History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: October, 1938 Vancouver Medical Association Oct 31, 1938

Item Metadata

Download

Media
vma-1.0214414.pdf
Metadata
JSON: vma-1.0214414.json
JSON-LD: vma-1.0214414-ld.json
RDF/XML (Pretty): vma-1.0214414-rdf.xml
RDF/JSON: vma-1.0214414-rdf.json
Turtle: vma-1.0214414-turtle.txt
N-Triples: vma-1.0214414-rdf-ntriples.txt
Original Record: vma-1.0214414-source.json
Full Text
vma-1.0214414-fulltext.txt
Citation
vma-1.0214414.ris

Full Text

 The BULLETIN
of the
VANCOUVER
MEDICAL ASSOCIATION
Vol. 15
OCTOBER,  1938
With Which Is Incorporated
Transactions of the
Victoria Medical Society
and the
Vancouver General Hospital
In This Issue:
EPILEPSY
B. C. MEDICAL ASSOCIATION ANNUAL MEETING
NEWS AND NOTES BULKETTS
(With Cascara and Bile Salts)
. . FOR I .
Chronic  Habitual
Constipation
BULKETTS POSSESS ENORMOUS BULK
PRODUCING PROPERTIES AND BEING
PROCESSED WITH CASCARA AND
BILE SALTS PRODUCE BULK WITH
MOTILITY. |
WE WILL BE PLEASED TO PROVIDE
ORIGINAL CONTAINERS FOR TRIAL
ON REQUEST.
Western Wholesale Drug
(1928) Limited
456 BROADWAY WEST
VANCOUVER   -   BRITISH COLUMBIA
(Or at all Vancouver Drug Co. Stores) THE    VANCOUVER    MEDICAL   ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
Offices:
203 Medical-Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. H. MacDebmot
Db. M. McC. Baibd Db. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XV.
OCTOBER, 1938
No. 1
OFFICERS  193 8-1939
Db. Lavell H. Leeson Db. A. M. Agnew Db. G. H. Clement
President Vice-President Past President
Db. W. T. Lockhabt Db. D. F. Busteed
Hon. Treasurer Hon. Secretary
Additional Members of Executive: Db. J. P. Bilodeau, Db. J. W. Abbuckle
Db. F. Brodie
TRUSTEES:
Db. J. A. Gillespie Db. Neil McDougalt.
Historian: Db. W. D. Keith
Auditors: Messbs. Shaw, Salteb & Plommeb.
SECTIONS
Clinical Section
Db. R. Palmeb  Chairman     Db. W. W. Simpson -Secretary
Eye, Ear, Nose and Throat
Db. S. G. Elliott Chairman     Db. W. M. Paton  Secretary
Pediatric Section
Db. G. A. Lamont   Chairman     Db. J. R. Davies  . Secretary
Cancer Section
Db. B. J. Habbison —     . Chairman     Db. Roy Huggabd . . Secretary
STANDING COMMITTEES
Library;
Db. A. W. Bagnall, Db. H. A. Rawlings, Db. D. E. H. Cleveland,
Db. R. Palmeb, Db. F. J. Buller, Db. J. R Davies.
Publications:
Db. J. H. MacDebmot, Db. D. E. H. Cleveland, Db. Mubbay Baibd.
Summer School:
Db. J. R. Naden, Db. A. C. Fbost, Db. A. B. Schinbein, Db. A. Y. McNaib,
Db. T. H. Lennie, Db. Fbank Tubnbull.
Credentials:
Db. A. B. Schinbein, Db. D. M. Meekison, Db. F. J. Bulleb.
V. O. N. Advisory Board:
Db. I. Day, Db. G. A. Lamont, Db. Keith Bubwell.
Metropolitan Health Board Advisory Committee:
Db. W. T. Ewing, Db. H. A. Spohn, Db. F. J. Bullee.
Greater Vancouver Health League Representatives:
Db. W. W. Simpson, Db. W. N. Paton.
Representative to B. C. Medical Association: Db. G. B[. Clement.
Sickness and Benevolent Fund: The Pbesident—The Teustees. Protection! Against Typhoid
Typhoid and Typhoid-Paratyphoid Vaccines
Although not epidemic in Canada, typhoid and paratyphoid infections remain a serious menace—particularly
in rural and unorganized areas. This is borne out by the
fact that during the years 1931-1935 there were reported,
in the Dominion, 12,073 cases and 1,616 deaths due to
these infections.
The preventive values of typhoid vaccine and typhoid-
paratyphoid vaccine have been well established by military and civil experience. In order to ensure that these
values be maximum, it is essential that the vaccines be
prepared in accordance with the findings of recent laboratory studies concerning strains, cultural conditions and
dosage. This essential is observed in production of the
vaccines which are available from the Connaught
Laboratories.
Residents of areas where danger of typhoid exists and
any one planning vacations or travel should have their
attention directed to the protection afforded by vaccination.
Information and prices relating to Typhoid Vaccine and to
Typhoid-Paratyphoid Vaccine -will be supplied
gladly upon request.
CONNAUGHT LABORATORIES
UNIVERSITY   OF   TORONTO
Toronto  5
Canada
Depot for British Columbia
Macdonald's Prescriptions Limited
MEDICAL-DENTAL BUILDING, VANCOUVER, B. C VANCOUVER HEALTH DEPARTMENT
STATISTICS—j
Total Population—estimated	
*lU
GU!
3T,
1938
259,987
Japanese Population—estimated...
8,685
Chinese Population—estimated....
7,808
Hindu Population—estimated	
335
Total deaths  I	
N
umber
239
6
12
196
357
list, 1938
9
25.2
10
► IN THE
1938
Deaths
0
0
0
0
0
0
0
0
0
1
9
0
0
Rate
Po
Aug
CITX
Sej
to 15
Cases
7
0
11
0
0
4
17
1
0
1
17
0
0
i per 1,000
pulation
10.8
Japanese deaths  	
8.1
Chinese deaths  	
18.1
Deaths—residents onlv	
8.9
BIRTH REGISTRATIONS—
Male, 191: Female, 166	
16.17
INFANTILE MORTALITY—
Deaths under one year of age.
Augi
ust, 1937
10
Death rate—per 1,000 births .
30.5
Stillbirths (not included in ab<
)ve)
DISE
July
ases
26
0
23
o
0
1
15
2
0
2
44
0
0
AS
,19
De
7
CASES OF COMMUNICABLE
c
Scarlet Fever 	
ES RE
38
aths
0
0
0
0
0
0
0
0
0
0
12
0
0
PORTED
August
Cases  ]
14
0
4
3
0
1
44
1
0
3
37
2
0
)t. 1st
th,1938
s  Deaths
0
Diphtheria       	
0
Chicken Pox 	
Measles    	
0
0
Rubella    	
0
Mumps 	
Whooping Cough	
Typhoid Fever 	
0
0
0
Undulant Fever	
Poliomyelitis          ..   	
0
0
Tuberculosis 	
Erysipelas   	
Ep. Cerebrospinal Meningitis	
0
0
V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEAI
DIVISION OF VENEREAL DISEASE CONTROL
Syphilis	
Gonorrhoea
Richmond
2
..        0
North Hospitals j
Vancouver Vancouver private doc
1 45 18
0 98 26
A PRESCRIPTION SERVICE . . .
Conducted in accord with the ethics of the Medical
Profession and maintained to the standard suggested by
our slogan:
Pharmaceutical Excellence
AACG! SOifme,
FORT STREET (opp. Times)
Phone Garden 1196
ind
tors
Totals
66
VICTORIA, B. C.
Paget  THE EDITOR'S PAGE
This number of The Bulletin is No. 1 of a new volume, the 15th. Our readers will
notice changes, and it may be remembered that some months ago we mentioned the fact
that negotiations were under way with the Victoria Medical Society and the Vancouver
General Hospital to include their Transactions as regular features of The Bulletin.
In order to do this, it has been necessary to enlarge The Bulletin—and it is now a
considerably bigger journal than before. The pages are larger and contain more words to
the page; the type is, we consider, a distinct improvement, and altogether we feel that The
Bulletin has taken another step forwards and upwards.
We must acknowledge here the ready co-operation of Dr. D. M. Baillie, Chairman of
the Publications Committee of the Victoria Medical Society; Dr. B. J. Harrison, who fills
the same position as regards the Staff of the Vancouver General Hospital, and perhaps
especially the help given by Mr. Macdonald of the Roy Wrigley Publishing Company.
Mr. Macdonald is our business manager and has done a very great deal to make these
changes effective.
Our policy has been, and will continue to be, one of steady and gradual development,
and we do not contemplate any radical changes, or any bold moves. For some time past we
have felt, however, that the time was pretty near for expansion, and inclusion of more of
the many things that are of interest to the medical men of British Columbia; for while this
is The Bulletin of the Vancouver Medical Association, it is far more than a Vancouver
journal. Our exchanges alone cover a very wide area, and The Bulletin reaches a long
way. As an example of this, we may mention that when we began publication, our monthly
issue was some two to three hundred copies. This first number of the new volume will
print a thousand copies—and our publisher tells us he thinks we should print more, and
seek for subscriptions outside the province. We receive letters from time to time, referring
to articles, etc., published in The Bulletin: these come from all parts of the world: the
United States, Canada, Great Britain; even South Africa and India have been heard from.
So no longer can we, or should we, be satisfied with purely parish-pump politics and
local news. We should, the Publication Committee feels, be guided by circumstances and
new possibilities, and as occasion offers, gradually include many new features, perhaps
one at a time. One of the most important, and perhaps the nearest to> hand, will be Public
Health matters. For example, we hope to have some short articles by Dr. D. H. Williams,
Director of the Division of Venereal Disease Control, Provincial Board of Health. These
will be of great importance, as well as interest, to every medical man.
There is not enough, by a long chalk, of interchange between the two divisions of
medicine—or rather, we should say, the two halves of medicine—the therapeutic half and
the preventive half. No medical journal that we can think of at the moment caters to
both sides at the same time. We have long felt that this is a great pity, and accentuates the
natural tendency to dichotomy in this regard. The Bulletin feels that it has a great
opportunity here to bring these twins together once again. They are like looking-glass
twins—allelomorphs, to use a long word—pictures of each other, and should never have
been separated as widely as they now are.
So we bespeak from our readers their interest and moral support. We would ask, too,
that they remember that our one source of revenue comes from our advertisers. Advertisers are, and have to be, rigidly controlled, in their allotment of advertising, by the
results obtained from that advertising. Our readers will notice that the great majority of
our advertising is what is called "national" advertising, that is, by large firms doing nationwide business here and in the United States. This, it may be said, is a proof, if any were
needed, of the significance of The Bulletin as an advertising medium—but it would be
greatly appreciated by your Publication Committee if all readers of this Bulletin would
make a point, wherever possible, of referring to this Journal as the source of their interest
in any particular advertisement, and also of patronising these firms, who are all above
reproach or suspicion. The Bulletin has always been very scrupulous about the character of the advertising it admits.
We hope that our new step will lead to wider horizons, more extensive fields, a clearer
and a higher air.  It has been a great joy to those of us associated with The Bulletin to
Page 2 see it grow and expand and become more useful and valuable—but it is only at the beginning of its career yet, and we must never be satisfied with achievement. May we never
arrive at the end of our journey of exploration—but travel hopefully, to do which,
Stevenson tells us in an inspired phrase, is better than to arrive.
By the time this goes to press, the Vancouver Medical Association will have celebrated
its fortieth anniversary at a dinner meeting. There may be more to say about this later, and
Dr. Frank Turnbull's paper, read at that meeting, will appear in an early issue of The
Bulletin. Meantime we record the meeting as a milestone in the history of our progress.
In this regard, we wish to pay our respects to the Vancouver News-Herald, which is publishing an anniversary number dedicated to the Vancouver Medical Association. Our
readers will no doubt find this a valuable and interesting document, and it will be preserved in the archives of the Vancouver Medical Association.
