History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: February, 1947 Vancouver Medical Association Feb 28, 1947

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 The • M
n u x l EmiK
of the . if:.
With Which Is Incorporated
Transactions of the
In This Issue:
By Drs. A. C. Frost and H. C. Gardner Frost .J^^103
By DrfrLeigh HimtM: ggg|g|mgBlKHKi no
By  Dr.  John  BHW ~^^^^j^^^^^^^S|i^^^S?11
NEWS AND NOTES ^^^^^^^^^S^Btt^ttMli 15
volMxiii. no. 5
February, 1947
ii'1 «
? I
"."   - -T - - Z'G- ?*..■■ '
WANEJ^^BiiQthe jsignificance of
fluorine in relation to dental health •
has become well established and the
prospect looks bright for|§he coi^p
ing generation.
FLUORINE Morieal E.B.S. contai|t§
1/80 grain of Fluorine in each tablel^M
PALATARLE ?Jferica|:^B.S^bas : Jgp
taste appeal fo|gyoungsteii^
But in spite of the decrease jfegrosslymal-
fbrmed^kmes thgisncidence of Subclinical
rickets   is   still  alarmingly
high 1^46.5%   in|| ^lildren
aged 2-14 years 1^
AND %ltAM I l^^l^lit ■
Contents of OricajyToblets^^
5gr.BONE MEAL('Calciuin^^i5%
|^lnorin^gP»25 %
CPhosphOnis^il %:
Vitamin d 400 int. units
i FoUisEt-Al (AV^i.IHs. Child: Julyr43)
DIgaAa *uJa • We have discon-
Pieaie, ««e^nued seiiing
this preparation.under the name
"Calfos" in view^ofpossible confusion with a trademark used by
another manufacturer.'There has,
however, been no change in the
character or quality of our preparation now offered under the name
"C. T. No. 175 Orical B.B.S."
A Wholly Canadian CompanyWiM Established1879
Published 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.
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. XXin FEBRUARY, 1947 No. 5
OFFICERS, 1946 - 1947
Dr. H. A. Des Brisat Dr. G. A. Davidson Dr. Frank Ttjrnrull
President Vice-President Past President
Dr. Gordon Burke Dr. Gordon C. Johnston
Hon. Treasurer Hon. Secretary
Additional Members of Executive: Dr. W. J. Dorrance, Dr. J. W. Shier
Dr. A. W. Hunter        Dr. G. H. Clement      Dr. A. M. Agnew
Auditors: Messrs Plommer, Whiting & Co.
Clinical Section
Dr. E. R. Hall Chairman Dr. Reg. Wilson Secretary
Eye, Ear, Nose and Throat
Dr. Roy Mustard Chairman Dr. Gordon Large,- Secretary
Paediatric Section
Dr. R. P. Kinsman iChairman Dr. H. S. Stockton Secretary
Orthopaedic and Traumatic Surgery Section
Dr. K. J. Haig Chairman Dr. J. R. Naden Secretary
Section of Neurology and Psychiatry
Dr. A. M. Gee Chairman Dr. J. C. Thomas Secretary
|||| Library:
Dr. W. J. Dorrance, Chairman; Dr. D. E. H. Cleveland, Dr. J. E. Walker,
Dr. R. P. Kinsman, Dr. J. R. Neilson, Dr. S. E. C. Turvey.
Dr. J. H. MacDermot, Chairman;  Dr. D. E. H. Cleveland, Dr. G. A.
Davidson, Dr. J. H. B. Grant, Dr. E. R. Hall, Dr. Roy Mustard.
Summer School:
Dr. L. G. Wood, Chairman; Dr. J. C. Thomas, Dr. A. M. Agnew,
Dr. Ii. H. Leeson, Dr. A. B. Manson, Dr. D. A. Steele.
Dr. H. H. Pitts, Dr. A. E. Trites, Dr. Frank Turnbull.
V. O. N. Advisory Board:
Dr. Isabel Day, Dr. J. H. B. Grant, Dr. G. F. Strong.
Representative to B. C. Medical Association: Dr. Frank Turnbull.
Sickness and Benevolent Fund: The President—The Trustees.
Founded 1898      : :
GENERAL MEETINGS will be held on the first Tuesday of each month at 8:00 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of each month at 8:00 p.m.
February 4      GENERAL MEETING.    Symposium on Thoracic Surgery.
Doctors Elliott Harrison, G. D. Saxton and Ross Robertson.
February 18    CLINICAL MEETING.    St. Paul's Hospital.
March 4 OSLER LECTURE AND DINNER.   Lecturer, Dr. Bede J. Harrison.
CLINICAL MEETING.   Vancouver General Hospital.
March 18
April 1
April 15
May 6
GENERAL MEETING.   Dr. W. S. Stanbury, National Director, Canadian Red Cross, Blood Transfusion Service.
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-ovarian
k    circulation and thereby encourages a
Ik    normal menstrual cycle.
1^4. ISO LAf»Tltt|  STRUT.  NIW YOMC N. T.
Full formula and descriptive
literature oh 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, visible only when cap*
sule is cut in half at seam* PHYSICIAN'S PHARMACY
MArine 2241
Agents for:
Suppliers of Stains, Reagents and Volumetric
This organization is devoted entirely to the professional practise
of pharmacy.
We are able to provide efficient mail service to doctors throughout
Total Population—Estimated 1 323 850.
Chinese Population—Estimated j 1     ' 6 566
Hindu Population—Estimated . j " 3gj
Rate per 1,000
Number Population
Total  deaths . %     318 13.3
Chinese deaths : :       17 30.5"
Deaths, residents only Ly^ 319 11.6
Male . 1 423
Female >     402
INFANT MORTALITY: December, 1946    December, 1945
Deaths under 1 year of age _       21 24
Death rate per 1000 live births _      25.5 43.6
Stillbirths (not included above) ! 6 8
November, 1946             December, 1946 January, 1947
Cases        Deaths          Cases        Deaths Cases        Deaths
Scarlet  Fever   \ - 12               0                     9               0 17 0
Diphtheria         3               0                     10 0 0
Diphtheria Carrier %        7               0                     0               0 0 0
Erysipelas         3               0                      8               0 6 0
Chicken Pox I g      73               0                 123               0 ,136 0
Measles .       40               0                 163               0 544 0
Rubella         3               0                     6               0 17 0
Mumps __ 145               0                   11               0 14 0
Typhoid Fever Carrier |jj      .0               0                     0               0 0 ff
Undulant Fever         10                     0               0 0 0
Poliomyelitis . -         0               0                     0               0 0 0
Tuberculosis 1       53             24                   3 8             19 0 0
Meningococcus (Meingitis) -s.         2               1                      0               0 0 0
Infectious Jaundice i         0               0                     0               0 0 0
Salmonellosis  '. 1       12               0                     6               0 5 0
Salmonellosis  (Carrier)            10                     0               0 10
Dysentery 1 . I !          5               0                     3               0 1 0
Dysentery   (Carriers)            0               0                     4               0 0 0
Tetanus .         0               0                     0               0 0 0
Syphilis  '3   119               3                   93               f| 0 0
Gonorrhoea  || - 205               0                 170               0 0 0
Cancer (Reportable) -"€Sr>
Resident       77               0                   69               0 90 0
Non-Resident   ^C|^ . _^£ 39                0                    34                0 45 0.
Research in the Connaught Medical Research Laboratories
now makes available to the medical profession in Canada a
highly purified penicillin in crystalline form.
HIGH PURITY—This product is supplied
as a white crystalline powder.
MINIMUM OF PAIN OR LOCAL REACTION—Because of its high degree of
purity, pain on injection is seldom reported and local reactions are extremely
Crystalline penicillin is heat-stable, and
in the dried form can be safely stored at
room temperature for at least three years.
No refrigeration is required except when
the material is in solution.
1 :i ni-
1- /if'   ', .    HOW SUPPLIED       jt' ' .If      ■
Crystalline   Penicillin-Connaught    is   available   from   the
Laboratories    in    sealed    rubber-stoppered    vials    of    100,000,
00,000,  300,000  and  500,000   International   Units.
University of Toronto Toronto 4, Canada
We wish that every medical man in Vancouver, indeed, in British Columbia, could
have heard Dr. Routley, General Secretary of the Canadian Medical Association, when
he spoke recently before a luncheon, meeting, called by the B. C. Medical Association's
Executive. He told us, in a necessarily very condensed form, things that should shake
us out of any complacency from which we may be suffering, and should make us, not
only very uncomfortable, but very much alive to the dangers that beset us, and to the
duties that confront us, as doctors first, as Canadians second, and finally as citizens
of this rapidly-contracting world.
Dr. Routley is well qualified to speak. He is rapidly becoming one of the outstanding figures in international medicine. He is the trusted representative, not only of the
Canadian Medical profession, which knows him well and trusts him implicitly, but of
the Canadian people as a whole, since the Canadian Government commissioned him in
the beginning, and has been adding duties to his already onrous tasks, as it learns to
depend on his competence and his capacity for leadership and initiative. So that we
must take very seriously what he says. We, in this most sheltered and most highly-
favoured corner of the one untouched area of the world, haVe ourselves little knowledge
or understanding of the absolute chaos and disaster that exist in huge sections of this
same world. Dr. Routley has such knowledge, since day by day he has met with men
who represent these areas. Ethiopia, where the Italian murderers killed every doctor
and every nurse, excpt one doctor, the now sole representative—Czechoslovakia, which
has lost 60 per cent of its medical profession; Poland, which has one medical school;
China, which for a population of 400,000,000 souls, has 9,000 doctors, of whom only
3,000 have had any medical training at all; Liberia, which for its 2,000,000 inhabitants,
has one doctor; Germany, where utter despair and helplessness has overwhelmed the
medical profession.
How can we hope for prosperity, for health, for happiness for ourselves, and still
more for our children, when this dreadful, black cloud of misery and despair and
defencelessness in the face of disease, hangs over our heads? Others are enveloped in
this fog and grope helplessly in it—it may roll in and engulf us at any minute.
But Routley and men like him on the various World Committees on which he is
serving, are doing something about this, and it is high time something should be done.
They are formulating and working out two great organizations, a World Health Organization, and a World Medical Association. Their objective is the same—though they
work on somewhat different, though parallel lines. This objective is to assure to all
the people of the world by all means available, whatever is necessary to enable them
to attain the maximum degree of health.
This sounds something like Utopia—but we must, as Dr. Routley urged us to do, get
two things firmly into our minds. First, that this must be done. If it is not done and
done completely and properly, nobody can gauge the size of the disaster that threatens
mankind—in the way of disease and death. And mankind, not the unfortunate in
China, Ethiopia, Liberia, and war-torn Europe, but us, ourselves, here in Canada.
