History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: May, 1930 Vancouver Medical Association May 31, 1930

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  Patient Types:
THE ELDERLY PATIENT
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Dept. V.M.  10. THE   VANCOUVER   MEDICAL   ASSOCIATION
BULLETIN
Published Monthly  under  the   Auspices  of  the  Vancouver  Medical   Association  in   the
Interests of the Medical Profession.
Offices:
203 Medical 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 abovi address.
Vol. VI. MAY,.1930~       ^^^    ZZZZZ     No" 8
OFFICERS 1929-30
Dr. G. F. Strong Dr. C. Wesley Prowd Dr. T. H. Lennie
President Vice-President Past President
Dr. E. M. Blair Dr. W. T. Lockhart
Hon. Secretary Hon. Treasurer
Additional Members of Fxecutive:—Dr. A. O Frost; Dr. W. L. Pedlow
Trustees
Dr. W. B. Burnett Dr. W. F. Coy Dr. J. M. Pearson
Auditors:   Messrs. Shaw, Salter & Plommer
SECTIONS
Clinical Section
Dr.   S.   Sievenpiper Chairman
Dr.  J.  E.  Harrison Secretary
Eye, Ear, Nose and Throat
Dr.  F.  W. Brydone-Jack   ~   Chairman
Dr.  N. E. McDougall  Secretary
CORRECTION
The ^ „f tlle Libr3ry Comm.ttee shou)d £|
Dr. D. M. Meekison
Dr. W. H. Hatfield
Dr. D. F. Busteed
Dr. C. H. Bastin
Dr. C. H. Vrooman
Dr. C. E. Brown
Rep. to B. C. Medical Association should read-
Dr. H. H. Milburn
Dinner Committee should read:
Dr. L. H. Webster
Dr. L. Leeson
Dr. E. E. Day VANCOUVER HEALTH DEPARTMENT
STATISTICS,  MARCH,
Total   Population   (estimated)   	
Asiatic   Population (   estimated)    I	
1930
Total   Deaths    1 	
Asiatic   Deaths   	
Deaths—Residents   only   	
Birth   Registrations    *	
Male      170
Female   154
INFANTILE MORTALITY—
Deaths under one year of age	
Death  Rate per  1000  Births	
Stillbirths   (not included  in  above)
         240,421
  _ 9,3 3 5
Rate per 1000 of Population
220
19
189
324
15
46.30
5
10.78
23.95
9.25
15.80
Cases of Contagious Diseases Reported in City
February, 1930
Cases
Smallpox   .__      3
Scarlet  Fever    21
Diphtheria     _   30
Chicken-pox      62
Measles         8
Mumps    :  30
Whooping-cough     59
Typhoid   Fever        1
Tuberculosis        16
Poliomyelitis         0
Meningococcus   Meningitis        0
Erysipelas       11
Deaths
0
0
3
0
0
0
18
0
0
0
March, 1930
Cases     Deaths
April 1st
to 15th, 1930
Cases     Deaths
3
12
19
53
10
45
48
1
19
0.
2
9
0
0
0
0
0
0
0
0
21
0
1
0
13
12
13
33
2
41
38
0
7
0
0
5
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Page 161 m   t&%
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YOUR decision to use diathermy
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references to diathermy in current
medical literature, and no doubt
intend to investigate for themselves when opportunity presents.
But a busy practice affords little of
the time required in searching the
files of the medical library, and so
it is put off indefinitely.
A preliminary survey of articles
on diathermy, published during
the past year or so, is available to
you in the form of a 64-page booklet entitled "Indications for Dia
thermy." In this booklet you will
find over 250 abstracts and extracts from articles by American
and foreign authorities, including
references to more than a hundred
conditions, in the treatment of
which the use of diathermy is
discussed.
If you number yourself among
the physicians who have not yet
adopted diathermy in practice, and
desire to investigate this form or
therapy in view of reaching your
own conclusion as to its value in
your practice, you will find this
booklet a convenient reference. A
copy will      _____________
Dlathe
J~
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be sent on
request.
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EDITOR'S PAGE
The last Session of the B. C. Legislature has been of particular
interest to our profession. The historical facts are well known to all,
but we feel that there are solid grounds for satisfaction with the results
obtained. For many years now, the so-called "irregulars," those who,
lacking training and the minimum of medical knowledge which we
know to be essential in those who would treat the sick ,have besieged
the House for legal recognition. To us, who know something of the
facts, this would constitute so grave a threat to public safety and the
advancement of public health, that will-nilly we have felt compelled
to protest with all our power, and oppose such legislation. This has had
more than one unfortunate secondary effect—it has exposed us, as a
profession, to misunderstanding and misrepresentation. Our opposition
is attributed to jealousy, to a desire for monopoly, to fear lest our
incomes be threatened by the success of the cultist under one of his
polyglot classifications. Such accusations are absurd on the face of
them, but, with the unthinking section of the public, they have their
effect, and, aided by the sympathy that everyone feels for the under-dog,
they present our profession in a bad light. Again, this participation in
a political fight constitutes a serious drain on our resources as a body,
and many have wondered whether we are justified in spending our
money on what is not, in one sense, our quarrel. It is, they argue, the
duty of the Legislature to protect the public, and not ours—recognition
of these cults would not in any way affect us, and we expose ourselves
to unfavourable criticism and deplete our funds, to protect people who
have not the sense to protect themselves.
We cannot agree with such a view. Our greater opportunity, of
knowledge and experience, entails responsibility which we cannot shirk,
and we feel that our representatives, the B. C. Medical Council, were
well advised to carry on the fight as they have done, against a lowered
standard of medical education and therapeutic practice. There have not
been wanting those of our number who predicted that disaster and failure would attend their policy of attempting to obtain limitation of the
use of titles designating the physician to those who were entitled by
right of study and training to use them, and there were others who
would urge a compromise. Such would be unpardonable weakness and
dereliction of duty, we cannot think of compromising in so grave a
matter as public health. The implications of such a compromise on our
part are such that we could never agree to it, and this was the view that
the Council and the leaders of the provincial and local associations were
unanimous in taking. The Council of the College deserves our thanks
and respect for the courage and sincerity with which it stuck to its guns
in both matters and that its judgment was a wise and correct one, is
shown by the outcome.
A further cause for satisfaction is the suggestion that was made
that a Judicial Commission should be appointed to consider this whole
matter and to report to the House for final settlement of the question.
The member of the Legislature is subject to intense and often unfair
political pressure, which makes it extremely difficult for him to steer
a clear course. To the credit of our legislators be it said that they have
in the great majority of cases refused to let political expediency induce
Page 162 them to tamper with public safety. But undoubtedly the other is the
better way. We should welcome such a Commission, we hope it will be
appointed at an early date and we will abide cheerfully by the findings
of a competent and unprejudiced inquiry such as we know it will be.
ERRATA
The Bulletin, Vol. VI., No. 6 (March, 193 0), page 126.
Line 27: for "10 per cent."  read "100 per cent."
Line 38: after "bladder"  read "disease."
!
THE 1930 SUMMER SCHOOL
The Vancouver Medical Association Summer School will be held
this year on June 24, 25, 26 and 27 in the Hotel Georgia. The Committee has met with considerable difficulty this year in providing a programme comparable in interest with former years. These difficulties,
however, have been overcome and several men of note in Canada and
the United States have agreed to speak.
It was originally planned to have the Summer School following the
British Medical Association meeting in Winnipeg and to secure some
British speakers. This plan, however, did not meet with the approval
of the Executive of the Canadian Medical Association and was dropped.
The American Medical Association, the American Paediatric Association
and the North West Medical Association all meet about the time of our
Summer School and this increased the difficulty in obtaining speakers.
The subjects of the lectures are not yet definitely decided but
the speakers will be:
Dr. W. F. Cheney, Professor of Clin. Medicine, Stanford University,
San Francisco; Dr. J. G. Fitzgerald, Prof. Hyg. and Prev. Med., University of Toronto; Dr. O. Klotz, Prof. Path, and Bact., University of Toronto; Dr. D. B. Leitch, Prof. Paediatrics, University of Alberta, Edmonton; Dr. K. G. McKenzie, Dept. of Surgery, University of Toronto;
Dr. Henry R. Viets, Neurologist, Harvard Medical School, Boston;
Dr. Geo. E. Wilson, Assoc. Prof. Clin. Surgery, University of Toronto.
