History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: June, 1944 Vancouver Medical Association Jun 30, 1944

Item Metadata

Download

Media
vma-1.0214523.pdf
Metadata
JSON: vma-1.0214523.json
JSON-LD: vma-1.0214523-ld.json
RDF/XML (Pretty): vma-1.0214523-rdf.xml
RDF/JSON: vma-1.0214523-rdf.json
Turtle: vma-1.0214523-turtle.txt
N-Triples: vma-1.0214523-rdf-ntriples.txt
Original Record: vma-1.0214523-source.json
Full Text
vma-1.0214523-fulltext.txt
Citation
vma-1.0214523.ris

Full Text

 **$
'*<i
The ■■■HK-
of the ■-
VANCOUVER
MEDICAL ASSOCIATION
Vol. XX
JUNE, 1944
No. 9
With Which Is Incorporated
Transactions of the
Victoria Medical Society
the
Vancouver General Hospital
and
S&Paurs Hospital
In This Issue:
Page
THE CHILD IN THE FAMILY—Dr. Clifford Swee^^fe|^^^^^^^ 2 3 5
THE CHILD AS A PATIENT—Dr. Clifford Sweet^Z^M^i^ ^^^240
FALLACIES IN THE CLINICAL EXAMINATION OF THE
SPINAL FLUID—S. E. C. Turvey, M.D.-  .;     M ^PBJJiK*44
B.C.M.A. Annual Meeting__^^ gHH SmBI 4^247
NEWS AND NOTES ^B   II Jt—I HM -|i;252 MBB»W«Ui« i IB B
DILAXOL E.B.S. has earned the approval of the
Medical Profession, because of its high efficacy in
control of gastric hyperacidity and the protection
it affords against threatened breakdown of the
gastric wall.
Though alkaline in reaction, Dilaxol, unlike strong
alkalies, does not stimulate the secretion of excess
add. Dilaxol neutralizes free acid and its acid-combining power is extremely high. It has prolonged action,
but does not interfere with digestive processes, nor
does it cause alkalosis.
Because of its colloidal nature, Dilaxol exerts a protective action on the mucous lining of the stomach,
thus preventing breakdown of the gastric wall.
It is indicated in the treatment of hyperacidity,
duodenitis, flatulence, functional dyspepsia, peptic
ulcer and nausea of pregnancy.
Each Fluid Ounce Contains:
Bismuth Subsalicylate 4 grains
Digestive Enzymes . ifiiara'* • • 1 grain
Magnesium Trisilicate, Carbonate and Hydroxide combined /tjf*.   .   Il|§|||ip?5 grains
DOSE: One or two fluid drachms, in water.
Also supplied in
POWDER FORM,
in convenient dispensing packages.
WHEN PRESCRIBING
Specify E.BS. Preparations
JUST TO
BE  SUREI
THE E. B. SHUTTLEWORTH CHEMICAL GO.LIMITED
TORONTO
MANUFACTURING   CHEMISTS THE   .VANCOUVER    MEDICAL    ASSOCIATION =
BULLETIN
Pulished Monthly under the Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
Offices: 203 Medical-Dental Building, Georgia Street, Vancouver, B.C.
EDITORIAL BOARD:
Dr. J. H. MacDermot
Dr. G. A. Davidson Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XX
JUNE, 1944
No. 9
OFFICERS, 1944 - 1945
Dr. H. H. Pitts
President
Dr. Frank Turnrull
Vice-President
Dr. A. E. Trites
Past President
Dr. Gordon Burke
Hon. Treasurer
Dr. J. A. McLean
Hon. Secretary
Additional Members of Executive: Dr. G. A. Davidson, Dr. J. R. Davies
TRUSTEES
Dr. F. Brodie Dr. J. A. Gillespie Dr. W. T. Lockhart
Auditors: Messrs. Plommer, Whiting & Co.
SECTIONS
Clinical Section
Dr. E. R. Hall Chairman Dr. S. E. Turvey Secretary
Eye, Ear, Nose and Throat
Dr. Letth Werster Chairman Dr. Grant LAWRENCE___Secretary
Pcediatric Section
Dr. J. H. B. Grant Chairman Dr. John Piters Secretary
STANDING COMMITTEES
Library:
Dr. A. Bagnall, Chairman; Dr. F. J. Buller, Dr. D. E. H. Cleveland,
Db. W. J. Dorrance, Dr. J. R. Neilson, Dr. S. E. C. Turvey
Publications: ■ -^
Dr. J. H. MacDermot, Chairman; Dr. D. E. H. Cleveland,
Dr. G. A. Davidson
Summer School:
Dr. W. L. Graham, Chairman; Dr. J. C. Thomas, Dr. G. A. Davidson,
Dr. R. A. Gilchrist, Dr. A. M. Agnew, Dr. G. O. Matthews
Credentials:
Dr. D. E. H. Cleveland, Chairman; Dr. E. A. Campbell, Dr. D. D. Freeze
V. O. N. Advisory Board:
Dr. Isarel Day, Dr. J. H. B. Grant, Dr. G. F. Strong
Metropolitan Health Board Advisory Committee:
Dr. W. D. Patton, Dr. W. D. Kennedy, Dr. G. A. Lamont
Representative to B. C. Medical Association: Dr. A. E. Trites
Sickness and Benevolent Fund: The President?—The Trustees Whether rationing is more or less liberal,
the pediatrician as always has the problem of
supplying sufficient vitamins A and D to his young
patients. Vitamin D in particular must be supplied
abundantly to insure adequate structural development and calcium-phosphorus metabolism.
For this purpose Navitol* with Viosterol offers
these features:
1. It has an unusually high vitamin A and D
content per gram—65,000 units of A—
13,000 units of D.
2. An average daily dose of THREE DROPS
supplies 5000 units of A—1000 units of D.
3. Cost per daily dose about one-half cent.
4. Highly palatable.
Navitol with Viosterol thus affords a convenient
and economical means of supplying the fat-soluble
vitamins A and D which every infant needs every
day. Specify it for expectant mothers, infants,
children, and patients requiring a vitamin A and D
supplement.
Navitol with 'Viosterol conforms to the maximum vitamin A and D potencies of U. S. P. XII
Concentrated Oleovitamin A and D.
•Navitol is a trade-mark of E. R. Squibb fit Sons.
For literature writ*
36 Caledonia Road
Toronto, Ont.
E-R: Squibb &Sons
OF CANADA. Ltd.
iianujacturini Chemists to the Medical Projtssiom
Sine* 1S58 VANCOUVER HEALTH DEPARTMENT
STATISTICS—APRIL, 1944
Total  Population—Estimated 288,541
Japanese Population ■ Evacuated
Chinese   Population—Estimated 5,541
Hindu  Population 301
Rate per 1,000
Number Population
 .     Population Evacuated
 20 46.4
Total deaths 	
Japanese deaths
Chinese   deaths
Deaths—Residents only  ,     300
BIRTH REGISTRATIONS:
Male, 305; Female, 275     580
INFANT MORTALITY: April, 1944
Deaths under one year of age '. 18
Death rate—per 1,000 births 31.0
Stillbirths   (not included above) : 10
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
12.2
23.6
March, 1944
Cases      Deaths
April, 1944
Cases      Deaths
May 1-15, 1944
Cases      Deaths
Scarlet Fever —,     199
Diphtheria
Diphtheria  Carrier  0
Chicken  Pox  188
Measles    26
Rubella  43
Mumps !  39
Whooping Cough   37
Typhoid Fever ,_  0
Undulant Fever i  0
Poliomyelitis ,  0
Tuberculosis  128
Erysipelas
Meningococcus  Meningitis
Paratyphoid Fever	
Infectious Jaundice 	
V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH
DIVISION OF VENEREAL DISEASE CONTROL
West North       Vane.   Hospitals &
Burnaby    Vane.  Richmond   Vane.      Clinic   Private Drs.   Totals
Syphilis 	
Gonorrhoea
Figures not yet available.
I B I O G L A N - A
The most effective therapy for waning mental and physical energy,
deficient concentration and memory, reduced resistance to infection,
muscular weakness and debility, neurasthenia and premature senility.
The efficacy of this very potent endocrine tonic has been confirmed by
the clinical evidence of many thousands of cases treated during
15»32-1$»43.
Stanley N. Bayne, Representative
Phone MA. 4027 1432 MEDICAL-DENTAL BUILDING Vancouver, B. C.
Descriptive Literature on Request
THE SCIENTIFIC HORMONE TREATMENT
Page Two Hundred and Twenty-seven "ELEMENTARy,
my dear
Watson!"
"Calcium A" readily solves the problem of
calcium supplementation. Many years of professional use have established the value of this preparation.
It is simple to prescribe and simple to take.
__
_\w
A therapeutically-sound
calcium-cod liver oil dietary supplement
Ctyetet
j
Each capsule contains:
Dibasic calcium phosphate      .     560 mg.
Vitajnin A    .    .    .    .     3500 Int. Units
Vitamin D    .    .    .    .       350 Int. Unite
Boxes of 40, 100 and 500 capsules
AYERST, McKENNA &  HARRISON  LIMITED
Biological and Pharmaceutical Chemists
MONTREAL, CANADA
210 VANCOUVER     MEDICAL     ASSOCIATION
FOUNDED 1898    ::    INCORPORATED 1906
*        *        *        *
PROGRAMME OF THE FORTY-SIXTH ANNUAL SESSION
GENERAL MEETINGS will be held on the first Tuesday of the month at 8:00 p.m.
CUNICAL MEETINGS will be held on the third Tuesday of the month at 8:00 p.m.
These meetings are to be amalgamated with the clinical staff meetings of the various
hospitals for the coming year.   Place of meeting will appear on the agenda.
General meetings will conform to the following order: -
8:00 p.m.    Business as per Agenda.
9:00 p.m.    Paper of the evening.
Nmtn $c GtlfnmBfltt
t
2559 Cambie Street
ancouver
, B. C.
i&Wi&OO^^
13 th Ave. and Heather St.
Exclusive Ambulance  Service
FAirmont 0080
PRIVATE AMBULANCES AND INVALID COACHES
WE SPECIALIZE IN AMBULANCE SERVICE  ONLY
J. H. CREL.LIN
W.  I_ BERTRAND
Page Two Hundred and Twenty-eight PERTUSSIS   VACCINE
FOR THE PREVENTION OF WHOOPING COUGH
WHOOPING COUGH is one of the most common communicable diseases
and it may be followed by death/ particularly in the case of children under
two years of age. Among older pre-school children serious complications
may follow an attack of the disease. It is desirable, therefore, to administer
pertussis vaccine to infants and young children as a routine procedure,
preferably in the first six months of life or as soon thereafter as possible.
PERTUSSIS VACCINE is prepared by the Connaught
Laboratories from recently isolated strains (in Phase I)
of H. pertussis. The vaccine contains approximately
15,000 million killed bacilli per cc.
Research studies relating to the bacteriology and immunology of H. pertussis
have been conducted for many years in the Connaught Laboratories.
Further advances in the method of preparation of PERTUSSIS VACCINE
have made possible reductions in the price of this product. For convenience
in use and as an added economy, it is supplied in packages for the inoculation of a group of six children as well as in packages for the inoculation of
one child. The following packages of PERTUSSIS VACCINE are distributed:—
Three 2-cc. ampoules — For the inoculation of one child.
Six 6-cc. ampoules — For the inoculation of a group of six children.
Also for the convenience of physicians who wish to inoculate children
against both diphtheria and whooping cough, the following packages of
DIPHTHERIA TOXOID and PERTUSSIS VACCINE (COMBINED) are
supplied:—
Three 2-cc. ampoules — For the inoculation of one child.
Six 6-cc. ampoules — For the inoculation of a group of six children.
CONNAUGHT LABORATORIES
University of Toronto    Toronto, Canada
DEPOT FOR BRITISH COLUMBIA
MACDONALD'S PRESCRIPTIONS LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. k
« a
0
DEXTRI-MALTOSE
DEXTRI-MALTOSE is no ordinary carbohydrate.
Step by step, its manufacture is surrounded
with every care and precaution, evolved through
long years of experience and research. Unseen by
physician and patient are numerous safety factors,
the practical effect of which nevertheless is present
in every package of Dextri-Maltose. To name a
few of these: 1
1. Dextri-Maltose is sampled for bacteriological testing
before drying.
2. Steam at 20 pounds pressure sterilizes Dextri-Maltose
filter presses which remove proteins, fat, and indigestible residue.
3. Blood agar tests are made to insure absence of hemolytic cocci.
4. Dextri-Maltose containers are paper-wrapped to prevent the cans from accumulating dust.
5. Bacteriological tests are made in a steam-washed plating room, the air of which is filtered.
6. Dextri-Maltose containers are automatically filled and
closed without human handling of the product.
7. The direct microscopic test which Dextri-Maltose receives is but one kind of 6 microbiological tests which
it must routinely meet.
8. The interiors of the large converters in which Dextri-
Maltose is processed are thoroughly scrubbed prior to
steam sterilization.
9. Steaming under 20 pounds pressure sterilizes the converters for processing  Dextri-Maltose.
10. After being packaged, Dextri-Maltose is held in storage
and released only after final approval from the bacteriological checking laboratory.
11. Portable equipment used in manufacturing Dextri-Maltose is sterilized in autoclaves at 20 pounds live steam
pressure for 20 minutes.
12. Dextri-Maltose is tested routinely to check the keeping
quality of prepared feedings held in refrigeration for
24 hours.
It is, therefore, no mere coincidence that Dextri-
Maltose enjoys greater paediatric acceptance today
than ever before. By constant research and everlasting watchfulness, we try to keep pace with,
paediatric progress, and we put forth every human
effort to merit the continued respect and confidence
of the medical profession.
