History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: January, 1926 Vancouver Medical Association Jan 31, 1926

Item Metadata

Download

Media
vma-1.0214599.pdf
Metadata
JSON: vma-1.0214599.json
JSON-LD: vma-1.0214599-ld.json
RDF/XML (Pretty): vma-1.0214599-rdf.xml
RDF/JSON: vma-1.0214599-rdf.json
Turtle: vma-1.0214599-turtle.txt
N-Triples: vma-1.0214599-rdf-ntriples.txt
Original Record: vma-1.0214599-source.json
Full Text
vma-1.0214599-fulltext.txt
Citation
vma-1.0214599.ris

Full Text

 XC
•H(
THE VANCOUVER MEDICAL
ASSOCIATION I
BULLETIN
Published monthly at Vancouver, B. C.
v. q. W. Staff
Sali
icin
Intravenous therapy
JANUARY, 1926
Published by
<£M.cGBeatk Spedding Limited, ^Vancouver, ^B. Q.
,,,  J^X*'1 —*-p®le
!IK2j3*?sl|b^K
*I@3H"
A few distinctive features of
Petrolagar
(Deshell)
PETROLAGAR {Deshell) is a corrective, not a cathartic. It
forms no habit, permitting decreasing instead of increasing
dosage and may be discontinued when regularity is established.
Its oil content is the greatest—65% mineral oil of the highest quality.    This
means maximum lubricating power and is of paramount importance.
The oil being emulsified, leakage is practically eliminated.
Agar is the sole emulsifying agent used—no fermentative gums or soaps.
Petrolagar   (Deshell)   is particularly palatable, more like ice cream thus making
the  physician's  task  easier;   both  children  and  adults  find   it  pleasant   to   take.
Three   years   of   satisfactory   results   in   clinical   usage   solely   under   physicians.'
prescriptions, prove conclusively the therapeutic value of Petrolagar   (Deshell).
PETROLAGAR  (DESHELL)  IS ADVERTISED ONLY TO PHYSICIANS
Petrolagar
(Plain)
No 1 Blue Label
The palatable emulsion of pure mineral
oil and agaragar is
indicated in the ordinary cases of constipation and as a follow
up in severe cases
when Petrolagar Phe-
nolphthalein has been
previously  used.
Petrolagar
(Phenolphthalein)
No.   2  Red  Label
Phenolphtbalein % gr.
to the tablespoonful,
is indicated in severely constipated individuals who have used
drastic purgatives. We
recommend reducing to
Plain after one or two
bottles.
Petrolagar Petrolagar
(Alkaline)
No. 3 Green Label
Contains magnesia calcined and is indicated in hyperacidity
and acidosis, and is
extremely useful in
gastric ulcer where
constipation is present.
Useful      in     Pyorrhea
and   acid-mouth.
(Unsweetened)
No. 4 Brown Label
Indicated for those
who do not like
sweets and may be
prescribed safely for
Diabetic patients. It
is bland like the
other numbers and
while unsweetened, is
unusually   palatable.
The principle of lubrication and balk calls for the  usage of Petrolagar Plain
in all cases unless special considerations indicate one of the other forms.
Deshell Laboratories of Canada, Limited, Dept. V.,
245 Carlaw Avenue, Toronto, Canada.
Please send without obligation, copy of Habit Time and samples of Petrolagar.
Dr.  I	
Address  	
c— ... . .       ...  i •	
<*S»  —way.
Page Two THE   VANCOUVER   MEDICAL   ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Association
in the Interests of the Medical Profession.
Offices:
529-30-31 Birks Building, 718 Granville St., Vancouver, B. C.
Editorial Board:
Or. J. M. Pearson
Dr. J. H. MacDermot Dr. Stanley Paulin
All communications to be addressed to the Editor at the above address.
VOL. 2.
JANUARY 1st, 1926
No. 4
OFFICERS, 1925 -26
Dr. J. A. Gillespie
President
Dr. A. w. Hunter
Vice-President
Secretary
Dr. G. H. Clement
TRUSTEES
Dr. W. F. Coy Dr. W. B. Burnett
Representative to B. C. Medical Association
Dr. a. J. MacLachlan
SECTIONS
Clinical Section
DR.   W.   L.   PEDLOW	
Dr. F. N. Robertson     -       -       -
Physiological and Pathological Section
Dr. G. F. Strong    "    - "     -
Dr. C. H. Bastin -	
Eye, Ear, Nose and Throat Section
Dr. Colin Graham      -       -   ■•   -
Dr. E. h. Saunders
Genito-Urinary Section
Dr. G. S. Gordon	
E>r. J. A. E. Campbell -       -       -
Physiotherapy Section
Dr. H. A. Barrett	
Dr. H. R. Ross	
COMMITTEES
Past  President
Dr. H. H. Milburn
Treasurer
Dr. A. B. Schinbein
Dr. J. M. Pearson
Auditor
Dr. A. C. Frost
Chairman
Secretary
Chairman
Secretary
Chairman
Secretary
Chairman
Secretary
Chairman
Secretary
Library Committee
Dr. Wallace Wilson
Dr. A. W. Bagnall
Dr. W. D. Keith
Dr. W. f. McKay
Orchestra  Committee
Dr. f. N. Robertson
Dr. J. A. Smith
Dr. L. Macmillan
Dr. a. m. Warner
Dinner Committee
Dr. G. F. Strong
Dr. W. A. Dobson
Dr. L. H. Appleby
Credit  Bureau   Committee
Dr. Lachlan Macmillan
Dr. J. W. WELCH
Dr. G. A. Lamont
Credentials Committee
Dr. Lyall Hodgins
Dr. R. Crosby
Dr. J. A. Sutherland
Summer School Committee
Dr. G. S. Gordon
Dr. Murray Blair
Dr. W. D. Keith
Dr. g. F. Strong
Dr. H. R. Storrs
Dr. R. Crosby VANCOUVER MEDICAL ASSOCIATION.
Founded 1898. Incorporated  1906.
Programme of the 28th Annual Session
GENERAL MEETINGS will be held on the first Tuesday of the month
at 8 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the month
at 8 p.m.
Place of Meeting will appear on Agenda.
General Meetings will conform to the following order:—
8.00  p.m.—Business as per Agenda.
9.00  p.m.—Paper of Evening.
1925.
OCTOBER   6th-
OCTOBER  20th—
NOVEMBER  3rd—
NOVEMBER   17th-
DECEMBER   1st—
DECEMBER   15 th-
1926.
JANUARY   5 th—
JANUARY   19th—
FEBRUARY 2nd—
FEBRUARY  16th—
MARCH 2nd—
MARCH   16th—
APRIL  6 th—
APRIL 20th-
General Meeting.
Presidential  Address:     DR.  J.  A.  GILLESPIE.
"The Progress and Future of Medicine."
Clinical Meeting.
General Meeting.
Paper:     DR. HlBBERT WlNSLOW HILL.
"The Part Played by  the  Laboratory  in Clinical
Medicine."
Clinical Meeting.
General Meeting.
Paper: DRS. WALLACE WILSON and LYALL HODGINS.
"Intravenous Therapy."
Clinical Meeting.
General Meeting.
Paper:     DR.  G.  F.  STRONG.
"Cardiac   Pain."
Clinical Meeting.
General Meeting.
Papers:     Dr. J. TATE MASON, of the Mason Clinic,
Seattle.
"Surgical Treatment of Thyroid Diseases."
DR. LESTER J. PALMER, of the Mason Clinic.
"Some Phases of  the  Diabetic  Situation."
DR. MASON will probably give a Clinic at the V.G.H.
on the morning of Feb. 2nd.
Clinical Meeting.
General Meeting.
The OSLER LECTURE.    DR. E. D. CARDER.
Clinical Meeting.
General Meeting.
Urological Evening.     DRS.  B.  H.  CHAMPION,  G.  H.
Clement, G. S. Gordon, and A. W. Hunter,
on
"Problems in Urological Diseases."
ANNUAL MEETING.
