History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: July, 1944 Vancouver Medical Association Jul 31, 1944

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 f^%
rn, BLi_tj__Hi
of the
Vol. XX.
JULY, 1944
No. tO
With Which Is Incorporated
Transactions of the
Victoria Medica 1 Society
the
Vancouver General Hospital
ami
St Paul's Hospital
In This Issue:
Page
CANCER CtMltHE THYROID—-By ^ W. R. Govan, R^C.A.M.C^^^p2_6
THE DIAGNOSIS AND TREATMENT OFi&PER RESPIRATORY
PfTlACTl^ENFECTIONS  IN   INFANTS  AND  CHILDREN—By
|gB^j|||M8SHM ^^^^^^^SJ^B_f-_-l^-l-li_-ili^-^-l-_-ii 268
FOOT PROBLEMS IN THE ARMY AND OUT OF IT|S|
0$y L&iCol. g|| Harris   jjMlj   ■ ^J^J^^^j^fl^J^j^g ^B
THE ROLE OF BODY MECHANICS IN THE HEALTH EXAMINATION
AND CAjS_|||F GROWING CHILDREN-^By Clififor^Sweet, M.D.M277
news AND^roTEs.^^Rv _____________ WWWWWi^M^BBH™
ANNUAIiMEETING BRITISH COLUMBIA MEDICAL
ASSOCIATION
EMPRESS HOTEL — VICTORIA, B. C^
SEPTEMBER 26, 27, 28, 29
Please make reservations directly -with the hotel^and early HI"';
i_Sra_&--i_E;. ;
One milligram of Oresfof by movfn is
equivalent to one mgm. of natural
follicular hormone by injection. (AOflOO
International mitt or 800I.B.UJjfS
Orestol may be employed in all con.
ditions in which the natural hormones
are used and is capable of the following actions:
1    Inducing uterine haemorrhage
in cases of amenorrhoea.
2
3
5
6
Relieving the symptoms of the
menopausal syndrome.
Leading to the appearance of
cornified cells in the vaginal
smear in menopausal cases.
Restoring the normal conditions of the vulva and vagina
in senile atrophic vaginitis.
Relieving the pain of dysmen-
orrhoea.
Inhibiting lactation.
When prescribing ORESTOL
the identifying initials "E.B.S.*'following the word Orestol insure the correct
filling of your prescription ^f^|
3? ORESTOL E.B.S.
/S_rV
ORESTOL E.B.S_
(Diethyl-stilboestrol
dipropionate) act.
similarly to the naturally
occurring oestrogens. It
is highly active by
mouth and its duration
of action is approximately the same as that
of oestradiol.
0RE5TDL
(DIETHYL-STILBOESTROL DIPROPIONATE)
ORESTOL E.B.S. is used With
success in the treatment -mm
PROSTATIC NEOPLASMS. Under
its definitely anti-androgenic influence, such growths frequently
soften and regress, urinary retention^decreases and patients
reportiiharkecif easing  of pain.
ORESTOL  E.B.S. is available in three
strengths, in bottles of 100 or 500 tablets,
C.CT.-No. 530.^.0.5 mgm|
C.C.T. No. 531 ..i^.O mgm.
C.C.T. No. 532 .J. 5.0 mgriipf
and is generally available on prescription.
THE E. BjHUTTLEWORTH CHEMICAL CO. LIMITED
TORONTO
MANUFACTURING CHEMISTS
CANADA
_&____ ___&__»__«-___'        ._i_ti__i        ,____.. w
USE *lBT
THE    VANCOUVER    MEDICAL    ASSOCIATION
BULLETIN
Pulished Monthly under the Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
Offices'. 203 Medical-Dental Building, Georgia Street, Vancouver, B.C.
EDITORIAL BOARD:
Db. J. H. MacDermot
Db. G. A. Davidson Db. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XX
JULY, 1944
No. 10
OFFICERS, 1944 - 1945
Db. H. H. Pitts
Presiden t
Db. Fbank Tubnbull
Vice-President
Db. A. E. Tbites
Past President
Db. Gobdon Burke
Hon. Treasurer
Db. J. A. McLean
Hon. Secretary
Additional Members of Executive'. Db. G. A. Davidson, Db. J. B. Davies
TRUSTEES
Db. P. Bbodie Db. J. A. Gillespie Db. W. T. Lockhabt
Auditors: Messbs. Plommeb, Whiting & Co.
SECTIONS
Clinical Section
Db. E. R. Hall Chairman Db. S. E. Tubvey Secretary
Eye, Ear, Nose and Throat
Db. Leith Websteb Chairman Db. Gbant Lawrence  Secretary
Pediatric Section
Db. J. H. B. Gbant Chairman Db. John Piters Secretary
STANDING COMMITTEES
Library:
Db. A. Bagnall, Chairman; Db. P. J. Bulleb, Db. D. E. H. Cleveland,
Db. W. J. Dorbance, Db. J. R. Neilson, Db. S. E. C. Turvey
Publications:
Db. J. H. MaoDebmot, Chairman; Dr. D. E. H. Cleveland,
Db. G. A. Davidson
Summer School:
Db. W. L. Gbaham, Chairman; Dr. J. C. Thomas, Db. G. A. Davidson,
Db. R. A. Gilchbist, Db. A. M. Agnew, Db, G. O. Matthews
Credentials:
Db. D. E. H. Cleveland, Chairman; Db. E. A. Campbell, Db. D. D. Pbeeze
V. O. N. Advisory Board:
Db. Isabel Day, Db. J. H. B. Grant, Db. G. P. Stbong
Metropolitan Health Board Advisory Committee:
Db. W. D. Patton, Db. W. D. Kennedy, Db, G. A. Lamont
Representative to B. C. Medical Association: Db. A. E. Tbites
Sickness and Benevolent Fund: The Pbesident—The Tbustees
V.
~J A^^
TOCOPHEREX       VIOPHATE-D
•     Suggested for Treatment
of Threatened or Habitual Abortion
Due to Vitamin E Deficiency
% Each capsule contains 50
milligrams of mixed tocopherols,
equivalent in vitamin E activity to
30 milligrams of a-tocopherol.
Tocopherex contains vitamin E
derived from vegetable oils by molecular distillation, in a form more
concentrated, more stable and more
economical than wheat germ oil.
For experimental use in prevention
of habitual abortion (when due to
Vitamin E Deficiency): 1 to 3 capsules daily for 83_ months. In
threatened abortion: 5 capsules
within 24 hours, possibly continued
for 1 or 2 weeks and 1 to 3 capsules
daily thereafter.
Tocopherex capsules are supplied in
bottles of 25 and 100.
For Increased
Calcium Requirements
# Each capsule of Viophate—D
contains 4.5 grains Dicalcium Phosphate, 3 grains Calcium Gluconate
and 330 units of Vitamin D. The
capsules are tasteless, and contain
no sugar or flavouring. Where
wafers are preferred, Viophate—D
Tablets are available, pleasantly
flavoured with wintergreen..
One tablet is equivalent to two
capsules.
How supplied:
Capsules—Bottles of 100 and
1,000.
Tablets —Boxes of 51 and 250.
'MAH_R_|f€TUIIN0. CHEMISTS   T0  THE   MEDlCA^P«&---ION MNCE-|S58 VANCOUVER HEALTH DEPARTMENT
STATISTICS—MAY, 1944
Total Population—Estimated      299,460
Japanese Population—Estimated  Evacuated
Chinese Population—Estimated ' 5,728
Hindu Population—Estimated  227
Rate per 1,000
Number Population
Total deaths ■  337                  13.3
Japanese deaths   — Population evacuated
Chinese deaths  14                  28.9
Deaths—residents only  299                  11.8
BIRTH REGISTRATIONS:
Male, 363; Female, 365.
728
INFANTILE MORTALITY : May, 1944
Deaths under one year of age      20
Death rate—per 1,000 births ; 27.5
Stillbir|_is (not included above) 16
28.7
May, 1943
22
31.4
7
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
April, 1944
May, 1944
June 1-15,1944
Cases      Deaths      Cases      Deaths      Cases      Deaths
Scarlet Fever i 158 0 160
Diphtheria • .      _ 0 _
Diphtheria Carrier  0 _           _
Chicken Pox 211 0 281           0
Measles I 32 0 44           _
Rubella _. 46 0 116
Whooping Cough 1 j 28 33
Mumps 42 0 23
Typhoid Fever 10 _
Undulant Fever  0 _           _
Poliomyelitis  0 _
Tuberculosis 75 16 77           8
Erysipelas      3 6 _
Meningococcus Meningitis = 7 1 _           _  v
V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH
DIVISION OF VENEREAL DISEASE CONTROL
West North       Vane.
Burnaby    Vane.  Richmond   Vane.      Clinic
55
Hospitals &
Private Drs.
Syphilis 	
Gonorrhoea
Figures not yet available.
Totals
B IOG LAN
The most effective therapy for waning mental and physical energy,
deficient concentration and memory, reduced resistance to infection,
muscular weakness and debility, neurasthenia and premature senility.
The efficacy of this very potent endocrine tonic has been confirmed by
the clinical evidence of many thousands of cases treated during
1932-1943.
Stanley N. Bayne, Representative
Phone AAA. 4027 1432 MEDICAL-DENTAL BUILDING Vancouver, B. C.
Descriptive Literature on Request
THE SCIENTIFIC HORMONE TREATMENT
Page Two Hundred and Fifty-five IMPROVED
•   • •   •
^ containeo and ex
Messed brewer   ve ^ 500
.. , in ***** °* 3 ^
Applied w ^^^^^
0.* ■*•'
0.5 mg«
^Nicotinamide increased 20%
^Riboflavin increased 100%
"Vitamin B6 increased 33-1/3%
7fa incneci&e ut 'Pnice f
There k a "Beminal" product to suH each requirement for B complex:
TABLETS    •    CONCENTRATE    •    INJECTABLE
COMPOUND      •      LIQUID      •      GRANULES
AYERST,   McKENNA    &    HARRISON    LIMITED
Biological and Pharmaceutical Chemists
MONTREAl CANADA
214 VANCOUVER     MEDICAL     ASSOCIATION
FOUNDED 1898    ::    INCORPORATED 1906
*        *        *        *
PROGRAMME OF THE FORTY-SIXTH ANNUAL SESSION
GENERAL MEETINGS will be held on the first Tuesday of the month at 8:00 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the month at 8:00 p.m.
These meetings are to be amalgamated with the clinical staff meetings of the various
hospitals for the coming year.   Place of meeting will appear on the agenda.
General meetings will conform to the following order:
8:00 p.m.    Business as per Agenda.
9:00 p.m.    Paper of the evening.
NtttM $c ®Ij0mj00n
t
2559 Cambie Street
ancouver
, B. C
13 th Ave. and Heather St.
Exclusive  Ambulance  Service
FAirmont 0080
PRIVATE AMBULANCES AND INVALID COACHES
WE SPECIALIZE IN AMBULANCE SERVICE  ONLY
J. H. CREI__IN
W. I* BERTRAND
Page Two Hundred and Fifty-six TETANUS   TOXOID
FOR LASTING PROTECTION AGAINST TETANUS
• As logical In the prevention of tetanus as is diphtheria toxoid in the
prevention of diphtheria.
• Adopted for use in the Armed Forces, including those of Great Britain,
Canada and the United States.
• Of interest to every physician in his private practice.
TETANUS TOXOID as prepared
in the Connaught Laboratories
is a development resulting from
studies extending over 15 years.
THE RECOMMENDED PROCEDURE is the injection of 1 cc. of
TETANUS TOXOID, administered in three doses with an interval of one
month between doses and a recall dose of Vi cc. one year later. In the
case of minor injuries occurring in persons so immunized a further dose
of TETANUS TOXOID is recommended. This product is supplied by the
Connaught Laboratories in packages containing:—
Three l-cc. ampoules—For the inoculation of one person.
CONNAUGHT LABORATORIES
University of Toronto    Toronto 5, Canada
DEPOT FOR BRITISH COLUMBIA
MAC DONALD'S PRESCRIPTIONS LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. The forthcoming Annual Meeting of the British Columbia Medical Association, to
be held in Victoria from September 26th to 29 th inclusive, is one of the outstanding
events of the year for the medical profession of British Columbia. It is, perhaps, the
most important event, for it includes the whole Province; and with it is associated the
Annual Meeting of the College of Physicians and Surgeons.
The business meetings are quite as important as the scientific programme, which
forms a great part of the proceedings. We shall hear the reports of the year's work, and
elect our new officers for the coming year. We could not have a pleasanter place wherein to meet than Victoria, which has always been noted for its hospitality and wholehearted efforts towards making any meetings held there a complete success—and we are
sure that every man who can possibly spare the time to attend will find himself more
than amply repaid.
Speaking of the scientific programme, of which full details will be found in this
issue, we can safely say that it promises to be excellent. We congratulate the Programme Committee, whose task has been a difficult one, and has been well fulfilled.
