History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: June, 1928 Vancouver Medical Association Jun 30, 1928

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The above picture is one of
a series illustrating the Seventh Edition of the treatise
"Habit Time" (of bowel
Separate enlargements of
this engraving and "Habit
Time" mailed free to physicians on request.
Spastic Constipation
Fantus and other authorities say cathartics are usually contraindicated.
Spasticity may be the result of inflammatory conditions.
It may occure from vagatonic disturbances or accompany other bowel
Petrolagar (65% mineral oil), in any colonic treatment, is superior to
cathartics or older methods, because
—it aids in allaying spasm,
—it lessens inflammation,
—it soothes the irritated mucosa and reduces hypersensibility.
?AS\^Borp°rRIvM0F Deshell Laboratories of Canada Ltd.
245  Carlaw Ave.,
Toronto, Ontario.
Gentlemen:     Please  send   me   copy
of your new brochure "Habit Time"
and specimens of Petrolgar.
245 Carlaw Ave.
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.
Volume 4 JUNE, 1928 No. 9
OFFICERS, 1927 - 28
Dr. W. S. Turnbull Dr. A. B. Schinbein Dr. A. W. Hunter
Vice-President President Past President
Dr. G. F. Strong Dr. A. C. Frost
Secretary Treasurer
Dr. W. F. Coy Dr. W. B. Burnett Dr. J. M. Pearson
Auditors:   Messers. Price, Waterhouse & Co.
Clinical Section
Dr. Gordon Burke - 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
Dr. E. H. Saunders Chairman
Dr. W. E. Ainley  Secretary
Physiotherapy Section
Dr. H. R. Ross  Chairman
Dr. J. W. Welch \  Secretary
Paediatric Section
Dr. E. D. Carder  Chairman
Dr.  G.  A.  Lamont  Secretary
Library &eP- to &• C. Med. Association
Dr. C. H. Bastin Dr. C. H. Vrooman
Dr. W. C. Walsh Credentials
Dr. W. A. Bagnall Dr. F. W. Lees
Dr. D. F. Busteed Dr. E. J. Gray
Orchestra Dr. W. F. McKay
Dr. J. A. Smith Summer   School
Dr. L. Macmillan Dr. H. R. Storrs
Dr. H. C. Powell Dr. B. D. Gillies
Dr. L. H. Appleby
Dinner Dr- W- T" Ewing
Dr. D. D. Freeze Dr- J- Christie
Dr. C. H. C. Bell Dr- J- T- Wall
Dr. T. H. Lennie Hospitals
Credit Bureau Dr. H. H. Milburn
Dr. L. Macmillan Dr. F. C. Brodie
Dr. J. W. Arbuckle Dr. A. W. Hunter
Dr. N. McNeill Dr. H. H. Planche
Page 267 Washington Post-Graduate     11
ff   Medical Lectures
The University of Washington Presents its Twelfth Annual
Post-graduate  Medical  Course
July 16 to 20 Inclusive
One lecture a day and one two-hour clinic during the week will be given
by the following faculty
Dr. Frank H. Lahey of Harvard, Surgery
1. Gastric and Duodenal Ulcer and Gastric Cancer.
2. Esophageal Pulsion Diverticulum.
3. Biliary Tract Disease. .
4. Hyperthyroidism.
5. Intrathoracic Goiter.
6. Adenomata, toxic and non-toxic.
7. The Diabetic Thyroid.
Dr. James B. Herrick, Rush Medical College, Medicine
1. The Requirements of Modern Diagnosis.
2. Medical Aspects of Tumors Recurring after Operation.
3. Visceral Syphillis in Lung, Heart, Blood Vessels, Liver, Stomach, etc.
4. Common errors in Diagnosis of Cardiovascular Disease.
5. The Diagnosis of Pyogenic Infections.
Dr. J. Whitteridge Williams, Johns Hopkins, Obstetrics
1. Maternal and Fetal Mortality  in Obstetrical  Practice,  with  Suggestions  as  to
how They May be Diminished.
2. The Significance of the Decidua under Normal and Abnormal Conditions.
3. Physiology and Conduct of the Third Stage of Labor  with Particular Reference to the Prevention of Hemorrhage.
4. The Indications for Cecarean Section and Its Abuse in this Country.
5. When is Advice Concerning the Prevention of Conception Justifiiable?
Indications for Therapeutic Sterilization.
6. Abortion—Its Causes, Prevention and Treatment.
Dr. Andrew C. Ivy, Northwestern Medical School, Physiology
1. The Functions of the Stomach and Pancreas.
2. The Etiology of Gastric and Duodenal Ulcer with a Physiological Consideration of the Treatment Used.
3. The Physiology of the Gallbladder,  with  a  Consideration of  the Etiology of
4. Intestinal Obstruction and Acute Dilatation of the Stomach.
5. Recent Advances of Practical Significance in the Fundamental Medical Sciences.
Dr.  John  Martin  Wheeler,   University  and   Bellevue   Hospital   Medical
College, Ophthalmolgy.
1. Mistakes in Diagnosis in Ophthalmology.
2. The Use of the Epidermal Graft in Eye Surgery.
3. Restoration of Obliterated Eye Socket.
4. The Surgical treatment of Ptosis.
5. Common Eye Problems that concern the Practitioner.
6. Rare Conditions  that  concern  the Ophthalmologist.
7. Pulsating Exophthalmos.
8. Operation for shortening the Palpebral Fissure.
Tickets are $15.00 for the  entire course, including scheduled social
Address University Extension Service, University of Washington,
Seattle. Secure your ticket before coming, as the course is limited to
300.   Money gladly refunded to those unable to attend.
Page 268 Tfadiant Heat "Therapy with the
uictor Thermospectral Lamp
A Duplex Outfit Using the
Incandescent Bulb and Infra'
Red Unit Interchange ably
WITH the countless number
and varieties of so-called
therapeutic heat lamps on the
market, advertised to both the
medical profession and the public, little wonder that many
physicians are at a loss when
it comes to the selection of an
outfit for the office or clinic.
Just as a correct drug prescription requires a knowledge
of the action of the drugs prescribed, so does the intelligent
use of any physical therapeutic
energy require a knowledge of
the nature of that energy. Eminent physicists deplore
the fact that
more accu-
rate data
have   not
been given in many investigations, especially pertaining
to the wave-lengths of radiant energy employed, and
the too frequent use of indefinite terms in describing
results. In other words, reported clinical results with
radiant energies are distinctly
valuable only when the spectral limits and the spectral
distributions of the energy
employed have been definitely determined.
Also furnished
with brackets for
wall mounting
It is on this basis that the Victor Thermospectral Lamp is presented.
It is virtually two outfits in one, in that the incandescent bulb and
infra-red unit may be used interchangeably. The spectral ranges of the
two energies derived are as follows:
Spectral Range
(Angstrom Units)
4000A— 25000A
Dominant in Region of
(Angstrom Units)
9000A—11000 A
\$nfra-Red Unit as used
interchangeably with In-
Ipanaescent Bulb in Victor
I Thermospectral Lamp.
1500-Watt Incandescent
Tungsten Filament Bulb
(Nitrogen filled)
1000-Watt Infra-Red Unit 7600A—150000A 20000A—30000A
The Victor Thermospectral Lamp is scientifically designed for a specific range of
therapeutic service and is submitted to the profession as a legitimate unit in the
physical therapeutic armamentarium.
Write for Bulletin No. 281 for complete description
Manufacturers of the Coolidge Tube
and complete line of X'Ray Apparatus
Physical Therapy Apparatus, Electrocardiographs, and other Specialties
2012 Jackson Boulevard Branches in all Principal Cities Chicago, 111., U.S.A
Vancouver Branch:   Motor Transportation Bldg.  570 Dunsmuir Street Georgia Pharmacy
will remain at
Granville and Georgia
We have secured a lease on our present premises from the new owners of the building
and will continue to give the same efficient
service in the future that we have during the
past 20 years.
Granville at Ceor^i'cs.
Say it with Flowers
Cut Flowers, Potted Plants, Bulbs, Trees, Shrubs,
Roots, Wedding Bouquets.
Florists' Supplies and Funeral Designs a Specialty
Three Stores to Serve You:
48 Hastings St. E.
665 Granville St.
151 Hastings St. W.
One Phone:
Seymour 8033
Connecting all three stores.
Brown Bros* & Co. Ltd.
The importance of post-graduate education is becoming increasingly
recognized. Not only are our medical schools doing their part, but the
Canadian Medical Association, by means of a grant from the Sun Life
Insurance Company, now carries some portion of this work to the most
remote practitioner. In the larger centres periods are set aside for the
purposes of post-graduate study. Medical societies are not slow to
adopt the method of co-operative instruction.
