History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: September, 1945 Vancouver Medical Association Sep 30, 1945

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 The
IlULLETIiN
of the ...
VANCOUVER
MEDICAL
AssociA_ro_s____ii
With Which Is Incorporated
Transactions of the
VICTORIA MEDICAL SOCIETYi
the
VANCOUVER GENERAL HOSPITAL
and
ST. PAUL'S HOSPITAL
*••
In This Issue:
A REVIEW OF PRIMARY ATYPICAL PNEUMONIA
Col. A. B. Walter, R.C.A.M.C._	
THE DIAGNOSIS AND TREATMENT OF CHRONIC
PROSTATITIS ASSOCIATED ^£^1 NON-SPECIFIC
URETHRITIS
Flt.-Lt. H. G. Cooper, R.C^fE^ul
Surg. Lt.-Cmdr. John T. MacLean, R.C.N.V.R.	
304
NEWS AND NOTES _____I1£_  311
ANNUAL DINNER
FRIDAY, NOVEMBER 30th, at 7:00 P.M.
BANQUET ROOM—HOTEL VANCOUVER
iVOL. XXI. NO. 12:
September, 194& I.!
The vasodilator Theobromine and
the mental sedative Neurobarb,
act synergistically/^elaxing both
musculature and mind.
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THEOBROMINE, well known as a vasodilator,
induces a marked relaxation of the coronary blood
vessels and is frequently all that is necessary for
relief in cases of angina pectoris and of syncope
anginosa. Its prolonged diuretic action rapidly
diminishes dropsical conditions except in cases of
severe renal damage. Theobromine is particularly
useful in the reduction of edema in cardiac dropsy,
which then responds readily to digitalization.
Theobromine, unlike caffeine and theophyllin,
exerts but iittle effect on the central nervous
system and, therefore, does not increase the
nervous tension so common in "heart patients'^
NEUROBARB, E.B.S. (Phenobarbital) provides sedation
by "action on the central nervous system, allaying the
anxiety that frequently accompanies high blood pressure.
In Theobarb, E.B.S. then, there are two actions to relieve
hypertension:
1. The effect of theobromine directly on the blood vessels,
producing vaspdilatioitj
2. The indirect effect of the sedative action of Neurobarb,
E.B.S., preventing vasoconstriction.
When prescribing, specify "&£.$/
m •_!__«_, *•„
Indications:
Cardiac dropsy, hypertensive
heart disease, angina pectoris,
cardiac pain, and following coronary thrombosis. \
THEOBARB, I.B.S. COMES IN
TWO STRENGTHS:
CT. No. 691, Theobarb;
contains:
Theobromine ^Xy^v^.. S grs.
Neurobarb. ..i/L~&^i35^.. J_ fl*»._,
Sod. Bicarb.$j&^&%*&~--0 9r*»
O.T. No. 691A TheobarbMUcU
contains:
Theobromine '^^^^^f^ti grs.
Neurobarb. ^^^^^HH H-HK0-.
Sod. Bicarb.:^^^^^^:S.nrs.
Packaged in bottles of 100,500
and 1,000.
nadian Company—Established 1879m
mmmm
THE E. BlSHUftLEWORTH CHEMICAL CO. LIMITED
TORONTO
MANUFACTURING CHEMISTS
CANADA THE    VANCOUVER   MEDICAL   ASSOCIATION
BULLETIN
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.
EDITORIAL BOARD:
Db. J. H. MacDermot
Dr. G. A. Davidson Ob. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XXI.
SEPTEMBER, 1945
No. 12
OFFICERS,  1945 - 1946
Dr. Frank Turnbull
President
Db. H. A. Des Bbisat
Vice-President
Db. H. H. Pitts
Past President
Db. Gobdon Bubke
Hon. Treasurer
Db. G. A. Davidson
Hon. Secretary
Additional Members of Executive: Db. R. A. Gilchbist, Db. D. M. Meekison
TRUSTEES
Db. J. A. Gillespie Db. A. W. Hunteb Db. W. T. Lockhabt
Auditors: Messrs. Plommeb, Whiting & Co.
SECTIONS
Clinical Section
Dr. S. E. C. Tubvey Chairman Db. E. R. Hall, ^Secretary
Eye, Ear, Nose and Throat
Db. Gbant Lawbence President Db. Rot Mustard Secretary
Paediatric Section
Dr. Howard Spohn Chairman Dr. R. P. Kinsman Secretary
Orthopaedic and Traumatic Surgery Section
Dr. D. M. Meekison Chairman Dr. J. R. Naden Secretary
STANDING COMMITTEES
Library:
Dr. W. J. Dorrance, Chairman; Dr. F. J. Bulleb, Db. R. P. Kinsman,
Db. J. R. Neilson, Db. D. E. H. Cleveland, Db. S. E. C. Tubvet.
Publications:
Db. J. H. MacDebmot, Chairman; Dr. D. E. H. Cleveland,  Dr. G. A.
Davidson, Db, J. H. B. Gbant, Db. S. E. C. Tubvey, Db. Gbant Lawbence
Summer School:
Db. J. C. Thomas, Db. A. M. Agnew, Db. L. H. Leeson, Dr. L. G. Wood,
Dr. A. B. Manson, Dr. A. Y. McNair.
Credentials:
Dr. J. R. Nellson, Db. H. H. Pitts, Dr. A. E. Trites
V. O. N. Advisory Board:
Dr. Isabel Day, Db. J. H. B. Gbant, Db. G. P. Strong
Metropolitan Health Board Advisory Committee:
Dr. W. D. Patton, Db. W. D. Kennedy, Dr. G. A. Lamont
Representative to B. C. Medical Association: Dr. H. H. Pitts
Sickness and Benevolent Fund: The President—The Trustees
") SODIUM   PENICILLIN - CONNAUGHT
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SODIUM PENICILLIN is supplied by the Connaught
Laboratories in sealed rubber-stoppered vials as a dry
powder which remains stable for at least a year if stored at
a temperature below 10° C. (50° F.). Each vial contains
100,000 International Units.
PHYSIOLOGICAL SALINE, sterile and pyrogen-free, is
supplied in 20-cc. rubber-stoppered vials, permitting of the
convenient preparation of various dilutions of penicillin, e.g.,
by adding 20 cc. of saline to a vial of penicillin a solution
containing 5,000 units per cc. is obtained, or if 2 cc. be
used, a solution containing 50,000 units per cc.
As supplied by the Connaught Laboratories,
Sodium Penicillin is of high quality and
is free from irritating substances.
CONNAUGHT LABORATORIES
University of Toronto Toronto 5/ Canada
DEPOT FOR BRITISH COLUMBIA
MACDONALD'S PRESCRIPTIONS LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. VANCOUVER HEALTH DEPARTMENT
STATISTICS—JULY, 1945
Total population—estimated   3 11,799
Japanese Population—Estimated  _   _^ 1_l'„   Evacuated
Chinese population—estimated            6,395
Hindu population—estimated , —         3 3 5
Number
Total  deaths      303
Chinese deaths  ._           22
Deaths—residents only  _     259
BIRTH REGISTRATIONS:
Male, 310; Female, 314 '     624
INFANT MORTALITY: July, 1945
Deaths under one year of age        13
Death rate—per 1,000 births       20.8
Stillbirths (not included above) .       10
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
Rate per 1,000
Population
11.4
40.5
9.8
23.6
June, 1945
Cases      Deaths
Scarlet Fever   20
Diphtheria  1
Diphtheria Carrier  0
Chicken Pox  97
Measles ;  243
Rubella ___  47
Mumps  14
Whooping Cough '  3
Typhoid Fever 1  0
Undulant Fever   0
Poliomyelitis  1
Tuberculosis  60
Erysipelas !___  4
Meningococcus Meningitis  1
Paratyphoid Fever   1
Infectious Jaundice   0
Salmonellosis  1  1
Salmonellosis  (Carrier)    0
Dysentery   0
Syphilis   80
Gonorrhoea   179
July, 1945
Cases      Deaths
_2
Aug. 1-15, 1945
Cases      Deaths
BIOG LAN-A
The most effective therapy for waning mental and physical energy,
deficient concentration and memory, reduced resistance to infection,
muscular weakness and debility, neurasthenia and premature senility.
The efficacy of this very potent endocrine tonic has been confirmed by
the clinical evidence of many thousands of cases treated during
1932-1943.
Stanley N. Bayne, Representative
Phone MA. 4027 1432 MEDICAL-DENTAL BUILDING Vancouver, B. C
Descriptive Literature on Request
THE SCIENTIFIC HORMONE TREATMENT
Page Two Hundred and Ninety-one "Now, young lady, you'll
have double immunity
against Pertussis!"
Clinical studies have indicated that the endotoxin of the pertussis
organism plays an important part in the aetiology of the disease
and that immunity to this endotoxin, as well as to the H. pertussis organism, is important.
® PERTUSSIS VACCINE WITH PERTUSSIS TOXOID
... the only vaccine which provides immunity to both H. pertussis organisms and the endotoxin produced by these organisms.
Rubber-capped vials of 6 cc. -and 24 c.c.
Other Ayerst Pertussis Products are Pertussis Antitoxin and
Antibacterial Serum (Rabbit) Combined for passive immunization and for treatment, and Pertussis Toxin for the Strean
Test to deterniine susceptibility.
Ayerst Pertussis Products are prepared and standardized under the supervision of Professor E. G. D. Murray, Department of Bacteriology and Immunity, McGill University.
326
AYERST, McKENNA & HARRISON LIMITED • Biological and Pharmaceutical Chemists • MONTREAL, CANADA mm
/
&
.
W-
•^C-
•   •   •
effective
acceptable...
u
spergum
for the relief
of
POST-TONSILLECTOMY
PAIN
• Seldom are therapeutic effectiveness and acceptability to the patient so
favorably joined as when Aspergum is employed for the relief of sore, irritated throat—following tonsillectomy. • Chewing Aspergum, the patient
releases a soothing flow of saliva laden with acetylsalicylic acid—bringing
the analgesic into prolonged contact with pharyngeal areas which often
are not reached, even intermittently, by gargling or irrigations. • Gentle
stimulation of muscular action helps relieve local spasticity and stiffness,
• With throat soreness and irritation relieved, the patient is more comfortable, partakes of an adequate diet earlier, enjoys a more rapid convalescence.
Dillard's Aspergum is available in packages
of 16; moisture-proof bottles of 250 tablets,
• Ethically promoted—not advertised to the laity. White Laboratories of
Canada, Ltd., 64-66 Gerrard Street, East, Toronto, Ontario.
- -_■ ■',! I TOCOPHEREX       VIOPHATE-D
Suggested for Treatment
of Threatened or Habitual Abortion
Due to Vitamin E Deficiency
Each capsule contains 50
milligrams of mixed tocopherols,
equivalent in vitamin E activity to
30 milligrams of a-tocopherol.
Tocopherex contains vitamin E
derived from vegetable oils by molecular distillation, in a form more
concentrated, more stable and more
economical than wheat germ oil.
For experimental use in prevention
of habitual abortion (when due to
Vitamin E Deficiency): 1 to 3 capsules daily for 8J_ months. In
threatened abortion: 5 capsules
within 24 hours, possibly continued
for 1 or 2 weeks and 1 to 3 capsules
daily thereafter.
Tocopherex capsules are supplied in
bottles of 25 and 100.
For Increased
Calcium Requirements
Each capsule of Viophate—D
contains 4.5 grains Dicalcium Phosphate, 3 grains Calcium Gluconate
and 330 units of Vitamin D. The
capsules are tasteless, and contain
no sugar or flavouring. Where
wafers are preferred, Viophate—D
Tablets are available, pleasantly
flavoured with wintergreen.
One tablet is equivalent to two
capsules.
How supplied:
Capsules—Bottles of 100 and
1,000.
Tablets —Boxes of 51 and 250;
'MANUFACTURING   CHEMISTS   TO   THE   MEDICAL   PROFESSION   SINCE'1858 VANCOUVER      MEDICAL      ASSOCIATION
Founded 1898    ::    Incorporated 1906
PROGRAMME OF THE FORTY-EIGHTH
ANNUAL SESSION
GENERAL MEETINGS will be held on the first Tuesday of the month at 8:00 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the month at 8:00 p.m.
These meetings will continue to be amalgamated with the clinical staff meetings of
the various hospitals for the coming year. Place of meeting will appear on the agenda.
October    2—GENERAL MEETING.    Psychopathic Personality.
Major C. H. Gundry.
October 16—COMBINED   CLINICAL   MEETING  AND   STAFF   MEETING  AT
VANCOUVER GENERAL HOSPITAL.
November 6—GENERAL MEETING.    Protruded Intervertebral Discs—Analysis of
Sixty Cases.  Major P. O. Lehmann, R.C.A.M.C.
November 20—COMBINED CLINICAL MEETING AND STAFF MEETING AT
ST. PAUL'S HOSPITAL.