VANCOUVER MEDICAL ASSOCIATION
ANNUAL DINNER
The Annual Dinner of the Association will be held on November 18th next. While
definite arrangements are not yet completed, it is announced that the dinner will be held
in the Oak Room of the Vancouver Hotel. Dr. D. E. H. Cleveland willj have charge of
the Programme and Dr. D. D. Freeze will manage business matters. KEEP THIS DATE
IN MIND—FRIDAY, NOVEMBER 18th, 1938.
VANCOUVER MEDICAL ASSOCIATION
Founded 1898    ::    Incorporated 1906.
GENERAL MEETINGS will be held on the first Tuesday of
the month at 8 p.m.
CLINICAL MEETINGS will be held on the Third Tuesday of
the month at 8 p.m.
Place of meeting will appear on the Agenda.
General meetings will conform to the following order:
8: 00 p.m.—Business as per Agenda.
9: 00 p.m.—Papers of the evening.
Programme of the 41st Annual Session
1938
October   4th—GENERAL MEETING.
Dr. Frank Turnbull : "Pituitary and Para-pituitary
Tumours."
October   18th—CLINICAL MEETING.
November 1st—GENERAL MEETING.
Dr. J. Ross Davidson : "Some Aspects of Contract Practice."
November 15th—CLINICAL MEETING.
December 6th—GENERAL MEETING.
Dr. Karl Haig : Subject to be announced later.
December 20th—CLINICAL MEETING.
PageS NEWS AND NOTES
The hearty congratulations of the Association will go to Dr. A. W. Bagnall, who was
married on September 12th to Mrs. Gertrude Helen Taylor of this city. We offer our very
best wishes to Dr. and Mrs. Bagnall.
Dr. J. R. Naden has left for one month's well-earned vacation.  He will motor south.
Dr. D. E. Alcorn has opened offices in the Belmont Building in Victoria and will confine
his practice to neurology and psychiatry.
Dr. E. D. Emery of Nanaimo, the energetic Secretary of the Upper Island Medical
Association, and Mrs. Emery have just returned from from a six weeks' vacation in Alberta.
Dr. L. Giovando of Nanaimo returned from the Timberlands District with a large bag
of birds.
Dr. G. A. B. Hall of Nanaimo was prevented from attending the Victoria meeting by
illness. We missed him at the Economic Conference. He has recovered and is back at
the office.
Dr. and Mrs. J. S. Henderson of Kelowna were holidaying at the Coast and are now
preparing for the Annual Meeting of No. 4 District Medical Association, which is being
held in Kelowna on October 2nd ;and 3rd.
Dr. R. B. Shaw of Nelson is in Montreal doing postgraduatei study.
Dr. F. M. Auld of Nelson, the First Vice-President of the British Columbia Medical
Association; Dr. Arnold Francis of New Denver; Drs. J. Bain Thorn, member of Council,
W. A. Coghlin and M. R. Basted of Trail represented the West Kootenay at Victoria.
Dr. C. H. Hankinson of Prince Rupert, representative on the Board of Directors of the
British Columbia Medical Association and member of the Committee on Economics of the
College, travelled to Victoria by Union Stemaship to Campbell River, where he landed
his automobile and motored down the Island to Victoria, arriving in time for the Breakfast
Meeting of the Committee on Economics on Friday morning.
Dr. S. Cameron MacEwen of New Westminster, a member of the Council and Chairman of the Committee on Economics, presided at the Breakfast Meeting on Friday, September 16th, at the Empress Hotel.
There were present: Doctors Anson C. Frost of Vancouver; G. W. C. Bissett of Duncan; C. H. Hankinson of Prince Rupert, C. C. Browne of Nanaimo (in the absence of Dr.
G. A. B. Hall); E. J. Lyon of Prince George; Stewart A.jWallace of Kamloops; J. Bain
Thorn of Trail; E. W. Boak, W. H. Moore and D. M. Baillie of Victoria; J. H. MacDermot
of Vancouver; T. C. Routley of the Canadian Medical Association, and M. W. Thomas..
Drs. G. A. B. Hall of Nanaimo and R. V. McCarley of North Vancouver were unavoidably absent.
Dr. E. J. Lyon of Prince George and Dr. B. J. Hallowes of Alexis Creek added Cariboo
colouring to the meeting in Victoria.
*t. »t. *.(. st,
Dr. John G. MacArthur of Prince George had an interesting trip by plane to Fort
McLeod, Fort Grahame and Whitewater.  One sees a lot of virgin territory when one flies.
Dr. A. L. McQuarrie has finally proven the authenticity of his aeroplane experience.
He was accompanied by Indian Agent Moore and Dr. Ross Stone of Vanderhoof.   The
Page 4 plane was taxiing up Stuart Lake at about 10 miles per hour and the pilot climbed out of
his cabin to make some minor adjustment when he lost his foothold and slipped off into
the lake. Dr. Stone quickly threw him a life-preserver, but—what next to do? The door
to the cockpit was locked and the windows of the compartment were 12 by 16 inches. The
three prisoners surveyed the scene and sized up their waistlines. Dr. McQuarrie was chosen
to be thrust through the window with the aid of some skilful obstetrical manoeuvres by
Dr. Stone. He then climbed into the driver's seat, and—what to do now? As he says, he
looked at everything and fiddled about a bit and turned the plane about and returned to
the floating pilot and then—to get it stopped. However, he did, and Dr. McQuarrie's
friends still marvel at his ability as an acrobat and aviator. Dr. Stone appeared to have
recovered from the experience sufficiently to laughingly verify the story.
Dr. A. L. Jones of Revelstoke has had his son "Johnny" admitted to the Royal Military
College in Kingston.
Si- Sj- Or >'r
Dr. and Mrs. R. Geddes Large of Prince Rupert are back after their two months' trip
to Glasgow, Edinburg and London, returning on the record trip of the Queen Mary.
•.». »(, »5. »?,
Dr. J. M. McDiarmid, formerly of Abbotsford, has opened offices in Vancouver.
•t. *5»
Dr. R. J. Macdonald of Abbotsford has left for Toronto to do a "Public Health" course
on the Fellowship of the Rockefeller Institute.
Dr. H. E. Cannon, who has been associated with Dr. A. McBurney at Langley Prairie,
has taken over the practice at Abbotsford.
"Behind him he hears a buzzing sound that indicated that one of the hospital's new
x-ray tubes has been brought to bear on his back."—Victoria Daily Colonist, Sept. 18,
1938. We could suggest other reasons for such sounds, if it was a pretty nurse.
Word has been received that Dr. W. T. Kergin of Prince Rupert has undergone a
successful operation recently at the Mayo Clinic, Rochester, Minn.
Dr. J. H. Carson contemplates going to England in connection with North Pacific
Halibut Liver Oils, which he so successfully manufactures in Prince Rupert, B. C.
LIBRARY NOTES
ALLAN B. KANAVEL, F.A.C.S.
Dr. Kanavel of Chicago, who died on May 27th after a motor accident in California,
was one of those surgeons who influence practice every day in all parts of the world. Outside his own country he was known for his work on infections of the hand, which will long
remain the basis of all study of these difficult and important conditions. His book on this
subject, first published in 1912, has gone through six editions, and has even been translated
into Chinese. It is founded on ten years of clinical observation and anatomical research; by
the forcible injection of opaque material into tendon sheaths he was able to show the directions in which pus would spread in the hand, drawing attention to the thenar and middle
palmar spaces not previously recognized by anatomists.   Inestimable benefit has followed
Page 5 the application of Kanavel's methods, and he himself became a master at restoring to function hands crippled by old infections. He wrote with authority, however, on a great variety
of surgical subjects and was specially interested in the surgery of the central nervous system
and in gynaecology.
At the time of his death Dr. Kanavel was professor of surgery at the Northwestern
University medical school. He was a founder and life member of the American College of
Surgeons, in which he had held many important offices, including those of regent and
president. During the late war he served as colonel in the medical corps of the U. S. army,
finally occupying the position of assistant to the chief consultant in surgery of the American
Expeditionary Forces. Of recent years he had largely given up practice and had spent most
of his time teaching and in editorial work. He was associated with Surgery, Gynecology
and Obstetrics from its inception in 1905 until 1935, when he became editor, and the July
issue contains memoirs and a portrait. He was 63 years of age.—Lancet, July 16, 1938.
BOOK REVIEW
Biological and Clinical Chemistry: M. Steel; Lea and Febiger, 1937.
"In the present text the author has attempted to blend theoretical and practical biochemistry and biophysics with chemical pathology and clinico-chemical methods." To this
excerpt from the preface it may be added that the book covers the fields of both biochemistry and pathological chemistry, as known in several of our own universities, and
includes instructions for laboratory work interspersed with the theoretical treatment of
these subjects. The subject-matter of the book is extensive and supplemented with adequate
references; the subject-form of the book is open to criticism. For example, vitamines and
hormones are treated in both their academic and pathological aspects in Chapters 11 and 12,
and nutrition and protein metabolism not till Chapters 18 and 21 respectively.
The dialectical relationship of theory and practice, of lectures and laboratory, is recognized by all teachers in the sciences, but is met in different ways. Through a keen desire,
no doubt, to keep the experimental evidence before the too speculative mind, Professor
Steel has attempted to include his practice with his theory. More strictly, he has given us
a mixture of theory and theory of practice; for reading about an experiment can never be
the same thing as doing it, or, conversely, the reading of textbooks is not a usual part of
laboratory work. Detailed instructions for experiments are distracting to the mind on a
definite train of thought. The incorporation of experimental evidence in the theoretical
treatment of a subject is quite a different matter from the addition of details—often requiring quite a different theory—as to how that experimental evidence is attained. Thus, in
the reviewer's opinion, this book would have been better without its experiments, although
these appear to be well enough chosen and adequately described. The book contains much
up-to-date and accurate information, and will be found useful by both students and medical practitioners.—Canadian Medical Association Journal, March, 1938.
NEW BOOKS ADDED TO THE LIBRARY
Treatment in General Practice—H. Beckman.  3rd ed., 193 8.
Radiation Therapy—Ira I. Kaplan.   1938.
Leukaemia and Allied Disorders—Claude E. Forkner.   1938.
Vitamin B and Its Uses in Medicine—T. R. Williams and T. D. Spies.   1938.
Approved Laboratory Technic—J. A. Kolmer and F. Boerner.   1938.
Diseases of the Skin—O. S. Ormsby, 1938.
Clinical Allergy—A. H. Rowe.   1938.
Primer for Diabetic Patients—R. M. Wilder.  6th ed., 1938.
Harvey Lectures—Series 33, 1937-38.
Page 6 BRITISH COLUMBIA MEDICAL ASSOCIATION
COMMITTEE ON PUBLIC HEALTH
"MILK SITUATION"
There has been a considerable amount of discussion about the milk situation during the
last year. There are some indications that the medical health authorities are considering a
more general application of pasteurization, but unless some active steps are taken by both
the Provincial authorities and the Municipal authorities, including the medical officers, no
appreciable progress will be made. While the power rests with the Provincial and Municipal
authorities, this does not excuse any laxity on the part of the medical profession, and we
must persist in our efforts to educate and instruct the public. If in the past the medical
profession throughout this Province had uniformly and persistently advocated pasteurization of milk, the public would probably be enjoying its benefits today. In the not far distant past we were able to demonstrate some of the advantages of a united front, and surely
in matters pertaining to scientific methods we should present unanimity. In regard to
medical advice concerning milk, this has unfortunately not been the case, and in some
cases serious doubts have been left in the public mind because of a seeming divergence of
opinion among medical men. As pasteurization has been universally accepted as the only
scientific method available to produce a safe milk, could we not, as a profession, resolve
to seize every opportunity to instruct the public properly about the kind of milk they
should use. If every doctor took the time to advocate and explain pasteurization to his
patients the public would soon be demanding universal pasteurization. The safety and
convenience of canned milk is well appreciated by the dairyman, who is alive to the possibilities of an ever-increasing demand for safe canned milk.