Because it is going to mean war, too, and we are going to be right in the middle
of the next war, if it comes.
The -second thing is, that it cannot be done by pious resolutions, or.by governments
alone, though they are doing their best to lead us. It must be done by individual
faith and effort: by the concerted effort of individuals. By the medical profession of
Canada, through its great Association, of which Dr. Routley is so able a representative.
Page Ninety-six 4
He told us of the great effort the American Medical Association is making. But the
first thing is that each of us should realize what the challenge is, and should realize how
vitally he himself is affected. It is not an academic question, that we can take time to
consider, and then appoint a Committee to deal with it.   We have no time.
In fact, we almost wish we had never gone to that luncheon. But we think that
this message of Dr. Routley's should be repeated again and again, till no man can have
the excuse that he didn't know the facts, because nobody told him of them. We
hope that some way will be found whereby these facts, and the challenge they present,
may be put squarely before every member of our profession. If we want to be free and
remain free, it is high time we knew the truth, which alone can ensure such freedom.
Monday, Wednesday and Friday—9:00 a.m. to 9:30.p.m.
Tuesday and Thursday—9:00 a.m. to 5:00 p.m.
Saturday—9:00 a.m. to 1:00 p.m.
Pulmonary Tuberculosis in the Adult, 1946, by Max Pinner.
Proceedings of the American Diabetes Association, 3rd Annual Meeting 1943.
Proceedings of the American Diabetes Association, 4th Annual Meeting, 1944.
Proceedings of the Americon Diabetes Association, 5 th Annual Meeting, 1945.
Studies of Organ Inferiority and its Psychical Compensation, 1917, by Alfred Adler,
trans, by S. E. Jelliffe    (Gift of Dr. Elda Lindenfeld).
Several new journal subscriptions have been entered this year and copies of the
following, commencing with the January, 1947, issue, now appear on our shelves:
Bulletin of the U. S. Army Medical Department.
Journal of Nervous and Mental Disease.
(Gift of Section of Neurology and Psychiatry).
Journal of Neurosurgery.
Western Journal of Surgery, Gynecology and Obstetrics.
The journal, Thorax, edited for the Association for the Stddy of Diseases of the
Chest, and published by the British Medical Association, is being received also, in
exchange for our "Bulletin."
(Now in Effect) •
The College of Physicians & Surgeons of B.C.
MArine 9634
(Ta be held in Hotel Vancouver)
8:30 a.m. - 9:00 a.m.—Medical Motion Pictures
12:00 n.
10:00 a.m.
12:15 p.m. -
2:00 p.m. -
—Scientific Session  (Four Papers).
Carcinoma of the Stomach.
Improvements in Anaesthesia (Including the use of Curare).
Surgery of the Kidney (Specific subject to be selected).
Surgery of the Thyroid in Relation to the Use of Thiouracil.
1:45 p.m.—LUNCHEON,  followed by ROUND TABLE CONFERENCE on subjects presented at the morning session.
3:3 0 p.m.—Panel Discussion:
3:45 p.m.-    5:15 p.m.—Panel Discussion:   /
Fractures of the Hip.
Fractures of the Forearm.
Fractures Involving the Elbow Joint.
8:30 a.m. -   9:00 a.m.—Medical Motion Pictures
10:00 a.m.- 12:00 n.   —Scientific Sessions (four papers).
The Use of Antibiotics in Surgical Practice.
Surgery of the Neck (Specific subject to be selected).
(a)  Surgical Measures.
. (b)  Use of Anticoagulants.
12:15 p.m.-   1:45 p.m.—LUNCHEON,  followed by ROUND  TABLE  CONFERENCE on subjects of the morning session.
2:00 p.m. -   3:30. p.m.—Panel Discussion.
3:45 p.m.-    5:15 p.m.—Panel Discussion:
«► *
British Columbia Branch Canadian Cancer Society
The Annual Provincial Meeting of the British Columbia Branch, Canadian
Cancer Society, will be held on Monday, 10th March, at 4:00 p.m., in the
Medical Building Auditorium, 925 West Georgia Street, Vancouver, B. C.
Reports will be received from the Auditors and the Board of Directors.
Elections of new Officers will take place and also the two members to Grand
Council, and such other business as may properly come before the meeting.
Page Ninety-eight -•*l
As a matter of guidance to the medical profession and to bring about a greater
uniformity in the data to be furnished to the Income Tax Division of the Department of
National Revenue in the annual Income Tax Returns to be filed, the following matters
are set out:
1. There should be maintained by the doctor an accurate record of income received,
both as fees from his profession and by way of investment income. The record should
be clear and capable of being readily checked against the return filed. It may be maintained on cards or in books kept for the purpose.
2. Under the heading of expenses the following accounts should be maintained and
records kept available for checking purposes in support of charges made:
(a) Medical, surgical and like supplies;
(b) Office help, nurse, maid and bookkeeper; laundry and malpractice insurance
premiums. (It is to be noted that the Income War Tax Act does not allow as
a deduction a salary paid by a husband to a wife or vice versa. Such amount,
if paid, is to be added back to the income);
(c) Telephone expenses;
(d) Assistant's fees;
The names and addresses of the assistants to whom fees are paid should be
furnished. This infomation is to be given each year on Income Tax form,
known as Form T.4. obtainable from the Inspector of Income Tax.
(e) Rentals paid;
The name and address of the owner (preferably) or agent of the rented
premises should be furnished (See (J) ) ;
(f) Postage and stationery;
(g) Depreciation on medical equipment;
The following rates will be allowed provided the total depreciation already
charged off has not already extinguished the asset value:
Instruments—Instruments costing $50 or under may be taken as an expense
and charged off in the year of purchase.
Instruments costing over $50 are not to be charged off as an expense in the
year of purchase but are to be capitalized and charged off rateably over the
estimated fife of the instrument at depreciation rates of 15 per cent to 25 per
cent, as may be determined between the practitioner and the Division according
to the character of the instrument, but whatever rate is determined upon will
be considerably adhered to;
Office furniture and fixtures—10 per cent per annum.
Library—The cost of new books will be allowed as acharge.   |1||
(h)  Depreciation on motor cars on cost: '^<\
Twenty per cent 1st year;
Twenty per cent 2nd year;
Twenty per cent 3rd year;
Twenty per cent 4th year;
Twenty per cent 5 th year.
The allowance is restricted to the car used in professional practice and does
not apply to cars for personal use.
Page Ninety-nine For 1940 and subsequent years the maximum cost of motor car on which
depreciation will be allowed is $1,800.
(i)  Automobile expense; (one car)
This account will include cost of licence, oil, grease, insurance, washing,
garage charges and repairs;
Alternative to (h) and (i) for 1940 and subsequent years—
In lieu of all the foregoing expenses, including depreciation, there may be allowed
a charge of 4^4c a mile for mileage covered in the performance of professional
duties. Where the car is not used solely for the purpose of earning income the maxi-
mdm mileage which will be admitted as pertaining to the earning of income will be
75 per cent of the total mileage for the year under consideration.
For 1940 and subsequent years where a chauffeur is employed, partly for business purposes and partly for private purposes, only such proportion of the remuneration of the chauffeur shall be allowed as pertains to the earning of income,
(j)  Proportional expenses of doctors practising from their residence—
(a) owned by the doctor;
Where a doctor practises from" a house which he owns and as well
resides, a proportionate allowance of house expenses will be given for the
study, laboratory, office and waiting room space, on the basis that this space
bears to the total space of the residence. The charges cover taxes, light,
address of mortgagee to be stated);
(b) rented by the doctor;
The rent only will be apportioned inasmuch as the owner of the
premises takes care of all other expenses.
The above allowance will not exceed one-third of the total house expenses
or rental unless it can be shown that a greater allowance should be made for
professional purposes.
(k)   Sundry expenses   (not otherwise classified)   — The expenses charged to this
account should be capable of analysis and supported by records.
Claims for donations paid to charitable organizations will be allowed up to
10 per cent of the net income upon submission of receipts to the Inspector of
Income Tax. This is provided for in the Act.
The annual dues paid to governing bodies under which authority to practice
is issued and membership association fees not exceeding $100, to be recorded
on the return, will be admitted as a charge. The cost of attending postgraduate courses or medical conventions will not be allowed.
(1)  Carrying charges;
The charges for interest paid on money borrowed against securities pledged
as collateral may only be charged against the income from investments and not
against professional income,
(m)  Business tax will be allowed as an expense, but Dominion, Provincial or Municipal income tax will not be allowed.
i f «
Professional Men Under Salary Contract
3. It has been held by the Courts that a salary is "net" for Income Tax purposes.
The salary of a Doctor is therefore taxable in full without allowance for automobile
expenses, annual medical dues, and other like expenses. If the contract with his employer
provides that such expenses are payable by the employer, they will be allowed as an
expense to the employer in addition to the salary paid to the assistant.
Page One  Hundred Vancouver Medical  Association
President . ; Dr. H. A. DesBrisay
Vice-President j . 1 , Dr. G. A. Davidson
Honorary Treasurer—I  ! . ,L_Dr. Gordon Burke
Honorary Secretary j ^ Dr. Gordon C. Johnston
Editor  . ; Dr. J. H. MacDermot
HISTORY OF V.M.A. (Continued)
The following members of the Vancouver Medical Association have from time to
time served on the City School Board as Trustees. Dr. W. J. McGuigan, 1887-1888,
1897-1903; Dr. W. D. Brydone-Jack, 1895-1900, 1902-1903, 1908-1913; Dr. W. B.
McKechnie, 1904-1906; Dr. McTavish, 1915; Dr. T. P. Hall, 1918-1919; Dr. Nicholson, 1904-1926.
The earliest medical supervision of school children in Vancouver was done by Dr.
Glen Campbell. In 1902 he conducted classes for teachers, instructing them in simple
methods of detecting impairment of vision among the pupils. In 1907 we find Dr.
Georgina Urquhart serving as a part time school medical officer, making an attempt
av physical inspection of the 6,000 children who comprised the city's school population
at that time.   Her appointment had no permanency.
From 1906 on, the Medical Association constantly pressed the City Council to institute medical supervision of schools. In 1908 the Society recommended the appointment of an assistant to the Medical Health Officer, one of whose duties would be inspection of schools. It was only when the Provincial School Inspection Act was passed
that the Council was forced to take action. In the autumn of 1909 the Medical Association was asked to submit to the Council a list of four names from among its
members—two men and two women—from which group a School Medical Officer
would be chosen. Duties were to commence in January, 1910. The Society forwarded
the names of Drs. Dyer and F. W. Brydone-Jack. The latter received the appointment.
