History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: April, 1928 Vancouver Medical Association Apr 30, 1928

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Page 202 THE   VANCOUVER  MEDICAL  ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Association in the
Interests of the Medical Profession.
Offices:
529-30-31 Birks Building, 718  Granville St., Vancouver, B.C.
Editorial Board:
Dr. J. M. Pearson
Dr. J. H. MacDermot Dr. Stanley Paulin
All communications to be addressed to the Editor at the above address.
Volume 4
APRIL, 1928
No. 7
OFFICERS, 1927 - 28
Dr. W. S. Turnbull
Vice-President
Dr. G. F. Strong
Secretary
Dr. A. B. Schinbein
.  President
Dr. A. W. Huntbr
Past President
Dr. A. C. Frost
Treasurer
TRUSTEES
Dr. W. F. Coy Dr. W. B. Burnett Dr. J. M. Pearson
Auditors:   Messers. Price, Waterhouse & Co.
SECTIONS
Clinical Section
Dr. Gordon Burkje . Chairman
Dr. L. H. Appleby Secretary
Physiological and Pathological Section
Dr. J. E. Campbell Chairman
Dr. F.J. Buller ■ Secretary
Eye, Ear, Nose and Throat Section
 Chairman
 Secretary
Physiotherapy Section
Dr. H. R. Ross j Chairman
Dr. J. W. welch Secretary
Paediatric Section
Dr. E. D. Carder Chairman
Dr.  G. A. Lamont Secretary
STANDING COMMITTEES
Rep. to B. C. Med. Association
Dr. C. H. Vrooman
Dr. E. H. Saunders
Dr. W. E. Ainley I
Library
Dr.
C.
H. Bastin
Dr.
W
C.   WALSH
Dr.
W
A. Bagnall
Dr.
D.
F. Busteed
Orchestra
Dr.
J-
A. Smith
Dr.
L.
Macmillan
Dr.
H.
C. Powell
Dinner
Dr.
D.
D. Freeze
Dr.
C.
H. C. Bell
Dr.
T.
H. Lennie
Credit Bureau
Dr.
L.
Macmillan
Dr.
J-
W. Arbuckle
Dr.
N.
McNeill
Credentials
Dr.
F. W. Lees
Dr.
E. J. Gray
Dr.
w". F. McKay
Summer   School
Dr.
H. R. Storrs
Dr.
B. D. Gillies
Dr.
L. H. Appleby
Dr.
W". T. Ewing
Dr.
J. Christie
Dr.
J. T. Wall
Hospitals
Dr.
H. H. Milburn
Dr.
F. C. Brodie
Dr.
A. W. Hunter
Dr.
H. H. Planche
Page 203
; VANCOUVER MEDICAL ASSOCIATION
Founded 1898. Incorporated 1906.
PROGRAMME OF THE 30th ANNUAL SESSION
GENERAL MEETINGS  will  be held  on  the  first  Tuesday  and
CLINICAL MEETINGS on the third Tuesday of the month at 8 p.m.
Place of meeting will appear on Agenda.
1928
April      3rd—General Meeting:
Paper—Dr. F. Epplen, of Seattle.
"Some newer methods of renal diagnosis."
April    24th—Annual Meeting.
VANCOUVER HEALTH DEPARTMENT
STATISTICS, FEBRUARY,  1928
Total   Population   (Estimated)    - i 142,150
Asiatic Population   (Estimated)     10,940
Rate per 1,000 of Population
Total  Deaths  	
Asiatic  Deaths  	
Deaths—Residents   only   	
TOTAL BIRTHS  	
Male      150
Female 141
Stillbirths—not included  in above 	
156
13.85
16
18.46
118
10.48
291
25.84
INFANTILE MORTALITY—
Deaths under one year of age
Death Rate per 1,000 Births _
13
20
68.73
CASES OF INFECTIOUS DISEASES REPORTED IN CITY
January, 1928
Cases    Deaths
February, 1928
Cases    Deaths
March 1st to
15th, 1928
Cases     Deaths'
Smallpox   	
Scarlet Fever
Diphtheria   	
19
13
34
Chicken-pox          140
11
117
18
2
15
11
0
1
Measles
Mumps	
Whooping-cough
Typhoid   Fever
Tuberculosis	
Erysipelas	
Poliomyelitis   	
Cerebral-Spinal
Diphtheria   	
Scarlet Fever	
Smallpox	
Typhoid  Fever
0
0
0
0
0
0
0
0
18
0
0
0
Meningitis-
Cases from Outside City-
  7 0
 6 0
  4 0
  1 0
13
2
32
138
16
102
7
2
14
4
0
1
-Included
4
1
0
2
0
0
0
0
0
0
0
0
15
1
0
0
above
0
0
0
0
8
3
14
94
16
93
8
0
15
3
0
1
3
1
2
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
Page 204 ft
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t shows it knocked down
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Whether the space available is small or large, or the current direct or alternating, there is available in the Victor
line of quartz lamps a model that will permit the treat-
meat of cases with the utmost facility and economy.
Yictor Quartz Lamps
—the dependable means of applying the findings
of clinical research in ultraviolet therapy
AS was the case with the X'Ray, the development
Jl\. of ultraviolet therapy brings with it the need
of practical, tested apparatus of authoritative design
and unquestionable reHabihty.
Victor air-cooled and water-cooled quarts lamps
meet this need in every particular. They represent
the findings of research in both medicine and physics.
They have been generally accepted as the most
practical devices of their kind, offering the physician
and hospital a thoroughly dependable means of apply
ing ultraviolet therapy.
Our Reprint Library Service can refer you to authoritative literature citing clinical results with ultraviolet  in conditions
common to your practice, general or specialized. Your inquiry
will not obligate you in any way.
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VANCOUVER, B. C.
Page 206 EDITOR'S PAGE
We are glad to record the hard work done and the interest shown recently by members of the Association in matters concerning the government of the Society and in other affairs of a semi public nature. We refer
to the recent revision of the Constitution and By-Laws and to the discussions on the report of the Hospital Committee. These, in addition to
the scientific programme of the session and the particularly attractive
clinical meetings, have meant a very busy time for the Executive.
The revision just completed and adopted has been thorough. It
contains the first official reference to this publication, now in the fourth
year of its existence. Previously, the duties of the Editor were nebulous
in character and the position somewhat of a sinecure. Now the office,
or that of the Publications Committee which has replaced it, is one of
considerable importance and responsibility (or so it seems to the present
occupants).
Final official sanction has also been given in this revision to the new
Sickness and Benevolent Fund, a branch of the work of the Society which
puts what has always been a difficult problem on to a sound contributory
basis. We would suggest to the members that this fund will form a
suitable outlet for their philanthropic emotions, either during their lifetime or by way of legacy.
We hope that the most recent reorganization of the staff of the
General .Hospital will result in the permanent salvation of that venerable
institution. Perhaps something more is required than verbal or written
expressions of reorganization and if so we hope that this time that informing and implementing "something" will be forthcoming.
With the Metropolitan Hospital scheme and its necessarily accompanying survey of the future hospital needs of the Greater Vancouver, we are in complete sympathy. We urged on this page that such a
scheme should be contemplated before the erection of the infectious
diseases department and again before the inauguration of the present
building programme. Such a survey leads directly to another active
interest of the Association, the proposition of a medical faculty in the
University. To our mind the two problems are inextricably mingled and
upon the proper consideration of both depends the proper solution of
either.
The attention of our readers is drawn to the advertisement of the
annual (or now even perennial) Summer School which appears in our
advertising columns. There is no need for us to enlarge upon the probable
merits of the Session, as a glance at the names of the speakers will be a
sufficient guarantee. Now is the time to arrange your attendance on
June 5 th to 8 th. A large attendance is especially necessary this year, as
the expenses of the School will be very materially increased.
