History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: September, 1944 Vancouver Medical Association Sep 30, 1944

Item Metadata

Download

Media
vma-1.0214437.pdf
Metadata
JSON: vma-1.0214437.json
JSON-LD: vma-1.0214437-ld.json
RDF/XML (Pretty): vma-1.0214437-rdf.xml
RDF/JSON: vma-1.0214437-rdf.json
Turtle: vma-1.0214437-turtle.txt
N-Triples: vma-1.0214437-rdf-ntriples.txt
Original Record: vma-1.0214437-source.json
Full Text
vma-1.0214437-fulltext.txt
Citation
vma-1.0214437.ris

Full Text

 TfieHUiiE«i
o_ the
' H »iiNG;OUpE_i
ME DIG a _i a si .-cm ATli) II
Vol. xx.
SEPTEMBER, 15*44
No. 12
With Which Is Incorporated
Transactions of the
Victoria Medical Society
the
Vancouver§3eS^ral Hospital
OJtut
St Pours Hospital
lH    In This Issue:
Pag«
B. CgMEDICAL ASSOCIATION i^^^^lt^^^^^^^^^^^^g ^ 15
FOUR CASES ^QF^ASTRIC SARCOMA gf     ■ j^^^j^^^^^^^fe?ia
THEUSE C^PENK^LENT IN THE MANAGEMENT OF
SOME OBSERVATIONS ON CANCER OF THE LOWER COLON—
By A.'|&y-or-Hei-_y, M.D.,:FJK.C^SJE._^^^^^^^^^^^^^^-1 |jp
ITEMS OF GENERAj^KlNTEREST ^^^^^ff^^^^^^^^^^^^H
NEWS AND NOTES^^rfj^^l^ft-j^^^^^^iMi^^^iy' - 3-53'
SUTOOR^THE ||__ CANADIAN VICTORY J^AN —
SUBSCRIPTIONiLISTS OPEI^O<_it)BE^23rd&944 ANAHilMIN B.D.H.
In all cases of pernicious and other macrocytic anaemias the
injections of Anahaemin B.D.H. is indicated, for, being the haemo-
poietic principle itself in a highly-active solution, ifi-produces
optimum response in minimum dosage with maximum intervals
between infections. Moreover, since Anahaemin B.D.H. possesses
the advantage of being free from therapeutically inert reaction-
producing protein substances, its injection causes only the minimum of reactions due to protein sensitivity.
The use of: Anahaemin B.D.H. alone is sufficient to bring about
complete recovery in all cases of pernicious anaemia and to correct all the remediable neurological signs and symptoms of subacute combined degeneration. Additional treatmenrMs not
required,, except in cases in which iron deficiency may be a complicating factor.
Stocks of Analxemin B.D.H. are held by leading druggists
throughout the Dominion, and full particulars are obtainable
from
THE       BRITISH
Toronto
DRUG      HOUSES
(CANADA)      LTD.
Canada
An/Cao/44> ^iSH  COLUMBIA
rHEfcfB^
THE    VANCOUVER    MEDICAL    A S S O qjb_=3-±S2ft_-
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:
Dr. J. H. MacDermot
Db. G. A. Davidson Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XX.
SEPTEMBER, 1944
No. 12
Dr. H. H. Pitts
President
OFFICERS, 1944 - 1945
Dr. Frank Turnbull
Vice-President
Db. A. E. Tbites
Past President
Db. Gordon Burke
Hon. Treasurer
Additional Members of Executive: Db. G. A.
Db. F. Brodie
TRUSTEES
Dr. J. A. Gillespie
Db. J. A. McLean
Hon. Secretary
Davidson, Db. J. R. Davies
Db. W. T. Lockhabt
Auditors: Messbs. Plommer, Whiting & Co.
SECTIONS
Dr. E. R. Hall
Clinical Section
 -Chairman Db. S. E. Tobvey Secretary
Eye, Ear, Nose and Throat
Dr. Leith Webster Chairman Db. Grant Lawbence Secretary
Pcediotric Section
Db. J. H. B. Grant Chairman Db. John Piters Secretary
STANDING COMMITTEES
Library:
Db. S. E. C. Tubvey, Chairman; Db. A. Bagnall, Db. F. J. Duller,
Db. "W. J. Dorrance, Db, J. R. Neilson, Db. S. E. C. Tubvey
Publications:
Db. J. H. MacDermot, Chairman; Db. D. E. H. Cleveland,
Dr. G. A. Davidson
Summer School:
Db. W. L Gbaham, Chairman; Db. 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, Db. W. J. Dorrance, Db. J. R. Neilson
V. O. N. Advisory Board:
Dr. Isabel Day, Db. J. H. B. Gbant, Dr. G. F. Strong
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
ARY
 .—— ■■■>_»-
„■■ 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 £ 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;
$MM
SfesojiB_mS^#oi Canada, 144
te«tatfAJC_irMJti9   C^E«**ST$   „€K-THt'jMEC^^Sfe>ROFES$tbN   SINCE  1058. VANCOUVER HEALTH DEPARTMENT
STATISTICS—JULY, 1944
Total Population—Estimated 299,460
Japanese Population—Estimated
Chinese Population—Estimated
Hindu Population—Estimated _
 Evacuated
  5,728
  227
Rate per 1,000
Number Population
Total deaths 256 10.1
Japanese deaths Population Evacuated
Chinese  deaths 15 30.9
Deaths—residents  only 223 8.8
BIRTH REGISTRATIONS:
Male,  296;   Female,  330 625
INFANT  MORTALITY: July, 1944
Deaths under one year of age 14
Death rate—per 1,000 births !       22.4
Stillbirths   (not included  above)         9
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
24.6
May, 1944
June, 1944
July 1-15, 1944
Cases      Deaths      Cases      Deaths      Cases      Deaths
Scarlet Fever 	
Diphtheria	
Diphtheria Carrier
Chicken Pox   i
Measles	
June, 1944
July, 1944
Aug. 1-15, 1944
Rubella  67             0 6             0
Mumps  15             0 3             0
Whooping Cough  11              1 2             0
Typhoid Fever 1  10 10
Undulant Fever  0            0 0            0
Poliomyelitis  0             0 0             0
Tuberculosis  67           16 77           16
Erysipelas  2             0 10
Meningococcus Meningitis i  0             0 0             0
Paratyphoid Fever  0             0 0             0
Infectious Jaundice ! :  0            0 0            0
V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH
DIVISION OF VENEREAL DISEASE CONTROL
Rich- North
mond        Vancouver
Vancouver
Syphilis   (June and July)     132
Gonorrhoea  (June and July) 327
West
Burnaby      Vancouver
2 0
0 1
BIOGLAN-A     H
The most effective therapy for waning mental and physical energy,
deficient concentration and memory, reduced resistance to infection,
muscular 'weakness and debility, neurasthenia and premature senility.
The efficacy of this very potent endocrine tonic has been confirmed by
the clinical evidence of many thousands of cases treated during
1932-1943.
Stanley N. Bayne, Representative
Phone MA. 4027 1432 MEDICAL-DENTAL BUILDING Vancouver, B. C.
Descriptive Literature on Request
THE SCIENTIFIC HORMONE TREATMENT
Page Three Hundred and Ten Vasodilator
Mental
Sedative
Theobromine
Neurobarb
(E.B.S. trade name for
Phenobarbital)
The vasodilator Theobromine and the mental sedative
Neurobarb^ act synergistically, relaxing both musculature and mind.
In Theobarb E.B.S.
the Theobromine and
Neurobarb act synergistically to relieve
spasm and allay apprehension. The patient
promptly shows its
rapid and effective
action by looking and
feeling better.
INDICATIONS:
Theobarb  E.B.S.
THEOBROMINE provides the rapid vasodilation
characteristic of the Xanthines, without the undesirable
side effects characteristic of caffeine and theophylline. At
the same time, it stimulates the heart action and finds great
value in syncope and cardiac dropsies. BY DILATING THE
CORONARY ARTERIES, THEOBROMINE FREQUENTLY
GIVES RELIEF IN   CASES  OF ANGINA PECTORIS.
NEUROBARB E.B.S. (Phenobarbital) provides
sedation through action on the central nervous system,
thus relieving the nervous tension that so often increases
blood pressure. This action, coupled with the direct action
of theobromine on the circulatory organs, gives marked
relief from hypertension. In Theobarb E.B.S., the Neurobarb
has a further value in limiting the diuretic action of the
theobromine.
Theobarb E.B.S. comes in two
strengths:
CT. No. 691 contains:
Theobromine ... 5 grs.
Neurobarb ..... \igr.
Sodium Bicarb. .   .   .   5 grs.
CT. No. 691A contains:
Theobromine .... 6 grs.
Neurobarb  Vigr.
Sodium Bicarb. .   .   . 5 grs.
is  indicated in cases  of
cardiac failure, hypertensive heart disease,
cardiac dropsies, angina pectoris, cardiac
pain and following coronary thrombosis.
When prescribing, specify E.B.S., thus: 1^ THEOBARB E.B.S.
THE E. B. SHUTTLEWORTH CHEMICAL CO. LIMITED
TORONTO
MANUFACTURING CHEMISTS
CANADA
__8»8^_8g_^_^_a_^^»_i»p__iB
mr VANCOUVER     MEDICAL     ASSOCIATION
FOUNDED 1898    ::    INCORPORATED 1906
*        *        *        *
PROGRAMME OF THE FORTY-SEVENTH
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 will continue 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.
October 3—GENERAL MEETING:
Symposium—Medical Education of the Future, from the standpoint of
(a) The Clinician—Dr. G. F. Strong.
(b) Preventive Medicine and Laboratory Research—Dr. C. E.
Dolman.
(c) The Medical Health Officer—Dr. S. S. Murray.
October 17—COMBINED CLINICAL MEETING and STAFF MEETING at
VANCOUVER GENERAL HOSPITAL.
November    7—GENERAL MEETING:
Symposium on Industrial Medicine, arranged by Dr. W. G. Saunders,
Director of Industrial Medicine, Wartime Merchant Shipping Ltd.
November 21—COMBINED CLINICAL and STAFF MEETING at ST. PAUL'S
HOSPITAL.
December    5—GENERAL MEETING:
Report of Work at Crippled Children's Hospital.    New Methods of
Treatment of Club Feet—Dr. Gerald Burke.
December 19—COMBINED CLINICAL MEETING and STAFF MEETING at
SHAUGHNESSY HOSPITAL.
Nutttt $c 3Hf annum
2559 Cambie Street
arte ouver
, B. C.
Page Three Hundred and Eleven EPINEPHRINE  PREPARATIONS
EPINEPHRINE is the name specified by the regulations under
the Food and Drugs Act of Canada for the pressor principle
of the adrenal gland and is employed to raise blood pressure,
as a heart stimulant and in the treatment of bronchial asthma.
EPINEPHRINE is prepared in the
Connaught Laboratories as a pure
crystalline compound from beef
adrenal glands. Each lot is assayed
for potency in terms of the
Government standard and is tested
for stability.
THREE preparations are made from the crystalline product
in the Connaught Laboratories:—
1. EPINEPHRINE HYDROCHLORIDE (1:1000). Issued as
a sterile solution in 30-cc. rubber-stoppered vials, to be given
by injection.
2. EPINEPHRINE HYDROCHLORIDE INHALANT (1:100).
Distributed in special dropper bottles containing 6-cc. Used
as an inhalant in the treatment of bronchial asthma.
3. EPINEPHRINE IN OIL (1:500). Supplied for injection as
a suspension of Epinephrine in oil in 20-cc. rubber-stoppered
vials.    For use when a prolonged effect is desired.
CONNAUGHT LABORATORIES
University of Toronto    Toronto 5, Canada
DEPOT FOR BRITISH COLUMBIA
MACDONALD'S PRESCRIPTIONS LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C.
JA EDITOR'S PAGE
At the Annual Meeting of the British Columbia Medical Association we had the
great pleasure of listening to Dr. Harris McPhedran's address given at the Luncheon held
on the opening day. Being in Victoria, we were footloose and free—able to attend all
the papers read, all the meetings held, all the functions, in fact, which one has perforce
to miss when the meeting is held in one's home town. So we sat back and listened
uninterruptedly to Dr. McPhedran's very sage and thoughtful remarks, and were much
impressed by the wisdom with which he spoke.
Dr. McPhedran is President of the Canadian Medical Association, as we all know.
This means that for the past few months he has been diligently touring Canada, visiting
all parts of his parish, which is the whole Dominion: meeting and talking with doctors
of all parts of the country, and when he speaks, it is with some authority, and not
according to any local or provincial bias. He was dealing with post-war problems,-
rehabilitation and reconstruction, especially, of course, as it would affect the medical
profession—but, and because of this to some extent, also as it will affect the people of
Canada as a whole—from a health standpoint primarily—but also from the standpoint
of the general wellbeing of Canada.
He was talking, first, of medical education, firstly as regards those who will later join
the ranks of medicine, and secondly, as regards those who are already in practice. He
emphasized insistently the need for a much greater social consciousness amongst medical
men. We must consider our duty, not only as therapeutists, but as guardians of the
public health. We do not pay nearly enough attention to the background against which
disease rears its head—to the soil from which disease grows. It is for us to learn much
more than we now know, about housing, diet, clothing, mental hygiene, shoes, all of
them large factors in disease production, about which we could and should advise the
public, if we would fulfil our duties and responsibilities. Again, we need, as the last war
first shewed us, while this war has reiterated and greatly emphasized the fact, to be
educated about psychiatry, psychosomatic disease, about the responsibility which is ours
to consider individual background, history, aptitudes, environments, maladjustments,
vocational misfits and the like, failures and defects in which account for so much of
the ailments of the body politic: modern psychiatry shouts this from the roof-tops, but
we close our ears to a great extent. But as a profession, we owe Dr. McPhedran our
thanks for his warning in this regard.
The second great basic need, and here we felt like applauding loudly, to which Dr.
McPhedran drew our attention, was the need for education of the public: education by
us in facts appertaining to medical and health matters. He urged that every medical
practitioner should take part in this education. The public hears only the vague and
glittering promises and daydreams of the uplifter, and the politicians, and those who
want something for nothing—it knows nothing of what the modern practice of medicine means—what it involves in research, in diagnostic procedures, in hospital measures, in long and continuous investigation, in more and more extesive and complicated
therapy. The public has, as Dr. McPhedran said, a medical Utopia promised it. It has
no idea of the hills and valleys to be crossed and overcome, of the cost of the journey:
all it sees is that it wants to be there enjoying it all, within the hour. And by no
process of magic or trickery can this dream be fulfilled. And it is for us to bring to the
public a clear understanding of the facts.
And this brought Dr. McPhedran to his last point—about Health Insurance. Here
he quoted from the report of Dr. Strong's Committee on Economics of the Canadian
Medical Association (published in the August issue of the Bulletin) and endorsed the
views therein expressed, to the effect that no plan of Health Insurance should or could
be imposed as a complete whole at the outset: that it should be applied in successive
stages: these being defined in the Report.
All this is sound, sane, constructive talk, and we need more of it. If the medical
profession in Canada is to maintain its standards of practice, and ever advance them—
if it is to retain its position as a highly-trained scientific body, capable of leadership and
Page Three Hundred and Twelve able to hold its own with the medical profession of any country in the world, it must
take the initiative, and set the pace. It must clean up its own house first, improve and
define its standards, open itself up to become a bulwark against all the maleficent forces
which produce disease: next, it must give to the people of Canada the facts and truths
which they need to know, and which, if they know, will range them on our side—and
lastly, it must define and lay down the policies of change and reform which medicine
must undergo, to keep up with the ever-changing needs of an ever-changing society.