Accounting Service—
—for Doctors
• OFFICE DETAIL SUPERVISION
• ALL GOVERNMENT AND INCOME TAX
RETURNS COMPLETED
• SERVICES DESIGNED TO ASSIST YOU IN
EVERY WAY
SPECIALIZED SERVICES
Phone
MArine 7729
Page Two Hundred and Niney-tv/o PE^«*T"*G
ROl
Ot*GED
operative Proce° .    of relatively'*e° „, _.*»«• •* %
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It is with great pleasure that we have received from Dr. Geo. Kill, our Archivist and
Historian, a first instalment of the History of the Vancouver Medical Association, now
nearly sixty years old, and getting stronger with every passing year. We intend to
publish this as we get it—and are going to make an effort to get it in loose-leaf form
for binding later. A suggestion has been made that we should secure a large number of
reprints for the keeping by the Association, to be bound later and issued in book form
at a price which will make it easy for everyone to own a copy, as everyone will certainly want to do.
Another excellent suggestion that has been made, which can be made into a reality
forthwith, is that all newcomers to the profession here and elsewhere be asked to furnish
the Bulletin their name, qualifications, interne, postgraduate or other experience, and
a small photograph, passport size. It is hoped to make arrangements with a photographer
of standing whereby these can be obtained at a minimum price, and of maximum
quality. A column in the Bulletin would be devoted to the purpose of publishing these
each month. This would serve as an introduction of new members to the older brethren
of the craft. In the olden days, when the youthful Thomas Doe, M.D., came to the
city, and hung out his shingle, he was supposed to go and call on his older, established
confreres, and introduce himself. It was sometimes a rather grisly business, as some of
us could testify. Some of the older, more disillusioned men would gaze at one with a
fishy, deflating sort of eye—would opine that it was rather a bad time to start practice
in the city—times were bad, money was scarce and hard to collect, and so on: and one's
morale rather tottered. It was not, of course, all like that. Some of the younger and
brighter spirits would ask one in for a drink, tell a few good stories, and buck one up
quite a bit—so that it came out about even. But perhaps this is a good way too. This
need not, of course, be limited to Vancouver, or Victoria; we shall be glad to hear from
any part of the Province. So please, all men who have been here two years or less, send
in your dossier, and we will start work on it as soon as possible.
We gladly publish a request by the Rehabilitation Committee of the College of
Physicians and Surgeons of British Columbia, to all doctors in Vancouver and Victoria
to do the very best they can to help doctors returning from the Armed Services to
re-establish themselves in offices, by sharing offices, doubling up, allowing use of offices
and equipment for even two or three days a week.
One of the worst features of this early phase of the post-war period is the appalling
shortage of room. For six years all available office space has been used by the various
Services, and they cannot evacuate as quickly as we should like. No doubt their departure or concentration in other centres will ease the shortage considerably when it comes.
Then there has been no new building of office buildings for-a long time—naturally
enough—and there is not likely to be for a considerable time longer. The city has
grown greatly, and office space has filled up rapidly. So we cannot be surprised at the
shortage. All we can do is do our best to share what we have. These men coming back
have lost enough in all conscience in practice and connections—have given more than
any of us who remained—and we cannot lightly look on while they struggle for a new
foothold. Will all those who have any room available, or any suggestions to make, get
in touch at once with Dr. L. H. Leeson, Chairman of the Committee, at 203 Medical-
Dental Bldg., Vancouver. It is suggested, too, that doctors in the Services who have
information in advance of the date of their discharge, and wish to get office space, get
in touch with this Committee, at the same address.
Page Two Hundred and Ninety-three Lastly, the Annual Dinner of the Vancouver Medical Association. Now that the
war is (technically) over, we rejoice to see that this Function of Functions is to be
resumed. It will be held on November 30, 1945, at the Vancouver Hotel, and the keynote of this dinner is a heartfelt welcome to all returning members from the Active
Services. It is also a welcome to new members. It will be run as of old, strictly by
members for members, and no outside talent will be employed. Advance notices look
good. Formal notices will be posted, but keep the date open, November the 30th, and
plug the telephone for that evening. Let us all turn out and welcome back our old
friends and extend a welcome to our new ones.
LIBRARY NOTES
RECENT ACCESSIONS TO LIBRARY—
Recent Advances in Medicine, 11th ed., 1944, by G. E. Beaumont and E. C. Dodds.
New and Non-official Remedies,  1945, American Medical  Association Council on
Pharmacy and Chemistry.
The Medical Annual, 1945, Sir Henry Tidy, Editor.
Surgical Clinics of North America, Symposium on Anaesthesia, August, 1945, Mayo
Clinic Number.
Index of Differential Diagnosis of Main Symptoms, 6th ed., 1945, Herbert French,
Editor.
SavilPs System of Clinical Medicine, 12th ed., 1945, E. C. Warner, Editor.
Treatment in General Practice, 5th ed., 1945, by Ha^ry Beckman.
BOOK REVIEW
MANAGING YOUR MIND: Kraines & Thetford. (Macmillan.)
One thesis of this book is that man is a total organism, his physical and his psychological conditions being not separate entities but different aspects of one totality. The
major premise of the authors is to demonstrate the validity of their statement: "Our
emotional states as definitely determine the well-being of our bodies as they reflect it."
In an interesting style the authors have presented a plan of action whereby one may
understand the relationship between good health and well integrated emotional states.
Tension states are simply defined and the various psychosomatic symptoms are dealt with
in as plain terms as possible.
Some constructive plans are-presented and their application to specific problems are
discussed.
Members of the profession, nurses and social workers should profit from careful
reading of this book and, it is safe reading for certain carefully selected patients.
J. T. C.
SPECIAL NOTICE !
All doctors in Vancouver and Victoria who are willing to help out
in the present office shortage emergency by sharing their offices at specified hours with doctors returning to private practice from the Services
are requested to submit their names immediately to the Chairman of the
Rehabilitation Conunittee, Dr. L. H. Leeson, or to the executive office
of the College of Physicians and Surgeons, 203 Medical-Dental Building,
Vancouver.
Medical officers in the Services who may have advance information
as to the date of their discharge and who may wish to take advantage of
the above plan are requested likewise to get in touch with Doctor
Leeson or the College Office.
Page Two Hundred and Ninety-four British  Columbia  Medical   Association
(Canadian Medical Association, British Columbia Division)
President Dr. A. Hi Meneely, Nanaimo
First Vice-President Dr. Ethlyn Trapp, Vancouver
Second Vice-President : Dr. E. J. Lyon, Prince George
Honorary Secretary-Treasurer Dr. L. H. Leeson, Vancouver
Immediate Past President Dr. G. O. Matthews, Vancouver
At the Annual Meeting of the British Columbia Medical Association, September 13 th,
1945, the above mentioned officers were elected for the ensuing year.
In addition, five directors-at-large were elected: Dr. H. H. Milburn, Vancouver; Dr.
P. A. C. Cousland, Victoria; Dr. L. A. C. Panton, Kelowna; Dr. C. H. Hankinson,
Prince Rupert, and Dr. F. M. Auld, Nelson.
CHAIRMEN OF STANDING COMMITTEES, 1945-1946
Constitution and By-Laws  Dr. D. F. Busteed
Programme and Finance . Dr. J. R. Neilson
Legislation Dr. Thomas McPherson
Medical Education JDr. K. D. Panton
Archives Dr. H. H. Pitts
Maternal Welfare Dr. A. B .Nash
Public Health -Dr. A. H. Spohn
Ethics and Credentials  \ Dr. P. L. Straith
Economics . Dr. G. F. Strong
Pharmacy Dr. R. A. Gilchrist
Hospital Service Dr. R. A. Seymour
Cancer . s Dr. Roy Huggard
Editorial Board * Dr. J. H. MacDermot
Nutrition f_ ; Dr. H. A. DesBrisay
Membership Dr. G. D. Saxton
Industrial Medicine Dr. J. C. Thomas
Divisional Advisory Dr. L. H. Leeson
Emergent Epidemics Dr. G. F. Amyot
GOLF
The final Golf Tournament for the year 1945 was held on Marine Drive Golf Course
on October 4th, 1945, with forty-two golfers competing. The winners were awarded
with appropriate prizes at the dinner which was held following the tournament. The
Joe Bilodeau Trophy was won by Dr. E. E. Day while the Worthington Cup was won
by Dr. Gerald Burke. Dr. George Langley won the Ram's Horn' Trophy. Dr. T. A.
Johnston was winner of the Macdonald Trophy and the silver cigarette case donated with
the Trophy. Dr. George Seldon and Dr. F. Day-Smith were the winners of the second
low gross and second low net for the day, respectively. These prizes were sports shirts
donated by Straith and Charlton & Morgan.
Page Two Hundred and Ninety-five Dr. J. R. Davies won the hidden hole competition, while Dr. J. W. Millar was again
the winner of the long drive and Dr. Boyd Story was closest to the pin. The highest
score turned in went to Dr. J. Stewart.
Following the presentation of prizes the officers for the coming year were elected:
Dr. Harold Caple as Captain, Dr. W. W. Simpson as Vice-Captain and Dr. J. C.
Thomas as Secretary.
The Committee in charge of Golf at the Annual Meeting wishes to thank the following donors of prizes:
Mead Johnson & Company of Canada, who originally donated the Trophy Cup,
which is competed for annually, and who also provide a prize for the member who holds
the sup each year.
Ayerst, McKenna & Harrison Ltd.—a fountain pen.
Ingram & Bell Limited—a stethoscope.
John Wyeth & Brother (Canada) Ltd.—a lighter.
Fisher & Burpe, Lirnited—Reflex hammer.
Ortho Products of Canada Ltd.—$4.00 War Saving Stamps.
Charles E. Frosst & Co.—$5.00 scrip.
Lederle Laboratories Inc.—Twin Thermometers.
Winthrop Chemical Co., Inc.—Book on Skin.
Parke, Davis & Co. Ltd.—Bill fold.
Vanzant & Company—$4.00 War Saving Stamps.
Sharpe & Dohme (Canada) Ltd.—Syringe set.
Abbott Laboratories, Ltd.—Bill fold.
Ciba Company Limited—Box of cigars.
B. C. Stevens Company—a stethoscope.
Davis & Geek Inc.—$500 War Saving Stamps.
EH Lilly & Company Ltd.—Caudal set.
Friendly Firm—jigger.
George Straith Limited—$10.00 scrip.
Henry Birks Lirnited—a pipe.
The Association is very appreciative of the support given in its Annual Meetings by
the above firms, who contributed golf prizes, and who participate as exhibitors and
panel-greeters from year to year.
We would like to thank the heads of the three Medical Services for providing speakers from the Navy, Army and Air Force at our Annual Meeting. These Medical Officers
contributed greatly to the programme.
We wish also to express our appreciation to the Canadian Medical Association for its
splendid support of our meeting. The participation by the C.M.A. party was appreciated by everyone.
NOTICE
We hope that men who are demobilized from the Forces 'will notify
the office of the Registrar of their addresses. This is important, as we
wish to get in touch with each and every one of the men who are returning.
A. J. MacLACHLAN,
Registrar. A REVIEW OF PRIMARY ATYPICAL PNEUMONIA
Col. A. B. Walter, R.C.A.M.C
Read at the Annual Meeting of the British Columbia Medical Association, September, 1945.
In August, 1935, Bowen, writing in the American Journal of Roentgenology, described as a new disease entity an "acute influenza pneumonitis" occurring among soldiers in Hawaii.
In the following year Allen1 wrote of this disease as an "acute interstitial pneumonitis"; in 1937 Scadding2 described in the British Medical Journal a series of cases as
"disseminated focal pneumonia."
Other reports of occasional examples appeared at intervals, but there was no indication that incidence was increasing enough to attain to more than a medical novelty.
In Canada, little special interest in the "new disease" was aroused until after the
outbreak of war, when radiologists again led the way; in the autumn of 1939, as soon
as enlistment radiograms were made routine, they began reporting unusual and unexpected lung densities among recruits for the Services. In many cases histories were
elicited of recent respiratory ijlnesses, often considered by the men to have been trivial
"colds." Deferment for a few weeks led as a rule to the return of a radiographically
clear chest; physical signs had not been present at any examination. The singularity of
the condition began to be suspected.
Large training camps arose across the Dominion, and with the concentration in each
of thousands of men living in close association there were inevitable epidemics, among
which diseases of the respiratory system took by a large margin the predominant place.
These camps were equipped with hospitals; in the larger ones there were good facilities for not only care of patients but also some analytical study of diseases. Unfortunately the exigencies of war did not often permit staff and sub-staff of wards and
laboratories to keep in line with equipment, and this put limitations on investigative and
statistical, work that are a matter for disappointment.
At first, with comparatively few cases identified, there was skepticism about the
individuality of this primary atypical pneumonia. We recollected how meagre had been
our previous advantage of chest radiograms in minor respiratory illnesses; it became
obvious that the diagnosis of this novel interest depended largely on X-ray findings;
was it possible that we were merely becoming cognizant of something that had been
always with us?
