History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: May, 1939 Vancouver Medical Association May 31, 1939

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 m
The BULLE
r
of the
I   VANCOUVER
MEDICAL ASSOCIATION
-Vol. XV.
MAY, 1939
No. 8
With Which Is Incorporated
Transactions of the
Victoria
ical Society
tbt
Vancouver General Hospital
tmd
St Paul's Hospital
In This Issue:
REPORTS OF CANCER ORGANIZATIONS
DAGENAN TREATMENT
NEWS AND NOTES BULKETTS
(With Cascara and Bile Salts)
. • FOR • •
Chronic Habitual
Constipation
BULKETTS POSSESS ENORMOUS BULK
PRODUCING PROPERTIES AND BEING
PROCESSED WITH CASCARA AND
BILE SALTS PRODUCE BULK WITH
MOTILITY.
WE WILL BE PLEASED TO PROVIDE
ORIGINAL CONTAINERS FOR TRIAL
ON REQUEST. ft
Western Wholesale Drug
(1928) Limited
456 BROADWAY WEST
VANCOUVER   |   BRITISH COLUMBIA
(Or at all Vancouver Drug Co. Stores) THE   VANCOUVER   MEDICAL   ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Association
in the interests of the Medical Profession.
Offices: 203 Medical-Dental Building, Georgia Street, Vancouver, B. C.
EDITORIAL BOARD:
Dr. J. H. MacDebmot
Dr. G. A. Davidson" Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. XV. MAY, 1939 No. 8
OFFICERS,  1939-1940
Dr. A. M. Agnew                  Dr. D. F., Busteed Dr. Lavell H. Leeson
President                            Vice-President Past President
Dr. W. T. Lockhart Dr. W. M. Paton
Hon. Treasurer Hon. Secretary
Additional Members of Executive: Dr. M. McC. Baird, Dr. H. A. DesBrisay.
TRUSTEES
Dr. F. Brodie Dr. J. A. Gillespie Dr. F. W. Lees
Historian: Dr. W. L. Pedlow
Auditors: Messrs. Plommer, Whiting & Co.
SECTIONS
Clinical Section
Dr. W. W. Simpson Chairman Dr. Frank Turnbull Secretary
Eye, Ear, Nose and Throat
Dr. W. M. Paton Chairman Dr. G. C. Large Secretary
Pediatric Section
Dr. J. R. Davies Chairman Dr. E. S. James Secretary
STANDING COMMITTEES
Library:
Dr. F. J. Buller, Dr. D. E. H. Cleveland, Dr. J. R. Davies,
Dr. W. A. Bagnall, Dr. T. H. Lennie, Dr. J. E. Walker.
Publications:
Dr. J. H. MacDermot, Dr. D. E. H. Cleveland, Dr. G. A. Davidson.
Summer School:
Dr. A. B. Schinbein, Dr. H. H. Caple, Dr. T. H. Lennie,
Dr. Frank Turnbull, Dr. W. W. Simpson, Dr. Karl Haig.
Credentials:
Dr. A. B. Schinbein, Db. D. M. Meekison, Db. F. J. Bulleb.
V. O. N. Advisory Board:
Db. I. Day. Dr. G. A. Lamont.
Metropolitan Health Board Advisory Committee:
To be appointed by the Executive Committee.
Greater Vancouver Health League Representatives:
Dr. W. W. Simpson, Dr. W. M. Paton
Representative to B. C. Medical Association: Dr. L. H. Leeson.
Sickness and Benevolent Fund: The President1—The Trustees. O^P&°*
^
oa*°c^
VITAMIN B«-
COMPLEX SYRUP
If the diet is deficient in Vitamin Bx it is logical for the Physician
to assume it is deficient in many of the other factors of the B-Complex.
In treating:
VOMITING IN PREGNANCY
POLYNEURITIS
ANOREXIA
CHRONIC CONSTIPATION
by prescribing Squibb Vitamin B-Complex Syrup the Physician
assures his patient adequate amounts of Vitamin Bx and all the
other recognized factors in the B-Complex.
AVERAGE DOSE: 3 teaspoonfuls T.I.D. plain or mixed with milk,
tomato juice or similar vehicle.
Supplied in 3, 6 and 12-oz. bottles and 10-lb. containers.
For literature and samples write
ERiSqjjibb SlSons of Canada,Ltd.
MANUFACTURING   CHEMISTS   TO   THE   MEDICAL    PROFESSION   SINCE    1858
Professional Service Department, 36 Caledonia Road, Toronto. VANCOUVER HEALTH DEPARTMENT
STATISTICS, MARCH, 1939.
Total population—estimated	
Japanese population—estimated __	
Chinese population—estimated J	
Hindu population—estimated	
Number
Total deaths    261
Japanese deaths .        7
Chinese deaths        6
Deaths—Residents only    228
  263,974
  8,891
  7,728
  389
Rate per 1,000
Population
11.6
9.3
9.1
10.2
BIRTH REGISTRATIONS:
Male, 201: Female, 180-
,381
INFANTILE MORTALITY: March, 1939
Deaths under one year of age . 1      14
Death Rate—per 1,000 borths      36.7
Death rate—per 1,000 birtlis      36.7
17.0
March, 1938
15
42.5
42.5
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
April 1st
Scarlet • Fever    24
Diphtheria         0
Chicken Pox  127
Measles         2
Rubella         2
Mumps      11
Whooping Cough     74
Typhoid Fever      2
Undulant Fever      0
Poliomyelitis         0
Tuberculosis     26
Erysipelas       3
Ep. Cerebrospinal Meningitis      0
V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH,
DIVISION OF VENEREAL DISEASE CONTROL.
,1939
Marc
h, 1939
to 15
th,1939
eaths
Cases
Deaths
Cases
Deaths
0
21
0
3
0
0
3
0
1
0
0
119
0
33
0
0
6
0
0
0
0
2
0
2
0
0
2
0
9
0
0
127
1
71
1
0
2
1
0
0
0
1
0
0
0
0
0
0
0
0
12
27
13
0
4
0
1
0
0
0
0
0
0
Syphilis 	
Gonorrhoea
West North
Burnaby   Vancr. Richmond Vancr.
.....     0 0 0 1
....     0 0 0 0
Vancr. Hospitals,
Clinic Private Drs.
50 36
52 20
Totals
USE
BIOGLAN   I
»
for "HYPERTHYROIDISM
5>
A Medical testimonial, quote: "I take this opportunity to comment on your extremely successful preparation. It has given me consistently successful results in seven consecutive
cases, so that I have become to consider it a specific 'cure'."
A Product of the Bioglan Laboratories, Hertford, England.
Represented by
STANLEY    N.   BAYNE
Phone: SEy. 4239
1432 Medical-Dental Bldg.
"Ask the doctor who is using it."
Vancouver, B. C.
Page 228 A NEW TREATMENT FOR
HYPERTENSION   HEADACHE
HYPOTENSYL is a synergistic combination of Viscum album extract (European
mistletoe) with hepatic and insuline-free pancreatic extracts.
Especially indicated for headache and dizziness associated with essential hypertension, fibrotic kidney and elevated blood pressure accompanying pregnancy.
The dose is 3 to 6 tablets daily, one-half hour before meals.
For literature and samples write to:
ANGLO-FRENCH DRUG CO., 3 54 Ste. Catherine E., MONTREAL
HYPOTENSYL
FOR RELIEF OF HIGH BLOOD PRESSURE. 9:00
10:00
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9:00
10:00
11:00
8:00
9:00
9:00
10:00
11:00
8:00
9:00
PROVISIONAL SUMMER SCHOOL PROGRAMME
VANCOUVER MEDICAL ASSOCIATION
June 6th to 9th, 1939
Tuesday, June 6th.
a.m.—Dr. Dwight L. Wilbur: Recognition and treatment of vitamin deficiency
diseases,
a.m.—Dr. Mathe: Diagnosis and treatment of perirenal infections,
a.m.—Dr. Conn: Abortion from the endocrine and clinical viewpoint,
p.m.—Luncheon: Speaker, Dr. F. R. Menne: "The Physician in Relation to the
Solution of Crime."
Afternoon—Clinics,
p.m.—Dr. Holman: Recognition and treatment of peripheral vascular diseases,
p.m.—Dr. Menne: Bronchogenic carcinoma.
Wednesday, June 7 th.
a.m.—Dr. Menne:  Diseases of the thyroid.
a.m.—Dr. Holman: Carcinoma of the Stomach.
a.m.—Dr. Conn: Prolapse of the Uterus.  Medical and Surgical treatment.
Afternoon—Clinics,
p.m.—Dr. Wilbur: Nervous indigestion,
p.m.—Dr. Mathe: Present day status of the treatment of prostatic hypertrophy.
Thursday, June 8 th.
a.m.—Dr. Mathe:  Conservative renal surgery.
a.m.—Dr. Menne: Modern concept of renal tumours.
a.m.—Dr. Holman: Important considerations in the technic of herniorrhaphy.
Afternoon—Golf Tournament,
p.m.—Dr. Conn:  Induction of labour,
p.m.—Dr. Wilbur: Management of patients with chronic nervous exhaustion.
I Friday, June 9 th.
a.m.—Dr. Wilbur: Headaches from an Internist's point of view,
a.m.—Dr. Mathe: Treatment of gonorrhceal urethritis,
a.m.—Dr. Conn: Treatment of convulsion toxaemias.
Afternoon—Clinics.
p.m.—Dr. Menne: Thrombotic embolism,
p.m.—Dr. Holman:  Pre-operative and post-operative care of surgical patients.
Palliative Treatment of Hernia
PATENTED
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IDIVIDUALLY FITTED J
INDIVI
Sv
SPRING BRASS
NON-SUP'SUPPORT
with the Heard Truss has been proved
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1. Every detail in the Heard Truss is
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the exact support he needs;
2. The spring brass support for the pads
eliminates leg-straps and other chafing
encumbrances, yet remains in place
under all circumstances.
If you are not familiar with the Heard
Truss we will gladly show samples or give
you names of Doctors who have recommended them.
if HEARD TRUSS
Phone   SEYMOUR 5403
Suite 10, 712 ROBSON STREET
Page 229 The Executive of the Vancouver Medical Association took this year what we feel to
have been a most decidedly forward step, when they arranged to make the Annual Meeting
of the Association one of the events of the year, by holding it as a dinner meeting, and
inviting as guest speaker a member of a sister profession, that of Engineering. Dr.
Rickard's speech was more than merely a good speech, worth listening to. It was an
excellent speech, provocative and full of interest. His historical pictures—his explanations of the fact and metallurgical science underlying such fables, as the Golden Fleece
and Eldorado, were most delightful and fascinating.
We hope and believe that this is really the first step towards realization of the dream
that many of us have held for some time, that the Annual Meeting of the Association
should be one of the best attended, most interesting and most constructive meetings of
the entire year. But we would like to point out that the Executive can lead the horse to
the water, but that it cannot make him drink. Undoubtedly we have considerable
distance to go yet—and this Annual Meeting showed it. The attendance was fairly
good, but the moment the speaker, who opened the programme, had finished, about half
the audience left. Apparently they regarded the business part of the meeting as quite
unimportant and too dull to stay for.
The retiring president, Dr. Lavell Leeson, showed considerable courage in the attack
he made on the apathy so commonly shown by most of our members. Unfortunately,
only the faithful ones were there to listen to it. So the Bulletin is taking this opportunity to publish his remarks and hopes that many will read them to their exceeding
profit.
This is our Association, running our business; influencing, for good or evil, our lives
and prosperity. Yet out of 292 members, the average attendance at meetings is 80, and
of these three were large meetings, and considerably raised the average. Yet all the
meetings are well worth attending.
We have a Library which is second to none—and which is potentially of extreme
value to each one of us. Those who use it find it indispensable. Every one of us needs
it, and could profit by it.
The reports of the Association year's work, read at the Meeting, were all well worth
listening to, and they were short and pithy. We cannot publish them in full, but certain highlights are worth recording. For instance, the work of the Relief Committee is
beyond praise. A total of nearly $60,000.00 was distributed to members of the profession.
Seventy-five of those were receiving cheques, probably every month, are not members of
the Association, without whose efforts they would never have received this money.
Incidentally, the cost of administration is slightly more than 2 per cent of the total
amount disbursed. A most creditable piece of work, and one for which we must sincerely
thank some half-dozen of our members who give generously and without much acknowledgment of their time and effort.
