History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: March, 1944 Vancouver Medical Association Mar 31, 1944

Item Metadata

Download

Media
vma-1.0214399.pdf
Metadata
JSON: vma-1.0214399.json
JSON-LD: vma-1.0214399-ld.json
RDF/XML (Pretty): vma-1.0214399-rdf.xml
RDF/JSON: vma-1.0214399-rdf.json
Turtle: vma-1.0214399-turtle.txt
N-Triples: vma-1.0214399-rdf-ntriples.txt
Original Record: vma-1.0214399-source.json
Full Text
vma-1.0214399-fulltext.txt
Citation
vma-1.0214399.ris

Full Text

 the BUiLtiSI
A
of the
vancouver
medicalIassociation
Vol. XX.
MARCH, 1944
No. 6
With Which Is Incorporated
Transactions of the
Victoria Medical Society
the
Vancouver General Hospital
and
St. Paul's Hospital
In This Issue:
SESSIONAL MEETING OF THE AMERICAN COLLEGE OF
SURGEONS—^ROGRAMMEJljp    jf     JPilliifei^
Page
. 145
THE OSLER LECTURE: "GOITRE»»-^
T. H. Lennie, M.L^Cl^FJUfc.S.(C.)., RA.CS.8111 »WjlfflijW
B.C.M.A. SPECIAL GENERAL MEETING ON HEALTH INSURANCE
WEDNESDAY, ^^B^p ^M^^&^^^^^ • : • 162
A CASE OF EMPYEMA COMPLICATED BY^JEUMOTHORAX—
W. J3fe Melvin, M.D.   l^^^^^^f^^^M^gj^^^^^^^0^6
STREPTOCOCCAL MENINGITIS TREATED WITH PENICILLIN-JIBI168
^
SUMMERfSCHOOL
The Annual Summer School of the Vancouver* Medical
Association will be held at the
HOTEL VANCOUVER, JUNE 20tf||o 23rd, Inclusive I
forIINat
COMMON BOIL
fYOVSl
E.B.S
13
JiE-B.shuuilp
fBMeilCK.PS
M
fOHTO    .   ~^|^~B
Most ruruneular growths are Caused by some type of staphylococcus
or strepfi^ccusf^acteria. As a^^ncentrated^accine^for local
appKcation^R^bvax E.BJ^ containsjp each gram, 40,000,000 each
of kiUedy^yk^hyloco^ arid si*ept^^^^an^fbr5|||ded streng^
20,000,000'lm ba^py^^arieous are also |pehided i^eac^gra^i
because ^|theAlde range^gf bactericidM|rct3|aty of pyocyanin||
Tl^tocal biologicar^^g^ihus ol^ineS|^aide|W^^he chemically,
disinfectantM?ti^^Kichthyosulphol and zkifloxide.
I*3^ax,^^^pful and J|pfcate|| wherever pu&l^^^^^Bhe-
affected partst^buld befell washed with boile^^at^^rovax-
applied, and^^ered wi^^terile gauze. Tt&^reatmenpshould'
be renewed each night:^d morning, while requned^iStannid E.B.S.
tablets, given orally^re jritise^a^lram^^S^ treatmet|||
Pyggax E.B.^^^V2^able a^^imodeift>harmacies,]tt^feivenient;
^|||||*pal j?|^^^^blejppiispensm^
In prescribing; Pyovax E.B.S. d^Stanni^^.B.S^^wayspollow the
name dCthe prod^S^i^pMidentiiyin^etters j(B.S^8
I^#yovax-|.B.Sg;
Ref^neeS^
Boyce, Lampert & McFe$ridge, New jE%leans J^p& S.
Jour: 86:158,1933.
Krueg«|l& Scribner^^^e<^ssn. JolM6, No. 19*
20 (194ili|fe»d||lAneet Minneapolis, Felj|*1941, g. 56.
1$ Stannid E.B.S^f
Descriptive folder
on request.
THE E. B. SHUTTLEWORTH CHEMICAL CO. LIMITED
TORONTO
MANUFACTURING CHEMISTS
CANADA
H:- >«?' i
laaigg: H'd
vfftIA
THE   VANCOUVER    MEDICAL   ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Asociation
in the interests of the Medical Profession.
Offices: 203 Medical-Dental Building, Georgia Street, Vancouver, B.C.
EDITORIAL BOARD:
Dr. J. H. MacDermot
Dr. G. A. Davidson Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XX. MARCH, 1944 No. 6
OFFICERS, 1943-1944
Dr. A. E. Tbites Dr. H. H. Pitts Dr. J. R. Neilson
President Vice-President Past President
Dr. Gordon Burke Dr. J. A. McLean
Hon. Treasurer Hon. Secretary
Additional Members of Executive: Dr. J. R. Davies, Dr. Frank Turnbull
TRUSTEES
Dr. F. Bbodie Dr. J. A. Gillespie Dr. W. T. Lockhart
Auditors: Messrs. 1'i.ommek, Whiting & Co.
SECTIONS
Clinical Section
Dr. J. W. Miller—_l_Chairman Dr. Keith Burwell Secretary
Eye, Ear, Nose and Throat
Dr. C. E. Davies Chairman Dr. Leith Webster Secretary
Paediatric Section
Dr. J. H. B. Grant Chairman Dr. John Piters Secretary
STANDING COMMITTEES
Library:
Dr. A. Bagnall, Chairman; Dr. F. J. Buller, Dr. D. E. H. Cleveland,
Dr. J. R. Davies, Dr. J. R. Neilson, Dr. S. E. C. Turvey
Publications:
Dr. J. H. MacDermot, Chairman; Dr. D. E. H. Cleveland,
Dr. G. A. Davidson
Summer School:
Dr. J. C. Thomas, Chairman; Dr. J. E. Harrison, Dr. G. A. Davidson,
Dr. R. A. Gilchrist, Dr. Howard Spohn, Dr. W. L. Graham
Credentials:
Dr. D. E. H. Cleveland, Chairman; Dr. E. A. Campbell, Dr. D. D. Freeze
V. O. N. Advisory Board:
Dr. L. W. MacNutt, Dr. G. E. Seldon, Dr. Isabel Day
Metropolitan Health Board Advisory Committee:
Dr. W. D. Patton, Dr. W. D. Kennedy, Dr. G. A. Lamont
Representative to B. C. Medical Association: Dr. J. R. Neilson
Sickness and Benevolent Fund: The President—The Trustees Si*HfiUfted DAILY RATIONAL VITAMIN THERAPY
NOW MADE POS
The OPTIMAL VITAMlJf SB
^recommended by the Food and NufrJlpa Soa^cf]
No trade name IS
ONE CAPSULE
Low cost to pqtien
Note the label
Check with the chart
Each   capsule   meets   the   Recommended Daily Allowances, Food and
Nutrition  Board,  National Research
Council.
n*-..glso /sh
11v vTlWInr
mum doily vTTOHiin requirements,
U S. Food ond Drug Adminis*
tration.
ss Optimal daily allowance
(adultI as recommended
by the Food and Nutrition
Boord of the National
Research Council*.
= s Supplied bt ONE SQUIBB
SPECIAL VITAMIN FOR*
MULA CAPSULE.
Minimum daily require*
ments U. S. Food ana)
Drug Administration.
NIC
**J.A.M.A. 116:2601, June
7, 1941.
*Not yet official.
and here is something NEW in Ethical Vitamin Therapy
»<*l,0°  — &SOSS
1. Squibb Special Vitamin Formula Capsules are
sold to druggists in bulk. The druggist does not
have to stock packages of various sizes. In fact,
there are none.
2. Prescribe for a patient whatever number of capsules for whatever period you with.
3. Druggists generally will fill your prescription at
the same cost per capsule whether you prescribe 10
capsules or 100—generally about seven or eight cents
per capsule.
4. Vitamin therapy with Squibb Special Vitamin
Formula Capsules is not expensive. The Squibb
Laboratories have done everything possible to keep
the cost low ... to encourage prescription of a
multivitamin preparation ... to keep the control of
vitamin therapy where it belongs—under the supervision of the physician with the collaboration of the
druggist. VANCOUVER HEALTH DEPARTMENT
STATISTICS—JANUARY, 1944
Total  Population—Estimated i 288,541
Japanese Population Evacuated
Chinese  Population—Estimated  5,541
Hindu  Population I    301
Rate per 1,000
Number
Total deaths      394
Japanese deaths   .  	
Chinese deaths       27
Deaths—residents only :     343
Population
15.5
Population Evacuated
55.7
13.5
BIRTH REGISTRATIONS:
Male, 285; Female, 286
INFANT MORTALITY:
571
January, 1944
Deaths under one year of age        15
Death rate—per  1,000  births        26.3
Stillbirths   (ribt included above) '£        9
22.5
January, 1943
18
30.8
14
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
Scarlet Fever	
Diphtheria <  0
Diphtheria  Carrier   ,  0
Chicken   Pox  141
 1  3
  2
December, 1943
Cases      Deaths
62 0
Measles	
Rubella	
Mumps  23
  12
!  o
  0
 .  0
 i !  22
■,   ■-,  4
2
  0
  0
Whooping  Cough	
« Typhoid Fever	
Undulant Fever	
Poliomyelitis	
Tuberculosis :	
Erysipelas	
Meningococcus   Meningitis =	
Paratyphoid Fever 	
Infectious Jaundice	
V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH
DIVISION OF VENEREAL DISEASE CONTROL
West North       Vane.   Hospitals &
Burnaby    Vane.  Richmond   Vane.      Clinic   Private Drs.
J        , Figures not yet available for January, 1944.
0
0
0
0
0
0
0
0
0
0
20
0
0
0
0
January, 1944
Cases
81
0
0
174
10
5
66
31
0
0
0
44
2
2
0
3
Deaths
0
0
0
0
0
0
0
0
0
0
0
18
0
0
0
0
Feb. 1-
Cases
41
0
0
143
11
7
28
16
0
0
0
39
2
4
0
1
15, 1944
Deaths
0
0
0
0
0
0
0
0
0
0
0
0
0
Totals
BIOGLAN-A
The most effective therapy for waning mental and physical energy,
deficient concentration and memory, reduced resistance to infection,
muscular weakness and debility, neurasthenia and premature senility.
The efficacy of this very potent endocrine tonic has been confirmed by
the clinical evidence of many thousands of cases treated during
1932-1943.
Stanley N. Bayne, Representative
Phone MA. 4027 1432 MEDICAL-DENTAL BUILDING Vancouver, B. C.
Descriptive Literature on Request
THE SCIENTIFIC HORMONE TREATMENT
Page One Hundred and Forty-tiw B. D. H.
SEX HORfflOnE PREPARATIOnS
SEROGAN—serum gonadotropic hormone. In the female, Sero-
gan is used in delayed puberty, amenorrhoea and sterility due
to non-ovulation. In the male, it is valuable in. impotence and
defective spermatogenesis.
GONAN—chorionic gonadotropic hormone. In the female, it
is used in menorrhagia and irregular uterine haemorrhage.
In the male, it is indicated in eunuchoidism, Frohlich's syndrome and in cryptorchidism.
OESTROFORM—a natural oestrogenic hormone. Indicated in
menopausal derangements, genital hypoplasia, amenorrhoea,
sterility, dysmenorrhoea, pruritus vulvae, vaginitis, vomiting
of pregnancy, missed abortion, inductfon of labour, uterine
inertia and inhibition of lactation.
PROGESTIN B.D.H.—the hormone of the corpus luteum*
Indicated in threatened and habitual abortion, menorrhagia
and metrorrhagia.
Stocks of B.D.H. Sex Hormone Preparations are held by leading
druggists throughout the Dominion, and full particulars are
obtainable from
THE      BRITISH
Toronto
DRUG      HOUSES      (CANADA)       LTD.
Canada
SHor/Can/443 VANCOUVER     MEDICAL     ASSOCIATION
FOUNDED 1898    ::    INCORPORATED 1906
'r 3fr "fr "P
PROGRAMME OF THE FORTY-SIXTH ANNUAL SESSION
| (SPRING SESSION) |     gg
GENERAL MEETINGS will be held on the first Tuesday of the month at 8:00 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the month at 8:00 p.m.
These meetings are to be amalgamated with the clinical staff meetings of the various
hospitals for the coming year.   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.    Paper of the evening.
March   7—GENERAL MEETING:
QSLER LECTURE—Dr. T. H. Lennie.
March 21—COMBINED CLINICAL MEETING and STAFF MEETING at
VANCOUVER GENERAL HOSPITAL.
April   4—GENERAL MEETING:
Dr. J. R. Davies—"Remediable Intra-thoracic Conditions in Childhood." (Illustrated by brief case histories and X-ray films.)
April 18—COMBINED CLINICAL MEETING and STAFF MEETING at
ST. PAUL'S HOSPITAL.
MAY   2—ANNUAL MEETING.
13 th Ave. and Heather St.
Exclusive Ambulance  Service
FAirmont 0080
PRIVATE AMBULANCES AND INVALID COACHES
WE SPECIALIZE  IN  AMBULANCE SERVICE  ONLY
J. H. CREL.LIN
W.  L.  BERTRAND
Page One Hundred and forty-three LIVER EXTRACT INJECTABLE
Purified and  Concentrated
15 U.S.P. UNITS PER CC.
The best therapeutic measure at present available for the treatment of
pernicious anaemia is the intramuscular injection of a potent, concentrated,
and purified liver extract. The concentrated extract prepared by the
Connaught Laboratories has the following advantages:—
ASSl JRFD POTFNC^y     ^ac'1 '°* is testec* clinically for therapeutic activity.
The potency is 15 U.S.P. units per cc.
PURITY
SMALL DOSAGE
The extract is a clear, light brown
solution, containing less than 100
mg. solids per cc.
In most cases initial treatment with
one cc. per week is sufficient — for
maintenance, one cc. at less frequent
intervals is generally adequate.
LIVER EXTRACT INJECTABLE is supplied by these Laboratories in 4-cc.
rubber-stoppered vials, and in 12-cc. vials for hospital use.
CONNAUGHT LABORATORIES
University of Toronto    Toronto, Canada
DEPOT FOR BRITISH COLUMBIA
MACDONALD'S PRESCRIPTIONS LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C.
■■■ EDITOR'S PAGE
Listening to the very able and stimulating Osier address of Dr. T. H. Lennie, and
to the introductory remarks of his introducer, Dr. W. D. Keith, we notice that both
speakers took occasion to recall the great emphasis that Osier used to put on Medical
Libraries. To him a medical library was one of the most vital necessities to the medical
profession of any locality. So much so that when he was told of the formation of ths
Vancouver Medical Association, his letter in reply was mainly devoted to a strong plea
for the immediate creation of a medical library. He wanted this at once: he wanted it
good: he wanted it constantly used and kept up to date. He underlined his plea by a
generous subscription towards the fund that would provide such a Library.
