History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: March, 1925 Vancouver Medical Association Mar 31, 1925

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Published monthly at Vancouver, B. C.
J^euroses in Practice
*Book <rReviews
^Health Statistics
ex  %
ex  13
es   «s
MARCH, 1925
^Published by
<&fCc<33eath Spedding Limited, Uancouver, <23. Q.
Published Monthly under the Auspices of the Vancouver Medical Association
in the Interests of the Medical Profession.
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.
MARCH 1st, 1925
No. 6
OFFICERS,  1924-25
Dr. H. H. Milburn
Dr. O. S. Large
Dr. Stanley Paulin
Dr. A. J. MacLachlan
Dr. w. F. Coy
Past President
Dr. W. B. Burnett
Dr. J. M. Pearson
Delegate to B. C. Medical Association
Dr. J. A. Gillespie
Clinical Section
Dr. Lyall Hodgins	
Dr. W. L. Pfdlow -        -        -
Physiological and Pathological Section
Dr. C. H. Vrooman     -	
Dr. R. E. Coleman	
Eye, Ear, Nose and Throat
dr. g. c. draeseke	
Dr. Colin Graham -        -        -        -
Dr. G. S. Gordon ......
Dr. J. A. E. Campbell -	
Library   Committee
Wallace Wilson
R. E. Coleman
W. F. MacKay
Orchestra Committee
L. Macmillan
F. N. Robertson
J. H. MacDermot
W. D. Patton
Credit Bureau Committee
L. Macmillan
J. W. Welch
Dinner   Committee
DR. N. E. MacDougall
Dr. A. W. Hunter
Dr. F. N. Robertson
Credentials  Committee
Dr. D. McLellan
Dr. Neil McNeill
Summer   School   Clinics
Dr. Alison Cumming
Dr. Howard Spohn
Dr. G. S. Gordon
Dr. Murray Blair
Dr. W. D. Keith
Dr. G. F. Strong
Founded 1898. Incorporated 1906.
Programme of the 27th 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 p.m.—Business as per Agenda.
9 p.m.—Paper of Evening.
MARCH 3rd—
MARCH  17th—
APRIL 7th—
APRIL 21st—
General Meeting.
Clinical Meeting.
General Meeting.
Paper:     DR. W. A. DOBSON,  "Neuroses in Everyday
Clinical Meeting.
Special Clinical Meeting.
DR. C. E. HAGYARD  (Seattle) .
Subject:     "Colitis."
General Meeting.
Paper:    Dr. R. B. BOUCHER, '-'Inflammatory Diseases
of  the  Ear."
Clinical Meeting.
General Meeting.
Paper:    Dr. J. L. TURNBULL, "Differential Diagnosis
of Acute Abdominal Conditions."
of the
Considerable progress has been made in the selection of speakers for the.
forthcoming session of the Summer School, to be held in Vancouver, July 2nd,
3rd and 4th. Among those who have accepted are Sir Henry Gray, Surgeon-in-
Chief of the Royal Victoria Hospital, Montreal; and Dr. Alan Brown, Phy-
sician-in-Chief of the Sick Children's Hospital, and Professor of Paediatrics,
Toronto University. In addition to these speakers the Committee is in communication with others of similar standing. It is needless to say that with
lecturers of this calibre no one can afford to miss this meeting.
Page Four X'Ray Laboratory of Dr. A. D, Willmoth, Louisville, Ky.  Victor Equipment Throughout
Time and Use Reveal Victor Quality
As months and years pass, the Victor X'Ray
machine installed in the physician's office or in
the specialized roentgenological laboratory unfailingly responds to the demands made upon
it. Day after day, the same trustworthiness in
operation, the same certain results as in the
Thus time and use reveal the quality pains-
takingly built into every Victor X-Ray machine.
There are simple Victor X'Ray
machines which meet the de'
mands of general practice, and
powerful diagnostic and deep-
therapy apparatus for institU'
tions   and   laboratories.   The
quality is
same Victor
into all.
We shall be glad to suggest the
type of Victor installation best
calculated to meet the require'
ments of the physician in general
practice, the hospital or special'
i^ed laboratory.
VICTOR X-RAY CORPORATION, 236 South Robey St., Chicago, Illinois
Territorial Sales and Service Stations:
Victor X'Ray Corporation of Canada, Ltd.
910 Birks Building
iiiiiiuiiiiiiiiiuiiiiiiiiiniiiHUjmmuiiiuiiiiiiuiiiJiuniiiiiiiiiiuiiiiiiiiiiimiiiiiiiiiiiiiiu EDITOR'S PAGE.
A great loss has been sustained by British Medicine.
Within the last few weeks the deaths have occurred of Sir
James Mackenzie and of Dr. John Irvine Hunter, Professor of
Anatomy at the University of Sydney, New South "Wales.