The financial status of the Association is quite satisfactory, and while not rich, we
are solvent, and able to spend adequate sums on the Library, etc. The report of the
latter shows substantial growth and an admirably stocked periodical shelf.
We wonder if our members realize to what an extent the work involved in administering the Association has grown. The Vancouver Medical Association is quite an
organization. It has a big Library, a staff to administer it, a Summer School that is now
a recognized institution in our professional life throughout the north-west of Canada
?p»c 230 and the United States, a Journal which publishes nearly a thousand copies monthly. All
this means work by someone—it should mean some work for everyone^—if it is only the
effort involved in attending meetings, using the Library, and so on. We suggest to all
our readers that they explore, during the coming year, the possibilities afforded them by
their membership in the Association—that they seriously consider whether they are not
missing a great deal—whether they do not, themselves, owe something to their Association—whether they cannot, in their turn, contribute something to the general good.
We can promise them a manyfold return for every such investment they may make, of
time, interest, and effort.
NEWS    AND    NOTES
Dr. Frank Turnbull flew to the eastern States, where he attended the Annual Meeting
of the Harvey Cushing Society, held this year at New Haven, Connecticut.
Dr. H. R. Mustard has returned from a three weeks' holiday trip to the south-western
States.
*       *       f.       *
Dr. R. H. Huggard has left for the east, and will be away for about six weeks.
Dr. and Mrs. W. L. C. Middleton have left for a three weeks' holiday in the south.
Dr. Middleton will attend the meeting of the North Pacific Branch of the American
Urological Society at Del Monte.
Dr. W. J. Dorrance, who has been away for six months, has returned from Chicago
and the eastern States.
We offer congratulations to Dr. and Mrs. S. Graham Elliot on the birth of a daughter
on April 2nd.
Dr. Arthur Proctor, who is now in England, has become the father of twins, a boy
and a girl, born in Vancouver on April 2nd. We offer our congratulations to Dr. and
Mrs. Proctor.
Dr. J. R. Naden has left for the east, and will be away until early in June. He will
visit the World's Fair at New York, and will also visit a number of Orthopaedic Hospitals
during his stay.
Congratulations to Dr. R. E. McKechnie II and Mrs. McKechnie, on the birth of a
son, April 27, R. E. McKechnie III.
Dr. H. H. Mackenzie of Nelson attended the Spokane Surgical Society meeting on
April 8th.
Dr. and Mrs. M. E. Krause of Trail are spending several weeks in Portland, Oregon*
where Dr. Krause is recuperating following an appendix operation.
Dr. Wilfrid Laishley of Nelson attended the Post-Graduate Course at the Oregon
Academy of Ophthalmology and Otolaryngology held in Portland, Oregon, April 3rd
to 8th.
Dr. and Mrs. F. L. Wilson of Trail spent a few days in Spokane where Dr. Wilson
attended the meeting of the Spokane Surgical Society.
Page 23 T Dr. R. Haugen, formerly of Enderby, has taken over Dr. J. A. Shotton's practice in
Armstrong.
Dr. and Mrs. J. A. Shotton, until recently of Armstrong, have left the province and
are at present located at Barrie, Ontario.
Dr. R. W. Garner of Port Alberni is doing post-graduate work in the east and will
return via Rochester, Minn.
At the Annual Meeting of the Prince Rupert Medical Society, held in February, the
election of officers resulted as follows: Dr. C. H. Hankinson, President; Dr. R. G. Large,
Secretary-Treasurer and representative on the Hospital Board.
Dr. C. H. Hankinson is convalescing in the Prince Rupert General Hospital following
a major operation.
Dr. W. T. Kergin of Prince Rupert has recently returned from a three months trip to
Honolulu, New Zealand and Australia. He reports a very pleasant journey and is much
improved in health.
Dr. C. A. Armstrong of Port Simpson has left for eastern Ganada where he will join
Mrs. Armstrong, who is visiting in Sudbury, Ontario. They will return in May.
Dr. A, G. McKinnon is relieving during Dr. Armstrong's absence.
Dr. M. J. Keys of Victoria travelled to Portland, Oregon, to attend the special school
in Ophthalmology and Otolaryngology. It is reported he won distinction in that he was
presented with a temporal bone in recognition of the fact that he was the brightest
student taking the course.
Dr. and Mrs. N. J. Ball of Oliver were in town and attended the St. Paul's Hospital
Alumnae Dance.
Dr. and Mrs. P. L. Straith of Courtenay were visiting in Vancouver. Dr. Straith
called at the office. foi
Dr. and Mrs. R. J. Wride of Princeton spent a few days at the coast.
Dr. R. B. White of Penticton visited Vancouver and incidentally attended to some
business matters.
Dr. Herbert Badgley McGregor of Penticton and Miss Pauline Eunice Elena Smith
of Richmond, Quebec, were married on April 10th. The bride is a graduate of Montreal
General Hospital. They will return through the States by automobile and reside in
Penticton, where Dr. McGregor is associated with his father in practice.
Dr. W. H. (Bill) White attended a meeting of the Spokane Surgical Society at that
point. Dr. Alton Ochsner addressed the meeting and presented excellent papers on
Thrombophlebitis, peripheral vascular diseases and Amebiasis.
Dr. Burt Ay cock, formerly an interne at the Vancouver General Hospital and at
Tranquille Sanitarium, is now located in Greenville, North Carolina. Dr. W. H. White
has heard from him and reports that he is doing well.
3j» >fr 5j* >I-
Dr. and Mrs. A. S. Underhill of Kelowna are spending a few weeks in California
where they expect to attend the World's Fair.
Page 23
TP ??? Dr. L. A. C. Panton of Kelowna spent ten days in Portland, Oregon, attending the
post-graduate course in Ophthalmology and Otolaryngology.
Dr. G. A. B. Hall of Nanaimo has returned from a trip to the South.
Dr. H. A. Bowker, who was formerly in practice at Chemainus, is now working at
the British Military Hospital at Mhow, India.
Drs. S. C. MacEwen and E. Wylde of New Westminster and Dr. Fred Sparling of
Haney attended the refresher course at the Mayo Clinic.
* * * *?•
Dr. James Wilson, son of Dr. and Mrs. G. T. Wilson of New Westminster, has received
notice of his appointment to a three-year fellowship at the Mayo Clinic.
''" i*~ r** i*~
Dr. F. R. G. Langston and Dr. Kathleen (Woods) Langston left New Westminster
at the end of April for extended post-graduate study. They go first to the University
of Alberta at .Edmonton and later to Europe.
Sj* Sp Jj* Sp
Dr. A. W. Bowles of New Westminster attended the meeting of the Oregon Academy
of Ophthalmology and Otolaryngology at Portland.
The Chilliwack Medical Association held its Second Annual Dinner on March 23 rd.
Dr. D. E. H. Cleveland, President of the1 British Columbia Medical Association, gave an
illustrated talk on Syphilis, and Dr. A. Y. McNair, President of the British Columbia
Branch of the Canadian Society for the Control of Cancer, outlined the work of this
Society giving helpful hints to those doctors who will be responsible for forming units
at that centre. A friendly visit from Dr. S. Cameron MacEwen, Councillor for the
district, and Doctors G. T. Wilson and E. H. McEwen, all of New Westminster, was
much appreciated, as were also the golf lessons which they were able to give the local men.
Congratulations are extended to Dr. and Mrs. J. K. Kelly of Zeballos on the birth of
a daughter on April 16th.
FREDERICK GEORGE LOGIE, M.D.
Died April 28th, 1939.
It is with deep and sincere regret that we record the passing of Dr. Frederick
G. Logie on April 2 8, 1939. Dr. Logie's was a quiet, unobtrusive personality,
but his was a sterling character, and all who knew him respected and liked him
greatly. Deliberate, even slow, in speech, cautious in expression of opinion, he
came to be known as an able and reliable diagnostician, an authority in internal
medicine, and a most helpful consultant.
Personally, there was never a more likeable, friendly character than his, and
he was always good company: possessed of a dry wit, given to droll sayings, and
fond of anecdote. Most of us will think of him chuckling over some yarn he had
just told or heard.
He served in the Great War and gave devoted service—in fact, it seems more
than likely that his life was shortened by the effects of war injury, and that in
this way, too, he gave his life to his country. Those of us who knew Fred Logie
know that the gift would be gladly and ungrudgingly made.
Page 233 11
NEW BOOKS ADDED TO THE LIBRARY,   193 8-1939
GENERAL COLLECTION.
Barsky, A. J.—Plastic Surgery, 193 8.
Beckman, H.—Treatment in General Practice.   193 8.
Boyd, Wm.—Surgical Pathology.  4th ed., 193 8.
Boyd, Wm.—Textbook of Pathology.   3rd ed., 193 8.
Canadian Medical Association—Handbook on Cancer.   193 8.
Cushing, Harvey—Meningiomas.   193 8.
Cutler, M., and Buschke, F.—Cancer, Diagnosis and Treatment.   1938.
deLee, J. D.—Obstetrics.  7th ed., 193 8.
de Schweinitz, K.—Growing Up.
Dover, Thos.—Physician's Legacy to His Country.   1733.
Encyclopaedia Britannica—Yearbook.   1938.
Forkner, C. E.—Leukaemia and Allied Disorders.   1937.
Franklin, K. J., trans.—Dd Venarum Ostiolis.   1603.   A monograph on veins.
Gradwohl, R. B. H.—Laboratory Technic.   2nd ed.   193 8.
Grant, J. C. B.—Method of Anatomy.   193 8.
Groves, E. R.—Sex Education in Childhood.
Kaplan, I.—Radiation Therapy.   1937.
Kolmer, J. A.—Approved Laboratory Technic.   193 8.
Lake, Norman—The Foot.   193 8.
Maher, C. C.—Electrocardiography.   1937.
McGregor, H. G.—Emotional Factor in Visceral Disease.   193 8.
McPheeters, H. O., and Anderson, J. K.—Injection treatment of varicose veins.   193 8.
Osier, Sir Wm.—Principles and Practice of Medicine.   13th ed.   193 8.  Ed. by H. Christian.
Piney, A., and Wyard, S.—Clinical Atlas of Blood Diseases.   193 8.
Rogers, Sir L.—The Truth About Vivisection.   1937.
Rowe, A. H.—Clinical Allergy.   193 8.
Schlanser, A. E.—Practical Otology, Rhinology and Laryngology.   193 8.
Sevringhaus, E. L.—Endocrine Therapy.   193 8.
Spicer, F. W.—Trauma and Internal Disease.   193 8.
Stitt, E. R., and Clough—Practical Bacteriology.   193 8.
Strecker, E. A., and Chambers, F. T.—Alcohol: One Man's Meat.   193 8.
Sutton, R. L. S.—Introduction to Dermatology.   193 8.
U. S. Treasury Office—Studies on Drug Addiction.   193 8.
Wangenstein, O. H.—Therapeutic Problem in Bowel Obstruction.   193 8.
Wilder, R. M.—Diabetic Primer.   193 8.
MEA CULPA and THE LIFE AND WORK OF SEMMELWEISS: Louis-Ferdinand
Celine, trans, by R. A. Parker; pp. 175.  London: George Allen & Unwin, Ltd., 1937.
Of this small volume, only the second and larger part, to which about 140 pages are
given, is of particular interest to the medical profession.  This concise but vivid story of
the tragic life and death of Ignaz Semmelweiss may be considered in a sense as a by-product.
Celine is an exponent of a peculiar philosophy of the futility of effort and the hell that man
makes of his world in his attempt to advance it by material means. He selects as examples
the martyrization of Semmelweiss for daring to proclaim truth that ran counter to tradition, and the spectacle of Soviet Russia as it appeared to him on a visit to that country.
This biography of Semmelweiss is well worth reading.   It is good writing, and, better
still, it is thought-provoking. —D. E. H. C.
MICROSCOPE WANTED
Dr. M. W. Thomas sometimes has inquiries for such equipment.   If such is available,
please leave details at the office of the College of Physicians and Surgeons.
INTERNATIONAL COLLEGE  OF  SURGEONS
The Fourth Annual Assembly of the International College of Surgeone will be held at
the Hotel Roosevelt, New York City, May 21-25 incl. Among* the speakers will be Dr.
J. R. Goodall of Montreal, Dr. Max Thorek and Dr. O. B. Nugent of Chicago, and a
number of Surgeons from Europe. Further information may be obtained from the Library.
Page 234 ancouver
ca
ssociation
SUMMER SCHOOL — June 6th to 9th, incl.
