History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: March, 1935 Vancouver Medical Association Mar 31, 1935

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Full Text

 The BULLETIN
OF THE
VANCOUVER MEDICAL
ASSOCIATION
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Vol. XI.
MARCH, 193 5
No. 6
In This Issue:
CASE AGAINST TOBACCO  ::  CASE REPORTS
CLINICAL MEETING
NEWS and NOTES
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FINEST QUALITY
Halibut Liver
Oil
Biologically tested, imported from Great
Britain. Guaranteed to contain at least
50,000 International Vitamin A Units per
gram.
This fine produce is unsurpassed and is at
your disposal for prescription either in bulk
or collapsible capsules at approximately half
the price of other similar products.
Capsules containing 3 minims (equivalent in
Vitamin A content to 4 teaspoonsful of Cod
Liver Oil) 50 in box for $1.00.
Obtainable at all
VANCOUVER  DRUG CO.  STORES
Western Wholesale Drug Co.
(1928) Limited
456 BROADWAY WEST
VANCOUVER   -   BRITISH COLUMBIA
!■■ THE     VANCOUVER     MEDICAL     ASSOCIATION
BULLETIN
'Published Olonthly under the ^Auspices of the Vancouver dledical ^Association in the
Interests of the ^Medical "Profession.
Offices:
203 Medical Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. H. MacDermot
Dr. M. McC. Baird Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address
Vol. XI. MARCH, 193 5 No. 6
OFFICERS  1934-1935
Dr. A. C Frost Dr. C H. Vrooman Dr. W. L. Pedlow
President Vice-President Past President
Dr. W. T. Ewing Dr. W. T. Lockhart
Hon. Secretary Hon. Treasurer
Additional Members of Executive:—Dr. H. H. McIntosh, Dr. L. H. Appleby
TRUSTEES
Dr. W. D. Brydone-Jack Dr. J. A. Gilles"ie Dr. F. Brodie
Auditors: Messrs. Shaw, Salter & Plommer
SECTIONS
Clinical Section
Dr. W. L. Graham      Chairman
Dr. J. R. Neilson   __.   -  Secretary
Eye, Ear, Nose and Throat
Dr. E. E. Day   __    - -  Chairman
Dr. H. R. Mustard           -  Secretary
Paediatric Section
Dr. G. A. Lamont   Chairman
Dr. J. R. Davies   —   - —Secretary
Cancer Section
Dr. A. B. Schinbein      Chairman
Dr. J. W. Thomson         .._ Secretary
STANDING COMMITTEES
Library Summer School
Dr. W.D.Keith Publications '     Dr. H. A. DesBrisay
Dr. C. H. Bastin Dr j h MacDermot Dr. H. R Mustard
Dr. A. W Bagnall Dr Jd. e r Cleveland Dr. I W. Thomson
Dr. a E^ Kidd Dr Murray Baird Dr. C E. Brown
Dr. W. K. Burwell Dr. J. E. Walker
Dr. C A. Ryan Dr. J. W. Arbuckle
Credentials Hospitals
Dinner t^    t>   a   c        «...
n    T w T Dr- R- A- Simpson d    t h Lennie
DR-^ Thomson Dr. J. T. Wall Dr. C F. Covernto>
nR'wT^EES Dr. D. M. Meekison Dr. H. H. Milburn
Dr.W.G.Gunn Dr.S.Paulin
V. O. N. Advisory Board
Dr. I. Day Rep- to B- c- Medical Assn.
Dr. H. H. Boucher Dr. Wallace Wilson
Dr. W. S. Baird
Sickness and Benevolent Fund — The President — The Trustees
>i MILK and TEETH
THE importance of milk in formation and protection of teeth is discussed by Dr. Annie S.
Veech, of the Kentucky State Department of
Health, in the November Bulletin of that Department as follows:
IMPORTANCE OF MILK
"The ONE defect most prevalent among school children is
decayed teeth.
"The building of strong teeth begins before the child is born.
"Its six-year molars are all formed in the jaws before it is born.
"They should be perfect in the jaws throughout life.
"Whether or not they last depends, first, upon whether or not
its mother had, during the prenatal and nursing periods, the quart
of milk, every day, which she needs.
"Whether or not these teeth decay depends, also, upon whether
or not the child has had a quart of milk, every day, during its late
infancy and pre-school life.
"Teeth are largely made of calcium, and there is no sufficient
source of supply except in the use, daily, of one quart of milk.
"The various parts of the body wear out and have to be rebuilt.
"The rebuilding material is carried by the blood to the parts
where it is needed.
"In this way calcium from milk is carried to the tee.th and does
rebuild them.
"This has been repeatedly shown by the X-ray."
A truth which is not covered by this statement is that the
body needs more Vitamin D if it is to make the best use of the
milk in the formation and protection of teeth.
The importance of milk in the production and in the protection of teeth is here stated so clearly that it should be understood by anyone.
ASSOCIATED DAIRIES
LIMITED
DISTRIBUTING
RICH—SAFE—CLEAN—MILK
SERVICE phones:
Fairmont 1000     North 122     New Westminster 1445 VANCOUVER HEALTH DEPARTMENT
STATISTICS—JANUARY,  193 5
Total Population  (Estimated) .
Japanese Population   (Estimated) —
Chinese Population   (Estimated)   .
Hindu Population  (Estimated)	
244.3 29
8,037
7,803
276
Total Deaths	
Japanese Deaths	
Chinese  Deaths ._
Deaths—Residents   Only	
Birth Registrations—
Male, 167; Female, 151.
INFANTILE MORTALITY—
Deaths under one year of age...	
Death rate—per 1,000 births—	
Stillbirths (not included in above).
Number
223
8
12
197
318
January,
1935
8
22.0
5
Rate per 1,000
Population
10.7
11.7
18.1
9.5
15.3
January,
1934
8
26.6
7
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
February 1st
December, 1934
Cases     Deaths
Smallpox  ,	
Scarlet   Fever	
Hpfehtheria   -	
Chicken Pox	
Measles _
Rubella  ..
Mumps     	
Whooping-cough   	
Typhoid Fever
Undulant Fever	
Poliomyelitis   ....
Tuberculosis 	
Meningitis   (Epidemic)..
Erysipelas    	
Encephalitis Lethargica
Paratyphoid   .
0
47
5
99
2
0
27
13
1
0
1
47
0
3
0
0
January, 193 5
Cases     Deaths
0
0
45
2
82
2
2
6
51
0
0
0
41
0
0
0
0
to 15th, 193 5
Cases     Deaths
0
0
2
0
0
0
0
0
0
0
0
13
0
0
0
0
33
0
43
4
3
11
28
0
0
0
28
0
0
0
0
BIOGLAN "A"
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A composite endocrine tonic for use in those cases where there is little
indication of a specific gland being at fault, but every indication ot a
general failing of all the endocrine organs.
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Indications:  Premature senility, lack of mental and physical energy
and concentration, reduced resistance to infection, impotence, sexual
frigity, muscular weakness and debility, neurasthenia.
THE BOWSHER LABORATORIES LTD.
Biological and Research
Fonsbcume Manor, Hertford, England.
Rep., S. N. BAYNB
1432 Medical Dental Building1       Phone Sey. 4239       Vancouver, B. C.
References: "Ask the Doctor who has used it."
till
Page 120 PUBLIC HEALTH
BIOLOGICAL PRODUCTS
Diphtheria Antitoxin
Diphtheria Toxin for Schick Test
Diphtheria Toxoid   (Anatoxinc-Ramon)
Scarlet Fever Antitoxin
Scarlet Fever Toxin for Dick Test
Scarlet Fever Toxin
Tetanus Antitoxin
Anti-Meningitis Serum
Anti-Pneumococcic Serum  (Type 1)
Anti-Anthrax Serum
Normal Horse Serum
Smallpox Vaccine
Typhoid Vaccine
Typhoid-Paratyphoid Vaccine
Pertussis Vaccine
Rabies Vaccine   (Semple Method)
Price List Upon Request
Connaught Laboratories
University of Toronto
TORONTO 5 - CANADA
Depot for British Columbia
Macdonald's Prescriptions Limited
Medical-Dental Building, Vancouver, B. C. VANCOUVER MEDICAL ASSOCIATION
Founded  1898     ::    Incorporated   1906
Programme of the 3 7th Annual Session
GENERAL MEETINGS will be held on the first Tuesday of the month
at 8 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the month
at 8 p.m.
Place of meeting will appear on 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.
1934.
October 2nd—GENERAL MEETING.
Dr. G. F. Amyot: "Infection, Its Spread and Control."
Discussion: Dr. E. D. Carder
Dr. H. A. Spohn.