The former died full of years and honours, the latter was
plucked untimely "dead ere his prime." A career already brilliant cut short as the promised fulfilment seemed about to mature.
Of Sir James Mackenzie's work it is difficult to speak save in
the language of hyperbole. A general practitioner of medicine
himself, his career is of special interest to those who carry upon
their shoulders the daily, practical and arduous tasks of the medical
profession. His work upon the heart, destined to revolutionize
the science of cardiology, was begun and finished during the years
of active general practice in the manufacturing town of Burnley.
Subject to incessant interruptions, working in a field where he
could get no help orally or through books, compelled to invent
and manufacture his own instrumental aids, only the firmest conviction of his ultimate success could have carried him through.
"This volume has been written," says Mackenzie in the preface to his first book—that on the Pulse—"amid the distractions
of the life of a busy general practitioner. I have seldom been able
to give an uninterrupted hour's study to the subject. While working out some argument, interruptions have often been fatal to its
completion, as it has been days and even weeks before I have again
been able to resume it."
Mackenzie's work gained recognition in English - speaking
countries very slowly. Long before it became general property
with us, he was recognized in Europe, and particularly in Germany, as having a very special and particular knowledge of the
cardiac mechanism and its disorders.
Unfortunately his communications to the medical press were
not only novel and controversial, but also too frequently acrimonious and insistent. Nothing short of a complete discarding
of the older theories would satisfy him, and not unnaturally many
of his contemporaries were not at first prepared for this. In later
years Mackenzie came to see very clearly that the practice of medicine was clouded and fogged with facile generalizations and inco-
ordinated observations. Especially was this the case, he thought,
with regard to the very early symptoms of disease. In season and
out of season for many years he insisted that laboratory methods
and hospital experiences were taking the art of medicine in a wrong
direction. His view of the way was that by which he had arrived
at his newer conception of the heart. Prolonged and patient
observations, over long years, of the effect and significances of certain physical signs or symptoms observed, it may be early in life.
As a justification of his faith he founded, as the last act of a long
Page Six life of devotion to his art, the St. Andrew's Institute. This is
actually an aggregation of general practitioners living in a relatively stable and self-contained community, who record and watch
their patients along these lines. Associated with them are certain
professors and laboratory workers, who endeavour to assist in the
interpretation of those phenomena and to explain their significance.
To this work, in the last few years, Mackenzie gave himself
unstintingly, and it is believed that it will be carried on even
though he is gone.
We regard Sir James Mackenzie as one of the Master Minds
of Medicine, destined to rank with Harvey, and Sydenham, and
others who have prepared the way for those who come after.
Professor Hunter, of Sydney, is the latest of that numerous
band, found in all walks of life, and of whom the medical profession has had more than its share, who have died in the atmosphere of unfulfilled achievement. With Keats and Shelley, with
Hilton Fagge and H. L. Barnard, and countless others, he joins
the long procession of those whose promise was never to be linked
to a completed work.
Nevertheless, short as his life was—for he died at the age of
27—it is almost incrediable to learn of the amount of actual
research that he had already accomplished. Only his latest work
—that on the skeletal muscle distribution of the autonomic nervous system and its practical application to the treatment of spastic
paraplegia—brought him prominently before the general view of
even his own profession.
Our sympathies are extended to our Sister Dominion, while
our regrets are felt for medicine in its universal aspect.
From this brief study of two lives in such different circumstances we may gather the consolation that the true apostolic succession in medicine is not lost. That even in our day and generation there arises, ever and anon, one or more whose privilege
it is to maintain and enhance the lustre of the medical profession
in the Empire.
A Regular Meeting of the Vancouver Medical Association
was held on February 3rd, in the Auditorium of the Normal
School.    Fifty members were present.
Dr. G. H. Clement gave notice of motion to amend the
by-law dealing with the election of nominees for hospital staff
appointments, the purport of which was to revert to the former
method of dealing with these elections instead of by proportional
A lengthy discussion concerning the proposed location of the
new Infectious Diseases Hospital occupied considerable time,  the
Page Seven majority of members present at the meeting being of the opinion
that the new hospital should not be erected on the site of the
Vancouver General Hospital or adjacent to it. A resolution to
this effect was carried.
Dr. W. A. Dobson gave a very interesting and instructive
paper on "Neuroses in Everyday Practice." This paper gave rise
to a very spirited and lengthy discussion, in which Drs. Manchester, Cumming, Coleman and Simpson took part. An abstract of
Dr. Dobson's paper appears in this issue.
At a meeting of the City Council, held on Monday, February
16th, it was decided to go ahead with the erection of the new
Infectious Diseases Hospital on the block now occupied by the
Infectious Diseases Huts.
Drs. W. C. Walsh and F. N. Robertson have gone to New
York for post graduate study, and expect to be back in Vancouver in about six weeks' time.
