History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: September, 1937 Vancouver Medical Association Sep 30, 1937

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Vol. XIII.
No. 12
In This Issue:
. IN EUROPE '^p|- ' Ij
(With Cascara and Bile Salts)
. . FOR . .
Chronic Habitual
Western Wholesale Drug
(1928) Limited
(Or at all Vancouver Drug Co. Stores) THE   VANCOUVER   MEDICAL   ASSOCIATION
Published Monthly under the Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
203 Medical-Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. H. MacDermot
Dr. M. McC. Baird Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address
Vol. XIII.
No. 12
OFFICERS  1937-1938
Dr. G. H. Clement Dr. Lavell H. Leeson Dr. W. T. Ewing
President Vice-President Past President
Dr. W. T. Lockhart Dr. A. M. Agnew
Hon. Treasurer Hon. Secretary
Additional Members of Executive—Dr. J. R. Neilson, Dr. J. P. Bilodeau.
Dr. F. Brodie Dr. J. A. Gillespie Dr. F. P. Patterson
Historian: Dr. W. D. Keith
Auditors: Messrs. Shaw, Salter & Plommer.
Clinical Section
Dr. R. Palmer Chairman     Dr. W. W. Simpson Secretary
Eye, Ear, Nose and Throat
Dr. L. H. Leeson Chairman     Dr. S. G. Elliott Secretary
Pcediatric Section
Dr. G. A. Lamont Chairman    Dr. J. R. Davies ...Secretary
Cancer Section
Dr. B. J. Harrison Chairman    Dr. Roy Huggard Secretary
Summer School
Dr. G. F. Strong
Dr. R. Huggard
Dr. D. D. Freeze
Dr. A. W. Bagnall
Dr. S. Paulin
Db. W. F. Emmons
Dr. R. Huggard
Dr. H. A. Rawlings
Dr. R. Palmer
Dr. J. H. MacDermot
Dr. D. E. H. Cleveland
Db. Murray Baird
Dr. A. C. Frost
Dr. R. Mustard
Dr. J. R. Naden
Db. H. A. DesBrisay
Dr. A. B. Schinbein
Dr. A. Y. McNair
Dr. A. B. Schinbein
Dr. D. M. Meekison
Dr. F. J. Buller
Metropolitan Health Board
Advisory Committee
Dr. W. T. Ewing
Dr. H. A. Spohn
Dr. F. ,T. Buller
Representative to B. C. Medical Association—Db. Neil McDougall.
Sickness and Benevolent Fund—The Pbesident—The Tbustees
V. O. N. Advisory Board
Db. I. Day
Db. G. A. Lamont
Db. Keith Bubwell In Obstetrical
and Surgical Practice
Pituitary Extract (posterior lobe), an aqueous
preparation derived from the separated posterior lobe
of the pituitary gland, holds a well-recognized place
in materia medica.
In response to requests of physicians and hospitals
the Connaught Laboratories have made available a
preparation of Pituitary Extract (posterior lobe).
This preparation is a highly stable extract, biologically
standardized to contain ten International units per cc.
It is supplied in packages of five 1-cc. vials having
rubber stoppers which make possible the aseptic withdrawal of individual doses without contaminating
extract left in the vials for later use. Information
relating to Pituitary Extract (posterior lobe) will be
supplied gladly upon request.
Toronto 5
Depot for British Columbia
Macdonald's prescriptions Limited
Total Population—estimated _ . .  253,363
Japanese Population—estimated 1 -      8,522
Chinese Population—estimated -      7,765
Hindu Population—estimated        352
Rate per 1,000
Number       Population
Total deaths    188 8.7
Japanese deaths        4 5.5
Chinese deaths _        8 12.1
Deaths—Residents only ■    164 7.6
Male, 172; Female, 163    335 15.6
INFANTILE MORTALITY— July, 1937       July, 1936
Deaths under one year of age      12 9
Death rate—per 1,000 births..       35.8 32.6
Stillbirths (not included in above)        3 5
June, 1937
Cases Deaths
Smallpox   0 0
Scarlet Fever  25 0
Diphtheria    0 0
Chicken Pox  68 0
Measles   6 0
Rubella    2 0
Mumps  115 0
Whooping Cough  9 0
Typhoid Fever  0 0
Undulant Fever  1 0
Poliomyelitis     0 0
Tuberculosis .  29 12
Meningitis  (Epidemic)  0 0
Erysipelas  5 0
ist 1st
to 15th, 1937
Amphojel is an amphoteric substance which effectively neutralizes
gastric hydrochloric acid without producing" an alkaline reaction in the
stomach. . . . Even prolonged use cannot produce alkalosis or secondary acid rise. Amphojel is palatable, mixes readily with water or
milk, or may be administered undiluted if desired.
Samples and literature upon request.
Page 248 Sampl
FOR rapid, efficient and safe relief of high
blood pressure and its associated symptoms, you can rely on Hypotensyl.
This is a synergistic combination of dependable hypotensive agents—Viscum album ( Au-
ropean mistletoe) and hepatic and insulin-free
pancreatic extracts. It hastens recovery and
wins your patient's confidence.
Viscum album has proven remarkably effective for relief of hypertension (O'Hare and
Hoyt 1928, Barrow 1930 and Danzer 1934).
Frequently Hypotensyl effects a reduction of
20 to 30 mm. Hg. in 12 hours. Headaches and
dizziness vanish and reduction is sustained.
Excellent results are obtained in cases of essential hypertension or benign hyperpiesia.
Hypotensyl is also efficacious in treatment of
high blood pressure accompanying pregnancy
or due to fibrotic kidney. The benefit obtained
from careful control of diet, as well as mental
and physical rest, is accentuated by Hypotensyl.
The usual dose is 3 to 6 tablets daily, one-
half hour before meals. Best results are
obtained when treatment is given in courses
lasting two to three weeks, with a week's
interval between, upplied in bottles of 50
and 500 tablets.
The  Anglo-French  Drug  Company
3 54 St. Catherine Street East Montreal, Quebec BRITISH COLUMBIA MEDICAL ASSOCIATION
12:30 p.m.
2 :00 p.m.
3:00 p.m.
5:00 p.m.
7 :00 p.m.
8 :00 p.m.
Lectures one-half hour with ten minutes for discussion.
MONDAY, SEPTEMBER 13th—9:00 a.m.
Addresses of Welcome:
His Worship Mayor G. 0. Miller, Vancouver.
G. H. Clement, President Vancouver Medical Association.
DR. ADAMSON: "The Use of the Sedimentation Test in General Practice."
DR. MacCHARLES : "Diverticula of the Colon."
DR. GORDON : "A Study of 3,000 Cases of Obesity."
DR. OSGOOD: "Therapeutic Thinking."
-OFFICIAL LUNCHEON—Hotel Georgia Ballroom, 75c.
Dr. T. H. Leggett, Ottawa; President, Canadian Medical Assn.
Dr. T.  C. Routley, Toronto;  General  Secretary,  Canadian
Medical Association.
—Motion picture—"Heart."
—Demonstrations of Newer Technique—Vancouver General Hospital, Main Operating Room.
—Meeting of the Council of the College of Physicians and Surgeons
of British Columbia.
—Motion picture—"Heart."
—Conference on Public Health.
Brief papers followed by questions and discussion.
8 :00 a.m.—Motion picture—"Heart."
9 :00 a.m.—DR. OSGOOD : "Recent Advances in Hematology."
DR. ADAMSOX: "The Treatment of Chronic Constipation."
Anaemia. Conducted by Dr. Lyall Hodgins.
Fractures. Conducted by Dr. F. P. Patterson.
3. Infant Feeding. Conducted by Dr. E. J. Curtis.
4. Gynaecological Endocrinology.   Conducted by Dr. W. N.
11:30 a.m.—DR. HENRY : "Surgical Treatment of Intra-Capsular Fractures
of the Hip."
12 :30 p.m.—NO HOST LUNCHEON—Hotel Georgia.
1:30 p.m.—Conference on Contract Group Practice.
Three papers—questions and discussion.
4 :00 p.m.—Conference for Coroners.
Four brief papers and discussion.
7:00 p.m.—Motion picture—"Heart."
8 :00 p.m.—Annual Business Session of the British Columbia Medical Assn.
Chairman: Dr. G. F. Strong, President.
9:00 p.m.—Annual Meeting of the College of Physicians and Surgeons of B.C.
Chairman: Dr. S. Cameron MacEwen, President.
8:00 a.m.—Motion pictures—-"Heart."
9 :00 a.m.—DR. MacCHARLES : "Some Problems of Biliary Surgery."
DR. ADAMSON: "Respiratory Sepsis."
DR. HENRY : "Fusion of Spine with Bone Chips."
DR. OSGOOD : "Hypertensive Cardiovascular Renal Disease."
12:15 p.m.—LUNCHEON—Board  of Directors,  British  Columbia  Medical
1:30 p.m.—GOLF—New Capilano Golf Course, British Properties, West
Page 2U
We were among those who had the pleasure of hearing Dr. Ethlyn Trapp,
who has just returned from a two years' trip to Europe, give an account
of her wanderings and observations, and it is with pleasure that we publish
this in the present issue of the Bulletin. Dr. Trapp was, of course, devoting
most of her time to studying the whole question of cancer therapy in its
various forms as best exemplified in various centres, and apart from the
aesthetic value of her travelogue, and this was high, it is a rather important
contribution to our present attempts in British Columbia to meet the cancer
problem successfully and establish adequate diagnostic and treatment
Of course British Columbia has its own peculiar difficulties. We cannot
hope, with our limited population and equally limited .financial resources, to
equal the efforts of large and wealthy centres of population; but it is vitally
important, as Dr. Trapp points out, that the problem be attacked from the
right angle. We must pay close heed to the advice, based on long and sometimes bitter experience, given us by the authorities whom Dr. Trapp quotes.