We are very pleased to report that Dr. H. M. Cunningham has recovered from his recent long illness and will resume practice in the Birks
Building (fifth floor) on the first of April.
Page 207 "THE DEVELOPMENT OF OUR KNOWLEDGE
CONCERNING TUBERCULOSIS"
By C. H. Vrooman, M.D., CM.
(The "Osier" Lecture, delivered before the Vancouver Medical Association, at the meeting of March 6th, 1928.)
Gentlemen:—
First I must thank you for the honour you have done me in asking
me to deliver the eighth Osier lecture. The honour carries with it a
considerable responsibility, which is made still greater by the high standard set by my predecessors in this lectureship. This lecture, however,
is rather an incident in a celebration, for we are gathered tonight not
merely to hear a lecture but to celebrate the life and work of that greatest of Canadian physicians, Sir William Osier. In paying our small
tribute to his memory we do but honour ourselves in honouring one who
by his life, his teaching and his practice did so much to keep high the
ideals of our profession.    He says of himself
"I have loved no darkness, sophisticated no truth, nursed no delusions, allowed no fear."
It would be hard to choose any subject in medicine for a discussion
that could not be illuminated by something which Osier has written.
From the beginning of his medical teaching Osier was greatly interested
in the subject of tuberculosis. He made fifty original contributions on
different aspects of this subject. He was one of the moving spirits in
organizing the National Tuberculosis Association in 1904 and became its
first vice-president. One of the last addresses he gave before his death
was on acute pneumonic tuberculosis—March 24th, 1919.
The subject I have chosen for discussion is the development of our
knowledge of tuberculosis, hoping that by a brief journey into the history of medicine we may better appreciate the way in which the kernels
of truth have been winnowed from the chaff of speculation.
Each method of diagnosis—each correct observation—each new experimental method—each new tool added to our armamentarium—has
meant laborious work. Pioneers in these fields were great; some were
geniuses, but they were not omniscient; they made mistakes, they
stumbled in their search for truth, yet each added some truth to the store
of knowledge and we are debtors to them today.
"I hold strongly with the statement," says Osier, "that it is a sign
of a dry age when the great men of the past are held in light esteem.
By the historical method alone can many problems in medicine be approached profitably. For example, the student who dates his knowledge
of tuberculosis from Koch may have a very correct but a very incomplete appreciation of the subject."
To the ancients any chronic wasting disease accompanied by cough
and expectoration was called consumption or phthisis. The description
of this disease by Hippocrates  and his aphorisms concerning it repre-
Page 208 sented for over two thousand years the sum of medical knowledge of a
disease that probably during this period was responsible for every fifth
or sixth death. That for two thousand years physicians should subscribe
to the authority of Hippocrates and Galen redounds to the credit of
these ancients, but it hardly increases our respect for those who would
be so submissive to tradition.
About the end of the 2nd century, A.D., a highborn Roman lady
who had spat blood consulted Galen. "I did not bleed her," writes the
great physician, "as she had fasted for four days on account of the
catarrh, but I ordered an active enema. I had her legs and arms rubbed
and tied and her head shaved and covered with pigeon's dung. I then
ordered the bath, desiring her to be well clothed after it, and to take
some austere wine with fruit and some drinks; and a mild opiate before
she slept. It appeared that her lungs still wanted cleansing but I suffered her to remain at rest through the day, only employing frictions
and giving an opiate at night. The next day she took boiled honey
and cream of ptisan and the frictions were repeated. This system was
repeated with proper alterations for some days and the patient recovered
without the use of milk."
Galen recommended his consumptives to live at Stabiae, a hill three
miles from the Bay of Naples, and advised that they drink much cow's
milk, or better goat's or asses' milk, or best of all, woman's milk.
Areta^us, a contemporary of Galen, was insistent in the virtues of
a sea voyage and much milk. "And if the patient have it at his command," says Aretaeus, "living on the sea will be beneficial, for the sea
water contributes something desiccant to the ulcers. . . . Often milk
alone sufficeth in place of all food, for milk is pleasant to take, is easy
to drink, gives solid nourishment and is more familiar than any other
food to one from a child. In colour it is pleasant to see; as a medicine
it seems to lubricate the windpipe; to clean as if with a feather the
bronchi, and bring off phlegm, improve the breathing, and facilitate the
discharges downward. If one then will drink plenty of this he will not
stand in need of anything else. For it is a good thing that in a disease
milk should prove both food and medicine. . . . Eggs from the fire, in
liquid state but hot; they are best when newly laid."
The nineteenth century was well spent before there was much improvement in the treatment of consumptives from that recommended
by Galen and Aretaeus. Much we will see was learned in the meantime
as to the pathology, diagnosis, clinical course, causation and prevention
before our modern methods of treatment became established. If one
were to judge by some of the effusions regarding the treatment of disease
that appear in the daily press, a large part of the population is still
dwelling in the Galenic age.
As illustrative of the state of knowledge that prevailed well into
modern times, let me read you Oliver Wendell Holmes' description of
the visits of Master Giles Firmin, physician to the good people of Ipswich, New England, who, accompanied by his one pupil answering to
the scriptural name of Luke, is making his calls.    It is the year 1647.
Page 209
1
mm "They jog along the bridle-path on their horses until they come to
another lowly dwelling. They sit awhile with a delicate looking girl in
whom the ingenuous youth naturally takes a special interest. The good
physician talks cheerfully with her, asks her a few questions. Then to
her mother: "Good wife, Margaret hath somewhat profited, as she
telleth, by the goat's milk she hath taken night and morning. Do thou
pluck a maniple—that is an handful—of the plant called maidenhair,
and make a syrup therewith as I have shewed thee. Let her take a cup
full of the same, fasting, before she sleepeth, also before she riseth from
her bed."   And so they leave the house.
"What thinkest thou, Luke, of the maid we have been visiting?"
"She seemeth not much ailing, Master, according to my poor judgment.
For she did say she was better. And she had a red cheek and a bright
eye, and she spake of being soon able to walk unto the meeting, and did
seem greatly hopeful, but spare of flesh, methought, and her voice something hoarse, as of one that hath a defluxion, with some small coughing
from a cold, as she did say. Speak I not truly, Master, that she will be
well speedily?"
"Yea, Luke, I do think she shall be well, and mayhap speedily. But
it is not here with us she shall be well. For that redness of the cheek
is but the sign of the fever which, after the Grecians, we do call the
hectical; and that shining of the eyes is but a sickly glazing, and they
which do every day get better and likewise thinner and weaker shall find
that way leadeth to the church-yard gate. This is the malady which the
ancients did call 'tabes,' or the wasting disease, and some do name the
consumption. A disease whereof most that fall ailing do perish. This
Margaret is not long for earth—but she knoweth it not, and still hopeth."
"Why, then, Master, didst thou give her of thy medicine, seeing
that her ail is unto death?"
"Thou shalt learn, boy, that they which are sick must have somewhat wherewith to busy their thoughts. There be some who do give
these tabid or consumptives a certain posset made with lime-water and
anise and liquorice and raisins of the sun, and there be other some who
do give the juice of crawfishes boiled in barley-water with chicken-broth,
but these be toys, as I do think, and ye shall find as good virtue, nay
better, in this syrup of the simple called maidenhair."
But even while Giles Firmin was jogging his rounds, great things
were stirring in the world. New discoveries were being made and beginnings of new methods acquired that would in time revolutionize the
whole world of medicine.