The True Measure of Economy Is Value
MEAD JOHNSON & CO. OF CANADA, Ltd., BELLEVILLE, ONT. r
Sit fUemortam
ROBERT EDWARD McKECHNIE, M.D., CM., LL.D., F.ACS.
Page Two Hundred and Twenty-nine EDITOR'S PAGE
Another Summer School has come and gone—and we really think this was one of
the best we have had. The speakers had a good deal to tell us, and it was all useful and
interesting to the practitioner at large; not "too pure and good for common nature's daily
food/' so to speak. We were fortunate in being able to secure some at least of the
papers. Two of Dr. Sweet's papers appear in this issue of the Bulletin, our stenographer secured some others, and we have been promised copies of some of the rest. As
we get them, we will publish them for a more leisurely perusal by many who were unable
to get the full value of them at the time.
The outstanding event of the past few weeks in medical circles in the Province has
been the death of our beloved friend and leader, Dr. Robert Edward McKechnie, known
to all as R. E. for the fifty years or more that he had practised in British Columbia.
He had come to be so familiar and essential a figure in the life of our community, that
his passing leaves a very big vacancy. Not alone in medicine did he attain pre-eminence,
but in educational and civic circles and in many other departments of our common life,
and there are few indeed whose interests are not in some way touched by his loss. We
shall for long miss the sight of that frail, slight figure, going to his work in hospital or
office, for, fortunate man that he was, he was in active practice to within a few days
of his death: or appearing in the full canonicals of his chancellor's office, admitting
young men and women to their graduation, and presiding over various university
activities.
As one looks back over one's memories of R. E., one is struck by certain of his characteristics that made for greatness—for we must put him among the list of great
Canadians. We have only to look at the long list of degrees and honours that came to
him, unsought on his part, and from every section of the world in which he lived:
ranging down from honours bestowed by his Sovereign, through Universities and Medical Associations and Colleges of Surgeons of both Canada and the United States, down
to what was perhaps the rarest of all, the Good Citizen Medal bestowed on him by the
citizens of his own city, Vancouver, as a token of their love and esteem.
He was a modest, unassuming man, with no boastfulness or egotism in him. One
cannot but feel that he wondered why everyone made such a fuss over him. He displayed that true modesty of the perfect gentleman set forth in the words of the Psalmist
. . . "he that setteth not by himself, but is lowly in his own eyes. . . ."
Perhaps the most striking thing about R. E. was his enduring sympathy with youth,
and the fact that he never became really old in mind. This, one feels, was his reward
for this sympathy and understanding of the young, that kept him perpetually in contact
with them. As a younger man, he took a keen interest in the sports of youth, and the
McKechnie Cup, the Rugby trophy of the Province, stands as a memorial of this: as he
grew older, he maintained his contact through the University, and drew vitality and
energy from that perpetual fount of youth. He was always happy and at home with
younger people.
His attainments and professional skill, his many contacts with the civic, political
and educational circles of this Province and elsewhere, are all matters of record, and we
need not dwell on them here. A fragrant memory of him remains with us, of a man
who always met the demands that life and his fellows made on him, with complete
adequacy—a well-rounded man, homo teres atque rotundus. as the Latins called it. It
is pleasant to think, that he had the recognition of his feftws while he was still with
them. As Dr. McLennan of Vancouver said when proposing a toast to him at a Dinner
given in his honour some four years ago by the B. C. Medical Association: "Happy is
the man who makes clear his title-deeds to the leadership of genius while he yet lives to
receive the acclaim of those with whom he has lived and toiled."
His life was a full and a happy one, active and useful to his kind: he had no enemies,
and everyone was his friend.   No one could ask for a better-epitaph.
Page Two Hundred and Thirty ITEMS OF GENERAL INTEREST
In this column each month, brief abstracts will be published of various items. Each
month the Bulletin receives notices of various kinds; many of these contain matters
of interest to our readers—but our limited space forbids their publication in complete
form. We will abstract them and give the important points, and if any reader wishes
to get further details or consult the original, this will be on file in the library.—Ed.
The Hospital for Joint Diseases, 1919 Madison Avenue, New York 35, N.Y., has
asked us to publish a notice regarding their General Rotating Internship.
House Staff Appointments to fill 12 places are now open—4 to begin October 1,
1944; 8 to begin July 1, 1945.
The service covers every important specialty. Maintenance, uniforms and $25 per
month are provided.
This is a 362-bed General Hospital, featuring Orthopedic Surgery.
See full notice in Library.
A copy of the June issue of the Digest of Ophthalmology and Otolaryngology has
been received and is in the Library. Our E.E.N.T. representative on the Publications
Committee tells us that this is a very good and practical digest. It is published by the
Medical Publishing Company of Ohama, Nebraska, U.S.A., and abstracts notable papers
and articles. This number contains two especially interesting articles, one on Sinusitis in
Children, by Dr. D. E. S. Wishart, of Toronto, and one on Acute Tonsillitis by Joseph
S. Slovin of New York—but all the other articles are well worth reading.
The Economics Control of the National Government writes us, drawing our attention again, and forcibly, to the urgent necessity for conservation of paper, and avoidance
of waste.   We direct our readers' attention to this.
A letter from Jerry Mathiesen, Physical Director of Pro-Rec and B. C. Representative on the National Council on Physical Fitness, encloses a copy of recommendations
coming out of the first meeting of the National Council on Physical Fitness, held in
Ottawa recently.
Jerry Mathiesen is well known in Vancouver for his work as a Pro-Rec leader. The
National Council is headed by Major Ian Eisenhardt, as National Director. This last
gentleman is nationally famous for his work in Physical Education. He was instrumental in developing Pro-Rec in B. C. under the auspices of the B. C. Government.
Dr. G. M. Weir, then Provincial Secretary, was the moving spirit in this, and gave
Major, then Mr., Eisenhardt the support and encouragement which made the development of Pro-Rec into a tremendous success, and attracted national notice.
This Report is excellent, and its recommendations, 20 in number, all deserve our
earnest support in every way possible.   The Report is in the Library.
A report (dated April, 1944) of the Baruch Committee on Physical Medicine has
been received, and is in the^brary. This is an amazingly complete and detailed joint
report, made by eight sub-committees, and recommends: (1) an immediate programme,
including establishment of teaching and research centres, of physical medicine in medical schools, provision of fellowships in physical medicine, etc.; (2) an eventual programme to cover future possibilities and developments.
Curative physical medicine, rehabilitation, occupational therapy, body mechanics,
are all considered fully, and public relations and information of the public are stressed.
Page Two Hundred and Thirty-one A linkage with the war and the physical problems presented by this, both during and
after, are provided.
A most interesting Abstract has been prepared by Dr. A. E. Archer, president of the
Canadian Medical Association, of the White Paper Tabled by the British Government.
It is brief and to the point, and contains a great deal of interest to us. We shall try
and publish it in an early number.
In 1939, Dr. T. A. Ross, of London, England, wrote a letter to the Lancet in which
the passage quoted below, "Psychic Shock following Injuries," occurred. It carries
a very timely warning to us all—that we would do well to note and bear constantly in
mind, and we publish it because we feel that we are all apt to overlook the point that
Dr. Ross brings out in it. Remember the apophthegm of our old friend Dr. Foster
Kennedy who addressed us some time ago:
"Traumatic neurosis is a state of mind, born of an accident, nourished by lawyers,
often prolonged by the medical attendant, and cured by a verdict."—Ed.
PSYCHIC SHOCK FOLLOWING INJURIES
"Shock, whether due to physical or psychical trauma, is a temporary affair, lasting
from a few seconds to a few days at farthest. It ends either in death or in recovery.
In the latter event, the amount of damages to be awarded should surely never be great.
Shock may be followed by severe neurosis, but I should have thought that by now it was
agreed that neither the trauma nor the shock was the cause of the neurosis—that there
was always something else, most commonly some advantage to be gained by the person
who developed an illness which could be attributed to trauma. At present the commonest causal factor is the possibility, rapidly becoming a certainty, of monetary gain.
Between 1914 and 1918 the chief factor was the hope of escape from intolerable danger.
The factors are almost always unconscious; nevertheless it is our duty as doctors to strive
vthat they shall not be fostered.
Names are of some importance, and it is time that we dropped the misleading term
"traumatic neurosis" and substituted the more truly descriptive one of "compensation
neurosis."
What has been said of physical trauma and shock is equally true of psychical trauma
and shock.. There is always another physical factor. In the past this was often something loke self-reproach or remorse; in future, we shall have to add cupidity.
Lancet, Jan. 7, 1939. T. R. Ross
LIBRARY NOTES
RECENT ACCESSIONS TO LIBRARY:
Clinical Diagnosis by Laboratory Examinations, 1943, by John A. Kolmer.
Strabismus: Its Etiology and Treatment, 1943, by Oscar Wilkinson.
New and Non-Official Remedies, 1944, Published by the Council on Pharmacy and
Chemistry of the American Medical Association.
Medical Clinics of North America, Symposium on Psychosomatic Medicine, May,
1944.
Transactions of the American Ophthalmological Society, 79th Annual Meeting, 1943.
Internal Derangements of the Knee Joint, 1933, by A. G. Timbrell Fisher (Replacement) .
Surgery of the Ambulatory Patient, 1942, by L. Kraeer Ferguson.
Human Gastric Function, 1943, by Stewart Wolf and Harold G. Wolff.
Collected Papers of the Mayo Clinic and the Mayo Foundation, 1944.
Page Two Hundred and Thirty-two BOOK REVIEW
BRONCHIECTASIS—By Lisa and Rosenblatt.
In this excellent monograph the authors discuss the pathogenesis, the pathology and
treatment of bronchiectasis. As they state in their introduction, "Clinical observations
and necropsy findings have repeatedly demonstrated a widespread incidence of bronchiectasis. The general concept has placed emphasis on the widening of the bronchial tubes,
which is the dramatic feature of the disease. However, dilatation is not the cause of the
patient's disability, and certainly is not the cause of his death. Bronchiectasis is a disease
of the entire lung structure. The changes which occur are complex and are not limited
to the ramifications of the bronchial tree." The first chapter gives a lucid account of the
anatomy of the respiratory system in general and of the bronchi, bronchioles and alveoli
in particular. The various hypotheses concerning the etiology of the condition are discussed with special reference to the related pulmonary conditions with which the disease
is associated. A large amount of experimental and clinical data is presented and the
general outline sheds new light on this condition.
Bronchiectasis is an ulcerative excavation in the lung which is in communication with
the bronchus. It is not a true dilatation of the bronchial wall and, whether this dilatation be saccular or fusiform is of no importance concerning the type or severity of the
bronchiectasis as these are merely the same types of degeneration which assume different
size and shapes. The necrosis is caused by infection and the prognosis depends, not on the
number and size of the bronchiectatic cavities, nor even on the degree or extent of the
roentgen findings, but on the amount of pulmonary infection which is present. They
emphasize that the highest incidence is in children and state that few of those affected
live to become adults. Congenital bronchiectasis is rare and most such cases in infancy
arise from an early pulmonary infection, most commonly in bronchopneumonia. Infection of the various nasal sinuses is commonly found hut the association between the two
conditions has not been definitely established. The middle-aged or elderly patient with
bronchiectasis has almost certainly not had this condition from childhood hut has developed it due to some pulmonary infection after reaching maturity.
Bronchitis, empyema, asthma and chronic cough are not discussed because the authors
feel that they are not primary processes hut secondary manifestations, even though there
is no history of the primary disease.
The authors discuss the newer methods of treatment but place greatest emphasis on
surgical removal of the involved pulmonary tissue. Palliative measures which are usually
used are considered useless except as an adjunct to surgery. They do recommend bronchoscopic aspiration, postural drainage and the use of sulfonamides. The operative
mortality has dropped spectacularly in the last few years and now resection should not
be considered as a procedure of last resort after other measures have been tried and failed.
Multiple lobar disease is no longer a contraindication to surgery and bilateral lobectomies
are being done more frequently recently. In certain advanced or extensive cases pneumonectomy may be indicated.
The monograph is well written, in excellent type, and is easily read. The illustrations are excellent and as numerous as anyone could desire. Tables of statistics concerning incidence and treatment are detailed and easy to follow. To those dealing,with pulmonary infection, this is an excellent review of the subject. Paediatricians will be particularly interested concerning the incidence in childhood and the gravity of the outlook, and the authors point out what so many paediatricians have recommended in the
past, namely adequate and prolonged treatment of every pulmonary infection in childhood. The general practitioner might well benefit by the statistical evidence of the
gravity of the condition and might be stimulated to greater preventive measures.
—Howard Weaver, Capt. R.C.A.M.C*
Page Two Hundred and Thirty-three Vancouver Medical Association
SUMMER SCHOOL, 1944
The twenty-second session of the Summer School of the Vancouver Medical Association was held from June 20th to 23rd, inclusive, and from comments heard, it can
be considered one of our most successful sessions.
The luncheon on the opening day was well attended, and our guest speaker, Surg.
Capt. C. H. Best, kept everyone interested by reminiscences, starting in the early days
of insulin, up to the present.
The lectures of Surg. Capt. Best mostly concerned his research work on vision, hearing, penicillin, etc., and as these were supplemented with coloured moving films, one
was able to envision how much his work has meant to the armed services and will in time
mean to civilians.
Col. Harris' lectures gave an insight into the tremendous amount of work and
thought being given to the care of our soldiers, and his coloured film on the first field
research work on penicillin caused much comment, as did his exhibition of prostheses,
which was shown at Shaughnessy Hospital and in the lecture room at the Hotel Vancouver.
S/Leader Bell's lectures were very instructive and were of general interest to both
the military and civilian members of the audience.
Dr. Clifford Sweet's lectures were outstanding in their presentation and for their
practicality'in everyday practice. He called on his years of experience to give useful
"tips" on many things, which he no doubt learned the hard way.
