History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: December, 1929 Vancouver Medical Association 1929

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 VOL. VI.
DECEMBER, 1929
The Bull
ofthe^
Vancouver Medical Association
Rheumatism
Serological ^Diagnosis of Syphilis
©he thymus Qland
"Published monthly at "Vancouver, "25. Q., by
McBEATH-CAMPBELL LIMITED
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For the convenience of the physician in the
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PetroIagar-u>ith Milk of Magnesia i* identified
by the number "3" a*d bear* a green label.
Petrolagar Laboratories of Canada, Ltd.
907 Elliott Street* Windsor, Ontario THE   VANCOUVER   MEDICAL   ASSOCIATION
BULLETI N
Published Monthly under the Auspices of the Vancouver Medical  Association in  the
Interests of the Medical Profession.
Offices:
203 Medical and Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. M. Pearson
Dr. J. H. MacDermot Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
VOL. VI.
DECEMBER,  1929
No. 3
OFFICERS 1929-30
Dr. T. H. Lennie Dr. G. F. Strong Dr. W. S. Turnbull
President Vice-President Past President
Dr. E. M. Blair Dr. W. T. Lockhart
Hon.-Secretary Hon. Treasurer
Additional Members of Executive:—Dr. W. A. Dobson; Dr. A. C. Frost.
Dr. W. F. Coy
Auditors:
Trustees
Dr. W. B. Burnett Dr. J. M. Pearson
Messrs. Price, Waterhouse & Co.
Physiological and Pathological Section
SECTIONS
Clinical Section
 Chairman
 —Secretary'
 i : Chairman
 -^1 : Secretary
Eye, Ear, Nose and Throat
Dr. F.  W.  Brydone-Jack Chairman
Dr. N. E. McDougall j .Secretary
Physiotherapy Section
Dr. H. R. Ross . .Chairman
Dr. J. W. Welch Secretary
Dr. J. R. Davies	
Dr.  S.  H.  Sievenpiper.
Dr. A.  M.  Menzies-
Dr. R. E. Coleman
Pediatric Section
Dr. C F. Cqvernton-
Dr. G. O. Matthews—
..Chairman
—Secretary
Library
Dr. C. H. Bastin
Dr. Wallace Wilson
Dr. S. Paeclin-
Dr. D. F. Busteed
Dr. W. H. Hatfield
Dr. D. M. Meekison
Dinner
Dr. W. T. Ewing
Dr. W. A. Gunn
Dr. L. Leeson
Rep. to B. C. Med. Assn.
Dr. A. Y. McNair
STANDING COMMITTEES
Summer School
D*. W. T. Ewing
Dr. R. P. Kinsman
Dr. W. L. Graham
Orchestra
Dr. J. R. Davies
Dr. J. H. MacDermot
Dr. F. N. Robertson
Dr. J. A. Smith
Publications
Dr. J. M. Pearson
Dr. J. H. MacDermot
Dr. D. E. H. Cleveland
Credentials
Dr. A. W. Bagnall
Dr. W. L. Graham
Dr. A. J. MacLachlan
Dr. J. Christie
Dr. C. E. Brown
Dr. T. L. Buttars
Hospitals
Dr. J. W. Arbuckle
Dr. F. Brodie
Dr. A. S. Monro
Dr. F. P. Patterson
Sickness and Benevolent Fund — The President — The Trustees VANCOUVER MEDICAL ASSOCIATION
Founded 1898 Incorporated 1906
PROGRAMME OF THE 32nd ANNUAL SESSION
GENERAL MEETINGS will be held on the first Tuesday and
CLINICAL MEETINGS on the third Tuesday of the month at 8 p.m.
Place of meeting will appear on the Agenda.
1929
December    3rd—General Meeting:
Papers—Dr. J. P. Bilodeau; "Practical Views on late
Toxaemias of Pregnancy."
Dr. W. L. Graham; "Post Operative Intestinal Obstruction."
December 17th—Clinical Meeting.
1930
January       7th-
-General Meeting:
Papers—Dr. C. H. Bastin; "Traumatic Neuroses."
Dr. C. E. Brown; "Chronic Cholecystitis."
January      21st—Clinical Meeting
February     4th
February   18 th-
March 4th-
March        18 th-
April
lst-
-General Meeting.
Paper—Dr. W.  E.  Scott-Moncrieff,  Victoria;  "The
Importance   of   the   Early   Recognition   of
Glaucoma by the General Practitioner."
-Clinical Meeting.
-OSLER LECTURE—Dr. J. J. Mason.
-Clinical Meeting.
-General Meeting:
Papers—Dr. L. H. Appleby; "Surgery of the Sympathetic Nervous System."
Dr. G. O. Matthews; "Common Practices in
Infant Feeding—their Use and Misuse."
April
15 th—Clinical Meeting.
April
22nd—ANNUAL MEETING.
Page 46 —Photo courtesy Iola-Monroe Co. (N.Y.) Tuberculosis Sanatorium
cylw cynetapaufic Lvuluxduj^
^IIIIIUHIIIIIIIIIIIIIIIIIIIItlllllllllllllllllllUIIIIIIIIIIIIIIIIHinillllllllllllllllUM
1 "Artificialultraviolettadiation  J
= has  proved  worthwhile  when  =
= gauged by the relief secured. Its  =
3 value depends on type of equip-  3
s ment, control of energy output,   =
= and technique of exposure.
3 "If ultraviolet is to be used,  3
H the strongest source should be  =
= secured and the time of exposure  =
s correspondingly shortened. Our  =
s experience has shown that the   1
s mercury quartz burner is the easi-  =
s est to control, the least expen- j
s sive to operate and a most satis-  H
= factory source as regards amounts  3
3 of ultraviolet in the region of j
s 2000  to 3200  Angstrom  units,  1
s which we believe at this time is  j
H most essential in the treatment M
= of tuberculosis. ...                          =
"We have also demonstrated 1
3 that a properly designed reflector  j§
3 increases   considerably   the   =
3 amount of radiation thrown on  =
|j the  surface exposed, and fur- 3
j ther that the wattage input to   1
j the burner should be constant in  =
| order that the output remain the  I
H same."                                                =
—Ezra Bridge, M. D.
s Supt. I ola-Monroe County  =
s (N. Y.) Tuberculosis San- =
atorium, in Annual Report =
iiiiiniiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiniiiiiiiiinimi
Vancouver Branch:
MUCH has been written concerning the therapeutic
application of ultraviolet radiation, and the bibliography is rapidly becoming voluminous. Every physician
realises that this form of energy is assuming an impor'
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An interesting booklet, "A Few Facts Pertinent to the Consideration of Artificial Sources of Ultraviolet Radiations," will
be sent you upon request; we feel sure you will appreciate the
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Montreal EDITOR'S PAGE
The newspapers have been occupied recently by a case which has;
aroused a good deal of argumentative comment, has a vivid human appeal
and has, moreover, a certain medico-legal interest.
The facts may be briefly recalled. A resident in France, evidently of
British extraction, is living with his mother who develops cancer. She
suffers a great deal, no cure can be hoped for and whether at her insistence or on his own initiative, he shoots and kills her. Trial and
acquittal in the French courts follow. Tragedy enough and, as we have
said, a storm of opinion has been aroused centreing, of course around the
question as to whether it is permissable or should be permissable to end
life in the face of intolerable suffering.