It is with deep regret that we have to record the death of one
of our members, Dr. J. E. Brouse. Dr. Brouse was a native son
of B. C. and a familiar figure in medical circles in the interior of
the province for many years. For the past few years Dr. Brouse
practised Dermatology in Vancouver, and was on the Staff of the
Vancouver General Hospital. His son, Dr. Ivan Brouse, is practising at Powell River, and to him and to Mrs. Brouse we extend
our sincere sympathy.
* * *
Medical Gynaecology. By Samuel Wyllis Bandler, M.D. 4th
Edition, thoroughly revised. 1924. W. B. Saunders Company, Philadelphia and London.  $8.00.
It would appear a great pity that the American College of
Surgeons, or the B. C. Medical Association, or some one, has not
taken up the question of the standardization of medical textbooks.
Any who do not agree with this lament should read Bandler from
cover to cover. The scientific (?) character of the work is well
illustrated in the first chapter, where, after two pages of suggested
questions covering very completely every phase of almost any case,
and well worth careful study, particularly by our younger men,
the teaching is that "Finally, let the patient in a few words define
and explain the annoyances and symptoms of which she complains
and because of which she comes." Excellent material—ridiculous
arrangement and treatment.
The sections on methods of examination stick closely to elementary outlines, though atmocausis,  which is not actually ap-
Page Eight proved of, is described with sufficient detail to tempt the inexperienced and venturesome. Fifteen pages on the use of the pessary
are good. Four pages on vitamins, if correct, afford all the knowledge along this line that any gynaecologist should require. At
any rate one line tells us that "Birds need B and not C," and the
next "Lack of A, B, C diminishes the resistance to infectious diseases." Some hundred pages devoted to the endocrine glands
seems to follow pretty closely the literature received daily through
the mails, and leaves one with the feeling that he should recall all
his recent patients and prescribe "mixed glandular treatment so
and so," or some other combination of at least three of the more
familiar endocrine products. This worship of the endocrines has
erected a shrine to the placenta, whose "secretion is a substance
which follows the course of the blood into all organs of the body,
In discussing eclampsia we are told that "logically we must
conclude that placental secretion is the important factor. It does
not produce this annoyance in a large proportion of instances
because some protective substances are secreted or formed anew.
They come from ovary and corpus luteum, from the thyroid and
adrenals, from the hypophysis gland, from the liver, and from
other structures in the body not yet recognized as taking part in
this protective function" (italics not in the text). How thankful the poor little foetus and the dear old excretory organs must
be to be absolved from all blame!
The book contains a lot of good common sense on the "associated nervous condition," and by the inclusion of many pages of
favorite prescriptions rescues the reader from absolute dependence
on the manufacturing druggist.
Sections on leucorrhoea, gonorrhoea, pain and constipation
are well worth reviewing, though in no sense should they be considered either as the law or the gospel. Under prophylaxis of
subinvolution following confinement some most extraordinary
advice is given as to exercises. How anyone of wisdom and experience can advise that "commencing one week after delivery patients
lie flat on their backs and raise themselves to the sitting position
without the aid of arms and hands," is difficult to understand.
Nevertheless the book contains a wealth of suggestion for him
who would deal fairly by his gynaecological patient, and younger
men particularly should read it through as somewhat of an antidote to the dangerous notion that the only place to treat a pelvic
derangement is in the operating room.
—W. B. B.
* * *
Essays and Addresses on Digestive and Nervous Diseases and on
Addison's Anaemia and Asthma.   By Arthur F. Hurst, M.D.
London. William Heinemann.     1924.    Price £1  Is. Od.
This, as the author states, is an attempt to place on record
his present views on various subjects.    It is a collection of papers,
all previously published, but revised and expanded to conform to
the author's present conceptions.
Page Nine H!1
While not attempting to deal with all the papers, one cannot refrain from drawing attention to a number of outstanding
Dealing with hyperemesis gravidarum, which is defined as a
form of hysterical vomiting, the author states that in the absence
of organic pyloric obstruction, vomiting which does not cease at
the end of six or eight weeks, is undoubtedly hysterical and can
be cured by psychotherapy. The disturbed metabolism he regards as due to starvation and dehydration, and as not etiological.
Duodenal ulcer is dealt with at length, the author ascribing
its occurrence primarily to the hypersthenic gastric diathesis, a
congenital hyperactivity of the gastric mucosa. His modification
of the Sippy treatment is described in detail. He is opposed to
operation unless there is definite pyloric obstruction, as he believes
that in the absence of obstruction, attention to focal injections and
diet will heal the ulcer. On the other hand, if there is any degree
of pyloric obstruction he believes a gastro-enterostomy should be
performed. He issues a warning that a full course of alkaline
treatment should not be undertaken if renal function is impaired.