In the 16th century Vesalius broke away from the old Galenic
authority and became the maker of modern anatomy. In 1628 Wm.
Harvey published his famous lectures announcing the circulation of the
blood. Towards the latter part of the 17th century, a Jesuit priest,
who is described as a mathematician, a physicist, an optician, an orientalist, a virtuoso and physician, Athanasius Kircher of Fulda, made a
crude lens and started to look at things.    He looked at the blood of
Page 210 plague patients and saw myriads of what he called worms and which he
thought were the cause of plague. We know now that what he saw were
the red blood cells. But it was the beginning of a new method, the study
of the "infinitely little," which was to mean much for mankind.
Then in Delft in the Netherlands in the latter part of the 17th
and beginning of the 18 th centuries there lived a man who spent most
of his life of 91 years making microscopes and looking at the wonderful
little things of the world. A queer character was old Anthony Van
Leuwenhoek (1632-1723). He earned his living sweeping out the city
hall and spent all his spare time grinding glass into lenses, making microscopes and looking at all varieties of things—hairs, flies, lice, bugs, rainwater, scrapings from his tongue and teeth. He wrote papers and sent
them to the Royal Society of London and caused great commotion. They
sent two of their learned men to Delft to see if he were telling the
truth. Old Leuwenhoek let the city hall go dirty while he showed them
the wiggly little things to be seen in stagnant water, the garlands and
chains of living things he could obtain by scraping his tongue and teeth.
He told them that the wiggly things disappeared from his mouth after he
had drunk several cups of hot coffee which he used to do in order to clear
his head from the effects of too liberal potations of spirits. They tried
to buy one of his precious microscopes but he would not sell; they were
the work of his hands and beyond price. Leuwenhoek made 247 microscopes with 419 lenses; he contributed 375 papers to the London Royal
Society and 27 to the French Academy of Science. No mean contribution to the progress of the world from a humble janitor, the establishment of a new method which finally culminated in the epoch-making
discoveries of Pasteur, Lister and Koch.
Would time permit it would be interesting and profitable to dwell
on the work of many of the pioneers of early research. Mention must
be made of a few who added to our knowledge and are now almost forgotten. Sylvius (1614-1672) who first pointed out the connection between tubercles and phthisis. Richard Morton (1635-1698) who wrote
most voluminously and described thirty different varieties of consumption; William Stark (1740-1770) a brilliant and almost forgotten
young Englishman. Stark wrote one of the most perfect descriptions of
the gross pathology of tuberculosis. He announced that all phthisis was
due to tubercles, thus anticipating by forty-eight years Lamnec's important pronouncement. He did only ten post mortems on tuberculous
subjects and died at the age of thirty.
There is one investigator of the 18th century to whom we must
give more than a passing notice because his discovery gave us another
new method which has added much to our knowledge of diseases of the
chest. It is Leopold Auenbrugger. He lived and practised medicine in
Vienna and in 1761 at the age of thirty-nine he published in Latin a
small volume on "Percussion of the Chest." It was really an epoch-
making book and it is worth our while to read the first paragraph of his
preface.
He says "I here present the reader with a new sign which I have
discovered for detecting diseases of the chest.    This consists in the per-
Page 211 cussion of the human thorax, whereby, according to the character of the
particular sounds thence elicited, an opinion is formed of the internal
state of that cavity. In making public my discoveries respecting this
matter, I have been actuated neither by an itch for writing, nor a fondness for speculation, but by the desire of submitting to my brethren the
fruits of seven years' observation and reflexion. In doing so, I have not
been unconscious of the dangers I must encounter: since it has always
been the fate of those who have illustrated or improved the arts and
sciences by their discoveries to be beset by envy, malice, detraction, and
calumny. This, the common lot, I have chosen to undergo; but with
the determination of refusing to every one who is actuated by such motives as these all explanation of my doctrines. What I have written I
have proved again and again by the testimony of my own senses and
amid laborious and tedious exertions; still guarding on all occasions
against the seductive influence of self-love."
Little notice was taken of Auenbrugger's modest work of ninety-
five pages and it was almost forgotten until the great French physician
Corvisart in 1808 translated and brought it again to the attention of
the medical world where it was at last accepted as a method of great
usefulness. Auenbrugger just lived one year after Corvisart's translation was published.
Among the pupils of the great Corvisart was one who combined
the patient industry of the investigator with the vision of a genius and
who was destined to carry the torch of truth far beyond any of his fellows. As the founder of modern clinical medicine Theophile Laennec
can easily be classed as among the great of our art. Born in 1781, raised
by his uncle at Nantes, we are told that he and his brother had to go to
school by the back streets in order to avoid the dreadful signs of the
.guillotine which was erected in front of their house. At fourteen he
was dissecting in the medical school; at nineteen he went to Paris; in
the following three years he wrote careful histories of four hundred
cases; in 1804, at the age of twenty-three, he graduated. He started
practice in Paris. In his first year of private practice we are told he
earned 150 francs; in his second year, 400 francs, but by 1813 it had
reached 10,000 francs and he had become a well-known physician in
Paris. He edited a medical journal and contributed extensively to the
medical literature. His contributions on morbid anatomy made him one
of the recognized authorities in France long before he ever thought of
the stethoscope. So it was no immature or unknown physician who was
appointed to the staff of the Necker hospital in 1816. It was a careful
and observant clinician who had learned that the only way to find truth
in medicine was to work for it. The discovery of the stethoscope was
such an epoch-making event in medicine that it is well for us to hear in
Lamnec's own words the account of it. He says in the introduction to
his treatise on "The Diseases of the Chest and on Mediate Auscultation,"
published in 1818:
"In 1816 1 was consulted by a young woman labouring under general symptoms of diseased heart, and in whose case percussion and the
application of the hand were of little avail on account of the great de-
Page 212 gree of fatness. The other method just mentioned being rendered inadmissible by the age and sex of the patient, I happened to recollect a
simple and well-known fact in acoustics, and fancied it might be turned
to some use on the present occasion. The fact I allude to is the great
distinctness with which we hear the scratch of a pin at one end of a
piece of wood on applying our ear to the other. Immediately, on this
suggestion, I rolled a quire of paper into a kind of cylinder and applied
one end of it to the region of the heart and the other to my ear, and was
not a little suprised and pleased to find that I could thereby perceive the
action of the heart in a manner much more clear and distinct than I had
ever been able to do by the immediate application of the ear. From this
moment I imagined that the circumstance might furnish means for enabling us to ascertain the character, not only of the action of the heart,
but of every species of sound produced by the motion of all the thoracic
viscera and consequently for the exploration of the respiration, the voice,
the rhonchus, and perhaps even the fluctuation of fluid extravasated in
the pleura or the pericardium. With this conviction I forthwith commenced at the Hospital Necker a series of observations from which I have
been able to deduce a set of new signs of diseases of the chest, for the
most part certain, simple, and prominent, and calculated, perhaps, to
render the diagnoses of the diseases of the lungs, heart, and pleura, as
decided and circumstantial as the indications furnished to the surgeon
by the introduction of the finger or sound, in the complaints wherein
these are used."
Think of it—in 1816—he discovers a new tool. In 1818 he published the results of his observations and these observations have proven
to be at least ninety per cent, correct. A new diagnostic method introduced by which our store of knowledge has been enormously increased
and the observations found substantially correct after one hundred years.
Laennec did more than observe the signs of diseases of the chest. He
spent hours and days in studying the morbid anatomy, especially tuberculosis, and announced definitely the unity of all forms of tuberculosis.