Our own summer school was one of the pioneers in the movement
of bringing post-graduate teaching to a group instead of necessitating
individual seeking of it by travel. The success of the method speaks for
itself. Yearly increasing numbers seek these centres of intensive training; indeed the danger, so far as the Pacific Northwest is concerned,
seems to be multiplication and overlapping.
There are, of course, degrees of value in such meetings. Not every
successful physician or surgeon, not every recognized university teacher
or professor, can fill acceptably the peculiarly critical requirements of
the attendance at the average summer school of instruction. A nice line
must be drawn between the too much and the too little, between the
too elementary and the over elaborate.
Your experienced general practitioner has a shrewd idea that he
can infallibly recognize what he wants when he hears it and no depreciation of his intellectual capacity must be implied or suggested. What he
is told must square with his ideas of common sense, with the dictates of
experience and with the likelihood of probability. It must be practical
without being puerile, modern without being speculative and withal
such as may have a bearing on the solution of his daily problems.
Adequate preparation of the subject matter presented is unerringly appreciated and the occasion is flattered by its evidence.
Undoubtedly more can be conveyed that will stick, by a talk delivered from notes than by reading of the formal paper. Manner and
method of delivery mean a great deal, and fortunate is the lecturer who
happens upon favourable conditions of acoustics, temperature and freedom from distraction. Punctual seating of an audience who will remain,
means a great deal in forming the peculiar atmosphere of intimacy between speaker and spoken to.
If the lecturer becomes conscious of that bond of sympathy, can
feel that he has a grip not only upon his subject but upon his hearers,
it is remarkable what an effect can be produced even by a plain man
with an unpromising subject.
Where then can we find this Adonis of the lecture platform?
Where indeed can we find a succession of them? Well, he comes along
now and again, even at present, and doubtless as the problem becomes
better understood he will come with greater regularity.
Meanwhile, also local committees are gaining experience of local
requirements  and  realizing   the  importance,   the  great  importance,   of
Page  271 suitable arrangements. The place of meeting and its relation to proper
hearing and seeing, the necessity of adequate ventilation and temperature
regulation, proper facilities of entrance and egress, arrangements for the
lowest possible minimum of said entrances or egresses. Punctuality is a
virtue recognized more often in the breach than in the observance, is
beyond the reach of any committee and must be left to the good sense
and courtesy of the audience.
A good lantern, screen and operator are invariably required and in
our own case we think as invariably forthcoming. We deprecate the
habit of throwing upon the screen long screeds of typewritten or printed
statistics or classifications or results. There are other ways of conveying the same information in a less particular but equally adequate
form. The lantern has its proper field in the presentation of illustrations.
With these few words we shall now get ready to enjoy the excellent
fare provided at the Summer School of 1928, June 5th to 8th.
Harry H. Pitts, M.D., CM.
From the Pathological Department of the Vancouver General Hospital
Unquestionably the treponema pallidum is the initial offender in
practically all cases of aneurysm at least of the aorta and one may say
of 95% and still be conservative. The lesion originates as a mesaortitis
with gradual destruction of the tunica media and consequent loss of
its support and resistance against the internal distending pressure. The
result is soon apparent in fusiform or saccular aneurysmal dilatations
of the arterial trunks in the involved area. The most common site is the
ascending aorta or the arch but they may occur in the abdominal aorta
or in any artery. Where an artery of the second order with all its
branches become distended, the name "cirsoid aneurysm" is applied.
Saccular aneurysms are the most common but the so called "dissecting aneurysm" is probably the most interesting. In these, rupture
through the intimal layer allows the formation of a new channel between
intima and media or media and adventitia. This new channel may
gradually dissect its way through into the pericardial sac with resultant
death or downwards, subsequently breaking again into the normal lumen
of the aorta, assuming a lining endothelium and becoming an established
vascular route causing no apparent discomfort to the patient. Then
again it may rupture through the adventitia at any point in its course,
with in consequence, a fatal result.
The purpose of this report, however, is not to discuss aneurysm "in
extenso" but merely to report an unusual case and so the various sequelae of aneurysms will be passed over.
The case to be cited is of interest for several reasons (1.) Location.
(2.) Size.    (3.) Etiology.
Page 272 A white male 74 years of age, but appearing at least 10 years less,
was suddenly seized with an acute lower abdominal pain while on board
ship en route to Vancouver from up the coast. He expired in a few
minutes with, as the captain thought, acute appendicitis. He had complained of no discomfort since boarding the ship. As far as could
be ascertained he had enjoyed good health, was married, with a family
of 8, his wife apparently having had no miscarriages. Further history
was unobtainable.
At autopsy he appeared as a well nourished and developed white male
of apparently about 65 years of age showing otherwise little on external
examination, of particular note. The heart was moderately enlarged but
the coronaries and valves were all intact and the aortic arch and ascend-
in? aorta showed no puckering suggestive of lues and only slight arter-
sclerotic changes. The heart muscle was rather friable. The peritoneal
cavity contained approximately a pint of fluid and clotted blood. No
source for this haemorrhage was found on examination of the spleen,
liver, pancreas, stomach, etc. Very extensive retroperitoneal haemorrhage
was apparent. On examining the abdominal aorta an extensive aneurysm
extending from just below the coeliac axis down into the pelvis was
found. Both common iliacs were involved in this and the whole length
of the sac was 22 cm.; the right common iliac measuring 8 cm. in
diameter the left 7 cm. The right had ruptured in two places, anteriorly
just at the lower extremity of the dilated portion and posteriorly about
its midportion. The sac was filled with laminated, degenerated appearing
clot and walls presented a markedly arteriosclerotic appearance with extensive atheromatous ulcers thoughout. Relatively little of further
interest was found on remaining examination.
Microscopic sections did not reveal any changes suggestive of lues
and in view of the age, the atheromatous condition of the abdominal
aorta, the relatively intact arch and ascending aorta and the location,
where the more advanced atheromatous ulcers and arteriosclerotic changes
were most consistently seen, it seems possible to regard this aneurysm as
arteriosclerotic in origin.
Owing to the recent revision of the By-laws and the new date
fixed thereby for the Annual Meeting it was possible to hold an extra
clinical meeting on April 17th in the Auditorium. The attendance
was excellent (75), and closed what has proved an exceptionally excellent session of the Clinical section of the Association.
The first case was one of lung abscess presented for Dr. Shimo-
takahara by Dr. F. W. Brydone-Jack who performed four bronchoscopies with irrigation of the abscess cavity and injection of lipiodol.
The history of the case was interesting in that the patient was struck
on the chest by a baseball fourteen years ago, the injury being followed
by an acute pleurisy.    The present disturbance dates back only two years
Page 273 when the man, a logger, developed an ordinary cold and shortly began
to expectorate large quantities of purulent sputum. The first bronchoscopy and lipiodol injection was done in October and the fourth in January. The clinical condition has improved, the patient now being free
of temperature. X-ray which at first showed cavitation of the left
lung and involvement of the lower two-thirds now shows only a density
of this portion of the lung and no cavity.
Discussion of the case brought out the incidence of surgical work
on the upper respiratory tract under anaesthesia as being one of the
most common causes of lung abscess and also that similar work under
local anaesthesia is not infrequently followed by abscess, the latter being
due to paralysis of the pharyngeal and laryngeal muscles by the injection. It was also brought out that practically all cases of tonsils and
adenoids under general anaesthetics show blood and mucous in the
trachea and bronchi as proven by bronchoscopic examination and suggests the advisability of the routine aspiration of trachea and bronchi
in such cases. Dr. Brydone-Jack called attention to the increased tendency towards the treatment of lung abscess by bronchoscopy, irrigation and local treatment rather than by radical surgery.
The second case was simply a history presented by Dr. J. A. Sutherland outlining the satisfactory result in the treatment of a case of ulcerative colitis by autogenous vaccine. The patient was a previously
healthy young woman who suddenly, following a meal of fresh pork
developed a severe diarrhoea (stools 18-20 a day). Examination of the
bowel with the sigmoidoscope showed a rectal mucosa covered with
small superficial ulcers. Following the work of Buie of the Mayo Clinic
cultures were made on a specially prepared medium from material taken
from the ulcers, a vaccine prepared from the bacillus grown and the
patient treated with increasing doses of this vaccine. Progress of the
case was at first slow but in two months' time examination showed a rectal mucosa healed over evenly, no blood in the stools which were reduced to 3-4 a day, general condition had improved very much and the
patient was apparently cured. Dr. Buie reports a series of 132 cases of
ulcerative colitis treated with autogenous vaccines (the organism being
apparently a specific bacilus), in which there were 58 cures, a very gratifying result in the treatment of a condition which often proves intractable.