October 16th—CLINICAL MEETING.
November 6th—GENERAL MEETING.
Dr. C. E. Brown: "Some Secretory Disturbances of the Stomach."
Discussion: Dr. H. A. DesBrisay.
Dr. A. Y. McNair.
November 20th—CLINICAL MEETING.
December 4th—GENERAL MEETING.
Dr. A. B. Schinbein: "Tumours of the Breast."
Discussion: Dr. J. J. Mason
Dr. B. J. Harrison
Dr. H. H. Pitts.
December 18th—CLINICAL MEETING.
1935.
January 8th—GENERAL MEETING.
Dr. W. E. Ainley: "The Relation of the Retina to Cardio-Vascular
and Renal Disease."
Discussion: Dr. W. D. Keith
Dr. Wallace Wilson.
January 22nd—CLINICAL MEETING.
February 5th—GENERAL MEETING.
Dr. Murray Blair: "Physiological Observations in Obstetrics."
Discussion: Dr. W. S. Baird.
February 19th—CLINICAL MEETING.
March 5 th—GENERAL MEETING.
The Osler Lecture—Dr. "Wallace Wilson.
March 19th—CLINICAL MEETING.
April 2nd—GENERAL MEETING.
Dr. F. "W. Emmons: "The Surgery of the Presacral Nerve."
Discussion: Dr. J. J. Mason
Dr. F. Turnbull.
April  16th—CLINICAL MEETING.
April 23rd—ANNUAL MEETING.
Page 121
m  EDITORS PAGE
"How far that little candle throws its beams!" We recently received a
letter from the editor of a biological journal in the U.S.A., published in
Philadelphia, asking us about the article written by Dr. T. Furuhata on
blood grouping some year or two ago, and wondering if we often did
that sort of thing. "We didn't think Philadelphia even knew there was a
Bulletin of the V.M.A. But (Carlyle could put it so much better)
there is no end to the ripples started in the pond of science, when a really
valuable contribution is made; they radiate on and on, and there are
plenty of people sitting ready to observe them. Every so often we have
proof of this, in letters from various parts of the world asking about some
original piece of work that we have been fortunate enough to secure. Some
doubting Thomases (and Thomasinas) have questioned the wisdom of our
Editorial Board in publishing so much in the shape of contributions, and
devoting so little space to local news, library news, abstracts, etc. Well,
"they are right, and we are right, and both of us are right"; it is partly a
matter of expediency, partly of policy.
We feel that a few words of explanation might not be out of place
here. Our ideal would be a magazine where heaps of room was available for
a record of local happenings and items of interest, these to be contributed
from other centres as well as Vancouver. Then there would be ample room
for the Library to set forth samples of its good things for tasting, and
whetting of appetites. Then there should be full accounts of the meetings
held, written up in a bright way, but so that the excellent work done by
those who present cases mig;ht not be lost. Then there should be space to
record the transactions of such organisations as the Osier Club, and
the Study Club, and the staffs of the hospitals might well be given an
opportunity to set forth details of cases of interest, and advances in hospital work. And, too, there should still be plenty of space for papers read
by members of our Association. Because very often these are much too good
to be allowed to slip back into oblivion; they will bear reading and re-reading. Some will say that if they are as good as all that, they should be sent to
magazines with a wider circulation than we can command. We are not
entirely in agreement with this, and feel that a paper read before the Vancouver Medical Association might well be regarded as the property of that
Association, and reserved for its Bulletin. Because, as we stated at the
opening of these remarks, there is no fear that it will be lost or missed, if it
is worthy of a wider circle of readers. Other journals, libraries, etc., take
the Bulletin and read it through, and abstract freely from it anything
that in their opinion is worth abstracting.
We feel, too, that this feature of the Bulletin secures a much wider
audience for our speakers; it reaches all of B. C. and enables our fellows to
share in our good things—and that, in our humble opinion, is one of the
most valuable features of the Bulletin. Local news is very delightful
(most of us, though we may protest weakly and unconvincingly, bridle and
simper a bit when we see our name in print) but it only appeals' to a local
audience, and it is very ephemeral. Abstracts and epitomes too frequently
are a lazy man's excuse for not doing the reading that he should, and so on.
But a good paper, well presented (and double-spaced of course), is a joy
for ever, and is available for a long time.
And lastly, it affords an opportunity, scant as it is so far, for original
Page 122
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work and research, to many who would be discouraged by the larger effort
necessary to reach the bigger and more crowded journals; and we cannot
but think that this policy should be emphasized as much as possible. Naturally, our scope is limited, and our space rather restricted, but who shall
set a limit to the possibilities of the future? Certainly not the present
Editorial staff, whose width of vision is quite capable of anything, even if
at present the field is somewhat narrowed by the exigencies of financial
limitations.
So, since we have to cut our suit according to our cloth, and sacrifice
something, we can only try to make as good-looking, hard-wearing, and
long-living a suit as we can; and even if we have to omit some pockets, and
limit ourselves to one pair of unmentionables, attempt to secure the object
expressed in the phrase "the greatest good of the greatest number."
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NEWS AND NOTES
Dr. Ross Davidson, well known to Vancouver medical men as a recent
interne at the V. G. H., appeared suddenly in Vancouver the other day in
the role of Lochinvar, and carried off Miss Buchanan, who for some few
years has helped us in our perplexities and soothed our ruffled susceptibilities,
as admitting officer at the same hospital. The happy pair have returned to
Ocean Falls, where Dr. Davidson is practising, and they have our best
wishes for long life and happiness.
Dr. Gordon Burke, missing the other day, was being eagerly sought
after by the photographers for the U.B.C. Totem, which wishes to record
his features for posterity. We hope he will be more adequately dressed than
in the picture usually published.
Dr. W. Y. Corry has been appointed medical officer to the Provincial
Home for Incurables at Marpole.
The following excerpt from the University of Manitoba news (CM.A.
Journal) is of interest, and we feel that Dr. Pedlow should be sent a marked
copy: "Following the bonspiel at Winnipeg in February a three days course
in cardiovascular diseases will be arranged. . . ." We gather (correct us if
we are wrong) that the clinical material will be taken from those participating in the bonspiel. We have always felt ourselves that golf is a much
safer game. It is just possible that the collapse of the roof of the Forum was
an "act of God" after all, and that the Lord still has some work for Dr.
Pedlow.
Dr. H. I. Campbell-Brown has decided to take up practice in Vernon,
for which town he will be leaving shortly.  We wish him the best of luck!
We all regret exceedingly the death of Dr. A. V. Webster, who had
practised medicine in Vancouver for many years. A quiet, unassuming
chap, he had faced ill-health and partial invalidism with great courage for
a long time, as his heart had given him trouble ever since college days.
Everyone liked "Hughie" and found in him a genial friend. He leaves a wife
and daughter, to whom we offer our sincerest sympathy in their loss.
Page 123 Our Librarian requests us to thank the unknown benefactor who has
recently returned, in a plain wrapper, with no clues in the shape of fingerprints or eccentricities of handwriting, a journal which has been missing
from the Library since 1929. Perhaps he has just got it read, or perhaps the
approach of old age, with its memento mori, has awakened a conscience
which we feel must be somewhat atrophic and nodular. But we are glad
to get the magazine back—and hope the gap in the restorer's shelves will
not be too painful a sight.
if!
Dr. Lyon Appleby flew south recently to attend a meeting of the Pacific
Coast Surgical Association at Santa Barbara, and has now returned.
Dr. G. F. Strong has returned from Honolulu, but was unfortunately
compelled to go east to Minneapolis, on account of the illness of his sister.
We hope, by this time, that she has completely recovered.
THE KING GEORGE V SILVER JUBILEE FUND
FOR CANCER IN CANADA
His Majesty, the King, has graciously given his consent to the twenty-
fifth anniversary of his accession to the throne being recognized in Canada
by way of a campaign to raise funds to combat cancer, the campaign to be
in charge of His Excellency, the Governor General of Canada. His Excellency has announced that the campaign will be inaugurated at an early date
and will close on May 5 th. It is hoped that all Canadian citizens will desire
to contribute to the fund, having regard to its testimonial character for so
belc/ved a sovereign, and the purpose for which the fund is to be used,
namely, to combat the ravages and growing menace of the dread scourge,
cancer.
When the fund is completed, it is to be turned over to a Board of Trustees of seven men, as follows: The Chief Justice of Canada (Chairman);
the Prime Minister of Canada; the Leader of the Opposition; the Minister of Health for Canada; the Chairman of the Cancer Committee of the
Canadian Medical Association; a representative of the French-speaking
Medical Schools; a representative of the Health Committee of the Canadian
Life Insurance Officers Association.