The British Columbia Medical Association has grown steadily in significance, and in
value to its members, throughout the years. For many of these years, it has been fortunate in its Executive Secretary, Dr. M. W. Thomas, whose whole time and energies
are devoted to its service, and who is outstanding amongst Provincial Secretaries. He
has worked hard and long over the preparations for this meeting, and we owe it to him
to show our appreciation of his work. So we urge all our readers to set aside these
dates, and regard it as a duty, as well as the pleasure that it cannot help but be, to be
in Victoria from September 26th to September 29th. Reserve rooms and tickets early—
and we are sure that the office of the B.C.M.A. will do all it can to help you.
Another important meeting of interest to all medical men is the Regional Meeting
of the American College of Physicians, to be held in Vancouver on September 14 and 15.
This is the first occasion on which this organization has held meetings in Canada, and
■will remind our readers of the Regional Sessions of the American College of Surgeons
held here some few months ago, under the chairmanship of Dr. A. B. Schinbein. Dr.
G. F. Strong of Vancouver will preside at the meeting of the American College of Physicians, and has issued an invitation to all medical men to attend the sessions. Notable
speakers will be present.
Perhaps the most dramatic and in one way the most interesting event of the meeting
will be the attendance of Commander C. M. Wassell, the internationally famous doctor
whose gallant and heroic work President Franklin Roosevelt described in such glowing
terms, and whose courage and devotion will never be forgotten in the annals of military
medicine. Dr. Wassell is expected to speak at the meeting, and we are sure everyone will
want to see and hear this man whose heroism was of the finest and highest type, in that
it was shown in the saving of life rather than its destruction, and under trie most perilous
and trying conditions which one can possibly conceive: not in the heat of battle, but
through long days and nights of cold and hunger and terrible hardship, under continuous
threat of capture and torture by a cruel and inhuman enemy. Every doctor of medicine
must feel a thrill of pride in this man, who represented the best and finest of his profession.
Page Two Hundred and Fifty-seven
I ITEMS OF GENERAL INTEREST
A new plant for the manufacture of "the miracle drug" Penicillin, in Canada, recently went into production. Located in Montreal, this plant, which is a private enterprise, was constructed in record-breaking time, and is now producing Penicillin "made
in Canada." While the actual capacity of the new plant was not announced, the output
will be large, and every effort is being made to meet the requirements of the Armed
Forces, as well as those for civilian medical needs. In fact, when the plant was only
partially constructed, the Company officials decided to double the originally proposed
capacity and the additional equipment was installed along with the initial facilities in
order that the greatly expanded enterprise could swing into operation at one time.
Further expansion is feasible and is now being studied for installation.
The production of Penicillin is a difficult and delicate microbiologic process influenced by a large number of factors, the slightest variation in any of which may alter
seriously the yield and potency of the material. -Faced with these problems, Company
microbiologists developed a method in which an aqueous suspension of spores of a high
yield of the mold, penicillium notatum, is mixed with sterilized soil. This soil-spore
mixture, when dried in a frozen state and placed under refrigeration, was found to retain
its potency indefinitely, thus affording a stable master culture from which factory
batches giving uniformly high yields could be started. Pioneering in the application of
microbiologic and chemical engineering principles to the problem of producing Penicillin
by submerged fermentation, chemists -have succeeded in developing a practical manufacturing process for producing the vital drug in large tanks, thus obtaining a purer product
in larger quantities, in less time, and with reduced manpower requirements.
Penicillin is subjected to repeated tests and control procedures throughout every
step in the production process, and the finished product is assayed, tested, and approved
under rigid standards established by the Government.
Penicillin has proved to be effective against a large number of infections which can
often be effectively treated in a period of hours or days, rather than the weeks or months
formerly required. In the treatment of war wounds and burns, Penicillin is a potent
weapon against bacterial infections, and is now being successfully used on the fighting
fronts throughout the world.
DOCTORS!   PLEASE READ THIS OPEN LETTER FROM
THE REGISTERED NURSES' ASSOCIATION
To the Members of the British Columbia Medical Association:
In spite of increased enrolment in our schools of nursing and the return of many
inactive and retired nurses, the shortage of nurses is becoming increasingly grave. The
difficulties created by this shortage are apparent in all fields but it is concerning, private
duty nursing that this letter is addressed. We are asking for the cooperation of all
doctors in curtailing luxury nursing. Doctors and doctors alone can control the use
made of private duty nurses. For this reason, the Registered Nurses' Association of
British Columbia asks that each doctor, when calling nurses, considers the following
points:
Does this patient need (not want) more care than can be given by the staff of
the hospital or by family or servants at home?
If so, does the patient need continuous nursing service, or will two, or even just
one nurse, be able to carry him over the busy or difficult times during the day?
addition, doctors are requested to encourage their patients to relinquish their
nurses as soon as the need for constant nursing care is over.
Governmental authorities have suggested that public opinion may impel some form
of control. Such control would carry with it the possibility of the elimination of
private duty nursing altogether.
Page Two Hundred and fifty-eight
1.
In
-__
__■ LIBRARY NOTES
RECENT ACCESSIONS TO LIBRARY—
Surgical Clinics of North America, Symposium on Post-Operative Complications and
Gastro-intestinal Surgery, Lahey Clinic Number, June, 1944. *
The Conquest of Epidemic Disease, 1943, by Charles E. A. Winslow.
A Hundred Years of Medicine, 1943, by C. D. Haagenson and W. E. B. Lloyd.
Supplements to the Oxford Loose-Leaf Medicine file have been received and include
the following articles:
Vol.  1—Revision of article, p. 545, "Aviation Medicine," by Dr. L. H. Bauer.
Vol. 2—New article, p. 492(93), "The Cor Pulmonale," by Dr. P. D. White.
Vol. 3—Revision of article, p.  1, "Diseases of the Esophagus," by Dr. E. S.
Revision of article, p. 783, "Diseases of the Adrenals," by Dr. R. F.
Loeb.
Vol. A—Revision of article, p. 79, "Gout," by Dr. J. H. Talbott.
Vol.  5—New article, p. 422(7), "Histoplasmosis," by Dr. H. Pinkerton.
New article, p. 438(1), "Q Fever," by Dr. G. Blumer.
New article, p. 488(36-la), "Ornithosis," by Dr. H. A. Christian.
Revision of article, p. 599, "Rabies," by Dr. H. N. Johnson.
Vol. 6—New article, p. 46(7), "Electrocephalography," by Dr*. W. G. Lennox,
Renewal pages have been received also for the Nelson Loose-Leaf Medicine System, as
follows: '
Vol. 2—-p. 67y "Acute Anterior Poliomyelitis," by W. Lloyd Aycock.
Vol. 5—p. 423, "Therapeutic Agents in Disorders of the Alimentary Tract," by
Ralph C. Brown.
Vol. 6—p.  3 85j "Meningovascular Syphilis," by Hans H. Reese.
p. 401—"Tabes Dorsalis," by Hans H. Reese,
p. 549, "Diseases of the Meninges," by Nathan Savitsky.
«M. S. A. PLAN RECEIVES ENTHUSIASTIC
ENDORSEMENT"*
Recently employees of the B. C. Plywoods Ltd. in plant and offices voted overwhelmingly in favour of the Conference Committee's recommendation that the Medical Services Association plan be adopted to replace the expiring medical contract,
thus firmly establishing the fourth point in the four-point programme of protection
which provides life insurance, mutual benefits, hospitalization and medical service.
The Conference Committee was keenly aware of its responsibility in selecting a new
plan. Guided by the expressed desire of plymakers for free choice of physician and surgeon, the Committee made the fullest investigation of all suitable plans available, paying
particular attention to this requirement. That 95 per cent of the voters approved the
Medical Services Association plan submitted is a tribute to the Committee, both for the
time and care spent nr general research and for the excellence of the arrangement they
made on the practical working details of the new scheme.
The development and adoption of this promising new medical plan is another striking
example of the power of the idea which brought the Employees' Conference Committee
into existence. The idea is simply that the interests of all connected with an organization are largely mutual. Experience has justified this belief in the minds of those who
have marked the Committee's progress, and has resulted in a wide understanding of the
Company's friendly attitude towards all sound proposals relating to employees' security
and well-being.
*From Sulvaply News, published by MacMillan Industries Ltd.
Page Two Hundred and Fifty-nine MEMBERS, MEDICAL SERVICES ASSOCIATION
A. I. Steel & Iron Foundry Ltd.
Alberni Pacific Lumber Co. Ltd.
Alberni Plywoods Limited
Allard Machine Works Ltd.
Arrow Transfer Co. Ltd.
Burrard Rivet & Forgings Ltd.
Campbell & Grill Limited
Canadian Pacific Air Lines Ltd.—Certain Depts.
Canadian Transport Co. Ltd.
Canadian White Pine Co. Ltd.
Clarke Bros. Timber Co.
Coast Mills Export Co. Ltd.
Coates Limited
G. FL Cottrell Ltd.
Crossman Machinery Co. Ltd.
Dominion Bridge Co. Ltd.—Burnaby Bridge Plant
Dominion Rustproofing Co. Ltd.
Electric Power Equipment Ltd.
Electro-Weld Metal Products Ltd.
Finning Tractor & Equipment Co. Ltd.
Graham Electric Co. Ltd.
Hayes Manufacturing Co. Ltd.
Heaps Engineering  (1940) Ltd.
M. B. King Lumber Co. (North Shore) Ltd.
Kootenay Engineering Co. Ltd.
Langley Manufacturing Co. Ltd.
I. F. Laucks Ltd.
Lawrence Manufacturing Co. Ltd.
Letson & Burpee Ltd.
- Lions Gate Lumber Co. Ltd.
Ash Temple Co. Ltd.
Associated Dairies Ltd.—Office.
Canadian General Electric Co. Ltd.
Fleck Bros. Ltd.
Fraser Valley Milk Producers' Association—Office
Galbraith & Sulley Ltd.
Henry Birks & Sons  (B.C.) Ltd.
Blane,  Fullerton & White Ltd.
Confederation Life Association
General Accident Assurance Co. of Canada
Johnston & Co. Ltd. •
A. E. Jukes & Co. Ltd.
Manufacturers Life Insurance Co.  (The)
Marsh & McLennan Ltd.
Agriculture, Food & Drug Division Employees
Campbell & Smith Ltd.
Canadian  Association   of   Social   Workers—B.   C.
Mainland Branch
Cowichan District School Teachers' Association
Crehan, Meredith & Co.
Creston Valley United School District
Dominion Income Tax Employees
Georgia Pharmacy Ltd.
MacKenzie & Son Ltd.
Metropolitan Health Committee
Longley Electric Co. Ltd.
McKay & Flanagan Bros. Lumber Mill Ltd.
H. R. MacMillan Export Co. Ltd.
MacMillan Industries Ltd. (Plywood Division)
McNair Bevel Siding Ltd.
Merchants Cartage Co. Ltd.
Mohawk Handle Co. Ltd.
Mohawk Lumber Co. Ltd.
Morrison Steel & Wire Co. Ltd.
Northwest Bay Logging Co. Ltd.
Pacific Coast Terminals Ltd.
Pacific Pine Co. Ltd.
Pacific Veneer Co. Ltd.—Logging Division
Pacific Veneer Co. Ltd.—Veneer Plant
Patterson Boiler Works Ltd.
Prefabricated Buildings Ltd.
Rat Portage Wood & Coal Yards Ltd.
Shell Oil Co. of B. C Ltd.
Standard Oil Co. of B. C. Ltd.
Steelweld Ltd.
Stewart Sheet Metal Works Ltd.
Storey & Campbell Ltd.
Tyee Machinery Co. Ltd.
Valley Lumber Yards Ltd.
Vancouver Breweries Ltd.
Vancouver Engineering Works Ltd.
Western Chemical Industries Ltd.
Westminster Canners Ltd.
Westminster Hog Fuels Ltd.
International Business Machines Co. Ltd.
Fred C. Myers Ltd.
Powell River Co. Ltd.—Vancouver Office
Seaboard Lumber Sales Co. Ltd.
George Straith Ltd.
Turner's Dairy Ltd.
Timberland Lumber Co. Ltd.
Vancouver Tobacco Co. Ltd.
Victor X-ray Corporation of Canada Ltd.
Montreal Life Insurance Co.
Retail Credit Co.
H. A. Roberts Ltd.
Sun Life Assurance' Co. of Canada
Shawnigan Lake Lumber Co. Ltd.
Travelers Insurance Co.  (The)
Yorkshire & Pacific Securities Ltd.
News-Herald Ltd.
North Vancouver General Hospital
Port Coquitlam School Board
Robertson, Douglas & Symes
Roy Wrigley Printing & Publishing Co. Ltd.
Smith, Davidson & Wright, Limited
Vancouver Board of Trade
Victoria City Hall Employees
Western Sales Book Co. Ltd.
Young Women's Christian Association—Vancouver
IT WOULD APPEAR THAT A CONSIDERABLE NUMBER OF DOC-
OTRS ARE WRITING LIQUOR PRESCRIPTIONS IN LATIN. AS THE
LIQUOR BOARD EMPLOYS NO PHARMACISTS, WE WOULD ASK
THAT LIQUOR PRESCRIPTIONS BE WRITTEN IN ENGLISH.