Phthisis was caused by successive crops of tubercles. Caseation was always preceded by tubercles. It was sixty years later before this unity
of all forms of tuberculosis was finally established by Villemin. This
truth, in the meantime, was vigorously combated by the great Virchow
who held that certain forms of pneumonia only became tuberculous
because of some hereditary predisposition of the tissues or some unknown
deteriorating influence. It was Virchow's pupil Niemeyer who was author
of the saying "the worst thing that could happen a consumptive was to
become tuberculous."
On August 2nd, 1826, in his forty-fifth year—ten years after he
invented the stethoscope—Lasnnec died of pulmonary tuberculosis. Sir
Wm. Osier says, "Lamnec's contribution to the study of disease of the
lungs, of the heart, and of the abdominal organs really laid the foundation of modern clinical medicine."
Lamnec not only put into our hands the means to recognize pulmonary tuberculosis clinically in its earlier stages but he described the
Page 213 disease as a clinical entity and gave us for all time a new means of diagnosis. As to the cause and as to the treatment Laennec and his contemporaries were still fumbling in the dark. The idea that a consumptive became such because of the curse of God or the influence of the Evil
Eye had pretty generally been abandoned. Physicians now said it was
due to heredity, or was a miasma brought on by damp east winds, or it
was a degeneration of the tissues fromn unknown cause. Some even
hinted it might be infectious but this was considered a wild speculation.
A rather close parallel may be seen in our present-day theories in regard
to the cause of cancer.
As to treatment—blood letting, tartar emetic, depletents, protection
from the cold, especially the evil effects of night air, were all that could
be done. They all died or nearly all died, who showed definite symptoms.
Louis tells us that the average length of life of a consumptive was two
years.
Early in the 19 th century scientific men were peering with renewed interest into the microscope and rediscovering the little wiggly
worms described by old Leuwenhoek. It was even thought by some
that these minute things might be a cause of disease but the controversy
was still waging as to the spontaneous generation of life. It was the
genius of Louis Pasteur that settled this matter for all time and started
a new epoch in medicine. It would lead us too far afield at this time
to even try to sketch the work of this wonderful French scientist. We
all know how Pasteur's work opened the way for Lister and all the
triumphs of antiseptic surgery. Scores of others less remembered started
investigating the many problems of medicine. It was inevitable that
tuberculosis as the "Captain of the Men of Death" should be attacked
as one of the major problems. The honour of proving that tuberculosis
was an infectious disease goes to another Frenchman.
Jean Antoine Villemin, December 5 th, 1865, presented a paper to
the French Academy of Medicine in Paris, in which he said:
"He had innoculated material from the gray tubercles of a consumptive's lungs into rabbits; that several weeks later he had killed the
rabbits and examined them and in their internal organs had found tubercles exactly like those met with in consumption. Therefore, tuberculosis
was an infectious disease due to a specific virus." A most amazing statement, which was received by that distinguished body of physicians who
composed the French Academy of Medicine with absolute incredulity.
Villemin stood alone and was subjected to the most acrimonious criticism.
Here is the peroration to an address of Pidoux criticising ViUemin:
"What a misfortune should things result thus: social economy,
public and private hygiene, prophylaxis, medicine—all their aspirations
condemned in advance. The poor consumptives sequestered like the
bearers of plague. Family tenderness at war with fear, and self preservation face to face with a malady which, because of its long course and
homicidal atmosphere, would wear out devotion. If consumption is
contagious, we dare not say it aloud."
Page 214 But Villemin was not depressed by these criticisms and three years
later published a masterly book on tuberculosis and reiterated his former
opinion backed by more complete experiments that consumption was an
infectious disease. The new method of experiment, animal innoculation,
brought out the new truth. Villemin did not crown his work by discovering the virus or infectious agent but he established the truth as far
as he could with his method. He re-established the doctrine of Latnnec
as to the unity of all tuberculous lesions which the authority- of Virchow
had successfully until then combated. The crowning achievement of
the discovery of the tubercle bacillus was left to another man who established another method in the study of diseases—Robert Koch.
In 1843, in a small village in the Harz Mountains, was born Robert Koch. Father Koch was not over blessed with this world's goods
and Robert was the eldest of a family of nine, so it was no spoonfed youth who won his way to fame. His early dreams were to
sail the seven seas, to explore the world, and to do this he wanted
to become a doctor, and then a ship's surgeon. So after much scraping
and scrimping he managed to enter the medical course at the University
of Gottingen. The Professor of Anatomy at Gottingen was Jacob
Henle, a man who did much more than give his name to certain tubules
in the kidney. Henle was a great personality. He not only taught his
pupils to peer through a microscope but he taught them to think. He it
was who wrote, many years before Koch became his pupil, this maxim—
"Before microscopic forms can be regarded as the cause of contagion in
man they must be found constantly in the contagious material, they
must be isolated from it and their strength tested." It is no doubt due
to teaching such as this that Koch became afterwards the accurate investigator.
Koch graduated in 1866 and he did not become a ship's surgeon.
He became a country practitioner and got married, thereby giving "hostages to fortune." He did not make a success at first of country practice
and we find him moving several times and at one time seriously thinking of emigrating to America, but finally we find him in 1872 settled
at Wollstein, in Posen, and his practice had grown to such an extent that
he had a little more than enough to buy the bare necessities of life. Frau
Koch celebrated the growing prosperity by presenting her husband with
a microscope for a birthday present—not a wise thing for her own happiness but a fateful thing for the happiness of the world. We find that
Robert for the rest of his life devoted more time to the microscope than
to his family. He curtained off a part of his consulting room and built
a laboratory, got an incubator, a microtome, some rabbits and guinea
pigs and for four years he worked. He neglected his practice, his meals,
his wife. It is true he tried to tell her what he was doing but Frau
Koch was practical and her reply was "But Robert, you smell so."
In April, 1876, Prof. Cohn of Breslau received a letter from his
old-time pupil Robert Koch stating that he had worked out the life
history of the germ of the disease anthrax. Koch went to Breslau at
Cohn's invitation and for three days before Cohn and his assistants he
(Continued on Page 222)
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Page 217 The
British Columbia Laboratory Bulletin
Published  monthly  September  to  April  inclusive  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.
Volume 2
APRIL 1st, 1928
No. 7
CONTENTS
B. C Laboratory Evening  Hill
Vaccination.—The New Method—The Immune Reaction Hill
Blood Grouping   F.O'R.
B. C. LABORATORY EVENING
Introductory—By H. W. Hill, M.D., D.P.H., L.M.C.C,
Director: V. G. H. Laboratories.
Gentlemen:—The demonstrations offered to you this evening in biochemistry and in bacteriology are in realization of a proposal made nearly
three years ago, that the Vancouver General Hospital Laboratories should
demonstrate its laboratory work at a meeting of this Association. The
idea has grown somewhat and we are glad to have secured representatives
from other Laboratories to join with us, Dr. A. Y. McNair, of the St.
Paul's Hospital Laboratory, Dr. C. S. McKee, of his own Laboratory,
Dr. John Christie and Dr. D. E. H. Cleveland in a demonstration of a new
diagnostic use of ultra-violet rays. We invited demonstrations from certain out-of-town Laboratories also, but two are undergoing the throes of
reoganization and expansion, Kamloops and Kelowna; while the Director
of the Jubilee Hospital Laboratory is away.
Realizing that the ordinary laboratory has as its chief reason for
existence the application of its tests to clinical work which are and can
only be made by the clinician, we have secured papers on such clinical
applications from physicians and surgeons in active practice; Drs. L. H.
Appleby, J. E. Campbell, A. W. Hunter, J. M. Pearson. These will be
presented first, the demonstrations afterward.