To many men, to whom a Library is as essential and as useful as their stethoscope, it
may seem rather superfluous and unnecessary to labour this point at all. But, to our
shame be it said, we do not all, not by any means all, use or appreciate our Library.
Victoria and Vancouver both have excellent medical libraries, well stocked and equipped
and well run. No doubt other centres in the Province also have good libraries. But we
can speak for Vancouver at least when we say that the library there is really available
as a provincial library, since arrangements have been made whereby books can be sent
to any part of the province—and many men take advantage of this fact. This is very
much as it should be—and is greatly to the credit of the very able Library Committees
who have so well served the Library, year after year, and have made of it a really first-
class Medical Library.
A good Library is a great deal more than a place of reference, or a source of information. One has only to visit such a Library as we have mentioned, to see that, rightly
used, it can contribute more to our professional well-being and contentment, than any
other single agent, not excluding the hospitals, which we all use so much more. It is
primarily, perhaps, what we have said, a storehouse of medical knowledge, past and
present, a place of reference, a very present help in our times of need. If it were nothing
more, these functions alone would more than justify its existence, and our failure to take
advantage of them would still be a reproach to us and our great loss. But it is more.
* It is a source of inspiration and stimulation: and this is almost, if not quite, its greatest
function. "The spirit keepeth alive." And in the Library you shall find, more than any
place, the spirits of our great ones, their keenness, their vitality, their power, which
through the years have built Medicine into a great Science, and a great Art. You
cannot spend half an hour in the reading room of the Library, browsing with no special
aim in view, except the satisfaction of appetite, without feeling stimulated and refreshed.
There are the technical periodicals, full of the latest information: there are all sorts of
auxiliary publications, and in the stacks you will find books, not only text-books, and
reference-books—but books whose subject is humanity in general, humanity in the
widest sense, and so of the greatest interest and value to us, whose whole life is spent in
touch with humanity in the raw.
So, more and more, we see how truly wise and right was Osier, in his championship
of the Medical Library. For books are men's minds and men's thinking in recorded
form. A wise man once said that the greatest benefit to be derived from university life
was not what one learnt in classrooms, or from professors' lectures, but that it was the
result of constant contact with other active and living minds. This is surely the case,
too, with books. As one reads them, and "books" here include periodicals and journals,
one is constantly coming-in close touch with other minds, suffering the impact of other
intelligences and other men's thinking, and this cannot but give us the stuff that makes
for growth and a wider and deeper life. And even from a material standpoint, it adds
immeasurably to our armamentarium and equipment, and makes us better docotrs, because it makes us, as Bacon reminds us books do, "fuller" men.
We record with great regret the illness of Dr. J. A. McLachlan—so well known to
every medical man in the province. He is, perhaps, as nearly indispensable as any man
could be, and we all miss him very badly. Nor is it only because he is such a valuable
man as Registrar of the College, but because of his own personality, which makes him
the friend of us all.   May he soon be well and strong again is the wish of every one of us.
Page One Hundred and Forty-four AMERICAN COLLEGE OF SURGEONS
The medical profession of British Columbia will be visited by the Sessional Meeting
of the American College of Surgeons in April. On the 18 th of that month there will be
a meeting in the Hotel Vancouver, lasting one day. During this day, a very busy and
most interesting programme will be put on. It will be open to all medical men who
"wish to attend, and will be absolutely free, except that if anyone wishes to attend the
luncheon and/or dinner, he or she will, naturally, have to pay for the tickets. Otherwise, we have been most generously extended an invitation to any or all of the meetings.
A synopsis of the very full programme is appended below. As will be readily seen,
this is a programme dealing almost entirely with War Medicine, and men in the services
will therefore be especially interested, though civilian practitioners will also find it of
the greatest value. Though the synopsis below does not state it specifically, there will
be also a very full Hospital Programme, and all those interested in Hospital matters will
have an opportunity to attend. This will run concurrently with the other.
This is a rather unique opportunity, and we appreciate very much this courtesy.
Our own colleague, Dr. A. B. Schinbein of Vancouver, will be in charge of the proceedings, and we know he would be glad to see a great many men take advantage of the
College's invitation. We hope, too, that men from other centres will regard this as their
invitation, too.
TUESDAY, APRIL 18, 1944
HOTEL VANCOUVER, Vancouver, British Columbia
PROGRAMME
T. H. Lennie, M.D., Vancouver; Senior Surgeon, Vancouver General Hospital,
Presiding.
MAYFAIR ROOM, 8:30 a.m.
MILITARY MOTION PICTURES:
Activities of the Medical Department of the United States Army in Theatres of Operation.   Produced by the Army Service Forces, War Department.
Medical Activities and Installations of the United States Navy in the South Pacific;
The Medical Department of the United States Navy in Amphibious Assault.    Produced for the Bureau of Medicine and Surgery, United States Navy.
MAYFAIR ROOM, 9:30 a.m.
EXPERIENCES IN THE THEATRES OF OPERATION
By representatives of the Surgeons General of the United States Army and the United
States Navy:
Major Clinton L. Compere, Medical Corps, United States Army, Temple, Texas; Mc-
Closkey General Hospital.
Captain Charles G. McCormack, Medical Corps, United States Navy, Bremerton,
Washington; Executive Officer, Puget Sound Naval Hospital.
MAYFAIR ROOM, 11:30 a.m.
WARTIME PROBLEMS IN COMMUNICABLE DISEASE CONTROL
W. P. Dearing, M.D., Senior Surgeon, United States Public Health Service, Washington.
SALON A, 12:15 p.m.
LUNCHEON FOR PHYSICIANS, SURGEONS AND
HOSPITAL REPRESENTATIVES
G. E. Selden, M.D., Surgeon-in-Chief, Vancouver General Hospital, Presiding.
Current Problems in Medical Manpower for the Armed Forces, Hospitals, and the
Civilian Population.
Air Commodore J. W. Tice, Ottawa; Director of Medical Service, R.C.A.F.; Member,
Canadian Procurement and Assignment Board.
Page One Hundred and Forty-five MAYFAIR ROOM, 2:15 p.m.
Frank M. Bryant, M.D., Victoria! Member of Surgical Staff, St. Joseph's
and Jubilee Hospitals, Presiding.
WAR WOUNDS OF THE EXTREMITIES
Lieutenant Colonel John B. Flick, Medical Corps, United States Army, Fort Douglas;
Surgical Consultant, Ninth Service Command.
NAVY WAR SURGERY
Captain Charles G. McCormack, Medical Corps, United States Navy, Bremerton, Washington; Executive Officer, Puget Sound Naval Hospital.
TREATMENT OF COMPOUND FRACTURES
Major Clinton L. Compere, Medical Corps, United States Army, Temple, Texas; Mc-
Closkey General Hospital.
PENICILLIN THERAPY
Major Wayland K. Hicks, Medical Corps, United States Army, Spokane; Baxter General
Hospital.
MEDICAL SERVICE IN INDUSTRY
Leon L. Goodnow, M.D., Aberdeen; Consultant, Department of Labour and Industries,
State of Washington.
EMERGENCY MEDICAL SERVICE IN WARTIME DISASTERS
W. P. Dearing, M.D., Senior Surgeon, United States Public Health Service, Washington;
Chief Medical Officer, United States Office of Civilian Defense.
EXPANSION OF THE PROGRAMME OF GRADUATE TRAINING IN SURGERY
AND THE SURGICAL SPECIALTIES BY THE AMERICAN
COLLEGE OF SURGEONS
Malcolm T. MacEachern, M.D., Chicago; Associate Director, American College of Surgeons.
BANQUET ROOM, 6:15 p.m.
(A. B. Schinbein, M.D., Vancouver;
Governor, American College of Surgeons, Moderator)
DINNER-FORUM SESSION FOR PHYSICIANS, SURGEONS AND
HOSPITAL REPRESENTATIVES
The Dinner will be followed by a Forum with all speakers on the programs for the
Medcial Profession and the Hospital Conferences (names listed below) as the Panel of
Experts. There will be discussion of any and all subjects presented during the day,
together with related topics of interest to the medical, hospital, and other groups attending the War Sessions.
Major Clinton L. Compere, Medical Corps, United States Army, Temple, Texas; Mc-
Closkey General Hospital.
Captain Charles G. McCormack, Medical Corps, United States Navy, Commanding
Officer, United States Naval Hospital, Puget Sound, Washington.
W. P. Dearing, M.D., Senior Surgeon, United States Public Health Service, Washington;
Chief Medical Officer, United States Office of Civilian Defence.
Air Commodore J. W. Tice, Ottawa; Director of Medical Services, R.C.A.F.; Member,
Canadian Procurement and Assignment Board.
Colonel John B. Flick, Medical Corps, United States Army, Fort Douglas; Surgical Consultant, Ninth Service Command.
Major Wayland K. Hicks, Medical Corps, United States Army, Spokane; Baxter General
Hospital.
Leon L. Goodnow, M.D., Aberdeen; Consultant, Department of Labour and Industries,
State of Washington.
Page One Hundred and Forty-six Malcolm T.  MacEachern, M.D.,  Chicago;  Associate Director,  American College of
Surgeons.
Percy Ward, Vancouver; Inspector of Hospitals for British Columbia, Department of the
Provincial Secretary.
R. A. Seymour, M.D., Vancouver; Assistant Superintendent, Vancouver General Hospital.
Sister Columkille, R.N., Vancouver; Superintendent of Nurses, St. Paul's School of
Nursing. /
Thomas W. Walker, M.B., Victoria; Superintendent, Provincial Royal Jubilee Hospital.
George F. Strong, M.D., Vancouver; Chief, Cardiac Clinic, and Director, Outpatient
Department, Vancouver General Hospital.
Alice L. Wright, R.N., Vancouver; Registrar, Registered Nurses' Association of British
Columbia.
E. M. Palliser, R.N., Vancouver; Director of Nursing, Vancouver General Hospital.
Mrs. R. C. J. DeSatge, Vancouver; Provincial Commandant, Red Cross Corps, British
Columbia.
Allan L. Willard, Seattle; Regional Representative of Government Division, War Production Board.
W. G. Welsford, Vancouver; Executive Director, Associated Hospital Services of British
Columbia.
Wing Commander G. W. Dunn, R.C.A.F., Ottawa; Executive Secretary, The Dependents' Board of Trustees.
PROGRAMME FOR HOSPITAL CONFERENCE
8:30—9:30 a.m., MAYFAIR ROOM
MILITARY MOTION PICTURES:
Activities of the Medical Department of the United States Army in Theatres of Operation.   Produced by the Army Service Forc.es, War Department.
Medical Activities and Installations of the United States Navy in the South Pacific;
The Medical Department of the United States Navy in Amphibious Assault.    Produced for the Bureau of Medicine and Surgery, United States Navy.
9:30—11:30 a.m., SALON B
Thomas W. Walker, M.B., Victoria; President, British Columbia Hospital, and
Superintendent, Royal Jubilee Hospital, Presiding.
Opening Remarks by the Chairman: Serving our Patients in Wartime.
Discussion of Wartime Hospital Problems from the Standpoints of:
1. How Hospitals are Meeting the Increased Demands for Service under Wartime
Condition.—Percy Ward, Vancouver; Inspector of Hospitals, Department of
the Provincial Secretary.
2. Maintaining Standards of Professional Services with Special Reference to Medical
Records, Medical Staff Conferences, and Adjunct Diagnostic Services.—R. A.
Seymour, M.D., Vancouver; Assistant Superintendent, Vancouver General Hospital.
3. Maintaining Standards of Nursing Service under Wartime Conditions.—Sister
Columkille, R.N., Vancouver; Superintendent of Nurses, St. Paul's School of
Nursing.
4. Maintaining Adequate Professional and Nonprofessional Personnel under Wartime
Condition.—Thomas W. Walker, M.B., Victoria; Superintedent, Royal Jubilee
Hospital.
Tage One Hundred and Forty-seven 5. What Hospitals Can Do to Provide Graduate Training for Returned Medical
Officers.—Malcolm T. MacEachern, M.D., Chicago; Associate Director, American College of Surgeons.
(Discussion of the above topics will be continued at the afternoon Round Table
Conference and the Dinner-Forum in the evening).
11:30 a.m.—12:00 noon, MAYFAIR ROOM
Wartime Problems in Communicable Disease Control.—W. P. Dearin
Surgeon, United States Public Health Service, Washington.
M.D., Senior
12:15—2:00 p.m., SALON A
LUNCHEON FOR PHYSICIANS, SURGEONS AND
HOSPITAL REPRESENTATIVES
George E. Seldon, M.D., Vancouver; Surgeon-in-Chief, Vancouver
General Hospital, Presiding.
Current Problems in Medical Manpower for the Armed Forces, Hospitals, and the
Civilian Population.—Air Commodore J. W. Tice, Ottawa; Director of Medical
Services, R.C.A.F., Member, Canadian Procurement and Assignment Board.
2:15—5:30 p.m., SALON B
Round Table Conference: Relation of Government Agencies and Voluntary Organizations to Hospitals in the Solution of their Wartime Problems.
Conducted by A. K. Haywood, M.D., Vancouver; General Superintendent,
Vancouver General Hospital.
Medical Education—Interns and Residents.—G. F. Strong, M.D., Vancouver;  Chief,
Cardiac Clinic; Director, Outpatient Department Vancouver General Hospital.
Nursing Education.—Alice L. Wright, R.N., Vancouver; Registrar, Registered Nurses'
Association of British Columbia.
Nursing Service.—E. M. Palliser, R.N., Vancouver; Director of Nursing, Vancouver
General Hospital.
Volunteer Services.—Mrs. R. C. J. DeSatge, Vancouver; Provincial Commandant, Red
Cross Corps, British Columbia.
Priorities—Hospital Equipment and Supplies.—Allan L. Willard, Seattle; Regional Representative of Government Division, War Production Board.
Protective Services.—W. P. Dearing, M.D., Senior Surgeon, United States Public Health
Service, Washington.
Postwar Planning.—A. J. Hockett, M.D., Seattle; General Superintendent, King County
Hospital.
Plan for Hospital Care.—W. G. Welsford, Vancouver; Executive Director, Associated
Hospital Services of British Columbia.
Relation of the Dependents' Board of Trustees to Hospitals.—Wing Commander G. W.
Dunn, R.C.A.F., Ottawa; Executive Secretary Dependents' Board of Trustees.