Page Four 1
156,000 square feet (over 3^ acres) of floor space devoted 10 the
scientific manufacture of X-Ray and Physical Therapy apparatus. This is a view of the Victor plant as a whole. Arrow points
to most recently completed unit.
^%
I Ready for 1926!    J||K
I This modern five story, reinforced concrete
I building is the latest addition to the Chicago
< plant of Victor X'Ray Corporation.
i The Medical and Dental professions are responsible for this.
' Because of their increasing demands for Victor X'Ray and
! Physical Therapy apparatus, it became imperative that our
: already extensive manufacturing facilities would have to be
| enlarged in order to meet them. Obviously, it would be poor
judgment to overcrowd production facilities and hope to retain
1 that quality which has led to world recognition of Victor prod'
i ucts as the standard in scientific design, construction and finish.
: The confidence placed in us by the Medical and Dental pro'
fessions is our greatest asset, and these increased facilities to
I meet their needs in electro-medical equipment is our tribute to
| that confidence. The same sincere efforts in research and manu'
j facturing activities, to the end that only the best that is scien-
' tifically possible to produce emanates from our specialised organ'
fixation, is the renewed Victor pledge for 1926.
Close-up of the latest addition
to the headquarters of Victor
OC-Ray Corp nation in Chicago. The first three floors will
be occupied by the general offices, educational departments
and di^blay rooms. The two
upper floors add 20,000 square
feet for manufacturing purposes, plus another 20,000
■ square fat as vacated by the
general ojfices en removal from
the old building..
*»
VICTOR X-RAY CORPORATION: 2012 Jackson Blvd., Chicago, 111
33 Direct Branches—Not Agencies—Throughout U. S. and Canad-
VICTOR X-RAY CORPORATION OF CANADA, LTD.
Vancouver Branch    -    910 Birks Bldg.
Jr
sk
XrRAY
Diagnostic and Deep Therapy
Apparatus. Also manufacturers
^       of the Coolidge Tube }
A
%*
PHYSICAL THERAPY
High Frequency, Ultra-Violet,
Sinusoidal,  Galvanic and
n^     Phototherapy Apparatus     ^ EDITOR'S PAGE.
It is a matter for regret that the Board of Directors of the
General Hospital was unable to accede to the suggestions of the
Medical Association regarding the appointment of the visiting
staff. The time at its disposal was too short to arrange for an
alteration' in the by-law to allow the new staff to take office at
the beginning of the year.
We think the ideas of the Medical Association were good,
and if adopted would at least have opened the way to an improved
service. An improved service that should have been of benefit to
the Hospital, the Medical profession, and the Patients.
Some years ago the interest of the medical world was focussed
on the Hospital as a large and successful example of the system
of the "open hospital." But we think that by now that reputation must be wearing a little thin. It still remains to enquire
what contribution a hospital of this nature can make to the general advance of medical science?
We have to confess that up to date this contribution has not
been large. Something more is evidently required than a great
institution and a large number of patients. A staff reorganized
along the lines suggested by the Medical Association might have
succeeded in utilizing and arranging the vast mass of clinical
material which is constantly to be found in the hospital, and producing something in the way of research of value to science and
of credit to the institution.
As we have pointed out before, the ease and satisfaction with
which the Directors are able to fill the indoor positions in the
Hospital, from General Superintendent to Interne, depends in the
long run upon the standing of the Hospital in the medical world.
Every piece of substantial work of a scientific nature which
is turned out of the Hospital is reflected in the enhanced reputation of the institution. Anything, therefore, which lends itself
to this end is worthy of the most earnest consideration. We
hope that, during the next three years, plans will be perfected to
permit of this reorganization. We scarcely think that the question of "limitation" of practice need be an insurmountable obstacle. If this requirement serves to push some long-hesitating
brother into a decision, which perhaps ought to have been made
long ago, it may indeed prove a blessing in disguise.
* * *
The BULLETIN has decided, with the approval of the Executive, to open its advertising columns to those members engaged
in certain definite branches of work. Advertisements will be
accepted from Clinical or Pathological Laboratories in charge of
medical men, from physicians doing X-ray work exclusively, and
from Physio-Therapy Institutions in charge of a qualified man
confining himself to that line of work.
Page Six Advertising rates may be obtained on enquiry at the offices
of the BULLETIN, or from the Publishers, Messrs. McBeath,
Spedding & Co., 569 Howe St.
* * *
It remains for us to wish our readers all the Compliments
of the Season. We shall hope that you have enjoyed the Christmas festival.
Although the excitement incident to the time when we were
very young may no longer be with us, we can rejoice in the little
halt in the world's activities which allows an expression of goodwill to all men and some endeavor to give it practical effect. We
wish you all a Happy New Year, moderately prosperous .as befits
a wise man, with scope and will and strength to do- your work
and to do it well.
* * *
NEWS AND NOTES.
The medical profession, equally with the general public, was
shocked by the recent tragic death of Miss Ann Roedde, following
an attack on her while pursuing her regular duties as nurse at the
Vancouver General Hospital. An impressive funeral service was
held at St. John's Church and was attended by a large body of
her fellow nurses, members of the medical profession, and the
general public.
Dr. Alex. Monro recently left for Rochester, Baltimore, and
New York. While away he hopes to get some relief from the
sciatica which has more or less incapacitated him for the past year.
We are glad that reports received before going to press indicate that
he is improved.
. Dr. J. J. Mason has recently enjoyed a short trip to Rochester
and New York.
Dr. Fred Robertson left on Christmas Day for Ontario to
visit his relatives. He expects later to proceed to New York for a
month's post-graduate study.
Dr. T. B. Anthony and Mrs. Anthony are holidaying in
Southern California.
MEDICAL MEETINGS.
The general meeting of the Vancouver Medical Association
was held on Dec. 1st, at 8 p.m. The Summer School Committee
announced the probability of the 1926 session being held in September, in order not to conflict with the annual meeting of the
Canadian Medical Association in Victoria, and to allow of cooperation with the post-graduate education scheme of that body.
The Dinner Committee announced a credit balance of $57.48
accruing from this year's annual dinner. Dr. W. W. Chipman
was unanimously elected to membership in the Association.    Drs.
Page Seven Wallace Wilson and Lyall Hodgins gave interesting and instructive
papers on "Intravenous Therapy," which appear in this issue.
A general meeting of the Association was held in the Auditorium, Tenth and Willow St., on December 10th, 1925. A
resolution passed by the Board of Directors of the Vancouver
General Hospital, stating its inability to accede to the request
of the Association that the appointment of the visiting staff be
deferred, was received and discussed. A resolution was then passed
amending the by-laws to allow the nominations and election to
be brought oh immediately. The President announced that nominations must be in by December 15th, and that voting by the
Association would take place on December 22nd, at 8 p.m.
The December meeting of the Clinical Section was held on
Dec. 15th, at the General Hospital, to hear Drs. D. J. Miller,
J. Nay and G. B. Murphy speak on Workmen's Compensation
matters.
Dr. Miller dealt principally with the Act, showing how the
employer and employee are benefited. The employer is freed from
liability. The workman receives 62^2 % of his wages and medical
attention. In case of death his dependants receive benefit and
$100.00 funeral expenses.
The Board is in the position of a court into which money
has been paid. They must have all the facts before judgment can
be given. Proof of accident is indispensable, or the workman receives no benefit. This rules out occupational injuries, e. g., an
injury caused by continued irritation. Occupational diseases are
not ruled out, however, such as anthrax, lead, mercury or arsenic
poisoning, cedar poisoning, dermatitis from cement, and caisson
disease, when occurring in specified occupations.
What is an accident?    This is defined by law.
'The nature of disability" as asked for in the reports, calls
for a thorough examination. The history of the accident should
be inquired into, as sometimes the major injury is at first overlooked.
"The period of disability" should be easy to decide, but the
profession falls down on this more than on any other point. A
fairly safe rule to use as a guide is, if there are no objective signs
after complete examinations made at different times, very little
attention should be paid to subjective ones. If a patient ceases to
improve under treatment, it should be reported, so that the Board
may make some settlement.