The papers prepared and presented by Prof. W. A. Scott showed him to be one of
the outstanding men in our profession, and added greatly to the interest of the meeting.
An account of the Summer School would not be complete without mention of the
Golf Tournament which was held at the Capilano Golf & Country Club. Some fifty
men participated, and the prizes were carried off by some of the veteran champions, as
well as some newer aspirants.
The Summer School Committee is very grateful to the Naval, Army and Air Force
Commands for providing three excellent speakers—Surg. Capt. Best, Col. Harris and
S/Leader Bell, respectively—and to John Wyeth & Brother (Canada) Ltd. for assuming
responsibility for the expenses of Professor Scott.
A large percentage of out-of-town doctors attended the School. Their names will
be found in the following list.
F/L. E. W. Aeberli, Pearce, Alta.
F/L. J. B. Aiken, Claresholm, Alta.
Dr. J. A. Alton, Lamont, Alta.
Major B. F. Anderson, Victoria, B.C.
Dr. R. N. Anderson, Ladner, B.C.
Dr. F. W. Andrew, Summerland, B.C.
Surg. Lt. S. R. Arber, Comox, B.C.
F/L. I. A. Balmer, Patricia Bay, B.C.
Major G. W. C. Bissett, Victoria, B.C.
F/L. K. R. Blanchard, Prince Rupert, B.C.
Capt. H. Bourque, Terrace, B.C.
S/L. L. O. Bradley, Swift Current, Sask.
Dr. T. A. Briggs, Courtenay, B.C.
F/L. C. B. Brown, Lethbridge, Alta.
Dr. H. I. Campbell Brown, Vernon, B.C.
Dr. R. B. Brummitt, Nelson, B.C.
S/L. D. M. Bruser, Macleod, Alta.
Capt. A. L. Buell, Chilliwack, B.C.
Dr. J. M. Burnett, Greenwood, B.C.
Capt. W. W. Bell, Victoria, B.C.
Dr. A. H. Campbell, Regina, Sask.
Page Two Hundred and Thirty-four
Dr. W. F. Carscallen, Innisfail, Alta.
Dr. G. A. Cheeseman, Field, B.C.
F/. L. S. Chipperfield, Alliford Bay, B.C.
Dr. H. C. Christopher, Seattle, Wn.
S/L. W. L. Clancey, Moose Jaw, Sask.
F/L. H. G. Cooper, Victoria, B.C.
F/L. R. J. Cowan, Torino, B.C.
Lt.-Col. F. E. Coy, Prince Rupert, B.C.
F/L. J. W. Caldwell, Patricia Bay, B.C.
Capt. Roy Clark, Nanaimo, B.C.
Lt.-Col. K. L. Craig, Port Alberni, B.C.
F/L. E. Daniel, Edmonton, Alta.
Dr. D. M. Dayton, Tacoma, Wn.
F/L. M. Donnelly, DeWinton, Alta.
Dr. Robert Dow, Portland, Ore.
Major H. R. L. Davis, Nanaimo, B.C.
F/L. M. R. Earle, Assiniboia, Sask.
F/L. D. M. Ewart, Calgary, Alta.
Capt. J. A. Fradette, Nanaimo, B.C.
F/L. T. W. Garrison, Mossbank, Sask.
F/. N. Goluboff, Edmonton, Alta. Dr. I. B. Greene, Everson, Wn.
Col. J. D. Griffin, Ottawa, Ont.
Capt. S. W. Hart, Wainwright, Alta.
Dr. R. Haugen, Armstrong, B.C.
Dr. G. B. Helern, Port Alberni, B.C.
Dr. W. E. Henderson, Chilliwack, B.C.
Dr. E. K. Hough, New Westminster, B.C.
Dr. R. A. Hunter, Victoria, B.C.
Dr. L. R. Hutchins, Seattle, Wn.
S/L. H. M. Hutchison, Calgary, Alta.
F/L. R. J. A. Hogg, Patricia Bay, B.C.
Capt. G. O. Hallman, Victoria, B.C.
Dr. R. W. Irving, Kamloops, B.C.
Capt. P. W. Jaron, Victoria, B.C.
F/L. L. C. Jenner, Regina, Sask.
Major D. B. Kelly, Prince George, B.C.
S/L. C. C. Lee, Regina, Sask.
F/L. T. B. Letts, Edmonton, Alta.
■ W/C. W. D. Marshall, Patricia Bay| B.C.
Surg. Com. A. Marshall, Esquimalt, B.C.
Dr. C. Melgard, Seattle, Wn.
Dr. T. Miller, Victoria, B.C.
F/L. S. P. Miller, Bowden, Alta.
F/L. A. H. Moore, North Battleford, Sask.
Dr. G. Morse, Haney, B.C.
Surg. Com. H W. Morton, Esquimalt, B.C.
Surg. Lt. T. B. McLean, Esquimalt, B.C.
Dr. J. A. Macdonald, Prince Rupert, B.C.
Dr. H. H. MacKenzie, New Westminster, B.C.
Surg. Lt. A. G. MacKinnon, Esquimalt, B.C.
Major C. G. G. Maclean, Vernon, B.C.
S/L. F. R. McManus, Vulcan, Alta.
Dr. G. K. MacNaughton, Cumberland, B.C.
Dr. John McGregor, Bellingham, Wn.
Dr. Dallas Perry, Ganges, B.C.
Caj>t. D. H. Reilly, Victoria, B.C.
Dr. G. A. C. Roberts, Chilliwack, B.C.
Capt. E. J. Rosen, Port Alberni, B.C.
Surg. Lt. J. D. Ross, Esquimalt, B.C.
F/L. D. B. Ryall, Comox, B.C.
F/L. G. S. Rothwell, Boundary Bay, B.C.
Dr. M. Schreiber, Port Coquitlam, B.C.
Dr. Ivan D. Shuler, Seattle, Wn.
Lieut. L. H. Silver, U.S.A., Seattle, Wn.
Dr. G. Simpson, Victoria, B.C.
Dr. L. E. Skinner, Tacoma, Wn.
W/C. H. G. Smith, Edmonton, Alta.
S/L. J. G. Smith, Medicine Hat, Alta.
F/L. J. F. Sparling, Patricia Bay, B.C.
Dr. P. L. Straith, Courtenay, B.C.
Dr. L. G. Steck, Chehalis, Wn.
Lt.-Col. F. H. Stringer, Prince George, B.C.
S/L. G. M. Stephens, Calgary, Alta.
F/L. G. W. Studley, Penhold, Alta.
Dr. Ralph L. Sweet, Seattle, Wn.
F/L. R. C. Talmay, Calgary, Alta.
Capt. J. F. Tysoe, Vernon, B.C.
Major K. Terry, Nanaimo, B.C.
F/L. A. W. Vanderburgh, Abbotsford, B.C.
Lt.-Col. D. VanLuven, Nanaimo, B.C.
Surg. Lt. Com. G. E. Verity, Esquimalt, B.C.
Lt.-Col. G. G. Wannop, Victoria, B.C.
Major D. R. Warren, Vernon, B.C.
F/L. R. T. Watkins, High River, Alta.
Dr. H. N. Watson, Duncan, B.C.
Dr. Paul Whelan, Seattle, Wn.
Capt. W. J. White, Vernon, B.C.
Surg. Lt. Com. D. M, Whitelaw, Esquimalt, B.C.
Dr. C. J. M. Willoughby, Kamloops, B.C.
Dr. A. R. Wilson, Chilliwack, B.C.
Capt. T. A. Wright, Victoria.
Dr. John Yak, Vegreville, Alta.
Major B. H. Young, Vernon, B.C.
THE CHILD IN THE FAMILY
Dr. Clifford Sweet
I speak of the child in the family because the family is the foundation of all civilization, as we know it, and while the child is subjected to other discipline and much other
teaching, his beginning is in the family; and those of us who do paediatrics are the first
to come in contact with the fond parent and that child, and we have the opportunity
of starting them going in one direction or another. We are all trained for most of the
work that we do except the job of becoming parents, and I say that trying to be a good
parent is the hardest job that I have tackled. I frequently admit to my parents, when
I see the look of despair, come over their faces, that I am not criticizing their methods
of training their children, I am only trying to help them. I have frequently had to go
and seek advice concerning the bringing up of my own children. One's emotions are
so involved when he deals with his own children and there is such a genuine fear lest he
do something that will harm the child that his judgment is apt to be poor. I find, for
example, if I can separate the parent from his child for a little while I can then see
the child in more perspective and am able to understand the child's problems better. I
am very much in favour of the community nursery schools in which the mothers of the
children take turns as assistant to the teacher. In this way each mother has the opportunity of observing other children of the approximate age of her own child. It gives
her an opportunity to realize that her child is either just like the others or that some of
the behaviour which her child is exhibiting is perfectly normal for the age he has then
obtained.
When one can help the young mother to realize that her fears concerning her child
—and every mother has been dreadfully frightened when a .young infant has been placed
• Page Two Hundred and Thirty-five in her care—when one can help her to realize that every other woman since Eve has had
the same fears, she then accepts them. The neurasthenic is very much the person who
has the same doubts and fears as everyone else but he feels they are his own individual
property.
A young mother gets into her first difficulty because her infant cries. As you and I
know, every child 'cries. Some children cry more than others just as some men swear
more than others. I will admit that the child makes wonderful use of crying. Crying,
of course, is undesirable only when the child continues to use it as the most effective
means of influencing his family after he has in his possession the power of speech, and
he will continue using crying as his major methods of influencing his parents only so long
as it is effective. Crying has never harmed a child since Adam's first one. I see no more
unhappy people than those young parents who have been told that if a child cries he
will rupture himself. The word "rupture" is a very bad word, as you and I know. The
thing to do is to explain to the parents the nature of a "hernia."
Perhaps the next problem that produces trouble in the parent attempting to understand his newborn baby is gas in the bowels. We have no machinery in our bodies with
which to make gas. The gas that appears in the human bowel is air which the child
swallows. There is no question in my mind that some children swallow much more air
than others, and when the child has ,any distress he swallows more air than is normal.
There are some infants who continue to be air-swallowers throughout their lives. Walter
E. Albers records people who are chronic air-swallowers. I remember one child with a
congenital heart who swallowed air continuously and at the time I had her under the
fluoroscope she said she was not swallowing air but I could see air going down her
oesophagus and accumulating in her stomach.
There is a popular belief that every small baby has pain in the abdomen. I think
possibly in an older day when every baby was confined in a binder there may have been
pain in the child's abdomen. You have all observed, in a barium meal, that you can hold
up the meal by very slight pressure on the abdominal wall. But I don't believe that
every infant has actual pain in the abdomen. Of course, sometimes he eats too much
and then he has to put up with a certain amount of discomfort, but I would like to point
out that in the training of any individual person his minor discomforts should not be
visited upon everyone with whom he comes in contact; so we must train the child in
that way. The matter of bowel movements I find to be of great importance in the
mind of the young parent. I think too much importance is attached to it. I have
brought to me many adequately fed breast babies whose mother is in great distress
because the child does not have enough bowel movements. He skips a day or two days
or sometimes three days. I don't care how long a breast fed baby goes without a bowel
movement. My usual experience is that these children are given either a cathartic, an
enema or a suppository and so the bowel gets overworked. Most of these babies will go
through two or three periods of two, three or four days without a bowel movement and
then the movements will begin to come with regularity. I often say all these children
need is a severe letting alone. Occasionally I see, however, a breast fed baby who continues throughout infancy without adequate bowel movements. Everything is alright
otherwise. Artificially fed children cannot be let go in quite the same way because
there is some danger of impaction in the lower bowel. However, that is generally easily
regulated by some change in the feeding. The simplest thing, which I learned a good
many years ago, is to add some dark molasses to the formula, replacing the usually used
sugar. It works so frequently that it is my first thought. Sometimes changing to one
of the malt sugars has the desired effect. Even artificially fed children can safely go
twenty-four hours without a bowel movement. There are some people who have a cycle
of bowel movements in which they skip a day. When I was in the Army during the
last War I observed one of my own children who would go 19 or 20 days every day
but on the 20th or 21st day would skip. She would keep up with this same cycle if she
were let alone. Hundreds of times since then mothers have told me that the child is
constipated—he will have 10 or 15 or 20 bowel movements and then will skip a day—
Page Two Hundred and Thirty-six "so I do something about it and then he will go four or five days without a movement."
Now, when one sees the young mother with her child he has to be careful to explain
to her these simple things which will cause her so much mental distress that she cannot
enjoy her child and which will upset her child so badly, and it is difficult for her to take
the proper care of her baby.
For example, once in a while I see the printed sheet from a hospital given to a
mother in which she is told to keep the child dry. Now, very small babies urinate every
14 to 20 minutes, so the mother cannot possibly keep up with changing the baby so
often, and if she does try to do this, the baby gets nervous and upset and the mother
herself will be upset, too. A wet diaper never hurt a baby providing the diapers
are boiled later on. Of course, if he has a bowel movement in his diaper then I tell them
by all means to change it.
At one time there was no regularity in the fife of a child and we had to work very
hard in order to establish a principle of regularity in the normal family life. Sometimes
it was carried too far and these poor people became the slaves of regularity and there
was some revolt in the method of the handling of the young child. I think when any
young mother has to take care of a baby and a household and keep her husband reasonably happy she can't do it unless she does it by planning her work and then by working
her plan. Little monkeys nurse their mothers about every ten minutes. I presume that
if the life of the human being was as simple as that of a monkey it would not make any
difference to the health of the mother or the child if the child just ate all the time, but
in our complicated civilized fife there must be regularity. It does not make much difference what outline you make hut it must be adhered to. Right now I see a lot of
"swing shift" babies whose day begins at 2 a.m. and ends at 2 p.m. The job of the
paediatrician is to help the mother plan her routine for the child.
