History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: August, 1925 Vancouver Medical Association Aug 31, 1925

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THE VANCOUVER MEDICAL
ASSOCIATION
BULLETIN
Published monthly at Vancouver, B. C.
(Convention    U\[umber
CX
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AUGUST, 1925
§85
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'Published by
(fffid^eath Spedding Limited, ^Vancouver, CB. Q.
>xc PHONE SEYMOUR 2487
McBeath Spedding Ltd*
Vancouver, B. C.
PRESCRIPTIONS
filled exactly as written
Phones: Seymour 1050 -1051
Day and Night Service
Qeorgia Pharmacy Ltd.
Qeorgia and Qranville Sts.
Vancouver, B. C.
Page Two THE   VANCOUVER   MEDICAL   ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Association
in the Interests of the Medical Profession.
Offices:
529-30-31 Birks Building, 718 Granville St., Vancouver, B. C.
Editorial Board:
Dr. J. M. Pearson
Dr. J. H. MacDermot Dr. Stanley Paulin
All communications to be addressed to the Editor at the above address.
VOL. I.
AUG. 1st, 1925
No. 11
OFFICERS, 1925 -26
President
Dr. J. A. Gillespie
Secretary
Dr. g. H. Clement
Past President
Dr. H. H. Milburn
TRUSTEES
Dr. w. F. Coy Dr. W. b. Burnett
Representative to B. C. Medical Association
Dr. A. J. MacLachlan
Vice-President
Dr. a. W. Hunter
Treasurer
Dr. A. B. Schinbein
Dr. J. M. Pearson
Auditor
Dr. A. C. Frost
SECTIONS
Clinical Section
DR.   W.   L.   Pedlow	
Dr. f. N. Robertson     ......
Physiological and Pathological Section
Dr. g. F. Strong -
Dr. C. H. Bastin	
Eye, Ear, Nose and Throat Section
Dr. Colin Graham	
Dr. E. H. Saunders	
Cenito-Urinary Section
Dr. g. S. Gordon	
Dr. J. A. E. Campbell	
COMMITTEES
Chairman
Secretary
Chairman
Secretary
Chairman
Secretary
Chairman
Secretary
Library Committee
Dr.
Dr.
Dr.
Dr.
Wallace Wilson
A. W. Bagnall
W. D. Keith
W. F. McKay
Orchestra   Committee
Dr.
Dr.
Dr.
Dr.
F. N. Robertson
J. A. Smith
L. Macmillan
A. M. Warner
Dinner  Committee
Dr.
Dr.
Dr.
N. E. MacDougall
A. w. Hunter
F. N. Robertson
Credit   Bureau   Committee
Dr. Lachlan Macmillan
Dr. J. W. Welch
Dr. G. A. Lamont
Credentials Committee
Dr. Lyall Hodgins
Dr. R. Crosby
Dr. J. A. Sutherland
Summer School Committee
Dr. Alison Cumming
Dr. Howard Spohn
Dr. G. S. Gordon
Dr. Murray Blair
Dr. W. D. Keith
Dr. G. F. Strong
Page Three VANCOUVER MEDICAL ASSOCIATION.
Founded  1898.- Incorporated  1906.
28th Annual Session
GENERAL MEETINGS will be held on the first Tuesday of the month
at  8  p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the month
at  8  p.m.
Place of meeting will appear on Agenda.
GENERAL MEETINGS  will conform to the following order:
8 p.m.—Business as per Agenda.
9 p.m.—Paper of Evening.
The regular work of this Session will commence on Tuesday, Oct. 6, 1925.
Programmes  to  be  announced  later.
HEALTH DEPARTMENT  STATISTICS.
JUNE, 1925.
Total Population  (estimated)  .
Asiatic Population   (estimated)
Total  Deaths     106
Asiatic Deaths       18
Deaths—Residents  only       86
Total Births—Male,   143
Female,   133     276
Stillbirths—not included in above      10
Infantile Mortality—
Deaths under 1 year of age      11
Death rate per  1000 births 39.9
   126,747
9,960
Rate per 1000 of
Pop. per Annum
10.2
22.0
8.3
26.5
Cases of Contagious Diseases Reported.
July
June. to  \5th.
Cases. Deaths.  Cases. Deaths.
May.
Cases. Deaths.
Smallpox       10 0
Scarlet  Fever    49 0
Diphtheria         9 0
Chicken-pox   42 0
Measles         0 0
Mumps      21 0
Erysipelas      4 0
Tuberculosis   34 11
Whooping Cough |_  25 0
Typhoid Fever I  .         10
10
24
11
12
3
21
1
2
28
3
0
0
1
0
0
0
0
8
1
0
(Cases from outside City included in above.)
Diphtheria  |__:      10 3       1
Smallpox         10 0       0
Scarlet Fever      7       0 3       0
3
0
5
0
4
0
5
0
0
0
0
0
4
1
3
0
14
1
1
0
)
3
0
0
0
0
0
Page Four r~
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Page Five EDITOR'S PAGE.
We are frequently reminded by those who regretfully regard
the past, that the golden age of clinical acumen is slipping away.
No longer, we are told, does the modern medical man cultivate
properly his powers of observation at the bedside or appreciate
fully the advantages of the tactus eruditus in the pursuit of diagnoses. On the contrary he neglects these things, rushing after the
so-called instruments of precision and laboratory methods, with
the consequence that the ways by which the fathers of the craft
enriched the book of knowledge are falling into undeserved disue-
tude.
It may be so. In this world of mutations the old order of
things constantly changeth, if it does not pass away. Men have
used the natural means at their command, but these were used not
on account of their superiority but because they were the only
ones at hand. With the advent of experimental methods and especially with the development in other arts and sciences which
may be laid under tribute by the medical profession, quicker and
more generally accurate means of diagnosis are now often available. It is true that with this alteration something of romance is
passing away and more rarely now has the experienced observer
or bold guesser such opportunities of exercising his powers of
divination. What, we may ask, has the world lost by the discovery and perfecting of the Widal reaction as a detector of typhoid infection, or of the Wassermann reaction of the presence of
syphilis? Or by the incursion of the radiographer to many dark
regions of the human form? We confess ourselves wholly on the
side of the "instruments of precision" party. If the X-ray can
detect early tuberculosis of the lung for the multitudes when that
opportunity was formerly the province of the few naturally gifted or as the result of long and arduous apprenticeship, the advantage is surely greater than the loss.
Nor is it any answer to point to the practitioner in remoter
districts and ask where are his X-ray plants and laboratories.
These things will follow and are following him. It does not
need a prophet to foresee the time when in some centre these will
be available to everyone.
However, the use of these instruments of precision may work
both ways, and one use of familiarity with their workings in certain instances is the increased ability to recognize by natural or
clinical methods the very manifestations of disease which these
instruments have unmasked. This is notably the case in the use
of the electro-cardiograph, familiarity with which in time enables
the cardiologist to recognize conditions which this instrument has
in the first instance revealed. Likewise by the frequent use of the
basal metabolism recorder many men have acquired facility in
detecting at all events the grosser departures from the normal
standard without resort to its use. But to the infrequent student
of these conditions these instruments remain invaluable, and he
may and will resort to their use with increasing confidence.
Page Six We have passed through the period when the experienced
clinician claimed to have estimated a patient's temperature by
means of a hand on the forehead. Or later to estimate blood pressure by a finger upon the pulse. The clinical thermometer and
the blood pressure machine have passed into daily and habitual
use, nobody now regretting their advent. In like manner we may
hope to see the increasing perfection of a large number of similar
aids to diagnosis, each of which in its turn will ultimately take
its place in halping the inerun-- development of our art.
The Life of Sir William Osier.    By Dr. Harvy Cushing.    In two
volumes.    Oxford University Press.     1925.    37s. 6d.