Lectures.
The Programme of Lectures is published in this number of the Bulletin, and a
glance at it will show that it is not below the high standard set in other years, in either
quality or variety. The Lectures are planned with the needs of the General Practitioner
in view, and Lecturers are all men who are up-to-date and keenly aware of the progress
of medicine in all its branches.
Clinics.
Dr. L. C. Conn, Dr. Emile Holman and Dr. Dwight L. Wilbur have been asked to
give clinics, and these will be held as usual in the afternoons. At present final details
are not available.
Luncheon.
This will be held in the new hotel, and the Committee is fortunate in being able to
announce that Dr. Frank R. Menne, who is no stranger in Vancouver, will give the
luncheon address; his topic being, "The Physician in Relation to the Solution of Crime."
Golf.
The Committee has asked those two capable and energetic golfers, Drs. H. H. Pitts,
D. Fraser Murray and J. P. Bilodeau to take charge of the affair this year, which assures
success.   It has not been decided at which courses the Tournament will be held, and the
Committee plans to extend the usual hospitality at the 19th hole.
Lectures will be held in the new hotel. Programmes will soon be available, and
tickets will be on sale early in May. Make your plans early, and buy your ticket early.
The Committee has announced that this year the papers will not appear in the Bulletin.
VANCOUVER MEDICAL ASSOCIATION
ANNUAL MEETING — April  25th,   1939
Dr. Lavell H. Leeson.
Retiring President's Remarks.
The active work for the year 1938-1939 is finished. Your new executive has been
elected—they are all good and true men. Your new President has served faithfully in
the past executive meetings, and for him I ask a continued interest and support from the
members.
For the directors of the V.,M. A. I trust that their new experience will receive the
wholehearted help of the profession.
I look at the past year's activities with regret that the time has passed so quickly—
that much needed work has been left partly finished and some not commenced. The
machinery is ready, some of it in operation for the executive to use this year.
Generalities are used as an excuse to cover deficient labours—particularities are personal. One searches one's mind for things done for the good of the Association—there
are many accomplishments which I feel have been for the benefit of the Association in
particular and the medical profession of Vancouver and British Columbia in general.
Your Secretary has reported on the meetings held.
Your Treasurer has given you a financial statement, of our Association but what have
the members received which is of value to them as men and doctors?
We have tried to bring before you men, who by virtue of their special talents in our
profession are fitted to give you ideas, and material which, it has been hoped, would make
Page 23 5 you better fitted to carry out your duties to your patients.    Those who were fortunate
enough to hear the speakers know how well the plan has worked.
There are several particular headings to a retiring president's address—which at this
time should be emphasised—so that the newly elected President may receive the support
which by vote you have accorded him.
How often it has been said that the Executive of this Association is a closed corporation! How true or false that statement is each and every one of you can in his heart answer.
The members of this Association show annually, by their indifference to the nominations for
the executive positions, that they are truly apathetic. This' should not be so. You have
a privilege in the election of your directors—how many exercise that privilege? How
many wish to give of their time and energy to this work for the profession of Vancouver?
These men who are asked to assume these duties on the executive and committees are
carrying on a busines without remuneration to themselves while the profession receive
dividends. Is this fair? We have a business organization handling $5000.00 a month
for distribution to the doctors—it would be enlightening to know how many accept
their dividends monthly. Many of these receivers are members of this Association—75
doctors in the city are not. Is it fair that some doctors give of their services willingly
and freely while others do not contribute at all ? Some go on their daily routine of seeing
patients while others have the added work of carrying on the duties given them of or-,
ganized medicine. What is organized medicine? Too few have stopped in their life to
ask that question—Why? They enjoy the privileges and safety set up about them by
their fellows, who work just as hard as they in their profession, and in addition take
time to be sure that medicine is safeguarded so that their fellow men may enjoy a life of
freedom from anxiety. Let us look to ourselves for the answer, or are we riding in the
wake of progress all too easily?
The day is coming—possibly sooner than some realize—when every doctor will be
asked to give his time; his energy; his skill, for what? No one knows what the labourer's
hire is worth.
There are those who have given an intimation to us—how soon will an ultimatum be
given? Take this to your hearts—digest it—think how you will help by your actions to
weld a stronger organization which will be of benefit to the sick and to our country
at large.
How can we obtain more members in our Association? The Executive have considered the matter carefully and have come to the conclusion that there should be a
Membership Committee appointed or elected, who would interview each new doctor
arriving in our city, explaining to him the reasons why he should become a member of our
Vancouver Medical Association as soon as he possibly can. The profession in Vancouver
is gaining in numbers rapidly. Who are these men? Have they friends in the profession
or have they decided to cast their lot in our city hoping that, with the natural growth
in population, that they will eventually be able to earn a living? Would it not be better
for some of our members to meet these men, offer them the handclasp of welcome, and
invite them to attend our meetings?
We are primarily a scientific body, not political, and as such, we should do all in our
power to see that the minds of these men and eventually their ideas and work will be for
our interests.
That is why I say, a Membership Committee, distinct in itself from that of the
Credentials Committee, should be elected.
There is in our Bylaws and Constitution, a place for privileged members. This is a
distinct group of men who are not practising medicine in competition with ourselves.
These men are the internes in the hospitals and the doctors attached to the hospitals in
administrative capacities. These are not men who are on salary to organizations, who
examine, treat, and prescribe medicines for the welfare of patients. These latter are not
a privileged group in our Association, but for the former group it has been suggested that
a letter from our Association go to each interne when he arrives in the city, offering him
the facilities which we are able to afford him.   This is a matter which may be taken up by
Page 236 the incoming executive so that these young men will feel that one of the most important
parts of our Association, viz—the Library, is at their disposal.
The Annual Dinner of our Association held in November, it has been said, was of a
very high calibre. Your Dinner Committee this year has found it increasingly difficult
to obtain material to take an active part in the several portions of the programme. It is
unfortunate that more of the younger men do not willingly come forward to help the
Dinner Committee in their work.
All the work is done by a few who have for years carried on, presenting programmes
which are enjoyed by all, but they are becoming tired of their labours and hope and expect
that others will come to take their places when that may be.
Why do doctors belong to our Association? There are 292 men in the profession who
are members. There are, however, approximately 100 doctors in Vancouver who do not
belong. It is not compulsory that men join. Why do they not? Is it on account of the
fees which are necessary to be paid for this Association as well as other contributory fees
to be paid to enable them to practice in the city? Is it because the Association does not
offer a programme of sufficient interest: to all? Your Programme Committee has devoted
much time and effort in trying to arrange meetings for this year which would be of
interest to the majority of members. Evidently this has not met with the success desired
for we had an average attendance of 8 0 men. This year an innovation was; attempted in
having dinner meetings. This, strange to say, has met with a decided success, for we
have had an average attendance of 125 at the three dinner meetings held.
I cannot let the opportunity pass without a few remarks about the Editors of the
Bulletin, our official magazine. You have read the Bulletin this past year and have
noticed that your editorial board has enlarged the magazine and has included transactions of the Victoria Medical Society, the Vancouver General Hospital and St. Paul's
Hospital. This has been a decided advantage to us, for within the pages we are able to
read the papers which are the latest in the particular subject of the writer. We have the
clinical cases of the hospitals reported, and we have the transactions of the clinical meetings in Victoria. The B. C. Medical Association are placing their writings in the
Bulletin, and the knowledge of how well this magazine is received is seen by the increased circulation to medical societies and libraries throughout North America.
In concluding, I wish to pay tribute to the work of the Committee which so ably
assisted me in this past year; to the Relief Committee who have carried on their work so
well and uncomplainingly, and to the members who have helped the Association in their
many ways. To the new President, Dr. Agnew, and his Executive who now take up the
work of the Association, I wish the unfailing support of the Association and loyalty during
their term of office.
I close my remarks by thanking you for the privilege and honour of having been able
to serve you for this past year.
Dr. A. W. Holm, who has been an interne in St. Joseph's Hospital, Victoria, has
taken up practice in a new field with headquarters at Sechelt.
MEMBERS of THE GUILD I
of PRESCRIPTION OPTICIANS of AMERICA
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Vancouver, Canada.
Page DEPARTMENT OF CANCER CONTROL
Dr. Ethlyn Trapp.
In the absence of Dr. Huggard, chairman of the Committee on the Study of Cancer
of the British Columbia Medical Association, I have been asked to put before you the
activities of the Department of Cancer Control of the Canadian Medical Association.
When this most recent department of the Association grew out of its cancer committee
in 1937, the cancer committees of the nine provinces were asked to be its local units,
and to organize and carry on the work in their respective provinces.
The present activities and future policies of this department have been fully and
clearly set forth in the December issue of the Canadian Medical Association Journal, and
this will repay careful reading. It has developed from the first cancer committee of the
Canadian Medical Association which was established in 1931 under the chairmanship of
Dr. Primrose, and I propose to review briefly the work of that cornrnittee. It met year*
after year at the time of the annual meetings of the Canadian Medical Association and as
early as 1933 the following resolutions were passed by Council to the Executive Committee for study and action:—
(1) To arrange for a section in the Journal in which each month some questions
relating to the diagnosis and treatment of cancer will be dealt with.
(2) To prepare from time to time leaflets or booklets dealing with early manifestations of cancer in various parts of the body, for distribution to all Canadian
doctors.
(3) To prepare and distribute, when the time is opportune, literature for the enlightenment of the laity on this subject.
(4) To arrange for special meetings at regular intervals in all local and district
medical societies throughout Canada, at which speakers secured locally, and from
adjacent medical teaching centres, will give addresses on some aspect of the
cancer problem.
(5) To arrange through the Provincial Medical Associations for speakers to address
public meetings on this problem.
(6) To use its influence with the provincial associations to appoint a Provincial
Cancer Committee in all provinces, where this step has not already been taken.
(7) To co-operate with the Provincial Cancer Committees in organizing a cancer
committee in each organized hospital of 100 beds and upwards.
In 1934 the King George V. Silver Jubilee Cancer Fund for Canada was inaugurated
and a campaign launched to raise money for that fund. The results were disappointing,
but the prospect of even a limited amount of money with which to carry on the work
put new life into the organization and in 1935 the Department of Cancer Control was
conceived, with the General Secretary of the Canadian Medical Association as its managing director, and with provincial chairmen of cancer committees and full time medical
secretaries as members of the Board of Directors.
In 1937 the Jubilee Fund provided an annual grant of $14,000 to the Canadian
Medical Association for the purposes of organizing and carrying on its cancer activities,
and the creation of a lay-medical body to help with this work. The Canadian Medical
Association passed this responsibility to its Department of Cancer Control, which already
has the following accomplishments to its credit:—
I. The establishment of facilities under this department for the correlating of all
cancer activities throughout Canada.  It is proposed to accomplish this by means of:
(a) The Canadian Medical Association Journal, which, under its new section, ''The
Cancer Campaign," is publishing each month material on cancer, including reports of
Page 238 activities throughout Canada, as well as of the work being carried on in other countries.
(b) The formation of a central body concerned with cancer statistics.
(c) The provision of uniform record forms to each study group, which shall be submitted to the central body for study.
(d) Provision for addresses and clinics at district, provincial and Dominion medical
meetings.   (These were provided for the 1938 meetings.)
(e) The formation of cancer study groups in all hospitals of 100 beds and over. Some
have already been inaugurated in Prince Edward Island, Manitoba, Alberta and Saskatchewan, as well as in British Columbia, and others are in process of organization in
New Brunswick, Nova Scotia and Ontario.
II. The Handbook on Cancer, published last October and distributed free to the profession throughout Canada. Before publication, the manuscripts of this book were submitted to the Deans of Canadian Medical Schools and the heads of the Provincial Cancer
Committees for careful study and criticism.
The British Medical Journal, reviewing it, says: "If it be granted that education of the
profession is at least as much to be desired as that of the public, an important service has
been rendered by the Canadian Medical Association in publishing a Handbook on Cancer
intended for the General Practitioner. This book of 2 3 2 pages is simple and unencumbered
by illustrations or masses of figures, but it has been written By experts and furnishes an
admirable account of the pathology, symptomatology, diagnosis and treatment of cancer
in every part of the body. The information given is authoritative, up to date, and surprisingly full and detailed for chapters so brief and easily read. . . . Almost everyone has
something to learn from a book such as this, and to many without special training it can
be a most valuable guide. Some of the funds available for promoting the study and improving the treatment of cancer could scarcely be better spent than in sending a copy of this
book to every practitioner in the country."