I am quite convinced that every human being who follows the schedule that we
outline will wake up during the night. When the child wakens and perhaps just whimpers a little bit and gets some attention he continues to waken at that same time every
night. A neighbour of mine got a drink of water every night at 2 a.m. until he was
eight years old. Another child ate a meal of vegetables and meat at 1 a.m. every night
for 18 months. She had been ill and was not eating and once while she was convalescing
she wakened up at 1 a.m. and was hungry and was fed and she kept this up.
When one sees a young mother for the first time he should begin to point out to
her the function of the father in the family. The child needs both parents and from
the very beginning the attitude of the young mother has a profound influence on that
of the young father. Now, girls are much better prepared for motherhood than men
are for fatherhood. At a certain period in a boy's development he is just as much interested in dolls as a girl. The maternal instinct is very strong in our lives but in these
days it is often smothered. When a baby is born into a family the young father is so
proud. When one is proud he is most easily hurt, and when this young father says something about what he is going to do with this child and what he is going to make him
into, someone says to him, "Get out of here; you don't know anything about babies" and
so he gets out and never develops into a real father.
I had a woman come to me with two children of similar age to my own. She came
to me with the baby but began to talk about the problem of her adolescent boy. She
said, "He is out of my control." When I asked her about the father she said, "Oh, I
would not let him have anything to do with my boy." The child must be accustomed
to the concern of his father in every aspect of his life. I think every young father
should be taught to change diapers, to put the child to bed, etc. He is not half as tired
as the mother is. I would like to suggest to you that when you introduce the father
fully into the life of the family, you form a team between the father and the mother.
No two people, or any group of people, can work together for a common purpose without being forever after attached to each other. When you start two young parents, each
putting the best of herself or himself into a cause, then you get a wonderful partnership.
One thing more about regularity of the child's life.   That is, about the older run-
Page Two Hundred and Thirty-seven about child. I almost daily talk to some young mother who says, "Doctor, my child is
bad every Monday morning." The father has been home on Sunday, the child has been
played with and has had a good time, and I am greatly in favour of that. I think a family
picnic is worth more than the child's nap. On Monday the child can be just put to
bed and will soon return to his regular way of doing things. But the child is called
bad, so the mother puts the child in his play-pen and she starts to do the family Washing
and the child howls and the mother runs back and forth from the child to the washing
machine and by twelve o'clock the child has been thoroughly spanked several times. If
she would say to him, "This is Monday morning and you can play there until I get this
washing done," then when it is over the mother has time for affection and attention to
the child. Keep the child in a safe place, tell these mothers, while they're busy. Three-
quarters of child injuries occur when the mother is terribly busy with the household
chores.
I don't want, anyone to think that when I spoke of the regularity of the child's life
I mean mechanical routine. The child must have love and devotion in the training and
teaching of that child. That can be accomplished only if the arduous duties of the
parent are done without too much interference with the child and he has time for their
attention and care and love. I think most of the psychiatric problems of children are
based on the fact that the child is a little bit suspicious of his security and place in the
family.
One human being has only two ways of influencing another human being: the first
way is to be reasonable and win that other person; the other way is to be disagreeable
and forcible. The child uses whichever one lies closest to hand and he uses it so long
as it produces results. I took a little child to the hospital once with a very acute
appendix. I took him in my car and he kept saying, "I don't want to go to the hospital,"
and he said it with each breath he drew all the way to the hospital. Was that child bad?
No.   He found that by repetition he usually got what he wanted.
The first slide illustrates the relationship between the mother, father and the new
baby. The father and mother are still much attached to each other. If that young
woman remains a wife as well as a mother, and if she is helped to understand and manage
her child successfully, the corners of the child soon wear off and the family circle should
always consist of father, mother and child. But if the child is allowed to follow out
disagreeable tactics, and if his father and mother have no training from anybody, then
they listen to the neighbours and think that the child must be beaten into behaviour.
Then this child—a square among circles—has a brother or sister born into the family
and this thing needs more adjustment still. So frequently parents say to me, "My
second child is much better than my first." I say to them, "Oh, no. You have just
become better parents."
Unfortunately, because of the burden put upon the mother, she devotes too much of
her time to this child- and no longer becomes a wife and the child becomes more important to her than her husband. Any child who is in this position is in a most unfortunate
situation. When that happens the adult adopts an abnormality which is strong because
no child ever took the place of an adult, no child ever satisfied the emotions of an adult.
Every parent has to assume a triple personality. He has to be a parent, but the man
has to be a husband and the woman has to be a wife. When a man does not find
emotional satisfaction in his own home he is very apt to get outside of the family circle.
The father begins circulating outside of the home. So often I hear it said, "If it weren't
for the sake of our child, we would have been divorced long ago."
As a child gets older he is faced with a fork in the road, and I don't know how
many parents say to me: "Doctor, my child was all right until . . ." About 90% of
the minor behavoiur problems of children had their beginning when the child was ill.
When he was ill he had certain privileges. Then he shows the characteristic which is so
prominent in discharged veterans at the present time. This child was all right "until."
Someone should have instructions to take him by the hand- to put him back on the
proper road again.
Page Two Hundred and Thirty-eight There is another kind of "until" and that is when the child comes to a steep narrow
path. He must take, up some more arduous task as he grows a little older. When he
comes to one of these difficult points he must be helped. There is no equality among
human beings, so far as ability is concerned. One child learns without any particular
difficulty. Another child has difficulty but his intelligence is just as great or greater.
In the public schools of Philadelphia some years ago some generous person voted some
money for the study of backward children. These children were divided into two
groups: First, the backward children—and of course you can't do anything with these.
Second, another large group who were found to be deficient in some small matter—they
had been ill, or something, and consequently they lacked some one thing. With proper
training many of these children rose to the middle and some to, the top group.
There are many things that can happen in the life of an individual which are only
temporary. When a child gets over an illness, or a visit from his grandparents, etc., one
must not let an incident of this kind get the child off the track.
One more thing about the equality of intelligence. This is the sort of thing I run
into all the time. The child was condemned, was punished, was told he was bad, and
he developed a confused attitude towards life; and so it goes from bad to worse until
the relationship between the child and the parents is nearly hopeless. Fortunately, the
child is rescued from' these things by other influences. In the first place there must be
parental authority. The parent has the responsibility. The church, state, public opinion,
holds the parent responsible for the child's authority. Your child has the same emotional
equipment that you have but you have had more experience than he has. The adult has
a developed intelligence. The child has a degree of development corresponding, in general,
with only the age at which he arrives. The parent is very much more attached to the
child than the child is to the parent. In the beginning every child does not love anyone.
I don't want anyone to call that bad. Every child in the beginning is self-centred.
How many parents do I see who, in the face of such an attitude, fail to carry out some
essential thing in the welfare of the child. I thoroughly believe in parental authority.
I am not in. favour of corporal punishment except as a last resort. The weight of the
parental authority must be lifted off the child's head.
One of my daughters went for years as a medical counsellor to a girls' camp. The
girls could do anything they wanted if it was not dangerous or unfair. That is a very
good plan to follow.
As each year goes by and your child's abilities increase, he must take on an increased
freedom in making his own decisions. A child faces so many other discipHnes—the other
children he plays with, etc. I still see too many children who are "street angels, house
devils." Every child should have an increasing part in carrying the burden of the family
life as he becomes older.   The child must be helped to become a responsible member of
the family.
In any human relationship that is going to be lasting or satisfactory there must be
some kind of balance and I have likened it to a teeter-totter, as you see in this diagram.
A spoiled individual is one who uses disagreeable tactics to get his own way too much of
the time. The child at first usually gets the long end of the fulcrum, but each year, as
the child increases in weight, strength and ability, he gets a shorter fulcrum.
A woman who is in my practice has four children. The children are cheerfully and
delightfully managed. When this woman was in the hospital with her fourth child I
said to her: "I have thoroughly enjoyed you and your children and I have admired the
way you have taken care of them." She said, "Well, doctor, I was the worst spoiled
child that ever lived and I got anything I wanted. My mother died when I was young
and my father took care of me. I got married and it was not long before I tried these
tantrums on my husband. Once he gave me a good spanking so I phoned my father and
told him all about it. My father said to me: "I should have given you that spanking
long ago." Now, had that young woman's father agreed with her there would have
been a divorce probably and several lives would have been wrecked. As it was, every-
thing turned out beautifully.
Page Two Hundred and Thirty-nine THE CHILD AS A PATIENT
Dr. Clifford Sweet
I am going to have a good deal to say about the importance of appreciating the
child's attitude and problems as well as his physical symptoms, signs and findings.
I would like to suggest to you first that anyone who practises medicine has children
as patients. The care of the child is by no means confined to paediatrics. In the United
States some 96% of our paediatricians are located in large cities as yet. The practitioner
of every type of medicine has something to do with children. The obstetrician sees the
small child. He is coming more and more to deal with the menstrual difficulties of young
girls. And I have found no surgeon so exclusive that he does not take care of the children of the well-to-do. And that doctor has an effect upon that child and upon his
whole attitude as he cares for them.
I would also like to call your attention to the fact that about two-thirds of our
population are brought to the doctor unwillingly. All children and most adults are
dragged in. So when the child goes to see you he is already hostile. He is very resentful
and then the mother, who has had a long problem with her child, is herself in a very bad
state of .mind. She says, "This child has a pain in his belly and I don't know whether to
believe him or not." Of course the child had been called a liar so often and so much.
In addition to that, if a physician has an unfortunate attitude to the child, many complications arise. I have said many times to my fellow physicians, "When a child is
brought to you for examination after the school physician has suggested something, and
if you are seeing red because one of your patients has been seen in the school department,
you can not make a good examination yourself."
Now, in any kind of a diagnosis history is extremely important, and I think one of
the gravest faults we make is that-we often take insufficient ones or because we are in
a hurry and we don't hear the important part of this history. Albert has told me that
when he has missed a diagnosis and someone else has made it and he has gone back to his
own history, there in the patient's own-words was the crux of the whole question. I
have had the same experience. I have seen a child who, his mother said, was spitting up
quarts of pus every day and I failed to get the significance of it and failed to make a
diagnosis of lung abscess. Even when the child is capable of giving his own history, if
you don't watch out the mother will tell him not to talk so much. So you have to get
his history from the mother, and that is not always very satisfactory. There is no part
of the examination of the child that is so important as the history and everything in the
child's fife must be looked into. We all know now that the child's habits of eating must
be covered and perhaps I could not have come to Vancouver if I did not derive a large
proportion of my income from the mothers of children who are trying to make them
eat. I think there is no more important service that you can do for a child than
straighten out the difficulties that arise at every meal time. The otmehs have been
deluged with nutritional information. None of us like all of our present food when we
see it or taste it for the first time. We have learned gradually to eat as well as we do.
We all have certain dislikes, and I am quite certain personally that I want spinach in
only one way—that I feed it to the cow and drink her milk! Many medical students
in the course of instruction have been asked to keep an accurate account of their own
food intake and invariably it varies considerably. I once—fortunately in my student
days—was on a food experiment for four months, during which time I had to eat the
same amount of food each day, and it was a very difficult thing to do. Then, too, in
our paediatric zeal we have done something that adds to this problem. We have been
too much in the habit of feeding the child away from the family table, so that he does
not see other people eat the food that he is expected to eat. I find very often in that
connection that I have to re-educate the father, who is in the habit very often of
grumbling about his food. If a strange food was suddenly presented to you in a room
all by yourself, you wouldn't entirely trust the parent who gave it to you. I think you
would be very careful about it at first.    These difficulties arise because of the idea that
Page Two Hundred and Forty a balanced diet must be eaten'every day. If I could I would like to delete that word
"every" from any instructions we give to patients about food. I often think of the
castigations I heard in my youth visited on the children of Israel because, after forty
years of manna they were tired of it.
A child will stop eating, say, about three days before any illness, even a cold. If
someone induced him to take that food it perhaps contributed to a gastro-intestinal upset
or it may arouse a feeling to that food very much like the one Dr. Bell described.
Within the office itself we have many problems to meet. As I have just said, the
child isn't eating well. That resentment is not expressed but it is there. In addition,
the mother is worried by the wonder of what the size of the fee is going to be. That
makes her very irritable. I find that whenever I am going to handle a problem in a child
that is going to be over a long period of time, it is best to make an estimate to treat
her child so that she can go home and talk it over with her husband and then it is discussed as to what they can do and will do in the way of payment. That not only con-,
cerns my welfare but concerns the success of the whole problem, that I am going to deal
with. The parent who has a problem that must be studied for some length of time and
worries about what it is going to cost him—that patient will come two or three times
and gradually will lose interest and then fail to come at all. The common sense method
is to settle upon how much you are going to charge. One cannot be avaricious, but
one just wants to make a living out of paediatrics.
I find many fail in the physical examination of the child because they have no
method of managing the child. I say to you that I can make any examination upon a
child that I can make on an adult with the assistance of the mother. If you are going
to do a physical examination on a child that is resisting, he must be held effectively so
he cannot, interfere with your examination. If you are trying to examine a child's throat
while he is grasping it with both hands you cannot do it. I have the child He upon the
table and I have the mother or the nurse stand on the same side of the table and hold
the child's hands—not the arms—firmly down on the table. In that way he has no
muscular power.
When I go into the room of a new patient, my nurse introduces me to the mother
and to the child. When I see the child in my office I speak to him and call him by
name. It takes him quite by surprise, often because perhaps that is the first time that
he has been treated like a human being. Then I speak directly to the child, asking him
to do what I want, and I ask the mother not to repeat my request as a command. In
fact, I say to her with my best smile, "Won't you please let me do all the talking to the
child while I examine him?"   He will be confused if he is talked to by too many people.
