinitely related at times to
waking conditions. For example, in European countries where famine has
been so prevalent, dreams of fat, butter and cream and other foods are frequent. Physiologically speaking, there are only two types of dreams: (1)
Those of cortical origin occurring in cortical individuals after concentration
during the waking hours. In such individuals intense thoughts may persist
through sleep. Hence, probably, the idea of sleeping over problems. (2) Subcortical dreams, where extra-cortieal excitations predominate. For example:
people suffering from thirst will frequently dream of water; with famine, of
fat, or other foods. Therefore it is best to use dream interpretations in a
physiological sense. One should determine whether the dreams are cortical
or sub-cortical and not attmpt to place too great significance on sub-cortical
dreams. Naturally the people of sub-cortical type—that is, individuals with
strong sub-cortical activity and relatively poor cortical control—will dream
more often and have more varied confused dreams than individuals with
well established cortcial inhibition. Further, those belonging to the hysterical
type will indulge in all sorts of weird sub-cortical excitations. The sleepwalker is usually a normal sub-cortical type and his excitations can often
be controlled by phenobarbital, a drug which influences chiefly the subcortical area.
This simple interpretation seems to eliminate much of the significance
attached to dream interpretations by some psycho-analysts and should also
Page 86 alleviate some of the dreads and fears of the functionally nervous patient.
The physiological explanation of dreams and of sub-cortical excitations in
fatigue, and in psychopathic states, places grave doubts on many of the
original teachings of Freud. I understand from information received in
Vienna that Freud in later years has greatly modified some of his early views.
Hypnotic State
In the hypnotic state the cerebral hemispheres are intensely inhibited
except for very restricted areas, which remain as when awake, leaving an
open pathway for stimuli which pierce or penetrate the conscious area
because of the inhibition of other parts. The hypnotized individual, with a
cleared line of communication reserved chiefly for the acoustic stimuli of
the operator, becomes temporarily, through the extensive inhibition of the
closed areas, completely in the power of the hypnotist. The restricted conscious area is therefore supremely susceptible for conditioning, and naturally
any conditioned reflex will be more intensive and more prolonged after
awakening than if established when fully conscious. This explains the much
more prolonged and successful conditioning that takes place in the treatment of dipsomania, schizophrenia and other psychoses, if the treatment is
carried out at first under hypnosis. Hypnosis has proved beneficial not only
in dipsomania, but also in the elimination of conditioned nervous habits of
the schizophrenic, the psychotic, and other nervous patients. In hypnosis
the individual responds to quiet repeated stimulation, and, needless to say,
the antics and hand passing of the stage hypnotist are on a par with the
horseplay of the professional wrestler. In a'hypnotic trance and in hysteria,
stable conditioned reflexes may be established in the waking or alert areas of
the brain, and the reactions arising persist as segregated process remaining
outside the consciousness of the person. Such patients perform conditioned
reflexes without knowing why they do so. In dipsomania the vomiting and
nausea associated with the aroma of liquor is therefore more firmly conditioned and the disgust more inherent if established under hypnosis. The
conditioning is therefore more successful and prolonged. Some of you may
remember the account in Time of the woman who murdered her husband,
and, after being accused and incarcerated, went into a hypnotic trance. She
resisted all efforts of restoration to consciousness, but being of the hysterical
sub-cortical type her small restricted conscious brain area was vulnerable
to the acoustic stimulation of a physician trained in hypnotism, and he was
soon able to bring her back to wakefulness.
Myxoedema
In children suffering from endocrinal disturbances, especially myxoedema,
definite types of conditioned reflexes are found. As there is a definite curative hormone in myxcedema, improvement under treatment can be definitely
co-related by reflex tracings. The insufficient production of the hormone
thyroxin greatly influences not only cortical but infra-cortical reflexes. The
conditioned secretory reflexes in myxoedema are greatly reduced and the
motor reactions are also decreased, that is, they are weak, slow and inert.
A great decrease of the excitability of the sub-cortical cells leads inevitably
to the decrease in excitability of the corresponding cortical fields; or to speak
in clinical terms, continued decreased excitability in the sub-cortical areas
will inevitably lead, in untreated or insufficiently treated myxoedema, to
degeneration in the cortical fields. The necessity of early diagnosis in
myxcedema cannot be too vigorously urged and it should be remembered that
two-thirds of the actual growth of the brain takes place during the first two
years of life. How unfortunate, then, that myxoedema or even hypo-thyroidism
of mild character should go unrecognized until the effect of treatment is
definitely limited. There are in all goitre belts many untreated cases of mild
hypo-thyroidism. In severe neglected cases of myxoedema the same characteristic changes of the cortical activity are found, as seen in congenital
Page 87 idiocy, that is, slow establishment and decreased magnitude of reflexes, long
latency, and after-effects of long duration. In normal children the curve rises
rapidly after a short latent period, attains its maximum within the fraction
of a second, then remains on the same level as long as the stimulation lasts.
In myxcedema the motor response rises slowly, reaching its maximum only
after 7 to 14 seconds or more. Thus, physiologically, by the Pavlov-Krasna-
gorski methods one can prove that insufficient supply of thyroxin leads to
great impairment of the function of the associated mechanism of the cortex.
Time will not permit a comparison of secretory activity tracings in myxoedema
and hyper-thyroidism and the normal state.
In all cases of myxcedema showing clinical improvement, a corresponding
improvement in the conditioned reflex activity occurred and treatment
raised not only cortical but infra-cortical excitability, increasing both unconditioned and conditioned reflex activity. If, before treatment, the conditioned
salivary reflexes was producing only 2 or 3 drops of saliva, after treatment
6 to 8 drops was produced.