A. J. MacLACHLAN, Registrar.
Page Two Hundred and Sixty British  Columbia  Medical  Association
(Canadian Medical Association, British Columbia Division)
President , Dr. P. A. C Cousland, Victoria
First Vice-President Dr. A. Y. McNair, Vancouver
Second Vice-President Dr. A. H. Meneely, Nanaimo
Honorary Secretary-Treasurer Dr. G. O. Matthews, Vancouver
Immediate Past President Dr. A. H. Spohn, Vancouver
Executive Secretary Dr. M. W. Thomas, Vancouver
1944 ANNUAL MEETING
SEPTEMBER 26, 27, 28, 29
EMPRESS HOTEL, VICTORIA, B. C.
Plan to attend your Annual Meeting.
Please make your reservations early, and directly with the Hotel.
SPEAKERS:
MAJOR GENERAL G. B. CHISHOLM, R.C.A.M.C., D.G.M.S., Ottawa.
SURGEON COMMANDER J. W. MacLEOD, Consultant in Medicine, Navy.
(Formerly Internal Medicine, Montreal.)
DR. HARRIS McPHEDRAN, Associate Professor of Medicine, Toronto.
DR. WILLIAM MAGNER, St. Michael's Hospital, Assistant Professor of Pathology,
Toronto.  \
SURGEON COMMANDER H. S. MORTON, Surgeon, Esquimalt. (Formerly
Montreal.)
DR. ALBERT ROSS, Assistant Professor of Surgery, McGill University.
DR. G. H. STEVENSON, London, Ont., Professor of Psychiatry, University of •
Western Ontario.
Guest lecturer from R.C.A.F. to be announced later.
REPRESENTING CANADIAN MEDICAL ASSOCIATION:
DR. HARRIS McPHEDRAN, Toronto, President.
DR. T. C. ROUTLEY, Toronto, General Secretary.
DR. WILLIAM MAGNER appears under the Department of Cancer Control, C.M.A.
SURGEON COMMANDERS MacLEOD and MORTON are provided by arrangement through the kindness of Surgeon Captain A. McCallum, Medical Director-
General, Navy.
Canadian Medical Association lecturers include Doctors McPhedran, Magner, Ross
and Stevenson.
The Committee on Programme has prepared excellent fare for this four-day meeting.
• Fifteen lectures on four mornings.
Page Two Hundred and Sixty-one • Afternoon sessions on Economics:
Wednesday afternoon in charge of the Committee on Economics of the Council; Chairman, Dr. H. H. Milburn.
Thursday afternoon under the (_ommittee on Industrial Medicine; Chairman,
Dr. D. J. Millar—Session on Industrial Medicine.
• Annual Meetings:
Tuesday evening—College of Physicians &  Surgeons.   All doctors should
attend.
Wednesday evening—British Columbia Medical Association (Canadian Medical Association, B. C. Division).
Note: Annual meetings are being held on separate evenings to avoid late
sessions.
• Official Luncheon, addressed by Doctors McPhedran and Routley of the C.M.A.
• Golf—Friday afternoon.
• Annual Dinner, Friday evening—Guest speaker, Dr. Norman MacKenzie, Presi
dent, University of British Columbia.
• Entertainment for Ladies.
• Public Meeting—Thiursday evening, addressed by Doctors Harris McPhedran,
William Magner and others.
PLEASE NOTE: Registration Desk Phone will be—BEACON 2241.
GOLF
Golf play on Friday afternoon, September 29th,
at 1:30 p.m. at the Oak Bay Golf Links.
Dr. F. M. Bryant, 1209 Douglas St., Victoria,
and Dr. E. L. McNiven, 701 Yates St., Victoria, are
arranging the tournament.
The British Columbia Medical Association trophy
is up for competition. Dr. G. A. Davidson is the
present holder and will defend his title. Other prizes
have been arranged. Send your handicap to Doctor
Bryant.
LADIES' REGISTRATION AND ENTERTAINMENT
All ladies are asked to register, and attend the Ladies' Tea and the Ladies' Dinner.
COMMERCIAL EXHIBITS
A large number of commercial exhibits, which are always interesting, have been-
arranged.
Page Two Hundred and Sixty-two PROGRAMME FOR THE
VICTORIA MEETING
September 26, 27, 28, 29
£7»  *__«i*
KM
lfc!s»!
8:30 a.m.
9:30 a.m.
10:15 a.m.
11:00 a.m.
12:00 noon.
2:30 p.m.
8:00 p.m.
TUESDAY, SEPTEMBER 26th
Registration.
Dr. Stevenson—"Psychiatry in General Practice."
Dr. Magner—"Pathogenesis in Anaemia."
Dr. Ross—"Refrigeration Amputation."
Official Luncheon—Grill Room.
Speakers: Dr. Harris McPhedran,
Dr. T. C. Routley.
Clinics and demonstrations at hospitals.
Annual Meeting—College of Physicians & Surgeons of B.C.
All doctors should attend.
9:00 a.m.
9:45 a.m.
10:30 a.m.
11:15 a.m.
12:00 noon.
2:00 p.m.
8:00 p.m.
WEDNESDAY, SEPTEMBER 27th
Dr. McPhedran:—"Management of Congestive Heart Failure."
Dr. Magner—"Infectious Mononucleosis."
Dr. Ross—"Fractures of the Surgical Neck of the Humerus."
Surg. Commander Morton—"Loose Bodies in the Elbow Joint."
Lunch hour.
Session on Economics—Chairman, Dr. H. H. Milburn, Committee on
Economics of the Council of the College.
Annual Meeting—British Columbia Medical Association.
All doctors should attend. »££§
9:00 a.m.
9:45 a.m.
10:30 a.m.
11:15 a.m.
12:00 noon.
2:00 p.m.
4:00 p.m.
8:00 p.m.
THURSDAY, SEPTEMBER 28 th
Dr. Stevenson—"The Prevention of Mental Diseases."
Surg. Commander MacLeod—Clinical Experience with Penicillin."
Speaker—to be announced later.
Dr. Ross—"Acute Diverticulitis of the Sigmoid."
Lunch hour.
Conference on Industrial Medicine—Chairman: Dr. D. J. Millar.
Conference on Emergent Epidemics—Chairman:  Dr. Gordon O. Matthews.
Public Meeting.
Page Two Hundred and Sixty-three FRIDAY, SEPTEMBER 29th
9:00 a.m.
9:45 a.m.
10:30 a.m.
11:15 a.m.
12:15 noon.
1:30 p.m.
7:00 p.m.
7:00 p.m.
Surg. Commander MacLeod—"Gastroenterological Problems in the Canadian Navy."
Major General Chisholm—"Mental Hygiene of Soldiers."
Speaker to be announced.
Surg. Commander Morton—"External Skeletal Traction."
Luncheon—Board of Directors.
Golf—Oak Bay Golf Links.
Annual Dinner. Guest speaker, Dr. Norman MacKenzie, President, University of British Columbia.
Ladies' Dinner.
REGIONAL MEETING
AMERICAN COLLEGE OF PHYSICIANS AND WAR-TIME
GRADUATE MEDICAL MEETING
SEPTEMBER 14-15       | HOTEL VANCOUVER
INVITATION
This is a joint Regional Meeting of the American College of Physicians and War Time
Graduate Medical Meeting. All medical officers of the armed forces in the United States
and Canada, Fellows and Associates of the American College of Physicians, and other
civilian physicians in the Pacific Northwest and Western Canada are cordially invited
to attend.
There is no charge of any nature for registration or attendance at the scientific sessions. The Luncheon tickets for Thursday, September 14, will be $1.50, and the Dinner
tickets for that night will be $2.50.
PROGRAMME
THURSDAY, SEPTEMBER 14
Morning Session, 9.00 a.m., Salon A, First Floor
Presiding: T. Homer Coflfen, F.A.C.P., Regent, Portland, Oregon
"The Recent Status of Rickettsia Disease": Dr. Matthew Riddle, Associate Professor of
Medicine, University of Oregon Medical School.
"Control of Staphylococcic Infections with Sulfonamide Drugs": Lieut. Col. Roy H.
Turner, Chief of the Communicable Disease Treatment Branch, Army Service
Forces, Washington, D.C.
"Clinical Experiences with Penicillin": Capt. Chas. E. Watts, F.A.C.P., Medical Officer
in Command, United States Naval Hospital, Seattle, Wash.
"Some Pharmacological Problems in the Use of Chemotherapeutic Drugs": Dr. Norman
D. Davis, Professor of Pharmacology, University of Oregon Medical School.
LUNCHEON, 12.30 P.M., MAYFAIR ROOM
Presiding: J. W. Scott, F.A.C.P., Governor, Edmonton, Alberta
Speaker: Maj. Gen. G. R. Pearkes, V.C., C.B., D.S.O., M.C.,
G.O.C. in C. Pacific Command
Page Two Hundred and Sixty-four Afternoon Session, 2.00 p.m., Salon A, First Floor
Presiding: E. G. Bannick, F.A.C.P., Governor, Seattle, Washington
"Respiratory Limitations in Altitude Flying": Group Capt. G. E. Hall, Consultant in
Medicine, R.C.A.F., Ottawa, Ontario.
"Respiratory Disease Problems in an East Coast Base": Surgeon-Comdr. J. Wendell MacLeod, Consultant in Medicine, R.CN.V.R., Halifax, N.S.
"Visualization of the Chambers of the Heart and Great Vessels": Lieut. Comdr. Israel
Steinberg, M.C.-V.'s, U.S.N.R., F.A.C.P.
"Experimental and Clinical Aspects of Carotid Sinus- Reflexes": Dr. Hance Haney,
Professor of Physiology, University of Oregon Medical School.
FRIDAY, SEPTEMBER 15
Morning Session, 9.00 a.m., Salon A, First Floor
Presiding: G. M. Poindexter, F.A.C.P., Governor, Boise, Idaho
"Hepatitis": Lieut. Col. Roy H. Turner, Chief of the Communicable Disease Treatment
Branch, Army Service Forces, Washington, D.C.
"Psychosomatic Medicine": Brig. W. P. Warner, Deputy Director General of Medical
Services, Ottawa, Ontario.
"Gastroenterological Problems in the Canadian Navy": Surgeon-Comdr. J. Wendell MacLeod, Consultant in Medicine, R.CN.V.R., Halifax, N.S.
"Some Principles and Problems in Immunity": Dr. C. E. Dolman, Head of Department
of Bacteriology and Preventive Medicine, University of British Columbia, and director of Provincial Laboratories.
"Thiouracil in Grave's Disease": Dr. David P. Barr, F.A.C.P., Professor of Medicine,
Cornell University Medical College, New York City.
Afternoon Session, 2.00 p.m., Salon A, First Floor
Presiding: Homer P. Rush, F.A.C.P., Governor, Portland, Oregon
"Body Section Radiography": Comdr. Wendell G. Scott, M.C-V.'s, U.S.N.R.
"Maintenance of Normal Body Temperature in Service Personnel": Group Capt. G. E.
Hall, Consultant in Medicine, R.C.A.F., Ottawa.
"Some Experience with the Use of Gold Salts in the Treatment of Arthritis": Dr. P. H.
Sprague, F.A.C.P., Assistant Professor of Clinical Medicine, University of Alberta.
"Observations on Active Rheumatic States": Dr. John MacEachern, F.A.C.P., Assistant
Professor of Medicine, University of Manitoba.
"Malaria Control"—with two films: Lt. Commander Frank P. Mathews, Malaria Indoctrination Officer, 13 th Naval District, Seattle, Wash.
OFFICIAL DINNER (Informal), BANQUET ROOM, 7.00 P.M.
Presiding: G. F. Strong, F.A.C.P., Regent, Vancouver, B. C
Speakers
David P. Barr, F.A.C.P., Pres.-Elect A.C.P., New York City.
Commander Corydon M. Wassell (M.C), U.S.N.R.
Page Two Hundred and Sixty-five CANCER OF THE THYROID
Lt. W. R. Govan, R.CA.M.C
(Formerly of the Interne Staff of The Vancouver General Hospital)
Cancer of the thyroid is more common'than is generally supposed. In a recent five-
year period, 1100 cases of thyroid disease were admitted to the wards of a large Canadian
hospital. Of these, 40 or 3.06 per cent, proved to be malignant. Nevertheless its possibility is so rarely entertained that the diagnosis is only suspected in the fully developed
and almost hopeless state in the majority of cases.
This is indeed unfortunate because the prognosis in cancer of the thyroid gland is
better than is generally realized. Mayo, in a recent report, states that 125 of 249 cases
treated were known to be alive at least ten years after treatment.
Cancer of the thyroid practically always arises in a thyroid already the seat of goitre.
In the majority of cases there is a pre-existing adenoma. Although it may occur early
in puberty, carcinoma of the thyroid is most commonly met with in the usual cancer
period. It is rather more common in women than in men. According to Ewing, true
tumors rarely develop in the Graves thyroid. When malignant tumors are associated
with Graves symptoms it is possible that the initial hyperplasia belonging to the general
disease passes rapidly into a malignant overgrowth which thereafter dominates the-picture.