Now, the child has an actual qualification that makes him slow to react. The adult
who has done a thing many times reacts in the same way that a trained soldier does, while
the child is like the raw recruit who is told to do an "About Face."
Some day I hope you will all read "Bone Soil," a book based on peasant life in northern Norway. I am certain that unconsciously the author has let us see life as it looks
to the eyes of a child—the curiosity of these people, their inability to understand, but,
most of all, the unbounded speed with which these more sophisticated people work.
If the mother is angry and the child is angry and afraid and then the doctor has
the attitude that the child is bad, and if the child has been to physicians previously then
he has been unnecessarily hurt. So don't hurt a child unnecessarily. The child does not
like to be hurt. One night in our Children's Hospital, when we had a child with a
lesion in the mouth, I sat and watched about twenty of our staff members examine that
child one after the other, and there was not one of them that did it with the skill and
gentleness that he might have used. If the child is reluctant to open the mouth, you can
slip a tongue blade in between the cheek and the teeth and his mouth will fly open by
a reflex action and you can see everything that is in there. You can teach any child
that if he will breathe rapidly with his mouth open you can touch any part of his throat
without hurting him.    With most people, by extending the tongue firmly and saying
Page Two Hundred and Forty-one "aaaaah", this opens the throat so you can see into it satisfactorily. One of the greatest
faults in childhood medicine is that the doctor does not see the throat because he does
not have a good light. I remember a few years ago a picture by an advertising firm in
which they show the old family doctor examining a child's throat and the old gent had
on bifocals and he was getting the light from a window on the other side of the room.
I use a head mirror and I have a good light in every examining room, and I have shutters
so that I can darken the room.
The upper respiratory tract in children, which is easily visualized, is the most important region in the body for a careful examination. Infection in the upper respiratory
tract in a child may give rise to any symptom that you may name. It is the usual cause
for vomiting, for diarrhoea, for coughing, for convulsions. It is often the source of
abdominal pain.
If a child has just become ill and you look into his throat ever so carefully yoU may
not see anything, because the infection has not been there long enough to make any
signs, but if you will look at that throat the next day and the next day and the next
day, the infection will have had a chance to give rise to inflammatory changes and you
will know that that is the place that the infection has entered to produce the illness
that may appear. Sometimes it is hard for the parent to understand that, because that
child is vomiting, he has a sore throat. No matter where the infection is, the toxin
which he absorbs from that may affect any other part of the body. It is too bad to
leave the mother of a child who has had a convulsion without telling her why that child
had that convulsion. You can generally find out why if you keep looking. The parent
often tells me, "I don't know what my child- had. The doctor just gave me some medicine but he didn't tell me a thing." You do great service to your patients if you tell
them, whenever you can, exactly what is the matter with them and write it down for
them.    I wish sometimes that every parent had a medical dictionary.
Now, having introduced myself, to the child and having explained to the mother that
I would like her not to do any talking, I then proceed with the examination of the
child and I generally look at his ears before I look at his throat, because I know he has
had a bad experience with his throat previously. I look at his left ear first and very
often he finds he is defeated when he finds I have not hurt his left ear. When I want
to examine a child's ears and he is resistant, if you will just flex his neck suddenly forward all his powers of resistance are gone. Then the child usually yells and screams
and I don't care how much noise he makes. I tell the mother that the yelling makes no
difference to me; then she usually calms down. The best possible circumstance under
which you can examine a child's lungs is when he is yelling. Many, many times I have
picked up a little area of bronchopneumonia because when the child yelled I noticed it.
The child is only yelling when he is expiring and at the end of each yell he inspires and
that is just what we want for an examination of the chest.
I see appendicitis in a child-overlooked once in a while because the doctor says he
cannot examine the child's abdomen while the child was crying. You cannot if you do
it in a hurry but you can if you take your time. The signs in the child's abdomen are
just the same as in an adult. The muscle spasm is not so pronounced but you can usually
detect it sooner or later. The most important symptom in appendicitis is pain. There is.
one bad fault in appendicitis in children that is very important—the child's signs and
symptoms of appendicitis are often intermittent. That is, he may have every single
physical sign of appendicitis and five minutes later his abdomen is perfectly soft. I have
had a good deal of experience with that. I was once asked to see a child in consultation,
and it happened that this child had been a patient of mine previously and I was perhaps
a little bit resentful of this. I went over that child's abdomen and I could find nothing.
Suddenly I saw him double up and I knew he had appendicitis. One morning I went in
to see a child whose mother gave me a very clear picture of appendicitis, but I could
find nothing. Just as I was ready to leave, I happened to see him double up with pain
and of course I knew for certain then, and about one hour later on the operating table
that child had a very cedematous and inflamed appendix removed.
Page Two Hundred and Forty-two Appendicitis is very common in childhood and I should like to emphasize that the
death rate from this in the United States is high in the early years of life and in the
late years of life. I am quite convinced that appendicitis is a chronic disease in the
adult and that it nearly always begins in childhood. I did adult medicine and surgery in
my youth and quite frequently a patient told me he was having his first attack'of appendicitis at the time he was going to be operated on, but as he lay in bed he remembered
previous upset stomachs in his youth and undoubtedly he had had appendicitis many,
many times.   I think you will find that this very generally holds true.
When a child presents symptoms that may be appendicitis, a very, very careful
examination of that child must be made. I have found that you can detect pain produced by it in the child if you are alert. In the first place, a child cries differently
when he is hurt. When you press over the region of his appendix he lets out a sharp
cry. He is also inclined to wiggle away from your fingers, and if I don't know whether
he is really sore there, then I make this pressure over the ribs or somewhere else. You
cannot help putting up the outer canthus of your eye if you are in pain, so I watch the
child's face to see if he shows pain. Most important of all is the rectal examination.
There is no point in the care of children in which you can make such a clear differential
diagnosis of appendicitis as there is in the rectal examination. The rectal examination
should be made with care. You cannot ram your fingers into a child's rectum without
hurting him. You have to use thorough lubrication. Vaseline is not a good enough
lubricant unless it is warmed to body heat. K.Y. jelly is excellent. So you lubricate
rectum and the meatus, too. Anything that is going to be introduced into any body
cavity should be thoroughly lubricated. Then the finger should be introduced slowly
and gently, taking advantage of the child's breathing and moving the finger forward
only during inspiration, when the child's abdominal and perineal muscles are relaxed.
The fingers should be introduced always first on the left side. Never go up on the
right side first. Go up on the left side and make a considerable degree of pressure
bimanually. Whatch the child's' face. See if he has acute tenderness. Then swing over
to the right side with half the pressure that you used on the left side.
Brennemann has given us a good aphorism between pneumonia and appendicitis—in
pneumonia there will be great pain and little tenderness; with something below the
diaphragm there will be much tenderness and generally less pain. If a child has an acute
appendix you can often put your finger right on it.
In these days of drugs, I still think we should make the diagnosis as early as possible.
It has been years now since I have had any great difficulty with parents as far as operating on their children is concerned. Give them the whole responsibility of the child's
outcome if they don't want an operation. Then you will generally find that they will
turn the child's whole care over to you and of course you will operate.
I will take up some of these other things later, but I want to speak of some of
the drugs that are very useful in the treatment of children. Children have pain just as
we have. They stand it less than the adult. No child should be allowed to lie in pain
and vomit for two or three days after his operation. Children stand all of the opiates
well under one consideration and that is that they are in pain. Children should not
have any sizable dose of opiates before their operation. A good many of the collapses
on the operating table are because they have had opiates beforehand. The child going
to the operating room should have his anxiety relieved by a barbiturate. You can very
safely give a child in terms of l/z gr. for every year of his life of sodium amytal.
One of my daughters was operated on. She was vomiting, and I went to see her,
and her surgeon was not available, so I asked permission to give her some sodium amytal
per rectum. I gave her 9 gm. per rectum. I timed her with a watch and in twenty
minutes she began to feel distinctly the effects of it. She stopped vomiting and went
to sleep and in the morning her post-vomiting was all over. Nembutal is twice as
powerful and does not last as long. When the child returns to bed after the operation,
he is given an opiate as soon as he is in pain. If you use morphine, combine it1 with
sufficient doses of atropine and the patient will not vomit.    Then my instructions are:
Page Two Hundred and Forty-three It is something of a
When that dose of opiate wears off—I am now using pantopon—the child gets a dose
of sodium amytal by rectum and then when that wears off, he gets another dose of
opium, so he lies and sleeps comfortably for forty-eight hours after his operation and by
that time the pain is all gone. Then I give him large doses of tap water by rectum for
four hours. Why do I do that? Because you will keep his water needs supplied by
tap water per rectum. He gets this every four hours by rectum throughout those two
first post-operative days. His stomach does not get distended. If you are going to have
a nurse give tap water by rectum you are going to have to tell her how to do it. It
must be given without pressure and the best way to do it is by an open funnel. If there
is an accumulation of air insthe rectum it can readily escape through the funnel. The
water must be warm so that there is no reflex action in the child's rectum when the
fluid goes in. The nurse must be instructed to hold the funnel at a low level. If the
child wiggles with a cramp in his abdomen, lower the funnel,
nursing problem, I know.
I operated on a child late one night and I was very tired, and I forgot about the tap
water and that child vomited more and his abdomen became quite distended. I had a
fifteen-year-old girl operated on for appendicitis and I left orders for a pint of tap water
every four hours and she made a very uneventful convalescence.
Now, the dose of opium. A child of two years of age can take 1/10 of a grain
of morphine P.O. A little baby can take 1/8 grain of codeine P.O. A good-sized child
of 10 to 14 to 16 years of age can have 1/4 grain of morphine and 1/150 grain atropine, just as well as an adult can. I think it is safe to give the child one good-sized
dose of opium and reinforce it with a barbiturate. I would like to be able to spend more
time on this.
In conclusion, I ask you to maintain a kindly attitude toward the child. Don't
blame him for all of his behaviour because behaviour is always the result of hereditary
characteristics and there comes to bear upon it all the child's former experience. He has
been hurt under certain circumstances. Get the best history at hand. Have a good
light. Take a good look. Make a good examination. Take care of the child and see
that he does not lie there with unnecessary pain. See that he gets sleep and rest. And
see that you are his friend.
V
ancouver
enera
Hospita
FALLACIES IN THE CLINICAL EXAMINATION OF
THE SPINAL FLUID #
S. E. C. Turvey, M.D.
It is doubtful if there is more controversy about any diagnostic examination than
that of the spinal, fluid. Almost every single test of the spinal fluid, except the measurement of the pressure, lacks standardization and certainly few clinicians or laboratory
workers agree on their'value. There is not even agreement on such a fundamental point
as whether tests are reliable after the fluid has been standing for some considerable time
between withdrawal and examination.
A few elementary points might be mentioned before the tests are discussed. An
adequate amount of fluid should be withdrawn and this should not be less than 12 cubic
centimeters. Unpleasant sequelae are not related to the amount of fluid withdrawn
except in a few patients with greatly increased intracranial pressure. If the fluid is too
bloody for satisfactory analysis, more fluid can be obtained by cisternal puncture after
a few days or by a second lumbar puncture one or two weeks later. There is serious
disagreement as to the value of fluids which are only slightly bloody.    Thus, Merrit and
Page Two Hundred and Forty-four Fremont-Smith state that a careful statistical allowance can be made for the degree of
contamination if the number of red and white cells in the spinal fluid are compared with
the number of red and white cells in the circulating blood. On the other hand, Lange
states categorically that this is highly unsatisfactory, and that it is inaccurate in the
extreme. Lange insists that any contamination of the spinal fluid with blood renders
it useless for any examination. His reasons for this are as follows: first, blood plasma
contains 300 times more protein than spinal fluid; second, whole blood contains 6,000
tunes more white cells; third, syphilitic blood serum may give a positive Kahn test in
dilutions as high as 1:1000; fourth, a bacteremia might contaminate a previously sterile
fluid.
The gross appearance of the fluid is important in many instances, both immediately
and after standing some time. Even in so simple an observation as this, however, there
is no agreement. Lange states that the only method for demonstrating fibrinogen is the
appearance of an opacity, often some time after the puncture. But Merrit and Fremont-
Smith say that the presence of fibrinogen can be readily demonstrated by the addition of
a fibrin ferment, which causes the typical fibrin clot to form. If the fluid is turbid
immediately after withdrawal, it is likely due to an increased cell count. If the fluid is
red, it is due to red cells or haemoglobin; if this fluid is centrifuged and the supernatant
fluid is clear, the admixture is recent and therefore most likely due to a bloody tap. In
Front's syndrome, the fibrin clot is thick and heavy, an appearance entirely different from
the thin web-like clot of tuberculous meningitis. In fluids that appear normal, the essential tests are the cell count, the estimation of protein and the complement-fixation,
rtaher than chemical or bacteriological tests.
The points of disagreement about the value of the various tests and even their significance are many. These shall be briefly considered in the following order: cell count,
protein tests, Kahn test, and quantitative estimation of crystalloids.
The cell count should be performed immediately after the puncture, especially before
the fibrin has clotted. - We have found a delay of 24 hours to cause little significant
change in the count if the fluid is kept in an icebox, and if no fibrin clot or bacterial
infection is present. As the normal protein content of the spinal fluid is 20-30 mgm.
per cet, the normal cell count must be 1-1 J_ cell per cubic millimeter. Even using a
Fuchs-Rosenthal counting chamber, the margin of error may be very high because this.,
normal value is so minute as to be below quantitative estimation. Therefore, the cell
count is only reasonably accurate when there are 10 or more cells present in each cubic
millimeter.