These people stress again and again the necessity for a co-ordinated and
coherent plant of construction, based on a central nucleus, and limited to this
at every step. Decentralization, the spreading of one's efforts over various
inco-ordinated centres, they deprecate most urgently. It has frustrated and
limited efficiency and retarded progress wherever it has been tried, notably
in such a city as London. Research has been stifled, and energy dissipated.
We should take this to heart here, where our B. C. Cancer Foundation has
made such a good start, and is at present at a rather critical crossroads in
its existence. We can not make Dr. Trapp responsible for our personal
opinion, that the Foundation must at all costs, even at the cost of some delay
and apparent waste of time, preserve its identity as a central provincial unit,
controlling absolutely any subsidiary centres that may be established. It
should not run the risk of being submerged in any other organization whatever—even if this would seem temporarily to give an advantage in speed
and apparent efficiency.
To quote Dr. Trapp: "The absolute necessity of centralization as a sine
qua non of efficient cancer work has been established. Here in British Columbia . . . we are tragically behind the times, but we have the tremendous
advantage of beginning from nothing, with nearly thirty years of the trial
and error of other places by which to profit."
% aft $ _fe
Medicine has many great and honourable traditions—and in no profession, we think, has a member greater cause to be proud of his calling—but one
of the greatest things, we think, about the art of medicine is its complete
freedom from national, religious and racial prejudice of any kind; also—and
this is perhaps a natural corollary ofxthe other—the complete freedom of
interchange between all medical men; we have no secrets, no patents, no
proprietary rights in any knowledge we may have, any discoveries we may
make, any skill we may acquire: all is freely and gladly given a deux mains
to any and every brother in the craft. It is one of the greatest glories of
medicine that this should be so—and we feel sure that it will ever remain so.
Dr. Trapp, to quote her again, in her travels through a Europe which is filled
to the brim with suspicion and hate and fear, born of national, racial and
religious prejudices and conflicts, moved serenely in a high and clear atmosphere, untroubled and untouched by any breath of doubt or suspicion. What
a magnificent thing this is! How clearly one sees that the only hope for the
world of men, for the endurance of civilisation, is that we should attain in
some degree to this exalted ideal of life. The moral underlying it is perhaps
that this is our reward, often undeserved, always unappreciated, for the fact
that the noblest exponents of medicine have always put the service of others
first, and self-interest last. Perhaps this may encourage and cheer those of
>/0 us who sometimes feel that life is all giving, and not much getting; and
perhaps, paradoxically, the opposite is the more really true.
Consider our everyday experience, that any and every medical man of
note that passes through Vancouver gladly and freely gives of his store to
his professional brothers here, and this is true all over the world. It was not
personal profit or self-advertisement that made Dr. Walter Schiller of Vienna
give three evenings to us, and three lectures that were of priceless value—
that brings the Rowntrees and the Boyds,and the Grahams, and all the rest
of them here, to tell us of their best and latest work in their respective fields;
that brought Dr. Emil Ries here last week to tell us of some work he has
done, of great value, which has not yet even been published. It is all part of
the same habit of giving that, as we said, is a part of the daily work of these,
our big men. One feels that it is good, from time to time, to think of these
things. It is like a deep breath of fresh air, refreshing and stimulating, and
we need it occasionally. 	
We urge all our readers to take the fullest advantage of the meeting of
the B. C. Medical, from September 13th to 15th inclusive. It is being held
in the Hotel Georgia in Vancouver, and has been thoroughly prepared for.
There is abundance for everyone, and the economics of medicine are
especially in evidence. The sectional meetings are bound to be of great value
and interest, and we congratulate the Executive on their wisdom in introducing this feature, a new one to our meetings.
The B. C. College of Physicians and Surgeons is holding its annual
meeting too, and this will be of great significance.
We bespeak a large attendance for this most important meeting. It is one
of the few occasions when no fee is charged, and this may be of some help.
Programme for Fall and Winter Session
Details of the Programme for the Session of 1937-38 are being completed
and will be published in the October Bulletin. The first lecture of the season,
at the General Meeting on October 5th, will be given by Dr. Howard Spohn,
the title being "Conditioned Reflexes and Their Relation to Medical Practice."
The profession throughout the whole province extends its sincere
sympathy to Dr. and Mrs. A. McBurney of Langley Prairie in their deep
sorrow sustained in the loss of their son Albert by death from a diving
Dr. and Mrs. Murray McC. Baird are being congratulated on the birth of
a daughter on August 19th.       *      *      *      *
Dr. C. W. Prowd, Dr. F. H. Bonnell, Dr. B. J. Harrison and Dr. Ethlyn
Trapp will attend the Fifth International Congress of Radiology, to be held
in Chicago September 13th to 17th.
♦ #      #      #
Dr. W. T. Ewing has left by automobile for a six weeks' holiday in the
East. He will go as far as Montreal.
* *      .      *
Dr. G. L. Watson, who has been at the Vancouver General Hospital for
some years, is relieving Dr. Ewing, during the absence of the latter in Eastern
Canada. *     *     *     *
Dr. T. McPherson and Dr. L. H. Appleby have left for Ottawa to attend
the meeting of the Medical Council of Canada.
Page 246 We are very glad to welcome back Dr. Ethlyn Trapp, who has been on an
extended trip to Europe. Dr. Trapp was away over two years, and during
that time travelled extensively, going by way of China and returning direct
from Europe.
* *     *      *
Dr. W. M. Paton has left by motor for Mexico for a holiday of a month
or six weeks.
* *      *      *
Dr. J. Wright has opened offices in the Medical-Dental Building.
.      *      *      .
Dr. H. H. Caple, who returned from England a few months ago, where
he did post-graduate work in various hospitals, will open an office with Dr.
W. S. Turnbull in the Medical-Dental Building.
* *      *      *
Dr. and Mrs. H. M. Ross are receiving congratulations on the birth of a
daughter on July 30th.
* *      *      *
We offer our heartiest congratulations to Dr. W. E. Harrison on his marriage to Miss Freda A. Garthorne. The wedding took place in West Vancouver
on July 31st.
* *      *      *
Another event of great interest to members of the Association was the
marriage on August 19th of Dr. J. A. Smith to Miss Gwendolyn Rothwell.
Following the ceremony Dr. and Mrs. Smith left on the Empress of Russia
for Honolulu.
* *      *      *
We are glad to hear that Dr. A. W. Bagnall, who has been in the Private
Ward Pavilion of the Vancouver General Hospital for nearly one month, is
well enough to leave the hospital, although it will be some weeks before he
will be able to resume his practice.
Dr. C. W. .Sanders, ship surgeon on the Empress of Russia, is recuperating at his home at Gordon Head, near Victoria.
♦ ♦ ♦ ♦
Dr. Giles B. Murphy sailed on August 19th as ship surgeon on the Empress
of Russia.
* *      *      *
Dr. A. N. Beattie, having returned from England, has left the Empress of
Japan, on which he served as senior ship surgeon of the Canadian Pacific
Steamships fleet. Dr. Beattie is now located at loco, having taken over the
practice of Dr. E. K. Pinkerton.
Dr. E. K. Pinkerton has moved from loco and is opening offices in the
Medical-Dental Building in Vancouver. He has almost recovered from the
effects of an automobile accident from which he escaped as an innocent ,but
unfortunate victim.
* *      *      *
Dr. R. W. Garner of the Albernis on Vancouver Island is away on a
vacation. Dr. J. King Kelly is associated with Dr. J. C. Thomas as locum
tenens during Dr. Garner's absence.
* *      *      *
Dr. R. W. Irving of Kamloops has spent his vacation between his Celesta
camp on Shuswap Lake and Vancouver. He always takes his horses along,
and during the racing season his horses have put the Sunshine Stud Farm
on the map, having captured two firsts, two seconds and a third place in
five days' racing at Lansdowne Park.
Page 247 July 26th was a great day, according to Dr. Lyon Appleby, Who shared
Dr. Irving's thrill when the latter's- two two-year-olds finished first and
second. Dr. Irving says it is more fun than surgery, and more sure pay.
3f- _|t )ft V
Dr. L. C. Steindel, who is well known at St. Paul's Hospital, Vancouver,
and at St. Joseph's Hospital in Victoria, and who has made many friends as
locum tenens at various points in this province, has been at Burns Lake
during August, relieving Dr. Holmes. Dr. Steindel was in charge of Burns
Lake Hospital when Lord Tweedsmuir and the Vice-Regal party honoured
this splendid institution in the north by a visit en route to Tweedsmuir Park.
* *      *      *
Dr. W. T. Kergin of Prince Rupert has returned to that port and is
reported to be in excellent health following a most enjoyable round-the-world
3JC 3fC 3|t JJ*
Dr. W. A. Kergin, who accompanied Dr. W. T. Kergin and did special
work in Great Britain, is now returning to Premier, where Dr. Kritzwiser
has been relieving him during several months.
* *      *      .
Dr. G. D. Oliver of Quesnel, who is associated with Dr. Gerald Baker in
the practice in the Cariboo centre, called on the Executive Secretary while
on a visit to Vancouver in August.
if: a|e sf; ..fe
Dr. D. A. Steele recently returned to the Province, and will share offices
in the Medical-Dental Building with Dr. Pinkerton.
Dr. S. Cameron MacEwen of New Westminster accompanied the gubernatorial party into Tweedsmuir Park. Dr. MacEwen had his Hardy along, and
we are certain he will soon make the Front Page with a mammoth trout in
his creel.
Dr. J. Ross Davidson, after spending several years in practice at Ocean
Falls, has moved to Vancouver and is opening offices.
-I- # * a.
Dr. R. D. Coddington, who returned to the Province several months ago,
is now associated with Dr. R. Gilchrist in the practice at Ocean Falls.
* ♦     ♦     ♦
Dr. W. S. Huckvale is associated with Dr. D. W. Davis of Kimberley as
locum tenens during the absence of Dr. J. S. F. Haszard on vacation.
* ♦      -t-      ♦
Dr. Huckvale will go to Hazelton and be associated with Dr. L. B. Wrinch
in the practice there.
9{e % s{s sf.