Both the hypersthenic gastric cases, and cases of achlochydria
should be studied with the aid of the fractional test meal. They
are frequently though not always congenital, and may never show
Achlorhydria is frequently associated with appendicitis,
cholecystitis, pancreatic disease and various forms of dysentery,
by permitting infection to gain access to the digestive tract, and
the author draws attention to the relationship sometimes existing
between achlorhydria and rheumatoid arthritis.
In view of the frequency of achlorhydria in pernicious
anaemia, the author believes that whenever achlorhydria is found
a complete blood examination should be carried out, as in this
way many potential cases of pernicious anaemia may be recognized and put upon appropriate treatment before the classical,
that is the hopeless picture, has developed.
The author deals at some length with cardiospasm, or as
he terms it "achalasia of the cardia." He is certain that this is
not a spasm such as occurs in hypertrophic pyloric stenosis, as
there is no hypertrophy of the cardiac sphincter; but that it is
due to a faulty reflex, so that the sphincter does not relax in
co-ordination with the oesophagral peristaltic wave. He finds
treatment with a mercury-filled tube almost invariably relieves
the condition.
The chapters on affections of the colon are extremely valuable. He says: "It is no more justifiable to treat a colitis, without
first inspecting the mucous membrane of the colon with the sigmoidoscope, than it is to treat a sore throat without looking at
the pharynx."
Cholecystitis, gallstones, asthma and hysteria in organic nervous disease, complete the volume.     The section on hysteria is
Page Ten most instructive. He shows that many organic nervous diseases
acquire an added functional element, in some instances to such an
extent that the impairment of function may be almost entirely
hysterical, and quite amenable to suggestion.
There is much condensed into each paper, the definitions are
lucid, and coming from one of the keenest minds in medicine
to-day, the book should be invaluable to both the general practitioner and the internist.
—C. H. B.
(With apologies to Shakespeare.)
In the Library of the V. M. A. at the hour of noon on a
dull day in the month of February, 1925. Enter a Physician.
He is about 40, stoutly built, scalp thinly covered, glasses reinforce a pair of keen blue eyes, and between firm lips a freshly
lighted cigar points upwards and outwards. As he pauses on the
threshold he sees at the other end of the room the seated figure of
the Librarian. Her bobbed head is resting on her folded arms,
which are in turn supported by the flat surface of an office desk.
To the left, through an open door, the physician can look directly
into the Reading Room, the floor of which is covered by a dirty,
disreputable and exceedingly threadbare carpet.
Physician:   "Now might I do it pat, now she is praying:
And now I'll do it."     (Reaches out and withdraws
from the shelves a large volume on "Litigation Neurasthenia.")
Librarian (with head still bowed and in a low trance-like tone) :
"To be, or not to be—that is the question:
Whether 'tis nobler in the mind to suffer
The very sight of that outrageous carpet,
Or to get up and rip it into pieces,
And by burning end it? 'tis a consummation
Devoutly to be wished.    To rip, to burn.
And whether we would meet again I know not.
Therefore my everlasting farewell take:
Forever, and forever, Farewell, Carpet!
If we do meet again, why, I am stung:
If not, why then, this parting was well made."
Follows a silence of three seconds,  during which time the
Physician, with an awed expression, replaces "Litigation Neurasthenia," takes down Freud on "Dreams," and noiselessly leaves
the room, without signing up.
Omitted, because of a firm refusal of the Editorial Board to
allot space, but it depicted a meeting of the Physician and the
Page Eleven Library Committee, an inspection of the Carpet, and the passing
of the following resolution:—
(1) That flowers be sent to the Librarian, who, thanks to
the Physician, is now convalescing nicely.
(2) That, owing to the scarcity of courteous and efficient
Librarians, and owing to the fact that a n'sor sardonicus is undoubtedly clearly to be seen on the face of the carpet; and, further, owing to the poverty of the Library exchequer: Be it resolved
that an appeal be made through the colmns of THE BULLETIN
to all members of the Association. This in the hope that some
man (or some man's wife) may donate a first or well preserved
second hand carpet to the Library. Thus would a mind be saved
and the dignity of the Library be upheld.
Addendum by Librarian:   The size of present carpet is 10^4
by 12.    Anything near this would do.
* * *
Total  population   (estimated)
Asiatic  population   (estimated)
Total Deaths     —
Asiatic  Deaths       —
Deaths—Residents only    .._
Total Births—Male,   166;
Female,    146   	
Stillbirths—not included in above
 ....   126.747
Rate per 1000 of
Pop. per annum
Infantile Mortality—
Deaths under 1   year of age
Death rate per  1000 births
Cases of Infectious Diseases Reported.
Smallpox   .::._:..,    101
Scarlet Fever        107
Diphtheria           17
Typhoid          ' 0
Chicken-pox         39
Measles   ■_.       0
Mumps       45
Poliomyelitis _■        0
Erysipelas   .        7
Tuberculosis   J 1 29
Diphtheria .