B. C. MEDICAL ASSOCIATION — ANNUAL MEETING
The Victoria meeting of the B. C. Medical Association must be given a very high
rating: it has probably set several records. To begin with, the attendance was excellent. A total registration of 270, which does not include a large number who came for
one or two days, and did not register, is a remarkable achievement in itself, in these
days when medical men find it hard to get time to do their work, much less to spend
attending meetings, no matter how attractive: and with the present-day difficulties
attendant on transportation and hotel accommodation, it is an even more impressive
figure.
An unusually large attendance came from Vancouver and the Lower Mainland, and
the Coast and Interior of B.C. were also well represented. Of course, there were many
attractions. Victoria, at its loveliest in September, has always been,a famous place for
conventions—and the perfect handling of the meeting by our hosts in that city will
remain as a model of how such affairs should be run. All the departments of the meeting were excellently managed—and we are sure that Dr. P. A. C. Cousland, the President of the Association, must be very proud of his aides. To Dr. Cousland himself must
go a large share of the laurels, and we heard innumerable comments on the way in
which he personally conducted the meeting: all loud with praise. The ladies who accompanied us men were admirably cared for and there were no weak spots in the programme
anywhere.
The scientific side of the affair was, too, excellent: and we owe much to our speakers,
all of whom gave us of their best. We have been fortunate enough to secure some of
the written papers, and will be publishing them as opportunity serves.
The Annual Dinner of the Association was a notable event. His Honour the Lieutenant-Governor attended this Dinner, and we greatly appreciate this gracious gesture
on his part. We were, too, most fortunate in our Guest Speaker, Dr. Norman MacKenzie, the newly-appointed Principal of the University of British Columbia. (Dr.
MacKenzie has evidently taken rather kindly to the medical profession, as he was good
enough to attend the first Sessional Meeting of the Vancouver Medical Association in
October, and spoke to us then.)
We were much impressed by the remarks of Dr. MacKenzie: and no less by his
personality. He has had a vast experience of men and affairs: has been a lawyer, a
soldier, and now an educationalist, by turns: and has formed, in his pilgrimage through
life, very definite and, we think, very profound and constructive opinions. He has the
courage of his convictions, too, and speaks frankly and fearlessly. His address led us
through a historical review of world history since 1918, to a very definite conclusion:
and it was this: We want the democratic view of life as a nation. This implies that
we must not only want the privileges of freedom, security, self-government—but; that
we must, too, accept and shoulder the duties and responsibilities that are ours. And
this leads logically and directly to the inescapable conclusion, that this means that each
one of us, individually, must do his or her share in the government of the country—
and.not leave it to any Prime Minister, or Cabinet, or Parliament, or party. We need
more men who will say this in the same clear and uncompromising way 'in which
Principal MacKenzie said it.
Dr. MacKenzie also said something that struck a responsive chord in our being. It
was this. As medical men, we demand certain standards of practice. We demand recognition of what we conceive to be our rights, to be heard, to be consulted.   Very well—
Page Three Hundred and Thirteen and all as it should be. But we must remember that in a democracy, which we claim
to be, one man's opinion is as much entitled to respect as another's, and only as we can
convince (we cannot compel) others of the justice of our cause, can we hope to succeed.
So we must educate the public; we must shew them our side of things—we must be
ready with a plan which will meet their needs, and satisfy their demands, as well as
meeting our own needs and demands. If we do not, the rule in a democracy, that t_te
majority must rule, will lead to the inevitable assumption by the government, forced
thereto by public demand, of powers which are rightfully theirs, to bring us into line.
What Dr. MacKenzie said deserves our careful thought and consideration—and we
owe him thanks for his warning, and advice.
It is hardly necessary to say that the machinery of the meeting, under the shepherding care of Dr. M. W. Thomas, our Secretary, and with the devoted work of Mrs.
Bender and Miss Smith, ran with perfect smoothness.
To Dr. McNiven, of Victoria, we owe our thanks for a delightful game of golf over
that heartbreaking, but fascinating, Oak Bay Links. Nobody but Victoria people,
with their addiction to wind and their passion for birdies ("Follow the birdies . . .")'
could have made such a good course out of such a wilderness of rock and water and
scrub oak and sand: but their efforts have been well rewarded: and Oak Bay is one of
the finest links in B.C.
We would end by thanking the Victoria men, and their charming ladies, for a most
delightful and successful meeting. We are sure that in this universal assurance of the
success of their hard work and devotion, lies all the reward they ask for.
LIBRARY NOTES
RECENT ACCESSIONS TO THE LIBRARY:
The March of Medicine, 1943, New York Academy of Medicine Laity Lectures.
Surgical Clinics of North America, Symposium on Problems in Surgery, Mayo Clinic
Number, August, 1944.
An Introduction to Medical Mycology, 1943, 2nd ed., by Lewis and Hopper.
Convulsive Seizures, How to deal with them, 1943, by Tracy J. Putnam.
Measles, Pneumonia  and Encephalomyelitis,   1943,  by Paul  G.  Kreider   (Gift  of
Author).
MICROFILM SERVICE
Once again, we wish to direct your attention to the microfilm service available in the Library.
This service constitutes a valuable source of auxiliary material to our present
journal holdings, inasmuch as microfilms may be obtained of almost any article
in the files of the Army Medical Library at Washington.
Except in the case of articles of unusual length or reproduction of books,
the service is free.
There is a very satisfactory reader of the desk-projector type in the Library.
We would be glad to have you inspect it at any time.
It is hoped that a worthwhile library of microfilms may be accumulated,
and as they are catalogued, they will form an auxiliary to our present resources.
Page Three Hundred and Fourteen Constitution and Bylaws Dr. D. F. Bus teed
Programme and Finance Dr. L. H. Leeson
Legislation Dr. Thomas McPherson
Medical Education Dr. K. D. Panton
Archives Dr. H. FL Pitts
Maternal Welfare——: Dr. H. H. Caple
Public Health Dr. A. FL Spohn
Ethics and Credentials Dr. P. L. Straith
Economics Dr. G. F. Strong
olumbia  Medical  Association
(Canadian Medical Association, British Columbia Division)
President	
First Vice-President	
Second Vice-Presidents	
Dr. G. O. Matthews, Vancouver
—Dr. A. H. Meneely, Nanaimo
—Dr. Ethlyn Trapp, Vancouver
Honorary Secretary-Treasurer Dr. S. G. Baldwin, Vancouver
Immediate Past President Dr. P. A. C. Cousland, Victoria
Executive Secretary Dr. M. W. Thomas, Vancouver
CHAIRMEN OF STANDING COMMITTEES
1944-1945
Pharmacy Dr. R. A. Gilchrist
Hospital Service Dr. R. A. Seymour
Cancer Dr. Ethlyn Trapp
Editorial Board Dr. J. H. MacDermot
Nutrition Dr. H. A. DesBrisay
Membership Dr. D. M. Meekison
Industrial Medicine Dr. W. G. Saunders
Divisional Advisory , Dr. Murray Blair
Emergent Epidemics Dr. G. O. Matthews
The following five Directors-at-large were elected at the Annual Meeting—Drs.
G. F. Amyot, Victoria; F. M. Auld, Nelson, C. H. Hankinson, Prince Rupert; J. S.
Henderson, Kelowna, and H. H. Milburn, Vancouver.
The representatives from District Societies on the Board of Directors are appointed
at the annual meetings of these societies. At this date Dr. A. E. Trites, immediate past
president of the Vancouver Medical Association, and Dr. D. J. Millar of North Vancouver, representing the North Shore Medical Society, have been appointed. Annual
meetings of other societies throughout the Province are being held during October.
Representatives of the Council of the College of Physicians and Surgeons for 1944-45
are Drs. F. M. Bryant of Victoria and G. S. Purvis of New Westminster.
*? ?c *c ?r
The (_ornmittee in charge of Golf at the 1944 Annual Meeting in Victoria wishes
to make grateful acknowledgment to the following donors of prizes:
The Trophy Cup, which is competed for annually, was originally donated by Mead
Johnson & Company of Canada, Ltd.
The prize, which goes to the member who holds the cup each year, was provided by
Mead Johnson & Company of Canada, Ltd.
Messrs. John Wyeth & Brother (Canada) Limited contributed $10.00 in War Saving
Stamps.
Fisher & Burpe, Limited, provided a transillumination set.
The B. C. Stevens Company Limited—a Michel clip set and also a pair of scissors.
Messrs. Davis & Geek, Incorporation—$5.00 in War Savings* Stamps.
The Management of the Medical-Dental Building, Vancouver, contributed $25.00,
with which War Saving Stamps were purchased, making a series of prizes.
The profession is very appreciative of the support given to the Association in
Annual Meeting by our friends who contributed the above golf prizes, and who, from
year to year, participate as exhibitors and panel-greeters. Their happy cooperation makes
them welcome and the profession enjoys seeing them at our meetings.
We were deeply appreciative of the kindness of His Honour the Lieutenant-Governor
and Mrs. Woodward in entertaining our members at the reception at Government House.
Page Three Hundred and fifteen The Ladies' functions were well attended, and 88 attended the annual dinner for
ladies, and 13 8 the doctors* dinner.
5? ■_* *_* "-■
Dr. and Mrs. Cousland made admirable hosts, and the local cornmittees in Victoria
lived up to the reputation of that city as an ideal place to hold an annual meeting. Their
cordiality in surroundings like the Empress Hotel makes for comfort and happiness
among the visiting members.
Much favorable comment was directed to the speakers and the visiting party from
the Canadian Medical Association. We wish to thank the C.M.A. for its splendid support, and all tell the heads of the three Medical Services how much the Officers from the
Navy, Army and Air Force contributed to the programme.
REGISTRATION — 1944 ANNUAL MEETING
-  VICTORIA, B. C.
Major D. E. Alcorn .Vancouver
Sg. Lt. E. A. Amos _ Sidney
Major B. F. Anderson ."Nanaimo
Dr. C. M. Anderson. _ Spokane, "Wash.
Dr. W. F. Anderson Kelowna
Dr. V. L. Annett.  Victoria
Capt. T. F. H. Armitage  Vancouver
Dr. Lennox Arthur .Vancouver
Dr. E. J. Artist  Bremerton, "Wash.
Capt. N. L. Auckland Vancouver
Dr. F. M. Auld  Nelson
Dr. G. F. Aylward Victoria
Dr. A. "W. Bagnall _ Vancouver
Dr. D. M. Bailiie..— _ Victoria
Lt. Col. "W.  S. Baird .Vancouver
Dr.  S.   G.  Baldwin Vancouver
Dr. W. T. Barrett Victoria
Dr. M. R. Basted  Trail
Dr. Hilda Behrns Mt. Vernon, "Wash.
Dr.  F.  C.  Bell  .Vancouver
Major Bennett    Victoria
Dr. D. Berman. _ .Victoria
Major G. A. C. Bissett Victoria
Dr. A. *W.  Black..._ Vancouver
Dr.  Murray Blair. Vancouver
S/Ldr. L. O. Bradley.  Victoria
Dr.  T. A. Briggs Courtenay
Dr. F. M. Bryant. _ _ Victoria
Dr. F. "W. Brydone-Jack —......Vancouver
Fl. Lieut. B. F. Bryson New Westminster
Dr. G. B. B. Buffam Victoria
Dr. F. J. Buller Vancouver
Major U. P. Byrne Vancouver
Fl.  Lieut.. J.  A. Caldwell Victoria
Dr.  E. A.  Campbell _ Vancouver
Dr. F. P. Cameron _ _ Vancouver
Dr. T. G. Caunt New Westminster
Dr. N. F.  Challenger .Victoria
Dr.   Irene  Clearihue Victoria
Dr. D. E. H. Cleveland Vancouver
Dr. M.  Cleland  Victoria
Dr. C. E. Cook Michel
Major A. L. Cornish .- „.Victoria
Dr. H. H. G. Coultbard _ -...Victoria
Dr. P. A. C. Cousland -Victoria
Lt. Col. F. E. Coy Vancouver
Lt. Col. K. L. Craig Nanaimo
Dr. L. "W. Cromwell...., .Victoria
Dr. J. S. Cull .-. .Victoria
Dr. T. V. Darke _ Regina, Sask.
Major C H. Davis Vancouver
Capt. M. Davis  —Victoria
Dr. E. E. Day  Vancouver
S/Ddr.  L.  G.  C.  d'Easum Vancouver
Dr. H. A. DesBrisay Vancouver
Dr. C. E. Dolman Vancouver
Dr.  C. EL Dwyer .Victoria
Dr. G. A. Dowsley Vancouver
Dr. E. N. East. ._ Qualicum
Dr. M. L. Edgar Vancouver
Dr. "W. E. J. Ekins _ Victoria
Dr. L. Ellison  Victoria
Dr. E. D. Emery  Nanaimo
Dr. Ella Cristall Evans —Vancouver
Col.  G.  S. Fahrni _ Ottawa, Ont.
Dr.  R. Felton .Victoria
Dr. G. W. Fletcher Victoria
Dr. J. M. Fowler Victoria
Dr. Arnold Francis New Denver
Surg. Lt.  R. H. Fortyie Victoria
Dr. R. N. Foxgord -.Victoria
Dr. C. A. Fraser Vancouver
Dr. F. R. Fursey : Spokane, Wash.
Dr. J. C. Finley Medford, Ont.
Dr. J. L. Gayton Saanich
Dr. B. J. Gilshannon Bellingham, Wash.
Fl. Lieut. W. C. Gibson Vancouver
Dr. B. D.  Gillies  .Vancouver
Dr. Colin W. Graham Victoria
Dr. H. C. Graham North Vancouver
Dr. T. "W. A. Gray Victoria
Dr. W. R. S. Groves Vancouver
Dr. George Hall .Victoria
Dr. B. J. Hallowes .Vancouver
Major R. C. Hamilton .Vancouver
Dr. C. H. Hankinson Prince Rupert
Dr. D. P. Hanington Victoria
Dr. J. L. Hansen Tacoma, Wash.
Dr. R. deL. Harwood Chemainus
Dr. W. E. Harrison Vancouver
Dr. J. M. Haulina Tacoma, Wash.
Dr. C. M. Henry Victoria
Dr. J. M. Hershey Nanaimo
Dr. D. A. Hewitt Vancouver
Fl. Lieut. R. J. A. Hogg Patricia Bay
Dr. Irene B. Hudson Victoria
Capt. A. L. Hunt Vancouver
Dr. G. H. Hutton Vancouver
Dr. R. L. Hufcchins Seattle, Wash.
Capt. S. Janowsky Victoria
Dr. Cooper Johnston Victoria
Dr. A. L. Jones Revelstoke
Dr. T. M. Jones Victoria
Dr. A. T. Karsgaard Tofino
Dr. P. N. Kenny Chatham, Ont.
Dr. M. J. Keys .Victoria
Dr. G. C. Kenning Victoria
Dr. G. F. Kincade _ .Vancouver
Dr. W. J. Knox Kelowna
Dr. C. W. Knudson Seattle, Wash.
Dr. W. Laishley _ Nelson
Fl. Lieut. A. W. Large _ Prince Rupert
Surg. Capt. A. G. Laroche .Vancouver
Dr.  L.  H.  Leeson Vancouver
Dr.  J.  W.  Lennox _ Victoria
Dr. W. T. Lockhart  Vancouver
Fl. Lieut. P. J. Losier  Vancouver
Dr. E. J. Lyon Prince George
Dr. O. O. Lyons Powell River
Major D. R. Learoyd Victoria
Dr. J. S. McCallum   Victoria
Dr. C. T. McCallum .Vancouver
Sg. Lieut. D. L. McRae _Esquimalt
Dr. J. H. MacDermot .Vancouver
Dr. W. A. McElmoyle  .Victoria
Dr. E. H. McEwen . New Westminster
Dr. S. C. MacEwen- .New Westminster
Dr. John McGregor.  JBellingham, Wash.