Later, however, with ever-increasing numbers of cases there grew on those who
attended these patients the strong impression that this was something beyond chance of
having been merely missed before.
Scattered cases were seen the year around; each October or early November a wave
of respiratory infections would arise in the camp, and the epidemic would continue,
with perhaps a remission or two, until the following May or early June.
There was a heavy contamination of the troops by hemolytic streptococci; a large
percentage of normal men were found to carry the organisms in their throats. Infections from these causing febrile illness, formed one large group of hospital admissions,
but the largest group was of an illness resembling influenza; an abrupt onset with fever,
chills or chilliness, general malaise, generalized aches and headache, often mildly sore
throat and hacking cough. Constitutional symptoms outweighed local respiratory symptoms. In a minority of cases there had been a prodromal few days of mild malaise and
symptoms of "common cold" but with or without this the striking event of onset was
the abrupt phase.
A system of admission was used whereby segregation of streptococcal infection was
attempted; a few mistakes made in ward assignment by admitting officers would show
that the clinical pictures of streptococcal and influenza-like infections were generally
distinct.
This influenza-like illness could not with hospital facilities be proved influenza, and
for working purposes was given the diagnosis of "clinical influenza."
Page Two Hundred and Ninety-seven I. i
Hare, Hamilton and Feasby in their "Investigation of Influenza and Similar Respiratory Infections in Canada"7 found that such cases fell under the identity of influenzas
A, B, and an unknown agent, that the percentage of pulmonary involvement was nil
in A type, and less in B than in the type of unknown agent, that types could not be
differentiated by clinical appearance or course, though each had minor trends as to symptoms and duration. .«&*
It was among the "clinical influenza" group that primary atypical pneumonia was
found. As between influenzas, so between clinical influenza and atypical pneumonia no
certain prodromal nor clinical distinction existed. Mild cases proved to have X-ray
pulmonary densities, severe cases might be free from them. Where present, there arose
the question of whether, in spite of non-significant sputum cultures, they represented
secondary infection as broncho-pneumonia and were reminiscent of the influenzal pneumonia of 1918.
A period of nine months in one hospital during which every patient with acute
respiratory infection received a chest radiogram upon admission and before assignment
to a ward, brought out an illuminating find; although these X-rays were usually taken
within twenty-four or at least forty-eight hours of the acute onset of illness, the parenchymal densities were already present in the vast majority of cases of atypical pneumonia; a small minority developed them during the first four days in hospital. This
early presence certainly weighed against the conception of secondary involvement of the
lung.
The onset seemed identical with that of clinical influenza. Of Dingle's5 series of
primary atypical pneumonias, 31% had histories suggesting acute upper respiratory infection immediately preceding the major phase, and he remarked on the comparison of
a similar prodrome in 64% of pneumococcal pneumonias. Van Ravenswaay12 noted an
abrupt onset in 33% of his cases. He also estimated the incubation period to be from
2 to 21 days, usually less than 15.
The course might remain identical with that of clinical influenza or might be much
more protracted. In some cases arising among hospital personnel and observedwery early
the temperature ran a low-grade course for a few days, rising abruptly to 102-105°,
continuing with medium remissions for three to five days and dropping by rapid lysis
to near normal, then tapering off to normal; this was the average routine of the uncomplicated. Karpel, Waggoner and McCown8 found that of their series (500), 10% had
no fever, in 55.8% the duration of fever was four days or less and in 28.2% it was
9 days or less.
In many instances the patient is not very toxic, and rarely is he toxic enough to cause
real concern. A non-productive cough is the rule, but in some the cough is almost
absent. After several days there begins to appear a little sputum, in some cases blood-
streaked; in uncomplicated cases it remains scanty. Substernal or parasternal distress is
present in a fair number of patients, related probably to tracheitis and cough-effort respectively. Lateral thoracic or lateral abdominal pain with splinting, present less often,
usually is explained later by signs of parietal or diaphragmatic pleural involvement.
During part of one season cyanosis was noted, enough to be noticeable in lips and
fingernails. The chief point of interest here is that it was present at the same period and
as often in cases of clinical influenza.
With elevation of temperature there is no disproportionate tachypncea nor tachycardia, no dyspnoea nor fanning of alae nasi except where pleural pain causes its characteristic breathing changes.
Physical chest signs are variable and unreliable. In the first two days many patients
show none; within four days probably the majority have the one which appears most
characteristic of the disease; that is, one or more patches of fine and medium crepitations quite contrastingly delimited. Often this sign is brought out by forced breathing
or coughing when absent during normal respiratory excursion. Its commonest site is in
the interscapular area between hilus and base, and its delimitation distinguishes it from
basal crepitations of other origins.   In severe and protracted cases piping rhonchi and
Page Two Hundred and Ninety-eight coarse bubbling rales may supervene, but the sounds of specific diagnostic value are the
first mentioned. Even they may never be present. In a fair percentage of cases, predominantly unilateral, there is deficient expansion of that side of the chest. Changes in
percussion note are doubtful, broncho-vesicular breathing away from the hilar area is
rarely definite. In a few severe cases, however, in which the diagnosis withstands reconsideration, there is frank local blowing breathing and dullness. This is not what one
would expect; the degree of underlying induration does not seem to warrant it.
X-ray findings exposed the disease, and X-ray findings still are the deciding factor in
diagnosis. If one were to carefully examine the chest of every patient with clinical influenza every day for a week he would identify most cases of atypical pneumonia, but
by no means all; the radiogram finds all except the occasional retro-cardiac lesion, and
perhaps over-diagnosticates a little regarding linear peribronchial densities that are borderline in appearance and significance.
The characteristic radiogram shows soft woolly densities about one or both roots and
along the bronchial tree; near the hilus they may be radiating, further out more globular.
More often than not they are multiple and predominantly basal. Karpel8 found lower
lobes involved in 92.4% of cases, Meakins10 in 94%. I believe that lesions are usually
bilateral; the right base is credited with showing most of them, especially near the cardio-
phrenic angle, but later or left oblique radiograms show left retro-cardiac densities also.
In upper lobe densities the distinction from tuberculosis on one film alone may not be
possible. An occasional case shows widespread or even universal mottling of the lung
areas. The shadows are not dense nor often wedge-shaped, they suggest infiltration rather
than consolidation as that is measured by lobar pneumonia, and I feel that the word
"consolidation" should not be associated with them. Their appearance is lobular, rarely
lobar; the latter appearance and heavy density lead to review on the suspicion of bacterial pneumonia. The X-ray densities in most cases have cleared within two weeks; in
complicated lesions they remain for months and have serious significance.
Laboratory data do not help in cUstinguishing primary atypical pneumonia from influenza; they do help, however, in distinguishing it from the bacterial pneumonias.
There are no specific urinary findings.
All writers agree that the white blood cell numbers are normal or only moderately
increased. In Karpel's8 series 56.6% had a W.B.C. count of between 5,000 and 10,000,
25% more had under 14,000. Sqd.-Com. Meakins10, in his series of 100 cases, found
73% of W.B.C. counts under 10,000 and 99% under 15,000. Major p. B. Kay (U. S.
Army)9 states that white blood counts often showed a secondary rise to 12,000 or
18,000 in the second week; we did not note this in uncomplicated cases.
While occasional counts up to 30,000 are seen, certain it is that subsequent evidence
in the form of sputum cultures, infected pleurisies and bacteremias has pointed out the
prudence of reviewing the diagnosis when the W.B.C. count is over 15,000; in one hospital we made this the arbitrary line above which sulphonamides should be administered
in the absence of more positive indications.
The differential count is usually considered normal, but some writers comment on a
raised mononuclear fraction; Drew et al6 find it as high as 3%.
The blood sedimentation rate is raise, not above 50 mm. x 60 min. (Westergren)
as a rule, and its course is extremely useful in gauging the progress of a patient; in the
average case it falls promptly after fever is past, but in the presence of poor resolution
or computations, actual or threatened, it may persist for months; a patient is worth
watching while it remains elevated above 15 mm. even if confirmatory abnormalities
are not found.
The presence of cold agglutinins in the blood-serum—said to be found in higher
titres only in trypanosomiasis, the orchitis of mumps, and primary atypical pneumonia—
has been described by several authors, some of whom consider it a valuable sign. On a
trial of thirty-three cases our laboratory was able to show cold agglutinins in one only.
Blood cultures in relation to the disease are uniformly .negative.
Throat cultures give varied growths of which haemolytic streptococcus and strepto-
Wj0 Page Two Hundred and Ninety-nine
H i, ! i
coccus viridans are the most common factors but which include staphylococci, a few
pneumococci; no predominant organism. Attempt to identify the anaerobic streptococcus
MG has been outside our experience.
Sputum in many cases is too scanty for satisfactory collection; findings there are
non-specific also. It has been suggested that more attention be paid to the cellular elements in sputum and that search be made for mononuclear blood cells.
The average case makes a quick recovery after his temperature falls, and after four
afebrile days is eating well, feels like getting up and has almost lost signs of disease;
subsequently he regains strength rapidly.
Complications are unusual; in Karpel's8 series they amounted to less than 3%.
During the illness, and comparably during clinical influenza, a few patients present
symptoms of encephalitic and meningitic involvement of which drowsiness, marked
headache and post-cervical or interscapular ache are the most conspicuous. Cerebrospinal fluid in the few of our cases on which lumbar puncture was done showed no
abnormahty except in some instances a cell count increased to 10 or less lymphocytes.
Otitis media has been described by others; we did not see it.
A few cases showed slight jaundice which was transitory. Four cases showed palpably
enlarged spleens; in one this persisted, probably coincidentally.
Minor pleural effusion—sufficient to fill the thoracico-hepatic angle in the radiogram
—was not unusual; large effusions were so rare as to arouse suspicion about etiology.
Karpel8 has reported an incidence of four cases among five hundred. Empyema was not
seen by us in any case where the possibility of bacterial pneumonia was excluded.
The commonest and anticipated complication is delayed resolution, which gives
trouble in something less than 5% of cases. The patient remains semi-mvahd, may or
mav not have cough with muco-purulent sputum, there are diffuse signs of alveolar
moisture, one or more X-ray densities persist and W.B.C. count and B.S. rate remain
abnormal. The residual lesion in such cases is evidently atelectasis. Sometimes it is ot
extent large enough to affect diaphragmatic level and mediastinal alignment. In its
earlier stages it is obvious as an X-ray density; later it is not, but can be shown as a
line or wedge-shaped blank in the lipiodol bronchogram. An instructive series of such
was shown in Chorley Park Military Hospital in early 1944. One such case of mme
had the sign, without bronchiectasis, fifteen months after his initial atypical pneumonia;
during the interim he had had four attacks of acute respiratory illness, each with its
recrudescence of X-ray density in the same region.
Major E. B. Kay9 describes this sequence of events: bronchial or bronchiolar obstruction, atelectasis, acute infection, chronic interstitial pneumonitis, bronchiectasis. Initial
obstruction is probably a direct effect of the atypical pneumonia itself, subsequent infection is presumed to be secondary since exudate removed by bronchoscope has been rich
in neutrophile cells as well as mononuclears, although poor and non-specific in bacterial
content. Twenty cases were studied whose histories gave no indication of previous
pnumonia nor symptoms of bronchiectasis but who developed such within at most two
years, some within months, after authenticated primary atypical pneumoma. Three of
the cases in the cylindrical degree of the disease proved "reversible." The study impresses one with the importance of delayed resolution.
The incidence of such a sequence is reported by Van Ravenswaay1 as 2.2%, by
Karpel8 as 2%; it presumably arises from those cases whose resolution is delayed, and
since these total three per cent or less of all patients, bronchiectasis incidence should
remain below this figure. |_M8 !|        ,    .
There are two schools of thought on the management of cases of delayed resolution;
one produces convincing figures in support of rest treatment, the other equally convincing figures in favor of graduated exercise. In our limited experience we favored the
principle of hyperpncea through exercise, and were under the impression that B.S. rates,
W.B.C. counts and X-ray densities were all accelerated thereby in their return to normal- we did not, however, initiate exercise unless the B.S. rate was falling to some extent.
Major C. H. Jaimet, R.C.A.M.C, at No. 6 Canadian C.C.S., has recently reported
Page Three Hundred that in post-operative atelectasis he has found two simple measures very useful in clearing bronchial plugs. One is stimulation of cough reflex by deep inhalation of cigarette
smoke, the other is the still more potent induction of bronchial relaxation by hypodermic
injections of adrenalin 1:1000. m v-viii. One would suggest trial of the same measures
in the recent atelectasis of primary atypical pneumonia.
Recurrences of the disease are rare; 14 cases out of 2000 in one series3 had second
attacks within fourteen months.
We were fortunate enough to have no deaths during the two and a half years personal experience of which I write, although a few patients were sick enough to cause
anxiety. The mortality of the disease is low; about 0.2% is the figure given by Karpel8.
The autopsy findings on his one fatal case are a typical report, and I quote from it.