Also, it is now known that there is tio direct relationship between the tvpe of cell
in the fluid and the etiology of the disease. There is only a relationship of the acute or
chronic nature of the disease with the degrees of permeability of the blood vessels. If
red cells are present, blood vessels have ruptured. Mononuclear cells may be of local his-
togenic origin as in normal spinal fluid where the permeaability is normal, or in a condition such as tuberculosis meningitis, they may be either of local origin or from the
blood vessels, the blood lymphocytes. In the latter instance, they are associated with
fibrin and polymorphs, to complete the picture of permeability. On the other hand,
polymorphs are always from the blood, and if they are present, there is always a gap in
the blood vessel barrier. Therefore, they are of the highest clinical significance. Fibrin
and polymorphs are simple and accurate means to demonstrate permeability.
The quantitative estimation of protein by any method except the micro-Kjeldahl is
highly inaccurate. Stokes places so little value on the turbidity tests that he does not
Use them as a routine test. Lange rather advocates the quantitative standardized gold
reaction, using the quantitative Heller ring test as a quick, preliminary test. I have
found discrepancies as high as 40%, and would compare the accuracy of our usual tests
to the old Tallquist method of estimtaing haemoglobin. Unless the protein is increased
to 65-80 mgm. per cent, too much reliance should not be placed on it. The chief clinical value of a normal protein content is to exclude the active and progressive forms of
neurosyphilis.
Page Two Hundred and Forty-five We have no chemical method for the determination of the albumen or globulin of
the spinal fluid. The globulin tests, previously used so widely, are so highly inaccurate
and of so little clinical significance that they should be discarded.
The other non-specific test for protein in the spinal fluid is the gold reaction, and
this may be used qualitatively or quantitatively. It is worthy of emphasis that the gold
reaction is a non-specific test for protein, and that it is chiefly of value only when considered with the history of the patient and the other clinical data. As it is non-specific,
it is erroneous to use the terms "paretic curve," "tabetic curve," "meningeal curve."
Rather should be use "first zone curve," "mid-zone curve" and "end-zone curve."
Probably the only value of the gold reaction is in four instances:
(1) the diagnosis of dementia paralytica in the very early stages,
(2) the detection of slight degrees of activity of neurosyphilis,
(3) the exclusion of activity of neurosyphilitic inflammation, and
(4) confirmatory first zone curve in disseminated sclerosis.
Any changes in the gold curve, in an otherwise normal fluid, are of no diagnostic significance except in disseminated sclerosis.
The serologic tests of the spinal fluid are probably the most standardized. It is now
generally agreed that the Kahn test is as accurate as the Wasserman test. The only
problem in the evaluation of a positive Kahn test of the spinal fluid is to decide whether
the "blood-brain" barrier has been rendered so permeable by the inflammation that
haematogenous reagins have seeped through and are causing the serologic response.
In "uncomplicated" neurosyphilis, in which no parenchymatous degeneration has
been caused by the destruction of blood vessels, the permeability is normal, and the
reaginS have a strictly local origin. Whereas in dementia paralytica, where the vessels
are damaged, reagins can come from the blood. Also, in meningococcal meningitis, the
blood vessels will be damaged, and if the blood Kahn was positive, a false positive of the
spinal fluid would be obtained.
The estimation of crystalloids in the spinal fluid has held a time-honored place in
clinical medicine but their values are seriously in doubt. Basically, they are only a
quantitative estimation of permeability, and as we have seen that this can be determined
far more simply by the presence of polymorphonuclear leucocytes, fibrinogen, red cells
or haemoglobin, it is probable they are over-rated- as aids in diagnosis. Certainly, every
increase of permeability due to inflammation is best demonstrated by the presence of
polymorphonuclear leucocytes. Most textbooks state that the glucose in the spinal fluid
is diminished in purulent meningitis, but surely there is no practical value in this observation. Similarly, it is stated that the chlorides in the spinal fluid are diminished in
tuberculous meningitis, but I have had four cases in which the chlorides were normal,
and I have seen the chlorides reduced in acute syphilitic meningitis and in acute meningococcal meningitis. The estimations of sugar and chlorides should both be done at the
same time as the levels of these substances in the blood are determined, as a patient who
has been vomiting, who has had a fever with perspiration, and who has been on a reduced
chloride intake, will undoubtedly have a low blood chloride and therefore a low chloride
content in the spinal fluid. This finding would be of no significance. It has never been
demonstrated that the tubercle bacillus uses more chloride, either in its own metabolism,
or in the production of its damage in the body, than any other organism.
Conclusion: The tests of the cerebrospinal fluid of practical value are the gross,
appearance of the  fluid;  the  cell  count,  especially the polymorphonuclear leucocyte
count; the Kahn or Wasserman tests; the estimation of total protein, only if it is markedly elevated; and the gold reaction.   Bacteriological methods are also included.   Estimation of crystalloids is of little clinical value.
Page Two Hundred and Forty-six BRITISH COLUMBIA MEDICAL ASSOCIATION
1944 ANNUAL MEETING
VICTORIA, B. C.
EMPRESS HOTEL
SEPTEMBER 26th, 27th, 28th, 29th
The Victoria Medical Society has invited the members of the British Columbia
Medical Association to Victoria for the Annual Meeting. We were glad to accept this
invitation. Victoria is a happy place to spend four days, and we are assured of a large
attendance and successful meeting.
You are advised to make early reservations directly with the Empress Hotel, stating
that you are attending the meeting, the date of your arrival, your needs, and whether
accompanied or not. It may be necessary to double up, as rooms are at a premium in
Victoria.
The Committee on Programme, of which Dr. J. Russell Neilson of Vancouver is
Chairman, is arranging a splendid programme. At this date they announce the following speakers for the lecture programme:—
DR. HARRIS McPHEDRAN, President of the Canadian Medical Association.
DR. WILLIAM MAGNER, Pathologist, Toronto.
DR. G. H. STEVENSON, Professor of Psychiatry, University of Western Ontario.
DR. ALBERT ROSS, Assistant Professor of Surgery, -Montreal.
DR. T. C. ROUTLEY, General Secretary, Canadian Medical Association.
During the four days of the meeting, the mornings will be devoted to lectures, the
afternoons to special conferences, including visits to the hospitals, the evenings to the
Annual Meeting of the College of Physicians and Surgeons, which all doctors should
attend, another evening for the Annual Meeting of the British Columbia Medical Association, and a third evening for Economics. It is proposed to hold a special session on
Economics on Wednesday afternoon, and the Annual Dinner on Friday evening. The
Official Luncheon will be held on Tuesday.
Special committees have been appointed in Victoria. Dr. P. A. C. Cousland, the
President, will be the chairman of these committees. The following are the sub-chairmen:
Reception and Registration—Dr. H. M. Robertson.
Arrangements for lectures and meetings—Dr. T. Miller.
Entertainment—Dr. E. W. Boak.
Golf—Drs. F. M. Bryant and E. L. McNiven.
Transportation—Dr. G. F. Aylward.
Press—Dr. H. E. Ridewood.
Commercial Exhibits—Dr. J. H. Moore.
Public Meeting—Dr. Thomas McPherson.
The Sessions on Economics will be under the chairmanship of Dr. H. H. Milburn,
Chairman of the Committee on Economics of the College of Physicians and Surgeons,
and Dr. G. F. Strong, Chairman of the Committee on the Study of Economics of the
British Columbia Medical Association.
Make your plans and reservations early.
There will be a programme for ladies.
Page Two Hundred and Forty-seven We publish in this issue a Table of Approximate Equivalents of Doses, Apothecaries*
and Metric Systems. It has been so placed that it can be removed and kept for reference
in the future.
More and more the metric system is coming into use, as it should, on account of its
convenience. The younger generation of medical students is learning to write prescriptions in this system, and to estimate all amounts of drugs, etc., by it. The modern scientific publications all use it, and in the case of many preparations, e.g. vitarnins, hormones,
which we use daily, the dosages are all given in the metric system. It would be an
excellent thing if the old Apothecaries' System of measurements, together with the
Avoirdupois System, could be discarded completely, and only the metric system used.
All pharmacists are equipped to fill prescriptions in this simpler method, and medical
men are coming gradually to its use.—Ed.
TABLES OF APPROXIMATE EQUIVALENTS OF DOSES,
APOTHECARIES' AND METRIC SYSTEMS
Apothecary
or Troy
1 ounce
4 drams
2% drams
2 drams
75 grains
1 dram
45 grains
30 grains
15 grains
10 grains
Metric
30      Gm.
7% grains  —
7 grains —
6 grains —
5 grains —
4 grains —
3 grains  —
2% grains  —
2 grains
1% grains
1 grain
% grain
3 Gm.
2 Gm.
1 Gm.
0.65 Gm.
0.5    Gm.
0.45 Gm.
0.4 Gm.
0.32 Gm.
0.25 Gm.
0.2   Gm.
0.16 Gm.
0.13 Gm.
0.1    Gm,
65      mg.
50      mg.
Weights
Apothecary Metric
1 pint — 480 cc.
12 fluid ounces — 360 cc.
8 fluid ounces — 240 cc.
6% fluid ounces — 200 cc.
4 fluid ounces — 120 cc.
3% fluid ounces = 100 cc.
2 fluid ounces —    60 cc.
1% fluid ounces —    50 cc.
1 fluid ounce — 30 cc.
% fluid ounce    —   25 cc.
5% fluid drams   —    20 cc.
4 fluid drams   —    15 cc.
2% fluid drams   —    10 cc.
2 fluid drams — 7% cc.
80 minims _£ 5 cc.
65 minims                    4 cc.
Liquid Measures
Apoth
ecary
or j
rroy
Metric
%
grain —
45
mg.
%
grain —
32
mg.
%
grain —
24
mg.
%
grain =
22
mg.
%
grain —
16
mg.
3/6
grain _«_
11
mg.
%
grain —
. 8
mg.
Mo
grain —
6.5
mg.
•   M_
grain —
5.4
mg.
Me
grain —
4
mg.
J_o
grain —
3.2
mg.
%2
grain =
2
mg.
%4
grain —
1
mg.
Moo
grain —
0.65
mg.
M20
grain —
0.54
mg.
Meo
grain =
0.4
mg.
%ic
1 grain —
0.3
mg
-1/
/250
grain ?p
0.26
mg.
}fco
grain —
0.2
mg.
%40
grain —
0.1
mg.
Apothecary
Metric
1 fluid dram -
- 3.7
cc.
50
minims —
- 3
cc.
45
minims -
- 2.8
cc.
32
minims -
- 2
cc.
30
minims -
_ 1.8
cc.
20
minims -
- 1.2
cc.
16
minims =
- 1
cc.
15
minims -
- 0.9
cc.
12
minims =
- 0.75
cc.
10
minims —
- 0.6
cc.
8
minims —
- 0.5
cc.
5
minims —
- 0.3
cc.
3
minims —
- 0.18
cc.
1%
minims —
- 0.1
cc.
1
minim
- 0.06
cc.
Page Two Hundred and Forty-eight For fairly accurate conversions
1 Gm.
—
15.43
grains
1 Gm.
—
0.2572
dram
1 Gm.
—
0.03215
Troy ounce
1 Gm.
—
0.03527
Avoirdupois ounce
1 Gm.
—
0.0022
Avoirdupois pound
1 grain
0.648
Gm.
1 grain
64.8
mg.
1 dram
—
3.888
Gm.
1 Troy or Apothecary ounce
—
31.1
Gm.
1 Avoirdupois ounce
—
28.35
Gm.
1 Avoirdupois pound
453.6
Gm.
1 cubic centimeter
—
16.23
minims
1 milliliter
—
16.23
minims
1 milliliter
—
0.2705
fluid dram
1 milliliter
—
0.0338
fluid ounce
1 milliliter
—
0.00211
pint
1 milliliter
—
0.000264
gallon
1 minim
—
0.06161'
cc.
1 fluid dram
—
3.6966
cc.
1 fluid ounce
—
29.57
cc.
1 pint
—
473
cc.
ABSTRACT OF WHITE PAPER TABLED BY
BRITISH GOVERNMENT
(Prepared by Dr. A. E. Archer)
1. Principles of General Practitioner Medical Service.
The family doctor is the first line of defence in the fight for good health—as a rule
he will be consulted first and through him access will be had to others. Necessary services such as specialists, consultants, hospital care, are included.
It is of first importance that everyone be free to choose his or her own doctor—
while admitting this, if the State is to provide a universal service, there must of necessity be some intervention.
2. Developments which may be anticipated:
A. Group Practice.
Group practice is discussed. It must be in the forefront of the planning for
National Health Services, but this "cannot represent the whole shape of the future."
Any such development will take time—and for some time and in some districts there
will be individual practice. It is necessary, therefore, to plan for a combination of group
practice and separate practice.
B. Health Centres.
It is planned to give full scope to the development not only of group practice but
also to a full Health Centre System.
It is anticipated that in the development of the Health Centre many individual
doctors, in joining the health centre, will bring in their whole practice with them.
However, "the wish of the local doctor to bring their work into the centres must obviously be a big factor in the decision to provide a centre, but in the last resort, the
decision will rest on the public interest."
It is planned to have Health Centres set up under a plan which requires action by
local authorities as to location, size of district, size of group premises, etc.
C. Spearate Practice.
A doctor in "separate practice" will engage himself to provide ordinary medical care
and treatment to all persons and families accepted by him, under the new arrangements
—but he will be backed by the new organized service of consultants, specialists, hospitals, laboratories and clinics of which he will be enabled and expected to make full use.
Page Two Hundred and Forty-nine D. Distribution.
To secure a proper distribution of medical personnel, some regulations controlling
new entrants into any practice will be necessary.
E. Central Medical Board.
A Central Medical Board will be established and this Board will be the "employer."
The General Practitioner service will be centrally organized. "As the doctors will
be remunerated from public funds the Minister himself must be ultimately responsible
for this central administration," but he will appoint for this purpose the Central Medical
Board."