Should there be any doubts among medical men, one cannot refer too often to
a recent experiment in Toronto, the capital city of a province where pasteurization is general. Dr. Marguerite Price, in an investigation of non-pulmonary
tuberculosis, examined 300 patients under 14 years of age and found 45 of them
were infected with the bovine type of bacillus. All the patients infected had
consumed raw milk and had come from outside Toronto. In Toronto itself not a
single case of bovine tuberculosis was detected in this investigation. Examination
of 100 samples of pooled raw milk before pasteurization revealed tubercle bacilli
in 26. (The percentage of the presence of the tubercle bacillus in raw milk averages from 7 to 10% in all countries.) In Dr. Price's investigations, not a single
sample of contaminated raw milk was found to contain tubercle bacilli after
pasteurization.
One would like to think that Vancouver is as scientifically minded as Toronto. In
England the cattle in attested herds must by law be fed milk from tuberculin-tested herds
or the milk must be pasteurized. One can say, then, that in England attested herds are
more safely protected by law against the dangers of raw milk than are the children of
British Columbia.
This Province must of necessity spend each year very large sums of money on the
treatment of tuberculosis. Does it not seem reasonable that the authorities should insist
on the universal use of such a scientific protective agency as pasteurization to reduce the
number of cases of tuberculosis? No nation is so decadent scientifically as the one that
persistently refuses methods that have saved lives and lessened the ravages of disease.
Just at present the perennial stalemate in the milk question is at its peak. The Provincial Government has issued an excellent Bulletin endorsing pasteurization. The medical
health officers in several large municipal districts, including Vancouver, have in the press
endorsed the principle of pasteurization; several local and our Provincial and Canadian
Medical Associations have strongly endorsed pasteurization. Much space has also been
given in the press for the discussion of this question. Is it all to end, as in the past, in a
multiplicity of words? Certainly the matter will never be adjusted by the Provincial and
Municipal authorities continuing the milk football game of passing the question from one
Paget seat of authority to the other. The medical profession at large has also a serious moral
obligation to perform. Isn't it about time that all interested parties rid themselves of
political and other astigmatisms and consider the question through the unbefogged glasses
of impartial medical science?
A. Howard Spohn, Chairman.
NEWS FROM THE TRAVELLING TEAM
Contributed by Dr. M. W. Thomas
The Lecture Team is still asleep at this early hour. On such a morning it seems to savour
of sacrilege to sleep. Chilliwack is peaceful and still slumbers although the sun is rousing
some of us and warming the chilled air as it casts its warm glow over the surrounding hills.
From my window, as I read the News-Herald at 6:30 a.m., I see the blue hazes welcoming
the light of another day.
I had a tired team on my hands last night. As I put them to bed and tucked them in
I felt pleased and proud of my charges, for they had started out strongly on what I now
presage to be a most promising tour. Last evening we dined with the newly-formed Chilliwack Medical Society at the Empress Hotel and we fraternized with the other visitors,
Drs. H. E. Cannon of Abbotsford and Dr. J. A. Taylor, who has recently acquired his
D.P.H. degree at Toronto and is now the Director of the Unit, with headquarters at
Abbotsford. Dr. R. McCaffrey presided, and others present were: Dr. J. D. Moore, Vice-
President; Dr. G. A. C. Roberts, Secretary; Drs. L. A. Patton, R. W. Patton, A. R. Wilson
and W. E. Henderson.
Following an excellent dinner and informal chat about the proposed new hospital and
happy reports on the value of the new organization of the local group, the President called
upon Drs. Murray Baird and Roy Huggard, who dealt with "The Treatment of Medical
Emergencies" and "Carcinoma of the Breast," and if the lively discussion of these papers
reflects the interest shown and the quality of these presentations, I would predict that the
meeting at Kelowna of the No. 4 District Medical Association (which includes doctors in
that whole area from Bralorne and Pioneer, Lillooet, Lytton, Ashcroft, Revelstoke, Kamloops, Merritt and all the places down the Okanagan to Penticton and Oliver and including
Princeton, Hedley and Blakeburn), and that at Trail of the West Kootenay Medical Association, which goes to Nakusp in the north, and then the meeting at Cranbrook, which
comprises the whole area from Invermere to Creston, and including Michel, Fernie and
Kimberley, would be eminently successful.
Both Drs. Huggard and Baird made a splendid contribution of well-prepared papers,
presented in their own inimitable ways. I was, I say, pleased and proud of this exordial
effort by my two star speakers.
They were both impressed by the fine spirit which pervades the profession and I may
quote them: they feel that we have in British Columbia a something which is virile and
vital—an organization that is both centrifugal and centripetal.
Page 8 DR. W. D. BRYDONE-JACK
OBIIT AUG. 30, 193 8.  AET. 78.
The present writer has a very special memory of Dr. William D. Brydone-Jack,
who was the first medical man he met on arriving in Vancouver some 32 years ago,
almost to the day. At that time he was in partnership with Dr. A. S. Monro, with
whom he remained associated till the death of the latter some years ago. The two
men were about as different as two men could be—and so got along splendidly.
Monro was quick, volcanic, and ready always to try new things, embark on new
ventures, and plunge head-first into any scheme that appealed to him. Brydone-
Jack seemed, in contrast with him, slow and reserved—quiet and courteous of
speech, gentle of manner, but friendly and kindly in his treatment of a newcomer
and stranger.
But this quiet reserve concealed a forceful and positive character, which has
left its mark on our community life, and which found expression in the many public
offices he filled and positions of trust that he occupied. It concealed, too, a depth of
wisdom and practical common sense that has rarely been surpassed. Time and
again one has seen him confronted with problems, important and urgent, but difficult of solution withal—and he rarely failed to find some practical, sane way out,
fair to all concerned. That feature of his character is one that sticks in the writer's
memory of our late colleague.
He had the gift of friendship, and was a welcome guest anywhere. He enjoyed
good-fellowship and the companionship of his fellows, and contributed a full share
to the entertainment.
As regard his work, it could hardly fail to be a success; he was a very busy
man in his prime, and very popular with his patients. In later years, he devoted
much of his time to his work as Coroner, and this position has never been more
competently filled than it was by him.
His passing leaves a gap, both in public and professional life, and his host of
friends will miss him sadly. But in the words of the old writer, "he has left a good
name"—and that is success of the highest kind. May he rest in an honoured peace.
—J. H. M.
BRITISH COLUMBIA MEDICAL ASSOCIATION
LECTURE TOURS^      |    §
Dr. Murray McC. Baird and Dr. Roy Huggard will travel by automobile with Dr. M.
W. Thomas to attend meetings in the Okanagan and East and West Kootenays.
Doctors Baird and Huggard will present papers to the Chilliwack Medical Society and
at the Annual Meetings of No. 4 District Medical Association at Kelowna, the West
Kootenay Medical Association at Trail, and the East Kootenay Medical Association at
Cranbrook.
Doctor Huggard will address luncheon, dinner and evening meetings en route in
support of the membership efforts of the various Units of the British Columbia Branch of
the Canadian Society for the Control of Cancer. The Canadian Clubs in the various centres
are co-operating in arranging these meetings. Doctors Baird and Thomas will support Dr.
Huggard and, as it were, bask in the light of reflected glory as this fluent and forceful
speaker carries a convincing message to these lay audiences.
CHILLIWACK
The first stop, on Friday, September 3 0th, will find the eight doctors of Chilliwack at
dinner at the Empress Hotel with the doctors from Abbotsford and Mission. Both Doctors
Baird and Huggard will present post-prandial papers to this augmented Chilliwack Medical
Society.
LYTTON
On Saturday, October 1st, Dr. J. P. Ellis has arranged a public meeting after dinner
at Lytton, when Dr. Huggard will speak on "Cancer."
On Sunday, October 2nd, the party will visit Dr. Drummond at Ashcroft, the doctors
in Kamloops, then on to Salmon Arm, Enderby, Armstrong and Vernon, where Dr. Huggard will address a public meeting.
Page 9
S KELOWNA
On Monday, October 3rd, the lecture team will participate in the Annual Meeting of
No. 4 District Medical Association. A full programme has been prepared, commencing
with golf on October 2nd, and a visit to the fruit packers and canners, and then on to the
winery.
After luncheon the lectures will include: Dr. Murray Baird on "Treatment of Medical
Emergencies" and "Some Remarks on Rheumatic Diseases"; Dr. Roy Huggard: "Carcinoma of Breast" and "Radical versus Conservative Treatment in Acute Cholecystitis."
Dr. G. Allan Mail, Dominion Entomologist at the Government Station, Kamloops, will
speak on "Tick and the Resultant Diseases."
The dinner of this Association is an outstanding feature and is followed by the Annual
Business Session, election of officers and the selection of the venue for the next Annual
Meeting. Dr. J. S. Henderson is the President and Dr. Reba E. Willits is the Honorary
Secretary-Treasurer.
TUESDAY, OCTOBER 4th
This will be a busy day for Dr. Huggard. The party will visit Peachland, Summerland,
West Summerland, and at
PENTICTON
Doctors R. B. White and H. McGregor will arrange a luncheon at which "Cancer" will
be the topic.
GRAND FORKS
The party will visit Oliver and Greenwood, and after dinner a meeting at Grand Forks
has been arranged by Dr. Windsor Truax, when Dr. Huggard will speak.
TRAIL
On Wednesday, October 5 th, the West Kootenay Medical Association convenes in its
Annual Meeting. Doctors Huggard and Baird will present papers, and Mr. Mail of Kamloops will deal with "Diseases Caused by Ticks."
There will be clinical features presented by local men. After dinner the Annual Business Meeting will be held. Dr. M. R. Basted is the President and Dr. Wilfrid Laishley of
Nelson is the Honorary Secretary-Treasurer.
NELSON
Leaving Trail on Thursday, October 6th, en route to Nelson, the party will visit Dr.
Goresky at Castlegar. Dr. F. M. Auld of Nelson is arranging a luncheon to hear Dr.
Huggard.
CRESTON
Creston will be reached for dinner on October 6th, and after Dr. Huggard talks on
"Cancer" the party will proceed to Cranbrook.
CRANBROOK
On Friday, October 7th, the members of the East Kootenay Medical Association will
meet in Annual Session. Doctors Baird and Huggard will present four papers following
luncheon at the Cranbrook Hotel. Dr. F. E. Coy of Invermere will preside and Dr. J. F.
Haszard of Kimberley is the acting Honorary Secretary-Treasurer. The lecture programme
will be held in the Training School of St. Eugene Hospital.
At this point the party will lose Dr. Murray Baird, who will have left his mark on the
two Kootenays and intervening points. Dr. Baird will travel by train to Rochester to visit
the} May os.
However, Doctors Huggard and Thomas will still continue the journey and more places
will be visited, and Doctor Huggard will be just as busy spreading his pep in the projection
of the British Columbia Branch of the Canadian Society for the Control of Cancer.
COWICHAN RIVER
If all the doctors will come to the Cowichan River, Doctor Thomas will have a few
days' fishing—perhaps.
Page 10 BRITISH COLUMBIA  MEDICAL ASSOCIATION
ANNUAL  MEETING, SEPTEMBER, 193 8
The Bulletin desires to extend its heartiest congratulations to the British Columbia
Medical Association on the very great success of its Annual Meeting, held at Victoria,
September 15 to 17. We feel particularly good about it, since we urged our readers to attend
in force, and promised them all sorts of good things, and our advice, for once (or as usual),
has turned out to be thoroughly sound, and our promises were all more than implemented,
as the saying is. Besides, we went ourselves, chiefly on our own recommendation, and we
felt that it showed our sincerity and honesty when we took our own advice.