Dr. Cushing has provided us with a fascinating book, every
page of which is of interest. Osier touched life at many points
and warmed both his hands with an enviable gusto. The development of this book has been internal rather than external, and
Dr. Cushing has said in his preface that "Little pretence is made
to do much more than let his story, so far as possible, tell itself
through what he puts on paper." Fortunately for the world,
Osier put a great deal on paper, most of it very well worth while,
and most fortunately, almost from his early days, the recipients
of many of his personal communications appear, with admirable
and almost uncanny foresight, to have carefully filed these
away for our present delectation. The work of connecting up
and amplifying these written statements has been excellently done,
and if we may say so, Dr. Cushing seems to have caught up some
of Osier's whimsical spirit into his own work.
Volume I. opens with the customary ancestral account which
in this case is more than perfunctory in that Osier's forbears were
of unusually vigorous and distinctive stock. His early teachers,
whose names are carried in the dedication of his text book in
medicine, receive careful and sympathetic handling. Tracing his
career through youth and early manhood, it is not long before we
find Osier established at Montreal as Professor of Medicine at Mc-
Gill. In 1884 he is called to Philadelphia and his cosmopolitan
career is fairly begun. Five years later we find him at the newly
established medical school of Johns Hopkins. In 1904, Osier
was appointed Regius Professor of Medicine at the University of
Oxford, and here, after a lively account of the strenuous leave-
taking ceremonies on this side of the Atlantic, the first volume
leaves him.
Says the New York Evening Post at the close of its review:
"How does it happen that this man .... was able to do so much
for his day and generation? The answer is so simple it will scarcely be grasped by a rising generation of wise men     From
Page Kei'en. his   beginning  Willie  Osier   had   to  work   and   work   hard   for
everything he got."
To which we say "Amen," the mere reading of his strenuous activity leaving us somewhat breathless.
The second volume of Dr. Harvey Cushing's work carries
us with the Osier family—father, mother and son Revere—-to
Osier's third transplantation, that of Oxford. As Regius Professor of Medicine in that ancient seat of learning, he enters into
the medical life of the three Kingdoms.
To a far-off observer at that time one felt that Dr. Osier's
removal to Oxford seemed to mean a retirement from the actualities of medicine, that it would give him time for meditation, for
assembling all his observations which he had stored away and
which fugitive time had not permitted him to gather into a useful
form. Also one felt sensitive as to whether in his new sphere,
Dr. Osier would have the opportunity of making a personal impress on medicine within the British Isles. However, Dr. Harvey
Cushing soon shows us that a change of location does not alter a
man's character. Soon we find Dr. Osier leading a more active life
than ever. Clinics are instituted at the Radcliffe Infirmary for
graduates as well as undergraduates. He immediately took a live
interest in Oxford's remarkable library—Bodley—and he allowed
his hobby for collecting rare old medical works to have full play.
For Osier believed in and taught all his students to have a hobby.
For giving addresses to medical students on special occasions,
Osier seemed to be ever on call. He threw all his energies into
getting anti-tuberculosis work in England and Ireland on a new
footing.
He also took a leading part in helping Sir J. W. G. Mac-
alister to unite the medical profession of London and to bring
to that great medical centre its proper position for postgraduate
study.
New duties and new interests seemed to be thrust upon him
almost daily. Then the war came. Here our author shows what
a noble part Sir Wm. Osier played, in keeping the amenities of
British, Canadian, and American medicine on a happy footing.
The migration to Oxford did not rob him of that great gift he
possessed to a rare degree—the knack of getting in touch with
young people; young children were his particular joy, and young
students felt the friendliness of a kindred spirit, that met them
on terms of mental equality. None of these students left his contact with Osier without feeling that he also could make something tell for righteousness in his life's work.
We of the Vancouver Medical Association have a special interest in the second volume of Dr. Cushing's work, since portions
of two letters written by Sir William to our Society are included.
His interest in our library and the practical encouragement he gave
us by a donation of $100.00, will be cherished always.
Dr. Harvey Cushing has performed a great and loving task
Page Eight in giving to the profession and to the world such an intimate
retrospect of the life of his great friend, William Osier. The task
has been a huge one, for Osier's idle moments were rare, and to
crowd even into two volumes anything that would adequately
represent the activities of Dr. Osier is a memorable feat.
B. C. MEDICAL ASSOCIATION NEWS FOR "BULLETINS
The Annual Meeting of the B. C. Medical Association was
held in the lecture room of the Wesley Church, Vancouver, on
Friday, July 3rd, 1925.
Dr. Vrooman, president, in the chair. There was a good
attendance, with a large number of out-of-town members.
It was decided, unanimously, that the honorary membership
of the Association should be extended to Dr. G. L. Milne, of Victoria, in recognition of the fact that he has been in practice in the
province for fifty years, and has performed eminent services to the
medical profession.
The auditor's report for last year was read and adopted.
The finances of the Association are in sound condition, and the
reduction of the fee has been justified by results.
The report of the secretary-treasurer gave an account of the
activities of the Association during the past year. A gratifying
increase in paid-up membership over this date last year was reported. The work of the Association shows steady growth in
bulk and importance, and the methods in which it serves the individual medical man as well as the profession at large, were described at some length by the secretary-treasurer.
Discussion of the report elicited some questions as to the
operating expenses of the Association. This was taken up later
by the executive, which appointed a small committee to investigate
the comparative costs of our Association and those in other provinces, and to report at an early date, as a first step to a complete
enquiry into the subject. As an outcome of the discussion it was
decided that steps should be taken to hold a conference between
the B. C. Medical Association, the B. C Medical Council and the
Vancouver Medical Association, with a view to discovering methods of economy both in money and time, and increased efficiency
of work.
Reports were read as follows:—
Legislative Committee.
Industrial Service Committee.
Publicity and Educational Committee.
Constitution and Credentials Committee.
Ethics and Discipline Committee.
Health Insurance Committee.
Page Nine A dinner was held at the Ambassador Cafe, in the evening,
at which Sir Henry M. W. Gray, of McGill University; Dr. Hugh
Cabot, of Boston: and Dr. Carr, of Chicago, were the guests of
honour. Each of these gentlemen spoke after dinner, and a delightful evening was spent, until it was time to return to the
Summer School meetings at the Wesley Church. At the close of
the dinner the officers for" the coming year were elected as follows:—
Dr. W. B. Burnett, Vancouver, President-elect.
Dr. W. A. Clarke, New Westminster, Vice-President.
Dr. J. H. MacDermot, Vancouver, Secretary-Treasurer.
Dr. M. G. Archibald, Kamloops; Dr. F. W. Andrew, Sum-
merland; Dr. T. A. Briggs, Courtenay, Members at Large of
Executive Committee.
The following letter is self-explanatory:—
The   British   Columbia   Medical   Association.
927 Vancouver Block,
Vancouver,   B.   C,
July 10th,  1925.
Open Letter to the Past President of the Vancouver Medical Association.
Dr. H. H. Milburn,
1190  Granville Street,
Vancouver,   B.   C.
Dear Dr. Milburn:
In the course of discussion at the recent Annual Meeting of the B. C.
Medical Association, I made certain remarks, which I learn since, have been
interpreted by yourself and by others who were present, as a reflection on the
work of the Executive of the Vancouver Medical Association, of which you
were  President   last   year.
I wish to express my sincere regret to you for having made these remarks,
which I can now see now were capable of this interpretation, though I assure
you that I did not mean to make any personal reflection on you, or any of the
members of your Executive, who all worked hard and loyally for the good of
the Association, as shown by the year's record and the good work accomplished.
I am sure that any suggestions that you made at any time were made for the
good of both Associations and of the profession as a whole.