An expert physiologist such as Krasnagorski could, in certain nervous
derangements, diagnose conditions and probable progress under treatment
through a study of the patient's reflex tracings. Therefore it is gradually
becoming possible to employ, in certain conditions closely associated with
the cerebrum, physiological reflex tracings in the same manner as a cardiologist would employ tracings in cardiac conditions.
Rickets
The physiologic study of the activity of the brain in, rickets is of especial
interest to paediatricians. It has always been apparent that the rachitic child
manifests certain clinical nervous manifestations and in very severe rickets
I have seen mental backwardness diagnosed. In one case, I know of a rachitic
<2hild being temporarily committed to a mental institution. Through conditioned reflex studies the physiologic mental disturbances in the disease
can be explained and understood in a much better way. As far back as 1913
it was demonstrated that the conditioned reflex activity is considerably disturbed in rickets. The chief changes noted are: (1) The establishment of
conditioned responses proceeds very slowly, being produced after 150 or more
trials, where normally the reflexes will be established with 20 or 30 trials.
(2) After establishment the conditioned reflexes are unstable and disappear
periodically, perhaps for days. (3) The motor reflexes have a characteristic
long latency, that is, 3 or 4 seconds, which time becomes shorter only after
long training. (4) The orienting reflex is greatly decreased in rachitic children and they react only slightly to new stimulations in their environment.
This explains the long continued apathy, of the rachitic child even after being
transferred from a bad, unhealthy environment to a brighter, more stimulating one. Experimentally, rachitic patients show fatigue much earlier than
normal children, and inhibitory fatigue states or fatigue defense reactions,
soon become manifest. (5) The inhibitory functions of the cerebral hemispheres is greatly disturbed in rickets and the abolishing of reflexes in these
patients, as in idiots, is slow, and the re-activation retarded; that is, the
Te-activity of the cortical cells is considerably retarded. (6) Rachitic children universally show muscle degeneration, and if the myotonia is extensive
the conditioned reflexes, following impulses originating in muscles, as with
electrical stimuli, are established with greater difficulty than impulses following other stimuli, as, for example, red light stimulation.
Thus in a severe rickets one can demonstrate features similar, but of less
severity and significance, than those seen in idiocy and myxoedema. However,
the cortical disturbances in rickets are not permanent and as soon as the
patients start to recover, these deteriorating changes improve and then, with
<?are, disappear entirely. One can understand the mental backwardness that
Page 38 might manifest itself in latent rickets persisting up to 8 or 9 years. This is
a condition practically unseen in this country but has been described by
Professor Findlay as being present in the slum children of Glasgow, where
the bad food, bad environment and inclement climate all predispose towards
the rachitic diathesis. The study of the cortical reactions of the rachitic child
demonstrate a close connection between the general chemical make-up of
the organism and the physiologic activity of the brain. This last statement
seems to me of tremendous importance. From the intensive reflex study made
by Krasnagorski in rickets, where one also knows the metabolic chemical
changes, perhaps may come a more definite knowledge of the chemical
changes, and associated physiologic disturbances in such nervous manifestations as neuraesthenia, various fatigue manifestations, and menopausal disturbances. With this knowledge one could anticipate more successful and
intelligent treatment for these baffling conditions.
Bed Wetting
Krasnagorski's treatment for bed wetting is an ingenious combination of
physiology and conditioned reflex training. The treatment consists of using
the common knowledge that salt retains water in the tissues, and the establishment of a dry conditioning process.
The child is allowed a total fluid intake of between 30 to 40 ounces. Salt
to taste is allowed in the first two meals. The last large fluid intake of milk
or other fluid is given at 3:30 or 4 p.m., and then a dry and salt-free supper
is given at 5:30 or 6 p.m. As the last fluid was given at 4 p.m. and was without salt, about 75% of the fluid intake will be eliminated in about 4% hours.
The child should then have voided most of his available water excretion by
8 :30 p.m. At this time he is given one dram of salt in cottage cheese, or
peanut butter, or an equivalent amount in salt meat sandwich. He voids and
goes to bed, and usually within a week or ten days is pleased with his progress towards recovery. I have tried this treatment many times with success.
It must be followed very carefully in every detail.
Masturbation
Masturbation in young children is a conditioned nervous reflex. As is
well known, especially by paediatricians, it is frequently seen as early as 6
months and chiefly in female children. Within the last few months I met with
the following experience in my private practice. A girl of 9 years had her
tonsils removed, and at this time it was discovered she had a vaginal discharge; the parts also showed signs of manipulation and scratching. The
mother then told me that the sister of 11 years of age had been masturbating
for some time. She had taught her sister of 9 years, and they both had taught
a younger sister of 3 years. The mother was a nervous reticent woman, and
had hesitated to tell me that when getting ready for bed the three children
retired to the bathroom, locked the door, and proceeded to masturbate
together. A conditioned habit which took one week to become established in
two of the children will take much longer to be successfully eradicated. The
habit will stop when cortical inhibition is established through gradual and
sympathetic conditioning. One way to prolong the habit is to inflict physical
punishment. The patient then usually develops a fear complex with other
sub-cortical excitations which are temporarily relieved by a performance
of the act.
Fatigue and Hysterical States
In hysteria the cerebral cortex is inclined to be in a segregated state with
some areas active and some inactive. It is, on the whole, an inhibitory
neurosis, and the patients cannot perform the work they could under ordinary
conditions, or tasks that offer no difficulties to the normal individual. It is
therefore essential to avoid conditions such as fatigue, which disturb cortical
control and precipitate hysteria. Intense over-stimulation or monotonous
Page 89 stimulations such as the continued blowing of a fog-horn may, in hysterical
people, produce hypnotic and other psycho-pathologic states of long duration.
Hysterical blindness, aphasia, paraplegia, and certain sexual disturbances
are too well known to need further comment. It is important to remember
that there is often, after hysteria, prolonged psycho-pathology. In general
the treatment consists of rest, quietness, vitamines and general therapeutic
measures, employing very weak stimuli. In psychoses the physician often
leaves the tedious reconditioning too much in the hands of attendants who
do not understand physiology, with the result that the patient may suffer
from fatigue and nervous defense excitations as the result of therapy intended
to produce the opposite effect.