After this favourable review, 97 requests for copies have been received from twelve
different countries. Free copies have already been presented to over 9000 Canadian doctors.
III. And not least important, the creation of the lay-medical Canadian Society for the
Control of Cancer, for the purpose of disseminating knowledge to the lay public on the
subject of cancer, and of collecting funds for the carrying on of this work.
You will remember that the bringing to life of such a body was one of the main objectives of the original cancer committee of the Canadian Medical Association, formed in 1931.
By way of demonstrating that such a scheme as the one in which we are asked to participate justifies the effort put into it, may I outline briefly the work accomplished in the
State of Massachusetts.
In 1926 a comprehensive programme for the public dissemination of knowledge about
cancer was inaugurated and was carried on by means of lectures, radio talks, newspaper
publicity, etc. In 1934, after eight years, an evaluation of this intensive publicity work
was undertaken.  This revealed:
1. That the traditional resistance to the discussion of cancer had been broken down.
2. That more people were presenting themselves for treatment, but that there was
no lessening in the average period of delay in seeking confirmation or otherwise of suspected symptoms.  In 1926 this was six months and in 1933 it was still six months.
3. The most encouraging fact obtained from the records was that the physicians were
sending patients for adequate therapy with only half as much delay in 1934 as occurred
in 1926.
This observation demonstrated that the pivotal figure in cancer control and cancer
education is the family physician. He sees the patient first and upon his advice depends
the outcome of most cancer cases.
With this knowledge gained, a comprehensive and well-organized programme for the
education of the doctor and his correlation with public education was undertaken. An
evaluation of this work from 1934 to 1938 has brought to light the following significant
facts:
Page 239 1. In this four-year period the cancer death rate for women with cancer of the breast
decreased 4.7%; with cancer of the uterus 7.5%; while the death rate of cancer for all
other regions increased 1.5%, thus demonstrating the effect of education on types amenable
to treatment.
2. In 1933, 12.4% presented themselves for treatment within a.month of the observation of the first symptom. In 1937, 18.5%.
3. The average time of seeking medical aid was reduced from 6 to 5 months. Still
far too long a period, but a definite improvement.
Of course, many such programmes have long since been undertaken throughout the
civilized world, but in not many places have such complete statistics been compiled.
I mention Massachusetts because our own recently inaugurated Canadian effort for
cancer control is being established on a similar basis, the important point being the recognition of the individual physician as the corner stone of the whole programme. This has
met with success in Massachusetts: it will meet with success in Canada' if it has the support of the individual physician and not otherwise.
Such programmes as that of Massachusetts demonstrate that we cannot fail if we
have the industry, patience and vision to carry out the scheme which is now presented to
us as a result of seven years of patient spade work by the cancer committee of the Canadian
Medical Association.
During these years the Vancouver Medical Association has also been mindful of the
problem of cancer. In 1931 a cancer committee, under the chairmanship of the late Dr.
Mason, was formed in this Association and an attempt was made to interest every member
of the Association by a regiorial study of cancer, each doctor being asked to participate in
the section which interested him most. A special cancer meeting was held each month and
many interesting cases and papers were presented. In that year the Provincial Government
made cancer a reportable disease, at the instigation of this society.
After some three years of enthusiastic work, the section was merged with the clinical
section, with the result that it has lost its identity in the larger body. Would it not be
feasible to revive such a section? Formerly its meetings were all well attended, the first
year showing an average attendance of 50. With the present widespread interest in the
subject these should be even more popular. Could there not be some form of close co-operation established between the Cancer Committee of this Association and that of the British
Columbia Medical Association? There is much to be done before the objectives of the
Department of Cancar Control can be realized. If the Vancouver Medical Association
would accept the responsibility for part of this work an important step would have been
taken towards a successful completion of the programme.
The formation of the Department of Cancer Control within the Canadian Medical
Association marks the first attempt that has been made to correlate the cancer work of
the Dominion as a whole, though each of the provinces has dealt with the problem in
some) way.
In British Columbia, as in the other provinces, the Cancer Committee of the Provincial Medical Association has accepted the responsibility for carrying on the work of
the Department of Cancer Control. It is a big undertaking and requires the assistance of
all the local medical associations.
As an initial effort, we have been obtaining what information we can on the existing
situation throughout the province, by correspondence: this is of necessity a time-consuming task and our headway has not been as great as we had hoped. However, something
has been accomplished.
In following out the programme of the Department of Cancer Control, we have
written to all hospitals of approximately 100 beds and over, asking them to form cancer
study groups and, where feasible, tumour clinics, within the hospitals. There are 17 of
these. To date we have received eight promises of co-operation. Tumour clinics have been
functioning for some time in both the Vancouver General and St. Paul's Hospitals and
have long since demonstrated their value; though with the wider support of the profession,
that value could be materially increased.   The Jubilee Hospital in Victoria has had a
Page 240 Cancer Study Group for some years and now both it and St. Joseph's also have their tumour
clinics under way.
We have asked for the annual average of the cancer cases treated in these hospitals.
Some report no available records.   Those that have records report the following number
of cancer patients treated:
203-X-ray
Average Ten-year total
xr ^ , TT      .   , [     650 447 in-patients 4477
Vancouver General Hospital  ,,-,,,      ,. T    •    r
r J 272 radiological
r     ^    u   TT     .   , 1     596 323 in-patients 3233
St. Paul s Hospital I ->-7->     j- i    •    i
r l^ 272 radiological
In both these hospitals there is some overlapping due to the fact that some of the patients
treated radiologicaUy have also been in-patients. At St. Paul's Hospital 3432 patients
have been treated with radium in 18 years.
Jubilee Hospital      184
St. Joseph's        64
Shaughnessy        2 5
Nelson  |        16
Cranbrook         13
St. Mary's, New Westminster        12
Port Alberni  7
Kelowna  6
Total   	
327 plus 650 V.G.H.
"    596 St. Paul's   =   1573
This leaves out Essondale and the Royal Columbian Hospital in New Westminster as well
as other smaller hospitals throughout the Province. There would be at least 100 at the
Columbian and possibly a similar number at Essondale. One would expect more at such
a colossal institution, but they report less than 1% of their deaths to be due to cancer.
There would easily be another 200 from the radiological departments of the Jubilee
and St. Joseph's and a few from each of the 100 smaller hospitals throughout the province.
Also a few treated by private physicians in their own offices.
With these figures in mind one may assume an approximate working total of 2500
cancer patients treated annually. The British Columbia Government reports approximately 900 deaths—4 to 5 active cancer cases are commonly computed for each cancer
death. This would mean that only slightly over half of the cancer cases of the province
are receiving treatment.
Of course, such figures are hopelessly incomplete and open to various sources of error,
but they give a rough estimate and serve to bring up the question of statistics. What sort
do we want, what use will they be to us and how can they be most advantageously obtained?
Repeated efforts have been made to obtain free biopsies, but this essential service has
not yet been made available for/ the province.
Broadly speaking, the objectives of the Department of Cancer Control are:
1. To focus the attention of physicians throughout Canada on the cancer problem.
2. To concentrate the efforts of the physicians in order to bring about a better control of the disease.
3. To take whatever part is required in the education of the public. The provision of
competent speakers is perhaps the most important part of such public education.
4. Previous history research, that is, the investigation of the antecedents of cancer
with the idea of finding means of preventing cancer, and for this important piece
of clinical research every practicing physician is qualified.
5. To keep the profession constantly posted on all facts pertaining to cancer and its
treatment.
As I have already pointed out, the initial organization work has been completed and
several of the original aims already accomplished.   The completion of this programme is
Page 241 obviously not the work of a day. The problem of cancer will be with us for many years to
come. It behooves us to lay our foundations solidly and not to feel too discouraged, if the
results of our efforts do not become immediately apparent. In this connection, may I
qute a paragraph from a letter of Dr. Routley's, received a few days ago:
"I think this point should be stressed, that no spectacular results should be looked for,
but rather, taking a leaf from our friends in Russia, we must look upon1 the initial plan as
a five-year programme; and probably at the end of that time commence a second five-year
programme, hoping that at the end of ten years we may point to a decrease in mortality
showing that some progress has been made in attacking this dread disease."
You may ask what is hoped to be gained from these hospital study groups. Dr. Scott,
chairman of that Committee, tells us the following:
"There are a few study groups in existence at the present time in some of the large
hospitals.
"1.   What has been learned by such study groups up to the present?
"(a) Valuable information has been obtained regarding the diagnosis of cancer.
Although the history and clinical findings will frequently make the diognosis
of cancer very probable, the fact remains that in the vast majority of cases
such diagnosis is only established by means of biopsy. . . .
"(b) Certain facts have been established about the results of various forms of
treatment. The small hospital must start wtih the acceptance of the methods
that have been established by larger clinics over a period of years. Deviation
from these established methods should only be pursued after the most careful
consideration.
"(c) The value of the proper supervision and control of therapeutic measures has
been well demonstrated.
"2. With the present methods of the treatment of cancer the great problem is the
recognition of the disease in its early stages. In many clinics the percentage of
early cases has not increased despite continued reiteration of the value of early
diagnosis. The causes of this delay are attributable to both patient and doctor.
In many instances the patient does not seek advice in spite of knowledge of the
possibility of cancer. In others, the symptoms are treated without eliminating
the possibility of malignant disease.
"3. It appears to your Committee to have been established that the great majority of
cancer cases should not be treated in small hospitals, but should be referred to
properly equipped cancer clinics.
The small hospital will likely have no contribution to make to general medical
knowledge, but can serve a useful purpose in making available statistics regarding
the early history of cancer patients.
'4.
ct5.   The medical personnel of any hospital will learn much by the systematic study
of all their cancer cases."
Gentlemen, I trust I have made clear to you the aims and objects of the department
of Cancer Control. May I make a plea for the support of this co-operative effort within
our own profession, tangible support in the form of:
1. Attendance at, and contribution to, the tumour clinics already functioning at the
Vancouver General and St. Paul's Hospitals. •
2. By the active participation of the Vancouver Medical Association in this work, by
whatever means may prove to be the most advantageous.
If the physicians of the Dominion, which means the physicians of each communtiy,
large and small, will assume the burden, after a few years the momentum of this basic form
of control will sweep away every vestige of an excuse for failure to secure the best form of
treatment without delay. Simultaneously there will be a steady increase in our own skill
in the fields of cancer diagnosis and treatment. Education will disseminate the knowledge
gained by clinical and scientific research and each year we ourselves shall be better equipped
for the handling of this important problem.
Page 242 AN ADDRESS ON
THE BRITISH COLUMBIA CANCER INSTITUTE
Dr. B. J. Harrison
It gives me very great pleasure, as Director of the British Columbia Cancer Institute,
to have the opportunity of explaining to you how this Institute came into being, what
is its present function and what it hopes to do in the future.
In April, 1935, the British Columbia Medical Association decided to take some steps
to improve the situation of potential and actual sufferers from cancer in British Columbia,
and with that object in view proceeded to set up a provisional committee composed of
representatives of the British Columbia Medical Association, the Vancouver Board of
Trade, and the Greater Vancouver Health League. Doctors H. H. Milburn and G. F.
Strong represented the Medical Association, Messrs. W. J. Twiss1 and W. C. Ditmars, the
Board of Trade, and Mr. N. C. Levin and Dr. B. J. Harrison, the Greater Vancouver
Health League. This provisional committee added Dr. C. W. Prowd to its membership
and after several meetings decided to form a representative body of citizens in the province
under the title of the British Columbia Cancer Foundation, and with this end in view
forwarded a letter to some seventy-eight prominent citizens of the province, asking
them to attend an inaugural meeting on June 12, 1935.
At this meeting thirty-eight gentlemen signed the membership roll and formed the
Board of Directors to carry on the work of the British Columbia Cancer Foundation
which was incorporated under the Societies Act.
The objects of the Association are laid out in general in the Articles of Association,
drawn up at the time of incorporation. These Articles gave the Foundation very wide
powers which as time went on came to be focussed in certain directions, as can be found
from examination of thei minutes of the meetings. These were at one time laid down by
Dr. Strong as consisting of, first of all, supplying facilities for diagnosis and treatment
of malignant disease; secondly, the education of the profession and the public; thirdly,
the carrying out of clinical research. On another occasion, Dr. Haywood of the Vancouver General Hospital emphasized that one of the functions of the Foundation should
be the establishment of a Cancer Institute in Vancouver, Dr. Prowd corroborating this
and suggesting to the management of the Institute the need for the education of the profession and the public and suggested that the sum of Five Hundred Thousand Dollars
($500,000.00) be raised for these purposes.