Smallpox ....
Scarlet Fever
(Cases from outside
city included above.)
1 1
2 0
1               0
to  15 th.
Communicated by Dr. R. E. Coleman from the Laboratories
of the Vancouver General Hospital.
On Aug. 22nd, 1924, a case of meningitis was admitted
under Dr. C. F. Covernton from Powell River. The laboratory
examination of the spinal fluid in this case showed it to be of
quite unusual interest. In addition to the usual findings associated
with purulent meningitis, the bacteriological examination showed
the presence of a bacillus which has not yet been certainly identified. So far its characters indicate that it belongs to that ubiquitous group of diphtheroid organisms. This group, though so
constantly found about the healthy animal, is seldom clearly demonstrated as the primary cause of pathological processes. In the
literature available only one case of the recovery of a diphtheroid
from the spinal fluid can be found.
Following closely upon the previous case, a second case of
meningitis was admitted on Jan. 1, 1925, under Dr. F. J. Buller,
which yielded streptococci from spinal fluid and blood.
Clinically the course was that of an uncomplicated acute
meningitis with apparent complete recovery to date. The only
treatment was mercurochrome intravenously. The rarity of recovery from this type of meningitis makes the case worth recording.
To January, 1922, Eagleton was only able to collect seven cases
in the literature.
* * *
The large amount of animal experimentation involving the
intravenous use of glucose, has constantly drawn the attention of
the laboratory worker to the toxicity of certain lots of otherwise
apparently pure glucose. Recently our attention was drawn by
Dr. W. D. Keith to the report of a committee appointed at the
Mayo Clinic to investigate the preparation of solution for intravenous therapy. As a result this Hospital and St. Paul's have
commenced testing each batch of glucose intended for intravenous
therapy, by the intravenous injection of rabbits, giving 0.5 gms.
of glucose per kilo of body weight.
We still have physicians coming to us with a certain form
of borrowed trouble. I say "borrowed" because it is easier to
avoid than to get into. It is in connection with the testing of
urine for sugar, and more particularly in connection with life insurance examinations. In the last four years every error in the interpretation of sugar reaction for which the physician has consulted
us, has been associated with the use of that archaic test described
by Fehling. Why does the physician persist in using a test which
is more troublesome than the Benedict test, when the latter in the
hands of the average diabetic has more precision, after a lesson of
ten minutes, than Fehling's test can ever have in the hands of the
most skilled?
Page Thirteen
A luncheon of the B. C. Medical Association was held in
Vancouver on Feb. 6th, at the Ambassador Cafe. There was no
special speaker, but the Executive took the opportunity to report
on the work of the year. Dr. E. D. Carder, of the B. C. Medical
Council, gave a brief account of the recent Congress of Medical
Services of Canada, held in Ottawa in December last, where he
represented the Council. He was followed by Dr. J. H. MacDermot, who attended the Congress as representative of the B. C.
Medical Association. Both speakers dwelt on the significance of
this, the first national Congress of the kind. It was called, at the
insistance of the Canadian Medical Association, and under the
auspices of the Federal Minister of Health, as a step towards unifying the work of the various "Medical Services." These included
the Medical Colleges, the Provincial Medical Councils, the Provincial Medical Associations, and the various health bodies of
Canada. It was felt that there was a lack of understanding and
co-operation between these various forces, and that it would be
productive of benefit to all, if they met and thrashed out their
peculiar problems, with each other's help. The course of the
meeting showed this to be the case. Each paper elicited very free
discussion, and the various points of view were well brought out.
Differences which seemed at first to be very real and serious, were
gradually proved to be quite capable of composition, and everyone
present was impressed with the potentialities for good of such
meetings. It is proposed to hold the Congress again this year,
probably in September—as there are numerous medical organizations meeting in or near Ottawa at that time—and it is probable
that the Minister of Health will be able to secure financial help
for the various bodies concerned—this being especially important
to the Western Provinces.
Reports were given by Dr. A. B. Schinbein, Chairman of
the Industrial Service Committee; Dr. Wallace Wilson, of the
Publicity and Educational Committee; Dr. J. A. Gillespie, Chairman of the Sub-Committee on Health Insurance; and Dr. A. W.
Bagnall, Chairman of the Credentials and Constitution Committee. These reports showed that the Committees referred to
have been doing hard and good work in the last few months.