The Canadian Medical Association is honoured lin having been invited
to occupy a seat on this Board, and is particularly pleased that that place is
to be filled by Dr. A. Primrose of Toronto, Chairman of the Association's
Study Committee on Cancer.
The announced objective of the fund is two-fold: (1) to carry on an
educational campaign to assist the medical profession in their fight against
cancer; and (2) to carry on an educational campaign to enlighten the laity
as to the part which they should play in combatting cancer. With the
magnificent assistance of the Sun Life Assurance Company of Canada, the
Canadian Medical Association carried on, over a period of seven years, a plan
of extramural postgraduate medical education covering the entire Dominion.
The value of this service has long since been fully recognized by the medical
profession. It is hoped that, when the cancer fund is available, the Board
of Trustees will invite the Association to resume its extramural work by
Page 124
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assuming the responsibility of carrying to the medical profession of Canada
information dealing with the manifestations of cancer in all its forms and
phrases.
Realizing the full significance of this campaign, it is hoped that the
medical profession will support it most heartily, not only with personal
contributions but by enlightening the people in their respective communities as to the opportunity-which is being given to them to pool some of
their resources to wage war upon cancer.
CLINICAL SECTION
A meeting of the Clinical Section of the Vancouver Medical Association
was held at St. Paul's Hospital on February 18th, 193 5, with Dr. J. R.
Neilson in the chair. In spite of inclement weather there was a good attendance.
The first case, a man of 52, was presented by Dr. Neil McDougall. The
patient, whose occupation was sailing a fishing boat up north, came to the
doctor for glasses because his eyes had been playing tricks with him. He had
found that other boats would be away on the horizon one moment, and
cutting across his bows the next. Dr. McDougall demonstrated the remarkable meiosis of this man's pupils, which were about the size of a pin's head,
and had been shown not to react to light, but to react slightly on accommodation. The test could only be done adequately if a little cocaine were
instilled to relax the pupil. Dr. Emmons then described the neurological
findings in addition to the Argyll-Robertson pupils, namely, absent ankle
jerks, decreased pain sensation in the legs, Rhombergism, decreased vibration
sense, blood Kahn plus 3, spinal fluid plus 4. Also, taking from his pocket
a tube full of ice-water, Dr. Emmons demonstrated very effectively a band
cf hyperesthesia to cold between the fourth and the twelfth dorsal segments, both in front and behind. Every time the cold tube touched this
area the man squirmed away from what was evidently a painful stimulus,
and it was disclosed that he had had some discomfort even from the lieht
pressure of his shirt in this area.  The diagnosis given was tabo-paresis.
Dr. Anthony discussed the mechanism of the Argyll-Robertson pupil,
stating that it was impossible to say exactly where the lesion was except
that it was somewhere on the reflex arc, or why some of these cases developed
a very small pupil and others a large one. Dr. Lockhart, in discussing
prognosis and treatment, was rather gloomy, and mentioned exitus accompanied by bed-sores and amentia. He admitted that malaria was now used in
these cases, but gave it second place to tryparsamide, which could be used
over |a long period even up to 100 doses. The patient's eyes should be
watched by an expert when this drug was being given. On cross-examination he admitted also the advisability of giving mercury, potassium iodide
and bismuth as adjuvants.
The next case, shown by Dr. Neil McNeil, was a boy of 16, who was
first seen in August, 193 3, complaining of pain and swelling in the front
of the right leg, of three months' duration. X-ray showed that the lump
originated in the periosteum of the tibia, and the leg was amputated above
the knee in September. 193 3. Pathological report showed "rapidly-growing
spindle-celled sarcoma." When seen by Dr. McNeil in November, 1934. the
patient complained of feeling tired and weak, with pain in the right chest
and cough. X-ray showed a right-sided pneumo-thorax and a rounded mass
Page 125 about the size of a Jap orange in the left lung. As the case was considered
too advanced for x-ray therapy, magnesium salts had been given, with
remarkable results. The dose was magnesium chloride gr. x in solution sub-
cutaneously twice a day, also one drachm of a 5 % solution twice a day by
mouth. The boy's general condition had improved rapidly, he had required
no morphia at all, had no cough, and had gained about eight pounds in
weight. X-ray taken the day before showed extension of the sarcomatous
process in both lungs, but in spite of this the boy's general appearance was
almost unbelievably good. Dr. McNeil called attention to the work being
done at present on the subject of magnesium salts, and produced some ideas
of his own which ranged from the effects of sunlight reflected from the
magnesium sands of Egypt to the complicated relationships of ergosterol,
vitamin D and the alkaline earths. This case aroused considerable interest
and discussion, to which Drs. Prowd, B. J. Harrison and Vrooman contributed.
The next case was one for diagnosis presented by Dr. R. A. Palmer and
Dr. W. D. Keith. The patient was a woman of sixty-five whose chief complaint was fatigue and weakness for a period of about two years. She had
been compelled to stop work in November, 1934. There was a history of a
single chill around Christmas time, 1934, and a few mild sweats at night.
There was loss of about thirty pounds in weight. The patient's antecedent
history and physical findings were given in detail by Dr. Palmer, who summarized the positive findings as follows: Fever up to 101, loss of weight,
leucopenia, enlarged liver and spleen, basal metabolic rate plus 22. Blood
pressure 150/88. Agglutinations negative for typhoid, paratyphoid and
brucella abortus. The blood films had been studied very caref\illy and the
patient had a persistent leukopenia of 3000, polymorphs 50%, lymphocytes
39%, mononuclears 4 to 10%. After a consideration of the differential
diagnosis Dr. Palmer apparently inclined towards subleukemia or aleukemic
leukemia. Dr. Keith added to the discussion by considering the various
possibilities and admitted that at the present time it was impossible to be
dogmatic. He was inclined to consider cirrhosis of the liver as the most
likely diagnosis but at the same time mentioned abdominal Hodgkins' disease. Some discussion followed, and it was suggested that the subsequent
history of this patient should be presented to the Association, especially if
a definite diagnosis should be arrived at.
The next item on the programme was a demonstration by Dr. Meekison
of various machines for reducing and fixing fractures of the lower extremity. First of these machines was the Roger Anderson Well-Leg Splint
for fracture of the neck of the femur. The principle of this splint is the
utilization of the unbroken limb to produce extension of the fracture, the
splint being incorporated in plaster on the two legs. Dr. Meekison stated
that nobody claimed an increase in the percentage of union in these fractures following the use of this splint, but the great difference was in the
tremendous increase in comfort experienced by the patient. These patients
could be put in a chair in two weeks time and the position of the fracture
was well maintained. Dr. Meekison also showed the Roger Anderson machine
for the reduction and fixation of fractures of the tibia and fibula using two
Steineman pins, one through the upper and one through the lower end of the
tibia. Patients were demonstrated on which these two forms of apparatus
had been used with very excellent results. This demonstration led to discussion by Dr. Naden of a recent trip to the East during which he saw
Page 126
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fractures of the neck of the femur being dealt with in various ways. These
methods included nails and wires of various kinds which were introduced
through the great trochanter in order to hold fragments in position. Dr.
Naden and Dr. Meekison enlivened the proceedings by producing at the
same moment two of these threaded wires for inspection. Dr. E. L. Garner
also contributed to the discussion on the treatment of these fractures.
The last demonstration of the evening was given by Dr. C. W. Prowd,
who showed three cases of carcinoma within the buccal cavity in different
stages of treatment by radium and x-ray. He pointed out that the superficial changes in the skin and mucous membrane resulting from treatment
and leading to desquamation were normal phenomena if adequate treatment
were given, and did not constitute an x-ray or radium burn.
Following the meeting the good Sisters of St. Paul's provided very excellent refreshments in a neighbouring room. Most of those present felt that
their time had certainly not been wasted and that the meeting had been a
very interesting and profitable one.
CASE  REPORTS
By Dr. Neil McNeill
[The attached report of cases by Dr. N. McNeill is of considerable interest
and importance. As regards the medical content, we have no comments to offer;
as regards Dr. McNeill's philosophical conclusions, well—we can only say they
are, so far, up to him to prove.—Ed.]
On August 8th, 193 3, a boy, J. E., 16 years of age, was brought to me
by his mother.
Complaints: About three months before, he had developed a pain in the front middle
part of his right leg, which was always worse at night. Dining this tirni; he noticed that he
tired more easily than he used to; about six weeks before, a swelling had developed over the
painful area, and this was now getting larger, but was not painful to touch.
Examination: The boy looked well.
Family History: Negative.