In a letter to the Vancouver General Hospital in September, 1936, as laid down for
the guidance of the Hospital the main objectives of the Foundation were stated to be:
(a) The collection and the distribution of funds for the control of cancer in British
Columbia.
(b) The improvement of the facilities for diagnosis and treatment of cancer in
British Columbia.
(c) The education of the profession and the public with regard to cancer in British
Columbia.
(d) The necessity of wide publicity regarding cancer.
(e) The establishment of desirable clinical research work among cancer sufferers.
A broad outline for cancer control was laid down on June 19, 1936, in the following
way:
It was proposed that a major clinic be established in Vancouver. That a submajor
clinic be established in Victoria. That minor clinics be established in the country parts
of British Columbia in such towns as Trail, and that diagnostic clinics be established in
smaller towns such as Chilliwack. It was suggested that all cases of tumour should be
reportable, and that the onus be on the doctor who first saw the tumour to report it and
to determine or have determined finally whether the tumour is< cancerous or not.
Under such a scheme a patient in any centre, no matter how sparse or how widely
distributed the population, who found himself with the evidence of a tumour, would report
himself to his doctor, who would then refer him to the nearest diagnostic centre report -
Page 243 ing him at the same time to the major clinic in Vancouver. At the diagnostic centre the
nature of this tumour would be determined in most cases, the facilities for consultation at
the major clinic in Vancouver aiding this considerably. The major clinic in Vancouver
having all the information regarding the patient at its disposal would lay down the line
of treatment to be followed and would refer the patient from the diagnostic centre to
the nearest centre at which the necessary treatment could be carried out. This might be
to the nearest minor clinic if surgical excision were necessary but in case anything further
than this were thought to be advisable the patient would be referred to the major or sub-
major clinic.
The institution of this system would mean extensive government aid for the purpose
of providing the necessary travelling facilities.
An attempt was made to enlist the support of the Provincial Government of British
Columbia and Dr. Weir proved to be extremely sympathetic. He was, however, unable
to commit the Government to any definite action regarding finnacial support, but expressed his belief that when the Foundation actually got under way the Government
would probably come to its help.
With the help of the Government plans were drawn for an up-to-date Tumour Clinic,
with fifty beds and complete laboratory, X-ray and radium facilities. The estimated cost
of the institution was Four Hundred and Fifty Thousand Dollars ($450,000.00).
As time went on it was found that the attainment of all the objectives which the
Foundation had in mind would require rather more money than it would seem possible to
raise without very definite assistance from the Government, and it was decided that the
efforts of the Foundation should be directed first towards the establishment in Vancouver
of certain facilities for treating and diagnosing cancer which were not in existence at that
time. Some of the objectives were left in abeyance but in trie meantime the question of
the education of the profession regarding cancer had been taken up very seriously by the
Cancer Section of the Canadian Medical Association and it was felt that the education of
the medical profession could best be left in the hands of the Medical Associations themselves. The establishment of the Canadian Society for the Control of Cancer was a means
whereby the education of the public could be carried out apart from the Foundation and
this part of the work has gradually been taken over by the Canadian Society for the
Control of Cancer, whose responsibility it will continue to be in the future.
Radium.
In March, 1936, three and one-half grammes of radium came into the radium market
at a price considerably below that which was paid for the self-same radium in Ontario,
and it was considered advisable that the British Columbia Cancer Foundation should
purchase that radium. The Government of British Columbia was thereupon approached
and an arrangement was entered into whereby the Dominion Bank placed the necessary
money, One Hundred and Five Thousand Dollars ($105,000.00) at the disposal of the
Foundation on the security of a note given by the Foundation, back by the Provincial
Government. The radium was therefore purchased and arrived in Vancouver in May,
1936.
The British Columbia Cancer Foundation thereupon became responsible for the payment of the interest to the Dominion Bank, and this charge was taken care of by His
Honor the Lieutenant-Governor, Mr. E. W. Hamber, for a period of several years. Mr.
Hamber had, from the inception of the Foundation, taken a very keen interest in its
activities and had extended to it the support of his sympathy as well as the financial aid
just mentioned.
Financial aid came to the Foundation from various sources, the most notable apart
that of the Lieutenant-Governor being a gift of Two Thousand Dollars ($2,000.00)
from the Vancouver Rotary, Five Hundred Dollars ($500.00) from the Vancouver
General Hospital Alumnae Association. The Vancouver Riding Club gave a sum of
Five Thousand Dollars ($5,000.00) in 1938. Numerous small sums totalling about Two
Thousand Dollars ($2,000.00) were given by various individuals and organizations.
In April, 193 8, an anonymous donor placed the sum of Fifty Thousand Dollars
($50,000.00)  at the disposal of the Foundation for the purpose of processing some of
Page 244 the radium and putting it to work. One gramme of the radium was purchased with
Thirty Thousand Dollars ($30,000.00), sent to Ottawa to be measured, and from Ottawa
was forwarded to Belgium where it was processed along lines laid down by various radium
centres throughout Canada and the United States, which were interviewed personally by
Dr. G. M. Shrum of the Department of Physics of the University of British Columbia
and myself. In October, 1938, the radium was returned from Belgium to Ottawa where
it was finally checked and arrived in Vancouver in time for the opening of the Clinic or
Institute on November 5, 1938, and housed in the Institution at the corner of Heather
Street and Eleventh Avenue, which with some of the anonymous bequest had been
prepared so as to render it suitable for a diagnostic and radium treatment centre for
ambulatory patients. The use of the house had been granted by the Vancouver General
Hospital free of charge, but the cost of the necessary alterations, the cost of furnishings
and equipment, the cost of processing the radium were all borne by the anonymous
bequest. To the clinic that was ready for use and opened officially by His Honor the
Lieutenant-Governor on November 5, 1938, the name of the British Columbia Cancer
Institute was given. It represented the first active unit of the British Columbia Cancer
Foundation and after its inception the organization of the British Columbia Cancer
Foundation was changed so as to meet this alteration in activity. The British Columbia
Cancer Foundation now consists of a Board of Governors from whom a Board of Directors
is elected. From the Board of Directors an executive body is formed to look after the
minutiae for the Board of Directors, and a Board of management entrusted with the
management of the British Columbia Cancer Institute is also elected.
The Institute itself consists of a two-storey house, with a basement and an attic. The
ground floor is arranged so as to contain a waiting room, an office, a number of dressing
rooms, two examination rooms, and a sterilizing room. The second floor contains the
Director's office, the radium room, a sterilizing room, and a small operating room, with
three restrooms for patients undergoing radium treatment. The attic is used as a Board
Room and also contains separate quarters for the nursing staff. The basement is not at
present in use.
The staff consists of a full-time radium therapist, a full-time radium nurse, a secretary, and a part-time orderly.
In addition, there is an honorary medical staff, fifteen in number, and the medical
control of the honorary medical staff and the paid staff rests in the hands of th© Director
and Assistant Director.
Throughout the development of the Cancer Institute the aid of the Vancouver
General Hospital has been very generously given and to them the Institute is indebted
not only for the house rent free but also for heat, light and power free of charge. The
X-ray and laboratory services of the Hospital have been placed at the disposal of the
Institute for indigent patients, also free of charge. The linen and the laundry have been
supplied by the Hospital without any cost to the Institute. Moreover, the Hospital has
at all times, within the limits of its capacity, been willing and ready to place beds at the
disposal of the indigent patients of the Institute.
So far no financial arrangement has been made definitely with the Government of
British Columbia nor with the municipal authorities of the city of Vancouver or elsewhere. Attempts are constantly being made to get the districts and municipalities to
undertake the cost of indigent patients referred from their centres to the Institute. So far
the response of the municipalities has been extremely gratifying, though at present there
is no hard and fast rule binding the municipalities in any way.
Aims and Objects of the British Columbia Cancer Institute.
The primary object of the Institute is to supply those forms of diagnostic help and
treatment which it is felt are not as freely available to the indigent public as one would
like. The present facilities consist of a diagnostic clinic of the clinical type with the
laboratory aid supplied by the General Hospital. On the therapeutic side, radium is
supplied to patients, free where necessary, administered in the case of ambulatory patients
in the Clinic itself or when the patient is confined to bed in the Vancouver General
Hospital, when the patient is unable to pay.
Page 245 It is felt that while this first step is satisfactory as far as it goes, it is necessary that
the Institute expand its facilities at the earliest possible opportunity, and though the
ideal originally aimed at when the matter was first discussed in 1935 appears to be still
far away it is anticipated that there will be, in the near future, considerable improvement
in the ability of the Institute to handle all its indigent cancer patients completely.
Co-operation.
It will be remembered that the British Columbia Medical Association took the first
step towards the formation of the British Columbia Cancer Foundation and when the
question of appointing a medical staff to the Institute arose it was decided to ask the
British Columbia Medical Association to draw up a roster of different specialists from
which the Institute could select its staff. Furthermore, a representative of the British
Columbia Medical Association was placed on the Board of Management. In these ways
it is felt that the co-operation between the British Columbia Cancer Institute and the
British Columbia Medical Association is as complete as is practicable.
When the British Columbia branch of the Canadian Society for the Control of Cancer
was about to come into being, a motion was passed by the British Columbia Cancer
Foundation, July 2, 1937, to the effect that "the British Columbia Cancer Foundation is
anxious to co-operate in this movement and is willing to be the British Columbia Provincial Branch of the Dominion-wide organization which is about to be formed." It did
not seem practicable to put this motion into effect and the British Columbia branch of
the Canadian Society was formed separately. It was felt that it was necessary to have
co-operation between the British Columbia Cancer Foundation and the British Columbia
Branch of the Canadian Society for the Control of Cancer, and with that object in view
a Committee of Co-operation was formed, consisting of members elected by both bodies
and placed under the chairmanship of Col. Sherwood Lett, a member of the British
Columbia Branch of the Canadian Society for the Control of Cancer, and it is through
this Committee that co-operation between the two bodies has been secured.
Early in its history, the British Columbia Cancer Foundation became affiliated with
the British Empire Cancer Campaign.
The British Columbia Cancer Institute has not reached its present stage without
considerable difficulty and considerable criticism, and while most of the criticism has
been fair and helpful there have at times been occasions when it was difficult to see
how the movement against cancer was being helped by the particular criticisms directed
at the activities of the British Columbia Cancer Foundation and of the British Columbia
Cancer Institute in particular, but as the Institute has developed criticism has become
more and more helpful and for that helpful criticism the Institute is very grateful. One
cannot let this opportunity pass without making mention of the helpfulness that animates
all the laymen connected with the Foundation and the Institute though on this side, too,
there has at times been apparent some hardly justifiable criticism. This, however, has
been felt to be due largely to lack of understanding and it, too, has now passed from the
stage of futility into that of helpfulness.
It is felt that sufficient co-operation bas been obtained to enable the work of expansion to progress satisfactorily. Though it is recognized that difficulties will still
continue to arise, both inside the Foundation itself as well as outside, it is considered that
none of these are insuperable and even if the expansion of the Foundation does not occur
as rapidly as those of us who are seeing a lot of cancer1 every day would wish, we feel that
it will probably be better if the Foundation expands its activities at a rate that will
secure continuity rather than attempting to attain its ideal before it is financially ready.
THE CANADIAN SOCIETY for THE CONTROL OF CANCER
Dr. A. Y. McNair.
I want to thank you for the honour which this Association has done me by asking me
to say a few words to you tonight. Dr. Ethlyn Trapp and Dr. B. J. Harrison have brought
you a great deal of information and it is our hope that these presentations will tend to
clarify many points about Cancer organization which have been very confusing to most
Page 246 of you. Cancer Control is one of the major activities of the Canadian Medical Association
and comes directly under the Department of Cancer Control.
I will now try and give you a brief outline of the composition of the Canadian Society
for the Control of Cancer and its relationship to the medical profession and laymen of
Canada. To do this it is best to go back and tell you something of the origin of this Society.
It has long been felt, both by the laymen and by the profession, that a society, whose
activities were largely educational, was necessary in Canada, to carry to the men and
women of this country some information regarding the early signs and symptoms of
cancer, and by so doing to enlist their assistance in a national effort to get an earlier presentation and diagnosis of cancer cases with the object of lowering our present high mortality from this group of diseases. It is well known that the majority of our people know
little or nothing about cancer, except that it is a fatal disease.