Capt. D. H. Mclntyre .Prince Rupert
S/Ldr. G. MacKay  Patricia Bay
Dr. J. McKenty _ Winnipeg, Man.
Dr. M. D. McKichan _ Saanichton
Page Three Hundred and Sixteen Dr. A. J. MacLachlan Vancouver
Wing Cmdr. M. S. MacLean Patricia Bay
Dr.  D.  McLellan Vancouver
Dr. E. C. McLeod _. .Vancouver
Dr.  J.  McG.  McLeod Vancouver
Surg. Cmdr. J. W. MacLeod _ Halifax
Dr.  L. Macmillan   .Vancouver
Dr. W. N.  Macnab _ .Victoria
Dr. F. P. McNamee  .Victoria
Dr. G. K MacNaughton Cumberland
Dr. Neil M. McNeilL Vancouver
Dr. E. L. McNiven Victoria
Dr. Harris McPhedran  Toronto, Ont.
Dr. Thomas McPherson Victoria
Dr. K. D. McQuaig Finch, Ont.
Dr. William Magner Toronto, Ont.
Dr. G. O. Matthews _ Vancouver
Dr. A. H. Meneely Nanaimo
Dr.  C.  W.  Mewhort  I _.Duncan
Dr. G. W. Meyer Ganges
Dr.  H. H.  Milburn _ Vancouver
Dr. D. J. Millar North Vancouver
Dr.   T.   Miller. Victoria
Dr. Stanley Mills Terrace
Dr. R. E. Mitchell New Westminster
Major W. C. Mooney Vancouver
Dr. H. A. L. Mooney Courtenay
Dr. W. H. Moore Victoria
Dr. J. H. Moore Victoria
Dr. George More Duncan
Dr.  C. G. Morrison Trail
Dr.   G.  Morse _ Haney
Surg.  Cmdr. H.  S. Morton Victoria
Fl. Lieut. J. McK. Mugan Vancouver
Dr.  H.  H.  Murphy Victoria
Dr. J. Scovil Murray West Vancouver
Dr. J. R. Naden Vancouver
Dr. A. B. Nash _ Victoria
Dr. J.  R.  Neilson Vancouver
Dr. C. M. R. Onhauser West Vancouver
Dr. G. F. Osier   Sidney
Dr.  K. D.  Panton | Vancouver
Dr. L. A. C. Panton Kelowna
Dr. Stanley Paulin Vancouver
S/Ldr. D. F. Perley -Patricia Bay
Dr.  G. A.  Petrie Vancouver
Dr. A. G. Price Victoria
Capt. D. H Reilly Nanaimo
Dr.  H.  E.  Ridewood Victoria
Dr.  J.  B.  Roberts Victoria
Dr.  H.  M.  Robertson Victoria
Dr. May Rodney Spokane, Wash.
Dr.  W.  H.  Roberts  Sidney
Dr. C. M. Rolston ~ Victoria
Capt. B. Rosenberg  Esquimalt
Dr. Albert Ross —Montreal, Que.
Sg. Lieut. J. p. Ross _ Victoria
Dr. T. C. Routley '. Toronto, Ont.
Dr. P. B. Rudy Spokane , Wash.
Capt.   P.   S.   Rutherford Vancouver
Surg.  Cmdr. H. Ruttan Victoria
Fl.  Lieut. D.  B.  Ryall — Comox
Dr. W. G. .Saunders North Vancouver
Dr. A. B. Schinbein Vancouver
Dr. G. E.  Seldon _ .Vancouver
Dr. Marion Sherman Victoria
Dr.  Glenn Simpson ...Victoria
Major W. W. S'mpson _ —Vancouver
Dr. H. C. Sloan Newfoundland
Lt.  Col.  W. D.  Smaill _ Vernon
Dr. H. L.  Smith Montreal, Que.
Dr. G. L. Sparks Williams Head
Dr. Roy Speelmon Spokane, "Wash.
Dr. Howard Spohn Vancouver
Dr.  D. E.  Starr Vancouver
Dr. G. H.  Stevenson London, Ont.
Dr. G. G. Stewart _Cadboro Bay
Dr. W. Ross Stone Vanderhoof
Lt. Col. F. H. Stringer Prince George
Capt. N.  Stringer ...Montreal,  Que.
Dr. G. F. Strong Vancouver
Dr. C. F. Story Victoria
Dr. E. M. Sutherland Victoria
Dr. J. C. Thomas .Vancouver
Dr. M. W. Thomas Vancouver
Dr. W. A. Trenholm Victoria
Dr. S. E. C. Turvey Vancouver
Dr. A. J. Venables Victoria
Dr. C. H. Vrooman _ Vancouver
Dr.  H.  Wackenroder Vancouver
Dr. W. J. Wagner Everett, Wash.
Major W. R. Walker Vernon
Dr. J. T. "Wall Vancouver
Lt. Col. G. G. Wannop .Victoria
Dr. Wasserman  Victoria
Dr. H. Watson Duncan
Dr. L. H. Webster. Vancouver
Dr. R. B. White Penticton
Dr. R. G. "Whitehead Victoria
Sg. Lieut. D. M. Whitelaw Esquimalt
Dr. W. A. Whitelaw Vancouver
Capt. F. L. Wilson Prince George
Dr. G. T. Wilson New Westminster
Col. Wallace Wison Vancouver
Dr. E. M. Woodman Victoria
Capt. F. A. Wright Victoria
Dr. H. M. Young .Victoria
COPY OF A LETTER RECEIVED FROM THE
LIQUOR CONTROL BOARD
Victoria, B.C.,
Dear Doctor MacLachlan:— 29th September, 1944.
Re: Liquor Quota—Tkfptors' Prescriptions.
As you are no doubt aware, the shortage of liquor for sale in Government Liquor
Stores in this Province is very acute at the present time, due to the fact that the population has increased very considerably; and under these circumstances it has been necessary to reduce the quantity of liquor for sale to individual liquor permit holders.
In order to obtain an equitable distribution of liquor it has been necessary for the
Board to review the distribution thereof, and after due consideration it has been found
necessary to fix the maximum quantity of spirits which may be prescribed by a physician
in any one prescription to one reputed quart, and the vendors have been instructed
accordingly.
If have also to advise you that the maximum quantity of spirits which may be purchased on Special Permits issued to physicians under clause (b) Section 11, of the "Government Liquor Act" has been fixed at owe reputed quart of spirits {including alcohol)
per month.
I understand you have a means of communicating with the Members of your Asso-
cation throughout the Province by a circular or monthly letter, and if you could include
this information in such a communication it would be greatly appreciated by the Board.
Your co-operation in this connection will be much appreciated.
|: 1 Yours truly> A. H. WYLLIE, Secretary.
Page Three Hundred and Seventeen ancouver
ienera
Hospital
FOUR CASES OF GASTRIC SARCOMA
Presented at the Pathological Conference of Dr. H. H. Pitts, The Vancouver General Hospital.
Discussion by Dr. J. G. McPhee
CASE  1: Interne, The Vancouver General Hospital.
The patient, a white male aged 73, was admitted to The Vancouver General Hospital
on March 15, 1944.   The complaints were:
1. Pain in upper abdomen.
2. Loss of 40 lbs. in three months.
The patient stated that up until three months prior to admission he had been feeling
moderately well with the exception of'a slight degree of epigastric discomfort, before
meals and especially at night, for some years. At this time (three months ago) he
became aware of an acute pain in this region which was more severe at night than at
any other time of the twenty-four-hour period. This pain, however, could be relieved
by alkaline powders. There had been no episodes of emesis, and anorexia was moderate.
There had been no derangement in the bowel motions, nor was there any knowledge of
blood in the stools.
Physical examination revealed a poorly-nourished elderly male, lying quietly in bed,
who responded to questioning reluctantly. The skin was soft and loose. Large bedsores were apparent at the base of the spine and on both heels. There were numerous
abrasions over both lower extremities which were slightly swollen. Both upper and lower
extremities were rather cyanosed.
With the exception of an elevated respiratory rhythm (30) nothing of note was
found on examination of the respiratory system. The heart was not enlarged; blood
pressure was 110/70, pulse 110. There was no arrhythmia or changes in the cardiac
tone.    The rectal temperature was 100° C.
Preliminary examination of the abdomen revealed an epigastric mass which could be
easily visualized. This mass was firm, irregular, slightly tender -and moved with the
diaphragmatic excursion. Palpation of the mass indicated that it extended somewhat
below the umbilicus and well up onto the epigastrium. It was found impossible to
palpate any other abdominal organs. The intestinal tract was considerably distended and
this rendered examination of the mass difficult. The reflexes were found to be normal.
The patient rapidly became worse after admission and died within two days. Urinalysis
was negative.   The haemoglobin was 65%; blood Kahn was negative.
Thus one is discussing an elderly patient, in poor physical condition with an epigastric mass. However, a careful analysis of the admittedly few facts obtained will
indicate that many of the conditions which must be. considered in a differential can be
eliminated.    Such analysis should consider the following possibilities:
1. Gastric carcinoma.
2. Pancreatic carcinoma.
4. Hepatomegaly (carcinoma)  right lobe.
3. Abdominal lymphadenopathy.
5. Abdominal aortic aneurysm.
6. Gastric lues.
7. Gastric sarcoma.
8. Transverse colon carcinoma.
9. Splenomegaly, including all the known causes of chronic splenomegaly.
Aneurysm:   It is difficult to conceive of an aneurysm of such proportion and possessing a surface such as was described for the mass.  A second contra-indication is the low
blood pressure and the fact that there is no mention of any pulsation on the part of
.the lesion. ^^
Page Three Hundred and Eighteen Splenomegaly: This possibility is considered only to be discarded, first, because the
great majority of enlarged spleens are quite smooth, and secondly, because the spleen
does not enlarge upwards into the height of the epigastrium.
Carcinoma of Transverse Colon: Carcinoma in this site and of such proportions as
that of the mass would most certainly be expected to be associated with symptoms of
obstruction, alternation of cnstipation and diarrhoea, either blood in the stools or intestinal colic and other signs and symptoms of gastro-intestinal carcinoma.
Hepatomegaly:   This is tentatively eliminated in view of the gastric symptoms.
The remainder of the possibilities are considered on the basis of the accompanying
chart which, due to lack of specific information, in some instances is not complete.
Non-Malignant
Gastric
Gastric
Pancreatic Co.
Gastric
Gastric Tumours
Carcinoma
Sarcoma
without   Jaundice
Lues
Frequency
1:200
1:111
1:3
Age Range
8-69 yrs.
21-90 yrs.
3J.-85 yrs.
33-88 yrs.
29-60 yrs.
Average Age
46
55
40
53
38
Age of Onset
5lVz
55
Distribution
.    Pylorus 69%
Pylorus      60%
Very   high   %
Head          53%
Body      26%
Lesser
on lesser curva
Body          25%
Cardia     5%
Curvature 20%
ture.
Tail              8%
Greater
Whole
Curvature 20%
Gland        13%
Usual appearance
1. Ansemia (sec
1. Dyspepsia
1.
Indigestion
1. G.I. dysfunction
96%
of signs or
ondary)
2. Anorexia
2.
Epigastric
2. Pain, 90%
symptoms:
2. Occult Bleeding
3.Wt. Loss
pain
3. Wt. loss, 85%
3. Pyloric obstruc-
4. Anaemia
3.
Tumour
4. Tumour, 80%
10%
(marked)
4.
Bleeding
5. General decline, 1
10%
4. Indigestion
5. Pain
5.
Weight loss
6. Constipation   }
25%
5. Dyspepsia 20%
6. Achlorhydria
6.
Weakness
Anaemia           )
( asyndromatic)
7. Presence of
7.
Vomiting
7. Diarrhoea, 15%
lactic  acid
8. Vague complaints, 10%
and blood
Non-Malignant Gastric Tumours (fibroma, adenomatous polyp, lipoma, myoma,
etc.) : Of these 90% are single, 17% are ulcerated, 4% associated with malignant change
and 50% are associated with other lesions; i.e., Gastric carcinoma 27%, gastric ulcer
25%, duodenal ulcer 30%, cholecystitis 27%, chronic appendicitis 5%, carcinoma of
caecum 5%. The clinical diagnosis is rarely made; actually the increasing familiarity on
the part of the roentgenologist is invariably the reason for such increase in correct
diagnosis as is apparent. There are many common characteristics between benign and
malignant gastric neoplasms. They can be preliminarily differentiated from gastrict
cancer in that:
1. The incidence of benign lesions is much lower.
2. Dyspeptic symptoms are nil—nutritional state is good.
3. Secondary anaemia and gastro-intestinal hemorrhage are outstanding symptoms.
4. Age group of cancer is somewhat higher.
Gastric Sarcoma: Pain, an almost constant sign in this condition, is of a burning,
gnawing type and is usually quite severe. Some patients give classical histories of gastric
or duodenal ulcer with characteristic sequence of the pain-food-ease syndrome. In 40%
achlorhydria is present and in 50% demonstrable epigastric mass is noted at the first
examination—in many instances this may be the first complaint. Obstruction is very
uncommon because the pylorus is rarely involved as the most common site is on the lesser
curvature. The cardiac end of the stomach is never involved. Frequently the tumour
extends to involve the pancreas and greater omentum. The gastric mucosa may be
intact or extensively ulcerated.    Once again, a definite diagnosis is rarely made and
Page Three Hundred and Nineteen gastro-intestinal roentgenograms are the most dependable method of examination; otherwise carcinoma is the invariable clinical diagnosis. Nevertheless, an epigastric mass,
occurring in a patient of the third to fourth decade, should always suggest sarcoma as
a possible explanation.
Pancreatic Carcinoma without Jaundice: In comparison with gastric sarcoma, a
pancreatic mass does not move with the respiratory excursion. When the lesion involves
primarily the head, jaundice is an early sign and in many instances a dilated gall-bladder
is diagnostic. Pain in this condition radiates to the thoraco-lumbar spinal region and
is attributed to dilation of the gall-bladder and bile ducts. In a high percentage of cases
the tumour mass is palpated only with difficulty due to rigidity of the recti muscles
even when emaciation is extreme. Still, when the mass is palpable it is conglomerate,
being composed of pancreas, lymph glands, and omentum, and there is usually extension
to the liver.
Gastric Carcinoma: It is well known that cancer of the stomach can preesnt itself
in a variety of ways; i.e., 63% are obviously carcinoma, 15% are of the "pseudo-cancer
type"; 22% are of the "ulcer type". The largest group (63%) have at least five consistent signs and symptoms:
1. Epigastric pain or discomfort immediately after eating (63%).
2. Progressively severe nature of the course (95%). Very frequently the patient
presents himself in a state of advanced malnutrition, even existing only on
fluids. In advanced cases the stomach is very often found to be severely
contracted.
3. Most common site is prepyloric.
4. Vomiting and pain are usually marked, while nausea and anorexia are relatively infrequent.
5. Hour-glass contraction (X-ray) is quite a common finding in this group.
Report of Autopsy (Dr. H. H. Pitts):
"There is, pressing up from behind the stomach and involving the whole of the lesser
curvature, a red nodular tumour mass which gives one the impression of a mass of
involved lymph nodes. In further exploring the abdominal cavity the aorta is surrounded by nodular masses of tumour tissues which have apparently involved all the
lymph nodes of the aortic chain. These can be traced down to each inguinal region."
Microscopically, this was a gastric sarcoma with metastases to regional lymph nodes,
mediastinal, inguinal and the entire group of the aortic chain of glands. The microscopic picture was that of a typical reticulum cell sarcoma."
During the past ten years The Vancouver General Hospital has recorded three
other cases of gastric sarcoma. For purposes of comparison, details of these are given
as follows:
CASE II: T. H., male, aged 51. Admitted January 22, 1936, discharged March 8,
1936.