Sufficient attention is not given to proper conditioning of nervous or hysterical children. Often one does not appreciate the delicate sensitiveness to
external stimuli and the great reduction in concentrating power that comes
with fatigue, hysteria and functional nervous states, etc. Great care must be
exercised in creating a suitable atmosphere for educational work in hysterical
children and in the reconditioning of the problem child. Time prevents a discussion of the similarity in physiology and reflex tracings in such conditions
as over-fatigue, hysteria and various inhibitory states in malnutrition children. One should be aware of the toll demanded of the nervous system in
childhood and adult life through indifference to early physiologic teachings.
There is, I think, in the education of normal children, a tendency to commence
too soon the inhibitory conditioning^, of education. The age period from 3
to 8 years is most interesting, because during this time the normal child
develops not only initiative, orientation and some independence, but also
brings into play those subtle qualities of creative genius and charm which
go so far in later life to develop individuality if they are not blighted and
suppressed by monotonous and often unsympathetic routine. One is not for
the moment taking into consideration the dullard, the apathetic, the problem
or mentally backward child. I hope also I fully appreciate the many difficulties of our early educational system and the necessity of providing educationally the greatest good to the greatest number of taxpayers. Still, giving
all sides due consideration, would it not be well to consider more the importance of preventing the psychic shocks and physical defects and fatigue states
that are precipitated through the regular and exacting requirements of education at too early an age? Certainly in most cases physical and cortical control and power would be greater at 15 years of age if children were admitted
to school at 7 years instead of at 6 years, or, as now permitted in Vancouver,
a few months before the sixth birthday. After fairly careful observations
made in Vancouver during many years, one can state that excellent posture
is not present in 10% of all children coming to clinics, nor in 15% of all children coming from the best homes in our city. Poor posture means some degree
of malnutrition or improper muscular development. In either case, physical
fatigue is easily produced, and physical fatigue goes hand in hand with
mental inertia and fatigue defense cortical inhibitions, which dull the keenness of endeavour and the zest for knowledge. Certainly also that nation
which guards the mental, psychic and physical requirements of its young
children will have fewer misfits and neurotics and more men of individuality.
In many cases early education might very advantageously be limited to
the opportunity of expression by drawing (not spoiled by routine methods
and instruction), by modelling, also without specific instruction, by simple
forms of dancing or by singing. The idea in such education is not to create
artists, but to permit early self-expression which will enable children to
express their own inner thoughts and desires and thus be able to employ their
leisure more or less independently without the use of numerous toys, radios,
phonographs and other stimuli so dear to the hearts of many Canadian and
American mothers. During this early period of life the child's innate thoughts
should be developed through expression, not through repressive routine. Cer-
Page 40 tainly the ideas and methods of others are too frequently imposed on children
at too early an age. If our children could gain confidence and preserve individuality through early self-expression, they would be able in adult life to
face the future with more equanimity. If anyone is interested in this type of
training I would recommend a study of the methods employed by Professor
Czeck in his art classes in Vienna.
Speaking generally, it is appalling to note the lack of interest in proper
reflex conditioning in hospitals and the disregard for dangerous conditioning,
which goes on in hospitals and clinics for the treatment of functional nervous
disorders. Such simple errors during the first few days of treatment as the
ordering of numerous laboratory tests, repeated examinations by members
of the house staff, continuous unnecessary noise, observation by the patient
of the nervous conditioned habits of other patients, frequently establish bad
conditioned reflexes which in the adult patient may take years of tedious
treatment to eradicate. Early treatment should, if it does nothing else, protect
the individual from added dangerous sub-cortical excitations during the time
when cortical control is so thoroughly inhibited. The depth and durations of
improper reflexes established at this stage is comparable with the length and
intensity of reflexes established under hypnosis. Often in acute cases it is
necessary to protect the nervous system by profound narcosis for several
days. The observations of Professor Weir Mitchell are as sound today as
when first pronounced. The alleviation of unnecessary fears and the elimination of unnecessary noises are two things that could be given greater consideration in all hospitals. Many of our institutions show either an ignorance
of, or a disregard for, the knowledge of the physiology of the central nervous
system evolved by Pavlov and Krasnagorski. While appreciating the extremely
valuable work done in large clinics and the many limitations imposed by
necessity, one wonders at the expense and elaboration of technical appliances
which often go hand in hand with conditions which greatly disturb the
dynamic equilibrium of the central nervous system of the patient. Most
hospitals and medical offices, modern and otherwise, seem to have been constructed with very adequate facilities for the prevention of noise conditioning,
and should there be any Doubting Thomases in this audience, I would suggest
that they try the experiment of sojourning for a few days in the ward of a
public hospital. I would venture the opinion that their respect for conditioned
reflexes will, in most cases, be awakened. The treatment of functional nervous
cases in large noisy clinics and the average time devoted to individual cases
in psycho-analytic and child behaviour clinics also indicates an insufficient
respect for the dangers of psycho-pathology.
Fatigue and Neurosis
One of the most important causes of cortical neuroses is fatigue or exhaustion of the cortical cells. When the cortical cells become tired they defend
themselves by inhibitions, ceasing to respond to stimulation. Sometimes for
days, even weeks, the stimulation of such cells (say by school work and
routine) will produce inhibitory effects. This explains the very wrong conclusions sometimes given about nervous fatigued school children. It is obvious
that that examinations, I.Q. and other tests, taking during the inhibitory
fatigue period, would be very unfair estimates of the child's real mental
ability.