Questions may be submitted in advance by hospital executives, which will be presented at the conference. In addition, an opportunity will be afforded all present to
submit for discussion any additional questions or topics to the panel of leaders in the
various organizations represented. It is hoped that this session will be a clearing house
for wartime problems of immediate concern to hospitals.
Page One Hundred and Forty-eight AMERICAN COLLEGE OF SURGEONS
ONE DAY WAR SESSION
The Meetings to be held in VANCOUVER at the HOTEL VANCOUVER on
TUESDAY, APRIL 18th (all day) are part of a series of War Sessions being held in
centres throughout Canada and the United States.
Through the kindness of this organization these sessions are open to all members of
the Medical Profession in British Columbia. An excellent programme has been announced
and you are cordially invited to attend.
Those residing in the Kootenays will please note that sessions will be held at the
Davenpor{: Hotel in Spokane on Friday, April 14th. It is hoped that all who can will
come to Vancouver, and plan to attend the Special General Meeting on Health Insurance
of the British Columbia Medical Association on Wednesday, April 19th.
OSLER LECTURE
The Osier Lecture for 1944 was delivered on March 7th, 1944, by Dr. T. H. Lennie,
at the Hotel Georgia, before an audience which included a great many men from out
of town, especially from Victoria. All this was a well-merited tribute to the speaker,
who is widely known in this Province as an authority on his subject, which was "Goitre."
His address held his hearers' close attention, and was in every way worthy of the traditions of the Osier Lecture in Vancouver.
Dr. Lennie was introduced by Dr. W. D. Keith, the first man to deliver the Osier
Lecture here. Dr. Keith gave a brief resume of the history of the Lecture, which is the
twenty-second of the series, having been inaugurated in 1921. He referred to his personal knowledge of the great medical luminary whose name the Lecture bears, and by
anecdote and person reminiscence brought out some of the traits of character which not
only made him one of the great men of history, but also endeared him to all who came
in contact with him, and warmed their hands at his blaze.
Dr. Keith referred specially to D^r. Osier's benefactions to the Vancouver Medical
Association, his unfailing interest and enthusiasm for anything that betokened a quickening of the scientific spirit in medical men, and his power to evoke the best in those whom
he met and counselled.
Dr. D. E. H. Cleveland then gave an account of the origin of the Osier Plaque, and
introduced the Osier Lecturer, Dr. T. H. Lennie.
Dr. Lennie, in his Osier Lecture, which is printed below, adopted, as we think, a
wise course. He did not give a lecture on Goitre, nor a text book disquisition. Rather,
he followed the Oslerian tradition of seeking to know the normal by a close study of
the abnormal. He quoted some four cases, each a museum piece, each a fertile source of
lessons in the physiology and pathology of the thyroid gland—each an album, from
which one could get abundant inspiration and food for thought. The delivery was to
some extent helped by slides and illustrations—but the speaker had so thoroughly worked
up his cases, and gave his reports so graphically and concisely, that illustration was not
altogether necessary, though it added greatly to the effectiveness of the paper.
So ended a memorable'evening, the pleasure and interest of which were enhanced
by the presentation of the P.G.F. degree to Dr. Wallace Bagnall. Unfortunately, Dr.
Bagnall has been ill, and was unable to attend in person to receive this degree, or heai
the applause which so spontaneously greeted the announcement of his name as recipient
—but in a graceful letter he acknowledged the honour, and thanked us for it.
Page One Hundred and Forty-nine THE OSLER LECTURE
tt
»
GOITRE
T. H. Lennie, M.D., CM., F.R.C.S.(C), F.A.C.S.
Delivered before the Vancouver Medical Association, March 7th, 1944.
One wonders just what influenced our Executive Conimittee in its selection of the
Osier lecturer for this year. Could it be that in this age of commodity shortages it
found a paucity of talent so great that it turned in desperation to one who has no flair
for essay composition, but hoped that the present lecturer, with approximately thirty
years association with the profession in Vancouver, might, as a result of this lengthy
experience, have something to contribute on such an occasion.
Whatever consideration may have led to its decision, I can assure you that I am
deeply conscious of the great honour that has been conferred upon me, and in memory
of the great physician it is our pleasure once a year to honour in this manner, and of
that galaxy of talent which has preceded me in this capacity,. I approach my task with
the deepest humility.
Unlike some of my predecessors, I can lay no claim to personal contact with the late
Sir William Osier, for McGill and Canada lost him to the University of Pennsylvania a
few years before I was born. The only things I can find we have in common are these
—that he, in a large family, was the youngest son of a clergyman, and that his father
y and mine were both ministers in Dundas, Ontario, thought of course at different times.
At this point any similarity ceases to exist. My early medical training, however, was
under some of those who were his contemporaries, and others who were steeped in the
Oslerian influence. Frankie Sheppard, a surgeon of Osier's day, in my time was Professor
of Anatomy. Dr. LaFleur, like Osier an illustrious son of a distinguished Canadian
family, was my chief in Medicine at the Montreal General Hospital for all too brief a
. period. Maud Abbott, curator of the Pathological Museum at McGill, always spoke of
Osier with reverence. These and many others carried over the Osier tradition to my
generation.
Of Osier's stay in Montreal, Dr. Harvey Cushing has this to say:—"During the short
span of years since his McGill appointment, he had stirred into activity the slumbering
Medico-Surgical Society; he had founded and supported a students' medical club; he had
brought the Medical School into relation with the University; he had introduced the
modern methods of teaching physiology; he had edited the first clinical and pathological
reports of a Canadian hospital; he had recorded nearly a thousand autopsies and made
innumerable museum preparations of the most important specimens; he had written
countless papers, many of them ephemeral it is true, but most of them on topics of live
interest for the time, and a few of them epoch-making; he had worked at biology and
pathology, both human and comparative, as well as at the bedside; he had shown courage in taking the smallpox wards, charity in dealing with his fellow physicians, in and
out of his own school, generosity to his students, and fidelity to his tasks; and his many
uncommon qualities had earned him popularity unsought and of a most unusual degree."
Even in far western Vancouver, for such it was in Osier's day, one finds a letter and
donation to the Vancouver Medical Library. This letter, which is framed and at present
hanging in the reading room of our library, was written from Oxford on February 1 Oth,
1908, and addessed to the late beloved Dr. J. R. Pearson. It is just another illustration
of the universality of Osier's interests and benefactions. In this letter, after stressing
the importance of a medical library and suggesting the collection of donations from
fellow citizens, Sir William says this:—"Tell some of the members from me, please, that
money invested in a library gives much better returns than mining stock." I can hear
some of my confreres echoing a loud "Amen."
"The Principles and Practice of Medicine" by Sir William Osier, was in my day,
and I suppose still is, the medical students' Bible.    In my copy, the eighth edition pub-
Page One Hundred and Fifty lished in 1912, the author in discussing diseases of the thyroid gland, speaks of them
under the following headings:—
(1) Congestion
(2) Thyroiditis
(3) Tumors of the thyroid
(4) Aberrant and accessory thyroids
(5) Goitre (struma, bronchocele)
(6) Hypothyroidism
(7) Hyperthyroidism.
His appreciation for surgery in certain lesions of the thyroid is pretty well that
accepted today. Commenting on his text book and his surgical judgment, Dr. Cushing
writes:—
"The paragraphs of his text book which deal with Therapeutics, critics had regarded
as the weakest features of the volume, and his courageously expressed views upon the
futility of many of the drugs in common usage had been deemed nihilistic. Perhaps
because of this, perhaps because of his unusual powers of visualizing disease, gained in the
post-mortem room, he was far more tolerant than most of his contemporaries with the
so-called surgical invasion of the traditional province of Internal Medicine which took
place during the next twenty years. He knew surgeons well, and their particular point
of view, and it has been said of him that few physicians have ever shown better surgical
judgment or had a more instinctive and certain knowledge of the proper moment for
surgical intervention."
But to return to the thyroid—
In 1935 we had the good fortune to hear Dr. Wallace Wilson, the Osier lecturer of
that year, speak on the subject "Concerning Goitre and the Background of Its Ancient
History." That subject was beautifully and exhaustively covered. Among those who
laid the foundation for the modern surgical management of the disease, a few names
stand out most prominently—Theodor Kocher of Berne, Switzerland; George Crile of
Cleveland; Charles H. Mayo and Plummer of the Mayo Clinic.
Kocher is credited by Garrison with being the first to excise the thyroid for goitre
in 1878, though this is probably historically inaccurate. He did, however, perform this
difficult operation two thousand times by 1901 with a mortality of only 4J4 per cent.
The fact that he was table to keep his mortality to that figure suggests that he was operating on a large number of colloid goitres which are so prevalent in Switzerland. In
fact only twenty-four of these were for exophthalmic goitre. The next statement, that
out of his first one hundred thyroidectomies thirty developed Cachexia Strumipriva or
Myxoedema, would also bear this out, and also that his operation was pretty radical.
These, and the following few years, constitute what Pemberton has called "The period
of trial and error."   The mortality in cases with hyperthyroidism was high.
Following this era surgical leaders like Crile and Charles Mayo sought a way to lower
the mortality rate, and developed the multiple stage operation. It was found that after
ligating one or more of the thyroid vessels the patient showed marked improvement and
could tolerate partial thyroidectomy much better. As many as four operations were
sometimes employed. Crile added to this his method of "stealing" the thyroid by administering oxygen daily in the patient's bed, and then one day adding nitrous oxide and
proceeding with his operation, either a ligation or lobectomy. As late as 1927, when I
spent some time at the Cleveland Clinic, Crile was still operating on all thyroid cases in
their beds, and doing a fair number of multiple operations.
In 1913 Plummer recognized that hyper-function of the thyroid gland occurs in two
distinct clinical entities, exophthalmic goitre and adenomatous goitre, with hyperthyroidism.
In 1922 Plummer established the value of the administration of iodine to patients
with exophthalmic goitre who were under preparation for operation.   In this connection
Page One Hundred and Fifty-one I would like to quote from his Charles Mayo lecture of 1936, as follows:—"Thus began
the third, or Todine period' in the development of surgery of exophthalmic goitre. Since
the changes wrought have been revolutionary in character this may more properly be
termed the 'iodine era.' Its effect may be briefly summarized as follows:—Achninistration
of iodine controls the spontaneous crisis of the disease, and thereby has practically eliminated the medical mortality of patients under preparation for surgery. It should be
emphasized that its effect is temporarily ameliorative, not curative, for experience indicates that its prolonged use offers little hope of effecting permanent cure. In a large
proportion of cases the adniinistration of iodine for a period of seven to ten days causes
abatement of all symptoms of the disease and this has resulted in a smoother post-operative convalescence, uninterrupted by the occurrence of explosive reactions. Because of
this, the need for preliminary surgical procedures, such as ligation, has been almost completely abolished and the mortality rate has been greatly reduced, to less than one per
cent."
As a result of these developments, thyroid surgery has for some years rested-on a
solid foundation. It is not my intention tonight, however, to pursue this hackneyed
subject further, but rather to present to you four rare cases that have come under my
observation during the past few years. A few of you know of some of these cases, and
to you I would offer an apology and hope that you will bear with me in their presentation.
The first case is of a girl twelve years of age I saw in consultation with Dr. Spohn
in November, 1937. The case history as given by Dr. Spohn in the Bulletin of the
Vancouver Medical Association of January, 1939, is so complete that I shall repeat
it verbatim.
"R.S., female, Cretinism. First seen in May, 1926, when the child was seven months
old. Family history negative. Both parents in good health and above average intelligence. Residence, Ashcroft, B.C. There are no other children in the family. Physical
examination showed an infant of seven months, weighing twelve pounds, with an unintelligent expression, a dry skin, flaccid muscles, poor hand grip, protuberant abdomen
and a large umbilical hernia. Although underweight there was evidence of myxoedema
and the hands were square and pudgy with wrinkled cedematous wrists. The pupils
reacted to light but the eyes followed objects very slowly; the eyes were not almond
shaped and the longitudinal eye slit did not incline toward the inner canthus as is characteristic in Mongolian Idiocy. There was a slight systolic murmur. In spite of the
enlarged heart, the circulation did not give much evidence of embarrassment except for
cold extremities. This child was placed on thyroid therapy, but for several reasons contact was not maintained and there was an interval of ten years before the patient came
to Vancouver. During this interval thyroid therapy was maintained, but not in sufficient dosage, so that the physical and mental development did not attain to as great a
degree as it might have. In January, 1936, the child was unintelligent in appearance,
but the answers to questions and other tests showed her mental age to be only about two
years below normal. At this time a cyst about the size of a small hen's egg was present
on the right lobe of the thyroid. The heart was still enlarged. The thyroid dose was
increased and she was asked to report in a few months. She did not return to Vancouver
until August, 1937, and I did not see her as I was away. At this time the cyst had
increased in size and another cyst had appeared in the left lobe, and the mother had
consulted an internist and surgeon in regard to removal of the thyroid. At this time
her physical condition and the enlarged heart caused the surgeon to advise against operation at that particular time. In November, 1937, the patient returned to Vancouver
on account of pressure symptoms from the rapidly growing cysts. The right cyst was
about as large as a Japanese orange and the left cyst slightly smaller. There was a great
deal of dyspnoea especially on exercise, and it was evident that the patient could not go
along much farther without an operation. She was put to bed for ten days; an electrocardiograph taken showed only right axis deviation; and Doctor Lennie removed the
thyroid on December 7, 1937."
Page One Hundred and Fifty-two The operation itself presented no particular technical difficulties. Both adenomata
were removed completely, the right one occupying the entire lobe and the left almost
the entire lobe. On this side there was a small amount of normal appearing thyroid
tissue which was preserved. The adenomata in the gross had rather a rubbery consistency and on section seemed to be solid tumour.
Sections of this gland were examined by two pathologists in Vancouver, Dr. McNair
of St. Paul's Hospital, where the operation was performed, and Dr. Pitts of the Vancouver General Hospital, and both agreed that this was a malignant process. Slides were
submitted also to Dr. Broder of the Mayo Clinic. His report was "Carcinoma of the
thyroid, malignant, grade two."
Operation was followed by deep x-ray therapy.
Regarding the frequency of carcinoma of the thyroid in children, search of the
literature up to 1935 revealed only fourteen reported cases under fifteen years of age.
This girl was last seen in October, 1943, at eighteen years of age, and was quite well
with no evidence of recurrence.
Case No. I.
Preoperative.
1 l/z years post operative.
The second case is that of a part Indian dwarf twenty-three years of age, who was
admitted to the Vancouver General Hospital August, 1941, with a B.M.R. of -f-100%.