We hope the attendance will be as good as it has been in the past
two years. The fee is Ten dollars. The Hon. Secretary is Dr. Wilfrid
L. Graham, of 719 Medical-Dental Building, Vancouver, B. C, from
whom all information can be obtained.
NEWS and NOTES
The Council of the College of Physicians and Surgeons of B. C.
desires through the medium of the Bulletin to thank the members of
the College in the various parts of the province for the assistance they
were good enough to render during the recent session of the Legislature,
at which matters of most serious import to the general public and to the
profession were before the House. That these matters were brought to
a successful issue the Council feels is in no small measure due to the
efforts of the profession throughout the Province and particularly to
the excellent work done by Dr. M. W. Thomas and the Legislative
Committee of the B. C. Medical Association, including Mr. C. J. Fletcher, Executive Secretary.        *        *        *
Dr. J. W. Thomson left at the end of April for a vacation in Europe. He expects to be away for several months and a feature of his trip
will be a motor tour through England,
Page 163 Mte
On April 4th a special dinner was held at the Vancouver Club by
the medical graduates of McGill University in Vancouver. The function was held to honour one of the oldest living medical graduates of
McGill, Dr. Andrew Henderson, of Powell River. One of the most
pleasant events of the evening was the presentation to Dr. Henderson
of a painting of himself. In his speech of acceptance Dr. Henderson was
in a most happy vein. His excellent reminiscences of early days at the
Montreal General Hospital, the Sairey Gamp genus of midwife who
flourished in those days, and recollections of Osier in his early days of
greatness, were related with a gusto, and enjoyed as much by his hearers
as by the speaker, which is far from being the case as a rule. Among the
special guests were Dr. Arthur of Peterboro, Ont., who is believed to be
the oldest living medical practitioner in Canada, and who made some
very acceptable remarks. Drs. Conklin representing Manitoba; D. M.
Mackay, Dalhousie; F. W. Brodie, Toronto; and W. Y. Corry representing Queen's, all made excellent, felicitous and graceful speeches according
to their several ability.
A joint meeting of the executives of the Vancouver and the B. C.
Medical Associations was held at the Hotel Georgia on April 5 th for
the purpose of meeting Dr. Harvey Smith of Winnipeg, President-elect of
the Canadian Medical Association. Dr. Smith came west for the purpose of
informing the western members of the Association of the arrangements
which were being made for the entertainment of the visiting members of
the British Medical Association in August. As a number of these will
be coming to the coast with their wives and families, it is necessary that
an appropriate and acceptable programme should be arranged, and knowledge of what eastern cities are doing will be useful as a guide.
Dr. Smith has recently visited Quebec where the visitors will first
enter Canada, and his description of what is to be dd"ne there and at
Winnipeg, where federal, provincial and municipal authorities are all
keenly interested in the matter of furnishing entertainment and making
generous contributions for the purpose, indicates that Vancouver and
Victoria will have a high standard set for them to aim at.
Dr. Fred Bell, the popular superintendent of the Vancouver General
Hospital, who has been very seriously ill, is now making satisfactory
progress, according to the latest reports.
MEETINGS
The March General Meeting of the Association was made the occasion for a Dinner at the Hotel Georgia. All business was suspended for
that evening in order to allow ample time for Dr. J. J. Mason to deliver
the Osier Lecture on "A study of a personal series of Hysterectomies
and Myomectomies," which we published in our April issue. The Osier
Lectureship was founded in 1920 and the first Lecture was delivered by
Dr. W. D. Keith in 1921. 112 of our members turned out to hear
Dr. Mason and do honour to the memory of Sir William Osier, for so
long an Honorary member of this Society.
The April General Meeting was held in the Auditorium of the
Medical-Dental Building on Tuesday the 1st. Eighty members were
present.    Dr. J. A. Gillespie presented an interim report of his special
Page 164
| i   I 1
Committee in relation to the new regulations at the Vancouver General
Hospital. The report was discussed by Drs. Monro, F. P. Patterson,
J. W. Welch and Lyle Telford, and eventually was carried unanimously.
The report is published in full in this issue.
Dr. John Brown, Dr. J. A. West and Dr. K. G. Yip were unanimously elected to membership in the Association.
The paper of the evening was delivered by Dr. G. O. Matthews
on the subject of "Common Procedures in Infant Feeding, their Use
and Misuse." Dr. Matthews' paper was well received and was discussed
by Drs. H. A. Spohn, Dr. C. F. Covernton and Dr. Coleman. After
a vote of thanks to Dr. Matthews the meeting adjourned at 10 p.m.
REPORT OF SPECIAL HOSPITAL COMMITTEE
APRIL 1st
Mr. President and Gentlemen:
Your committee has endeavoured to carry out the wishes of the
Association and has tried to arrange a conference with the Provincial
Secretary and the Cabinet, but so far has not succeeded. You have heard
the correspondence from the Provincial Secretary in which he evinces
the desire to leave the arrangement of a meeting until the report of the
Hospital Survey Commission has been received. There has been very
little progress made in our dealings with the Board of Directors of the
Vancouver General Hospital. It was decided by our committee not to
publish in the press the letter drafted by a special committee as an answer
to Mr. McVety's remarks in the Province, but our letter was sent to
the Hospital Board through the Chairman of the Medical Staff. This
letter was discussed and the answer has been already read. After a special
meeting between the Hospital Board and the Medical Staff on March
17th, held for the purpose of discussing the new regulations and the
resolutions sent up by the Staff asking that cases be admitted to the
hospital under their attending doctor, there was not a great deal of discussion and very little, if any, progress was made. The Board did not
show any special signs of agreeing to this resolution and no definite
answer was given to the Staff in reply. The same arguments were used
by certain members of the Board as at the original meeting held with
your committee in December, 1929. They argued that these regulations were advised by some of the Medical Staff, endorsed by the members of the Hospital Survey Commission and that they were brought in
principally to improve financial conditions and for the benefit of the
Internes, and contended that they should be given a trial and they asked
if it was not fair that the Medical Staff should carry on until the report
of the Hospital Survey Commission was received, which was expected
very soon. After this report was received and discussed the whole question could be taken up again. One of the members of the Staff stated
that the report of the Hospital Survey Commission would not affect
the opinion of the medical men in regard to the principle of free choice
of doctor by the patient, and that medical men were united in standing
for the right of following their patients into the hospital if they so
desired.
These new regulations have now been in operation three months,
which was the time the Hospital Board asked that they should be given
a trial.    While our Association went on record as not agreeing to the
Page 165 regulations, we have endeavoured to take no antagonistic attitude and
have by our actions tacitly acquiesced in giving them a trial and have
carried on with the belief that the disagreement between the Hospital
Board and our Association on the question of these regulations might be
satisfactorily settled by amicable discussion. While the administration
of the hospital has shown a tendency to leniency in the enforcement of
these regulations, and it was stated in the meeting between the Staff
and Board by the Superintendent that the administration staff had been
hampered somewhat in carrying them out, still enough cases have
arisen in the three months to show the effect of these regulations on the
patient, the doctor, and the hospital. The effect on the patient in many
cases is a feeling of resentment and many of them have been much disturbed at the action of transferring them to another doctor on account
of poverty or inability to pay in advance. We have enquired from many
of the medical men as to their attitude after this three months' trial
and we find that there has been practically no change in the attitude of
the men. Practically all the men are just as much opposed to them
as they were three months ago, if not more so. We find that after
cases have been turned over to the Staff, the sympathy and co-operation
of many of the men have been alienated and that there are now many
men sending their private cases ond other pay-work elsewhere, and in
this way much work which helps the hospital financially has been taken
away. We find also a growing feeling of resentment against the hospital
on the part of many, and also an unpleasant feeling springing up between the members of our profession and members of the Executive of
the Hospital Staff, who up to the present have been supporting these
regulations. From our observation we are fully convinced that there
will be no amicable settlement between the medical men and the hospital
board on the question of these regulations unless the principle of free
choice of doctor by the patient is allowed, and the doctor be permitted to
follow a case into the hospital if he wishes. But we also believe that
with the knowledge the medical men have received of hospital problems they would voluntarily turn over a large number of their non-
pay cases to the Staff and the Hospital for use as clinical material, etc.,
and would co-operate with the hospital in making it a financial success.