Chief complaint: Tarry stools of one day duration—previous to this had always felt
perfectly well. Abdominal examination was negative. X-ray revealed a large filling
defect at the junction of the middle and distal thirds which was interpreted as a benign
gastric neoplasm. An operation was performed removing a tumour "the size of a fist,"
and part of the posterior gastric wall. No glandular or hepatic involvement was noted.
The pathological diagnosis was gastric spindle cell myosarcoma. The patient was discharged three weeks after operation evidently quite well. The subsequent history is
unknown^
CASE HI: J. S., male, aged 57. Admitted November 24, 1937, discharged December 18, 1937.
Entrance complaints:
1. Epigastric discomfort—one year.
2. Fullness in epigastrium—one-half hour after meals, followed by emesis one
hour after meals for two months.
3„   Loss of weight—eighteen pounds in two months.
Page Three Hundred and Twenty Abdominal examination revealed a firm tender mass principally to the right of the
midline in the epigastrium. X-ray films revealed in the distal third a filling defect which
suggested a new growth (malignant) of the annular type. A Polya type operation was
performed and the surgical specimen interpreted as a lymphosarcoma of the pyloric end
of the stomach.   The patient died four days post-operatively.
CASE IV: J. S., female, aged 63. Admitted November 22, 1938, discharged December 13, 1938.
Entrance complaints:
1. Burning sensation in epigastrium.
2. Loss of weight—twelve pounds.
3. General malaise and weakness, each of one and one-half years' duration.
This patient had had an X-ray diagnosis of "gastroptosis" at the age of 44.    On
examination there was a "suggestion of a mass to the right of the epigastrium." Surgical exploration revealed four separate nodules the size of walnuts, one at the pyloric
end of the stomach, which had ulcerated. The remainder were on the posterior wall.
A similar sized nodule was palpated in the left lobe of the liver. A Polya procedure was
carried out. The pathological report was that the specimen was a gastric myosarcoma.
The patient was discharged three weeks after the operation. The subsequent history is
unknown.
SUMMARY: A case of gastric sarcoma is discussed. The most pertinent diagnostic
differences are mentioned including the observation that the condition is rarely diagnosed clinically. A brief comparative note is made of all the known cases of gastric
sarcoma that have appeared in The Vancouver General Hospital during the period 1934
to 1944.
AN APPRECIATION
We should like to express our appreciation here of the exhibits at the Annual Meeting, which were put on by various of our friends in the Pharmaceutical Drug Houses,
Surgical Supply Houses, and Medical Booksellers, notably Lippincott and Macmillan Co.
These exhibits were excellently mounted, and attracted a great deal of attention. We
were able, at our leisure, to see and talk over these products and instruments and books:
and we hope there was profit on both sides.
The following exhibited:
Ayerst, McKenna & Harrison Limited.
Mead  Johnson  & Company  of Canada, Limited.
Eli Lilly and Company  (Canada) Limited.
E. B. Shuttleworth Chemical Company Limited.
B. C. Stevens Company Limited.
Carnation Company Limited.
Fisher & Burpe, Limited.
Davis & Geek, Inc.
John Wyeth & Brother (Canada) Limited.
Charles R. Will & Company, Limited.
Charles E. Frosst & Company.
Macmillan Company of Canada Limtied.
Ferranti Electric Limited.
Anglo-French Drug Company.
Victor X-Ray Corporation of Canada, Ltd.
Rougier Freres Incorporated.
Ciba Company Limited.
Winthrop Chemical Company, Inc.
J. B. Lippincott Company.
Reckitt & Colman   (Canada)  Limited.
Page Three Hundred and Twenty-one
Abbott Laboratories Ltd.
William R. Warner & Co. Ltd.
Lederle Laboratories, Inc.
Vanzaht & Company.
Burroughs Wellcome & Co.
Parke, Davis & Company.
J. Edde, Limitee.
Frank W. Horner, Limited.
E. R. Squibb & Sons of Canada, Ltd.
Dohow Chemical Company Limited. -
Laboratory Poulenc Freres of Canada LtLd.
J. F. Hartz Co. Limited.
Spencer Supports  (Canada) Ltd.
Milqo Limited.
British Drug Houses  (Canada) Ltd
Ingram & Bell Limited.
Anglo Canadian Drug Company.
McAinsh & Co. Limited.
Canadian Surgical Supplies Ltd. THE USE OF PENICILLIN IN THE MANAGEMENT
OF  INFECTED WOUNDS
By Colonel R. I. Harris
Given at Vancouver Medical Association Summer School, 1944.
My part in this programme is to try to tell you something of the application of
this substance, discovered by Sir Alexander Fleming and developed by Professor Florey,
insofar as clinical problems are concerned, and what I have got to say is based partly on
investigations in which I have had some slight contact and partly on investigations
which have been carried on elsewhere, to the reports of which we have access and which
may not be as accessible in their report form in the general literature.
One of the important reports is that of Florey and Kearns, as a rseult of their work
in the Sicilian campaign last winter.
Captain Best and Doctor Dolman have told you that penicillin is a substance which
is developed in the growth of a mould. It is an organic acid and it is unstable. Its
salts are very much more stable and the sodium and calcium salts are the forms in.
which it is used clinically—the sodium salts for intravenous administration, the calcium
salt for intramuscular injection and for local use. The latter method would be universally used were it not for the greater tendency it has to produce coronary thrombosis.
A unit is based on the comparison of the standard pemcillin substance established at
Oxford. We need some measure of unitage in order that we may establish doses. It is
necessary to speak of the use of penicillin in terms of units.
Captain Best and Doctor Dolman have told you interestingly of the original discovery of this substance by Fleming. In the years that followed, his application became
most widespread in the bacteriological laboratory because he conceived of it as having a
value, which it proved to have, in facilitating the separation of cultures when they
were a mixture of organisms, some of which were sensitive to penicillin and some of
which were not. It was fairly widely used to facilitate the separation of mixed cultures of bacteria. He visualized the possibility of using it clinically but he encountered
difficulties in the use of it—difficulties that were only solved by Florey's work.
Clinically, it must be acbninistered either intravenously or intramuscularly or, in the
case of wounds, used locally in the wound. The substance, as we use it, is destroyed by
acid. Hence it cannot be administered by mouth because the HCl. of the stomach
destroys the penicillin. It can be administered by duodenal tube, and has been effective,
but the inconvenience of so doing, as contrasted with the intravenous or intramuscular
use, makes it impractical. It is destroyed by an enzyme in the colon so it is impossible
to introduce it by rectum. It is an impractical and ineffective means of administration.
So we are left with the necessity of using it either intravenously or intramuscularly or
locally, in the case of wounds.
There are advantages and disadvantages to all these methods. If we have a severe
infection and we decide to administer the penicillin intravenously, we have a rather
prolonged use of the drug. Either penicillin or some of the substances which are present
in the product which we now use, are sufficiently irritating to the intima of a vein to
produce thrombosis in a number of cases, so we cannot use the intravenous method too
long. Used intramuscularly, some of the solutions have been productive of irritation
and pain at the site of injection. That is particularly true in Florrie's work in Sicily
last year. It is obvious that the local irritation produced by the intramuscular injection
is due to impurities which can be eliminated and, insofar as the Canadian production is
concerned, have been theoretically eliminated. The material can, of course, be used
locally either in a powder as it comes from the ampoule but because it is scarce that
way, it is usually diluted with water or with some inert powder, such as dried blood
serum, or with some of the sulphonamides.
Florey's early observation on the treatment of infections with penicillin were concerned with such things as septicaemia, with a variety of organisms, and with local
infection such as cellulitis, and his early success with these infections led to rapidly
spreading use and investigations of it until, in a year or two, we had a considerable
Page Three Hundred and Twenty-two ■
amount of knowledge about its merits. It has been demonstrated, as a result of this
work, that the substance is effective against Gram positive organisms, with the exception
of certain Gram negative cocci, and has no effect on the remainder of the Gram negative
organisms. The Gram negative B. coli produces a substance which destroys the penicillin. So we have a mass of knowledge regarding the organisms which are affected
by penicillin and those which will not be affected, and at least one group which produces
a substance which destroys penicillin.   That is important.
My concern tonight is to discuss with you the merits of penicillin in the treatment
of wounds. I must, however, say something about the background; viz., its value in
the treatment of infections which were not necessarily localized—septicaemia, such as
that produced by streptococci, staphylococci or pneumococci. Where the clinical picture
is dominated by the generalized infection, the use of penicillin has been successful. One
of the best, and one of the earliest reports on the use of penicillin in wounds is that of
Florey and Kearn late last year on the results of its use in the Sicilian campaign. Though
their supply of penicillin was small, they had organized a plan of its use in war wounds
and had enlisted the help of medical personnel to see that it was conducted in a manner
to draw some reasonably accurate reports regarding its merits.
There have been some criticisms of this report to the War Office, but I think we
must regard this as one of the historic documents of surgery. I say surgery, because
the importance of it lies in the field of surgery, historic as it is also in the field of
bacteriology. I think we must realize that the things which we criticized about this
report are due to the enormous difficulties under which they laboured, shortage of supplies, shortage of scientific supplies, etc. The alternative—to have made a report that
was incapable of being criticized—would have resulted in the investigation being impossible. They had to plan to use the penicillin economically and they decided to use it
only in the wound itself. They decided to use it in several ways in the wound. First,
as a solution, by melting the penicillin in distilled water and injecting it through the
wound, not unlike we injected Dakin's solution in the last war, using it every two
hours. Another method of using it locally, which they carried out, was to mix the
powder with sulphathiazole powder in varying concentrations and dust the wounds
with this mixture. This, of course, is one of the things which have been criticized
about Florey's report. There are those who have said that the results might have been
produced by the sulphathiazole as much as by the penicillin. Occasionally they used it
intravenously, and in some cases intramuscularly. In a few cases they used it as an
ointment.   That was for superficial wounds and especially for burns.
Out of the turmoil of that campaign, and out of th eplan they must have made in
haste, and under enormous difficulties, they were able to report upon a considerable number of cases. They have divided their cases into those which involved the soft tissues
only—171 cases—which were treated, with penicillin from three to twelve days after
the injury. Many of them were septic. Many of them were regarded as serious because
of sepsis. Their procedure was to undertake a revisionary operation of the wound and
to close it tightly with the exception of a drainage tube in one corner through which
penicillin in dissolved form was irrigated, 3 to 10 cc. several times daily for 4 days.
That is a small dose as we know it now.
Of 171 cases so treated, of gross soft tissue wounds without bone injury, 104 cases
completely healed by primary union, 60 cases healed incompletely, and there were only
7 failures. This is a somewhat extraordinary result for gross soft tissue wounds dealt
with from 3 to 12 days after the injury. That such a high percentage of these septic
wounds were capable of healing by secondary closure is of great significance. Florrie
notes that there was a discharge of Gram negative pus, that it was green, and he says
and believes that it is not of great significance. My own experience would make me feel
differently about that, but it does not affect the importance of this conclusion. One of
his associates made this statement "With penicillin the obstacle of infection has been
practically overcome."   I think that is nearly true.
They found that the causes of failure in this group of wounds were due to various
things which are worth mentioning. The reasons why they failed to secure more perfect
Page Three Hundred and Twenty-three results were: stitching up the wound tightly in layers so that it was impossible for the
solution to penetrate into every part of the wound. I think the intravenous or intramuscular use of the solution would overcome this difficulty. Another cause of failure
was placing the sutures too close to the edges of the skin wound, so that they pulled out.
Another one was, removing the sutures too soon, so that the wound opened up. Another
difficulty was, injecting too much solution at one time, so that it prevented the wound
from healing. In using powder alone, it was often washed away with blood. One
thing more—there were no controls of these cases and we must contribute that to the
exigencies of the campaign under which they worked. There were no cases treated by
sulphonamides alone and without penicillin.
In addition to these soft tissue wounds there were 37 cases of recent fractures—
mostly severe corruninuted fractures of the long bones, 5 to 14 days old. These were
treated by the systemic method—100 units for 5 days intramuscularly. Thirty-one of
these wounds were sutured after 5 days of systemic preparation of the solution. Of
these cases, in 16 instances there was primary healing of the secondary closing of the
wound. In 10 instances there was incomplete healing. There were 5 failures. That was
a remarkable result. Of the 6 cases which they were unable to suture, 5 healed rapidly
by granulation; 1 died of fat embolus. The fractured femurs were most difficult.
Perhaps their closure was too complete, perhaps there should not have been drainage
and this would have been beneficial.
There were some miscellaneous cases of some importance—notably 7 cases of gas
gangrene with 4 recoveries. There were 3 deaths which were outside the control of
penicillin. They stressed the fact of the need for adequate surgery. In this connection
I think I should like to read to you an excerpt from a letter by Capt. Ian Davidson, who
is now in Italy. This is a letter which he wrote to Col. McFarlane and it is of interest
to us because he is talking about the treatment of gas gangrene by means of pemcillin.
(Dr. Scott quoted further from the letter.)
The rest of Florey's cases are of less importance to us. There were 23 head wounds
which were treated. Of these 23 cases, only 3 died, and only 2 of these died of infection. They used the undiluted powder and primary suturing. They had a few cases of
burns and a few cases of G.C., and there is one sentence in this summary which I should
read to you: "There can be no doubt that the prevention of infection by pyogenic cocci
or its control of war wounds is within our reach and no criticism without its emphasis
on difficulties should be allowed to stand in our way."
(At this point Flotey's film was shown.)
I think Dr. Dolman has added a great deal to the programme this evening. He
mentioned the very modest letter from Prof. Fleming. I was present at that meeting
(Society of Medicine) and the Chairman was my companion on my trip to the beaches
of Normandy. He is one of the best diabetic specialists in the world and is himself a
diabetic. The film which you have just seen illustrates the work of Florey and Kearns
in Africa. Kearns was a Rhodes Scholar in Australia. Florey is also a Rhodes Scholar.
You see many points of criticism but we can sympathize with them and the outstanding
criticism that they used a mixture of sulphadiazine with penicillin. I suppose at that
time they were true clinicians and used the best combination that they had available for
the treatment of those cases. The film illustrates very clearly the difficulties they had—
the dust, the heat, the flies, etc.
We are indebted to Surg. Capt. Best for the opportunity of seeing Florey's film
because this is a historic document. The thing with which we always associate Dr.
Best is the discovery of insulin. The discovery of penicillin is likely to prove of vast
importance in the treatment of infection.
I have several other things to say regarding the treatment of wound infections.
In the following report is a statement about fractures of the femur which had been
treated with penicillin, among other things.   There were 160 of them.   They arrived at
the Basic Hospital in a Tobruk splint approximately 48 hours after wounding.    The
wounds had been debrided and packed with vaseline gauze.   The procedure was to leave
Page Three Hundred and Twenty-four them for 48 hours, if they were comfortable, until they recovered from their journey.
They were then given penicillin intramuscularly for 24 hours and then they were operated upon. There was secondary closure of thewound with a drain. The fracture was
treated. In 12 cases the fractured femur was plated and all of these healed without
difficulty. Then penicillin was given intramuscularly for 5 to 7 days. The results were
regarded as most promising, though Bristow makes the statement that good front -line
surgery is essential and that secondary closure can only be obtained if good front-line
surgery has been carried out.
Hirschfield discussed the number of cases of compound fracture in civilians: 17 of
them treated with penicillin with 14 cases healing by primary union and 3 minor infections; and to that I can add 3 more cases treated in Christie Street Hospital, in all of
which there was primary union.
With the addition of these powerful aids I think we can look forward with confidence to the time when we can deal with compound fractures in industry and civil
practice, and perhaps in war wounds, in such a manner as to treat them as closed wounds
and treat them as closed fractures.