Another fundamental cause of cortical neurosis is the conflict between
excitory and inhibitory processes. The conflict arises when the child has to
inhibit quickly some intense conditioned or unconditioned activities, as when
a nervous child (trying to keep quiet when he has a conditioned nervous
twitching) is questioned in classes and put under the test of examinations.
The physiology of conflicts and conditions under which they arise should
be well known by both the physician and all who participate in the education
Page 41 of the child. By careless development of inhibitory habits and an incorrect
or too casual estimate of the intensity of excitations, one risks the development of disturbances of depth and duration. It may seem that I have dwelt
rather long on some safeguards that are apparent. However, every week
every paediatrician sees children with conflicts and other manifestations. In
certain types of children definite neuroses show as early as the second year
of life. What will be the nervous future of these children if improperly
treated? Another danger seems to exist. There is at least some danger that
in the absorption of many ideas and influences from other nations we may
crowd out some of those well-balanced cortical reflexes which are characteristic of the best people of the British Isles. If one who is past mid-life might
be allowed to reminisce, I might suggest that if we employed our leisure time
more in the English fashion, if we were content to proceed more leisurely
but perhaps more effectively in our more serious endeavours, perhaps we
should, say in fifty years, set an example to the world as the most self-reliant,
commonsense young nation in the world. Many Europeans think that people
in North America do not allow themselves the time to become philosophers.
Before concluding, may I apologize for presenting certain physiologic
truths without accompanying laboratory data. Time, of course, prevented
this. May I also apologize for hopping from neuroses to rickets—from myxcedema to masturbation. My excuse is that I wished to intimate that these
teachings have many applications, and that they may even fit in with a more
perfect philosophy of life.
One cannot in a short period begin to mention the many interesting clinical
applications brought out by Krasnagorski in his painstaking laborious investigations during the last thirty years. A consideration of this work will, however, give the physician a much better physiologic background with which
to study and successfully treat his patients. It will also enable medical science
to eliminate some antiquated treatments, discard some faulty hereditary
beliefs, and will create a greater sympathy and understanding between the
patient and his physician. It may even enable the physician to protect himself
against some of his own bad conditioning.
TRAUMATIC ENUCLEATION OF FIBROMA
Case Report by Dr. H. R. L. Davis
The patient, a woman of 64,.had had a small tumour on the palmar surface
of the middle phalanx of the left index for many years. It was just mesial to
the flexor tendors and not attached to the overlying skin.
On September 14th, 1937, the finger got pinched between the rollers of an
electric wringer and the tumour was extruded through an opening in the
overlying skin, being perfectly free from the tissue. It came out like a pea
from a pod. Examination shortly afterwards showed an opening %" long,
slightly curved and immediately over the previous site of the tumour. The
edges were drawn together, a dry dressing applied and healing by first intention was complete in a week.
The pathologist's report furnished by Dr. H. H. Pitts is as follows:
"Macroscopic examination: Specimen consists of an ovoid well circumscribed, firm tumour mass, 1.2x0.7x0.8 cm. On section it presents a firm, fairly
homogeneous, greyish-pink, fibrotic appearing cut surface.
Miscroscopic examination: Sections through the tumour mass show it to
consist of very dense, almost hyaline, quite mature fibrous connective tissue,
with here and there very fine calcarious deposits. There is no evidence of
any malignant process in any of the sections examined.
"Diagnosis: Fibroma durum of finger."
Page 42 DEODORANT PADS
Daniel McLellan, M.D., CM., B.A., Vancouver, B. C.
Down through the ages, Medicine and surgery have advanced all along
the line, except in one salient, viz.: the elimination of offensive odours. From
the time that the caveman hunted the woolly rhinoceros and beat his enemy
with a club, human flesh has been heir to suppurating and gangrenous wounds
with their consequent malodours, stinks and stenches. Primitive man accepted
this as part of his lot. He either endured, ignored, or enjoyed "bad smells."
But that was in the dawn of human intelligence—according to scientists,
millions of years ago. There is nothing in that to wonder at. The marvel is
that in the year A.D. 1937, in spite of our almost perfect surgical technique,
our hospital wards and sick rooms in the home still reek with the stench of
gangrenous and suppurating wounds. What surgeon is not familiar with the
stink of B. Coli pus from a ruptured appendix, or the nauseating odour of
osteomyelitis.
Efforts to combat offensive odours have usually been in the direction of
substituting a more pleasant odour for an offensive one—for example, the
burning of incense—or in overwhelming one odour with another. Very often
the last state is worse than the first. Perhaps the most nauseating and cloying
smell of all is a perfume superimposed on a disagreeable odour.
That these efforts have been fruitless is prove nby the fact that doctors,,
nurses and attendants still work in the midst of these sickening smells and
that sensitive patients often suffer more from offensive odours than they do
from actual pain. Substitution of one odour for another is not the solution,
the answer is abolition.
The substance which will do that very thing was on earth probably before
man arrived. That is Peat.
There are a great many kinds of peat, but the one applicable here is that
produced from sphagnum moss. The use of sphagnum moss for wounds is said
to date back to the ancient Egyptians. The British Columbia Coast Indians
used it in making diapers for their babies, and it is claimed that it is still in
use by the Alaskan Indians for that purpose.lt was used in first-aid dressings,
in the Russo-Japanese war and as surgical dressings during the Great War.
This, however, was the actual moss, which, being long-fibred, soft and
fluffy, lending itself readily to the making of pads, was considered a good,
substitute for cotton, which was scarce. It was gathered by hand, carefully
selected, sorted and dried by those who wished to "do their bit" in the war
that way. At the close of the war, when cotton was again available, its use
for that purpose ceased.
It is now found that the screened peat which is the product of sphagnum
moss, when properly enclosed in cellucotton and ganze, makes an ideal surgical dressing. That peot is a powerful absorbent and deodorant there can be
no doubt. There may, however, be some question as to how it acts that way.