That a simple colloid goitre presenting a structure that usually remains harmless for
years may give rise to metastatic tumors of benign or malignant type is one of the
striking anomalies of the pathological thyroid.
Pathology
The gross appearance varies considerably. Where arising from an adenoma the tumor
remains encapsulated for a considerable time. Sooner or later there is invasion of the
capsule, and infiltration of the surrounding tissue with involvement of the regional
lymph nodes.    In other cases the tumor is diffuse from the beginning.
Microscopically, cancer of the thyroid is usually classified into medullary, adeno-
carcinomatous and scirrhous forms. Metastases occur by both lymphatic and blood
stream spread. The question of metastases is of peculiar interest. Secondary tumors are
most common in the lungs and then in the bones. Metastases pass chiefly by the blood'
vessels.
The bones are involved only less frequently than with mammary and prostatic cancer
and in the following order: skull, sternum, spine, ribs, humerus, femur and pelvis.
One peculiarity of these malignant metastases is their ability to revert to the normal
type of thyroid tissue. In other words, if a microscopic examination of such metastases
is made the malignant character of the tumor may have disappeared entirely or have
diminished to such an extent that the microscopic picture is mostly one of normal glandular structure.
Metastases are capable of normal physiological function. Classical is the case of Von
Eiselberg who performed a complete thyroidectomy for a malignant tumor. Nothing
worth notice followed the operation but later on, when in a subsequent operation a
metastasis was removed, marked symptoms of myxcedema soon developed.
Signs and Symptoms
The early signs and symptoms of malignant change in a thyroid are few and no one
is pathognomonic. Certain findings are however suggestive. A goitre slowly increasing
in size which commences to enlarge at an accelerated rate should be suspected of being
malignant. Increasing hardness suggests malignant change. Pain and fixation to the
surrounding parts are features of importance. Such fixation occurs, as a rule, first in
the region of the trachea. Hoarseness due to involvement of the recurrent laryngeal
nerve is indicative.    A patient who presents herself complaining of hoarseness accom-
Page Two Hundred and Sixty-six panied by a nodular goitre should be suspected of suffering from cancer of the thyroid.
Occasionally the original tumor remains small while metastases develop and in a few
cases the thyroid tumor has been overlooked and a metastatic tumor in bone or lungs ■
has first attracted attention. That many metastatic thyroid tumors function is indicated
by the presence of colloid, and has been proved experimentally by von Eiselberg. The
presence of iodine in metastatic adenocarcinoma demonstrated by K. Ewald is a further
indication of functional activity.   Briefly the most important signs and symptoms are:
1*. Accelerated rate of growth.
2. Increasing hardness.
3. Hoarseness.
4. Pain and fixation.
5. Poor appetite.
6. Loss of weight.
Methods of examination include a careful history, thorough physical examination,
laryngeal examination and surgical biopsy.
Treatment
Three methods are available: surgery, radiation therapy or a combination of the two.
The best known therapy is the last. If post-operatively an area of unsuspected malignancy is found in the centre of an encapsulated adenoma, no further treatment is required. If the capsule has been infiltrated or if the carcinomatous change has occurred
in a diffuse goitre, it is advisable to follow radical surgical extirpation with adequate
radiation therapy.
In a brief summary of malignancy of the thyroid gland in The Vancouver General
Hospital during the ten-year period from 1932 to 1942, the following facts are revealed:
Number of cases proved by pathological examination i 45
Of these, there were women 30 cases
men.^  15 cases
Average age was 47 years.
1. Rapid increase in size;
2. Increasing hardness of tumor.
3. Loss of weight.
4. Increased nervousness and palpitation.
5. Signs of extension of tumor, i.e., cough, stridor, signs of metastases.
'Pathological Reports of These 45 Cases:
Malignant adenoma 19
Diffuse carcinoma !  12
Papillary carcinoma     7
Squamous cell carcinoma     1
Anaplastic carcinoma j 1
Every gland examined had previous thyroid disease.
Results of autopsies showed metastases as follows in order of frequency:
Bones, Lungs, Local extension, Cervical glands, Liver, Adrenals, Mediastinal glands,
Kidneys.
Ribs and skull were the bones most frequently involved.
It was found almost impossible to check on length of life following thyroidectomy
and radiation therapy on these patients. Some twenty-four persons have received radiation therapy to the thyroid gland. Only a few cases were followed up post-operatively,
and most are still alive. Two of them, eight years after operation and radiation therapy,
and six others were still alive after three years.
The following is a case report of a patient recently admitted to The Vancouver General Hospital:
Page Two Hundred and Sixty-seven Mrs. J. B., aged sixty-three years, history of thyroidectomy in 1923. The thyroid
increased in size and symptoms of hyperthyroidism returned so that in 1929 she underwent another thyroidectomy. The pathological report was adenoma with hyperplasia.
On admission in 1942 complaints were pain over the upper third of the sternum for six
months and intermittent pain over the left scapula for three years. Physical examination was negative. Radiograph of the chest showed a large mass in the left axilla invading the thoracic cavity. The third and fourth ribs were noted to have completely disappeared for a distance of two inches at the site of the mass.
A biopsy of this mass was taken at operation. The pathological report was metastases
of malignant adenoma of thyroid to the third and fourth ribs. Radiographs of the
cranium revealed several small, more or less' circular areas of absorption of lime which
suggest small secondary malignant deposits.
Diagnosis: Metastases to the third and fourth ribs and to the cranial bones from
malignant adenoma of the thyroid.
Conclusion
1. Malignancy of the thyroid gland is not uncommon,
common.
2. Malignancy occurs in glands already the seat of thyroid disease.
3. Prognosis after thyroidectomy and radiation therapy is good.
4. All adenomas of the thyroid should be removed.
REFERENCES
Ewing: Neoplastic Diseases.
Boyd's Pathology.
Canadian Handbook of Cancer.
THE DIAGNOSIS AND TREATMENT OF UPPER RESPIRATORY TRACT INFECTIONS IN INFANTS AND CHILDREN
WITH SPECIAL REFERENCE TO SINUSITIS
By Dr. Clifford Sweet
(Summer School, Vancouver Medical Association)
Wherever man travels his infectious diseases follow him, and that is particularly true
of the upper respiratory tract of our body, and the upper part of the intestinal tract.
We have learned to control the infections of our food and drink quite well. We are just
beginning to do something with air-borne infection. We are, perhaps, on the eve of
discovering some means of raising the local immunity of the upper respiratory tract
infections. The Russians have done some very good work with influenza by means of
vaccine. No one is immune to the common cold. The" young child is born with little
or no immunity. The upper respiratory tract infections and the common cold in a child
may be serious and the complications are severe—fever, prostration, diarrhoea, vomiting.
As the child grows older he gradually develops an immunity to these infections and when,
he gets them he does not get the severe reactions which were common in his infancy.
This varies with the individual but is somewhere between nine and ten years of age and
t hen he no longer gets the high fevers and no longer is he so severely ill. However, every
child is subjected to repeated infections of his upper respiratory tract, and the maintenance of his upper respiratory tract in a state of physiologic health is of the greatest
importance. No one knows exactly what the significance of the sinuses connected with
the nose may be, but they are there—we all have them—and they are easily infected and
infection may reside in them for a very long time.    It has been found, in a recent
Page Two Hundred and Sixty-eight analysis in the Henry Ford Hospital, that the most frequent cause for prolonged fever
in children is due to residual and previously undiscovered sinusitis.
Sinusitis is no new disease and I think it is highly important that we give our
patients a word of explanation when we use that word. In my youth every newspaper
and magazine had a cure for catarrh, which is just another name for sinusitis. This is
proven by the fact that freshmen classes have an upper respiratory tract in much better
health than were those of the students even twenty years ago. Unquestionably the
wholesale removal of tonsils and adenoids has added very greatly to the well being of
the children of our country.
I used, before I knew of some of our present methods of treating sinusitis, to be
consulted by mothers concerning their children because the child had been in a poor state
of health for a long time. Very frequently on examination we found that condition
which has been termed broncho-sinus disease. It was in reality an infection in the upper
respiratory tract and the lymphatics lying along the tracheal tree were infected. An
infection cannot exist for any length of time in the sinuses or the tonsils without producing enlargement of the lymphatic structures along the tracheal tree.
The diagnosis of sirftisiti-s in the very young child is difficult because no one can
look into the nose of a young child very effectively. If you look in and see a purulent
discharge, he has a sinusitis, but the fact that you cannot see this discharge does not prove
that has not got a sinusitis. In very young children the nasal discharge goes back again—
at least 80 or 90 per cent of it drops back into the pharynx. When I ask mothers if the
child has any discharge from the nose, they invariably answer "No." The very young
child does not know how to blow his nose. When he is a small infant I think the discharge from his nose is carried out entirely by gravity. When he gets a little older he
sniffs his nose and draws back the discharge into his throat. I often encourage mothers
to let the child sniff his discharge out of his nose. If they don't a large part of that
discharge goes down into the child's stomach where I think it probably does little or no
harm. The gastric secretion is a powerful sterilizing agent and it has been shown in
experiments with mice that if discharges are allowed to go into the stomach, little damage results. When the child gets this secretion down into the throat and some of it goes
into the upper part of his treachea, he begins to cough and of all the causes of coughing
that there are, the greatest cause in young children is secretion going down from the
nose, and the coughing which the child does is highly beneficial. Often this secretion does go down into his lungs and then is a contributing cause of bronchopneumonia.
No amount of cough medicine is going to be of any very great value. In fact, I tell my
patients that there is no such thing as a cough medicine; that all we have is something
that will liquefy the discharge and let it run out more easily. A sedative should be
given in sufficient doses for these children to get some rest. Put him in a position so
that the secretion will come out of his treachea.
The physiology of the nasal sinuses is quite well known now, thanks to a number of
investigations. When the. nose is open and nasal breathing is going on normally there is
a entrance of air into and out of the sinuses which tends to keep them in good health.
The mucous membrane of all the sinuses is very rich in mucus-secreting cells and that
mucus is of the highest importance in cleansing the sinus.
In the treatment of sinusitis by any means at our command we should help that
individual to return his nose to a normal physiological state and we should not do anything that interferes in any way with the physiology of the nose.
When I say to a mother that her child has a sinus infection and I see a look of
horror on her face, I tell her that when anyone gets a cold severe enough to produce
thick mucus then he has an infection of the sinuses.
There is no part of the nasal cavity proper which becomes infected in the ordinary
sinusitis. It is possible that there is infection in the nose after a sinusitis has lasted for a
very long time and there is considerable destructive process in the nose itself in an
atrophic rhinitis.
Page Two Hundred and Sixty-nine The age, incidence of sinusitis is from one hour after birth on. I have frequently
seen babies come home from the hospital with their mothers, having an acute purulent
sinusitis. From the noses of those babies I have been able to remove large amounts of
that purulent material. In babies' the sinuses exist as grooves in the nose without any
well-defined cavity but that part of the antrum which is already developed can be infected just as well as in the adult. Very early in babyhood the ethmoid sinuses develop.
The frontals and the sphenoids come later.
When one gets a common cold, secondary infection follows with many kinds of
organisms. When that happens there is at once a swelling of all the structures, within
the nose, which interferes in three ways with its physiological action:
1. With the increase in size of the spongy turbinates and these are unable to enlarge
and shrink as they normally do.   You know, the nose is the greatest air-conditioner.
2. The sinuses open into the nose and this swelling of this mucous membrane tends
to close up the orifices of the sinuses.
3. The inflammatory process plus the load of mucus plus the bacteria interfere with
the ciliary action.
Therefore, when we want to treat a nose which is blocked up so the individual cannot breathe through it, we must find some way of getting air through it. In the very
young child, if the child's nose is plugged over long periods of time he fails to get a
development of the sinuses which keeps pace with his age. I used to be consulted about
these children and I had no satisfactory treatment to offer them except to put the child
to bed for long periods of time, which I did, sometimes putting these children to bed for
three to six months if necessary in order to spare them from re-infection and to recover
from their respiratory tract infection.
Approximately fifteen years ago there were some very important experiments carried
out. We had had, prior to that time, two agents for shrinking the mucous membranes
and they were cocaine and adrenalin; but the shrinkage is followed by a period of
turgescence and both these paralyze ciliary action. It was found that ephedrine would
produce very effective drainage and did not leave behind a state of turgescence. Ephedrine stimulated the ciliary action. Since ephedrine has* come into common use, other
substances have been produced which act in the same manner as ephedrine, but in
my hands I have had less satisfaction from them than I have had from the solution of
ephedrine which I now have been using for ten years. The ordinary commercial solutions of all the substances which are used for the shrinkage of the mucous membranes
have in them some form of preservative and there is no preservative that has been discovered that it is not irritating to the nasal mucus membranes, so if you want one you
will have to have it made up without any preservative in it. | There is no antiseptic
which can be used in the nose as yet advantageously.