A report on the use of penicillin in infected wounds was given. When it was first
available in the United States it was distributed by a Special Committee. Chester Keefer
was on the staff of the Massachusetts General Hospital and he was entrusted with the
responsibility of using penicillin in wounds and certain surgical conditions. Shortly
after he joined the Army and again was given the responsibility of using penicillin in
the treatment of various types of wounds. Two hundred and nine cases were contained
in his report with very good results. Of 19 cases of bacteria-mia, 12 were improved
though 7 died. Of 79 cases of severe staphylococcus infections with localized infections with localized infections, 69 were improved, 1 died and only 9 were not improved.
Of 11 streptococcus infections, 10 were improved and 1 died. Of combined infections
of staphylococcus and streptococcus infections, there were 8 cases. Six improved, 1 died
and in one there was no effect.
Perhaps his most important observation had to do with infections in gunshot wounds
involving bones. First, the infection which is present may be acute or may be latent.
Second, he divides the organisms into putrid infections, staphylococcus, streptococcus
and pyogenic. He makes the important observation that in severe infections there may
be a profound protein deficiency. There is a relationship between wound healing and
response to infections in this protein loss. Penicillin causes slow improvement in the
protein deficiency but penicillin plus protein therapy is immensely satisfactory.
He stresses, and rightly, the necessity of penicillin control in bacterial therapy. I
should like to add my opinion. We have already said that there are some organisms not
influenced by penicillin and there are some which destroy penicillin. Some infections
require more penicillin than others. So that you can see that it is of fundamental
importance that our treatment should be based upon bacteriological knowledge of the
kind of infecting organisms which are present. We may be wasting our penicillin if
there are B. coli in the wound or we may not be giving enough to control the particular
kind of infection that is present. So to unnecessarily avoid waste of penicillin and to
permit accurate dosage, bacteriological knowledge of the kind of infection is essential.
In Canada there is a conunittee set up by the medical services of the Navy, the
Army and the Air Force, and those joint services have a penicillin committee and they
have controlled the distribution and use of penicillin in the armed forces. I have had
a slgiht contact with that conunittee and seen the work of that committee, and particularly the work that has been done in infected compound fractures which has been
carried on at Christie Street Hospital. I have been very much impressed with the results
that have been obtained. One is apt to allow one's enthusiasm for something new and
something valuable to lead one to an over-statement. I have already done this once
before. I am quite sure that in general we have in penicillin an extraordinarily valuable
agent to aid us in the mastering of infection. It is perfectly true that it will not.
replace other and fundamental measures in the treatment but, combined with those
Page Three Hundred and Twenty-five measures of treatment, it is a powerful and useful aid and I am certain that penicillin,
or something like it and better, will continue to be one of the most valuable aids in
the management of infection.
In Christie Street Hospital we have treated 48 cases of compound fractures of the
bones, most of them G.S.W. Of these 48, 31 healed completely. Four have healed
completely without operation of any sort, and when I tell you that two of these were
the result of infections in the spine through osteomyelitis, I think you will be impressed,
because osteomyelitis of the spine is one of the most difficult problems in diseases of the
spine that the orthopaedic surgeon has to deal with. It is true that this is an observation
which has extended only over a period of months and that they may break down again.
Nevertheless, healing occurred in a very few weeks after the initial dose of penicillin.
One of the cases was the first patient to whom penicillin was given in that hospital.
He was an extraordinary patient who developed a severe infection as the result of a
flare-up of osteomyelitis from a compound fracture. It proved to be an exceedingly
severe recurrence with the development of a septic arthritis of his knee and a large
abscess in the popliteal space. We were desperate. He had been under treatment for
some time when penicillin came into use and we gave it to him and his improvement
was dramatic. He had to have one drainage of the popliteal abscess without a frank
operation.
Generally speaking, in the management of chronic osteomyelitis it is necessary to
precede or accompany the use of penicillin by adequate surgery. If sequestra are present,
they must be removed. If bone cavities exist, they must be dealt with surgically. If
there are soft tissue abscesses, they must be drained, broadly speaking. If there is a
Brodie's abscess, it must be drained. Generally speaking, there is an essential part for
surgical play before we can expect penicillin to have its effect. When this surgery has
been performed, then we can, in a manner which I have not seen before, anticipate
early mastering of the infection and early healing of the wound.
Of the 27 cases that were operated on and treated by pemcillin successfully, 11 were
closed at the time of the operation and they healed by primary union.
We have come to feel, as have other workers, that the best administration is intramuscularly. It is true that it requires more penicillin but it is more effective. It is
hard to distribute the penicillin to every interstice of the wound and one usually has
the opportunity to administer one dose, if we use it in the form of powder or as an
irrigation. Intravenously, 10,000 units every two hours or, intramuscularly, 20,000
units every four hours is the observation of choice.
In one of our "big general hospitals a somewhat similar investigation is going on. It
is with acute osteomyelitis and certain other bone infections. Here is a slide showing
the story of a boy 15J_ years old who was admitted to hospital on February 21st with
a four-day history of acute osteomyelitis of the humerus. He was desperately ill;
W..BC. of 10,000; blood culture positive; acute tenderness in the surgical neck of the
humerus and the arm was markedly indurated. He was given 120,000 units of penicillin,
administered intravenously twice on February 22nd, and continued at the rate of
120,000 units daily. His general condition rapidly improved. The blood became sterile
on the third day and the temperature came down to normal. By March 10th all pain,
redness and swelling had disappeared and the arm was normal except for a slight thickening of the bone in the region of the surgical neck. Here you see the original X-ray
taken on February 22nd.    This is the X-ray taken on March 2nd.
There have been, in all, 8 cases of acute osteomyelitis treated with penicillin, in
general with spectacular effects. So we can anticipate the cure of the infection without
surgery and without sequestration in a manner unlike anything we have seen before.
There have been 6 cases of osteomyelitis, one of which was very spectacular. The
original wound had remained healed for 3 5 years and then the patient had a recurrence
and became desperately ill. This was treated by pemcillin intramuscularly, by aspiration
of the knee joint, with prompt mastering of the infection and prompt return to normal.
Page Three Hundred and Twenty-six TT
We are now in the midst of some observations upon the use of penicillin in the
treatment of surgery upon bones which recently have been infected—bone grafts in
ununited fracture due to G.S.W. which has healed not by primary closing. It is a little
too early for the results.
There are those who are inclined to minimize the effects of penicillin and who say
that without surgery it would be of no use. That is true, but I do not believe it
detracts at all from the merits of penicillin. Indeed, I think it is a stimulus to better
surgery to know that we have an agent which can master the infection that is present.
I feel that it will have a big field of usefulness in the surgery of bones which recently, or
fairly recently, have been the seat of infection and that seldom, from now on, need
we be troubled by the recurrence of infection in bones which we operate on and which
ruin th operation because of infection.
I understand that penicillin will shortly be available for civilian use and the opportunity to use it will become more widespread. I would enter a plea for its careful use.
It still is too scarce to be used indiscriminately. We should be wasting it to use it in
certain infections and we should be using it unwisely in certain bactera which is present
in the wounds.
SOME OBSERVATIONS ON CANCER OF
THE LOWER COLON
A. Taylor Henry, M.D., F.R.C.S.E.
Read at meeting of North Pacific Surgical Association held in Vancouver, November, 1943.
I will not endeavor in this paper to review again the etiology, symptomatology or
accepted surgical treatments well known to you all and found in any recognized text
book, nor am I going to report further on statistics or a series of cases for they are also
abundant and easily available. Rather than this I prefer to discuss briefly, with the time
that is available, a few points and difficulties that we meet with in a common and
formidable surgical entity.
Cancer of the lower colon takes up about 12% of all cases of cancer and about 80%
of these are in the sigmoid and rectum. I reviewed our cases at the Vancouver General
Hospital 1941-42, there were a total of 791, of which 54 were in the rectum and 52 in
the colon, chiefly sigmoid. Even with the equipment for diagnosis and the amount of
knowledge that the layman gets through the press and magazine articles it is tragic that
cases still come in such advanced stages. True enough, fear keeps some people from
seeking advice, but all too often they have been seen by medical men and even given a
digital examination, then told that nothing could be felt or that it was just piles. No
one who has passed blood per rectum should, even in the presence of obvious hemorrhoids,
be allowed to leave without a sigmoidoscope examination.
The sigmoidoscope is one of our most useful instruments and also cne of our most
neglected ones. How common it is to have our internes stay in hospital for a year or
longer and leave without ever having used the instrument. I have had them come to
me after starting up in practice, and ask for instruction, as they had found that there
were many more calls for such an examination than they had realized. The use of a
sigmoidoscope in untrained hands is not only difficult but dangerous and also very disagreeable for the patient. I was present in an operating room once when a surgeon perforated the sigmoid by rough handling. I think that one should have the instrument
passed on oneself before using it on anyone else.
Personally I prefer the knee-shouler position, with as much sagging of the back as
possible, rather than a specially built proctoscopic table. In my opinion it makes it
much easier to advance the scope beyond the rectal sigmoid junction where often the
bowel has to be rotated around to allow the instrument to pass. Owing to an acute
angle and a short mesentery there are propably about 15% of cases in which it is impossible to pass it. Great gentleness is required, for if you press the instrument against the
bowel it will set up a spasm which makes the passage much more difficult.   One should
Page Three Hundred and Twenty-seven feel one's way up rather than by pushing it up, particularly with metal instruments,
and they should be warmed under water and well lubricated the full length. Remember
to insert the finger before the instrument to get an idea of the angle and, shape of the
anal canal. These are more or less elementary points but they are often neglected.
Before leaving this subject, do not forget that the passage of this instrument under
intravenous, spinal or general anaesthesia is much more difficult and also dangerous from
the standpoint of perforation: this is due to the position so that the bowel is more collapsed, does not hold air as well under insufflation and the sphincters relax. Insufflation
is seldom required in the knee shoulder position.
The next subject, and a very important one, is the preparation of these patients,
many of whom are old and in poor condition. If the sigmoidoscope reveals the tumour
X-rays are not indicated, yet I find many who still go ahead with a barium enema to
determine the amount of obstruction. This is a good way to get complete obstruction
and I have seen it happen in a good many cases. If visualization by scope is negative
and symptoms suggest a growth higher up, by all means have a barium enema but see
to it that the Radiologist stops his flow after reaching an obstructive lesion. At our hospital this is a routine order with my own cases. A collection of hardened barium
above a constriction has to be handled to be appreciated. I have seen a colon packed
with hardened barium balls the size of oranges. It does not help when you are doing
a colostomy.
Of course in acute obstruction there is only one surgical principle and that is
caecostomy. A proper caecostomy requires bringing out a good sized knuckle of bowel
so that drainage is profuse and not the old original method of a catheter inserted into
a caecum and pulled out through a stab wound. There are of course cases in which continuous suction is required; later I will discuss this point and mention the Miller-Abbott
tube. Before starting a major surgical removal in these cases I believe that their general
condition must be improved, if necessary using blood or plasma transfusions and feeding
them Vitamin B Complex with their intravenous injections of glucose apd saline. Attention should be given to the condition of the mouth, especially care of the gums and
teeth. If extraction is not advisable we paint the gums pre-operatively with an iodine
solution, feeling that this lessens the likelihood of post-operative pulmonary infections.
Between procedures, I like to get elderly patients, especially, out of bed—this is
particularly true in two-stage operations. So often these people have a colostomy done
and perhaps part of the sigmoid removed and he in bed 10 days before the really major
part of the operation is undertaken. If we were to stay in bed for 10 days without
being ill we should be so weak we could hardly stand, and yet this is the state that our
patients are in to face a formidable operation with resulting shock.
This brings up the value of a one-stage operation, which I believe is being generally
accepted now more than ever before. I know this is a controversial point and naturally
depends on the state of the patient, but I feel sure that with a patient reasonably nourished and with no technical surgical difficulty the one-stage operation is the one of
choice. I say this because the patient is in better condition for it than he or she will
be later. It is remarkable how little shock seems to result from the resection of the
rectum itself.
Paralytic Hens.-—This is one of our serious complications and what a bad actor it is.
Since the institution of continuous suction either by a Levine tube or the Miller-Abbott
the condition can be more easily controlled. I think that quite often these tubes are
used when it is too late and as a last resort. I am not sure that the routine use of these
tubes from the beginning is a good thing. This brings up the use of the Miller-Abbott
tube. While from a theoretical standpoint it is perfect, from a practical standpoint it is
often difficult and I think this is particularly so in the paralyzed bowel as compared to
the mechanically obstructed one. In the first instance we are dealing with a non-motile
bowel. With the paralytic type I have not had much luck with the use of these tubes.
I suppose it usually has been attempted too late.
Page Three Hundred and Twenty-eight A procedure we use is to half fill the stomach with water, insert the tube and inflate
the bag, with the patient lying on the left side, this is supposed to carry the bulb up
toward the pylorus; after twenty minutes the patient is turned on the right side and
the tube deflated to allow it to enter the pylorus. Of course such difficulties as looping
and actual knotting of the tube have been met with, inside the stomach.
The theory of trauma and rough handling of the bowel as the cause of the paralytic
state, I do not accept, nor do I think infection of the peritoneum is necessarily associated
with it except as an end stage. In resection with the patient in the Trendelenburg
position and the small intestines held up by a warm pack, no handling is required at
any time. As regards infection, the plastic peritonitis is an end result from bacterial
invasion, probably through distended bowel wall. Once I had a paralytic case in which
I did a jejunostomy through which we were able to introduce the sulfa drug daily. This
man eventually died from an acutely dilated small bowel which never came back. An
autopsy proved no mechanical obstruction, he had a perfectly clean peritoneal cavity.
In passing, this brings up the routine use of sulfa drugs in all these cases, both by intraperitoneal insufflation as wel as by mouth or intravenously. Personally I do not think
we need a high concentration in these cases and am satisfied with any amount, say from
1-5. In the past we have encountered the odd case of B. Welchii infection following
crushing of the bowel wall with clamps and it undoubtedly seems that our sulfa drug
is a great safeguard against such infection. I can remember two such cases, in one the
patient was dead within 24 hours of the operation, and an autopsy showed the heart
cavities full of gas.
Let me mention in passing the use of intravenous hypertonic saline to relieve the
paralytic state. I have used it in percentages of 5 up to 30%. There is often severe
circulatory shock in the higher percentages of say 30 cc. of a 20% solution or 20 cc.
of a 30% solution. If used in these amounts it must be given very slowly. I have had
good results from 100 cc. of a 5% solution given by drop method.
Haemorrhage is another contending condition that only occasionally arises but is
nevertheless a very anxious one; this can be divided into primary and secondary. Only
once have I had a fatal case from a primary haemorrhage which occurred immediately
after expelling the rectum and came from a large vessel high up or just below the pelvic
floor. As the superior haemorrhoids had been ligatured I felt certain that it was an
accessory vessel. Unfortunately the operating room room had no large rolls immediately available for packing and by the time I was able to pack her tightly she had almost
bled out. This patient died while receiving a blood transfusion an hour or so later,
owing to inability to control the bleeding. Since that time I have made it a rule to
have blood present in the operating room at the time of operation, in all cases. At this
time I also had a large gauze roll about 10 inches wide and about 3 feet long, made
for me, and as soon as the rectum is expelled I pack the cavity with this roll which has
been heated, and leave it for some minutes; this controls oozing and event spurting;
later when it is removed it allows one to easily pick up the odd bleeder, if necessary.
It is preferable to diving about in a raw field with a forcep, in case of haemorrhage.
This brings up the use of vaseline packing or leaving the cavity bare. I have used both
methods but of late have returned to the packing, for although in many cases the cavity
remains dry, at times I have found that after the shock and reduced pressure have
returned to normal many cases start to ooze considerably. I find that I sleep better the
night following the operation if they are packed, but I usually remove it within 2 or
3 days.