It has the power of absorbing from 15 to 20 times its own weight in liquids,
according to the degree of hydration, and although odourless itself, is probably the best natural deodorant in existence.
The following is the explanation which has been given:
The leaves and stems of sphagnum moss are made up of roundish or oval
cells. In one end of each cell there is a minute pore through which the liquid
is drawn by capillary action into the cell. Every schoolboy knows that a small,
phial filled with water, though turned upside down, will not empty itself.
So the cells when filled, by the same capillary action retain the liquid. Foul-
smelling discharges, when thus drawn into the cells, are imprisoned there.
Page 43 This theory seeds to be borne out by the fact that to date there is no known
method of forced drying of peat that will not destroy or impair its absorbent
and deodorant qualities. It is piled up in airy sheds and allowed to dry in
the air, and it takes two years to do it. Whether there is any chemical action,
the writer cannot at present state, but it is believed the action is largely
mechanical.
It would be a mistake to assume that any peat at all will do for this
purpose. Chicken-raisers scatter peat about the floors of the henhouses,
because not only is it a suitable litter for the hens to scratch in, but it was
found that the henhouse remained sweet and clean for weeks on end without
changing the peat. It is to this circumstance, or rather to an extension of this
thought, that we owe the fact that deodorant pads are now available for
hospital use.
However, the peat here used is not the crude material such as is used in
henhouses. It is carefully selected, dehydrated, and refined. British Columbia
peat is probably the finest in the world for this purpose. Samples have been
obtained from many parts of North America, but none of these samples even
remotely approach the quality of British Columbia peat for use in
dressings.
surgical
As it would be difficult to measure smells mathematically, personal
reaction must be taken as our guide. The results obtained in cases tried out
in the Vancouver General and St. Paul's Hospitals, and in private homes,
were nothing short of amazing. Two cases, of many which could be given,
will suffice to illustrate.
Case 1: A young boy, with a sloughing sarcoma of the arm, was being
dressed every two hours. Four-gauze soaked in permanganate of potash solution was applied to the wound, while the larger dressings were impregnated
with charcoal, in spite of which it could be smelt out in the adjoining hall.
The stench was so nauseating that the boy often could not take his food; he
vomited instead. When the deodorant pads were instituted, dressings were
changed once in twenty-four hours, and in one instance were actually left
on forty-eight hours. Not only was the boy freed from the pain of frequent
dressings, which in his case was great, but the room was so free from odour
that one morning on entering the room—a two-bed ward—the other patient
was found sitting at the foot of the boy's bed reading a magazine.
Case 2: Empyema with rib resection; a two-bed ward, one bed empty.
No attempt will be made to describe the odour. This was made a test case,
the Assistant Superintendent of the hospital kindly consenting to witness
whatever change might occur after the application of the deodorant pads.
Before any change was made, he entered the room and readily agreed with
the two internes present as to the general density of the atmosphere. Then
the deodorant pads were applied. The next day he again entered the room,
walking slowly towards the bed, endeavouring to get the odour as he went.
It was not until he actually bent over the patient that he could detect any
smell whatever. As a hospital man his first reaction was"We can now put a
patient in that other bed."
While an endeavour has been made to more or less standardize the pads
most in demand, they can be made of any size or shape to suit particular
cases. They can be sterilized in the autoclave in the same way as any other
dressing.
In applying the pads a few layers of moist gauze are placed next the
wound, and the deodorant pad or pads directly over that. As the peat acts
by capillary action the moist gauze "starts the lick." The wrong way is to
pile on several ordinary pads and then the deodorant pad over all. It cannot
get at the job that way. The pad should extend beyond all the wound edges,
Page 44 and the more closely the edges are applied the better, as the odours are caught
in trying to escape through the pad. It will often be found more economical
to apply a smaller-sized deodorant pad first, and then a larger-sized deodorant
pad over that.
Ointments of any kind desired may be applied to the wound; there is no
interference. In osteomyelitis cases, after the wound is packed with vaselined
gauze, deodorant pads made especially for that purpose are applied lengthwise and so as to surround the limb, the cast being applied over all. These
pads are so constructed that a greater part of the peat contained can be
placed wherever desired.
Although we so often hear the expression, "Doctor, spare no expense," it
is nevertheless true that cost is a factor that must be considered. It is therefore necessary to state that in cases of profuse discharges, whether accompanied by very offensive odours or not, by using the deodorant peat pads a
saving of 50 per cent and over can often be effected.
ANNUAL MEETING OF No. 4 DISTRICT OF
BRITISH COLUMBIA MEDICAL ASSOCIATION
The annual meeting of the No. 4 Division of the British Columbia Medical
Association was held in Revelstoke on October 4th. The attendance was
rather small, and those who were unable to come may well regret it. Doctors
Jones, Hamilton and Watson made every effort to give us a good time and
they succeeded admirably.
Golf was the attraction for those who arrived on Sunday, and the course
is a treat, if somewhat tricky. Monday morning everyone motored up the
Big Bend highway to Goldstream for lunch. Dr. W. B. McKechnie had many
interesting tales to tell of his trips up the highway many years ago, when he
had to travel on horseback.
In the afternoon Dr. P. A. McLennan presented a paper on "Fractures
Involving the Upper Extremities," and Dr. Lee Smith spoke on "The Urological Problems of the General Practitioner." Both papers were interesting
and instructive, and we are grateful to these men for coming so far and
giving us their time.
Those present were: Dr. M. W. Thomas; Drs. Irving, Willoughby and
McNamee, of Kamloops; Dr. Alan Buck, Salmon Arm ; Dr. W. B. McKechnie,
Armstrong; Dr. Harvey, Vernon; Dr. Tyerman, Nakusp; Drs. Jones, Hamilton and Watson, Revelstoke; Drs. Henderson and Willits, Kelowna.