During the same year the first school nurse, Miss Breeze, was appointed.
In 1912 Dr. A. W. Hunter was named Assistant S.M.O., and in 1914, with 31
schools and 13,000 pupils to look after, Miss Belle Wilson was also added to the staff.
Later in this year Dr. Hunter resigned to go on active service. In 1918 Dr. Brydone
Jack retired and his place was taken by Dr. Wightman, who remained in office until
1922, when he too resigned, and was succeeded by Dr. Harold White.
During the years immediately succeeding Dr. White's appointment the city's
school population grew rapidly and the work, of the medical staff was greatly extended.
In 1924 diphtheria toxoid clinics were opened. Dental attendance ill the schools, which
had begun in a small way as far back as 1914, was expanded. Summer open air schools
for debilitated children were conducted from 1926 until 1933, when the depression
forced their shut down. In 1930 the preventive treatment of goitre was undertaken
in the schools.
In 1929 there took place the amalgamation of Vancouver City with South Vancouver and Point Grey. P** G. A. Lamont, who had been S.M.O. for South Vancouver,
and Dr. Dykes of Point Grey, now served under Dr. White as Chief School Medical
Officer. The depression of the early thirties retarded the work of the School Medical
Staff, eliminating the Dental Clinics and reducing the work of the nurses to part time.
Dr. Dykes also retired owing to shortage of funds. The services progressed, however,
and in 1933 we find the first skin tests for tuberculosis being made in the schools.
Page One Hundred and One Up until 1936 the School Medical Services had been conducted as an independent
unit, but in November of that year, with the formation of the Metropolitan Health
Board, it became a part of that organization. The health services of Vancouver City,
North Vancouver, Richmond and the University Area were united under the following
officers: Dr. J. W. Mcintosh, City Health Officer; Dr. E. Carder, Assistant Health
Officer; Dr. Harold White, Director of School Health; Dr. Stewart Murray, who in
May, 1936, had been appointed to the school Medical Staff, was now made* Director of
Mental Hygiene and Child Welfare. Burnaby and West Vancouver came under the
Metropolitan scheme in 1937, and the entire area, for purposes of school supervision
was divided into Units, with a Medical Officer in charge of each.
In 1937 Dr. Carder died. Dr. Murray was now made Assistant City Health Officer,
and Dr. Kitching came on the staff as School Medical Officer of Unit No. 3. When
Dr. Mcintosh resigned in 1938, Dr. Murray was appointed Senior Health Officer, with
Dr. Kitching as his assistant.
The medical supervision of the schools of Greater Vancouver has, under the Metropolitan Health Services, today become a huge enterprise. Heading the organization is
Dr. Murray, assisted by Dr. Kitching. Dr. Gundy, who succeeded Dr. White when the
latter resigned in 1945, is now Senior School Medical Officer, with Dr. Willett as his
assistant. Under them are seven full time School Medical Officers and three serving
part time. They are assisted by a staff of fifty school nurses. Six full time dentists
are in charge of the various clinics distributed throughout the Metropolitan area. This
highly-trained personnel watches over the health of every school age boy and girl in
Vancouver. The organization has advanced a long way since Dr. Brydone-Jack, unassisted, took over the work during that January of 1910..||(The assistance of Dr.
White and Dr. Kitching in preparing this article, is gratefully acknowledged.)
r m
The Eighth Annual Spring Post Graduate Course in Ophthalmology and Otolaryngology will be held in Portland, April 7-12, 1947. Another fine program has been
arranged by the Oregon Academy and the University of Oregon Medical School. We
are particularly fortunate in having two outstanding men in their respective fields as
guest speakers:
Dr. John Dunnington, Professor of Ophthalmology at Columbia University, New
York City^ Member of the American Board of Ophthalmology.
Dr. George Shambaugh, Professor of Otolaryngology at Northwestern University at
Chicago, Illinois.
There will be lectures, clinical demonstrations and ward rounds.
Wives invited, social activities will be arranged later.
Preliminary programs will be out about March 1st and yod may secure yours, and
further information, from Dr. Harold M. Uren, Secretary, 1735 N. Wheeler Ave.,
Portland 12, Oregon.
Important: In order to make the course more personal and practical we will be
forced to limit registration to 125.
Page One Hundred and Two REVIEW OF 422 CASES OF "STERILITY"
'        - '. IN PRIVATE PRACTICE 'flS"
(Read before V.M.A. Association December, 1946, by Dr. Gardner Frost.)
I have chosen the subject of sterility in the female this evening because, in my
opinion, it is one of the greatest problems that we have to treat in our office practice.
It has been estimated by various authorities that 13 to 17%, or one in every eight
marriages, is barren.    From these figures you can realize what a problem sterility is.
Another reason for this paper, although a personal one, is that my father, Dr. Anson
Frost and myself have wished to know
(1) How many of our "sterility" patients had become pregnant, and
(2) How we could improve our results, and
(3) What further investigations we might carry out on our patients in the light of
more recent research in this problem.
I shall attempt first to describe briefly our general treatment, next to give our results, and finally to outline a basic programme to be used by us in all our cases in the
Our plan of examination and treatment in the past has been,
First, of course, a general physical examination.
A rputine chest plate; if this has not been done in the past year, a routine blood
Wasserman and complete blood test. f;'ifei
A sedimentation rate.
A cervical and vaginal smear which is sent to the Government Laboratories.
A B.M.R. is done on all patients.
All retroversions were fitted with Finlay Smith pessaries.
All local pelvic conditions, naturally, were treated, such as cervicitis, vaginitis, etc.
Inductotherm was used on all those with salpingitis or a history of salpingitis.
All were given thyroid extract, unless contra-indicated by the B.M.R.
Vitamin E was given to most patients and sodium benzyl benzoate was used a.good
deal, its role being that of an antispasmodic.
Now our results. We have taken all patients that came into the office with the
complaint of sterility, from 1938 up to the present time—an eight-year period.
(Numerous slides.were shown.    These are summarized here.)
Slide No. 1—In all, there was a total of 422 women who sought treatment for
sterility. In this study, our criterion for sterility is based on those who have been attempting to become pregnant for one year or longer. Consequently, we have not included those cases who came complaining of sterility of under one year's duration.
There has been no follow-up study of these patients whatsoever. Some, no doubt, have
sought treatment elsewhere and some, no doubt, have become pregnant.
Of these 422 patients 110 or 26% have become pregnant.
The average number of visits for all these patients was 7.3. The average number
of visits for those who became pregnant was 7.2.
Slide No. 2—There were 286 cases, or 67.7% of the total, with primary sterility,
and 72, or 25.5%, of those who became pregnant.
There were 136 cases of secondary sterility, or 32.3% of the total, with 37 or 27.2%
becoming pregnant.
Page One Hundred and Three There were 73 patients who made only two visits—the shoppers, as we call them—
if these could be excluded, then 31% of our patients would have become pregnant.
However, in a study of this nature, these cases must be included in our totals.
Slide No. 3—This slide shows the average duration of sterility in years. One can
see from this that the great majority seek treatment within the first five years. One
would think the graph would be reversed, that is, the longer the duration of their sterility, the more anxious they would be to seek treatment, but apparently, by this time,
they have either adopted children or have given up hope of ever becoming pregnant.
Slide No. 4—Of the 110 patients who did become pregnant, there were 83 full term
living children, with two sets of twins.
14 are not yet delivered.
One premature separation of the placenta with resulting stillbirth.
One ectopic. j£|~
One hydatidiform mole, and
11 abortions, or 10% of the total.
This high rate of abortions is in agreement with other authors and shows that
abortions occur much more frequently in sterility cases.
As a result of this study, we are treating our sterility cases who become pregnant
as potential aborters and give thyroid, Vitamin E, more rest and large doses of corpus
luteum extract.   In this way we hope to reduce the incidence of our abortions.
Slide No. 5—And now we come to the male side of the problem for a few moments.
Of the suhbands of these 422 patients there were 129 or 30.5% examined. These men
129 husbands who were examined 45 or 34.8% were found to be abnormal. Of these
were not examined by ourselves, but referred to various urologists in the city. Of the
abnormal cases 14 or 31% had no spermatozoa; 27 or 60% had only a few, and in 4
or 9% only non-motile forms were present.
In this small study we have one-third of our patients, who have husbands with a
gross abnormality in their spermatozoa. Although we were aware of the high incidence reported where the male was at fault, this high percentage in our figures was
quite a surprise.
As a result of these findings, we are going to, more than ever, impress upon the
patient at her first visit, the importance of the male factor in sterility, and to halve
the husband examined as soon as possible.
It is a peculiar trait of the male that he never thinks that the fault in his sterile
marriage might be his. Seventeen husbands flatly told their wives they would refuse
to be examined. No doubt, there were many more than the proud wife would not
Slide No. 6—We next wished to know if those husbands who had abnormal spermatozoa and were under treatment, could be made fertile, and if so, were their offspring
Of the 110 patients who did become pregnant. 15 or 13.6% of the husbands were
10 of their wives had normal, full term children,
3 are not yet delivered,
1 had an abortion, and
1 an ectopic.
One can see from this, that because the male is abnormal and has received treatment, his offspring are not any more likely to be abnormal than those of his healthy
As you are aware, it is impossible for anyone to say definitely why one patient becomes pregnant and the other one does not. Most patients have many factors that may
account for their sterility and all one can do is to attempt, to treat these factors one
by one.
Page One Hundred and Pour
>   «i Consequently we have classified these factors under six groups:
I. Constitutional Factor.
II. Vaginal Factor.
III. Cervical Factor.
IV. Uterine Factor.
V. Tubal Factor.
VI. Endocrine Factor.
Slide No. 7—Constitutional Factor. It is a remarkable fact that nearly all sterility
patients appear to be in excellent condition by general physical examination.
You will note that we have placed obesity in the constitutional group rather than
the endocrine group. True, some of them may be purely endocrine cases, but a good
many we feel are normal women who just love to eat, and with diet and thyroid over
one-third of them become pregnant.
Slide No. 8—Next we come to the vaginal factor—where one finds congenital defects, vaginitis; probably the most common cause being trichomonas, the next yeast infections, then mixed infections.
The vaginal secretions in these cases tends to be much more acid than that of a
patient ,with vaginitis, and this in turn is much more likely to cause early death to the
In only five cases was gonorrhoea found on the taking of routine smears of the
cervix and vagina.