I would ask you to accept this as a retraction of anything I may have
said of a disparaging nature.
I  remain,
Yours sincerely,
W. B. Burnett.
The Thirteenth Annual Meeting of the Pacific Coast Oto
Ophthalmological Society was held in Vancouver, June 18th.
19th and 20th, under the Presidency of Dr. H. M. Cunningham.
There was a large attendance and many excellent papers were presented.
After welcoming the visitors, Dr. Cunningham touched briefly on the many unsolved problems in Eye, Ear, Nose and Throat
Page Ten work, referring particularly to the etiology of glaucoma, trachoma
and cataract. He reported a case of congenital atresia of the post
nasal choanae with complete obstruction in which the sinuses were
fully developed. He considered a case of this kind absolutely disproved the pneumatic pressure theory of development of the sinuses. Dr. Cunningham also dealt with recent advances in the
study of cardiospasm, referring to the work of Plummer of the
Mayo Clinic, Jackson of Philadelphia, and Mosher of Boston. He
mentioned some work he was doing on this subject in conjunction
with Dr. H. H. Mcintosh of the Vancouver General Hospital, on
which he had hoped to make a preliminary report, but they had
decided it would be premature to do so at the present time.
It had been confidently anticipated that Dr. George Piness, in
his paper on "Allergies of the Upper Respiratory Tract," would
give results of the work carried on by him during the past few
years, but Dr. Piness, beyond stating that they had cases relieved
over a period of seven years, would not make any statement as to
final results. He outlined the symptomatology and methods of
diagnosis of these conditions. Most'allergies of the upper respiratory tract gave a history of onset early in life. Every case of
eczema and allergic coryza in infancy and childhood must be considered a potential asthma. All asthmas must be classed as chronic
except those due to the introduction of a foreign protein. Angioneurotic oedema is an allergic condition similar to the disease'produced in a patient who eats foods to which he knows he has an
idiosyncrasy, but who does not react when tested against such
foods. Another type of oedema definitely allergic is that accompanied by an urticaria. Methods of diagnosis include a complete
physical examination—X-ray, blood, urine and sputum examinations— and studies against proteins, also in certain cases personal surveys of the environment and botanic surveys. He advised the cutaneous method of testing. The interpretation of reactions is important. Reactions may occur that are not true, but
pseudo or skin reactions. The true reaction is the one with a
wheal with pseudopodia and an erythema regardless of size. An
analysis of reactions is the final criterion for determination of
treatment. With regard to surgery in allergies of the upper respiratory tract, Dr. Piness said that out of a series of 854 cases not one
had been cured by operative measures. No man should promise
an allergic individual relief by surgery. Obstructive interference
should be removed regardless of the allergy. He was firm in his
belief that Dr. Sluder's work on Meckel's ganglion was absolutely
wrong, and he urged upon the members present to. be more conservative in their treatment of the allergic individual by surgical
measures.
Dr. Gordon B. New, of the Mayo Clinic, gave three lantern
slide demonstrations, the first dealing with advances in the treatment of congenital and acquired deformities of the face and neck,
particularly saddleback and luetic noses and rhinophyma. He advocated the use of full thickness skin grafts rather than Thiersch
grafts in the plastic repair of these cases, bringing the flap down
Page Eleven i_f c
from the forehead. In cleft palate and hare lip operations he recommended the two stage operation with the use of lead plates to
prevent post operative flaring of the nasal alae. In his second
lecture on "Malignant Tumours of the Nose and Throat," Dr.
New drew special attention to nasopharyngeal tumours, the most
commonly overlooked of all growths of the head and neck; 25%
to 30% of these cases have neurological symptoms only; forty
cent, come primarily to the Internist, only a very small percentage
come primarily to the Laryngologist. The results of treatment
are not good, as patients are seen so late in the disease. He discussed the relative merits of radium, diathermy and surgery in
treatment of these tumours. In his third lecture on "Unusual
Lesions Seen First by the Laryngologist," Dr. New drew attention
to cases of acute and chronic leukaemia which were easily mistaken
for malignant conditions, and in which very close co-operation is
necessary between pathologist and laryngologist. He referred to
the value of the differential blood count in diagnosis of these conditions. Other unusual lesions seen by the Laryngologist are
pemphigus, thrush and actinomycosis. In 107 cases of the last
named condition examined at the clinic, only seven had been correctly diagnosed beforehand.
Dr. Harry Wurdemann, discussing Dr. H. G. Merrill's paper
on "The Light Sense" and its test by means of Percival's rotating
discs, referred to it as one of the most important papers presented.
Aviation was making rapid strides in the industrial world, and it
would be their duty as ophthalmologists to decide what men could
safely fly. The test was simple, easily and quickly made, and
should be done as a routine test by all ophthalmologists.
The value of the blood count as an aid in early diagnosis and
deciding for or against operative interference, was emphasized by
Dr. L. Klemptner in his paper on "Bezold's Mastoiditis." He
agreed, however, that a leucocytosis was not certain evidence of
acute mastoiditis, and the number of his cases was as yet too small
to draw definite conclusions. The X-ray had proved a disappointment, as plates very often showed no visible bone destruction, yet
on operation very considerable destruction was found.
Dr. Colin Graham, of Vancouver, in the discussion on Dr.
G. F. Chase's interesting paper on "Thrombosis of the Sigmoid
Sinus and Blood Stream Infection," mentioned several cases in
which he had used exsanguination transfusion with success. One
of these was a double mastoid with a temperature of 106 per rectum at time of operation. He thought exsanguination transfusion
a valuable procedure in these cases, as it helped to wash out the
infection.
Dr. Edward Jackson, in describing the eye as "the laboratory
and clinic of the living body," said that from observations made
in this laboratory were coming some of the great advances in modern medicine. The eye is peculiarly favourable for exact observation. It may be termed the bulletin board for diseases of the
brain and spinal cord.    As the observer on the mountain top gives
Page Twelve fire protection to thousands of miles of forest, .so the ophthalmologist, by interpreting the signals given by the eye, has command of a great territory of disease. The study of the living eye
with the ophthalmoscope has bridged the gap between the studies
of the dead house and the laboratory. The ophthalmoscope has
doubled the clinical value of Harvey's great discovery, and training in its use by the general practitioner should, in the very near
future, play as important a part in the observation of general disease as feeling the pulse did 70 years ago.
Dr. Martin D. Icove, speaking on "Intra Orbital Anaesthesia
in Ophthalmic Operations," said the reason so many men were
disappointed in its results was because they did not allow sufficient
time to elapse after induction before commencing to operate. They
should wait at least half an hour. Dr. A. S. Green said the dangers were practically nil. The method had been in use in Paris
for six years with no ill effects. He considered it the anaesthetic
of choice in all cases where the eye had to be pulled upon or cut.
Dr. F. P. Hyde reported a case of ligation of the external
carotid with recovery in a case of simple uncomplicated epistaxis.
He thought this treatment should be included in the text books as
an emergency operation of great value in severe idiopathic nasal
haemorrhage.
Dr. Ira E. Gaston's paper on "Milk Injections in Ophthalmic
Diseases" led to a spirited discussion as to whether better reactions
were obtained by whole milk than by the use of preparations, such
as aolin, kaseosan, etc., and whether any therapeutic results could
be attributed to the injections. Dr. Wurdemann thought if any
good was accomplished it was by the reaction of the system to
the bacterial products, and the general opinion appeared to be that
the more contaminated the milk the better the results obtained.
Dr. A. C. Jones said the fulminating character of the acute
ethmoiditis which breaks through into the Orbit led him to believe that there may be a chemical action produced by the bacterial
growth which leads to the formation of carbon dioxide under
great pressure, and that the etiology is not always a defect in the
osseous boundaries. The theory of the formation of carbon
dioxide under pressure is the probable explanation of the bulging
eye and meningeal complications in this type of ethmoiditis.
