History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: August, 1929 Vancouver Medical Association Aug 31, 1929

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 r
)1.V.
AUGUST,  1929
The Bullet
of the^
Vancouver Medical Association
CS. ^B. of IQdney and Ureter
c3tead Injuries
(Laboratory bulletin
^Published monthly atlJancouvcr, ^B.(?., by
McBEATH-CAMPBELL LIMITED
~**>Trices $1.50 per year^~ T
Patient Types:
THE MAN ON HIS FEET
Irregular and uncertain times for defecation may lead to hemmor-
hoids and more often to constipation.    Cathartics aggravate the condition.
Petrolagar is very helpful in managing these cases. It brings about
normal peristalsis in a natural way. It prevents the congestion of the
hemorrhoidal veins caused by straining at stool.
Petrolagar is a mechanical emulsion of liquid petrolatum (65% by
volume) and agar-agar, deliciously flavored and pleasant to take. It has
many advantages over plain mineral oil. It mixes easily with bowel
content, supplying unabsorbable moisture with less tendency to leakage.
It does not interfere with digestion.
Petrolagar restores normal peristalsis without irritation, producing a
soft-formed, normal stool consistency and real comfort to bowel movement.
refrol
agar
Petrolagar Laboratories
245 Carlaw Ave., Dept VM 8,
Toronto, Ont.
Gentlemen:—Send me copy of "HABIT TIME" (of bowel movement) and
specimens of Petrolagar.
Dr	
Address    	 THE   VANCOUVER   MEDICAL   ASSOCIATION
BULLETI N
Published Monthly  under  the Auspices of  the  Vancouver  Medical  Association  in   the
Interests of the Medical Profession.
Offices:
203 Medical and Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. M. Pearson
Dr. J. H. MacDermot Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the abov; address.
VOL. V.
AUGUST, 1929
No. 11
OFFICERS 1929-30
Dr. T. H. Lennie Dr. G. F. Strong Dr. W. S. Turnbull
President Vice-President Past President
Dr. E. M. Blair Dr. W. T. Lockhart
Hon.-Secretary Hon. Treasurer
Additional Members of Executive:—Dr. W. A. Dobson; Dr. A. C. Frost.
Trustees
Dr. W. F. Coy Dr. W. B. Burnett Dr. J. M. Pearson
Auditors:    Messrs. Price, Waterhouse & Co.
SECTIONS
Clinical Section
Dr. J. R. Davies Chairman
Dr.  S.  H.  Sievenpiper . Secretary
Physiological and Pathological Section
Dr.  A.  M.  MBTywnw    ■ ■ •■ : Chairman
Dr.  R. E. Coleman abjbi .     Secretary
Eye, Ear, Nose and Throat
Dr.  F.  W.  Brydone-Jack.   Chairman
Dr. N.  E. McDougall    |j|    Secretary
Physiotherapy Section
Dr. H. R. Ross  Chairman
Dr. J.  W. Welch     -  Secretary
Pediatric Section
Dr. C.  F.  Covernton ! Chairman
Dr.  G.  O.  Matthews     Secretary
STANDING COMMITTEES
Library
Orchestra
Dr.
C. H. Bastin
Dr.
J. R. Davies
Dr.
Wallace Wilson
Dr.
J.  H. McDermot
Dr.
S. Paulin
Dr.
F. N. Robertson
Dr.
D. F. Busteed
Dr.
J. A. Smith
Dr.
W. H. Hatfield
Publications
Dr.
D. M. Meekison
Dr.
J. M. Pearson
Dinner
Dr.
J. H. McDermot
Dr.
W. T. Ewing
Dr.
D. E. H. Cleveland
Dr.
W. A. Gunn
Credentials
Dr.
L. Leeson
Dr.
A. W. Bagnall
Rep. to B. C. Med. Assn.
Dr.
W. L. Graham
Dr.
A. Y. McNair
Dr.
A. J. MacLachlan
Sickness and Benevolent
Fund — The Preside
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Summer School
L. H. Appleby
B. D. Gillies
W. T. Ewing
R. P.  Kinsman
W. L. Graham
J. Christie
Hospitals
J. W. Arbuckle
F. Brodie
A. S. Monro
F. P. Patterson
The Trustees Our Obligation
For twenty-one years the Georgia Pharmacy has assumed the obligation of rendering
a more complete service to the medical profession by strict adherence to high standards
of pharmaceutical dispensing.
Nine
Graduate
Pharmacists.
©fl©
Phone Seymour 1050
Ceovgxa
Grsmville atQeor^is^
W
Open
All
Night.
in cystitis and pyelitis
TRADE
MARK
PYRIDIUM
Phenyl-azo-alpha-alpha-diamino-pyriduie hydrochloride
(Manufactured by The Pyridium Corp.)
For oral administration in the specific treatment
of genitO'Urinary and gynecological affections.
Sole distributors in Canada
MERCK & CO. Limited     Montreal
412 St. Sulpice St. EDITOR'S PAGE
That for all round excellence, without any weak spots, the session
of the Summer School just closed was the best yet, is the opinion everywhere expressed by those fortunate enough to be present. The attendance ,it is true, fell a little below high-water mark, chiefly because
the impending meeting of the American Medical Association at Portland, Ore., reduced materially the size of the Washington State contingent. Otherwise it was normal or slightly increased. British Columbia, outside Vancouver and vicinity still fails to attend in anything like
adequate numbers. Whatever the cause and it is probably the relatively
simple one of the inability of the out-of-town practitioner to leave his
work without making arrangements which, if made, will serve for a
longer vacation than the four days of the School, it forces the Committee to consider chiefly what form of instruction is most useful to the
City man and to consult bis wishes. Thus the departure from or modification of the original idea of the School, which was to foster and
present local clinicians and local clinics, is being justified by circumstances. Local clinicians require more than local audiences and if extra-
urban support is not forthcoming in sufficient amount the purpose of
the School must perforce be changed.
If a- revival along the original lines is contemplated it must be less
intensive, more prolonged, embracing more demonstrations and more
teaching: Laboratory technique, X-ray technique, surgical technique,
with clinics less on the rare and unusual and more on the newer views
of older things. In other words a definite post-graduate course of two
or three weeks must be arranged. There is, it is obvious, no reason why
both forms of instruction should not be undertaken, not necessarily
concurrently. The clinical material is here, laboratory provision is
here, clinical ability is here, nothing is wanting but the will to do.
The arrangements for the meeting were satisfactory and the programme was worked through with that smoothness and celerity we are
coming to take for granted. Do not let us forget the amount of forethought and downright hard work which the Committee had to provide
and expend. It is indeed creditable to the City that year by year men
are found willing to do this gratuitous and perhaps thankless (certainly
unthanked)   work.
We trust that our guests, lecturers and audience alike, enjoyed
themselves apart from their official duties. We can only judge from
appearances and judging thus we should say they did. Part of the
pleasure and more than part of the profit of the meeting comes from
the informal talk in the intervals of rest or at all events intervals between the lectures. The duration of the meeting and the informality
of the proceedings is long and marked enough to make acquaintance possible. We shall print a fair share of the proceedings of which an instalment appears in this issue.
Page 218 DIABETIC IDENTIFICATION CARD
From the Journal of the American Medical Association of June
29th we abstract the idea of an identification card for diabetics. As
these unfortunate sufferers are liable to attacks leading to loss of consciousness from two causes: In one case having too much sugar in the
blood, in the other too little, one can easily see how useful such a concise
record might be if found on the person of the individual. The following is the form suggested:
Diabetic Card
Name   	
Address    	
Telephone 	
Family Doctor  . Tel.	