In the case of Health Centres, a third party enters the picture, the "local authority."
This local authority "sets up" the Health Centre and must have a voice in its operation.
The Board will also watch over the general distribution of public medical practices.
In "separate" practices the Board must consent before a vacant practice is filled or a
new one established. In Health Centre practice, the centre will be the agency through
which new doctors are introduced.
The Board is to be a small body with a few full time members and the rest part time.
Since the Minister is responsible for the service, the Board will be appointed by him,
but all appointments will be made in close consultation with the profession.
F. Remuneration and Terms of Service.
These are matters for discussion with the medical profession. The Government,
however, puts forth certain proposals. They say that it would be easiest to put all on
salary, but admit that this is "highly controversial." They say that both the opinion of
the doctors and of the laity is divided on this matter.
The Government approaches the problem "solely from the point of view of what is
needed to make the new service efficient." In a Health Centre, these doctors "should not
be in competition," therefore the capitation system is inappropriate, and they propose
that these men should be on salary, or some basis other than capitation, and they will be
ready to discuss with the medical profession which method should be adopted and the
appropriate salary scales. This would apply also, probably, to doctors in group practice.
Normally in the case of the separate doctor, the capitation system would apply, with
careful regulation of the size of the panel.
In any system, "the substantial issue will be to decide what is, on ordinary professional standards, a reasonable and proper remuneration for the whole time doctor engaged
in a public service."
G. Private Practice May Be Retained.
They hope to get the majority of doctors to engage in the new service and therefore
"it is not proposed to prohibit" any doctor who enters the service from also treating
the private patients "who do not desire to take advantage of the new public arrangements."   If he wishes to do this, he will have fewer public patients on his panel.
Also the doctor who is on salary will be allowed "to treat the few who will not want
to take advantage of the new public service," privately.
"The essential point is, that no person must have reason to believe that he can obtain
more skilled treatment by paying privately for it than he can. in the public service."
H. Entry into Public Service.
"There is a strong case for and the Government proposes" that young doctors go
through a short period as assistants to more experienced men. Also Government must be
able "to require the.young doctor during the early years of his career, to give full time
to the public service, if the needs of the public service require this."
As the new system is set up, there will be compensation for the sale value of practices in certain areas.
Superannuation rights will be arranged in Health Centres.
The matter of the sale and purchase of practices is to be left for further discussion.
I.   Drugs and Appliances.
These will be supplied, but with perhaps some fee to the patient.
Page Two Hundred and Fifty J.   Hospitals.
"A fully organized system of Hospitals is the keystone of the National Health Service." This system must be complete and hospitals "ready of access." "The Government proposals are based upon the fullest co-operation between the two hospital systems
in one common service." There should be a planned hospital service in each area. "To
achieve this object and to remedy the present lack of coherence, there is need for a single
authority which "has the duty to secure for that area a complete hospital service."
Unit of Hospital Administration:
A hospital area must fulfil three conditions:
(a) It must have sufficient population and sufficient financial resources to make
make possible an adequate efficient service.
(b) It should normally include both rural and urban areas.
(c) It should be such that most of the varied hospital and specialist services can be
organized within its boundaries in a self-sufficient scheme, leaving only certain'
highly specialized services for inter-area arrangement.
Voluntary Hospitals:
These should receive "certain payments from the authority" in accordance with
centrally determined scales, and "being less in amount than the total cost of the service
rendered."   There is no question of these hospitals surrendering thir autonomy.
Mental Hospitals:
These create some difficulty, but "despite the difficulties the mental hospital service
should be taken over by the new joint authority."
Infectious Disease Hospitals:
Should be taken over as a part of the plan.
Routine inspection of hospitals "at not too frequent intervals" is provided for.
Local Tuberculosis Dispensaries will henceforth be regarded as out-patient centres of
hospital consultant service.
K. Dental Service.
It is highly desirable, and should be a full service, but there are not enough dentists
at present.
L. Administration.
Must be under the Minister of Health, but only the general practitioner service will
be centrally controlled. For the rest "there will be local responsibility with control at
the centre." "Though it is in the Minister of Health that the responsibility must rest,
the government attaches great importance to ensuring that the service is shaped and
operated in close association with professional and expert opinion."
"Set up by statute, at the side of the Minister, is a special professional and expert
body to be called the Central Health Services CounciL" This body is advisory, while
the Central Medical Board is an "Executive body responsible to the Minister."
The Council will have the right to advise on "any matter within its province." The
Minister will be obliged to submit a report annually to parliament of the work of this
Council.
M. Consultants.
It is desirable that provisions should be made for "every one to obtain whenever he
needs it and without charge, skilled specialist advice." The government consider that a
service of consultants can be best and most naturally based upon the Hospital services."
"The Hospital will itself enter into arrangements with the consultants and specialists
concerned." There is need for more consultants and for better distribution. (Apparently
Hospital payments will include enough to provide for the services of consultants and
specialists.)
Consultants might perhaps be associated with more than one hospital. They should
be employed either on a full time or part time basis and there will be need for central
control "to avoid competition."
Page Two Hundred and Fifty-one N^Child Welfare.
Child Welfare is to be cared for by another department related to Education.
O Maternity.
Maternity benefits must include arrangements for home nursing, midwifery and
health visitors.
P. Financial Arrangements.
"The cost will fall mainly upon central and local public funds. It will be met partly
by the ordinary process of central and local taxation and partly by an insurance contribution under whatever social insurance scheme may be in operation."
(Supplement to B.M.J., February 26, 1944.)
NEWS AND NOTES
Dr. H. E. Ridewood of Victoria is a proud grandfather, on the birth of a son to the
dformer Anne Ridewood.
Squadron Leader and Mrs. H. R. Christie are receiving congratulations on the birth
of a daughter, Margaret Linda, on June 17th. Squadron Leader Christie was formerly
in practice at Rossland.
of
Dr. and Mrs. W. A. Trenholm of Vicotria are receiving congratulations on the birth
a son.
Capt. W. P. Teevens, R.C.A.M.C, formerly interne at the Vancouver General Hospital, was married recently.
Dr. W. G. Trapp, who is on the staff at Tranquille Sanitarium, and Mrs. Trapp are
receiving congratulations on the birth of a daughter at the Royal Inland Hospital, Kamloops.
The profession has suffered a severe loss in the passing of Dr. R. E. McKechnie and
Dr. F. J. Nicholson of Vancouver and Dr. J. H. Carson of Prince Rupert. Dr. Carson
has during the war years been doing special work at Ottawa arising out of his former
activity in producing haliver oil at Prince Rupert.
*       *       *       *
i
The whole profession, and especially those who knew Dr. D. W. Davis, until recently
in practice in Kimberley, has been shocked by the sad accident which resulted in the
death of both Dr. Davis and- his wife.    Dr. Davis and Mrs. Davis had been visiting at
Vesuvius Lodge on Salt Spring Island during-the first two weeks of June, and had then
spent two weeks at Qualicum, and at the time of the motor accident were proceeding to
Victoria to take up temporary residence at the Empress Hotel.   Their son, Jack, who is
serving with the Navy, was notified and arrived by plane after his father's death.    The
■elder son, Edmond, has been studying medicine in England and is now serving with the
R.C.A.M.C. The sympathy of the profession is extended to both Edmund and Jack in
their sad bereavement.    Cremation in Victoria followed the funeral service in Duncan.
*t *_ »C *C
^ *F *r •!•
Drs. D. S. McHaffie and H. N. Watson of Duncan gave every attention to Dr. Davis.
Mrs. J. F. Haszard and Drs. F. W. Brydone-Jack and L. W. MacNutt of Vancouver
attended the funeral service at Duncan.
Page Two Hundred and Fifty-two Dr. W. J. Knox of Kelowna attended the funeral services of the late Dr. R. E.
McKechnie and servd as an honourary pallbearer."
Dr. F. W. Andrew of Summerland attended the funeral as representative of District
No. 4 Medical Association.
Dr. M. G. Archibald of Kamloops was visiting in Vancouver and attended the
funeral.
Doctors A. K. Haywood, C. W. Prowd, P. A. McLennan, W. D. Patton, B. D. Gillies,
H. H. Pitts, J. A. Smith and Harold White were honorary pallbearers.
Doctors W. H. Hatfield, Lieut.-Col. G. H. Clement and Major R. E. McKechnie
were active pallbearers.
Lieut.-Col. G. H. Clement was in attendance at the Canadian Medical Association
annual meeting in Toronto and flew west to be present at the funeral of his uncle, the
late Dr. R. E. McKechnie.
Dr. S. R. Waldman, who has been serving as medical officer with the spruce logging
operations in the Queen Charlotte Islands, was in Vancouver recently.
Capt. C. M. Robertson, R.C.A.M.C, formerly associated with Dr. F. M. Auld in
the practice at Nelson, and until recently on the staff at Borden, has been visiting in
British Columbia.
Capt. P. H. Spohn, R.C.A.M.C, who has been stationed in the North, is home for a
visit before leaving for other fields.
Dr. S. G. Mills of Terrace has been visiting in Vancouver and called at the office.
The Prince Rupert Medical Society at its annual meeting elected the following officers: President—Dr. C H. Hankinson; Secretary-Treasurer—Dr. W. S. Kergin; Representative to Hospital Board—Dr. R. G. Large; Representative to Board of Directors of
the British Columbia Medical Association—Dr. L. W. Kergin.
Dr. J. W. Vosburgh of Princeton has been visiting at the Coast and called at the
office.
* *      *      *
Capt. S. A. Creighton, R.C.A.M.C, is now serving overseas.    He was formerly at
the Vancouver General Hospital.
* *      *      *
Major H. R. L. Davis has returned from Great Britain.
Recent promotions include that of Lieut.-Col. A. R. J. Boyd, serving with headquarters in Great Britain; Major F. W. Grauer and Major A. W. Bagnall, overseas.
The following are Majors: C E. G. Gould, C. H. Gundry, Gardner Frost, A. M.
Evans, W. L. Boulter, G. B. Bigelow, F. H. Bonnell, H. H. Boucher and R. D. Codding-
ton.
Dr. and Mrs. R. V. McCarley of North Vancouver attended the graduation exercises
at Queen's University, Kingston, when their son, Dr. J. S. McCarley, received his medical
degree.   Dr. J. S. McCarley is an interne at the Vancouver General Hospital.
* *      *      *
Dr. G. A. McLaughlin of North Vancouver is on a short holiday in Saskatchewan.
Dr. D. J. Millar of North Vancouver is about ready to proceed on his annual fishing
trip to the Cariboo.   "D. J." deserves a vacation.
Page Two Hundred and Fifty-three Dr. A. W. Bagnall of Vancouver, having retired from active practice, is now holidaying at Balfour on the Kootenay Lake.
Dr. R. B. White of Penticton is on his annual pilgrimage to his old stamping ground
at Camp McKinney.
Dr. L. A. C. Panton of Kelowna is at Little River Fishing Camp.
* *      *      *
Dr. W. J. Knox and Mrs. Knox of Kelowna are spending two weeks at Qualicum.
*r w sfr ♦      ettL.
Dr. R. J. Paine of Premier was in Prince Rupert for several days, recently.
* * # * •
We are glad to report that Dr. M. J. Keys of Victoria has recovered and is now able
to return to work, following a rather serious illness.
J». 3*. _>, ;»„
Dr. F. P. McNamee, who practised at Kamloops, confining his work to Eye, Ear,
Nose and Throat, has returned to civil life, having served as Surgeon Lieut.-Commander
during several years.   He is now associated with Dr. Keys in Victoria.
Dr. Arthur Nash, who is Officer Commanding, 13 th Field Ambulance, Reserve
Army, received the rank of his Command.   We congratulate Lieut.-Col. Nash.
Dr. T. M. Jones of Victoria has returned from a vacaiton at Kamloops.
* *      *      *
Dr. W. H. Moore of Victoria called at the office when in Vancouver recently.
echve
nnhng
CAMPBELL & SMITH LIMITED
620 Richards Street   •   Vancouver, B.C.   •   PAcific 3053
Page Two Hundred and Fifty-four ANAH_SMIN B.D.H
Anahaemin B.D.H. is the haemopoietic principle of liver; it is
active in minimum doses with maximum intervals between
injections. Indeed, the administration of Anahaemin B.D.H. is
the most economical method of producing blood regeneration
and maintenance in pernicious anaemia.
Anahaemin B.D.H. possesses the additional advantage of being
free from therapeutically inert reaction-producing protein substances.
The use of Anahaemin B.D.H. alone is sufficient to produce
complete recovery in all cases of pernicious anaemia and to correct all the remediable neurological signs and symptoms of subacute combined degeneration. No additional treatment is
required.
Stocks of Anahcemin B.D.H. are held by leading druggists
throughout the Dominion, and full particulars are obtainable
from
THE       BRITISH
Toronto
DRUG       HOUSES      (CANADA)
LTD.
Canada
An/Can/446 URINE-SUGAR DETERMINATIONS
Are Now Simplified
9W3_UJ^Cg^ER|
REDUCTION METHOD
The Simple Technique .
1. Squeeze 5 drops (M C.C.) of urine into
test tube.
2. Add 10 drops (3_ C.C.) water.
3* Drop one Clinitest Tablet into test tube
. . . that is all. Allow for reaction . .. then
compare with color scale which indicates
sugar content up to 2 per cent.
Fast. • • Convenient... Economical
Clinitest is thoroughly dependable. It is a simplified
modification of the well-known Benedict copper reduction method. The use of test tube confines the test to the
known agents and reagents. It guards the test from
possible oxidization by atmospheric oxygen.
The Complete set ... as illustrated above ... is self-
contained. Is equipped with enough Clinitest Tablets for
50 tests. Costs the patient $1.75. Tablet Refills (for 75
tests) $1.75.
