History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: April, 1932 Vancouver Medical Association Apr 30, 1932

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  i
STBSSNDr&HEAme   BLDG.
VANGOU Vm,, CANADA
57
ANDERS COD LIVER OIL
Certified by the PHARMACEUTICAL SOCIETY of GREAT
BRITAIN for its therapeutic efficiency.
The only Cod Liver Oil sold in Vancouver at the present time
approved by the colorimetric method in which the chromogen content
is determined by the Antimony Trichloride method and expressed in
Lovibond blue units, (as suggested by Drummond, Hilditch and other
authorities.)
This method is obviously the most satisfactory test for vitamin A
potency yet devised and eliminates the ambiguity of "Vitamin 'A' Units"
which judging from the claims made by many manufacturers are just
"Arbitrary Units."
This high grade Cod Liver Oil is used in
Anders Vitamin Cream
(which is  SO per cent Cod  Liver  Oil)
also
Anders Cod Liver Oil
and
Malt Extract
(which is 25 per cent  Cod Liver  Oil)
Anders Cod Liver Oil is 45c.   85c and SI.50.
CHAS. H. ANDERS, Chemist
GORDON M. CLAY, Associate Chemist THE     VANCOUVER     MEDICAL     ASSOCIATION
BULLETIN
Published Monthly under the Auspices of  the Vancouver Medical Association in  the
Interests of the Medical Profession.
Offices:
.203 Medical Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
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. VIII.
APRIL,  1932
No.  7
OFFICERS 1931-1932
Dr. C. W. Prowd Dr. E. Murray Blair Dr. G. F. Strong
President Vice-President Past President
Dr. L. H. Appleby Dr. "W. T. Lockhart
Hon.  Secretary Hon.  Treasurer
Additional Members of Executive:—Dr. A. C. Frost; Dr. W. L. Pedlow
TRUSTEES
Dr. W. D. Brydone-Jack Dr. J. A. Gillespie Dr. J. M. Pearson
Auditors: Messrs.  Shaw, Salter & Plommer
SECTIONS
Clinical Section
Dr. J. E. Harrison Chairman
Dr.  A.  M. Agnew ^Secretary
Eye, Ear, Nose and Throat
Dr. J. A. Smith Chairman
Dr. A. O. Brown Secretary
Pediatric Section
Dr.  C. A. Eggert : Chairman
Dr. S. S. Murray Secretary
Cancer Section
Dr. J. J. Mason -- Chairman
Dr. A.  Y. McNair  Secretary
STANDING COMMITTEES
Library Orchestra Summer School
Dr. D. M. Meekison Dr. J. R. Davies Dr-  c- e- Brown
Dr. "W. H. Hatfield Dr. F. N. Robertson Dr- J; L. Butters
Dr. C. H Bastin Dr. J. A. Smith Dr. "C. H. Vrooman
Dr. C. H. Vrooman Dr. J. E. Harrison Dr- J- w- Arbuckle
Dr. C. E. Brown Dr- H- A- Spohn
Dr. H. A. Spohn ,, Dr- H- R- Mustard
Publications Ho&tiU
■Dinner Dr- J- M- Pearson Dr.  w. q walsh
Dr. J. H. MacDermot pjR   p   -yp  lees
Dr. J. E. Harrison Dr. D. E. H. Cleveland      Dr; a\ W. Bagnall
£R- £? S-J*™* DR- F- J- Buller
Dr. N. McNeill \       , J
Credentials V.O.N. Advisory Board
„ ,    ,    _   _   ,, .    . Dr. A. J. MacLachlan        Dr. Isabel Day
Rep. to B. C. Med. Assn.     Dr   a   y   McNair Dr   h   r  Caple
Dr. H. H. Mtlburn Dr. T. L. Butters Dr. G. O. Matthews
Sickness and Benevolent Fund — The President — The Trustees VANCOUVER HEALTH DEPARTMENT
STATISTICS, FEBRUARY, 1932
Total Population   (Census,  1931)   	
Asiatic  Population   (Estimated)   	
Rate per
226
14
203
301
13
43.2
246,593
15,000
000 Population
11.5
18.4
10.4
15.4
Total   Deaths    ■—
Asiatic   Deaths    £ 	
Deaths—Residents only 	
Birth Registrations 	
Male       164
Female 137
INFANTILE MORTALITY—
Deaths under one year of age	
Death  Rate—per  1,000   births  	
Stillbirths   (not included in above)     3
CASES OF CONTAGIOUS DISEASEIS REPORTED IN CITY
March 1st
January, 1932 February, 1932 to 15th, 1932
Cases     Deaths Cases    Deaths Cases    Deaths
2 23 10 8 1
Smallpox          13
Scarlet   Fever         9
Diphtheria     '.  8
Chicken-pox       60
Measles     2222
Mumps   	
Whooping-cough	
Typhoid Fever 	
Paratyphoid   	
Tuberculosis   	
Poliomyelitis    	
Meningitis   (Epidemic)   	
Erysipelas	
Encephalitis Lethargica 	
80
23
2
0
57
0
'V
"A
o
o
o
o
l
o
l
0
0
11
0
1
0
0
23
5
6
45
1059
62
25
1
0
35
0
0
5
0
10
0
1
0
3
0
3
0
0
12
0
0
1
0
9
3
18
178
47
18
1
0
24
0
0
0
0
REST HAVEN SANITARIUM
On Marine Drive, near Victoria, B. C.
Practising Physicians and Surgeons are invited to send
their chronic or convalescent patients to Resthaven. High
Blood Pressure and Diabetic Diets prepared and administered by competent Dietitian. Your instructions carefully
carried   out.     Qualified   physician   and   nursing   staff   in
attendance.
Write, Telephone or Wire
Manager,  Rest Haven, Sidney, B. C.
Telephone Sidney 61L or 95
— Rates are no higher than Hospital Rates •—
Page   131 Studies in Scotland
A recent comparison of the effect of raw and pasteurized milk was carried out by the Department of Health
for Scotland. In this study there was provided a supply
of tuberculin tested raw milk with fat content of 3.5%
and a maximum bacterial count of 200,000 per cubic
centimeter. This supply was blended and half of it pasteurized at 145 degrees for thirty minutes. Three-quarters
of an Imperial pint was furnished daily to each of 10,000
school children, one-half of them receiving the raw milk
and the other half the pasteurized milk.
This test was continued for four months. The height,
weight and general condition of the children was noted
carefully by physicians and nurses at the beginning and at
the end of the test. As a control of these results similar
measurements were made of 10,000 comparable children
who did not receive the daily allowance of milk.
For our present purposes we will quote only two conclusions as they appear in this very interesting report:
"1. The influence of the addition of milk to the diet
of school children is reflected in a definite increase in
the rate of growth both in height and weight.
2. Insofar as the conditions of this investigation are
concerned, the effects of raw and of pasteurized milk,
on growth in weight and height are, so far as we can
judge, equal."
Both the carefully controlled experiments and the
experience of more than twenty years on a large scale agree
in indicating that pasteurization does not have any appreciable harmful influence upon the desirability of milk as a
food, and at the same time adds very materially to the
safety of the food substance.
1 ASSOCIATED DAIRIES
Limited
DISTRIBUTING RICH, SAFE, CLEAN MILK
Phones:
Fairmont 1000—North 122—New "Westminster 1445 After 25 Years
MOVING!
Leslie Henderson has enjoyed and appreciated the privilege of serving
the Medical Profession in Vancouver for the past 25 years.
On March 31st, the Georgia
Pharmacy moves to 777 Georgia
Street, just 37 yards around the
corner from its present location.
We invite your inspection of our
new home, and continued confidence
in our organization.
As an organization of seven graduate pharmacists we are devoted to
the ethical practise of the profession
of Pharmacy. We assume a serious
obligation in helping to protect the
health of your patients. Our first
principle is absolute accuracy in prescription work.
The  same familiar  phone number—SEYMOUR   1050
night service . . . immediate deliveries.