Diabetes Specialist  Tel ..„	
Diet:    Carbo Gm., Prot. Gm., Fat Gm., Cal.	
Insulin: A.M. units, M. ^ units, P.M units
(This card is carried so that in case of emergency or accident the patient may receive the proper attention quickly and
mistakes may be avoided).
NOTICE
Blister Fluid
In order to continue some studies commenced several years ago
and on which new light has been shed recently, Dr C. S. McKee will
appreciate fresh fluid from blisters (a few drops will do) due to any
cause. Dr. McKee or Dr. Coleman are prepared to call for such
material at any hour of the day.
NEWS AND NOTES
We have heard and written so much about the acute hospital bed
shortage in the City that for a change we are pleased to announce a
real increase of twenty beds. A fully equipped modern hospital unit
will be one of the features of the new Medical and Dental Building.
Miss Bennett and Miss Jamieson, who are the originators of this enterprise,
are both well known to the medical men in the City as they have been
in charge of the Operating Rooms of the Vancouver General Hospital
for a considerable time. Miss Bennett is a graduate of the Vancouver
General Hospital and Miss Jamieson graduated from the Montreal
General.
Vancouver will be the third city in Canada to have a fully equipped
hospital unit housed in a medical office building. Montreal and Toronto
have such hospitals which are very successful. The hospital in our City
will have private an dsemi-private rooms and wards, all of which face
Page 219 south an dare sunny and very airy. There are two operating rooms
which face north and are equipped with every modern improvement and
with the new scialytic lights. An electric sterilizer will be installed
and supplies of sterilized dressings etc. will be available at all times.
The kitchen in the centre of the hospital is fitted with electric stoves
and with an exhaust fan to convey the odours out of the hospital.
The nursing will be done entirely by Graduates and there will be a
twenty-four hour service. An orderly will be in attendance. The
hospital is fully equipped to deal with all types of surgical cases, and
eye, ear, nose and throat cases, and medical cases for observation and
diagnosis.
The rates will compare favourably with other hospitals in the
City and cards will be mailed to the profession very soon. It is expected
the hospital will be ready to receive patients early in August, and we
take this opportunity of wishing Miss Bennett and Miss Jamieson every
success in such a strenuous undertaking.
Cases will be accepted from all practitioners and service is not
confined to medical men in the building. One of the elevators is specially constructed to convey stretcher cases to and from the hospital which
is situated on the third floor.
It is hoped that the move to new quarters will not interfere with
the activities of the Library for more than a day or two.
A number of Vancouver men attended the Annual Meeting of
the American Medical Association at Portland in the second week of
July. Among them were: Drs. C. E. Brown, Wallace Wilson, Colin
Graham, G. F. Strong, H. A. Spohn, A. W. Hunter, G. A. Petrie, C. H.
Vrooman, R. E. Page and D. M. Meekison. They report that the registration was around 3,000, chiefly from.California, Oregon and Washington. There were not many outstanding Eastern men, and the scientific
programme was so extensive that it was impossible to take in more than
the fringe.
Dr. J. P. Bilodeau who formerly practised in Vancouver and for
the last few years has been in Bellingham is enjoying a vacation on
Orcas Island. He returns to Vancouver on July 28 th and will be
associated in practice with Dr. C. F. Covernton. We are glad to welcome Dr. Bilodeau back to practice in Vancouver though he has never
missed attending our Annual Dinner during the time he has practised in Bellingham.
NEWS FROM THE GENERAL HOSPITAL
With the opening of the Private Ward Pavilion recently, the Hospital has practically brought to completion a part of its building programme which has involved a great deal of planning and effort. Modern
in every respect in its layout and equipment, this building supplies a
type of accommodation and service has not been attempted previously
Page 220 in Vancouver. Situated at some distance from the main group of buildings, it is practically a self-contained unit and includes separate X-ray,
physiotherapy and metabolism laboratories. A fully equipped operating
suite is provided on the top floor. A feature of the operation of this
building is the central tray service whereby the diets are completed for
each patient under the check of a dietitian, before they leave the kitchen
in the basement, and are carried by automatic elevator direct to each
floor.'
The Board of Directors has recently given notice of a revision of
its by-laws as they affect the organization of the attending medical
staff, and of its appointment of the following senior members, the first
named have been subsequently elected as chairman of the department:
Medicine:
General—
Neurology—
Psychiatry—
Dermatology—
Tuberculosis—
General—
Urology—
Orthopaedics—
Proctology—
Obstetrics and Gynaecology-
Pediatrics—
Eye, Ear, Nose and Throat-
Drs.   B.   D.   Gillies,  Wallace. Wilson,
F. N. Robertson, C. H. Vrooman.
Dr. F. Brodie.
Dr. J. G. M|cKay
Dr. T. R. B. Nelles
Drs. Morris and Barker.
Drs. P. A. McLennan, A. B. Shinbein,
G. E. Seldon.
Dr. A. W. Hunter.
Dr. F. P. Patterson.
Dr. J. A. Sutherland.
-Drs. W. B. Burnett and J. J. Mason.
Drs. E. D. Carder and C. F. Covern-
ton.
-Drs. G.  C. Draeseke, W. E. Ainley,
F. W. Brydone-Jack and J. A. Smith.
In" continuous occupation for more than twenty years, the wards
in the main building are undergoing a much needed renovation which
has necessarily been extended to many renewals of plumbing and the
whole re-wiring of parts of the electrical system. A matter of considerable expense, this work is opportune at the present time when ward
accommodation has been released by transfer to other buildings; in fact,
it is doubtful what other chance would have permitted its accomplishment. By fall, it is anticipated that the renovations, which are being
carried out by the mechanical staff, will have completely restored the
old building to its full capacity for heavy service.
We are very sorry to announce the resignation of Miss K. W. Ellis,
R.N., who has held the position of Superintendent of Nurses in the
Vancouver General Hospital since 1921. During her very successful
tenure of appointment, Miss Ellis has met many changing situations
created by an ever increasing number of hospital days and coincidental
additions to the activities of the Training School. Before leaving at the
end of June to attend the International Congress of Nurses at Montreal,
Miss Ellis was the recipient of a number of presentations which included
Page 221 one from the Directors and Officers of the hospital. She will travel
abroad during the summer and it is our earnest wish that she may find
rest and pleasure in the relaxation of laying aside for a while the
manifold responsibilities which she has shouldered so well since she came
to Vancouver.
Owing, perhaps, to the very widespread notice given of its requirements, the Vancouver General Hospital has secured a larger number of
internes than has been possible for some years previously. It is still
desired to add further to their numbers, the new staff organization
carrying with it plans for ward attendance which will utilize the services
of many internes.    The present interne staff is:
Dr. H. S. Stalker        U. of Manitoba, 1928
Dr. Murray   Baird     ,_Oxford, 1924
Dr. N. B. Hall   McGill, 1927
Dr. R.   K.   Johnston   Kingston, 1916
Dr. P.   A.   McDonald  ..Western   Univ., 1903
Dr. D.   R.   Chisholm   Dalhousie, 1927
Dr. H.  J.   Nunn ■ Western  Univ., 1928
Dr. C.   Brown Dalhousie, 1929
Dr. J.   H.   Chappie  Minnesota, 1929
Dr. R.   Harlow Dalhousie, 1929
Dr. L.   M.   Mullen    Toronto, 1929
Dr. C. Pitts  .Kingston, 1929
Dr. E. A. Taylor  Iowa, 1929
Dr. H. B. Galbraith  Manitoba, 1930
Dr. B.  M.  Unkauf   Manitoba, 1930
HEAD INJURIES
Given before the Vancouver Medical Association, Summer School,
1929, by Dr. Ernest Sachs, St. Louis, Mo.