Expenses depend upon the profession, and doctors must be
guided by what they would do for the patient if he himself paid
the bill. The surgeon should ask himself, "Does this man really
require this service?"
Dr. Murphy dealt with specific cases, but before touching
these he explained something of how the Board works and what
happens when a workman is injured and reports beg'n to come in.
Page Eight One of the largest departments of the Board is the Claims
Department. Proper reports are necessary or the claim cannot be
properly handled.- Claims are divided into various classes; some
of these are active claims, no time loss claims, suspended, partial
payment claims, and rejected claims. Suspended and rejected
claims may be due to: No proof of accident, failure to report, or
no application from the workman.
In rejected claims there is a reason not always obvious to the
parties interested. About 75% of reductions of doctors' fees are
for want of sufficient information. A few are due to misunderstanding of the schedule of fees. Hospital fees can only be paid
when the case really demands hospital care.
Dr. Murphy read many actual reports which indicated the
sort of mistakes made and which led to misunderstandings.
In one case the doctor said the man would be off three weeks.
The man was at work in three days. Another case of a fractured
foot, where the fee is set by the schedule, the doctor's bill was disallowed, as he had charged for visits made. Another doctor had
put in a bill for transporting the injured man in his car. The
employer is supposed to supply transportation, so the doctor's bill
was reduced. Another doctor, treating a case of a lacerated finger,
charged for surgery, house, office and night visits. His bill was
disallowed till he explained that the man was confined to bed with
influenza. The matter of changing doctors also was illustrated.
This cannot be done without the Board's sanction, and in a case
cited the second doctor received no pay.
Dr. Nay took up the subjects of strained back, hernia, and
neurasthenia.
Strained backs are mostly myalgic, and as such cannot be
allowed. There must be an accident. If a man is seized with a
pain in the back while doing his regular work, and nothing unusual
has happened, it cannot be termed an accident.
Hernia is not generally allowed. Traumatic hernia is exceedingly rare. It is generally a congenital or an occupational condition. In these cases the hernia is allowed if some special strain
can be shown.
Neurasthenia was dealt with at some length. Dr. May showed
that much could be done to prevent it. It is usually seen in head
and spine injuries, especially if told that they have a "broken
back." The patients brood over this till they believe they are
hopeless cripples. Assurance by the doctor in the early stages is
most necessary.
Neurasthenia is divided into anxiety, spinal and hysterical
types. In anxiety neurasthenia there is headache, insomnia, tremor, loss of appetite, pain at the seat of injury. They blink their
eyes and look anxious.    There is nothing to be found.
Page Nine In spinal type, "My poor back" people, they walk with a
cane and hold their backs. The spine is tender, but nothing is
found.
In hysterical type, paralysis and paresis develop.
The discussion was opened by Dr. Whitelaw. Speaking.of
X-ray examinations of the head, he thought more plates than one
lateral view should be taken. Short fractures would not so easily
be overlooked. The spine should also be examined in different
positions. A fractured wrist is sometimes difficult to demonstrate
and may lead to some future trouble.
Dr. F. P. Patterson said that in lumbo-sacral injuries the
period of disability was hard to estimate. Some joint injuries are
also difficult. Fractures involving nerve injury may not show up
the nerve lesion till a later date. These may be caused by the
injury, manipulation, or by splints.
Dr. Riggs said head injuries may be very serious without any
fracture. Injury to the brain substance is more serious, either
concussion, haemorrhage or oedema, and may be the cause of a
condition which has been diagnosed as neurasthenia.
A vote of thanks to the three doctors was moved by Dr.
Duncan, and replied to by Dr. Miller.
SALICIN CONTENT OF BRITISH WILLOWS.
a
By R. H. Clarke and K. B. Gillie.
Department of Chemistry,  Unwetsity of British Columbia,
Vancouver.
(Reprinted from the American Journal of Pharmacy.  Sept.,   1921.)
SALICIN.
Salicin [ortho-hydroxy-benzyl-glucoside, CGH4 (OC-eHnO.-,) -
CH, (OH) ], was one of the first natural glucosides to be discovered.
It occurs in most, but not all, species of willow and poplar bark.
It is hydrolysed by mineral acids and by emulsin of almonds, to
dextrose and o-hydroxy-benzyl alcohol. As determined by this
enzyme action, salicin must be a glucoside. Populin, another glucoside, also occurs in the leaves and bark of poplars. It is not,
however, hydrolysed by emulsin of almonds. On the other hand,
it may be hydrolysed by barium hydrate to benzoic acid and salicin.
Salinigrin, a third glucoside, has been found in only one species
of willow, Salix discolor. Helicin, a glucoside isomeric with
salicin does not occur naturally.
The bark from the following species, Salix Nuttallii, Salix
Hookeriana, Salix sitchensis, Salix lasiandra, Salix purpurea, Pop-
ulus trichocarpa and Populus tremuloides, were analysed. We
wish to thank Professor John Davidson for his kindness in providing the various samples.
Page Ten Method of Analysis.
The bark was dried for forty-eight hours at a temperature of
about 110 degrees. Two samples of each, weighing twenty grams,
were taken, and digested separately for three hours with boiling
water and the solution filtered. Two grams of lead acetate were
then added to the filtrate to precipitate the proteins, which were
removed by filtration. The excess of lead was then precipitated
by the addition of the required amount of sulphuric acid, and the
liquid filtered. To this filtrate was added 100 cc. of the emulsin
of almonds solution, and the mixture allowed to stand sixty hours,
at which time the solution was diluted to two litres and two portions of 100 cc. were taken for analysis with Fehling's solution.
The weight of glucose present being found by reference to Munson
and Walker's tables. One mole of salicin gives on hydrolysis one
mole of glucose.
The emulsin of alnuands solution was prepared from sweet
almonds, from which the oil had been pressed, as follows: The
press cake was macerated for twenty-four hours with water, to
which a small amount of chloroform was added. The mixture
was then strained through a cloth and two drops of acetic acid
were added per 100 cc. of the liquid for the precipitation and removal of the proteins. To the filtrate was then added an equal
volume of alcohol, 50 cc. at a time, which caused the enzyme to
come down as a fine precipitate, which was filtered off, washed with
alcohol and immediately de-dissolved in water, to which a small
amount of toluene had been added. The solution of emulsin of
almonds so obtained was tested by treating solutions containing
known amounts of pure salicin. It was found that the hydrolysis
was complete after sixty hours. The results obtained were correct
to within less than  1 per cent.
As is seen from the following table of determinations, the
duplicate analyses are in close agreement, whilst the salicin content of the various species of willow and poplar show a considerable variation. Likewise the spring samples in most cases run
higher than the corresponding fall samples, in the cases of Salix
Hookeriana and Salix sitchensis a most notable difference was
found.
Table of Analyses.
FALL SAMPLES. SPRING SAMPLES.
Species                               (1)          (2)        Av'g. (1) (2) Av'g.
Per Ct. Per Ct. Per Ct. Per Ct. Per Ct. Per Ct.
Salix Nuttallii       3.88 3.92       3.90
4.47 4.51 4.49
Salix Hookeriana           0.79 0.84       0.81 5.18 5.00 5.09
Salix  sitchensis        2.68 2.92       2.80 7.32 7.43 7.38
Salix lasiandra .            .....     2.45 2.55        2.50 2.50 2.53 2.51
Salix purpurea* .1                                                        3.78 3.88 3.83
Populus trichocarpa       0.95 0.96       0.955            3.83 3.89 3.86
Populus   tremuloides  ......     3.80 3.74       3.77              2.42 2.48 2.45'
Page Eleven It might be pointed out that there is a large quantity of bark
at present annually available at the Vancouver basket factory. In
addition there is a very large supply of native willow on the lower
mainland of the province and on Vancouver Island.
ANALYSIS OF THYROID CASES
TREATED IN ST.  PAUL'S HOSPITAL  FORNTWO YEARS
ENDING OCTOBER,   1925.