His weight at that time was eighty-two pounds, pulse 160, and B.P. 150/85. His complaints were shortness of breath, nervousness, loss of weight, and hoarseness extending
over approximately one year's time. The Intern's notes in rgard to his thyroid gland
are as follows: "The whole thyroid is grossly enlarged, practically filling both triangles
on either side of the neck. The right lobe seems somewhat larger than the left. The
isthmus is greatly enlarged. There is an easily palpable thrill at the right upper pole and
over most of the left lobe.   There is marked pulsation of the vessels of the neck."
The most striking feature of this patient, however, is the skeletal development. There
is practically no neck. The left scapula is undescended-, occupying the left supraclavicular region, the so-called Sprengel's shoulder. Movement of the head is extremely limited.
The dorsal and cervical spines seem to be fixed.
X-ray examination reveals a large mass involving the thoracic inlet below the level
of the clavicles.
Radiologically "there is marked elevation of the left scapula, its superior angle
reaching to the level of the angle of the jaw. The right scapula appears to be in satisfactory position. The first and second cervical vertebrae appear to be subluxated
slightly backwards upon the third as far as the bodies are concerned, though this appearance may be due to lack of development of the body. The third, fourth, and fifth cervical Vertebrae appear synarthrosed and this is continued down to the first dorsal verte-
Page One Hundred and Fifty-three
1 bra which is divided almost completely in two throughout its body as is also the seventh cervical." Our Radiologist, Dr. B. J. Harrison, says this:—"The deformities which
this patient exhibit appear to be a combination of Sprengel's shoulder, Klippel-Feil syndrome and pterygo-nuchal deformity."
From the above description it will be seen that the surgical approach to this thyroid
presented considerable difficulty. He was, however, prepared in the usual way and our
hospital instrument-maker made for me a special sternal knife which I tried out on a
cadaver.
The B.M.R. gradually came down to a low of -{-40%, about which time the patient,
fortunately or unfortunately, developed a temperature, cough, and bloody sputum. This
naturally upset all our plans, and following his recovery from this acute illness, he was
given X-ray therapy to his thyroid. To our surprise his response was most satisfactory
and before leaving the hospital his B.M.R. was -f~3%, his weight 96l/z pounds, and his
pulse in the 70's.
The X-ray report at that time was as follows: "There is no evidence of intrathoracic
goitre, and the density in the suprasternal region has diminished since the previous examination."
A year later we re-admitted this patient for examination and found his condition, as
far as the thyroid was concerned, to be quite satisfactory; his B.M.R. -f-10%, weight
99/2 pounds, and pulse of 70. His thyroid could not be palpated and the X-ray was
negative.
A letter received from .this boy in December, 1943, would indicate that there are
no symptoms of hyperthyroidism, and he gives his weight as 116 pounds.
I do not wish to convey the impression that I am advocating X-ray treatment of
hyperthyroidism generally, but in this particular case it proved to be a happy issue out
of all our difficulties.
In British Columbia we are seeing an increasing number of goitres in the Oriental
population. This disease among these people was unheard of a few years ago. At the
present time the incidence is relatively common and the cases are apt to be extremely
toxic.
On July-24, 1940,1 operated upon a Chinaman in his forties, for a substernal thyroid
adenoma the size of a large orange. The Pathologist reported it as a fcetal adenoma.
While it appealed suspiciously malignant in the gross, microscopically it was one of the
so-called pure fcetal type of adenomata. At this time there was some deformity of the
trachea. His condition remained quite satisfactory until July, 1941, when he began to
have some respiratory difficulty and coughed up some blood. He was advised to return
to the city and came under my observation again, the end of December, 1941. At this
time he showed considerable loss of weight. There was very definite stridor. The external muscles of respiration were very active and breath sounds greatly diminished. A
tentative diagnosis of intratracheal growth was made. Bronchoscopic examination by Dr.
W. E. Harrison revealed a growth in the trachea about 2 inches below the larynx. This
tumour acted partially as a ball valve and during expiration the tracheal opening was
represented by only a slit. A biopsy, to our surprise, revealed only normal epithelial
tissue. Lipiodol was later injected and the trachea was seen to be markedly kinked to
the left, suggesting a tumour outside and to the right of this organ.
On January 10 th exploration of the neck was done. On the morning of this day the
patient brought up more blood than usual and a definite tumour could be palpated low
down in the neck and to the right of the trachea.
An incision was made through the old scar and the flaps dissected. The strap muscles
and fascia were then divided vertically and a hard mass about the size of a walnut felt
low in the neck and to the right of the trachea. It was freed from surrounding tissue
with difficulty and was found to continue behind the trachea. On cutting the thyroid
mass on its inner aspect a cartilaginous ring appeared in the thyroid tissue and on
removing the thyroid adenoma it was found that the trachea had been opened on its
lateral aspect.
Page One Hundred and Fifty-four Case No. II.
Showing Sprengel's shoulder.
The same lateral view.
Showing cercival subluxation. Showing division of the bodies of the
seventh cervical and first dorsal
vertebrae.
The lumen of the trachea was then explored and a pedunculated polyp about the
size of the end of the little finger was removed. The rent in the trachea was then sutured
with chromic catgut, the sutured area covered over with tissue borrowed from one of
the strap muscles, and a tracheotomy performed below the site of the adenoma. A Penrose drain was left in the right side of the neck. The muscles were sewn with chromic
catgut and the skin with clips.
Pathological Report, January 10, 1942:
"Tissues examined: Thyroid tissue.
"Macroscopic Examination: Specimen consists of a walnut-sized piece of what
appears to be thyroid tissue which has an adenomatous appearance and many dense fasciculi running through it. Attached to this is considerable dense fibrous tissue. Attached
also to the posterior and inferior surface of the above mentioned tissue is what appears
to be a piece of the trachea 3 cms. in diameter and there are adenomatous polypoid
growths coming from the. thyroid tissue and growing through into the trachea.   On
Page One Hundred and Fifty-five sectioning this, there is on one side firm cartilaginous-like tissue and, in the inferior
portion, a soft cellular mass which appears to He in or on the tracheal wall. Received
also is what appears to be grossly an adenomatous polyp the size of a pea, with two small
branching polypoid structures protruding from it, the size of barley grains. These are all
well encapsulated and on cut section have a smooth, uniform cut surface.
"Microscopic Examination: A very great many sections were taken through various portions of the tissue received and, for the most part, they are seen to consist of
thyroid adenomata of an intermediate fcetal type with considerable numbers of the
more immature pure fcetal type of acini, showing no, vesiculation, but these acini are
generally well circumscribed.
"In those sections taken through the portion of tissue which apparently were within
the tracheal lumen there is seen both this fcetal adenomatous type of structure and in
addition what appears to be definite malignant change in some of the adenomata. These
areas are characterized by generally sheet and cord-like masses of large, more deeply
staining cells, showing both pleomorphism and polymorphism, no attempt at acinar
arrangement and quite frequent' mitotic figures. In other areas composed of similar
cells there are aborted attempts at acinar formation. Definite infiltration into adjacent
tissues is noted and several of the sections are surmounted by a varyingly thick layer of
squamous epithelium, which in several areas shows definite erosion and considerable
haemorrhagic extravasation beneath these areas and the underlying fibrous tissue is infiltrated with these atypical cells. It gives the impression that the malignant adenomatous
tissue has infiltrated through the tracheal wall to produce a semi-polypoid structure
within the tracheal lumen. In one of the sections there is definite cartilaginous tissue
present, apparently from a tracheal ring.
"Diagnosis: Malignant adenoma of thyroid, infiltrating through tracheal wall to
produce a polypoid-like obstruction of the trachea."
Subsequent to operation, deep X-ray therapy was instituted and on February 13,
1942, a bronchoscopic examination was again done by Dr. W. E. Harrison, who reported
as follows: "On account of this man's history of an operation involving the trachea, a
small bronchoscope^was used. A 6 mm. Jackson bronchoscope was passed through a
Jackson laryngoscope without difficulty. Approximately one inch below the vocal" chord
the right-hand wall of the trachea is made up of red soft appearing tissue and no
tracheal rings are visible. The left-hand wall appears to be normal. There is a depression in the anterior wall of the trachea, probably due to the tracheotomy which was
done.   There is no evidence of tumor formation now."
In October, 1943, this patient again returned to the city for bronchoscopic examination. There was still no evidence of intratracheal tumor. However, he did exhibit
a very small tumor in the chest wall which was excised for microscopic study. This
was reported as a metastic thyroid tumor, which would confirm the suspicion of carcinoma in the original thyroid adenoma.
Case No. III.
On November 29, 1941, I was asked by Dr. J. R. Davies of the paediatric staff of
the Vancouver General Hospital to see a child, born seven days previously, regarding a
swelling in the baby's neck. Because of the similarity of this case to certainly one, and
possibly two more, in the same family, it will be necessary to discuss briefly the family
history.
The mother in 1941 was twenty-nine years of age, was born in Jugo-Slavia, has
lived in Canada for thirteen years, and has been married eleven years. The father, thirty-
eight years old, also a Jugo-Slavian, has been in Canada fifteen years. Their first three
children, normal males, delivered at full term in the years 1931, 1932, and 1935, are
all alive and well.
The fourth child, also a male, was born on October 15, 1936—normal delivery.
Immediately after birth the infant was dyspnceic and cyanotic. There was a large
bilateral mass connected by an isthmus occupying the anterior part of the neck.. The
mass was firm and movable.
Page One Hundred and Fifty-six Bronchoscopic view of Malignant
Thyroid Metastasis
View Following Removal
X-ray Report, October 19, 1936: "There is a large soft tissue swelling in the neck
which displaces the posterior wall of the pharynx markedly forward. It extends laterally
on either side of the hypopharynx and anteriorly so as to practically surround it. The
upper part of the trachea has been displaced forwards also and the laryngo-tracheal
junction is considerably deformed. The impression gained is that of a large mass with
more or less spherical nodules arising in the retropharyngeal tissues and extending forwards on either side of the trachea as well as the larynx. It does not suggest a thyroid."
On the ninth day (October 23), gavage was necessary as the child waa unable to
swallow.   The baby died of pressure asphyxia on the thirteenth day.
Autopsy Report, by Dr. H. H. Pitts: "There was a swelling in the neck which
proved to be a thyroid gland. A number of sections were taken through the thyroid
gland and these show very marked hyperplasia and hypertrophy of the acini. They are
tortuous, enlarged, for the most part; very few contain colloid material and the epithelium generally is of high columnar or cubo-columnar, frequently thrown into intra-
acinar papillary infoldings. This is a very definite picture of marked hyperplasia and
hypertrophy.
"Diagnosis: Marked congenital hyperplasia and hypertrophy of thyroid. There is
nothing particularly remarkable in the section through other organs beyond a diffuse
but early broncho-pneumonic process throughout both lungs.
The fifth child, also male, was born on August 28, 1938. On the eleventh postnatal day a swelling was noticed on the right side of the neck. Cyanosis and dyspnoea
also developed on this day and physical examination revealed enlargement of the heart.
On the twelfth day X-ray showed marked enlargement of the heart and enlargement of the supra-cardiac shadow. There was no displacement of the trachea. The child
received a treatment to the thymus.
Respirations became more difficult and cyanosis increased, and the child died on
September 24th.
Unfortunately no autopsy was performed, so that one has no proof that the thyroid
contributed to the baby's death.
On February 11, 1940, the mother gave birth to her sixth and first female child.
This child is still alive and does not appear abnormal in any way.
"Now to return to the child under discussion, the seventh, and a male, which was
born on November 22, 1941.
Examination revealed a week-old baby with slight duskiness of the skin and an
inspiratory stridor when crying. There was a mass on either side of the neck connected
by a firm band across the trachea. This was obviously thyroid.
Page One Hundred and Fifty-seven '■n'M X-ray Report, November 25, 1941—Dr. B. J. Harrison: "The trachea appeared to
be displaced grossly forwards at the junction with the larynx, this space appearing to be
approximately the size it normally is in an adult. It gives the impression that the mass,
palpable in the neck, extends behind the oesophagus and trachea."
My examination included inspection of this X-ray and also that of the fourth child
which died of pressure asphyxia on the thirteenth day. There was a remarkable similarity. In addition I, discussed wth Dr. Pitts, the Pathologist, the histological picture
of the thyroid removed at autopsy. He remarked as follows: "If I did not know that
this thyroid was from a new-born I would say that it was a typical Grave's disease."
The baby was being given sodium iodide, grains 1/3 once daily.
As a result of all these investigations, my note on the consultation slip of November
29, 1941, was as follows: "Suggest stepping up sodium iodide to grains 1/3 t.i.d. If
signs of compression develop the neck should be explored."
Some of the notes recorded subsequently are as follows: December 1st. Child is
rather listless at times. Slight stridor noticeable on crying and there is considerable
gurgling in the throat. December 2nd. Listlessness is more noticeable; child cries very
little, but when he does, cyanosis is evident. Breathing is somewhat noisy and labored
and there is some difficulty in swallowing. December 3rd. Cyanosis and stridor are
becoming more marked and the mass in the neck appears to be enlarging and firmer.
My own impression on this day, December 3rd, was that the child was definitely
worse and I advised thyroidectomy. This was performed the following morning, viz.
December 4th, when the child was thirteen days old.  My operation report follows:
"Under intratracheal ether anaesthesia, the usual collar incision was made, the flaps
dissected and the fascia and muscles divided longitudinally. Retraction exposed a large
thyroid isthmus together with an enlarged right and left lobe.
"Between mosquito haemostats the isthmus and a portion of both lobes was resected
and the trachea freed. All bleeding points were tied. There was a nodule on the right
side about the size of a golf ball which was lying posterior and lateral to the trachea.
This was delivered with Lahey forceps.
"After consultation with the anaesthetist, who expressed the opinion that the child
was quite pale, it was decided to discontinue the operation and either trust to idoine to
shrink the remaining portion of the gland or to remove this nodule at a subsequent
operation. A small Penrose drain was inserted into the wound, the muscle closed with
fine chromatic catgut, and the skin with dermal. A blood transfusion followed the
operation.
The post-operative course, with the exception of the second day, when it was necessary to aspirate some mucus from the trachea, was uneventful. Sodium iodide was
continued until January 4, 1942, when Lugol's solution, minims ii daily, was administered-. During this time the remaining part of the thyroid gland was gradually diminishing in size.
The baby was examined at intervals up to October, 1943. He is a beautiful child,
normal in every respect.  The thyroid cannot be palpated.