Well, there is no doubt that it was good advice. The meeting, from first to last,
admirably fulfilled its purposes. These were chiefly, we take it, to strengthen and tighten
the bonds of union between us as members of this Association; to provide the latest educational and scientific material for our professional betterment, and to provide for growth
and progress in the work of the medical profession. Incidentally, there was an entertainment radical somewhere in the gigantic molecule of unsatisfied affinities—and this entertainment radical, which contained a great deal of carbon dioxide and an alcohol ester of
one kind or another, probably did as much to satisfy these affinities as anything else. The
carbon dioxide was, of course, provided by the trees on golf courses and the like.
The scientific part of the programme was excellent, and we owe much gratitude to
the speakers who gave so liberally from the "bonded storehouse of their knowledge," as
Jorrocks would say. All the speakers were good, and the loud-speaker arrangement ensured
that nobody missed a word—except when our good friend Dr. Cleveland, acting as chairman, kept moving it out of the way of the speaker; perhaps he was afraid they would
speak into it.
The attendance was very good indeed, and we are sure our hosts at Victoria must have
felt gratified, as every good host must do, to see so many partaking of the good things they
had provided. Half the Vancouver medical profession seems to have gone, either for part
or all of the time, and we saw a great many men from all parts of the province.
Victoria, as we prophesied, proved to be one of the very best of hosts. The weather was
superb, the golf courses in excellent shape (rather excessively bunkered, on cannot help
feeling), and there was ample entertainment for everybody. Garden parties, teas, dances,
dinners, for men and women alike, were thoroughly enjoyed, and left us all with a delightful feeling of having had a thoroughly good time. There was no effort and no strain, and
eveiything moved so easily and as if on oiled bearings, that one forgot that there had been
a good deal of hard work and organisation necessary before this meeting could function
as it did.
For there was this preparation and effort, unsparingly contributed by those in charge
of the meeting. Dr. M. W. Thomas, our Executive Secretary, has been perhaps the busiest
man in the Western Hemisphere for some weeks, and this rose to a climax during these
three days, as he had to be everywhere at the same time, and keep all thj& pots boiling,
without allowing any to burn, or go out, or boil over. Quite an assignment—but it was
in good hands, and by the time dinner came on the table everything was just right. We
add our most sincere congratulations and thanks to the many that he has already received.
Speaking of dinners, we were very glad to have with us the Hon. T. D. Pattullo, the
Premier of British Columbia, and the Hon. G. M. Weir, Provincial Secretary, at the Annual
Dinner. Mr. Pattullo was our guest speaker, and we hope he enjoyed being with us as much
as we enjoyed having him. His speech was short and to the point, and showed a great deal
of friendly understanding of our points of view.
A great deal of praise, and our sincere thanks, are due to the officers of the Association,
notably Dr. Gordon Kenning, the President, who was admirably at home in conducting
the proceedings, and made an excellent chairman at the Dinner.
9r •£ 9p ${■
We propose to publish in the form of a Supplement the papers read at this meeting.
They are, to some extent, presented as read. In other cases, our stenographer took notes,
and these are given. We feel that in this form they will be of most value to the members
of the Association.
Page 11 VICTORIA  MEDICAL SOCIETY
Dear Dr. MacDermot:
Duncan, V.I., Sept. 23rd, 193 8.
Dr. Baiilie has written me saying that you are bringing out the next Bulletin in its
enlarged form and indicates that a short statement from me in my capacity as President
of the Victoria Medical Society would be acceptable for inclusion.
Personally, and also in my official capacity, I consider this the major accomplishment
of one year: a true stepping-stone forward.
I should like to say that the Victoria members will bej gratified to have their transactions and papers included in The Bulletin. We feel that much of value has been lost
to ourselves and the profession elsewhere in the province through our lack of publishing
facilities. We further feel that this budding graft onto The Bulletin will be received
with general acclaim as a very tangible piece of evidence of the growing unity within the
profession.
I wish to take this opportunity to thank you personally for your own efforts, which I
feel have played a large part in making this good thing possible.
Yours sincerely,
G. W. Bissett.
Dear Dr. MacDermot:
Victoria, B. C, Sept. 29t9h, 1938.
May I say, on behalf of the Publicity Committee of the Victoria Medical Society, how
pleased and grateful we are for the hospitality of The Bulletin's columns.
We feel that this new development is of great significance to our profession in the
Province and particularly to the Victoria Medical Society. We hope that it will lead to
the organization in the near future of a British Columbia Medical Journal.
Yours sincerely,
David M. Baillie.
FROM THE CANADIAN MEDICAL ASSOCIATION
To the Profession:
The Authorship Committee appointed by the Department of Cancer Control of the
Canadian Medical Association has undertaken as its initial effort the production of a handbook on cancer, for the Medical Profession.
The manuscripts for this handbook were submitted for criticism, through the Deans
of the nine Medical Schools in Canada, to the leaders in our profession interested in cancer,
as well as to the Cancer Committee of each of the nine Provinces. The final text is an
attempt to express the combined opinion of these collaborators.
Cancer of the various anatomical sites is discussed from the standpoint of pathology,
diagnosis, treatment and prognosis.  The book will be off the press thisj summer.
If you feel that such a book would be of value to you in your work, thje Canadian
Medical Association will be glad to mail you a copy with its compliments, if you will write
your request (using your professional stationery) to the Department of Cancer Control
of the Canadian Medical Association, 184 College Street, Toronto.
# Yours faithfully,
T. C. Routley, General Secretary.
Page 12 CANADIAN MEDICAL
ASSOCIATIO N
DEPARTMENT  OF
CANCER CONTROL
CANADIAN SOCIETY FOR
THE CONTROL OF
CANCER
For the Medical Man
The education of the doctor in the
latest known scientific facts about
cancer, by means of books, pamphlets, lectures and films.
The establishment of Tumour Clinics in Hospitals—making biopsies
available.
The encouragement of Cancer Study
Groups in Medical Societies.
All this tending to make the Doctor
"Cancer Conscious" and ready to
co-operate with the layman in his
desire for a complete examination
leading to early recognition of disease and prepared to advise the layman as to the proper lire of treatment to be adopted.
The provision of standard records
for clinical and statistical purposes.
For the Lay Man
OBJECTS
^Mc
The education of the layman by
means of pamphlets, lectures and
the showing of films on cancer sub-
jects, to demonstrate the necessity
and value of PERIODIC HEALTH
EXAMINATIONS.
The education of the layman leading
to an understanding of the grave
potentialities of certain definite
signs and symptoms and the necessity of immediately consulting his
doctor and insisting on a complete
examination.
Warning the layman of the danger
of delay in acting upon the advice
of his medical man.
To prove to the layman that Cancer
is curable when diagnosed early and
treated adequately.
In general to do everything possible to lower the mortality and morbidity statistics of cancer in the Province of British Columbia: to help in every way towards
a solution of the cancer problem in the Dominion: to support all humanitarian
efforts to alleviate the sufferings of patients with cancer: to this end to enlist the
sympathetic support and financial aid of the general public by building up
membership in the
CANADIAN  SOCIETY  FOR  THE  CONTROL  OF  CANCER
Page IS THE CANADIAN SOCIETY for the CONTROL OF CANCER
British Columbia Branch
jective — 50,000 Members
UNIT:
An Executive of five, consisting of: Chairman, Secretary,
Treasurer, two elected members.
Executive cf Five
and members.
DISTRICT
COUNCIL:
PROVINCIAL
COUNCIL:
Approximately 36 members—sending two elected representatives to
the Provincial Council—one lay and
one medical.
I
15 0 Units in British Columbia, each with an Executive of
five. Endless chain method of
obtaining members. Each unit
sending two elected representatives to their District Council—one lay and one medical.
9 District Councils in
British Columbia, each
receiving two representatives from each unit
in their District. The
number of members of
each District Council
varies with the number
of units in their district.
Forty members, which include two representatives from each District Council plus 22
members at large, 11 medical and 11 lay.
Now in process of organization by a Provisional Board of Directors under the chairmanship of Dr. A. Y. McNair.
The Provincial
Council of British
Columbia receiving two representatives from each
of the nine District Councils.
DOMINION
GRAND
COUNCIL:
Eighteen  members—two  from   each   Provincial   Council.
Now in process of organization by a Provisional Board of
Directors under the chairmanship of Dr. J. S. McEachern,
assisted by three laymen and three medical men.
Head
Office:
Toronto,
Ont.
Department of Cancer Control of the Canadian
Medical Association with a Board of 18 members.
The Canadian Medical Association
The Trustees of the
King George V Silver
Jubilee Fund.
Page U EPILEPSY
Discussion of the Surgical and Non-Surgical Treatment
By R. Glen Spurling, M.D.,
Louisville, Ky.
Read before the Summer School of the Vancouver Medical Association, June 21-24,1938.
There is perhaps no single group of chronic sufferers who are so utterly miserable as
those composing the epileptic group. They do not ordinarily die of the disease; many of
them must await some intercurrent ailment to relieve them of what has been a horrible
existence. Many of them are thwarted in their attempts to make something useful of their
lives. Most of them are denied the pleasures of marriage and children because of the
hereditary feature of the disease. What may be more pathetic is the social stigma which
descends upon the immediate family of the victim. For centuries the sufferers of fits have
been spoken of in hushed tones and with lifted eyebrows. They and their f amines are forced
by social customs to be secretive at best and social outcasts as a rule.       •
That the source of the disease has not been eradicated and its treatment more efficient
is not due to lack of interest among clinical and laboratory investigators; scores of brilliant
men have devoted their lives to the study of the problem. Much has been accomplished
and I believe if these accomplishments were better known to the profession, the plight of
the epileptic as far as treatment is concerned would be tremendously improved.
I shall attempt to discuss today the practical rather than the theoretical aspects of
the problem. I shall tell you the methods we use in the study and treatment of the various
types of epileptics.
When the patient enters the hospital—and every case should be hospitalized during the
investigation—he is subjected to a complete clinical study. Since convulsive seizures occur
as a manifestation of general systemic disease, notably cardiorenal disorders, hyperinsulism,
febrile illness of childhood, parasites, arteriosclerosis and chemical poisoning, these causes
are eliminated in the beginning. If a primary disease of the central nervous system is
present, such as a cerebral tumour, a cerebral abscess, cerebral birth paralysis, or a traumatic lesion of the brain, a painstaking neurological examination should ordinarily disclose
it. However, it is rather striking how frequently one of these cerebral lesions has been
missed clinically in our series of over four hundred epileptic patients, and their presence
finally disclosed by air studies—a subject I shall discuss at some length a bit later in the
paper.
Perhaps the most important part of the clinical investigation is an accurate history of
the attacks. This should always be obtained from the patient and some person who has
observed him repeatedly. What was the first symptom noted at the beginning of an attack?
What did the patient do? How did he act? What was the sequence of events after the
onset of the attack? To which side did the head turn? In which direction were the eyes
rotated? Did one arm and leg behave differently to the corresponding member? These
and many more similar questions and their answers often lead the investigator into an
accurate localizing diagnosis. It is often desirable for the physician to observe personally
the pattern of a seizure. In most epileptics a convulsion can be induced by hyperventilation
(hyperpncea) or by hydration. When an accurate account cannot be obtained, then I feel
justified in deliberately inducing a seizure.