The problem is not a new one for the medical profession. Periodically it is debated in private, and occasionally in print. We are all
familiar with the terrible accident jammed beneath the wreckage who
begs to be put out of his misery, we are only too familiar with the incurable case, often of cancer, where the inevitable end is looked forward
to by all concerned. We know, in addition, the patient who is headed
for a hopeless, long drawn out illness where we alone carry the knowledge of what is in store for the still sanguine patient and his friends.
The impossibly deformed mentally or physically child is another problem
to the future of whom no doctor looks with equanimity.
We bear these cases, we carry them along, we hope that after all
we may be mistaken in our view, we relieve their sufferings as best we
may, we solace the relatives with the old tag, so overworked, but still so
strangely comforting "where there is life there is hope."
What can be done about these things. From a medical point of
view we say "absolutely nothing." We have seen unexpected advances
in the past we look forward with every confidence to the future. We
feel that the incurable disease, if not the Incurable accident of today
may be amenable to palliation or even cure tomorrow. It is this belief,
this hope, instinctive it may be which impels us still to strive for the
amelioration of apparently hopeless cases. This and the common feelings
of humanity inherent in us all. "Never give a patient up until you
give him up to the undertaker" is a good working rule.
We are convinced that the body of medical opinion could not and
would not ever become a party to severing the hold on life of even the
most desperate case. To do so would be to stultify our training, destroy
our hope and paralyze our initiative.
The tendency of modern development at least in normal times of
peace is all directed towards the preservation of life. The Greeks, with
their less intensive anticipation of a future responsible existence did not
deny the individual right to seek relief for insupportable reverse or distress. Oriental peoples also have regarded such right as proper and reasonable.
But with the evolving idea of the modern state its recognition of
the nature of the force majeure resident in the number of its subjects,
the interest of the state in the life of the individual has intensified the
doctrine of human inviolability and constituted any interference with
Page 47 this, whether individually or in the case of another, a crime of the first
order. All religion with its literal assurance of immortality as compensation for the evils of the world has been wisely enlisted in this protective
scheme, Church and State joining hands in this doctrine so valuable to
both.
There is also working towards this end that powerful apprehension
we call superstition, fear of the unknown. The great Master whose
dramatic knowledge covered the whole gamut of human experience has
moralized upon this situation. Why he says should a person bear intolerable ills when he could his quietus make with a bare bodkin? Oblivion
is easy to obtain. But is it? "To sleep, perchance to dream—ay there's
the rub."   And again we are constrained to carry on.
And so forces and interests are all arrayed against the possibility of
limiting a human life which has not any prospect of a restoration to
health. Bernard Shaw may suggest "the possibility of appeal to some
authority representing the community." Clarence Darrow may demand
that "the State should make provision for relieving the suffering of
human beings" and Arbuthnot Lane may draw an unflattering parallel
between man and animals on this subject. All in vain, we fear. It never
will be done.
NOTICE
Dr. J. S. Plasquet, F.R.S., the world-famous Director of the
Astronomical Observatory, at Saanich, B. C, is to speak on "The
Rotation of the Galaxies" under the auspices of the Vancouver Institute,
at the Science Building, University of B. C, 8:15 p.m., Monday, December 2nd, 1929. He is speaking on behalf of the B. C. Academy of
Sciences, which extends a cordial invitation to be present to all members
pf the Vancouver Medical Association.
Dr. Plasquet's address will indicate the results of his last five years'
investigation of the stars c$f the Milky Way and has already received
world wide recognization.
NEWS and NOTES
Volume 176 of the American Journal of the Medical Sciences is
missing from the Library. The Committee asks every member to make
3 search for this book as it contains some important articles which are
needed at the present time. The Librarian has been forced to obtain a
loan of the volume from the Medical Library, Seattle. This is, perhaps,
a good opportunity to state how very ready Mrs. Coburn, the Librarian
of the Washington State Medical Library is to help us out on any occasion.
We regret extremely to hear of Miss Donna E. Kerr's impending
resignation from the Laboratory of the Vancouver General Hospital.
Miss Kerr has been particularly associated with all the diabetic work that
has been done in the last seven or eight years and has followed the developments that have occurred with interest and ability.    She will be
Page 48 greatly missed by the Clinicians having much laboratory work to do and
her place will not be filled easily.
The British Medical Association will hold its annual meeting in
Winnipeg, from August 26th to 29th, 1930.
It will be evident that the hotel accommodation will be severely
taxed, and those intending to go to the meeting will be well-advised to
make their reservation as early as possible. This may be done at any time
through Mr. Fletcher, Executive Secretary of the B. C. M. A.
Further details will appear in subsequent issues of the Bulletin.
Dr. R. B. Boucher has recently returned from a trip to the east
in which business and pleasure were combined with most happy results.
During his absence of seven weeks Dr. Boucher made visits to Montreal,
Toronto and Chicago.
Dr. W. T. Ewing was the happy recipient of a presentation on All
Saints' Day—adsit omen—consisting of one son-and-heir. The mother is
doing nicely. Bill is progressing favorably, and the young hopeful is
"going right up the line."
Dr. H. W. Riggs has returned from a four-weeks' visit to eastern
clinical centres. His intinerary included the Mayo Clinic, the Frank Billings Memorial of the University of Chicago, the Toronto General Hospital and the Lahey Clinic of Boston, where he was able to glean the
results of the most advanced work in connection with goitre.
Miss Eleanor Riggs, B.A., daughter of Dr. Riggs has been awarded
a fellowship for the purpose of continuing her work in bacteriology and
biochemistry at the University of Toronto, proceeding to the degree of
M.A. This fellowship is one of eight open fellowships given by the
University of Toronto annually to Canadian students living outside of
Toronto.
MEETINGS
Dr. T. Homer Coffen, of Portland, Oregon, was the speaker at the
second General Meeting of the 1929-30 Session of the Association on
Tuesday, November 5th, his subject being "Progress in Cardio-vascular
Disease." Dr. Coffen gave a most interesting talk which was later discussed by Drs. Pearson, Strong and Keith.   Ninety members were present.
The Chairman introduced Drs. A. K. Haywood, of Montreal and
Dr. M. T. McEachern, two members of the Hospital Survey Commission.
Both these gentlemen impressed the audience with their intention to do
everything is their power to make the report of the Commission as full,
complete and without bias as lay in their power. The third member of
the Commission, Dr. Walsh, was unable to be present owing to stress of
work connected with the Survey. The report of the O>mmission is not
expected before January or February.   Dr. Haywood asked for the fullest
Page 49 co-operation on the part of the Association and on motion of Dr. Wallace
Wilson, seconded by Dr. Freeze a resolution was carried enlarging the
Standing Committee on Hospitals so as to form a representative Committee to meet the Commission on Sunday, November 10th, the selection
of the enlarged Committee to be left to the Chair.