While we have had no definite answer from the Board we believe it would
be wise to wait until the report of the Hospital Survey Commission has
been received and all parties have been given an opportunity to discuss
it, and feel that we should then insist on a definite answer to our request
as before stated, before taking any other action which would alienate
our Association, which represents the great body of medical men, from
the Hospital. We believe that our case has been much strengthened by
not taking any hasty action up to the present; we also believe that with
the exception of a very few of our men, we are more united than ever
and that our men on the Staff have shown and will continue to show a
loyalty to our Association, and whatever action we decide to take will
be taken .as a united body. We also hope and trust that the scattered
few in our profession, who, we believe, have been quite conscientious in
their views when they have opposed the opinions of the rest of the men,
when they realize the unpleasant conditions which will arise if an attempt
is made to force these regulations on the profession against their wishes,
will agree to co-operate with the rest of our Association in influencing
the Hospital Board to agree to an amicable arrangement in accordance
Page 166 with our views, as being in the best interests of the hospital, the sick
patient and the medical man. We believe that the lessons learned these
last three months will be helpful to us all and that medical men as a
body will be much more willing to co-operate with the hospital and the
staff in their sincere attempt to improve conditions in the hospital. We
believe that the financial income from public-ward patients will be just
as large if proper financial management is carried out, and the income
from private cases and other lines of pay-work will be much larger, if
the hospital has the sympathy and co-operation of the medical profession.
Our belief is that the Vancouver General Hospital could be made one of
the most efficient and successful hospitals in the country if this plan is
carried out. But we think that this is a very critical time in its history
and if it has not the whole-hearted co-operation of the medical men this
hospital cannot be run successfully, either from a financial or medical
point of view. The co-operation of the men, we are convinced, cannot
be secured unless these regulations are modified as we request, and if
the Board still persists in enforcing these regulations the hospital will
suffer for years to come.
J. A. Gillespie,
Chairman.
ANNUAL MEETING
The thirty-second annual meeting of the Vancouver Medical Association has come and gone and left the Association larger and probably
more united than at any time in its history. The retiring President,
Dr. T. H. Lennie, is to be warmly congratulated on having successfully
steered the Association through the troubled and ofttimes stormy
weather of the past few months. In his closing remarks he referred to
the rupture of the pleasant relations which had endured for so many
years between the Vancouver General Hospital Board and the Association,
and lamented the withdrawal of the privilege so long enjoyed of nominating members for appointments on the Staff. He advocated the appointment of a direct representative of the Association on the Hospital
Board and hoped such an appointment might some day be arranged.
The efforts of the Association to bring about a reorganization of the
Staff led to a division in the Staff itself, and this was largely responsible,
in his opinion, for the present unhappy situation between the Board of
Directors of the Hospital and the Association. He asked the loyal support of the members for their new President, Dr. G. F. Strong, who was
unable to be present owing to illness. For many years Dr. Strong had
done valuable work for the Association, first on the Summer School
Committee, then for two years as Secretary and later as Vice-President.
Dr. C. Wesley Prowd, the newly elected Vice-President, took the
Chair in the President's absence. The keynote of his remarks was friendship and co-operation between the three bodies dealing with the medical
affairs of the Province. He eulogized the action taken by the Council
of the College of Physicians and Surgeons of B. C. during the recent
session of the Legislature and referred in the warmest terms to the
excellent work done by the B. C. Medical Association and Mr. Fletcher,
the Executive Secretary. During the coming year he hoped to see a
definite working agreement come to between the provincial and local
Associations whereby the Library of the Vancouver Medical Association
Page 167 could become available to all the medical men in the Province and he
stated that he knew Dr. Strong had the whole question of amalgamation
and a consequent reduction in fees very much at heart.
Elections for the various offices and Committees resulted in the
election of Dr. Strong as President, Dr. C. Wesley Prowd as Vice-President, Dr. E. M. Blair as Hon. Secretary and Dr. W. T. Lockhart as Hon.
Treasurer. The two members of the Executive from the Association
elected were Dr. A. C. Frost and Dr. W. L. Pedlow. The Trustees, Drs.
W. B. Burnett, W. F. Coy and J. M. Pearson were re-elected and Dr.
Pearson was again chosen Editor, a post he has held for many years.
Dr. J. H. McDermot was re-elected to the Publications Board of the Bulletin. The three new members of the Library Committee elected were
Drs. C. H. Bastin, C. E. Brown and C. H. Vrooman. Dr. H. H. Millburn
was chosen as the representative of the Association to the B. C. Medical
Executive. Drs. L. H. Webster, Lavell Leeson and E. E. Day will be
responsible for the Annual Dinner in November and Drs. W. S. Turn-
bull, A. J. McLachlan and P. W. Barker will act as a Committee to pass
on applicants for membership. The Association Orchestra, which forgot
to function last year, was re-elected and given another chance to make
good. Drs. Isabel Day, H. H. Caple and G. O. Matthews were elected
as the Advisory Board to the Victorian Order of Nurses for the ensuing
year, and Drs. W. C. Walsh and F. W. Lees were appointed to the Standing Committee on Hospitals.
ADDRESS OF THE RETIRING PRESIDENT
As a result of the ground work done by last year's Executive with
the Executive of the B. C. Medical Association and the Council of the
College of Physicians and Surgeons we were established in our new home
last August and held our first general meeting in the auditorium last
October. I am sure that all the members of this Association are favourable
to this move. Our Library accommodations are greatly enhanced both
as to book space and study facilities, our meeting place a tremendous
improvement upon former halls, and medical matters generally coordinated in a manner impossible in the past. This has been a distinct advantage to the profession generally, as it brought the three
medical executives closer together. This has been exemplified in discussions on the recent medical legislation, and should lead in the
future to a better understanding of each others' difficulties and responsibilities. It is my hope that the amicable relations which now exist will
continue and will ultimately lead to still closer co-operation. Committees
of our Association and of the B. C. Medical Association have this matter
in hand and their deliberations I am sure will lead to some plan which
will be acceptable to both Associations.
Unfortunately during the past few years the kindly feelings, and
co-operative spirit which formally existed between the Vancouver General Hospital and this Association have been strained, and antagonism
has apparently arisen, which was first demonstrated by the action of the
Board of Directors of the Hospital in withdrawing from this Association
the privilege of nominating its members for positions on the medical
staff of the Institution, a privilege which this Association had enjoyed
for years.   This action had its inception, I believe, directly as a result of a
Page 168 request from this Association for a staff organization. I also believe that
the request of the Association would have been granted had not the
staff itself divided on the question and at one of its meetings rescinded
one of its resolutions which it had passed at a former meeting endorsing
the request of the Association.
At subsequent meetings of a special committee of the Association,
which had this matter in hand and of which I was a member, with the
Board of Directors of the Vancouver General Hospital, it was apparent
that some of the Board members were not too kindly disposed to this
Association, at least, that was my impression. I mention this matter
because I believe it has a definite bearing on subsequent events and might
have been avoided had the Board been differently constituted.
The strained feelings which resulted from this action of the Board
were nothing compared to those engendered by the new Hospital regulations which came into operation on January 1st of this year.
At a meeting of this Association in December in introducing this
subject I said this: "The solidarity and unity of this Association is more
important than any other consideration." I don't mind admitting to
you now that this question has caused me a great deal of anxiety and
sometimes fears that the profession would be split wide open, but I
firmly believe that our general meeting on April 1st demonstrated that
our profession is now more firmly united than ever before. I have been
criticised for the stand I have taken in this matter but I have simply
tried in a humble way to represent what I believed to be the opinion of a
vast majority of our Association of which I had the honour to be president.
The situation at present is that all parties interested are awaiting
the report of the Hospital Survey Commission. The Vancouver Medical
Association is standing for the principle that every qualified medical man
shall be allowed the privilege of following his case into the hospital
whether that case be pay or charity. Whatever may be contained in the
report cannot alter our attitude in regard to that principle. Our policy
at present is to see what disposal is made of the request submitted by the
medical staff to the Board of Directors of the Hospital supporting that
principle, and the action of the Medical Association will depend altogether
on the answer to that request.