Report to the Staff of St. Paul's Hospital, compiled by
Dr. C. E. Brown.
There were forty-one cases in all admitted to the Hospital
for treatment of a thyroid condition during the two-year period.
Of these five were treated non-surgically and thirty-six surgically.
Five cases treated non-surgically:
One died after four days in hospital. The final diagnosis
in this case was cholecystitis and hyperthyroidism. The patient
was a woman of 36, giving a history of indigestion for years, nervousness and palpitation. The nurse's notes show continuous
vomiting with a pulse always under 100. A slight enlargement
of the thyroid is noted. No basal metabolism recorded. There
is no apparent evidence of a thyroid death in this case.
Two had X-ray treatments. One of these, a woman of 54,
with moderate enlargement of the thyroid for the past 14 years,
nervous, irritable, depressed, choking sensations, B. P. 160-90,
P. 68-88, no B. M., diagnosis hyperthyroidism. Results of treatment not noted. The other case, a woman of 29, palpitation,
weakness, fainting, rapid irregular pulse 90-120, enlarged left
lobe (right lobe previously removed at operation), B. M. + 33
and + 47, diagnosis exophthalmic goitre, discharged slightly improved, pulse  124.
Two cases, one diagnosed hyperthyroidism and the other
exophthalmic goitre, were given iodine and both discharged slightly
improved.
Thirty-six cases treated surgically:
The diagnoses given in these cases were as follows:
Adenoma 10, toxic adenoma 7, exophthalmic goitre 11,
exophthalmic goitre with adenoma 2, toxic goitre (unclassified) 4,
toxic adenoma with malignancy  1, colloid goitre  1.
Three of these were subjected to a ligation operation only,
and were as follows:
(1) A woman, 38, with dizziness, exophthalmos, thyroid
showing bilateral enlargement, pulse rapid and irregular, no B. M.
recorded. Diagnosis on chart, toxic goitre; operation, ligation of
superior thyroid arteries.    Discharged improved.
Page Twelve (2) A woman, 54, with enlarged thyroid of two years'
standing, nervousness, tremor, rapid heart, P. 120, thin, anaemic,
no B. M. recorded. "Thyroid" artery had been tied a year ago.
Diagnosis, toxic goitre; operation, ligation of "thyroid" artery.
In .hospital ten weeks, discharged still nervous and pulse rapid.
(3) A woman, 50, goitre of eight years' duration, severe
palpitation, nervousness, weakness, sweating, dyspnoea, vomiting,
irregular heart. Symptoms commenced after empyema operation
three years previously. Pulse 140, B. P. 200, no diastolic limit,
general condition poor, thin, pale, exophthalmos, well marked,
symmetrical enlargement of thyroid passing behind sternum, rales
in chest, marked tremor and nervousness, B. M. + 53. Ligation
right superior thyroid; death three weeks later; diagnosis, exophthalmic goitre.
The remaining 33 cases were all subjected to operations on
the gland, which varied from lobectomies to sub-total thyroidectomies and bilateral partial lobectomies. In a good many no description of the type of operations done was given.
In only one case was the operation preceded by a preliminary
ligation of an artery, and in this case, one of exophthalmic goitre,
one superior thyroid artery had been tied several months previous
to a sub-total thyroidectomy.
Of these 33 thyroidectomy cases there was one death. The
patient, a man, 5 1, with dyspnoea, swelling of legs, nervousness,
loss of weight, insomnia, palpitation, enlarged heart following
history of rheumatic fever, large adenomatous goitre, B. M. + 47.
Partial removal of thyroid, with death on the following day. Section of thyroid showed adenoma with carcinoma.
Of the 36 operated cases one surgeon had 15 cases and no
deaths. The balance was under the care of 15 different surgeons,
10 of whom attended one case each.
The operative reports were very meagre on practically all
•cases, the history sheets in some cases were complete but many
were extremely vague and incomplete. The basal metabolic rate
was not recorded on many of the toxic cases, though no doubt a
number had been done previous to admission to hospital. Very
few specimens taken at operation were reported on by the laboratory. This has been remedied and all specimens in future will be
examined routinely.
The results following thyroidectomy, according to the information on the charts, have been good, the cases, with the one
exception, being discharged "improved" or "good."
The terms "toxic goitre" and "hyperthyroidism" we believe,
might be eliminated from the final diagnosis if a little more care
were taken with the history, physical examination, operative findings and laboratory reports.
Page Thirteen CITY HEALTH DEPARTMENT.
Vancouver, B. C.
STATISTICS — NOVEMBER, 1925.
Total Population  (estimated)      126,747
Asiatic Population   (estimated)           9,960
Rate per 1000 of
Pop. per Annum
Total  Deaths  ...._    116 11.1
Asiatic Deaths       12 14.7
Deaths—Residents only       85 8.2
Total Births—Male,     125
Female,   134     259 24.9
Stillbirths—not included in above       13
Infantile Mortality—
Deaths under one year of age ■_      1 0
Death Rate per 1000 Births 38.6
Cases of Infectious Diseases Reported.
October. November.       Dec.  1  fo 15
Cases. Deaths. Cases. Deaths. Cases. Deaths
Smallpox    M     2 0 0 0 0       0
Scarlet   Fever       16 0 28 0 10       0
Diphtheria       16 3 31 2 7       0
Chicken-pox    24 0 20 0 5       0
Measles       0 0 0 0 10
Mumps     49 0 101 0 44       0
Erysipelas           4 1 2 0 0       0
Tuberculosis       9 9 11 10 10
Whooping Cough       3 0 5 0 10
Typhoid Fever .                    4 0 3 1 2       0
Cases from outside City—included in above:
Diphtheria   _r      3 1 8 2 0       0
Smallpox        0 0 0 0 0       0
Scarlet Fever       5 0 8 0 5        0
Typhoid Fever _           ...     2 0 10 10
Page Fourteen LIBRARY NOTES.
(The Library is situated in 529-531 Birks Building, Granville Street, Vancouver. Librarian: Miss Firmin. Hours: 10
to 1 and 2 to 6.)
This month Drs. J. E. Campbell, F. C. McTavish and W.
S. Turnbull have given us reviews of books recently added to the
Library, and Drs. C. H. Vrooman and D. E. H. Cleveland have
forwarded extracts from current journals in the Library. Both
extracts are of interesting articles on different phases of tuberculosis. Dr. Keith's interesting note on gifts of old books to the
Library brought Hippocrates to the attention of the Committee,
and a copy of his writings, translated into excellent English, has
been ordered. The translation is by Jones, and is published in
the Loeb Classical Library.
ARS LONGA, VITA BREVIS EST.
A niche in our Library is given to the History of Medicine.
A niche which we trust will grow and become' quite a treasure
house for the medical philologist. Our Library possesses a grand
old volume, "The Oeconomia" (printed in Geneva in 1657, appeared first in Frankfurt in 1588), which was secured through
Dr. G. S. Gordon's activities. It contains something of the writings of the Deus Medicus. The September number of the Bulletin
of Johns Hopkins Hospital contains a most interesting paper entitled "Hippocrates," by Dr. John Rathbone Oliver. From this
I quote: —
"Modern scholars are fairly in accord nowadays in believing
that our Hippocratic Corpus represents the remains of a Medical
Library, the Medical Library of the great Medical School at Cos.
Such a Library would evidently contain books by the greatest of
its teachers, Hippocrates, not only complete treatises, but his clinical
notes or his headings for lectures. Then other important physicians of other schools would naturally send copies, 'presentation'
copies, of their publications to the Coan Library."
—W.. D. K.
BOOK REVIEWS.
"Common Infections of the Female Urethra and Cervix." By
Frank Kidd, F.R.C.S., and A. Malcolm Simpson. Oxford
Medical Publication. Oxford University Press. London and
Toronto.    1924.    7s. 6d.
It gives one almost a shock in reading the opening chapter of
this book, to find that so much fervour is spent on the necessity of
getting away from the traditional Sims' position in examining
women, and some gratification to realize that to us it is meaningless.