Dr. W. J. Dorrance and Dr. G. A. Sutherland were unanimously
elected to membership. The Chairman, Dr. Lennie, reported the result
of communications which had passed between him and the Vice-President
of the Canadian National Railways with reference to the method to be
employed in connection with the structural steel of the new Hotel.
The Vice-President in a very courteous letter expressed regret at being
unable to meet the wishes of the Association stating that their contractors did not think the method suggested was suitable for so large a
building as the proposed Hotel.
The first meeting of the Clinical Section was held at the Vancouver
General Hospital on October 15 th, with Dr. J. R. Davies in the chair.
There was a large attendance and the seating capacity of the room was
taxed to the utmost.
The first case was presented by Dr. G. F. Strong, the condition being
one of sino auricular block. The patient was a man of 20, sent here from
Edmonton. An irregularity of the heart had been discovered in January
of this year following an attack of influenza. While the pulse was still
rapid and irregular there was no indication of heart failure. An electrocardiogram showed that the rhythm consisted of twenty to thirty rapid
regular beats followed by three or four slow beats at about one-half the
previous rate. There was a normal sequence of waves P R and T.
In the earlier tracing T waves were inverted to all leads but later became
upright.
At first the patient was kept at rest but has since been allowed up
with gradually increasing range of activity. Trial doses of Quinidine
lessened the arrhythmia but increased the rate.
The second case was one of transverse myelitis from the service of
Dr. C. E. Brown.
A man of 24 was taken ill two weeks ago with a cold. Owing to a
feeling of weakness he stayed in bed. Three days ago legs went numb
and became powerless. Sphincters not affected at that time. General
physical examination otherwise negative. Spinal fluid and blood Wassermann negative. Knee and ankle jerks were present, ankle clonus obtained. Plantar reflexes extensor in type. Since he was first seen there has
been some disturbance of bladder function in the direction of incomplete
emptying.
Sensation is affected as high as the tenth dorsal distribution with
considerable pain at the level of the epigastrium. Movement, of which
there was still slight evidence at first, practically disappeared.
The patient was examined and the case discussed by a number of
members.
The next case was demonstrated by Dr. A. B. Schinbein as a condition of neuro-fibromatosis or von Recklinghausen's disease. The patient
Page 50 a young man, age 21, was said to have been first affected when seven
years old when two tumours appeared on the back of his head. Gradually the disease spread to nearly all parts though there has been no
development during the last two years. At that time he noticed that
he was dragging his left foot and later he was unable to produce dorsi-
flexion.
On examination numerous tumours were seen, universal in distribution, painful in character. The disability in the left foot is probably
due to several large tumours on the external popliteal nerve. Areas of
pigmentation are present on the body and development has been delayed.
After the examination and discussion of Dr. Schinbein's case, Dr.
Pearson read the history of a young man suffering from the Henoch-
Schoenlein type of purpura. He discussed also the main varieties of the
purpuras and their clinical significance. Dr. Vrooman and Dr. McLean
of Woodfibre spoke on the previous history of this patient when he was
suffering from severe bronchial asthma and prior to the onset of his
present symptoms.
The meeting adjourned at 10 p.m.
LEADERS IN BRITISH MEDICINE
Lord Moynihan of Leeds
A big man in every way is the President of the Section of Surgery
who will deliver the Listerian oration at the Winnipeg meeting of the
British Medical Association in August, 1930. Those who are privileged
to listen to his oration on that occasion will enjoy a rare treat, for among
English speaking medical men there is no finer speaker than this noted
surgeon with his commanding presence.
Berkeley George Andrew Moynihan was born in Malta, 1865; is the
oldest son of Capt. Moynihan, V.C., 8th (King's) Regiment, educated
in the Royal Naval School he received his first medical degree in 1887,
and since then has gone on acquiring honours and fame. His title is
taken from that Yorkshire town where he practiced with such signal
success, especially as an abdominal surgeon. He is the author of
"Abdominal Operations," the fourth edition of which appeared in 1925,
"Gallstones and their Surgical Treatment," "Surgery of the Spleen," and
Addresses on Surgical Subjects (1928).
He served in the Great War, 1914-18, was mentioned in despatches,
and retired with the rank of Major-General Army Medical Services.
Honorary degrees have been awarded him by the Universities of
Leeds, Edinburgh, Bristol, Ghent, Dublin, Belfast; he is an honorary
Fellow of the American College of Surgeons, and honorary Fellow of the
American Surgical Association. He is president of the Royal College of
Surgeons.
In 1895 he married Isabella Wellesley, daughter of T. R. Jessop,
F.R.C.S. and in their family are one son and two daughters. .
Page 51 THE THYMUS GLAND
By Dr. H. H. Pitts, Pathologist to the Vancouver General Hospital.
Read before the Osier Society of Vancouver.
The thymus is frequently dubbed the enigmatical gland and assuredly deserves its appellation probably being on a par with the pineal
gland as regards authentic data relative to its function, etc. It is the
piece de resistance of many a controversy and furnishes abundant material for one who revels in debate. More or less chaos exists relative to the
function, size and appearance of the thymus and its role in deaths,
particularly in those due to the so-called status thymicolymphaticus.
Practically every observer who has compiled any amount of data has a
different standard of size and weight for various age periods. This undoubtedly adds to the confusion existing amongst physicians as to what
to accept as the normal limits of weight and size for various ages.
The subject will be treated under three main headings, (1) Anatomy, (2) Physiology, (3) Pathology.
Anatomy
The thymus develops from various epithelial outgrowths of the
ventral wall of the third pharyngeal furrow from which long cylindrical
masses of closely packed epithelial cells grow downward and temporarily
enclose a lumen which gradually disappears. These epithelial cords
undergo marked changes and conversion into stellate cells to form the
reticulum. From other cells, by repeated division, are produced numerous small cells that fill the meshes of the reticulum. These are generally
believed now to be of lymphocytic origin. A loose fibroblastic capsule
invests the gland and from this septa arise dividing the gland into
lobules. The cortex of the gland consists chiefly of closely packed
lymphocytic cells while the medulla has both reticulum and loosely arranged lymphocytic cells and in addition irregular, spherical or elongated
bodies consisting of concentrically arranged epithelial elements. These
are the thymic bodies or Hassal's corpuscles.
The gland derives its blood supply from inconstant branches of the
inferior thyroid artery and also from the internal mammary artery. The
veins are irregular and join the inferior thyroid, innominate and internal
mammary veins. The nerve supply is derived from fine filamentous twigs
of the vagus and sympathetic, while the capsule receives small branches
from the phrenics.
What is the normal weight of this gland? The figures are variable
and the averages taken from a series of 461 cases reported by a number
of observers in various countries are as follows:
N.B.
1-2M.
5-6M.
1-2Y.
4-6Y.
10-12Y.
12-14Y.  14-16Y
(1)
13   Gms.
18.4
18.6
24.2
24.6
29.6
27.5    29.2
(2)
7.8 Gms.
6
4.7
4.5
6.9
5.8
9.5   	
Group 1 comprise 461 cases of well nourished, apparently normal
individuals dying of diseases not definitely attributable to the thymus.