Your Association has been notably served by the special committee
which has this matter in hand. The members have given untiringly of
their time and thought to this matter, innumerable meetings have been
held and I believe that I have been present at all these meetings. I want at
this time to express my heart-felt thanks for their services and particularly to the chairman, Dr. Gillespie, who has been the acme of tact and
diplomacy.
I said something a short time ago about the. constitution of the
Board of Directors of the Vancouver General Hospital. It is my opinion
that this latter question, as well as, that of the staff reorganization would
have received favourable consideration had the Vancouver Medical Association a direct representative on the Board, one who would represent
only the considered opinion of this association.
Before closing I want to express to the officers, executive, committee
members, and members of the association at large, my appreciation of
their support through what has been in some respects a trying year, and
Page 169 to thank you again for bestowing upon me what I consider a great honour
and bearing with me in my feeble efforts to uphold that position.
I should like here to bespeak for the new officers you have
elected tonight, a similar hearty support. In your selection of president
you have chosen a man who has done notable service for the Vancouver
Medical Association, as honorary secretary for two years, and vice president for one year, one who has shown rare executive ability and under
whose aegis I believe this association will continue to prosper.
COMMON PROCEDURES IN INFANT FEEDING,
THEIR USE AND MISUSE
By Dr. G. O. Matthews
Infant feeding as a medical specialty is a comparatively recent
study. Until the end of the last century it mainly concerned mothers
and wet nurses. Unfortunately, with the twentieth century, there
began to appear more and more mothers who were unable to nurse their
offsprings. This necessitated the compounding of artificial foods on
which a baby could be raised. As it became apparent that an infant
could, if necessary, be raised without breast milk, more and more babies
were found that had to be bottle fed, until, at the present time, roughly
75% of all babies born in this country are artificially fed, wholly or in
part. As the necessity of the feeding bottle increased, so, too did
medical thought become stimulated in the art of making suitable formulae to fill these bottles. Like many other advances in Medicine it has
been overdone. Much has been learned,—feeding a normal infant is,
today, a comparatively simple problem, but we are deluged with so many
feeding formulae, proprietary foods and theories, all so highly advertised
and each with its own particular usefulness, that it is often difficult to
choose the most suitable.
This paper therefore, will bring you nothing new, neither is it in
any way a history or a complete exposition of infant feeding, but
merely an attempt to simplify the many modern methods of infant
feeding into a rough broad classification, and then to point out, as I see
it, the advantages and disadvantages of each method.
In feeding a baby there are a few general rules that might well be
mentioned at the start. . It has been truly said that being regular in the
feeding of her offspring is a mother's first chance of telling her baby the
truth. It is more than that, it means that the mother controls the baby
rather than being controlled by it, and, more important still, the baby
itself will be more contented. The interval between feedings is usually
debatable and depends largely on the baby—remember that infants, like
adults, are all different and that in treating them there can be no dogmatic set of rules. I think that a 4-hour interval from birth, with a
fair sized baby, and an adequate supply of food, is usually preferable. But
whatever the interval, the regularity is the main essential.
Breast Feeding
There is but one ideal baby's food, and between it and its nearest
imitator there is so much difference, that there is hardly room for comparison.  VI speak of breast milk—it is nature's food, and the harder we
Read before the Vancouver Medical Association, April,  1930'
Page 170 1
try the more readily we admit that we cannot equal it, that at the best
its nearest competitor is but a fair imitation. The young mothers of today
are largely desirous and able to nurse their children, and it is for us, as
doctors, to encourage them to do so. Much perseverance is often needed
to well establish feeding, and it is sometimes the easiest way to put the
baby on the bottle, when a little extra time and trouble, at the start,
would perhaps have saved so much worry later on. Do not start a baby on
a bottle until it is absolutely necessary. If the weight loss, after birth,
seems excessive, and the breast milk is not yet abundant, the baby is
commonly given a formula, often before it is essential. The baby is
stuffed with food, and as a result will not suckle forcefully enough to
increase its natural food supply—it soon learns how much easier the
bottle is, and often gives up trying to nurse, entirely. Breast milk will
agree with the baby in practically 100% of cases. It may be insufficient
in amount, but only rarely does the milk itself cause digestive upsets,
and when it does, by calming the mother, correcting her diet, and relieving her worries—perhaps even putting her to bed for a few days—
the baby's indigestion will often disappear. One hears far too frequently
the misinformed mother's story, told her by a doctor, that her milk
was poison to the baby.
Proper pre-natal instruction, care of the breasts, etc., will go far in
preparing the expectant mother not only to be able, but to want, to be
a successful nursing mother. Oliver Wendell Holmes, when speaking
on the subject of breast feeding, stated "That a pair of substantial
mammary glands have the advantage over the two hemispheres of the
most learned professor's brain in the art of compounding a nutritive
fluid for infants;" and what was true of his time is just as true today.
Artificial Feeding
There are two broad types of artificial infant foods. First: Those
with a cow's milk base. Second: Those built up from some other basic ingredient. These latter foods are few and hardly call for mention, but
occasionally they are useful in treating allergies to cow's milk. That is
practically their only value except in the case of goat's milk, which is
sometimes more readily procurable than cow's milk. In using goat's
milk remember that although goats are free from tuberculosis, their milk
is still a splendid carrier for other infections, notably typhoid, and that
it is seldom or never pasteurized.
Practically, therefore, all baby foods have cow's milk as their basis.
The reason for this is obvious.    They may be grouped into two main
divisions—sweet milk mixtures and acid or sour milk mixtures.
The sweet milk mixtures may again be grouped into:
First—Simple dilutions of cow's milk with added carbohydrates.
Second—Condensed milk.
Third—Evaporated milk.
Fourth—Dried or powdered milks which may be pure milk, or milk
with the addition of other ingredients.
The sour milk mixture may be:
First—Cow's milk acidulated by a culture of lactic acid bacilli.
Second—Cow's milk acidulated by the addition of some inorganic
acid.
Third—Dried  milks  with  or  without  the  addition  of  other  ingredients.
Page 171 musa
Fourth—Protein milk, which may be either a  fresh culture or a
powder.
Nearly every drug house and big dairy advertises products from
each one of the above groups. Certain products of the same type are
undoubtedly better than others, just as a drug made by one firm is
more potent than the same drug manufactured by a competitor. However, it is not my intention to advertise any one firm's products, but
merely to discuss the pros and cons of each food group.
Cow's Milk Dilutions
Given a thorough elementary knowledge of infant food requirements, one is able to feed 75% of all normal healthy infants on a
formula composed of milk, water and white sugar. Mixed in suitable
proportions, such a formula contains all our essentials—it is simple,
adequate, and cheap, and on it most babies will thrive. At our local
feeding clinics such mixtures are fed to the great majority of the patients
attending, with fairly uniformly good results. With such patients their
cheapness and easy availability are of prime importance. Of course, the
proportions of each food element must be reasonably correct, and the
milk must be of good quality, certified if possible, otherwise pasteurized
or boiled—and it has been demonstrated that milk, boiled for three
minutes, undergoes less chemical and biological change than milk which
has been pasteurized for a longer period.
Evaporated Milk
Evaporated milk is cow's milk from which part of the water has
been removed by evaporation. Nothing is added and the concentrated
milk is canned and then sterilized. A high-grade of fresh cows milk is
used in its preparation, it is comparatively inexpensive, obtainable at
any grocery store and conveniently packed in small tins, one tin being
sufficient for each day's feeding. This product, known to us all as
St. Charles, Carnation, or Pacific, can be used successfully in feeding
infants. It fulfills all the requirements found in fresh cow's milk,
except in regard to vitamines, which should be otherwise supplied. Of
all the processed milks, evaporated milk is probably one of the best
adapted for use, as a food, for a baby who has demonstrated an inability
to tolerate either raw or boiled cow's milk. Its ready digestibility is
probably due to its prolonged cooking, which changes both the fat and
protein molecules. It is specially indicated for premature and feeble
infants, or when small amounts of a concentrated feeding are necessary.