"Gross Findings: The lungs were voluminous, crepitant and spotty. There were irregular nodules-—these had a firm consistency but not that of consolidated lung. The cut
surface of the left lung revealed dark red, haemorrhagic areas, which had an increased
density. There were also fleshy red areas of collapse mingled with yellow, feathery lung
tissue. The pleura of the right lung was a mottled blue and gray. The dark blue collapsed areas were depressed and often surrounded by bullae of sub-pleural emphysema—
the lower trachea and the bronchi of both lungs were filled with thick, slimy secretions;
the hilar lymph nodes were large and succulent.
"Bacteriological Findings: Direct »smear and culture of bronchial secretion showed a
few pneumococci present. Direct smears of various portions of the lung parenchyma
proper showed no bacteria present and gave no growth. Culture of the heart blood gave
no growth.
"Microscopic Findings: The interstitial tissue of the upper lobe of the right lung
including the alveolar septa was thickened and infiltrated primarily with mononuclear
cells. A rare, pyknotic polymorphonuclear cell was seen. There were numerous large
phagocytes laden with blood pigment. No fibrin was seen. Some of the alveoli were
empty and were the seat of a compensatory emphysema. An occasional large bronchus
was partially filled with muco-purulent exudate. There was also an acute pleuritis with
mononuclears predominating.   The examination of other lung areas corresponded."
Other writers agree in stressing the monocytic preponderance, both in interstitium
and in alveolar exudate, and the minority of neutrophiles. Major Kay9 and others note
that walls of bronchi showed ulceration with an inflammatory process of the mucosa,
and lumens plugged with exudate composed chiefly of neutrophils; ulcerative bronchitis
with haemorrhagic interstitial broncho-pneumonia.
Treatment of the illness, it is agreed everywhere, is non-specific. It is quite definite
that neither sulphonamides nor pemcillin are of any help, and this supports assumption
that the disease is of virus origin.
On the other hand, these drugs are of decisive help in bacterial pneumonias, and in
spite of all evidence there are occasional cases in which the decision betwen primary
atypical pnumonia and bacterial pneumonia is almost impossible at the stage when action
counts. Although there is no justification for the routine use of sulphonamides, we concluded that it was prudent to use them, in absence of other differential evidence, where
the W.B.C. count was above 15,000 or the X-ray shadow was of lobar form or of
"consolidation" density; this was with the idea of meeting both pneumococcal and streptococcal possibilities.
Van Ravenswaay12 advocates the use of sulphadiazine for patients whose temperature
is above 102°, with the purpose of combatting secondary invaders, and employs ammonium chloride to render bronchial plugging less liable, he avoids the use of opium and
morphine derivatives which lower the cough reflex, after finding that the use of Dover's
powder in acute upper respiratory infections increased the incidence of pneumonias.
He however does administer morphine or codein for severe cyclic cough, acute pain and
gross haemoptysis.
One's own impression is that the minority with severe cough are depressed thereby
Page Three Hundred and One and have enough excess cough reflex to benefit from the loss of some of it. This is an
argument that has gone on for thirty years.
Difficulties in feeding are seldom encountered, and the only rule is to give the
patient as much food as he can be persuaded to take, especially protein and carbohydrate.
If dehydration occurs it is usually the fault of attendants.
Oxygen is occasionally indicated for dyspnoea and cyanosis.
We found no advantage in keeping the average patient in bed for more than four
days after defervescence provided he felt like getting up, and in 1944 the policy was
initiated, with benefit, of having "setting-up" exercises started as soon as temperature
became normal. On the other hand, careful observation during convalescence was
found necessary, especially as to radiographic progress and B.S. rate, and the patient's
activity was determined by such measurable criteria until they reached normal limits.
Of particular significance is the distinction between a raised sedimentation rate that is
falling and one that is not. Even a subsiding rate merits watching while it is above
15 mm. x 60 minutes.
Through the several years of camp hospital service one watched a progressive increase in numbers of cases; it reached a peak in 1944, and since a marked decrease has
occurred in 1945 it may be hoped that the disease is to be added to those which have
come in mystery and gone in mystery, like the much more dreadful influenzal pneumonia
of the past World War. In the largest Canadian training camp there were admitted to
hospital, during the first six months of 1944, 1043 cases of acute respiratory illness, of
which 296 were primary atypical pneumonia; in the equivalent period of 1945 the
numbers were of 867 acute respiratory infections and only 144 atypical pneumonias.
There were variations in virulence from time to time; the interlude of cyanotic cases
has been mentioned before.
Identity of the disease has given rise to much controversy. In the earlier days some
held the view that it was simply a non-specific broncho-pneumonia following chronic
upper respiratory infection such as sinusitis, or a summation of repeated acute infections.
Others compare it to the influenzal pneumonia of 1918-1919; by others again, and by
more as experience has grown, it is considered something distinct. Although again associated with clinical influenza it differs greatly from the pneumonia of 1918-19 in stage
of onset, in clinical picture, in mortality rate and in pathological findings; the characteristic exudate of influenzal pneumonia2 consisted of oedema fluid, red blood cells, no
fibrin, few leucocytes.
Prevalence alone makes it difficult to assume a non-specific broncho-pneumonia. It
seems conceivable that conditions of civilian practice might have allowed the overlooking of a smattering of cases, but not of tens of thousands in our own and other countries.
If it were the culmination of chronic or repeated acute respiratory infection one
would expect some indication in the patients' histories and further one would expect
recurrences on a large scale, for upper respiratory infections are no novelty.
An attempt to collect figures of susceptibility to nose and chest "colds" and of previous attacks of pneumonia was unsatisfactory in point of numbers and is not quoted,
but the figures did not indicate any greater incidence of these among atypical pneumonia patients than among streptococcal throat infections or among patients with non-
infective, non-respiratory disorders; it was of interest to note that among 125 of the
latter, 16.8% gave histories of previous pneumonias and 38.4% had had "colds" within
a month of admission.
Prevalence, early onset, character of clinical course and signs, of degree of toxicity,
of white blood-cell findings, and of autopsy findings all tend to dissociate the picture
from one of secondary bacterial pneumonia; one might say that the radiographic picture
affords the only resemblance.
A similar syndrome has been seen in a number of cases of muco-cutaneous fever,
and in our rare cases of lymphocytic chorio-meningitis; it is associated with rickettsial
and virus diseases reported from abroad such as psittacosis, ornithosis, American Q fever
and Australian Q fever.   In its characteristics it has more resemblance to these than to
Page Three Hundred and Two bacterial pneumonias. If the disease with which it is a part could be identified beyond
cavil, the name "primary atypical pneumonia" would probably be replaced by the name
of that disease, as have the others mentioned of its class.
The work of Wier and Horsfall13 in 1940 was decisive in giving primary atypical
pneumonia an identity. After failing to inoculate the disease into various animals they
decided to try the mongoose, as a relative of the ferret which Andrews, Smith and Laid-
law in 1933 had found susceptible to influenza virus. The experiment was successful;
throat washings from four cases of primary atypical pneumonia, raw and filtered through
Berkefeld V candle, were instilled intranasally and induced general pulmonary hyperaemia
and areas of consolidation. In serial passages, 64% of 90 animals exhibited pulmonary
lesions, 44% consolidations.
Post-mortem exarnination of lungs showed extensive oedema and thickening of
alveolar walls, and sparse cellular exudate composed almost entirely on mononuclear cells.
Attempted inoculation of mongooses with PR 8 strain of A influenza was not successful.
In 1944 the Commission on Acute Respiratory Diseases, U. S. Army4, made studies
on transmissability. Seventy-eight human volunteers, isolated from one another, were
inoculated intranasally with pooled sputa and throat washings from seven soldiers with
frank primary atypical pneumonia. Washjngs were used untreated, autoclaved, or passed
through Seitz filters. Sixteen men developed characteristic disease including lung lesions;
twenty-six more developed "minor illness" varying from mild upper respiratory symptoms to a sharp febrile episode resembling atypical pneumonia except for absence of
lung lesions.
In this experiment there is proof of transrmssability from man to man and an interesting suggestion of relationship with a modification resembling "clinical influenza."
The investigations of Hare, Hamilton and Feasby7 indicate a close association between
primary atypical pneumonia and influenza B and influenza of unidentified type. Van
Ravenswaay12 has noted its association with influenza A and B.
The close relationship which seems so apparent clinically has not to my knowledge
been proved by inoculation from clinical influenza to produce atypical pneumonia;
reversal is suggested in some effects of the experimental inoculations done by the Commission no Acute Respiratory Diseases, U. S. Army, but the resultant illness was not
proven influenza.
Indeed, one should not lose awareness of the fact that no scientific proof has ever
appeared that a relationship closer than association exists between influenza and atypical
pneumonia.
Among our own patients, with cases of both diseases together in a ward, there has
been apparently no cross-infection; an itnmunity is suggested here. In contrast, four
of six medical officers in attendance on those patients contracted atypical pneumonia
during one winter.
There is nothing difficult to appreciate in the thought that identical lung lesions are
the product of a heterogenous influenzal group; we accept the fact that identical lesions
are produced by a very heterogeneous group of pneumococci.
No the least of blessings from definite alliance would be the chance to attain a more
satisfying name to replace "primary atypical pneumonia of unknown etiology"—we
would gladly dispense with five of the words. Good evidence that the word "virus"
could legitimately be used arrived in 194511 but the word, in absence of specific qualification, is still unsatisfactory. So, too, is the word pneumonia if the lung lesions represent merely one form or degree of a disease of larger implication.
REFERENCES
1. Allen, W\ H.: Annals Internal Med., 10:441-446, Oct., 1936.
2. Boyd, Textbook of Pathology, 1943.
3. Commission on Acute Respiratory Diseases  (U.S.A.)   for 1943-44.
4. Commission on Acute Respiratory Diseases, Army Epidemiological Board, U. S. Army, Annual Report, 1944-45.
5. Dingle et al, Amer. Jour, of Hygiene, Jan., Mar. and May, 1944.
Page Three Hundred and Three 6. Drew, Samuel and Ball, Lancet, June 19, 1943.
7. Hare, Hamilton and Feasby, Canadian Journal of Public Health, Oct., 1943.
8. Karpel, Waggoner and McCown, Annals of Internal Medicine, Mar., 1945.
9. Major E. B. Kay, Archives of Int. Med., Feb., 1945.
10. Sq.-Comm. J. F. Meakins, C. M. A. Journal, April, 1943.
11. Scadding, J. G., B.M.J., Nov. 13, 1937.
12. Van Ravenswaay et al, J.A.M.A., Jan. 1, 1944.
13. Wier and Horsfall, Jour, of Experimental Med., Nov., 1940.
THE DIAGNOSIS AND TREATMENT OF CHRONIC
PROSTATITIS ASSOCIATED WITH NON-SPECIFIC
§ -   ff URETHRITIS     j jjjl-    II .
From Urology Special Treatment Centre, Montreal Military Hospital.
(Preliminary Report)
Flight-Lieutenant Harry G. Cooper, R.CA.F., and
Surgeon-Lieutenant Commander John T. MacLean, R.C.N.V.R.
Read at the Annual Meeting of the British Columbia Medical Association, September, 1945.
One of the major medical problems in the armed services today is the diagnosis and
treatment of chronic urethral discharge and chronic prostatitis. In a short while this
will become a civilian problem. The magnitude of this problem is in part due to an
increased incidence of the disease, but chiefly due to the fact that effective treatment of
the chronic cases has, we believe, been almost unknown. The results of routine treatment carried out under our direction were so unsatisfactory and discouraging as to make
it obvious that we should concern ourselves with this problem.
Early in May, 1945, routine treatments using sulfonamide therapy, penicillin—
100,000 units, irrigations, diathermy, and urethral dilatations, was discontinued. In an
endeavour to find a more satisfactory form of therapy a detailed investigation of the
cases that had falied to respond to the accepted forms of therapy was carried out. One
hundred and fifty cases have been studied to date. This report deals with the first one
hundred so studied. It was found that the cases could be divided into three main groups:
those with (1) a previous ■history of gonorrhceal urethritis, (2) a previous history of
non-specific urethritis, and (3) no previous history of urethritis. In this third group
the main complaints were varied, but urological in nature.
All of these patients had had one to ten previous hospital admissions, the average
number being three. The average number of hospital days was 4.8 days, the maximum
number being 120 days. The range in years was from nineteen to fifty-three years of
age; the average age being 26.5 years.
In one hundred cases studied, as indicated in Table I, 36% of cases had a previous
history of gonorrhoea. In an additional 50% there was a history of a previous urethral
discharge which had been reported negative for gonorrhoea, and classified as non-specific
urethritis. The remain 14% had no previous evidence of urethritis. The symptomatology is also indicated in Table I.
The chief symptoms complained of were: urethral discharge, frequency, burning
terminal haematuria, vague perineal discomfort, and backache. In the group of cases in
which there was a previous history of gonorrhoea or non-specific urethritis, urethral discharge was present in 84% to 91% of the cases; being the presenting symptom in over
70% of the cases. In Group III, in which there was no previous history of urethritis, a
urethral discharge was the presenting symptom in only 21%. Pyuria without symptoms
was present in 28% of this group; while vague perineal discomfort, frequency, and backache, were present in another 21%. This is the group in which the diagnosis is so apt to
be overlooked. A combination of these symptoms existed in many patients.