Group 2 comprises 559 cases of poorly nourished but otherwise normal
individuals. It would seem from these figures that the weight of the
thymus varies directly with the state of nutrition.    It was  formerly
Page 52 thought that the thymus grew in size and weight up to the second year
and then began to involute, but Hammar's researches show that it does
not begin involutionary changes until about puberty.
Physiology
What is the function of the thymus? Herein lies a point of considerable controversy. Its period of greatest size and activity seem to be
confined to the period between infancy and puberty, i.e. when growth
and development are generally most marked. Does it elaborate an internal secretion governing or influencing metabolism and growth? Many
hold that the thymic bodies are analagous to the islands of Langerhans
in the pancreas. Others that they are simply vestigial remnants of the
original epithelial elements of the gland. Still others, probably the
majority and these have the painstaking researches of Hammar as a convincing basis for their tenets, maintain that it functions simply as a
lymphoid organ in infancy and childhood, when large numbers of lymphoid cells and leucocytes are needed to combat infection. Park and
McClure have shown by thymectomy in dogs that the gland is not
essential to life. Hammar fed thymus to young rats and found delay
in the development of the testes and in adult rats degeneration of the
testes, which is in keeping with the ordinary concurrence of puberty and
thymus involution. Marine, Manley and Bauman demonstrated that
thyroidectomy hastens and orchidectomy delays involution of the
thymus. Jaffe observed thymus hyperplasia in young and mature animals
as a sequel to double adrenalectomy which he believes is a manifestation
of disturbed interrelation between gonads, thymus and adrenal cortex.
Riddle found that thymectomy in pigeons was followed by the production of shell-less eggs and with the .feeding of thymus to these birds,
normal eggs resulted. The thymus is said also to undergo hyperplasia
and hypertrophy in exophthalmic goitre. May one assume from these
findings that the thymus may play a role in calcium metabolism and be
responsible for toxic manifestations in thyroid and parathyroid disease?
Pathology
Clinically, diseases of the thymus gland are relatively few. Congenital absence has been reported. The gland in infancy is occasionally
involved in a luetic process producing Dubois' abscess. It is the seat
occasionally of sarcomata, teratomata, thymomata, lipomata and myxo-
mata. What concerns us chiefly, however, is that condition known as
status thymicolymphaticus and the not infrequent tragic sequels to its
presence. Infants and older children with this disease or, if you will,
state, are usually rather pale, large and flabby with rather prominent eyes.
They may have some dyspnoea and stridor under ordinary circumstances,
exaggerated after crying or nursing either at the breast or bottle. There
may be some cyanosis. These all vary in intensity. It would seem that
the mechanical element plays a part in these, as the dyspnoea and stridor
appear to be more marked if the head be thrown back and relieved to
some extent if it is held in a more horizontal or natural position. That
this is possible can better be realized when one remembers that the superior opening of the infant's thorax is very narrow, the anteroposterior
diameter measuring only 2 cm. between the sternum and the vertebral
column.   This space contains the trachea, oesophagus, great vessels, nerves
Page 53
mm ftN&j»
and thymus.    Obviously a  thickened,  bulbous thymus  could produce
compression of the contiguous structures.
Percussion with the head slightly retracted may reveal the presence
of increased dulness over the thymic area which should be confirmed by
the fluoroscope or X-ray film. However, even this seemingly confirmatory evidence does not appear to be entirely satisfactory for in many of
the larger pediatric clinics series of cases have been X-rayed, revealing
very large thymic shadows while the glands are shown at necropsy to be
of relatively normal size in many instances. Many of the cases with the
largest shadows have often no suggestive symptoms. Some quote figures
of 40% of the newborn as having enlarged thymi but this enlargement
is not symptomatic in this percentage. Cases are reported having thymus
glands weighing 80 and 90 grms. The largest in my own experience was
53 grms.
One is confronted with the problem—Is the preoperative X-ray of
the thymus in children productive of enough definite information as to
warrant its adoption as a routine procedure? Opinion is divided on this
point. In the Vancouver General Hospital during the years 1927 and
1928, 3,150 operations were performed on tonsils and adenoids, many
of these in adults it is true but the great majority in children and relatively few, I believe, had preoperative X-rays made. Yet only two
deaths occurred in this series, curiously enough within the same week.
These were found at autopsy to be definite cases of Status Thymicolymphaticus.
It is generally accepted that practically all the tragedies of the
tonsillectomy room, that is with regard to children, are due to the
presence or existence of this state which entails on the individual a susceptibility to anaesthetics. Tkis seems to be true, but Coe and Peden
report an interesting case in Northwest Medicine of April, 1928,
which rather refutes this idea. An infant with a harelip and cleft palate
was first operated on at the age of nine months when under ether anaesthesia lead plates were applied to the outer aspects of the alvolar processes and held in place by silver wire. The anaesthesia and operation proceeded smoothly and recovery was uneventful, except for a persistent
bronchitis. Radiographs taken at this time showed an enlarged thymus.
During the thirteenth and again in the fourteenth months, operations
were performed under ether anaesthesia with no untoward sequelae. During the twenty-second month it was decided to unite the palatine
fissure. Shortly after the ether induction was instituted the respirations
became shallower and the anaesthesia was discontinued. Artificial respiration and stimulation were given to no avail, respirations finally ceasing but the heart continuing to pulsate for several minutes after.
Autopsy revealed a thymus weighing 45 grms. the trachea somewhat flattened beneath it; hypoplasia of the aorta and hyperplasia of the
lymph nodes. In addition the spleen was situated on the right side, the
liver and caecum on the left, the pyloric end of the stomach pointing
toward the left, the heart on the right side of the thoracic cavity and
presenting a large interventricular foramen.
Here then is a case which fulfills all the pathologic and to some
extent   clinical requirements  of  status  thymicolymphaticus,  which had
Page 54 been subjected to three successful ether anaesthetics and expired during
the early part of a fourth administration, yet with no definite signs of
asphyxia but rather of respiratory centre paralysis.
Various explanations have been offered as the cause of death in status
thymicolymphaticus among them tracheal compression, involvement of
the vagi, intoxication and anaphylaxis. The first two are not very definitely supported, however. Symmers advanced the theory that the body
is sensitized by germinal centre necrosis and then shocked by subsequent
necrosis. This has not been borne out, however, by studies of the anaphylactic phenomena. The germinal centre necrosis is probably due to a
general unknown intoxication which may be responsible for death. It
is well known that infectious diseases in these persons run a severe course
and they are probably highly susceptible to intoxications.
There is considerable evidence on record of thymic enlargement in
hyperthyroidism even in adults and Leech and Smith of the Lahey
Clinic in Boston report a case of a woman 40 years of age with hyperthyroidism who died suddenly after subtotal thyroidectomy performed
60 hours before. Autopsy revealed a thymus 45 grms. in weight with
the other evidence of status thymicolymphaticus. Miller reports a case
of a young man 19 years of age who died suddenly during a tennis match
showing what was termed a "mild condition of colloid goitre" and
autopsy findings of definite status thymicolymphaticus.
Symmers reports as a typical, consistent microscopic finding in cases
of thymic death, hyperplasia of the germinal centres in the spleen and
lymph nodes with central cellular disintregation, with, in addition, the
usual gross findings previously referred to.