A case of pernicious anaimia was to have been presented by Dr.
Lyall Hodgins, but Dr. Hodgins was unable to be present. Patient was
a man who first showed signs of failing health about nine years ago,
who was sent home from China on sick leave six years ago when a
diagnosis of pernicious anaemia was made. He has been on liver treatment for about two years and shows very gratifying improvement,
being able to carry on quite actively. Details as to blood counts, weight,
etc. unfortunately cannot be given.
The election of officers of the Clinical Section for the coming year
led to the selection of Dr. Appleby as Chairman and Dr. J. R. Davies
as Secretary.
Page A most interesting talk was given by Dr. F. M. Auld who has been
for the past seventeen years a medical missionary in Honan, China. Dr.
Auld in a few general remarks called attention to the mediaeval conditions which still prevail among the great mass of the Chinese as regards
general living conditions, sanitation, food, etc. Attention was called
to the prevalence of infections of all sorts, particularly T.B., which takes
a fearful toll. The next most striking point brought out was the presence of tumours and neglected disease conditions of all kinds, owing to
the inadequate number of medical practitioners. Roughly speaking at
present there is in China one medical mon for every 300,000 people.
The proportion in B. C. in the same ratio would be one practitioner for
the City of Vancouver and two for the whole Province, and the ratio
of hospital beds would give the city one hospital of eight beds and the
province a hospital of fifteen beds. The first medical man went in in
1834. He was not strictly speaking a medical practitioner, he was a
health officer of the British East India Company. The first qualified
medical man to go in was a Harvard Graduate, Peter Parker, in 1872.
Medical development was very slow until about twenty years ago, since
when the work has been carried on with a great deal of activity. Attention was called particularly to the work of the Rockefeller Institute
in Pekin and to the work of the medical missionaries under various
Boards who are carrying out a very difficult task in a very striking way.
Lantern slides showed some general views of Chinese cities and
villages which bore out previous remarks on living conditions. Other
slides showed hospitals and patients. Very interesting pictures were
shown of various tumours with which the Chinese are loaded down.
This is due to the inadequate number of medical men and the isolation
of patients. A very common tumour shown was a fibroid of the cervical region some of these having been carried for over 20 years, weighing from 20 to 25 pounds. Sarcomata are also very common. Carcinoma of the female genitalia and breast are numerous while carcinoma
of the gastro-intestinal tract is very rare. The infrequency of appendicitis among the Chinese as compared with the white races was also
remarked. Very aggravated cases of necrosis of the mandible and
maxillae were shown, these being due to the deplorable oral hygiene and
also to work with phosphorus in the match factories.
This meeting concludes the work of the Clinical Section for the
year 1927-28.
Miss Firmin, Librarian and assistant Secretary of the Association,
is enjoying a well earned vacation in the Eastern States. Her return is
expected at the end of May. Library work in Boston, Washington and
other centres will doubtless present features of interest and provide suggestions which may prove valuable for our own institution.
Dr. H. A. Rawlings, Medical Director of the Rotary Clinic for
Diseases of the Chest, has returned from a brief visit to the Eastern
States and Canada.    Recent advances in roentgen diagnosis in  clinics
Page 275
4*. in Chicago, Toronto and Winnipeg were studied, and some time spent
at the General Electric Research Laboratories at Schenectady.
* * *
Medical circles are again being agitated by the periodically recurrent rumours of the impending erection of a Medical Building, or rather,
several Medical Buildings. Three rivals for the favour of the profession
are at present in the field, the sites chosen by the three groups of promoters, in order of entry, being the corners of Richards and Georgia
Streets, Georgia and Hornby Streets, and Howe and Dunsmuir Streets.
Apparently none of the promotion-groups are willing to make any
material move towards actual construction until 75% of their projected
space has already been signed up by the doctors, while with commendable and characteristic caution the latter appear unwilling to commit
themselves individually or collectively to leasing space on the blue-prints
of, as yet, non-existent structures. A representative for the latesc
entry exhibited plans for his building before those interested at the
Vancouver General Hospital recently, and we understand that the
Georgia and Hornby proposed building, about which nothing has been
heard for some months, has not been dead but sleeping. Under slightly
different arrangements this building is again claiming attention, and
assurances are made that an actual commencement on the foundations is
To furnish additional accommodation for the increase in the size
of the nursing staff, St. Paul's Hospital has leased the building at 1101
Burrard Street, formerly occupied by Dr. F. X. McPhillips and used as
residence and professional office. Dr. McPhillips is now residing in
Kensington Place and has opened offices in the Medical Arts Building.
Taking sweet revenge for their defeat in Seattle on April 26th last,
the Vancouver and Victoria Medicos met and turned back the Seattle
invaders on the links of the Vancouver Golf & Country Club on May
10th last, to the tune of 94/2 to 67/2 points.
It was an ideal golfing day and the links were in perfect condition,
having being well tonsured for the occasion.
An abundance of caddies added greatly to the comfort of the day,
no less than 92 reporting for duty.
The morning round finished with a gain for Vancouver and Victoria
of 24 points.
In the afternoon Vancouver took on both Seattle and Victoria and
succeeded in adding another 3 points to their previous gains.
Especial mention must be made of the performance of Dr. Wilfred
Graham, one of our newest members who, owing to the absence of his
partner, was forced to play single handed the entire day against the invaders, and succeeded in turning in the fine quota of six points for
his team.
Page 276 Dinner was served at 7:30 p.m. and proved a most enjoyable function, and after the presentation of prizes over which our genial member
Dr. P. A. McLennan presided, the members followed their respective inclinations for the remainder of the evening.
The following are the scores.
Graham and Boucher 0
Hunter  and  Bryant 1
Freeze and Houston V/2
Seldon and Whitelaw 3
L. McMillan & E. H. McEwan |j
Moncrief and Smith 2
Nelles  and  Bilodeau —. 3
McMicking and Boyd 3
Lockhart and Dunlop 1
B. D. Gillies and Worthington 0
Frost and Ewing 0
Patterson and Milburn 0
Webster and  McNichol 2r/2
Bagnall and McLennan ll/2
Lowrie  and  Murray 3
Brydon-Jack  and Thomson 3
Panton and G. H. Wilson 3
Blair and Griffin 0
Carder and Sutherland 2l/2
Smith and Day 3
McKay  and  Pedlow 2l/2
Day Smith and Welch 3
Hodgins   and  Appleby 3
Boak and McPherson ll/2
W. Graham  3
Lennie and McNutt 0
G. E. Gillies and McDougalL—3
Houston and Speidel 3
Perry and Helpler 2
Mpore and Shannon V/2
Woolley and Coffin 0
Restive and Hancock ll/2
Ruge and Turner 1
Glasgow and Forbes 0
McCurdy and Durand 0
Lyle and Dudley 2
Rembie and Cefalin 3
Long and Rohred 1
Gray and Kinberry 3
Eaton and Mitchell  l/2
Allen and Dowling V/2
Miller  and  Crookall 0
Guthrie and Nicholson 0
Kidd and Wilkins 0
Reddy  and Davidson 3
Young and Somers  x/2
Kisling and Cady 0
Goodward and Cunningham  l/2
Baumgarten and McChesney. 0
Robertson  and  Graham 0
McLellan and H. McMillan.„„.lJ4
Lennox and Frost 0
Baillie  3
Maclachlan and Elliott 0
Freeze and Housten 0
Graham and Boucher V/2
Nelles  and Bilodeau  l/2
L. McMillan & E. H. McEwan 0
Lockhart and Dunlop 2%
Webster and McNichol 0
Lowrie  and  Murrey 0
Bagnall and McLennan V/2
Gillies  and Worthington 1
Houston and Speidel 3
Perry and Hepler 1/4
Moore  and Shannon 2l/2
Wooley and Coffin 3
Ruge and Turner  l/2
McCurdy and Durand 3
Rembie and Cefalm ..-3
Lyle and Dudley V/2
Ristine and Hancock ' 2
Page 277 Smith and Day 3
Brydon-Jack and Thomson  l/2
Patterson and Milburn V/2
Panton and S. C. McEwan 1
Robertson  and  Graham 3
Blair and Griffin 2l/2
Pedlow and Lennie 3
H. McMillan and McLellan 3
G. E. Gillies and McDougall 0
Hodgins  and Appleby 3
Welch and McNutt 2
Glasgone and Forbes 2
Seldon and Whitelaw 2x/2
Frost and Ewing l 2
Carder and Sutherland 1
McLachlan and Elliott \l/2
Hunter and  Clement 2^2
Day Smith and Welch 1
Grand Total 94J/2 42
Long  and Rohrer 0
Gray and Eikenberry 2l/2
Eaton   and   Mitchell 1/i
Allen and Dowling 2
Miller  and  Crookall 0
Guthrie and Nicholson  l/2
Reedy and Davidson 0
Young and Sommers 0
Kislong and Cady 3
Kidd and Wilkins 0
Baumgerten and Cunningham  1
Boyd  and  Bryant 1
Hunter  and Smith  x/2
Scott Moncrieff and Bailie 1
McMicking and Robertson 2
Boak and Fraser \l/2
McPherson  and  Woodward  l/2
Graham and Lennox 2
Grand Total 67l/2
H.  W.  Hill,  M.B.,  D.P.H.,  L.M.C.C;  Director,  Vancouver  General
Hospital Laboratories; Professor of Bacteriology; and of Nursing and
Health, The University of British Columbia, Vancouver, B. C.