The King George V Silver Jubilee Cancer Fund for Canada, launched by Lord and
Lady Bessborough as a fitting memorial to our late Sovereign, did not get the support it
might have had. The total fund amounted to approximately $450,000. The Board of
Trustees of this Fund have had many requests for it, or for a portion of it. However, it is
their policy to keep the fund intact until such time as they deem fit to use part, or all of
it, for some worthy cancer activity in Canada. The Board of Trustees does not consider
it their duty, nor did they desire to engage in any national educational scheme. After
careful consideration and investigation, they selected the Canadian Medical Association as
the one organization in Canada best equipped and organized to undertake such an educational scheme. This was accepted by the Canadian Medical Association and, in return,
the Association was given the interest on the Bessborough fund amounting to approximately $14,000 a year, for several years. This grant carried with it a plan for the reorganization of the cancer educational committee of the Canadian Medical Association
and brought into being the Department of Cancer Control to promote and supervise
cancer activities and education in Canada.
So it was that, in June, 1937, acting on instructions from General Council of the
Canadian Medical Association, a Department of Cancer Control was set up in the Association. It was on this department that the responsibility of organizing and initiating a lay-
medical educational society, fell. This society is known as The Canadian Society for the
Control of Cancer. Dr. T. C. Routley was appointed Managing Director of the Department of Cancer Control, and that Department then set up a provisional Board of Directors
of the Canadian Society for the Control of Cancer in Toronto. Its composition was half
laymen and half members of our profession. Dr. J. S. McEachern, of Calgary, was elected
president of this new society as it was largely through his efforts that the society now
exists.
In March, 1938, a Dominion Charter was obtained. In May, 193 8, the organization
of the provincial branches was started. This was done by laying the responsibility for
organization on the shoulders of the Chairman of the Cancer Study Committee who is a
member of the Board of Directors of the Department of Cancer Control (C.M.A.) in
each province.
In British Columbia, a provisional Board of Directors was selected and organization
started immediately. By November 1st, 31 units out of a total of 135 to be organized,
were completed.   To date 62 branches are functioning well.
In November, 1938, together witji Mr. Duncan Bell-Irving, I had the honour to
represent the British Columbia Branch as Grand Councillors, in Toronto, and also attended
the meeting of the Department of Cancer Control. At that time reports showed that
British Columbia was completing its organization and work far in advance of any of the
other provinces. At this, the first meeting of the Board of Directors and Grand Council,
the Canadian Society for Control of Cancer, became a separate and distinct organization:
separate as far as the operation of the Society is concerned, with its complete organization
and full time secretary, but in activities, help and advice, inseparably linked with the
Canadian Medical Association, Department of Cancer Control.
To date, there are 62 branches or units in operation in British Columbia. A Unit is a
group of individuals interested in cancer education.   It consists of a doctor, who is asked
Page 247
F to organize it, and four others who form the executive and who appoint two representatives, one of which must be a doctor, as representatives of that Unit on the District
Council. The Unit further organizes and, adds to its number so as to include a representative of every organization in that area. A public meeting is arranged and one or
more speakers are asked to initiate their membership drive.
British Columbia is divided into nine medical districts and the District Councils to be
set up will conform largely to these areas. Each Council will be composed of a doctor
and lay representative from each unit. They will elect their officers and appoint two
members as councillors on the provincial executive, which, in turn, will elect two Grand
Councillors as representatives of British Columbia on Grand Council in Toronto.
From this it can be seen very readily, that this is truly a lay-medical organization and
that medicine plays a large and important part in this Society in the direction of its
activities and policy.
Aims and Objects.
Its aims and objects briefly are:—
(a) To aid in co-ordinating and correlating the efforts of individuals and organized
bodies to reduce the mortality from cancer in Canada;
(b) To disseminate knowledge on the subject of cancer;
(c) To give  aid in investigating the nature of  alleged "Cancer cures" when so
requested by a Dominion or Provincial Department of Health;
(d) To aid in establishing and maintaining or to establish and maintain research
activities in the field of cancer;
(e) To obtain money by way of public appeal or otherwise and to receive gifts,
bequests and donations of property both real and personal;
(f) The Society is given full powers to deal with all property, real and personal,
(g) in any manner they see fit for the benefit of the Society and its aims and objects;
and a further object is to help needy patients obtain treatment for cancer, if and when,
funds are available.
Lay Education.
Lay education is the primary object of this Society. It has been an important activity
of those engaged in cancer work in practically every country in Europe and in the United
States. Canada has lagged far. behind in this work. The necessity for it is obvious if we
ever hope to get a much larger number of cases under treatment during the early stages
than we are now getting. This is essential to increase our number of cures. The fear of
creating a cancerophobia is probably a minor danger. It has been said that "Cancer
phobia kills a very few, while cancer kills many." This may be said to be the major
drawback to this educational scheme. The responsibility for the presentation of this
subject—Cancer—lies on the members of our provincial medical association, of which
each of you is a member. Whether or not cancer phobia is created, depends on the
manner in which the subject is presented. Medicine has taken up the challenge, to help
lower our death rate and it is of the utmost importance that the subject of cancer be
presented by those who-are interested and best equipped to present the information. Our
best men should be actively engaged in this work. On the high standard and quality of
these addresses, depends the success of this campaign. Our sincerity in this work is being
judged by the co-operation of the profession. This is a movement which the layman is
not only waiting for, but eagerly waiting for. We need speakers for the Speakers' Bureau
of the Committee on the Study of Cancer. Every request for speakers is sent to the
chairman of the Speakers' Bureau who arranges for speakers to be sent out. He needs your
support. We, as an organization, have guaranteed this support. Let us not falter in this
most humanitarian effort.   The dividend in useful human lives will amply repay us.
Correlation of Cancer Activities.
In each province, the problem of correlating the activities of all bodies working in
the field of cancer is difficult, yet it is a most important one. It should be done to
designate the activities of each so that there is no overlapping, and they may work harmoniously together and eventually develop a policy for effectively handling the cancer
problem in this province.
Page 248 To date our work has largely been that of organization, with education as a minor
factor. It is hoped that before long a special effort at correlating these various bodies
may be a great help in the mutual understanding of each other's problems and in the
better organization for cancer control.
Membership.
The responsibility for the affairs of the Society within the various provinces is delegated
by the Federal body to the provincial branches. The officers of the provincial branches
are: the President, the Secretary and a Treasurer and an executive, which includes one
doctor and a layman as provincial representatives on Grand Council. All those who have
paid their membership fees are members of the Provincial Society.
The fees are: (1) Annual membership at one dollar per year, (2) $5.00 contributing
membership, (3) $25.00 sustaining membership, (4) $100.00 Life membership, (5)
$1000.00 as a donation.
These memberships are of particular value if they are coupled with the active interest
on the part of the member. The monies so collected by the provincial branches will be
spent to carry out the aims and objects of the Society—75% to be retained in the province
and 25% will be sent in to National Head Office to help defray expenses. This division
of monies is not a hard and fast rule, the percentage may be changed by Grand Council
if and when it is. felt it would be in the interest of the Society so to do. Monies donated
to the provincial society, specially earmarked, are not subject to the above percentage
division and may be spent entirely in the province. The same holds true for donations to
the national body; funds specially earmarked for them will be spent entirely by them.
It is essential that every effort be made to obtain as large a membership as possible in
each unit. Our objective is 50,000 to 60,000 members in British Columbia. With such
a membership adequate funds for education would be available, and, with education,
adequate funds for research.
To each member goes the Bulletin issued by national headquarters, together with
pamphlets from time to time. With the establishment of a library at national headquarters, for books, pamphlets, addresses, slides, etc., we hope that good educational films
will soon be available to the public.
The helping of needy patients to get treatment, is something which is entirely in the
future and can only be met if and when funds are available. The form this will take is
that of paying for transportation, housing while undergoing treatment, clothing, etc.,
where the necessity indicates it.
In conclusion there are several points I want to emphasize:
1.   That this is a national medical-lay organization, sponsored by the Canadian and
Provincial Medical Associations.
That this Society is primarily a lay educational society.
That on the Provincial Medical Association lies the responsibility for speakers
on cancer education and the manner and type of presentations best suited for
this field.
That the public will judge the profession by the standards which are set in carrying out this programme. We need our best and most able men to take an active
part.
Join this Society and work with it, as a tangible expression of your belief in its
aims and objects and fulfilment of our promise to the Society from the Canadian
Medical Association.
The active interest in the future of cancer patients in British Columbia is earnestly
asked; by doing your share in an effort to aid our provincial medical association
and all bodies actively engaged in cancer work to develop and carry out a plan to
correlate these activities.
The success of the organization of the Canadian Society for Control of Cancer,
B. C. Branch, is largely due to keen and interested members of the executive. They
have devoted many hours to this task and are continuing to do so. They ask your
support and continued interest in a field where education in Cancer Control is
eagerly sought.
Page 249
2.
3.
4.
6.
7. I wish to take this opportunity to thank all those of the Provincial Executive and
those of the various units of the Society and the B. C. Medical Association
Executive, the College of Physician & Surgeons, for their loyal support and advice
during the last five months, and the Cancer Study Committee for its one hundred
per cent co-operation in the launching of this Branch of the Canadian Society for
the Control of Cancer.
V
ancouver
G
enera
Hospita
REPORT ON DAGENAN TREATMENT OF
1    3 2 CASES OF PNEUMONIA
Brock M. Fahrni, M.D., Vancouver General Hospital.
Dagenan or M. & B. 693, known on this continent chiefly as Sulfapyridine, was first
available for use on the staff wards of the Vancouver General Hospital on December 26,
1938. A committee was appointed from the medical staff at that time to investigate
the action of this drug in pneumococcal pneumonia, and since then has supervised the
treatment of 32 consecutive cases. Through the co-operation of the Laboratory and
X-ray departments much more information was available on these cases than would
otherwise have been possible. Portions of this information, which helps to illustrate
any of the actions of Dagenan, will be presented below, together with the observations
and conclusions of the committee.
The series treated consisted of eighteen lobar and fourteen bronchopneumonia cases.
No case was called lobar which did not have a fairly typical history of onset and lung
distribution confirmed by X-ray. This latter group responded .promptly to Dagenan
therapy as evidenced by the temperature charts plotted in the graph. . All bronchopneumonias, with the exception of one fatal post-operative case, responded equally
promptly, though frequently a day longer was required for the temperature to reach
normal. Also a low-grade temperature in a few cases persisted for several days following
the initial temperature drop. As will be seen from the table, often no pneumococcis
could be found in the sputum of these cases with bronchopneumonic distribution. All
cases received oxygen therapy where necessary as well as the usual symptomatic treatment.
Dosage and Blood Concentration* of Dagenan:   (1 tablet = 0.5 gm.):
Treatment in general of the first clases in the series consisted of the administration
of four tablets of Dagenan (as soon as the sputum specimen and blood culture were
obtained), repeated in four hours and then two tablets every four hours for 24 to 48
hours after which the dose was reduced to one tablet every four hours. This meant the
administration of 8 gm. in the first 24 hours, which we found gave a blood concentration
of free Dagenan from 5.0 to 12.0 mgm. per cent. Previous articles have suggested that
a concentration of 10.0 mgm. be aimed at in the early stages of treatment of pneumonia
but in our experience 5 mgm. or more would appear to be sufficient in the average case.
It was noted that our cases which showed this blood level responded quite as rapidly as
those having a blood concentration of 10.0 to 12.0 mgm. Consequently, because we
felt that unless the case was particularly severe a lower dosage was possible, the later
cases in the series were subjected to the following routine, which was apparently equally
satisfactory:
Tab. IV (2 gm.) stat.; then Tab. II (1 gm.) O.H. IV until temperature normal (or
falling) usually within 24 to 36 hours; then Tab. I (0.5 gm.) every six hours
until four days of normal temperature, making a total of 15—22 gms. as against
an average total dose of 30 gms. in earlier cases. In an acutely ill patient we
would advise greater dosage at the start in an effort to obtain a higher blood concentration more rapidly.
Page 250 "v*
There 'appears to be no direct relationship between gastric upset and the blood-level
of Dagenan, as some of the patients with the highest concentration were not nauseated;
also, in a few of the cases who were nauseated early, this symptom disappeared in spite
of the fact that the drug was continued and the blood-level thus increased. However,
although approximately one-half the cases on the reduced dosage were nauseated at some
point in the treatment, only two of ten patients so treated vomited, and not severely
enough to warrant discontinuing Dagenan therapy.