In the majority of the cases I have autopsied which showed no other
gross demonstrable lesions but hypertrophied thymus gland, this structure
showed petechial haemorrhage subcapsularly and there were generally
petechiae in heart and lungs but I have never been absolutely satisfied
with the existence of the hypoplasia of the great vessels or marked
lymphoid hyperplasia. I have been struck with the*close association,
one might indeed say, incorporation of the lateral borders of the gland
with the phrenic nerves and frequently wondered whether or not this
close association is of any pathologic import.
The thymus glands of only 14 cases have been studied as a part of
the material for this paper, six being thymic deaths, the remainder dying
of some other definitely demonstrable lesion. The ages vary from newborn to eight years and the weights from 5 to 45 grms. In all but two
of the thymic deaths, the rnircoscopic examination of the gland shows
marked hypertrophy and central necrosis of the Hassal's corpuscles one
of these having had one X-ray treatment. This fact seemed to me rather
suggestive but I could find no mention of it in textbooks. However, in
' another case that of a boy eight years of age, who died of a fractured
skull, the thymus weighing 42 grms., also showed on microscopic examination marked hypertrophy of the Hassall's corpuscles. The sections
from the other cases show no such hypertrophy of the corpuscles nor any
other significant feature beyond the presence of fairly well marked congestion of the vessels which is seen in practically all of the sections.   The
Page J 5 What's good
for a cough?
We are frequently asked this and similar
questions.
Our answer that "a physician, after
examination, is the only one properly
qualified to state," evokes considerable
surprise.
Our policy does not countenance counter prescribing and is 'rigidly adhered to.
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Medical-Dental Building Vancouver other  microscopic findings  described  by  Symmers  were  not  definitely
found in the spleen, lymph glands and adrenal cortex.
The above findings are merely stated and may be taken for what
they are worth. No conclusions are drawn from the corpuscle hypertrophy and central necrosis other than that it would suggest that these
phenomena may be factors in the sudden death from an internal secretory
dyscrasia. The number of cases studied in this particular instance is so
small that one cannot presume, as stated above, to draw any conclusions
from the rather inconclusive findings.
The weights of the thymus glands of 19 cases autopsied at the Vancouver General Hospital in the last two and a half years with the ages
of the patients and the cause of death are given below and they conform
generally to the findings for their various age periods found elsewhere.
Congenital heart.
Congenital heart.
Stillborn.
Congenital heart.
Congenital heart.
Congenital heart.
Congenital heart.
Thymic death.
Thymic death.
Otitis media and septicaemia.
Influenza pneumonia.
Thymic death.
Thymic death.
Fractured skull.
Thymic death.
Thymic death (anaes.)
Thymic death (anaes.)
Fractured skull.
Arsenical poisoning.
N.B.,
7
grms.
N.B.,
24
grms.
N.B.,
22
grms.
N.B.,
19
grms.
2 days
5
grms.
3 days
9
grms.
3 days
11
grms.
6 weeks
25
grms.
2 x/z months
45
grms.
3 month
11
grms.
7 months
18
grms.
9 months
13.6
grms.
2 years
30.8
grms.
3 years
39.9
grms.
3 years
44
grms.
6 years
26.7
grms.
6 years
55.3
grms.
8 years
42
grms.
14 years
27.9
grms.
THE SEROLOGICAL DIAGNOSIS OF SYPHILIS
By Dr. J. Ewart Campbell
Apparently as a matter of expediency it has been decided by the
laboratories of the Vancouver General Hospital to substitute the Kahn
test for the Wassermann as a routine procedure in the serological diagnosis
of syphilis. Both these tests have been done as a routine measure for
several months and it is presumed that the profession is satisfied with the
accuracy of the more recent one, but even so some criticism or some
attempt at comparison seems desirable.
In addition to the Kahn test there are a number of other precipitation or coagulation tests, as they are called, and as most of their creators,
while not exactly clamouring for recognition, at least have been so convinced of the superiority of their creations that it was judged necessary
by the scientific section of the League of Nations to compare them with
Page 56 the Wassermann reaction. Six (6) of these procedures were compared
with the Wassermann reaction or rather with eight (8) different Wassermann reactions or modifications thereof. This was done in May and
June of last year, 1928.
On the whole the correspondence was very close. The Kahn proved
almost the most sensitive, and with the exception of the Murata the
simplest to perform.
The conference recommended that two (2) tests should always be
done for the diagnosis of syphilis and that one of these should be a
Wassermann reaction, as there was a feeling that too sensitive a test
might react with a non-specific serum giving false positives. This, in
the opinion of Colonel Harrison and, I think, most other syphilographers,
is a calamity of the first order. While the Kahn may be a superlatively
sensitive test and when further refined may tell us exactly the state or
activity of the disease, its value at present depends on the close correspondence or parallelism between it and the Wassermann done by a
proved and accredited method. Where there is any great variation there
tends to be a doubt as to the value of either test and it is eminently
desirable to see whether these conditions are fulfilled in our local or
public laboratory.
An analysis was made of 152 consecutive Kahn and Wassermann reactions which were both done from the same sample of blood.
The Kahn agreed with the Wassermann 68 times and disagreed on
84 occasions.
The Kahn was positive and the Wassermann negative 70 times and
in an additional 14 the Kahn was the stronger reaction.
In six tests the Wassermann was the stronger reaction.
Of these 78 tests in which the Kahn was positive and the Wassermann negative or nearly so, 13 were definitely and clinically syphilitic;
7 had typical chancres; 37 of this number represent treated cases.
In treated cases it is very difficult to say whether the Kahn reaction
really represented the presence of active disease as the Kahn seems to fade
or disappear more slowly than the Wassermann reactions with which I
am familiar and it also appears to be provoked to a stronger reaction
after treatment somewhat more frequently than does the Wassermann.
There were seven doubtful cases showing positive Kahn reactions
with negative Wassermanns which may or may not have been syphilitic.
One might say that the positive Kahn was the chief symptom.
On the six occasions in which the Wassermann was the stronger test
the Wassermann more accurately indicated the state of the disease.
Where Kahn and Wassermann agreed, there seems no doubt; such
cases were either clinically negative or positive. It is possible that the
agreements are greater than the numbers given as there was a period
when only the disagreements were recorded or notified by the laboratory.
This period was not very long and the number of unrecorded Kahns is
not likely to be very great.
Page 57 One case is of interest because both Kahn and Wassermann agreed
and both gave a very weak reaction and yet the case was florid secondary
syphilis. No doubt it was due to some accident to the blood in the process of collecting it or at some other stage in its career before it was
incorporated in the test.
These figures though not very numerous certainly reveal an astonishing lack of agreement between the Kahn and the Wassermann. We
might conclude that the Kahn is superior because it has detected 13
definitely syphilitic cases which the Wassermann has missed, but against
that are seven doubtful cases and a fairly large number of treated cases,
some of which are by no means clinically active. Of the 13 definitely
syphilitic cases detected by the Kahn (where it wasn't needed) seven
were primary, and primary cases should not be diagnosed by blood tests.
Six (6) times the Wassermann was stronger than the Kahn and the
Wassermann was probably right.