(Being a condensation of a paper presented before the local
branch of the Society of American Bacteriologists, at the University
of Washington, Seattle, Wash., April 10, 1928).
The thesis here presented offers facts which indicate that "general
resistance" is a very minor, if not a non-existent, factor in most of the
ordinary infectious diseases, i.e. in those diseases which are due to pathogenic parasites; and that, in these "specific immunity," not "general
resistance," is the controlling factor, both in the invasion by the germ
and in the outcome of the invasion.
On the other hand, facts are also offered which indicate that, in infection by pathogenic (and also by non-pathogenic) saprophytes, "general resistance" is a factor in the invasion, (although again specific immunity is the controlling factor in the outcome of the invasion).
Briefly, with saprophytes, damage conduces to invasion; but with parasites, it is invasion which conduces to damage.
Saprophytes and Parasites
To review briefly  the whole question;  we are  all  now  convinced
that microbes act on animals as disease producers only in one way of any
Page 2/ importance; namely, by the production of various poisons, differing
with each microbic species, and of widely varying intensity. Such
poison-producing microbes constitute but a small fraction (perhaps
10%) of the total microbic species known to us. Of these microbic
poison-producers, a few (e.g. the gas-bacillus, tetanus, diphtheria—all
saprophytes) are characterized by showing little or no power to invade
the living tissues, and they therefore produce damage in living tissue
almost wholly by means of the dissemination of their intense poisons
from the non-living material in which they are growing; from which
dead tissue the poisons alone (e.g. diphtheria) may be disseminated into
the surrounding tissues; but sometimes the germs also (e.g. the gas bacillus) are likewise disseminated, especially if the tissues are reduced to, or
nearly to, the point of death by the barrage of poison issued ahead of the
invading hosts. In the case of these three saprophytes, the dead tissue
is usually a part of the living body; in the case of the saprophyte,
botulinus, the dead tissue (e.g. infected food) is usually quite distinct
from the living body; which is therefore poisoned, not by dissemination
of the poison directly from the dead to the living tissue, but by gross
transfer of the dead tissue to the living body, per os. In all four diseases,
however, as their poisonous products kill out the living tissues, these
saprophytes can extend their invasion into the now dead tissues, as they
could not while the tissues were alive.
The other class of microbic poison-producers, (parasites) are notable
for developing only in the living tissue itself. They originate their
poisons actually within the living tissues. To this group belong most
of the organisms which produce the ordinary infectious diseases, notably
typhoid fever, syphilis, gonorrhea, tuberculosis, the meningitides, etc.,
and we nave good reasons to add those of smallpox, chickenpox, measles,
mumps and some others.
Note, at this point, the contrasting functions and results of the
poisons which the saprophytes and parasites respectively produce against
the body. In the case of the saprophytes, which cannot invade healthy
and vigorous tissues, which require for their nourishment dead or at
least dying tissues, the poisons which they produce in dead or dying
tissues, or portions of the tissues, may extend to other as yet healthy tissues or portions of tissues, and reduce those also to the dead or dying
condition, i.e. to a condition in which the saprophytes may invade
them, secure nourishment from them, and further increase and multiply.
Such a sequence of events is obviously of great value to the saprophytes
—a logical and consistent sequence, tending to the preservation and extension in the world of the saprophytic species involved.
In the case of parasites, which require for their nourishment living
tissue, the poisons which they produce in the body tend also, as in the
case of saprophytes, or reduce the body to a dead or dying condition; but
in strong contrast with the case of the saprophytes this means reduction
of the body or body tissues to a condition in which the parasites will
be unable to secure nourishment and must ultimately perish. Such a
sequence of events is obviously harmful to the preservation or extension
of the parasitic species involved; it militates directly against their best
Page 279 interests in the world. It was long ago pointed out by Theobald Smith
that the more fatal the poisons of a parasite, and the earlier the death of
the host ensues, the shorter will be the career of the parasites in the
host, therefore the greater the tendency to the extinction of such
highly poisonous species and strains from the earth.
The species or strains of parasites most successful in surviving and
spreading are therefore those who do the least damage to their hosts.
The most successful parasites (from the parasites standpoint) are the
parasites that can flourish most extensively in the longest-living and
healthiest host, such as the tubercle bacillus; and at the same time spread
most readily from that host to others, such as the typhoid germ in
"carriers." The least successful parasites are those that most promptly
and inevitably kill their host and thus terminate their own careers, e.g..
the bacillus of pneumonic plague, which is almost one hundred per cent,
fatal to its host.
Poison production is therefore a real aid to the saprophytic species,
(e.g. the gas bacillus) but a real detriment to the parasitic species, (e.g.
the plague bacillus). (Hence I think we may look upon the toxicity
of parasites as usually representing a "vestigial remnant" of a former
saprophytic existence—as a characteristic once extremely valuable, now
a detriment; and we should expect, with Theobald Smith, that the natural evolution of the present pathogenic parasitic bacteria will in time
result in the loss of poison production, which is for them, an unfortunate relic of the past).
So far I have considered the subject from the standpoint of the
bacteria in its effects on bacterial races.
Turning now to the consideration of the same facts from the standpoint of the attacked human individual, let us consider the evidence as
to the relative results in practice of "general resistance" and "specific
immunity" as they affect the incidence and outcome of disease in the
individual human.
Specific Immunity
Active specific immunity is definitely understood as that quality of
a living body which protects the body against some one infectious disease, and against that disease alone. When required, it is acquired solely
through a reaction of the living body to the disease concerned, or to its
microbic cause, or to the poisons formed by the microbic cause, or to
some modification of these "antigens." No other substance administered, nor modes of life followed, can in any way initiate specific immunity
in the absence of the specific antigen; nor are any known (except the
passage of time, in some diseases) that will reduce it, once it is formed.
The duration of this immunity varies inherently with the antigen in
different instances; thus, once acquired through an attack of smallpox,
chickenpox, measles, scarlet fever, the corresponding immunity lasts for
life, but smallpox immunity, if acquired only through cow-pox vaccination, protects fully for only about seven years, although partially
for life; typhoid and diphtheria immunities (derived from an untreated
attack)  last but a few years; immunity to colds perhaps a few days;
Page 280 while the immunities to tuberculosis, to syphilis, and to malaria last
only during the periods while the corresponding antigen is active in the
body, and disappear with the disappearance of the corresponding antigen.
This latter type of immunity is known as tolerance.
Given an antigen operating in the body, the chief recognized factor
in the production of immunity is the ability of the body to make the
corresponding specific antibody. This ability finds its most favoring
circumstances when the initial dose of antigen is not too great; when
the dose is increased but not too rapidly; and when intervals of rest
between doses can be had. The only other advantageous factors so far
definitely recognizable and dependable seem to be rest of the whole body
during the immunity-forming period, together with sufficient food,
water, air, etc., to keep the metabolic processes at the efficient energy-
producing level required for the manufacture of antibodies.
Such active specific immunities in many instances are known to be
derived from the existence of specific substances, demonstrable in the
blood-serum, (e.g. diphtheria antitoxin); and the transfer of such sera
to other living bodies will transfer the immunizing substances, which
will then protect the second body for a brief period, usually about two
weeks, conferring thus what is called a passive specific immunity.