The other reason for the existence of the laboratory is the contributions it may make to research. During the course of the last 2l/2 years,
our Laboratory stoff has contributed between 80 and 90 articles an laboratory investigations; and there are now proceeding five major researches,
Page 218 one on cholesterol in cooperation with the University; two on glucose,
one of which is in cooperation with Tranquille Sanitorium; and two on
Hospital matters.
Research is, of course, slow and difficult in any laboratory faced
with an enormous and continually increasing routine. Our own is peculiarly subject to this because of lack of staff and space. We average 255
routine specimens per day every day of the year. Of the two great
divisions of our work, Hospital specimens total a little over half (54%),
Public Health work a little less than half (46%). Both are increasing
rapidly; 1927 showed, as compared with 1926, an increase of 27% in the
Hospital work, of 21% in the Public Health work. Taking only the
Hospital work, we reconize three divisions, Routine urines, Clinical work,
and Pathological. Thepathological work, under Dr. H. H. Pitts, has
shown the largest increase of all, 35%. The Clinical work has increased
14%. The Urines have decreased about 3 3%. It is this decrease in urines
which has made the clinical increase possible. We owe this decrease, and
therefore the advances in clinical lines, to the work of a staff committee,
Drs. A. W. Bagnall, G. F. Strong, and Wallace Wilson, to whom our
best thanks are due.
VACCINATION-
-THE IMMUNE
H.
-THE NEW METHODS
REACTION
W. HILL, M.D., D.P.H., L.M.C.C., Director V. G. H. Laboratories
Given, with demonstrations, at the B. C. Laboratory Evening,
February 29, 1928
The methods today (of which there are four, very slightly differing
from each other) have in common great reduction in the area of insertion; great reduction in, almost complete absence of, trauma; based on
these two, a clean cut "immune reaction" (when failure to "take" results from immunity); and finally, the total absence of indication for
dressings of any kind.    All consist in:—
(a) Cleansing of the skin, usually of the left arm; often the
particular site is on the outer surface of the left arm just below the
shoulder; but now more and more often, on the inner surface of the
left arm, rather more than half-way up. This latter site is just as good
as the other; the vaccination "take" is less likely to be rubbed or struck
as the vaccinee goes about before it is healed; and the scar does not show
when the shoulder is exposed.
Soap and water, alcohol and ether, ar best of all, aceton alone, may
be used for this cleansing. The alcohol, ether, or aceton should of
course be allowed to evaporate completely before proceeding.
(b) The vaccine, a drop of which is obtained by breaking a sealed
glass capillary tube, is deposited on the skin at the site selected.
(c) The merest tip of a sterile sharp-pointed needle is pressed,
not into the true skin, but on or into the epithelial layer only, the needle
being inserted through the drop of vaccine. No blood is drawn and
even children do not complain of pain.
Page 219 (d) The surplus vaccine is wiped off and the sleeve pulled down,
without dressing of any kind whatever.
The total time taken need not be over a minute (including the
•cleansing of the skin)  from baring the arm to drawing the sleeve down
The slight differences in the four methods above referred to are
found only in the details of manipulation followed in using the needle
point.   Paragraphs (a), (b) and (d) are exactly the same in all methods.
Under paragraph (c), the first or Canadian method (H. W. Hill)
consists in pressing the needle point forward one-thousandth of an inch
into the epithelium 6 or 8 times (all within an area of 1/16th of an
inch). The second or Dominion Health Department method consists
in pressing the needle point forward 1/16 of an inch, into the epithelium, once only. The third or U. S. Public Health Service method (J.
P. Leake) consists in pressing the needle point against the skin and
"wiggling" it up and down or sideways very gently, about 3 0 times.
The movement is very slight, like the vibration of a tuning-fork, but,
of course, much slower. The fourth or "One-Press method" (R. A.
.Seymour, M. B.,) consists in pressing the side of the needle and needle
_point flat against the skin, once only, the pressure being made directly downward upon the skin through the drop of vaccine. This completes the whole process.
In none of the four methods is blood drawn or pain suffered. In
all four methods the Great Safety-First device is the omission of all
•dressings, of any kind whatever. It has been found by the most carefully controlled experiments that the only "takes" that go bad are those
"that are dressed. Even virulent germs (e.g., tetanus) experimentally
mixed with the vaccine and used on animals, produced trouble only in
dressed wounds (see Vancouver Medical Association Bulletin, Feb., 1928,
Page 159.)
THE RESULTS OF THE NEW METHODS OF VACCINATION
1. A "take" is characterized by the following features: The day
after the vaccinating is done, the site shows nothing at all or perhaps a
tiny, brown, dry spot is just visible. Nothing at all usually happens
further for four or five or six days. Then the site becomes red; later
it swells a little, forming a small papule; then a head, about the area of
a Canadian five-cent piece or perhaps a dime or even a quarter; then
this dries up into a small compact, more or less spherical scab; and finally
this scab drops off, leaving a smooth, clean scar which shrinks slowly.
Total time about two or three weeks. Such a development occurs in
those who are not immune to start with; and it makes them immune.
IMMUNE REACTIONS
2. In those who are already completely immune, the vaccination
acts quite differently. The day after the vaccinating is done, usually,
the site of the vaccination shows a red, itchy papule (instead of nothing
as in the previous case); in two to five or eight days this is gone, without any head forming; i.e., it is all over, usually by the time that a "take"
would first begin to show. Such a quick-forming itchy papule which
disappears quickly again is known as an "immune reaction"; i.e., it indicates that the person showing it is immune, and is now accepted as
legal proof of that fact.   It leaves no scar.
Page 220 3. In those who are only partially immune, the red papule comes
up at once, as already stated in 2; but instead of fading out, it develops
a small vesicle which then promptly dries and scabs. This is a "take"'
on a very early and abortive scale. It is the so-called "accelerated reaction." In the case either of a "take" or of an "immune reaction""
there is no need to repeat the vaccination at the time.
FAILURES
4. The only occasion when an attempted vaccination should be
at once repeated is when neither a "take" nor an "immune reaction'*
occurs, i.e., when nothing at all happens. This non-reaction indicates
either a failure to get the needle point into the skin at all, or, much
more often, that the vaccine has lost its power, either from being too
old, or from being warmed. Over-warming can occur very readily indeed. Vaccine should always be kept in a refrigerator, up to the moment
of use if possible. If it stands about in a warm room or is carried for a
short time in a vest pocket, it may easily become warm enough to lose
its power, and thereafter is permanently inert.
BLOOD GROUPING
We have recently adopted in this Laboratory the ABO system of
nomenclature for blood grouping. The Moss classification was originally established in this Laboratory, although since that time the Jansky
classification has been given general priority in the literature, since his
work was published before that of Moss.
However, it has been decided to replace the Moss classification in.
this Laboratory with the ABO classification, which seems to have been
given preference in the more recent reviews and literature.
The following table illustrates this ABO classification and compares it with the two sets of classification formerly in use.
MOSS JANSKY        Per cent.        ABO
(discarded) (original) incidence        System.
GROUP         1 4 4 AB
GROUP         2 2 40 A
GROUP         3 3 14 B
GROUP         4 1 42 O
GROUP AB—Persons having all corpuscles sensitive to the two
common agglutinins. These persons have neither agglutinin themselves.
They are dangerous as donors; are relatively safe as recipients; and are
(wrongly) called "Universal Recipients."
GROUP A—Persons having corpuscles sensitive to agglutinin "a"»
These have no agglutinin "a" themselves; but do have agglutinin "b".-
They are most dangerous to B and O.
GROUP B—Persons having corpuscles sensitive to agglutinin "b"-
These have no agglutinin "b" themselves; but have agglutinin "a"..