The most frequent localizing sign is elevation of the eyes and turning of the head to
the side opposite the hemisphere involved. Seizures which have their origin in the frontal
lobe are usually characterized by loss of consciousness (without aura) and turning of the
eyes, head and body to the opposite side. This is followed by a nearly simultaneous convulsion of the opposite extremities, falling, and generalization of the attack. In seizures
which arise from lesions just anterior or posterior to the Rolandic fissue, unconsciousness
does not ensue until later. A tingling sensation may follow a jacksonian march, just as
movement follows in seizures arising in the frontal lobe. In fact, consciousness is apt to
be lost late in seizures arising anywhere behind the central sulcus. Such seizures are ushered
in by aurae.  It must be remembered, however, that a major attack may leave retrograde
Page 15 amnesia, so that the aura is forgotten. In such circumstances, the aura may be remembered
only in slight seizures which do not progress to generalization. Seizures originating in the
occipital pole or in the supramarginal gyrus are characterized by "trembling" or "flashing"
of lights, seen in the contralateral field. An aura of epigastric distress or pain is frequently
experienced with lesions of the sensory cerebral cortex usually of the postcentral convolution. "Buzzing sounds" and dizziness are characteristic of unilateral temporal lobe
lesions. Uncinate attacks, those queer hallucinations' of smell, are always pathognomonic
of a lesion involving one or both temporal lobes.
With the introduction by Dandy in 1919 of pneumoencephalography, the study of
organic cerebral disorders received a tremendous impetus. This important diagnostic procedure has revolutionized the localization of obscure brain lesions and has opened up,
because of the additional information obtained, new avenues of treatment heretofore
unknown. No epileptic has been completely studied until he has been subjected to air
studies. Whether air is injected directly into the ventricular system (ventriculography)
or into the spinal subarachnoid space (encephalography) is a matter of individual preference. I prefer the latter procedure in those cases without marked increased intracranial
pressure. By replacing the entire volume of cerebrospinal fluid with air, or oxygen, it is
possible by means of carefully taken x-ray films to study not only1 the interior of the brain
by visualization of the ventricular system but the exterior of the brain as well by visualization of the cerebral subarachnoid spaces and basal cisternae. Pneumoencephalography
stands in the same relative importance to neurological diagnosis as do pyelography to
urology and cholecystography to abdominal surgery. Curiously enough, the injection of
air into the subarachnoid space has a beneficial effect upon the number and severity of the
convulsive attacks. Patients have been known to be free of seizures for many months
following this procedure when no other therapy has been employed. However, it is not
because of the possible therapeutic benefits that we advise encephalography in every
epileptic patient, but because the information obtained provides us with data which may
be indispensable for the proper management of the case.
With our knowledge of treatment of epilepsy in its present state, the patients may be
divided roughly into two groups:  (1) The surgical;  (2) the nonsurgical.
The Surgical.
The operative treatment of epilepsy has been the perennial vogue in various clinics for
the past forty years. Simple decompression operations, implantation of foreign bodies upon
the surface of the brain, various types of cervical sympathectomy, drainage of arachnoidal
lakes of fluid, surgical alterations of venous drainage—all of these and many more, such as
colectomy, have been employed from time to time with the hopes of bringing relief to the
epileptic patient. Needless to say that most of these have been lacking in rationale and,
consequently, have been discarded. Today it is generally conceded that there is no approved
or accepted surgical procedure for cases of idiopathic epilepsy. On the other hand, there
are two types of epilepsy in which surgery offers very satisfactory end-results: (1)
Traumatic epilepsy with localized cortical scars, and (2) jacksonian epilepsy with a sharply
defined trigger point with or without scar formation.
The principles laid down by Foerster, Penfield and their pupils form the basis for all
modern treatment of traumatic epilepsy. Penfield summarizes the situation perfectly in
these words: "If the patient's history, the encephalogram, the pattern of the seizures and
perhaps the neurological examination all incriminate the same area of thle brain, then
electrical exploration is justified. If this exploration is in accordance with the rest of the
evidence, complete radical excision of the focal lesion is the rational method of treatment,
a treatment which has been justified by its practical results."
In order to carry out satisfactorily an electrical exploration of the brain, it is necessary
that the operation be done under local anaesthesia or perhaps local supplemented by a light
basal anaesthesia. If stimulation of the suspected area with a weak faradic current produces a convulsion with the same pattern as observed during the investigation, whether
there be gross evidence of disease or not, then that area should be excised with the electro-
surgical knife so widely that further stimulation fails to reproduce the muscular responses
Page 16 already noted. If there be bony defects overlying cortical scars, these are always repaired
with either a bone graft or a celluloid plate. We have used the latter method exclusively
for the past four or five years with better results and with considerably less work than
when massive bone grafts were attempted.
While much has been written about the repair of cortical scars in traumatic epilepsy,
little has been said about their prevention. In most cases of acute head injury resulting
eventually in a localized cortical cicatrix there has been a depressed fracture of the skull
with an area of local contusion and laceration to the brain and meninges. It has been a too
common practice, if any operation is done at all, simply to elevate or remove the skull
fragment and disregard the devitalized brain tissue. In the process of healing, all such
tissue is replaced by an astroglial network, which often becomes thoroughly fixed to the
meninges and tissues of the scalp. Such a scar exerts a pull over a widespread area of the
brain. If at the time of the acute injury all devitalized cerebral tissue is clearly removed,
the resulting gliosis is reduced to a minimum and the cavity thus created becomes filled
with cerebrospinal fluid. The likelihood of an extensive scalp-meningo-cerebral scar is
thus greatly diminished. A thorough debridement of the entire traumatized area at the.
time of the acute injury would certainly reduce the incidence of traumatic epilepsy to the
minimum.
The Nonsurgical.
By far the largest number of epileptic patients (perhaps 80 per cent) fall into the
nonsurgical group. They are the ones most difficult to treat chiefly because the etiology
is so frequently obscure. After the air studies are completed and the possibility of a surgical lesion has been ruled out, the patient is then started on a routine which in my experience brings some measure of relief to all cases and has enabled others to remain free of
seizures over a period of years.
I shall discuss the nonsurgical treatment under four headings: (1) General hygiene;
(2) drug therapy; (3) ketogenic diet; (4) dehydration.
General Hygiene.—It is most important that the patient subject to convulsive seizures
should lead a carefully regulated life as free as possible from emotional stress, mental and
physical fatigue. A moderate amount of daily exercise in the open air is advisable. Alcohol
and all stimulants should be eliminated from the diet. If the patient's occupation is such
that attacks endanger himself or co-workers, it should be changed. Likewise, he should
not be allowed to operate a motor vehicle or engage in any recreations where, should he
have an attack, his own life of that of others would be endangered.
Proper elimination is an essential feature of the routine.
Because of the stigmata associated with the term "epilepsy" in the minds of the laity,
physicians are reluctant at times to tell the family or patient the true condition. This point
of view is wrong. If it has once been established that the patient is suffering from epilepsy,
the responsible member of the family should be told. This not only promotes better
co-operation from the standpoint of treatment but avoids having the patient or his family
discover the true nature of the malady from sources other than their medical advisors.
Drug Therapy.—For the control of the seizures, drug therapy is by far the simplest
method. The bromides have for years been the generally accepted medication for the
epileptic. With the introduction in 1912 of phenobarbital (luminal) as a nerve sedative,
this drug has practically replaced the bromides in popular favor. These two drugs, given
singly or in combination, do control in a fairly satisfactory manner the number and severity
of the seizures. These beneficial effects are in the majority of instances only temporary, as
a tolerance is developed rapidly. There will always be a group of patients in whom, for
one reason or another, more exact and desirable methods cannot be instituted. Drug therapy
in this group will be the only method available. Phenobarbital is perhaps the most satisfactory drug to use. It should be given in doses sufficiently large to control the convulsions.
In many cases, four and a half to six grains daily will be required. This drug should never
be prescribed unless the patient returns to the physician for frequent observation, so that
the dose may be properly regulated. The maintenance should be as low as possible to
control the seizures.
Page 17 Ketogenic diet.—Dietary treatment has been perhaps the greatest single advance in the
treatment of epilepsy. It has been known for centuries that fasting wlill stop convulsive
seizures temporarily. While fasting as a means of treatment has been discredited by most
investigators because it does not give permanent results, yet the chemical changes observed
in the body as a result of fasting form the basis for all modern dietary treatment of the
condition. Careful investigation has shown that when a patient becomes free of seizures
from fasting, the sugar content of the blood is low and acetone bodies, i.e., acetone and
diacetic acid, are present in increasing quantities in the blood. Also, the carbon dioxid
combining power of the blood is diminished and the hydrogen ion concentration is slightly
reduced. Wilder9 and later Peterman' first suggested that the. improvement associated
with fasting is not attributable to the starvation itself but to the ketosis with which starvation is naturally associated. Acting upon this assumption, they placed their epileptic
patients on a diet which was calculated to produce a constant ketosis. Many authors,
notably Talbot8, Helmholz5 and others, have experimented along the same lines and their
efforts have been crowned with considerable success. In many instances there has been a
complete cessation of the attacks over a period of years, and in others a decrease in the
number and severity of seizures has occurred. Furthermore, it has been demonstrated
beyond doubt that a patient may remain on this diet indefinitely without detrimental
effects to the general health. In fact, normal growth and development take place even in
the young. Some authors believe that patients maintained on a ketogenic diet are freer
from intercurrent illnesses than on a normal diet. This is true particularly in the case of
the common cold.
In our experience, it is futile to attempt the diet unless the patient and some other
responsible person have been instructed thoroughly in the practical side of dietetics. Hospitalization for a week or ten days is essential. First, encephalographic studies are made
and following this procedure the patient is placed in charge of the dietitian for instructions
into the theory and practice of the diet. He is taken to the diet kitcjien and taught to
prepare his meals under supervision. He learns to test daily his state of ketosis by analysis
of his urine for diacetic acid. When he is sufficiently conversant with all the details, he is
discharged from the hospital and is instructed to report to the physician or the dietitian
when any change is to be made in the diet, or when the diet fails to produce tHe desired
ketonuria.
It is possible for patients in any walk of life to learn this diet and adhere to it rigidly.
We have records of labourers who have learned the diet and who have carried it out over a
period of years. Young children offer the most difficult problem, because in many instances
it is impossible to make them understand the importance of rigid adherence to the routine.
Many of them will steal candy or sweets and, of course, spoil the state of ketosis. Other
children learn very early the importance of rigid adherence. One of my colleagues in
Lexington, Kentucky, tells a most illuminating story of one of his little patients who had
been on the diet for several months. This boy came into a corner drug store with three of
his playmates. The playmates each bought an ice cream cone, and this little fellow showed
no inclination to obtain one. A travelling salesman standing in the store noticed that the
boy did not have a cone and feeling sorry for the youngster he suggested that he would be
glad to buy one for the child. The boy looked up at him and said: "Thanks, Mister, but I
wouldn't eat one of them things for fifty dollars. I would be sure to have a fit tonight if
I did."
Dehydration.—The possible relationship of hydration and dehydration to epileptic
seizures has attracted the attention of many investigators. Sine the days of Hippocrates a moist brain has been thought to be associated with epilepsy. McQuarrie6 in
1929 showed that there was a tendency for the epileptic to store water during the active
stage of the disease in amounts that were harmful. He also showed that convulsions tend
to occur when a water balance above a certain magnitude is established, and that after
dehydration occurred, convulsions, in many instances, were prevented. He found that
it was possible by a sudden increase in the water intake to throw the severe epileptic patient
into convulsions, and by dehydrating him to relieve the convulsive manifestations. Temple
Fay3 has been the chief proponent and advocate of this method of treatment.  On the basis
Page 18 VANCOUVER GENERAL HOSPITAL SECTION
a    S FOREWORD
It is with a great deal of satisfaction that I write this introductory paragraph on the
occasion of the first issue of The Bulletin to which the Vancouver General Hospital
contributes a part. There is a wealth of clinical material passing through the institution
from which can be drawn a great deal of valuable information for the medical profession.
The Outpatient Department work warrants study that will add to our experience and
knowledge in the practice of Medicine. The various special' clinics can broaden the scope
of this endeavour. In the Pathological Department last year there were over 600 autopsies,
and this work is now forming the basis for the Wednesday Pathological Conferences.