Other interesting papers were "Sinus Infection in Children,"
by Dr. F. M. Shook; "Mucocele of the Frontal Sinus," by Dr.
Mearle C Fox; "Central Retinal Haemorrhage Synchronous with
Onset of Menstruation," by Dr. E. Nelson Neulin; "Fibroma of
the Larynx in a Child of Three, with Operation and Recovery,"
by Dr. Chester Bowers; and "The Value of the Ultra Violet Ray
in Eye, Ear, Nose and Throat Field," by Dr. H. F. McBeth.
On Friday morning Dr. A. S. Green gave a clinic at the Vancouver General Hospital when he operated on five cases of cataract
by the Barraquer method. Demonstrations by Dr. Lewis of his
test for differentiation between Stapes Fixation and Obstructive
Page Thirteen Deafness; by Dr. Pischel of a test for localization of foreign bodies
in the eye by means of markers in the conjunctiva; and presentation of a case of "Jaw Winking" in a little girl, by Dr. Spencer
Howe, concluded the scientific programme.
At the business meeting held on Friday, the 19th, Dr. Kasper
Pischel was elected President, and San Francisco was chosen as the
place of meeting in  1926.
THE PACIFIC NORTHWEST MEDICAL MEETING
AT PORTLAND.
The meeting of the Pacific Northwest Medical Association,
held in Portland, June 29th, 30th, and July 1st, was well attended and was enjoyed by all present, among whom were eight
Vancouver medical men.
Sir Henry M. Gray was present and gave three interesting
papers which he later presented at the Vancouver Medical Association Summer School. These are abstracted in the account of that
meeting.
Dr. Geo. N. Stewart, of Cleveland, presented three papers,
respectively on the "Physiology of the Suprarenal Glands," "The
Thyroid," and "The Islands of Langerhans." In speaking of
the suprarenals he pointed out that we are dealing with two separate and distinct glands, the cortex and the medulla. Most is
known about the medulla, whose secretion—epinephrin—is entirely under the influence of the nerves and can be detected in the
blood qualitatively and quantitatively, being present in a dilution
of 1-100,000,000, although even to a strength of 1 in 1 to 5
million in the blood of the adrenal vein. He estimates that a good
sized man daily produces the equivalent of one P. D. & Go. one-
ounce bottle of adrenalin. Dr. Stewart found that the medulla
experimentally is not indispensable to rabbits, rats and dogs, and
the blood pressure is not affected by removal, either together or at
different times. We do not know what the cortex produces, but
when it is removed (with the unimportant medulla) certain definite things happen, although 50% of white rats live indefinitely
and have bred young after such complete removal. Deprival of
vitamins and other nutritional deficiencies also make the operative
results less good. Dogs, however, live from six to seven, or even
sixteen days, without any treatment and are apparently well, but
they all die, and probably suddenly, after one, two or three days
of anorexia, with sometimes nervous symptoms and spasms, "but
asthenia is not the prominent symptom, if at all." Coupled with
the anorexia is a well marked condition of the alimentary canal
—congestion—present from the cardiac end of the stomach to
the anus, with bloody stools and even vomit, reverse peristalsis,
with bile also, and concurrently a highly congested pancreas. Dogs
can be kept alive four or five times as long by injections of Ringer's
solution containing some sugar, beginning preferably 24 hours
after operation, lessening the general concentration, which is also
shown by considerable increase of the red blood cells.
Page Fourteen Dr. W. McKim Marriott, of St. Louis, gave an instructive
paper on "Some Newer Viewpoints Concerning the Nature and
Treatment of Nephritis." He described the tubular type (nephrosis) and the glomerular or haemorrhagic type. In the tubular
variety (nephrosis) there is a gradually decreased secretion of
urine with small amount of blood, if any, but large amount of
albumen and casts; no acidosis or increase in blood pressure;
N. P. N. not increased and no true uraemia; also the eye grounds
and skin capillaries are normal. There is, however, marked general oedema and anaemia, and the patient's nutrition is such that
resistance is poor and death not infrequently follows infection.
Post mortem the kidneys are found to be large and white, the
tubules being filled with degenerated cells. However, the majority recover completely. Nephrosis in childhood is most frequently due to a staphyloccocus infection of nasal sinuses, the successful treatment of which clears up the kidney condition. Blood
cultures are mostly negative, but the general condition seems due
to a toxaemia. Phthalein tests do not show lack of kidney function, but the tissues retain salts and water. The protein of the
blood serum is lowered and oedema increases as this occurs. This
is apparently coincident with lowering of the surface tension of
the serum, which can be measured by weighing a drop of serum.
The smaller the drop the lower is the surface tension. In cardiac
oedema or that due to glomerular nephritis, the surface tension
of the serum is not lowered. In these cases there is apparently a
substance in the blood which changes the permeability of animal
membrane and acting on the kidney epithelium causes the latter
to pass albumen freely. This substance has been isolated from
urine of these cases by Clausen and experimentally has produced
albuminuria.
Treatment.—Examine nose and throat carefully, remove enlarged tonsils and adenoids to improve drainage, and prevent reinfection. Treat sinus infection if present. Diet is important,
due to large loss of albumen. They need a high protein diet (2 to
4 grms. per kilo of weight per day), milk, eggs and meat, also
green vegetables and those containing protein. Salt and water
need not be limited. Sweating is of no value. Intravenous injections of blood are useful. Theobromine occasionally produces
marked diuresis and may increase the surface tension, thus lessening oedema.    Heliotherapy also may aid patient.
In contrast to preceding variety is acute glomerular or haemorrhagic nephritis, coming on acutely with diminution or suppression
of urine, which is of a smoky colour from contained blood. Microscopically large numbers of red blood cells and some white
blood cells are seen. A moderate amount of albumen is present
and casts may be seen at first. Here a definite inflammatory condition of the glomeruli exists which may cause permanent fibrosis,
but in most cases also the damage is not too extensive and recovery
may occur. The kidney function is much altered. Non-protein
nitrogen, urea and chlorides are all retained. Acidosis is present
and phthalein excretion is diminished.    The serum protein is not
Page Fifteen reduced and the surface tension of the blood is not diminished,
therefore oedema is rarely marked. The capillaries are definitely
narrowed and beaded and blood pressure increased. Dr. Marriott
stated that by simply examining the capillaries at the base of the
nail with a microscope it is possible to diagnose this form of nephritis. True uraemia may occur, and, if late, is grave. These cases
are also due to an infection, probably of a haemolytic streptoccus,
most frequently following a sore throat or tonsillitis, but may be
from elsewhere. There is no definite evidence of septicaemia, but
the capillaries in general are damaged and the result in the severer
cases may be chronic nephritis with high blood pressure.
The Treatment.—Removal of focus of infection, as operation on acute mastoid, may clear up case. Do not remove acutely
inflamed tonsils. Keep in bed for some time after subsidence of
acute condition. On account of possibility of uraemia a low protein diet is necessary—1 gram per kilo of weight or less in older
children or adults. Milk protein is the best, but one must give
sufficient calories with the milk to maintain nutrition by using
fats, cream and carbohydrates, especially arrowroot. Salt-free
food is indicated. Curds and eggs may be given in the more chronic
stages, and meat may be given after the blood has disappeared from
the urine. If the blood persists, or is marked, put on free sugar
diet, giving 10 grams of sugar per pound of body weight, give in
water. A large intake of water is useful. Diuretics, especially
diuretin, are contra-indicated in this form. Alkalies may cause
alkalosis and tetany. Acidosis, if present, is due in these cases to
retention of acid sodium phosphate, and is best treated by calcium
lactate in large doses by mouth—even 15 to 30 grains every four
hours. Sweating is contra-indicated. Hypertonic solution of
glucose, 20%, is good—1 oz. of solution per kilo given intravenously.