The most important thing to remember about a fracture of the
skull is that the fracture is unimportant and that the important point
to remember and determine is what has happened to the intracranial
contents.
Therefore though in every case of head injury we try to determine
if there has been a fracture, our greatest concern must be the nature ol
the intracranial injury, for the treatment of the patient depends on this
factor and so does the prognosis. Fractures of the skull may be simple
or compound, and these may be either linear, depressed, vault or basal.
With  any one  of  these  fractures   there  may   be  intracranial  injuries.
These intracranial injuries will all fall into one of the following groups:
1. Frank haemorrhage from a ruptured vessel.
2. Contusion and laceration of the brain.
3. Rupture of  the  arachnoid with escape of  cerebrospinal  fluid
into the subdural space.
4. Oedema of the brain.
5. Concussion.
Page 222 Any one of these injuries may have associated with it evidence of
increased intracranial pressure.
How, then, may we distinguish these various injuries?
1. Haemorrhage. As a rule when a vesesl is ruptured, it is the
middle meningeal, or a branch of it. This may occur without any
fracture being present and very little if any brain injury. The classical
picture of such a hemorrhage is the momentary period of unconsciousness followed by the return to consciousness, the lucid interval, and then
a second period of unconsciousness which comes on in minutes, hours,
and rarely in the course of several days. The extent and rapidity of the
haemorrhage is the factor that determines the rapidity with which the
second period of unconsciousness and deepening coma develops; while
the first brief unconscious period is due to the force of the blow, the
second is due to the gradually developing compression due to the clot.
With this deepening coma there are certain characteristic signs and
symptoms. If the blood pressure is frequently observed every fifteen
minutes, a progressive rise of blood pressure will be noted and with
it a slowing of the pulse. If the patient should have fever at this
time, what appears to be a normal pulse may actually be a slow pulse
in view of the elevation in temperature.
There may be a hemiparesis or hemiplegia with the characteristic
increased pathological reflexes and the presence of such pathological
reflexes may be the only means of knowing on which side the vessel
has given way. The reflexes will be of course increased on the side
opposite the lesion.
The eye grounds may show some changes but in the vast majority
of cases they do not show much abnormality, possibly oedema of the
disc and full veins, but very, very rarely a choked disc. There may be
Jacksonian convulsions.
The patients with contusion and laceration do not have the lucid
interval nor do they have a rising blood pressure, but they may be in
various stages of unconsciousness, depending upon the severity of the
brain injury. With such contusion and laceration there commonly develops oedema of the brain and this I believe is an important factor in
the unconsciousness  and  the  associated  increased  intracranial  pressure.
In other cases there may be very little contusion and laceration
but rapidly developing pressure symptoms due to the rupture of the
arachnoid and the constant pumping of cerebrospinal fluid into the
subdural space where it collects and cannot be absorbed. The picture
these cases present is very similar or identical to that of a middle
meningeal hemorrhage. I have operated two such cases expecting to
find a hemorrhage and found slightly yellow cerebrospinal fluid in the
subdural space under great pressure. With the evacuation of ^his fluid,
the patient's symptoms promptly cleared up.
Finally we have so-called concussion—a most unfortunate term.
It may include any of the cases which have a contusion and laceration
and these constitute the vast majority of head injuries. There is no
known pathology to concussion, consequently it is really impossible to
Page 223 speak intelligently about it but the term is in the literature and we
cannot ignore it. My own feeling is that only those cases should be
called concussion that have a slight cerebral trauma. The patient who
is hit with a golf ball and is stunned or perhaps momentarily unconscious, has a headache and perhaps a slow pulse for an hour or two, but
no neurological symptoms.
These then are the various types of lesions that may occur with an
injury to the head.    How are they to be dealt with?
First, the compound fractures. These are to be treated like ail
potentially infected wounds elsewhere in the body. They should be
cleansed out, debrided, and sewed up without drainage, especially if the
dura has been torn. Such a debridement may be a very formidable
operation for in order to get a good result all traumatized tissue must be
excised, brain as well as dura, and the more superficial tissues. The
neurological symptoms should be disregarded as the problem is entirely
one of preventing infection.
Depressed fractures. My rule and firm belief is that all depressed
fractures, even if they are producing no symptoms, should be elevated
since it is these cases that are more likely to develop symptoms of
epilepsy. If the dura is torn, all tissue that may form a scar is to be
removed.    Brain wounds heal much more kindly after clean excision.
All cases of frank haemorrhage should be operated promptly and the
guide as to where to operate should be the neurological symptoms, not
the point where the blow was struck or the site of fracture. The middle
meningeal is often injured by contrecoup.
From this it might appear that I advocate much surgery in head
injuries; far from it, for the compound and depressed fractures and
middle meningeal haemorrhages constitute but a very small portion of all
head injuries. The vast number, in fact, most of the cases have a
contusion and laceration and in these the problem is to combat cerebral
oedema. This is most effectively done by dehydration. Magnesium sulphate in saturated solution per rectum every four hours or by mouth if
the patient is not vomiting; intravenous glucose, 50%, or sodium
chloride saturated solution intravenously.
TUBERCULOSIS OF THE KIDNEY AND URETER
By Dr. O. S. Lowsley, New York
Being an abstract of an address delivered before the Summer School,
(June, 1929), of the Vancouver Medical Association.
This type of tuberculosis is always secondary and never primary.
The portal of entry may be from the epididymis by way of the lymphatics to the glands at the hilus or it may be blood borne from a distant focus such as, the lungs or throat. Often the source is obscure.
The surprising thing is that there is not more tuberculosis of the urinary
tract when there is marked tuberculosis elsewhere. It is a fact that
tubercle bacilli may pass through the entire urinary tract in moderate
Page 224 numbers for a long period of rime without causing any recognizable
infection.
On the other had there are certain rare cases of renal infection in
which there is marked peripheral tuberculosis and no organisms appearing in the urine, the lesion having sealed itself off perfectly.
Ail grades of the condition may be found from solitary calcified
lesions of small size to tuberculous abscesses extending even to auto-
nephrectomy.
Symptoms
The urinary symptoms are at first frequency both day and night,
this later becomes painful extending even to strangury. There is hematuria present usually fairly early and always pyuria later.
The general symptoms consist of loss of weight although this is
not invariably the case, in fact, some cases appear to be very well fed
in spite of the trying disturbance to rest and sleep due to urinary symptoms.
All cases are neurotic. They often do not have any pain in the
lumbar region or over the course of the ureter. There is often pain in
the suprapubic region fairly early.
One must carefully question the patients regarding any previous history of tuberculosis of the lungs, throat or epididymis.
Examination
General: A thorough general physical examination is made of the
entire body in the usual way.
Inspection: It is particularly noted whether the patient is poorly
developed, has a general attitude of nervousness, and the body carefully
inspected for evidence of pulmonary damage.