Further a Kahn 4, the strongest Kahn reaction, does not mean the
same as a Wassermann -j-4 -\-4. It is a weaker reaction or is produced by a comparatively weak stimulus. I am basing this statement,
not on the Wassermann under review, but on my experience of Wassermann reactions generally.    This of course is purely a matter of opinion.
Both these tests as carried out at present are to me unsatisfactory,
the Kahn I feel is too sensitive and the Wassermann the very reverse; an
opinion I have held for some years. However, apart from any personal
bias, there is not that parallelism or reasonably close correspondence which
is usually obtained between a good type of Wassermann and the Kahn
test.
This criticism only applies to the tests carried out at the Vancouver
General Hospital Laboratories.
RHEUMATISM
By Dr. Norman B. Gwyn
Read before the Summer School of the Vancouver Medical Association,
June, 1929
My excuse for dealing with the subject of this discussion is that
many years ago in Osier's clinic in Baltimore, to me was given the opportunity of seeking for a matter of two years the possible cause of acute
rheumatism. Though we had a perfectly negative result as far as the
research was concerned, yet it gave us a proper scepticism where the
matter of a fixed bacteriological cause was concerned. A little later at
Professor Welch's instigation, in seeking to determine the nature of the
organism claimed by Aschame Phiroloix to be the cause of rheumatism,
we had the good fortune to run into his—Welch's—gas bacillus, in one
of the cases of chorea which, as you know, is frequently spoken
of as a rheumatic manifestation. It had been Dr. Welch's idea that his
organism was that with which the French observer had been working. In
this particular case death at the end of a long illness seemed to be due to
a general streptococcic infection.
Page 58 The present view as to the cause of rheumatism and rheumatic fever
is that it is a reaction due to a streptococcic infection. Not infection
alone but some peculiar bodily disturbance ensuing as a result of the
infection. We have a similar suggestion in the course of scarlet fever
in which we all recognize, first the infection in the throat and the subsequent peculiar arthritis, nephritis and even endocarditis, which does not
show the general suggestions of infection as much as those of a peculiar
toxic reaction.^ From the clinical and pathological side we have had to
completely revise our ideas as to the nature of rheumatism because, (1)
there has been the insistence that the so-called Aschoff bodies are something peculiar to rheumatism; (2) because there are now so regularly
demonstrated, thanks largely to Klotz, the diffuse arterial lesions of
rheumatism; (3) because it is now so regularly insisted on that disease
of the mitral valve, particularly stenosis, means rheumatism, whether
there is a history of rheumatic infection or not.
Swift, to whom we owe so much in the elucidation of the meanings
of rheumatic manifestations, makes the following interesting observation
"arthritis is not common in the tropics. Mitral stenosis, however, is
found in the tropics with presumably the same frequency as elsewhere—
therefore there must be rheumatism existing in some other form than the
arthritic." A case of this sort has recently come to my observation.
The wife of a doctor, not feeling up to the mark for some months, had
her tonsils removed. Immediately following the operation there developed a streptococcic membrane in the tonsil area and pharynx. It took
nearly three weeks to disappear. Going South to convalesce she began to
complain of a little vague muscle stiffness which she thought was simply
due to over-use of her muscles at golf. A few days later, however, she
broke out with one of the very characteristic lesions of rheumatism,
namely subcutaneous fibroid nodules. She thought she could have no
rheumatic infection because, as she told us, she had lived most of her
life in the tropics.
To these three reasons which we have given for the revision of our
ideas as to the nature of rheumatism, one might add a fourth, namely
that in all the many claims for the isolation of a streptococcus peculiar
to rheumatism, there is distinct variation in the nature of the streptococcus found. Poynton and Paine, Klause, Birkhaug and Small have all
in turn isolated organisms belonging to the streptococcus group yet by
no means identical one with the other.
The recognition of the first two reasons for the revision of our ideas,
namely the nature of the Aschoff bodies and the diffuse arterial lesions
found in the disease, has speedily recast the clinical picture of rheumatism. We no longer say rheumatism or rheumatic fever is a disease in
which arthritis, chorea, pancarditis, a few skin lesions and the subcutaneous fibrous nodules, make up the picture, but that it is a disease which
involves the entire body (Libman); a disease which may be, as he
says, arthritic, gastro-intestinal, pulmonary or typhoidal. Any of these
types co-existing with such other manifestations as chorea, endocarditis,
pericarditis, subcutaneous fibroid nodules, may be the picture held up for
our inspection. How far one must let their imagination run today in
considering the clinical signs and symptoms due to rheumatism can per-
Page 59 haps be well exemplified by two details. In a discussion of the reports
before the Association of American Physicians describing death as a
result of multiple minute pulmonary thrombosis, the question was at
once asked "Were those arteries sectioned looking for the rheumatic
manifestations and for the presence of Aschoff bodies?" Again in the
discussion of rheumatism by Libman he points out that wherever there is
a vessel, there may be rheumatic reaction with, perhaps, fibromatosis and
infarction as a result. This being the case he suggests that the angina
seen in some cases of rheumatic infection may not of necessity be related to the coronary arteries but may be an expression of the involvement of the aorta, innominate, pulmonary arteries or veins or the caval
veins. It should be remembered in this connection that in a rheumatic
infection, thrombosis of pulmonary arteries or of a pulmonary vein or
even of the azygos vein may result in pulmonary lesions or in chronic
persisting pleural effusion. This was very much our idea in the case of a
physician who was said to have had three attacks of coronary thrombosis.
On the very face of it it would seem unusual for anyone to come clearly
through with such a history. We had overlooked in earlier examinations
the patient's statement that he was down with a febrile rheumatic attack
immediately preceding his second severe chest pain. An interesting feature in his subsequent history was fourteen months of recurring pleural
effusion and as has been referred to in a previous case, the development of
a streptococcic membrane in his throat immediately following a tonsillectomy. In the light of the ideas put before us by those most interested in the study of rheumatism today, all such affection as phlebitis,
arteritis, myositis, pleuritis, pericarditis, even cerebritis, must be looked
at from a rheumatic viewpoint. The number of unusual symptoms and
syndromes that are recorded are almost legion. For instance, to quote
Libman again, fever, recurring nose bleeds, abdominal pain, may well be
an expression of rheumatism in the child.
Great as may be the alteration in our clinical viewpoint of the
rheumatic infection, it is no greater than that which has taken place
along the line of determining the aetiology of the disease.
It does not seem that simple infection in the general meaning of the
term is enough to explain the clinical and pathological response. Infection by streptococci usually ends in the production of pus or begins in
a small pus-producing area. Even the active haemolytic streptoccus will
produce pus in its growth in the body or body cavities. The mild
viridans has, as we know, the capacity of associating itself with the
large infected thrombus on the heart valve, whereas the picture seen in
the fatal case of rheumatism shows us the clear serous exudate associated
with, perhaps, only the finest wart-like vegetation on the heart valve.