Page Fifteen Mr. Kidd is anything but a philosophical writer in that he
combines lucidity and an almost appalling certainty, but as he is
essentially a teacher and a propagandist, and his main insistence
is on the paramount importance of a meticulous examination, certainly no one can fail to be impressed with what he has to say.
In addition to his faith he has hope.
Frankly he is eminently sane, and several of his statements
are of decided interest. He seems to have unbounded faith in antiseptics, of which potassium permanganate holds the first place. He
implies that the urethra and cervix are infected at the same time,
but seems to give the urethra more honour than it deserves, while
he makes the categorical statement that gonorrhoea does not travel
to the tubes, the endometrium acting as a barrier, until the case
has been complicated by pregnancy. Therefore gonorrhoea does
not cause absolute sterility, only one-child marriages.
He is comfortingly definite on the Schwartz or complement
fixation test, which he discards, and equally sceptical of vaccines.
It is certainly a most useful book on gonorrhoea in women
and most pleasing, especially when our ideas coincide.
—J. E. C.
* * *
' The Advance of Orthopaedic Surgery." A. H. Tubby. Cloth,
7s. 6d. net. Pp. 144 with 31 illustrations. Lewis & Co.,
London.    1924. W§
This is a compilation, in book form, of six articles previously
published by the author in the Clinical Journal. He draws attention to the wonderful progress which has been made in this special
branch of surgery during the last thirty years, but more especially
during the period since the outbreak of the Great War in 1914.
This distressing experience provided a tremendous number and
variety of this class of case, to which surgeons throughout the
whole world devoted their best abilities and skill.
Chapters deal with: "Congenital and Growth Deformities,"
"Static and Postural Conditions," "Infantile and Spastic Paralysis," "Reconstructive, Regenerative and Re-creative Surgery," and
"Re-education: The Problem of Cripples: The Teaching and
Future of Orthopaedic Surgery."
In these Mr. Tubby emphasizes the many well recognized
and accepted orthopaedic principles which now guide the leaders
in this work. He draws his conclusions from his own experiences
in a long and extensive practice of this specialty, as well as from
the experiences of others practicing in his own country, on the
continent, but more particularly those in America.
In conclusion, this little book is a resume of progress made,
up to the present time, in the above named subjects, and is well
worth study. The "Bibliography" at the end of each chapter
is most exhaustive and helpful to anyone wishing to follow up
the subject.
—F. C McT.
Page Sixteen Appendix (1925) to Gynaecological and Obstetrical Monographs.
|   Published by Appleton 8 Company, London, 1925.    1 2s. 6d.
To those who have read the original monographs, the appendix comes as a very welcome addition. The monographs, up to
the time of publication three years ago, covered these subjects in
the most practical and complete manner of any work up to that
time. The appendix covers the work done since that time, and
presents the progress that has been made in very concise form.
Outstanding contributions are those on "Menstruation and
Its Disorders," "Pelvic Neoplasms," "Toxaemias of Pregnancy,"
and "Complications of Pregnancy." Perhaps in no phase of
gynaecology has more original and exhaustive work been done
than in that of the neoplasms, and while much of the information given is statistical, nevertheless it represents considerable progress.
The toxaemias of pregnancy, especially with reference to the
etiology, make interesting reading, while progress is apparent in
the treatment. The complications of pregnancy, other than the
toxaemias, affords valuable information for those doing obstetrics.
It affords some satisfaction to know that much of the complex and unsatisfactory treatment advocated a few years ago in
many pelvic conditions, has been discarded.
On the whole this book is a real addition to an already valuable work by outstanding men.
—W. S. T.
ABSTRACTS.
American Review of Tuberculosis, October,
1925.
"The Effect of Mercurochrome in-Experimental Tuberculosis of
the Rabbit."    H. J. Corper, Saul Mebel, and Rose Silver.
Numerous personal requests for information as to the possibility of using mercurochrome in tuberculous empyaemata and in
tuberculous pulmonary cavities, as well as by intravenous injection
for tuberculosis, prompted this study.
In tuberculosis De Witt has found that mercurochrome-220
inhibits the growth of tubercle bacilli in glycerol-agar completely
in a dilution of 1-5000 and partially at 1-10,000. In dilutions
of 1-100, but not in higher dilutions, it killed the tubercle bacillus
in 24 hours so that it would not infect guinea pigs.
The local tissue toxicity of mercurochrome was determined
in normal dogs by intracutaneous, intratracheal and intrapleural
injections.
Intracutaneously various dilutions were tried, and it was
found that the injection of 0.2 cc. of concentration as low as
0.5% of mercurochrome resulted in marked tissue destruction,
and 0.1 or 0.5% solutions produced evident though only transient
pathology with tissue changes.
Page  Seventeen Intratracheal Injections. 5 cc. of 0.5% mercurochrome produced areas of acute haemorrhagic pneumonia. Injection of 5 ?c.
of 0.01% caused a few suspicious areas of congestion, but no
pneumonia.
Intrapleural Injection. Injected into the pleural cavity 10 cc.
of 0.5% mercurochrome produced haemorrhagic pleurisy; 10 cc.
of 0.1% caused a dry fibrinous pleurisy.
Conclusion. As it has been demonstrated that mercurochrome
i? inhibitory to the tubercle bacillus in vitro only in dilutions above
0.02%, and it required exposure to 1% for 24 hours to kill them,
little can be expected from mercurochrome as a local antiseptic in
tuberculosis.
Intravenous Injection. Fifty-four rabbits were used, half receiving intravenous injections of virulent bovine tubercle bacillus
and half receiving an intravenus injection of virulent human tubercle bacillus. Half of the animals were treated immediately with
mercurochrome (5 mgm. per kilo) and daily for two weeks; the
other half were treated one week after infection.
Conclusion. Mercurochrome 220 soluble injected intravenously had no appreciable effect on the tuberculosis developing in
rabbits after intravenous injection of suspensions of virulent human or bovine tubercle bacillus.
—C. H. V.
* * *
"The Tubercle Bacillus as an Etiologic Factor in Lupus Erythematosus. A. Benson Cannon, M.D., and Geo. G. Ornstein,
M.D.    New York.    Arch. Derm, and Syph. 12: 690-699.
In this paper Cannon and Ornstein give a brief review of the
literature referring to the etiology of Lupus Erythematosus. They
demonstrate, in a series of cases where the Departments of Dermatology and Syphilology and of Bacteriology of the College of
Physicians and Surgeons' of Columbia University worked together, that there is a definite hypersensitiveness to tuberculin,
general, local and focal, in cases of Lupus Erythematosus, not
present in normal individuals. Further, in a series of 23 cases
of the disease, five furnished biopsy material producing tuberculosis, microscopic and macroscopic, when inoculated into guinea
pigs. Of these five patients four failed to show evidence of tuberculous lesions elsewhere in the body.
Most dermatologists at present regard Lupus Erythematosus
as a "cutaneous symptom which may be called forth by a variety
of causes of a toxic or septic character" (J. M. H. MacLeod),
which may in some instances be tuberculous. The insistence upon
its exclusively tuberculous nature is not now common, although
the Vienna school has that tendency. The total exclusion of tuberculosis from etiological consideration is rarer. This article gives
further support to the broad and inclusive view expressed by MacLeod.
—D. E. H. C.
Page Eighteen B. C. MEDICAL ASSOCIATION NEWS.
It is with very sincere regret that we record the death of
Dr. Melbourne Raynor, of Victoria. The circumstances of his
death were particularly tragic and painful, and great sympathy
is felt with his widow and family in their overwhelming loss.
Dr. Raynor was an outstanding man in the profession, and had
held many offices in the local and provincial Associations. He
was taking a prominent part in the preparations for the meeting
of the Canadian Medical Association in Victoria in 1926. He
took great interest in all civic and political affairs, and his influence and vote were always used for .social and moral betterment
and progress.