Secondary haemorrhage can be severe and delayed. Several years agbT was associated
with a case in which the man died from a massive haemorrhage on his twentieth day,
following operation. As I remember, it occurred at night and there was delay in packing. It is a good idea to have some vaseline packing near at hand in case of emergency.
Just a few months ago one of my patients had a severe secondary haemorrhage forty days
after her operation. She was an elderly woman of about 70 years with an elevated blood
pressure, and she very nearly died.   By the way, to speed up cleansing of the rectal area
Page Three Hundred and Twenty-nine in her case I had used caroid solution in some of my irrigations and I am not sure that
it may not have accounted for congestion around one of her arterio-sclerotic vessels.
Cauterization—Small or early cancerous tumours that can be visualized by the proctoscope or sigmoidoscope may be satisfactorily dealt with by electro cautery. I have
been using this method for some years now and have been very pleased with the results.
Tumours up to the size of a small walnut can be dealt with even with a sessile base.
This may require one or more cauterizations, which can be done in the office and of course
do not require anaesthesia. After their removal the patient must be seen every few
months for several years, as small recurrent buds may develop which can again be
cauterized.
The so-called inoperable case.—Unless a case is hopelessly advanced and in the terminal stages I believe that we should endeavour to remove the primary tumour. This is
so even with secondaries in the liver, for these people may live in comfort for a considerable time and aside from this they are often saved from a miserable ending. We all
have seen these cases go 4 and 5 years and finally die from carcinomatosis.
Pain.—After removal of the tumour cases that have involvement beyond the field of
surgery later often develop a low back pain which radiates either into the perineum or
down the side of the legs. Secondary growths in the neural sheaths are blamed for this
pain. In these cases a chordotomy is indicated as otherwise they will often carry on
for months in great discomfort. We have had a number of cases treated in this way
and while there is a tendency to some resulting weakness of the legs, the results are
most beneficial and even in the terminal stages thy are almost entirely relieved of pain.
Radium and X-ray.—I think that it is generally accepted that most adeno-carci-
nomas of the bowel are not very radio-sensitive, yet the type of tumour that we find in
the ano-rectal region appears the opposite, they are pathologically more of a transient
cell tumour and a number of times I have seen these tumours locally, melt away.
Within the past year three such cases might be mentioned. One a young woman, in
which there was a small tumour in the haemorrhoidal area actually resembling a hemorrhoid and which I believe was removed as such. The pathology report was active malignancy of a high grade. I was asked to see her and made a wider resection and had
radium implanted. The local tumour never recurred but she died within 6 to 8 months,
with acute carcinomatosis. The second case was a middle-aged woman who a year ago
presented herself with a moderately sized tumour at the ano-rectal junction. I did a
temporary colostomy, at which time her liver was a mass of secondaries, the size of
grapes. The tumour locally disappeared and just the other day I received word from
her that she was still active on her ranch up country. The third case at present under
me is a man of 70 years, who had a malignant gland removed from his left groin 9
months ago. Later a carcinoma of his lower rectum just inside the ano-rectal junction
was discovered although he was not aware of it until shortly before I saw him 5 months
ago. Radium was used and the tumour disappeared. At present there is no evidence of
local recurrence.
At present I also have a case of cancer of the recto-sigmoid quite advanced, in which
I did the first stage and due to technical difficulties felt that I could not conclude the
secOnd stage. This man is receiving X-ray therapy with definite diminution in the size
of the tumour and we anticipate experimenting with radium as soon as he recovers from
his present reaction.. This case brings up a technical state that I might discuss at this
time: How far to go in the first stage of a two-stage operation. For some years I have
been doing a colostomy and resecting the sigmoid down to the superior hemorrhoidal
vessels, in a good many cases. By doing this I felt that I was shortening my secondary
stage operation, that is, in cases in which I felt it inadvisable to do the complete resection with folding down of the proximal loop of the rectum beneath the pelvic floor and
then waiting. These cases are chiefly of the type of tumour at the recto-sigmoid and
are most difficult to separate and remove. In such cases I have found, too often,
resulting adhesions of the small intestine to my sutured floor and invaginated sigmoid
which have made the second stage operation more complicated.   That is what happened
Page Three Hundred and Thirty in the case of the above noted man. When I went in for the second time he had 3 or
4 loops of small bowel attached so firmly that in removing one loop I perforated it and
had to resuture a large opening in the small bowel. By the time I had cleared him for
the real, job he was not in a condition to stand it and now I am sure he has more
adhesions.-
I might mention here the possible relationship of adhesions to the intra-abdominal
use of the sulfa drugs. It seems to me that since using this manner of instilling the
drug, adhesions are more in evidence. This view apparently is being considered by others
in recent surgical papers. I think this drug is somewhat of an irritant and probably
therefore stimulates adhesions. While it is readily absorbed, in most cases, into the blood
stream from the abdomen, I recently saw caked quantities of it present at an autopsy
two weeks after its instillation.
Probably the best procedure is the original method of making a colostomy and
throwing the invaginated distal segment into the abdomen with as little cutting and
trauma as possible to give interference later. Even after a Lahey type of operation with
the distal opening for irrigations I have seen such adhesions with attending difficulties,
so no longer use it.
Let us briefly review the making of a colostomy opening. First, to get some sphincterlike control one should bring the bowel out through as thick a muscle belly as possible.
The lateral third of the rectus muscle is the best. Prolapsus of the bowel through the
colostomy is annoying and of course is due to not keeping the proximal loop of bowel
taut enough when doing the colostomy. The opening, both in the peritoneum and fascia,
should be snug and sutured carefully. This is especially true with the fascia, which if it
gives way will allow a general ventral hernia around the colostomy. Infection due to
early opening of a colostomy accounts for much of this trouble so that in doing a temporary colostomy in which the gas can pass over and through the loop it is advisable to
wait as long as possible before opening it. In the usual double-barrelled colostomy one
frequently finds the spur thickened and difficult to crush or to get a good hold of with
a crushing forceps before the patient is able to go home. There usually is considerable
inflammatory reaction in these spurs to account for this thickening. I think that often
it is better not to try and crush these spurs too early; rather to let the patient go home
and wait for several months—by that time the spur will be found to be shrunken and
much easier to destroy completely. This of course does not hold for all cases, for this
amount of reaction does not always occur. One should spend time and care in the
making of a colostomy.
In conclusion, I hope that some of this discussion, while elementary, has not bored
you, for I feel that a review of our every day problems of this nature are of considerable
importance and value. There is more than surgical technique required to give the best
end results in carcinoma of the sigmoid and rectum.
Page Three Hundred and Thirty-one First, the 7th Canadian Victory Loan is opened to the public of Canada on Ocotber
23rd. It is our plain and inescapable duty to support this to the limit of which we are
capable. It is the best investment we can make: but if it were interest-free—if it were
a gift instead of a loan—it would still be the best investment we could make. We have
had full value for every dollar we have lent towards the prosecution of this war: for
the taxes we have paid. We cannot relax now—and after all, we are only asked to give
and lend money.
The Second Wartime Public Health Conference, emphasizing "Tools From the War,"
was held in the Hotel Pennsylvania, New York, October 2, 3, 4 and 5.
Thirteen organizations co-ordinated their own conferences, demonstrations and symposiums with the 73rd Annual Business Meeting of the American Public Health Association in discussion of all phases of public health protection.
New diseases encountered by American armed forces in various parts of the world,
insect problems, control measures against importation of disease by returning veterans,
and new disinfectants were among the things discussed.
From the civilian front came reports on sanitary engineering, laboratory techniques,
milk control, dental care, social and industrial hygiene, school health, public health
nursing, wartime nutrition, wartime food and drug adulteration, air-borne infections,
and various diseases.
On Sept. 11th, 1944, Donald Gordon, Chairman of Wartime Prices and Trade Board,
made a notable speech before the Canadian Club of Toronto on "Problems in Transition
from War to Peace." It was a frank and forthright presentation, and dealt with restrictive control, prevention of inflation, priorities, manufacture, use and direction of
manpower, and such matters as metals, electrical appliances, markets, etc. He wisely
warned Canadians that they must expect changes to be slow and gradual—indeed, they
must work with Government to tham so.    The original is in the Library.
The 1943-44 Canada Year Book is now available for distribution. This publication
will be supplied to the public, as long as copies are available, by the King's Printer,
Ottawa, at the price of $2.00 per copy. This covers merely the cost of paper, press
work, and binding, and leaves no margin available for advertising the volume. By a
special concession, teachers, university students and ministers of religion may obtain
paper-bound copies at $1.00 each, but the number that has been set aside for this purpose is restricted, owing to the need for ecoonmy, and early application for copies on
the part of those desiring to purchase them is desirable. Applications for paper-bound
copies should be addressed to: The Dominion Statistician, Dominion Bureau of Statistics,
Ottawa.
1
The Federal housing plans designed to relieve the shortage in the coming years envisions the building in the next ten years of 6—06,000 urban, and 125,000 farm dwellings, at a cost of some $400,000,000. Many building experts endorse this plan, as
leading to a lowering generally of rental costs and making it possible for a far greater
proportion of the community to own houses at a cost they can afford.
We have received releases from the Canadian Paint, Varnish and Lacquer Association.
These are of considerable interest, but cannot be reproduced here.    They deal with new
Page Three Hundred and Thirty-two methods of traffic marking, new combinations of colours, designed to help clarity of
vision, especially at night, e.g., in the use of luminous paint, white markings on the rear
of cars, etc.—they deal, too, with the value of paint as a protection against fire. This is
endorsed by the National Board of Fire Underwriters. Paint, too, as a means of preventing accidents, should interest us. For instance, the City of Montreal is having the
concrete walls and roof of the Wellington Tunnel painted white to increase lighting and
prevent accidents. This tunnel was specially designed to prevent accidents, but the
original safety features were defeated by the poor Ught-reflecting qualities of the concrete walls. Autoists coining in out of the light into the tunnel were suddenly unable
to see clearly. Hence the painting project. This opens up a great many possibilities:
better lighting in schools, factories, elimination of glare, all by the judicious use of a
planned system of painting.
NEWS    AND    NOTES
We regret to record the passing of Dr. J. B. Swinden of White Rock and Dr. Robert
Elder of Vancouver, Dr. Elder had practised for many years in this city and had won
for himself many friends in the profession and among the people. His passing leaves a
gap in our ranks.
Dr. Swinden practised at several points in the Province during the past ten years,
notably at Ucluelet, Whonnock, Cloverdale and White Rock. Sincere sympathy of the
profession is passed to the wives and family of both Dr. Swinden and Dr. Elder.
Another break in the ranks has occurred in the passing of Dr. A. A. King of Ladner,
who was seventy-five years of age, and in practice for many years in this province, and
had become widely known.
It is with sincere regret that we record the loss by Dr. G. H. Worthington of two
sons, Lieut.-Col. D. G. Worthington and Major J. R. Worthington, who were killed in
action in the Caen-Falaise area.
Dr. and Mrs. H. A. MacKechnie of Vancouver are receiving congratulations on the
birth of a son.
Major G. M. Kirkpatrick, R.C.A.M.C, was married to Lieut. Mary H. Galer of
Port Coquitlam recently.   They have the good wishes of the profession.
We learn that Wing Commander B. T. H. Marteinsson, recently promoted, is consultant in surgery to the R.CA.F. overseas. Dr. Marteinsson formerly practised in
Port Alberni.
A very interesting dinner meeting was held by the Victoria Medical Society when
Mr. Stuart Henderson, K.C, was the guest speaker. Mr. Henderson told many interesting stories from his long experience as a criminal lawyer.
Following the address of the evening, Dr. Herman M. Robertson, on behalf of the
Society, presented Dr. Thomas McPherson with a silver tray engraved with the signa-
Page Three Hundred and Thirty-three tures of the members. Following this Dr. F. M. Bryant, member of the Council of the
College of Physicians and Surgeons, presented to Dr. McPherson on behalf of the members of the College a beautiful tray. This was all in the nature of a surprise for Dr.
McPherson on the eve of his wedding to Miss Doris Grubb. It was a very happy occasion and Dr. McPherson was the recipient of many good wishes.
Dr. J. B. Roberts of the Department of Radiology at the Jubilee Hospital, Victoria,
and his wife spent their holidays at Grouse Nest at Sooke, Vancouver Island.
Lieut.-Col. G. H. Clement has returned to civilian life and is resuming practice in
Vancouver after several years' service with the R.CA.M.C
The British Columbia Medical Association is to be congratulated upon its selection
of officers for the year 1944-45.    The elections placed in office the following:
For President, Dr. G. O. Matthews, Vancouver, who has served the Association as
Honorary Secretary-Treasurer during two years, and as Chairman of important active
conimittees.
First Vice-President—Dr. A. H. Meneely of Nanaimo, who has been a member of
the Board of Directors during several years past, and a moving force in the organization
of the Upper Island Medical Association, having been President of that body and very
active in all its affairs.
Second Vice-President—Dr. Ethlyn Trapp, Vancouver, who has, during a number
of years, served actively as a member of the Board of Directors, and during recent years
Chairman of the Conunittee on Cancer, which is recognized as a very active committee.
Dr. Trapp was Honorary Secretary-Treasurer in 1934 and 1935, and, like Drs. Matthews
and Meneely, has been very interested and active as members of General Council of the
Canadian Medical Association. This recognition of work well done will meet with widespread approval among all who know Dr. Trapp and her splendid contribution to organized Medicine.
As Honorary Secretary-Treasurer the Association is fortunate in having secured Dr.
S. G. Baldwin, who has been active in other ways in support of the Association and its
committee activities.
Dr. P. A. C. Cousland, the Immediate Past President, will retain his place among
the active officers and on the Board of Directors, and deservedly so, for by common
consent it is agreed that Dr. Cousland has served the Association faithfully and well.
Dr. Cousland is representative from British Columbia on the Executive Conunittee of
the Canadian Medical Association, and Dr. A. Y. McNair, who likewise made a valued
contribution to organized Medicine, is the alternate member serving with Dr. Cosuland .
on the Executive Committee of the CM.A.
W Buy VICTORY BOMS! W
Page Three Hundred and Thirty-four 45 grains
30 grains
15 grains
10 grains
7% grains
7 grains
6 grains
5 grains
4 grains
3 grains
2%
2
TABLES OF APPROXIMATE EQUIVALENTS OF DOSES,
APOTHECARIES' AND METRIC SYSTEMS
Weights
Apothecary
or Troy
Metric
1 ounce
— 30      Gm
4 drams
— 15      Gm
2% drams
— 10      Gm
2 drams
8      Gm
75 grains
5       Gm
1 dram
4       Gm
grains
grains
1% grains
1 grain
% grain
Apothecary
1 pint
12 fluid ounces
8 fluid ounces
6% fluid ounces
4 fluid ounces
3% fluid ounces
3      Gm.
2 Gm.
1 Gm.
0.65 Gm.
0.5    Gm.
0.45 Gm.
0.4 Gm.
0.32 Gm.
0.25 Gm.
0.2    Gm.
0.16 Gm.
0.13 Gm.
0.1    Gm.
65      mg.
50      mg.
Metric
480     cc.
Liquid Measures
2
1%
1
%
fluid ounces —
fluid ounces —
fluid ounce —
ounce —
fluid drams   —
360
240
200
120
100
60
50
30
25
20
cc.
cc.
cc.
cc.
cc.
cc.
cc.
cc.
cc.
cc.
4
2%
2
fluid drams
fluid drams
fluid drams
80 minims
65 minims
15 cc.
10 cc.
7% cc.
5 cc.
4 cc.
A.pott
tecary
or
rroy
Metric
%
grain —
45
mg.
%
grain —
32
mg.
%
grain —
24
mg.
%
grain —
22
mg.
%
grain =
16
mg.
%
grain —
11
mg.
%
grain —
8
mg.