Many very unusual pathological conditions are being found which perhaps would not be
so unusual if autopsies were done on all cases of death. The various clinical ward rounds
can and should be extended to cover all departments or specialties in Medicine. Thus, you
can see that this hospital has facilities that can be major factors in the contributions to
medical knowledge and the extension of postgraduate experience for the local medical
profession.
To the Medical Profession is extended a cordial and ready welcome to avail themselves
of this opportunity.
A. K. Haywood, M.D., General Superintendent.
EPILEPSY (Continued from preceding page)
of his own experience, he finds this method has given relief to patients when other methods
have failed.
Dehydration automatically occurs in patients upon the ketogenic diet. Barbour1
experimentally demonstrated that dogs on a high-fat, low-carbohydrate diet take voluntarily approximately 50 per cent less water than animals under similar environmental conditions will take on a normal mixed diet. From our experience, we find that patients on
a high ketogenic ratio do not desire water in large quantities. We have for several years
limited the fluid intake of epileptic patients in connection with the ketogenic diet and have
found that they remain comfortable on a fluid intake as low as 600 cc. per 24 hours. It is
our belief that the combination of ketosis plus dehydration is the method of choice in the
treatment of the epileptic.
In closing, let me say that for one to appreciate fully the change that has occurred in
the attitu.de toward the treatment of epilepsy, he must read the literature of a decade ago
and compare it with that of recent date. More exact information has taken the place of
surmises, conjectures and pseudo-knowledge. I do not mean to imply that the problem is
solved; it is far from that state, but I have attempted to show that sufficient scientific
advances have been made to justify our substituting a spirit of hope and expectancy for
that of utter despair when dealing with the epileptic patient.
BIBLIOGRAPHY
1. Barbour, H. G., Hunter, L. G., and Richey, C. H.: Water Metabolism and Related Changes
in Fat-Fed and Fat-Free-Fed Dog under Morphine and Acute Withdrawal. J. Pharmacol.
&Exper. Therap., 36:251-277 (July), 1929.
2. Dandy, W. E.: Roentgenography of Brain after Injection of Air into Spinal Canal. Ann.
Surg., 70 : 397 (May), 1930.
3. Fay, Temple: Therapeutic Effect of Dehydration of Epileptic Patients. Arch. Neurol. &
Psychiat, 23:920-945 (May), 1930.
4. Foerster, A., and Penfield, W.: Structural Basis of Traumatic Epilepsy and Results of
Radical Operation. Brain, 53: 99-119 (July), 1930.
5. Hemholz, H. F.: Treatment of Epilepsy in Childrood: 5 Years' Experience with Ketogenic Diet. J. A. M. A., 88: 2028-2032 (June 25), 1927.
6. McQuarrie, I.: Epilepsy in Children: Relationship of Water Balance to Occurrence of
Seizures. Am. J. Dis. Child., 38:451-467 (Sept.), 1929.
7. Peterman, M. G.: Ketogenic Diet in Treatment of Epilepsy.   Am. J. Dis. Child., £8:
28-33 (July), 1924.
8. Talbot, F. B.: Epilepsy. New York : The MacMillan Companv, 1930.
9. Wilder, R. M.: Mayo Clinic Bulletin, 2 : 307- 1921.
Page 19 EDUCATIONAL FACILITIES OF THE
' OUTPATIENTS' DEPARTMENT
E. Christopherson
The morning clinics, beginning at 10 o'clock, are open to all medical men, who will be
welcomed by the attending staff. The afternoons are given over to admission of new
patients, who are examined by internes and required laboratory work ordered, on the
completion of which they are referred to the proper clinics. If treatment is urgent it is
commenced that same day. We are desirous of having all our new patients in the afternoons
between 1 and 2 o'clock except Saturday,    j
The schedule of Clinics is as follows:
Medical and Surgical—Monday, Wednesday and Friday, 9 a.m. .
Ear, Nose and Throat—Monday and Thursday, 9 a.m.
Eye—Tuesday and Friday, 9 a.m.
Skin—'Tuesday, 9 a.m.
Dental—Every day but Friday, 9 a.m.
Neurology—Tuesday, 9 a.m.
Psychiatry—Wednesday, 9 a.m.
Proctology—Wednesday, 9 a.m.
Diabetic—Thursday, 9 a.m.
Genito-Urinary—Friday, 9 a.m.
Varicose Veins—Friday, 9 a.m.
Orthopaedics—Saturday, 9 a.m.
Medical Arthritic—Saturday, 9 a.m.
Paediatrics—Saturday, 9 a.m.
Fracture—Thursday, 1:30 p.m.
Tumour—Thursday, 10 a.m.
It will be noted that there are no general medical clinics, which is unfortunate, as there
are many patients who do not belong to any particular clinic.
It has been my duty to direct the distribution and disposal of patients. The former is
easy but the latter is more difficult. Many patients require regular attendance on account
of a chronic disease or their social status. Others in the lower income group or on City
Relief are referred back to their own doctors with a report on the findings after investigation and the line of treatment as recommended by the attending staff.
MEDICAL RECORDS
From the Perspective of the Vancouver General Hospital.
etHow long, how long in infinite pursuit
Of this and that endeavotir and dispute."
—Omar Khayyam.
While medical records have been more widely discussed in the past twenty years, they
are by no means a subject of recent origin. Hippocrates reputedly made his bedside notes,
but doubtless deplored his isolation, so that it is only reasonable to expect that in another
hundred years from now sighs will be heard because of the inadequacy of medical records
as a whole.
Of their value no doubt exists—patient, doctor and hospital are equal beneficiaries, and
their aid in legal matters, public health and medical research is undisputed. Proofs of this
are forthcoming daily. The patient's viewpoint may be instances in various ways, and,
while the following may have its humour, one detects a note of anxiety:—
"Genl Hosp
Vancr
Will you kindly let me know hows that pig.  I beleave they give him some of
my T B germs the dr said he'd tell me if he dies or not hope to here from you in
the near future thank you."
Instances of the dependence upon good records of domestic peace range all the way
from the mother keeping her "Baby's record" who, having failed to remember her child's
birth weight, telephones the Records Department, to the man whose son, failing to sustain
himself in the country to the south of us and endeavouring to return, was refused permission to cross the border until he could furnish proof of Canadian birth; the father, being
communicated with, came to us, admitted his boy's birth was unregistered, and asked our
aid.  Sex consciousness 25 years ago was not so acute as now, but although we could only
Page 20 give him a certificate showing that Mrs. "gave birth to a baby," he came in a month
later to say his boy was home again.
The 1937 survey of hospitals by the American College of Surgeons revealed, according
to the report, that the greatest weakness is a lack of adequate medical records. Those who
have essayed reviews of Vancouver General Hospital records in the past few years should
be competent judges, but while their verdict still awaits definite pronouncement, expressions of disappointment are not wanting.
The situation today is that while By-laws No. 102 and 103 of the Vancouver General
Hospital demand from the attending and visiting staffs a history within 48 hours of admission of a patient, the work devolves upon an interne staff whose inhibitions, as well as their
activities in other directions, all too often preclude this instruction being rigidly observed.
Often a conscientious but harassed interne is left to his own devices to obtain a case
history from a patient who he feels is the subject of a "twice-told tale." In this connection,
what excellent use could be made of the much-vaunted standardized medical form, an
original for the doctor's office and a duplicate for the hospital.
The fluctuation in interne staffs—never so marked in the past seven years as in this
present year of grace—can also be charged with being a factor in the lack of adequate histories. We commenced this interne year with a staff of approximately 40, but have
descended to as low as 26, with even two seniors failing to complete their year of seniority.
Is it not obvious that adequate histories are an impossibility in such circumstances? Small
blame to the interne before whose eyes is dangled the alluring prospect of the comparative
wealth of private practice as against his honorarium as an interne, but until interneships
are at a premium, or until completion of at least one year plays a definite part in the issue
of a license to practise, this aspect of the situation will remain unchanged.
The medical value of the individual record applies equally to patient and doctor.
Patients' memories are frequently quite vague on even vital matters, and the doctor being
consulted is at a disadvantage without reference to the written word. "Patients forget:
records remember."
In 1937, for medical, legal and research reasons, 5545 charts were extracted from the
records, of which some 250 dated back anywhere from 4 to 30 years ago; 1020 were taken
to wards for review upon readmission of patients, and 1107 were perused in the department
by doctors to discover the nature of previous illness of current patients. The year's correspondence included 18 requests from out-of-town doctors and hospitals for medical information on former V. G. H. patients. Essondale sought details of 12 and Shaughnessy 20
cases. This surely speaks volumes for the necessity of continued effort to secure good
records. Of the satisfaction gained from their perusal it is not the prerogative of this
writer to make any estimate, but it being the duty of the Records Department to secure a
history on every case, it can at least be said that this objective is not altogether easy of
achievement.
Fredk. J. Fish, Director of Medical Records.
MEDICAL WARD ROUNDS
The Ward Rounds of the Medical Staff of the Vancouver General Hospital are held
every Thursday morning at nine o'clock. Instead of the older method of a large group of
physicians standing at the bedside of a sick patient in ai public ward, the physicians meet
in one room to which the patient is wheeled on his bed, and chairs, a blackboard, and x-ray
view-boxes are provided.
Four to six patients from the medical service are shown each morning, and these are
of two types: (1) Interesting or rare syndromes; (2) puzzling, undiagnosed cases. Not
infrequently, patients from the Outpatient Department are shown also.
The interne reads the history; a member of the x-ray department is present to interpret
x-rays; a pathologist is present to interpret tests and biopsies; and the discussion is led by
the Chairman. The diagnosis and ultimate disposal of patients previously shown are also
reported.
The ward rounds are attended by fifteen to twenty physicians and have been improving
steadily. All physicians are invited to attend and to join in the discussions.
Page 21 CASE REPORTS
Postmortem Finding: Hyperthyroidism with Large Thymus
in Adult.
The following case is reported with a short history and a resume of the highlights of
the autopsy findings, as it was thought that it might be of some interest:
Miss J. K.; 24 years.—Dr. Hodgins.
Admitted, May 16th, 193 8; died, May 28th, 1938.
This patient was admitted giving a history of palpitation, profuse perspiration, voracious appetite and nervousness and tremor for the past three or four months. The onset
of her illness had been gradual and slowly progressive. Patient stated that she had been
worried for some time, due to unemployment of her father, and also there was a history of
emotional upset over a boy friend. There had been no bouts of diarrhoea or vomiting.
Menstrual history, normal.
Physical examination.—Patient was flushed and obviously very nervous; exophthalmos
moderate, was present; also lid lag. Thyroid was uniformly enlarged, quite firm, and bruit
was heard over both lobes.  Heart, normal; blood pressure, 148/74; B.M.R., plus 50.  No
anaemia.
May 19th—Presented at medical ward rounds, where it was decided that deep x-ray
should be given to the gland, preliminary to operation, provided this opinion was concurred
in by surgical consultant. Received x-ray treatment on three occasions.
May 23rd—Patient was upset; speech was slurred and at times incoherent; pulse rapid.
May 26th—Very toxic; pulse rapid and thin; flushed; confused and incoherent; pulse
continued to rise from 140 on admission, and patient finally died, May 28th.
Treatment.—In addition to x-ray therapy, patient was given a high carbohydrate diet
and sedation. During the last two days she was given intravenous glucose three times a
day, containing sod. iod. grns. 15.
The highlights of the autopsy findings are as follows:
The body is that of a well developed but only fairly well nourished white female, 24
years of age. There is nothing particularly noteworthy on external examination. The lungs
are quite congested, and in the left lower lobe there are fairly extensive bronchopneumonic
areas. A well defined purulent bronchitis is also present. The heart is moderately enlarged
and the musculature shows the so-called "thrush breast" type of appearance, denoting a
well-marked degenerative process. The liver shows a moderate degree of fatty infiltration;
the kidneys show evidence of parenchymatous degeneration, but the spleen, uterus and
adnexa and adrenals show nothing particularly noteworthy.