Palpation: In addition to the general examination of the body
the loin is carefully felt bimanually to determine whether the kidney
is palpable, tender, or enlarged. The pressure is made over the course
of the ureters to determine whether there is tenderness present. In the
male the testicles, epididymis, prostate and seminal vesicles are examined
for evidences of tuberculosis.
Percussion: Sometimes reveals enlargement of a kidney which cannot be felt. This is particularly true of well fed patients. Ballottment
may reveal an enlarged or tender kidney not otherwise made out.
Special Examination
The urine is examined completely including an occult blood test
and carefully search for tubercle bacilli by all methods (including
Guinea Pig inoculation and potato culture.
Cystoscopy: Ordinarily novocaine borate solution one per cent,
will be a satisfactory anaesthetic; if, however, the patient has a particularly irritable bladder it is wise to do the cystoscopy under sacral
anaesthesia.
Pt
ige i. The vesical fundus is carefully examined for tuberculous ulcerations or other evidences of irritation. The uretural orifices are observed
and any pathological appearances carefully noted. The trigone and
vesical orifice are then observed for oedema or other irritative lesions.
The ureters are then catheterized. One may not be able to get in
both sides in which case all the tests are done as usual, the specimens
being removed from the bladder which will give us information regarding the secretions of the side not penetrated. The specimens thus
collected are sent for comparative urea, microscopic, guinea pig inoculation, and the potato culture. A comparative phenolsulphonephthalein
test is then made in the usual manner.
A plain X-ray is followed by a pyelogram on the side which has
been determined by this time to be defective. A ureterogram is then
done by withdrawing the catheter and injecting sodium iodide, the
patient being in a sitting posture.
If neither ureter can be catheterized the bladder is irrigated for
one week with Rivanol dextrose 1-1000 or Acriflavine 1-6000 and then
a further attempt made to examine both sides. If neither ureter can yet
be catheterized an indigo carmine test is done. The output from each
kidney is observed and an idea may be obtained regarding the comparative function of the two kidneys.
Perirenal insufflation by means of oxygen or other gas after the
method of Carelli may bring out the kidney shadow sufficiently.
Operative Treatment
When one kidney only is involved very definitely, nethprectomy
and ureterectomy under regional anaesthesia is the procedure of choice.
If one kidney is very badly involved and the other only slightly so as
shown by functional tests one also performs a nephrectomy. One never
operates unless the remaining kidney is able to sustain life as demonstrated by the various functional tests above mentioned.
Kidney Operation Under Paravertebral Anaesthesia
Certain conditions such as tuberculosis make it particularly important not to give any type of general anaesthesia for kidney operations;
therefore, the use of procaine 1% for the purpose of inducing anaesthesia by the block method is particularly useful in urological surgery.
The administration of this anaesthesia is quite easily accomplished.
Wheals are made in the skin, following which a needle is passed to the
angle formed by the transverse process and the lamellae of bone covering
the spinal cord. The posterior roots emerge just at this angle and
therefore the needle is passed over the edge of the bone and from three
to five cubic centimeters of 1 % procaine is induced into the area around
the emerging routes of the eighth, ninth, tenth, eleventh and twelfth
dorsal and first lumbar nerves. A particularly large amount of the solution is introduced into the costo-vertebral angle formed by the twelfth
rib and the spinal column, because here emerge three important innervations of the loin, namely the twelth subcostal nerve,  the ilio inguinal
Page 226 and the ilio hypogastric nerves. Superficial and deep infiltration of
procaine is used in the loin. In addition a long needle is introduced into
the region of the splanchnic ganglion just below the costo-vertebral angle
and six or eight cubic centimeters of procaine solution is injected into
this area.
The patient is then placed on the well side, the diseased side being
put on a stretch by a special appliance used in kidney surgery. The incision is then made through the skin and deepened through the muscle
wall of the loin, care being taken to avoid injury to the important nerves
of the loin which pass through this region. The incision of the costovertebral ligaments allows the twelfth rib to swing up so that it is not
necessary to resect a rib. However, this is unhesitatingly done if it is
deemed advisable. The fatty capsule surrounding the kidney is then
incised and separated, the kidney freed by blunt dissection from surrounding structures and any aberrant vessels that are met are ligated and
cut. The ureter is then isolated and ligated. The vascular pedicle is
freed from surrounding structures, clamped with a kidney clamp and
then ligated before being incised. At the time, the knot is tied tightly,
the clamp is relaxed, thus allowing the pedicle which has been pressed
into a ribbon form to assume a circular form and thus prevent slipping
of the vessels after the excision of the kidney. Having tied this knot
firmly but not tight enough to cut through the blood vessels the pedicle
is incised and the kidney removed. It is our custom to put a transfixion
suture in the pedicle, tying it beneath the first ligature before finally removing the clamp. This permits one to be certain that there will be
no bleeding. The abdominal wall is now repaired in layers with proper
drainage of the area of operation. We believe that the patient is much
better off to have his wound repaired in layers than by the method
sometimes used abroad of repairing the abdominal wall en masse. The
tuberculosis may be accompanied by some other pathological lesion such
as case No. 1, in which the tuberculosis lesion occurred in an adenomatous hypertrophy of the prostate gland.
There are very few conditions in which surgical removal of a tuberculous prostate is indicated. Evacuation of tuberculous abscess is to
be avoided when possible as such a procedure is liable to be followed
by sinuses which heal slowly or not at all and may become a source of
great annoyance.
Non-Operative Treatment
It is our practice to subject cases that have been operated upon as
well as those upon whom operation is not done to a continual period of
observation and care.
In the clinic which we have established for this purpose and in
fact for the treatment of all cases of post operative and inoperable
tuberculosis of the organs of the genital and urinary tracts, the patient's
temperature is taken and recorded, the weight is observed. Instructions
as to diet, exercise, rest, fresh air, sunlight and other hygienic measures
are carefully explained and enforced as far as possible. In addition parallel   series  of   cases   are  being  observed,  one   group  of  which   is   given
Page 227 Alpine light or quartz light therapy and the other Koch's old  tuberculin in graduated doses.
At the clinic for the treatment of inoperable and postoperative
Urologic Tuberculosis, Urological Department, (James Buchanan Brady
Foundation), of the New York Hospital, tuberculin has been in use for
more than three years. It is not used alone but it is included in the
regime of treatment as an adjunct or subsidiary agent. The regime
comprises besides tuberculin, the hygienic, dietetic and rest treatment
of tuberculosis, mercury vapor quartz light therapy, heliotherapy and
the indicated urologic treatment. The general plan is to combine the
urologic treatment with the treatment of tuberculosis to the extent
it is applicable, thus developing a regime of treatment which may be
adapted to the needs of the individual patient. Those patients with
active pulmonary tuberculosis in addition to their urologic lesions are
not given tuberculin.
The theory upon which tuberculin is given a place in the general
plan of treatment is the present day accepted theory that tuberculin
causes an inflammatory focal reaction at the site of the disease and thus
promotes fibrosis of the lesion. It is recognized that it is difficult to
bring about unharmful focal reactions since the characteristics of the
lesions vary so widely, particularly in renal tuberculosis. In the same
renal lesion young tubercles, old tubercles, small uncaseated tubercles
and large pus filled or fibrotic cavities frequently coexist. It is evident
that the effects of a given amount of tuberculin on the various lesions
must vary widely. Therefore, it has not been deemed wise to adhere to
the plan of small dosage relying on the appearance of any evidence of
local, focal or constitutional reactions as the guide to the dosage. This
method is of course open to criticism on the grounds that focal reactions are not always obtained when there is no subjective or objective
evidence in them. However, the method seems to have worked out
satisfactorily.