Page Three Hundred and Four Table I.
SYMPTOMATOLOGY
Group I Group II Group III
Previous   History    Previous   History    No Previous His-
of Gonorrhoea of N.S.U. tory of Urethritis
Total of
3 Groups
No. of
Cases
Symptoms: 36
Urethral Discharge
Presenting Symptom 26
Associated Symptoms i	
Total	
lenc
[ng
linal
e P«
iche
Signs:
Pyuria   (without symptoms)
Total	
91
84
14
No. of cases
and percent.
100
35
Frequency
1
3
i
i
2
1
7
2
Burning
2
Terminal Haematuria	
—
1
7
1
Vague Perineal Discomfort
1
3
4
8
I
7
6
Backache	
1
3
O
14
3
28
In those who had a discharge, it was a thin, watery grey in 90%, and thick mucoid
material of varying shades of yellow, in the remaining 10%.
SOURCE OF ORIGIN.—The majority of these patients gave a history of alcoholism
and sexual excess immediately preceding the onset or recurrence of symptoms. We
believe this is a factor in lowering the resistance of the urethra and prostate, favouring
subsequent invasion by: (a) Organisms from the host which are normally non-pathogenic. They may reach the prostate via lmphatics or possibly the blood stream, (b)
Exacerbation of a previous prostatitis in which there is still some residual infection
present, (c) Organisms from a carrier that may or may not be pathogenic to the carrier.
In two cases there was no extramarital exposure, and the wives did not exhibit any signs
or symptoms of infection.
BACTERIOLOGY.—The bacteriology showed on direct smear and culture:
staphylococci alone in 5 5 cases, diphtheroids in 10 cases, and staphylococci in combination
with micrococci, streptococci, and trichomona, in an additional 32 cases. Gonococci were
found once, and trichomonas vaginalis twice.
A diagnosis was made by: (1) the history and symptoms, (2) the presence of a
urethral discharge, (3) the three glass urinalysis, and (4) the examination of the prostatic fluid.
The symptoms of urethral discharge, frequency, burning, terminal hematuria, and
vague perineal discomfort, are almost pathognomonic of the condition present. Palpation
of the prostate is not indicative of the disease present. In some cases the gland is firm
and fibrosed; in others it is soft and normal to palpation, thus indicating that an exam-
inaion of the prostatic fluid is an essential step in the establishment of a diagnosis.
TREATMENT.—In five cases, preceding the hundred reported in this series, Stil-
besterol, 6 mgm. was given daily for one week. There was some clinical improvement,
but the number of pus cells in the prostatic fluid was not materially reduced. Stilbes-
terol therapy was discontinued for this reason, and because of the established fact that
administration over a period of time will result in sterility.
In considering returning to penicillin therapy we felt that with the usual courseof
100,000 units of penicillin in twenty-four hours, the degree of tissue saturation was
Page Three Hundred and Five probably adequate, but that it was not maintained for a sufficient length of time. It
was therefore decided to give experimentally 25,000 units every four hours for fourteen days, and to observe the results obtained. A total of 2,100,000 units of pemcillin
was given each patient. (Studies of the urine and blood penicillin levels were not carried
out.) On admission, cultures for gonorrhoea and other organisms were taken from
either the urethral discharge, or prostatic fluid. Bi-weekly examinations of the discharge *
or prostatic fluid were made, and the cell count noted. It was found that symptomatic
improvement was first noticed at the fifth to the tenth day of treatment, usually occurring at the seventh day, at which time there was also found _n appreciable decrease in
the number of pus cells in the prostatic fluid. In many cases the prostatic fluid is obtained by gentle compression of the gland without true massage.
In classifying the results obtained, a "cure" is defined as one in which (a) the patient
is entirely asymptomatic, and there is no urethral discharge, (b) the three glass urinalysis
is normal, (c) the prostatic fluid on culture is negative for gonococci, (d) the number
of pus cells in the prostatic fluid is reduced to below five per H.P.F., and (e) re-examination in three months' time confirms these findings. Re-examination is carried out
routinely at monthly intervals. "Apparently cured" would indicate that the patient
has satisfied the criteria (a) to (d) above, but has not yet returned for the three-month
check-up. The term "improved" is used to indicate that the patient is asymptomatic,
but the prostatic fluid shows more han five pus cells per H.P.F. and less than twenty.
The term "failure" is used to indicate those cases in which symptoms or signs persist.
COMPLICATIONS OF TREATMENT.—There were six failures on penicillin
therapy alone, for the reasons shown in Table II.
Table II
COMPLICATIONS — FAILURES ON PENICILLIN THERAPY
ALONE
Complications in all three Groups                           No. of~
Cases
Additional        E
Treatment
Carried  Out
nd Result
Cured
oK-Treatment
Apparently
Cured
Reri'iinn'anr  foreskin                                                                                    2
Circumcision
1
1
Small external urinary meatus.                                  ....         1
Meatotomy
1
Stricture of urethra  .                           .                       —         1
)Ureteral dilatation
1
No Stricture of nretnra  on   ralinrafinn                                         2
Ureteral dilatation
and Urethroscopy
2
When the complications were corrected by circumcision, meatotomy, or dilatation, as
indicated, the end results were satisfactory. Calibration of the urethra with bougie-a-
boule is always carried out before urethral dilatation. One was cured and five were
apparently cured. If these five maintain their status at the "three-month examination
they will then be classified as "cured."
There were two cases of Trichomonas Vaginalis. They were treated with Atabrin, gr.
iy2 three times a day for five days. In one the discharge disappeared entirely; in the
other, a mixed infection, the discharge continued but trichomonas was absent.   .
END RESULTS OF TREATMENT.—All 100 patients were asymptomatic at the
time of discharge from the hospital, soon after the completion of the two weeks of
treatment. (Table III and Table IV.)
Table III
END RESULTS OF TREATMENT
Group I—36 cases
(Previous history of G.C. Urethritis)
On Discharge
From Hospital
No.        %
On 2-Month
Re-Examination
No.        %
Cured	
Apparently Cured	
Page Three Hundred and Six
On 3-Month
Re-Examination
No.        %
4
25
69.4
26
72.2 Improved	
Failure	
No follow-up available
Group II—50 cases
(Previous history of N.S.U.)
Cured	
Apparently cured 	
Improved	
Failure	
11
30.6
No follow-up available	
Group HI—14 cases
(No previous history of urethritis)
Cured	
Apparently cured	
Improved _.
Failure	
No follow-up available 	
There was one recurrence in Group II.
12
Table IV
END RESULTS OF TREATMENT
Total of all 3 Groups—100 Cases
On Discharge             On 2-Month On 3-Month
From Hospital        Re-Examination Re-Examination
End Results                                                               No. of Patients         No. of Patients No. of Patients
Percent                       Percent Percent
Cured 1              —                                — 14
Apparently Cured 75                                74 —
Improved j 25                                 10 6
Failures —                                   1 —
(recurrence)
No   follow-up  available —                                 15 80
75% of them were "apparently cured" (the number of pus cells in the prostatic fluid
was below five per H.P.F.), and the remaining 25% were "improved" (the number of
pus cells in the prostatic fluid was above five per H.P.F., but below twenty). At the
re-examination, two months later, 74 were still "apparently cured" and 10 "improved,"
although 15 could not be traced. There was one recurrence in this group. He denied
re-exposure. He was readmitted to the hospital and treated with irrigations of Protargol,
% of 1% four times a day. He was not given any further penicillin treatments..
Urethroscopy showed an apparently normal urethra. He was discharged from the hospital, asymptomatic and improved, two weeks later. The results for the three-month
re-examination are not yet available. Of the twenty patients who were due for this
examination and have reported back, fourteen were cured, and six were improved. All
twenty were asymptomatic.
INFORMATION OBTAINED FROM STUDIES OF AN ADDITIONAL FIFTY
CASES NOT REPORTED IN THIS GROUP.—As already stated, there have been
fifty cases investigated in which the study is not yet completed. We have learned some
interesting facts from these additional cases.
Caspar, in a study of the cultural characteristics of gonococci, has made what we
consider to be a most significant observation. He has in many instances been able to
curette from the urethra of so-called "cured" cases of gonorrhoea, a large monoform
cell which on culture grows out a gram negative diplococcus, and on transfer to a new
host produces gonorrhoea. We have constantly looked for such a cell, and frequently
found a similar type, although in our cases we believe it is an intermediate stage of a
non-neisserian organism. This impression is confirmed by by our own experiences in
another study, wherein the urine from cases of cystitis and pyelonephritis is cultured.
On many occasions a peculiar large monoform cell, about four times the size of a
staphylococcal organism, has been grown out, and the organism on culture would appear
Page Three Hundred and Seven to defy identification. By' repeated subculture and the elapse of one month's time, this
large cell would eventually produce what was readily recognized as a gram negative
organism, frequently Bacillus Coli. Caspar pointed out that this large monoform cell
in gonorrhoea may be the factor responsible for recurrence of infection, or relapse after
treatment.
In five of the additional cases studied, we have found no improvement either symp-
tomatically or in the prostatic fluid at the end of the two week course of penicillin
therapy; these temporary failures were all given a second course of penicillin (25,000
units every four hours for fourteen days) at the end of which time three were cured,
and two remained infected. Another case in which the penicillin was continued, because
of Vincent's Angina (Trench Mouth); five roilHon units of penicillin were given. He
became asymptomatic on the seventh day, but the prostatic fluid remained grossly infected' throughout, showing over one hundred pus cells per H.P.F. Two points are
obvious here. The first is that the organisms may possibly become "penicillin resistant,"
as has been claimed by many workers to occur with a variety of organisms. The second
is the desirability of a means of treating these patients as ambulatory cases. This may
possibly be achieved by the use of pemcillin in peanut oil, or other oil base, in which
case one dose would be given daily, and absorption would continue slowly over a period
of time.  So far we have been unable to obtain penicillin in an oil base.
In a few of the failures to penicillin therapy alone, we have used a combination of
pemcillin intramuscularly, and sulfathiazole with methylene blue parenterally. A synergism between sulfathiazole and penicillin has been decribed, and more recently a
synergistic action between certain dyes and pemcillin. "This is based on the theory that
the bacteriostatic agent may 'poise' the oxidation reduction potential in the immediate
environment of the cell at a level which will preclude the normal functioning of one or
more desmolytic enzyme systems." In one case so treated, in which the urethral discharge was due to staphylococci and diphtheroids, the result was spectacular, the discharge
stopped the same day. In another case so treated, with the same type of bacteriology,
there was no noticeable change.
In the new cases presenting, we do not hesitate to do a circumcision or meatotomy if
we feel that the drainage of the urethral canal is in any way interfered with, or recon-
tamination may be occurring. We are carrying out urethroscopy in most of these cases,
and have observed that although a urethral discharge is present in nearly 80% of them,
that in the majority the anterior urethra looks perfectly normal on urethroscopy, and
the prostatic urethra is intensely engorged and inflamed. This suggests the possibility that
the urethral discharge present may be due to an excessive inflammatory prostatic secretion, and in fact may be a prostatorrhoea rather than a urethritis. It is our impression
that in many cases this is so, but as yet we have found an insufficient number of cases
for proper evaluation. On this basis one might question the correctness of the diagnosis
in those patients who had a previous history of non-specific urethritis. Was it really a
urethritis or was it a prostatitis with excessive prostatic secretion?
We have given up the use of urethral irrigations and pelvic diahermy.inthe se casee,
because the results of treatment with two-week courses of penicillin appear to be so
satisfactory, and the results with diathermy and lavage so disappointing.
The authors wish to thank Dr. Fred Smith, Associate Professor of Bacteriology,
McGill University, for the valuable suggestions which he has made in carrying out
penicillin therapy.
CONCLUSIONS
1. A study of chronic prostatitis associated with non-specific urethritis has been
made. A preliminary report of 100 treated cases is presented.
2. The cases divided themselves into three main groups: (1) those with a previous
history of gonorrhceal urethritis; (2) those with a history of a previously diagnosed nonspecific urethritis, and (3 ) those with no previous history of urethritis.
3. A urethral discharge was present in 84% to 91% of the cases in Groups I and
II, being the presenting symptom in 70%.  It was the presenting symptom in only 21%
Page Three Hundred and Eight of the cases in which there was no previous history of urethritis, urinary frequency,
backacha, terminal hematuria, and vague perineal discomfort, were frequent symptoms.
4. Pyuria without symptoms was present in 28% of the group with no previous
history of urethritis.
5. Alcoholic and sexual excess are believed to be predisposing factors which lower
the resistance of the urethra and prostate, favouring subsequent invasion by: (1) organisms from the host which are normally non-pathogenic, (2) exacerbation of a previous
prostatitis in which there is still some residual infection present, (3) organisms from a
carrier that may or may not be pathogenic to the carrier.