To prepare a suitable formula dilute the evaporated milk to its original
volume, which is done by adding an equal part of water, and then modify
as one does with fresh cow's milk.
Dried Milks
The successful use of a dried milk, depends upon a knowledge of
its composition and qualities. Dried milk is marketed in three forms—
The first in whole cow's milk, dried and powdered. Klim is the best
known example of this class. The second is made from fat-reduced milks.
Of this class Dryco is the most widely used. The third product consists of whole or skimmed milk, to which some carbohydrate or other substance is added before drying. S. M. A. is a well known example of this
class.
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Medical-Dental Building Vancouver When clean fresh cow's milk is available, and an infant can digest it,
there are few indications for the use of dried milk. When an infant
demonstrates an inability to tolerate fresh cow's milk, or when good
fresh milk is not available, then dried milk may be found to be a most
satisfactory food. At present, however, the enthusiasm for dried milk,
which has been largely induced by intensive advertising, has reached
such a point that many normal infants have never been offered milk in
any other form. It must be remembered that all evaporated and dried
milks are only cow's milk, subjected to certain processes. Their value as
a food depends upon the nutritive qualities of the original cow's milk.
Any advantage or disadvantage over fresh cow's milk depends upon
any changes introduced by the processing, and also by the manner in
which the dried milk is used. There is a tendency for the physician
to give more calories, when a dried milk is the food, than he would
venture to give when prescribing fresh milk. Because of this, its success
is often due to a more generous food intake than was formerly used.
Dried milks are often well tolerated by infants who show an allergy to
fresh cow's milk, and as a complemental feeding to nursing babies, they
are often highly useful. They are simple to prepare, and are sterile,
but except for Klim are not an economical food. On the whole, dried
milks are useful substitutes for fresh milk, when any processed milk is
definitely indicated. Any evidenced superiority to fresh milk is due to
low bacterial count, to increased digestibility, or to convenience in form
or availability. Their inferiority to fresh milk is due to reduction of
the biological factors. Dryco is a partially skimmed milk and should be
used only where a reduced fat is indicated. S. M. A. is a product modified in manufacture to resemble breast milk in its food percentage, even
to the addition of some vitamin and wherever a dried whole milk is indicated it is perhaps one of the best.
Sweetened Condensed Milk
Condensed milks are made from whole cow's milk with the addition,
before condensation, of 15-20% of cane sugar. After evaporation,
therefore, the sugar content becomes 80% or higher. Condensed milk is
easily digested by infants, being probably second only to woman's milk.
It is used extensively in infant feeding, because of its keeping qualities,
its convenience and the fact that it rarely disturbs digestion, and that
babies show on it a rapid weight increase. Eagle Brand is its most
popular trade name. It has been learned by experience, and has also been
demonstrated in animal experiments, that the rapid weight gain achieved
is not always a normal growth, but is due to excessive water retention,
and it not desirable. It is not a well balanced food, and infants fed on it
for long periods lose their resistance to infection, and tend to become
water logged. All biological factors are destroyed in preparation, and in
their extensive propaganda its manufacturers do great harm by vastly
overstating its usefulness. If there is an intelligent comprehension of the
composition of sweetened condensed milk, the product may be found
useful in cases where a concentrated, easily digested, formula is required.
Such needs are found in premature and marantic infants, but in no case
should it ever be more than a short stepping stone to a more adequate
feeding.
Page 173 Mfiafi
Acid Milks
During the past few years, cow's milk, whole or skimmed, which
has been rendered acid, has won a well deserved place in the feeding of
infants. Originally acid milk mixtures were brought forward more or
less as a panacea for all difficult feeding cases. Time has shown that they
are not cure-alls, but they have-proved most valuable in certain feeding
problems.
There are Two Main Types of Acid Milks
the fresh
Second:
milk is
Where
First: The cultured lactic acid mixture, where
rendered acid by the growth of acidifying bacteria,
the fresh milk is rendered acid, by the addition of inorganic acid. The
former was the original method of preparation, but later it was found
that the simple addition of inorganic acids to the milk achieved much
the same result. Both types have advantages, but as the latter is much
simpler, and as it is now fairly uniformly conceded to be the acid and
not the bacterial growth that is the successful factor, the simple addition
of an acid to cows milk is the more common practice. Lactic Acid: A
dilute solution of H CI. or citric acid in the form of lemon juice, are
all used for this purpose, and in each case the end result is the same,
namely, a milk acid rather than alkaline in reaction, where the curd is
partially broken down, facilitating digestion. The protein in cow's milk
is much larger in amount than in woman's milk, besides being largely
casein, and this necessitates an excess amount of H Cl in the baby's
stomach, before complete digestion of cow's milk can take place. The
addition of acid to cow's milk, or the development of acidity through
bacterial growth, helps to overcome this difficulty. Infants, therefore,
who require a large caloric intake, or who have difficulty in digesting
sweet milk mixtures, will often do well on L.A.M. The particular
infant's trouble will determine whether such acid milk should be fat-
free, partially skimmed, or whole milk acidified. The majority of
babies, however, do not require acid mixtures, and to give an abnormally
high caloric feeding to any baby, to induce it to show an excessive gain
in weight, although not perhaps a harmful practice is certainly an unnecessary one. The use of acid milks, therefore, should be considered as
a therapeutic measure and when digestive conditions permit, should be
gradually replaced by a fresh milk mixture. Although perfectly normal
babies will thrive splendidly on acid formulae, to me they do not seem
to progress more favorably than those fed on equivalent fresh milk mixtures. Grulee states that acid milks are necessary in only 1 in 300
infant feedig cases. Infants with gastro enterospasm do not tolerate
L.A.M. as well as sweet-milk. Their need for the more highly buffered
milk is probably due to a hyperacidity associated with the obvious
hypermotility.
Protein Milk
Protein milk is  a  modification of  cultured  L.A.M.  whereby  the
sugar content is lowered, and the casein and fat are raised, and changed
somewhat in composition. Such a mixture is only indicated in
diarrhoeal conditions, but here is a most important addition to the
dietotherapy of infancy. The best results in protein milk therapy for
diarrhoea will be achieved by giving, at first small feedings, and gradually
Page 174 increasing them as digestive conditions permit. Protein milk is not a
well balanced food, and should not be continued after digestion has become normal.
Powdered Acid Melks
All the different acid milks, including protein milk, are now available in powdered form, with or without the addition of extra carbohydrate. Broadly speaking, they are indicated whenever acid milks are
necessary, and are not easily availabte. When diluted properly they will
achieve practically the same results as freshly prepared acid mixtures,
but they have the same drawbacks, and lack in the same essentials, as do
all powdered fresh milk mixtures.
The Choice of Carbohydrate Additions
To make any cow's milk mixture similar in composition to woman's
milk, the addition of extra carbohydrate is always necessary. There are
many varied opinions regarding the proper selection of this carbohydrate, and the multitude of patented and highly advertised products
makes our choice most difficult. Carbohydrates are divided into two
main classes—sugars and starches. Although we depend largely upon
the sugars for the carbohydrate intake of the artificially fed infant,
there is a small group of babies where part of the carbohydrate in the
form of starch is most beneficial. Clinically, it has often been noticed
that the substitution of a flour for a part of the sugar in a formula will
start a lagging weight curve upwards. Such infants are less inclined to
vomit, have smoother stools and are less apt to become constipated.
Starch in excess, however, tends to give quickened peristalsis, loose stools
and real intestinal disturbances. Never use, therefore, more than a third
to a half the total carbohydrate in the form of starch, and of course it
must be well and thoroughly cooked.    It makes little difference which
O        J
starch is used—wheat, rice or barley flour are all equally good. The
extensive used of the more expensive barley flour is largely the result
of advertising. Such so-called proprietary infants' foods as Mellin's,
Allenbury's and Nestle's, are largely made up of carbohydrate in the
forms of sugar, starch, and the intermediate product dextrin and may be
useful as a carbohydrate addition of this class, rather than as a complete
infant food.