The 1925-26 sessions of the Fraser Valley Medical Society
opened on September 3rd.    Officers were elected as under:
Dr. G. T. Wilson, President;
Dr. W. A. Robertson, Vice-President;
Dr. O  Van Etter, Secretary-Treasurer.
Addresses were given by Dr. S. C. McEwen on "Physio-Therapy"
and Dr. Bruce Cannon on "Infective Infantile Diarrhoea."    A discussion followed, in which Drs. H. Collins, W. A. Robertson and
D. A. Clarke took part.
Clinical meetings of the Fraser Valley Medical Society, with
presentation of cases and case reports, are held at the Royal Columbian Hospital, New Westminster, on the third Thursday of each
month.
A "Well Babies" clinic is held at the Royal Columbian Hospital on the Wednesday of each week.
A clinical meeting of the No. 6 District Medical Society
(Vancouver Island) was held at Nanaimo on December 4th,
when Dr. George E. Seldon, of Vancouver, gave an instructive
talk on "Surgery of the Upper Abdomen," and Dr. C. E. Brown,
also of Vancouver, on 'Rehfuss tube in Diagnosis and Treatment."
An animated discussion followed each address. The Executive Secretary of the B. C. Medical Association gave an outline of the
proposed scheme for "Extra Mural Post-graduate Medical Education," which will be carried on throughout the Dominion by
the Canadian Medical Association in 1926.
The December meeting of the Victoria Medical Society was
addressed by Dr. A. S. Lamb, of the Provincial Department of
Health. He dealt with his work, in the capacity of specialist medical consultant in tuberculosis clinics, in charge of educational propaganda carried on by the Department throughout the province.
Dr. W. T. Barrett has just returned from a visit to eastern
clinics, notably the Mayo Clinic, the St. Paul Congress, and the
meeting of surgeons in Philadelphia.
Dr. Gordon C. Kenning has returned from a trip to New
York, Chicago, Detroit, Montreal, and the Mayo Clinic.
Dr. Hermann M. Robertson, of Victoria, has just returned
from a journey through the clinics in Eastern Canada and States.
Page Nineteen BLOOD TRANSFUSION.
By Dr. Wallace Wilson
READ BEFORE THE MEETING OF THE VANCOUVER MEDICAL
ASSOCIATION,  DECEMBER   1,   1925
Harvey Cushing remarks of any revolutionary advance in
surgery that it appears necessary for it to pass through three stages:
optimism, pessimism, and finally adaptation. Now it is true that
as a result of the impetus given by the undoubted success of blood
transfusion in haemorrhage and shock behind the lines in France,
the procedure has had an immense vogue in the years following
1918, and this is particularly true of the North American continent. Almost every known disease of any magnitude has had its
blood transfusion, enthusiastic reports and statistics have been
published, and the transfusion needle has swung far over to the
positive pole. From some reports now coming in it appears that
in some quarters at least the needle is commencing to swing in the
direction of the negative pole. Let me give you two examples of
these extremes:
(1.) Strauss (Surgery, Gynaecology and Obstetrics, November, 1925)—"For fourteen years I have used blood transfusion on
the slightest provocation when there was any question about the
risk to the patient, and usually before operation, with the result
that a questionable risk was converted into one that was absolutely
safe. ... I always perform blood transfusion when there is the
slightest suggestion of an indication for it, and with the most
gratifying results. . . . Repeated weekly small transfusions in extensive carcinoma have quite a telling effect."
(2.) Coffey commenced blood transfusion in 1908, and
thought he was saving many lives. He now only employs it two
to three times a year and has reached the stage where he says: "It
(blood transfusion) is a therapeutic measure which is probably
being overworked to such an extent that the question might be
raised as to whether, taken as a whole, the good it accomplishes
greatly outweighs the bad." (Quoted by Baldwin, American
Journal Medical Sciences, July, 1925).
Blood transfusion is, however, undoubtedly not only beneficial but a life saver for certain patients under certain conditions,
and it should be worth our while to discuss freely the When, How
and Why of this procedure, and to see if we are yet ready for the
stage of adaptation.
In the first place let it be granted that we know all abou.
blood incompatibilities and the blood groups of Jansky and Moss,
and then let us ask why it is that, with the exception of the paediatricians, we, in Vancouver, nearly all turn automatically to the
sodium citrate method. It is true the technique is simple, little
skill is required, and it is rarely necessary to cut the veins, and it
may be also true that for just those same reasons we are also all
the more easily persuaded by Lewisohn, its father, that sodium
citrate neither increases the fragility of the red cells nor decreases
the protective power of the whites.
Page Twenty If the Kimpton-Brown paraffined tubes are used for blood
transfusion, practice and skill are required in paraffining the tubes
and the veins are cut down on; with Unger's four-way swivel.
record, and Luer syringes the procedure is not without its technical
difficulties; and in using three 20 cc. glass syringes assistants are
required and time may be lost, yet why is it that, with the notable
exceptions of Frazier of Philadelphia and the Mayos, so many of
the leading surgeons of America use, and persist in using, the whole
blood method?
Apparently they do not subscribe to the innocuousness of
sodium citrate, and they do not like the chain of events that commences with the donor's blood flowing into a beaker with concurrent stirring and subsequent standing with possible cooling, and
finally ending with the blood flowing down a long rubber tube
into the recipient's vein.    They fear for a weak link.
Evidence has been advanced from time to time both for and
against both methods, and it is evident that the question is still a
moot one. It is only in a very few places, such as the Mount
Sinai Hospital, that both methods are used side by side, and there,
as far at least as post-transfusion chills are concerned, there seems
to be little to choose between whole and citrated blood.
Post-transfusion complications occur ever and anon with anyone who is doing blood transfusions. There may be, not infrequently, a chill, occasionally haematuria, and rarely death. Sooner
or later these complications will inevitably occur if we neglect to
group and if we neglect to re-group the recipient for a second transfusion. Trouble may also arise through faulty grouping, through
inaccurate technique of the actual operation, through lack of judgment in the choice of patient, and through a dim, indeterminate
admixture of all these three in varying proportons. Occasionally
even when the greatest care is exercised all the way through, the
unlooked for happens. Copher reports two cases of fatal haemolysis in which the blood grouping was perfect both before and after.
We are bound to admit that blood transfusion is never without
possibilities of trouble.
Direct matching of donor's and recipient's bloods is probably
more accurate than grouping in picking out incompatibilities. It
is stated that chills may be anticipated in recipients who have received previously anti-toxins, vaccines, bacterins, serums or coagulants, and such drugs as quinine and antipyrin, but undoubtedly,
speaking generally, as far as the choice of patient is concerned the
greatest number of chills follow transfusion for leukaemia and
acute sepsis, while it is rarely seen in acute massive haemorrhage.
It is definitely established that, to date, blood transfusion has
its greatest sphere of benefit in acute haemorrhage with marked
loss of blood and shock. Here the new blood acts as a coagulant,
reduces shock and, where operative interference is necessary, may
convert a grave surgical risk into a moderate one. In the same
way it should be of value following operation where there has been
considerable loss of blood and shock. Some cases of marked chronic
Page  Twenty-one secondary anaemia also benefit when the transfusion is used, either
as a curative procedure alone or preparatory to operation.
Herr, in the Boston Medical and Surgical Journal, points
out that a blood with a haemoglobin of 40% will carry on oxidation with the patient at rest in bed, and advocates transfusion when
the haemoglobin remains between 20 and 30 per cent, for any
length of time.
It must not be forgotten, however, that many cases of low
haemoglobin content stand operation remarkably well. In 1913,
Cullen, of Baltimore, reported on all gynaecological records of the
Johns Hopkins Hospital for the previous 23 years in which the
haemoglobin was 40% or below. There were 170 cases, made
up of:
Bleeding uterine fibroids       42  cases
Hyperplasia of the endometrium       23   cases
Carcinoma of the cervix      18  cases
and the remainder was made up of pelvic inflammations, retained
placenta and tubal pregnancies.
Several of the patients were moribund when brought in, and
died within a few hours without operation.
The haemoglobin content in the 170 cases ranged between
40 and 10 per cent.