Pathological Report of Thyroid Gland. Microscopic Examination: "A number of
sections were taken at different levels through the gland and they show it to consist of
large and smaller acini,' practically all containing colloid material and lined by single
layers of cuboidal epithelium. In a considerable number of instances there are definite
papillary infoldings of the lining epithelium, suggesting previous hyperplasia, and some
of the acini are quite dilated, almost cystically dilated, and there are a few rather broad
fibrous bands interspersed throughout, in which some lymphocytic infiltration is present.
The histological picture is somewhat suggestive of a subinvolution stage in a previously
hyperplastic thyroid gland.
"Diagnosis: Subinvolution stage in a previously hyperplastic thyroid."—H. H. Pitts.
A.few more words regarding the mother.   When I saw her about ten days postpartum one got the impression that she was hypothyroid—her B.M.R. at this time was
Page One Hundred and Fifty-eight —%%
ot„
She gave a history of developing severe asthma in 1934 and still has attacks,
though less severe.   She administers adrenalin to herself when these attacks occur.
She had an enlargement of the thyroid which I took to be an adenoma.
No prenatal iodine had been taken, as she says three doses during one pregnancy
aggravated her asthma.
It occurs to one to enquire what effect adrenalin had in the production of a hyperplastic thyroid in the fcetus, but on further investigation one learns that while she was
carrying her sixth and only female child the asthma was particularly bad, necessitating
the use of considerable adrenalin.
A comparison of the pathological reports of the autopsied gland and that of operation is very interesting. The first is typically hyperplastic, and the second, a subinvolution stage of hyperplasia; in other words, the untreated and treated Grave's disease. You
will recall that our child received considerable iodine preoperatively, and this is the
report one receives in a gland properly prepared for surgery.
And now to justify my operation. It might be maintained that this gland would
have receded by the exhibition of iodine in large enough doses and over a long enough
time—witness the behaviour of the gland postoperatively. My reply is that, having in
mind the unfortunate experience in other babies in the family, and having no precedent
to guide us as to dosage, and that the babyfs condition was worsening, justification for
operation was for the relief of pressure. Resection of the isthmus and a portion of each
lobe was sufficient to relieve that pressure.
Interesting speculation might be indulged in as to why hyperplastic congenital glands
should develop in these particular children. One comes to the conclusion that the
mother must of necessity be suffering from a deficiency of thyroxin and this factor produced a compensatory hyperplasia in the fcetus. As to why this type of gland should
have been produced in male children only, one who admits a woeful ignorance of genetics might be excused for suggesting that, as the mother's chromosomes predominate in
the male child, the explanation may lie therein.
After writing the above paragraph I felt that one should make some attempt to
justify such an hypothesis, and to this end, I consulted Professor A. H. Hutchinson, head
of the Department of Biology at the University of British Columbia. I would like at
this point to record my thanks to Dr. Hutchinson for his kindness, the intense interest
he showed in the problem, and for his exhaustive search of the literature. He expressed
the opinion that in many respects this case was unique, and that he could find no record
of a parallel case.   In fact the literature is not very helpful.
In regard to the thyroid and inheritance, he kindly prepared a few abstracts which I
shall give you now. Some of these you will note were the reverse of the case here
reported.
Hyperthyroidism—Recent Discussion
Cameron, A. T., Recent Advances in Eindocrinology, P. Blakeston & Co., Philadelphia, 1935 (second edition)—a more recent edition published—p. 8-237. An extensive list of references is given. An excellent summary of the classification of thyroid
and parathyroid abnormalities and their treatment. There is no mention of inheritance
and the slightest reference to congenital features.
Means, J. H., The Thyroid and Its Diseases, J. B. Lippincott & Co., 602 pages, 73
figures, Philadelphia, 1937. Written in collaboration with the physicians and surgeons
of the Thyroid Clinic of the Massachusetts General Hospital, largely based on clinical
experience gained at this Institution.
"The pituitary control of the thyroid is relative, not absolute, there being other factors (internal) in the regulation of its functioning, even in the production of disease."
There seems to be no mention of inheritance. (Biol. Abs. 9689, 1938).
Page One Hundred and Fifty-nine Case No. IV.
Trachea displaced forward by thyroid
mass.
Pre-operative.
Pre-operative.
22 months post-operative.
Page One Hundred and Sixty 1
Congenital Goitre in Man and Animals—
Recent Publications
1. Man.
Wespi, H. J., Die Verhutung des Neugebornenkropfes, Schweig Med. Wochenchr,
70 (39) 925-928, 1940.  Reported in Biol. Abs. 10448, 1941.
In an upland district of Switzerland, where goitre was prevalent, pregnant females
were provided with iodized salt regularly (10 mg. Kl per kg. of common salt), with
additional Iodine prophylaxis as required. The frequency of goitre in the new-born
dropped from 50% to 5.3%.
2. Camel.
Finkelstein, L. E., Congenital, macro-follicular, cystic goitre in a dromedary, Zoo-
logica (New York), 24 (3), 289-292, 1939.  Biol. Abs. 1193, 1940.
This rare form of congenital goitre occurred in a full grown, still-born dromedary.
The thyroid follicles were enormously dilated. The maternal thyroid gland at autopsy,
16 months later, revealed a marked parenchymatous hyperplasia.
3. Rats.
Cunningham, Bert, Cretinoid progeny from hyperthyroidized rats, Jour. Elisha
Mitchel Sci. So., 57, 85-90, 1941. Biol. Abs. 6777, 1941.
Females, hyperthyroidized by feeding low iodine food, tend to produce cretinized offspring. In this case the ratio of cretinized offspring to normal was 65:42. Evidence in
offspring of cretinism—slower growth, reduced size of thyroid, lower metabolic rate,
slower heart rate.
In addition, some of you will recall the excellent work reported some years ago by
our own colleague and first Osier lecturer, Dr. W. D. Keith, in reference to the incidence of goitre in new-born animals in the Pemberton Meadows district of British Columbia.
To add to our confusion, this mother recently gave birth to a perfecly normal male
child.
And so we come to the end of our clinical presentation, hoping that there is enough
pathology in it to justify including it in an Osier lecture, for it was with a comprehensive knowledge of pathology that Osier laid the foundation for his brilliant medical
career.
Sir William Osier was not only a great physician, he was also a great teacher, a
great writer, a friend of little children, and a counsellor to his students and younger colleagues. His interest in medical schools, hospitals, pathological museums and libraries,
both lay and medical, was universal. One of his outstanding attributes was leadership.
This was manifest in him as a schoolboy in Ontario, during his early life as a physician
in Montreal, on through Philadelphia, Baltimore, and finally at Oxford. This quality
probably reached its zenith while he was at Baltimore.
Were he a resident of British Columbia today, one wonders what his reaction would
be to the proposed regimentation of the medical profession under Health Insurance or
State Medicine, toward which we seem to be heading at the present time. There can be
no doubt, however, as to the part he would play in the organization of a medical faculty
at our own University. He would supply the necessary inspiration and leadership for
that undertaking.
One catches a glimpse of the stature of the man in the words of Professor Adami
upon the death of Sir William Osier on December 29th, 1919: <fSo passed into history,
untimelv, even though he had attained unto the allotted span, the greatest physician in
history."
Page One Hundred and Sixty-one SPECIAL GENERAL MEETING — HEALTH INSURANCE
The SPECIAL GENERAL MEETING of the BRITISH COLUMBIA MEDICAL
ASSOCIATION will be held on WEDNESDAY, APRIL 19th, at 8.00 p.m., in the
BANQUET ROOM, HOTEL VANCOUVER.
The members are urged to attend this Special Meeting to discuss Health Insurance.
The Committee on Economics of the British Columbia Medical Association has requested
the Board of Directors to arrange for a large meeting of the profession to consider the
opinions which should be advanced by the profession of this Province, and if possible
adopt principles which the members can unanimously support. These opinions will be
presented to the Canadian Medical Association. The Committee on Economics has
drafted Twenty Principles and Eight Important Comments for consideration.
LIBRARY NOTES
RENEWALS FOR THE NELSON LOOSE-LEAF MEDICINE:
Vol. 1.
Page 7: Infections and Immunity, by Augustus B. Wadsworth.
Vol. 2.
Page 131: Tetanus, by Willard J. Stone and Paul M. Hamilton.
Page 208A: Gonorrheal Infections: Recent Progress, 1943, by Howard S. Jeck.
Page 238A: Erythema Arthriticum Epidemicum (Haverhill Fever) by Franklin M.
Hanger.
Page 673: Aviation Medicine, by Alvan L. Barach.
Vol. 3.
Page 115V: Von Gierke's by Franklin M. Hanger.
Vol. 4.
Page 91 A: Multiple Myeloma, by Edith E. Sproul.
Page 103: Hemorrhagic Diseases and Conditions: Introduction, by George R. Minot.
Page 105: The Physiology of Blood Coagulation, by F. H. L. Taylor, Charles S.
Davidson, and George R. Minot.
Page 171: Blood Transfusion Reactions, by Louis K. Diamond.
Vol. 6.
Page 265: Encephalitis Epidemica, by J. M. Nielson.
Page 6201: The Myopathies, by Angus MacDonald Frantz.
Page 6464A: Headache and Migraine, by Henry Alsop Riley.
BOOK REVIEW
ACUTE INFECTIONS OF THE MEDIASTINUM, Harold Neuhof and Edward E.
Jemerin, 407 pp., $6.00, Williams & Wilkins, Baltimore.
This recent acquisition to the Library is well worth the attention of every physician.
The mediastinum has been unknown territory to most physicians and, as the authors point
out, infections in this region are far from rare. An excellent survey of the literature
on the history of the development of our knowledge of "this region is given in the introduction.
Page One Hundred and Sixty-two For purposes of systematic presentation, the cases have been divided into four groups,
on an etiological basis.
A. Acute mediastinitis secondary to esophageal trauma.
B. Acute mediastinitis secondary to infections of the upper respiratory passages.
C. Acute mediastinitis secondary to infections of the lungs or pleura.
D. Acute mediastinitis of miscellaneous etiology.
Cases described which illustrate these various types, with comments on each.
These case reports occupy the greater portion of the book.
The third part of the book deals with the fundamental considerations such as anatomy, classification, etiology and pathology.
Another excellent chapter deals with the signs and symptoms. The treatment is outlined in detail, and it is emphasized that many of these cases recover with adequate
surgical treatment.
In conclusion it is noted that X-ray evidence is most valuable but mediastinitis must
be kept in mind and diagnosed early. The portion of the book on treatment is especially
valuable.
The book is excellently printed and illustrated, and is easily read.
—W. E. H.
MANUAL OF FRACTURES: TREATMENT BY EXTERNAL SKELETAL FLXA-
TION: C. M. Shaar, M.D., F.A.C.S., Capt. Medical Corps, U.S.N., and F. P. Kreuz,
Jr., M.D., F.A.C.S., Lt. Comm. Medical Corps, U.S.N.
After reading the volume, it is felt that the title is misleading, even with the subtitle as an adjunct to the title. One would understand a "Manual of Fractures" by title
to cover the entire field of fractures. This volume is largely composed of a review of
the Stader splint with external pin fixation as a reduction and a retention apparatus in
certain selected fractures and orthopaedic problems. The preface states this "is not
intended to convey the impression that the first or most important method of treating
fractures is external fixation to the exclusion of other methods."
This book covers the treatment of a group of fractures and orthopaedic problems in
the Medical Corps of the United States Navy since December of 1941. The use of the
splint in over 157 cases is reviewed. The importance of the use of external skeletal
fixation in war surgery is stressed. The impression is given in the preface that the need
for teamwork, organization, and the control of asepsic and antisepsis are not as important in external skeletal fixation as in internal fixation.
The book proper begins with some general considerations of skeletal fixation. There
is a short chapter on the historical approach to pin fixation from the time of Parkhill in
1897 until the present; a short chapter on shock associated with fractures and other
injuries in war surgery; and another one with reference to pin seepage.
The principles of the Stader splint and its use as a reduction and fixation splint are
covered briefly. A fracture of the tibia on a prepared skeleton specimen is used to show
the mechanical principles of the splint and the method of application. The splint consists of two half-pin units of two pins each; one unit goes into the proximal fragment
and one into the distal fragment; and a connecting bar which acts as a reduction
mechanism. The pins which are inserted through the bar of the half-pin unit of necessity are inserted to suit the half-pin bar and not necessarily to suit the fracture. The
pins are inserted by a flexible shaft drill which is operated by an unsterile assistant. (This
is probably satisfactory in a service establishment where there is extra help but does
not necessarily apply on the average fracture service in civilian practice.)
A chapter on the errors in the treatment by external skeletal fixation* covers the
improper selection of cases, errors in pin insertion, errors in reduction, and other errors
Page One Hundred and Sixty-three in technique. The final paragraph states that external skeletal fixation is contra-indicated in the treatment of fractures in children. (It is felt, after reviewing the entire
book, that the authors have had no experience with the use of external skeletal fixation
in children.)
A survey is made of delayed union and nonunion and the process of fracture healing,
and the relationship of external skeletal fixation to these problems.
Following this mote or less introductory portion of the book are chapters on special
fractures, and the technique in each is covered quite fully. This includes fractures of
the mandible, the clavicle, the humerus, the radius and ulna, the femur and pelvis, and
the tibia and fibula. (In the fractures of the long bones, the use of the Stader equipment has vertain very definite limitations as indicated by the text, the splint being used
largely for fractures of the shafts of the long bones which do not involve either the
proximal or distal ends.) In fractures of the pelvis as described, the half-pin is used
only as a method of lateral traction without the use of the reduction apparatus.
Fractures of the tibia and fibula are covered quite fully, and in these, fractures
involving both the proximal and distal ends of the bones are taken care of by right-
angled pin bars which may be used in the short fragments or, in the case of the lower
end of the tibia, a pin may be inserted into the oscalcis. A special splint has been
devised for the oscalsis. With this splint it is necessary to put two parallel transfixing
pins through the lower end of the tibia and a third one through the oscalsis. This part
of the book on fractures of the oscalsis is covered quite fully and is a summary of nine
cases taken care of by this method.
The problems of complications in fractures from the primary care of early fractures and the care of late fractures, covering details of treatment, are gone into quite
fully. The use of the splint in compound fractures with osteomyelitis and old ununited
fractures, as well as old fractures with malunion, is iluustrated with case reports.
The chapter on the arthrodesis of joints and the use of the Stader splints in these
.cases, as well as its use in a subtrochanteric osteotomy, are inserts more befitting a volume on reconstructive surgery or orthopaedics, and are probably to show the further uses
of the splint.
The use of the splint for preoperative and postoperative fixation where bone grafts
are necessary is illustrated by cases of nonunion of the tibia end and of the forearm.
A short review is made of the incidence of fractures in the United States Navy and
Marine Corps.