. day  and
Open All
Night
Georgia
Pharmacy
Seymour
1050
While we are on the subject of Cod Liver Oil
may we mention our capsules, numbers 28
and 29. Full vitamin content of course,
with in the former a little quinine
and in the latter quinine creosote and guiocol.  These
capsules    are    hand
filled and both
soft   and
soluble.
B* C* Pharmacal Co*
In Vancouver Since 1913 VANCOUVER MEDICAL ASSOCIATION
Founded 1898 Incorporated 1906
PROGRAMME OF THE 34th ANNUAL SESSION
GENERAL MEETINGS will be held on the first Tuesday of the
month at 8 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the
month at 8 p.m.
Place of meetings will appear on Agenda.
General Meetings will conform to the following order:
8:00 p.m.—Business as per Agenda.
9:00 p.m.—Paper of Evening.
1931.
November 3rd—GENERAL MEETING.
Papers:
Dr. H. A. DesBrisay: "Syphilis in Medical Practice."
Dr. W. T. Lockhart: "Treatment of Syphilis."
D.  A.  L.  CREASE of  Essondale will discuss  the treatment of
Degenerative Types of Neurosyphilis.
Discussion: Dr. J. E. Campbell; Dr. W. L. C. Middleton.
November 17th—CLINICAL MEETING.
December 1st—GENERAL MEETING.
Papers:
Symposium on Fractures to be arranged by Dr. A. B. Schinbein
and Dr. D. M. Meekison.
Discussion: Dr. F. P. Patterson; Dr. J. A. West.
December 15th—CLINICAL MEETING.
1932.
January 5th—GENERAL MEETING.
Papers:
Dr. C. S. McKee: "The Inteipretation of Blood Pictures."
Dr.  Murray  McC.  Baird:  "The  Clinical Aspect of  Some  Blood
Diseases."
Discussion: Dr. W. H. Hatfield; Dr. A. Y. McNair.
January 19th—CLINICAL MEETING.
February 2nd—GENERAL MEETING.
Papers:
Dr. H. Dyer: "Tracheotomy in Children."
Dr.  C. Graham: "Inflammation of the Accessory Nasal Sinuses
in Children."
Dr. E. E. Day: "Indications for Endoscopy."
Discussion: Dr. J. A. Smith; Dr. H. R. Mustard.
February 16th—CLINICAL MEETING.
March 1st—GENERAL MEETING.
The Osier Lecture: Dr. F. P. Patterson.
March 15th—CLINICAL MEETING.
April 5th—GENERAL MEETING
Papers:
Dr. J. W. Thomson: "Emergencies in Abdominal Surgery."
Dr. A. W. Hunter: "Diagnosis and Treatment of Some Urological
Emergencies."
Discussion: Dr. G. E. Gillies; Dr. Lee Smith.
April 19th—CLINICAL MEETING.
April 26th—ANNUAL MEETING.
Page 132 EDITOR'S PAGE
We wonder if Dr. Coleman's contribution to last month's Bulletin
has affected many of our readers as it has ourselves.
It is probably true that the real value of any speech, sermon, lecture,
or written article, lies not in its contents per se., no matter how full it
be of matter, nor how pregnant with meaning; but in its power to make
the hearer or reader think for himself, to make him use his imagination,
to enlarge his vision, >to force him to see, in short, to educate him, in
the true sense of the word "educate." If any such utterance have in it
a phrase which lingers in the mind and memory, and, sticking like a burr,
teases and irritates one into action, it has earned its keep.
Dr. Coleman's article contained two ideas at least which merit our
most earnest and thoughtful consideration, and they are constructive.
We cannot say all we should like about either of them, but we feel that
they should be emphasized.
The first, is his reference to the sterility of the doctor's life, in so
many of the things that make life full and happy, as opposed to those
that merely make it busy.
These are the days of service clubs, and associations, and committees, and activities of every sort, most of them designed to increase
communal activity, and to ensure a thorough mixing of the elements of
society. One sometimes wonders if the best work is done this way: if
working in a crowd, en masse, is conducive to the development of one's
individual ability. The Babbitry of modern life is rather dreadful really.
We belong to so many things, but never to ourselves. We have no time
for hobbies, for pictures, for writing or talking, or music, or any of the
things that make life beautiful.
We have no leisure. Rabindranth Tagore that wise old poet,
said in one of his addresses in Vancouver, "We should never forget that
if time is money, leisure is wealth"—and it has been said even more
beautifully, "What shall it profit a man, if he gain the whole world, and
lose his own soul?"   What, indeed?
We live in an age of speed and ever-increasing speed—why we are
in such a hurry, and where we are in such a hurry to arrive, and what
we shall do after we get there, are not so apparent. We speed along the
road in a motor-car and a cloud of gasoline fumes and miss all the wayside flowers and little trees and lanes. If Mr. Jones' budget, with its
increased gasoline tax, puts some of us afoot again, we shall have reason,
some day, to bless Mr. Jones.
It is a pity: there must be more in the world, even for those of us
who must work hard to make a living, than merely work and food and
sleep, more even than success and fame. Dr. Coleman is to be thanked
for reminding us of it.
The other idea that has stuck in our mind, and moves us to comment, is his remark that if reforms are to be effected in our economic
status as a profession, it must be done by the younger men. We hope
the younger men have taken note of this: it would be well for them to
think it out. Not but what the older men are ready and glad to help
Page 133 with their advice and personal effort, but they have been through their
time of struggle, and their point of view is conservative, rather than
aggressive. Moreover, the younger men are even more vitally concerned,
though we are all in the same boat to some extent: but they have the
strength and the freshness of energy as well as the greater incentive, and
it is for them to man the oars and battle with the waves. There is rough
water ahead, and it is going to need a long pull, a strong pull, and a
pull all together. The experience and seamanship of the older hands will
be of great value no doubt, but it is the younger and stronger men who
must do the heavy work.
We shall need unity and strength and unselfishness of purpose and
devotion to the common good, in the days to come, and we should begin
now to organize our forces.
OSLER DINNER
The Annual Osier Dinner was held at the Hotel Vancouver on
March 1st. This is the twelfth Osier Dinner since Dr. F. Brodie, then
President of the Vancouver Medical Association, first suggested that an
annual dinner be held in honour of the late Sir William Osier. Dr. C.
W. Prowd, this year's president, in his short introductory speech took
occasion to point out that the number of members present at this dinner
was exactly twice the number present at the first dinner, thus showing
growth of the Vancouver Medical Association and perhaps growing interest in the Osier Dinner.
The dinner was held in the Oval room of the hotel and there were
117 present besides several who came in later in the evening. The head
table was graced by many past presidents and Osier lecturers.
Dr. F. P. Patterson was the speaker of the evening and his paper
will be reported in full in a later number of the Bulletin. We feel perhaps that the large turnout was mainly a tribute to Dr. Patterson himself,
who commands the earnest attention of any audience he may address on
any subject connected with his specialty. This lecture was no exception,
and though the subject he chose was a difficult one, not of immediate
interest to the practitioner, the rapt attention with which his audience
followed him through two hours of close and careful speaking shows the
ability with which the speaker handled his topic. We cannot but feel
that it is far the best course for an Osier lecturer to pursue, to aim high
in his choice of subject and treatment of that subject, as Dr. Patterson
did. Lesser subjects may be kept for ordinary occasions, but the standard
of Osier lectures has on the whole, been very high, and it is unnecessary
to say that Dr. Patterson maintained that standard at its highest. His
address was illustrated by lantern slides which will unfortunately be
missing in the published article.
A short business meeting was held before the actual address and
on the motion of Dr. A. Y. McNair, the Cancer Investigation Committee
was organized into a regular section of the Vancouver Medical Association, to be known as the Cancer Section.
No other business was transacted and the meeting adjourned at
10:30 p.m.
Page 134 NEWS AND NOTES
We extend our sympathy to Dr. James T. Wall, upon the loss of his
father, Mr. W. H. Wall, who died on February 21st. Mr. Wall was a
genuine British Columbia pioneer who came to the Colony sixty-eight
years ago, rounding the Horn in a sailing ship.