In the minor operations, such as curettage, there was little
or no trouble.
Seventeen hysterectomies were performed with Hb. as low as
19% in one case, and the results clearly showed that with a very
low Hb. hysterectomy could be safely undertaken.
Of all the cases operated on only 13 died, and in none could
the low Hb. content of the blood be held directly responsible, but
rather to preceding conditions or complications, of which the
anaemia was at most only a small part.
In cases of chronic sepsis it has been argued that the benefit
derived is only proportional to the associated anaemia, and R. G.
Hoskins, Professor of Physiology at the Ohio State University,
goes so far as to state that he knows of nothing in the transfusion
of blood which could physiologically combat infection.
Probably all of us who have exhibited blood transfusion in
the presence of pernicious anaemia, can recall cases in which there
has appeared an apparent amelioration of the symptoms and a prolongation of life. Richard Cabot states: "I do not believe that
the modern habit of treating pernicious anaemia with transfusion
prolongs life. It will improve the condition for a certain period
of weeks. It will bring almost any patient up for a time. But if
I had pernicious anaemia I would not be transfused; I would not
take the bother."
MacLaren goes even further and states that while some years
ago he was very enthusiastic about transfusion in pernicious anaemia, now, after following a large number of these transfused cases,
he has no doubt that the transfusion did them more harm than
Page Twenty-two good, and many of them died earlier than they would have otherwise.
Transfusion in the leukaemias and acute sepsis is considered
to be not only useless but dangerous by many leading medical men,
and it is certain that the greatest number of post-transfusion chills
occur in these cases.
Blood transfusion is being used to some extent in severe
burns, and although Finney pronounces it dangerous, and Deaver
would use it only with anaemia, I think a case for it has been made
out by its protagonists.
Splendid results are undoubtedly obtained in haemorrhage of
the new-born, and in these cases it appears unnecessary to type,
the mother's blood being injected straight away into a vein or the
superior longitudinal sinus.
The list of conditions that have been submitted to transfusion could be continued indefinitely, and reference to the literature
shows glowing reports on the results obtained in conditions ranging from pneumococcal peritonitis, encephalitis lethargica, influenzal pneumonia and bacterial endocarditis, to the jaundice in connection with impacted stones in the common duct and carcinoma
of the pancreas.
It is not unlikely that such reports influenced Bevan when
he said, this year: "When I have seen a clinic in which dozens or
scores of blood transfusions were made, I felt that they were, with
the exception of a very small percentage of cases, of no value, and
employed without any sound indication. . . . Show me a clinic
in which a large number of transfusions are being done, and I will
show you a clinic in which a large number of unnecessary transfusions are made."
There are other phases of blood transfusion that can only be
mentioned. Immuno-transfusion does not appear to be based on
sound premises. Exsanguination-transfusion has been used with
success in certain selected cases, specially at the Sick Children's
Hospital, Toronto, and the paediatricians appear to be the pioneers
in this modification. Do they get absorption of the blood injected
into the peritoneal cavity? It appears to be the case in healthy
animals, but recently, in three infants coming to autopsy three
days after injection, the unaltered blood was found lying in the
peritoneal cavity.
For the purpose of this discussion I have here outlined in a
disjointed fashion some of the problems involved in blood transfusion. It is evident that many of them are still unsolved. It is
evident that what progress has been and is being made has been
and is being accomplished by the method of trial and error. It is
a sound scientific method and it is also the method recommended
by St. Paul to: "Prove all things, and hold fast to that which
is  good."
Page Twenty-three INTRAVENOUS THERAPY.
By Dr. G. Lyall Hodgins.
READ BEFORE THE MEETING OF THE VANCOUVER MEDICAL
ASSOCIATION,  DECEMBER   1,   1925
Intravenous therapy is used in the treatment of a large and
varied number of conditions. From one's own experience one
cannot form fair conclusions, because of lack of large numbers of
cases under control conditions. I, of course, am able only to give
a review of the subject.
To first mention a few points of physiology. Drugs, organic or inorganic, when given by mouth reach the blood stream
slowly and gradually. If a dose of 10 grs. of urotropin is taken
it reaches the blood stream particle by particle, and may be effectively dealt with without harmful results. This gradual admission is in contrast to the shock like admission of drugs by the
intravenous route.
Drugs by mouth, as a rule, first pass through the liver on
their way to the general circulation. Now it is clearly established
that the liver is a detoxicating organ. For instance, 1 m. of
horse serum by carotid vein in an anaphylactic animal may cause
death; 5 m. by mesenteric vein would be harmless. If the liver
is destroyed or diseased, protein diet soon causes coma in an experimental animal;   glucose revives it.
The blood is a fluid of a complex and finely balanced nature.
(1) It contains numerous chemical compounds, organic and
inorganic. These compounds are, in many cases, extremely complicated. They are unstable and are changing by interaction from
instant to instant.
(2) In physico-chemical terms the blood is a colloidal system, colloidal or glue-like, having a viscosity above that of
water. In a true solution the ions are dissociated, separated
as Na and CL in saline solution. The ions are, of course,
extremely small, the finest division of matter. The particles
of a colloidal solution, say, egg - white, are much larger,
are not simple ions but are complicated organic proteins, albumin,
etc. These particles are ultra-microscopic in size in permanent
suspension. One should, I believe, have some simple concept of
these physico-chemical characteristics to have a clear appreciation
of the hoped-for results of intravenous therapy. To illustrate one
effect of colloidal solution, a cube of metal 1 cm. each.edge with a
surface of 6 sq. cm. if in a colloidal state will have a surface of
60,000 cms. So that the colloidal condition of the blood implies
a tremendous surface of material, perhaps acres in extent. An acid
H2S04 and sodium bicarbonate will react in proportion to the
area of surface of contact. The acid on a lump of bicarbonate
having a surface of 1 sq. inch reacts at a definite rate. If the same
amount of soda bicarbonate is finely divided and spread out, the
reaction is very rapid. Of course, the energy of the reaction is
proportional only to the mass of each by weight, the speed of
reaction to the surface of contact.
Page Twenty-four The animal body, to maintain life, must avoid large mass
reactions with violent results, as excessive heat, etc., but must at the
same time during digestive, respiratory, secretory and muscular
activity, have speed of reaction to maintain a fine equilibrium.
The colloidal system of blood and cells provides a mechanism to
accomplish the above. It is an economical system, by weight a
small amount of solid material, but a large volume of water, the
universal solvent, conductor and insulator, slow to change in
temperature.
The buffer substances in the blood, bicarbonates, phosphates
and proteins, which are acid to bases and basic to acids, maintain
the blood in a slight degree of alkalinity, so that in life there is
never a variation equal to the range of tap to distilled water.
Colloidal systems of cells or the tissue of organs have strange
and weird chemical affinities. Tetanus toxin for nerve tissue,
digitoxin for heart muscle. Phenopthalein is excreted by kidney and
liver. Phenosulphophthalein, an SO radical added, excreted by
the kidney. Phenotetrachlorphthalein, a CL atom added, excreted
by the liver aolne. Such a list might be extended. Drugs
act differently on dogs, cats, rabbits and man. The haemoglobin of animals differ. But much more to the point is
the fact that a percentage of humans react differently from the
average expected reaction. These people are called reactors, are
said to be anaphylactic, allergic, anaphylactoxid, or to have an
idiosyncrasy. All these terms, I believe, mean the same thing.
With our present knowledge, a physico' chemical explanation is
the only possible one. There is a chemical upset rapid because of
the large colloidal surface and the complexity of the compounds,
a colloidoclasis, using Widal's term. Such a concept explains
symptoms of cardiac and respiratory failure, urticaria, chills, fever,
thrombosis, etc.
It is through a knoweldge of the above colloidal structure
and specific chemical affinities, that we hope to secure by intravenous administration of chemicals death to infecting organisms. For
instance, Ehrlich achieved, after many trials, in producing salvar-
san, a chemical death to spirochastes.
The value of non-specific protein therapy is hard to explain.