Slide No. 9—Cervical Factor. In the cervical factor group we find erosion 51 times,
with 12 patients becoming pregnant.
Stenosis 42 times with 11 patients becoming pregnant.
Cervical polyps six times, and
Endocervicitis 21 times, with six patients becoming pregnant.
It is in this cervical factor that I feel we can improve our results.- The importance
of the cervical mucus at the time of coitus, in helping the sperm along its way and
probably supplying it with nourishment is becoming more and more apparent.
Wm. Cary, who is in charge of the New York Hospital Sterility Clinic, states that
2 3 % of sterility is due to this factor alone.
He divides the abnormality of the cervical mucus into three groups.
FIRST—The grossly infected cervix and endocervix with profuse muco-purulent
discharge.    This type is treated with either electrical coagulation or the actual cautery.
It is far better to coagulate lightly several times than to put the patient into the
second group which has a lack of, or decrease in, the amount of cervical mucus. This is
quite often the case if too thorough a cauterization or coagulation is done.
The third group with abnormal cervical mucus, and the largest of the three, are
those patients who, when examined around ovulation time, instead of showing the clear,
thin, semi-fluid, normally occurring mucus, have a thick, tenacious and at times cloudy
mucous plug in the cervical canal. This condition is due to a very low grade infection
of the endocervical glands, which causes them to secrete a thick cloudy mucus. Treatment is simple, but often prolonged. The cervical canal is massaged with a dry applicator and then with an applicator soaked in one or two per cent Ag NO 3. Stronger
antiseptics may destroy the glands rather than stimulate them. Gentle cervical dilation
with small dilators is necessary if the abnormal mucus is associated with cervical stenosis.
Treatments are usually given twice a month, over a period of several months.
Coagulation or stronger antiseptics are resorted to in only the few cases who are
entirely resistant to treatment.
In order to prove the fact that the cervical mucus is not infected, not acid, and not
antagonistic to the spermatozoa, we are now employing the Huhner's test routinely,
in all our patients.    This test must be done at the time of ovulation because it is at
Page One Hundred and five this period of the cycle, that the cervical mucus is alkaline and most receptive to the
We ask the patient to have intercourse in the morning, and examine her as early
as possible that afternoon. A small glass canula is inserted into the cervical canal and
the contents aspirated and examined under the microscope. Normally, one should find
four or five motile spermatozoa per h.p.f. several hours after coitus. If we find this
we can conclude that
(a) The cervical mucus is compatible with the sperm.
(b) There has been adequate delivery of spermatozoa into the cervical canal.
Another test which we are now routinely using when the husband will co-operate is
the Kurzrack-Miller test. This is simply placing a drop of freshly obtained seminal
fluid, on a slide, side by side with a drop of the patient's endocervical mucus.
Another slide is gently placed on top, thereby compressing the two drops so that
they meet.
Normally, the spermatozoa can be seen, under the high power, to gather at the
border of the cervical mucus, two or three rows deep, and begin to invade it. The
object of this simple test is to ascertain the ability of the sperm to penetrate the cervical
mucous plug. If the mucus is infected, acid or incompatible to the spermatozoa no
invasion of the sperm will be found.
Another form of treatment that we are now using is the pre-coital douche of isotonic
glucose in Ringers solution. It has been shown that the spermatozoa metabolize sugar
and that this douche not only lessens the acidity of the vagina, but enhances the sperms
chances of survival and of their migration up into the cervical canal.
We prescribe vials of nutraortho, put out by the Orth company, one vial being dissolved in a pint of warm water and used as a douche.
Next we come to the third factor—the Uterine Factor. Wjjjk
Out of 422 cases there were 236 patients who had some degree of retroversion.
Some authorities say that retroversion is not a cause of sterility. We agree with others
who feel that it is indirectly a cause in some cases.
First, because with a retroversion, the cervical os is pointing upwards behind the
symphysis, and cannot be bathed in the seminal pool in the posterior fornix of the
vagina. §||
Second, because the retroverted uterus tends to become oedematous and boggy, especially if bound down by adhesions, causing congestion of the endometrium.
Third Third, because the tubes may become kinked upon themselves, causing some
degree of swelling and probably some obstruction.
In our series of seven patients, who had a retroversion and were seen only once,
and in whom a Finlay-Smith pessary was inserted at that visit, became pregnant. Simula rly, nine patients became pregnant after the second visit. There were other factors,
of course, such as erosion, vaginitis, etc., and some were given thyroid, but, we feel
that the retroversion may have been a contributing factor in these patients not becoming pregnant.
Slide No. 11—Operation for retroversion and insertion of stem pessary was advised
only as a last resort, after previous treatment, over a period of time, had failed to bring
results. As well as doing a uterine suspension, the ovaries were also suspended to the
uterus, near the round ligaments.    Of 19 such operations 7 or 36.8% became pregnant.
Slide No. 12—Next we come to the Tubal Factor. 21 patients out of the 422 admitted having one or more criminal abortions, six of whom became pregnant. 17 gave
a history of previous operation for salpingitis—none becoming pregnant.
47 had salpingitis, either clinically or found at operation. 11 or 23.4% becoming
pregnant. pP|
Page One Hundred and Six
H m i i
41 t
There were five proven endometrioses and one became pregnant which is rather rare.
One with T B of the tubes was found.
Slide No. 13—The Tubal Insufflation test was done in 129 patients with 36 or
31.9% of these becoming pregnant. Not only was this done with a view to diagnosis
but also as a therapeutic agent.
Partial or complete tubal occlusions may be due, to mild endosalpingitis, to mucous
plugs, adhesions, maybe sequelae to pelvic infections or due to kinking and tortuosities
due to malposition of the uterus.
It has pretty well been proved clinically, especially by Rubin, that tubal insufflation
sometimes does relieve these slight obstructions.
Accordingly, we do repeated insufflations on patients at the estimated time of
ovulation, hoping that the tube smay be cleared of mucus or small adhesions broken
Slide No. 14—Lipiodol Injection. Although the injection of Lipiodol was first done
20 "years ago, recent literature stresses the therapeutic value of this test. Such authorities as Green-Armitage in England, states that of 2000 patients in which this was done,
when one or more Fallopian tubes were patent, 30% of his public and 40% of his
private patients became pregnant. American results are in substantial agreement with
It is thought that the iodine in the oil acts therapeutically on the lining of the tubes
and uterus. The oil itself is thought to break down adhesions and relieve kinks in a
similar but more efficient manner than air insufflation. Some authorities go so far as
saying that lipiodol injection is the best therapeutic agent we have at our disposal for
the treatment of scterility.
The injection of oil will also reveal any subserous fibroids and will accurately locate
the site of obstruction in the tubes. As a result of these recent reports, we are now
routinely doing salpingograms on all our patients unless contra indications exist, such
as infected cervix, endocervicitis, or those with a recent history of tubal or uterine infections.
Slide with Instruments, X-ray Slide, No. 16—We do the instillation on the radiologists table. It takes aboue 15 minutes to do and if simple sterile precautions are taken
is relatively free from any risk. Our figures, about 25 to date, are yet too recent to
Slide No. 17—Endocrine Factors.
There were 3 5 patients whom we noted clinically as having an infantile uterus and
cervix, eight of whom became pregnant. In three patients there was amenorrhoea.
None became pregnant.
Obesity probably should come under the endocrine group, but with thyroid and diet
this can, in a good many cases, be corrected. As I have said previously, we classified
these under the constitutional factor in this study.
If an endocrinologist could get hold of these patients, we would no doubt have a
much higher percentage of endocrine factors present.
So much has been written, and such a glowing account given of the cure of sterility with this or that hormone, only to be refuted again in another article. The canons
of sound endocrinology do not hold such optimistic views. The one exception, however, is thyroid extract. Novak of Baltimore, Litzenberg of Minneapolis, Mussey of
Mayo, all agree that thyroid medication in sterility and abortion is often more efficacious than any other form of organotherapy. >|||
We do a B.M.R. on all our patients and all are given some degree of thyroid therapy
unless hyperthyroidism is present. We feel we are groping in the dark and hoping for
the magic cure when we use other hormone preparations. We have used all of them
at some time or other. They may have aided some in becoming pregnant or they may
have done the opposite.   Some say that a holiday is "more effective than any hormone.
Page One Hundred and Seven Next in the line of endocrine investigation is to discover whether our patient is
ovulating or not. In the past year we have been doing an endometrial biopsy routinely.
This of course must be done a day or two previously to the expected period. If ovulation has occurred the endometrium will be in the secretory phase. We have done 22
biopsies to date, 19 of them showing a normal secretory, two showing inadequate phase,
three showing syperplasia and one with hypoplasia.
Slide No. 18—We use the Novak biopsy curette in these cases. It can easily be
done in the office without any cervical dilation for anaesthetic and causes no more discomfort than tubal insufflation.
Slide No. 19—Another method of determining whether ovulation has occurred or
not is a daily basal temperature reading. We give each patient a printed tempperature
chart (put out by Ortho Products) and she records her daily morning temperature.
The general trend of the temperature will rise at ovulation time, which is about 14 days
prior to her next expected period. This is especially helpful in determining the time of
ovulation in patients with irregular menses. Some authorities say this is more reliable
than the uterine biopsy.
A word about direct insemination. We have done only a few cases in the past,
with no successes, but we plan to do more in the future, if the patient and husband
are normal and all other forms of treatment fail.
Slide No. 20—In conclusion our general plan of attack in all our sterility cases is,
besides general physical examination and B.M.R. and Rh. Factor:
(1) Precoital douche.
(2) Basal temperature to be charted by patient.
(3) More insistence on the male being examined.
(4) Huhners Test.
(5) Kurzrak-Miller Test.
(6) Tubal Insufflation.
(7) Salpingogram. gl"
(8) Endometrial Biopsy. }£$*
In this paper on Sterility my discussion has been based entirely on cold, bare, objective clinical findings and investigation.
There is another side of sterility however—probably just as important—of which I
have said nothing—that is the subjective or psychological side. In this group there
comes vaginismus, frigidity, dyspareunia and so on. Also we are familiar with the
patient who became pregnant when the nagging mother-in-law moved out, or when the
highrstrung worried business man takes a less responsible position or a holiday.
We ourselves have delivered three patients in the past year who became pregnant
after having adopted a child.
I have only formulated a basic programme by which we clinically investigate all
our cases. The psychological factors are put together piece by piece as they are discovered, hoping to complete this jig-saw puzzle of sterility.
1. Fertility in Women, Siegler. J. B. Lippincott Co., 1944.
2. Management, Sterility, A. S. Parker Jr. Surgical Clinics of North America,
June, 1945.    Pages 566-581.