Lieutenant Commander D. E. Hale, M.C.-V.(S), U.S.N.R., gives a full chapter on
anaesthesia in the treatment of fractures. This covers preoperative preparation, the use
of local anxsthetic, brachial plexus block and nerve block in certain cases with detailed
technique, and also the detailed use of spinal anaesthesia with the use of a single injection and of continual spinal anaesthesia. Intravenous anaesthesia is described and its use
in special cases along with contra-indications of the technique. Ether is the only inhala-
tive anaesthesia that is discussed.
Lieutenant Commander Stephen L. Casper, M.C.-V.(S), U.S.N.R., gives a fairly
extensive review "of the roentgenological study of fracture healing and bone reaction
adjacent to metallic pins used in external fixation." This covers the appearance of the
bone following the insertion of the pins, the bone reaction while the pin is in situ, along
with certain reactions which occur following pin seepage and the so-called electrolytic
reaction. (Much more marked reaction about pins is shown on preceding X-rays reputedly due to causes other than electrolytic bone reaction.)
There is a very short review on the healing of fractures that have been reduced and
immobilized by means of external fixation.
A short chapter covers the variety of splints that are necessary to take care of the
previously described fractures. There are seven sizes of splints, the various sizes of
stainless steel pins as used for the various splints, thirteen sizes of pin bars, a flexible
Page One Hundred and Sixty-four
A shaft drill, a hydraulic and screw type pin cutter, a right-angled pin bar, and a projected pin bar.
The book closes with an appendix, the title of which is "Treatment of Fractures at
Sea by Skeletal Traction." This seems to be largely an historical review of continuous
traction and extension. This is followed by a chapter on "anti-pendulum extension
apparatus and fracture frame" which was devised by one of the authors (C. M. Shaar).
An adjustable hammock for use in fractures of the pelvis is also described. The bibliography is fairly extensive.
"The Manual of Fractures" is really a survey of the use of the Stader splint in
selected fractures and in certain orthopaedic problems. It does not stress the great
importance of aseptic and antiseptic technique in the use of pin fixation nor the necessity of special training in the use of the equipment even by men experienced in fracture
care.
The two great disadvantages of the Stader equipment as described are the necessity
of having different types of equipment for the differnt fractures. The fracture has to
suit the equipment, and not the equipment the fracture without the use of parts espe-
cailly designed for special fractures. This necessitates a grat variety of equipment to do
a group of fractures of unspecified types.
As previously stated, the book covers patients taken care of in military services and
does not cover the use of pin fixation in children or in elderly people.
J. R. N.
RE: BENZEDRINE INHALERS
A warning emanating from the Pharmaceutical Association of British Columbia was published in the Bulletin bearing on the misuse by certain persons
in the community of the Benzedrine Inhaler and this therapeutic agent. It is
now known that the Benzedrine is extracted from the inhaler and used in the
place of other narcotics. The demand for these inhalers and this drug has increased due to the difficulties encountered in securing other drugs. It is unfortunate that such abuses arise, and when they do the criticism is unjustly
directed toward the doctor who issued the prescription.
SUMMER SCHOOL CLINICS
VANCOUVER MEDICAL ASSOCIATION
June 20th to 23 rd, 1944, incl.
HOTEL VANCOUVER, BALLROOM
Speakers:
Squadron Leader L. G. Bell, R.C.A.F., Medical Consultant to Command
Medical Board of No. 2 Training Command.
Surgeon Captain C. H. Best, R.C.N.V.R., Senior Officer of Naval Medical Research Unit.
Lieut. Colonel R.  I. Harris, R.C.A.M.C., Consultant in Surgery for
Eastern Canada.
Dr. W. A. Scott, Professor of Obstetrics and Gynaecology, Faculty of
Medicine, University of Toronto.
Dr. Clifford Sweet, Pediatrician, Oakland, Calif.
Page One Hundred and Sixty-five V
ancouver
G
enerai
Hospital
A CASE OF EMPYEMA COMPLICATED BY
!' •     PNEUMOTHORAX      fll§!
By Dr. W. J. S. Melvin,
Senior Interne in Paediatrics, The Vancouver General Hospital.
On December 18, this small three-year-old boy was admitted to the Infectious Diseases Hospital of The Vancouver General Hospital following a week of indefinite illness
at home. Of the events preceding his admission to hospital we were quite unable to
obtain any intelligent account from the family. The tentative diagnosis on admission
was cerebrospinal meningitis, but careful physical examination and laboratory investigation of the spinal fluid failing to substantiate this he was transferred to Ward U under
Dr. G. O. Matthews.
When first seen in Ward U he was a small, flushed, obviously very ill child with a
rectal temperature of 104°. Physical examination failed to indict any but the respiratory
system. The lips were dry and cracked, the tongue was dry and thickly coated, and the
pharynx was inflamed. There was slight but not too significant cervical lymph-
adenopathy.
Examination of the thorax revealed the classical text-book findings of pleural effusion on the right. The right hemithorax was the less active in respiration, there was no
pleural friction thrill and the entire right side of the chest was dull on percussion. The
breath sounds on this side were distant and moist with many rales and. rhonchi although
no frank bronchial breathing was noted. On the left side there was the occasional
rhoncus heard but the balance of the examination suggested no more than slight involvement.
X-ray examination at this time showed considerable pleural thickening on the right,
with marked general opacity on the same side indicative mainly of pleural effusion
although there was also evidence of pulmonary infiltration.
Laboratory examination indicated a normal cerebrospinal fluid, no evidence of anaemia
and a white cell count of 29,000 of which 83% were of the myeloid series.
The child was treated with full doses of sulfathiazole, which subsequently maintained a concentration of 4.4 to 6.0 milligrammes percent. Since there was a noticeable
degree of cyanosis he was put in an oxygen tent. His resentment of this latter form of
therapy could only be overcome by continual mild sedation with phenobarbital.
On this treatment the child seemed to do very well. His temperature showed a
slow but consistent decline, although the physical findings remained unaltered.
On the evening of December 25 (one week after admission) his condition suddenly
declined rapidly. Even in an oxygen tent his respiratory embarrassment became so
alarming that immediate thoracentesis was carried out. One thousand cc. of purulent
fluid material were withdrawn. Subsequent culture revealed staphylococcus aureus
present. Following this aspiration the child became noticeably brighter and his breathing
become much less laboured.
A radiograph taken the next day revealed an almost complete pneumothorax on the
right side with minimal displacement of the mediastinum to the left. Strangely enough
the physical findings at this time did not suggest pneumothorax—the right hemithorax
was dull and breath sounds could be distinctly heard although more distant than on the
left.
Page One Hundred and Sixty-six Further attempts at reaspiration were fruitless. However, a radiograph on December
27 showed a pneumothorax extending to about three-quarters of an inch to the left of
the vertebral column.
At this point there was considerable alarm over the eventual outcome of so tremendous a pneumothorax. However, as the clinical condition of the child improved
rapidly it was decided to wait until such time as the presumed bronchopleural fistula
had healed before attempting further evacuation of the chest contents. Accordingly
repeated radiographs were taken over the course of the next few weeks; they remained
identical.
Clinically the child progressed magnificently. He was allowed out of the oxygen
tent for increasingly long periods and eventually refused to have the tent at all. Despite
the fact that over half of his thorax remained full of air he began to take a great
interest in his surroundings.   To superficial examination he was well.
With the danger of the mediastinum remaining permanently in its displaced position
due to adhesion formation an attempt was made to evaluate the pressures within the
thorax and to assess the condition of the fistula. Accordingly, on January 5, a further
thoracentesis was made and the pressures recorded with a pneumothorax machine. The
initial pressure blew all the measuring fluid out of the manometer. Following the replacement of this fluid the pressure returned to approximately atmospheric. On removal
of 200 cc. of air the intrathoracic pressure fell to —5 cm. of water. This pressure was
maintained for only two minutes, at the end of which time the pressure was once again
atmospheric. Removal of another 50 cc. of air gave a negative pressure of —5 cm. of
water, which was sustained for only 65 seconds.
Radiological checks in the meantime indicated a return of fluid to the right base
with no diminution in the mediastinal shift. With this in mind, and as after two weeks
of persistent deviation the danger of adhesions fixing the mediastinum in its deviated
position was becoming very real, on January 7, a closed drainage was inaugurated. A
No. 14 French catheter was inserted into the thoracic cavity and approximately 15
ounces of frank purulent material evacuated. Subsequently the thorax was drained by
Wangensteen suction ten minutes every hour. After three hours this was discontinued
and the catheter was lead into a closed water-trap.
Within two hours of the operation the radiographic appearance had altered radically.
The pneumothorax was completely resolved, the mediastinum was in the conventional
position and apart from pleural thickening on the right the pleural cavities appeared
normal.
The catheter was withdrawn a few centimetres every day but there was never anything but small amounts of seropurulent material aspirated.
As there was evidence of localization of pus within the pleural cavity a further
thoracentesis was made on January 17, and 7 cc. of mucopurulent material was withdrawn from the fourth right interspace at the posterior axillary line.
Following this the child's recovery continued briskly. There was a small amount of
air in the thorax at the right axilla but this gradually was absorbed. The catheter was
removed entirely on January 26.
On February 8, the child was discharged well. The physical findings were identical
on both sides of the chest and apart from pleural thickening on the right there was
no indication radiologically of the previous events.
Page One Hundred and Sixty-seven STREPTOCOCCAL MENINGITIS TREATED WITH
PENICILLIN
Measurement of Bacteriostatic Power of Blood and
Cerebrospinal Fluid
By A. Fleming
Lancet, 2, 434-438, 9/10/43.
This paper reports fully a case of which some notes were given by Florey & Florey
(1943). Penicillin was administered intrathecally for the first time in man, in conjunction with intramuscular injections. The detailed observations made by the author
established the value of intrathecal injection and led to the treatment of subsequent cases
of meningitis by intrathecal injection alone.
The patient was a man of 52 who had been febrile for 7 weeks and had had signs of
meningitis for 3 weeks. There had been an early response to sulphapyridine, but afterwards sulphathiazole was without effect. About 6 colonies per cm.3 of a non-haemolytic
streptococcus were isolated from the cerebrospinalfluid 6 and 2 days before jpenicillin
treatment was begun, by the "sloppy" glucose agar cultures (0.2% agar), after ordinary
culture methods had failed. The patient's serum specifically agglutinated this organism,
which was shown in vitro to be insensitive to sulphathiazole and sensitive to penicillin,
though less so that a sensitive strain of Staph, aureus.
When penicillin treatment was started the patient appeared to be moribund. Some
improvement occurred on 2-hourly intramuscular injections (usually 10,000 Oxford
units), and further improvement when intrathecal injections (usually 5,000 units) were
given once daily in addition. On one occasion the penicillin was dissolved in the
patient's serum for injection, with the object of providing opsonins. Treatment was
continued for 14 days, after which the patient's condition was excellent. Recovery was
complete.
By in vitro tests the author was able to show that during intramuscular therapy the
• cerebrospinal fluid had only half the bacteriostatic power of the blood serum, but that
intrathecal injections greatly raised its titre. At the best, 24 hours after an intrathecal
injection, the cerebrospinal fluid inhibited Staph, aureus at 1:160 and the patient's streptococcus at 1:40, compared with 1:2 and 1:1 for the serum 2 hours after an intramuscular injection.   The cerebrospinal fluid was coloured yellow by the penicillin.
The bacteriostatic power of the serum was tested by micromethods based on the fact
that staphylococci and streptococci will grow as well-defined colonies in human serum,
either whole or diluted with saline up to 1:100 or more.
i. Slide-ceil cultures. On a waxed slide were placed 50 mm3 volumes of the diluting
fluid (normal serum diluted, e.g. 1:10 with saline); 2:3 or 1:2 serial dilutions of the
serum to be tested were made on the slide, 2.5 mm.3 of a diluted culture of staphylococcus or streptococcus was added, and the resulting fluids were run into slide-cells and
sealed and incubated.
The bacterial cultures used in this test were so diluted as to produce between 15 and
50 colonies from the 2:5 mm.3 used.
ii. Capillary tube cultures. Twenty-five mm.3 of the patient's serum (whole or
diluted) mixed with 2.5 mm.3 of culture diluted as above, was run into a capillary tube,
which was then sealed and incubated.
iii. Use of haemolysis as indicator. Defibrinated human blood, free of leucocytes, was
added in equal volume to serial dilutions of the patient's serum in saline (25 mm.3 volumes). A loopful of culture of a haemolytic streptococcus was added to each preparation and the fluids were run into slide-cells (when testing bacteriostasis due to sulphon-
amides the culture had to be considerably diluted, but this was not necessary with penicillin) .   After incubation haemolysis was easily seen wherever the streptococci grew.
REFERENCE
1. Florey, M. E., & Florey, H. W. (1943), Lancet, 1, 3 87.
1.  (See B.M.B. 233.)
Page One Hundred and Sixty eight NEWS AND NOTES
The sympathy of the profession is extended to Dr. C. H. Hankinson and family of
Prince Rupert in the passing of Mrs. Hankinson.
We regret to learn that Dr. R. A. Seymour, Assistant Superintendent of the Vancouver General Hospital, has lost his mother by death.
»t *t •*. *t
~C '»* *i* *r
Captains A. Leigh Hunt, R.C.A.M.C., and Kenneth Telford, R.C.A.M.C., and Dr.
O. E. Kirby of Vancouver have all been presented with sons during the past month.
Dr. T. C. Harold, formerly with the R.C.A.F., has a new daughter.
Dr. A. A. O'Neill and Dr. Agnes J. Eagles, internes at the Vancouver General Hospital, were married recently.
Recent visitors at the office were Dr. J. A. Taylor of Pouce Coupe, Director of the
Health Unit in the Peace River Block; Dr. W. J. Knox of Kelowna; Dr. W. S. Kergin
of Prince Rupert; Dr. C. A. Armstrong of Ocean Falls; Drs. W. Harold Moore, Thomas
Miller and E. L. McNiven of Victoria; Dr. G. E. Bayfield, who supplies medical services
to the Morgan Logging operations on Moresby Island in the Queen Charlotte group;
Dr. R. B. White of Penticton; Dr. F. W. Green of Cranbrook.
The Committee on Programme of the British Columbia Medical Association under
the Chairmanship of Dr. J. R. Neilson of Vancouver, took full advantage of the visit of
Colonel L. C. Montgomery and Colonel W. P. Warner and arranged an evening meeting
when both these Officers gave most instructive lectures. The Committee is grateful to
Colonel Wallace Wilson, Command Medical Officer, Pacific Command, for having secured these speakers. The meeting was attended by a large number of Medical Officers
and others—235 in all.