Dr. F. R. G. Langston and wife (Dr. Kathleen Woods) are away on
holidays, returning in August. Dr. D. C. MacKenzie is associated with Dr.
W. B. Cannon while Dr. Langston is away.
» *
Dr. H. T. Hogan is at Blakemore during the absence of Dr. H. W. Cannon.
H5 H* H* ♦
Dr. S. G. Baldwin and wife are leaving Vernon and will be absent from
the Province until next Spring. Dr. Baldwin will visit European centres
before coming to Vancouver to practice.
Dr. H. J. Alexander has left for Vernon, where he will take over the
practice of Dr. Baldwin, and be associated with Dr. Frank H. Pettman.
Ethlyn Trapp, M.D.
First may I say how pleased I am to be back among my associates and
thank your President for having asked me to address this meeting. There
is nothing like a trip abroad to make one appreciate one's native land. One
sees with fresh eyes advantages that have always been accepted as a matter
of course, and discovers conscious pride in a Canadian birthright.
Second-hand travel is notoriously dull, but I ask your patience while I
briefly sketch in a few of the highlights of a tour of European cancer centres,
in search of methods of organization and treatment that could be brought
back and be of use in British Columbia.
London, of course, seemed the obvious place for a Britisher to begin, so
I set out to renew my acquaintance with the London clinics, of which there
are some eight treatment and three research centres. Excellent individual
work is being done in each of these places, but as far as treatment goes
there is absolutely no centralization or co-ordination, with the result that
each place must learn through its own experience which methods are good
and which bad, and clinical research of any magnitude is quite impossible.
This fact is bitterly regretted by all those involved, but up to now all efforts
at co-ordination have been fruitless, and one is warned again and again to
beware of this mistake of decentralization and advised to begin with a
central nucleus, however small. This was the opinion of every cancer therapist I talked with. As a result of that mistaken initial policy, London still
lags years behind the Continent, and even some of the English provincial
centres, in its grasp of the cancer problem. The National Radium Trust and
Commission, when they took over the distribution of the large quantities of
radium purchased in 1929, made centralization one of their chief objects.
They also laid down rules concerning the personnel of centres using this
national radium. These must have at least one full-time radium therapist
with a recognized standard of training and an adequate physics department.
By this step the National Radium Commission recognized the paramount
importance of centralization and of a trained personnel for the treatment of
cancer, and the new centres established in Great Britain since that time are
practically all on this satisfactory basis.
In London itself there are only two clinics whose work is recognized
abroad as being of international importance. They are the Radium Beam
Research Branch of the Radium Institute and the Marie Curie Hospital for
the Treatment of Cancer in Women. The latter has the best five-year survival
rate in the world for cancer of the cervix and uses the Stockholm technique.
Becoming a little discouraged with the time spent in going from one
London clinic to another, I decided to set out for the Continent and return
to the London attack later. The fact that my sister and her car were available had some bearing on this decision, and to the horror of our English
friends the two of us set out for Berlin in mid-winter in an open Ford—an
English one at that. On looking back, I cannot recommend too highly this
means of transportation for a medical tour; cheap and reasonably comfortable, and affording unlimited opportunities for seeing the countries through
which we passed. We did have fool's luck—just missing a three-day English
fog and arriving in Berlin before the worst snowstorm of the year effectively
blocked the roads for some days.
Berlin hospitals are colossal, but a few letters of introduction and a
smattering of German make the way very easy. Neither of these is really
essential, but they do help. Medicine is truly international and I have never
yet visited a hospital where a professional card did not assure a welcome.
This is an interesting anomaly of the fear-ridden Europe of today, where
no man dares to trust his neighbour, or, at times, even his own brother.
Page 249 Germans have been pioneers in the field of x-ray therapy and in their
thorough and painstaking way have investigated all that can be accomplished
by voltages up to two hundred thousand. Post-war poverty has prevented
their doing much with radium, though each centre makes use of a certain
amount. The same reason has prevented the development of super-voltages
which are so popular in America, but not the use of contact therapy as used
first by Chaoul at the Charite, and imported into Vancouver about a year
ago by Dr. Prowd. This is an ideal type of therapy for certain superficial
cancers and is now being widely used throughout the world.
Of course, as in other countries, surgery plays its own essential part in
the management of cancer, but that is not a new development, and in some
fields, notably cancer of the cervix, it has been almost entirely replaced by
radiological treatment.
The weather being bad, and we not caring to trust our luck too far, the
"Flying Hamburger" took us to Professor Halthusen's clinic in that city. To
my mind he is the most important of the German x-ray giants. It was he
who put the measurement of depth dosage on a scientific basis. He speaks
excellent English and gives frequent lectures in England and in the United
After some weeks of Berlin clinics we set out for Frankfurt, on the way
spending a month at the gynaecological clinic of Professor Martius in Got-
tingen. This is the oldest university town of North Germany and one of the
bitterest Jew-baiting centres of the country. It affords a good demonstration
of the effect of the National Socialist regime on German scientific work. In
the first place the actual number of students has shrunk from six to two
thousand, and professors complain bitterly, though not openly, that Nazi
activities are so sapping the energy of their young men that none is left for
adequate research work, or indeed any other scientific endeavour. However,
Professor Martius himself has developed an interesting three-fold method
of treatment for cervix cancer; an x-ray contact tube after the type of the
Chaoul tube, applied to the parametria, as well as the usual radium applications and deep x-ray therapy. He believes that this method has materially
improved their results, but the thesis has not yet been published and it is
too early to draw accurate conclusions.
Professor Holdfelder at Frankfurt is another of the very well known
German radiologists. Some ten or twelve years ago he developed the Holdfelder "Canon" and ingenious methods of tumour localization. The tangential
method of treating breast cancer also originated with him. His methods, or
modifications of them, are still widely used in all x-ray clinics.
Wintz in Erlangen is famous for his short massive dosages and still
steadily maintains the virtue of this method, in spite of the opposite trend
throughout the rest of the radiological world.
It is now cherry blossom time and we bid a reluctant farewell to the
Rhine and follow the Danube to Vienna. This was my third visit to that city
of misfortunes and each time one marvels afresh at her survival, but as somebody has remarked, "Whoever heard of a beautiful woman starving?" To
quote Stephen Spender: "The two traditions that still live and seem to
have a future are medical science and the performance but not the creation
of music."
Vienna is pre-eminently a surgical and pathological centre and is the only
place of note on the Continent that still considers early cancer of the cervix
a surgical problem; and it is handled with consummate skill, largely by
vaginal hysterectomy.
This city is also unique in having specialists in pathology, notably such
men as Schiller in the gynaecological field, who has recently lectured to you
here in Vancouver, demonstrating the possibility and importance of the early
diagnosis of uterine cancer. Radium and x-ray therapy, however, have not
Page 250 been neglected. For years each hospital has had its own department for this
type of treatment, and since my last visit some five years ago, a large new
cancer centre has been established at Lainz, on the outskirts of Vienna, and
here one finds the same sort of co-ordinated work that has proved itself to be
of value elsewhere.
With Vienna as a centre we drove into Hungary and Czecho-Slovakia.
Brunn has one of the best cancer institutes in Europe, simply but completely
equipped for all types of treatment, an adequate and enthusiastic personnel
and a very efficient record and follow-up system. It also has research facilities and maintains an excellent physics department.
Budapest has a new centre of the same type as that in Brunn and its
staff is equally enthusiastic over the success of their efforts. It is difficult to
associate cancer with that fairy-land city of dreamlike buildings and gypsy
music, and after an exhaustive tour of the new Institute we forgot the
medical side of Budapest.
From Vienna we returned to the Rhine once more and made our way
back to England. After further visits in London clinics we flew to Moscow,
where we had arranged to meet the Spohns, and had a three weeks' glimpse
of the Soviet Union. A fantastic three weeks it was, difficult and uncomfortable, but one of the highlights to be remembered. We saw no medical work
in Moscow, but on reaching Leningrad, Professor Krasnagorski, formerly an
associate of Pavlov's and now a psediatrist of international note, took us in
hand and kept us enthralled for a fortnight. We saw Pavlov's town laboratory
and his experimental farm, where conditioned reflexes are being investigated
in apes as well as in dogs. The former fared better than any humans we saw,
including tourists like ourselves, and our mouths watered when bowls of ripe
raspberries appeared to complete their lunch of fresh beef and vegetables.
We had not set eyes on such luxuries since arriving in Russia.
Cancer work, like everything else, is in the throes of new development.
There is a tremendous new institute in Leningrad which carries on extensive
research work as well as the usual clinical activities. Patients there are in
unbelievable numbers but one gets an impression of chaos, and must reserve
judgment. An interesting sidelight is the way in which state medicine is
carried to its logical conclusion, medical students being trained by the State
and actually given a small salary during their training. The entrance examinations are competitive and the first five years after graduation must be
spent in a country practice.
Then followed Scandinavia, the only sane countries of Europe. The
Radiumhemmet in Stockholm was established in 1910 with a very modest
beginning. There are now three centres in Sweden and, to the best of my
knowledge, it is the only country in the world where cancer is adequately
dealt with from the point of view of the whole population. It was the pioneer
in the field of centralization for cancer work and has been the inspiration
for similar centres throughout the world. Their methods of treatment have
been more widely used than any others, Paris being the only rival in this
field. In this connection it has been well said that the whole world follows
either Stockholm or Paris.
Brussels and Louvain, the most important Belgian clinics, having the
advantage of large quantities of radium at their disposal, have been pioneers
in pure radium therapy, and were responsible for the inauguration of beam
or telecurie therapy. They were also pioneers in physical measurement and
were the first to use the roentgen "r" to measure the gamma rays of radium.
This was a great advance and has made possible the accurate physical
measurement of radium dosage, which gives a common basis for comparison
of treatments from patient to patient and clinic to clinic.
This particular phase of the Brussels work was adopted and simplified
in Manchester. It has been successfully used there for the past five years and
has played no small part in the phenomenal development of this clinic.
Page 251 The Second International Cancer Congress was held in Brussels last
September and was an interesting event, although no new facts of outstanding importance were forthcoming. However, it did give one a very good
birdseye view of the present position of cancer research as well as therapy.