3. Causes of Sterility in Women and Infertility in Men, Charles M. McLane. The
Journal Lancet, vol. LXIV, No. 10.
4. An Analysis of Sterility Studies in the Female. Roy E. Meodemes, LeRoy F. Rit-
miller.    Am. Jr. O.B. and Gyn, Vol. 49, 1945, 95-100.
5. Sterility, F. A. Bellingham, Med. Jr. of Australia, Vol. 1, Feb., 1945, pages
Page One Hundred and Eight 6. Effort and Result in Sterility—An audit of 407 cases.    Alan Grant, Mer. Jr. of
Australia, Vol. 1, February, 1945, pages 134-138.
Vol. 1, Feb., 1945, pages 138-142.
7. General Aspects of Sterility in the Female.    J. W. Johnstone, Med. Jr. Australia,
8. Hystero Salpingography in Sterility, Colin MacDonald, Med. Jr. Australia, Vol 1,
Feb. 10, 1945, pages 142-144.
9. Lessons and Virtues of Salpingography.  V. B. Green-Armytage, Jr. of O.B. and
Gyn. of B. E., Vol. 50, Feb., 1943.    Pages 23-26.
10. Some Recent Studies and Investigations in Sterility.   Albert Scharman Jr. O.B.
and Gyn. of Brit. Empire.   Vol. 51, No. 2, April, 1944.
11. The Sims Test.   Mary Burton, B. Wiesner, the Lancet.   Vol. 2, Oct. 28, 1944.
Pages 563-565.
12. The Endocrines in Relation to Sterilityand Abortion.   Jennings and Litzenberg.
Jour. A.M.A., Dec. 4, 1937.   Vol. 109, No. 23.    Pages 1871-1873.
(Given at V.M.A. Meeting of December 3, 1946.)
In the treatment of disease from bacterial invasion, we have all used to a greater or
lesser degree, most of the Sulpha Drugs, and latterly Penicillin. More recently using the
latter by mouth and the single daily injection in wax and oil, one is able to treat more
and more cases without hospitalizing them. This, in these days of acute hospital bed
shortage, is certainly something.
There seems little room for doubt that we are indeed, if not in the age of major
miracle, truly in the age of minor ones. However, it would seem from cases seen that
we cannot rely altogether too much on one or even the two widely known agents as
absolute cure-alls. We must not let the warnings in the literature go unheeded as Cassandra-like pleadings in vain for improved surgical and aseptic technique.
It is particularly on gynaecological conditions that I wish to lay stress tonight, but
while the pelvic inflammatory process is peculiar to the female in its anatomical pathological considerations, it is not unlike any other general disease formation elsewhere in
the body.
So fast has the advancement been in the use of the various Chemotherapy agents,
that in culling over recent literature I found that little has yet been written on pelvic
inflammatory disease with reference to combined Chemotherapy. So recent a paper as
one published in September, 1946, did not mention Penicillin. There has been, though,
a marked drop in the number of cases in which resort has finally been made to surgery
to establish a cure, so-called.
There will no doubt be a great flood of literature soon, when clinics with sufficient
cases and experience can assess the cases arid findings in the full light of time.
For purposes of discussion there are cases we have seen which seem to fall into fairly
well-defined groups.
There are the acute cases of V. D. G. and post-abortal sepsis which respond to sul-
phanamides, or if not, do so to Penicillin or a combination of both. These clear up
rapidly and leave no calling cards in their wake. It is not of these that I wanted to
speak particularly tonight. Rather it is of those that either do not respond to early
treatment or have not had early treatment, and are seen with a full-blown acute P. I. D.
—Pelvic Inflammatory Disease, if one does not care for the use of abbreviations. The
diagnosis, shall we say, has been made by history, clinical and laboratory findings.
Page One Hundred and Nine In casting about for a title for the paper, several came to mind, and "Melting the
Frozen Pelvis," while apt, seemed too dramatic. To many here tonight, the words
"Frozen Pelvis" no doubt conjures up memories of cases with pain, heartache, wearisome
treatment, and for most the castration by surgery as the final sequence of events. Of
many others who have more recently graduated, there might be some acquainted with
the phrase and others not, as evidenced when recent graduates in the forces asked what
I meant by "Frozen Pelvis."
Pelvic infection of this type has most commonly reached the pelvic peritoneum by
way of the lymphatics of the broad ligament, although there may be a direct extension
through the uterine wall. That is, the parametritis usually precedes the peritonitis.
The organs involved lose their motility as a consequence. On examination per vacinam,
the cervix is fixed and painful to pressure. The fundus of the uterus is completely lost, both vaults usually are splinted or may be depressed. The entire pelvis may
seem to be one mass of irregular cellular exudite. Per rectum the finger passes
through a ring of exudate at the level of the internal os of the uterus and the rectal
or combined rectovaginal examination is very painful. The word "choked pelvis" i's
sometimes used and is descriptive. Abdominally, masses arising to varying degrees toward the level of the umbilicus are the common finding.
Formerly these cases after a long stormy course, with or without actual abscess formation, the former doing better for the most part when abscess formation pointed to
the cul-de-sac and could be drained, finally resolved in varying degrees of chronic frozen
pelvis. Heat in the form of hot douches, milk injections as mild protein fever thejrapy,
and later diathermy were of not too much avail, and many were the cases in which as
a last resort, a complete clean-out was done. Many were made tolerably well, but before
the advent of hormonal therapy, suffered the pangs of surgical menopause to the full.
Many were physically able to go back into their respective ways of life as at least more
valuable members of the community than they had been when first presenting themselves as pelvic cripples. Not an inconsiderable number were actually in the forces,
where only by chance accident was it found that radical surgery had been done prior
to enlistment.
However, it is to be hoped the above picture will be seen less and less. The following two cases would suggest this. The fijrst case had been one of rather more than
passing interest. A vexatious thorn in the side of the V. D. Control, as all of three
different male cases of V. D. G. had been stated to have come ffom this source. On
each separate occasion the individual had been sent for smears and cultures, and these
were reported negative both before and after a course of sulphonamides. Pelvic examination had failed to reveal any sign of a chronic pelvic inflammation; these examinations we're done by two reputable men on the first two occasions and by myself on
the third. This, mind you, before the advent of Penicillin. The patient was discharged
to her unit, but arrived back in hospital some three weeks later a very sick girl. A
high temperature, bilateral masses of typical acute salpingooophoritis and pelvic peritonitis with lower abdominal wall rigidity, the bilateral masses the size of large grapefruit. Again, as so often seen, the patient was clinically more sick than her general
appearance would suggest. Smears this time were positive, and Penicillin, now available for V. D. G. was given; 100,000 units, repeated in six hours by 50,000 units for
a total of 400,000 units.
The masses became increasingly large and were practically up to the umbilicus. Heat
in the form of hot foimentations and linseed poultices, and general supportive measures,
were instituted from the first and were kept up. In a few days the acute phase subsided, but a frozen pelvis with the large masses remained. In some three weeks the
sedimentation rate which originally had been well over 100, gradually dropped to about
50 arid the masses had decreased to about the size of grapefruit. Five weeks later the
sedimentation rate had dropped to below 25, and it was felt safe to start short wave
treatments.    This was given for some fifteen minutes every third day for some eight
Page One Hundred and Ten f*,
. 'II
doses, with a lay-off three days before expected menses, and not started until three
clear days after the period.
While in bed the patient had bed exercises which kept her extremity muscles in fair
tone, and Occupational Therapy was a great help to her morale. Some eight weeks after
admission, the patient was up on the second day after treatment and was discharged to
convalescent centre after some ten weeks of hospitalization. On discharge, examination
disclosed bilateral tubal masses size of hen's eggs, some residual pelvic pain and dy%-
menorrhoea. At that time assessment was made and recommendation made as unfit for
further service.
On her return some four weeks later for Medical Board, pelvic examination disclosed
some bilateral thickness only, very little tenderness, and history of only slight dysmenorrhea with her last period. She subsequently returned to her home in the interior
where further history is lacking. It is possible she may have had another flare-up, but
in view of the above, one is hopeful that she is not the pelvic cripple she might well
have been.
It is interesting to read of some of the work done in England regarding the possible
change in staining qualities of the Gonococcus following sulphonamide therapy, and one
wonders if that might not be at least part, if not the whole answer to the so-called
negative smears some of those reported V. D. contacts had.
The second case which typifies our changed concept of the condition was a young
recently married woman, 21 years of age, admitted with an acute abdominal condition*
first suspected as a possible ruptured appendix. Her appearance, first history and clinical findings suggested this, but further history disclosed that prior to the onset there
had been a heavy discharge, and smears and cultures were reported as positive for
V. D.^J&sxPemc^in^isKss^^vcn in^sfweseabed doses ass-therpatient^had -beensunable to
tolerate sulphonamides. Within forty-eight-hours a rather amazing change took place.
The peritonitis subsided and a pelvic examination seventy-two hours after admission
disclosed bilateral masses, size of a large orange on the right and a pullet's egg on the
left, with bilateral parametritis. A diagnosis was made of bilateral salpingo-oophoritis
of specific origin. Again general supportive measures as previously mentioned were
taken, and when some four weeks later the sedimentation rate which on admission had
been 160, had fallen to below 25, short wave therapy was instituted. Some five weeks
later she was discharged to the reconditioning centre with only slight residuatf bilateral
thickening and moderate pelvic tenderness. She returned in six weeks to say she had
missed her menstrual period, and pregnancy suspected was confirmed by Frog test.
Later she wrote to say she was safely delivered and well.
This might well be the outcome for these types of cases in the future, but I venture
to say was a rare occurrence before the advent of chemotherapy.
However, to remind us that there are still certain cases that chemotherapy is only
of some value and that good technique and careful handling of cases are still primary
requisites.   Let me cite one other case.
There was a young married woman of 26 who was unfortunate enough to have an
incomplete abortion while travelling. She was taken off the train and rushed to a small
hospital in rural Ontario. Then some three days later a D. & C. was performed and
she was discharged from hospital some six days later apparently well enough to travel.
That same evening she became very sick, with chills, fever, and lower abdominal pain.
She had received no chemotherapy. Diagnosis was made of post-abortal pelvic peritonitis. Briefly, she was placed on Penicillin, 50,000 units stat. and 25,000 units every
three hours, and sulphadiazine, a gram, two every four hours. On admission there was
some lower abdominal tenderness and rigidity, and pelvic examination showed bilateral
thickening, acute tenderness on moving the uterus, and a slight amount of sanguinous
discharge. Despite treatment, the patient's condition became progressively worse.