One of the most interesting findings is a very markedly enlarged thymus gland. This
gland weighed 5 3 grms. According to the tables given by Hammar, the thymus, between
the ages of 21 and 25 years, weighs at the maximum 2 5 grms., so that here we have a
thymus that is more than twice the maximum weight at this age period.
The thyroid is somewhat slightly enlarged, weighing 40 grms., and is very firm and
beefy, presenting on section a compact greyish-brown color, very definitely and markedly
hyperplastic in appearance. Microscopically, in general it gives the impression of a
markedly hyperplastic thyroid gland.
Microscopic examination confirms the presence of the bronchopneumonic process, and
also the fatty infiltration of liver, the parenchymatous degenerative changes in the kidneys and in the heart.
The main and interesting features in this case are the very marked hypertrophy and
hyperplasia of the thymus gland. It is a well-known fact that hyperplasia of the thymus
and practically all lymphoid tissue is a fairly consistent finding in hyperthyroidism, but
enlargement to such a marked degree in the thymus is not usually seen.
The handling of these thyrotoxic cases is also a very controversial subject; whether
prolonged rest with Lugols' iodine before attempting any surgical intervention, or whether
prolonged rest with sedation or the ligation of the superior thyroid arteries with an interval
of three or four days between ligations and then followed, after two or three months' rest
period, by thyroidectomy or possibly one lobectomy.
Page
9.9. Apparently the general consensus of opinion is that they are extremely difficult cases
to handle and that the mortality, with practically any mode of treatment, is very high.
Fibrosarcoma of Small Intestine Causing Obstruction of Bowel.
Mr. Fred Ganski, age 30, Polish labourer, was admitted to the Emergency Ward of the
Vancouver General Hospital on May 13, 1938, at 5:50 a.m. Past admissions—none. Common complaint—cramp pain in abdomen, 24 hours; vomiting 10 hours. Admitted to
Ward "J", May 13th 193 8, at 7:00 a.m.
Present information.—This man was apparently in good health until 1 p.m. yesterday
when he was suddenly seized with an acute spasmodic pain about the umbilicus. Following
the pain he vomited and the pain seemed to be temporarily relieved. Later in the day, however, he had several attacks and called his doctor, who administered morphia. With persistent pain, patient was admitted to hospital.
There was no history of any chronic complaint, debilitating conditions or familial
diseases.
Functional enquiry.—No headache or dizziness. No cough, sputum, or loss of weight.
No dyspnoea or swelling of feet and ankles. Has had some belching of gas, but no food
-intolerance.  Occasional periods of constipation.  No genito-urinary symptoms.
Physical examination.—A well developed, well nourished adult, male, at present lying
quietly in bed, having a moderate amount of abdominal discomfort. Head, neck and eyes
normal. Mouth dry, but clean. Teeth in good condition. No cervical adenopathy. Chest
expansion poor, but equal. No adventitious sounds. Heart, no enlargement or irregularities. Blood pressure, 130/80. Abdomen, normal contour; "Maximum point of tenderness
just to the right of the umbilicus." No rigidity. No abnormal masses. Genitalia normal.
Extremities negative.
Laboratory report.—Urinalysis negative; white blood count 11,200.
Differential diagnosis—(1) Ruptured gastric ulcer; (2) acute appendicitis; (3) intestinal obstruction.
Operative report.—Surgeon, Dr. S. A. McFetridge: Pre-operative diagnosis—Intestinal
obstruction; post-operative diagnosis—Intestinal obstruction. Operation performed—
End-to-end anastomosis and enterostomy:
The abdomen was opened by a paramedian incision. A loop of small bowel found to
be greatly dilated to the size of the stomach adherent into the pelvis. This was freed and
obstruction found to be a mass the size of a walnut in the mesentery of the small bowel
and a ringlike constricture involving the lumen of the small bowel. This loop was resected
6 inches distal to the growth and about 3 feet above where we could find semi-normal
oowel. An end-to-end anastomosis was done and an enterostomy above as a safety-valve,
-and catheter brought out through the wound.
The abdomen was closed in layers.
Pathological Report (Dr. H. H. Pitts)
Macroscopic examination.—Specimen consists of 24 cms. of small intestine superficially
pale and smooth but extremely thick-walled, as though it had been chronically obstructed.
The distal extremity of this portion of the intestine is definitely constricted, and the intestine beyond this point, laid open, measures only 4.5 cms.; at the point of constriction, a
firm mass is palpable, a smooth superficial area of thickening being noted in the serosa
extending into the attached mesentery. On section through this area, the lumen of the
gut laid open in this point measures only 2.2 cms. and in situ this would probably amount
to complete obstruction, as a ridge-like area projects into the lumen. This is covered by
smooth, intact mucosa over most of its surface, but centrally is superficially ulcerated. On
section, the musculature at this site is seen to be tremendously hypertrophied, measuring
on the average about 1 cm. in thickness. The muscle coat can be traced throughout the
entire area, but superficially it appears extremely pale, greyish-white in colour, as though
partially replaced by a fibrous process, and from this surface fibrous bands of similar con-
Page 28 sistency extend into the adjacent mesenteric fat. This does not altogether suggest a carcinomatous process although it may be a neoplastic one, but rather suggests a chronic inflammatory process. Numerous sections were taken through this area to include practically the
entire thickened portion. The remainder of the mucosa is intact and there is no evidence
of a neoplastic or inflammatory process in it.
Microscopic examination.—A great many sections were taken through the firm fibrotic
mass mentioned above and this is seen to consist of a moderately cellular structure, apparently arising in the subserosa and consisting of very pleomorphic and polymorphic cells,
in some instances arranged in somewhat whorl-like aggregations. The cells vary greatly in
size and shape, with many almost giant-like forms, with reduplication of nuclei and, in
some instances, these cells are aggregated to form almost pearl-like formations, although
not in the same sense as epithelial pearls. The cells apparently are fibroblastic in origin, the
majority quite plump, fairly deeply staining, and yet there is a quite abundant, rather wavy
fibrous intercellular substance. There is very extensive inflammatory reaction as well,
some edematous imbibition and the tumour tissue is well vascularized throughout. In
some of the sections infiltration throughout the muscularis and into the submucosa is noted,
but the mucosa itself appears quite well preserved. There is also a very marked hypertrophy
of the muscularis. I believe that this is probably a fibrosarcoma, arising in the subserosa,
and does not appear markedly malignant.
Dignosis: Fibrosarcoma of small intestine causing obstruction of bowel.
May 24, 1938—Enterostomy tube removed. Well-formed stools with enemata. Passes
gas per bowel freely. Soft diet well retained. Still some discharge from wound. No severe
complaints. Progress satisfactory.
May 30, 1938—Up and around ward daily. Incision clean. Discharged.
June 8, 193 8—Seen in Outpatients' Department. Bowels moving with enemata, free
from pain or discomfort.
AMPHOJEL
WYETH'S ALUMINA GEL
for the Management of
PEPTIC ULCERS
through the control of Hyperacidity
Amphojel is superior to alkalies in the
management of peptic nicer.
Amphojel fits perfectly into the diet-
antacid treatment and provides more
comfort for the patient.
It may he used in large doses for an
indefinite period of time without ill
effects.
Peptic ulcers heal with greater rapidity.
Write for free literature.
■ JOHN WYETH
& BROTHER, Inc.
WALKERVILLB, ONTARIO
For Complete
BINDING
OF
THE   BULLETIN
A phone call will bring
immediate attention.
Sey. 6606
Roy   Wrigley  Printing
and Publishing Co. Ltd.
300 West Pender St.
Vancouver, B. C.
Page 2k DESICCATED
FRESH BILE
m a READILY-SOLUBLE FORM
m      i
100
KAPSEALS
DESICOL
-J of I
•-.-:
S^tgffl**...,
«3
In    a*
Through a special method of production
Parke, Davis & Company makes available to the medical profession a preparation of desiccated whole bile which is
promptly soluble and essentially similar
to whole bile in therapeutic activity.
Each 5-grain KAPSEAL DESICOL is
equivalent to approximately 2.5 cc. of
whole fresh bile.
Kapseals Desicol (No. 359) are
supplied in bottles of 100.
Kapseals   are   hermetically'
sealed capsules which protect the
contents from the effects of oxidation and insure
unusual stability-
PARKE, DAVIS & CO. - WALKERVILLE, ONT.
The   World's   Largest   Makers   of  Pharmaceutical  and   Biological   Products Doctors-
YOUR
PRESCRIPTION
AND
RECOMMENDATION
Is Our Guide
Always--
OUR
MECHANICAL
and
SCIENTIFIC
ORTHOPAEDIC
EQUIPMENT
Is At Your Service
Avail Yourselves
of   our   experience   in   last
making to aid correction in
Minor Foot Ailments.
PHONE
Pierre Paris
FOOT CLINIC
Sey. 3778       51 W. Hastings
The Purified
ACTIVE PRINCIPLE
OF
SANDALWOOD OIL
A*0MM» ECONOMICAL
Dosage Form
Doctor, why use ordinary sandalwood
oil when you can just as easily administer the active principle of the oil
with the irritating and therapeutically
inert matter removed—and at a cost
to your patients of only a very few
pennies more?
You can do this by prescribing the
new, economical 50-centigram capsules of
ARHEOL
(ASTIER)
now obtainable in bottles of 12, 24 and
100 capsules at $1.00, $1.75 and $6.00
a bottle respectively.
ARHEOL is the purified active principle of sandalwood oil. It is a uniform, standardized product with which
prompt and dependable results may
be expected. Undesirable sequelae
often associated with sandalwood therapy are either absent or reduced to a
negligible degree.
A3-
BVMA
Dr. P. Astier Laboratories
36-48 Caledonia Rd.
i Toronto.
■      Please   send   me   a
:      ARHEOL,   (Astier)
i      economical dosage
samp!
in the
form.
e   of      i
new
M.D.     j
Street	
:      City	
Prov....
Dr. P. ASTIER LABORATORIES
36-48 Caledonia Road, Toronto THIAMIN CHLORIDE SQUIBB
I
Indicated in all degrees of Vitamin Bj deficiency, especially the more severe forms. Permits adequate dosage in small volume. Stable and convenient to use. Bottles of 50 tablets
-in 2 potencies—300 (1mg.) and 1500 (5 mg.) International units per tablet. Boxes of 6x1-cc.
ampuls—each ampul containing 3000 I.U. (10 mg.) of the crystals in solution; also in 5-cc.
vials containing 3000 I.U. per cc.
SQUIBB VITAMIN B COMPLEX SYRUP
For Patients Needing the Several Factors of the "B Complex"
The therapeutic usefulness of Squibb Vitamin B Complex Syrup depends upon the fact
that it supplies an abundance of naturally occurring thiamin (Bi), Riboflavin (B2)» Vitamin B6, the filtrate factors and the pellagra-preventive factor (nicotinic acid). There is
also qualitative experimental evidence suggesting the presence of factor W and Vitamin B4.
INDICATIONS: Anorexia, Chronic gastro-intestinal mal-function, Constipation, Pregnancy
polyneuritis and vomiting, Lactation, Alcoholic polyneuritis, cardiovascular disturbances,
Retarded growth in infants, Retarded growth in older children, Infant feeding Pellagra.
DOSAGE: Infants, y2 teaspoonful a day; children, 1 to 2 teaspoonfuls a day; adults, 2 to
4 teaspoonfuls a day.
Supplied in 3 and 6-oz. bottles and 12-oz. jars.
Vitamin Content as Shown by Multiple Physiologic Assays:
VITAMIN P,!—50 International units per 1 cc.
Thiamin, as it occurs naturally.