Koch's old tuberculin is the only tuberculin used. It was chosen for
no particular reason except a somewhat more extensive experience in its
use and it has been suggested that it causes more inflammatory changes
at the focus of the disease.
Serial doses begun in small amounts are slowly increased until evidence of a local or constitutional reaction occurs, then the dose is reduced and continued with a cautious increase until a reaction again
occurs. It is again reduced and continued as before. The usual beginning dose is one-tenth cc. of a one to ten million dilution of tuberculin.
The injections are given subcutaneously on the outer aspect of the
upper arm.
The serial dilutions of tuberculin are prepared in the following
manner which is at least in part widely used. Seven small wide mouthed
glass stoppers bottled, a graduated one cc. glass pipette and a graduated ten cc. glass pipette are sterilized. In one of the glass bottles one
cc of Koch's Old Tuberculin is placed.    To this is  added nine cc
(Continued on page 233)
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618 Georgia Street West - Vancouver British Columbia Laboratory Bulletin
Published irregularly in co-operation with the Vancouver  Medical  Association Bulletin,
in the interests of the Hospital, Clinical and Public Health Laboratories of B. C.
Edited by
Donna E. Kerr, m.a., of The Vancouver General Hospital Laboratories
Financed by
The British Columbia Provincial Board of Health
COLLABORATORS: The Laboratories of the Jubilee Hospital and St. Joseph's Hospital,
Victoria; St. Paul's Hospital, Vancouver; Royal Columbian Hospital, New Westminster;
Royal  Inland  Hospital,  Kamloops;  Tranquille  Sanatorium;  Kelowna  General  Hospital;
and Vancouver General Hospital.
All communications should be addressed to the Editor as above.   Material for publication
should reach the Editor not later than the seventh day of the month of publication.
Vol. HI
AUGUST, 1929
No. 5
CONTENTS
Blood  Sugar  Determinations Matheson
"Ten   Clinical  Aphorisms"     	
Two Months' Series of Wassermann and Kahn Tests  —Malcolm
BLOOD SUGAR DETERMINATIONS
J. E. Matheson, M.B.
Technical Medical Assistant, V. G. H. Laboratories.
In an effort to be of the most aid to the practising physician in the
treatment of patients, there will be published, in this Laboratory Bulletin
from time to time, short articles on the various laboratory examinations
and their interpretations.
One must not forget that a laboratory examination is only an additional aid to the physician, to be correlated with his other findings, history and physical examination. It is not and cannot be of value if
carried out at random, being then, more or less, a shot in the dark;
and further it cannot be expected to be, in itself, an absolute, and complete means of diagnosis, forgetting all other methods. True, the occasional shot in the dark does sometimes reveal the true soitrce of trouble
but this. is an exceedingly uncertain method. Laboratory procedures
are additional aids as the stethescope is to the ear, and the X-ray machine
to the eye.
Blood Sugar
Blood sugar determinations should be asked for only in those cases
in which the other findings, history, physical and urinary, suggest an
altered blood level. It might be as well to mention here that in suggestive or borderline cases of diabetes single blood sugar determinations are
of little value.   It is in this type of case that a sugar curve is indicated.
Blood Sugar Curve
On the other hand, the known diabetic is in no way benefited
nor is his treatment enhanced, by his being submitted to a sugar curve
determination. The sugar curve is a sugar tolerance test to determine,
in a patient suggesting a diagnosis of diabetes, if the blood sugar content will rise above the normal level and how long it will be maintained
above the normal, following the ingestion of 100 gms. of glucose.
The healthy fasting individual should not, following the ingestion of
100  gms.  of  glucose,  show  a  blood  sugar above  160-180  mgms.   per
Page 229 100 cc. of blood and by the end of two hours this level should have
dropped to normal again.    There should be no glycosuria.
The patient is asked to fast over night in order that the result will
in no way be distorted by any peculiarities or variations in diet for
which he is responsible. The first sample of blood taken, before feeding
glucose, therefore, gives the fasting blood sugar level for that individual,
i.e., a base line from which can be calculated the subsequent changes.
The interpretation of these subsequent changes is important. In
normal individuals the rise from the fasting blood sugar base line, say
80 mgs. to, say, 150 mgs. per 100 cc. occurs within the first hour,
returning to normal in the second hour. In pathological conditions
(diabetes, hyperthyroidism and severe nephritis) the curve rises to a
higher peak and remains high for a period of three hours or longer.
In diabetes particularly the curve is also longer in reaching the peak,
usually about two hours. Some regard the height of the curve, others
the length of time the curve remains high, as the criterion for a diagnosis of diabetes.
High blood sugar levels may be encountered in conditions other
than diabetes, as hyperthyroidism, severe nephritis, pancreatic disease
and certain liver disorders, so that an abnormal sugar curve report indicates only the amount and the degree of the impaired sugar tolerance,
not the final diagnosis.
Diabetic Coma
In the treatment of cases in diabetic coma, we frequently see a
rise in blood sugar content over that found on admission, even after
treatment has been instituted. The patient even when given insulin
along with an interstitial of glucose may show this rise in the second
sample of blood taken up to two hours. The insulin not having had
sufficient time to act has no effect on the blood sugar level, while the
interstitial has produced a further rise in blood sugar. This would
seem to indicate that 1-2 hours after the first dose of insulin, the
interstitial of glucose should be given, at that time repeating the insulin,
should the blood sugar determination warrant it.
In known cases of diabetes which have been taking insulin and
which are seen in coma, it behooves one to have a blood sugar determination done at once, in order to rule out the possibility of the patient
being in a state of hypoglycemia.
Blood sugar determinations are done on unclotted blood samples.
In those instances where the blood has to stand any period of time
before being examined, a preservative as well as an anticoagulant should
be added. Here we use a mixture of one part thymol to ten parts
sodium flmoride, of which 0.11 gms. are added to the tubes for each
10 cc. of blood.
With the particular method used in the Vancouver General Hospital Laboratories, the normal limits for blood sugar concentration are
80 - 120 mgms. per 100 cc. (Other methods give normal limits as 70 -
80 and 80 - 110, but of course it is the relative not the absolute which
is of practical significance).
The upper limit is set by the kidney threshold, i.e. the point at
*vhich the glucose commences to "spill over" into the urine. In diabetics
this renal threshold is frequently raised.
Page 230 There are numerous factors which influence carbohydrate metabolism. Fasting decreases the tolerance of the body for carbohydrate.
On the other hand diets of protein, and those of carbohydrate increase
the capacity of the body to use glucose while a diet of fat decreases this
capacity. Preliminary Technique
FASTING  SUGAR
After an overnight fast, the sample of blood is taken as for Wassermann from the median basilic vein, and placed in the specially prepared tube. GLUCOSE CURVE
After an overnight fast, the sample of blood is taken as above and
the patient is then given 100 gms. of anhydrous glucose, along with the
juice of a lemon. Samples of blood are taken % hour, 2 hours, and
three hours after. The urine is also collected at the same times and
examined quantitatively for sugar.
The actual determination is done by Folin and Wu's method. The
latest method, though giving perhaps a more absolute result, has not
been adopted widely for routine examination, being more complicated
and lending itself less readily to ordinary rapid laboratory requirements.