The commonly used sugars are lactose, saccharose, glucose and
maltose, this last usually in combination with dextrin. Lactose or sugar
of milk is often not as well tolerated as would seem logical, and if used
in too great concentration may give a tendency to increased intestinal
fermentation and a consequent looseness of stools. It is also expensive,
retailing at about 70c a lb. Saccharose or ordinary cane sugar is the
most readily available, and is usually quite well tolerated. When given
in excess it too may cause undue fermentation, but not more so than
lactose. Glucose is the most easily digested of all sugars, but unfortunately is not readily obtainable commercially.
The different dextri-maltose mixtures are extremely popular in
infant feeding, having become so, largely through the thorough and
persistent advertising propaganda of their manufacturers. They are
undoubtedly readily digested, and form an excellent carbohydrate
addition.    Also they may be given safely in somewhat higher concentra-
Page 175 ■Km
tion than cane sugar, and do not make the formula excessively sweet.
However, it is still doubtful if much specific advantage attends the use
of any of the commercial dextri-maltose preparations in the feeding of
the great majority of normal infants. A cheap and readily available mixture which is nowadays extensively used, particularly with the acid
milk formulae, is Karo Corn Syrup. It contains about 3 5' < dextrin,
10% cane sugar and 30%; glucose. As would be expected it is easily
digested and is certainly a valuable carbohydrate for infant feeding.
With our present knowledge,   the  choice of  a  suitable  sugar   for
feeding  normal   babies  remains   more  or   less   open,   with  perhaps,   the
preference being given, first to cane sugar, and second to Karo, because
of their economy and convenience.
Feeding the Sick Baby
Over-feeding is the common mistake made with a sick infant.
Usually the baby will refuse most or all of its food, but occasionally
one finds an infant who, although quite ill, still takes its food eagerly.
It is not at all uncommon at autopsy to find stomachs full of food,
showing that the baby had taken its regular feeding even while dying.
Never try to make a sick infant gain in weight. Cut down its food,
both in strength and amount, until it is being offered only sufficient to
supply its basal needs, and then, as it becomes well again, increase its
food gradually, and it will soon regain its lost weight. With a sick
baby, only the most easily digested mixtures should be used, and it is
here that the processed milks, and the acid milks, have their greatest
usefulness.
Summary
Just as an accumulation of pennies makes a pound, so in infant
feeding does attention to the smallest details make success. In no other
medical specialty is it so important that the most apparently trivial
signs and symptoms receive careful attention. A well baby that is
receiving a sufficiency of suitable food will always be a good baby,
and the oft repeated saying that 'considerable crying is necessary to
the baby's welfare' is most misleading.
As with therapeutics in general, there is a big personal factor in the
choice of food formulae. If one man obtains successful results with a
certain food, it is natural for him to use that particular preparation
frequently. However, in feeding infants the medical practitioner must
have many strings to his bow, must know what string to use and when
to use it, and will be well advised to avoid the cultivation of any particular feeding into a fad. He should know the composition and particular usefulness of each common infant food as I have tried to indicate
them, and should prescribe them only after a diagnosis has shown them to
be particularly indicated. And lastly in choosing a formula, let him
always remember that it should be simple to prepare, that it should be
adequate in all food elements, and that, in the main, it should be moderate
as to cost. As no two babies are alike it is quite impossible to feed
infants by any rule of thumb, and these three necessary requisites are the
only hard and fast, dogmatic rules that can ever be applied to the feeding problems of infancy.
Page 176 British Columbia Laboratory Bulletin
Published irregularly in co-operation with the Vancouver Medical Association Bulletin,
in the interests of the Hospital, Clinical and Public Health Laboratories of B. C.
Edited by
A. M. Menzies, M.D., of The Vancouver General Hospital Laboratories
Financed by
The British Columbia Provincial Board of Health
COLLABORATORS: The Laboratories of the Jubilee Hospital and St. Joseph's Hospital,
Victoria; St. Paul's Hospital, Vancouver; Royal Columbian Hospital, New Westminster;
Royal Inland Hospital, Kamloops;  Tranquille Sanatorium;  Kelowna  General  Hospital;
and Vancouver General Hospital.
All communications should be addressed to the Editor as above.   Material for publication
should reach the Editor not later than the seventh day of the month of publication.
Vol. IV. MAY, 1930 No. 4
NOTES ON COLLECTION OF SPECIMENS AND DELIVERY
OF THESE TO THE LABORATORY
By A. M. Menzies, M.D.
Vancouver General Hospital Laboratories
Uniformly accurate examination results on specimens sent in to any
laboratory are to be obtained only when such specimens are collected
and delivered for examination, in the accepted manner which has been
adopted by the laboratory concerned. Speed is also an essential requisite.
Not only to the doctor and patient concerned in each case, but also to
the laboratory, time means money. And with the supply of this commodity very definitely limited, it becomes necessary, particularly for a
laboratory such as the Vancouver General Hospital Laboratory, making
about 10,000 examinations per month, to cut the cost per specimen in
time (which means money) to the lowest possible limit. This can only
be accomplished by having examinations done in groups of large numbers
and under uniform routine methods.
Partly, then, with a view toward securing a low cost in time per
specimen and in an effort to be of most assistance to the physician, I
have taken the Requisition Blank of the Vancouver General Hospital
Laboratories, and, including each item on this requisition, have made a
list of the methods of collection of specimens and of delivery to laboratory which best meet the requirements of the laboratory. It is to be
hoped that this list will be used as a sort of handy reference and guide
by the physician, and it may be of some value to other laboratories when
used as a basis of comparison. To make the list of still further use as a
guide, the normal range of findings has been added wherever applicable.
Blood
Note. In tests requiring extraction of blood from a vein, if the
patient is under three years of age, the blood must be taken by the
attending physician or interne, as laboratory technicians, owing to probable difficulties, are not allowed to collect the blood from such cases.
Page 177 Agglutination (Widal etc.) From 2 to 5 drops of blood taken from
ear or finger into a capillary tube; outfit supplied with mailing case
and directions, by the Provincial Board of Health. (Used for
Typhoid, Paratyphoid A and B, Shiga and Flexner, Undulant fever,
etc.)
Culture. 10 cc. of blood taken from vein (usually with hypodermic
syringe of sufficient capacity), and transferred immediately to
Erlenmeyer flask, containing a broth culture medium. (Used in
the diagnosis of blood infections). If specimen has to be mailed,
the Wassermann-Kahn outfit or a similar sterile container may be
used, though not as satisfactory as a specimen cultured as above
while fresh.
Kahn. 5 cc. blood taken from a vein (usually with a syringe), and
placed in a clean test tube which must be dry or the blood will
haemolyze. If specimen is to be mailed, the tube should be full,
to avoid haemolysis due to churning. A sterile corked test tube in
a screw-cap cardboard mailer, with data blank, is the regular Kahn-
Wassermann outfit supplied by the Provincial Board of Health for
the mailing of specimens.
Wassermann.   About 5 cc. blood—same as for Kahn.
Red Cells and Hb. A drop or two of blood taken from ear or finger
into special pipettes and diluted at once with diluting fluids. This
requires special technical skill. Such specimens cannot be mailed
satisfactorily.
White and Differential—Same as for Red and Hb.
Platelet Count—Same as for Red and Hb.
Coagulation—A drop of blood on special apparatus. Usually done by
laboratory technician.    Must be examined at once.
Grouping—2 to 5 drops of blood from ear or finger, collected in a
capillary tube; also one drop of blood into a test tube containing
1 cc. normal saline solution. It would not be practical to send
blood for grouping by mail.
Bleeding Time. Timing bleeding from a small puncture wound in
ear or finger till clotting occurs.    Normal = 2 to 3 minutes.
N.P.N. 6 cc. of blood collected into test tube containing one drop of
20% potassium oxalate solution. Normal range = 25 to 35 mg.
per 100 cc. of blood. Specimen may be mailed in outfit similar to
that used for the Kahn-Wassermann specimens, substituting as anticoagulant a mixture of one part thymol to ten parts sodium fluoride;
0.11 gms. of this mixture being placed in the tube for each 10 cc. of
blood to be taken.
Urea Nitrogen. 6 to 10 cc. of blood taken from vein into test tube
containing one drop of 20% potassium oxalate solution. Normal
range = 12 to 15 mg. per 100 cc. blood. Specimen may be mailed
similarly to N.P.N, specimen.