In the death of Mr. Richard Hall in Vancouver recently, British
Columbia lost its oldest McGill graduate. He was the father of Dr. W.
K. Hall, to whom we offer our condolences in his bereavement.
We are sorry to record the death of another whose son is numbered
among our colleagues. The death occurred recently at Penticton of Mr.
A. DesBfisay. We sympathize deeply with Dr. H. A. DesBrisay in the
loss of his father.
Among the distinguished personages from Vancouver who attended
the opening of the Provincial Legislature was Dr. R. E. McKechnie. We
understand that the Honourable Dr. Josiah Hinchcliffe did not insist upon
his being vaccinated before landing at Victoria.
The marriage took place at High River, Alberta, on February 13 th,
of Miss Dorothy Young of High River, to Dr. C. D. Moffatt of Vancouver. Dr. Moffatt and Mrs. Moffatt are both well-known in Vancouver,
the doctor having practised here for some years, while Mrs. Moffatt is a
former member of the Vancouver General Hospital staff.
Drs. G. F. Strong and H. H. Pitts are guest speakers at the Sixteenth Annual Clinical Session of the American College of Physicians in
San Francisco, on April 5th. Their subject is "Further Observations on
Primary Carcinoma of the Liver in Chinese."
Overheard in the Medical Dental elevator.
"Hello, Lena, are you going to see a doctor here?"
"Oh, yaw; last week ay bane see one frash faller, and he yust tall
me ay bane eat too much. Now ay bane go see new doctor; he bane
good Swede faller, his name Dr. Neilson.
Losh man, there wis a muckle din at the Forum on Thursday February 18th. The Laird o' Fintry, or one gey like—or it micht ha' been
that chield Bilodeau, lately known as Houghmaghandi—wi' a wheen o'
they doctor-bodies were a' takin' a fling o' the stanes. Och ay! Sic a
skirlin' an' a loupin' an' bletherin' o' "Soop her up " ye never did hear
the like. They ca'd it a Medicinal Bonspiel, or sae it wis announced by
Roy Pedlow wha got it up an' did a' the wark. An' did ye no see the
bonny picturs forbye that was stickit up i' the hospitals? 'Twas Miss
Bernie Wilson, the wee niecie o' Neil MacDougal wha pentit them, and
the doctors thank her kindly. She showed Dunnie Meekison, bunnet an'
a', wi' sax rid hairs on the ane knee an' fower black yins on t'ither tae
the life.    Scotty McNair wis  there,  an' wee Geordie  Clement forbye
Page 13 5 iukin' braw in kilt an' plaidies. Anson Frost, E. H. Saunders and Chairlie
Walsh got prizes, but Scotty Conklin fair surpassed himsel in walkin'
awa wi' a prize. The canny auld veteran 3 8 years oot o' th' game wis
for dingin' oot the stanes o' sic young buckies as Boucher an' a'. Jock
McCrae, the bagman frae Frosst (Tootootoo) brocht up prizes for a'
the winners, and votit a guid and leal freend o' th' profession. Had he
bin gien yin for the bonniest-lukin curler it shairly wud ha' gane to that
canny body wha minds th' bawbees, Lockhart himsel, wi' his tammie an'
reefer, skelpin' th' ice an' flingin' his stanes wi' th' best o' them. Taylor
Henry brocht a load o' new broomies, but it grieves me sairly to relate
that he's still lookin' for some feckless loons wha hadna th' siller at hand
for them.
A'thegither there wis mair nor 80 braw curlers makin' merry, sic
an aggregation as wad dae ye guid to tak' a blink o' them. An' gin ye
dinna ken the taste o' a wee drappie when the stanes are ringin' doon
the ice, come an' tak a scunner wi' th' lads th' neist time.
Hoot man, awa wi' ye an' yer pickle haverin'; gin ye come hame
tae yer guidwife a wee bit daft-like, she'll ken na deeference an' pit it
doon tae yer vaccination!
Congratulations to Dr. R. de L. Harwood. Lady Luck dropped a
handful of green-backs on his front door-step on March 15th. Dr. Harwood is not interested in news about the new oil-well developments, silver
stocks or other holes-in-the-ground.
Dr. "Bill" Gunn admits that he may not know his groceries, but
he does know a milk-wagon when he sees it, even in the pre-dawn hours.
And he knows just where to hit to get the biggest splash.
The Bulletin feels that due acknowledgement should be made to
Dr. C. A. Ryan for the trouble and time he has spent on the picture gallery which now appears on the Library walls, comprising the Past-Presidents of the Association. Dr. Ryan has spent many hours on this and has
done a remarkably neat piece of work. The lettering is his own, and
each photograph is neatly inscribed with the name of the President that
appears thereon, with his date of office.
INDICATIONS FOR ENDOSCOPY
By Dr. E. E. Day
The purpose in presenting this subject tonight is to direct your
attention to some of the advantages of endoscopy and to foster a spirit
of co-operation between those who are interested in this subject and the
other departments of medicine.
The writer will not be quoting his own experiences and impressions,
rather the views of men, well qualified by education and experience in
this field, will be given.
Killan in 1897 was the first to employ a rigid metal tube, introduced through the mouth, to remove a bone from the right bronchus
Read before  Vancouver  Medical Association,  February,   1932.
Page   136 of a man, 64 years of age. In the early days endoscopy was a difficult and
formidable feat. Today, thanks to the efforts of such pioneers as, Chevalier Jackson Sr., Mosher, Ingals, Johnson, Friedberg, Coolige Arrowsmith,
Yankauer, Lynah, Imperatorii and others, it has become a relatively
simple procedure.
Bronchoscopy and eosophagoscopy can no longer be looked upon as
emergency measures of last resort and to him who still believes that such
terms are to be associated with only the foreign body case, together with
all the old time dread of complications, this is to be said. In Jackson's
clinics in Philadelphia, foreign body work represents only 2% of the
total number of cases examined and operated upon, and furthermore the
mortality rate is as low as 1%, including all cases treated by Jackson and
his associates.
A complete list of the indication for laryngoscopy, bronchoscopy
and oesophagoscopy is long. Any list that mathematically states indications often arouses doubt of value, and to one not familiar with the
scope of the work may seem to approach exaggeration. Rather clinical
acumen will recognize conditions as they present themselves and in consequence determine whether endoscopy is necessary for diagnosis, treatment, or both. From a narrow field, which a few years ago was restricted
to emergency foreign body operations, the list of indications for endoscopy in exploration for diagnosis and treatment of conditions to be
found in the larynx, bronchial tree, pleural cavity, pharynx, oesophagus
and stomach, has so lengthened that at the present time it is possible for
an endoscopist to render invaluable assistance to both internist and surgeon.
The larynx shall be considered first because it is so accessible to
examination, either by the indirect or direct method.
Hoarseness, voice change or discomfort call for laryngeal examination for diagnostic purposes. Hoarseness is the most common pathological
laryngeal symptom and is due to some interference with the proper
vibration and approximation of the vocal cords. It is a symptom common
to vocal nodules, papilloma, laryngeal inflammations or malignancy.
Hoarseness as a symptom offers no variation in type diagnostic of the
particular condition present.
To quote the late J. A. MacKenty. "Persistent, progressive hoarseness, in or after middle life may and often does mean that laryngeal
cancer is present. In no other situation in the body does cancer give such
early or such easily recognizable warning of its presence." He further
states, "that only by early examination and with biopsy of early and
suggestive lesions, an early diagnosis and cure can be obtained as
the only hope in this dire disease is radical removal, to eradicate to a
large extent the unspeakable misery attendant on uncontrollable laryngeal cancer. "According to Gabriel Tucker, "the average length of time
between the onset of symptoms of carcinoma and the time of diagnosis
is eleven and one half months." It may be interesting to know that
laryngeal cancer comprises 5% of all cancer.
Bronchoscopy
It is well known that bronchoscopy is indicated in the presence of
a foreign body in the lower air passages. However, there are other condi-
Page 137 tions in which obscure signs may be rendered more clear and very often
treatment efficaciously administered.