Available through your surgical supply house or prescription pharmacy. Write for full descriptive literature.
Eliminates
Heating...
Measuring
of Reagents
H§\ and
Complicated
Apparatus
LABORATORY UNIT
The Clinitest Laboratory
Unit contains 10 vials of
25 tablets each ... 250
tests... a special Clinitest
dropper; and instruction
book with color scale.
Reasonably priced.
EFFERVESCENT   PRODUCTS   INC
FRED.    J.    WHITLOW    &
Sole Canadian Distributors
CO.,    LTD.,     187    DUFFERIN     STREET,    TORONTO Antonio Stradivari, At
master violin maker, in
his workshop ...
AS in the creation of a Stradivari masterpiece, the skill
-L±- implicit in the preparation of a superior vaginal jelly
entails the highest of specialized insight, utterly painstaking care, and a zealous insistence on faultless achievement.
Ortho-Gynol is offered for professional prescription with
full confidence in its preeminent merit. It is kind to delicate
tissues, and esthetically pleasing to discriminating patients.
Instantaneous action, ready miscibility and buffered acidity,
bespeak the finest in pharmaceutical craftsmanship... they
justify the physician's preference whenever a vaginal jelly
may be indicated.
ortho-gynol
VAGINAL   JELLY
ORTHO   PRODUCTS   OF   CANADA,    LIMITED   •  TORONTO M
*1*
'ffi
W&i
m
m
v
|||A ''Wyethibixl'^p^a medicinal product,
made by John Wyeipiii Broth^CCed_%da)
Limited and li^oni^d only to the medical
profes||sn. ' If may be*, a ph«|rmaceutical.
|M;;^B^|)Io^c^_y|gc a nutritional product
But || must.lilecEEire us^fc^lhe uncomr
l^omismg jsiandc^te c^jualityiareoision,
ij§KMi strictly ^ethical promotion.
maintained l^^^^ath since 1883.
Th||s w%t a W^thiccd^is.   jjjUrf that's
why yoi^^zn rel^upc^any^Wyethical."
Jokl W-|t# & STttH* (0 ama da) Limited
«!»;_ EiV I L L E
ONTARIO
L %w rfwtifa&le
There has long been a real need for a potent, mercurial
diuretic compound which would be effective by, mouth. Such
a preparation serves not only as an adjunct to parenteral
therapy but is very useful when injections can not be given.
After the oral administration of Salyrgan-Theophylline tablets a satisfactory diuretic response is obtained in a high percentage of cases. However, the results after intravenous or
intramuscular injection of Salyrgan-Theophylline solution
are more consistent.
Salyrgan-Theophylline is supplied in two forms: jjj
4*9  0JbtfA     (enteric coated) in bottles of 25, 100 and 500. Each tablet
• contains 0.08 Gm. Salyrgan and 0.04 Gm. theophylline.
_* /js__&M6   *n ampuls of 1 cc, boxes of 5, 25 and 100; ampuls of 2 cc.,
S^^^boxes of 10, 25 and 100.
Write ioi literature
GAN-THEGPHYL
"Salyrgan." trademark Reg. U. S. Pat; Off. & Canada
Brand of MERSALYL with THEOPHYLLINE
WINTHROP
WINTHROP CHEMICAL COMPANY, INC.
Pharmaceuticals of merit for the physician
GENERAL OFFICES: WINDSOR, ONTARIO
Quebec Professional Service Office: Dominion Square Building,
Montreal, Quebec il
■P
tyeama/m' promptly reduces acidity within the
stomach. The antacid effect is persistent. There is no
local compensatory reaction; such as commonly occurs
with alkalies, and hence no belated oversecretion of
hydrochloric acid. Moreover, there is no risk of producing alkalosis.
Wreama^n^ promptly   relieves   pain   and   heartburn
associated with gastric hyperacidity.
Wreamauvz/ often   induces   healing   of   peptic   ulcer
when employed with an ulcer regimen.
cen&eniimt &carr& andfo/a4#
carru>
dfficcetzt<&& actum
CRlAMALIN
CREAMALIN
Reg. U.S. Pat. Off.
Brand of ALUMINUM HYDROXIDE GEL
|T ABLETS
WINTHROP    CHEMICAL    COMPANY
Phamaceuticals of merit for the physician
GENERAL OFFICES: WINDSOR, ONTARIO
Quebec Professional Service Office:
Dominion Square Building, Montreal, Quebec VIOfORfll
TRADE MARK REG'D.
I
INSERTS
INSUFFLATE
VIOFORM INSERTS and INSUFFLATE (iodochlorhydroxquinoline with boric
acid and lactic acid) are offered to physicians as a time-saving, effective and
economical means for combating Trichomonas vaginalis. VIOFORM acts to eradicate this parasite, while other included medicaments quickly restore the acidity
and normal flora of the vaginal vault.
VIOFORM INSUFFLATE, intended for office use, is a specially prepared
powder which is easily administered in any standard vaginal insufflator. VIOFORM
INSERTS may be given to patients for home use, necessitating fewer office calls in
these war-rushed times.
Insufflate
Bottles of  1   oz.
Inserts
Bottles of  15.
Write for literature
C M _»_%
MONTREAL, CANADA
flbount peasant ZHnoertaRtng Co. Xto.
KINGSWAY at 11th AVE. Telephone FAirmont 005S VANCOUVER, B. C
R. P. HARRISON W. B. REYNOLDS CASE HISTORY
Joe G. Age 46.
Occupation:   Hypnotist.
HISTORY OF PRESENT ILLNESS:
Patient reports that while in Munich several' years
ago he was forced to shelter in an infested
Rathskeller. He believes he was bitten by one
Hiranuma—(a species of rattus rattus japonica).
Fever immediately developed, together with strange
mental symptoms, eg., desire to winter in Russia.
A peculiar incontinence of speech developed,
marked by mental confusion and patient's interpretation of events that have taken place even
the previous day is beyond recognition. No distinction is made between fact and fantasy. An
anemia has developed and the tongue is a peculiar
white colour.' He claims that constant exercise
of the organ gives him partial  relief.
DIAGNOSIS:
Rat-bite  fever complicated by psychoneurosis  and
TREATMENT
Glossectomy and confinement in an atmosphere of
hydrogen cyanide for at least six hours. The
treatment is almost invariably fatal but tptriil
circumstances associated with this case hiiiIi i it
strongly advisable.
ffilMK Ul. HOMIER LimiTED
Montreal Canada
BECOl
TABLETS
High   potency — Economy
Becol Tablets (Horner) contain Vitamin B
complex in both synthetic and natural form
—in a small chocolate coated tablet at loir
coat  to the patient.
Formula per tablet:
Thiamin  hydrochloride
Riboflavin
Pyridovine  hydrochloride
Calcium   pantothenate
Niacinamide
2000  LU.    6 mgm
3 mgm
250 gammas
$00 gammas
20 mgm
(
Together with all other members
complex natural in 194 mgm of
Brewer's  yeast  and  extract of corn.
Dose:   One  to  three  tablets  daily.
Package:  In bottles of  SO and  100
of   the   B
combined
- •.. ^.7.:ry^y^:^:^-"'r".^
Breaks the vicious circle of perverted
menstrual function in cases of amenorrhea,
tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic
relief by stimulating the innervation of the
uterus and stabilizing the tone of its
musculature. Controls the utero-ovatian
circulation and thereby encourages a
normal menstrual cycle.
_ A
% MARTIN H. SMITH COMPANY
Full formula and descriptive
literature on request
Dosage: 1 to 2 capsules
3 or 4 times daily. Supplied
in packages of 20*
Ethical protective mark MHS
embossed on inside of each
capsule, risible only when capsule  is cut in half at seam. EFFECTIVE
THERAPY
•k " 18 3 cases of various urologic conditions
were studied for the effect of pyridium on
the presenting symptoms."
if "The results of pyridium therapy were
most marked in order enumerated: (1) cystitis, (2) pyelonephritis, (3) prostatitis,
(4)  urethritis,  (5) obstruction,  (6) mis-
cellaneous."
«2_B__
CHRONIC CYSTITIS
Infiltration of plasma cells,
eosinophiles, and lymphocytes
in mucosa and submucosa.
ir "The most satisfactory result of pyridium
therapy was obtained in the patients with,
cystitis, prostatitis and pyelonephritis."
(Reynolds, J. S., Wilkey, J. L., and Choy,
J. K. L., Clinical application and results of
pyridium therapy, Illinois M. J. 78:544-547,
Dec 1940.)
PYRIDIUM offers a combination of advantages, in that it possesses minimal
toxicity, has a local analgesic effect on the
urogenital mucosa, is effective both in the
presence of acid and alkaline urine, does
not require accessory medication or a spe-i
cial diet to enhance its action, and is con«J
veniently administered in tablet form.
Literature on request
H1ERCK & CO. Limited JL^^^
vt^
i?
letrn.
u fflontreal & Toronto sbnm_s
Both are claimed to be allergic
Both suggest mineral deficiency and
impaired elimination. Clinically,
each is symptomatically improved
by the oral use of
LYXANTHINE ASTIER
which combines the therapeutic
actions of iodine, calcium, sulphur,
and lysidin bitartrate —— a potent
eliminator of endogenous toxic
waste.
Write for Information.
L-16
Canadian Distributors
ROUGIER FRERES
350  Le Moyne   Street,   Montreal
Colonic aid
Physiotherapy Centre
Up-to-date Scientific Treatments
COLONIC IRRIGATIONS, SHORTWAVE
DIATHERMY, SINNEWAYE GALVIN-
ISM, IONIZATION, ULTRA VIOLET
RAY, STEAM  BATHS AND SHOWERS
Medical and Swedish Massage
Physical Culture Exercises
STAFF OF GRADUATE NURSES
Superintendent:
E. M. LEONARD, R.N.
Post Graduate Mayo Bros.
1119 Vancouver Block
MArine 3723      Vancouver, B.C.
Interesting Facts
about laxation
and "bulk"
rpWO important facts about
all-bran are of much interest. (1) The comparative
effectiveness of all-bran's cd
lulosic bulk, against that of other bulk-forming
foods. (2) The action of all-bran's bulk in the
colon compared to other laxatives operating on
various bulk principles.
COMPARISON WITH BULK EFFECT OF OTHER
FOODS. In a University test among chemistry
students — on controlled diets containing theoretically equallized amounts of crude fibre —
all-bran proved more effective in bulk-forming
properties and satisfactory laxative action than
most fruits and vegetables.
COMPARISON WITH OTHER BULK LAXATIVES. It
is generally known all-bran does not get laxative
action by great distension in the colon. It works
by preparing wastes, rather than propelling
them. For all-bran is one of nature's most
effective sources of cellulosic elements which
help friendly flora to fluff up and soften colonic
wastes for easy, natural elimination.
Many doctors, therefore, find it advisable to
suggest kellogg's all-bran in cases of constipation due to lack of bulk in the diet.
■ Full reports of experiments are available to doctors
I     and others interested. Please send request to:
| KELLOGG CO. OF CANADA LTD., LONDON, ONT. llllMllIlllIltlllllllllllllllilltlllllllllllllllllllllllllllllllllllllllllllllltlllllllMIIIIllllirilMIIIIIIIllllIIlIlllIIIIIIllIlllllIIlllIlIIIIllIIIllIIIIIIIIIIIIIIJtlllllllllitllllllllllllllllilllllltllllllllin
FACTS
that  bear  repeating
JVLuCH has been said of the importance of evaporated milk for
infant feeding. The facts on which this statement is based seem
worth reviewing at this time.
Uniform Composition: The percentage of fat and non-fat
solids in evaporated milk do not vary.
, Soft, Flocculent Curd: Heat treatment causes the milk to form
extremely fine, soft curds, like those formed by breast milk.
Homogenized Fat: Breaking up the fat globules makes them
more accessible to the fat-splitting enzymes. Uniform dispersion
throughout the milk keeps the fat content of the formula constant.
Hypoallergenic Properties: Heat treatment markedly diminishes the antigenic properties of evaporated milk.
Sterility: Sterilized after being hermetically sealed, die milk is
free from bacterial organisms and safe from contamination. It
need not be boiled in preparing the formula.
Carnation Addenda: In addition to possessing these virtues,
Carnation Evaporated Milk is irradiated, becoming a dependable automatic source of vitamin D. And protection at the source
and scientific control of processing make it an evaporated milk
of highest quality. With many physicians, it is the preferred milk
for the construction of infant-feeding formulas.
CARNATION COMPANY, LIMITED, TORONTO, ONT.
IRRADIATED
Carnation
ATM IRMOMIt*
%* 'Kn C»mtfttd Om
Ml LIP
"FROM CONTENTED COWS'
Milk
A Canadian Product
llinilllllllllllllllllllllllllllllllllllllllllllllllllllllllllltllllllllllltllllllllllllllllllllltlllllllllllllllllllllllMIIIIIIIIIIIIlMIIIIIMllIIIIItllllilllllllllllllllllllllllllllllttlllllllllllllllllllllllltl BUSY DOCTORS . .1
Find that the Georgia prescription service allows them to save time and worry.
Our several registered pharmacists
check and double-check for your protection and ours.
a
Phone
MArine 4161
\jbduL ~&. JUhaU*9n
GEORGIA PHARMACY
(&mtn $c^mntf£fo
ESTABLISHED 1*91
VANCOUVER, B. C.
North Vancouver, B. C.
Powell River, B. C. ^ou %Ut,it
(ttti. Ilitmtrti **S+
New Westminster, B. C.
For the treatment of
NEUROPSYCHIATRIC
DISORDERS
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 721 Medical-Dental Building, Vancouver, B. C.
PAcific 7823
Westminster 288
»_7

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
https://iiif.library.ubc.ca/presentation/cdm.vma.1-0214523/manifest

Comment

Related Items