Page 178 Ill'
Uric Acid. 6 cc. of blood collected as for urea nitrogen. Normal
range = 2 to 3.5 mg. per 100 cc. blood. Specimen may be mailed
similarly to N.P.N, specimen.
Creatinine. 6 cc. of blood collected as for urea nitrogen. Normal
range = 1 to 2 mg. per 100 cc. blood. Specimen may be mailed
similarly to N.P.N, specimen.
Chlorides. 6 cc. of blood collected as for urea nitrogen. Normal
range = 580 to 630 mg. per 100 cc. blood. Specimen may be
mailed similarly to specimen for N.P.N.
Calcium. 10 cc. of blood collected in dry test tube without anticoagulant. Normal range = 10 to 11 mg. per 100 cc. blood. For
mailing, serum only should be sent. This may be obtained by allowing the blood to clot, then pipetting or pouring off the serum.
Phosphorus. 10 cc. of blood collected as for calcium. Normal range
= 3 to 4 mg. per 100 cc. blood. Specimen may be mailed same
as for calcium.
Sugar (fasting). 3 cc. of blood collected as for N.P.N.. Normal range
= 70 to 110 mg. per 100 cc. blood. Specimen may be mailed, as
for N.P.N.
Sugar (curve). 5 specimens of blood (3 cc. each), the firsts pecimen
after a 12 hour fast; others at hourly intervals after ingesting 100
gms. glucose immediately after the fasting specimen is taken.
Normal findings at end of first hour = 150 to 175 mgs. per 100
cc. blood returning to normal (70 to 110 mg.) at end of second
hour.
Urine specimens are collected at same time as blood specimens. The
blood specimens may be mailed if anti-coagulant is added, as in
specimens for N.P.N.
Van Den Bergh. 10 cc. of blood, collected from vein into a clean,
dry, test tube.
For mailing long distances, about 4 cc. of blood serum should be
sent. This may be obtained by allowing the blood to clot, then
pipetting or pouring off the serum.
SPINAL FLUID
Sterile corked centrifuge tubes in a sand-jar receptacle are used on
the wards in the collection of spinal fluid.    Since the centrifuge tubes are
graduated,  the amount of fluid withdrawn is easily measured.     Spinal
fluid may be mailed in these tubes if well protected against breakage.
Wassermann.    Collect 3.5 cc. spinal fluid.
Kahn.    Collect 2 cc. spinal fluid.
Colloidal Gold.    Collect 1 cc. spinal fluid.
Culture.    Collect 1 cc. spinal fluid.
For T.B.    Collect 5 cc. spinal fluid.
Routine. Collect 1.5 cc. spinal fluid. This includes gross appearance,
colour, cell count, type of cell, pre-dominating, presence of globulin
and reduction of Fehlings.
Page 179 General appearance = clear.
Colour = colourless.    Cell count
Reduction of Fehlines == slight.
NORMAL FINDINGS
3 to 10.    Globulin
absent.
Protein (quantitative). Collect 2.5 cc. spinal fluid; normal = 18 to 40
mgs. per 100 cc.
Chlorides (quantitative). Collect 2 cc. spinal fluid; normal = 725 to
740 mgs. per 100 cc.
Glucose (quantitative). Collect 2 cc. spinal fluid, normal range = 40
to 60 mgs. per 100 cc. fluid, or roughly about half the blood sugar.
URINE
Routine General (Vancouver General Hospital patients only). 100 to
150 cc. sent to laboratory as "early morning" specimens so that they
can be done in bulk. This examination includes colour, reaction,
specific gravity, presence or absence of sugar and albumen, and
microscopic findings.
Routine Special. Similar amount as for "Routine General." These
are specimens which, for various reasons, do not arrive with the
morning routines and which must be done separately. Mailed specimens are included here.
Urine specimens may be mailed, using an ordinary, clean, two ounce
bottle, well packed in a suitable mailer. A thymol crystal, the size
of a grain of wheat, should be added as preservative.
Routine Diabetic 24 hour specimen, collected and sent to laboratory
in Winchesters. This examination includes specific gravity, sugar,
reaction, total volume, and presence or absence of acetone. If
specimen is mailed, it should be a 2 to 4 ounce representative sample
of the 24 hour collection of urine, and should have, as preservative,
a thymol crystal added as' for "Routine Specials."
Sugar Quantitative. 24 hour specimen sent to laboratory in Winchesters. Mailed specimens may be sent similarly to specimens for
"Routine Diabetic," as given above.
Albumen Quantitative. 24 hour specimen, same as above. Mailed
specimen should be about 2 ounces in quantity and should be taken
from the 24 hour specimen.
P.S.P. Two specimens collected at 1 hour and 10 minutes, and 2 hours
and 10 minutes, after subcutaneous injection of 1 gm. Phenolsulphonephthalein.
*
Bile.    The routine specimen my be used.
Ureter Catheter. Collected by the surgeon into sterile test tubes.
(For hospital cases only).
Urine for T.B. Catheter specimen collected in sterile test tubes. Such
specimen could be mailed if adequately protected against breakage.
Page ISO Culture (urine). Must be a catheter specimen. Specimens could be
mailed if in sterile tube and adequately protected in suitable mailing
cases.
MISCELLANEOUS
Culture. Various material—swabs of wounds, pieces of bone, etc.
sent to laboratory in proper sterile containers for examination. These
may be mailed if properly protected in suitable mailing cases.
Diphtheria (cultures). Sterile swab used to swab throat and nose,
and sent to laboratory in proper sterile containers. In Vancouver
City two separate swabs are required, one for nose and one for
throat, in separate tubes. In outside districts the Provincial Health
regulations require swabs from both nose and throat, but both may
be mailed to the laboratory in a single sterile test tube, and regulation screw top mailing case. Such swabs, it has been found, will
still give a suitable culture up to one week after being used. It has
also been found that 18 hours incubation in the laboratory are
needed.
Diphtheria (virulence). Done by special request, from positive diphtheria cultures.
Smear, G.C. Thin smear of suspected material on glass slide. If two
slides are sent, care must be taken in wrapping, to see that they do
not stick together—pieces of match or tooth pick, placed between
the ends will do. If sent by mail, the slides should be well protected
against breakage.
Smear, Vincents. Smear on glass slide, using sterile swab to collect
material from affected area. Slide may be mailed if adequately protected against breakage.
Smear, Spirochaetes. Thin smear on glass slide. Best results are obtained
with almost clear serum or lymph from suspected sore. If being
mailed, the slide should be well protected against breakage.
Sputum for T.B. Sputum collected in regular laboratory vials, containing a small amount of 5% phenol solution, to sterilize sputum.
Note. If this vial is used to collect sputum to be cultured for
other organisms, the phenol solution must be poured out and the
vial and cork rinsed with sterile water, or vial and cork sterilized
by boiling. Sputum specimens may be easily mailed in the regulation vials and screw top mailing tubes provided by the Provincial
Board of Health and which may be obtained from any Public
Health laboratory on request.
Vaccine (Bacterial) Sterile swab of infective material is taken and sent
to laboratory in proper sterile container. These may be safely mailed
in a suitable screw top, mailing tube, and labelled to indicate the
examination required.
Vaccine (Milk).   Made in laboratory from sterile milk.
Tuberculin Solution.   Made up in laboratory.
Ringworm. A few hairs pulled out by roots from affected region, and
folded carefully in paper to avoid being lost. Such specimens may
be safely mailed.
Page 1 SI «u
Animal Inoculation.   Done at laboratory when required.
Stomach Contents. Collected in sterile, corked, culture tubes, which
may be obtained from the laboratory if necessary. Four consecutive
specimens, at least, should be obtained at intervals of 2 0 to 30 minutes following the test meal. Mailing of such specimens is not practical.
Skin Protein Tests. These are done in the laboratory or in hospital
wards when required, a fairly complete list of foreign proteins being
available for test .
Faeces Parasites. If collected on hospital wards, the regulation faeces
jar should be used. If specimen is to be mailed, a small jar with
tightly closed lid should be used.