Perhaps only those whose circumstances bring them into direct
contact with the Industrial Service Committee, can realize how
much work this Committee does pro bono medico. It is continually in touch with the W. C. B., with whom its relations are most
amicable in matters affecting compensation cases. Its attitude is
strictly impartial, and Dr. Schinbein took this opportunity to
point out that whilst the B. C. Medical Association is at all times
ready to fight for the rights of its members, or to help them in
explaining their position in any case, it does not intend to attempt
to defend claims that are founded on inaccuracy or carelessness,
or that are exorbitant or unreasonable. Such glaring errors, for
instance, as dating visits on February 30th, are really unpardon-
Page Fourteen able, and yet this has been done again and again.    Other instances
were cited by Dr. Schinbein.
The work of the Publicity and Educational Committee was
reviewed by Dr. Wilson, who announced that, thanks to the
courtesy and co-operation of the Vancouver Daily Province, daily
articles on "Health and Disease" would be inserted in the columns
of the editorial page, to run for a year. These articles have been
very carefully prepared by some fifty or sixty men, and the response
of these men to the requests for articles has been very gratifying
to the Committee. In no case has a man declined, when asked,
and the level of excellence of the articles is surprisingly high, when
one considers the difficulty that faces the medical man who is called
upon to write a short and easily understood article for popular
reading. These articles are all very carefully edited before submission to the paper, and every attempt is made to keep clear of
controversial or disputed matter.
Dr. Bagnall foreshadowed the bringing forward of a motion
to establish a benevolent fund by the Association for cases of distress and want amongst medical men of the province, whether
members or not—this fund to be administered by the Executive
at their discretion. Fuller details of this will be brought up at
the Annual Meeting, where it will be discussed.
At the December meeting the Victoria Medical Society unanimously decided to invite the Canadian Medical Association to hold
its 1926 Annual Meeting in Victoria, B. C. Climatic conditions
which are a feature in that city, should make such a meeting place
popular. It is important that as many medical men from B. C.
should attend the Regina meeting in July as can possibly do so.
The interest taken by each locality in the Annual Meeting of the
C. M. A. will have its due influence on the minds of the Executive in determining their choice of a next year's meeting place, and
if Victoria and B. C. generally wish to secure the meeting for
1926, it behooves them to go and work for it.
At the January Clinical Meeting of the Victoria Medical
Society, held at the Jubilee Hospital, after the presentation of
cases, Dr. A. S. Lamb, of the Provincial Health Department, gave
an interesting talk on the work being done by the Department to
combat the spread of tuberculosis in the province. The medical
profession is fortunate in that Dr. Lamb holds the position he
does, as he has been uniformly loyal to the interest of local practitioners in all his work. He may feel sure that this is greatly
appreciated by the medical profession, and it is fitting that this
should be said, as his attitude in this matter, as a Health Officer,
proves that there need be no conflict between the health authorities and the medical profession; and that where such apparently
exists, it is due to misunderstanding and lack of an effort on the
part of one side to see the other's point of view.
Abstract of address delivered before the Vancouver Medical
Association on February 3rd, 1925, by Dr. W. A. Dobson.
The lecturer said that neuroses were often spoken of in two
classes: (1) the actual neuroses with a more or less.definite organic basis, as neurasthenia, anxiety neuroses and hypochrondria-
sis; (2) the Psychoneuroses, which included conversion hysteria,
anxiety hysteria, fixation hysteria and the obsessional neuroses.
It was only since the experience of the war that the functional
phase in illnesses has been receiving wide and favourable attention.
Too often these patients were allowed to wander from doctor to
doctor, with or without operative interference, until they ended up
in the toils of the irregular practitioners.
Physicians were loathe to consider seriously the possibility
of any real mischief which cannot be demonstrated as a tangible
The lecturer then went on to discuss the question of the
examination of these sufferers.
"Examination.—This is the most important feature in our
handling of the functional case. For in the large majority our
findings constitute our treatment and cure. In the first place,
whatever our feelings may be as to the diagnosis, a careful physical examination should be made. Often times the general appearance and the complaints of the patient suggest at once the presence
of a functional disorder, and we are then inclined to make a slipshod examination. Nothing could weaken our hand more than
such a procedure, for no patient, probably because of our own
attitude towards functional diseases in the past, cares to be classed
as a "neurotic." He is inclined to observe very closely and form
an opinion as to the completeness of our physical examination.
Moreover it is the universal tendency of humans to evade the
responsibilities for disease by transferring its presumed origin from
the mental to the bodily sphere, and if our physical examination
is careless and unimpressive there is left a loop-hole for further
evasion by the patient.
Our examination now will have to do with the emotional
side of life, and will have for its goal the bringing out of morbid
fears, wrong emotions, grief, worry, unpleasant love affairs, domestic unhappiness, lack of mental peace and the like, which eventually brought about the lack of adaptation to the patient's social
environment; for what, after all, is a neurosis but failure on the
part of the patient to meet, in an acceptable manner, the problems
of life—it is a retreat—a psychological dugout—an unconscious
and bad solution of a difficulty which seems too great to be overcome, and it is these unconscious factors which must be exposed if
we are going to help the patient.