They are most dangerous to A and O.
GROUP O—Persons having no corpuscles sensitive to either agglutinin. These have both agglutinins themselves. They are dangerous
as recipients; are relatively safe as donors; and are (wrongly) called
"Universal Donors."
— F. O'R., V. G. H. Lab..
Page 221 (Continued from Page 215)
•demonstrated. He first showed the anthrax bacillus in the blood of
animals. He planted the blood on sterile blood serum (it had taken
many months to find out this simple method of growing germs). He
recovered the anthrax from the culture, injected it into animals and
produced the disease—thus fulfilling for the first time the dictum laid
down years before by his teacher, Jacob Henle. Imagine the excitement
in the laboratory. We find Prof. Cohn Cohnheim exclaiming to his
assistants: "The greatest discovery in bacteriology ever made has just
been demonstrated and this is not the last time that this young Robert
Koch will surprise and shame us by the brilliance of his investigations."
Back Koch went to Wollstein for another two years and did patient
work an various infections. It was not until 1880 that, a vacancy occurring in the Imperial Health Bureau in Zerlin, Koch was offered the
position and moved to Berlin, where he remained for the rest of his life.
His activity at this time was enormous and it would take too long to
recount the steps by which he developed the various methods of growing
germs, isolating pure cultures and studying their life history. It was
only a natural evolution that when in 1881 he devoted his attention to
tuberculosis he should at last isolate the tubercle bacillus which had so
long evaded the grasp of so many other careful investigators.
On March 24th, 1882, before the Berlin Medical Society, Koch read
his paper announcing that he had discovered the bacillus causing tuberculosis. It is probably one of the most complete and flawless scientific
demonstrations ever made of a new discovery. There was no loop-hole.
The chain of evidence was complete and no investigator has found a flaw
in it since. The tubercle bacillus causes all forms of tuberculosis. We
are told that there was no discussion following this paper. The great
Virchow was there—the veteran of many a scientific battle—but even
"Virchow could find nothing to criticize. The demonstration was complete; they filed out in silence.
Over in the Adirondacks by the shores of Saranac Lake, there was
living at this time a physician who, nine years before, had been told he
had tuberculosis of the upper two-thirds of his left lung. He had gone
there to die but life in the fresh air combined with rest had restored
him to comparative health. Dr. Edward Livingstone Trudeau, inspired
by the writings of Brehmer and Deitweiler, was gathering money from
his wealthy friends to build a sanatorium where poor as well as rich could
have the treatment he had found so beneficial. To him came the news
of Koch's discovery.    He says in his autobiography:
"This time in medicine was the dawn of the achievements of the
new experimental method. ... If I could learn to grow the tubercle
bacillus and if I could produce tuberculosis at will with it in guinea pigs,
the next step would be to find something that would kill the germ in
the living animal. If an innoculated guinea pig could be cured, then
in all probability this great burden of sickness could be lifted from the
human race."
Page 222 Trudeau learned to grow and isolate the tubercle bacillus, but alas!
he did not, nor has any one, yet discovered how to kill the tubercle
bacillus without destroying the animal affected. Unfortunately, what
Trudeau said to his students forty years ago still remains true—"The
tubercle bacillus bore cheerfully a degree of medication which proved
fatal to its host."
While practically all our modern knowledge of the pathology and
the prevention of tuberculosis is founded upon Koch's discovery, our
knowledge of treatment is largely based upon that slow and often inaccurate method, namely, clinical observation. The first man in any way
to advocate a method approximating our modern treatment was an
Englishman, Dr. George Bodington. In 1840 he published an essay, "The
Treatment and Cure of Pulmonary Tuberculosis," in which he says:
"Having mentioned the shutting-up plan in close rooms, the use
of antimony and digitalis, if I add the use of-demulcents, of blisters, of
leeches, of plasters, etc., I shall have described the helpless and meagre
system of medical treatment of consumptives in use at the present day."
Having laid these methods aside as useless, he describes how a consumptive should be treated, namely, a nourishing diet, wine for the stomach's
sake, opium to relieve cough and give sleep, and above all, "the free use
of a pure atmosphere . . . the application of cold, pure air to the interior surface of the lungs is the most powerful sedative that can be
applied . . . the patient ought never to be deterred by the state of the
weather from exercise in open air . . . " He goes on to advocate the
building of special institutions for the care of consumptives. He says:
■"The generality of the medical profession have not the opportunity of
thus treating their consumptive patients. If they are to succeed they
should have country houses in proper situations, well ventilated, provided
with all the appliances and means and where their patients should be
under their own eyes and strictly watched and regulated in all respects
as regards exercise, air, diet, medicine, etc. Or there should be a certain
class of practitioners who should exclusively pursue this practice as a
distinct branch, to whom those in large towns should confide their consumptive patients, instead of sending them, as many now do, to take
their chance or probably fall into the hands of mercenaries at some
distant sea port, where they commonly die far away from friends and
home."
These were wise words spoken sixty years ahead of their time. If
Bodington had been able to establish these institutions where he could
have observed his patients, he would no doubt soon have eliminated exercise from his regime and substituted rest and then he would have expressed the whole modern idea of the treatment of consumptives. He
was, though, so severely handled by his critics that he had to abondon
the use of his house for the treatment of consumptives and use it for a
private insane asylum.
It remained for a German to demonstrate successfully the value of
sanatorium treatment in pulmonary tuberculosis. It was in 1854 that
Dr. Herman Brehmer, a victim of tuberculosis himself, opened at Gor-
Page 223 bersdorf, Silesia, a few simple buildings for the treatment of consumptives. Following to a large extent the principles advocated by Bodington, he demonstrated that by keeping his patients on a strict regime over
a long period of time he was able to cure cases of pulmonary tuberculosis.
It took over thirty years—a long time—before he convinced the profession of the soundness of his practice. In the meantime his pupil
Deitweiller, another consumptive, established another institution at Falk-
enstein and insisted on the necessity of absolute rest. He was able to
demonstrate results in treatment that had never been thought possible.
Then Trudeau, fighting his lonely fight in the Adirondacks, was inspired
to build "the little Red cottage"—a building fourteen by sixteen joined
onto a porch "so small that only one patient could sit out at a time and
that with difficulty." On February 1st, 1885, there moved into it two
factory girls sent by Dr. Loornis of New York to Trudeau for treatment.
"Frail, ill-clad and nearly dead with fatigue, to begin the great experiment . . . here in the depth of winter, with a wood stove, two cot
beds and a kerosene lamp." This is a picture of the first sanatorium in
America. Who could foresee from this small beginning that Canada and
the United States in less than forty years would be spending millions of
dollars in erecting most palatial institutions in order that all afflicted
with pulmonary tuberculosis might have the benefit of the methods so
successfully demonstrated by these early pioneers.
To be continued
BLOOD TRANSFUSION
Paper given at "Laboratory Evening" Meeting, February 29th, 1928,
By Lyon H. Appleby, M.D., F.R.C.S.  (Eng.)
The idea of transferring the blood of one animal to another dates
back before the Christian era and it is quite impossible to state just when
the first transfusion was performed or by whom. It is, however, quite
definitely established that the first blood transfusion operation performed
on a human was carried out by M. Denis, a physician practicing in Paris
during the latter half of the 17th century. Just how this operation
was received by the medical world is told in a passage in one of the standard works of surgery of that day, "A Course in Chirurgical Operations"
by M. Pierre Dionis, an eminent French surgeon. This book is in our
Library, and with your permission I should like to give his description
of this operation:
THE TRANSFUSION OF BLOOD.