Dr. Nathaniel Allison, of Boston, gave two addresses which
were of great interest. He dwelt mostly upon the pathology of
arthritis, stressing the fact that the disease may originate in either
the synovial membrane or in the bone contiguous to the joint,
and spread to it. In the former the structures become swollen,
opalescent and loaded with exudation products. Granulation tissue spreads out over the cartilage, which loses its natural bluish"
white and polished surface and becomes dull, yellowish and
opaque. Pits form which coalesce and completely destroy portions of cartilage, which are thrown off into the joint. Or the
disease begins in inflammatory foci in the bone beneath the cartilage. As these become larger, they coalesce and approach the
cartilage, which is raised from its source of blood supply, becomes
necrosed and cast loose. In similar manner all the structures about
the joint are invaded with granulation tissue and disorganized.
Dr. Hugh Cabot gave two papers on "The Management of
Small Stones in the Kidney and Ureter" and on "Renal Tuberculosis," which were enjoyed by everyone present.
Dr. L. F. Barker gave papers on "The Medical Aspects of
Page Sixteen Gastric Ulcer,"  "Psychic Factors in General Medicine,"  and on
"The Present Status and Future Prospects of Endocrinology."
Dr. Henry Woltman, of the Rochester Clinic, gave two comprehensive lectures on "The Syndrome of Compression of the
Spinal Cord" and "The Significance of Pain as a Symptom in
Diagnosis of Diseases of the Nervous System."
Dr. Jas. B. Herrick, of Chicago, read three papers of interest
on "Angina Pectoris," "Diseases of the Coronary Arteries," and
on "Syphilis of Heart and Aorta."
Dr. Reginald Fitz, of Harvard, gave two papers on "The
Action of Insulin" and "The Importance of a Routine Wasser-
mann Test in Private Practice."
Dr. R. L. Benson, of Portland, lectured on "The Pathology
of Coronary Artery Sclerosis."
Dr. R. W. Te Linde, of Johns Hopkins, gave two papers on
the "Present Status of Adenomyoma and Endometrial Growths"
and on "Diseases of the Endometrium." In his second paper
he gave some interesting results of recent research in the physiology
of the endometrium before and during menstruation.
The Pacific Northwest Urological Society and the North
Pacific Paediatric Society met during the same time. At the latter
meeting Drs. H. A. Spohn and R. E. Coleman, of Vancouver, read
a paper on "Some Metabolic Observations in Cases of Herter's
Disease," which was very favorably received and commented on
by those at the meeting.
* 3)C H= s(:
LIBRARY NOTES.
(The Library is situated in 529-531, Birks Building, Granville Street, Vancouver. Librarian: Miss Firmin. Hours: 10
to 1, 2 to 6.)
Dr. Alan U. Drury, from the Medical Research Council of
England, gave four interesting and instructive papers. In his paper on "Clinical Signs in Cardiological Practice," he began with
method of examination. Has the patient cardiac failure of the
congestive type or not? If present, rest over long period is necessary. Cases with ascites, oedema and small urinary output are
easy of diagnosis, but we should get them sooner. In the borderline cases there is a reliable and certain sign—first the right side
of the heart is engorged, then the veins become engorged—in a
normal person the veins of the neck are flat when in the upright
position, but if his neck veins are full the heart is failing; similarly the liver becomes enlarged and rales are heard at base of
the lungs.
No enlarged heart is healthy, and not all normally sized
hearts are healthy. The maximal impulse marks the border of
the heart.
Page Seventeen This maximal impulse is small and definite and pushes the
finger out and holds it. It may or may not be surrounded by a
diffuse impulse. Sustained and forcible movement of the ribs indicate an enlarged heart. Gross cardiac displacement must be excluded. Percussion of the left border will give ventricular enlargement, but does not say which ventricle. If this sign does not
agree with maximal impulse, then take the latter. The right border is more difficult. Heart sounds alone are not taken as evidence of heart trouble unless this fits in with other symptoms.
Gallop rhythm can occur in effort syndrome.
Valves—If affected it is most likely that heart muscle also
has been injured by the same process.
Cardiorespiratory systolic murmur — best heard during inspiration—is probably only a broken up breath sound, but this
is not certain;   it is not important.
Systolic murmur over pulmonary is of no prognostic significance, but if there is a thrill present it may be pulmonary stenoses,
when cyanosis either transient or permanent will be present.
There may be a long systolic with a thrill from a patent
Ductus arteriosus.
Aortic systolic murmurs with thrill are not necessarily stenosis, unless with evidence of regurgitation also, which is probably
always present, and one finds a slow-rising flat topped pulse.
Apical systolic murmurs may be:
(a)   Position murmurs—heard only in certain positions.
(6)   Inconstant murmurs.
(c) Constant murmurs, mitral regurgitation, it must be decided whether it is from diseased valve or relaxed ring.
Tricuspid murmurs may be unimportant, as this ring dilates
easily under stress.
Aortic regurgitation: A diastolic murmur at base, heard best
at left of sterinum, is a reliable sign in early stages. Later there is
the water hammer pistol shot pulse with throbbing.
Mitral Stenoses: There is almost always a diastolic rumble
(occasionally a thrill only), an accentuated first sound or increased secondary pulmonary sound alone are not sufficient evidence. Raise the rate of the heart-beat and place patient on the
left side, when you can get the diastolic rumble necessary for
diagnosis.
Rhythm.—There may be no enlargement or murmur, but
a disturbed rhythm, which may have significance; e. g., if bradycardia is present it may be:
(a)   Physiological; or  (b)  due to heart block.
There is a ^good clinical sign which indicates heart block—
when the auricle and ventricle go off together (synchronize) there
is a definite increase in the heart sound at that time.
Page Eighteen Auricular fibrillation may occur in the normal, but usually
in a damaged heart—as also is the case in extra systole. If the
heart rate is raised by amyl nitrite or exercise to, say, 120 and
the irregularity persists, it is fibrillation; but if irregularity ceases
it is due to extra systole.
Tachycardia.— (a) Physiological; (b) Paroxysmal, which
may occur in a healthy or damaged heart and is not affected by
exercise; (c) Flutter, which occurs in a damaged heart, the rate
is about 160, which is not affected by mild exercise, but violent
exercise may even double the rate and the patient faint.
Speaking of the use of the galvanometer, Dr. Drury insisted
that to-day this instrument could give diagnostic information beyond that procurable by clinical examination in only from 5 to
10% of cases.    It will disclose:
(a) Mild heart block, which cannot be diagnosed clinically
with certainty.
(b) Arborization block or some disorder of conduction in
the ventricle, splitting of the R. or widening of the
Q. R. S. wave.
The T-wave, whether up or down, has at present no known
significance.
:je ^c ^c 3jc
THE SUMMER SCHOOL OF THE VANCOUVER MEDICAL ASSOCIATION, JULY 2-4, 1925.
In beautiful weather, with the city decorated and en fete for
the Dominion Day celebrations, the Annual Summer School of the
Vancouver Medical Association opened on July 2, under brilliant
auspices, which the progress of the meeting did not belie. The
committee in charge is to be congratulated upon the smooth working arrangements it had perfected. It is quite safe to say that,
despite the many successful meetings which have been held, none
has exceeded, if indeed any has reached, quite the perfection of
the one which has just closed.
We hope that the registration of attendance measures up to
the deserts of the programme. If it has not, it should have done
so, for nobody could afford to miss so comprehensive and sound
a series of lectures, so well presented and so full of information.