Personal History: Influenza in 1918, and again in 1919. Severe with convulsions on
both occasions. No convulsions before or since. Scarlet fever as a child. Smallpox in 1918.
Mild.
Height 5 ft. 9 in. Weight 139 lbs., with his street clothes on. T, 98.2. P., 64. R.,
16.   B.P., 90/60.   Urine negative.   His blood showed a secondary anxmia.
A complete systematic physical examination was made, and nothing
special found, with the exception of a narrow swelling about 4 in. long over
the front of his right leg, which did not pit on pressure, and was not painful
on palpation.
A preliminary diagnosis of possible sarcoma was made, and he was sent
to see Dr. Frank Patterson in consultation, who agreed that the boy should
be sent to hospital at once, have a biopsy and afterwards be treated as indicated. About this time the father and mother were rather doubtful about
the diagnosis, and were influenced by some so-called friends to take him to
an irregular practitioner, who washed out his stomach a few times, and had
some sort of poultice applied to the painful part, without relief. About a
month later they brought him back to my office, but as I was out of town,
and Dr. Patterson was in the East, they were sent to Dr. R. E. McKechnie,
who had him admitted to St. Paul's Hospital, and on Sept. 11th, 193 3, Dr.
McKechnie amputated his right leg above the knee.
On November 2 8th, 1934, the father brought him to my office again,
when the boy complained of being awfully tired and weak for a month or
more. Pain had developed in his right chest, which was sharp, especially on
Page 127
saa
«U   ! JJUJ deep breathing or coughing, with shortness of breath, a dry cough which
kept him awake at night, and some loss of weight.
Examinations The patient looked to be very ill, and was breathing quickly, with
apparent pain.
Height 5 ft. 10 in., weight 139 lbs. with his street clothes and artificial leg on. T.,
101. P., 118. R., 26. There was bulging over the lower part of his right chest, and on
percussion flatness over this area, with some loud splashing gurgling sounds on auscultation.
Owing to his being so ill, no further examination was made at the time,
but he was sent up at once for an x-ray of the chest, which was reported as
being "lesion of left lung, size of a Japanese orange, probably secondary
malignancy, right side pneumothorax, with free fluid in the pleura."
He was admitted to St. Paul's Hospital, where Dr. Prowd, the radiologist, considered the case too far advanced for deep x-ray therapy.
At this time it was though that perhaps, as there did not seem to be any
other form of treatment available, magnesium might be of some service—
at least it could do no harm.
On December 1st, 1934, he was put on magnesium sulphate, dr. 1 daily,
by mouth, and on December 4th this was changed to magnesium chloride,
gr. 10, B.I.D. in 2 cc. of sterile water subcutaneously, with dr. 1 of a 5%
solution of the same B.I.D. by mouth.
On December 10th, his temperature was 98.2, P. 80, R. 20. Cough less,
pain gone, breathing easier, weight 140 lbs., with his artificial leg and
pyjamas on.  Felt well, and wanted to go home.
On December 17th, 1934, his temperature was 98.2, P. 80, R. 20, no
cough, no pain, breathing less labored, and his weight dressed as above was
140 lbs. Another x-ray was taken of his chest at this time, which showed
the lesion to be about the same size, a large pneumothorax on each side, no
fluid in his right pleura; the lungs seemed to have a contracted appearance.
On percussion the same dull sound was found over the right base, and on
auscultation, the splashing sounds had disappeared.
He wanted to go home for Christmas, so on Dec. 23rd, 1934, at 4 p.m.,
he was again examined. His temperature, at this time, was 98.1, P. 86, R.
18, no pain, no cough, breathing only twenty times a minute after two
minutes exercise in bed, and his weight was 143 l/z lbs. with his pyjamas and
artificial leg on, using the same scale. If we allow about 4 lbs. for his street
clothes, this would then show a gain of about 8 l/z lbs. since November 28th,
1934, or in about three weeks. He was discharged from hospital, on magnesium chloride, by mouth, dr. 1 B.I.D. Since that time I have seen him
about once a week, and he continues to be about the same condition, as well
as being in the best of spirits, in fact when I last saw him on January 9th,
193 5, he was sitting up at the piano, playing, and trying to sing.
In this case there would appear to be relief from pain, gain in weight,
disappearance of fluid from the right pleura, and a general feeling of well-
being. In a review of some of the literature available on this subject, we
find that M. J. Shear, in the American Journal of Cancer for August, 193 3,
page 1018, in his summary of a very interesting paper in which he reviews
"The Role of Sodium, Potassium, Calcium and Magnesium in Cancer,"
states that "The analyses of tumours for magnesium is far too scanty to
warrant any conclusions; the analyses of body fluid for magnesium have not
established any relationship between magnesium and cancer."
"Interesting leads have been uncovered which warrant further study,
especially the reputed opposing effects of potassium and of calcium on
tumour growth; systematic comprehensive investigations are required to
clarify the present confused situation."   However, in my reading I have
Page 128
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noticed that most of the work reported done was on rats, and not on active
tumours in human beings as we find them in our clinical work.
It would appear that if we can secure with magnesium, even if only in
some cases, relief from pain without having to drench the patient in morphine, that it might be a step forward.
A few years ago, in 1927 I think it was, I had another rather interesting
experience with sarcoma.  This one was in a female 3 3 years of age.
Family history: Negative.
Personal history: Negative until 1917 when, while she was playing badminton, she was
struck over the middle of her left humerus with a racquet. In 1918 her left arm was
removed at the shoulder by Sir Alfred Pierce Gould in London, England. Pathological
diagnosis "lympho-sarcoma of thfe left humerus." She was married in 1920, has had 3
children, all normal, with normal confinement, with the exception of the last, in which I
confined her myself in 192 J, when she suffered from anaemia of a secondary type and pregnancy nephritis.
In August, 1927, she came to me with a secondary condition in the
retroperitoneal space, and was being treated at the Vancouver General
Hospital with deep x-ray therapy, when she developed indigestion. For the
indigestion she was given calcium, magnesium and soda bicarb, in large
ooo o
doses. Shortly after beginning this alkaline treatment it was noticed that
the lump was growing smaller, which change had not taken place under
deep x-ray therapy alone.
When the indigestion got better, the medicine was discontinued, and
in a short time the lump was noticed to be getting larger again, and the
patient had more indigestion.  The medicine was again given and the lump
again receded.
By this time she was in a very weak condition, and the x-ray treatments
were discontinued. However, the alkaline treatments were continued in
even larger doses, but with apparently no effect on the lump, which continued to grow larger, and, finally, after about two years of treatment,
she died.
An autopsy could not be held in this case.
We may think that this tumour was simply dehydrated as a result of
taking these inorganic salts, but why did they seem to act on the tumour
only and not on the other tissties in her body which until near the last
appeared to be in good condition?
In this case also we got a general feeling of well-being for months, and
at times we were able to discontinue morphine altogether. Up until near
the last we could reduce the quantity of morphine given if she was having
alkalies.
Many of our local men saw this case in consultation with me, and one
very eminent cancer specialist from the Eastern States, who happened to be
in town at the time. When I told him about the behaviour of this tumour,
while the patient was on alkalies and deep x-ray therapy, he appeared to be
very much interested, and asked me to have her history written up in detail,
to send it, together with all pathological slides and x-ray plates, down to
him, as he wanted to study them, and to have some work done in his own
laboratory along the above mentioned line. This, I may say, was never done.
During the last decade a number of very interesting articles have appeared in print on "The role played by the inorganic salts in the treatment
of cancer," and some on the alleged rarity of cancer in Egypt. A few years
ago I happened to be in Egypt myself, and while in conversation with some
of their medical men I was led to believe that there is perhaps less cancer
there than we have, for instance, in Vancouver.   One should, I suppose,
Page 129 really go to the British Cancer Research Commission's records for confirmation, or otherwise, of this statement, before making any comparison on
paper, but the above was the firsthand impression I received while there.
Of course, if this is so, we all wonder why. Is it possibly due to their
dry atmosphere, their continuous sunshine, the alkaline condition of their
soil, which we are told contains a lot of magnesium, or a combination of
some or all of these,'which has something to do with it? We all know that
the Nile is their only source of fresh water for all purposes. Therefore, it
has been thought that if the direct rays of the sun, or of light of any kind,
has an effect on the matter with which it comes into contact, that perhaps
there are indirect or reflective rays which may also have but a different
effect after having passed through or being reflected upon these various
inorganic elements which are to be found in our body tissues. If that is the
case, then perhaps the same theory could be applied to the earth's surface,
and we might say that all cell life, birth, growth, development and death,
is influenced by these reflected rays throughout the whole animal and
vegetable kingdom.