Vomiting became marked and so sulphonamides were discontinued, and patient given
intravenous glucose salines and transfusions, as her blood count was down.    A gross
Page One Hundred and Eleven For the high dosage essential to the oral route
A  NEW   50,000  UNIT TABLET
"Provided enough is used'. . . the
oral route of administration of penicillin ... is an effective way to treat
infections" . . . requiring "five times
as much, on the average . . ."l
Parenteral medication should be used
in the initial stages of acute infections,
however, and Tablets Penicillin Calcium may be used effectively in the
convalescent period following the
remission of fever.
The new 50,000 unit Tablets
Penicillin Calcium Squibb simplify
oral therapy by providing in a single
tablet 50,000 units of the calcium salt
of penicillin combined with 0.5 gm.
For Literature write
trisodium citrate to enhance absorption as well as to attain "less irregular,
higher and more prolonged blood
levels. "2
You can prescribe the precise number of tablets needed without fear of
potency deterioration. Each tablet
of Penicillin Calcium Squibb is individually and hermetically sealed in
aluminum foil. Economical and convenient.  Packages of 12 and 100.
1. Bum, P. A.: in Conferences on Therapy: New
York State J. Med. 46.527 (March 1) 1946.
2. Gyorgy, P.s Evans, K. W.; Rose, E. IC;
Perlingiero, J. G., and Elias, W. F.: Pennsylvania M. J. 49:409 (Jan.) 1946.
TORONTO  Riogepesiliniypochromic anemias
i «
Studies of clinical hypochromic anemia treated with molyb-
denized ferrous sulfate (Mol-Iron) reveal the therapeutic superiority of this form of medication over ferrous sulfate alone
in equivalent dosages:
QUICK RESULTS—Normal hemoglobin values are restored more
rapidly, increases in the rate of hemoglobin formation being
as great as 100% or more in patients studied.
COMPLETE UTILIZATION—Iron utilization is similarly more
BETTER TOLERATED—Gastrointestinal tolerance is excellent—
even among patients who have previously shown marked
gastrointestinal  reactions  following oral administration of
other iron preparations.*
White's Mol-Iron is a specially processed, co-precipitated complex of molybdenum oxide 3 mg. (1/20 gr.) and ferrous sulfate
195 mg. (3 gr.). Bottles of 100 and 1000 tablets.
«k 4
*Healy, J. C.: Hypochromic Anemia: Treatment with Molybdenum-Iron Complex, The
Journal-Lancet, 66:218-221 (July) 1946.
»5«t ttMMMtWt *
,// i h
I B.D.H.
each capsule contains
Vitamin A
1,500 int. units
Pro-vitamin A
1,500 int. units
Vitamin D
600 int. units
.Thiamine Hydrochloride (Vitamin Bi)
1.2 mgm.
Riboflavin (Vitamin
B2).....    1.0 mgm.
10.0 mgm.
Ascorbic Acid
(Vitamin C)
2 5.0 mgm.
each tablet contains
Ferrous   Sulphate   Exsiccated
. B.P 2.0 grains
Calcium Phosphate
B.P 2.0 grains
To preserve the thiamine hydrochloride
from the known destructive action of iron
salts, Dietary Supplement B.D.H. is presented in two parts—
the vitamins in capsules and the minerals
in tablets.
• The "ordinary mixed diet" often
fails to supply sufficient 'protective'
foods. Health and well-being may
be effectively safe-guarded by the
daily administration of Dietary Supplement B.D.H.
One Capsule and One Tablet Constitute a
Single Dose
Issued in cartons containing one bottle of
100 capsules and one of 100 tablets.
71A pelvic cellulitis developed and extended to a good hand's breadth above the symphysis,
more marked on the right. A typical acute frozen pelvis had developed. After receiving some 700,000 units of Penicillin, the patient developed Giant Urticaria, and while
she had had three transfusions which may have accounted for this, we stopped the Penicillin and the condition seemed to improve, but became worse again on reinstituting
the treatment. A paralytic ileus was successfully overcome with a Miller Abbott tube
and suction, and finally the cellulitis resolved into abscess formation and was successfully drained after pointing into the lateral fornices.
It was felt this patient was in extremis on several occasions, but she was blessed
with a fighting constitution, and even when to top it all she developed a serious pneumonic condition she would not give up and neither did we. Soluthiazole and the oxygen
tent and supportive measures of amigen and glucose-salines finally cleared that up, and
gradually the pelvic condition improved, as did her general condition. After some two
months in our hospital, she was transferred to her local hospital where later she had
short wave treatment, and one heard later that she had finally been discharged to her
home fairly well.
That case was almost a medical education in itself. On looking back now, one
wonders if it might not have been avoided with judicious prophylaxis such as one or
other of the chemotherapy agents. One is perhaps a little lesss enthusiastic about giving
sulphonamides as readily as formerly. They are not without their pitfalls, as you all
know. To date, Penicillin seems to have relatively few drawbacks. One wonders in
that last case whether or not we might have had a batch of Penicillin K. which apparently has no therapeutic value, and may have been responsible for the Giant Urticaria.
In conclusion, Pelvic Inflammatory Disease with all its potentialities is still a factor.
The causes as of old are still with us, and it would seem the post-abortal conditions are
most vicious now. The means to combat it are many more than formerly, and others
are on the way. The attempt to lower its incidence offers indeed a bright star to shoot
at in the field of Preventative Medicine.
That the male could be the offender in an unproductive marriage has been known
for centuries but general interest in the problem has not been apparent until recently.
The writings of Hotchkiss in this country and Jeffcoate in England have focussed attention on the many aspects of the problem. Tonight I would like to review briefly
some of the salient points in the examination and treatment of the non-fertile male.
All these patients should be thoroughly checked, even those who have had children by a
previous marriage. Fertility is always relative, and a high index in one partner may
offset a low index in the other. Also, male fertility is not stable, and may wane suddenly for no apparent reason. There are about 16,000 subfertile males married each
year in the United Kingdom, at a conservative estimate. The comparable figure for
Canada would be above 4,000 per year.
The functional enquiry should be complete with particular reference to mumps,
epididymitis and recent febrile states. An acute fever may cause sterility lasting up to
3 months. In some patients, strangely enough, there is a family history of sterility.
Operations for hernia are sometimes a factor, particularly if repeated. Any exposure
to X-rays or other radiation should be noted.
Detailed enquiry into coital habits is necessary. There is on record the case of the
university professor who did not know that penetration was usual in coitus. The
ejaculation may be premature or there may be none.    The more frequent the coitus,
Page One Hundred and Twelve
If *4- the more chance of pregnancy. If the normal positions are reversed, there is less chance
of the sperm reaching the cervix because of a smaller vaginal pool. Age appears to be
a factor: 200 copulations per pregnancy in the age 20 group, 1500 copulations per pregnancy in the age 40 group.
The general physical examination should pay particular attention to foci of infection. The distribution of hair and fat should be noted. Any local abnormality in the
external genitalia may be a cause of sterility. Hypo- or epispadias, stricture of the
urethra, epididymitis and prostatitis are looked for. It has been shown that sperms do
not survive in the presence of hydrogen peroxide, so if any bacteria which have this as
a by-product are present in the prostate, a relatively low grade infection may result
in necrospermia. Pneumococcus, haemolytic strep, gonococcus, meningococcus and B.
coli can produce hydrogen peroxide. The position, size and consistency of the testes
are noted. Cryptorchids are notoriously sterile. Orchidopexy about or after puberty
has a high percentage of infertility associated with it. The atrophy of mumps is often
obvious but mumps rarely affects the testes before puberty. Medium sized hydroceles
are generally unimportant, but large ones and varicoceles are often associated with
small, soft, atrophic testes.
A complete prostatic smear and urinalysis should be done in all cases and a B.M.R.
is indicated at times. The main feature by which male fertility may be assessed is, of
course, by examining the ejaculate. There should be abstinence for 72 hours before
obtaining the sample.
The specimen can be collected either by coitus interruptus or by masturbation, and
deposited in a clean, dry, wide mouthed bottle. A condom should not be used because
of substances in them which kill the sperm. The specimen should not be subjected to
extremes of temperature before examination. Normally the specimen is a white opalescent liquid containing sago-like bodies which become homogeneous in 10-15 minutes.
A reddish tinge may be due to blood, suggesting tumour or inflammation in the accessory sex glands. The pH of the ejaculate is normally about 7.8 and its volume 4 to
6 c.c.'s. Most of the ejaculate comes from the accessory sex glands and its purpose is
to sustain the sperm until they reach their destination. Less than 5% of total volume
is from testes, vasa and epdidymes. Low volume of ejaculate suggests disease of the
accessory sex glands, loss of time of collection or diverticulum of uretha. It may also
be du to underdevelopment of the prostate and vesicles due to too little testosterone.
The viscosity of the specimen can be checked by dipping an applicator into it and
observing how the liquid clings when it is withdrawn. Increased viscosity impedes the
progress of the sperm and again usually results from infection of the accessory sex
The cell count can be done in much the same way that a W.B.C. is done, using a saturated solution of sodium bicarbonate with 1% phenol as mixer. The average count
in normal fertile males is about 120,000,000 per cc. and below 100,000,000 is regarded
as subfertile. People with counts as low as 3,000,000 per cc. have, however, had children which were probably their own. It is dangerous to tell a man he is absolutely
sterile—the statement may have repercussions.
Examination of the stained smear to distinguish normal and abnormal sperms can
also easily be done. Four general types of abnormal forms are recognized—the tapering or round, the duplicate forms, giant or pinhead forms and amorphous forms. Twenty
to. thirty per cent of abnormal forms is commonly regarded as the high threshold compatible with fertility, but authenticated cases of conception in the presence of 50%
abnormal forms are reported. Wm
An ordinary smear of the specimen will allow the motility of the sperm to be assessed. Each smear will normally show all types of sperms—the healthy, the sick, the
young and the old, the living and the dead, the normal and the deformed.    The more
Page One Hundred and Thirteen aggressively motile large numbers of sperm are in any one field, the better their chances
of surviving the journey.
A decreased number of sperms or oligospermia suggests disease of the testes. Absence of sperm or azoospermia suggests either non functioning spermatogenic cells or a
block. If the obstruction is proximal to the seminal vesicles and prostate, there is no
appreciable diminution in volume of the ejaculate. Testicular biopsy is more accurate
than testicular puncture in finding which is present because of failure to find sperms
in large numbers of normals by puncture.