The results obtained are not any more satisfactory from the clinical
point of view. The method as given in the Journal of Biological
Chemistry, 1920, 41, 367, "Determination of Sugar in the Blood," is
the technique used in this laboratory.
1. Single fasting blood sugar determinations are of little value
in borderline cases of diabetes, except when high results are
obtained.
2. A blood sugar curve determination is only of use in borderline cases suggesting diabetes, from the other findings, and
showing" a normal fasting blood sugar.
3. The report of a sugar curve is a record of the patients glucose
tolerance and not a final diagnosis.
4. The amounts determined are relative quantities and vary slightly with the method used.
5. Patients who have been on insulin, if in coma, should at once
have a single blood sugar determination to ascertain whether
the condition is one of hyper—or hyper-glycemia.
6. The examination is done on whole, unclotted blood, which
must have a preservative added to it if it will be standing any
appreciable length of time before examination.
"TEN CLINICAL APHORISMS"
From an editorial in the Journal of Laboratory and Clinical Medicine, March,  1929, extracted from article  by Reed and Rockwood on
Chemical Tests of the Blood.
"1.    Never ask for both non-protein nitrogen and urea on the same
patient.
Except in emergency, never ask for a non-protein nitrogen
determination when the phenolsulphonephthalein secretion is
normal. Determine the output of the phenolsulphonephthalein
first.
Never ask for the creatinine value of the blood unless the non.
protein nitrogen content is above 60 mg. per hundred  cubic
2.
3.
Page 231 9.
10.
centimeters.    Then determine the concentration of the creatinine as a matter of routine.
Order determinations of the uric acid content only in cases of
gout.
Order blood-sugar determinations only in cases of diabetes or
suspected diabetes or hypoglycemia.
Ask  for   a   test  of   the   carbon   dioxide   combining  power  of
plasma in:
(a) Diabetic patients with diacetic in the urine.
(b) Uremic patients with nitrogen retention and dyspnea.
(c) Patients showing toxic symptoms who are receiving large
doses of alkali.
(d) Conditions associated with disturbed motility of the gastrointestinal tract with marked toxemia.
(e) Tetany of any type.
Order chlorides, non-protein nitrogen and carbon dioxide combining power determinations in all cases of disturbances of the
gastrointestinal motility with marked toxemia.
Ask for serum bilirubin or icterus index tests in cases o^
jaundice, but do not pay much attention to borderland values.
Ask for blood calcium determinations only in cases of rickets
and infantile tetany.
Order inorganic phosphorous tests, if practicable only in cases
of rickets and infantile tetany."
TWO MONTHS' SERIES OF WASSERMANN AND KAHN TESTS
* Mabel M. Malcolm
Head, Bacteriology Division, V. G. H. Laboratories.
After running as a routine test for two months the Kahn Precipitation Test and the Wassermann Complement Fixation Test in a
parallel series, we find that the Kahn Test shows 20% more positive reactions than the Wassermann Test.
The following table is a resume of results obtained during the two
months:
Number  of  Wassermann  Tests 1841    j
Number of Kahn Tests  ....1717   "j    355S
Number of agreements in both tests 1366
Number of Kahns positive and Wassermanns negative 351
Number of Wassermanns positive and Kahns negative 0
This series of about 1800 comparative tests tends to show that the
Kahn Test is more sensitive both in picking up new cases and in remaining positive after treatment has been given. In all cases where we
have been able to obtain information regarding the disagreements there
has been reason for a positive reaction; and we have not been able to
find any instance where a false positive reaction has been obtained with
the Kahn Test.
We sincerely hope that physicians will continue reporting to us the
clinical conditions of patients showing "Kahn positive, Wassermann
negative," especially if the clinical findings indicate a discrepancy from
the Kahn positive.
Page 232 (Continued from page 228)
of the diluent consisting of distilled water to which eight-tenths of one
per cent, of sodium chloride and twenty-five hundredths of one per
cent, of phenol have been added and sterilized by autoclave. The bottle is
labelled O.T. 1 and for convenience the date of the preparation is also
placed on the label. The bottle is shaken vigorously by hand and one
cc. is withdrawn and placed in one of the remaining bottles. To this
is added nine cc. of the diluent and the bottle is labelled O.T 01.
After shaking, one cc is then withdrawn from this bottle and the
dilutions are carried on in the same manner through the remainder of the
seven bottles.   There are then seven bottles labelled as follows:
O.T. 1; O.T. .01; O.T. .001; O.T. .0001; O.T. .00001; O.T.
.000001;  O.T.  .0000001.
The tuberculin is not designated in milligrams or grams as the
above liquid measurements have been found practical for both estimating
the individual patient dosage and for record keeping. The dilutions are
kept in the refrigerator in the intervals between clinic sessions. Fresh
dilutions are made about every two weeks during summer months and
monthly during the winter. The diluent has been kept as long as a
year with no evident deterioration.
Conclusions
In conclusion I wish to repeat that the diagnosis of tuberculosis is
now based largely on the appearance of the pyelogram and the decision
to remove a kidney for tuberculosis is based entirely upon its function
as compared with the other. The mere finding of tubercle bacilli in
the urine from a suspected kidney or the positive guinea pig test plays
almost no part in one's decision to remove the kidney.
The removal of a tuberculous kidney marks the beginning of the
wise surgeon's work and not the end. We now feel that the after
care of this type of patient is the most important feature of such a
case; also that the word "arrested" is better when applied to a case of
urinary, tuberculosis than cured just as the medical man considers the
pulmonary case arrested and never cured.
THE NEW "CANADIAN JOURNAL OF RESEARCH"
of the
NATIONAL RESEARCH COUNCIL OF CANADA
Volume 1, No. 1, May, 1929 of this welcome accession to Canadian
Scientific literature is now in our hands. All Canadians, and especially
all interested in Canadian contributions to science, must welcome it
heartily. Not always has it been fully recognized that Canada has contributed very notably to literature, especially to scientific literature, and
to such an extent that Canada and Canadians rank very high indeed in
scientific fields; outstandingly in Medicine, e.g. Osier, Barker, and in
Geology, e.g. Dawson, Coleman.
The first volume of this new Journal, introduced by a Foreword
from H. M. Tory, contains articles, all from Canadian sources, on Rust
Page 233 in Wheat, Aluminates of Calcium, Vaccination with B. C. G., Ultraviolet light—a wide range. The Universities of Alberta, Saskatchewan,
Manitoba, Toronto, Queen's, McGill, and Montreal, the Federal Department of Agriculture, the Biological Board of Canada, Sanatoria in
Qu'Appelle, Saskatchewan and London, Ontario, and the Sun Life Assurance Company, have all contributed to one or more of the co-operative
investigations here reported, in conjunction with the National Research
Council of Canada.
Amongst other items of interest,  the following extract throws a
side-light  on   a   biological  problem  of   everyday  practice   of medicine,
in a field not yet fully worked out—the problem of general resistance
to infection as distinct from specific resistance.
Newton, Lehmann and Clarke of the University of Saskatchewan,
reporting on "Studies of the Nature of Rust Resistance in Wheat" as
the first article of the first volume, make the following statements (the
italics are ours):
"There existed some years ago a popular impression that the susceptibility of a plant might be influenced directly by its general condition
ef health, and that improved methods of culture might maintain the
plants in a thriftier state in which they could better ward off their
fungus enemies. In view, however, of the quasi-symbiotic relationship
between susceptible host and parasite, it is not surprising to find that
most investigations on this> point have shown the reverse to be true.