I would like to speak of the instillation of the sulpha drugs in the nose as a bad practice. If I have a patient who is sufficiently ill with sinusitis so that I want to use the
sulpha drug, I give it to him by mouth and raise his' blood level sufficiently high to act
upon the nose.
We have found no antiseptic which can be used in the nose or in the eyes which is
more beneficial than Nature's own discharges.
The object of intranasal breathing is to shrink the structures within the nose so that
air can pass through and so that the natural openings of the sinuses may be free and
the secretions pushed out by the cilia. When this method, which I am going to describe,
was first brought out, some of my colleagues were afraid of it. Jones of London wrote
very clearly that you cannot infect an open sinus. A closed sinus will become infected
almost within hours after it is once closed up.
I think there is absolutely no danger of spreading infection from one sinus to another by introducing a properly made liquid for the nose. This liquid should not produce any irritation. Therefore, it should be isotonic with the fluids of the body. The
ephedrine molecule is a very large molecure and therefore it ionizes imperfectly. Physiological salt solution must have other salts added to it.    We have found a very simple
Page Two Hundred and Seventy way of producing an isotonic salt.solution, and that is by making up the solution with
tap water instead of distilled water. Tap water is always the same pH as the body. Our
acid-alkaline balance is the same as that in which we live. A 1 % solution of ephedrine
added to tap water with 6/10 of 1% salt solution makes a solution that is almost perfectly isotonic. No preservative is added to it. Dr. Parkinson and I have tried to get
several of the large manufacturers to make this up but they have refused to do it. One
of their highest executives said they will not put out any solution that has no preservative in it. We have gotten around that by having our pharmacists put up this sterile
solution and the ephedrine and salt can be boiled right in the tap water and they dispense with it a small dropper bottle, and we warn the patient that he is to use it only
after he has poured the solution into the smaller bottle. Some bacteriological work was
done some years ago in which they found you can get a very fine growth of bacteria
from any bottle of nose drops after the dropper has been introduced into the nose of a
patient.
Since I have known this method. I have had more real health in treated infants and
children who have sinusitis than I have had before. I have had so many of these children brought to me who have not been well for weeks or even months. In an earlier day,
little or no attention was paid to upper respiratory tract infection. One day I was
talking about sinusitis in children in the Library of one of the larger hospitals. An old
man who had retired said, "What are you talking about, anyway? Every kid has a snotty
nose."   And I guess that is just about the case.
After the acute stage of sinusitis the child may be free from fever, and may not
have any signs of continuing illness except that he is not quite well. It is remarkable
to -me that people can carry so much infection in the sinuses for so long without producing more systemic trouble than they do. I think I need not argue—I presume that at
some time in the life of every individual in this room, bacteria have been in his body.
After any part of the body has had repeated damage by infection, certain changes
occur which put that infection into the chronic stage. I am quite convinced that if
we go on taking care of the acute sinusitis in children, of helping the child to get over
the sinusitis which follows the ordinary cold, the sinusitis whic his particularly due to
scarlet fever, then we can bring up a generation of children, very few of whom will
have chronic sinus disease.
I said the little child cannot blow his nose and there is no way in which you can
prove that he has a sinusitis—unless you can actually see the discharge in his nose.
I am often guided to the diagnosis of an upper respiratory tract infection by the fact
that I find the child had red inflamed eardrums, although' at no time has he had an
otitis media.
Then after shrinking the nose with ephedrine I use intermittent suction. With
ordinary water suction I make gentle suction. In the small infant you need not close
the other nostril while you make suction. If the child is a little older you have to
occlude the other nostril, which is done most effectively by applying the ball of your
thumb on and off the other nostril In the small child you may close both nostrils and
not know it. If I get a purulent secretion the child has a sinusitis because that secretion
can come from nowhere else. A negative result does not disprove sinusitis. Quite frequently, when I suspect a sinusitis, I instruct the mother to use the ephedrine at home
once in four hours for two or three days and then come back again. I don't get the
sinuses open with the first or second application but gradually they do get open. When
the child's nose is very much swollen, only a small amount of the solution can be
introduced into it and you have to introduce some and wait for that to have its shrinking process and then put in more. This solution in a child takes about three minutes
to do its work; in the adult about five minutes to do its worki One spray will not be
enough in a badly swollen nose. Sprays do not work very well with children because the
child has spray shock.
Now. all of the commercial solutions that are made up that contain ephedrine are
not beneficial, because they all contain alcohol.    I have tried them all personally in my
Page Two Hundred and Seventy-one office and my patients know the difference between the commercial product and the
normal solution. Besides that, they are very expensive. You can, if you want, prescribe a powder made up of ephedrine and salt in powder form and have the mother
put 100 c.c. of water with it and this is very economical.
Postural drainage is very important in treating respiratory tract infections in
children, no matter whether it be upper or lower. This slide shows the method of
giving postural drainage to a child. This is a means of postural drainage that we have
devised in our hospital. These children who have perhaps some signs of bronchectasis
nearly, if not always, have the upper respiratory tract infection also. With a child in
that position the sinuses become just as dependent as if the child were bent back with
his nostrils perpendicular. Ephedrine has a systemic reaction; you will get abdominal
pain and other symptoms if you get any in the throat. By using this position you treat
the nasal mucous membranes withou getting any in the throat. After three to five
minutes the face is turned down toward the floor and the excess of the solution comes
out. In the small infant it is important that the mother or the nurse be instructed
how to instill this solution into the baby's nose. The baby is wrapped in blankets, put
face down on the attendant's lap and his face is lowered beside her knee so that his
head is well beyond 45 degrees and she puts the ball of her thumb on the child's ear
in order to hold his head. She then instills that solution into his nose for at least three
minutes by the clock.
Now, I have a very short reel that will illustrate this method of instillation. The
nose should be blown with. a hanky or other means and it should be held loosely so
as to catch the secretion. The nose should never be blown when it is blocked up.
People who have ha^ fever who waken up in the morning with a blocked up nose should
not attempt to blast it open. If you walk around for a few minutes you will most likely
remove the blockage. This treatment should be continued until no more excess secretion can be obtained from the nose. I have used this with so much satisfaction that
I cannot be too enthusiastic about it. I should say that in general the sinusitis which
follows an acute common cold, with the effective use of the ephedrine alone, will have
its normal course cut in half.
Formula:
Ephedrine -       .9
Sodium Chloride       .6
Tap water -- 90.
Boil all together and add no preservative.
NOTICE
We have been informed that drug addicts are visiting doctors'
offices and obtaining Prescription D 10 in the B. C. Formulary or D 6
in the Pharmacopoeia of the Public Welfare and City Relief Department
for the purpose of extracting the 5 minims of Opium Pro Dosa.
The Royal Canadian Mounted Police have requested that the tincture of opium be deleted when writing this prescription.
A. J. MacLachlan,
Registrar.
Page Two Hundred and Seventy-two FOOT PROBLEMS IN THE ARMY AND OUT OF IT
By Lt.-Col. R. I. Harris
Read at Vancouver Medical Association Summer School.
An astonishing amount of misery to human being arises from foot disability. Scarcely
ever is the disability more than the source of continued discomfort or misery. Rarely
does it involve a serious detriment to health and yet the interference of function which
foot disabilities give rise to can be serious, not only because of the way they modify
the patient's activities but, in times like these, when we are training men to be soldiers,
sailors and airmen, it can be a source of a tremendous amount of lack of fitness and is
a great problem in the army. If your experience in being taught to be a doctor as a
student was like mine, it will have been that the teaching of foot problems was pushed
aside. There were so many other major problems to teach the student and they were
so much more important and so much more interesting that nobody ever took the
trouble to tell us much about foot problems. It took me a great many years to discover that, after all, there is an intelligent background of approach to foot problems and
it is not without its interest, and if I can in some brief way give you some inkling of
the basis of foot problems and arouse your interest, it will have served a purpose.
At the moment, these foot problems are of tremendous importance in the armed
forces, especially in the army where we are training mn to be fit for tasks which are
almost at the limit of human capacity, especially in front line army service. A man
must be physically superfit in order to be a soldier, and if he has any defect in his
feet he may not be fit to be a soldier. That puts a tremendous burden on the medical
service of the armed forces, and especially the army. They have to have a great
knowledge about foot defects. If a man has a deviation from normal to his feet he
had better not be in the army, or if he does enlist he needs to be properly graded. It
brings up problems of training. A man may enlist and not have had any trouble with
his feet before. If he suddenly, in his army training, is thrust into a much more strenuous kind of life it may bring out weaknesses in the feet which should be prioperly
treated or he should be properly regraded. The M.O. must have a knowledge of these
foot defects and be able to differentiate between problems which are real and those
which are not real. If you complain enough you may get something that you want.
Napoleon said that an army marches on its stomach. That is not quite true. It still
has to march on its feet and they have to be good feet.
A large proportion of the problems of feet arise from the fact that our feet, which
we now use as structures to support our weight and to propel us when we walk, have
developed from lower extremities which long ago served different functions. This slide
will illustrate that in a simple way because it represents the outline of the feet of our
types of primates as they exist today. They came from a common stock and, while we
have no knowledge of what the feet of that common ancestor were like, we can be
sure that they had qualities which we see in the fee_Tof its descendants. It changed
slowly from a grasping organ into one which supports our weight and propels us when
we walk. We see its highest development in the feet of human- beings who now no
longer use their feet for grasping at all and use them solely for bearing weight and for
propelling themselves when they walk.
Just as individuals are born with noses which are not all alike, so they are born with
feet which are different from each other. These deviations may4?e of such a nature as
to interfere with their function. A man who is a boxer and whose arms are long has
an advantage over one whose arms are short, and so the structure of our feet may
influence the function of those feet—the amount of work which can be done by those
feet. , All the more serious foot problems are based upon these structural deviations from
normal and must be recognized as serious aspects of the foot problem.
In this slide we see the structure of the feet for grasping objects. When we come
to the human foot we see that the long axis deviation has gone.
I would like first of all to discuss some of these deviations from average structure
which we should recognize because they interfere with function. It is not sufficient to
look at a man and say he has flat feet.   It is necessary to determine why he has flat feet.
Page Two Hundred and Seventy-three The term flat feet~_neans very little. It may mean nothing in terms of function because
it may be that this man has one foot which is functionally good and strong. We cannot
be entirely guided by the appearance. and the shape of the foot. I have only to point
out to you the disability of claw-foot to remind you that we had to do something more
than recognize a foot as looking flat in our attempt at assessing the quality of individual
feet. One such abnormality which is of importance, although it is rare, is the presence
of an accessory tarsal bone on the inner end of the scaphoid. This slide illustrates it
moderately well. One can recognize them frequently by the presence of a projection
at the inner end of the scaphoid. It is usually bilateral. Nearly always it is necessary
to have an X-ray to determine this accessory bone. The significance of this defect is
that it interferes with the function of the post-tibial tendon. In consequence, the
tendon no longer functions as efficiently as a lifterrup of the inside of the foot. It now
expands a good deal of its effective force in tilting the foot at the mid-tarsal joint.
This is a foot in which the capacity .for weight-bearing is diminished. If a patient has
an accessory tarsus scaphoid there is a limit to the load that you can put on that foot.
So for the army, any attempt to train this man by graduating his training period will
only succeed up to a certain level as there is nothing you can do with these feet outside
of an operation. Here is another slide in which the accessory tarsus scaphoid is on one
side only. The tubercle of the scaphoid is enlarged and that in itself can produce similar symptoms.
Apart from the recognition of this as an army problem, I would call your attention
to it as a problem of civil life. One can usually recognize it in childhood. The child
is brought to the doctor because of a bulge on the foot. An X-ray will show what it
is. One must early assess the degree of disability which this is causing the patient.
Nearly all in my experience have some disability. It may be slight but usually it is
considerable, and if that proves to be the case then you would be wise early to operate
and relieve .them of their disability, because it can be done, and the operation is one of
the most satisfactory operations undertaken for improvement of the function of the
foot. It consists in removal of the accessory tarsus scaphoid and then the displacement
of the tendon to a poine more near the centre line of the foot, where, after the removal
of the accessory tarsus scaphoid, it can now act as a better lifter of the inside of the foot.
Those of you who have had a long experience with the Mayo operation for the
treatment of hallux valgus will have learned that there is one shortcoming to this otherwise excellent procedure for the cure of this thing. You have cured the bunion but you
have disturbed the weight-bearing of the foot. This slide shows such a case. A similar
disability which is produced by this operation exists in life as a result of undue shortening of the first metatarsal. Morton observed that patients who had certain kinds of
trouble had short first metatarsals. This is the X-ray of the foot of a nurse who came
complaining of trouble in the fore part of her foot and, in looking at the soldiers' feet,
it was possible to see that she had undue weight-bearing on the soles of her feet; so we
had a pair of patients suffering from a similar disability—one caused by operation and
one congenital. This is a picture of the soles of a soldier's feet in which we see the
trademark of a short first metatarsal with callouses as you see here. These can be a
source of considerable disability. One can appreciate that when you see a patient who
is complaining of difficulty in the fore part of his feet, you must ask yourself why this
is so, and one of the reasons is because he has a short first metatarsal. How are we
going to find out? A simple way to get some inkling of it is to flex his metatarsophalangeal joints sharply and if it is possible to do this you can get some inkling as to
the position of the first metatarsal and you can see if it is shorter than his second. This
is usually somewhat greater in this examination than is actually the case and an X-ray is
really necessary. These are the X-rays of a patient with a very short first metatarsal.