Those who were attended were well repaid as Colonel Warner dealt with "Some Virus
Diseases with Pulmonary Complications." Colonel Montgomery took as his subject,
"Some Medical Problems in Canadian General Hospitals Overseas" and covered a wide
range of subjects, all of which were full of interest, especially his discussion of the
epidemic diseases encountered.
Dr. P. A. C. Cousland of Victoria, President of the British Columbia Medical Association, presided. Dr. A. Y. McNair, Vice-President, proposed a vote of thanks which
was seconded by Dr. G. F. Strong.
S% A *t ^L
•r *r n" *r
We see by the paper that Dr. G. F. Strong has been made a member of the Board of
Regents of the American College of Surgeons at a recent meeting in Chicago.
Nttmt Sc Sfjflmantt
t
2559 Cambie Street
ancouver
> B. C.
Page One Hundred and Sixty-nine BALANCED!
SUPPLAVITE
One "Supplavite" Tablet daily provides adequate amounts of all the
most essential vitamins; the potency
of this product conforms to the minimum daily vitamin requirements as
outlined by the Council on Pharmacy
and Chemistry of the American
Medical Association.*
Each tablet contains:
Vitamin A... 5,000 Int. Units
Vitamin D... 500 Int. Units
Vitamin Bi ..     333 Int. Units
Riboflavin         2 mg.
Nicotinamide       10 mg.
Vitamin C      35 mg.
\    *     \
SUPPLIED IN BOTTLES OF
6 AND 100
*J.A.M.A. 119:948
(July 18) 1942.
198A
YERST, McKENNA & HARRISON LIMITED • Biological and Pharmaceutical Chemists • MONTREAL, CANADA DOWN
COSTLY REPAIRS
INTERRUPTED SERVICE
| LOSS OF TIME
INEFFICIENT OPERATION
$»•
Afr^X-P-1 •""'*•
An item of small expense ceases to he burdensome when it represents insurance against
additional expenses of unpredictable magnitude, and the consequent inconveniences.
G. E. X-Ray's Periodic Inspection and Adjustment Service has
so proved to thousands of users of x-ray and electromedical apparatus
throughout the United States and Canada. For these users know
from experience that they can rely on G. E.'s service engineers to keep
their  equipment tuned up to its highest operating efficiency the year round. They
know, too, that these men, when working on periodic service calls, are
ever on the alert to detect and immediately correct electrical and mechanical
deficiencies at their very inception, to thus avert breakdown and probably cosdy
repairs that result from oversight or neglect.
The fact that Victor X-Ray's branch offices and regional service depots are strategically
located throughout the Dominion, makes P. I. and A. a tangible service that extends far
and wide, and functions the year round in the interest of those who contract for it.
There are many other important phases of P. I. and A. Service which our
local representative will be glad to tell you about. Write us for his headquarters address.
XAti Sat ««? - Afc» SaviHft G*tific*tn
VICTOR X-RAY CORPORATION of CANADA, Ltd.
DISTRIBUTORS FN GENERAL <§> ELECTRIC X-RAY CORPORATION
TORONTO: 38 Bloor St., W. • VANCOUVER: MotorTrans. Bldg., 570 Donsmuir St.
MONTREAL: 600 Medical Arts Building • WINNIPEG: Medical Arts Building OF PRESCRIPTIONS
if
PAGtMCCetOiCaUr CU^ as a prescription
vehicle. Wyeth's Bewon Elixir* enhances the pal*
abiHty and appearance of prescriptions.
-Ike^neuiicalU 14*4*1 as cm appetite stim-
ulant.7provides a convenient way to encourage
increased food intake.   Each fluidounce contains 500
^emotional Units of Vitamin B, (Thiamin Chloride).
•Trademark  Reg'd in Canada
John Wyeth I Brother (Canada) Limited    -   Walkerville, Ontario
^
Supplied in 16 fluidounce bottles
cfaafr
i ^0* '7K*A4we
VITAMIN D THERAPY
in
CHRONIC ARTHRITIS
and Psoriasis
OFORTE
CAPSULE No. 651  "Sfa£
(Each capsule contains 50,000 International Units of Vitamin D.)
NOTE: — Regardless of the process employed — ultra-violet irradiation or any
other — the  vitamin   D2 resulting from the various methods of manufacture is
chemically and pharmaceutically identical.
The recommended method of treatment is as follows r—•
An initial dose of 50,000 Vitamin D units (1 capsule "Ostoforte").
This is gradually increased to the effective dose which may be
300,000 or more units daily, depending on the patient's response
and tolerance to the medication. When maximum improvement
occurs, the dose is reduced to a maintenance level which may vary
from 100,000-200,000 (2-4 capsules, "Ostoforte") daily.
• Rest and regulation of the diet.
Massage and exercise of the affected parts when indicated.
Correction of bowel habits. • Removal of foci of infection.
MODES OF ISSUE
In boxes of 100 and 50 capsules for your prescription.
//
While the results of High Potency Vitamin D therapy
are not always dramatic and it may require a number
of months of continuous treatment before improvement becomes evident, the fact that we are dealing
with frequently i ntractable and progressive diseases
warrants tria I of this treatment. The following results
have been observed in those cases responding to
treatment:—Decrease in pain; Decrease in swelling;
Recalcification of osteoporotic bone; demobilization
of joints and Improvement in general health.
70e S*tfi&cu&fe
A. No criteria have been established which would enable one to
select the cases which will respond
favourably to treatment from
those which will fail to react.
B. No physiological basis exists for
the employment of this therapy.
It is at present entirely empirical.
The Canadian Marie of Quality
(PtOddt 1
Pharmaceuticals Since 7899
aia/ifed &9tt»et &&>.
MONTREAL
CANADA 1 q-iq Tisdall. F. P., Drake. T. G. H.. and
*-~jyj Brown, A.: A new cereal mixture containing vitamins and mineral elements, Am.
J. Dis. Child. 40:791-799. Oct. 1930.
toil Tisdall,- P. P.: Dietary factors and
lyjl health, Soc. Tr., Am. J. Dis. Child.
42:1490, Dec 1931.
1932 Summerfeldt, P.: The value of an in-'
A7 creased supply of vitamin Bt and iron
in the diet of children. Am. J. Dis.- Child.
43:284-290. Peb. 1932. .- Morse, J. L.: Fads
and fancies in present day pediatrics, Pennsylvania M. J. 35:280-285, Feb. 1932. Hen-
ricke. S. G.: The vitamin B complex: Its role
in infant feeding in the light of our present
knowledge. Northwest Med. 31:165-169,
April 1932. Langhorst, .H. F.: Vitamins:
Their role in the prevention and treatment of
disease. M. J. & Rec. 135:326-329, April 6.
1932. Crimm. P. D.: Dietary of Childhood
Tuberculosis: Cereal as a source of added
mineral and vitamin elements; preliminary
report, J. Indiana M. A. 25:205-206, May
1932. Troutt, L.: Quality studies of thera-
peutic diets: I. The ulcer diet; a committee
report, J. Am. Dietet. A. 8:25-32, May 1932.
Summerfeldt, P., Tisdall, F. P., and Brown,
A.: The curative effects of cereals and biscuits on experimental anaemias, Canad..
M.A.J. 26:666-669, June 1932. Sneed. W.:
Ununited and delayed union of fractures,
Kentucky M. J. 30:363-370, July 1932.
Silverman, A C.: Celiac disease. New York
-State J. Med. 32:1055-1061, Sept. 15, 1932.
von Meysenbug, L.: Infant feeding with
especial reference to some of its problems
during the first year, Texas State J. Med.
28:543-547, Dec. 1932.
1933 Sampler, F. J., and Forbes. J. C: Cal-
-      cium and phosphorus metabolism in a
case of celiac disease. South. M. J. 26:555-
558, June 1933. Brown. A., and Tisdall.
P. P.: The role of minerals and vitamins in
growth and resistance to infection, Brit. M.
J. 1:55-57, Jan. 14. 1933; Effect of vitamins
Orleans M. & S. J. 87:738-743. May 1935.
Tarr, E. M., and McNeile, O.: Relation of
vitamin B deficiency to metabolic disturbances during pregnancy and lactation. Am.
J. Obst. & Gynec. 29:811-818, June 1935.
Blatt, M. L„ and Schapiro, I. E.: Influence
of a special cereal mixture on infant development, Am. J. Dis. Child. 50:324-336, Aug.
1935. Coward, N. B.: Infant feeding.
Nova Scotia M. Bull. 14:525-532. Oct. 1935.
Tisdall, F. F.: Inadequacy of present dietary
standards,-Tr. Sect. Pediat., A.M.A.. 1935:
Canad. M. A. J. 33:624-628, Dec. 1935.
Marriott, W. McK.: Infant Nutrition, second
edition, C. V. Mosby Co., St. Louis, 1935, p.
202. Summerfeldt, P.: Iron and its availability in foods, Tr. Sect. Pediat., A.M.A.
1935. pp. 214-220.
1936 Dafoe, A. R.: Further history of the
care and feeding of the Dionne quintuplets, Canad. M. A. J. 34:26-32, Jan. 1936.
' Conn, L. C, Vant, J. R„ and Malone, M. M.:
Some aspects of maternal nutrition, Surg.,
Gynec. & Obst. 62377-383. Feb. 15, 1936.
Ross, J. R., and Summerfeldt, P.: Haemoglobin of normal children and certain factors
influencing its formation, Canad. M. A. J.
34:155-15X. Feb. 1936. Smyth, F. S.: Allergic diseases, J.  Pediat.  8:500-515,   April
1936. Lemmon, J. R.: Problems of the crying infant. Southwestern Med. 20:248-250,
July 1936. Rice, C.V.: The success of treating
celiac disease from a standpoint of vitamin
deficiency, Arch. Pediat. 53:626-629, Sept.
1936. Smith, C. H.: Management of nutritional anemia in infancy, M. Clin. North
America 20:933-950, Nov. 1936. Strong.
R. A., editor: Nutritional anemia of infants,
Orleans Parish M. Soc. Bull., pp. 6-9. Nov.
9, 1936. Jeans, P. C: Specific factors in
nutrition. Round Table discussion, J. Pediat.
9:693-698, Nov. 1936. Young, J. G.:
Meeting the requirements for proper nutrition in infancy, Texas State J. Med. 32:531-
533, Dec. 1936.
1937 Stearns, G., and Stinger, D.: Iron re-
tention in infancy, J. Nutrition 13:127-
ner, B..and Gruehl. H. L.: Anaphylactegenic
.properties of certain cereal foods and bread-
stuffs: Am. J. Dis. Child. 57:739-758. April
1939. Monypenny, D.: Early introduction
of solid foods in the infant diet, Soc. Tr., Am.
J. Dis. Child. 58:1144-1145, Nov. 4939. Brown.
A., and Tisdall, F. F. Common Procedures in
the practice of paediatrics, third edition,-McClelland & Stewart, Ltd., Toronto, 1939, pp.
77-79.
1940 McD°ugal. L. L., Jr.: Feeding a nor-
™ mal infant, Mississippi Doctor 17:437-
442, Jan. 1940. Monypenny, D.: The early
introduction of solid foods in the infant diet,
Canad. M. A. J. 42:137-140, Feb. 1940.
Robinson, E. C: A study of two hundred and
forty breast-fed and artificially fed infants in
the St. Louis area. Am. J. Dis. Child. 58:816-
827, April 1940. Ratner. B.: Round Table
discussion on food allergy, J. Pediat. 16:653-
672, May 1940. Rosenbaum. I., jr.: The
. management of the allergic child, Kentucky
M. J. 38:199-203. May 1940. Barondes. R.
de R.: Report of a case of pellagroid, M. Rec.
151:376-380, June 5. 1940. Brown, A.:
The fourth Blackader lecture on a decade of
paediatric progress, Canad. M. A. J. 43:305-
313. Oct. 1940. Dmeck, C. J„ Vitamin
therapy in colon and rectal disease, Illinois
M. J. 78:337-341, Oct. 1940. Swift. F. L.:
Infant feeding, Lackawanna Co. M. Soc
Reporter. 33:16-18, Nov. 1940. B.ogert.
L. ).. and Porter, M. T.: Dietetics Simplified,-
ed. 2, Macmillan Co., New York. 1940, p.
181. Davison. W. C: The Compleat Pedia-
trician, third edition, Duke University Press,
Durham, N. C, 1940, No. 216. Hawley,
E. E., and Maurer-Mast, E. E.: The Fundamentals of Nutrition. C. C' Thomas, Springfield, 111., 1940, pp. 296, 455. Kugel-
mass, I. N.: The Newer Nutrition in Pediatric
Practice, J. B. Lippincott Co., Philadelphia.
1940. p. 372. Leaman. W. G.. Jr.: Management of the Cardiac Patient. J. B. Lippincott Co., Phila.. 1940, p. 549. Paterson,
D., in Index of Treatment, edited by R.
Hutchison, ed. 12, revised, Williams & Wilkins
Co., Baltimore. 1940, p. 491.     Thomas, G.
SCIENTIFIC   BACKGROUND
Mead's Cereal was introduced in 1930, and Pablum in 1932, by
Mead Johnson & Company. Since then, the growing literature
. indicates early recognition and continued acceptance of these
products and the important pioneer principles they represent.
and the inorganic elements on growth and
resistance to disease in children. Ann. Int.
Med. 7:342-352; Sept. 1933. Crimm. P. D..
Raphael, I. J., and Schnute, L. P.: Diet of
I tuberculous and non-tuberculous children:
Effect of increased supply of vitamin B concentrate and minerals. Am. J. Dis. Child.
^Kfc751-756, Oct. 1933. Smith. A. D.: Consideration of various infants' foods. Pacific
; Coast J. Homeop. 44:463-465. Sept.-Dec. 1933.
1 934 Somers, R., Rotton, G. C. and Rown-
~tree, J. I.: Possibilities of improving
dental structures, Soc Tr., Bull. King Co. M.
Soc 13*. Jan. 15, 1934. Blatt, M. L.:
- Development of infants on a diet of a special
cereal mixture, Soc Tr., Am. J. Dis. Child.
47:918. April 1934. Rice. C. v.: Anemia of
infancy and early childhood, J. "Oklahoma
M. A. 27:125-129. April 1934. _ Hawk. W.
A: A few of the commoner feeding problems
In-infancy. Univ. Toronto M. J. 11218-229.
May 1934. Ross. J. R.. and Burrill. L. M.:
The effect of cooking on the digestibility of
cereals, J. Pediat. 4*54-659, May 1934..
Rice. C. V.: Sauerkraut juice for the acidification of evaporated milk in infant feeding.