The Invention and. Story of it—Success and Disgrace of it.
There is another Operation which we call Transfusion; which has made
a great Noise in Paris these forty Years; and though 'tis a modern Invention
and from its beginning has been condemn'd, the Chirurgeon ought yet to be
acquainted what it is; for which reason, before I conclude the Operations of
the Arm, (the Part on which 'tis practised) I thought it proper to inform
you what it is, not to learn it you in order to practise it, but to give you a
just Horrour at the Thoughts of it.
Its Original and pretended Advantages.
Transfusion  consists in finding out  ways  of passing  the Blood  or some
other Liquor into the Vessels of an Animal.    On what  Etmuller  relates of
Page 224 an infinite number of Experiments of different Liquors injected into the Veins
of a Dog. Mr. Denis, a Physician, who at his own House held Medicinal
.and Physical Conferences, imagin'd that if he could introduce Blood into
the same Veins, and at the same time draw out that contained in it, we should
renew the whole Mass of Blood, and that by injecting young Blood in the
place of old, we should render the Animal young again. Having communicated his Notion to some Lovers of this sort of Conferences, it met with a general Approbation: Experiments were made on several Animals, as well of
different as the same Species, and ip all Conversations we were entertain'd
with no other Discourse, than that of the wonderful Effects of this Invention.
These Gentlemen promised to secure Man by this means from all sorts of
Diseases, to make him live as long as he pleased, and to preserve him in the
same state in which he was when they should begin the Practice of this
Transfusion  on  him.
How performed.
To prove what they advanced, 'twas necessary to try the Experiment on
Men:    And  accordingly  they  found   some  miserable  enough   to  suffer   it  for
a Sum of Money; they open'd the Artery of a Calf, and by the assistance of
a Tube, one end of which was fix'd in the mention'd Artery, and the other
in one of the Veins of the Arm, they forc'd the Blood of that Animal into
the Veins of the man; at the other Arm also at the same time they drew out
as much as they thought they caus'd to enter.
Success of the Experiment.
They perform'd several of these sorts of Operations, which, according to
them were to have been attended with anextraordinary Success; but the fatal
End of these miserable Victims to Novelty, in one Day destroyed the mighty
Opinion which they had entertain'd of their Notion; for their Patients became senseless, distracted and afterwards died. The Parliament, inform'd of
what had passed, interposed its Authority, and publish'd an Arrest, by which,
on rigorous Penalties, the Practice of this Operation was forbidden.
But these false Philosophers did not yet easily yield up their Notion, but
being forc'd to submit to the Commands of their Superiors in the case of
Transfusion of Blood, they confined themselves to the Infusion of Liquors
into the Veins. They made several Trials of various sorts, and gave us a
List of the Diseases which they pretended must be cured this way; also affirming, that by syringing Broth into the Veins after a great Haemorrage, the
would repair the lost Blood in less time, than if it passed through the ordinary
Channels; they asserted that if Man would submit to this Infusion of Liquors,
all Diseases whatever would be sooner and more certainly cured, than by the
Rules of the Medicinal Art.
Never was any Arrest more seasonably publish'd than this, to destroy
the Prepossession of these Innovators, and prevent the course of this Operation,
which would have prov'd of pernicious Consequence, with regard to brotherly
Love and Religion, if they had been suffer'd to perform it from Man to Man,
which was the end the proposed. But those who invented this horrible Project are dead ,and 'tis itself almost buried in Oblivion, and though I mention
it now, 'tis only in order to rank it amongst those Operations which ought
never to be practis'd.
It is a very far cry from that operation to our scientifically controlled transfusions of to-day. The opposition of yesteryear gradually
gave way, largely due to the lessons of the great war, to a veritable orgy
of transfusions for almost every disease or condition to which the human
flesh is heir. It is now becoming increasingly evident that the preponderance of opinion is swinging back, and the inordinate number of transfusions of the past year or so will give place to a more rational selection
of cases and a more definite understanding of its actual indications.
Page 225
mm The years between have been filled with experiment—even now it
is a dull and fruitless week when at least one new method, complete with
apparatus for giving transfusions, is not foisted upon a long-suffering
profession.
The first great experimental wave had to do with overcoming the
mechanical difficulties and the second might be described as the chemical
experimental period.
The earliest method in the mechanical period was the method of
direct transfusion of whole blood to the vein of the recipient from the
artery of the donor and many and various are the ways and means devised to bring the two vessels into intimate contact. Next followed
the silver cannula method, followed in rapid succession by innumerable
and long-forgotten and equally unsatisfactory methods. Unsatisfactory
because it was not possible to accurately gauge the amount of blood the
recipient received, the reactions which followed, the prevalence of clotr-
ting, etc. These were followed by the paraffin glass apparatus to delay
coagulation, the various syringe methods and defibrinated blood. About
the same time when one group of workers was attempting to overcome
the mechanical difficulties of clotting, other groups were working in the
chemical field. Their results gave an immediate filip to blood transfusion. It was found that hirudin—an extract from the head of a
leech—would prevent clotting and this was used to prevent coagulation
of the donor's blood during the course of the operation. Other methods,
such as the addition to the blood of some of the salts of oxalic acid were
then tried, but these proved much too toxic. The outcome of the chemical investigations was the discovery of the effect of sodium citrate upon
the coagulability of blood and this gave the final touch to blood transfusion and put the mechanical difficulties of the operation out of business.
Nevertheless it was still noticed that tragedies of various types—
severe reactions, etc., were continually being observed. About this time
Jansky in 1909 and Moss in 1910 made the discovery of agglutinins and
divided the blood into four groups according to the types of blood cells
and serum agglutins present. This was a tremendous step forward and
placed the hitherto unexplained tragedies in a clear light and offered the
possibility of almost certainly avoiding them. The four groups outlined
by Moss and Jansky still remain practically unchanged and are the
accepted blood groups of to-day. However, an unfortunate confusion
arose in nomenclature—the groups of Moss do not mean the same groups
as those of Jansky. The numerals indicating each group are devoid of
any meaning. I wonder how many members of the Vancouver Medical
Association receiving a report from the Laboratory that their patient
was in group 11 know whether that grouping is in the Moss or Jansky
terminology. I fancy a very small proportion of the men in this room
could tell me which Moss groups correspond to the Jansky groups or
are aware of the fact that the Laboratory has at various times changed
from one system to another. Group numerals mean nothing, they tell
you nothing, they are worth nothing, and my sole excuse for presenting
this little paper is to plead for the adoption of a standard nomenclature
as recently adopted throughout America.
Page 226 The new ABO system of grouping means something, it designates
both the type of cells in donors' and recipients' bloods and the serum
agglutinins present. The old terminology is dead. The new ABO
system has been adopted by all the medical schools of the country, the
students are being taught it. Why should we not have adopted it?
Anyone who hopes to understand the medical literature of the future
on transfusion must know it.
The blood cells are of two types represented by the capital letters-
A and B. The blood serum agglutinins are represented by the small
letters a and b. The theory is that no blood can contain both A cells
and a agglutinins otherwise they would auto-agglutinate themselves out
of existence. Conversely if A cells are present and B cells absent we
assume the blood to contain b agglutinins as evidenced by the absence of
B cells. This causes the blood to fall into the same four groups of Moss
and Jansky but whereas their numerals meant nothing and actually contradict each other the newer ABO groupings are full of meaning and
much more scientific. Expressed in the form of a table it might appear
as
Corpuscles
A
B
Group   Jansky
Serum
a
b
Oab
42%
1
Ab
40%
Ba
I
14%
ABo-
4%
From these groupings it is obvious why so many transfusions were
successful prior to a knowledge of agglutinins. The I most dangerous
group ABo is the least common and the so-called universal donor group-
Oab the most common.