One possibility is that the anti-bodies are present but fixed, and
the non-specific protein injected frees them. The anti-bodies are
specific, but the means to free them is non-specific. I believe such
therapy should never be intravenous.
As to technique:
(1) The drug should always be given slowly, and one
should stop on any signs of reaction.
(2) A small needle, preferably a hypo, needle.
(3) Old tubing.
(4) The distilled water should be made with a special still,
since some triple distilled may contain a toxic product of bacteria
that causes reaction. This has recently been proven in the Sprague
Laboratory, Chicago.
Page  Twenty-five As to the curative effects of some drugs:
Glucose—The most useful. Five to six per cent, is isotonic.
Hypertonic is best: give slowly. 10% to 20% solution biologically tested on animals. One gram per kilo or Yi grain per lb.
of body weight, two or three times in 24 hours, supplies energy:
best given by vein, since a concentrated solution by rectum is irritating and a dilution useless. Glucose is a diuretic, taking water
from the tissues, valuable in liver conditions. Example, jaundice
is improved, uraemia improved.
Saline—Very useful in shock, haemorrhage and dehydration.
Sodii Bicarb.—Prepared as in the V. G. H. in ampoules.
Hypertonic salt 30% in Ringers 30 to 100 cc, to diminish brain
volume and cerebro-spinal fluid pressure. Hypotonic salt or distilled water to increase cerebro-spinal fluid pressure. Both controlled by manometric readings.
Digitalis—Effect by mouth two to six hours. Only justified by vein in emergencies. By mouth, excess, will be vomited.
By vein, excess is fatal in auricular fibrillation by causing ventricular
fibrillation, or if coronary sclerosis and a poor muscle may cause
ventricular fibrillation, and death. If given, use 0.5 mg. oubain
one dose.
Arsenicals—Out of 3,152 patients ten show reactions, shown
as nitritoid crises. Actrenalin prevents. These ten will react to
other drugs.    Persistence in treatment dangerous.
Mag. Sulph.— 1% solution 10-30 cc. helps convulsions in
children, due to acuate kidney disease.
Urotropin in pyelitis.
Calcium chloride and sodium iodide 10% solution 10 cc.
daily or twice daily, in asthma, urticaria, etc.    Sometimes helps.
Peptone—Intravenously for asthma, etc.    Reports show from
0 to 80% relief.
Serums and Vaccines, as a rule, can be given with as great
advantage subcutaneously or intramuscularly, and without as
much danger.
Distilled Water, used in hay fever, etc., may be dangerous.
Dyes—Merurochrome, acriflavine, gentian voilet. Five
grams per kilo of 1 % solution. May repeat and expect reactions.
This method of treatment is an attempt to cause death to organisms with chemical disinfectants. I believe, in serious infections their use is justified. The final judgment will be delayed
for years.
Conclusion—It can be shown by chemical and physical examination of the blood that almost any drug or solution by vein
causes an upset. It is a known clinical fact that in a percentage
of people the procedure is dangerous. Medical editorials and authorities advise against the method, yet it is used the world over.
1 believe, in serious, almost hopeless conditions, one is justified in
using any method offering a hope of relief. That for chronic
non-fatal conditions drugs should not, as a rule, be given by vein,
with the exception of salt and glucose.
Page Twenty-six THE UNIVERSAL CAR
housands of Medical men
from coast to coast are finding
in the FORD closed car the
solution of their transportation
problem from the standpoints of
ECONOMY, COMFORT and
SERVICE.   WHY NOT YOU?
We   offer  you a  24 hour  shop
service. Leave your car at night
and it will be ready in
the morning.
STONEHOUSE MOTORS LTD.
tyord "Dealers
418 GEORGIA STREET WEST
VANCOUVER, B.C.
<??$:
»F^>
Page Twenty-seven B. Q Pharmacal Co* Ltd.
329 Railway Street,
VANCOUVER.
Manufacturers of Hand-made Filled Soluble
Elastic Capsules.
Specimen  Formulae:
No. 20a—
Cascara Liq. Ext., 30m
Euonymin,  1 gr.
Podophyllin, J gr.
No, 29—
Cod Liver Oil, 25m.
Quinine, 1 gr.
Creosote, Beechwood,
2m.
Guaiacol, Pur., 2m.
Special Formulae Made on a Few Hours' Notice.
Price Lists and Formulae on
Application.
PRESCRIPTIONS
filled exactly as written
Phones: Seymour 1050 -1051
Day and Night Service
Qeorgia Pharmacy Ltd.
Qeorgia and Qranville Sts.
Vancouver, B. C.
Page Twenty-eight
v^ Frost Pharmacy LtcL
Gordon Frost
c+*s
Prescriptions a Specialty
OhS)
TWELFTH AVE. AT GRANVILLE
Phones:
Bay. 540 Bay. 1720
Say it with Flowers
Cut Flowers, Potted Plants, Bulbs, Trees,  Shrubs,
Roots,   Wedding  Bouquets.
Florists'  Supplies and  Funeral Designs  a specialty.
Three Stores to Serve You:
48 Hastings St. E. Phones Sey. 988 and 672
665 Granville St. Phones Sey. 9513 and 1391
151 Hastings St. W. Phone Sey. 1370
Brown Bros* & Co. Ltd.
VANCOUVER, B. C. Every Qood Wish
for your Happiness during the
New Year
CAPITOLA PHARMACY LTD.
FRED Q. BROWN
Prescription Specialists
Cor. Davie and Bute Streets Phone Sey. 158
The OipI Drug
Co., Ltd.
J{\\ prescriptions dispensed
bu, qualified Druggists.
l]ou can depend on the Ou?l
for Jlccuracu, and despatch.
VJe deliuer free of charge.
5 Stores, centrally located.    We
would appreciate a call while
in our territory.
Ambulance
Service
TELEPHONE
Fair. 58 & 59
M.ount Pleasant
Undertaking Co.   Ltd.
R. F. Harrison    W. E. Reynolds
Cor. Kingsway and Main
Page Thirty H. A. BARRETT, M.D.
TELEPHONE SEY. 4144
Practice  limited   to  Physiotherapy.
Quartz   Lamps,   water   and   air-cooled;    High   Frequency.
Galvanic Static and Wave Currents; Massage, etc.
Special   facilities   for   surgical   diathermy    (electro-coagulation) .
Hydrosine  bath  for   weight   reduction—by   artificial   exercise  of  muscular  tissue—not a  dehydrating process.
Electrolysis for hyertrichosis, etc.
Ionization for otorrhoea.     A. R. Friel's method.
Authorized   by   the   Workmen's   Compensation   Board   to
treat their cases.
Trained assistants only.
Hours   9   a.m.   to   6   p.m..   including  Saturday.     Evenings
by appointment.
Address:    Court House Block, 812 ROBSON STREET
Electro-Medical &
X-Ray Equipment
& Publications
Latest British and European
Apparatus. All types ULTRAVIOLET Lamps, including the
New Sun Lamps and Tungsten
Lamps.
Recent Works—
"Ultra-Violet Radiation," by
E. H. Russell, M D., and W.
Kerr Russell, M.D.
"Manual of Practical X-Ray
Work," by John Muir.
"Ultra-Violet Rays," Percy
Hall. M.D.
"Principles   of   Electro-Therapy," Turrell.
JDi$trib uto rs—
Empire Agencies Ltd.
543   Granville  Street
Vancouver
Nurses' Central
Directory
Phone Fairmont 5170
Day and Night
Mourly, Institutional and Private Nurses
Supplied
Registra.r--M.iss Archibald, R. N.
601 13th Ave. West, Vancouver
Patronize the
BULLETIN
advertisers.
Page Thirty-one £©c=
Iff
n@sf-
Hollywood Sanitarium
LIMITED
tyor the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference - <&. Q. dMedical ^Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183 Westminster 288
!5®>>
Page Thirty-two

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
https://iiif.library.ubc.ca/presentation/cdm.vma.1-0214599/manifest

Comment

Related Items