Mo
grain —
6.5
mg.
}__
grain —
5.4
mg.
Me
grain —
4
mg.
&>
grain —
3.2
mg.
%2
grain —
2
mg.
%4
grain —
1
mg.
MoO
grain —
0.65
mg.
#20
grain —
0.54
mg.
M«>
grain —
0.4
mg.
%i0 grain =
0.3
mg
}_50
grain —
0.26
mg.
%20
grain —
0.2
mg.
. }_40
grain —
0.1
mg.
Apothecary
• Metric
1 fluid dram =
- 3.7
cc.
50
minims =
- 3
cc.
45
minims =
- 2.8
cc.
32
minims —
- 2
cc.
30
minims __
z 1.8
cc.
20
minims —
- 1.2
cc.
16
minims =
- 1
cc.
15
minims —
- 0.9
cc.
12
minims —
- 0.75
cc.
10
minims =
= 0.6
cc.
8
minims =
- 0.5
cc.
5
minims =
- 0.3
cc.
3
minims —
- 0.18
cc.
1%
minims __
- 0.1
cc.
1
minim
- 0.06
cc.
For fairly accurate conversions
1 Gm.
1 Gm.
1 Gm.
1 Gm.
1 Gm.
1 grain
1 grain
1 dram
1 Troy or Apothecary ounce
1 Avoirdupois ounce
1 Avoirdupois pound
1 cubic centimeter
1 milliliter
1 milliliter
1 milliliter
1 milliliter
1 milliliter
1 minim
1 fluid dram
1 fluid ounce
1 pint
Page Three Hundred and Thirty-five
15.43
0.2572
0.03215
0.03527
0.0022
0.648
64.8
3.888
31.1
28.35
453.6
16.23
16.23
0.2705
0.0338
0.00211
0.000264
0.06161
3.6966
29.57
473
grains
dram
Troy ounce
Avoirdupois ounce
Avoirdupois pound
Gm.
mg.
Gm.
Gm.
Gm.
Gm.
minims
minims
fluid dram
fluid ounce
pint
gallon
cc.
cc.
cc.
cc. If^ Vj IV ■ >   * _,    rt ^ one oi
w-nct o£ **xce «+Keetvttfe
2^ extiacx aoUice9ott-ve
Ct taieSticVvestsoux BalaJlCed
^ataxe »       n Biolog_caUY »
B-CottvP^      _ ^a	
BiPLEX
^
Each two teaspoonfuls (8 c.c.) supply
Thiamine Hy<irochlaride
Riboflavin   -
Niacin
Pyrido_in€^Byd_ochlo_i<le
Calcium Pantothenate
aUi
1000 gamma \/
2000 gamma \
10000 gamma y
1000 gamma \
5000 gamma V/
significant amounts of
y  Cbcdine
V  Inositol
and
jj£j| Folic Acid
jMBiotin
i/ Unidentified .actors as found in rice bran extract
Most Palatable
Economical
Balanced Potency
S.M.A.    Biochemical    Division
John   Wyeth   &   Brother   (Canada)   Limited
WALKERVILLE
ONTARIO ec
live
rinhng
CAMPBELL & SMITH LIMITED
820 Richards Street    •    Vancouver, B.C.    •    PAcific 3053
13 th Ave. and Heather Sft.
Exclusive  Ambulance  Service
FAirmont 0080
PRIVATE AMBULANCES AND  INVALID COACHES
WE  SPECIALIZE  IN  AMBULANCE  SERVICE   ONLY
J. H. CRBL__IN
W. L. BBRTRAND For Fall and Winter Months
Supplementation with one of the Ayerst Cod Liver Oils helps maintain
summer health, even during periods when essential vitamins A and D
are less readily available from natural sources.
AYERST
"10-D" COD LIVER OIL
Each teaspoonful contains approximately 10,000 International
Units of vitamin A and 1,300
International Units of vitamin D.
^51
AYERST
COD LIVER OIL
Each teaspoonful contains approximately 7,000 International
Units of vitamin A and 480 International Units of vitamin D.
AYERST COD LIVER   OILS
Biologically tested and standardized   •    Bottles of 4 and 16 ounces
AYERST,   McKENNA  &  HARRISON   LIMITED
Biological and Pharmaceutical Chemists
Montreal, Canada
222 In this folder the citizens of British
Columbia are told about the mobile
chest x-ray survey unit bought with the
money which they themselves contributed through the purchase of Christmas
Seals.
The steadily increasing number of these
G-E equipped travelling x-ray laboratories, operating in all sections of the
continent, is the best evidence of
acceptance of this method, and the
demonstrated efficiency and practicability of this G-E development
To best evaluate this mobile x-ray unit
and its potential value, in view of contemplated plans for a chest survey in
your community, write for complete
details, including authentic reprints of
articles citing results of extensive surveys with this method.
Ask for Reprint Set No. K69.
MA$% Sat***/ Certificates
VICTOR X-RAY CORPORATION of CANADA, Ltd.
DISTRIBUTORS FN GENERAL <§? ELECTRIC X-RAY CORPORATION
TORONTO: 30 Bloor St., W. • VANCOUVER: Motor Trans. Bldg., 570 Dunsmuir St.
MONTREAL: 600 Medical Arts Building • WINNIPEG: Medical Arts Building LSS*3
31
SK
e_mi
SK
S&HJMi
^S»S*«^_
^£1
„* -»»wsjra^ss.'
&*M
K
as?
_s ^S6s_c> „^^_P
literature on request.
HEXESTROL
A synthetic estrogen with minimum toxicity.
Economical  to  prescribe.   Effective  in  use.
Safe Hormone Therapy.
FRANK  W.  HORNER  LIMITED
MONTREAL CANADA 6
mm
./ *\
M
m&i
•;?ss??
ml.
%k&x <t
znefflm
mm
sBftg
^_tT»l__
A Canadian soldier . . i somewhere in France . . . lies
wounded. He has invested his all in Canada's future . . . and
the price he paid was his youth . . . perhaps his life.
We at home can "Invest in Victory" much more easily . . .
merely by purchasing bonds *in Canada's Seventh Victory Loan.
Contrast the cost . .. v?_iis blood—perhaps his life . . . Our
money earned under blue£ peaceful Canadian skies!
Can there be any hesitation on our part when we are asked
to "Invest in Victory"?
Only by our cash investment in Victory can we justify the
blood investment we have asked him to make on our behalf.
BUV VICTORV BOnDS FATHERS OF CANADIAN MEDICINE
Mr-
^P
m
**l—«W
*ONE   OF  A   SERIES
u/hwt wada*t£<
PHYSICIAN -JURIST- (1734-1792)
DR. MABANE studied medicine in Edinburgh,
the city of his birth. After practising briefly,
he is believed to have acted as Surgeon's Mate
on one of the- King's vessels. Following this
experience, he sailed to America to join Amherst's forces, landing in New York in 1758.
He was at Crown Point, N.Y., 19 days before
the invasion of Quebec.
A letter of introduction from Lord Elibank to
his son, General Sir James Murray probably
resulted in Mabane's remaining to practise
medicine in Quebec after the conquest. When
Murray became Governor in 1764, he named
Mabane to his first Council and appointed him
a judge of the Court of Common Pleas and of
the Surrogate Court.
Mabane not only continued his medical work
but also served as a Councillor and on the
Bench under three Governors, Murray, Haldi-
mand and Carleton (Dorchester), the latter of
whom removed Mabane from the Council, in
1767 only to reinstate him in 1774. Dr. Mabane
remained on the Bench throughout, however,
and his judgments were noted for clarity and
regard for the common weal — a fact which
won him many friends but also a few unscrupu
lous enemies who made strong but unsuccessful
efforts to unseat him in 1783.
When American invasion under Benedict
Arnold threatened in 1775, Mabane was entrusted with many important missions and supplied lists of parishes and old officers of militia
who would serve. He was Surgeon of the Garrison Hospital when Carleton arrived after fleeing
from Montreal.
Although Dr. Mabane maintained his connections with the General Hospital and the Garrison
Hospital while pursuing his career as a Jurist,
he gave up his private practice.
Dr. Mabane was unmarried. He died on
January 5th, 1792, from pneumonia due to a
cold contracted on the Plains of Abraham
where he lost his way in a blizzard. He had
a sister Isabel, who survived him.
The example set by pioneer men of character
like Dr. Mabane in helping to establish a sound
foundation for the practice of
medicine in Canada, inspires
this organization to maintain
with unceasing -vigilance its
policy — Therapeutic Exacf-
ness and Pharmaceutical
Excellence.
THE SYMBOL OF
PHARMACEUTICAL
EXCELLENCE
OMNISOPBIS
WILLIAM  R,
-COMPANY LTD.
Manufacturing Pharmaceutists
727-733 JUNGJ&TREE|tWEST,   TORONTO
'S&S6 - 1944
WARNER
ESTABLISHED 1836 • Diodrast is a highly radiopaque substance. Moreover, it is so constituted that
in most instances excretion proceeds in sufficient concentration to produce
quickly dense shadows of the upper urinary tract. This is accomplished with
relatively low dosage—only from 20 cc to 30 cc of 35 per cent solution. ...
Diodrast has been safely employed in hundreds of thousands of adults as well
as in infants and children. However, as with all radiopaque media, a preliminary sensitivity test is advisable.
Diodrast sterile solution (35 per cent by weight/volume) is supplied in ampuls of 10 cc, 20 cc. and 30 cc.
(boxes of 1, 10 and 25), and in vials of 30 cc with
diaphragm stopper (boxes of 1, 10 and 25).
Write for copy of booklet, "Excrerioa
Urography and Retrograde Pyelography."
This contains a comprehensive discussion of
the underlying principles, indications, contraindications, etc., of excretion urography.
D
100 RAST
Reg. U. S. Pat. Off. &. Canada
Brand oj lOPYRACYL
{5,5-diiodo-4-pyridone-N-aceHC acid diethanoiamme)
Pharmaceuticals of merit far the physician   •
WINTHROP   CHEMICAL  COMPANY,  INC.
Generof Office*. WINDSOR. ONT.
Qsetet rrihiilinil Stint Site:  OwH-ll Sqaan Wf^ MNftMl -«*■ _» M #  ,
i v I _f f ___f _«_*_*
r# r*i_r ■
iio«b|?;
*|iere   *»as
ltoidar**ls'
: h fnr*pr^nir
JjtlVV*VaijOXMj   I OTUJU^C    -f*L£/l£A
OF      CANADA       LIMITED-AfOATAf^Z 6 different forms
.r.HlAXOU CIBA
in I poWDER
PB,„m.«lo.   Men,B- I '„._,,
h,|.«.«col Infection*. \ #   OINTMENT
,n,*t,ed!Lc—~ *•"•*• U SUPPOSITORIES
Gonorrhoea,
CIBil
' O' UnNTR 1
MONTREAL, CANADA
-lbount Peasant IHnbertafcing Co. %tb.
KINGSWAY at 11th AVE. Telephone FAirmont 005S VANCOUVER, B. C.
R. F. HARRISON W. E. REYNOLDS R_$MRft    -H
„_Siwm_. ^^P  f|^    -:$5RS
35BEX
HOQS ss
3SEASS    TKA1MST
LB.
•MEAbrsS
KTRI-MALTOSE
A product consisting of maltose
and dextrms, resulting from the
enzymic action oibarfey rnait
on cerea! starch.
with
;SG DAL! MV/CHLO ride 2%
V
SPECIALLY PREPAi
I UStiMBKf AhT
, OF CANAPA,-TO.
BE -Lc V t LL6..0JNTT.
& CO.
_S£P>ES «__ja
:_i_oi—v i_3_
%SS3~_ SSI   i
THE use of cow's milk, water and carbohydrate mixtures represents the
one system of infant feeding that®consistendy, for over three decades,
has received universal pediatric recognition.  No carbohydrate employed
in this system of infant feeding enjoys so rich and enduring a background
of authoritative clinical experience as Mead's Dextri-Maltose. "OSTOFORTE"
FOR MASSIVE VITAMIN D
THERAPY IN CHRONIC ARTHRITIS
AND PSORIASIS.
Capsule No. 651 "Su&f (Each capsule
contains 50,000 International Units of
Vitamin D)
Treatment: The recommended method of treatment is as follows:—An initial
dose erf 50,000 Vitamin D units (1 capsule, "Ostoforte"). This is gradually increased to the effective dose which may be 300,000 or more units daily, depending
on the patient s response and tolerance to the medication. When maximum improvement occurs the dose is reduced to a maintenance level which may vary from
100,000-200,000 (2-4 capsules, -Ostoforte") daily. Rest and regulation of the diet.
Massage and exercise of the affected parts when indicated. <_orrection of bowel
habits. Removal of foci of infection. Results from this treatment may not be
apparent for some weeks, therefore the administration of an analgesic (Acetophen
Compound with Codeine, CT. No. 222 _wadf) may be indicated in order to promote comfort.
Results: While the results of High Potency Vitamin D therapy are not always
dramatic and it may require a number of months of continuous treatment before
improvement becomes evident, the fact that we are dealing with frequently intractable and progressive diseases warrants trial of this treatment. The following results
have been observed in those cases responding to treatment:—Decrease in pain;
Decrease in swelling; Recalcification of osteoporatic bone; Remobilization of joints;
and improvement in general health.
We Emphasize: A—No criteria have been established which would enable one
to select the cases which will respond favourably to treatment from those which
will fail to react. B—No physiological basis exists for the employment of this
therapy. It is at present entirely empirical.
Modes of Issue: In boxes of 100 and 50 capsules for your prescription.
GJlOtet
ChMlleA &,<BhoM!rt6c(2o. Montreal. Canada
WHERE QUALITY AND PRICE ARE EQUAL OR BETTER, PRESCRIBE CANADIAN PRODUCTS
The Canadian Mark of Quality
Pharmaceuticals since i8gg. Colonic and
Physiotherapy Centre
Up-to-date Scientific Treatments
COLONIC IRRIGATIONS, SHORTWAVE
DIATHERMY, SINNEWAVE GALVIN-
ISM, IONIZATION, ULTRA VIOLET
RAY, STEAM  BATHS AND  SHOWERS
Medical and Swedish Massage
Physical Culture Exercises
STAFF OF GRADUATE NURSES
Superintendent:
E. M. LEONARD, R.N.
Post Graduate Mayo Bros.
1119 Vancouver Block
MArine 3723      Vancouver, B.C.
Both are claimed to be allergic.
Both suggest mineral deficiency and
impaired elimination. Clinically,
each is symptomatically improve-
by the oral use of
LYXANTHINE ASTIER
which combines the therapeutic
actions of iodine, calcium, sulphur,
and lysidin bitartrate — a potent
eliminator of endogenous toxic
waste.
Write for Information.