The only medication used in an effort to allay gastric irritation was Soda Bicarbonate
(one 10-grain tablet with each dose of sulfapyridine). As previously reported, where
there was difficulty swallowing the large tablets, these could be readily powdered and
given in milk or fruit juice.
The rectal route of administration was tried in one patient (not pneumonia) and was
found unsatisfactory in this case, for, although more than twice the oral dose was given,
blood specimens taken during this time never showed more a trace of Dagenan. "Sodium-
Dagenan" is a soluble preparation suitable for intramuscular or intravenous injection or
rectal use, but is not yet available here. When obtainable, this should be of great assistance in the treatment of cases who persistently vomit the oral preparation.
Three cases (1, 7 and 25) showed a secondary rise of temperature when Dagenan was
stopped shortly after the initial temperature drop. The last case (25), who had a positive
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Page 251 blood culture on admission, also showed an extension of the pneumonic process.    We feet
that had the drug been continued (at reduced dosage, e.g. ,one tablet O.H. IV) for four
to five days of normal temperature, this probably would not have occurred.
Toxicity:
1. Cyanosis.—Only marked in one case (4), mild in six others. Dosage of the drug;
was reduced but not stopped in these cases. It might be mentioned at this point that
clinical appearance was frequently no guide as to the patient's condition; early in the
disease while the drug is being given in fairly large doses, many patients appear very ill
and apathetic and a few develop an unhealthy and corpse-like pallor, due partly to
cyanosis and partly to nausea, so that while actually the patient's condition is improved—
i.e., the temperature and pulse rate have fallen to normal indicating that the infection
has been successfully combatted—the appearance of the patient is such as to cause alarm,,
until the true state of affairs is realized. This weak, apathetic state readily passes off on
reducing or stopping the drug.
2. Nausea and Vomiting.—Undoubtedly these were the toxic manifestations of most
concern. Of the thirty-two cases, twenty-three (70%) were nauseated, fourteen (40%)
to the point of vomiting the drug when taken. The female patients appeared to vomit
more often than the male. As reported in the previously published article, owing to the
apparent rapid absorption of the drug, the nausea and vomiting were not thought to be
sufficient cause to discontinue administration, because quite adequate blood concentrations were obtained in many of these patients despite the vomiting. When vomited, the
dose should be repeated at once. Since the intake of fluids was seriously interfered with
in the nauseated patient, the lessening of this symptom in the later cases of the series
through early reduction of dosage greatly assisted general treatment.
3. Skin Eruptions.—Two of the thirty-two cases treated developed a rash during
treatment—the first a generalized, pruritic raised erythematous type after 29 gms. of
Dagenan in a man aged 75—the second a pustular rash on the back of a man aged 25.
Neither of these eruptions caused troublesome symptoms and disappeared on stopping
Dagenan.
None of the cases of this series presented mental symptoms, haematuria (as has been
reported elsewhere) or any serious effect on the red or white cell count which could be
attributed to Dagenan.
Mortality:
In the series of thirty-two, two cases died. It should be noted that both these cases
had other lung pathology. The first case was a post-operative gastroenterostomy
patient, aged 50, who was not seen until the fourth day of his pneumonia when he had
consolidation of the lower half of each lung. There were no signs of peritonitis but the
patient had developed a bilateral parotitis. Post-mortem examination showed he suffered
from a generalized chronic fibrotic condition of the lungs resembling silicosis, and there
were multiple small abscesses throughout the lower lobes. The other case was seen on
the sixth day of her disease when she appeared moribund. Ten years previously she had
had a thoracoplasty for lung abscess with good result, and on admission had consolidation
of the lower lobe on her thoracoplastic side as well as complete involvement of her
opposite lung. This distribution was confirmed at autopsy. Including these cases in the
series entails a mortality rate of six per cent (6 %). There were no deaths among the
uncomplicated cases in several of whom (particularly the older patients) the prognosis
was poor on admission because of extensive lung involvement, a weak myocardium, etc.
Complications :
Two patients developed pleural fluid. In the first case (1) the Dagenan was discontinued immediately the tempertaure had dropped, from 105° to 99°. The patient
continued to run a fairly normal temperature until the eighth day when a second rise was
noted. She had pain in her chest and definite signs of fluid on the thirteenth day when
14 ozs. of cloudy fluid were withdrawn. Dagenan was restarted on the eighth day
(Tab. II, q.4.h.) and this case showed us the difficulty of giving even moderate doses of
the drug for any considerable length of time to a nauseated patient.    However, a con-
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'age centration of 3 mgm. was obtained and with the aid of repeated aspirations, the empyema
cleared. When seen two months after admission all physical signs in the chest were
absent. The only other case which developed fluid was a man, age 66, with myocardial
weakness, in whom a low-grade temperature persisted for several days after Dagenan
therapy was started, rising again on the fourteenth day. 250 cc. of cloudy dark brown
fluid were removed from the left base which did not recur. Good, recovery. This patient
had a positive blood culture on admission.
In a gastroenterostomy case (17) where pneumonia of the left base developed on
the second post-operative day, the question arose how the drug should be administered
without giving fluids by mouth or otherwise causing gastric irritation. The routine
dosage was given, the patient holding the tablets in his mouth until they absorbed or
possibly reached the stomach in small amounts with the saliva. A satisfactory blood
concentration was obtained in this way (8.3 mgm.), fluids were given intravenously, and
the patient was discharged well on the morning of his fourteenth post-operative day.
Note:—It has been fairly conclusively shown by different workers, notably Fleming,
that the action of Dagenan is wholly bacteriostatic—i.e., it prevents multiplication or
reproduction of the pneumococcus, and itself exerts no degenerative effect on the infecting organism. Thus the infection is limited and is readily handled by the body so
long as there is some immunity to the infecting pneumococcus present; but phagocytosis
and ultimate recovery does not occur without this. Cases of pneumonia which do not
respond to Dagenan therapy within twenty-four to thirty-six hours are thought to
possess no specific antibodies in their blood, or the immunity mechanism is in some other
Way impaired. Consequently, in every severe case of pneumonia, typing of the pneumococcus is advised at the outset, for if the patient does not appear to be responding to
Dagenan, immune bodies may be readily supplied passively by the administration of
pneumococcal antiserum of the specific type.
Summary:
1. Thirty-two cases of pneumonia were treated by Dagenan alone with a resulting
mortality of 6%, both cases who died having previous lung pathology.
2. The remaining cases of lobar type showed a marked temperature fall within
thirty-six hours.
3. The bronchopneumonias (many with no pneumococci in sputum) also responded
well to Dagenan treatment.
: 4. Two cases (6%) developed empyema, neither case requiring rib resection, clearing
with aspiration and continued Dagenan therapy.
5. No serious toxic manifestations of the drug were noted.    Nausea and vomiting,
though frequently troublesome, are not to be considered a serious sign nor an indication
to stop the drug.
Conclusion:
Dagenan therapy constitutes a safe, effective method of treating pneumonia, and
should be tried in all cases regardless of type.
We wish to thank Dr. H. H. Pitts and his laboratory staff as well as Dr. B. J. Harrison
and his X-ray staff for their valuable assistance in the study of these cases. The Dagenan
used in this investigation was kindly supplied by the Poulenc Freres pharmaceutical house,
May and Baker's representatives in Canada.
Dr. D. W. Davis of Kimberley called at the office during a visit to Vancouver.
Dr. John Brown is relieving Dr. E. M. Robertson in the practice at Sooke.
Dr. G. L. Watson of Revelstoke visited the office.
At the meeting of the Victoria Medical Society, held on April 3rd, Dr. C. E. Dolman
of Vancouver spoke on "The Evaluation and Interpretation of Laboratory Technique,
and the Clinical Application of Laboratory Tests."
Page 254 Victoria  Medical   Society
Officers, 1938-39.
President Dr. P. A. C. Cousland
Vice-President Dr. W. Allan Fraser
Hon. Secretary.. Dr. W. H. Moore
Hon. Treasurer Dr. C. A. Watson
PATHOLOGY OF CARCINOMA OF CERVIX
Dr. D. B. Roxburgh.
Carcinoma of the cervix comprises about 90% of malignant uterine tumours. In the
time at my disposal it would be impossible to describe the variations which occur in the
gross and microscopic appearance of carcinoma of the cervix. Three general types of
lesions are recognized. One of these tends to extend on the surface, forming a large, fun-
gating, cauliflower-like mass which projects into the vagina. This type usually arises from
the portio vaginalis and shows little tendency to invade deeper tissues. . The second type
tends to extend deeply in the direction of the internal os, thereby causing enlargement of
the cervix as a whole or eventually producing a deep, rugged crateriform cavity. This type
is commonest and at the same time most malignant. It causes early involvement of the
regional lymph nodes. The third type appears as a flat indurated ulcer which spreads superficially and grows slowly. It is less commonly met with.
Three stages in the progress of the lesion are recognized: (1) Induration without tissue
loss; (2) disintegration; (3) excavation.
When the lesion is sufficiently advanced to cause symptoms, it is usually an ulcer with
indurated edges, but it may present a cauliflower-like growth. Some lesions erode the
tissues deeply at the outset. A large percentage of carcinomata of the cervix originate on
the portio vaginalis, and a relatively small percentage originate within the cervical canal.
Carcinoma of the cervix spreads by direct extension, by invasion of the lymphatics and by
the blood stream. By direct extension it spreads into the corpus uteri, invades the broad
ligament and pelvic lymph nodes, and may involve the rectum, vagina and bladder. Extension into the endometrium causes obstruction of the cervical canal. Distinct metastases
occur rarely but are occasionally found in the lungs, liver, the pelvic bones and vertebrae.
Theoretically there are three types of epithelium from which squamous cell carcinoma
of the cervix may arise: (1) Squamous epithelium covering the vaginal portion of the
cervix; (2) thickened epithelium covering a cervical erosion; (3) columnar epithelium
lining the cervical canal.
The transition from the columnar epithelium of the cervical canal to the stratified squamous epithelium of the portio vaginalis is abrupt. The border line is usually just
inside the external opening of the cervix. At the time the lesion is recognized it iff usually
impossible to tell from which type the growth has arisen. It is probable that before and
during the development of carcinoma from the columnal epithelium, this epithelium is
transformed in the stratified cells and replaced by these cells from a lower level. This
metaplasia may often be traced in chronic erosions. The most frequent form presents cords
of pavement epithelium in which neither epithelium pearls, spine cells nor hornification are
demonstrable. The earliest cases appear as a localized downward growth of hypertrophied
epithelium papillae in portions of chronic erosions. These lesions are classified by many
pathologists as pre-cancerous. The branching columns of cells growing down into the
deeper tissues form large masses of squamous cells showing numerous mitotic figures. The
absence of cornification and epithelial pearls is explained by the fact that the tumour cells
usually originate from thd epithelium covering the portio vaginalis or from the columnar
epithelium by a process of mat aplasia and normally keratinization is not characteristic of
these cells. The malignant cells are of large dimensions, polyhedral or rounded in shape,
and possess hyperchromatic nuclei and large, single nucleoli.   The stroma is scanty, vas-
Page 25 5 cular and usually infiltrated by different types of leukocytes. The centre of the cellular
masses may degenerate and become liquefied with the formation of gland-like spaces. This
should not cause confusion and suggest the diagnosis of adenocarcinoma.
In addition to the squamous cell carcinoma one occasionally sees a typical adenocarcinoma of the cervix. This type usually originated in the glands of the cervix but may be an
extension from adenocarcinoma of the corpus uteri. Adenocarcinoma arising from the
epithelium of the cervical glands is not as invasive as the squamous form. The structure of
even an adenocarcinoma tends to approach the epidermoid type. Occasionally the two types
are seen together in the same lesion.
Squamous cell carcinoma of the cervix may be graded on the basis of the proportion of
large, flat squamous cells with small nuclei and showing varying degrees of keratinization,
to the number of undifferentiated cells. Microscopically some epitheliomas of the cervix
resemble the basal cell carcinoma of the skin. However, they should not be considered in
the same group because they are highly malignant and behave like the same type of
epithelioma of the tonsils and nasopharynx. The number of mitotic figures and the number
of cells with single, large, deeply staining nucleoli play an important part in grading. In
one series of 8 83 cases of squamous cell carcinoma of the cervix graded by Dr. A. C. Broders,
five were classified as Group 1; 135 as Group 2; 407 as Group 3; 336 as Group 4. It will be
seen immediately that about 80% fall in groups 3 and 4 and about 20% in groups 1 and 2.