The present picture of rheumatism is something distinctly different from
those of the usual streptoccic infection. The minute cardiac vegetations,
the vascular lesions described by Klotz and the later occurring and interesting Aschoff bodies have come to be looked upon more as a tissue
reaction than as a real tissue infection. In the vessels, in the capillaries
of the joints, of the serous membrane, of the endocardium, of the valves,
it is this curious reaction which produces the damage in rheumatism
rather than the localization of a number of purely septic foci. A study
of these remarkable lesions has shown very interestingly, a resemblance
Page 60 to the lesions which occur as the result of diplococcus and staphylococcus
infection. The vascular lesions resemble closely those of syphilis in their
distribution about the finer blood vessels, whereas the structure of the
Aschoff body, containing as it does the peculiar giant cells, suggests at
once the well-known picture of the tubercle, minus, however, the detail
of caseation and the peculiar zone of epitheloid cells which represent part
of the tuberculization. Once these lesions have become well established
in the body throughout the whole of the vascular system, particularly in
its finer parts, the idea is that they convey to the cells of the part, as
well as take on themselves, a peculiar susceptibility in response to all
subsequent infection of a rheumatic nature, or perhaps, of even other
nature. A tonsillitis, a sinusitis, a badly infected tooth, perhaps, supplies
the necessary stimulus and the many affected and sensitized areas react
just as tubercle in the iris or the scattered tubercles in a lung react to the
tuberculin injection. Or, again, just as the tissue of the body reacts in
the simple protein sensitization test. The victim of hay fever has absorbed his poison years before through the respiratory tract but each cell
in the body has from this time taken on a new quality and the mere
rubbing into the skin at the periphery incites these cells to inflammatory
reaction. Rheumatism today to the men who have proposed the allergic
theory is in many cases the lighting up of an old infection of the body
by the introduction of an infecting agent through some portal of entry.
Swift has carefully worked out in animal experiments the details which
belong to this theory. After the sensitization of the animal by the various
strains of streptococci, it is apparently an easy matter to light up reactions by the introduction of the proper toxins into the joint under the
skin or into the vesels.
We have in this allergic theory a much more reasonable explanation
of the persistently sterile effusions, of endocardial excresences and a hur-
ther explanation of the few positive results in blood cultures in the
general run of the rheumatic cases. Once established as an affection in
the body, and as years go on, the vascular lesions tend to take on their
tubercle-like structure which has been so well described by Aschoff.
This allergic theory is even substantiated by the work of others
who are more interested in pushing forward the idea that rheumatism is
a direct bacteriological infection and invasion. Small, of Philadelphia,
whose name is associated with the micrococcus cardio-arthritides, a firm
believer in the idea of the streptococcal nature of rheumatism, has gone
to the extent of making an anti-serum or anti-toxin from his strain of
streptococci. With this anti-toxin he seems in some instances to have
had almost curative results. In some cases, however, it is quite apparent
that the injection of the serum seems to light up the acute symptoms of
the disease and many cases are reported in which anti-rheumatic serum
has been followed by acute polyarthritis.
It is pointed out by the adherents of the allergie theory that this is
not the reaction to be expected with an antitoxic serum (the larger the
dose of the curative serum in diphtheria, for instance, the more distinct
the tendency to cure) and in the reaction described by Small, Swift, and
others, they see again an allergic response of the affected unsensith.ed
tissues.
Page 61 A detail of interest in Small's reports however is that these acute
flare ups following serum treatment are readily relieved by the giving of
salicylates. This action on the part of the salicylates is in conformity
with what we already know. The salicylates usually relieve the acute
painful joint, reduce the fever and the heart rate, but have, as we know,
no effect on the more chronic proliferative lesions which are represented
by the periarterial infiltrations and the Aschoff bodies.
The value of the salicylates as far as the heart is concerned might be
perhaps comprehended in the statement that if an oedematous valve is
spared unnecessary trauma by the reducing of the heart rate, that' something at least in the way of prevention has been accomplished. Salicylates in general have no effect on the more chronic tubercle-like manifestations represented by the Aschoff bodies and the subcutaneous
nodules.
THE OSLER SOCIETY OF VANCOUVER
The Osier Club started its year's activity on October 2nd. This
meeting and all others are being held in the Hotel Georgia, as suitable
space could not be definitely assured in the Medical-Dental Building.
The programme for the ensuing term of 1929-30 will consist of nine
scheduled evenings with presentation of two papers each evening and
systematic discussion of each paper presented by a certain number who
will be detailed in advance, thereby hoping that the discussion will be a
little fuller and more academic.   The list of subjects is as follows
Oct.      2—Dr. D. M. Meekison Low Back Pain
Dr. J. R. Davies . Pre-School Child
Oct.    23—Dr. R. P. Kinsman .-. Pre-Natal Child Hygiene
Dr. L. H. Leeson : The Common Cold
Nov.   27—Dr. W. L. Boulter Induction of Premature Labor
Dr. A. Y. McNair Some Aspects of Diabetes
Dec.     18—Dr. A. M. Agnew Caesarian Section
Dr. E. J. Curtis Body Fluids
Jan.     22—Dr. W. L. Graham Gall Bladder
Dr. W. H. Hatfield , . AJlergy-Asthma
Feb.     16—Dr. G. O. Matthews Hypertrophy of the Pylorus
Dr. J. E. Harrison The Kidney in Pregnancy
Mar.    26—Dr. W. L. C. Middleton Asymptomatic Haematuria
Dr. H. H. Pitts Cancer
Apr.    23—Dr. J. E. Walker .-Empyaema
Dr. H. A. Rawlings X-Ray Exam, of the Mastoid
May     28—Dr. J. R. Neilson  .Thrombo Phlebitis Obliterans
Dr. R. A. Seymour Some Cases of Incipient Pulmonary
Tuberculosis
Dr. E. E. Day Allergy
The Editor of the Bulletin will be glad to have the
opportunity to consider for publication any of the above
papers which their authors may wish to submit.
Page 62 B. C. MEDICAL ASSOCIATION NEWS
- In order to stimulate interest and active co-operation in the B. C.
Medical Association, and to let the profession know what this Association
does, we publish the following:
1. It looks after the material and economic welfare of the profession
individually and collectively. The local societies look after the
professional side of it only.
2. Money Talks. The Association was responsible for that change
in the provincial income tax which brought about a reduction
from one half to one qtiarter per cent, on the gross income. This
item alone pays the membership fee to the B. C. Medical Association.
3. It watches legislation at the cost of considerable time and money
and, in the last eight years, has done much to safeguard the interests of the profession. As recently as the last session of the
legislature, the B. C. Medical Association was wholly responsible
for bringing in an amendment to the "Coroners" Act, which
meant very considerable advanced remuneration to the ninety-five
coroners in this province, to say nothing of the men doing autopsy
work. Other parliamentary bills, inimical to the interests of the
profession, were vetoed through its efforts. It works with the
Council in all legislative matters.
4. Health Insurance might be a boon or a menace. The profession
is interested in this most important matter which is a live issue
in the House at the present time. The B. C. Medical Association
has already spent considerable time and hundreds of dollars in
the last few years in securing data, compiling statistics, working
out tentative schemes, etc., all with a view ot protect the interests
of the profession as well as the public.