Stakman and Levine (63) found that adverse environmental conditions,
unfavourable for wheat, were also unfavourable for the rust parasite,
decreasing its virulence and spore size. Raines (57) reported a direct
correlation between vigour of host and virulence of disease in a number of other cereal rusts. An apparent exception to this relationship is
reported by Lee (37), who was able to prolong for several months the
sound, healthy condition of sugar-cane cuttings in soil, by a system of
pruning which maintained the cuttings in an actively functioning state.
Normally, when the new shoots are allowed to form independent roots,
the cuttings fall an early pr*y to soil fungi. But it would appear that
the issue is complicated here by the onset of natural necrosis, independent of parasitic attack, in tissues which have ceased to function.
Peltier (53) investigated the influence of soil temperature, soil
moisture, air temperature, relative humidity, and light intensity on infection by wheat stem rust. He found that the longevity of the
urediniospores, the ease of initial infection, and the vigour of development of the disease could be modified to some extent by controlling
these factors; also that two biologic forms of rust showed certain differences in adaptations. In general, however, changes in groiving conditions caused the vigour of host and parasite to fluctuate together, and
in no instance was the characteristic type of infection changed.
While it appears, therefore, that we cannot look to environmental
adaptations as a basis for true resistance or susceptibility, we must nevertheless recognize the direct relation of environment to the metabolic
status of the plant, and in consequence to the probable virulence of
disease attack.    Henning   (28)   drew attention to the relation between
Page 234- resistance to yellow rust in wheat and the acid-sugar ratio in the plants
found in certain experiments. Dickson and Holbert (21,22) were able
to modify the severity of seedling blight in corn and wheat by controlling the growing temperatures. This result was associated with the
altered composition of seedlings grown at different temperatures, particularly in regard to carbohydrate distribution. Pentose substances
were shown by culture experiments to be superior to hexose compounds
as a source of carbon for the causal organism, and in practice those conditions which favoured the accumulation of pentosans in the seedlings
also favoured the development of blight. The metabolism of susceptible
and. resistant host strains was significantly different, and seemed in this
instance to be the determining factor in disease reaction."
There is much "food for thought" in the above, which is recommended to students of these problems everywhere for careful consideration.
H. W. H.
B. C. MEDICAL ASSOCIATION NEWS
The Annual Meeting of the B. C. Medical Association will be held
on Wednesday and Thursday, September 25 th and 26 th. A very strong
clinical, business and social programme is being arranged, and already a
great many out-of-town doctors have signified their intention to be
present. The following gentlemen from the east are included in the
list of speakers:
Dr. A. T. Bazin, President C. M. A., Montreal.
Dr. K.  A.  MacKenzie, Associate Profesor  of  Medicine,  Dalhousie
University, Halifax.
Dr.   Geo.  H.   Murphy,  Associate  Professor  of  Surgery,   Dalhousie
University, Halifax.
Dr.'.G. E. Richards, Professor of Radiology, University of Toronto.
Dr.   Geo.   S.   Young,  Associate   Professor  of  Medicine,   University
of Toronto.
Dr. H. B. Van Wyck, Associate Professor of Obstetrics, and Gynaecology, University of Toronto.
One need hardly add that this group of speakers will present a
type of programme which will be most acceptable. Subjects will be
published in the next issue of the Bulletin.
In addition to the above, Dr. Ross Millar of Ottawa will bring
greetings from the Department of Health for Canada. Dr. G. Harvey
Agnew will also have something to say about the Department of Hospital Service of the Canadian Medical Association.
Dr. A. T. Bazin, as President of the C. M. A. will speak on one
subject only, viz.; "A potpourri—the Pitfalls of Practice." This is due
to the fact that he desires, on this trip, to talk medical organization,
etc., rather than to stress the scientific side of the programme from his
point of view.
Page THE COOKING OF LIVER FOR THE TREATMENT OF
PERNICIOUS ANAEMIA
By C. E. Pollock, M.R.C.S., Eng.
Reprinted from the Lancet, September 22,   1928.
Liver as usually cooked soon palls. Being myself an involuntary
member of the "honourable company of liverers," and not relishing the
prospect of having to eat the same preparation of liver four or five days a
week, I set to work to find ways of converting our mainstay of life into
an attractive item on the menu. I give the results obtained up to the
present, and with further experience I hope to add to the list.
When cooking liver the following general rules should be observed:
(a) Fresh ox liver is more effective than calf liver.
(b) The cooking should be short, and the temperature should be
kept as low as possible—just sufficient to make the liver seem
to have been cooked.
(c) No more fat should be used than is actually necessary for
each dish.
(d) Grilling makes the liver tough.
(e) Only a little salt should be used in the cooking; more can be
added when it is eaten.
(/)   Any sweet flavouring, such as chutney, should be used sparing-
ly-
Some Recipes
Liver Sandwiches.—The following has been successfully used by
friends for a child. Put the raw liver through a mincer and remove
any fibrous parts. Spread the minced liver on thinly cut slices of bread
and butter, or a piece of toast which has been split in two. In either
case use little or no butter. Add pepper and salt according to taste,
sprinkle it freely with fresh lemon juice, and a trace of grated onion.
A few dabs of Bovril, or a thin layer of grated cooked ham improves
the flavour.    Finely-chopped pickles may be used in place of ham.
Fried Liver.—Cut the liver into rather thin slices. Put a small
quantity of butter, margarine, or a slice of not very fat bacon into
the frying-pan and heat to low frying temperature. Cook gently from
five to ten minutes to suit the individual's taste.
Dry Curry.—Slice the liver as above. Put into the frying-pan a
little butter and a dessert-spoonful of chutney with a squeeze of lemon
juice. Heat this while stirring it to a low frying temperature. Roll the
slices of liver in dry curry powder and place them in the pan. Cook
gently for five to ten minutes.
Liver Puree.— (a) Prepare a white sauce. Stir in six ounces of
grated raw carrots; if it is coarse, or, if young carrots are obtainable,
the same quantity finely chopped. Boil gently for a few minutes. Stir
in the minced raw liver and let it stand for three minutes on the warm
top of the stove, away from the flame.
(b) Prepare a brown gravy, using as little fatty substance as possible. Bring this to the boil, then move the pan away from the flame,
and stir in the minced raw liver.    Let it stand for three to five minutes.
Page 236 Green peas or finely-sliced young carrots improve the flavour.    Serve on
toast.
(c) Prepare a breakfast-cupful of Bovril or Marmite. Bring it to
the boil, stir in the minced liver, and let it stand for a couple of minutes
on the top of the hot stove. This is very useful when the liver is required at short notice.
Liver Soups.—Prepare a breakfast-cupful of any of the following
soups: Tomato, veal broth, chicken, or rabbit broth. Many others,
such as potato soup, game soup, milk and celery soup, make a pleasant
variation. Bring the soup up to the boil. Take the pan off the fire, stir
in the minced raw liver, and let it stand for a few minutes.
Minced Liver on Toast.—Prepare a tasty gravy flavoured with a
sauce such as A. 1 or Harvey's. Chop the liver and cook gently in the
gravy for three minutes, spread it on the toast, and serve hot.
Liver and Eggs.—Minced raw liver may be beaten up with milk and
eggs and served as scrambled eggs. An omelette may be filled with
minced liver cooked slightly in a tasty gravy.