In this connection it may be of interest to quote the summing up of the
Lancet report of this meeting, which was attended by five hundred delegates
representing forty-two countries:
"In retrospect two main impressions emerge from the papers read
at this important congress. As regards treatment, much hope must be
attached to future developments in x-ray therapy; with growth in
knowledge concerning the application, combined with scientific standardization of the dosage, this mode of attack appears to carry the
greatest promise. In the laboratory the present recognition of carcinogenic agents of an extrinsic character seems to mark a definite stage
in research, and the feeling is widespread that efforts must now be
directed towards the discovery of some more fundamental intrinsic
factor or factors which may determine the development of cancer in
the presence of one of these known extrinsic agents."
Two British scienists, Professor Cook in association with Professor Ken-
naway, investigating the carcinogenic properties of certain chemical agents,
won the prize offered through the International Cancer Union for the best
research of the year. The work was carried out in the research laboratories
of the Royal Cancer Hospital in London.
Political tensions were not absent and there were incidents to remind one
of the fantastic nationalism of modern Europe. The Italian delegate, though
speaking both English and French, was ordered by Mussolini to read his
paper in Italian and addressed empty chairs, which was a pity as he was
a distinguished man and had important research work to report.
The Poles refused to give their addresses at all, and left the Congress in
high dudgeon because Polish was not made one of the official languages.
The Germans had almost to return through lack of funds, being limited
to the usual fifteen marks on leaving Germany. The Nazi Government had
given them maintenance cheques, but these the Brussels banks refused to
honour. The German Consul eventually came to the rescue out of his own
private funds.
Paris and the Foundation Curie, the home of Regaud and Coutard, is,
like Stockholm, too widely known to require much comment. An impressive
feature was the meticulous clinical observation and care of the patients under
treatment. Coutard himself examined each patient before or after treatment,
which was twice and sometimes three times daily. In no other way could he
make such accurate prognoses. It is a leisurely clinic and no patients are
accepted for treatment unless there is some hope of cure. There is no so-called
"palliative" treatment, which involves so much of the time of other clinics.
Villejuife, the city cancer institute, takes care of the hopeless cases and a
large and well-equipped institute it is, supported entirely by the French
More days in London, then Edinburgh, which has not yet got its cancer
work successfully co-ordinated, though reorganization has recently been
undertaken by a man trained in Manchester. I was advised to stop in that
city on my way south, which I did, planning to remain for a few days, and
finding myself still there at the end of six months; I might add with a few
week-ends in London in the interval, which lightened the prevailing atmosphere of smoke and depression.
Nothing could be a greater tribute to Manchester work than a prolonged
stay in that dark city of the Midlands, which accepts philosophically the
worst that the English climate can offer, together with the worst of economic
depressions. Such a clinic combined with the delights of Vienna, Paris, or
even London, would be too much for this imperfect world.
Page 252 However, here I found what I had been seeking on the Continent for
months—that is, a reasonably accurate method of radium dosage established
on a combined physical and clinical basis, and thus not entirely dependent
for its success on the experience of one particular radio-therapist; a method
which could be used elsewhere without the usual learning by experience
which may be paid for so dearly by the patient.
Centralization began in Manchester in .1915 with the formation of the
Manchester District Radium Institute, which at first was merely a pooling
of the available quantities of radium, so that the supply should always be
adequate for different types of treatment and also that it be kept constantly
employed, a most important practical consideration with such an expensive
It soon became obvious that specialized medical attention was necessary
and a medical director was appointed, this in spite of the difficulties of
carrying out treatments in different hospitals.
In 1921 a central nucleus of beds was provided by the purchase of a
small nursing home.
In 1929, when the National Radium Trust and Commission was formed
for the purchase and allocation of radium throughout Great Britain, the
University, the Radium Institute and the Manchester Infirmary became the
Manchester centre of the Commission.
Soon after the Institute amalgamated with the Christie Cancer Hospital
and large new quarters were built. These were completed in 1932.
Since then, under its present Director, Dr. Ralston PatersOn, it has
grown to be one of the most important centres of Europe, and visiting doctors
come from all parts of the world.
A striking demonstration of the influence such an Institute can exert
in a community is shown by the fact that whereas in the early years of its
career the percentage of deaths to admissions was eighty, in the last annual
report it had decreased to eight. This fact must be largely attributed to the
greater percentage of early cancer rather than the improvement in the
technique of treatment, though that, no doubt, played its part. It also"exemplifies the statement that early and late cancer are two different diseases,
one curable and the other not.
It seemed to me that the Manchester plan which has been in successful
operation for some years would, with some modification, be suitable for
adaptation in British Columbia, so I propose to briefly outline their work.
There is a central unit with a whole-time specialist radio-therapeutic
staff, a pathologist, physicists, technicians and a well-organized record and
follow-up system; adequate radium and x-ray equipment, and the ordinary
ancillary services of a hospital. The surgical work is done by the honorary
surgical staff, with specialists in the various fields, who, of course, receive
fees for private patients. Daily diagnostic clinics are carried on throughout
the year with consultation on all new and recurrent cases. In addition to
this a radium service scheme was evolved by which specialist services became
available by voluntary agreement to towns of the surrounding hinterland.
A "radium clinic" is held in the local hospital at regular intervals, dependent
on the number of patients. This clinic is conducted by a member of the staff
of the central Institute in collaboration with the local staff. All new patients
are seen first in this clinic and all post-treatment follow-up visits are also
here. The patients go to Manchester for radium treatment, but any surgical
procedure is carried out locally and when possible collaborative treatments,
that is, surgery of access and radium. X-ray treatment depends on the
available local equipment but frequently must be carried out in Manchester.
Page 258 Arrangements for this can be made comparatively easily, as hospital beds
are not often necessary.
As well as this work carried on in nearby towns, other agreements have
been made with the large voluntary hospitals of Manchester itself. Regular
"treatment visits" have been arranged for and visiting therapists from the
Radium Institute carry out these treatments. For example, the Manchester
Infirmary has placed a whole ward at the disposal of the Radium Institute
and an operating room is available for an afternoon a week. For x-ray treatment bed patients are daily transported by ambulance to the central unit—
an expensive method, but at that cheaper than providing the large number
of beds that would otherwise be required.
One is tempted to continue indefinitely about Manchester, which is an
inspiring clinic and has solved so many of the problems of cancer organization and treatment, Dr. Paterson having picked out the best from the various
English and Continental centres and adapted it to his own particular needs.
However, my half hour must be nearly over and I would like to just touch
on Rome.
I had not previously planned to go so far afield, but a last-minute decision
took me to Egypt and I thus had the opportunity for a birdseye view of
Italy's most important cancer clinics. I was not long enough there to see a
great deal of the actual treatment, but it seemed to follow the general trend
of other Continental capitals. The cancer work is centralized in special institutes, and amazing places there are in Rome, even surpassing the American
conception of luxury in equipment. Mussolini evidently believes in doing all
his building on the grand scale and does not confine it to huge forums named
after himself.
In passing may I mention Cairo's 2,000-bed hospital with its daily quota
of 8,000 outpatients* The interminable corridors were a test of endurance,
but fortunately a taxi took us from one department to the next and the panorama from the roof was a rich reward. Cairo and her mosques, the Nile and
the pyramids and the endless desert. The effects of the new regime were
already apparent and British and American doctors were being rapidly
replaced by Egyptians.
I have deliberately confined my remarks to European clinics, though
equally important work is being done on this side of the Atlantic.
On returning to Vancouver I am astonished to find the situation apparently the same as when I left two years ago. At that time the B. C. Cancer
Foundation had been inaugurated and I thought then the foundation stone
of a Cancer Institute practically laid. I learn that there have been various
upheavals in the interval. However, the work of the cancer foundation has
gone on. The Government guaranteed a loan for the purchase of three and a
half grammes of radium. The King George V Silver Jubilee Cancer Fund
gives us their moral and mildly financial support with a $14,000 annual grant
for organization purposes throughout Canada, and the United Commercial
Travellers of Canada have dopted cancer as their permanent charity.
The absolute necessity of centralization as a sine qua non of efficient
cancer work has been established. Here in British Columbia, where nothing
of a public nature has been done, we are tragically behind the times, but
we have the tremendous advantage of beginning from nothing, with nearly
thirty years of the trial and error of other places by which to profit.
So, gentlemen, with no mistakes to rectify, we have here the opportunity
of establishing the very best type of cancer work that present-day knowledge
permits, indeed of leading Canada in this field. With the spade work already
done, now is the time to seize our opportunity and to act.
Monday, September 13th, 3:00-5:3 0 p.m.
Demonstration of Various Technical Procedures of General Interest.
All of these will be held in the Main Operating Room of the Vancouver
General Hospital, with the exception of Artificial Pneumothorax, which
will be held in the Tuberculosis Centre of the Provincial Department of
Health, Tenth and Willow St.
1.   3:00-5 :00 p.m.
3:00-3 :25 p.m.-
-"Artificial Pneumothorax"—Dr. Wesley Simpson.
(Tuberculosis Centre, Tenth and Willow St.)
-"Various Anaesthetic Procedures"—Dr. D. D. Freeze.
3 :00-3:55 p.m.—"Taking Blood Specimens in Infants, Intravenous Therapy in Infants"—Dr. E. J. Curtis.
4:00-4:25 p.m.—"Examination of the Eye for Foreign Body and Technique for Removal Thereof"—Dr. F. W. Brydone-Jack.
4:30-4.55 p.m.—"Cistern Puncture—Diagnostic Novocaine Block in Cer-
vico-thoracic Sympathetic Chain"—Dr. Frank Turnbull.
5:00-5 :30 p.m.—"New Appliances for the Treatment of Fractures"—Dr.
J. R. Naden.
Note: These demonstrations will start and finish on time.