6. The bacteriology found on culture was staphylococci alone in 55 cases, diphtheroids in 10, and staphylococci in combination with micrococci, streptococci, and
trichoma in 32 cases.  Gonococci were found once, and trichomonas vaginalis twice.
7. A diagnosis was made by: (1) the history and symptoms, (2) the presence of a
urethral discharge, (3) the three glass urinalysis, and (4) the examination of the
prostatic fluid.
8. Palpation of the prostate is not indicative of the disease present. Examination
of the prostatic fluid is essential.
9. Criteria of "Cured," "Apparently Cured," "Improved," and "Failure" are defined: "Cured" is one in which (1) the patient is entirely asymptomatic and there is no
urethral discharge, (2) the three glass urinalysis is normal, (3) the prostatic fluid on
culture is negative for gonococci, (4) the number of pus cells in the prostatic fluid is
reduced to below 5 per HJ.P.F., and (5) re-examination in three months time confirms
these findings.
10. Treatment with Stilbesterol, urethral irrigations, sulfonamides, 100,000 units
of penicillin, and pelvic diathermy, were all found to give unsatisfactory results.
11. Penicillin, when given in doses of 25,000 units every four hours for fourteen
days gave an "Apparently Cured" in 75% of cases, and the remaining 25% were improved.  All were asymptomatic at the completion of treatment.
12. Symptomatic improvement occurred on the fifth to the tenth day, usually on
the seventh. A decrease in the number of pus cells in the prostatic fluid coincided with
the symptomatic improvement.
13. There were six temporary failures, or complications in the group, requiring particular treatment, such as circumcision, meatotomy, urethral dilatation, etc.
14. In smears of the urethral discharge or prostatic fluid a large monoform cell is
frequently seen, which we believe is an intermediate stage of the pathogenic organism
present in that particular individual.
15- In further cases studied, five temporary failures are given a second course of
penicillin, 25,000 units every four hours for fourteen days, with three apparent cures
and, two remaining infected.
16. In some of the temporary failures, pemcillin is given intramuscularly, and sulfathiazole with methylene blue given orally. In one case the urethral discharge, which had
been present for one month, ceased the same day
17. Urethroscopy has been carried out on a gradually increasing number of this type
of case. It is our impression that the anterior urethra is entirely normal in the majority
of these patients, though the prostatic urethra is intensely inflamed. It is thought that
the urethral discharge present may be due to the prostatitis causing an excessive inflammatory prostatic secretion rather than due to a true urethritis. On this basis., the cases
which have previously been diagnosed as non-specific urethritis may be open to question.
JULY, 1945, BULLETINS WANTED
Doctors who have on hand copies of the July, 1945, "Bulletin"
■with which they are finished, are urgently requested to turn them in
to the Library, at the earliest opportunity.
Page Three Hundred and Nine [fl
NEWS    AND    NOTES
We regret to record the passing of three members of the profession in British
Columbia: Dr. Bruce S. Smith of Vancouver, on September 25th; Dr. Benjamin
deF. Boyce of Kelowna on September 25th; and Dr. B. S. Walker of Summer-
land on September 24th.
Sympathy is extended to Dr. and Mrs. J. A. Porter of Vancouver in the loss of their
two months old son.
Congratulations are being received by Dr. and Mrs. R. S. Woodsworth of Kelowna
on the birth of a son, and by Capt. and Mrs. K. P. Groves of Vancouver on the birth
of a son, on October 9th.
Among the many prisoners of war who have been repatriated from Japan is Captain
J. A. G. Reid of Vancouver. Captain Reid was attached to the Winnipeg Grenadiers
and taken prisoner when Hongkong fell on Christmas Day, 1941. The men were kept
at Hongkong until early in 1943 when they were transferred to Camp Tokyo, and later
to the notorious coal mine slave camp, Sendai No. 1. Captain Reid has the very best
wishes of the profession in establishing himself again in civil life.
Lieut.-Col. J. H. Sturdy, R.C.A.M.C, has received his discharge and is now located
at the Vancouver General Hospital in the Department of Pathology.
Lieut.-Col. W. L. Boulter, R.CA.M.C, has returned to Vancouver following service
in casualty clearing stations in Italy, France, Belgium and Holland.
Colonel M. McC. Baird, who recently returned from service overseas, has received
his discharge from the Army, and is returning to practice in Vancouver.
Capt. L. A. Patterson is now out of the Army, and located in Vancouver.
NOTICE
It has been brought to our attention by the Pharmaceutical Association of the Province of British Columbia that some members of the
profession are using prescription pads which designate certain drug
firms. Inasmuch as this is contrary to the Medical Act we would like
to draw the matter to the attention' of each and every medical practitioner in the Province of British Columbia.
A. J. MacLACHLAN,
Registrar.
Page Three Hundred and Ten ANNUAL DINNER
The Annual Dinner of the Vancouver Medical Association will be held on
Friday, November 30th, at 7:00 p.m., in the Banquet Room of the Hotel
Vancouver.
The Annual Dinner is being resumed this year after being discontinued for
the duration of the War. This will be an occasion to fittingly welcome home
those members of the profession who have been in the Armed Forces.
De luxe entertainment will be provided and the dinner follow all the prewar traditions.
It is requested that all life members and holders of the P. G. F. Degree will
make a special effort to attend.
Members of the Services and new practitioners in the city will be welcomed.
Major A. B. Manson, R.CA.M.C, has returned to civilian life and to his former
office in the Medical-Dental Building, Vancouver.
■_• "_■ »_■ *s*
Major E. J. Curtis, R.C.A.M.C., has received his discharge from the Army, and will
join Dr. J. A. Ganshorn, recently discharged from the R.C.A.M.C, in their former
offices in the Medical-Dental Building; Vancouver.
Surgeon-Lieut. J. M. Murray of Vancouver has received his discharge from the
Navy, as has Surgeon-Lieut. A. J. Venables, who is at present in Newfoundland.
Major K. J. Haig has received his discharge from the R.CA.M.C, and has resumed
practice in Orthopaedics, with offices in the Medical-Dental Building, Vancouver.
Dr. W. T. Lockhart of Vancouver has retired from active practice following many
years of service. Doctor Lockhart has been a very active member of the Vancouver
Medical Association for a number of years, holding the positions of Treasurer of the
Association, a Trustee, and Chairman of the Relief Administration Committee. He has
our best wishes for a happy retirement.
Capt. W. J. Endicott, R.CA.M.C, has received his discharge from the Army and
has resumed practice with the C S. Williams Clinic at Trail.
Dr. and Mrs. J. S. Daly of Trail were visitors in Vancouver during the week of the
Annual Meeting of the British Columbia Medical Association.
Dr. M. E. Krause of Trail has returned from a month's vacation.
Doctors F. M. Auld, G. R. Barrett and W. Laishley of Nelson attended the Annual
Meeting of the British Columbia Medical Association in Vancouver.
Colonel W. E. M. Mitchell and Major G. B. Bigelow have resumed practice in Victoria, following their discharge from the Army.
Dr. D. M. Baillie of Victoria has just returned from a trip to Eastern Canada. During his absence Dr. A. N. Reid did locum tenens for him.
* * * *
At the annual meeting of the Victoria Medical Society, held October 1st, the following officers were elected: President—Dr. T. M. Jones; Vice-President—Dr. G. B. B.
Buffam; Honorary Secretary—Dr. W. E. M. Mitchell; Honorary Treasurer—Dr. A. B.
Nash.
Page Three Hundred and Eleven The following members were placed in office at the annual meeting of the Fraser
Valley Medical Society: President—Dr. G. H. Manchester; Vice-President—Dr. J. G.
Robertson; Secretary-Treasurer—Dr. J. T. Lawson.
Lieut.-Col. S. A. Wallace has rejoined Dr. R. W. Irving's Clinic at Kamloops after
an absence of almost five years' service in the R.C.A.M.C.
* *      *      *
Mrs. M. G. Archibald, relict of the late Dr. M. G. Archibald, died in Kamloops on
October 10th, having outlived her husband just ten months.
Surgeon-Lieut. W. S. Archibald has joined the Burris Clinic at Kamloops.  He arrived
home only a few hours before his mother was taken ill.
* *       *       *
Major O. C. Lucas of Victoria has returned from service overseas.
OBITUARY
DR. BENJAMIN DE FURLONG BOYCE
of Kelowna, B. C.
The death of Dr. Boyce of Kelowna marks the passing of a pioneer in medicine .in this province—and caused widespread mourning in the Okanagan Valley. Dr. Boyce was 75 years of age when he died of a heart attack, and was
greatly beloved by the people of Kelowna, where he has practiced for nearly
fifty years, from 1894 to 1940. Flags were flown at half-mast in token of the
general sense of loss at his death, and prominent citizens in every walk of life
bore testimony to the affection and respect that everyone felt for this beloved
physician.
Dr. Boyce was a true pioneer physician, and practised "horse and buggy4'
medicine at its best. Strong and rugged of constitution, he took his full share
not only in professional life, but as a citizen. He served in the C.A.M.C in
World War I and was active in all movements which pertained to the public
welfare.
Dr. Boyce leaves a fragrant memory, as of the best type of physician, who
helped te build his community and his country.
DR. BRUCE S. SMITH
of Vancouver
Obiit Sept. 25, 1945
Vancouver lost one of its old-timers in the recent death of Dr. Bruce Smith,
who passed away suddenly in his apartment at 1245 Nelson St. Dr. Smith had
practised in Vancouver steadily since 1909, when he graduated from McGill.
Those of us who have been here for twenty-five years or more will remember
him well as a quiet, most retiring man, of whom few -of his colleagues knew
more than his name. He practised chiefly internal medicine, and did not mingle
freely with other medical men. But he was always genial and friendly, and had
a wide practice in the city.
We extend our condolences to his sisters and family.
Page Three Hundred and Twelve DR. DONALD MURRAY MEEKISON
The sudden and untimely death of Dr. Murray Meekison, of Vancouver,
has come as a great shock to the medical profession, it is not too much to say,
of the whole of British Columbia. Since his work was well known up and
down the North Pacific Coast, there will be many in the States to our south, as
well as throughout Canada, who xwill mourn the passing of this brilliant and
accomplished orthopaedic surgeon, who bade fair to be an outstanding leader in
his specialty.
Dr. Meekison had been under terrific strain for a long time. Shortly after
the outbreak of the war, he joined the R.CA.F. medical services and proceeded
overseas, where he was in charge of the orthopaedic work of a large general hospital, and did excellent work. During this time he worked very hard, and his
health was not good. As was his way, he threw himself entirely into his work,
and lectures given by him since his return shewed how thoroughly and exact-
ingly he did this work, keeping careful records, compiling statistics, and being
ever on the search for better and more efficient methods.
After his return about a year ago, he took up an enormous practice, and
worked day and night. He never seemed to rest, and undoubtedly worked
much too hard. He suffered a heart attack some two weeks or so before he
had another, and a fatal, seizure.
Murray Meekison will be greatly missed by all who knew him. He was
earnest in his work, always willing to help the medical men amongst whom he
worked with advice and counsel—given freely and most generously. It is
superfluous to say that his own work was of the highest order, and he was
recognised by leaders in his department of medicine as pne of the outstanding
orthopaedists of Canada.
We extend our sincerest sympathy to his family.
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of water and consequent gain in
weight is noted2 . . . The uniform
potency and stability of crystalline
PERCORTEN* offers more exact
control of therapy.
PERCORTEN is recommended in
other cases of electrolytes and
water imbalance, such as occur
after extensive burns, certain types
of shock, and some acute infections.
1. Thorn,   G.   W.:   J.   Mt.   Sinai  Hospital,
March-April,   1942
2. Loeb,   R.   F.:   J. A.M. A.,   May  31,   1941.
PERCORTEN
IN ADDISON'S DISEASE
>Trade Mark Reg'd.
C MB.%
" & MMVMTRI
MONTREAL, CANADA ■HI
Ik
light has long been used both for identifying and measuring solution constituents. I ight is a key to precise and
extremely sensitive analytical procedures.
The photofluorometer illustrated is an instrument which
uses fluorescent light in determining vitamin concentrations, trace metal concentrations etc, and" it is used in the
analysis of Horner specialties.
This instrument focusses a beam of ultraviolet (Mack)
light on to a test solution — the solution fluoi _>tts under
the influence of the light — die fluorescence is deflected
on to a photo-electric cell — the intensity of the secondary
radiation (deflected light) is referred to a dial from
which readings may be taken. These readings can be
interpreted in quantitive measurement of a constituent
of the solution being tested. ■
This is one of many tests applied to Horner specialties
before being passed for use in Canada's dispensaries; —
before being prescribed by Canada's medical profusion
Horner specialties cover a wide field of therapeutics,
from general tonics for convalescents to .specialized
products such as Vagicaps. Jl
Vagicaps are gelatin capsules containing sulfanilamide
and lactic acid — they are used for the treatment of
trichomonas vaginalis vaginitis and non-specific bacterial
. infections of the vagina. These troublesome sj_|S£_.ons
are usually cleared up within oni week, by the use of
Vagicaps.