Foreign Body
Choking, coughing and wheezing coming on suddenly in a healthy
individual should make one think of foreign body. X-ray plates must
be made before bronchoscopy is attempted, for from these, if the foreign
body is opaque, information as to its size, shape and position can be
ascertained. It is advisable to have a plate taken immediately prior
to operation as foreign bodies often migrate. If the foreign body is
non-opaque there are usually radiographic evidences of partial or complete obstruction in the lungs. McCrea has pointed out that one can
find some diminished expansion and fine rales even in cases of small
non obstructive foreign body. Even if foreign body is suspected and
there are no discernible physical or radiographic signs it is safer to do a
bronchoscopy, for often they are overlooked.
Jackson has on record over two hundred (200) cases of opaque
foreign bodies which were overlooked for periods varying from six (6)
months to forty (40) years. This writer's postulate that every ailing
child should have a roentgen-ray examination from occiput to ischia
to exclude foreign body merits some consideration when on considers that
more than 50% of all foreign bodies removed have been from children
under two years of age. Failure to diagnose, locate and remove a foreign
body from the lungs usually results in permanent destruction of lung
tissue which may cause the patient to become a chronic invalid and
frequently leads to untimely termination.
Pulmonary Suppuration
The bronchoscope is a valuable aid in the diagnosis and localization
of pulmonary suppuration. It is frequently the best therapeutic method
available.
There are two types of lung suppurations. First the lesion characterized by dilatation of the bronchial elements, termed bronchiectasis,
and secondly the lesion in which the lung parenchyma is primarily involved with formation of localized abscess and cavitation. Both of these
conditions are primarily the result of bronchial obstruction and secondarily of infection. According to Van Allen, "Bronchial obstruction is
essential to the production of abscess irrespective of the organism introduced." Early lung suppurations should be considered primarily as a
medical disease and as such should be handled by the internist. Chronic
pulmonary suppuration calls for surgery.
Spontaneous cure results in 50 to 60% of cases but it cannot be
predicted which will recover spontaneously. Fulminating cases usually
terminate fatally regardless of treatment.
By means of bronchoscopy in these cases the suppurative area can
be attacked through its communicating bronchial connection. Localized
abscess and suppurative bronchiectasis can be differentiated and the presence of foreign body or neoplasm can be excluded. In chronic cases
strictures can be dilated and granulations removed.    The exudate can be
Page   13 8 ^^
aspirated, irrigation carried out when indicated and medicaments directly
applied.
Centrally located lung abscess can be cured by these means but
bronchiectasis is not so encouraging, but here the symptoms of bronchitis and asthma can be relieved.
Atelectasis and Pheumonia
Massive collapse of the lung, especially post operative, is due to
bronchial obstruction, usually by mucus plugs and direct aspiration of
the mucus by means of the bronchoscope is indicated. Post operative
pneumonia is a type of obstructive atelectasis of the lung. According
to the experimental work of Coryllos and Birnbaum, post operative
atelectasis and post operative pneumonia represent two phases of the same
pathological process, the prominent factor being bronchial obstruction
and the result depends upon the infective organism in the obstructing
mucus. They cite one case of pneumonia in which bronchoscopic aspiration led to a hastening of the crisis and ultimate recovery. Similarly
by aspiration and lavage unresolved pneumonia can be benefited.
Neoplasm
For diagnosis of neoplasm of the lung there is one procedure as
valuable as bronchoscopy. The vast majority of pulmonary tumours are
of bronchogenic origin. The radiologist may diagnose an opacity and by
inference neoplasm, but a definite diagnosis is only possible by biopsy.
A non productive cough gradually increasing in severity, with breath
sounds suggestive of asthma, or haemoptysis with no evidence of lung
suppuration or tuberculosis, should be investigated bronchoscopically with
the prospect of finding an early carcinoma. Yankauer states, "that in
cases presenting symptoms of pulmonary suppuration after 40 years of
age, 50% have malignant growths." Benign tumours are occasionally
met with such as haemangioma, papilloma and fibroma. Carcinoma of
the bronchus is not an extremely uncommon disease. Bronchoscopy offers
the best means of early diagnosis. Patients with obscure chest conditions
should have a bronchoscopic examination in conjunction with the other
methods of examination.
Asthma
Bronchoscopy is positively indicated in cases of asthma when all
other means of investigation have failed to establish a correct diagnosis
and when relief of symptoms cannot be obtained by the usual measures,
as often the underlying cause is neoplasm, compression stenosis or foreign
body. Jackson's dictum "that all is not asthma that wheezes" has been
only too often proved. Again by means of the bronchoscope uncon-
taminated secretion can be obtained from deep in the lungs for the
purpose of preparing vaccines. Bronchoscopic treatment by aspiration
and instillation of bland medication relieves a great number of these
cases of asthma—why this relieves is not known.
Tuberculosis
Clerf in a recent article states that, "the value of bronchoscopy in
pulmonary tuberculosis is limited largely to diagnosis.    It is rarely indicated  in  uncomplicated  pulmonary   tuberculosis.     The   chief   value  in
tuberculosis is to aid in diagnosis of unexplained signs  and symptoms
Page 139 and in cases presenting obscure pulmonary symptoms in which tuberculosis may be suspected but cannot be proved, for in these cases the
tubercle bacillus can often be discovered in secretion aspirated from a
lesion deep in the lungs, where the usual methods fail."
Stenosis
Clinical data are seldom sufficient and adequate to determine the
aetiology and type of stenosis, whether it be intra-bronchial or compression from without as, for example, by enlarged bronchial glands or a
dilatation of the aorta. Only by bronchoscopy can the diagnosis of the
cause of the stenosis be arrived at.
Yankauer goes so far as to say, "that no diagnosis of an intrathoracic lesion is complete without a bronchoscopic examination and
further that in general no operation upon an intra-thoracic condition is
justifiable without including the endoscopic findings in the indications
for operation."
Oesophagoscopy
Dysphagia is the one symptom common to practically all oesophageal
conditions. This symptom is present whether there is foreign body, stricture, mild or ulcerative oesophagitis, diverticulum, mediastinal pressure,
carcinoma or the so called cardiospasm, in varying degree from a slight
discomfort to severe pain. Dysphagia is not pathognomonic of any one
of these conditions. It is an early symptom and often the only one of
beginning oesophageal malignancy. Pain, regurgitation and haemorrhage
are advanced symptoms while cachexia and loss of weight are toxic or
nutritional symptoms due to obstruction.
Often we witness the removal of a normal or slightly inflamed
appendix to avoid more serious conditions. Yet is one not even more
justified in performing a diagnostic oesophagoscopy, so that direct inspection and removal of tissue for microscopic examination may offer at least
an early opportunity to avoid more serious conditions?
Granted that at the present time, malignancy of the oesophagus is
100% hopeless. Nevertheless only by early diagnosis can any degree of
hope be held out for this distressing condition, as is the case with carcinoma elsewhere.
Jackson reports cases of angioneurotic oedema, urticaria, serum
disease and herpes involving the oesophageal mucosa, and that the only
means of arriving at a diagnosis in these cases is by direct inspection of
the lesions. Peptic ulcer of the oesophagus in patients complaining of
pain back of the sternum, gastric haematemesis and regurgitation should
be considered and perhaps would be found to be less rare if a direct examination were made.
A few words concerning the swallowing of foreign bodies reaching
the stomach and intestines are in order.
Myerson, commenting on this accident, feels that there is no great
cause for alarm if a foreign body is swallowed into the stomach. In a
series of thirty-nine (39) such accidents, thirty-six (36) of the foreign
bodies passed through without incidence, even though 82% of these were
pointed. This indicates that the patient should be watched fluoroscopi-
cally and that surgical measures need not be resorted to unless positive
Page  140 indications of obstruction or perforation arise. Nor is it necessary to
prescribe special diets or feed absorbent cotton to entangle the foreign
body. The last mentioned item may so increase the bulk that obstruction
is inevitable. Although the giving of cathartics is contraindicated, yet
in most cases seen, this remedy has already been tried before medical
advice is sought and no untoward results have occurred.