Arch. Pediat. 51:390-395, June 1934. Eder,
H. L.: Iron therapy: A routine procedure
during infancy. Arch. Pediat. 51:701-713,
Nov. 1934. Lynch, H. D.: Fundamentals
of infant feeding, J. Indiana M. A. 27:571-
574. Dec 1934. Chaney, M. S., and Ahl-
bom, M.: Nutrition, Houghton Mifflin Co.,
Boston, 1934. p. 323.
1935 Bailey, C. W.: Anemia in infants and
young children, J. South Carolina M.
A. 31:54-58. March 1935. Kugelmass, I.
N.: The recent advances in treatment of
nutritional disturbances in infancy and'childhood, M. Comment 17:5-13, March 1. 1935.
Ross, J. R., and Summerfeldt. P.: Value of
increased supply of vitamin Bi and iron in
the diet of children: Paper II, Am. J. Dis.
Child. 49:1185-1188. May 1935. von Meysenbug, L.: Breast feeding with especial
reference  to  some   of  its   problems.   New
141, Feb. 1937. Strong. R. A.: Nutritional
anemia, Mississippi Doctor 15:13-16, Aug.
1937. Smith, C. H.: Prevention and treatment of nutritional anemia in infancy. Preventive Med. 7:115-124, Aug. 1937. Saxl.
N. T.: Pediatrics, in Dietetics for the Clinician, edited by M. A. Bridges, third edition.
Lea & Febiger, Philadelphia, 1937, pp. 637-
639. Boyd. J. D.: Nutrition of the Infant
and Child. National Medical Book Co., Inc.,
New York, l937, p.. 110. Brennemann, J.:
Practice of Pediatrics, W. F. Prior Co., Inc.,
Hagerstown. Md., 1937, Vol. 1, Ch. 25, p. 19.
Griffith, J. P. C, and Mitchell. A. G.: The
Diseases of Infants and Children, second
edition, W. B. Saunders Co., Philadelphia.
1937, pp. 106. 111. Saxl. N. T.: Pediatric
Dietetics, Lea & Febiger, Philadelphia, 1937,
pp. 131-133.
1938 Hoffman, S. J., Greenhill, J. P., and
Lundeen, E. C: A premature infant
weighing 735 grams and surviving, J.A.M.A.
110:283-285, Jan. 22, 1938. Krasnow. F.:
Nutritional influence on teeth. Am. J. Pub.
Health 28:325-333. March 1938. Ratner, B.:
Round Table discussion on asthma and hay
fever in children, J. Pediat. 12:399-413,
March 1938. Ratner, B.: Panel discussion
on the role of allergy in pediatric practice,
J. Pediat. 13:582-604, Oct. 1938. Snelling.
C. E.: Nutritional anaemia. Bull. Acad. Med.
Toronto 12:710, Oct. 1938., Dauphinee,
J. A.: The iron requirement in normal nutrition,   Canad.   M-A.J.   39:483-486,   Nov.
1938. Summerfeldt, P., and Ross, J. R.:
Value of an increased supply of vitamin Bi
and iron in tile diet of children. Paper III,
Am. J. Dis. Child. 56:985-988. Nov. 1938.
Tisdall. P. F„ and Drake, T. G. H.: The
'utilization of calcium, J. Nutrition 16*13-'
620, Dec. 1938. Drake, T. G. H.: Introduction of solid foods into the diets of children, Canad. M. A. J. 39*78-580. Dec 1938.
1939 Strong,  R. A.: The most frequent
causes of vomiting in infancy, Texas
State J. Med 34*65-676, Feb. 1939.     Rat-
in
ma
I.: Dietary of Health and Disease, ed. 3, revised. Lea & Febiger, Phila.. 1940, pp. 171.
IQ41 Gipson. A. C: The role of allergy
" pediatric practice, J. M. A. Alabai
10:272-274, Feb. 1941. Ross. J. R., Monypenny. D., and Jackson, S. H.: II. The effect
of cooking on the digestibility of cereals. J.
Pediat. 18:395-398, March 1941. Kennedy.
A. S., Snider. O., Hazen, J. S., and McLean,
C: The dietary management of intestinal
tuberculosis, Canad. M. A. J. 44:380-385,
April 1941. McAlpine, K. L.: Management of the nutritional anaemia of infancy,
Canad. M. A. J. 44:386-390. April 1941.
Patek, A. J., Jr., and Post, J.: Treatment of
cirrhosis of the liver by a nutritious diet and
supplements rich in vitamin B complex, J.
Clin. Investigation 20:481-505, Sept. 1941.
Bercovitz, Z., and Johnson, H. J.: Ulcerative
Colitis, in Dietetics for the Clinician, by M.
A. Bridges, fourth edition, revised, Lea &
Febiger, Phila., 1941, p. 295. Bridges, M.
A.: Dietetics for the Clinician, fourth edition,
•revised. Lea & Febiger, Phila., 1941, pp. 727,
751, 809. Griffith. J. P. C. and Mitchell.
A. G.: Textbook of Pediatrics, ed. 3, revised.
W. B. Saunders Co.. Phila., 1941, pp. 87. 91.
Roue, A. H.: Elimination Diets and the
Patient's Allergies, Lea & Febiger, Phila.,
1941. p. 230. Twiss, J. R.: Gall-bladder
Disease, in Dietetics for the Clinician, by
M. A. Bridges, fourth edition, revised. Lea &
Febiger, Phila., 1941, p. 401.
1QAS7 Gleich, M.: The premature infant.
A7^*' Part II, Arch. Pediat. 59:99-135. Feb.
1942. Part IV, .Arch. Pediat. 59241-263.
April 1942.      Brown,  A.,  and   Robertson,
E. C: Factors to be considered in the construction of the diet of die older child, J.
Kansas M. Soc. 43:237-244, June 1942. Porter, L., and Carter, W. E.: Management of the
Sick Infant and Child, ed. 6, C. V. Mosby Co.,
St. Louis, 1942. p. 125. Proudfit. F. T.:
Nutrition and Diet Therapy, ed. 8, Macmillan
Co., New York, 1942. p. 515. Willard, J.
H.: Digestive Diseases in General Practice.
F. A. Davis Co.. Phila., 1942, p. 147. ^\
\G\N ^
in the Treatment of
TRICHOMONAL
VAGINITIS!
Stovaginal is especially indicated in
pathological conditions of the vaginal
mucosa resulting from or associated
with the Trichomonas Vaginalis, as well
as in mixed and non-specific infections
of the vagina.
STOVAGINAL POWDER constitutes
a practical means of office or hospital
treatments by the physician.
STOVAGINAL TABLETS provide a
convenient and effective means of uninterrupted home treatments by the patient.
Stovaginal is supplied in containers of 20, 100 and 500 vaginal tablets
and in bottles of 30 and 200 grams of vaginal powder.
jLaJrv%GLJtjcriif I otctenx  jxe/ue/i
OF      CANADA      LIMITED  — MONTREAL Prevention of rickets is part of the
daily routine in the care of infants
and young children. Hence there is
a big advantage in simplifying the
administration of vitamin D.
Two drops of Drisdol in Propylene
Glycol in the daily ration of milk is
the prophylactic dose.
Drisdol in Propylene Glycol disperses uniformly in milk and does
not affect its palatability.
ffs^
m
I
- ^^      Reg. U. S. Pat. Off. & Canada
N   PROPYLENE  GLYCOL/
Brand of Crystalline Vitamin D
from ergosterol
TMEDICAiT
ASSN.
WINTHROP CHEMICAL COMPANY, INC.
General Offices: WINDSOR, ONTARIO
Quebec Professional Service Office: Dominion Square Building, Montreal, Que. flDount peasant Xttnbertaking Co. !ILtb.
KINGSWAY at Uth AVE. Telephone FAirmont 0058 VANCOUVER, B. C.
R. F. HARRISON W. E. REYNOLDS
Dnbioax
ucina . . .
fllETAnDREn LMGUETS
A specially designed form of methyltestosterone for
perlingual use.
— disintegrate slowly and permit complete
absorption.
— sidetrack portal circulation and liver, thus
preventing partial inactivation ... 1/3
to Vi less dosage required.
ISSUED:   Metandren   Linguets,   hard   compressed   wafers  containing   5   mg.
methyltestosterone, in boxes of 30 and 100.
Literature and samples on request.
C MB A
" V MflMTBl
MONTREAL. CANADA
MB s
H
Clinical Observation No. 3
H. G. Age 51
Occupation Corporation director
Patient referred by Dr. H. Goebbels,
February 1,1944, complaining of loss of
weight and insomnia because of irritation by mosquitus Britannicus. Careful
examination elicited the following:
Patient went to the front in 1914 and has stayed
mostly at the front ever since. Association with
zeppelins led to development of physical char*
acteristics conforming to his environment. In 1918
patient suffered accidental bilateral orchidectomy
which was obviously a severe psychic trauma.
His marriage may have been influenced by over-
compensation for his limited sexual ability, for he
was shortly confined to a hospital for the insane.
Occupational therapy (costume jewelry and medal
designing) was beneficial and patient discharged
after two years.
.Sympathetic association with a political radical
of the time (A. H.) led to a shot in the putsch.
(Munich, 1923.)
In 1930 female characteristics became more pro*
nounced. High pitched voice, girdle obesity and
gross fat distribution on hips, buttocks and
breasts. Perverted desires manifested in bizarre
costumes and decorations/
SUMMARY OF POSITIVE FINDINGS:—
Frbhlich syndrome (dystrophia adiposogenitalis).
Parorexia and penicilliform penis.
TREATMENT:
Confinement to rest home (concentrated).
PROGNOSIS:
Early death (through rope or lead poisoning),
appears inevitable.
A NEW TYPE OF
SULFATHIAZOLE PASTE
An innovation in sulfonamide therapy for topical use; combining sulfathiazole
with allantoin and proflavine in a water soluble base.
FORMULA: Sulfathiazole 5%        Allantoin 0.5%        Proflavine 0.1%
in a water soluble base.
INDICATIONS:    As a general antiseptic for office use. For skin infections,
burns, traumatic wounds and other skin lesions, therapeutically and prophy-
lactically.
PACKAGED:  In collapsible tubes—% oz. In jars—16 oz.
FRANK W. HORNER LIMITED
MONTREAL
CANADA DILANTI
S O D I U
utgrowthof the "stop-and-go" sign and the red-and-
n light, the modern highway intersection represents
s triumph over the hazards of crossroad traffic, pro-
g better control of vehicular travel.
■by-step...first with bromides, then with phenobar-
. . . man has advanced toward control of epileptic
zures. His most recent contribution is Dilantin* Sodium,
effective   anticonvulsant   whose  selective  action
most completely a voids undesired sedative, hypnotic,
or depressant effects.   With the physician's skilful
management of dosage and time of administration
to meet the   requirements  of  individual  cases,
Dilantin Sodium often provides control of seizures
in patients not benefited by phenobarbital or
bromides, enabling the epileptic patient to lead
a more normal and useful life.
Dilantin Sodium (Diphenylhydantoin Sodium) is available In
Kapseals* of 0.03 Gm. (J^ grain), and 0.1 Gm. (1% grain),
in bottles of 100, 500, and 1000.
*Trade-Mark» Reg.
Buy War Bonds
and
Savings Stamps
■asi Colonic and
Physiotherapy Centre
Up-to-date Scientific Treatments
COLONIC IRRIGATIONS, SHORTWAVE
DIATHERMY, SINNEWAVE GALVIN-
ISM, IONIZATION, ULTRA VIOLET
RAY,  STEAM   BATHS  AND  SHOWERS
Medical and Swedish Massage
Physical Culture Exercises
STAFF OF GRADUATE NURSES
Superintendent:
E. M. LEONARD, R.N.
Post Graduate Mayo Bros.
1119 Vancouver Block
MArine 3723      Vancouver, B.C.
i	
:iiiMERE'ftH i
Atmms-eczema
SYNDROME?
Both are claimed to be allergic.
Both suggest mineral deficiency and
impaired elimination. Clinically,
each is symptomatically improved
by the oral use of
LYXANTHINE ASTIER
which combines the therapeutic
actions of iodine, calcium, sulphur,
and lysidin bitartrate — a potent
eliminator of endogenous toxic
waste.
Write for Information.
L-M
Canadian Distributors
ROUGIER FRERES
350   It Moyne   Street,   Montreal
mmmmmmmsssssam
Breaks the vicious circle of perverted
menstrual function in cases of amenorrhea,
tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic
relief by stimulating the innervation of the
uterus and stabilizing the tone of its
musculature. Controls the utetb-ovaHan
circulation and thereby encourages a
normal menstrual cycle.
». iPaT
♦ MARTIN H. SMITH COMPANY   H
fc. ISO  1*1 ftYIITl StiHt.   NIW  TOM.   N. T.
Full formula and descriptive
literature on request
Dosage: 1 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.
Ss§§SiKita MILK -
Canada'i Vital
FOOD FOR VICTORY
Milk is accepted as the most valuable protective
food because it surpasses all others in supplying
vitamins, minerals, and high quality proteins that
build and maintain sound physical fitness. No
wonder our fighting forces are among the best fed
in the world—their milk consumption is exceptionally high—and no wonder Canada's home front,
too, is by far the best fed!
A quart of milk (4 glasses) gives the following
percentages of your DAILY FOOR NEEDS.
Iron   16%
Vitamin C*%~~~16%
Energy  22%
Vitamin  B 28%
Calcium
* Values Variable.
Vitamin A 37%
Protein __. -49%
Vitamin G 79%
Phosphorus    69%
 100% A^ULL S"teCKS
i^th&jgftedicinals yd^ require are toj^lpltad,
we have them.
There are ^^n^^jrndder^^^Nscoveries^nd
preparations that are replacing some of those
not^pw available^fhe Medical profession can
depend oh Georgia Pharmac^ralwaY&
Phone
MArine 4161
s&t/lt. '&J&*oUa**A
OCifiGIA PHARMACY
WL
tofrr tc IpnttaJEifc
ESTASLISHID IMS
VANCOUVER, B. C.
North Vancouver, B. C.
Powell River, B. C. ^
$
m^zjtu
tfr
\Vv *<*. Stain*      m **
New Westminster, B. C.
tor the treatment of
NEUROPSYGHIATiaC
DISORDERS
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 721 Medical-Dental Building, Vancouver, B.'C.
PAcific 7823
Westminster 288
^■M^y'M
S7
r  ■»■ .Hinii.ff.iwi/igi
^Mfa^MM

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:
http://iiif.library.ubc.ca/presentation/cdm.vma.1-0214399/manifest

Comment

Related Items