Morton, in his study of disabilities due to short first metatarsals, tried several ways of
determining the relative amount of weight borne in various parts of the foot and this
slide is one of the attempts on his part to indicate graphically those parts of the foot,
which bore most weight.   Now, Morton's device for indicating graphically the relative
Page Two Hundred and Seventy-four amount of weight bone is not easy to reproduce. We have been engaged in the army for
sime time past in a study which we hope will provide us with some statistics of value
in foot problems, and one of the things we have been trying to do is to devise some
means of making a footprint. Most foot prints only indicate how much of the foot is
in contact with the ground. This is an attempt to show clearly and simply and with
certainty the relative amount of weight borne by various parts of the foot. Here in this
slide you see a drawing of it. Here we have some prints that Were made with this gadget.
You can see that if a patient has a short first metatarsal, he has a deviation from
normal which will inevitably give rise to disturbance in weight-bearing in the fore part
of the foot. That may or may not result in interference of function. Commonly, all
the short first metatarsals of any serious degree do give rise to disturbance in function.
This is a slide of an associate of mine in the army who went through the last War.
He got through the last War with difficulty due to his feet and in this War he was
persuaded to retire to an M.D. H.Q.
One must not put too much upon the discovery of organic deviations from the normal structure. One has to assess a man's disability. Here we see several other examples
of feet which have disabilities from short first metatarsals. Here we see a nursing sister
who has a great deal of trouble with her feet, chiefly because of a short first metatarsal.
She has callouses and it is difficult to give her a pair of feet that will give her good
function. In civil life you can sometimes supply them with a metatarsal pad. This is
a man who is engaged in a munitions plant and who was seriously disabled because of
pain and who has been greatly elrieved by a metatarsal support. Here is a case in which
the short first metatarsal is associated with another type of increased weight bearing.
Fryberg's infarction is present here in the second metatarsal. Morton says some other
things. He says that one of the evidences of this disturbance of weight-bearing is found
in the X-ray in that the second metatarsal becomes thicker and heavier than normal and
will show up in an X-ray. He also said that two other conditions will give rise to a
similar condition: (1) Posterior displacement of the sesamoid; (2) hypomobility of the
first metatarsal and scaphoid.
One of the reminders of the fact that our ancestors had grasping feet is the fact
that the first metatarsal is set at an angle to the rest of the foot. This is one of the
causes of hallux valgus, and since we are talking about congenital deviations from normal structure, we will discuss that while we are here. That can be the foundation of
many severe types of hallux valgus, as you will see in this next case. Here are the feet
of a person with severe hallux valgus. You can see here the callouses which she has.
Here is an X-ray of that same patient. I would not have you think that a metatarsus
primus varus is the basis of all hallux valgus. Nearly always there is an accessory factor
which results in the style of the deformity. A single pair of shoes which are too short,
worn in childhood, can produce a deformity which, although slight, can disturb the
action of the toes and perpetuate the deformity.    An injury can do the same thing.
This in my opinion is the best operation for hallux valgus. No operation gives the
patient a perfectly normal toe. I have already discussed with you the changes in the
function of the foot with the Mayo operation. This Kellar operation is much simpler
than the Mayo operation but does leave the patient with a flail joint. One must recognize that when advising a patient to have this operation because unless their disability
has been severe they will be distressed by the fact that the toe is longer than normal
and it is only when they have a lot of trouble with bunions that they will be content
to have that operation that leaves them with a flail joint.
One of the most disabling of foot problems is a curious disability, the exact cause
of which is not yet clearly understood.   Several years ago Russell K _— wrote about
something which he called muscle-bound foot which must have been the kind of foot I
am talking about not. It is also based upon deviations from the normal foot. It is
characterized by three outstanding features which are determined on examination: (1)
If you maintain the foot in the mid position you will be surprised to find that the
Page Two Hundred and Seventy-five range of dorsiflexion of the ankle joint is greatly limited. The knee, of course, must be
fully extended. This is a demonstration of the effect. That means that the patient
can't get his heel on the ground by means of movement at the ankle joint. If he does
get his heel to the ground, he puts his foot into marked valgus. We see here the foot of
a chaplain in the army and you will see that he has this condition to a very marked
degree. His feet are only flat when he stands on them. These are X-rays of his feet.
These are the X-rays of a nurse who all her life has been greatly disabled _»y her feet
and she has markedly flat feet and she also has characteristics of this unstable foot. She
has a short first metatarsal, it is true, but her complaint is here and not there. Here is
the imprint of one such foot, and you will notice that most weight is borne along the
inner margin of the foot.
(2) Movement of the subastragaloid joint is excessive.  They are hyper mobile.
(3) The disability exists only when the patient bears weight on the feet and disappears when he takes his weight off his feet.
Here is an X-ray of another case. If one searches for the cause of this problem in
the Department of Anatomy, you will find some interesting factors. This is the type
of foot in which one gets the unstable foot which I have just described. Here are the
X-rays of three such cases. Here, perhaps, is an even more revealing picture. If one
looks at it from the side, you don't see very much. In this one there is no support of
th head of the astragalus. Here is a normal foot. Here are the X-rays of that patient
we have just seen.
These, then, are some of the abnormalities which we must recognize in men's feet
if we are to assess properly their ability to use their feet for function, because if certain
abnormalities exist there is a limit to what these people can do and it would be folly
for us to try to make them do what they can't do.
This is an example of a disease of the bone which follows trauma, the cause of which
is obscure. It is greatly disabling and out of all proportion to the trauma. In this case
there was a fracture of the external malleolus. Here is another example of it. This
man had a minor injury and developed this condition. It slowly improved with some
setbacks.
One of the acquired disabilities is an osteoarthritis of the metatarso-phalangeal joint,
of the first toe. It interferes greatly with function. These patients are unable to dorsi-'
flex their toe because of the pain. Because it is due to trauma, it is much more frequently seen in young men. Spastic flat foot has something to do with an acute arthritis
of the tarsal joint. The foot is held in valgus and is held tautly there. You w__ recognize this as a patient with a flat foot and you will find he can't swing his foot to the
correct position. The reason is that his peroneal tendons are continuously contracted.
How the mechanism develops is still obscure. It is most often seen in young pepole.
I have not had much success with any form of treatment.
This is an example of a print with a localized lesion on the sole of th efoot there
and these are other prints of patients with disturbances at the point of weight-bearing.
This is a lesion which one sees in adolescents only. It is not very common but certain
young individuals will produce an injury to the epiphysis of the os calcis. Here we see
a type of fracture produced by use of the foot by walking which is of considerable
interest. We are recognizing these things now when we didn't do so in civil life. It is
due to the fact that the bone is not able to bear the ordinary stress which is put upon
it and slowly gives way at a certain point. When the patient first presents himself there
is nothing in the X-ray. Gradually we see this change occur. It is much more common in some armies than in others. It is much more common in the American Army
than in the Canadian Army.
There are many other things about foot problems which I have no time to talk
about tonight.
Page Two Hundred and Seventy-six "THE ROLE OF BODY MECHANICS IN THE HEALTH
EXAMINATION AND CARE OF GROWING CHILDREN"
By Dr. Clifford Sweet
Read at Vancouver Medical Association Summer School.
I know I am appearing in a peculiar role—I don't do the sort of work that has
been just illustrated (i.e., Fractures of the Os Calcis). I started my work in the
country. Like every other young man, I tried to do something for every patient that
came to me. One of the first problems was one of backache. It is still there and I expect
to see backaches until I die. I find that in many young children backaches and leg
pains are not due to rheumatic fever but are due to postural defects. I see many children with tender heels who have tender heels because their heels are taking a constant
pounding as they walk or stand. Some of these children need thyroid. I see many pain-
fid and injured knees in young adolescent children. I have seen several cases who were
thought to have Osgood-Schlatter's Disease of the tibial tubercle when all that they had
was weak quadriceps and femoral muscles and strong over-active hamstrings. There
was one boy whom I shall never forget— a very large boy—and that boy had such
weak quadriceps and such strong hamstrings, and his pain was so strong each day that
he had to learn to back down a hill in order to take the pull off his quadriceps. Inci-
dently, he was wearing great enormous shoes with a large metal arch support in each
shoe. By training that boy he recovered and the next autumn he played football. He
did have some rarefaction of the tibial tubercle because of the damage that had been
done.
Then I began to notice, as I looked at the little children who came to me, that
they all had pronated feet at a certain age, that they were all knock-kneed at a certain
age, and it was common practice at that time to put a wedge on the inner border of
the heel and many of them had a great enormous wedge on the inner side of the sole
involved; and I would like to mention that the wedging of the inner sole of a shoe
is generally only to be condemned. The so-called Thomas heel is of some use but need
not be applied universally. My reason was that if it occurred in all cihldren then it
must not be abnormal. There are certain patterns which occur in the life of the child
as it grows. He does a certain .thing when he first stands. There are certain things
that occur in him at two years of age, three years of age, and so on. I think that
those knock-knees are apparent rather than real, and depend upon a muscle balance which
is part of the child's age at that stage of growth, and it is the inward rotation of
the femur. The child gains in weight and strength and muscular development. In the
human body the last muscles to develop in a growing child are those which are attached
to the pelvis. Consequently the gluteal muscles are generally poorly developed and the
child at that age has an inward rotation of the femur which is normal and physiologiacl
for him. He comes out of that, if he has developed normally, at about six or seven
years of age.
Now, heredity plays a large part in the mechanics of the body. It is quite evident
that the stocky, short-backed people have an easier time of it than the people with
long backs. Squadron-Leader Bell pointed out the effect which a slothful life has upon
the heart of an individual. I would like to point out to you that every internal organ
in the body through the pericardial ligament is attached to the cervical spine, so that
when the spine slumps everything goes down. When the spine is at its full height
everything is lifted up, even the patient's spirit. Unquestionably, many of the functions
of the body, particularly the vital capacity, depend upon the complete upright stance
of the body. Now, man is, I think, just a part of the whole animal creation. Undoubtedly he was once quadruped. He has everything that a quadruped has and, in addition
he has only the clavicle, and the clavicle comes down from our reptilian ancestors. The
problems of lack of muscle balance, I believe, are fundamentally related to the change
of a quadruped into a biped. I spoke a moment ago of the imbalance of the quadriceps
and the hamstrings. It is so universal. I find that children who come to me with
repeated strained ankles all have short hamstring muscles.   One can see quite readily
Page Two Hundred and Seventy-seven how this injury occurs. With a short muscle, when the joint is subjected to force it
suddenly meets the impact between the force and muscle that stops it. When the
muscles are stretched and freed that joint can then get out of the way.
I have adolescent girls who have knee injuries that they have sustained, sometimes
only in walking downstairs. X-ray examination of those knees is negative. The hamstring muscles are found to be very short, and in any sudden movement the hamstring
muscles actually jerk the head of the tibia back under the femur. I have repeatedly
had these girls balance up the muscles and they no longer sustain the injury.
I was delighted to hear Col. Harris speak of shoes the other day. I am quite sure
that shoes are greatly responsible for the difficulties which people suffer in later life.
I found that 75 % of my patients coining from a very good class of people were wearing
shoes that were too short. Now, a shoe is necessary but it should be a proper shoe:
(1) It should fit at the heel. Many shoes are made too wide in the heel for the human
foot. (2) The shoe should fit in the arch, and I mean that the back of the great
toe joint should always come at the turn of the sole. One of the grave faults
of all shoe manufacturers now is that too little of it is in the length of the arch.
(3) Then the shoe should have room enough for the forefoot. A shoe should be wide
enough so that when it has been worn for a long time you can see the welt of the
shoe all the way around.
When the arch of the shoe is too short the individual is forced to walk with his
feet everted in order not to have to force a hinge in his shoe. Also, the short arch
pulls that leather down on his metatarsals with every step and so we have the child's
foot encased in the shoe and he is forced to walk everted. The little baby stands up
with just one idea in mind and that is stability. You will see that he stands with his
feet everted and with all of his weight-bearing joints slightly flexed. When he finally
gets brave enough he will take his first step. Very soon he begins to gain skill and
reaches out with that stepping foot. Then someone says, "Now it is time for a good
heavy shoe to support his foot." The child who is beginnnig to walk should not be
interfered with by a stiff rigid shoe. The foot has two functions: (1) Weight-bearing,
and (2) Propulsion of the act of walking. The child must develop his feet and because
of rigid shoes, because of the lack of the use of his feet and because of too narrow or
too short shoes, I see children with poorly developed feet at nine or ten years of age.