Contra Indications
Contraindications to endoscopy are few and limitations of the procedure from the patient's standpoint are governed by the physiological
reaction, age, intended co-operation, part to be examined, anaesthesia to
be employed, anatomical or pathological obstacles to be encountered, such
as advanced arteriosclerosis with aortic aneurysm or kyphosis of the
cervical vertebrae. Also in cases of pulmonary tuberculosis where pneumothorax, marked haemoptysis, extensive pulmonary involvement or
laryngeal involvement are present.
Chevalier Jackson has repeatedly emphasized the value of endoscopy
as a therepeutic and diagnostic aid. Yet he recognizes that this procedure is subject to definite limitations and should be more or less restricted
to selected cases, and therefore subject to the combined opinion of a
team, made up of internist, roentgenologist, pathologist, thoracic surgeon
and endoscopist. Each one indispensable, no one always final and in combination making up a co-ordinated team that is capable of giving a finely
drawn diagnosis and directing a most rational treatment.
THE CHALLENGE OF STATUS LYMPHATICUS
W. N. Kemp, B.A., M.D., Vancouver, B. C.
On Friday, August 28th, 1931, Baby F., aged 19 months and apparently a normal child, developed a nasal discharge that was unaccompanied
by a cough. On Saturday he was listless and refused his milk (modified
cow's milk with dextri-maltose). He gradually became more listless and
by evening he did not appear to notice anything in his environment.
Occasionally he would give utterance to a shrill cry. At 5:00 a.m.,
Sunday, the 30th, he had a convulsion. His eyes were fixed and staring
and his respirations were laboured and noisy. At 9:50 a.m. he was admitted to the Infants' Hospital. At this time he was comatose and his
lungs seemed to be "filled with secretion." His colour was waxy white
with his lips and finger nails a "pallid blue." His chest was full of coarse
moist rales and respiration was laboured. His extremities were cold and
clammy and flaccid. The little patient's condition became steadily worse
in spite of all the usual supportive treatment and he died at 12 noon as
preparations were being made to perform a diagnostic lumbar puncture,
(post-morten tap showed a normal spinal fluid).
Exactly seven hours later on the same day, Sunday, August 30th,
Baby R., aged 6 months, was carried into the Admitting Room of the
same hospital. He was cyanosed and in a state of shock. He died fifty
minutes after admission in spite of the heroic efforts of the attending
interne. There was nothing of significance in his previous history. He
had been attending the outpatient clinic regularly and was gaining and
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Vancouver,  B. C. progressing normally. The only abnormality previously noted was a
history of loose stools for 24 hours preceeding death. Four other children
of these parents were alive and well.
Post mortem examination was conducted by Dr. H. H. Pitts, Pathologist of the Vancouver General Hospital on August 31st. The autopsy
findings were remarkably similar in each case. In the first child no signs
of pneumonia or meningitis were found. After a careful and thorough
search nothing of abnormal significance was found except many hyperplastic mesenteric lymphatic glands and a thymus gland weighing 33 Y2.
grams. In the second infant (Baby P.) the only fundings of note were
the presence of numerous enlarged mesenteric lymphatic glands, a thymus
that weighed 30 grams and an oedematous condition of the brain (but
no meningeal exudate).
In one day, within eight hours two children have died rather suddenly from the same underlying constitutional deficiency which, for
want of a better term, we call status lymphaticus. Every practitioner
of medicine in Vancouver knows that many, even more sudden and
tragic, fatalities occur among the infants and children of this city. The
presence of this constitutional anomaly in such a comparatively large proportion of our children is a definite challenge to our powers of clinical
investigation and our scientific training. Status lymphaticus is essentially a clinical problem which is particularly prominent in the Pacific
North-west. Surely, by availing ourselves of recent animal experimental
results, by examining definite cases from every angle and by pooling our
results and comparing theories and facts, we can arrive at a working
solution of this tragic condition. This is the challenge of status lymphaticus.
As a start in this hoped-for research the writer has made a review
of the history and present opinions in regard to status lymphaticus. These
and a new theory of its aetiology will be briefly indicated here in the
hope that more interest will be aroused in this, our own problem, and
that a sound theory or explanation of its aetiology will be established on
a clinical basis.
It would appear that the overwhelming emphasis that has been
placed upon the presence or absence of enlargement of the thymus gland
has greatly clouded the issue and hidden the real cause of status lymphaticus for many decades. The thymus enlargement, (there is usually some
slight enlargement) is only incidental to the real deficiency, which is
elsewhere. The really most constant and diagnostically significant of the
postmortem findings in status lymphaticus are enlargement of the mesenteric lymph glands and Peyer's patches. The thymus may, or may not,
be enlarged, depending upon the nutrition of the child. There is also
a sad lack of knowledge concerning the real normal weight of the thymus.
It would appear that this normal thymic weight varies in different
geographical localities and the only sound way of arriving at a true
normal weight is by the autopsy of every child dying suddenly from
trauma. Seven to eight per cent, of these children will show some of
the signs of status lymphaticus and should be excluded in computing the
normal weight. It is only by first arriving at a true value of the normal
thymic  weight  that  we  can  rationally  discuss   any  particular  case  of
Page   142 sudden death from the point of view of thymic enlargement and the inferences thereof.
The recent activities and results obtained by workers in various
physiological laboratories in "researching" suprarenal cortical insufficiency are of great interest and importance to any student of status lymphaticus. Briefly stated, it has been shown by many laboratory animal
experiments that the adrenal cortex is essential to life. When deprived
of its cortex, the animal dies in a short time and the manner of his death
resembles that of the unfortunate babies discussed in the early part of
this paper. On postmortem, every animal (in Banting's series of 37)
had marked enlargement of the mesenteric, retroperitoneal and mediastinal
lymphatic glands and an enlargement of the thymus in every case.
More interesting still, are the results of partial cortical adrenalectomy
in dogs. It has been found that dogs can survive and live an apparently
average dog's life if only one eighth of their adrenal cortex is left in situ.
Such dogs are more subject to infection than normal dogs, but otherwise
they pass as normal dogs. If they are killed (and it takes much less than
an average dose of poison to kill them) a most significant set of postmortem findings meets the autopsist.
For basis of comparison the following autopsy report in a case of
accidental death is recorded at this point:
"The post-mortem findings are:
(1) A large vascular thymus measuring 14 x 6 x 2.5 cms.
(2) Large mesenteric, retro, peritoneal and mediastinal lymph
glands.
(3) The lymph follicles in the lower portions of the small
intestine are large and prominent.
(4) The spleen is slightly larger than normal.
(5) The tonsils are much larger than normal."
The above findings are typical and are those commonly seen by
competent pathologists in cases of sudden and unexplained death in
children. However, the above described autopsy was made by Crowe and
Wislocki, on a dog, aged 18 months, in whom a partial adrenal cortical
insufficiency had been operatively produced 4/4 months before his death
in a street accident.
If the condition that we call status lymphaticus in children is due
to an adrenal cortical insufficiency, how is such insufficiency incurred?
The answer to this question entails a brief review of the best opinion
regarding the prenatal and immediately postnatal state and function of
the adrenal cortex. In foetal life the adrenal cortex, having important
morphogenetic functions, is relatively many times larger than in adult
life or even in the first year of life. When these morphogenetic functions
have been largely discharged at about the fifth month of foetal life, the
adrenal cortex gradually undergoes involution. After birth, the most
important change is the degeneration of the inner cortical layers (foetal
reticulata and fasiculata) to make room for the rapidly developing
medulla, the cortex regenerating from the glomerulosa to form the
permanent cortex of the gland.
Page 143 Although Nature's ways are wonderful and perfect in 99 per cent,
of individuals, yet it is quite within reason and common sense to assume
that the degeneration and subsequent regeneration of the adrenal cortex
before and after birth are not perfectly timed and accurately controlled
in every individual "born of woman." When the degeneration is too
rapid or the regeneration is too tardy in its inception, a period will occur
when the infant many be temporarily without the cortical secretion that
we know is absolutely essential to life. It is at such a period that the baby's
hold on life is a very precarious one. He may die suddenly in bed or in
his mother's arms. Or he may succumb to a slight infection or a mild
physical shock that would have little or no effect upon a child with
average cortical function. At autopsy, all that is found is a thymus
gland that is usually larger than the true normal gland and enlargement
of the mesenteric lymphatic glands with prominence of Peyer's patches
in the intestine. For want of a better term the coroner's physician makes
a post-mortem diagnosis of status lymphaticus.