5. At the present time a special block of automobile license number
plates for 193 0 is being secured for the profession. The advantages, which will accrue from this, need not be enumerated, but
one important point may be stressed viz: such a system obtained
in Toronto and, as a result, the number of stolen doctors' cars was
reduced in one year from ninety to eight.
6. The Canadian Medical Association will hold its annual meeting in
Vancouver in 1931. Only members of the Provincial Association
can join the Canadian Medical Association.
7. The B. C. Medical Association is looked upon by the Workmen's
Compensation Board as the connecting link between the profession
and itself. Many disputes between the W. C. B. and the doctors
have been settled through the good offices of the B. C. M. A.,
frequently to the financial benefit of the doctor. There are many
doctors who have, in this connection alone, received much more in
actual cash than their dues to the Association.
Non-members not contributing in any way to the support of the
Association derive the benefit of its work.    Are they content to
Page 63 continue to allow the burden to rest on the shoulders of  their
colleagues, who have paid their dues consistently year after year?
8. The foregoing deals only with a few of the activities of the
Association as affecting Vancouver doctors—the men outside
throughout the Province know full well the value of organized
medicine as shewn by their practically 100% paid up membership.
9. No details are here given of the innumerable and varied economic
problems in contract and other practice which have been settled
satisfactorily by our Association; suffice it to say that even better
results could be expected with a solid united organization.
10. The B. C. Medical Association is looked upon by most members
as an insurance policy against injury to one of their most valued
possessions viz: their profession and living. The premium asked
is very modest when one considers its advantages and the protection when the Executive can guarantee every member that his
material professional interests will be watched over, cared for, and
protected by a vigilant group of representative brethren chosen by
the profession for this purpose.
11. No medical man can afford to remain outside of this Association.
The motto "all for one and one for all' is applicable in our case.
These points are surely deserving of serious consideration.
Rest Haven Sanitarium and Hospital
MARINE DRIVE, SIDNEY, B. C.
(Near Victoria)
(Visited by Qualified Physicians)
Semi-Private Wards Surgical Wards
Private Rooms Maternity Wards
Rates as low as $21.00 Weekly.
Beautiful for situation.
Por further information apply to:
MEDICAL  SUPERINTENDENT.   SIDNEY.   B.   C.
or the Manager
Page 64 Back of Every Pain ♦ ♦ ♦
is a disturbance in the physical or mental equilibrium, an
interruption of some vital function, a deviation from the
normal. Injuries, inflammations, excessive muscular strain,
disturbances of the circulation, all are productive of pain.
And be it trivial or severe, prolonged or ephemeral, uppermost in the mind of the patient is the prompt suppression
of that pain.
To the patient wracked by the painful pneumatic process,
nothing is more grateful or comforting than an Antiphlogistine jacket applied over the thoracic walls. Physicians conversant with this simple procedure generally concede that
this plastic anodyne dressing increases the superficial circulation by the induction of artificial hyperemia setting up
a highly decongesting process in the deeper seated tissues
and thereby relieving the dyspnea and the stress on the
right heart.
Doctors the world over are more and more coming to recognize the unique properties of
@4tJMiilMidttne
as an invaluable auxiliary in the management of the pneumonias or wherever pain is a prominent factor. VANCOUVER HEALTH DEPARTMENT
STATISTICS, OCTOBER, 1929
Total   Population    (Estimated) 228,193
Asiatic   Population    (Estimated) 12,300
Rate per 1000 of Population
Total   Deaths 165 8.51
Asiatic  Deaths 15 14.36
Deaths   (Residents  only . 142 7.33
Birth   Registration: 356 18.37
Male       179
Female    177
INFANTILE MORTALITY—
Deaths under one year 6f age ! 10
Death  rate per   1,000   births 28.09
Stillbirths not  included  in above) 12
Cases of Contagious Diseases Reported in City
September, 1929
Cases Deaths
Smallpox 4 0
Scarlet Fever 11 0
Diphtheria 52 3
Chicken-pox : 12 0
Measles 6 0
Mumps 16 0
Whooping-cough        1 0
Erysipelas 8 0
Meningococcus  Meningitis-      2 0
Tuberculosis 18 14
Poliomyelitis 2 0
Typhoid   Fever 2 0
October, 1929
Cases    Deaths
November 1st
to 15th, 1929
Cases    Deaths
3
11
65
9
2
8
12
j3i
0.
18
1
1
0
1
0
0
0
0
-»o';
o
o
n
:o'
o
l
8
39
7
1
4
10
0
0
4
0
0
0
0
2
0
0
0
0
0
0
0
0
66
me Name Is VIOSTEROL"
As
kS clearly pointed out in an editorial in the Journal of the A. M. A.
of October 5, entitled "The Name Is Viosterol," this name identifies
those irradiated ergosterol preparations which have been accepted
and approved by the Council on Pharmacy and Chemistry.
To get the carefully standardized Parke-Davis brand of irradiated
ergosterol, please specify Viosterol, P. D. & Co.
Viosterol, P. D. & Co., is put up in 5-cc. and 50-cc. pack*
ages, with a dropper that delivers approximately 3 drops
to the minim. Your druggist has Viosterol, P. D. & Co.t
in stock, or can easily get it for you.
PARKE, DAVIS & COMPANY
WALKERVILLE, ONTARIO
WINNIPEG, MANITOBA
MONTREAL, QUEBEC
Page 65 Doug. 3406
1436 Harwood Street
PRIVATE HOSPITAL
Vancouver      -      B. C.
Overlooking English Bay
Specializing in
THERAPY WORK and DIETORY
Patients can be visited in their own homes.
Non-resident patients treated.
(Visited by Qualified Physicians) Miss R. Backett, R.N.
♦»
/   Try It at Ow Expense.,. jilt: \
v "Return Cmipon for Sample     /
I earn for yourself how promptly out the irritation of inhalants
j and effectively Swan-Myers containing menthol, thymol,
Ephedrine Inhalant, 1%, No. 66, eucalyptus, or other aromatics...
relieves the nasal congestion of Stocked by dealers in 1-ounce
colds, coryzas and hay-fever with- and 1-pint bottles.
THE WINGATE CHEMICAL CO., Ltd., 468 St. Paul St., West, Montreal
Send physician's sample Swan-Myers Ephedrine Inhalant, No. 66, to
Address. McKEE-COLEMAN
CLINICAL LABORATORIES
Vancouver, B. C.
1030 Medical Dental Building
Telephone Sey. 2996
C. S. McKee, M.B., Res. Bay. 268.
R. E. Coleman, M.B., Res. Bay 5194
Mary M. McKee, B.A.
Say it with Flowers
Cut Flowers, Potted Plants, Bulbs, Trees, Shrubs,
Roots, Wedding Bouquets.
Florists' Supplies and Funeral Designs a Specialty
Three Stores to Serve You:
48 Hastings-St. E.
665 Granville St.
151 Hastings St. W.
One Phone:
Seymour 8033
Connecting all three stores.
Brown Bros. & Co. Ltd.
VANCOUVER, B. C.  ^*r
-•-»•=
Hollywood Sanitarium
LIMITED
^or the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference '*. T>. Q. cPftedical ^Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
WteXS
5MV

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