So I say that every child should go bare-footed. If the child is to wear any sort of
appliance with which to put his foot in the proper position, this should be removed
for a reasonable time each day so that he can use his feet for a little while.
Now, for my first slide. This first is a copy of a drawing showing our descent from
the fish. I know why, in the evolution of the quadruped and the biped, we now
have certain muscles which are always weak and others which are over-strong. If you
will think, for example, that I am a quadruped and I am walking, you will see that my
quadriceps muscles has a very easy job. It just has to clear my foot from the ground.
My psoas is one of the driving muscles. So that in the change from quadruped to
biped we have unbalanced flexor and extensor muscles. The gluteal muscles in the
quadruped have no function except to wag the tail and stabilize the hip joint a little.
Now, this slide illustrates the reason why the bow-leg in the young infant persists
when he has no rickets. The child is bow-legged when he is born. When the child
begins to walk, his bow legs disappear and he goes on to knock-knees.
Now, I said that gravity pulls you forward. Learn to stand properly. I have
learned to stand with one foot forward and to use my knee and my hip joint to get
over what I am doing. My back is extended to its full length; therefore, my shoulder
girdle is elevated and my hands are free. In the schools they try to teach the children
to write with an arm movement. If you are going to do this you must sit at full
height.
Now, this slide shows a boy of approximately three years of age and he is not very
knock-kneed. Now that boy is a young man, a magnificent specimen. This is his
sister, who is a little older—about four and a half or five years here.   You see the
Page Two Hundred and Seventy-eight apparent knock-knees. This is an X-ray taken of that girl's legs at that time. You
will see that there is notiiing abnormal except that they are rotated inward. Now.
here is that same little gjirl when she was about six years of age and she has almost
recovered from her knock-knees without any wedged shoes or anything else. She was
allowed to go bare-footed a great deal. Here she is at about nine years of age and I can
see nothing wrong with her legs.
The human body is made in such a way that we are liable to fall forward as this
illustration shows. It shows how the curves of the spine straighten out when the body
is elongated.
One of -the most harmful things in the teaching of body mechanics is the clinging
to the military parade posture. This slide illustrates this posture. The military parade
position is nothing but a method of starting. The soldier, sailor and airman can develop
a magnificent body because of his training. There is no athletic exercise of any sort
known to man which can be done with great skill by an unbalanced body. I keep a
picture of Helen Wills in my office as a horrible example of a bad back. This slide
illustrates in an exaggerated form the way in which the average human being stands
as soon as he becomes tired. Now, this cartoon illustrates five very prominent athletes
who were going up for military induction. If they go into military service they will
have many faults corrected if they have a good trainer.
I should like briefly to review with you some points in physiology as I see them.
I believe the practice of medicine should be based more on physiology than upon any
of our scientific studies. I had an old Scotch professor who always went into the
physiology of the condition he was treating.
What ist he physiology of the bones? We are not supported by bones except as
they act as levers. Bones are subject to change in position at any time of life. You
can improve your body mechanics at any time in your life if you have sufficient interest.
The physiology of ligaments is to limit the joint and hold it in place. Ligaments do
stretch when they have stress put upon them for a very long time but the ligament
is a pretty stout fellow whose job is to keep one end of a bone from slipping off the
other. A tendon is an inelastic structure. If a tendon could stretch it could not carry
out its physiological function. You can lengthen a tendon but you can't stretch it.
The thing you stretch is the muscles. Then there is the physiology of the muscle and
this is a structure which is elastic and can contract.
Then, of course, you have habit pattern.
During growth very often one leg will get longer than the other and when that
happens, the individual has to get a compensatory scoliosis and that, scoliosis can be
treated successfully only in one way and that is to put a lift under a short leg until
it catches up. For some reason or another it occurs about three times as often in girls
as it does in boys. Girls get a functional scoliosis because anyone who has binocular vision must have his eyes on the same plane. I have learned a very quick method
of inspecting the eyes of a child sufficiently to make suspect that the eyes are not
right. Get a little distance'in front of the child and throw a source of light into his
pupils and while he looks at it, if that point of light falls directly in the centre of
both pupils he has no muscular imbalance of his eyes. If you find the light in one
pupil and out of the other, then I know he has some imbalance of his rectus muscles.
When that child gets scoliosis for any reason, the muscles of that short side get shorter
and shorter, and the muscles of the other side get stronger and stronger. Then this
individual develops a habit pattern of walking and walks as best as he can. When one
attempts to straighten him up, it actually hurts him. At first he gets discouraged when
he is told to improve his posture. They have to go at it gradually. It is often very
painful when these patients try to stretch these muscles too suddenly.
Page Two Hundred and Seventy-nine Obiit
DANIEL WADE DAVIS
Died—July 4th, 1944
The late Doctor Davis was born in Canada in 1887. He entered McGill
University as a freshman in Medicine in 1904 at the early age of seventeen.
An illness interrupted his medical course, and he graduated with the class of
1909.
Doctor Davis served overseas as Medical Officer during the last war. He
practised in Alberta during several years, and was for some time at Coleman.
The profession in British Columbia will always associate Doctor Davis with
his long years of service at Kimberley. He was capable and gave much of himself to his work and the people, and would be looked upon as a doctor who had
been successful and had made a contribution, not only to the people whom he
served, but to his profession as well. We have to look with satisfaction and
gratitude upon the work of men like Dr. Wade Davis. It is through these fine
medical gentlemen, who have built and maintained standards in medical practice in all parts of the Province, that British Columbia has been able to point
with pride to the quality of its practising profession.
Doctor Davis exerted through his strong personality an influence upon all
with whom he had been associated, and I think I can safely state that the
younger men who had been associated with him throughout the years at Kim-.
berley had benefited very largely in experience and instruction. Wade Davis
had built for himself strong friendships which had largely been attracted by
the force of his personality. He possessed a quaintness of expression which
left a lasting impression with those who had learned to know and understand
him. Those who knew him best enjoyed the frankness with which he attacked
any question, and at times the sharpness of the jibes from which his most intimate friends were not spared.
Doctor Wade Davis will be long remembered in this Province as a man who
had made his contribution to the best in Medicine. He possessed strong opinions
on the conduct of medical practice, and in leaving Kimberley just before the
sad accident which ended his life while having a well-earned rest on Vancouver
Island, he had striven at great sacrifice to himself to have the agreement under
which the doctors provided service in Kimberley ridded of those features which
he felt were wrong in practice and were the cause of irritations which disturbed
the best relations in medical practice between patient and physician.
To have lost both parents in such a tragic way was a great shock to his
two sons, the elder Edmond, who is now serving with R.C.A.M.C and has
returned from overseas, and the younger, Lieut. Jack Davis, who is now serving
with the Navy on the Atlantic coast. These two young men who we hope will
receive some comfort in this sudden bereavement from the knowledge that
their parents had made such a splendid place for themselves with the medical
profession.   They have our sincerest sympathy.
M. W. T.
Page Two Hundred and Eighty NEWS and NOTES
We regret to record the passing of Doctor Thomas H. Lougheed at Winnipeg. Doctor Lougheed practised at Blubber Bay during several years. His son, Doctor Morley
Lougheed, is the Medical Health Officer in Winnipeg.
Dr. R. J. Patche.t, formerly ship surgeon on the Empress of Canada, was practising
at Sooke near Victoria at the time of his death. A number of the profession knew
Doctor Patchett during his practice at Telegraph Creek and on the Queen Charlotte
Islands. *       *       *
The sympathy of the profession is extended to Doctor and Mrs. A. N. Dobry, who
recently lost their infant son, Norman, by death. i
We regret to record the loss of W02 C F. Coleman, R.CA.F. He is the son of
Doctor C E. Coleman, who after his discharge from the R.C.A.M.C. took up practice
in Vancouver.
The following Officers, formerly located at New Westminster, are receiving congratulations on the birth of daughters: Major B. H. Cragg, R.C.A.M.C, and Flight-
Lieut. V. A. Pepper.
The following Officers with the R.C.A.M.C. are very proud of their hewly-born
sons: Capt. H. Edward White, formerly of Vancouver; Capt. S. A. Creighton, formerly
at the Vancouver General Hospital, and Capt. F. A. Olacke, formerly practising at
Ashcroft.
The birth of a son to Doctor Eleanor Riggs, now Mrs. Monty Wood, wife of Lieut.
B. M. Wood, R.CN.V.R., aroused considerable interest among the profession in Vancouver where Doctor Riggs formerly practised.
Daughters were born to Dr. and Mrs. G. F. Kincade of Vancouver and Dr. and Mrs.
J. G. Robertson of New Westminster, and a son to Dr. and Mrs. R. E. Page of Vancouver.
Among recent marriages are listed that of Major Douglas R. S. Milne, R.C.A.M.C,
to Miss Margaret Petrie. Major Milne was an interne at St. Paul's Hospital where Miss
Petrie, neice of Dr. G. A. Petrie, received her-nurse's training.
Lieut. J. A. McLaren, R.CA.M.C, was married this month, as was Dr. Glen A.
Agnew, son of Dr. T. H. Agnew of Vancouver. Doctor Glen Agnew has been associated with Dr. R. W. Irving at Kamloops.
Major G. A. Kirkpatrick, R.C.A.M.C, who has been overseas during the past three
years, has arrived in Vancouver for a brief visit.
We regret to learn that Capt. W. S. Huckvale has been wounded, although we understand that reports are favorable to his recovery.
Congratulations on recent promotion to Wing Commander A. J. Elliot, who has
been serving overseas as eye consultant with the R.CA.F. Mrs. Elliot and her young
daughter are at present residing with the former's parents, Doctor and Mrs. G. K. Mac-
Naughton of Cumberland.
*s* *r •_*
Dr. Douglas W. Graham of Victoria is receiving congratulations on his recent
marriage.
Page Two Hundred and Eighty-one It is reported that Flight-Lieut. Don S. Munroe has become a Member of the Royal
College of Physicians. Flight-Lieut. Munroe will be remembered as an interne at the
Vancouver General Hospital and more recently before appointment to the R.C.A.F.
associated in practice with Doctor G. F. Strong.
Colonel C. A. Watson, Officer Commanding a General Hospital in England, looks
very fit in the recent photograph published where he received the Queen during her visit
at the hospital. Colonel Watson, better known as "Charlie Watson," formerly practised in Victoria.
The Victoria Medical Society, which is the host society to the provincial association
for the Annual Meeting in September has made plans for a very splendid meeting. Surgeon Commander H. S. Morton, Navy, now serving as Surgeon at Esquimalt Naval
Hospital, read a paper to the Victoria Medical Society at its last meeting. His subject
was "Fighting Fractures." This very excellent paper dealt with fractures of the jaw
and hand.
Dr. R. A. Hunter has had a month's holiday at Shawnigan Lake.
All the Medical Officers to the Reserve forces in this Military District have been in
camp for annual training.   The Officers of the 13 th Field Ambulance Reserve have just
completed their two weeks' training.
* *      *
Dr. G. A. McCurdy, Pathologist at Jubilee Hospital, is on vacation near Kamloops.
We hope that Doctor McCurdy has recovered his health.
Dr. J. Stuart Daly and family of Trail spent a month at the coast. On their return
journey they visited in Penticton.
Flight-Lieut. G. S. Rothwell, R.CA.F., visited Penticton during his furlough.
Dr. W. H. B. Munn of Penticton had a week-end's fishing near Summerland.
Dr. A. P. Miller of Port Alberni has just returned from a short holiday in Penticton.
* __ __, __
Dr. W. C. Pitts of Port Alberni had a vacation at Wall Beach.
__ _L _L
*F ^ ^
Lieut. E. V. Helem, .C.A.M.C., former interne at the Vancouver General Hospital,
was married in Toronto.   He is now stationed at Camp Borden.
*f •_* t
Dr. C .T. Hilton of Port Alberni has been in Vancouver for a short visit.
S/Ldr. R. N. Dick, R.C.A.F., formerly of Chemainus, had the misfortune to break
his forearm.
* ♦      *
Dr. M. G. Archibald of Kamloops visited the office during a recent visit in Vancouver.   Doctor Archibald is looking uncommonly well.
Dr. and Mrs. E. J. Lyon of Prince George are holidaying at Fort St. James on Stewart Lake.
______
W *v w
Capt. B. T. Dunham, R.C.A.M.C, formerly of Nelson, is Medical Officer with an
artillery unit in Normandy.
Page Two Hundred and Eighty-two  //
IMkoMtf
n»v^
HI
Boxes of 12 Ointules
COURSE OF TREATMENT
FOR MINOR RECTAL CON*
DITIONS the contents of one
ointule in the morning, one
after each bowel movement
and one before retiring keeps
the affected surfaces constantly bathed with the
ointment.
FOR MINOR VAGINAL CONDITIONS the contents of one
ointule in the morning and one
before retiring is usually
sufficient to control Itching
and promote comfort.
FOR MINOR SURFACE CONDITIONS cover the affected
part and bandage lightly.