EDITOR'S NOTE—The above paper warrants, we think, the serious
consideration of our readers. Two recent deaths in children, one under an
anaesthetic, the other at home in bed, give added point to the question
that Dr. Kemp puts to us in his article, "Have we got to the bottom of
status lymphaticus? Do we know the real cause of it?"
The thymus gland has held the centre of the stage so far, as the
villain of the piece. But we all know that the role the thymus
plays is not clearly understood. Dr. E. D. Carder, in a paper read some
years ago on the thymus gland, and its relation to sudden deaths, stated
that while the thymus would appear to have some connection with the
condition that causes these, we are not at all clear as to what the connection really is.
Dr. Kemp suggests that we must go further back, to a deficiency
in the adrenal cortex, a deficiency that may be temporary, and coincident
with certain stages of growth in the child, or that may be permanent.
He has spent much time and labour in his study, and many of his points
are too striking to be ignored. The whole question of calcium in the
organism, a question that is so prominent nowadays in the minds of all
who deal with children, is involved.
We congratulate Dr. Kemp on his work. He himself does not consider it final, but feels that it is worth following up. Perhaps a committee might be formed which would study the question, and either prove
or disprove the theories put forward by Dr. Kemp. We cannot have too
much of this sort of thing, it benefits those who do it, and may lead to
results which will be of value to humanity.
MEDICAL ECONOMICS (2)
Minimal Fees
By R. E. Coleman, M.B.
The first paper on this subject was designed to establish the reality
of a medical economic problem right here in Vancouver. The intention
was to follow with a series of discussions of the various phases with the
Page   144 object of ultimately developing a range of fees which would be more
scientific in character. For this purpose a second paper was prepared
and presented to several physicians for criticism. The result was almost
complete condemnation on the grounds that the paper was too technical,
too far from the main point and that proof of the points discussed was
unnecessary. As a matter of fact these criticisms were unsound in that
any attempt at complete proof must be of necessity highly technical.
Further numerous conversations with physicians concerning problems of
medical conomics has shown that in actual practice they constantly
make economic decisions on extremely far-fetched points. Lastly, one of
the physicians who was most insistent that proof was unnecessary would
not admit a practical consequence until the connection was pointed out
and the proof adduced. There was, however, another criticism which
could not be met. It was pointed out that a detailed analysis of this
character would lack the general interest so vital to the problem. As
one physician said "Much more interest would be shown and more rapid
progress made if a "hat" were thrown into the ring, with a challenge for
anyone to kick it, the owner of the hat then undertaking to iron out
the dents."   The following is the "hat":
As I am the owner of this "hat", it will be described in the first
person singular. Also since I wish you to give it plenty of kicks I will
promise not to put any bricks in it, though of course I cannot prevent
others slipping in a brick or two, nor can I be responsible for your aim.
When I entered the University I had absorbed the usual lay impression that medicine was a noble altruistic profession with the surgeon on
top. To-day I am not so pleased with the mechanism by which altruism
is developed in the individual nor with the mechanism which has placed
the surgeon where he is. Economically I thought that medicine offered
anything from a good living up. Today I know that here in Vancouver
this is in error. At the University I absorbed another idea, to the effect
that no physician could maintain his own self respect unless he exhausted
every effort in the diagnosis and treatment of every patient he saw. It
was the logical development of this last that finally forced me, much
against my will, to accept the fact that the patient, the practitioner,
the community and the advancement of science were financially inseparably interdependent. Soon after I entered the clinical laboratory I accepted
the general statement of the visiting physicians that laboratory aids to
diagnosis and treatment were too costly. I did not know in those days that
each branch of medicine thought this of every other branch nor that it
was simply the general attitude of the consumer to the producer. So
for thirteen years I studied ways and means of reducing the cost to the
patient of clinical laboratory examinations. I invented shortcuts and
trained technicians but absolutely no progress was made toward lowering
the charges. I made abortive attempts to find what individual tests cost,
which were profitable and which were done at a loss, but it was not until
Dr. H. W. Hill became director that any progress was made. It then
took us six months to collect the first set of data. About three years
later we were able to incorporate our results in the work. It had previously become obvious that the clinical laboratory had earned a profit
from the very beginning, though it had always been and was still shown
in red ink in the hospital books.    I saw then that the clinical laboratory
Page 145 profits were always diverted into other channels, and my goal of lower
prices would always be unattainable under such conditions.
I then turned to private practice with the idea that the profits of
the clinical laboratory would thus be available for improvements and reduction of costs within its own field. Appreciating the value to the
clinical laboratory of the cost-accounting that Dr. Hill and I had done,
I began to study the costs of other phases of medical practice. This
double experience, of personal private practice and numerous very personal
conversations with physicians regarding their own costs and selling price,
led to a real surprise, and a complete change of front on the whole question of medical economics. In short I definitely decided that medical
fees were too low. Today I am convinced that the patient, the practitioner, the community and the advancement of medical science will all
profit, when more money finds its way into medical activities. It is quite
true that there are many economies that should be effected, but when
these are made we should not repeat the mistakes of the past. Such
savings must not be passed on immediately to the consumer, but rather
used to build up a solid well balanced financial structure first. This, in
the last analysis, is in the interests of the consumer. In my opinion
there is a real medical fee which is independent of the observer. That is
a fee which is more or less independent of any prejudices on the part of
the patient or physician. It is about this real fee that fluctuations occur.
Modern medical fees are below this real fee. My objective is to find the
general range of this real fee for different classes of medical activities.
To make a start I will produce a "hat" in the statement that any
work done by a recent graduate here in Vancouver should be charged for
at the rate of over $6.00 per hour if it is a private patient, and at least
$3.80 if on a salary basis. Any smaller charge than this is quite equivalent to giving away the same amount of cash. (I can see the physicians
looking over their biggest boots so that they will be sure to kick the hat
right out of the ring the first kick, in spite of my friend who says that
my statements will be accepted.) As a matter of fact I expect to raise
this figure before I am satisfied, but then, after all, personal economics is
a matter of personal satisfaction. There are many ways of calculating
this basic figure and they all yield different results.   Here is one way.
A postal clerk might have started here in Vancouver on a salary of
$1,080.00 per annum. There are many reasons why I chose a postal
clerk, but this is not the place to give them, so I am told. He enters
by examination and advances by examination at a rate of $100.00 per
annum to a maximum of $1,700.00 per annum. Now the average age
at graduation at one of our Canadian Universities for the year 1930 was
27 years. That is, for 9 years these students sacrificed a steady income
which represents $14,520.00. I allow 5 per cent, compound interest
making the amount $18,183.00. In this particular class the expenditures,
exclusive of living and amusements, was $1,640.00 and at 5 per cent this
becomes $1,812.00. In this particular class there was also a wastage due
to failures and repeating, which, at 5 per cent, becomes $263.00. Thus
at graduation each student represented a capital investment of $20,258.00.
That is, a graduate of 1930, commencing practice in Vancouver, should
receive the equivalent of a postal clerk's salary plus  compensation for
Page   146 his investments. I would allow him 5 per cent, on $20,258.33 (his invested capital) which is $1,012.91. I would also allow him 5 per cent,
for his sinking fund so that when his machine (himself) was worn out
ht would have his money back. That is, I would allow him $2,025.83
per annum to carry his investment. From a questionnaire that I collected
I know that the professional costs of a practice of this size in Vancouver
would be at least $2,400.00 per annum. The total yearly income would
therefore be the postal clerk's salary of $1,700.00 plus investment dues
$2,025.83, plus running expenses $2,400.00. This makes a total of
$6,125.00. I am also convinced that he can not do justice either to himself or his patients and show more than 1,000 income producing hours
in the year. He should therefore receive $6.12 per income producing
hour.