Conference on Public Health
This special meeting has been developed by and will be presided over by
Dr. J. R. Naden, Chairman of the Committee on Public Health of the British
Columbia Medical Association. All members are requested to attend this
important meeting. It will commence at 8 p.m. promptly on Monday, September 13th. The programme provides for presentation of papers as hereunder:
1.    "Provincial Tuberculosis Control"—Dr. W. H. Hatfield.
"Provincial Venereal Disease Control"—Dr. S. C. Peterson.
"Provincial Vital Statistics Division"—Dr. K. F. Brandon.
"Provincial Laboratory Services"—Dr. C. E. Dodman.
"Rural School Medical Services"—Dr. J. R. Naden.
"Provincial Mental Hygiene Programme"—Dr. E. J. Ryan.
Metropolitan Health Department—
"General Outline of Metropolitan Health Department"—Dr. J. W. Mcintosh.
"Infant and Pre-School Programme"—Dr. S. Stewart Murray.
"School Medical Services"—Dr. Harold White.
"Communicable Disease Control and Immunization"—Dr. E. D.
Papers will be limited to 7% minutes by the clock and gong,
and questions will require three minutes, and speakers will thus have 2%
minutes for replies. Owing to the length of the programme the speakers
must be restricted in time and discussion must be similarly prompt.
The idea underlying this feature is to define the programme of Public
Health rather than to defend it and to assure sympathetic understanding
and enlist support and co-operation of the general practitioner.
Thursday, September 14th
Round Table Conferences, 10:30 a.m.
Four separate conferences in four separate rooms, as follows:
1. "Anaemia"—Dr. W. Lyall Hodgins.
2. "Fractures"—Dr. F. P. Patterson.
3. "Infant Feeding"—Dr. H. A. Spohn.
4. "Gynaecological Endocrinology"—Dr. W. N. Kemp.
These Round Table Discussions are a new feature. You will attend the
discussion of your choice. Questions are invited, to carry on the discussion-
Page 255
Discussion Conference on Contract Practice, 1:30 p.m.
Three brief papers as detailed hereunder:
1. "Some Salient Points in Contract Work"—Dr. J. B. Thorn, Trail, B. C.
2. "A Study of Medical Service in Logging Operations"—Dr. G. W. C.
Bissett, Duncan, B. C.
3. "The Mining Industry and Its Medical Service"—Dr. R. J. Wride,
Princeton, B. C.
The presentation of the various phases by these three speakers will open
the discussion. Many interesting speakers will be heard and much will be
learned which should be productive, leading towards improvement in conditions.
All members of the Association should attend these conferences.
Dr. S. Cameron MacEwen, Chairman of the Committee on Economics of
the Council, will act as Chairman at this meeting.
Conference for Coroners, 4:00 p.m.
This Conference is under the chairmanship of Dr. Osborne Morris of
Vernon. The following definite programme will be presented:
1. "The Relation of the Coroner to the Profession and Public"—Dr. J. D.
Whitbread, Coroner, Vancouver, B. C.
2. "Observation of Causes, Natural and Other"—Dr. A. W. Hunter, Cor
oner's Physician, Vancouver, B. C. ffl
3. "Examination at Autopsy"—Dr. H. H. Pitts, Pathologist, Vancouver
General Hospital.
4. "The Laboratory in Coroner's Investigations"—Inspector J. F. C. B.
The above programme will be presented, leading up to discussion and
questions. All members are invited to attend this meeting.
*      *      .       .
Lecture Periods
The lecture periods are all confined to the morning sessions of all three
days. Please see the General Programme for details of speakers and subjects.
The lectures are arranged as follows:
Four lectures on Monday morning.
Three lectures on Tuesday morning.
Four lectures on Wednesday morning.
Official Luncheon, Hotel Georgia Ballroom
Monday, September 13th, 12:30 p.m.
This luncheon should be largely attended. The Mayor of Vancouver will
be present and speakers and visitors will be introduced and welcomed. Dr.
T. H. Leggett of Ottawa, President of the Canadian Medical Association, and
Dr. T. C. Routley, General Secretary, will be present and will address the
members at this luncheon. Please secure tickets at the Registration Desk
at the Ballroom entrance.
Dr. Roy Huggard is in charge of Registration and requests that all members register early and signify what functions they wish to attend.
Dr. Bilodeau will want to know how many will play golf on Wednesday.
Dr. N. E. MacDougall will want to know:
1.   How many for Official Luncheon on Monday.
How many for Annual Dinner on Wednesday.
W. McNutt will want to know how many will require transpor-
Dr. L
To the Vancouver General Hospital for Demonstrations at 3 o'clock
2.   To the North Shore for golf on Wednesday at noon.
IMPORTANT: Members residing in Vancouver are requested to register
early on Monday. There will be no registration fee.
Page 256 Annual Meetings
The Annual Meeting of the British Columbia Medical Association will
be held at 8:00 p.m. on Tuesday and will precede the Annual Meeting of the
College, which will convene at 9:00 on the same evening. These are YOUR
The British Columbia Medical Association Trophy will be competed for
by the members. This trophy has been provided for the competition by the
Mead Johnson Company.
Many other prizes are offered by Dr. Bilodeau and his Committee, and
will be presented at the Annual Dinner.
To be able to play on the new golf course on the British Properties at
West Vancouver, on Hollyburn, is going to make this feature very popular.
Golf play is on Wednesday, September 14th.
Annual Dinner
The Annual Dinner of the British Columbia Medical Association will be
held on Wednesday at 7:00 o'clock in the Ballroom, Hotel Georgia. The guest
speaker will be the Honourable Gordon S. Wismer, Attorney-General of the
Province of British Columbia, who will address the members on "Law and
Representatives of other Provincial professional bodies will be present
at the Annual Dinner, as guests of the British Columbia Medical Association.
Dr. J. Reid Morrison, of Bellingham, President of the Washington State
Medical Association, will attend as a guest, as will also the visiting speakers
at the Convention. ^ • t _- _•_•_
Commercial -exhibits
The members are requested to reciprocate by visiting the exhibits on the
Mezzanine Floor in the Hotel Georgia.
Hotel Georgia
Reservations may be made at the Hotel Georgia, the Convention Headquarters, by communicating directly with the Hotel.
*      *      *      *
Monday, September 13 th
9:00 a.m.—Registration—Mezzanine Floor, Hotel Georgia.
All ladies, whether resident in Vancouver or other points, are
requested to register, signifying their intention of participating in
the various features of entertainment.
Tuesday, September 14th
2:00 p.m.—Scenic drive for visiting ladies, leaving from Hotel Georgia.
4:00 p.m.—Tea at Jericho Country Club, as guests of the British Columbia
Medical Association.
Local ladies are invited to attend the tea and are requested to
secure invitation cards at the Registration Desk before 1:00 p.m.
on Monday.
Wednesday, September 15th
7:00 p.m.—Ladies' Dinner at the Georgian Club. Tickets $1.25.
The limited accommodation restricts attendance to 100. Tickets
may be obtained at the Registration Desk on the Mezzanine Floor,
Hotel Georgia.
The Committee in charge of the Ladies' Dinner requests that the
ladies residing in Vancouver arrange to secure their tickets for
the dinner before 1:00 p.m. on Monday.
Ladies residing in Vancouver may have registrations made, tickets for
Dinner purchased, and Tea invitations secured, either by themselves or by
their husbands, on Monday morning, commencing at 9 o'clock.
Ladies wishing to play golf will be assisted by the Ladies' Committee.
The Ladies' Reception Committee will be in attendance on the Mezzanine
Floor, Hotel Georgia, during the Convention.
Dr. Donald V. Trueblood
(Read at Vancouver Medical Association Summer School, June, 1937)
Tumours of the uterus, whether large or small, are in many instances
important factors in the health and comfort of the patient. Often a large one
is symptomless,, while a small one—depending upon its location and type—
may cause severe illness.
It is the purpose of this discussion to deal primarily with the clinical
features of uterine tumours, rather than the pathological peculiarities of
them. We will be obliged, in certain instances, to refer to the pathological
characteristics of some tumours, in order that the clinical picture can be
properly presented. A thorough understanding of these features, peculiar to
a few tumours, will aid the clinician materially in visualizing the pathological
disease which the patient is harboring, permitting thereby more intelligent
A good clinician, before examination is made, will obtain a complete
history which has not neglected the story of pregnancies, abortions, miscarriages, operations, nursing, breast difficulties and abnormalities of the
menstrual cycle past or present. Physical examination must certainly include,
beside other areas, examination of the lymph gland bearing regions, thyroid,
breasts and rectum. The pelvic structures are examined last, beginning with
the vulva. One inspects and palpates the clitoris, urethra, both labia, the
vaginal orifice and the perineum. A speculum is now passed, and with the
aid of a good light a thorough inspection of the cervix is made. The condition
of the vaginal walls is also observed. On uterine examination, the commonest abnormality that is seen is endocervicitis. This condition is not a
tumour, yet it must be labelled with tumour significance because of the
frequency with which cancer of the cervix has been attributed to this disease.
Inasmuch as the major significance of it is its relationship to cancer, we will
discuss it later at the proper place.
Bimanual examination is next instituted. With two fingers of one hand
in the vagina and the other hand on the abdomen, the uterus, adnexae and
other tissues are palpated. Before the fingers are removed, they should be
turned anteriorly, palpating the anterior vaginal wall and base of the bladder.
Then they are turned posteriorly, feeling the cul-de-sac and rectum. Lumps
thought to be in that organ may be in the septum. If such masses are found,
examination should be repeated after the rectum has been emptied. I have
found it of diagnostic help, after washing off the glove, to place one finger
in the vagina and the other in the rectum, repeating the bimanual procedure.
Occasionally it is advisable to use the opposite hand to better explore the
opposite pelvic area.
The most common symptoms relative to the uterus of which the patient
may complain are bleeding, increased discharge, pain, menstrual disorders,
backache, pressure symptoms relative to bladder and rectum, or merely a
bearing-down sensation within the pelvis. As one or more of these symptoms
may occur with the majority of uterine tumours, it is thought advisable to
discuss the general symptomatology of each of the more common neoplasms
in turn, rather than to concentrate upon the relative frequency of each of
these symptoms individually.