Vagicaps are a valuable contribution to modern medicine
— they are effectiM. in use — they are simplt to admihis-
~ter — treatment can be conducted <u home by the pitunt,
Saving valuable office time for the physician,
Vagicaps are prescribed in boxes of twelve.
FRANK W. HORNER LIMITED "OSTOFORTE"
FOR MASSIVE VITAMIN D
THERAPY IN CHRONIC ARTHRITIS
AND PSORIASIS.
Capsule No. 651 "§auF (Each capsule
contains 50,000 International Units of
Vitamin O)
Treatment: The recommended method of treatment is as follows:—An initial
dose of 50,000 Vitamin D units (1 capsule, "Ostoforte"). This is gradually increased to the effective dose which may be 300,000 or more units daily, depending
on the patient s response and tolerance to the medication. When maximum improvement occurs the dose is reduced to a maintenance level which may vary frorri
100,000-200,000 (2-4 capsules, "Ostoforte") daily. Rest and regulation of the diet.
Massage and exercise of the affected parts when indicated. Correction of bowel
habits. Removal of foci of infection. Results from this treatment may not be
apparent for some weeks, therefore the administration of an analgesic (Acetophen
Compound with Codeine, CT. No. 222 "<§5bwF) may be indicated in order to promote comfort.
Results: While the results of High Potency Vitamin D therapy are not always
dramatic and it may require a number of months of continuous treatment before
improvement becomes evident, the fact that we are dealing with frequently intractable and progressive diseases warrants trial of this treatment. The following results
have been observed in those cases responding to treatment.*—Decrease in pain;
Decrease in swelling; Recalcification of osteoporatic bone; Remobilization of joints;
and improvement in general health.
We Emphasize: A—No criteria have been established which would enable one
to select the cases which will respond favourably to treatment from those which
will fail to react. B—No physiological basis exists for the employment of this
therapy. It is at present entirely empirical.
Modes of Issue: In boxes of lOO and 50 capsules for your prescription.
e#tOcV>t
dtd/tfod G>.<ShotetSc(3o. Montreal, Canada
WHERE QUALITY AND PRICE ARE EQUAL OR BETTER, PRESCRIBE CANADIAN PRODUCTS
The Canadian Mark of Quality
Pharmaceuticals since iSgg. un
Canadian
qitub
Patent No. 419879
A New Aid
to the
Medical
Profession
1. Pull one end of
Surgitube over extremity and twist bandage
a half turn, then
I
2.   open free end of
bandage and
3.  double back over
first part, then
Seamless gauze fabric in tubular form, in rolls of 50 yards
each, packaged in handy dispenser. Made in five sizes for
bandaging fingers, toes, hands, feet, arms, legs, breasts
and head. Its form and flexibility makes for easy application and removal, plus perfect conformation to all contours
without binding. Surgitube makes possible better, neater
and more comfortable bandaging of all extremities with
great saving of time and astounding economy of material.
Hospitals, Surgeons, Physicians, Chiropodists and Nurses
throughout the country are using Surgitube more and more.
4. bring ends of bandage together and apply
adhesive tape to hold
in place.
SAMPLES — Generous samples of all five sizes of Surgitube gladly supplied upon
request on letterhead of Hospitals, Surgeons, Physicians, Registered Professional Nurses.
ROUGIER   FRERES       350 le moyne, Montreal 1 SHOULD VITAMIN  D BE
GIVEN ONLY TO INFANTS?
ITAMIN D has been so successful in preventing, rickets during infancy that there has been little emphasis on continuing its use after
the second year.
But now a careful histologic study has been made which reveals
a startlingly high incidence of rickets in children 2 to 14 years old.
Follis, Jackson, Eliot, and Park* report that postmortem examination of 230 children of this age group showed the total prevalence
of rickets to be 46.5 %.
Rachitic changes were present as late as the fourteenth year, and
the incidence was higher among children dying from acute disease
than in those dying of chronic disease.
The authors conclude, "We doubt if slight degrees of rickets,
such as we found in many of our children, interfere with health
and development, but our studies as a whole afford reason to prolong administration of vitamin D to the age limit of our study, the
fourteenth year, and especially indicate the necessity to suspect and
to take the necessary measures to guard against rickets in sick
children.9'
*R. H. Follis, D. Jackson, M. M. Eliot, and E. A. Park: Prevalence of rickets in children
between two and fourteen years of age, Am. J. Dis.- Child. 66:1-11, July 1943.
MEAD'S Oleum Percomorphum With Other Fish-Liver Oils and Viostero>
is a potent source of vitamins A and D, which is well taken by older chil»
Jren because it can be given in small dosage or capsule form. This ease of
administration favors continued year-round use, including periods of illness.
MEAD'S Oleum Percomorphum furnishes 60,000 vitamin A units and
8,500 vitamin D units per gram. Supplied in 10- and 50-cc. bottles and
bottles of 50 and 250 capsules.   Ethically marketed.
MEAD JOHNSON & CO. OF CANADA, LTD., Belleville, Ont. i WITH
iownffl*"
SULFATHIAZOLE GUM.
* o-«_-I_^<,i00,
One tablet of
White's Sulfathiazole Gum
chewed for
one-half to one hour
"
jm**s
1. promptly provides a high salivary concentration of locally active (dissolved) sulfathiazole
2. that is sustained throughout the chewing period in immediate contact with
infected oropharyngeal mucosal surfaces,
3. yet even with maximal dosage, resulting blood levels of the drug remain
so low as to be virtually negligible.
INDICATIONS: Local treatment of sulfona-
mide-susceptible infections of oropharyngeal areas; acute tonsillitis and pharyngitis;
septic sore throat; infectious gingivitis and
stomatitis; acute Vincent's disease.
DOSAGE: One tablet chewed for one-half to
one hour at intervals of one to four' hours
depending upon the severity of the condition. If preferred, several tablets—rather
than a single tablet—may be chewed successively during each dosage period without
significantly increasing the amount of sulfathiazole systemically absorbed.
V
Available in packages of 24 tablets, sanitaped,
in slip-sleeve prescription boxes.
IMPORTANT: Please note that your patient requires your prescription to obtain this product
from the pharmacist.
*A Product of WHITE LABORATORIES OF CANADA, LTD., Toronto, Canada WANTS
4& 4H0fc**e*t>
Human sperm, In contact with hostile genital secretions, apparently
suffer early immobilization—particularly if the seminal picture is character!—ed
by a low sperm count and feeble motility.*
In clinical tests, a pre-coital douche of Nutra-Ortho (a physiologic glucose douche powder)
has been found to promote fertility in many stubborn cases free from detectable
deficiencies or pathogenies.   In temporarily relieving local incompatability, it also
supplies the nutrient glucose, metabolized by the sperm for motile energy.
The results obtained with Nutra-Ortho may obviate the necessity for more elaborate
diagnostic procedures.
Ortho Products of Canada, Limited, Toronto,
4^-61^?
♦MacLeod and Hotchkiss. Amer. J. Obst. & Gynec,
Sept. 1943
FOR USE IN SELECTED CASES OF INFERTILITY 7_
I
For Specific Progestational Therapy
Progestin B.D.H., on intramuscular injection, produces a rapid
progestational response. Therefore it is employed for the treatment of threatened or habitual abortion and in menorrhagia and
metrorrhagia of functional origin. Dysmenorrhcea unassociated
with uterine hypoplasia and "after-pains' following childbirth are
further indications for the administration of Progestin B.D.H.
Stocks of Progestin B.D.H. are held by leading druggists
throughout the Dominion, and full particulars are available from
THE BRITISH DRUG HOUSES (CANADA) LTD.
Toronto Canada
Prgn/Can/459 OF CANAD
*ONf   OF   A   SERIES
p_5?j
^_s?$iS
_Tw'
W r
\m- A
WW
The Holmes Gold Medal
founded by McGill University  in   1865.
(ffttdteut K&wme<$
M£>., LL.D., M;R.CS. (1797-1860)
TO Andrew F. Holmes and his three colleagues,
Robertson, Caldwell and Stephenson, is attributed "iHfe establishment of the Montreal
Medical Institution. In 1822, when it was
organized. Holmes agreed to lecture on Chemistry, PlSmacy and Materia Medica. This organization later became the Medical Faculty of
McGill University, In 1854 Andrew Holmes became the first Dean of the faculty, which position
he held until his death.
Holmes was born in Cadiz, Spain. The ship in
which his parents were travelIh|||was captured
by a French frigate and they were interned
there. In 1801 the family arrived at Quebec,
later moving to Montreal. Holmes was a pupil
of Dr. Arnoldi, Eater continuing his studies
abroad. In the year 1819 he returned to
Canada and practised with his former teacher.
A dark man,, short and slight in stature.
Holmes was slightly stooped. He had a quiet,
retiring manner but possessed an abundance
of zeajtdiligence and alertness. Christian principles characterized his life and he was known
?and respect.d for his beliefs.
Much of his free time was devoted to the study
of the natural sciences. His extensive collection of
the plants of-Canada he presented to the Red-
path Museum of McGill University. The library of
McGill also benefited by his energies and he
contributed, in no small measure, to building its
collection of books.
Holmes was one of the first physicians \n
charge of the Montreal General Hospital and a
member of its medical board. He was also petive
in all professional associations and for three
years was president of the College of Physicians
and Surgeons of Lower Canada.
On October 9th, 1860, Andrew Holmes passed
away suddenly. The Holmes Gold Medal
awarded for the highest aggregate of marks
obtained in the medical course was established
in his honour in 1865. The ambition of Andrew
Holmes to elevate the practice of medicine in
Canada, still further encourages William R.
Warner & Company to maintain their policy of
Therapeutic Exactness ijl . Pharmaceutical Excellence ... . One price and one discount to all.
*m_I
j COMPANY LTD.
_,*»•■ $Yj._Oi. Of
MCAtMAC-imCAt,
( X C I t t I**Ct
MANUFACTURING PHARMACEUTISTS   •    727-733  KING ST.  WEST, TORONTO
(lUUtiMD  IM . Ib service
A complete blood and urine
laboratory service that is fast
and reliable.
ASCHIEM — ZONDEK and
blood containers supplied tree
of charge on request.
HOUR PREGNANCY
TEST   SERVICE
IS-SatO 4
Dept. 9
Colonic and
Physiotherapy Centre
Up-to-date Scientific Treatments
COLONIC IRRIGATIONS, SHORTWAVE
DIATHERMY, SINNEWAVE GALVIN-
ISM, IONIZATION, ULTRA VIOLET
RAY,  STEAM   BATHS  AND  SHOWERS
Medical and Swedish Massage
Physical Culture Exercises
STAFF OF GRADUATE NURSES
Superintendent:
E. M. LEONARD, R.N.
Post Graduate Mayo Bros.
1119 Vancouver Block
MArine 3723      Vancouver, B.C.
2559 Cambie Street
Vancouver, B.C.
PIHHI
ARTHRITIS and ECZEMA
of endogenous origin
claimed to be allergic, may be
favored or induced by calcium
and sulphur deficiency, impaired
cell action, and imperfect elimination of toxic waste.
LYXANTHINE ASTIER
administered per os, brings about
improved cell nutrition and activity, increased elimination, resulting symptom relief, and general functional improvement.
Write for Information
L-17
Canadian Distributors
ROUGIER FRERES
350  Le Moyne   Street,   Montreal ^^
9n New!
Qendeti QatmAf
Shorlime
Pasteurizing Process
Shortime Pasteurization is the newest development in milk processing. With- this new type of equipment, the milk is pasteurized in a
completely enclosed system, or stainless steel plates and tubing.
Pasteurizing by this shortime method simply means warming the
milk to a temperature of one hundred and sixty-one degrees fahren-
heit, holding for sixteen seconds, and then immediately cooling it to
a temperature of thirty-nine degrees. The older method of pasteurizing involved warming the milk to one hundred and forty-five
degrees and holding for half an hour, and then cooling to below
forty degrees.
The instruments which accurately control the pasteurizing process
are all automatic, and sealed to a tolerance of one-half degree. This
control, together with the speed of the process, and the fact that
all contact between milk and air is eliminated, results in a more
uniformly controlled product, with better flavor and appearance.
The installation of this shortime pasteurizer, together with accessory equipment, improved refrigeration, and the renovation of the
building, are all a part of a reorganization aimed at keeping Jersey
Farms one of the most up-to-date dairies in Canada.