May it not be, then, that it is these reflected rays that are perhaps keeping some of these good people of the Nile from becoming pathological specimens in some Egyptian cancer museum?
LIBRARY NOTES
Some recent accessions to the Library
Medical Clinics of North America for July, Sept., Nov., '34, and Jan., 193 5.
Surgical Clinics for Aug., Oct., Dec, 1934.
Chronic Arthritis.  Pemberton and Osgood.
Applied Physiology.   5 th ed.  Samson Wright.
Life of Sir Robert Jones, by Frederick Watson.
Trans. Pacific Coast Surg. Society.
British Pharmaceutical Codex.  1934.
To Remind and Principles of Therapeutics. Abraham Flexner Lectures.
Fifty Years of Medicine and Surgery.  Franklin Martin.
Catalogue of Onodi Collection.  Royal Coll. Surgeons, England.
Human Sterility. S. R. Meakor.   1934.
Diseases of the Skin. Dore and Franklin.
Hypertension and Nephritis. Fishberg.  3rd ed. Revised.   1934.
Proceedings American Proctologic Society.   1934.
Taylor's Principles and Practice of Medical Jurisprudence.  9th ed.   1934.
Architecture of Physiological Function. Barcroft.   1934.
Clinical Descriptions of Disease. Major.
Early Forerunners of Man. W. E. Clark.
Diseases of Rectum and Colon. Lockhart-Mummery.  2nd ed.   1934.
Nutrition and Disease. Mellanby.   1934.
Tumours of the Breast. Lenthal Cheatle and Max Cutler.
Manipulative Treatment for the General Practitioner. T. Marlin.
Transactions Am. Assn. of G. U. Surgeons.  1934.
Trans. Ophthalmological Society of the U.K.   1934.
Clinical Electrocardiography. Wm. Evans.   1934.
Trans. Amer. Laryngol., Otol. and Rhinol. Society.   1934.
The Library has received a presentation copy of the Catalogue of the
Onodi Collection, which has been prepared for the Laryngological and
m\
M'l
«
if
130 Otological Section oof the Royal College of Surgeons, England. The volume
s composed of plates and explanatory matter based on the anatomical collection of the late Professor A. Onodi, Director of the Rhino-laryngological
Clinic in the University of Budapest. This collection was purchased from
his son by a number of British Laryngologists and others interested and
presented to the? Royal College of Surgeons, England. The volume is well
worth the consideration of the oto-laryngologists of our Association and
any others who are interested in the anatomy of the head. We would advise
these to spend at least an hour looking over the book.
The recent generous donation of Dr. Nicholson to the Library funds
has facilitated the purchase of the above group of books and periodicals,
which the Library Committee consider the choice of recent publications.
Outstanding are several new editions of books already in the library, books
which have become classics, such as Taylor's Medical Jurisprudence, and
Lockhart-Mummery's Diseases of the Rectum and Colon. In Tumours of
the Breast, we have a work produced under the combined authorship of
two men, each of whom is an outstanding authority in his own country.
In the small volume on Manipulative Treatment, members will find practical points in a branch of medicine which tends to be passed over by many
of us. Nutrition and Disease by Mellanby and co-workers, contributes much
of interest as to the cause of disease of the teeth and of the thyroid gland.
Those who care for such will enjoy reading "Early Forerunners of Man" by
Clark of Oxford, dealing with comparative anatomy of the anthropoidea.
In addition to the above, books on order include: Carson's Operative
Surgery, a two-volume work, the former edition of which was much in
demand by the members. Also Bohler's Fractures, an author with whom
everyone is familiar. The new edition is recently out. The Autonomic
Nervous System, by Kuntz, was recommended by the neuro-surgeons as
the best book available on this subject. Dr. Vrooman has recommended
that the British Journal of Tuberculosis be placed on our subscription list.
The editorial staff has been changed and a series of special articles will appear
during the year.
We are glad to announce that the fine collection which was provisionally loaned by Dr. G. S. Gordon some years ago, he has now presented to
the Library. It includes several valuable books, such as an early edition of
Burton's Anatomy of Melancholy and a first edition of John Hunter's
Venereal Diseases.  There is also a copy of Spalteholz.
THE CASE AGAINST TOBACCO
H. A. DesBrisay
This paper was read before the Osier Club of Vancouver and was presented by
Dr. DesBrisay as a prosecutor might present his case against a defendant. .
Your Lordship, Gentlemen of the Jury: I present the case of the Crown
versus Fernandes Nicotianum Tabacum, a member of the notorious night-
shade family.
As prosecutor it behooves me to place the facts of the case before you
as impartially as I may. You shall be judge and jury. Some of you will,
I hope, act as defense-counsel.
The friend of most of us is on trial, for in our time over 80 per cent of
men are smokers, and now a fair percentage of women have joined the
Page 131 throng. In this generation, gentlemen, from 1905 to 1930—in twenty-five
years—the consumption of cigarettes increased by over 3000 per cent. In
the United States alone, for the year 1932, the estimated value of the
tobacco consumed exceeded $1,3 50,000,000.
Do we often stop to consider the possible insidious effects of this habit
on the health and lives of our patients, and ourselves? We find that numerous
scattered articles on tobacco have appeared, but the subject still continues
to be mainly a topic for idle speculation and medical gossip.
Tobacco (the word being a latinized form of the Indian word for pipe)
was first introduced into Europe in the 16th century by Francesco Fernandes
(a physician of Portugal). After it had been carried to France by John
Nicot (who left his name for its chief alkaloid), and brought to England
by Lane and Sir Francis Drake, and popularized by Sir Walter Raleigh,
fierce controversies began, and have continued ever since. While such poets
as Spencer sang its praises on the one hand, there were laws passed against
its use in some countries. In Russia at one time smokers' noses were chopped
off by royal edict, and in Turkey the penalty for smoking was death. "Hail,
social pipe, thou foe to care" indicates the feeling of some, while at the same
time James I published a bitter pamphlet against its use.
As prosecutor I shall attempt to place before you some of the most
damning evidence against this, our constant companion, our false friend.
For clarity's sake let me indicate that the prosecution will be based on the
assumption that tobacco may produce its deleterious effects in two chief
ways: (1) by reason of the nicotine and other products of destructive distillation; (2) by reason of allergic responses to substances in the tobacco-
leaf, apart from the nicotine.
It is not to be denied that the puffing of pipes, cigars and cigarettes is a
solace, and with some satisfaction we find that this is merely a habit, and
not a true addiction. As I composed this effusion I find myself smoking one
cigarette after another. Of course this is a conditioned reflex.
Primitive man apparently did not smoke, but as we follow history up
through the ages, and as we approach the era of semi-civilization, we find
men seeking comfort from the increasing trials of life in the sucking of the
sugar-cane, and the chewing of the betel-nut, and finally the indrawing of
smoke from a burning root or roll of leaves—as noted by Columbus.
In the last analysis, we find that this habit, so widespread now, is merely
a reversion to the old nursing habit of the infant. A civilized, full-grown
man must still apparently run back for solace to a symbol of his mother's
breast. The time lost looking for a mislaid pipe and running to the corner
drug-store must be enormous. Smoking may be branded, then, as an unmanly, time-wasting, pernicious and expensive habit.
Now let us review some of the pharmacology of tobacco: The chief
constituent, nicotine, is a volatile alkaloid (C10H14 No) having a pyridine
and a pyrolidine nucleus. It occurs in the leaf in the form of salts of
organic acids. It composes from ' i to nearly 10 per cent of the dried leaf.
Other less volatile alkaloids occur, but are apparently of little importance.
Nicotine causes a stimulation of all cells of the nervous system, central
and peripheral, followed by depression, going on to paralysis if the dose be
large enough. All ganglia of the autonomic system are first stimulated and
then paralyzed. In man it produces a mental excitement followed by a
sedative action. Strychnine is a true physiological antagonist. Nicotine is
in part destroyed by the liver, but the greater part is eventually excreted
Page 1 3 2 by the urine, excretion beginning within a few minutes, and being complete within 18 hours, experimentally.
The nicotine present in half a cigar if injected intravenously would be
a fatal dose for a man.
Five or six grains of tobacco swallowed will cause vomiting.
A case is reported of death in a child of 8 years, who had tobacco applied
to a ringworm of the scalp.
In man, after smoking a cigar, nicotine may be found in the urine
within 1 Yz hours and excretion continues for 6 hours. Smaller amounts are
also excreted in the saliva, sweat and bile, and by the lungs. Nicotine may
be recovered from a body 3 months after death. It has been demonstrated
in the smoke present in a room.