Polyp : Polyps of the cervical or uterine canal may be single or multiple.
They are often symptomless. Bleeding is the usual sign. If the polyp is visible
in the cervical canal, one is tempted to believe that that is the only causative
factor of the bleeding. The removal of such a polyp may cure the patient; but
inasmuch as all polyps have a cancer significance, and inasmuch as there may
be others invisible within the uterus, the cervical canal should be curetted
first, bringing with it the visible polyp with its base for microscopic examination, and then the uterus should be curetted, offering to the pathologist the
Page 258 mucous membrane lining of that organ to be separately studied microscopically. This procedure is suggested because the cervical polyp may not be the
cause of bleeding, and the patient might have hidden evidence of more serious
disease within the uterus. As the patient is under an anaesthetic this additional procedure carries with it much to gain and nothing to lose should a
malignancy or other pathology be found. If nothing but the cervical polyp is
found, its base should be cauterized.
When multiple polyps are encountered, as shown by the curettage, further
treatment is not indicated at the time unless malignancy is found. If, within
the uterine cavity, a large submucous fibroid presents into the uterine cavity
or cervical canal a hysterectomy is often indicated, because there are doubtless other fibroids in the organ which will continue to grow.
If conservatism is desired, pass a tonsil snare around it at its pedicle
base, severing it gradually. The application of the coagulating current to
this instrument is an advantage.
Uterine Fibroid (Myomata) : This tumour may be large and symptomless,
or bleeding may be the only symptom (whether the fibroid is large or small)
associated often with evidence of secondary (sometimes profound) anaemia.
There may be symptoms of pressure, as described above. The treatment of
such a tumour is surgical. I have not been convinced that radiation therapy
is indicated except in those individuals who cannot, be considered surgical
risks. But it must be remembered that those who are very anaemic by reason
of loss of blood cannot withstand radiation therapy as well as surgery. Most
of these, after blood transfusion (having at hand the immediate facilities
for additional blood transference), can often survive a rapidly performed
supravaginal hysterectomy. A 40% haemoglobin is probably the low limit of
safety. Additional blood is indicated to raise a lower percentage to this more
favorable level.
Here we can logically discuss the advisability or inadvisability (in the
well conditioned patient) of removing the cervix with the uterus, obviating
thereby the possibility of cancer developing at some later date in the cervical
stump. Statistics tell us that this happens in from one to two and a half
per cent.
It is my opinion that if the cervix is badly infected and badly deformed—
the correction of which would require considerable valuable operative time
in the vagina—panhysterectomy is indicated. Should such a patient be very
obese, or have a very deep pelvis, surgical experience testifies that the
enucleation of the cervix would be very difficult. In such patients I believe
the cervix should be thoroughly coned out from below by the Sturmdorf
method, or amputated; in either case, removing sufficient of the cervical
mucosa and cervical glands high enough to obviate the possibility of cancer
having an epithelial bed in which to originate. Following this, during the
hysterectomy, the cervical canal is thoroughly cauterized from above, destroying most of the remaining potential field for cancer.
If the cervix, associated with a uterine fibroid, suggests a suspicion for
cancer, the abdominal operation for hysterectomy should not be undertaken
until after the pathologist states from a frozen section that cancer is not
found. Should malignancy be found in the cervix, sufficient radium should be
introduced into the cervical and uterine canal—as well as around the coned
or amputated cervix—for the purpose of destroying that disease, leaving
the uterine fibroid for later operation if still indicated. This radium application will stop the uterine bleeding.
I have learned by my own experience and that of others that in those
instances where the fibroid is in close association with the rectum because
of size or location, a proctoscopic examination should be performed before
the operation, and that at operation the rectosigmoid flexure should be palpated as far down as possible. I know of three cases during the past three
Page 259 years in which uterine fibroid was removed and cancer of the rectum in that
location was overlooked.
Adenomyoma Endometrioma : Such tumours confined to the uterus were
first brought to the attention of the medical profession by Von Recklinghausen in 1896. In 1908, Cullen produced his excellent monograph on the
subject, showing that this tumour not only arose in the uterus, but was found
in the broad ligament, rectovaginal septum, around the umbilicus, and in
postoperative wounds. He proved that these tumours had a central though
irregularly located lining of endometrial tissue, and in the uterus he was
able to trace this misplaced endometrial tissue as having arisen from the
endometrial mucosa in that organ and penetrated down through the characteristic stoma (myomatous tissue) into the depths of the uterine wall. The
majority of those tumours that were extra-uterine also had, in most instances,
momatous tissue surrounding the extraneous endometrium. A striking
characteristic, and a symptom-producing one, was that at menstrual time
this misplaced endometrial tissue would undergo hyperplasia and bleed,
causing symptoms of pain due to tension, the haemorrhage having no outlet.
In 1912, Sampson* began adding knowledge to this interesting subject. It
was his belief that at menstrual time endometrial cells could escape from
the uterus through the tubes, and implant themselves on the nearest structures, namely, the ovary, pelvic floor and intestinal wall. There, they would
invade, somewhat* similar to the invasion of cancer. Those landing upon the
ovary—where it is suggested they obtained a more fertile field for growth—
would eventually cause chocolate-coloured cysts increasing in size with each
menstrual blood accumulation. If such a chocolate-coloured cyst should be
ruptured at operation, it is his belief that further implantation was permitted. Rarely does one of the endometriomas invade the bowel sufficiently
to produce obstruction; but it has occurred, requiring resection.
The major symptom of this interesting condition is primarily dysmenorrhoea if the adenomyoma is uterine. Bleeding is not expected because the
uterine mucosa is normal. If the endometrial implants have grown to sufficient size in other areas, they will produce symptoms relative to those areas
and organs.
On examination, the uterus may or may not be found large. If large, it
would be difficult to differentiate from a fibroma. Such a finding, associated
with enlarged ovaries, is more diagnostic, but not absolute. A mass in the
rectovaginal septum creates more suspicion, and an umbilicus that bleeds
with menstruation approaches a specific diagnosis. A small, very hard uterus
is not beyond suspicion.
A lump in any area (inguinal or vaginal) that increases in size at menstrual time is very suggestive of an endometrioma. However, most of these
tumours are diagnosed only at operation. A chocolate-coloured cyst of the
ovary should be removed without breaking the capsule. Small chocolate-
coloured or bluish-black spots found elsewhere are easily eradicated by means
of the coagulating cautery tip, and all other implants should be so treated,
if possible.
This disease is cured spontaneously by the menopause. When menstruation
ceases, these tumours are no longer stimulated to activity, and either regress
entirely or leave small or large innocuous cysts. Castration of the patient
by removal of both ovaries may be justifiably considered in those instances in
which—by reason of extensive adhesions, which are characteristic of these
tumours—the involved tissue cannot be removed. For instance, the uterus,
tubes and both ovaries may be in such an adhered mass that complete removal
is impossible, but the removal of all the ovarian tissue on each side might
be accomplished. Then the spilling of chocolate-coloured cyst contents would
be of no consequence. Further, if the bowel has been obstructed by reason of
* Sampson, Surgery, Gynaecology and Obstetrics. January, 1924, v. 38.
Page 260 an endometrial tumour, which is apt to cause much more serious damage to
the patient than castration, bilateral oophorectomy and colostomy are sufficient.
Any surgeon hesitates to castrate a young woman. I agree with those
observers who believe that removal of only the most involved ovary with its
chocolate,coloured cyst is justified, hoping that the smaller cyst on the
opposite gonad can be safely resected. The uterus is always removed if
possible, because (avoiding embryological argument) it is a likely source of
future endometrial implants. When, however, the uterus is small, creating
no suspicion of containing adenomyoma, its removal depends on symptoms,
examination, age of the patient and surgical judgment. I believe it is wise,
however, when conservatism of ovarian tissue or uterus has been selected,
to notify the family and patient that subsequent developments might require
another operation.
Sufficient radiation applied to the ovaries, producing a premature menopause, will have the same effect upon the activity of these tumours as castration ; but such treatment can be applied intelligently only after the proper
visualization of the disease by operation. If surgery at that time cannot cope
with the extent of the disease, radiation therapy is indicated. Fortunately,
these tumours are not common; but they are more common than has been
suspected, and very important.
Chorioma : These are tumours arising from and composed of chorionic
epithelium. The first one of this group worthy of consideration is the hydatidiform mole. It is a degenerated lesion of the placenta. It is rather rare,
occurring one in about every 1,500 pregnancies. It has the symptoms and
signs of pregnancy, and occasionally its complications, such as toxaemia and
eclampsia. During this pregnancy, vaginal haemorrhage begins. If grape-like
masses are passed, they are diagnostic. When one examines this bleeding
patient, the uterus is found to be larger than the pregnancy time would
warrant. The absence of foetal heart sounds and the failure of an x-ray film
to reveal small bones creates suspicion. One would hesitate to interrupt such
a gestation unless the bleeding continues. Another test that will be of help
prior to curettement is the Ascheim-Zondeck test, which if positive only confirms the pregnancy, but in hydatidiform mole will be positive in more dilute
urine. The curettement, if it is a hydatidiform mole, will bring into view the
characteristic gross pathology of the disease. If the patient persists to bleed
after this procedure, a positive Ascheim-Zondeck test then indicates that
portions of the tumour still remain within the uterus, and curettement is
again indicated. Hysterectomy may be necessary for continual bleeding or
may be chosen as a means of precluding the development of a more serious
tumour, namely chorio-epithelioma.
Ewing specifies three types of this tumour, differentiation of which will
not be discussed here, because the diagnosis and treatment are the same.
These types, however, differ in degree of malignancy. This tumour may begin
months after a normal delivery, may follow miscarriage, abortion or ectopic
pregnancy. They more commonly occur in the multipara. Rarely the first
symptom of the disease is haemoptysis.