The complete lack of motility of sperms or poorly sustained motility, the so-called
necrospermia, may be due to improper collection, an inherent defect in the process of
spermatogenesis, a fault in the ripening process in the vasa or epididymes, or malfunction
of the vesicles or prostate. Testicular sperms are non-motile and sterile. They spend
some two weeks maturing in the epdidymes and vasa before they are ready to fertilize
the ovum.
The treatment of the sterile male should be directed to eliminating any of the sterility factors present. Lical disease as urethral stricture or prostatitis should receive appropriate treatment. Any foci of infection should be cleared up. Surgery is advocated in some obtrusive lesions. A short circuiting of occluded epididymus has been
done successfully, and even implantation of a normal vas into a normal epididymis has
been done. Stimulating doses of x-ray to the tests have been tried with reported success.
Hormone therapy appears to be of proven value in selected cases of poor testicular
function. Lack of Vitamin A and E may be responsible for tubular degeneration without affecting Laydig's cells. If this degeneration is complete, it is apparently irreversible.
Thyroid extract should be used if the B.M.R. is low.
The value is the androgens such as testosterone propionate (produced by Leydig's
cells) is questionable. In small doses they appear to stimulate spermotogenesis but in
large doses they depress it. The pituitary gonadotropins, luteinizing follicular stimulating, have a stimulating effect upon both Leydig's cells and the spermatogenic cells. All
hormonal preparations are weak, contain both factions and can be given 4 to 5 times
weekly for 15 weeks, 1000 units daily. All are water soluble so should be given at
least 4 times weekly. One can expect definite improvement in a few cases but cannot predict the response from case to case. None are specific for spermatogenesis. They
should be used only where the people want a child badly, and with no guarantee of any
No hormonal therapy is of any value where the testicular tissues are completely
atrophic as shown by testicular biopsy.
; r ■
The third annual convention of the American Society for the Study of Sterility
will be held at the Hotel Strand, Atlantic City, New Jersey, on June 7 and 8, 1947,
preceding the annual A.M.A. Convention. The convention will include original papers,
round table discussions, scientific exhibits, and personal demonstrations. Registration
for the sessions is open to members of the medical and allied professions.
Additional information may be obtained from the secretary, at the above address.
Page One Hundred and Fourteen
i* w
Members of the profession in British Columbia were sorry to learn of the sudden
passing of Dr. Wilfred Graham of Vancouver who died on February 5th. Doctor
Graham, a graduate of Toronto, 1923, was licensed to practise in this Province in
1927. Deepest sympathy of the profession is extended to Mrs. Graham and family in
their bereavement.
. Deepest sympathy of the profession is extended to Dr. and Mrs. Neil Stewart of Vancouver in the loss of their baby twin daughter.
"We regret to report the passing of Dr. W. A. De Wolf Smith, one of the Province's pioneer doctors, in his 87th year. Doctor De Wolf Smith, a graduate of McGill*
1884, was licensed to practise in B. C. in 1886. He practised for many years in New
Westminster until his retirement, when he moved to Sardis.
From England comes the news that Dr. Harry Winter has been discharged from
the Army and is doing post-graduate work at the Hospital for Consumption and Diseases
of the Chest at Brompton.
Another news item from England comes from Dr. C. S. Rennie, who reports that
he is taking a course in internal medicine at the British Post Graduate Medical School.
Dr. Rennie expects to return to Vancouver to practise. Ipi
We are very pleased to hear that Dr. H. A. DesBrisay of Vancouver has returned
to practice after his recent illness and convalescence in the South.
Dr. Austin Dobrey has recently been made a Fellow of the American College of
Dr. C. C. Jackson, formerly of West Vancouver, has gone to practise in Hanna,
Dr. A. E. Trottier, formerly of Vancouver, has gone to practise in Windsor, Ontario.
Word comes from Montreal that Dr. W. C. Gibson has been discharged from
the R.C.A.F., and is taking a post-graduate course at the Montreal Neurological Institute, after which he expects to return to the Coast.
Dr. S. K. Shapiro, formerly of Vancouver, is visiting the United States where he
will remain to complete post graduate training.
Dr. R. W. Garner of Port Alberni, and Dr. L. H. Appleby of Vancouver attended
a meeting of the Surgical Society in Seattle recently.
Dr. R. D. Nasmyth, formerly of Victoria, is now practising at Alert Bay.
Dr. A. N. Beattie of Vancouver has been appointed Director of the Okanagan
Health Unit with Headquarters at Kelowna.
Congratulations to the following parents on the birth of daughters recently:
Mr. and Mrs. Monty Wood (Dr. Eleanor Riggs), Toronto.
Dr. and Mrs. H. G. Weaver, Sea Island.
Dr. and Mrs. H. F. Inglis, Vancouver.
Dr. and Mrs. G. D. Saxton, Vancouver.
Dr. and Mrs. J. W. Frost, Vancouver.
Dr. and Mrs. G. Schilder, Vancouver.
Dr. and Mrs. H. D. Sparkes, Vancouver.
Dr. and Mrs. Neil Stewart, Vancouver.
and on the birth of sons to:
Dr. and Mrs. G. A. Badger, Hedley
Dr. and Mrs. Austin Dobrey, Vancouver.
Page One Hundred and Fifteen Visitors to Vancouver in February were Doctors C. M. Robertson and W. Laishley
of Nelson; R. G. Large, Prince Rupert; E. J. Lyon, Prince George; J. R. Parmley, Pen-
ticton; F. W. Green, Cranbrook; A. H. Meneely, Nanaimo; A. B. Nash, S. G. Kenning,
D. M. Baillie and F. M. Bryant of Victoria.
Dr. P. W. Semenchuk will be located in Victoria for a period of three months as
locum tenens for Dr. G. H. Grant while the latter is absent from Victoria doing post
graduate work.
Dr. Ethlyn Trapp, President of the British Columbia Medical Association, entertained
at a tea at her residence in West Vancouver, in honour of Dr. T. C. Routley," General
Secretary of the Canadian Medical Association, when he was in the City recently.
A Joint Luncheon of the Vancouver Medical Association and the British Columbia
Medical Association was held in honour of Dr. T. C. Routley in the Hotel Georgia,
February 24th. After luncheon Dr. Routley addressed the members of the Associations,
speaking on the World Health Organization of the United Nations and World Health
Organization.   Dr. John Valens of Saskatoon was a visitor at the Joint Luncheon.
Dr. W. Stuart Stanbury, who is Director of the National Blood Transfusion Service
of the Canadian Red Cross, is spending some weeks in B. C. organizing the local branch
of this Service.
Dr. D. E. H. Cleveland, of Vancouver, recently flew to Los Angeles, where he
attended the joint meeting of the Los Angeles, San Francisco and Pacific North West
Derrnatological Societies.
41 .
Carly Diagnosis of Pregnancy
by the
Ten to fifteen cc. of urine are injected into the ear vein of a female
rabbit which has been segregated for one month. After 36 hours the
ovaries are inspected.  Hemorrhagic follicles constitute a positive test.
Immediate tests can be performed on all urine specimens. Price on
application. Mailing tubes will be sent to Physicians upon request.
TeM.o„e   mMICflL LABORATORY 312 Vaneouver Bloek
r OF
PAeifie 4839Dr> p. s> RUTHERFORD    ' WM£M
Ml #
Page One Hundred and Sixteen t  4
SAFE * Four years of intensive clinical research, with more than 1,400 published cases, have
established Demerol analgesia in labor as a safe procedure. Demerol analgesia is harmless
to mother and baby. It does not weaken uterine contractions or lengthen labor. There are no
post-partum complications due to the drug.
*   *
SIMPLE AND EFFECTIVE • Demerol hydrochloride is administered orally or by intramuscular
injection. Average dose: 100 mg., when the pains become regular, repeated three or four,
times at intervals of from 1 to 4 hours. In analgesic power Demerol hydrochloride ranks
between morphine and codeine,- it also has a spasmolytic effect comparable with that of atropine, as well as a sedative action. It may also be used in conjunction with scopolamine or
barbiturates for amnesia.
'  Trademark Reg. U. S. Pat. Off. & Canada
(Subject to regulations of the Canadian Narcotics Division)
Pharmaceuticals of merit for the phyiscian
Quebec Professional Service Office: Dominion Square Building, Montreal, Quebec The rooster's legs
are straight.
The boy's are not.
The rooster got plenty of vitamin D.
Fortunately, extreme cases of rickets such as the one above illustrated
are comparatively rare nowadays, due to the widespread prophylactic use of vitamin D recommended by the medical profession.
One of the surest and easiest means of routinely administering vitaniin D (and vitamin A)
OILS AND VIOSTEROL. Supplied in 10-cc. and 50-cc. bottles. Also available in capsules,
48 and 192 per package.   Council Accepted.  All Mead Products Are Council Accepted.
Double indemnity
--':lg|       §    A MULTIVITAMIN CAPSULE
and stabilized by mixed tocopherols which assures your patient the indicated
dosage of vitamin A. Vitules also supply adequate amounts of the other
vitamins recognized as essential for human nutrition.
Supplied: Bottles of 30 and 100
Each capsule contains:
Vitamin A Activity*.... 50001.U- V Ascorbic Acid .30.0 mg. V
Thiamine Hydrochloride ....1.0 mg. V Vitamin D ? 5001.U. V
.^^HBH Riboflavin 2.0 mg. V Mixed Tocopherols 3.0 mg. V
Pyridoxine 1.0 mg. V Liver Concentrate (derived from
Niacinamide 10.0 mg. V        2.5 gm. whole liver).... 125.0 mg. V
Calcium Pantothenate 10.0 mg* V Brewers' Yeast 125.0 mg. V
* 1000 units from carotene; 4000 units from fish liver oils.
JOHN WYETH & BROTHER (CANADA) LIMITED    •    WALKERVILLE, ONTARIO <^0* 1/ou* 9wUtated Patient* .  .  .
a non-irritating
stable solution
For local application, in infections of the
nose, throat and ear.
A happy combination of the least toxic
of the sulphonamide derivatives with ephedrine. Its neutral pH renders it nonirritating
to the most sensitive mucosa.
Soluseptazine with Ephedrine, supplied in bottles of 30 cc. and 250
cc, can be applied with dropper or
atomizer, or with the aid of a swab
or tampon.
Samples on request.
JjCLwnxitxnjf I ojujutc ~fxesi£A
OF       CANADA        LIMITED   —   MONTREAL flfoount flMeasant Tanfcertaking Co. %tb.