Liver Roll.—Mince together twelve ounces of liver, six ounces of
beef (preferably steak), and six ounces of rather lean bacon. Add a
trace of finely chopped onion. Mix a teacupful of breadcrumbs with
the minced liver and bacon. Beat up one egg and stir it into the liver
mixture, flavouring the whole with a little tomato sauce. Wrap it in
grease-proof paper, and cook in a steamer from one to one and a half
hours. Let it get cold and eat it as a sandwich, or in place of cold
meat.   This is a useful preparation when travelling.
Rissotto.—Boil some rice in the ordinary way. Cut the liver into
dice of about half an inch, and cook in a savoury sauce, tomato for
preference. Place the cooked rice in a hot dish, making a hollow in the
middle. Put the liver into this. If preferred, the liver may be sprinkled
with lemon juice and lightly fried. In this case a well-flavoured sauce
should be served to pour over the rice. Cooked macaroni may be used
in place of rice.
Stuffed Potatoes.—Bake or boil two large potatoes in their skins.
When cooked cut off the upper third. Scoop out one-third of the
potato. Into the space thus formed put minced liver, previously cooked
in brown gravy and well seasoned with ketchup and lemon juice. Mash
the removed potato, and use some of it to form a cap to the liver.
Place a thin slice of bacon over the top, and put them into a hot oven
for three minutes.
Chicken and Liver Fricassee.—Minced liver mixes well with chicken
fricassee prepared in the ordinary way.
Toad-in-the-Hole.—Liver may be used in this dish in place of beef.
When making the batter stir in a teaspoonful of ketchup. Cold cooked
liver and potato salad made with mayonnaise is excellent for an occasional change, but contains too much oil to be used frequently.
With experience other recipes will suggest themselves to the interested cook, and the anasmic brother will bless her ingenuity.
Page 237 CERVICITIS
AND ENDOCERVICITIS
do not cause acute pain but by reason of extension of the
infection by way of the lymphatics into the parametrium
there is often considerable sensation of weight and bearing
down in the pelvis. In these conditions it is surprising
what relief can be given by the insertion of the Antiphlogistine tampon, which, on account of its marked
hygroscopic property, induces an abundant serous transudation.
@4n£ifmwaid£in&
with its 45% cp. glycerin, is ideally adapted for the
vaginal tampon, combining as it does the much needed
mechanical support with the prolonged glycerin action.
Leading obstetricians and gynecologists generally concede
its practical value in all those cases where prompt depletion
is a paramount consideration.
Antiphlogistine is antiseptic, non-irritating and by
virtue of its thermogenetic potency may be relied upon
to maintain moist heat longer than any similar preparation now available to the medical profession.
The Denver Chemical Mfg.
Company
153 W. Lagauchetiere St.
Montreal VANCOUVER HEALTH DEPARTMENT
STATISTICS JUNE,  1929
Total   Population    (Estimated)       — — - — -    228,193
Asiatic   Population    (Estimated)       12,300
Rate per 1,000 of Population
Total    Deaths     _   	
Asiatic   Deaths     _     	
Deaths—Residents    only    — _
Birth   Registrations      -	
Male       175
Female    160
INFANTILE MORTALITY—
Deaths under one year of age	
Death   rate  per   1,000   births	
Stillbirths   (not included in above)
197
10.50
25
24.73
171
9.12
335
17.86
14
41.80
14
CASES OF CONTAGIOUS DISEASES REPORTED IN CITY
May, 1929
Cases      Deaths
June, 1929
Cases     Deaths
July 1st
to 15th, 1929
Cases      Deaths
Smallpox      22
Scarlet   Fever       14
Diphtheria        35
Chicken-pox      6 5
Measles       607
Mumps       156
Whooping-cough        13
Tuberculosis
Erysipelas       x. 	
Typhoid   Fever   	
Poliomyelitis ,_	
Meningococcus    Meningitis..
16
8
1
2
5
1
0
0
0
1
0
0
15
0
0
0
2
13
15
26
27
236
77
17
22
12
1
0
1
0
0
: -4
0
0
26
1
0
0
1
4
6
14
4
10
2
0
6
4
0
0
0
N.B.—Typhoid case from outside City.
A SHOCK PROOF X-RAY APPARATUS
One of the large manufacturers of electrical machines has invented
a new type of X-ray apparatus which is completely insulated in oil and
with all high voltage wires eliminated.
The Coolidge tube is concealed in an aluminum container filled with
oil with an adjustable slit through which the rays are projected.
The usual noises and other evidences of electrical energy are not
appreciable to the bystander, thereby eliminating the effect of the use
of the usual apparatus on susceptible persons.
If the claims submitted by the manufacturers prove to be all that
have been set forth, a new era of safety will ensue which will prevent
the hitherto serious danger to patients and operators connected with
X-ray exposure. It may be that suits for damage due to X-ray burns
will be a matter of history.
—From the New England Journal of Medicine.
Page 23 8 Try It at Our Expense ...
•»
wan
Xphedrine §a m
nhdanti^66i
"Return Coupon for Sample
I earn for yourself how promptly out the irritation of inhalants
j and effectively Swan-Myers containing menthol, thymol,
Ephedrine Inhalant, 1%, No. 66, eucalyptus, or other aromatics...
relieves the nasal congestion of Stocked by dealers in 1-ounce
colds, coryzas and hay-fever with- and 1-pint bottles.
THE WINGATE CHEMICAL CO., Ltd., 468 St. Paul St., West, Montreal
Send physician's sample Swan-Myers Ephedrine Inhalant, No. 66, to
Address.
.M. D.
Say it with Flowers
Cut Flowers, Potted Plants, Bulbs, Trees, Shrubs,
Roots, Wedding Bouquets.
Florists' Supplies and Funeral Designs a Specialty
Three Stores to Serve You:
48 Hastings St. E.
66 S Granville St.
151 Hastings St. W.
One Phone:
Seymour 8033
Connecting all three stores.
Brown Bros* & Co. Ltd.
VANCOUVER, B. C. McKEE - COLEMAN
Clinical Laboratories
We expect to move to the new Medical and
Dental Building during the latter part of August.
There will be no break in the service.
Lab.: Sey. 2996     Dr. C. S. McKee, Bay. 268
(No change)     Dr. R. E. Coleman, Bay. 5194
McBeath-
Campbell
Limited
Printers and,
Publishers
Vancouver, B. C.
The Owl Drug
Co*, Ltd*
All prescriptions
dispensed by qualified
Druggists.
You can depend on the
Owl for Accuracy
and despatch.
We deliver free of
charge.
5    Stores,   centrally   located.
We would appreciate a call
while in our territory. 536 13th Avenue West
Fairmont 80
Exclusive Ambulance Service
FAIRMONT 80
ALL ATTENDANTS QUALIFIED IN FIRST AID
"St. John's Ambulance Association"
WE SPECIALIZE IN AMBULANCE SERVICE ONLY
R. J. Campbell J. H. Crellin W. L. Bertrand
STEVENS'
SAFETY PACKAGE
STERILE GAUZE
is a handy, convenient, clean commodity
for the bag or the office.
Supplied in one yard, five yards and
twenty-five yard packages.
ESTABLISHED   NEARLY A
.CENTURY^
B.C. STEVENS CO.
Phone
Seymour 698
730 Richards Street
Vancouver, B. C m
gOaj »••
Hollywood Sanitarium
LIMITED
fyor the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference ~ 33. Q. <&fteo\ica\ ^Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
"*«V

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