A short preliminary talk that will show the patient that disorders like his are considered real and not imaginary, and that they
Page Sixteen often depend on worries that one does not like to discuss, will
often establish confidence on his part and make it easier for him
to speak freely.
Encourage the patient to talk and assume the role of a patient
listener. We all feel better at times, after unburdening ourselves.
The outstanding feature of our examination is, to borrow
a legal term, for "Discovery"; not only by the physician, but
mainly so that the patient will be made to make a discovery, and
a large part of the success of treatment will depend upon how
much the patient has discovered in the process. In other words,
the patient is a conundrum to himself, as well as to the doctor.
Why is it often so difficult to discover the sources of these
functional disorders? It is because of the activities of those well
established mental mechanisms, as result of which the original
experiences or wishes are hidden or distorted.
There are present in all of us, from infancy onwards, wishes
and strivings of an instructive kind. Many of these tendencies
have to be restrained and controlled by moral codes, civil laws
and social conventions. For example, the sight of a fine overcoat
may arouse an impulse to possess it, accompanied by a feeling of
Social law and custom successfully inhibit the impulse in
most people.
Again, the soldier may feel the instructive wish to fly from
danger, but military discipline, patriotism and duty urge him,
usually successfully, to ignore the danger and carry on.
Whenever there is opposition between primitive instructive
wishes and tendencies, and forces of a social kind preventing their
gratification, a conflict is said to be present. The conflict is usually
always between pleasure and social impulses. Conflicts must
somehow be dealt with and resolved. A constant state of mental
tension and irresolution is impossible to the individual. The correct way to solve the conflict is by a logical and fully conscious
choice on the part of the individual, and a conscious selection of
the line of conduct to be followed.
Were this method always possible and always adopted, a
great step would be taken towards the prevention of nervous and
mental disease.
Too often conscious resolution of conflict does not take
place. The wish, impossible of gratification, is then banished
from the consciousness to become part of the unconscious mind.
The conflict is forgotten and remains unconscious, but it remains
to influence conscious thought and action, and often produce
The term "Complex" is now pretty well in general use. It
refers to a subconscious group of ideas concerning some wish or
experience about which there is a definite emotional tone, which
may be pleasant or unpleasant.  If any one of us picked up a morn-
Page Seventeen ing paper and on the front page noticed an article on some medical
subject, we would run through it before reading anything else.
Another immediately unconsciously turns to the crossword puzzle
and begins to waste his time on the problem for the day. This
occurs because of our medical or crossword complex. Our complexes are many and depend on past experiences and frequently
forgotten ones.
The politician aligns himself on the side of a particular
measure brought forward by his own party, and frequently fools
himself into believing that he is taking a stand after mature and
careful consideration of the context of the measure. As a matter
of fact he unconsciously takes his stand because of political bias
or political complex.
Thus it will be seen that complexes as well as conflicts,
although unconscious, influence thought and action.
A complex has been compared to a malignant growth. It
grows at the expense of the normal mind, and invades and'distorts
the proper conscious adjustment of the individual to the world
of reality.
Repression is the process by which complexes are removed
from the consciousness. The girl with the paralysis had several
conflicting emotions. She did not meet her problems frankly, but
repressed them. There was no annihilation or destruction. Conflict came on and unconsciously produced severe symptoms. The
symptoms produced rarely suggest the cause of them, and to find
out the original experience is often a difficult task and means
exploring the subconscious or the application of the principles of
psycho-analysis. The resistance or barrier that must be overcome in order to reach these unconscious complexes is termed the
Sublimation is a condition in which the energy and interest
attached to the repressed wish are transferred to some object or
pursuit which is not in conflict with the censor.
The middle aged spinster, exceedingly prudish about sexual
matters, may devote the energy normally expressed in marriage
and the upbringing of children, to the care of cats and dogs. Another may find satisfaction in art or music.
Sublimation is not abnormal. When we encourage vigorous out-of-door games in our schools, we are giving an opportunity for sublimation of the beginning sex urge to activities socially
Rationalization means self-deception, and it is one of the
most common of the mental processes.
The crossword puzzle fiend probably asserts that working
out a puzzle is educative, as it is increasing his vocabulary.
A woman, who had been frightened by a dog at a certain
corner, crossed the street just before she reached the scene of her
unpleasant experience.    When asked why she crossed, she said:
Page Eighteen "In order to be out of the sun"-
rational or reasonable.
-an explanation which seemed
Compensation.—When one kidney is removed from the body
the remaining organ does the work for the two. In the course of
time it usually increases in size, and likely no serious effects follow the loss of its fellow. In other words, there is compensation
taking place to make up for the loss of the other.
The loss of parts of the body may also be compensated for,
not by another organ assuming increased functional duty, but by
compensation in the mental activities.