Now the work of Moss and Jansky unquestionably has done away
with the gross and often fatal accidents of transfusion by making it
comparatively easy to be sure that the donor and recipient are in the
same blood groups, but this is not wholly sufficient—in addition each
serum ought to be separately tested against the other's corpuscles, the
method of "cross" or, a better term "reciprocal" agglutination. I wish,
however, to stress the fact that at no time is transfusion risk free. Even.
with bloods in the same groups and shown to be compatible by reciprocal
agglutination we still get reactions. These have been variously attributed to citrate, rubber tubing, cooled blood, too rapid delivery and a host
of other things. I wonder if we are not overlooking a very fertile field
of research. Do we as a rule pay the slightest attention to the diet of
a donor prior to a transfusion. We know for a fact that many proteins
are absorbed into the blood-stream in an incompletely hydrolysed form.
Is it not possible that some patient suffering from some of the allergic
disturbances, asthma for instance, might not so receive the very protein,
incompletely hydrolysed in addition, to which they are sensitive. Are
these not, perhaps, in themselves allergic phenomena. We have been too
prone to blame these reactions on careless grouping—sub-groups within
the four main groups (and there are sub-groups as shown by the fallacious and now abandoned ice box temperature method of testing,) etc.
Do we, again, make any attempt to find out whether the other cells of
Page 22/ the blood beyond the reds—I refer to leucocytes, platelets, lymphocytes,
etc.—are compatible. May not the minor reactions be explained or partially so upon this basis? Sir Humphrey Rolleston estimates the reactions after wholly compatible transfusions according to modern standards
as high as 66%. He regards fever of any degree as a reaction. These
reactions are much more common after repeated transfusions than primary ones; may the serum proteins hitherto unconsidered predispose to
the formation of antibodies which, with a subsequent transfusion,
elicit minor anaphylatic phenomena. Are we sufficiently careful in regrouping and repeating our reciprocal agglutination tests prior to re-
transfusion?
My compliments and apologies to the V. G. H. Laboratory staff fot
daring to suggest that their terminology is antiquated. There are many
robust children of the parent transfusion and several marasmic ones.
Such methods as immuno-transfusion, vaccination transfusion, defibrination transfusion, exsanguination. transfusion and auto-transfusion—
all have their advocates. I wish to take a few moments to discuss auto-
transfusion. I reviewed nine of my own cases in the Canadian Medical
Journal two years ago. Since then I have performed two more auto-
transfusions. Much of the fluid blood in the peritoneum can be safely
returned to the patient. There is no question of faulty grouping, allergic
or anaphylactic phenomena—the patient usually requires it and it is
easy to get and costs the patient absolutely nothing. From my own experience of eleven cases I can heartily recommend it.
As to the use of stored blood of various groups it proved a valuable
remedial measure during the war. It is difficult to see where it could be
applied in civil life to any great advantage. I suggest the establishment
of a travelling blood clinic with headquarters at the Vancouver General
Hospital Laboratories and outlying doctors requiring blood could receive the blood of the universal donors, not in a jug but actually on the
hoof. It ought to be just as easy to send the donor as the blood. I
think if the country doctors were informed that such a service was
available here advantage would be taken of it. It is, I feel, perhaps the
one place where the use of a universal donor might be justified and
I suggest that cases of polycythasmia who also happen to be universal donors, be used to the mutual advantage of donor and recipient.
Such a donor has worked for 21 years in the Edinburgh Royal Infirmary.
As to the indications for transfusion this perhaps is not exactly the
type of paper where this should be discussed, nevertheless briefly they
fall into four groups:
(1)    Acute haemorrhagic shock, traumatic or where the bleeding
has been controlled prior to the transfusion.
II?
(2)
(3)
Page 228
Bolstering a chronic anaemia prior to operation or after it.
This is perhaps of more importance to the anaesthetist than
to the surgeon.
Supply of functionally active haemoglobin in such conditions
as severe carbon monoxide poisoning and this perhaps is the
best place for exsanguination transfusion. (4) Haemorrhagic diseases which chiefly concern the pediatrician-
malasna neonatorum, etc., and haemophiliacs prior to necessary
operations.
From my excursions into the medical literature I now firmly believe
that the use of transfusions in such conditions as blood dyscrasias, pernicious anaemia and diseases of the blood forming organs is worse than
useless. In pneumonias, pyaemias, septicaemias and the acute infections,
competent observers working on much larger groups of cases then we
here have the opportunity of acquiring, have definitely established the
fact that it increases the mortality rate rather than diminishes it. The
local cure of an individual case means absolutely nothing. I have no
hesitation in saying that the number of blood transfusions given is out
of all proportion to the established indications for it, and I honestly
beleive that the numbers would be very materially reduced if the dramatic advertising appeal known to be produced in the surrounding district
or municipality ceased to be considered a justification for it in doubtful
cases.
Will any member who proposes to attend the C. M. A. meeting at
Charlottetown in June kindly communicate with the executive secretary
of the B. C. Medical Association.
Summer School Clinics
VANCOUVER MEDICAL ASSOCIATION
June 5, 6, 7 and 8, 1928.
Speakers:
Dr. J. C. Bloodgood, Prof. Clin. Surgery,
Johns Hopkins University.
Dr. John Phillips, Prof. Med.
Western Reserve University, Cleveland.
Dr. Andrew Hunter, Prof. Bio-Chemistry,
University of Toronto.
Dr. Fred. H. MacKay, Dept. Neurology,
McGill University.
Dr. F. A. C. Scrimger, V.C., Dept. Surgery and Exp. Med.
McGill University.
Dr. C. A. Peters, Dept. Medicine,
McGill University.
Fee, $10.00 Georgia Hotel
Information: Dr. L. H. Appleby, Vancouver, B. C.
718 Granville Street
Vancouver, B. C.
Page 229 Emergency Service
Given all Medical Men
Knowing how essential the automobile is to the Doctor, we
go out of our way to give the .Doctor's damaged car
preference.
BODY FENDER WHEEL REPAIRS
Quick touching-up with Duco Finish
Complete Painting—Duco or Varnish
Tupper and Steele Ltd*
1669 3rd Avenue West
BAYVIEW 138-139
McBeath-
Campbell
Limited
Printers and
Publishers
Vancouver, B. C.
The Owl Drug
Co., Ltd.
Jill prescriptions dispensed
bu qualified Druggists.
TJou can depend on the Ou?l
for tAccuracn and despatch.
TDe deliver free of charge.
5 Slores. centrally located.    We
would appreciate a call while
in our territory. •mm
1111  ! 1 11 I
536 13th Avenue West Fairmont 80
Exclusive Ambulance Service
FAIRMONT 80
ALL ATTENDANTS QUALIFIED IN FIRST AID
"St. John's Ambulance Association"
WE SPECIALIZE IN AMBULANCE SERVICE ONLY
R. J. Campbell J. H. Crellin W. L. Bertrand
STEVENS'
SAFETY PACKAGE
STERILE GAUZE
is a handy, convenient, clean commodity
for the bag or the office.
Supplied in one yard, five yards and
twenty-five yard packages.
ESTABLISHED   NEARLY  A
kCENTURYd
B. C. STEVENS CO.
Phone
Seymour 698
730 Richards Street
Vancouver, B. C.
Page 231
mm ~+-t&im
^fc.
■a^aj-t-
Hollywood Sanitarium
LIMITED
tyor the treatment oj
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference & 6$. Q. <fM.ed.icaX Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183 Westminster 288
5*sV
Page 232

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