Zebrowski found that nicotine injections into rabbits produced thickening of the intima of the descending aorta in three out of five animals. Experiments have also shown that it is capable of causing coronary constriction
and pathological changes in these vessels as well as others.
Excessive smoking leads to cardiac irregularity, disturbed digestion,
shortness of breath, restlessness, and more rarely to optic neuritis, loss of
memory and muscular tremors.
Tobacco smoking delays the action of pepsin and may inhibit the normal
hunger contractions of the stomach; with excessive smoking hvoerchlor-
hydria and pyloric spasm are said to occur. Workers at Yale have shown
that smoking produces a temporary, thoueh definite, rise in the rate of sugar
metabolism, due to the action of nicotine on the adrenals. When the blood
sugar was below 130 mgm., smoking caused a definite rise in blood sugar.
This rise, with the lessening of normal contractions, evidently decreases
hunger and often spoils the appetite. The oxygen consumption in some
individuals may be increased as much as 10' '< to 1 5 % . It is thought by
some that nicotine may play a part in cirrhosis of the liver.
The first real effort to analyze the use and effects of tobacco was made
by the Lancet in 1912. It was found, in tobaccos used by the public, that
there was seldom more than 3% nicotine, the average being about 2%.
Cigars were found to contain a smaller percentage than smoking mixtures,
and even less than some cigarettes.
In the smoke itself, eariy experiments failed to show nicotine, but this
was later accomplished.
Behind the burning point destructive distillation takes place—the
products being jjioportional to the size of the burning point. Thus, cigars
and pipes yield more of these products (about 4 times) than do cigarettes.
Experimentally tobacco is smoked by an apparatus, and the smoke is
drawn through a glass tube containing a known amount of certain chemicals, as sulphuric acid, or silico-tungstic acid.
In an intermittent stream of air most of the nicotine may be collected
in the fumes (over 80%). Nicotine and other alkaloids volatilize from
portions of leaf near the burning end, and condense with water vapour
between puffs, and with the next breath these are again volatilized and
drawn into the mouth, some to be dissolved in the saliva, swallowed arid
absorbed, some to be absorbed by the lungs, and some to be exhaled.
About 67% of the nicotine is held in the body if one does not inhale,
and about 90% if one does inhale. In the smoke there is also found carbon
monoxide, pyridine, cyanides and sulpho-cyanides, ammonia, arsenic and
nitrates.
Page 133 As would be expected, the smallest amount of nicotine may be recovered
from the smoke of a cigarette, while a much greater amount may be recovered from the same tobacco smoked in a pipe. A high percentage (83%)
has been recovered from cigar-smoke, but cigars themselves may have a
nicotine content as low as 0.64(/( . The last quarter of a frequently relighted
cigar contains more nicotine than all the rest put together.
It appears that from the point of view of nicotine poisoning, cigarettes
are the least harmful, and the pipe the worst. I have heard the pipe defended
as being the most sanitary, for it has been stated that as health depends on
an abundant supply of fresh air, and as each person in a dwelling must have
a certain number of cubic feet of air, a man who steps into a crowded room
and lights up an ancient pipe, almost immediately has the room to himself
and so gets his full quota of air. This, as you will note, gentlemen, makes
for selfishness.
In one cigarette there are approximately 22 mgm. of nicotine. When
20 cigarettes are smoked (one-third of each being discarded), the 300 or
more mgm. of nicotine in the tobacco consumed yield at least 45 to 90
mgm. in the smoke. Allowing even 60% absorption, we find that from
one day's smoking there may be absorbed at least 18 to 36 mgm. of nicotine.
Rapid smoking increases the amount of products in the smoke, as does also
moisture.
Warbery points out that with the absorption and retention in the system
of 6' < to 11 % of the tarry material in smoke, there must be absorbed considerable amounts of pyridine bases (and pyridine has been shown to cause
epithelia proliferation), cyanide and aldehydes as well as nicotine. The
fatal dose of nicotine for man is 60 to 120 mgm. (This, of course, in one
dose.) Even so, can we say that the daily absorption, over a long period, of
even 18 mgm. of nicotine, along with the other substances mentioned, is
without significance?
Toxic effects from smoking substances which contain no nicotine have
been observed, as in juveniles puffing the old "smoking cane." Therefore,
the sickness here produced must be due to other end-products of combustion. Aldehydes, such as furfurol, pungent substances causing an irritation
of mucous membranes, are present.
Carbon monoxide may occur in the smoke up to 1.3% of the weight of
the tobacco and paper. The affinity of hemoglobin for carbon monoxide is
about 210 times as great as that of oxygen, and even very small amounts
may prevent the complete oxygenation of the blood. A concentration of
1.6 parts in 10,000 parts of air is dangerous, and a concentration of 2 to 5
parts is generally fatal. In chronic cases of poisoning there occurs headache,
vertigo, weakness, anemia, slowing of the intellect, failure of memory and
an elevation of blood-pressure. However, a tolerance for CO may be
induced—by means of an increase of hemoglobin and red blood-cells.
The smoke as it reaches the mouth may contain up to 2.5 parts of CO
in 10,000 parts of air (which of course is a dangerous amount), but the
lungs are ventilated before there is time for much absorption.
The U. S. Bureau of Mines found that in a confined space after excessive smoking the CO concentration in the air did not increase above 0.01' <
and'that the maximum blood concentration did not rise above 5%  (which
was considered negligible).
Hanson and Hastings found in a short series of normal individuals,
non-smokers, that the CO in the blood may be up to 1.5%; whereas in
Page 134 i1
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t
• ■
smokers, after 10 to 15 cigarettes, the CO saturation was up to 3 to 4%.
Gettler and Mattice found that when cigarette smoke was drawn
through blood in a smoking apparatus the concentration of CO went up to
0.63 volumes %, about 3% hemoglobin saturation. These workers found
that the CO of the blood was a continually varying figure in the human
subject, and found the greatest amount in street-cleaners exposed to automobile exhaust fumes, and in taxi-drivers, but it was noted that the cleaners
who smoked showed the highest figures. One street-cleaner working among
trucks all day showed 0.2 5 volumes %, equal to 1.2''/< hgb. saturation,
whereas another cleaner off duty, who smoked six cigarettes on the way to
the laboratory, showed 0.77 volumes'^—over three times as much as the
man who spent the whole day on the street. (The more rapid the smoking
the greater the concentration of CO present.)
A smoker of cigarettes who uses 20 gm. daily absorbs 400-1600 cc. of
CO, while wtih the same amount in a pipe the figure is 1600-22 00 cc. of
CO. 61' ( of the CO is said to be absorbed by inhalers. It is probable that
headaches experienced by heavy smokers are due in part to the inhalation of
CO, and also to furfurol.
Tobacco smoking, then, has been shown to appreciably increase the
carbon monoxide of the blood. Who will dare to say definitely that this can
have no effect on the individual?
Tobacco Hypersensitivity
Sulzberger and others believe that it has been demonstrated that a major
harm from tobacco is probably done by fractions of the leaf, other than
nicotine. Sulzberger points out that hypersensitivity to a substance may be
localized and circumscribed as in certain drug reactions. It may be confined
to certain tissues, e.g., to the epidermis alone (as with quinine); it may
cause chronic and permanent organic damage, even to thrombosis, with
obliteration and necrosis (as seen in ulcerating bromodermas), and he states
that the vascular system in man s;ems to be peculiarly susceptible to sensitizations. This worker emoloyed intra-dermal tests with denicotinized
tobaccos, using a solution of nicotine sulphate as a control. He found that
nicotine itself gave no reactions, but that 77' < of 24 patients with thrombo-
aneiitis obliterans gave immediate positive reactions, and that the others
of this group were hypersensitive to other allergins. He found that of 145
other cases (all smokers) (some patients with other diseases, and others
healthy adults), 36% were positive to tobacco, whereas ni 5 8 non-smokers
only 16' (  were positive to tobacco.
From these results he deduces that smoking causes a sensitization to
tobacco, which is present in a high percentage of cases with Buerger's disease, and that these immunological effects are caused by substances other
than nicotine. Harkavy found 3 6' \ of patients with coronary disease sensitive to tobacco, especially noticeable in those who developed the anginal
syndrome at an early age. The same man also found 83 % of 68 cases of
Buerger's disease positive to tobacco skin tests. It has been observed also
that a patient may be sensitive to one brand of tobacco and not to others
(as Deri-oral eczema due to Chesterfield tobacco).
What practical and clinical proof have we that smoking is deleterious?
It is well known that athletes in training are not allowed to smoke.  Why?
At Columbia University smokers were found to be much inferior to
non-smokers in their studies as well as in other college activities.