The meetings for the first time were held down town, and
the change in venue was, we think, amply justified and a pronounced success.
The proceedings were opened by a short address of welcome
from Dr. W. D. Keith, acting president of the committee during
the regretable illness of Dr. Alison Cumming. Dr. Hugh Cabot,
Professor of Surgery, University of Michigan, gave the first address on the subject of "Non-tuberculous Infections of the Kid-,
ney."    These infections were in general of two types, those pro-
Page Nineteen duced by the colon-typhoid group of organisms which do not
readily produce suppuration, and those produced by the pus producing cocci. Dr. Cabot discussed in an amusing and instructive
manner the supposed methods of infection, but thought the only
probable one was by way of the blood stream. He referred to the
lesions produced and considered that the pyelitis generally present
was really a pyelonephritis. A large proportion of these cases was
produced by organisms of the b. coli type. Coccal infections, on
the other hand, tended more to lodge in the kidney substance, producing cortical abscesses, the rupture of which was probably responsible for the occurrence of perinephritic abscess.
The next paper was presented by Dr. Alan Brown, Professor of Paediatrics, University of Toronto, whom the audience
recognized as an old acquaintance. Dr. Brown devoted this lecture
and the one delivered on the evening of the same day, to a consideration of the nutritional disturbances of infancy and childhood. These disturbances he regarded as those of quantity and
those of quality. Considering the various food stuffs, Dr. Brown
said that children absorbed 85% of the fats. Calcium soaps were
an end product of their digestion and were present in large amounts
when fat was in excess. By virtue of this calcium soap the tendency of fats was to constipate rather than produce diarrhoea. The
digestion of carbohydrates took place by way of acids of fermentation, such as lactic and succinic, with the formation of CO 2.
It is the carbohydrates which are largely responsible for the
diarrhoea and the CO 2 "gas" which so often produces colicky
pains. In cases of artificially fed babies on patent foods, the excess carbohydrate is stored in the liver and tissues as glycogen.
Each molecule of glycogen requires two molecules of water and
leads to the production of the over-fat "water-logged" baby. The
protein of the diet rarely causes any nutritional disturbances except
the occasional cases of anaphyl actic sensitization. The lecturer
considered that all (even certified) milk should be boiled before
being fed. Boiling for the short period necessary in no way interferes with the digestibility and renders the liability to infection
of tubercular nature much more remote. He said that practically
all the milk in Toronto was pasteurized and that in eleven years
out of 60,000 cases not a single instance of abdominal tuberculosis had occurred in the Sick Children's Hospital. Nutritional
disturbances were by no means limited to artificially fed babies.
Breast fed babies were not exempt. In these, disturbances might
be due to mechanical defects, such as hare lip, cleft palate or adenoids, or the babies might be weak or indolent or awkward nurs-
ers. Again, overfeeding was at times a factor, whether due to
parenteral disturbance or to the constitutional peculiarities of the
baby. Finally there might be underfeeding, which might be detected by careful weighing before and after feeding. Dr. Brown
distributed various formulae and instructions as used in the Sick
Children's Hospital, Toronto, for the preparation of foods, their
care and administration. Lactic acid milk was found to be a very
acceptable article of diet in a great many instances, and both the
Page Twenty natural and artificial methods of preparation were described. Butter soup (which no doubt tastes better than it sounds) was useful
when a high, easily assimilable fat diet was required.
The concluding paper of the first session was presented by
Dr. J. G. Carr, Associate Professor of Medicine, Northwestern
University, Chicago. Dr. Carr was invited on the recommendation of Dr. M. T. McEachern, and the audience evidently heartily
endorsed that recommendation. The condition of auricular fibrillation, though apparently first recognized in 1835, was more
fully described by Cushing in 1899 without attracting much attention. In 1907 another paper by the same author firmly established it as a clinical entity. At one time it was presumed that
fibrillation once having occurred was permanent, but to-day the
existence of paroxysmal auricular fibrillation is well recognized.
Among diagnostic features the usually rapid and always irregular
cardiac rhythm was important, while "pulse deficit" was characteristic. The lecturer referred at some length to the use of Quinidine
which had been used on about 100 cases at the Cook County
Hospital, Chicago. The opinion there was favourable to its use
and no untoward results had been experienced. Abolition of the
irregular rhythm had been maintained in selected instances for as
long as two years.
After the lunch interval, during which Dr. Cabot was entertained by and spoke at the Kiwanis luncheon, Dr. A. J. Pacini
lectured on "Diathermy and the Violet Ray." Dr. Pacini, who
had attended the meeting of the Canadian Medical Association in
Regina, had already addressed a large meeting of the Vancouver
Society on Monday, June 29. At this lecture he took as his subject "The Relation of Light to the Growth and Development of
Animal Life Upon the Earth," reviewing in an interesting way
the work of Moore and Bailey on irradiation of inert material and
the production of synthetic sugar substances in that manner.
The next paper of the busy afternoon session was by Dr.
Roscoe Graham, of the Surgical Department of the University of
Toronto. Referring to the question of simple colloid goitre, Dr.
Graham said that in view of the possibility of later toxaemia the
question of removal should be placed before the patient, the mortality of operation in this variety being about 0.25%. The average length of time that an adenoma was present before being
brought to the attention of the surgeon is 16 years, the patients as
a rule being much older than those with diffuse hyperplasia. In
toxic cases the blood pressure reading showed a fairly high systolic
with a diastolic remaining unchanged, while the metabolic rate
might be high or low and was only of value in connection with
clinical symptoms. In diffuse hyperplasia the blood pressure runs
in cycles: (1) a high systolic with a normal diastolic which in a
few weeks may fall to (2) a low systolic with diastolic unchanged.
This again to be followed by (3) a high systolic and a rising diastolic which if it reached 100 m.m. or more indicated a dangerous
risk.    They had had unsatisfactory results with X-ray therapy,
Page  Twenty-one and preferred surgical measures with or without the use of iodine.
Dr. Hugh Cabot took as the subject of his afternoon lecture
the very practical one of the so-called "Catheter Cystitis." This
annoying complication was one which particularly dogged the
footsteps of the gynaecologist and the obstetrician. Usually when
after an interval of hours the patient had not urinated and distension was becoming obvious, the catheter was passed—by some
one else. When and if cystitis later developed, the catheter and
its manipulator were blamed for the occurrence. Dr. Cabot reviewed experimental work which showed the extreme difficulty of
infecting a normal bladder in animals, with or without trauma in
addition. Practically it could not be done. Something additional
was required, and that something was overdistension. Given
overdistension, infection was easy to produce. Instructions in his
clinic were that when an amount of urine was present, estimated
at ten ounces, the catheter was passed regardless of the time which
had elapsed.
The first lecture of the evening session was given by Sir
Henry Gray, Surgeon in Chief to the Royal Victoria Hospital,
Montreal, on "Developmental Abnormalities Affecting the Colon." This paper, which was illustrated by lantern slides, dealt in
a very thorough manner with the whole question of the development of the intestinal canal and the manner in which it came to
occupy its final position. The work of Arbuthnot Lane was considered and the affect of the various bands and kinks in the production of symptoms. Sir Henry detailed his methods of examination in these cases and gave the steps of the operation he used
for the fixation of the ascending colon and caecum.
Dr. Alan Brown's continued paper on "Nutritional Disturbances," which has already been referred to. brought to a close
the first interesting, albeit strenuous day of the School.
On Friday, July 3, the meeting was called to order at 9 a.m.
and Sir Henry Gray delivered his second lecture, taking as his subject the important one of "Cancer of the Breast." He showed by
means of lantern slides the various ways in which cancer might
spread from this area. While lymphatic fermention as demonstrated by Handley might account for local dissemination, blood
or lymph migration must be called for to explain more distant
metasasis. Generally regarded as a disease of later life, of 311
cases 27.3% were under 40 years of age. He referred to the large
statistical material of 24,800 cases gathered from all parts by Dr.