Following cocktails at the home of Dr. and Mrs. Hamilton, a banquet was
held in the King Edward Hotel. After dinner the business meeting was held.
It was decided by vote that the next meeting be held in Kelowna and that
Dr. J. S« Henderson be the President and the representative of this District
to the British Columbia Medical Association. Dr. R. E. Willits was elected
Secretary and reported to the Bulletin. Dr. Thomas then addressed the
meeting, emphasizing the united front shown by the medical men in matters
of medical economics.
The evening's entertainment drew to a close around the piano at the
home of Dr. and Mrs. Jones, where everyone voted Revelstoke "tops."
—Reba E. Willits, Reporter for No. 4 District.
Page 45 GREATER VANCOUVER HEALTH LEAGUE
Under the sponsorship of the Greater Vancouver Health League, an
Institute on "Sex and Living" will be held in the Medical-Dental Auditorium,
November 22-26.
Tickets will be $1.50 for the full series of lectures, and will not be transferable.
The lecturer, Nadina R. Kavinoky, M.D., was a delegate to the Pan-Pacific
Women's Conference held in Vancouver in July of this year. Dr. Kavinoky
is an Honorary Life Member of the Los Angeles County and California State
Medical Associations. She is supervisor of numerous Mothers' Clinics of
Los Angeles County, under the County Health Officer, and is a very public-
spirited practitioner.
Further particulars will be forthcoming shortly.
A PRESCRIPTION SERVICE . . •
Conducted in accord with the ethics of the Medical
Profession and maintained to the standard suggested by
our slogan:
Pharmaceutical Excellence
McGill & Ormr,
LIMITED V_*^
FORT STREET (opp. Times)      Phone Garden 1196     VICTORIA, B. C.
G
eorge
p. p
aris
D.S.C.
Ttecently arrived from three years' study
and practice in the Chicago Foot Clinic
and the Illinois College of Chiropody and
Foot Surgery, licensed in Illinois and
British Columbia, joins the Paris Foot
'Clinic for the manipulative, massage,
orthopaedic and electrical treatment of
foot ailments—in conjunction with shoe
and appliance therapy.
Doctors: Patients referred are ethically
treated according to your prescription
and recommendations.
Studies in College included:
Anatomy, Dissection, Physiology. Pathology,
Basteriology, Histology, Chemistry, Physiological Chemistry, Physics, Appliance Therapy,
Shoe Therapy, Orthopaedics, Mechanical Orthopaedics, Physical Therapy, Roentgenology, Surgery, Medicine, Dietetics. Physical Diagnosis,
Urinalysis, Blood, Materia Medica, Therapeutics, Neurology, Dermatology, Chiropody, Massage and Manipulation.
-Page 46 ^1—1
". .  . I use Radio-Malt extensively • •  • there is no
other like it."
^s^  , M.B., Ch.B_
The above is representative of medical opinion based upon clinical
experience extending over more than a decade.
Radio-Malt is the original standardised vitamin preparation; it is
administered as a routine prophylactic measure in leading hospitals,
clinics, schools, offices and factories, whilst in the household it has
proved to be the ideal family safeguard.
RADIO-HALT
(Standardised Vitamins A, Bx, B2 and D)
Stocks of Radio-Malt are held by leading druggists throughout the
Dominion and full particulars are obtainable from:—
The BRITISH DRUG HOUSES (Canada) LTD.
Terminal Warehouse Toronto, 2, Ont.
RM/Can/3711
-IDount flMeasant IT.noertal.in0 Co. %tb.
tINGSWAY at 11th AVE.
Telephone Fairmont SS
VANCOUVER, B. C»
R. F. HARRISON
W. R. REYNOLDS Mamma-i think
i saw a germ i
Mercy, child-run
quick for the
borden inspector 1
_■-#
ACTUALLY. • . there are numerous inspectors and veterinarians on the Borden payroll who do nothing but hunt for
trouble. It sounds strenuous, and is—for Borden rules are
very strict.
It is this extra care all along the line that accounts for
the unvarying quality of Borden's St. Charles Irradiated
Evaporated Milk. It is made, always, from pure full-cream
milk—as fine as the country can produce.
Thousands of Doctors write "Borden's"
when prescribing irradiated evaporated milk for
infants. Doctors know, as many mothers do not,
the extra safeguards that surround all Borden
products.
If you are not familiar with Borden's St.
Charles Evaporated Milk, unsweetened, write
The Borden Company Limited, Yardley House,
Toronto, Ontario, for professional literature
and samples.
Qordei0 DON'T BE A
tts^M|. tom:
^■-_ST*T_ff__i. »^S.-_^~^i__w_&.Vi!H;*_t__.'i*i>**
/^_5_4T* ^1ffJ^u/q (,g jfi^rie u r i my
sciatica, lumbago, and so-called
"musculdr rheumatism", demands
. , prompt relief.; .^^^i|^v'§«^^t||
/Jw «i|';> underlying"i|jj_auses of
such affections should be removed
as thoroughly as possible.   _M$#<
Etiologically allied to arthritis,
chronic rheumatism and gout, their
effective treatment calls for sulphur,
calcium, iodine, and a solvent
^        and eliminant of meta
bolic waste.
LYXANTHINE ASTIER
is an efficient association of
sulphur, calcium and iodine
with lysidin bitartrate—a solvent and eliminant of uric and
metabolic waste which is eight
times more powerful than
piperazin.
Lyxanthine Astier relieves
symptoms and removes causative factors without irritating
or toxic effects. Contains no
analgesic, no narcotic drug.
Pleasant to take. Administered
by mouth only.
Please send Sample and Literature
of Lyxanthine Astier.
Dr	
Address	
City    Province.
LC11-BVM
Dr. P. ASTIER LABORATORIES
36-48 Caledonia Road, Toronto
Nitntt Sc
t
2559 Cambie Street
ancouver
18. C.
Colonic
Irrigation
Institute
Superintendent:
E. M. LEONARD, R.N.
Post Graduate Mayo Bros.