Pa.
m Let us briefly look at a few clinical conditions:
(1) Cancer.—The chemical relationship between smoking and cancer
of the lip, tongue and mouth has often been noted. With the increase in
tobacco consumption there has> been a coincident increase in carcinoma of
the lung and of the oesophagus. In a sanitarium in California, the only
woman with cancer of the lung ever autopsied there, gave a history of over
15 years of excessive smoking of cigarettes. In Holland, where tobacco is
used more extensively than anywhere else in Europe, the death rate for
cancer of the stomach is 553 per 100,000. In England it is 333. It is, of
course, much more prevalent in the male than in the female. The tar of
tobacco smoke has been blamed for this, but in experiments with tobacco
tar by Bogen and Loomis, attempts to cause local carcinoma in animals
failed. It may well be, however, that over a much longer period of time
the tar irritation may produce sufficient hyperplasia to start the malignant
process—as shown by other workers, who produced carcinoma in a rabbit
after three years.
(2) Tobacco amblyopia does occur. Possibly hypersensitivity here plays
a part, especially when other conditions are present. A heavy smoker may
notice no effect on his vision, and a diabetic may suffer no visual disturbance,
but if a heavy smoker acquires diabetes, trouble may ensue. Foster Moore
states that "There can be no doubt that diabetics are more vulnerable to
toxic effects of smoking than are healthy patients."
(3) The respiratory system.—No one doubts but that smoke which contains pungent aldehydes and the other substances mentioned, will cause
irritations of the mucous membranes of the upper respiratory tract, with
cough and expectoration. These effects are too well known to call for further remarks. Probably cigarettes are the worst offenders in this respect.
Hypersensitiveness again may play a part here, as in a case of asthma I recall.
(4) The gastro-intestinal tract.—In speaking of the pharmacology of
tobacco, it has already been noted how smoking may inhibit hunger contractions of the stomach, and how excessive smoking may cause spasm.
Practically, I am sure all of us have had cases with pyloric spasm, simulating
peptic ulcer or gall-bladder disease, where all examinations, including x-rays,
were negative, and the patient were only free of their symptoms when they
gave up smoking. It would seem that in such cases, before subjecting them
to the expense of many laboratory procedures, it were wise to tell them that
the cheapest test is to stop the use of tobacco. It is agreed by gastro-enterolo-
gists that a person with a peptic ulcer should not smoke, but as Trowell
remarks in the Lancet, the concept of tobacco as an etiological agent in
duodenal ulcer appears to have originated from the freely accepted opinions
of certain authorities, and not from any kind of proven evidence. Hurst
states that most people with duodenal ulcer have smoked excessively for
years. Trowell found that in 50 male patients with this condition they did
not on the average smoke more than normal men, but did inhale more commonly. This seems a very lame point. I submit that such patients probably
rut down their excessive smoking because they find that it increases their
discomfort.
(5) The cardiovascular system.—It has already been shown that there
is a strong presumptive evidence that tobacco hypersensitivity affects the
vascular system, notably in Buerger's disease but also very likely in some
cases of coronary disease, and that smoking evidently causes some degree
of sensitization to substances in the leaf other than nicotine.   Clinically, as
■Mr i
hi, i
Page 136 i||
I
'Vj
R
can be shown by trial and error, tobacco is often responsible for heart
irregularities—extra-systoles, an occasional case of paroxysmal tachycardia,
and even paroxysmal auricular fibrillation. As to its causation or contributory effect on angina pectoris, it is generally admitted that there are rare
cases where this is so. Paul White of Boston states that he has seen only 3
cases of tobacco angina. He found in examining 750 cases with angina
pectoris, along with 750 controls of the same age and sex, that there were
more in the control group who used tobacco to excess, than in the former.
Maddock and Coller of Ann Arbor found that 87% of individuals with
Buerger's disease (350 cases) used tobacco and the severity of the disease
was greater in the excessive users. Experiments on 20 students showed that
after smoking one to two cigarettes the blood pressure increased on the
average 8 to 20 points systolic, and 10 to 2 5 points diastolic; that the pulse
rate increased by from 8 to 3 8 beats per1 minute, and that there was a decrease of the average skin temperature of the fingers by from .7° to .6°
Centigrade, showing increased vaso-constriction. They also gave intravenous
injections of nicotine of 1 mgm. in saline to four subjects (smokers), and
found essentially the same changes in blood pressure, pulse and skin temperature. In two cases of Buerger's disease the circulation was still further
reduced by smoking. Wright and Moffatt noted in many cases slowing
and even stoppage of the blood flow in capillaries of the nail fold during the
smoking of a cigarette. These workers also found that smoking of one
cigarette or less in confirmed smokers caused an average drop in the surface
temperature of the finger tips of 5.3° Fahrenheit, and in some as much as
9.5° to 11° F., and even 15.5° F. in one case. The same results were
obtained with mentholated cigarettes. Cigarettes made from filter-paper
shewed no appreciable change. The length of time for the effects of
smoking to wear off was found to vary greatly in different individuals, and
in the same individual at different times. Heavy smokers often showed some
of the moost marked temperature and symptomatic reactions under controlled conditions. It was felt that a purely psychological explanation could
be ruled out. On the whole, then, we know that, experimentally at least,
tobacco definitely affects the vascular -tree—evidently through the nervous
system.
Before summing up, let me ask you to be on your guard against trite
sayings and innuendoes intended to curry favor for the accused. Levity and
ridicule have ever been the weapons used by those who have not the facts on
their side. I refer to such remarks as Kipling's: "For a woman is only a
woman, but a good cigar is a smoke," and to the following bit of doggerel
by a 17th century poet:
Tobacco, an outlandish weed,
Doth in the land strong wonders breed,
It taints the breath, the blood it dries,
It burns the head, it blinds the eyes,
It dries the lungs, scourgeth the lights,
If numbs the soul, it dulls the sprites,
It brings a man info a maze
And makes him sit for others' gaze,
It mars a man, it mars a purse,
A fat one lean, a lean one worse,
A uhite man black, a black man xvhite,
A night a day, a day a night,
It turns the brain like cat in pain,
And makes a fack a Gentleman.
Especially, I ask you not to believe that Mark Twain spoke seriously
when he said: "I have no respect for a poison that takes 86 years to kill
a man."
The Crown, then, in summary submits: That apart altogether from
the moral and economic aspect, it has been shown that tobacco is definitely
deleterious to certain individuals: (1) those with idiosyncrasies against it;
Page 137 ■Ml
(2) those with certain conditions, especially vascular, as thrombo-angiitis
obliterans, coronary disease, optic atrophy and peptic ulcer, and those with
irritable vasomotor control; and that we should forbid the use of tobacco
in cases where there are positive skin reactions along with clinical evidence
incriminating the plan; and furthermore, that even in the apparently
healthy, the possibility of subclinical injury, not apparent on casual observation, must be borne in mind.
Gentlemen of the Jury, will you continue to sanction the accused in
'your homes, in your pockets, his noxious fumes in your lungs, with carbon
monoxide and furfurol dulling your wits, harsh irritants causing cough,
filthy expectoration and halitosis, and with nicotine and allergins increasing
the all too rapid wear and tear of modern life on your vascular systems.
Will you banish him from your daily life, or will you allow him out on
suspended sentence, only forbidding his companionship to certain of your
patients (removing the last comfort that some of them have), and will you
continue to puff complacently, and blow rings about the subject—to hold
you wedded to the weed?
Fellow smokers, I shall listen with pleasure to any evidence that may be
offered, in rebuttal of the proven falsity and criminal destructiveness, of
this our lovable companion.
' il'fi
■M
Just a few days'
Rest at the
Beautiful
HARRISON
HOT SPRINGS HOTEL
tr\i&i1'£
2'.-hour diive from Vancouver, over good
roads, or by rail direct to Agassiz with bus
connection direct to Hotel.
Bubbling
Hot
POTASH &
SULPHUR
SPRINGS
The
SPA
OF CANADA
TIRED professional men And the beautiful Harrison
Hot Springs Hotel a rendezvous for rest and complete relaxation. Only a few feet above sea level, yet
enveloped in invigorating high mountain air; a paradise of glorious scenery, mountain and lake. Rates are
moderate, accommodation is luxurious—a few days
revitalizes and eliminates that tired feeling.
Wire or write direct for Reservations and details
or telephone Sey. 85 85.
Harrison Hot Springs Hotel
HARRISON, B. C.
3M
Page 13 8 Dispensing Opticians
631  Birks Bldg., Vancouver, B.C.
S. BOWELL & SON
NEW WESTMINSTER, B. C.