"Gadolets" provide a convenient, sanitary, individual application of a measured amount of
Gadoment (Cod Liver Ointment "moddf). "Gadolets"
stimulate the process of epithelization; inhibit the
growth of staphylococcus and streptococcus. They
are sterile and bactericidal.
FOR THE TREATMENT OF
Internal Hemorrhoids Pruritus Vulvae
External Hemorrhoids   Senile Vaginitis
Cryptitis Eye Conditions
Fissure-in-ano (Bums,' abrasions, ulcers)
Fistula-in-ano Pilonidal Sinus
Pruritus Ani Minor Abrasions, Cuts, Bums
^GADOMENT"
Ointment No. 753 ~§ic&£
The original Gadoment formula
Contains 70% non-destearinated cod liver oil in a wax base*
Carbolic add   0.38%  has   been   added  as a  mild tissue
anesthetic Benzoin and zinc oxide are present in small quantities
for their soothing and drying factors.
For the treatment of Varicose Ulcers — Decubitus Ulcers -"■■
Abrasions — Bums — Indolent Wounds — Intertrigo ■»
Pilonidal Sinus.
Available in One ounce Tubes and One pound Jan.
£na/ile. &eftoa_t &©>.
MONTREAL -   CANADA
*3_
THE CANADIAN MARK OF QUALITY
ii'iii_fflffiii'''r
eftoddt ,1
PHARMACEUTICALS   SINCE    1899 ANACARDONE
Trade Mark
(NIKETHAMIDE B.P.)
Nikethamide B.P. is, the most generally useful cardiorespiratory
stimulant. It acts by stimulating the respiratory and vasomotor
centres in the medulla. It raises the blood pressure and increases
the coronary blood supply. Nikethamide is of value, therefore,
for the treatment of all forms of shock, collapse and sudden
cardiac failure, such as during pneumonia and other infections,
and of post-operative narcosis and coma from narcotic poisoning.
Nikethamide B.P. is available for clinical use as Anacardone—
solution in ampoules for injection (Injection of Nikethamide B.P.)
and in flavoured solution for oral administration.
When an immediate effect is essential, Anacardone is given by
injection, the subcutaneous, intramuscular or intravenous route
being employed. In less urgent conditions, Anacardone is administered orally.
Slocks of Anacardone are held by leading chemists throughout the Dominion, and full particulars are obtainable from
THE BRITISH DRUG HOUSES (CANADA) LTD.
Toronto Canada
Ancd/Can/447 STOVAGINAL
Stovaginal is especially indicated in pathological conditions of the vaginal mucosa resulting from or associated with the Trichomonas Vaginalis. It is also
indicated in cases where the leucorrhoea may be the
result of mixed and non-specific infections of the
vagina.
Vaginal Tablets in Bottles of 20,100 and 500
Vaginal Powder in Jars of 30 gm. and 200 gm.
Physicians are invited to request clinical sample. %m ^(MfUiaMe
^^^mm^m^^^^m^^^^^^^^^^^s^s^^^^^^^^^^^^^^msm^
	
_____^__^^gp
There has long been a reed need for a potent, mercurial
diuretic compound which would be effective by mouth. Such
a preparation serves not only as an adjunct to parenteral
therapy but is very useful when injections can not be given.
After the oral administration of Salyrgan-Theophylline tablets a satisfactory diuretic response is obtained in a high percentage of cases. However, the results after intravenous or
intramuscular injection of Salyrgan-Theophylline solution
are more consistent.
Salyrgan-Theophylline is supplied in two forms:
-*? fJbtitb     (entenc coated) in bottles of 25, 100 and 500. Each tablet
contains 0.08 Gm. Salyrgan and 0.04-Gm. theophylline.
1 cc, boxes of 5, 25 and 100; ampuls of 2 cc,
and 100.
Wzite for literature
t"j[lrifa*    m amPuls °*
>**^    boxes of 10,25 or
ffi^_$i___i^§_§!_
WINTHROP
"Salyrgan.** trademark Reg. U. S. Pat Oil. & Canada
Brand at MERSALYV with THEOPHYLLINE
WINTHROP CHEMICAL COMPANY, INC.
Pharmaceuticals of merit for the physician
GENERAL OFFICES: WINDSOR, ONTARIO
Quebec Professional.Service Office: Dominion Square Building,
Montreal, Quebec
^S5»S«SS*_cS^______i
WtNTH ROP lagnosis
INTRACUTANEOUS TESTING FOR PROTEIN SENSITIVITIES
QU4CK, EASY, ACCURATE
WITH
ALLERGENIC TESTING SET
(BARTOS SYSTEM)
ONLY ONE SYRINGE—the new "Breech-loading"
"Tubex" syringe—for administering all allergens.' No
battery of syringes needed!
NO DILUTING ALLERGENS—'Tubex" hold specific
allergens in suitable dilution—all ready for immediate
injection!
TESTS READ WITHIN 10 MINUTES—saving your
time!
TESTS ECONOMICAL —each "Tubex" contains
enough allergen for 20 to 30 tests!
John Wyeth  &   Brother   (Canada)   Limited
REICHEL
Walkerville
DIVISION
Ontario
To prepare syringe: Simply insert Tubex of possible exciting allergen
into breech-loading syringe—then dose breech which locks Tubex
into place.
Complete! Wyeth Allergenic Testing Set (Bartos System) in handsome cabinet, includes breech-loading Tubex syringe, over 200
Tubex of essential allergens, one dozen needles, plus other helpful
accessories.
far descriptive Booklet fully describing
advantages and technique of this new
system, write JOHN WYETH & BROTHER
(CANADA) LIMITED, Reichel Division,
Walkerville, Ontario.
Name.
Address..
City	
Province. DID WARTIME PRACTICE FIND
YOU INADEQUATELY EQUIPPED?
Medical practice on our home fyont has demonstrated a
lot of things the past two years — notably, the indomitable will-to-do and the self-imposed personal sacrifices
of physicians while bearing their share of the greatly
increased load.
With more patients to care for daily, presenting new
problems and requirements, perhaps you, like thousands of
your colleagues, sought additional office equipment with
which to facilitate the work and help you to maintain a
thoroughly efficient professional service. Unfortunately,
as you know, wartime restrictions on manufacture made
it practically impossible to obtain this equipment.
But now that the War Production Board sanctions the
purchase of equipment for civilian practice, you may
resume planning for your particular needs. And if it's
an office x-ray unit you have in mind, or an Inducto-
therm, ultraviolet lamp, phototherapy lamp, extremity
baker, or electrocardiograph, ask us for information on
today's popular G-E designs for discriminating physicians.
To place your order now for some future—yes, even
postwar delivery, may ultimately prove good judgment
on your part.
Let us help you to reach a decision. Write Dept. K67.
VICTOR X-RAY CORPORATION of CANADA, Ltd.
DISTRIBUTORS FOR GENERAL© ELECTRIC X-RAY CORPORATION
TORONTO: 30 Bloor St., W. - VANCOUVER: MotorTrans. B!dg.f 570 Dunsmuir St
MONTREAL: 600 Medical Arts Building * WINNIPEG: Medical Arts Budding
/&V &tf 7?*9-t0#tS**«esG*fificefi>t
wm
V ypfi^c^uir-^L
*
When discomfort from sunburn, other minor burns or
abrasions keeps your patients from work or restful sleep,
use NUPERCAINAL. This effective anaesthetic ointment
provides quick relief from pain in the treatment of many
everyday accidents. It- is also of value in the control of
pruritus of the skin and mucous membrane. It provides
Lasting symptomatic relief of dry eczema, chapped and
roughened skin.
NUPERCAINAL does not contain cocaine or any
other narcotic drug. It has a prompt and prolonged anaesthetic action.
1 ounce tubes — 1  pound jars
*Trade Mark Reg'd. "Nupercainal" identifies the product as
containing "Nupercaine" (brand of Dibucaine) in lanolin and
petrolatum, an ointment of Ciba's manufacture.
C MB_%
^€mt/u^nu SBdd.
MONTREAL, CANADA
TO-MORROW'S MEDICINE FROM TO-DAY'S RESEARCH
flfcount pleasant TUnbertaking Co. %to.
KINGSWAY at 11th AVE.
Telephone FAirmont 0058
VANCOUVER, B. C.
R. P. HARRISON
W. E. REYNOLDS .y—....,,-..,   ."....„.,.„..,....„..„„...
'AGICAPS
Effective Treatment for Leukorrhea
VAGICAPS 47 are gelatin raos—les
containing 10 grains sulfanilamide pins lactic acid, and are
used for- the treatment of nonspecific bacterial infections of
the vagina, for gonorrheal vaginitis   and   trichomonas.
VAGICAPS 47 are prescribed—one
in the morning and one at night
—for one ■week.
VAGICAPS 47 are packaged in
boxes of 12.
!w_*__•_ . -'.£_!2KJ^Qm§
FRANK W.  HORNER
LIMITED
Montreal. Canada.
CASE  HISTORY
R. H.
Age 48
Occupation: Second Fiddle.
Patient was suffering from
the symptoms derived
from abnormal continuance of anxiety. There
was a constant fear of
the necessity for making
decisions and the shock
of impending disaster
- made itself apparent before the occasion had
arrived.
The fear of the resignation of his superiors caused him
great mental strain. He was particularly afraid of the
responsibilities incumbent upon him should he be left
holding  the  bag.
These entirely justified fears led the patient to seek help
from friends in England. His escape from those who
sought to prevent his recovery was spectacular and in
keeping   with   traditional   Nazi   behaviour.
TREATMENT
Occupational therapy is definitely indicated in this case.
Reorientation of the mind is essential and the necessity
for resigning the patient to his greatest fears is paramount.
Breaks the vicious circle of perverted
menstrual function in cases of amenorrhea,
tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic
relief by stimulating the innervation of the
uterus and stabilizing the tone of its
I.    musculature. Controls the utero-ovamn
»    circulation and thereby encourages a
^   normal menstrual cycle.
V j
_ * MARTIN H. SMITH COMPANY
I&. ISO l Af ATITII   STRUT.   HI W TOW. NT. J,
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. fNBTAINED from the aerobic
^■^ spore bearing soil bacterium, Bacillus brevis, PARKE-
DAVIS TYROTHRICIN is effective
against certain gram-positive
organisms including pneumo-
cocci, staphylococci, streptococci, diphtheria bacilli, and
others.
Use by local application: wet
pack, instillation, or irrigation,
in treatment of abscesses . • •
infected wounds . . . indolent
ulcers ... chronic ear infections
... empyema ... infections of
nasal sinus . . . and following
mastoidectomy.
TYROTHRICIN, Parke-Davis, is
supplied in 10 cc. vials, as a
2 percent solution, to be diluted
with sterile distilled water before use. It is for topical use
only—not fo be injected.
WALKERVILLE, ONTARIO '
BUY    WAR     BONDS     AND    SAVINGS    STAMPS Colonic and
Physiotherapy Centre
Up-to-date Scientific Treatments
COLONIC IRRIGATIONS, SHORTWAVE
DIATHERMY, SINNEWAVE GALVIN-
ISM, IONIZATION, ULTRA VIOLET
RAY,  STEAM   BATHS AND  SHOWERS
Medical and Swedish Massage
Physical Culture Exercises
STAFF OF GRADUATE NURSES
Superintendent:
E. M. LEONARD, R.N.
Post Graduate Mayo Bros.
1119 Vancouver Block
i
MArine 3723      Vancouver, B.C.
ARTHRITIS and ECZEMA
of endogenous origin
claimed to be allergic, may be
favored or induced by calcium
and sulphur deficiency, impaired
con action, and imperfect elimination of toxic waste.
LYXANTHINE ASTIER
administered per os, brings about
improved cell nutrition and activity, increased elimination, resulting symptom relief, and general functional improvement.
Write for Information
Canadian Distributors
ROUGIER FRERES
350  Le  Moyne   Street,   Montreal
echve
rtnhng
CAMPBELL & SMITH LIMITED
82O Richards Street    •   Vancouver, B.C.    •    PAcific 3653 MILK-
Ganada'l Vital
FOOD FOR VICTORY
Milk is accepted as the most valuable protective
food because it surpasses all others in supplying
vitamins, minerals, and high quality proteins that
build and maintain sound physical fitness. No
wonder our fighting forces are among the best fed
in the world—their milk consumption is exceptionally high—and no wonder Canada's home front,
too, is by far the best fed!
A quart of milk (4 glasses) gives the following
percentages of your DAILY FOOR NEEDS.
Iron 16%
Vitamin C*% 16%
Energy  22%
Vitamin B 28%
Calcium
* Values Variable.
Vitamin A 37%
Protein -.49%
Vitamin G 79%
Phosphorus    69%
 100% busy 1 doctorsI .
Find that the Georgia prescription service allows them to save trrne and worry.
Our several registered pharmacists
check and double-check for your protection and ours.
Phone
MArine 4161
J&dL&J&»J*A^
GEOBCiA PHARMACY
(&mtn ^mm%ih
SSTAILISHIB ltfl
VANCOUVER, B. C.
North Vancouver, B. C.
Powell River, B. C. 

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