Canadian Distributors
L-16
ROUGIER FRERES
350  Le Moyne   Street,  Montreal
wmmssmmmmmammmmmmmmmm
f   Breaks the vicious circle of perverted
menstrual function in-cases of amenorrhea,
tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic
relief by stimulating the innervation of the
uterus and stabilizing the tone of its
musculature. Controls the utero-ovarian
L    circulation and thereby encourages a    A
normal menstrual cycle. Ji
V        • j
_ • MARTIN H. SMITH COMPANY      A
5_ ISO t»f»TITTf STRUT.  Nlw TOM. N. T. _H
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. MILK --
Ganada'i, Vital
FOOD FOR VICTORY
Milk is accepted as the most valuable protective
food because it surpasses all others in supplying
vitamins, minerals, and Tiigh 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% INDEX TO VOLUME XX, V.M.A. BULLETIN, 1943-44
A
AIR RAID CASUALTY SURGERY,—SOME ASPECTS—F. W. Grauer, Capt. RC.A.M.C. 62
AMERICAN COLLEGE OF PHYSICIANS AND WAR-TIME  GRADUATE MEDICAL
MEETING     _  264
AMERICAN COLLEGE  OP SURGEONS—WAR  SESSIONS   PROGRAMME         145
AMPUTATIONS AND USE OP SATISFACTORY PROSTHESIS—R. I. Harris, Colonel
RC.A.M.C  302
ARCHER, A. E.—Abstract of "White Paper tabled bv British Government  249
ARCHIBALD, M. G., and GRAFTON, H. F. P.—Erythroblastosis foetalis—
Report of case     53
B
BELL, W. N. and STRONG, G. F.—Preliminary report on the use of thiouracil in the
treatment of hyperthyroidism   185
BLACK, A. WESTON—Localized outbreak of diphtheria     84
BLOOD GROUPING—T.  R.  E.  Morgan,  Major,  R.C.A.M.C     67
BODY   MECHANICS,   ROLE   IN   THE   HEALTH   EXAMINATION   AND   CARE   OF
GROWING CHILDREN—Clifford Sweet  277
BOOK REVIEWS—
Acute infections of the mediastinum—Neuhof & Jemerin „  162
American Review of Soviet Medicine ,      91
Bronchiectasis—Lisa & Rosenblatt   _  233
Foundations of Neuropsychiatry—^Stanley Cobb .-.     91
Manual of Dermatology—Pillsbury, Sulzburger & Livingood       6
Manual of Fractures: Treatment by External Skeletal Fixation—Shaar & Kreuz  163
Physiology of the Nervous System, 2nd ed.—John Fulton  175
Psychosomatic Medicine—Weiss & English _.    60
Recent Advances in Pathology—Hadfield & Garrod     33
White Blood Cell Differential Tables—Theodore R. Waugh  119
BRIEF SUMMARY OF BACK PAIN AND INTERPRETATION. OF  ORTHOPAEDIC
SPECIALISTS'   REPORTS—S.  A.   McPetridse,  Major,  R.C.A.M.C     81
BRITISH COLUMBIA MEDICAL ASSOCIATION  18, 49, 213
Annual Meeting,  1944 _  247,  261, 287,  313
Annual Reports, 1943-44  290
Annual Reports,  1944-45  315
British Columbia Cancer Institute 1  49, 126
Committee on Economics, Annual Report     19
No. 4 District Medical Association, Annual Meeting     10
North Shore Medical Society, Annual Meeting     49
Upper Island Medical Association, Annual Meeting ,     50
West Kootenay Medical Association, Annual Meeting :     17
C
CANADIAN MEDICAL  ASSOCIATION—ANNUAL  MEETING  224
CANCER OP THE LOWER COLON: OBSERVATIONS—A. Taylor Henry 1 327
CANCER OP THE THYROID—W. R. Govan, Lieut. R.C.A.M.C  266
CANTOR, MAX—Sex steroids in general medical practice     21
CHILD AS A PATIENT—Clifford Sweet _  240
CHILD IN  THE FAMILY—Clifford  Sweet  235
CLEVELAND, D. E. H.—Sulphonamides in skin disease: A warning  188
CLUFF, J. W.—Complications of acute frontal sinsuitis with report of case  105
COLLEGE OF PHYSICIANS AND SURGEONS  OF B.  C.—
Extract of letter from Registrar Pharmaceutical Association of B. C     97
CUMMINS, J. F.—Northwest Campaign of 1885—Organization of medical services     72
DAVIES. J. R-
DIPHTHERIA,
-Remediable intrathoracic conditions in
LOCALIZED OUTBREAK—A. Weston
childhood  176
Black     84
EMPYEMA, COMPLICATED BY PNEUMOTHORAX, CASE—W. J. S. Melvin.
EPILEPSY, PROBLEM IN THE COMMUNITY—S. E. C. Turvey	
ERYTHROBLASTOSIS FOETALIS, Case report,  Royal Inland Hospital—
M. G. Archibald and H. F. P. Grafton	
53
FLEMING, A.—Streptococcal meiningitis treated with penicillin  (abstract) __ 168
FOOT PROBLEMS IN THE ARMY AND OUT OF IT—R. I. Harris, Colonel, R.CA.M.C. 273
GARROD, L. P.—Treatment of war wounds with penicillin (reprinted)	
GOITRE—OSLER LECTURE—T. H. Lennie	
GOVAN, W. R.—Cancer of the thyroid I	
GRAFTON, H. P. P. and ARCHIBALD, M. G.—Ca^e report—Erythroblastosis foetalis....
GRAUER P. S.—Some aspects of air raid casualty -surgery	
H
HALL, EARLE R.—Tumours of the urinary bladder	
HARRIS, R I.—Foot problems in the Army and out of it	
—The use of penicillin in the management of infected wounds	
—The management of amputations and the use of satisfactory prosthesis.
HARRISON, BEDE J.—The thymus gland from the roentgenologist's angle	
HEALTH  INSURANCE  PRINCIPLES	
HEALTH WORK IN THE SOVIET UNION—Henry R. Sigerist (Reprinted)	
HENRY, A. TAYLOR—Some observations on cancer of the lower colon 	
HEREDITY AND CLINICAL SIGNIFICANCE OF THE Rh FACTOR—S. E. C. Turvey.
192
150
266
53
62 I
INCOME TAX RETURNS—MEMORANDUM FOR MEMBERS OF THE MEDICAL
PROFESSION      128
INGUINAL  HERNIA—R  E.  McKechnie,  Major,  R.C.A.M.C _      78
INTRATHORACIC CONDITIONS,  REMEDIABLE,  IN CHILDHOOD—J.  R. Davies  176
_C
KENNY TECHNIQUE, REPORT ON COURSE AT UNIVERSITY OP MINNESOTA—
Alice J. McDonald     98
KINSMAN, R.  P.—The thymus gland     38
J,
LENNIE, T. H.—Osier Lecture—Goitre  150
if
MATTHEWS, G. O.—The thymus gland and its relation to sudden death in infancy     37
MEDICAL SERVICES ASSOCIATION  48, 259
MELVIN, W. J. S.—Case of empyema complicated by pneumothorax  166
MENINGITIS,   STREPTOCOCCAL,   TREATED   WITH   PENICILLIN   (Abstract)—
A. Fleming .   168
MOORE,  ALLIN  and  TURNBULL,   FRANK—Thrombosis  of  internal   carotid  artery
resulting from a shotgun wound  103
MORGAN,  T. R. E.—Blood grouping     67
MORRISON, MACKENZIE—Staphylococcal acute infectious gangrene     47
Mc
McDONALD,   ALICE   J.—Report   on   attending   the   course   in   Kenny   Technique   at
University of Minnesota.  98
McFETRIDGE, S. A.—Brief summary of back pain and interpretation of orthopaedic
specialists' reports   81
View box for observing foot imprints — 69
McKECHNIE,  R.  E.—Inguinal hernia.  78
McPHEE, J. G.—Four cases of gastric sarcoma  318
IT
NORTHWEST  CAMPAIGN  OF   1885—ORGANIZATION   OF  MEDICAL   SERVICES—
J. F.  Cummins, Lt.  Col.,  C.S.M.C 1     72
O
OBITUARIES—
Buckell, Edward      55
Christie, H. A  Ill
Davis, Daniel Wade  280
Drysdale, William Frederick  113
Elliot, Robert Scott  114
Montgomery,  James Allen _  114
"Morris,  Osborne   -  130
McCaffrey, Peter Sinclair  309
McCordick,  Austin William     55
McKechnie, R. E  229.
Nicholson,  F.  J  226
Olivier, Joseph Edward  114
Paterson, Peter Harold 1     55
West, John A     20
Ziegler, Ray E     55
OSLER LECTURE—GOITRE—Dr. T. H. Lennie  150
JP
PANIKOV, P. A.—Spasokukotski's method of feeding abdominal wounds (Abstract)  138
PENICILLIN, IN MANAGEMENT OF INFECTED WOUNDS—
R  I. Harris, Colonel, RC.A.M.C  322
PENICILLIN IN TREATMENT OF WAR WOUNDS  (Reprinted)—L. P. Garrod  192
PENICILLIN   IN   TREATMENT   OF   STREPTOCOCCAL   MENINGITIS   (Abstract)—
A. Fleming   168
PIN TRANSFIXION—INFLUENCE ON TREATMENT OF FRACTURES—
Donald E. Starr  122
PITTS, H. H.—The thymus gland _     35
PREGNANCY, ABDOMINAL, PULL TERM—Case report—K. K. Pump  110
PRIVATE CITIZEN TO PRIVATE SOLDIER—W. Roy Walker, Capt. RC.AM.C     80
PROVINCIAL BOARD OF HEALTH—Division of Venereal Disease Control  7,    61
PUMP, K.  K—Full term abdominal pregnancy,  Case  Report  110
K
Rh  FACTOR,  CLINICAL  SIGNIFICANCE   OF,  AND  ROLE  OF  HEREDITY—
S. E. C. Turvey  100
S
ST. PAUL'S HOSPITAL.: -  201
SARCOMA, GASTRIC—FOUR CASES—J. G. McPhee  318
SEX STEROIDS IN GENERAL MEDICAL PRACTICE—Max Cantor     21
SIGERIST, HENRY R.—Twenty-five years of health work in the Soviet Union
(Reprinted)   131
SINUSITIS,  ACUTE  FRONTAL,  COMPLICATIONS,  WITH  REPORT  OF A CASE—
J. W. Cluff, Capt, R.C.A.M.C  105
SPASOKUKOTSKI'S METHOD OP FEEDING ABDOMINAL WOUNDS (Abstract)—
P. A.  Panikov -  138 SPINAL FLUID, FALLACIES IN CLINICAL EXAMINATION OP—S. E. C. Turvey  244
STAPHYLOCOCCAL ACUTE  INFECTIOUS  GANGRENE—Mackenzie  Morrison „    47
STARR DONALD E.—The influence of pin transfixion on treatment of fractures  122
STATUS THYMICOLYMPTHATICUS—S. E. C.  Turvey 1 _    41
STRONG,  G.  F.  and BELL,  W.  N.—Preliminary  report  on  the  use of thiouracil  in
*      the treatment of hyperthyroidism  185
SULPHONAMIDES IN SKIN DISEASE: A WARNING—D. E. H. Cleveland  188
SWEET,  CLIFFORD—The child in the family  235
The child as a patient  240
The diagnosis and treatment of upper respiratory tract infections
in infants and children with special reference to sinusitis. „ 268
The role of body mechanics in the health examination and care
of growing children „ '..   277
T
TABLES  OF  APPROXIMATE   EQUIVALENTS   OF  DOSES,   APOTHECARIES'   AND
METRIC  SYSTEMS    - _ _  248
THIOURACIL IN TREATMENT OF HYPERTHYROIDISM, PRELIMINARY REPORT
—G. P. Strong and W. N. Bell t  185
THROMBOSIS OP INTERNAL CAROTID ARTERY RESULTING FROM A SHOTGUN
WOUND—All_n Moore and Frank Turnbull _  103
THYMUS GLAND—SYMPOSIUM      34
—Dr. H. H. Pitts     35
—Dr. G. O. Matthews     37
—Dr. R. P. Kinsman _     38
—Dr. B. J. Harrison „. „...    39
—Dr. S. E. C. Turvey     41
TURNBULL, FRANK and MOORE, ALLIN—Thrombosis of the internal carotid artery
resulting from a shotgun wound  103
TURVEY, S. E. C.—Problem of epilepsy in the community     11
—Status thymicolymphaticus       41
—Role of heredity and clinical significance of the Rh factor  100
—Fallacies in the clinical examination of spinal fluid  244
IT
UPPER RESPIRATORY TRACT INFECTIONS—DIAGNOSIS AND TREATMENT
IN INFANTS AND CHILDREN WITH SPECIAL REFERENCE TO SINUSITIS
—Clifford Sweet     268
URINARY BLADDER,   TUMOURS  OF—Earle  R  Hall     92
▼
VANCOUVER GENERAL HOSPITAL—Case reports  47,  103,  105,  166, 185,  318
VANCOUVER MEDICAL ASSOCIATION  8,    34
Annual Meeting, 1944 1  205
Annual Reports—1943-44  ~ 205
Library Notes  "  5, 33, 60, 90, 121, 162, 175, 212, 232, 259, 286, 314
Summer  School    174, 202, 234
VIEW BOX FOR OBSERVING FOOT IMPRINTS—S. A. McFetridge, Major, R.C.AM.C.    69
W
WALKER, W.  ROY—From private citizen  to  private  soldier     80
WHITE PAPER TABLED BY BRITISH GOVERNMENT,  ABSTRACT—
Prepared by A E. Archer.   249
WORKMEN'S   COMPENSATION  BOARD—Correspondence     43 Mycelia and spores of Penicilliuzn notation.
Growing in a liquid culture medium, this mold
produces penicillin which later is extracted and
purified.
Crystals Penicillin Sodium Squibb X100. In the course of studies
concerned with the chemical structure of penicillin Dr. H. B.
MacPhillamy and Dr. Oskar Wintersteiner were first, July 1943,
to accomplish crystallization of penicillin sodium; activity
about 1,600'Oxford units per milligram.
iW ■■
New Squibb Penicillin Building, now in operation. Built without
government subsidy, it is designed and equipped for the most
efficient production and control of penicillin. Instead of a few
pounds, now over a ton of mold is grown each day. Its productive capacity is not exceeded by any other penicillin plant in
the United States.
Unusual care maintains purity, activity and stability. Workers
package Penicillin Squibb in air-conditioned rooms sterilized
with ultra violet light. For over two years Squibb has produced
penicillin for the National Research Council and the Armed
Forces.
Squibb
HAD
READY
When the War Production Board's
Office Of Civilian Penicillin Distribution recently announced the limited
allocation of penicillin for civilian use
and the plan for its distribution, the
Squibb Laboratories were ready with a
substantial supply after having first
met the requirements of the Armed
Forces, Lend Lease and the Office of
Scientific Research and Development.
The Squibb Laboratories have been
actively engaged in the development
and production of penicillin ever since
the first culture was received from
England in the autumn of 1940.
Remarkable changes have occurred in
the method of manufacture. Huge
tanks have replaced bottles for growing
the mold; production time is less than
three days instead of two weeks.
It is hoped that the day is not too
distant when penicillin production
will be sufficient to eliminate the
need for allocation. We want physicians to know that Squibb is doing
everything possible to hasten the
coming of that day.
For literature write
E. R. SQUIBB & SONS OF CANADA, LTD.
36 Caledonia Road, Toronto
Squibb
c/r/faw&Zfau Can Jtortt KEEPING PACElIl
As many of the erstwhile restricted medicinals
are becoming more procurable, Georgia Pharmacy is placing them again at your disposal.
Trade connections of over 35 years standing
is a great help in times like these!
Phone
MArine 4161
{<&^^.Jhmd*>iA**\
GEORGIA PHARMACY
'.*_ I.M  t T  CD
•mimma
4TKMT W.
(htAt& % anna lift
ESTABLISHED 1891
VANCOUVER, B. C.
North Vancouver, B. C.
Powell River, B. C. Co. Cteritrti *•_/•
■ISBm    ■ m&B
New Westminster* B. C.
For the treatment of
NEUROPSYCHIATRIC
DISORDERS
Reference—B. C. Medical Association
For information apply to
^^^^^^^^^^i^^^^^^^ffi W__5_fcONSTER, B.|[_f|f
New Wi^TMiNStER 288
p^z 721 jNIepic^-Den^al Building, Jvancouv_$r, B. G.
PAcn.c^2i^ PAcific8036
»_7    University of British Columbia Library
DUE DATE
SERIALS
JUN    9 1981 \M
fIvUtAi          V '
■: /-. *:&£[ |
FORM  310S  

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/cdm.vma.1-0214437/manifest

Comment

Related Items