Janet Lane Claypon, and read from an article published as long
ago as 1867 in which the modern operation is very closely detailed.
The second paper of the morning session was by Dr. Alan
Brown, on "Eczema." This, as the lecturer explained, was really
a discussion of the exudative diathesis, which is a very definite
thing. These children may be restless, irritable and excitable,
may   suffer   from   itching,   intertrigo,   eczema   and   subcutaneous
Page Twenty-two abscess. They vomit easily and frequently. Catarrhal infections
are frequent, and later asthma may develop. There is a tendency
to general hyperplasia of the lymph glands. A high fat diet is a
sort of function test of the exudative diathesis and may produce
any or all of these reactions. There is also a susceptibility to certain foreign proteins and some of the profounder reactions produced by the injections of sera occur in children of this type. In
the treatment of eczema the immediate causes had to be considered.
These were excess fat or sugar in the diet or the use of some unsuitable form of protein. No irritating clothing should be allowed next to the skin. Water should not be used for cleansing
purposes, oil being substituted. The urine should be kept alkaline, Sod. Bicarb, grs. 30 to 40 daily being used. Scratching
should be eliminated if necessary by means of jacket and mitts.
For the acute weeping type of eczema affecting chiefly the face,
apply crude coal tar as obtained from the gas works. May need
to be used on three or four successive days. Later, bismuth paste
was applied; this is a mixture of bismuth subcarb., lime water
and lanoline. For the acute intertrigenous form exposure to the
air in a warm room was recommended and the use of 4% resorcin
ointment in the seborrhoca type.
Following the conclusion of Dr. Brown's lecture, Dr. James
G. Carr took up the subject of the "Intrathoracic Complications
of Pneumonia." It is to be remembered that in the large majority of cases which hang over, there is no such thing as unresolved pneumonia, which is a diagnosis that should never be made
in the early stages of a complication, and also that in a large proportion there is pus in the chest. In cases of empyema following
pneumonia the pneumonia may not have disappeared and the alteration of the breath sounds consequent upon this may be transmitted through the pus. Tactile fremitus is invariably absent and
is, the lecturer considered, the best sign of the presence of fluid.
We must continue to look for pus in every patient with pneumonia who does not do well. Lung abscess was found to be less
common in lobar pneumonia than in the broncho-pneumonic variety, most of the cases he saw being post-operative. Treatment
of these acute abscesses was often disappointing.
The afternoon proceedings were opened by Sir Henry Gray
with a paper on "Acute Osteomyelitis." Sudden attacks of pain
in bone should always make one think of osteomyelitis. The
disease may affect a joint by direct spread, and this secondary suppurative arthritis was as dangerous as the primary variety. Multiple lesions are common. As to diagnosis it is important to remember that the X-ray will very rarely show changes in the early
stages; it is not until two or three weeks have elapsed that alteration in bony structures takes place. The question is often asked
as to whether if the periosteum be left at operation the formation
of new bone can be looked for. In children it can, but not in
adults. The disease may be cut short by drilling or by gouging
the bone so as to give vent to the pus. Several lantern slides were
shown illustrating the conditions and the means for its relief.
y
Page Twenty-three The next lecture was that of Dr. Alan Brown, on "Deficiency
Diseases." Out of the number of diseases which have been shown
to be of this variety, the lecturer confined his remarks chiefly to
rickets. Interest in this subject had been re-awakened by Mel-
lanby of Sheffield, in 1918. It was very widespread and was
probably present in some degree in every artifically fed baby, while
even breast fed babies were by no means immune if the mother's
diet was not well balanced. Rickets was produced by defects in
diet, by lack of radiant energy, and by undue confinement. In
the diet it is the lack of phosphorus rather than the absence of
calcium which, together with the absence of the anti-rachitic factor, produces the disease. Symptoms are restlessness, excessive
perspiration, cranio tabes, beading of the ribs with flaring out of
the lower ribs, enlargement of the ends of bones, etc. Numerous
lantern slides were here shown illustrative of the experimental variety of rickets in animals and of the natural variety in children,
radiographs showing the mushroom-like appearance of the ends
of the bones, with micro-photographs showing the process of
healing under the administration of cod liver oil or by means of
ultra violet radiation. Of all cod liver oils Dr. Brown considered that the Newfoundland oil as prepared by Mead, Johnson &
Co. was the best.
The rest of the afternoon was given up to the annual meeting of the B. C. Medical Association. An account of the proceedings will be found on another page of this issue. This meeting was followed by a dinner under the auspices of the same Society at the Ambassador Cafe, at which Sir Henry Gray and other
guests spoke.
The evening session of July 3rd was opened by Dr. Carr
with a paper on the "Treatment of the Anaemias." Referring
especially to pernicious anaemia, the speaker considered that nothing was so likely to produce improvement as prolonged rest in bed.
Arsenic in some form should be used, usually as Fowler's solution
or sodium cacodylate. Forced feeding with a diet high in protein was important. As to removal of foci, while he considered
that any gross or evident foci should be removed, he did not think
that the results had come up to what was hoped for. Transfusions were useful, but pernicious ^anaemia was not cured by these
proceedings. The results after splenectomy were not very encouraging, though there was considerable difference of opinion on this
point. Dr. Carr thought that the blood picture of a pernicious
anaemia might be simulated by a severe secondary anaemia following cancer, syphilis, tuberculosis or nephritis.
The final paper of the day was presented by Dr. Hugh Cabot,
who had selected "Ulcer of the Stomach and Duodenum" for his
subject. Regarding etiology Dr. Cabot reminded his hearers that
this was the day of "foci," but while he thought they were of
some importance that importance had been greatly over-rated. As
to hyperacidity he was at a loss to know whether the acidity produced the ulcer or the ulcer the acidity. In diagnosis he considered that history was of great value, though at times the disease
Page Twenty-four was very closely simulated by appendicitis or by disease of the
gall bladder or ducts. The X-ray was important, though these
useful members of the profession—the radiographers—came in
for a good deal of good humoured criticism by the lecturer. Treatment, Dr. Cabot considered, should be combined medical and
surgical. The economic factor had to be carefully considered.
For ulcers of the duodenum gastro enterostomy was the most useful procedure, while for ulcers of the stomach he was coming
more and more to rely on the operation of partial gastrectomy.
Nothing daunted by the strenuous work of the last two
days and nights, lecturer and audience turned out betimes on Saturday morning for the final session of the School.
Dr. Carr, who had previously held a clinic at St. Paul's Hospital, opened at 9 a.m. with a lecture on "Coronary Sclerosis,"
which we hope to reproduce in full in a later number of the
BULLETIN. Dr. Carr said that arterio sclerotic hearts showed
diminished reserve and a lack of recuperative power. One of the
common occurrences in these hearts was anginal pain, due, according to one theory, to disease of the coronary vessels; according to
another theory, to disease of the aorta. Coronary thrombosis was
often overlooked and but rarely was the diagnosis made. A description of the symptoms of this complication was given.
For his final address Dr. Hugh Cabot spoke on "Disease of
the Gall Bladder." For the diagnosis of gall bladder conditions
it was difficult to get assistance from any instruments of precision.
Clinical methods had to be used, and it was safe to say that a
correct diagnosis could be arrived at in this way in some 80% of
cases, and in stone even higher. Recently, however, there had come
to our aid a new method in which substances were introduced
into the blood which were absorbed by the liver and secreted into
the bile. They passed into the gall bladder and there produced
a shadow under the X-ray. It seemed possible that an estimate
of the density of this shadow might be of value in determining
the absorptive properties of the mucous membrane of- the gall
bladder, and therefore its condition as affected by disease processes. Removal of a gall bladder has certain outstanding objections, and there seems to be at present a reaction against its removal in many cases. There are borderline cases when it is very
difficult to know what is best. Drainage may tend to increase
inflammation. In some instances when stones have been removed
and the wall of the gall bladder has seemed reasonably good, Dr.