To return to our "hat". I maintain that here in Vancouver the
minimum fee charged to the patient should be over $6.00 per hour. I
am also prepared to maintain that this is in the interests of the patient,
the practitioner, the community and the advancement of medical science.
I furher maintain that since the production, distribution and financing of
a product is of necessity in the hands of the producer, it is the duty of
the medical profession to arrange the financing and to sell their price as
well as their product. Finally, since the present situation is the result
of group opinion and as group opinion is but the sum of individual
opinions our problem is to alter a sufficient number of individual opinions
to alter the group opinion.
B. C. MEDICAL ASSOCIATION NOTES
We are able to publish this month a certain amount of advance
information regarding accommodation and proposed entertainment which
is being prepared for the members of the B. C. Medical Association, who
will attend the Annual Meeting in June, at Kelowna, B. C, May 26, 27
and 28.
Hotels
The Royal Anne will be able to make reservations for fifty. Most
of the rooms have private baths.
The Mayfair Hotel also can make about fifty reservations. There
are no private baths, but the hotel is comfortable and attractive.
The Willow Inn can take twenty-five reservations with or without
private baths as desired.
The Eldorado Arms is four and one-half miles from Kelowna, on
the lake-point. This is a well-known establishment and ideal for family
parties, especially if there are children. Its accommodations, for about
thirty-five, will all be held open for B.C. Medical reservations.
The local management of the C.P.R., will keep the steamer Sicamous
tied at the wharf and can furnish accommodation for one hundred. Both
railroads will keep a sleeping-car on the siding, provided a party from
the coast fills either of them. A porter will be in charge and the charge
will be based on a daily rental per berth.
It is important that everyone intending to be present shall write
at once to Dr. Underhill,  the local secretary at Kelowna,  asking  for
Page 147 reservations, in order that each one may be accommodated as he wishes.
This will also make it possible to decide whether the steamer and either
or both sleeping-cars will be needed.
The Golf Tournament will be a major event, and takes place on
Saturday afternoon. At the same time many of the beautiful gardens
of Kelowna will be the scene of afternoon teas. Numerous auto trips
through the valley have been arranged, and can be taken at any time
without any cost. The orchards should be in their gayest robes of
blossom and leaf, and saturating the whole atmsophere with their fragrance.
Two dances will be given, one of them at least at the Aquatic
Pavilion, so well-known to coast people who have attended the regattas
there.
Another item that is attractive will be an excursion by the steamer
Sicamous up the lake to visit Captain Dunwater's ranch at Finty.
The annual banquet will be held at the Royal Anne Hotel.
It hardly seems necessary to add after considering the list of entertaining features, that apart from the many advantages arising from the
meeting of the doctors from all corners of the Province to discuss the
affairs of their profession, and the scientific programme under preparation, a visit to Kelowna in the early summer will be a most delightful
way of taking a holiday. A change is as good as a rest, and going into
the highlands of the interior for a few days will offer all the elements to
provide a change, that can be found.
Change of altitude, change of atmosphere, change of scenery, change
from sea to lake, change from our daily grind to physical relaxation and
mental stimulation.    Come to Kelowna!
THE STRUGGLE TO MAINTAIN THE EDUCATIONAL STANDARDS OF THE COUNTRY IN THE
TREATMENT OF THE SICK
By Dr. A. P. Procter
In the Province of British Columbia there has been concluded an
inquiry into Chiropractic and Drugless Healing, presided over by the
Honourable Mr. Justice Murphy of the Supreme Court of British Columbia, who has just issued his report. A history of the struggle in this
Province of the profession to maintain the educational standards of
those who seek to treat the sick may be of some interest to the profession throughout the Dominion.
About the time of the Great War, and perhaps just before it,
chiropractors began to come in to British Columbia from the United
States, as they doubtless did in every Province in the Dominion. Their
primary and secondary educational qualifications were practically nil.
They based their claims as they do now for the right to be entrusted
with the treatment of the sick on the amazing theory that all disease
is the result of a misplaced vertebra, which impinges on the nerve passing through the intervertebral foramen resulting in the disease, whatever
it may be.    The cure is, of course, to reduce the so-called subluxation
Page   148 and Nature does the rest. Even infectious diseases, we are gravely told
by these people, will not occur in those whose spines are in proper alignment. In the Commission just held it was stated that the sublaxation
for infectious disease may not always occur in the same region. This,
briefly, is the Chiropractic theory, as stated by their representatives in
evidence to the Commissioner. Nothing else in the way of education,
apparently, or very little, is considered necessary. When one of these
gentlemen was asked ifi a recent inquiry in this Province what preliminary education he had received, he replied with apparent self-satisfaction that he had got into the third reader twice. It was only natural,
then, that the profession here, as elsewhere, viewed with alarm the granting of the right to treat the sick, with all that that responsibility means,
to men whose educational qualifications were a joke.
In 1921 and 1922, the chiropractors of British Columbia brought
Bills before the legislature for their legal recognition. The principle
upon which the profession took its stand was that no one should be
allowed the right to treat the sick unless he or she possessed a fundamental knowledge of certain standard subjects. In other words, when
these people showed knowledge and competency, the profession had no
desire to interfere with the particular line of treatment they desired to
adopt, but the knowledge of the human body and the ability to recognize
disease, were held to be essential, and no one without these qualifications
should be granted legal recognition. With these views, in 1921 and
1922, special committees appointed by the legislature to inquire into
this question, agreed, and a special section was placed in the Medical
Act providing for an examination in these subjects for chiropractors,
and later on, drugless healers, who also became insistent for recognition.
An examining Board was also provided for, composed of three doctors
and two Chiropractors, or three doctors and two Drugless Healers, and
it is interesting to note, from that date, not a single chiropractor or
drugless healer has ever presented himself or herself for examination.
The reason, of course, is obvious. They have little or no knowledge
whatever of these subjects, and doubtless felt there was no possibility of
passing an examination before anybody competent to examine them.
The agitation, however, has continued, one demand being for an Examining Board of their own members—the blind examining the blind—
their statement being that they refused to be examined by medical men
who do not understand the chiropractic standpoint, whatever that might
be, although it is a little difficult to understand how there can be one
kind of anatomy, physiology, or pathology for chiropractors, and another for the medical profession. The human body is the same for us
all, however much the mental processes may differ. However, since 1922
the agitation and demand for recognition has gone on and an enormous
amount of energy and money has been expended and a great deal of
time, both of the profession and the legislature, wasted, so that a year
ago when further bills in the interests of chiropractors and drugless
healers were brought before the legislature, in order to take this question out of politics and put an end to the ceaseless agitation, the profession requested the Government to refer the whole matter to a Commissioner, preferably a judge of the Supreme Court, upon whose report
the legislature might act.    To this the Government finally agreed, and
Page 149 the understanding was that the claims of these cults for legal recognition
would be referred to a Commission and a report presented at the next
session of the legislature, which it was hoped would dispose of the matter.
With this the profession was well content and awaited the appointment
of a Commissioner.
What the profession had every right to expect, was that a commission would be issued which would enable the Commissioner to go
into all questions necessary to enable him to come to a conclusion on
the matters involved, regarding Chiropractic and Drugless Healing. In
due course, the Honourable Mr. Justice Murphy was appointed as Commissioner, and I should like to take this opportunity of saying that no
better appointment could have been made. Mr. Justice Murphy holds
the respect and confidence, not only of the medical profession, but that
of all shades of opinion in the Province. A few days after this, the
Commission was issued, and to the amazement of the profession, it was
found that it was divided into two parts—one for chiropractors, which
was so restricted as to make the inquiry a farce—and one for drugless
healers, which was left fairly wide open. In the inquiry into chiropractic, as will be seen from Mr. Justice Murphy's report, he was absolutely prevented from going into the one question that really mattered,
and of paramount importance, that is, whether the qualifications these
people possessed rendered them safe in the public interest. His report
in opening the commission reads as follows:
"Questions of the efficacy of chiropractic or of its relative merit
as compared with medicine, were not open to be considered. In particular, no inquiry was to be made as to the adequacy or otherwise, from
the standpoint of protection of the public, of the accepted chiropractic
training for the diagnosis of disease, nor for the accepted chiropractic
method of treating human ailments."