If examination for amoebae is required, the specimen must be kept
warm and delivered immediately to the laboratory. It may be kept
warm by placing jar of faeces in a dish of hot water. Examination
for amoebae in a specimen received through the mail is of no value.
Faeces, Occult Blood. This is done when required on routine specimens as sent to the laboratory.
Basal Metabolism. This test is done with a special machine and in a
quiet, suitable room." Appointments must be made through the
laboratory, so that instructions can be given the patient, who must
have fasted for, at least, 14 hours previous to the test, water only,
being allowed.
Water (for Bacteria). Special sterile bottles, with suitable mailing
cases, are provided by the Provincial Board of Health, and can be
obtained from Public Health laboratories on request—a printed
sheet of instructions for collecting the sample accompanying the
outfit. Specimens sent in other than regulation containers are
unsuitable.
Water (for Chemical). A gallon sample should be sent to the laboratory in a thoroughly chemically cleaned glass stoppered bottle. If
being sent from a distance it should be suitably crated and shipped
by express.
Milk (for Bacteria). At the present time the Vancouver General Hospital Laboratory does these tests routinely for the City of Vancouver only.
Specimens should be submitted in the original containers in which
they are offered for human consumption, and should be kept packed
in ice until delivery at the laboratory.
Note. If regulation labelled mailing cases are used for other specimens than those for which they were intended and labelled,
great care should be taken to see that they are prominently labelled
so as to show at a glance, the examination required. Every specimen in every case, should be clearly labelled, giving the name of
attending physician, name of patient, address of patient, date specimen was collected, material to be examined, and type of examination
required.
Page 1 82 B. C. MEDICAL ASSOCIATION NEWS
The Victoria Medical Society held its Annual Sessional Dinner at
the Empress Hotel, when it had as its guests the Honourable the Premier
Dr. S. F. Tolmie and the following medical members of the Legislature,
Doctors George K. McNaughton, J. J. Gillis, and L. E. Borden. Dr.
George Seldon was also present.
Following the Dinner which was presided over by Dr. Gordon C.
Kenning the President of the Victoria Medical Society, Dr. Tolmie
addressed the members in his usual happy way. Dr. Borden reviewed
the work done by the Commission on Health Insurance. Doctors
Gillis and McNaughton also spoke briefly. Dr. Hermann Robertson contributed several songs and instrumental numbers to the enjoyment of a
real good dinner.
Dr. Harvey Smith of Winnipeg, President-elect of The Canadian
Medical Association who will also be president of The British Medical
Association at the Winnipeg Meeting in August, happened into Victoria
at this time and joined the party after dinner and spoke briefly of the
plans and arrangements for the Winnipeg Meeting, bringing greetings
to Victoria and a warm invitation to come to Winnipeg in August. The
visit of Dr. W. Harvey Smith of Winnipeg was a great stimulus to the
Victoria profession and all are looking forward to the British Medical
Association meeting and the visit of the British guests to Victoria on
September 3rd, 4th and 5th. Already plans are under way to entertain
the visitors.
A joint luncheon meeting of the B. C. and Vancouver Medical
Associations was held at the Hotel Georgia on March 19th, when Major
Steere Clark, (Safety Director of the B. C. Loggers' Association) gave
an interesting talk on "Treatment of Industrial Accidents (from the
employers' point of view." Major Clark outlined the logging operators'
viewpoint and the alarm felt at the increased cost of medical services,
due to various causes, The rate had gone up from three and a half per
cent, five years ago to five and a half and six per cent, at present. A
further meeting was later held between the local members of the B. C.
Medical Association Executive and Major Clark, to find a solution of
some of the difficulties enumerated by the latter. After considerable
discussion, it was decided to circularize the profession in regard to the
matter. Dealing with the question of the rejection by the Workmen's
Compensation Board of doctors' accounts, Major Clark pointed out that
many of the doctors' grievances on this score could be eliminated if the
doctor would only satisfy himself, at the beginning of a case, by asking
for confirmation of an accident, where, when, and under what circumstances, from the employer. This could easily be done by either telephone or letter when the patient first reports.
The Executive of the Association feels that thanks are due to
Major Clark for his frankness, and the fact that he has come and
discussed these things in a friendly and cooperative spirit; the matter is
of great importance both to industry and to the medical profession, and
it is vital that the two should solve these problems together, rather than
apart from each other.
Page 1 S3 Inguinal
and Femoral Adenitis
To relieve the swelling and pain, stimulate the circulation,
hasten resolution and deplete the enlarged glands in these
conditions.
applied in hot, thick layers, over and beyond
the affected areas will be found distinctly
beneficial.
More and more doctors are giving preference to Antiphlogistine over the old-fashioned poultices, for in addition to
its plasticity and osmotic action, it has the great merit of
cleanliness   and   asepticity.
m
THE DENVER CHEMICAL MFG. CO.
153 W. Lagauchetiere Street
Montreal The B. C. Medical Association took a very active interest in the
various bills, medical and otherwise, which were introduced or were
attempted to be introduced this session—The Title of Doctor Amendment was given good support and it was most gratifying to find that
the legislature could devote one whole evening to its best and most
eloquent effort in eulogy of the profession of Medicine—sometimes it is
helpful to know just where one stands.
Many forms of bills were planned for the licensing of drugless
healers, chiropractors, sanipractors, naturopaths and others, but all
proved unavailing for this session—but they wil be back, we may be
assured of that, which makes it imperative that the profession define a
policy based on a minimum standard of eduction for all who practise
the healing art and that something definite be done before the eleventh
hour in defining some safe procedure for our legislators.
Dr. R. B. Brummitt recently relinquished his practice at Terrace
and is now practising at Smithers, B. C.
Dr. C. H. Hankinson, late of Smithers, is now practising at Prince
Rupert.
Dr. D. W. McKay of Nelson, who it will be remembered had a
serious automobile accident last December, is still an invalid in Vancouver. We are pleased to hear, however, that he is making good, if slow,
progress.
The B. C. Medical Association desires to ally itself with his many
friends in wishing Dr. F. C. Bell, Superintendent of the Vancouver
General Hospital, a speedy recovery from his present serious illness.
536 13th Avenue West Fairmont 80
Exclusive Ambulance Service
FAIRMONT 80
ALL ATTENDANTS QUALIFIED IN FIRST AID
"St. John's Ambulance Association"
WE SPECIALIZE IN AMBULANCE SERVICE ONLY
R. J. Campbell J. H. Crellin W. L. Bertrand
Page 184 FBSS
The Modification of Powdered Milks
P   Governed by the Same Riges
■,■:.    as Cow's Milk J|   ff
When physicians are ^confronted
with undependable fresh milk supplies in feeding infants, it is well to
consider the use of reliable powdered
whole milks such as Mead's or the
well-known Klim brand* Such milk
is safe, of standard composition, and
is easily reliquefied*   f IP
Under these conditions, Dextri-
Maltose is the physician's carbohydrate of choice just as it is when fresh
cow's milk is employ ed.  ffijjiM
The best methoc§to^^^^^^»rAto
restore the powpered^M^^^rtepro-
portiqji of one ounce a^bail^BseVen
oimces of wate|| and thenjip proceed
buildup up the formula as^fswL'flj
DEXTRI-MALTOSE NOS. 1,2 AND 3, SUPPLIED IN 1-LB. AND 5-LB.
TINS AT DRUGGISTS. SAMPLES AND LITERATURE ON REQUEST.
MEAD JOHNSON 8b CO., OF CANADA, LTD., BELLEVILLE, ONT. 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 $21.00 Weekly.
Beautiful for situation.
For further information apply to:
MEDICAL  SUPERINTENDENT,   SIDNEY,   B.   C.
or the  Manager
Miss R- A. Backett, r, n.
M.asseuse
Rooms 503-504 Birks Building
Phone Trinity 2004
Sun Ray
with
Quartz Lamp
Cabinet Baths
and Shower
Swedish or
Weir Mitchell
Massage
Specializing in Physio-Therapy
Patients may be visited in homes
(Qualified Physicians invited to visit)  -*-$s©e
Mg^^^f^B
!*&*-+-
Hollywood Sanitarium
{! LIMITED
"titer the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference ■- <23. Q. (Medical ^Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
vtfe>«?
■W5V

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