Telephone FAirmont 0058
VANCOUVER: 13th Avenue and Heather Street        f Air. 0080
NEW WESTMINSTER: 814 London Street |)UJ.  60
We Specialize in Ambulance Service Only
lii iife^
• I
Wight on the Job.. * §
and Performing Efficiently
Neo-Synephrine minimizes the distressing nasal symptoms of
common colds . . . permits patients to work more comfortably
sleep more restfuily— even during the acute stages of coryza.
For Nasal Decongestion
Quick-acting, long-lasting . . .
nasal decongestion without
appreciable compensatory re-
congestion; virtually free from
cardiac and central nervous
system stimulation ^consistently effective upon repeated use;
no appreciable interference
with ciliary activity; isotonic
to avoid irritation. .
INDICATED for symptomatic
relief in common cold, sinusitis,
and nasal manifestations of
' *o.n*mnM e
[■moauoni t
Trial Supply Upon Request
dropper, spray or tampon,
using the J^% in saline or in
an emulsion in most cases—
the i% in saline when a
stronger solution is indicated.
The J^% jelly m tubes is
conyenien t for patients to carry.
SUPPIJED as ?4% and 1%
in isotonic salt solution, and
as }^% in an emulsion, bottles
of 1 fl. oz.; J^% jelly in % oz.
collapsible tubes with applicator.
"T^Otear n s*3*^
; r m
Neo-Synephrine Trade-Mark Regd. '»
ADULTS: 2 to 4 tablets daily
CHILDREN: 1 to 2 tablets daily
Samples and literature on request
J* t^cety*®*
1^ fad*"-       I
fit many cases of congestive heart failure mercurial diuretics are next in importance to digitalis in maintaining the patient's comfort and prolonging life.
following an injection of Salyrgan-Theophylline m patients with marked
edema the urinary output frequently amounts to three jn four liters in twenty*
four hours.
Through suchsdjwp^fs the heart is relieved of the added burden of propelling
the blood through the compressed blood vessels. The blood volume is decreased,
and in all probability the efficiency of the heart is increased by elimination of
I «'   4
myocardial edema.
Salyrgan-Theophylline is available in ampuls of 1 cc. and 2 cc. for intramuscular or intravenous
administration . .. For oral use (as an adjunct to decrease the frequency of infections and
when parenteral therapy is impracticable) tablets in bottles of 25, 100 and 500.
"Salyrgan"   trod.mark   R.g.   0.   S.   Pat.   Off.   *   Canada
Brand   of   M e r talyl   and   Theophylline
factent nielcWutU eUtibeOc
Pharmaceuticals      of      merit      to  r&t   he      physician
Quebec Professional Service Office: Dominion Square Building, Montreal, Quebec I»fc
i i
S;C:rE fc^E^T T H E   S E R V I n r   n f   M E D , c , „ £j Physicians know the dramatic results in respiratory
failure through the use of Coramine intravenously.
Of equal value in ambulatory patients with chronic
cardiovascular disease is
LI\X^-9 I maw  This form of Coramine is
indicated where drastic action is not required, but
where maintenance and progressive improvement
are sought. Taken orally, Coramine Liquid enables
the patient to move about freely and to carry on
moderate normal activities with an easy mind—
in itself an important factor in management
of cardiac conditions.
Liquid, for oral use—bofries of
15,45 and lOOc.c.
For intravenous or intramuscular use,
ampoules of 1.5_cc—
cartons of 5,20 and 100
5 cc—cartons of 3 and 1 2
^1     Biiikbw.
p^^j ^^fea»^          y
• debianett fob 'U&tt/i frlactice
ttwt/ vxwfy fat/tew f A <xmwe'nd&Mce
a convenient method of prescribing control
when you deem it advisable for certain of
your patients. It combines in a single prescription package the three essentials: a tube
of Ortho-Gynol Vaginal Jelly*, the Ortho
Diaphragm, and the new plastic Ortho
*Also available with Ortho-Creme.
... also known and described as Digitaline Nativelle in the
U.S.P-XIII (Official April 1947). In the year 1868 Digitaline
(Digitoxin) was first isolated by Claude Adolphe Nativelle
and has been used since that date, as it is today by world
renowned clinicians such as: Basil-Parsons-Smith, James Orr,
Harry Gold, S. A. Levin'e, Sir James MacKenzie and many
other authorities in the field of digitalis therapy.
The Digitoxin Original as the Name it Bears.
Strictly Ethical Preparations.
to !<-■
Is Medication Called For
in the
Correction of Constipation?
New investigation emphasizes
dietary requirements in treatment of
physiologic constipation
IN a recent article published in - the American'
Journal of Digestive Diseases* the causes of con- •
stipation were reviewed, and a simple dietary procedure recommended for patients lacking in adequate
cellulosic residues.
Doctors were reminded that patients suffering
from constipation as a rule indulge in self-treatment,
and it is therefore important to establish and correct
the physiology in each patient over a 24-hour period.
Outline a diet in keeping with basal requirements,
providing the essentials needed for residue and
Diets prepared by investigators called for a wheat
bran—such as Kellogg's All-Bran—for the following
1. Cellulose content. Wheat bran supplies a
resistant form of cellulosic material necessary
for normal functioning of the alimentary tract.'
2. Laxative properties. Wheat bran operates
to assist the regularity of bowel movement by
action on the contents of the colon, rather than
on the colon itself.
If this simple procedure does not correct constipation, particularly in individuals where a substantial
amount of cellulose is lacking in the diet—then medi-
cation is called for.
9 Management of Chronic Constipation:
by Michael H. Stretcher. M.D.
.The Kellogg Company, makers of Kellogg's All-Bran,
will be pleased to send you a reprint of the article from
which this report has been summarized. Please use
the coupon.
PLEASE SEND me a reprint of Dr. Streieher's
article as published in the American Journal of
Digestive Diseases.
Nam* •.	
Mall to Kellogg Company, London, Ontario, Canada.
Zlle+t J*. Qansi&i
R.N., C.S.M.M.G,
(Great Britain)
Member of
Canadian Physiotherapy Association
Chartered Physiotherapists of British Columbia
Only Medically Referred Work Accepted
Hours of Business: 9.30 - 4.30
Thursdays and Saturdays 9 - 1
PAcific 6551
1118 Rose Street
HAst. 4189-L ill
Nmut $C
2559 Cambie Street
Vancouver, B.C. TRADE  MARK  REG.   IN CANADA ,
During the life-time of a woman there is a periodic need for
iron.    Uncomplicated, acute iron deficiency anemia responds
dramatically to treatment with Hematinic Plastules Plain.   When
the anemia is chronic or of nutritional origin, many clinicians find it advisable
to combine liver and iron therapy. 1-2
1. WHIPPLE, G.H., F. S. ROBSCHEIT-ROBBINS and G. B. WALDE N. Blood regeneration in severe anemia. XXI.
A lirer fraction potent in anemia due to hemorrhage. Am. J. Med. Sc. 179:628-643 (May) 1930.
2. MOORE, C.V., Iron and the essential trace elements in Wohl, M.G. Dietotherapy, Philadelphia and London.
W. B. Saunders Co.. 1945 pp. 98-107.
pematlnic /^iastules
Trade Mark Reg. in Canada
DOSE: One Plastule three times daily
Prescribe 75 to ensure at least 25 days medication
BOTTLES OF 5ft and 150
DOSE: Two Plastules three times daily
Prescribe 150 to ensure at least 25 days medication
e Man's longing for a simple, topical cure for disease,
symbolized in the King's Touch, now approaches reality with
the development of TYROTHRICIN and topical antibiotic therapy.
Many gram-positive' microorganisms now yield to the bactericidal
potency of TYROTHRICIN in infected wounds, various types of
ulcers, abscesses, osteomyelitis, and certain infections of eye,
nasal sinus and pleural cavity.
Whenever streptococci, staphylococci and pneumococci are present
and directly accessible, TYROTHRICIN may be called upon for
purely topical therapeusis by irrigation,
instillation and wet packs.
TYROTHRICIN, P. D. & Co., is one of a
long line of Parke-Davis preparations
whose service to the profession created
a dependable symbol of significance in
medical therapeutics—MEDICAMENTA VERA.
P. D. & CO.,
Is available in
10 cc. and 50 cc.
vials, as a 2 per £5
cent solution, to be
diluted with sterile
distilled water before use.
< c A 4r
E * yRTDiuM, administered orally in a dosage of
2 tablets t.i.d., will promptly relieve disusing urinary symptoms in a large percentage
ambulant patients, thereby permitting them
pursue normal activities without undue dis-
The prompt symptomatic relief provided by
iridium is extremely gratifying to such pa
tients suffering from the distressing symptoms
of painful, urgent, and frequent urination, tenesmus, and irritation of the urogenital mucosa.
* I*yridium produces a definite analgesic effect
on the urogenital mucosa following oral administration. This action is entirely local, and is not
associated with, or due to, systemic sedation or
narcotic action. Literature on Request.
(Phenylazo-alpha-alpha-diamino-pyridine mono-hydrochloride)
Concentrated Partly Skimmed Milk
The average gain in weight was greater.  .   .   .
There was a smaller incidence of feeding disturbances.   .  .  .
There was a greater gain over birth weight on
discharge from hospital.  .  .   .
Such were the advantages corroborated after investigations* carried
out by the Department of Pediatrics, University of Toronto, on two
groups of infants kept under control, one on regular evaporated
milk, the other on partly skimmed evaporated milk.
Delta Brand Milk is a low butterfat evaporated milk of 4%,
Irradiated and Vacuum Packed under careful control which when
diluted with water presents a milk of 2% butterfat. Non-fat solids
are the same as standard evaporated milk, but calories per ounce
in Delta Milk are 31.5 instead of 42.
Delta Brand,Milk makes available to the Medical Profession an
important milk food for difficult and normal cases in the field of
Composition of Delta Brand Milk
Fat-  4%        Total Solids '.  22.0%
Vitamin D 324 International Units per Imperial quart
Calorific value per ounce (avoirdupois)  31.5
*Sneiling,   E.  C    The  Uses of  Evaporated  Half  Skimmed  Milk  in   Infant  Feeding.     C.M.A.
Journal, 1943, 48, 1, P. 32.
Packed by
425 WEST 8th AVE.
VANCOUVER, B. C. At the Right Hand
of the Doctor
— stands our modernized prescription
departmenp—Spacious, efficienfgand
available — with potent medicinals and
a trained staff of pharmacists.
MArine 4161
(&mtn $c ffiannaffiti
North Vancouver, B. C.
Powell River, B. C.
9/ %
New Westminster, B. G.
Far the treatment of
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
Next Westminster 288
or 721 Medical-Dental Building, Vancouver, B. C.
PAcific 7823 PAciPic 8036
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