Mr. Justice Murphy went to some pains in his report to drive this
fact home, and later on in the report, he reiterates in order to make the
limitations that had been forced upon him quite clear. "Once more (he
says) to guard against misapprehension, your Commissioner repeats that
the terms of the commission preclude him from making any investigation
as to whether or not the Chiropractic standard in reference to the proposed subjects for examination, does adequately protect the public." In
other words, Mr. Justice Murphy has gone to some pains to point out
in his report that he was quite unable to bring out the one fact that
ought to have mattered to the legislature of this Province, or any other
Province, as to whether the qualifications of the members of this cult
were of such a kind as to adequately protect the public. It may be
wondered, that with this question unsolved, because under the .terms of
the commission the Commissioner was effectively muzzled, how any
legislature can point to this report in order to justify the granting of
legal recognition to these people to treat the sick.
It naturally occurs to anybody interested enough to consider the
matter, as to why any government would appoint a Commissioner and
then under the terms of the commission effectively prevent his being able
to bring out any salient facts from which he could present a real report.
Page   150 The painful fact is that under our present political system, whenever it is considered that a sufficient number of people with a sufficient
number of votes, desire a thing, it would appear to be extremely difficult to prevent it, even though it is recognized to be all wrong. It may
well be asked, why in this country where we are spending hundreds of
thousands of dollars on higher education, and where, if our boys or
girls desire to study medicine, they have to spend from seven to ten
years before being considered safe to be entrusted with the great responsibility of treating the sick, our legislature, from motives of political
expediency, should be found apparently ready and willing to break down
the educational standards of the country and grant legal recognition to
those whose educational qualifications they know to be largely non
existent in any real sense.
The profession in this Province during the past ten or fifteen years
has done everything in its power to induce the legislature to confine
the granting of legal recognition to treat the sick to those whose qualifications adequately protect the public. It now feels that the responsibility for legalizing those who do not possess these qualifications should
be left squarely on the shoulders of the legislature where it properly
belongs.
Mr. Justice Murphy's report is not long, and is so interesting that
is may be found possible to print it for the information of the profession,
and will be found to bear out everything that has been written above.
Bay. 4234 L
MRS. KATE PEGRAM
C.A.M.R.G.
Medical and  Surgical Massage
Electricity                    Remedial Exercises
1645  11th AVENUE WEST
Vancouver,  B.   C.
Remedial
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Our  work  conducted  under
supervision    of    trained    instructors,       endorsed       by
members    of    medical    profession.
Doctor's   close  contact  with
patient   maintained   by   progress   charts   for   medical
reference
TRINITY 1550
n. s. Mcdonald
"Physical Culture"
804 Pender St. W.
Office Sey. 2855          Res. Doug. 4682Y
MISS BEATRICE GALLOP
C. A.  M.  R.  G.
Graduate
McGill   University   School   of   Massage
and Remedial Exercises
419 VANCOUVER BLOCK
Vancouver, B.  C.
Telephone Sey. 3334
MRS. E. M. PARR
Chartered Society of Massage and Medical Gymnastics,  England
Canadian   Association   of   Massage   and
Remedial   Gymnastics
430-431   BIRKS   BUILDING
Vancouver, B.  C.
Advertising
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Application
Page 151 ENDOCREOCOL
In Acute Colds, Coughs, Pneumonia,
Bronchitis,   Influenza  and  Asthma.
ENDOEERARSAN
In Anaemia, Pellagra, Mai Nutrition,
and    in    all    Secondary    Anaemias.
ENDOSAL
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BISMUTH SUSPENSION
Is a Painless Endo Product of Special Value in
relieving   Cerebro-Spinal   and   General   Syphilis
Endo Solutions are used in the Treatment of Varicose Veins
Endo Products are used by the leading hospitals and
physicians.
We cordially invite enquiries for our
Literature and Prices.
Dept. "A"
Endo Medical Products Ltd.
1870 Davenport Road, Toronto 9, Ontario
All solutions are made in our own laboratories. Why "Sweeten" the Baby's Bottle?
DEXTRI-MALTOSE IS A CARBOHYDRATE
THAT DOESN'T CLOY THE BABY'S APPETITE
When the time comes to feed soups, vegetables and
cereals to the infant whose formula has been modified
with Dextri-Maltose (not a sweetener)—both the
physician and the mother are gratified to notice the
baby's eager appetite for solid foods, because
Dextri-Maltose Does Not Cloy
Viosterol Safe in Pregnancy
USE    OF   VIOSTEROL    DURING    PREGNANCY
To the Editor:—Please advise me whether administration of irradiated
ergosterol to pregnant women could, cause a premature calcification of the
fetal head, resulting in dystocia, with possibly damage later to the child.
J.A.M.A.,
Dec. 19, 1931,
p. 1914
M.D., Waco, Texas.
Answer.—There is no danger to mother or ehild from
therapeutic doses of viosterol (irradiated ergosterol) given during pregnancy. In fact, such medication probably would be
of advantage, owing to the excessive drain of calcium and phosphorus that takes place during this period. This medication is
especially indicated in cases in which the intake of calcium-
compounds has been insufficient.
XTEAD'S VIOSTEROL IN OIL 250 D, because of its well-known effect upon
-!>▼•*- calcium absorption, is attracting increased interest among obstetricians for
use during pregnancy, especially in connection with foods rich in calcium, such as
Mead's Cereal (220 mgm. Calcium per oz.). Aside from its mineral nutritional
aspect, Mead's Viosterol in Oil 250 D has a marked effect in lowering blood coagulation time. Samples and literature on request. Mead Johnson & Company
of Canada, Ltd., Belleville, Ontario.    Pioneers in Vitamin Research.
Please enclose professional card -when requesting samples of Mead Johnson products to cooperate in preventing their
reaching unauthorized persons. (^Answers to Questions
THAT    PHYSICIANS    ARE    ASKING    ABOUT
PARKE-D AVI S
HALIVER OIL
WITH   VIOSTEROL —250   D
QUESTION:
What is Parke-Davis Haliver Oil?
ANSWER:
It is halibut liver oil, standardized to contain
60 times as much vitamin A as high grade
cod-liver oil, and with its vitamin D content
adjusted to equal that of Viosterol.
QUESTION:
Does Haliver Oil represent vitamin A in its
most concentrated form?
ANSWER:
Yes. It enables the physician to prescribe in
terms of drops or minims instead of teaspoon-
fuls. One minim equals a teaspoonful of
cod-liver oil.
QUESTION:
Is halibut liver oil rich in vitamin D as well
as vitamin A?
ANSWER:
Yes. It is the richest natural source of both
these vitamins. While especially rich in
vitamin A, halibut liver oil also contains from
20 to 25 times as much vitamin D as cod-liver
oil, which potency is increased to 250 D in
the finished product.
QUESTION:
Why has not halibut liver oil been available
to the medical profession before?
ANSWER:
Because the oil from the liver of the halibut
cannot be extracted by the methods commonly used for removing oil from the liver
of the cod. The method for extracting halibut
liver oil has but recently been perfected.
question-
Is this new product indicated wherever either
cod-liver oil or Viosterol has been used in
the past?
ANSWER:
It is. It successfully meets these indications,
because it provides both vitamins A and D in
highly concentrated form.
QUESTION:
What dosage is recommended?
ANSWER:
The average dose is 3 minims (10 drops) or
one capsule, once a day. Larger doses when
specifically indicated.
PARKE,   DAVIS    &    COMPANY
The world's largest makers of pharmaceutical and biological products
WALKERVILLE, ONTARIO
WINNIPEG, MANITOBA
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Liquid     —     Ampoules     —     Tablets
CIBA COMPANY LIMITED
MONTREAL
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Messrs.  McGill & Orme, Ltd.      -      Victoria,  B.  C.
keep a full range of "CIBA" specialties.
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Reference—5. C. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288

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