VITAMIN P»2—10 gammas per 1 cc.
"Riboflavin" is the accepted new term for the artificial vitamin B2.   In Vitamin B
Complex Syrup, riboflavin is present in naturally occurring form.
VITAMIN B6—100 gammas per 1 cc.
This vitamin can be prepared in crystalline form; here it occurs in its natural form.
FILTRATE FACTORS—Jukes-Lepkovsky factor value of 27 per 1 cc.
PELLAGRA—Preventive Factor contains an abundance.
Recent literature refers to this factor as nicotinic acid.
lor descriptive literature address Professional Service Department, 3 6 Caledonia Rd., Toronto, Ont.
ER:Squibb & Sons of Canada, Ltd.
MANUFACTURING   CHEMISTS   TO   THE   MEDICAL   PROFESSION   SINCE    1858 INDIVIDUAL    TOWELS    PREVENT    WASHROOM    INFECTION
ONLIWON TOWELS
The crepe finish and unusual "stretch" of Onliwon Towels
enables them to be used like a cloth towel: they don't go to
pieces in wet hands.
The exclusive "double-fold" gives you a bigger towel although
the cabinet occupies less than usual space.
And because ONE Onliwon Towel is ample for the average
user, you will find that Onliwon cuts down your washroom
maintenance costs to a minimum.
Get the facts for yourself. Call your nearest E. B. Eddy Co.
branch or distributor.
OHiw°n
TOWELS
The E. B. EDDY CO., LIMITED
Tissue Division
HULL
QUEBEC "BULK," VITAMIN Blf and
utilizable I RO N are supplied in
7&0&9S* ALL-BRAN
• Many foods of fibrous content
have been suggested as a source of
laxative bulk. Such bulk is not
available as an eliminating agent,
however, unless it reaches the colon
undigested.
The effectiveness of Kellogg's All-
Bran as a source of bulk lies in the
fact that in the average person a
large part of its fibrous content does
not digest, but provides an ideally
soft bulky residual mass in the intestine.
In addition, All-Bran furnishes a
significant amount of vitamin Bi,
beneficial to the intestinal tonus.
Also as a source of iron, All-Bran is
especially valuable . . . because in
All-Bran the iron occurs with cop
per, thus becoming readily available
for making hemoglobin.
These contributions by Kellogg's
All-Bran to important physiological
functions suggest its use as a dietary
aid in constipation resulting from
lack of bulk. Made by Kellogg in
London, Ontario.
THE
NATURAL
LAXATIVE
CEREAL
ALL-BRAN
•FOR- I
CONSTIPATION '
NfTvtEt.HT OHt
35
MAGSOL
(HORNER)
ANTACID AND ADSORBENT.
A COLLOIDAL POWDER.   NOT AN
ALKALI.
INDICATED IN HYPERACIDITY and
PEPTIC ULCERATION.
Relief from pain and control of acidity.
Immediate and sustained action.
Neutralizing and adsorptive power
prolonged.
Not toxic.  Cannot be  absorbed  or    Dose: One teaspoonful or more as
cause alkalosis. required.
Prove for yourself that pain is quickly relieved, acidity controlled.
Send for a generous sample.
FRANK   W.   HORNER ILIMITED
MONTREAL
Magsol is not advertised to the public.
CANADA
V.M. When the formula is constructed with Irradiated
Carnation Milk, one vitally important assurance is
always present: the milk as it pours from the freshly
opened can is safe. Sterilization after hermetic seal-
ing affords positive protection. No
further boiling is needed—the consequent simplification of the home
routine is in itself an added safeguard
. . . Irradiated Carnation Milk may be
bought anywhere, taken anywhere,
with complete confidence in its purity.
A BOOKLET FOR
PHYSICIANS
—You are invited to
write for "Simplified
Infant Feeding," an
authoritative publication treating of
the use of Irradiated
Carnation Milk in
normal and difficult
feeding cases. . . .
Carnation Company, Ltd., Toronto,
Ontario.
Cl    IRRADIATED   •%.    JT
arnation JVLilk
A CANADIAN PRODUCT— "from contented cows" The New Synthetic Antispasmodic
Trasentin "Ciba"
(Diphenylacetyldiethylaminoethanolester-hydrochloride)
SUPPRESSES SPASMS OF THE GASTRO-INTESTINAL
TRACT, GENITO-URINARY SYSTEM AND
OTHER SMOOTH MUSCLE ORGANS
Tablets—bottles of 20 and 100. Ampoules—boxes of 5 and 20.
1 tablet or 1 ampoule contains 0.075 grm.
of the active substance.
CIBA COMPANY LIMITED
MONTREAL
/SiSsfev
IH^j^i
iaAM^y>)WW)W>Xv
IWOWOOOOOCCv-
&&M!M<M<4wH4MW$rao8£
13 th Ave. and Heather St.
Exclusive  Ambulance  Service
FAIRMONT 80
PRIVATE AMBULANCES AND INVALID COACHES
WE SPECIALIZE IN AMBULANCE SERVICE ONLY
J. H. CRELLIN
W. L. BERTRAND t
2559 Cambie Street
Vancouver, B. C.
Colonic
Irrigation
Institute
Superintendent:
E. M. LEONARD, R.N.
Post Graduate Mayo Bros.
Up-to-date treatment rooms;
scientific care for cases such as
Colitis, Constipation, Worms,
Gastro-intestinal Disturbances,
Diarrhoea, Diverticulitis, Rheumatism, Arthritis, Acne.
Individual Treatment $ 2.50
Entire Course $10.00
Medication (if necessary)
$1 to $3 Extra
631  BIRKS BUILDING,
VANCOUVER, B. C.
Phone: Sey. 2443
506-7 CAMPBELL BUILDING
VICTORIA, B. C.
Phone: Empire 2721
1$ IT
>
IS IT
>■
Soreness, stiffness, slight enlargement of the phalangeal
joints (other joints may be involved), impaired motility, or
progressive loss of function . . .
particularly manifested about
middle-age—such is the symptom-picture many cases present.
It   suggests   either   a   case
gout, or one of arthritis . .
LYXANTHINE ASTIER
given per os in teaspoonful
doses, once or even twice daily,
usually brings about prompt
amelioration of the condition,
and, if administered persistently, often a complete disappearance of all symptoms.
Lyxanthine Astier so acts by
virtue of its associated synergists—Iodine, Calcium, Sulphur,
Lysidine bitartrate*; the latter
a powerful solvent and elimi-
nant of metabolic waste.
hEthylene-ethenyIdiamine.
Dr. P. Astier Laboratories
36-48 Caledonia Rd., Toronto.
Please send literature and
sample of LYXANTHINE
ASTIER.
Dr	
Address	
City Prov	
LC12-BVMA
Dr. P. ASTIER LABORATORIES
36-48 Caledonia Road, Toronto
COUPON STEVENS' SAFETY PACKAGE
STERILE GAUZE
is a handy,
convenient, clean commodity for the bag or the office.  Supplit
sd in
one
yard,
five
yards and twenty-five yard packages.
.     ESTABLISHED  NEARLY A ^_
■WCOMPANIEsMl
1K\     . a. r-      AH
B. C. STEVENS CO.
Phone
Sey
mour
698
730 Richards St.
, Vai
icouver, B
. C.
S.
BOWELL
&
SON
Distinctive   Funeral
Service
Phone 993
66 SIXTH STREET                                          I
^EW WESTMINSTER, B. C.
Breaks t^Mieious circle of perverted
•vmenstrua^p^jction in cases of amenorrhea,
tardy J^!i|(tJmnon-physipIogical) and dysmenorrhea. Affords remarkable symptomatic
relief by stimulaffng the innervation of the
uterus and stabilizingjifie tone of its
muscuI^ure^Cbntrols the uterogbvarian
circulation and thereby encourages a
normal menstrual cycle. .'
»MARTIN H. SMITH COMPANY
Iki-'pi ISO lAfAYlTTi STRUT, NIW TOM, N. T.
Full formula and descriptive
literature on request
Dosage:   l to 2 capsules
3 or 4 times daily.   Supplied
in packages of 20.
Ethical protective mark MHS
embossed on inside of each
capsule, visible only when capsule  is  cut in  half  at  seam. IMPORTANT OBSTACLES DURING ORAL
MEDICATION OF UROGENITAL INFECTIONS
ARE TOXICITY AND LOCAL IRRITATION
Published literature for a decade demonstrates that
o*°c
*V
&*»
&e)
*****
is well tolerated.
> non-irritative in therapeutic dosage.
• productive of local analgesic effect and prompt
symptomatic relief.
• effective both in acid and alkaline urine.
# useful in conjunction with other urogenital
therapy.
conveniently administered in tablet form
Literature -will be mailed on request.
MERCK & Co, Limited
MANUFACTURING CHEMISTS
MONTREAL RAP1GST0LEUM
(Standardised Vitamins A and D)
In General Practice
In Prophylaxis
The daily ingestion of Radiostoleum acts as an effective safeguard
against attacks of invading organisms in epidemics of acute infections.
In Treatment
If infection has supervened, the administration of Radiostoleum in
massive doses aids in reducing the virulence by building up the patient's
resistance.
In Convalescence
The administration of Radiostoleum makes good depleted reserves,
stimulates the jaded appetite, restores vitality, reinstates normal
metabolic processes and hastens the return to normal health.
Stocks of Radiostoleum are held by leading druggists throughout
the Dominion and full particulars are obtainable from:
THE BRITISH DRUG HOUSES (CANADA) LTD.
Terminal Warehouse Toronto, 2, Ont.
RKt.m/rifm/38in
mm§
flftount flMeasant TUnbertaktno Co* %tb.
KINGSWAY at 11th AVE. Telephone Fairmont 58 VANCOUVER, B. C.
R. F. HARRISON W. R. REYNOLDS Intrauterine glycerine treatment
has long been considered one of the best methods
of treating
ENDOCERVICITIS      •      CERVICITIS
ENDOMETRITIS    •    PARAMETRITIS
It is appropriately applied by means of a tampon of
AntipMoghtine
With its 45% glycerine content, its iodine,
boric and salicylic
acids and essential oils,
rendered plastic and
penetrating in a vehicle of hygroscopic
silicate of aluminum,
its formula is unusually suitable.
Few methods render possible such prolonged
glycerine application as does Antiphlogistine
Sample and literature sent on request
THE DENVER CHEMICAL MFG. CO.
153 Lagauchetiere St. W. Montreal
Made in Canada \i**m
Mow Much Sun
Does the Infant
7
Really Get ♦
Not very much: (1) When
the baby is bundled to protect against weather or (2)
when shaded to protect
against glare or (3) when the
sun does not shine for days
at a time. Oleum Percomorphum offers protection against
rickets 365 % days in the year,
in measurable potency and in
controllable dosage. Use the
sun, too.
I HP
Oleum Percomorphum is an economical source of vitamins A and
D.   We purposefully selected a classic name which is unfamiliar
to the laity, or at least not easy to popularize.  Oleum Percomorphum is supplied without dosage directions. Samples are
furnished only to physicians.
Mead Johnson & Co. of Canada,Ltd., Belleville,Ont.,does not advertise any of its products to the public. tUurn.■■-'.'< J,1
Responsibility
Trained pharmacists, plus the
invaluable experience of over
thirty years in filling Doctors'
prescriptions—these are the
ingredients   of   responsibility.
OHKMl
HIOMT
Seymour
2263
GEORGIA PHARMACY
LIMITED
W. OIOROIA
STREET
(&mtn $c ijamui Sift
Established 1893
VANCOUVER, B. C.
North Vancouver, B. C.-J§ Powell River, B. C. Hollywood Sanitarium
Limited
For the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
ROY WRIGL.KY PRINTING a^Sg3fa>8> PUBLISHING CO.  LTD.

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.1-0214414/manifest

Comment

Related Items