Resistance, in contrast with specific immunity, is a vague term,
vaguely understood to represent a quality of a living body ("general
resistance"), or of a living body cell ("local" or cellular resistance)
which resists invasion of the living body or body cell by any foreign
living cell. It is held to belong in some degree to all living cells, by
virtue of the mere fact that they are alive; and to vary more or less
inversely with the "health" or "vitality" or "vigor" of the attacked body
or body cell; and also of the attacking cell. As concerns the human
body and microbial invasion, it is very widely held that the "health"
of the individual body or body cell, and therefore its resistance, may be
"depressed" either by local injury or by systemic ill health, or by specific
conditions unfavorable to efficient metabolism; thus by systemic fatigue
or malnutrition; by systemic temperature disturbances; by specific metabolic disturbances (avitaminosis, diabetes, etc.); and by vague "rundown conditions";also, by preceding microbic poisonings (notably in
streptococcus pneumonia following influenza infection). Resistance,
in further contrast with immunity, is held to be non-specific, i.e. to be
more or less operative against invasion by any and all microbic species.
It is not demonstrable as a particular function of any specific substance,
as acquired immunity is; and therefore it cannot be transferred from
one body to another, as acquired immunity can. Moreover, resistance
is held to be of a very fluctuating character, as specific immunity certainly is not.
The relation of these two, Specific Immunity and General Resistance, to each other, as affecting the incidence of microbial disease, is
usually held, rather vaguely, to be that there occurs first a lowering of
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necessary to sell Stock or Bonds to ensure
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Auditorium   (Observation)   above   the   10th
Building fireproof and soundproof.     Beautiful   Commercial-Gothic architecture.     Slung
ceilings  carrying pipes  and  ventilation.
Fast    and    adequate    self-leveling    elevator
Forced  ventilation.
Ideal  Professional  location  on  Georgia  St.,
between     Granville    and     Burrard,    facing
Court    House   gardens,    Vancouver   Hotel,
Devonshire   Apartments    and   new    C.N.R.
Hotel site.
Free  from noise  and  street-car vibration.
Good light and panoramic view.
Suites    elegantly    finished    in    mahogany—
doors   and   trim.     An   office   every   doctor
may  feel  proud  of.
Light,  gas  and  compressed  air  free.
Space   is   going   rapidly—there   are   about
400 doctors—we cannot call on all at once
—if   you   desire   some   particular   location
kindly   call   or   telephone   for   reservation.
Medical and Dental Building Department
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Diphtheria Toxin for Schick Test
Diphtheria Toxoid (Anatoxtne-Ramon)
Scarlet Fever Antitoxin
Scarlet Fever Toxin for Dick Test
Scarlet Fever Toxin
Tetanus Antitoxin
Anti-Meningitis Serum
Anti-Pneumococcic Serum (Type 1)
Anti-Anthrax Serum
Normal Horse Serum
Smallpox Vaccine
Typhoid Vaccine
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Pertussis Vaccine
Rabies Vaccine (Semple Method)
Price List   Upon Request
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Depot fir British Columbia
macdonald's prescriptions limited
618 Georgia Street West - Vancouver
Page 283 "general resistance" which it is supposed is necessary to lay the body
open to invasion by any microbe; and that if then one of the microbial
causes of any infectious disease be present, this germ may enter and
proceed to produce its poisons. (Therefore, even on this "general resistance" hypothesis, the ultimate outcome depends upon these poisons
versus the ability of the body to develop specific immunity against the
microbe or the poisons, or both). This "general resistance" hypothesis
further implies that, provided the "general resistance" be high, invasion
by pathogenic germs will not take place; and hence that the subsequent
sequence of poison production, immunity, etc., will not occur; while if
"general resistance" be lowered (as on this hypothesis it may be very
easily and abruptly, by fatigue, a missed meal, a cold draft, wet feet,
etc.) invasion may occur. (Hence the query of Armstrong. "Is it a
menace to be healthy?"; for a high general resistance, subject to such
ready depression at any time, may, while it exists, prevent the acquiring
of a permanent specific immunity; and when it later becomes "depressed",
its depression may permit a fatal invasion.)
A careful review of the evidence presented by the various microbic
diseases indicates that both Specific Immunity and General Resistance,
as above defined, have their respective fields of operation in the human
body; but that the relation of the two to each other, in the case of
microbic diseases, is not that outlined in the last paragraph. It would
appear that General Resistance opposes invasion of the body by saprophytes, (e.g. botulinus, gas bacillus, tetanus, diphtheria); but that Specific Immunity opposes rather the poisoning of the body by either saprophytes or parasites; and that General Resistance does not affect invasion
of the living body by parasites. Hence high health is neither a protection
nor a detriment, as concerns the ordinary infectious diseases, most of
which are due to parasites.
Briefly, lowered resistance, systematic or local, is necessary to make
living tissues invasible by saprophytes, (e.g. systemic death, agonal conditions, gangrene, necrosis from frost-bite, crushing, poisoning, etc.)
and without such lowered resistance, saprophytes are powerless to invade. But parasites, (e.g. B. tuberculosis, B. typhosus, etc.) are characterized by their inherent ability to live in healthy bodies (we nearly all,
ill or well, harbor tubercle bacilli,—there are many quite healthy typhoid carriers, etc.). Lowered resistance is therefore unnecessary to
invasion by these parasites— and the incidence and outcome of their
attacks are wholly matters of specific immunity.
To review briefly, lowered resistance in the sense of a depression of general or local health from unfavorable environmental
conditions (other than invasion by parasites) may encourage invasion
by saprophytes; but does not encourage invasion by parasites, which
latter are capable of invasion despite high general resistance, and even
in the presence of specific immunity (e.g. carriers of tuberculosis,
typhoid, malaria, etc.)
Practical Effects
But even the invasion of saprophytes is not encouraged,  as is so
widely  held,   by   slight  depressions   of   general   resistance,   that  is,   by
Page 284 slight departures  from  the more favourable  environmental  conditions,
but only by extreme ones.
Thus, invasion of the tissues by saprophytes from the intestinal
tract, occurs quite obviously after death; also before death, if there be
a prolonged agony; but, as seen in taking blood cultures from persons
in extreme ill-health, e.g. typhoid fever, or septicemia (which cultures
show the parasite concerned, without mixture with saprophytes) these
saprophytes do not invade the body until death occurs or is just at hand.
The tetanus germ may be harboured in the intestine for years or for
life, without tetanus developing, despite the inevitable ups and downs in
general health and hence, (hypothetically), in general resistance. The
botulism organism (as distinguished from its very intense poisons) in
the intestine is harmless during life and invades only dead tissues readily.
We may then recognize clearly that even the saprophytes require extreme
lowered resistance in the attacked, before invasion can occur; while
parasites do not require lowered resistance of any degree for invasion,
indeed they soon perish with such extreme lowered resistance as permits
saprophytic invasion (e.g. the death of the patient). To this latter
group of pure parasites belong most of the microbic causes of the
ordinary infectious diseases.
Contrasts Between Resistance and Immunity
Let us take a disease caused by a strict saprophyte, say B. tetani.
Introduce into a healthy muscle a washed culture of spores of this bacillus. Nothing happens unless the muscle be now crushed or otherwise
devitalized. Then the tetanus germ grows and disseminates its poisons
from its stronghold in the crushed area; and when the poisons have killed
the tissues, the tetanus germ may further invade them but not until
. So also, mutatis mutandis, acts the saprophyte, Staph, epidermidis
albus, the skin coccus. This saprophyte flourishes in the dead epithelium
constituting the outermost layer of the skin. Despite its growth almost
in contact with the immediately underlying living epithelium, this coccus
cannot invade the latter unless the latter is "devitalized" by trauma, or
morbid lesions —e.g. by the compression of stitches drawn too tight, by
burns, certain skin diseases, etc.
Contrast with this the history of a strict parasite, say, the
microbe of vaccinia. In vaccination, a drop of vaccine placed on the
intact dead epithelium covering the true skin has no effect and
quickly dies. But remove or merely puncture this dead epithelium,
however so slightly, and at once the vaccine has its chance. Note that
the vaccine microbe is so pure a parasite that the dead epithelium of the
outer surface of the skin is sufficient to act as a complete bar to it. But
if the underlying living tissue can be reached, the microbe at once invades the living tissue where, being a pure parasite it is thoroughly at
home, grows and produces its poisons. Note that it is the healthy arm
of the unvaccinated person—baby, athlete in the pink of condition,
soldier at his best—which vaccine invades, unless specific immunity
exists. -On the other hand, provided specific immunity be present, the
Page 285 diabetic, the drunken, the half-starved, the half-frozen refuse to "take".
It happened that it became necessary at Saranac Lake to vaccinate tuberculous people in considerable numbers. The vaccinations were done in
fear and trembling because of the "run down" condition of the patients,
but the vaccinations which "took" ran entirely normal courses, even in
the advanced cases, conversely the course of the tuberculosis was not
adversely affected by the vaccination.