College students who rank low in their work compensate
by assuming that they are unusually bright, better than the average student, but they do not care for the marks they receive in
their studies, because the professors are very dull and do not interest them in the least.
It is important to be remembered that this compensation
takes place without one knowing what has gone on, much like the
manner in which digestion and respiration take place.
A college student who does poor work and then developes
an attitude of superiority, does not know why he has assumed
that attitude. He is "kidding" himself along, rather than anyone else.
This is important to be remembered, this so-called mental
mechanism of compensation, for it is very common. At times it
determines the characteristics of groups of people. The chivalry
of the romantic South, of a generation or more ago, was largely a
compensation. Women were honoured, feted, toasted, and their
honour defended with the sword—but the slaves were chained,
beaten, cursed and their honour violated. The chivalry was a compensation for the brutality and oppression.
Projection.—This mental mechanism is well illustrated in
the following case: A woman who lived in a small village was
left a widow fairly early in life. She soon complained that the
villagers were talking about her. She accused them of saying she
was a "designing widow." As a matter of fact her neighbors had
been saying nothing of the kind. Close study of her indicated the
fact that she was a designing widow. The desire to remarry had
been repressed. Her repressed tendencies found an outlet in the
projection in the imaginary remarks of others.
This is often the mechanism which operates in the political
radical and the chronic fault-finder, who sees no good in anything. They feel that way, because so far as they can see, there
is but little good within themselves.
This mechanism of projecting repressed activities is common
in the daily behavior of everyone. The tennis player who blames
his poor playing on the sun, or the racket and balls, is projecting.
Page Nineteen
JA As a rule, the faults we find with others oftentimes lie within
ourselves. Unwilling to blame ourselves, we blame others with
similar failings. Hence it is, that in giving a patient plenty of
leeway to talk, he will often, even in discussing others, point out
to the close observer many of his own weaknesses and own failures.
Treatment.—Prevention has long been recognized as one of
the most important factors in the treatment of medical diseases.
In recent years, due to the activities of mental hygiene societies,
this phase has been taken up to an increasing degree respecting mental and nervous disorders. In the last edition of "Osier," the following statement is made at the beginning of the section on "Treatment of Neurasthenia": "Many patients come under our care a
generation too late for satisfactory treatment, and it may be impossible to restore the exhausted capital. The greatest care should
be taken in the rearing of children of neuropathic predisposition.
From a very early age they should be submitted to a process of
psychic hardening, every effort being made to strengthen the bodily
and mental condition."
This applies not only to neurasthenia, but equally well to all
cases of a mental and functional nervous nature.
The idea that neurotics are born and not made, has about as
much to justify it as the belief that tuberculosis is inherited. If
the grandparents of the neurotic child or adult are to be blamed
for his shortcomings, there is little use to consider any sort of
treatment beyond prevention of marriage of those of neuropathic
makeup. To-day we take a more hopeful view by laying stress
on the influence of environment and early teaching.
There is often inborn sensitiveness, abnormal suggestibility
and a tendency to nervous instability, which predispose to nervous
disorders, but if those native tendencies are not reinforced by bad
reactions and training of early childhood, or by later psychic
assaults, these conditions are not likely to occur.
How much time do we spend in advising the mother about
the mental hygiene of her child? The mother is taught to weigh
her infant and how to feed it by algebraic formulae, but little or
nothing is taught her regarding the mental life. The so-called
spoiled child, which does not get along well at school, who can
not submit to any sort of discipline, who gains her own way by
having tantrums and hysterical fits, and who in later life finds it
impossible to adjust herself to ordinary standards of life, was
not born that way. She is a product of improper training. In
many of the large cities on this continent there have been established Behavior Clinics, where problem children are studied, and
where mothers are given expert advice with regard to proper
Page Twenty The lMedical Profession is United
in recognition of the fact that the MOST IMPORTANT
FACTOR IN THE LIFE OF A CHILD is the Milk supply.
MlLK is the first and only food the new-born child receives, and when—as is frequently the case—cow's milk has
to be substituted for the natural mother's milk, too much care
cannot be taken to secure the best and purest milk obtainable.
THE BEST AND PUREST MILK can come only from
the MOST SANITARY AND EFFICIENT DAIRY. Therefore, when recommending a supply of Milk, for either BABY,
I The Children's Friend §
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Bay view 55 3
Burns Druq Company
The Dispensing Department is an entirely separate
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We stock all the  leading   manufacturers'  lines.
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J{\\ prescriptions dispensed
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Page Twenty-two GOITRE
Windsor Free Running
Salt Iodized
Contains the required amount of Iodine
recommended by the Medical Association
for the prevention of
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Page Twenty-three 7}r
Hollywood Sanitarium
tyor the treatment of
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Reference | "38. Q. oMedical ^Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
Page Twenty-four


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