• To enable the physician to
fit the treatment to the
particular need of the
patient, the five types of
Petrolagar afford a range of
laxative potency which will
meet practically every
requirement of successful
bowel management.
Samples free on request
Petrolagar Laboratories of Canada, Ltd.
WalkerviUe, Ontario
PetrDlanar
for CONSTIPATION
Distinctive
PRINTING
CARDS
STATIONERY
that really are nicer
AND COST YOU
NO MORE
ROY
WRIGLEY
Limited
300 WEST
PENDER STREET
VANCOUVER, B. C. BRAN   SUPPLIES  THE  "BULK"
THAT AVERAGE  MEALS  LACK
DINNER WITHOUT BULK
DINNER WITH   BULK
THE average Canadian menu often has too little
"bulk"— needed to aid elimination. This "bulk"
is furnished by fruits and vegetables — and by bran.
Tests have indicated that, with some individuals,
much of the fiber of fruits and vegetables is broken
down in the alimentary tract. Addition of bran to their
diet brought satisfactory taxation.
Microscopic examination of the intestines of bran-
fed laboratory animals, over a period corresponding
to 30 years of human life, failed to show any sign of
injury to the intestinal tract.
Special processes of cooking and flavoring make
Kellogg's ALL-BRAN finer, softer, more palatable than
ordinary raw bran. Except in cases of individuals who
suffer from intestinal conditions where any form of
"bulk" would be inadvisable, ALL-BRAN may be used
with safety.
Kellogg's ALL-BRAN is also a good source of iron
and vitamin B.
Kellogg's ALL-BRAN may be enjoyed as a cereal or
in cooked dishes. Sold by all grocers. In the red-and-
green package.  Made by Kellogg in London, Ontario. For relief in
NERVOUS INSOMNIA
CARDIAC INSOMNIA
POST-OPERATIVE INSOMNIA
ALL INSOMNIAS DUE TO PAIN
SONEBYL is non toxic, non. depressing', non habit-forming1.
1 or 2 pink tablets in hot beverage before retiring.
LABORATORY POULENC FRERES
OF CANADA LIMITED
Distributors: ROUGIER FRERES, MONTREAL
A PRESCRIPTION SERVICE .
Conducted in accord with the ethics of the Medical
Profession and maintained to the standard suggested by
our slogan:
Pharmaceutical Excellence
AAcG!ll 6 Otmr.   <
l_l fs/l ITED v—'
FORT STREET (opp. Times)      Phone Garden 1196      VICTORIA, B. C.
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.
B. C. STEVENS CO.
Phone Seymour 698
73 0 Richards St., Vancouver, B. C. One of a series of advertisements prepared and published by PARKE, DAVIS & CO. in
behalf of the medical profession.  This "See Your Doctor" campaign is running in the
Saturday Evening Post, Maclean's and other leading magazines.
Dear Dr. Armstrong:
Nothing would do but that Bobby bring this
to you himself, in person.
It's partly because you and he became such
good pals when you pulled him through that
siege last summer.
But more than that, he had heard his Dad and
me talking, and he knew that this was different from the ordinary check we send out—
that it deserved something more than the slapping on of a Stamp and routine delivery by
the mail man.
And Bobby is right.
You couldn't have done more if he had been
your own child. "We've always known this,
and yet your bill has lain here, put off month
after month, while bills for other things have
been paid.
It wasn't*that we didn't want to pay you, for
we did. But after we bought those things
necessary to keep us going—food, and clothing, and coal—our bank balance was pitiful
to behold.
Now, thank heavens, things are a little brighter.
And here at last is our chance to send you
something more than thanks for all you did
for Bobby and for us.
Sincerely,
Mrs. J B	
PARKE,   DAVIS   &   COMPANY
WALKERVILLE,   ONTARIO
The World's Largest Makers of Pharmaceutical
and Biological Products
■\   I
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if For your next case of
INFLUENZA
TN the treatment of influenza the application
■*■ of Antiphlogistine not only helps to relieve the
irritating cough, but, when used early, it may be
the means of warding off pulmonary and other
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It is best applied as hot as the patient can bear
with comfort, all over the front and back of the
chest, and renewed at the end of 12 hours.
Sample on Request
The Denver Chemical Mfg. Co.
153 Lagauchetiere Street W.
MONTREAL
ANTIPHLOGISTINE
Made in Canada TELLING    IT    TO    THE    WORLD
Agarol has told its slory of dependability to the medical profession of the world, not in words but in actions What a good
mineral oil emulsion, made of finest ingredients promised in theory, Agarol has performed in practice ....
That is why Agarol today is accepted as a standard in
the treatment of constipation in almost every land
of the globe where modern medicine has found
its way... With its therapeutic efficiency Agarol
combines unusul  palatability, unaided by
artificial flavoring. Its highly purified
ingredients   demand   no    disguise.
AGAROL
FOR     CONSTIPATION
Agarol is supplied in bottles containing 6,10 and
16 ounces.   The average dose is one table-
spoonful. Liberal trial quantities gladly
supplied to the medical profession.
ESTABLISHED IBS6
WILLIAM R. WARNER <& CO., LTD., Manufacturing Pharmaceutists since 1S56
727 King Street, West    -    -    -    Toronto, Ontario
Laboratories in Many Foreign Countries
J'l:
M.
Iii W. C. ECCLES
X-Ray Department, St. Paul's Hospital, Vancouver, B. C.
A Medical Institution for the restoration of health,
situated eighteen miles from Victoria, overlooking the
Gulf of Georgia.
Modern facilities for the treatment of all classes of
patients with the exception of those suffering from
mental or contagious diseases. Hydrotherapy, electrotherapy, massage, and diet, under medical supervision.
Physicians referring patients or convalescents for
treatment are requested to send such reports and suggestions as may assist in their treatment.
REST HAVEN SANITARIUM
and  HOSPITAL
SIDNEY, B. C. Coramine "Cifoa
jy
A non-toxic circulatory and respiratory stimulant  for oral,  hypodermic,  intravenous  and
intracardiac administration.
Improves the pulse and blood pressure, reinforces the contractions of the myocardium.
Very wide margin of safety (1-15 cc.)
AMPOULES LIQUID
CIBA COMPANY LIMITED
MONTREAL
;H
)m
flfoount Peasant Ulnbertakino Go. %tb.
KINGSWAY at 11th AVE. Telephone Fairmont 58 VANCOUVER, B. C.
R. F. HARRISON W. R. REYNOLDS
i-
t AT The Continental Breakfast
I growing
Ax far too many homes, a breakfast of a roll and a cup of coffee is the fare for children as well as adults.
Woefully deficient in vitamins and minerals, such a meal furnishes little more than a small amount of
calories. A dish of Pablum and milk, however, is just as easily prepared as a "continental breakfast," but
furnishes a variety of minerals (calcium, phosphorus, iron, and copper) and vitamins (A, B, G, and E) not
found so abundantly in any other cereal or breadstuff. The addition of a glass of orange juice and one
Mead's Capsule of Viosterol in Halibut Liver Oil can easily build up this simple breakfast into a nourishing meal for the children of the family as well as the adult members. It is within the physician's province
to inquire into and advise upon such matters, especially since Mead Products are never advertised to the
public. Servamus Fidem, "We Are Keeping the Faith."
Pablum (Mead's Cereal pre-cooked) is a palatable cereal enriched with vitamin- and mineral-containing
foods, consisting of wheatmeal, oatmeal, cornmeal, wheat embryo, alfalfa leaf, beef bone, brewers' yeast,
iron salt, sodium chloride.
sional card to Mead Jot:
f Canad
nlint' th
Ltd., Belle
chins unauth
, when re<.
•d persons.
iting samples of Mead Products to cooperate
SSBBB NO GREATER
TRIBUTE
could be given to Georgia Pharmacy service and
reliability than the fact that our 25 years of
experience as prescription specialists have firmly
established us in the complete confidence of so
many members of the medical profession.
?SEYIOSO
ONNAU
NIOHT
OPEN
ALL
NIGHT
GEORGIA PHARMACY
W.OEORQIAavaViMV  STREET
SEYMOUR
1050
' ■!!
Mi
f'l
1
)*
Gfrttter & ifrnma 10th.
Established 1893
VANCOUVER, B. C.
North Vancouver, B. C.    Powell River, B. C.
Published Monthly at Vancouver, b. c by ROY WR1GLEY ltd., 300 West Pender Street
1
il
i     1
1 ^£S^^^S^gJr^^g^S^£^^^S^g!^^r^
Hollywood Sanitarium
Limited
Tor the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or S15 Birks Building, Vancouver
Seymour 4183
Westminster 288
SS^3SSSSSS^35SS^SSSSSSSSSS|

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