I t is true that besides the strict parasite and the strict saprophyte,
there may possibly be a third class—microbes which conceivably possess
some of the features of both. It is intended to discuss later the question
whether or not such a class exists and if so, what organisms belong to it.
R. E. Coleman, M.B., V. G. H. Laboratories
In response to a request we are here submitting a list of the
"normal" ranges of body constituents as at present in use in the Vancouver General Hospital Laboratories. In using these the physician is
reminded that the results of any laboratory analysis are but 1 a response
to a technic," so that these "normals" are subject to changes of technic.
For the same reason they may not be directly comparable in given instances with results from other laboratories.
Determination Normal
Basal Metabolism   —10 to —|-15
Blood calcium,, mg. per 100 cc.      10 to      11
Blood chlorides, mg. per  100  cc.    588 to    630
Blood creatinine, mg. per 100 cc.         1  to        2
Blood non-protein nitrogen, mg. per 100 cc.      25 to      35
Blood phorphorus, mg. per 100 cc.        3  to        4
Blood sugar, fasting, mg. per 100 cc      80 to    110
Blood urea nitrogen, mg. per 100 cc.      12 to      15
Blood uric acid, mg. per 100 cc.        2 to     3.5
Spinal fluid, cells per cmm.        0 to        5
Spinal fluid, chlorides, mg. per 100 cc.   725 to 740
Spinal fluid, sugar  about l/2  blood sugar
Fragility  beginning  at  0.44%
complete at 0.36%
Phenolsulphonephthalein   (P.S.P.)   in two hours 60 to 85%
Red blood cells per cmm.   (men)        4,700,000 to 6,100,000
Red blood cells per cmm.  (women)      4,300,000 to 5,300,000
Haemoglobin, per cmm.   (men)    83% to 106%
Haemoglobin, per cmm.   (women)    71% to    92%
Color index  (men and women)   0.85 to   1.15
White cells per cmm.   5,000 to    10,000
Platelets,per cmm.       2 80,000 to 540,000
In the case of glucose curves, two hourly urine tests and fat in the
stool the physician will find it more satisfactory to consult the laboratory staff since the normal range is not so easily expressed as are the
above. —
A meeting of this association will be held in Victoria, on June the
eleventh and twelfth, and the members of the Victoria Medical profession
are intending to make it a great success. With this in view, they have
arranged a two day programme as set forth below:
It will be noticed that part of the programme will be scientific,
part business, and part of a social nature. - A complete programme of
entertainment has been arranged, including golf, tennis, drives to Butch-
art's Gardens, if possible a boat trip, luncheons, and a dinner. Special
arrangements are being made for entertaining ladies.
The speakers will include: Dr. F. H. McKay, associate professor in
the department of neurology at McGill University; Dr. F. A. Scrimger,
associate professor of surgery at McGill, and associate Surgeon of Royal
Victorian Hospital; Dr. Andrew Hunter, of the department of medicine,
Toronto University, and Dr. C. A. Peters, associate professor of clinical
medicine, McGill University.
These gentlemen are members of a Post Graduate team, sent out by
the Canadian Medical Association, and will be taking part in the Summer School of the Vancouver Medical Association during the preceding
Every means will be taken that there shall be no conflict with the
Summer School, and the subjects chosen for the Victoria meeting will be
entirely different from those in Vancouver. Many subjects are coming
up at the annual meeting, which are of great importance to the medical
Pr- ;   "1"""***t>     '■
Colwood Golf Course, Victoria, B. C.
Page 28/ profession of B. C. It will not be forgotten that Health Insurance is
now becoming a possibility, and it is imperative that the provincial
organization should keep close watch on the progress of this matter,
so vital to all of us. Every member of the profession is concerned, and
should take his share in the discussion that is bound to be caused on this
During the next week or two a questionaire will be sent out to all
members of the B. C. Medical Association in an endeavor to ascertain
how many will be present. Every effort is being made to have a large
attendance, and it is hoped that many ladies as possible will be visitors
during these two days.
To those who know Victoria, with its wonderful scenery, and many
beauty spots, and especially to those who know the medical men of Victoria it will not be necessary to enlarge to any extent upon the opportunity that is here offered, for a delightful holiday.
Those of us who enjoyed the hospitality of Victoria in 1926, when
the Canadian Medical Association held its annual meeting, will have
many happy memories of a most pleasant time.
Regarding the programme we have arranged as follows:
Monday morning to be free for entertainment, golf, etc.
1     — 2       p.m.—One speaker.
5.30— 6.30 p.m.—One speaker.
7 — 8       p.m.—Dinner.
8 — 9       p-ni.—Speaker with lantern.
9 —10       p.m.—Speaker with lantern.
10     —11       p.m.—If necessary a speaker with lantern.
Tuesday, 9—10 a.m.    If necessary one speaker without lantern.
10—11 a.m.—Speaker without lantern.
11—12 a.m.—Speaker without lantern.
Afternoon free for entertainment.
6:30 p.m.—Formal Dinner followed by the Annual Meeting of the B.C.
Medical Association.
The death of Doctor Howard Miller, at his home in Victoria on
May 2nd, deprives the medical profession of one of its most promising
Born in Topsail, Newfoundland in 1890, Dr. Mjiller went to Victoria
when three years of age. He was educated in the Victoria Public and
High Schools and later went to McGill University to study medicine.
Graduating in 1916 he immediately returned to Victoria, entered the
Canadian Army Medical Corps, went overseas and was attached to
various military hospitals for the duration of the war.
Dr. Miller's loss will be particularly felt in the work of the service
organizations of Victoria in which he was an important factor.   He had
Page 281 been a member of the Kiwanis Club almost since its inception and three
years ago served as its President. Dr. Miller, also, did valuable work on
the consultant staff of the Jubilee Hospital. He was a member of the
Victoria Medical Society, Canadian and B.C. Medical Associations.
Unselfish, loyal and genuine,Dr. Miller had a host of friends who
will regret his untimely passing and who will sympathize with his wife
and children in their bereavement.
Dr. R. E. Coleman
Vancouver General Hospital Laboratories
If the conversations that I have with practitioners are a true indication of a general condition—and I have reason to think that they are—
then there is no class of order, that the physician more often fails to
effect than those that call for prolonged rest. In the business world
it is generally believed that if a salesman does not succeed in selling a
good article it is usually because he has either not "sold" it to himself
first or because he has not been posted on its selling features. In defense
of the use of this word here, it is to be noted that somehow or other
the expression " to sell a thing" or "to sell an idea" has come to have
a technical significance that completely and exclusively conveys the idea
of convincing the recipient of the suggestion that they must possess the
thing being offered even at the price asked. The following discussion
is therefore offered with the object of both "selling" an idea to the
physician and at the same time posting him as to some of the "selling"
features of the idea which he is offering.
In a general way the physician is already "sold" to the clinical value
of rest; first because we were taught it in our student days; second
because we experience ample evidence of its value in our rounds; and
third because we are familiar with the results of rest as effected in sanatoria. Yet we as a class do not visualize very concretely the harmful toxic
effects of fatigue. Now every physician is familiar with the fact that
when a muscle is overworked there is an accumulation of lactic acid to
the point where the lactic acid becomes toxic. It is also familiar to
all of us that the efforts on the part of the diabetic to produce energy
in the face of a deficient carbohydrate metabolism, lead to the production
of ketones in toxic amounts, ending eventually in diabetic coma.
It is familiar to all bacteriologists that diphtheria organisms produce diphtheria toxins when they turn to the protein, etc. of the media,
after the carbohydrate has been used up, i.e. after the most readily
available source of energy is gone. It is also known to the biochemist
that the production of histamin from histidin by the action of bacteria
occurs only late in the incubation of the culture, i.e., again after the
most readily available sources of energy have been used up. This same
histamin is familiar to the clinician as a substance which produces
many of the symptoms of surgical stock.
In short there is definite evidence that metabolic processes, usually
yielding nontoxic products, may, when subjected to certain restrictions,
produce  extremely  toxic  ones.     So  that  the  solution  of   the  familiar
Page 289 clinical effects of fatigue may be traced to toxic metabolic products;
the result of the exhaustion of the best energy producing foods, by excessive energy demands; this exhaustion forcing the body to turn to
proteins, etc., where it gets energy but at the expense of toxic byproducts.
Granted then that fatigue leads to the accumulation of definite
toxic products, how much can the physician reduce the rate of energy
demand, and thus reduce the toxin production, by ordering complete
rest in bed?    Probably not more than a saving of 30%!