Up-to-date treatment rooms;
scientific care for cases such as
Colitis, Constipation, Worms,
Gastro-intestinal Disturbances,
Diarrhoea, Diverticulitis, Rheumatism, Arthritis, Acne.
Individual Treatment $ 2.50
Entire Course $10.00
Medication (if necessary)
$1 to $3 Extra
631  BIRKS BUILDING,
VANCOUVER, B. C.
Phone: Sey.2443
506-7 CAMPBELL BUILDING
VICTORIA, B. C.
Phone: Empire 2721 STEVENS' SAFETY PACKAGE
STERILE GAUZE
is a handy, convenient, clean commodity for the bag or the office.  Supplied
in one yard, five yards and twenty-five yard packages.
ESTABLISHED  NEARLY A
B. C. STEVENS CO.
Phone Seymour 698
730 Richards St., Vancouver, B. C.
S. BOWELL & SON
DISTINCTIVE FUNERAL
SERVICE    f §
Phone 995
66 SIXTH STREET
NEW WESTMINSTER, B. C.
1.
I
w®
Break_m^^^l|c9i%||rcle of|perverted
menstrual f ujicriori i n cases of ameriorrhea,
tard y-\ pe.^^^^^^^^^1 o^^M;vand[^p^
menorrhea. Affords remarkablt^ymptomatrc
reli^by stim_l|ating|.^_%nothmw^S^thc
u t er ir^B^^st a b i 1 i z i '.>ii^$|^Bpffip^ 1 *s
muscu 1 a^^^Kontroislfhe i^ero-^arian
" ^;-norm'ili^nstrualti^S^ft^^^
* MARTIN H. SMITH COMPANY
s-^^s? ■'*?->.. is_'^_l_^_^,''-*i
W ISO IAFAYITTI STRUT, NSW YORK. N. Y.
r
ffl&$£i%&<'si
Full formula and descriptive
literature on request
MsMM
:_WA¥:_W:'::i:::SfiS_S
<M««W>X«»
Dosage:   l to 2 capsules
3 or 4 times daily.   Supplied
in packages of 20.
Ethical protective mark MHS
embossed on inside of each
capsule, visible only when capsule  is cut in half at seam.
 ;_„^ ,,. -,,* . THEIR TROUBLES
COULD BE TRACED
DOCTORS are giving increasing atten*
tion to the importance of foods in
maintaining physical well-heing. Unbalanced, faulty diets—long continued—can
lead to many ailments.
A common fault of our present-day,
highly refined foods is lack of sufficient
"bulk.'1 Too often, as a result, common
constipation develops.
This condition can be relieved by
adding a natural laxative food to the
average menu. Kellogg's ALL-BRAN supplies corrective "bulk," as well as vitamin B to help tone the intestines, and
iron for the blood.
Within the body, ALL-BRAN absorbs at
i least twice its weight in water, forms a
soft mass, gently exercises and cleanses
i the system.
ALL-BRAN may be served as a cereal
> with milk or cream, or cooked into muf-
ifins, breads, etc. Sold by all grocers.
I Made by Kellogg in London, Ontario.
ALL-BRAN
Ml-BRAM
PtUdOUSWHAVOMO
y./
CONSTIPATION Announcement .  .  .
SONERYL
the well-known hypnotic with analgesic effect
is now offered in the form of
SUPPOSITORIES
producing a rapid effect and avoiding all possibility of
gastric disturbance.
SONERYL is now available as follows:
the well-known pink tablets for
oral use, each containing 0.10 Gm.
of the active product (Butylethyl-
malonylurea). Tubes of 20.
Suppositories for rectal administration, each containing 0.20 Gm.
of the active product and an equal
dose of Camphor. Boxes of 10.
Specify SONERYL for all forms of Insomnia
jLaJrtnxdxriif I o~uJl£mc -fxe/ieA
OF      CANADA       LIMITED-  MONTREAL
Distributors:  ROUGIER FRERES, 3 50 Le Moyne Street, Montreal. E A T   H ELPS  YOU   FIGHT
/.
y relieving pain,  promoting  relaxation
nd frest/land   lessening   apprehension *
1 THESE, certainly, are vitally important considerations, tending
■lake your task LIGHTER by
ling the patient's comfort
jGI ATER, and enabling you to carry
jthi :ase along by routine medication
inn it has run its course. Eminently
qu ified investigators concur in these
collusions    and    so    state    in    the
liti iture.:
le G-E Inductotherm offers the
tit means of heating human tissues,
biunly because of the proven effec-
Iti. less of the basic principle—electro agnetic induction—but because
|e extreme simplicity of applica-
tio and absolute control of dosage.
■Tb patient's coverings need not be
Is rbed; there need be no weight on
r rect contact with the body; there
an to electrodes to apply to the skin
wi tee. There is deep, soothing, bene-
ci t heat that comes instantly when
'tin witch is closed.
>u should know the Inductotherm
»a  intimately, for its use is defi-
% indicated wherever heat is indi-
l. You can learn all about it by
Wily mailing the handy coupon.*
.
IllllllllllllllllllllllllllllllllllllllllllllIIIIIIIIIIIIIMIIIIIIIIIIIIIIIIIIIIIIIIHIIIIIIIIIIIII
MAIL THIS COUPON TODAY
General Electric X-Rray Corporation     A511
2012 Jackson Blvd., Chicago, 111.
Please do these two things for me, neither of
which place me under any obligation.
1. Have your representative arrange with
me for a demonstration of the Inductotherm.
*2. Send me "Electromedical Notes and
Abstracts" D2, dealing with the employment
of heat in pneumonia.
LAY C
JACKSON BLVD.
I'ancouver Branch:
Name	
Address.