The Ascheim-Zondeck test is very valuable here because, if positive, it
means that chorionic epithelium exists. Curettage is helpful if diagnostic
tissue is obtained; but such tissue may be missed. Should the curettings be
negative, and the Ascheim-Zondeck test persists, a second curettage is indicated. If curettage is still negative and the hormone test positive, a hysterectomy for chorioma is indicated.
Cancer : The most important tumour arising in the uterus is, of course,
cancer. Cancer of the cervix is to be considered separately from that of the
fundus, because the treatment of one is definite, while that of the other is
still being discussed by authorities.
Page 261 Cervical cancer seems, according to statistics, to arise most commonly
from a childbirth wound that nature is attempting to heal. A cervix once
split tends to stay open. The gaping lips are held apart by the anatomical
arrangement of cervical musculature and fibrous tissue. There are no
anatomical structures which tend to pull them together. The healing of such
a wound must, then, depend upon epithelium to spread over the raw surface.
This epithelium must come either from the mucous membrane of the uterine
canal or the squamous covering of the cervical surface. Doubtless, this
attempt is more or less continuous, but rarely successful.
Many observers have suspected this repeated effort and failure on
the part of the epithelium (associated with chronic irritation ever present)
as a cause of cancer. The high percentage of cervical cancer in women who
have borne children is confirmatory evidence, inasmuch as practically all of
them have cervical tears to a greater or less degree.
The symptoms of endocervicitis may be nil; or there may be increased
discharge, or bleeding, or urological symptoms. Most women do not know
that they have it. If women could see their cervices they would force the
profession to do its duty. It is easily found by examination. If found, it
should be corrected either by surgery or by a cautery. I prefer surgery, the
Sturmdorf, inasmuch as it gives to the pathologist a larger amount of tissue
for examination than does a removal of a small piece. This small piece might
be selected from one area and be proven negative, while cancer might exist
in another. All cervical tears should be removed in one way or another.
However, before doing the Sturmdorf operation, or amputation if selected,
the cervix is dilated, and the cervical canal endometrium is removed separately, and then the uterine endometrium is removed. These two specimens
are sent to the pathologist, as described earlier in this paper. If they are
negative, cervical surgery is undertaken. If the tissue from the cervix,
amputation, or Sturmdorf is negative, nothing further need be done. If
positive, radium is the method of choice.
Schiller has proposed the application of an "iodine solution"* for that
type of cervix that lacks erosion or ulceration and therefore would not be
ordinarily biopsied. On such a cervix a spot of leukoplakia will not take the
stain as deeply as the normal epithelium. He believes that an early cancer
lying under the surface will cause that surface to also fail to take a good
stain. Finding these poor or unstained areas, he institutes a biopsy of that
tissue, and believes that early cancer is thereby diagnosed. His test is of
clinical value because it stimulates the average clinician to search further
for cervical lesions than he otherwise would, and in such an exercise he will
certainly not overlook the ordinary erosion and ulceration which is visible
and so important. Many pathologists disagree with Dr. Schiller in his interpretation of the microscopic evidence of cancer in those cases positive for
his test.
For those who are so situated that they have not at hand such expert
pathological aid as I have described, it is permissible for them to send the
tissue away in one, two or three labelled containers, accompanied by a full
history of the case, and await the pathologist's report.
Cancer of the Uterine Fundus : Cancer of the body of the uterus may
produce no symptoms until it has reached a large size; or it may produce a
water-like discharge or bleeding. If the uterus has become enlarged by reason
of it, there may be pressure symptoms—as in fibroid. Physical examination
is negative in most instances, the curette being our best diagnostic instrument. Curettage should be very cautiously performed, as it is possible—and
has often happened—to pass that instrument through the uterine wall in
advanced cases. If these curettings are positive for cancer, the subsequent
treatment rests between panhysterectomy, including tubes and ovaries (not
* Schiller's  formula:   Tincture   of   iodine,   1;   potassium   Iodide,   2;   water
Q.S., 300.
Page 262 the Wertheim) or radiation therapy (meaning radium in the uterine cavity,
and applied also to and in the cervix, followed by external deep x-ray
Statistics seem to indicate that with operable cases either procedure, in
good hands, is satisfactory. Poor surgical risks should receive radiation. But
if the condition feared is anaemia, transfusion and surgery is better than
extensive radiation directed toward a cure. Such patients can't stand that
regime. One or two x-ray doses might help to control the bleeding temporarily
in preparation for surgery. Those patients evidencing advanced cancer are
all treated by radiation.
The good risk apparently has equal chances for a cure in a good clinic
regardless of which therapeutic method is chosen. However, outside of such
centres there are more surgeons capable of doing a thorough panhysterectomy
than there are radiologists equipped with apparatus and experience sufficient to offer curative measures. Furthermore, I believe that, when radiation
therapy has been selected in favorable patients, it is wise to later remove the
uterus and adnexa. That tissue harboured cancer at one time and might still
do so. Why not remove it?
The choice of radium for cervical cancer, and surgery for cancer of the
body of the uterus, is based upon two or three important factors. One is
that cervical cancer, by reason of the richer lymphatic connections from the
cervix to the parametrium, broad ligament, iliac glands, as compared to that
of the uterine body, permitting thereby a more rapid and earlier spread of
the disease from the cervix than from the fundus, created a different problem
for therapeutic attack. Second, the extensive and radical Wertheim operation
for cancer of the cervix performed by the best operators produces a mortality
of 19%, and a higher morbidity (damage to ureters, bladder and rectum).
Third, the five-year cures following such radical procedure are no better
than those obtained by the use of properly administered radium; while the
radiation treatment has practically no mortality and little morbidity.
Cancerof the fundus, having a less abundant lymphatic field through
which to spread, does not require for its removal such an extensive operation.
The five-year cure reports obtained by surgery, in cancer of this part of the
organ, are apparently just as favorable as those from radiation therapy.
When doing a hysterectomy for any tumour I agree with Sampson that it
is wise to avoid grasping the uterus with any sort of a compression clamp
for fear that endometrial tissue being capable of producing endometriomata
or cellular elements from a chorioepithelioma or cancer be forced out through
the tubes to implant themselves for growth elsewhere.
Before the abdomen is closed the surgeon should cut open the uterus for
inspection. Important information might be discovered requiring attention
at once.
If enlarged lymphatic glands are palpated along the iliac vessels, aorta
or within the sigmoid mesentery, these can be thoroughly cooked by puncturing them individually with the cautery tip and turning on the current,
theoretically destroying in this manner the more advanced spread of the
cancerous disease.
A complete history and thorough physical examination emphasizing certain areas and organs are expected if the clinician hopes to obtain a thorough
picture of the problems offered by each new patient.
Inasmuch as cancer is the most feared disease likely to involve the uterus,
its possible presence must be constantly kept in mind. Eradication of its
forebears is essential, such as cervical or uterine polyp anc} endocervicitis.
For uterine fibroid, supravaginal hysterectomy is selected after the cancer
potentialities of the cervix have been eliminated. Panhysterectomy is chosen
if the same objective can be obtained easier. Blood transfusion is advisable
for the woman poor in blood. Radiation therapy is indicated only for those
who, not because of anaemia, are poor surgical risks.
Page 268 ITT.
If the patient is pregnant and shows alterations from normal progress,
many complications can be thought of, but amongst those must be remembered
hydatidiform mole. Following the delivery or the removal of the products of
conception, subsequent symptoms should cause the clinician to remember
that there had been a recent pregnancy, and amongst the other diseases suggested he must not forget chorioepithelioma and the value of an Ascheim-
Zondeck test.
When the abdomen is open, thorough search for pathology throughout its
contents, which is undertaken by every surgeon, should include a recognition
of the importance of chocolate-coloured cysts on the uterus, ovaries, broad
ligament, mesentery, intestines, even though some may be minute. These are
endometriomata, prone to grow with each menstrual effort, may cause serious
complications, but are futile after the menopause—artificial or natural.
Cancer of the cervix should be entirely separated by biopsy and curettage
of the cervical canal from suspicious tissue of the uterine fundus, because
the treatment of these two portions of that organ is different.
September 13, 14 and 15, 1937
The programme of the Forty-fifth Annual Meeting of the British Columbia
Medical Association is published, in this issue of the Bulletin of the Vancouver Medical Association. The generous acceptance of the material is
acknowledged with thanks.
The sessions will open on September 13th with addresses of welcome by
the Mayor of Vancouver and the President of the Vancouver Medical Association, Vancouver being the host city. The lecture programme will commence
each morning at 9 o'clock, morning sessions being devoted to lectures, with
a diversion on Tuesday at 10:30 a.m. when the Round Table Discussions will
be held. These Round Table discussions are a new feature at our meetings
and will be held in four separate rooms, four subjects being covered, i.e.,
Anaemia, Fractures, Infant Feeding and Gynaecological Endocrinology. It is
proposed that these be opened by three or four brief introductory talks and
that the remainder of the hour be left open for questions and discussion.
Such meetings have an immense practical value, this method of study providing for the elimination of many details, the elaboration of some practical
points, the elucidation of the obscure, and the introduction of the new.
Whenever one speaks of the Annual Meeting Dr. J. P. Bilodeau pops up
with his "Golf Announcements," and let us silence him by emphasizing the
fact that the British Columbia Medical Association will this year, "thanks to
Joe," play off on the "new" Capilano Golf Course just completed on the
British Properties at Hollyburn, at West Vancouver. Thanks to Dr. Bilodeau,
we are to play on this new course, which is reputed to be the last word in
smoothness and will help to reduce the handicaps. Let us not hope that this
will prove to be the raison d'etre for attendance at the Annual Meetings.
Come to the meetings and plan to play golf.
In addition to the Round Table discussions, the newer features include
a motion picture showing the Heart in ordered and disordered action. Dr.
Vrooman, who saw these films in the East, tells us they are worth seeing
several times. They will be screened on every possible occasion. It may
require two vie wings to see it all.
Then there is the programme developed by Dr. Frank A. Turnbull
whereby demonstrations of Newer Technique will be held in the Vancouver
General Hospital on Monday at 3 :00 p.m. Six demonstrations will be featured.