To take the particular case of a man, age 30 years, height 5 foot
7 inches and weighing 150 pounds; his basal metabolic demands
would be about 1600 calories. If he were a diabetic, an additional
30% would supply him with enough energy to carry on a light work
such as in an office. If he were a healthy carpenter he might require
50% over this basal (1600) caloric requirements. Conversely if a
healthy carpenter, up and about, requires but 50% over his basal (1600)
calories (i.e., 2400 calories) then resting him in bed, which can only
approximate basal requirements (1600), could only effect a saving to
him of not over 30%. Frequently the energy demand in the case of the
bed patient are quite appreciably above basal. This is largely due to
three factors; many patients run a temperature above normal and for
every degree above the normal the demand for energy increases 10%
of the basal requirements; except for short periods of time it is impossible to keep patients in the degree of repose recognized as basal or
minimal; finally the sick individual often exhibits a marked decrease in
mechanical efficiency, i.e., sick individuals expend more energy doing a
piece of work (i.e. lifting a book) than they would if they were well.
Altogether, when the human machine shows signs of failure (sickness)
its minimal demands for energy often tend to increase.
There is one particular disease that is worthy of special notice because of its importance in British Columbia, namely hyperthyroidism.
In this condition it is not uncommon to find a basal demand for energy
which is 60% over the normal. Such an individual at complete rest
in bed without food or movement may require more energy than he
actually needed for the performance of his normal activities when well.
Sometimes these individuals have a basal demand for energy that is
more than twice their normal. Another feature of hyperthyroidism is
the marked loss of efficiency. It is not infrequent for such individuals to
expend more than twice the energy doing a piece of work that they
would in normal health. From this it was not much to be wondered
at that an undiagnosed case in my experience, when ordered to play golf,
ran a very rapid course.
So much for "selling" the idea to the physician; enough has been
said to indicate that rest is a real factor capable of concrete analysis.
How, then, are we to "sell" this idea to the patient and, as the clinician
appreciates only to well, to the friends and what might be called "acquaintances?" Of course one commences with the comparison between
the human machine and some form of engine. Both consume fuel and
yield work. We tell the layman that the human body requires a definite
number of calories. We say, for example, that the manual laborer may
be consuming enough food to yield 3000 calories.    Then if the layman
Page 290 is really trying to understand, he will ask what does a calorie mean?
We then tell him that it is the amount of energy necessary to heat
about one quart of water one degree centigrade. It is true that we
have answered his question but careful investigation will soon show that
he does not feel that he is a bit wiser for our answer. The reason is
that there seems to be but one form of energythat the man on the street
feels that he can really visualize and that is mechanical work. How accurate this visualization is may be rightly questioned but the fact is
that he feels that he can understand work-energy, and our problem
therefore, as salesmen, is to convert our calories into work-energy.
One physiological calorie is the energy equivalent of raising one
and a half tons (3000 pounds) a foot into the air. With this tool let
us make a few interesting conversions. A man sitting in front of a
door rises, turns the key and sits down. He has expended one calorie;
the equivalent of raising one and a half tons a foot into the air. If he
had been a hyperthyroid case with the characteristic decreased efficiency
of that disease he might easily have expended two calories, or the equivalent of raising three tons a foot into the air.
A laborer consumes 3000 calories a day. This is the equivalent of
raising 4500 tons a foot. But here again we have a comparison that is
very apt to lack real meaning. To convert this into a picture, with at
least some significance, we can imagine a fully loaded freight train, and
picture lifting this train a foot into the air.
Our hypothetical individual with a basal metabolic rate of 1600
calories per diem is consuming enough energy to raise a cube of ice 43%
feet square a foot into the air once every day. If he develops a fever
of 103 degrees, say an increase of 4 degrees, this would increase his
basal energy requirements 40 % or 640 calories. The man on the steam
roller working in front of my house to-day tells me that it weighs 17
tons. Then in a day and a half the extra 640 calories per diem would
raise this roller over 75 feet, i.e., about level with the roof of the new
private wards block of the General Hospital.
If our hypothetical man were to develop pulmonary tuberculosis and
run an increased temperature of one degree, he would require 160 extra
calories per diem. This would be equivalent to raising about two and a
half locomotives (100 tons each) a foot per day, or a total lift of 90 feet
in three months.
The final question is whether the admittedly small savings that we
can effect are of real value. To discuss this, it is necessary to consider some of the lessons learned from functional tests. We know that
the ventilation may be increased as much as 50% without any clinical
evidence of a change. We also know that tests of kidney function and
other functions do not indicate any change till gross loss of tissue has
been effected. Clearly these observations indicate that the very fact
that there is clinical evidence of failure is the very best evidence that
the machine is already badly strained beyond its ability to handle the
situation without damage. Therefore the physician, whose function it is
to keep the machine running till it has had time to effect its own repair,
should grasp every opportunity to gain a calorie when he can.    Exper-
Page 291 ience  has   shown  that   this   constant   preparedness   to  seize   every  little
advantage often spells ultimate success.
In conclusion the clinician knows from experience that rest is often
the only, as well as the best card he can play. Reasons are offered to
account for some of the needs for conserving energy. A method of
converting caloric energy into mechanical work for illustration to the
patient is given.
Dr. Herman S. Judd
Director of Health, Tacoma, Wash.
No attempt has been made to select any special group of cases upon
which to base this report; but, instead, the group is taken at random
from the records of this office and includes all Wasserman blood tests
with Kahn control test, made August, 1926 to March, 1928, inclusive.
A blood test as reported to us always carried both Wasserman and
Kahn. The bloods of this series were taken from two sources; Food
handlers (bakers, butchers, grocers, milk handlers, hotels and restaurants, etc.); and Health Department Clinic (indigent, drifters, delinquent minors, police characters, etc., etc.) This explains the marked
difference in the ratio of positive and negative returns in the two classes.
Food handlers:
Total   examined 3321
Total  negative 3026
Total positive 295
Total POSITIVE Wasserman, Positive Kahn  105
Total NEGATIVE Wasserman, Positive Kahn  190
Total  Kahn Positive  295
Clinic—Health Dept.:
Total examined 528;
Total POSITIVE Wasserman, Positive Kahn  138
Total NEGATIVE Wasserman, Positive Kahn  104
Total Kahn  Positive  242
Attention is called to the fact that in the 3 849 cases listed there
was not one instance where there was a positive Wasserman with a
negative Kahn. On the other hand there were 294 instances out of a
total of 5 3 7 positive reports where the Kahn was positive and the Wasserman negative. All "delayed negatives" and "anti-complementary"
Wasserman reports were recorded as positive Wasserman. Therefore
the Wasserman gave a positive but 243 times—less than one-half of the
537 positive reports.
In the "Kahn-only positive" cases we have found by repeating both
the Wasserman and Kahn that the Kahn in these in some cases had "tip-
Page 292 ped off" a beginning acute syphilis and the Wasserman increased in intensity as repeated tests were made at proper intervals. A search for a
chancre in these cases revealed the lesion which had been denied. In other
cases, denying infection, or being confronted with a Kahn positive and
th eassurance that it was a delicate test for syphilis ,they made a confession of syphilis with treatment and often they said they had been discharged cured—Wasserman negative. Some of these cases asked for more
treatment; and in treatment the Kahn positive was either made a Kahn
negative, or was lessened in intensity. Most cases became Kahn negative
in a reasonable time.
In cases where positive Wasserman and positive Kahn was the signal
for beginning treatment there was not one instance where the Wasserman
positive persisted and the Kahn positive disappeared. The rule was that
the Wasserman positive gradually lessened and when negative the Kahn
positive remained for an indefinite time under treatment and then itself
became a negative. Review of the treated cases in our clinic shows a
constant Kahn positive so long as the treatment was incomplete; the
Kahn positive was the last to go and the first to show again in the
report which routinely follows each period of rest during treatment.
In at least one case failure to take a course of treatment when the
Kahn alone was again found positive resulted in a rather rapid return to
Wasserman 4-4 for a second time. This case again became a police
case and was detained for treatment* This enforced second course
of treatment resulted in disappearance of Wasserman positive and finally
of Kahn positive also.
Case I.—        Miss M.—Wasserman negative.
1/14/27—Wasserman negative, Kahn -f-2. When shown the
report this woman, who seemed beyond suspicion, admitted sex irregularity at one time with syphilitic infection and treatment in 1926 by one
of the leading surgeons who gave her "9 shots neo," and declared her
cured because of constant Wasserman negative. In view of our Kahn
positive she at once accepted treatment and 5/16/27 Wasserman was
negative and Kahn 4-1; 9/16/27 Kahn also was negative; 3/21/28 after
an extended rest from treatment Kahn was again -4-1 and she resumed
treatment. The general health of this woman has improved under treatment.