"Pasteurized Milk Is Safe Milk"
*aAmb
LIMITED
Fnn JERSEY QUALITY INDEX TO VOL. XXI, BULLLETIN OF THE VANCOUVER
MEDICAL ASSOCIATION, 1944-45
A
ARNOLD-CHIARI MALFORMATION—Allin Moore  108
ASSOCIATED HOSPITALS  SERVICE  OF BRITISH  COLUMBIA  236
BATTLE, C. E.—The modern conception of burns—Review of literature	
BELL, W. N.—Follicular lymphoblastoma—Review of literature and case report	
BERRY METHOD OF CORRECTION OF PARALYSIS—S. E. C. Turvey	
BEST, C. H.—Penicillin, non-clinical aspects	
BOOK REVIEWS—
Managing Your Mind—KraineS and Thetford i	
Manual of Military Neuropsychiatry—Solomon and Yakovlev	
Marihuana Problem in the City of New York—Mayor's Committee on Marihuana	
My Second Life—T. H.  Shastid _	
Narco-Analysis—J. Stephen Horsley	
Psychosomatic Diagnosis—Flanders Dunbar 	
BOXALL, ERNEST A., and PRUETER, GORDON W.—Report of a case of tetanus with
recovery	
BRITISH COLUMBIA MEDICAL ASSOCIATION—
Annual Meeting    215,  243,
Annual  Reports  	
Committee on the Study of Cancer—Cancer Reporting in British Columbia.	
District No. 4 Medical Association, Annual Meeting	
East Kootenay Medical Association Meeting	
Upper Island Medical Association, Annual Meeting 	
Spring  Meeting  	
"West Kootenay Medical Association, Annual Meeting	
BRITISH COLUMBIA BOARD OF HEALTH—Division of Venereal Disease Control,
Distribution of free penicillin—venereal infection  201,
BRONCHIECTASIS IN SERVICE PERSONNEL—W/Cmdr. R. C. Laird,  R.C.A.F	
BURKE, GERALD L.—Club Feet  ... 	
BURNS, MODERN CONCEPTION OF—Review of literature—C. E. Battle	
BURNS, THERMAL, TREATMENT OF—Stuart D. Gordon,  Lt.-Col., R.C.A.M.C	
203
232
261
99
182
283
CANADIAN SURGEON FIGHTS AS PRIVATE     93
CARCINOMA OF THE CERVIX—Ethlyn Trapp  .   119
CARCINOMA OF THE CERVIX—UROLOGICAL COMPLICATIONS—L. R. Williams  128
—LATE MANIFESTATIONS, LOWER BOWEL AND
RECTUM—A.   T.  Henry.....  131
—ASSOCIATED  PAIN   (Abridged  Remarks)—
Frank Turnbull   133
CHISHOLM, G.  B.—Emotional problems of demobilization _    53
CLUB  FEET—Gerald  L.   Burke     99
COLLEGE OF PHYSICIANS AND SURGEONS OF B. C.—
Election  Results,  1945    143
Medical Economics    159
COOKE, E. H.—Fatigue syndrome from the use of pneumatic tools      71
COOPER, HARRY G., and MaeLEAN, JOHN T.—The diagnosis and treatment of chronic
prostatitis associated with non-specific
urethritis (preliminary report)  304
DAVIDSON. GEORGE A.—The diagnosis of a neurosis..	
DOLMAN, C. E.—The future of medical education from the standpoint of preventive
and laboratory research  _	
Note on case of tularaemia .	
Experimental trial of streptomycin in treatment of tularaemia	
49
ECTOPIC GESTATION—W. A. Scott _  81
ECTOPIC PREGNANCY—LEUCOCYTE COUNT IN—J. G. McPhee  110
EMOTIONAL PROBLEMS OF DEMOBILIZATION—G. B. Chisholm, Maj. Gen., R.C.A.M.C. 53
EMPLOYMENT OF LEISURE—Osier Lecture—A. H. Spohn  146
P
FATIGUE SYNDROME FROM THE USE OF PNEUMATIC TOOLS—E. H. Cooke  71
FIELD SURGICAL UNIT, ACTIVITIES OF—Rocke Robertson, Lt. Col., R.C.A.M.C  205
GENITAL PROLAPSE—W. A.  Scott	
GORDON,  STUART D.—The repair of deformities of the hand.
Mandibular fractures 	
Treatment of thermal burns	
75
279
281
283
HAND, REPAIR OF DEFORMITIES—Stuart D. Gordon, Lt. Col., R.C.A.M.C	
HARRIS, R. I.—Fractures of the os calcis: improved methods of treatment	
HARRISON, ELLIOTT—An unusual case of pulmonary haemorrhage 	
HEALTH SERVICES FOR ALL—Reprinted from 'Plans for Progress," Saskatchewan	
HEART DISEASE IN PREGNANCY—W. A. Scott	
HENRY, A. T.—Late manifectation of carcinoma of the cervix (lower bowel and rectum)
HODGKIN'S DISEASE AND ALLIED CONDITIONS—Henry Jackson. Jr	
HOSPITALS APPROVED FOR GRADUATE TRAINING IN SURGERY	 I
ITEMS  OF GENERAL  INTEREST .'.  94, 136,  176
J
JACKSON, HENRY, JR.—Leukemia and allied  diseases  253
Hodgkin's Disease and allied conditions  269
_E
KITCHING, J. S.—Salmonellosis   217
KONONENKO, ILARION—Public health services in the Ukraine  199
LAIRD, R.  C.—Low back pain  .'.  196
Common injuries in the region of the shoulder  220
Surgical treatment of  pulmonary tuberculosis  222
Bronchiectasis in service personnel  261
LEUKEMIA AND ALLIED DISEASES—Henry Jackson, Jr  253
LOW BACK PAIN—R. C. Laird, "W/Cmdr. R.CA.F :  196
LYMPHOBLASTOMA, FOLLICULAR—A review of the literature and case report—
W. N.  Bell     67
M
MANDIBULAR   FRACTURES—Stuart D.  Gordon,   Lt.-Col.,   R.C.A.M.C  281
MEDICAL EDUCATION,  THE FUTURE OF—SYMPOSIUM—
From the standpoint of the clinician—G. F. Strong       9
From the standpoint of preventive medicine and laboratory research—C. E. Dolman..    13
From the standpoint of public health—Stewart Murray '     21
MEDICAL  SCHOOL  FOR  BRITISH  COLUMBIA      96
MEDICAL SERVICES ASSOCIATION—Annual report, 1944     27
MENTAL DISEASES, PREVENTION—G. H. Stevenson     63
MOORE, ALLIN—The Arnold-Chiari malformation  108
MURRAY, STEWART—The future of medical education from the standpoint of public
health  ■.     21
He
MaeLEAN, JOHN T., and COOPER, HARRY G.—The diagnosis and treatment of chronic
prostatitis associated with non-specific urethritis  (preliminary report)  304
McPHEE, J. G.—Leucocyte count in ectopic pregnancy  110
Pathological conference  -  228
N
NEUROSIS,  DIAGNOSIS OF—George A.  Davidson     49
O
OBITUARIES—
Archibald, M. G     62
Bagnall, A. W - -     47
Boyce,   Benjamin  deF _.— 312
Franckum, J. R I _  118
Greer,   R.   F  187
Meekison, D.  M _  313
McCurdy, Gordon A _     58
McDiarmid, Colin A -  234
Smith,  Bruce  S - i  312
Stringer,  Lt.-Col.  F.  H  187
Thomas,   M.   W     48
Wray-Johnston,  K.   H _  234
OS CALCIS,  FRACTURES OF—IMPROVED METHODS OF TREATMENT—
R.  I.  Harris,  Lt.-Col.  R.C.A.M.C     43
OSLER LECTURE—THE EMPLOYMENT OF LEISURE—A. H.  Spohn  146
P
PARALYSIS, BERRY METHOD OF CORRECTION—S. E. C. Turvey .'.  195
PENICILLIN, NON-CLINICAL ASPECTS—C. H. Best,  Surg. Capt.,  R.C.N.V:R  178
PHOTOGRAPHY EXHIBIT  _ 1 •   233
PNEUMONIA.  PRIMARY ATYPICAL—REVIEW—A. B. Walter, Col.,  RC.A.M.C  297
PRUETER, Gordon W., and BOXALL, ERNEST A.—Report of a case of tetanus
with   recovery   203
PROSTATITIS, CHRONIC. ASSOCIATED WITH NON-SPECIFIC URETHRITIS—DIAGNOSIS AND TREATMENT (Preliminary report)—Harry G. Cooper, F/Lt., R.C.A.F.,
and  John  T.' MacLean,  Surg.  Lt.
Cmdr.,   R.CN.V.R  304
PSYCHIATRY IN GENERAL PRACTICE—G. H. Stevenson.....     37
PUBLIC HEALTH SERVICES IN THE UKRAINE—Ilarion Kononenko  199
PULMONARY  HAEMORRHAGE—UNUSUAL  CASE]—Elliott  Harrison  135
PUMP, K. K.—Case report—tularaemia  105
R
ROBERTSON, ROCKE—Activities of a field surgical unit  205
S
SALMONELLOSIS—J.  S.  Kitching  217
SAXTON, G. D.—Some cases of extra-pulmonary tuberculosis  226
SCOTT, W. A.—Genital prolapse  ;     75
Heart disease in pregnancy     78
Ectopic gestation      81
SHOULDER, COMMON INJURIES IN REGION OF—R. C. Laird, W/Cmdr., R.CA.F *220 SPOHN, A. H.—Osier lecture—The employment of leisure  146
STEVENSON, G.  H.—-Psychiatry in general  practice     37
The DrcvGrition of men __il c_is&_is6s fi^
STREPTOMYCIN, EXPERIMENTAL TRIAL IN TREATMENT'OFrTUL__E____MIA— "
C  E.  Dolman   191
STRONG, G. F.—The future of medical education, from the standpoint of the clinician      9
T
TETANUS, REPORT OF A CASE WITH RECOVERY—Ernest A. Boxall and
Gordon W.  Prueter  203
THIOURACIL, CASE REPORT—G. M. Wilson „  286
TRAPP,   ETHLYN—Carcinoma  of   the   cervix  119
TUBERCULOSIS, PULMONARY,  SURGICAL TREATMENT—R. C Laird, W/Cmdr.,
R.CA.F _. 222
TUBERCULOSIS, EXTRA-PULMONARY, CASES—G. D.  Saxton  226
TUTaARAEMIA, CASE REPORT—K. K. Pump   105
TULARAEMIA, NOTE ON CASE—C. E. Dolman  107
TULARAEMIA, EXPERIMENTAL TRIAL OF STREPTOMYCIN IN TREATMENT OF—
C.  E.  Dolman    191
TURNBULL, FRANK—Pain associated with carcinoma of the cervix (abridged remarks)  133
TURVEY, S. E. C.—The Berry method of correction of paralysis  195
V
VACCINATION,   SOME OBSERVATIONS  ON—Harold White '..      8
VANCOUVER GENERAL HOSPITAL—
Case reports  67, 108, 110, 135, 203, 226, 228, 286
VANCOUVER MEDICAL ASSOCIATION—
Annual   reports,   1944-45  170
Doctor Bagnall and the medical library     36
Library notes  31,  35, 62,  92, 118, 143, 168, 192, 193, 214, 241,  268,  294
Message from the library     31
Relief  administration  committee _  242
Summer  School,   1945  144, 192
VICTORIAN ORDER OF NURSES—Classes for young mothers _ ,  164
WALTER, A. B.—A review of primary atypical pneumonia-  297
WHITE, HAROLD—Some observations re vaccination       8
WILLIAMS,  L. R.—Urological complications in  carcinoma of the cervix  128
WILSON, G. M.—Case report—thiouracil  286
Ol^nter ^ l|atttta 5Itb
ESTABLISHED 1893
VANCOUVER, B. C.
North Vancouver, B. C.
Powell River, B. C. DIPHTHERIA TOXOID and
PERTUSSIS VACCINE <«-«_,
The death rate from diphtheria and whooping cough is highest among
children of pre-school age. It is desirable, therefore, to administer diphtheria
toxoid and pertussis vaccine to infants and young children as a routine
procedure, preferably in the first six months of life or as soon thereafter as
possible.
For use in the prevention of both diphtheria and whooping
cough the Connaught Laboratories have prepared a combined
vaccine, each cc. of which contains 20 Lfs of diphtheria
toxoid and approximately 15,000 million killed bacilli from
freshly-isolated strains (strains in Phase 1) of H. pertussis.
CONVENIENCE
The combined vaccine calls for fewer injections, and, in consequence, the number of
visits to the office or clinic may be considerably reduced. It is administered in three doses
with an interval of one month between doses.
DIPHTHERIA TOXOID & PERTUSSIS VACCINE (COMBINED) is supplied
by the Connaught Laboratories in the following packages:
Three 2-cc. ampoules—For the inoculation of one child
Six 6-cc. ampoules—For the inoculation of a group of six children
CONNAUGHT LABORATORIES
University of Toronto Toronto 5, Canada
DEPOT FOR BRITISH COLUMBIA
MACDONALD'S PRESCRIPTIONS LIMITED
MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. For thirty odd years Georgia Pharmacy has
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Reference—B. C. Medical Association
Tor information apply to
Medical Superintendent, New Westminster, B. C.
New Westminster 288
or 721 Medical-Dental Building, Vancouver, B. C.
PAcific 7823 PAcific 8036
37  British Columbia Libra
-T* DATE
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