(See announcement elsewhere in this issue.) Transportation for this trip to
Page 264 the hospital and for the golf will be provided by Dr. L. W. McNutt and his
Committee on Transportation.
Public Health will be paraded in a pageant of ten brief papers on Monday
evening at 8 o'clock. (See announcement elsewhere in this issue.) These will
be presented by members of the Association who work in this field. Many
phases of the various ramifications of Public Health work will be covered in
7%-minute papers, and time will be allowed for discussion, questions and
reply. This meeting should attract a crowded house. Every opportunity will
be provided for questions and discussion and it is hoped that much misunderstanding will be cleared up, and a better and more sympathetic understanding developed, and that the result will be beneficial to this important department of medicine. It is to be hoped that co-operation by the man in practice
will be secured as the just dessert of the Public Health programme in this
The Conference on Contract Practice on Tuesday at 1:30 p.m. will attract
a large group, and its programme, with three feature speakers representing
the Industrial, Mining and Logging operations, will allow ample time for
questions and discussion. (See announcement elsewhere in this issue.)
The Conference for Coroners (see announcement elsewhere) is another
of the newer features of the Annual Meeting and will introduce Dr. Osborne
Morris of Vernon as Chairman. Dr. J. D. Whitbread, in the exordial paper,
Dr. A. W. Hunter and Dr. H. H. Pitts, of Vancouver, will discuss Observations and Examinations, and Inspector J. F. C. B. Vance, of the Criminal
Investigation Department of Vancouver, will deal with Crime Detection in
the Laboratory.
The Annual Meetings of the College of Physicians and Surgeons of British
Columbia and the British Columbia Medical Association will be held on
Tuesday evening, the latter commencing at 8 p.m. and the former at 9 p.m.
This announcement seems confused, but what does it matter, in that you
will attend both meetings! Dr. Routley will have something to tell us at the
9 o'clock meeting, and other important announcements wlil be made at that
session. These Annual Meetings are important and space will be provided
for a large number of members.
The lecture programme is inviting and has been developed by the Committee under chairmanship of Dr. Colin Graham with a view to being practicable.
Dr. Bilodeau thinks that all this will lead up gracefully to relaxation on
the "New Golf Course at the British Properties," on the North Shore. Be that
as it may, "dinna forget" that the 19th hole will precede the Annual Dinner
of the Association at 7 p.m. Wednesday, September 15th.
The Annual Dinner will be informal and will be largely attended. The
British Columbia Medical Association will have as its guest speaker the
Honourable Mr. Gordon S. Wismer, Attorney-General of the Province of
British Columbia. This should assure the attendance.
Dr. Bilodeau insists on appearing at the Dinner with an armful of prizes
for golf. He reports a large list of prize-winners and prizes. We agree that
Joe has reason-to be proud of his past record, and of his achievement on this
occasion in providing for play on this Wonder Course on the new British
Properties at West Vancouver.
Dr. G. F. Strong, the President of the British Columbia Medical Association, joins Dr. S. Cameron MacEwen, the President of the College of
Physicians and Surgeons of British Columbia, in an invitation to each
member of the College and of the Provincial Association to attend the Annual
The Ladies' programme is in the capable hands of a ladies' committee,
under the convenorship of Mrs. Strong, wife of the President of the British
Columbia Medical Association. (See announcement elsewhere.)
BALFOUR, J. D., M.D.—Small Bowel Obstruction _  169
BERGLAND, J. McF., M.D.—Puerperal   Infections 1     10
Relief of Pain in Labour     57
Prom a Surgeon's Journal, by Dr. H. Cushing—W. D. Keith, M.D     50
William S. Thayer, by E. G. Reid—W. D. Keith, M.D  179
BOYD, WM., M.D.—Tumours of the Neck  208
BOULTER, W. L., M.D.—Some Gynaecological Sequelae of Uncomplicated Delivery  181
Notes     84
Programme Annual Meeting  255
BURWELL, W. K., M.D.—Report of Gynaecological Division of
Vancouver General Hospital  192
Notes—Dr. H. H. Milburn  152
Notes of Annual Meeting—Dr. H. H. Milburn  240
CALVERT, W. D., M.D.—Poetical  Selections  113
Tribute to Mrs. Anne Starr  173
CANCER OP THE CERVIX—Walter Schiller, M.D     50
A. Y. McNair, M.D  106
COLON, TUMOURS OF—Drs. C. W. Prowd and F. H. Bonnell  103
CURTIS, E. J., M.D.—Some Factors Regulating Nutrition and Growth     71
DOLMAN, C. E., M.D.—Undulant  Fever     27
GALL BLADDER DISEASE—J. Evarts Graham, M.D     12
GRAHAM, J. EVARTS, M.D.—Gall  Bladder  Disease     12
Surgery  of  the  Pancreas     40
W. K. Burwell, M.D  192
W. L. Boulter, M.D   181
HARRISON, W. M., M.D.—Surgery of Pulmonary Tuberculosis     30
HUGGARD, R., M.D.—Some Physiological Concepts of the Stomach and
Duodenum  143
Page 22 INDEX TO VOL. XIII—Continued
LEESON, L. H., M.D.—Relation of Mastoid Infection to Gastro-enteritis
in Infants     79
McNAIR, A. Y., M.D.—Carcinoma of Large Bowel and Rectum  106
Cancer Control  153
MAGNUSON, P. B., M.D.—Fracture of Both Bones of Forearm  228
Fracture of Elbow in Children  237
L. H. Leeson, M.D     79
MEDICAL PIONEERING IN B. C.—M. W. Thomas, M.D     17
MEEKISON, D. M., M.D.—Preliminary Report on Two Cases of
Acetabuloplasty    „     38
NECK, TUMOURS OF—Wm. Boyd, M.D  208
NEW, GORDON B., M.D.—Reconstructive Surgery of the Face     16
Dr. F. V. Agnew  141
Dr. W. Chipman _  179
Dr. W. F. Coy       5
Dr. J. W. Ford  112
Dr. J. J. Mason „       5
Dr. W. A. Watson _     44
Dr. H. E. Langis  202
Dr. G. E. Stanley  202
Dr. E. J. Coulthard  202
PANCREAS, SURGERY OF—J. Evarts Graham, M.D     40
PETERSON, S. C, M.D.—Venereal Disease Control  118
POET'S   COLUMN  113,  173
PROWD, C. W., M.D., and BONNELL, F. H., M.D.—Tumours of the Colon.. 103
RELIEF OF PAIN—J. McF. Bergland, M.D     57
ROWNTREE, L., M.D.—Endocrine Diseases  230
SCHILLER, WALTER, M.D.—Cancer of the Cervix     50
Practical Gynaecological Endocrinology  126
STATUTES OF B. C.  (EXTRACTS)   62,  87, 111
R. Huggard, M.D  143
STOKES, J. H., M.D.—Control of Syphilis (abst.)  142
THOMAS, M. W., M.D.—Medical Pioneering in B. C. (Part 2)     17
Risor Sardonicus     59
Trigger-finger    151
Angling—An Incurable Disease  173
TRAPP, ETHLYN, M.D.—Cancer Situation in Europe „  249
TRUEBLOOD, D. V., M.D.—Tumours of the Lip and Oral Cavity  213
UNDULANT FEVER—C. E. Dolman, M.D     27
UTERUS, TUMOURS OF—D. V. Trueblood, M.D  258
WALKER, J. E., M.D.—Physiology of the Stomach  164
WALL, J. T., M.D.—Some Sequelae of Normal Labor  190
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L..MIXED v—f
FORT STREET (opp. Times)      Phone Garden 1196     VICTORIA, B. C.
Nlttttt   $C   ®lj0m00tt
2559 Cambie Street
> B. C
13 th Avenue West
Fairmont 80
John's Ambulance Association"
R. J.
J. H. Crellin
W. L. Bertrand The CELLS that REPAIR
respond "well to the stimulus of the
heat and therapeutic qualities of
The activity of these
cells, as well as the
enhanced capillary
circulation, is an
important fundamental factor in all
Successive stages of development of polymorphonuclear cells and lymphocytes from early
connective tissue cells.
Generous    clinical
sample, together with
literature, sent on
request to
The Denver Chemical Manufacturing Co
Made in Canada.
1 lest arch, Constant Researcl
continues to improve the c uality c
Mead's Brewers Yeast* in the foil
lowing respects, without increase
cost to the patient:
1 Vitamin B potency raised to not less than 25 Intd
national units per gram.
9 Bottles now packed in light-proof cartons, for bettj
protection.  §
3 Improved bacteriologic control in harvesting ai
packing* §
4# And NOW, since August 1,1936, all bottll.
are packed in vacuum. This practical])
elisninates oxidation. Mead's Yeast staji
Sresh linger, as you can tell by its improv|
odor and flavor! if"        |
* A dietary accessory for normal persons, for the prevention and treatm
of conditions characterized by partial or complete deficiencies of vitam i
Bi and G, as in beriberi, pernicious vomiting of pregnancy, anorexiap
dietary origin, alcoholic polyneuritis, pellagra.
Mead's Brewers Yeast Tablets in bottles of 250 and 1,000.
Mead's Brewers Yeast Powder in 6 oz. bottles* Not ad»
vertised to the public. Samples to physicians, on request.
MEAD JOHNSON &. CO. OF CANADA, LTD., Belleville, 0|(|
Please enclose professional card when requesting samples of Head Johnson products to cooperate in preventing their reaching unauthorized pi A
An Emergency^
while the Cityhleeps!
Instantly three services
spring into actions-Doctor
Telephone Operator—Georgia Pharmacy! Wide-awake
service, day or night, including speedy delivery.
2 263
(Hunter $c 2? antra IGi-ct
Ettablisbed If93
North Vancouver, B. C.    Powell River, B. C.
Published Monthly at Vancouver, b. C. by ROY wrigley ltd., soo West Pender street
IS—_■ Hollywood Sanitarium
For the treatment of
Alcoholic, Nervous and Psychopathic Cases
Reference—B. 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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