Case II.—
Mrs. E.—Delayed negative Wasserman.
2/26/27—Wasserman Delayed negative, Kahn -j-4. Then admitted a miscarriage two years ago with Wasserman positive found
and treatment given with neo. etc. Had denied venereal infection until
shown Kahn -f4. Treatment begun and carried on in clinic
and 10/10/27—Wasserman negative, Kahn -p.
Case III.—
Mrs. F.—Wasserman -{-1.
S/io/27—Wasserman -4-\ Kahn -f-4. A few days later 8/17/27
Wasserman -j-4, Kahn -f4. Treatment begun after woman changed
her original statement and confessed to an illegitimate child that lived
two hours and was born in Germany. Treatment in clinic resulted in
Wasserman +1 and Kahn 4-2—2/20/28 with marked improvement in
general health.    This case is continuing treatment.
Page 293 Case IV—
Mr. L.—Anti-complementary Wasserman.
7/29/28 Wasserman anti-complementary and Kahn -|-4.     (Health
card refused).
8/8/27 Wasserman anti-complementary and Kahn -4-4.
11/28/27 Wasserman 4-4, -4-4,  -}-4 and Kahn -f4.
This man was the proprietor of a restaurant and had been refused
a permit to handle food when first report was received 7/29/27 and
he had positively denied venereal infection. He continues to deny said
infection even in the face of the fact that he has been given Wasserman
-j-4 at the Tacoma General Hospital and at the office of one of the
leading surgeons of the city. This surgeon believes that he should
have a spinal fluid Wasserman test but the man refuses the same. This
man had been eliminated from the restaurant business upon the report
of 7/29/27 and the Court has seen fit to sustain that decision. This
man refuses treatment.
Case V.—
Mr. M.—Old Treated Case.
Came with voluntary statement that he had contracted syphilis in
.Centralia, Wash, in 1913 and "treated a short time." Again treated for
six months in 1926 and again for three months in 1927. Was referred
to clinic because of lack of funds. Man is plainly below normal mentally and this is believed due to central nervous system involvement,
but spinal fluid was NEGATIVE.
9/12/27  Wasserman  negative,   Kahn   -(-3.     Was   treated   for   five
months   and   4/3/28   Wasserman  negative,   Kahn   -|-4—no   physical  or
mental improvement.
Case VI.—Wasserman -\-i, Kahn   4-4.
Miss S.—Prostitute—Waitress.    Under arrest.
7/14/27 Wasserman -j-4, and Kahn 4-4. Treated continuously and
12/7/27 Wasserman negative and Kahn 4-3.
2/1/28 Wasserman negative and Kahn -f-1.
Case IV—
Mi-. H.—POSITIVELY denied all venereal infection.
12/19/27—Wasserman -f-1 and Kahn -|-4. Confronted with this
test and assured of the value of the Kahn he admitted syphilis contracted
(or discovered) in Eatonville in 1917 and treated at that time until
Wasserman was constantly negative. This man was re-tested and
1/18/28—Wasserman negative and Kahn -|-4.
3/9/28—Wasserman -f-2 and Kahn -|-4. This was after treatment
had begun and it probably acted as a "provocative."
NOTE should be made of the fact that but for the Kahn -|-4 this
man's true condition might have been overlooked.
1. In the tests the blood Wasserman picture changed each time—
first plus -j-1, then Wasserman negative, and then Wasserman
-p while the KAHN REMAINED CONSTANTLY Kahn 4-4.
2. Only when confronted with the test did a confession come.
3. With Wasserman -I-1 followed by Wasserman negative the
findings would have been ignored and no confession obtained
and no treatment given. Plainly the Kahn test in this case was
of more value than the Wasserman.
Page 294 Case VIII.—
Mr. S.—Food Handler—DENIED all venereal infection.
Wasserman blood was NEGATIVE and Kahn -f3. When confronted with this Kahn test and told its nature and value he admitted
syphilis three months ago and treatment at that time. This was apparently a ne wcase of syphilis treated in beginning and announced as
cured because of Wasserman negative.
3/18/27—Wasserman -f-3, -f2, and Kahn  + 3.
7/5/27—Wasserman negative and Kahn -4-1—the result of intensive treatment.
1. We believe that the Kahn test is of great value and that it will
detect many cases which would not be detected by the Wasserman test only.
2. No Kahn test is ignored even though it be a 4-1, which may
come a Kahn negative upon re-check, because there seems to be
greater chance of it coming stronger than a plus -f1 upon re-
3. Our experience with the Kahn test as compared with the Wasserman test convinces us that errors are made when the old
custom of ignoring a Wasserman -j-1 or 4-2 is followed and
that these should never be ignored when there is a Kahn positive.
4. All Kahn positive reports are re-checked and the results have
more than justified the time and expense involved.
5. The value of the Kahn test, just the same as the value of the
Wasserman test, depends entirely upon the skill of the laboratory technician and a poor Kahn is as worthless as a poor Wasserman. One should never condemn the Kahn test until he is
assured of the fact that the laboratory technique is perfect.
6. The Kahn should be the test of choice with the Wasserman as a
check test and eventually the Kahn test will probably be retained and the Wasserman eliminated.
7. No attempt has been made to write a scientific paper upon the
Wasserman-Kahn tests, but this report is submitted in the hope
that it may be of value to those whose experience with the
Kahn test in a laboratory of faultless technique has been
limited. At the time this report was made, Dr. C. R. McColl,
Pathologist to St. Joseph Hospital, Tacoma, Wash, reported a
series of 5,000 Wasserman-Kahn tests combined, 2,000 of which
were umbilical  cord  blood.     In  this  series he gave only one
instance where there had been a Kahn negative with a Wasserman positive. In my series of 3,849 cases there was not one
case where Kahn was negative and Wasserman was positive.
This combined total of 8,849 reported cases therefore showed
but one failure of the Kahn test to register positive when the
Wasserman was positive. However, the contrary was true;
more than 50% of the reports of positive in my series (as
shown by positive Wasserman and positive Kahn 537, and
"Kahn-only positive" 294) were Kahn positive and Wasserman
Total   Population    (Estimated)	
Asiatic   Population    (Estimated)	
Total  Deaths	
Asiatic   Deaths   	
Deaths—Residential  only	
Male        120
Female    125
Stillbirths—not  included  in  above	
Deaths under one year of age	
Death Rate per  1,000 Births	
Rate per
1,000  of
 . 10,940
March, 1928
Cases     Deaths
May 1st to
April,  1928 15th,  1928
Cases     Deaths Cases    Deaths
Scarlet   Fever
Chicken-pox          148
Typhoid Fever _
Cerebro-Spinal   Meningitis
Scarlet   Fever   .
Typhoid   Fever
Cases from Outside City-
Id 1
1             0
5              0
0              0
Summer School Clinics
June 5, 6, 7 and 8, 1928.
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 296 eyqr
For Rapid Relief in Cases of
Nose  and   Throat  Infection
TT7HM the nose is blocked and the accessory sinuses
yy are closed by pathogenic organisms and the resulting inflammatory exudate, Adrenalin Inhalant usually
affords the patient immediate relief and aids the healing
process by maintaining drainage through its tonic,
astringent effect on the tissues and blood vessels.
Adrenalin Inhalant is also of value in the control of
hemorrhage from accessible mucous membranes. It may
be applied directly to the bleeding surface on cotton or
in the form of a spray.
In rhinitis, pharyngitis, tonsillitis, laryngitis, angina,
hay fever, etc., Adrenalin Inhalant is very useful. It
likewise promptly controls certain forms of bronchial
irritation attended with coughing.
Adrenalin Inhalant is supplied in
1-0%.. bottles only.
Parke, Davis & Company
Page 297 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
Quick touching-up with Duco Finish
Complete Painting—Duco or Varnish
Tupper and Steele Ltd*
1669 3rd Avenue West
BAYVIEW 138-139
Printers and
Vancouver, B. C.
The Ou?l Drug
Co., Ltd.
JiW prescriptions dispensed
bu qualified Druggists.
Ijou can depend on the Ou?l
for ^Accuracy and despatch.
lUe deliuer free of charge.
5 Slores. centrally localed.    We
would appreciate a call while
in our territory.
Page 298  ,:#
Hollywood Sanitarium
'tfor the treatment of
Alcoholic, Nervous and Psychopathic Cases
Inference $ <&. (J. cMedical ^Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183 Westminster 288
Page 300


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