Cabot has sewn it up without drainage.
At the close of his lecture Dr. Cabot received an ovation.
His various lectures deeply interested the large audiences present.
Sir Henry Gray, with his final address on "Acute Intestinal
Obstruction," brought the session to a close. This address has
been left with the Committee, and will be published in another
issue.
Page Twenty-five =Ksfc»
THE    ORIGINAL
PITUITARY
EXTRACT
L)ITUITRIN was the first preparation of its kind ever
used in obstetrics as an aid in labor.    It is a standard
product employed the world over in uterine inertia, and
for other definite indications as well.
Among pituitary extracts Pituitrin should be preferred
because it is always the same. Every lot is doubly tested—
for its effect on blood pressure and for its effect on uterine
muscle. What the physician wants in a preparation of
this kind is not excessive activity, but uniformity so that
he may avoid both the danger of an overdose and the
embarrassment of ineffectiveness.
In addition to the security afforded by double standardization, every package of Pituitrin is dated.
These advantages are yours if you specify on your orders
for pituitary extract "Pituitrin, P. D. & Co."
If Surgical Pituitrin is wanted specify Pituitrin "S."
This preparation is twice the strength of Pituitrin—1 cc
equivalent to 2 cc of the latter. Pituitrin S" is not
recommended for obstetrical use.
PITUITRIN and PITUITRIN "S" are supplied in liquid form
only, in ampoules, six to the box—Pituitrin in 1 cc and %-cc
ampoules; Pituitrin    S" in 1-cc ampoules only.
Ask for our booklet "Pituitary Therapy"; requests from
physicians are welcomed and gladly complied with.
PARKE, DAVIS & COMPANY
PITUITRIN  IS INCLUDED IN THE N. N. R. BY THE COUNCIL ON PHARMACY
AND CHEMISTRY OF THE AMERICAN MEDICAL ASSOCIATION
=  ma* I
SHIRTS
Genuine English Broadcloth
"Loomed in England."
$2.95
Coat Model, Negligee Style, Soft Cuffs. Beautiful Lustrous
Fabrics, light in texture and weight, but will wash like a linen
handkerchief.    For Business or Sport.
To  out-of-town Doctors we  will  send two,  three or six
of these Shirts on approval, along with half a dozen selections
of Neckwear.     You may select what you like from lines sent,
I
return any you do not like, and send us a cheque for the ones
you keep.    We will pay mailing charges each way.
Just let us know your preference as to color and price.
D. K. BOOK LIMITED
!
Correct Clothes
1
137  HASTINGS  STREET  WEST
Vancouver,   B.   C.
■Slss^--'s
Nurses' Central
Directory
Phone Fairmont 5170
Day and Night
Orthopedic
Appliances
1
Hourly, Institutional and Private Nurses
Supplied
Extensions for short limbs,
1
Registrar-'Miss Archibald, R. N.
Trusses, Arch Supports
601 13th Ave. West, Vancouver
Abdominal Belts,
Sacroiliac Supports and
Artificial himbs,
manufactured and made
■
by Experts and guaranteed
Patronize the
by
BULLETIN
A.LundbergCo.
advertisers.
938 Pender Street West
Vancouver, B. C.
h
Page Twenty-sever
. B. C. Pharmacal Co. Ltd.
329 Railway Street,
VANCOUVER.
Manufacturers of Hand-made Filled Soluble
Elastic Capsules.
Specimen  Formulae:
No. 20a—
Cascara Liq. Ext., 30m
Euonymin, 1 gr.
Podophyllin, J gn
Special Formulae Made on a Few Hours' Notice.
Price Lists and Formulae on
Application.
No, 29—
Cod Liver Oil, 25m.
Quinine, 1 gr.
Creosote, Beech wood,
2m.
Guaiacol, Pur., 2m.
Say it with Flowers
Cut Flowers, Potted Plants, Bulbs,  Trees,  Shrubs,
Roots,   Wedding   Bouquets.
Florists'  Supplies and Funeral Designs a specialty.
Three Stores to Serve You:
48 Hastings St. E. Phones Sey. 988 and 672
665 Granville St. Phones Sey. 9513 and 1391
151 Hastings St. W. Phone Sey. 1370
Brown Bros. & Co. Ltd.
VANCOUVER, B. C.
Page Twenty-eight Prescription Service'—•
That merits your confidence.
Free Delivery Service anywhere in the city
from 8 a.m. to 11 p.m.
Distributors i
Mulford's Biologicals       Fraisse Serum
Capitola Pharmacy Ltd*
(FRED G. BROWN)
Seymour 158       New Address: Davie and Bute Sts.
Stevens
Pink Back Z* O. Adhesive
•-; Plaster
Made in England
Adheres to the limit, yet will not irritate.
A Perfect Plaster.
Fully  Guaranteed.
Stocked in Rolls 12 in. by 5 yds. and in Spools of
5-yd.  and   10-yd.
1 in., 2 in., 2y2 in., 3 in. widths.
THE B. C. STEVENS CO., LTD.
730-732  Richards  Street,
u^
Page Twenty-nine To the
MEDICAL PROFESSION
Desire to announce to the Medical Profession that they have
opened for business at
Qranville Street and 12th Avenue
and will specialize in Prescription Service.    Our Prescriptions
are filled as ordered, without deviation and our delivery
service is decidedly prompt.
Our Prescription Department
will at all times be in charge of a graduate.
GORDON FROST
(Formerly of the V. Q. H.)
Phones: Bay. 540 and 1720 Qranville at Twelfth
The Ou?l Drug
' Co., Ltd.
Jl\\ prescriptions dispensed
bvj qualified Druggists.
IJou can depend on the Ou?l
for ^Accuracy, and despatch.
IDe delber free of charge.
5 Stores, centrally located.    We
would appreciate a call while
in our territory.
Ambulance
Service
TELEPHONE
Fair. 58 & 59
Mount Pleasant
Undertaking  Co.   Ltd.
JR. F. Harrison    W. E. Reynolds
Cor. Kingstvay and Main
Page Thirty 110,000 Policyholders in the
Mutual Life of Canada
rTUE MUTUAL LIFE OF CANADA is a Company
of approximately 110,000 policyholders bonded
together for mutual protection and support in time of
trouble. They obtain the insurance practically at cost.
Surplus profits over and above provision of necessary
reserves are divided among participating  policyholders.
Last  year,   the  sum  of   $2,689,000   was   thus  distributed to Mutual policyholders as dividends.
Mutual Annual Dividend policyholders have three options:—
1. To reduce the second and future premiums, or,
Left- with the Company to accumulate at compound interest and applied to shorten the premium paying period.
To Purchase Bonus Additions.
The Mutual Book tells you the whole story. Write
or call on
2.
3.
402 Pender St. W.
WILLIAM J. TWISS
Phone Sey.  1610.
Vancouver, B. C.
Burns Drug Company
limited
732 Qranville Street, Vancouver
■   TELEPHONE
SEYMOUR 606
To the Doctor out of town:
We will look after any Mail Order Prescription
promptly.
INSULIN DEPOT FOR B. C.
Dispensary Specialists.
Page Thirty-one -~Hs©e
PI
'■<n^Aisrz>•■
sai^N-
Hollywood Sanitarium
LIMITED
tyor the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
"Reference I "23. Q- (fM.ed.ical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
<*©(■
;«<5V
Page Thirty-two

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