CHICAGO, ILLINOIS
109 MOTOR TRANSPORTATION BLDG
-i 1111111111111111 n 111111111 m 1111111111111111111 m 111111111111111111111111111111111 m 1111111111111
570 D.NSMUIB STREET For Hysterical Affections prescribe
BROVALONE
HARTZ
A non-narcotic sedative elixir in which the disagreeable
taste of the medicinal ingredients is well masked.
FORMULA An effective antispasmodic
Each fluid ounce represents: , . ,.      , «
Sodium Bromide ..__80 grains ^d nervine stimulant for
Tincture Valerian the treatment of Hysteria,
Ammomated 80 minims
Extract Hyoscyamus 1 grain Insomnia,   and   the   func-
Laxagrada 20 minims ,.       ,   ,. .   ,   ,
tional diseases associated
DOSE: One to four fluid
drachms as indicated. therewith.
The J. F. HARTZ CO., Limited
Pharmaceutical Manufacturers
TORONTO I MONTREAL
536 13th Avenue West
Fairmont 80
Exclusive Ambulance Service
FAIRMONT 80
ALL ATTENDANTS QUALIFIED IN FIRST AID
"St. John's Ambulance Association"
WE SPECIALIZE IN AMBULANCE SERVICE ONLY
R. J. Campbell
J. H. Crellin
W. L. Bertrand Underlying All Inflamation
. . . is change in the
Capillary Net-work
_^»
Lessened resilience and permeability of the ^-^©^^^p1,
capillary wall,
stasis in capillary
channels, cause a
decrease in tissue
nutrition, lowered local resistance, and serious
damage to the tissue cells.
Section through healing wound
1. Dead cells and detritus.
2. Regenerating epithelium.
3. Regenerating connective tissue.
4. Budding new capillaries.
The application of hot dressings of
Antiphlogistine
stimulates   capillary   activity;   brings   fresh
fluids and cells to the part, and thus accelerates the entire reparative process.
Generous clinical
sample and descriptive literature
on   request  from
The Denver Chemical Manufacturing Co.
153 LAGAUCHETIERE ST. W., MONTREAL.
Made in Canada,
EBB Nutritional Anemia in Infants
75%
Months of Age.
4-5    5-6    6-7    7-8
10-11
70%
65%
Art f icially fed London infants
The accompanying chart of the hemoglobin level in the blood of infants is
based on more than 1,000 clinical cases
studied by Mackay. The sharp drop in
hemoglobin during the early months of
life has also been reported by a number
of other authorities. It is noteworthy
that this fall in hemoglobin has been
found to parallel closely that of diminishing iron reserve in the infant's liver.
The usual milk formula of infants in early life further contributes to this anemia because milk is notably low in iron. It is now possible, however, to increase significantly the iron intake of bottle-fed infants from birth by feeding Dextri-Maltose With Vitamin B in the milk formula. After the third month
Pablum as the first solid food offers substantial amounts of iron for both breast- and bottle-fed babies.
Reasons for Early Pablum Feedings
1 The iron stored in the infant's liver at birth is rapidly depleted during the first months
of life.   (Mackay,1 Elvehjem.2)
0 During this period the infant's diet contains very little iron—1.44 mg. per day from
~* the average bottle formulae of 20 ounces, or possibly 1.7 mg. per day from 28 ounces
of breast milk.   (Holt.3)
For these reasons, and also because of the low hemoglobin
values so frequent among pregnant and nursing mothers
(Coons,4 Galloway5), the pediatric trend is constantly toward
the addition of iron-containing foods at an earlier age, as
early as the third or fourth month. (Blatt,6 Glazier,7 Lynch8).
The Choice of the Iron-Containing Food
1 Many foods reputed to be high in iron actually add very few milligrams to the diet
because much of the iron is lost in cooking or because the amount fed is necessarily
small or because the food has a high percentage of water. Strained spinach, for
instance, contains only 1 to 1.4 mg. of iron per 100 gm.   (Bridges.?)
O   To be effective, food iron should be in soluble form.  Some foods fairly high in total
~* iron are low in soluble iron.   (Summerfeldt.10)
3 Pablum is high both in total iron (30 mg. per 100 gm.) and soluble iron
• (7.8 mg. per 100 gm.) and can be fed in significant amounts without digestive
upsets as early as the third month, before the initial store of iron in the liver
is depleted. Pablum also forms an iron-valuable addition to the diet of
pregnant and nursing mothers.
Pablum (Mead's Cereal thoroughly cooked and dried) consists of wheatmeal, oatmeal, cornmeal, wheat embryo, brewers' yeast, alfalfa leaf, beef bone, iron salt and sodium chloride.
l-io Bibliography on request.
MEAD JOHNSON & CO. OF CANADA, LTD., Belleville, Onf.
Please enclose professional card when requesting samples of Mead Johnson products to cooperate in preventing their reachina unauthorised persons The Observance of
National Pharmacy Week
throughout North America is simply a reminder that in all circumstances—day or
night, good weather or bad, simple instructions or difficult—your druggist endeavors
to earn the right to serve you by his exacting
care and a complete stock of quality drugs
and sick-room supplies.
OP-MAU
MIOHT
Sey. 2263
Quick Delivery
GEORGIA PHARMACY
U I M
W. GEORGIA
STREET
Open
Day and
Night
<&mtn Sc 1| an na lOtfr
Established 1893
VANCOUVER, B. C.
North Vancouver, B. C.   Powell River, B. C.
Published Monthly at Vancouver, b. C by ROY w rig ley LTD.. 300 west Pender street Hollywood Sanitarium
Limited
For the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference—B. 0. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
E5E5^^-^SSs^^S^E^_^_5E5S^S5^-5S

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
https://iiif.library.ubc.ca/presentation/cdm.vma.1-0214392/manifest

Comment

Related Items