About 1.3% in this series showed a combination of squamous cell carcinoma and adenocarcinoma.
Carcinoma of the cervix leads to a number of complications—obstruction of the cervical canal by carcinoma may result in distension of the uterine cavity by pus, or the condition known as pyometra; involvement of the broad ligament will cause fixation of the
uterus; fistule may develop between the bladder and vagina or between the rectum and
the vagina; obstruction of the ureters will lead to hydronephrosis and pyelonephritis;
occasionally hydrosalpinx or pyosalpinx may be formed.
For years attempts have been made to recognize cellular types more or less responsive
to irradiation, but their practical value remains open to doubt. In general an undifferentiated type of carcinoma grows more rapidly but is more radio-sensitive than the other
forms. The most important basis of prognosis is the extent of the disease at the time treatment is begun. Tumours that have not extended beyond the cervix offer a relatively good
prognosis regardless of the histological structure, and) advanced cases of any type have a
poor prognosis. To conclude my remarks, I may add that typical mucous adenocarcinoma
of the cervix and scirrhous carcinoma of the cervix havei been described. Occasionally a
tumour resembling an endothelioma is observed, but probably this is an atypical type of
adenocarcinoma.
CANADIAN MEDICAL ASSOCIATION ANNUAL MEETING
Montreal, June 19th-23rd, 1939
The following arrangements have been authorized by the Canadian Railway lines
for the above event:
Territory and   From British Columbia,
dates of sale:   June 11th to 17th, inclusive.
Return limit:   Thirty days in addition to date of sale.   Passengers must reach original
starting point not later than midnight of final return limit.
Fare basis: Round-trip tickets to be sold at rate of fare and one-third of current
fares, plus 25 cents, upon presentation of Identification Certificates to ticket agents at time of purchase of tickets. Going and
returning via same route. Going via one authorized route and returning via any other authorized route.
Summer excursion fares where on a lower basis than Identification
Certificate plan fares will also apply.
Page 256 A CASE OF POST-OPERATIVE MYXCEDEMA
Robert E. McKechnie II
The case being presented is one where myxcedema developed subsequent to a sub-total
thyroidectomy for exophthalmic goitre with associated cardiac decompensation.
The patient, was a married white female, aged 46 years, a resident of Alberta and the
mother of six healthy children. Her chief complaint was "pounding of the heart," present
for two months. The past history was essentially negative other than that connected
with the present complaint. Her menses were regular. The history of the present illness was that about four or five years ago the patient noticed an enlargement of the
right side of her neck. At the same time she became very nervous. This condition was
said to be the result of a goitre and she was treated by a herbalist for one year and was
much better. About a year ago she began to lose weight, and, in spite of a good appetite,
has lost 35 pounds. She was nervous and tired easily. Three months previous to admission, some shortness of breath on exertion developed. Two months previously she
had what was called the "flu" and was in bed several days with an elevated temperature
and general malaise, and since then she has had some pounding of the heart. Two weeks
ago her ankles began to swell. Physical examination revealed a nervous white female of
apparently stated age. Her temperature was 98.4° F., pulse rate 104 beats per minute,
blood pressure 145/65, and weight 138 pounds. The tonsils were slightly infected. The
eyes showed widening of the palpebral fissure and exophthalmos grade ii. The skin was
moist and somewhat flushed. There was a tremor of the fingers, grade ii plus. The
thyroid gland was enlarged and firm, the right lobe being larger than the left. The heart
showed signs of auricular fibrillation and there was some pitting oedema of the ankles.
There was some endocervicitis present in a lacerated uterine cervix.
Laboratory investigation revealed the Kahn test to be negative; the red blood count
was 4,200,000; haemoglobin 70% and the white blood count 5,500. Urinalysis was
negative. Fluoroscopic examination of the heart and lungs was negative. An electrocardiogram showed auricular fibrillation present. The basal metabolic rate was +29 on
two occasions.
A diagnosis was made of hyperthyroidism of the exophthalmic type with associated
auricular fibrillation and early cardiac failure. The patient was put to bed to rest and
given lugols solution and digitalis.    The response was very satisfactory.
Seventeen days later a bilateral subtotal thyroidectomy was done and 80 grams of
firm thyroid tissue was removed. The gland was adherent to the surrounding tissues.
Pathological examination revealed evidence of a hyperplastic gland with some thyroiditis
and the suggestion of early malignancy, although no definite blood-vessel invasion could
be demonstrated.
The post-operative course was more or less uneventful except the patient did not
recover her strength rapidly. Today, six weeks after the operation, she presents the
typical appearance of myxcedema. Her haemoglobin is 63% anod basal metabolism 24%—
on two occasions. The basal pulse rate is 46 beats per minute. The patient has not
yet been started on thyroid extract.
Comment: The development of a low basal metabolic rate and even myxcedema as in
this case, subsequent to a thyroidectomy for exophthalmic goitre occurs not infrequently.
It is not always the result of removal of too much gland, as according to Davis the
metabolic rate may be lowered to the point of development of myxcedema during a spontaneous remission of the disease where an operation has not been performed. In those
cases where the metabolic rate has become lowered either following a subtotal thyroidectomy or a remission, a severe recurrence of exophthalmic goitre may subsequently develop.
A review of pathological changes in these cases reveals the frequent presence of thyroiditis. I believe the persistence of thyroiditis and subsequent suppression of the function
of the gland is the explanation of the myxcedema in this case. Her response to the administration of 'thyroid extract by mouth should be very satisfactory.
Reference.—Davis, A.C., "Clinical significance of low metabolic rate."    Lancet 54:329-332, June, 1934.
Page 257 ACCOMMODATION FOR
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Duncan Graham, W. P. Warner, J. A. Dauphinee
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NEW from stem to stern;
packed with inherent advantages, the G-E Model "C" Unit
has been built to enhance the benefits of electrosurgery. This is its
introduction to the medical profession.
So complete and refined is the
method of control that the surgeon may have at the electrode tip
just the quality and quantity of
high-frequency current desired
for the work at hand, whether it
be the delicate coagulation of some
growth or transurethral prostatic
resection.
Factory-adjusted self-compensating gaps of an entirely new type
are incorporated. They assure an
unfailing supply of smooth current for cutting, desiccating, or coagulating. So closely calculated
have been the factors of heat expansion and so nicely engineered the
gaps, that even long continued operation will not cause a change in
the spacings. You will appreciate that this feature spells real dependability.
From the beautiful streamlined case to the smallest integral part of
the unit there is excellency of manufacture, soundness of design, and
indication of long, satisfactory, economical life. There are many
other advantages that would be of interest to you, such as for instance
the reasonable price.
Send for Descriptive Catalogue.
You will want to study this book, for not only does it tell the complete story of the G-E Model "C" Electrosurgical Unit but also
reprints authoritative information regarding electrosurgery. We
would appreciate your addressing your request for a copy to Department A000.
I VICTOR X-RAY CORPORATION of CANADA, Ltd.
DISTRIBUTORS FOR GENERAL («Mtf ELECTRIC X-RAY CORPORATION
TORONTO: 30 Bloor St., W. • VANCOUVER: Motor Trans. Bldg., 570 Dunsmuir St.
'   MONTREAL: 600 Medical Arts Building   •   WINNIPEG: Medical Arts Building
mm^^^m^^^^^^sam^mmmmm^m^ms^^m^^^ \ i i im Tt f
Protection Against Typhoid
Typhoid and Typhoid-Paratyphoid Vaccines
Although not epidemic in Canada, typhoid and paratyphoid infections remain a serious menace—particularly
in rural and unorganized areas. This is borne out by the
fact that during the years 1931-1935 there were reported,
in the Dominion, 12,073 cases and 1,616 deaths due to
these infections.
The preventive values of typhoid vaccine and typhoid-
paratyphoid vaccine have been well established by military and civil experience. In order to ensure that these
values be maximum, it is essential that the vaccines be
prepared in accordance with the findings of recent laboratory studies concerning strains, cultural conditions and
dosage. This essential is observed in production of the
vaccines which are available from the Connaught
Laboratories.
Residents of areas where danger of typhoid exists and
any one planning vacations or travel should have their
attention directed to the protection afforded by vaccination.
Information and prices relating to Typhoid Vaccine and to
Typhoid-Paratyphoid Vaccine will be supplied
gladly upon request.
CONNAUGHT LABORATORIES
UNIVERSITY   OFiTORONTO
Toronto  5
Canada
Depot for British Columbia
Macdonald's Prescriptions Limited
MEDICAL-DENTAL BUILDING, VANCOUVER, B. C The New Synthetic Antispasmodic
Trasentin "Ciba"
(Diphenylacetyldiethylaminoethanolester-hydrochloride)
SUPPRESSES SPASMS OF THE GASTRO-INTESTINAL
TRACT, GENITO-URINARY SYSTEM AND
OTHER SMOOTH MUSCLE ORGANS
Tablets—bottles of 20 and 100. Ampoules—boxes of 5 and 20.
1 tablet or 1 ampoule contains 0.075 grm.
of the active substance.
CIBA COMPANY LIMITED
MONTREAL
13 th Ave. and Heather St.
Exclusive  Ambulance  Service
FAIRMONT 80
PRIVATE AMBULANCES AND INVALID COACHES
WE SPECIALIZE IN AMBULANCE SERVICE ONLY
J. H. CRELLIN
W. L. BERTRAND STERILE!
STABLE!
ABBOTT INTRAVENOUS SOLUTIO
IN LITER CONTAINERS
After extensive investigation and research, the Abbott Laboratories offer
the medical profession solutions of the highest standard of quality. This
achievement of the Abbott Research Staff now enables hospitals to free
themselves of the heavy burden and responsibilities connected with the
preparation of bulky intravenous solutions.
Abbott Intravenous Solutions are guaranteed to be STERILE, STABLE and
SAFE. They are prepared from chemicals of the highest quality and from
chemically pure water. Moreover, they are altogether free from all impurities, including pyrogens. They are supplied in the Abbott Container, a
bottle specially designed to resist high steam pressure sterilization. Its
outer protective seal gives positive assurance of sterility.
Detailed information supplied on request.
ABBOTT LABORATORIES  LIMITED
388 St. Paul St. West, MONTREAL STEVENS' SAFETY PACKAGE
STERILE GAUZE
is a handy, convenient, clean commodity for the bag or the office. Supplied in one yard, five
yards and twenty-five yard packages.
ESTABLISHED   NEARLY  A
.CENTURY^
B. C. STEVENS CO.
Phone Seymour 698
73 0 Richards St., Vancouver, B. C.
1
s.
BOWELL
&
SON
Distinctive   Funeral
Service
Phone 993
Hi sfff c
66 SIXTH STREET                                          I
VEW WESTMINSTER, B. C.
::«:$:S>S^^mSS^i::Wwx¥
Breaks the vicious circle of perverted
menstrual function in cases of amenorrhea,
tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic
relief by stimulating the innervation of the
uterus and  stabilising the tone of its
musculature. Controls the utero-ovarian
circulation and thereby encourages a
normal menstrual cycle.
%
• MARTIN H. SMITH COMPANY
V ISO IAFATITU STRUT.  NIW TO«K. N. Y.
w
I
m
Full formula and descriptive
literature on request
Dosage:   1 to 2 capsules
3 or 4 times daily.   Supplied
in packages of 20.
Ethical protective mark MHS
embossed on inside of each
capsule, visible only when capsule  is  cut  in  half  at seam.
1
I
i
I
1
8&>
1
m mzKmm
■■ii
filllllilsiis
GASTRIC ACIDITY
Immediate control
Prolonged control
Localized control
ULCER PROTECTING POWER
Maximum
GASTRO-INTESTINAL SPASM
Corrected
GASTRO-INTESTINAL FUNCTION
Not disturbed
TOXIC ALKALOSIS
Absent
CLINICAL RESULTS
Excellent
. . . in the treatment of
digestive disturbances; associated with
increased   acidity   of   the   stomach ....
In respect to its acid neutralizing and adsorbent qualities, magnesium
trisilicate (the active ingredient of "Tricepiol") ,lfar transcends bismuth
salts, magnesia, aluminium hydroxide, prepared chalk and other medicaments in these conditions". Mutch, N. Hydrated magnesium trisilicate in peptic
ulceration. Brit. Med. f. 1:254-7 (Feb. 8) 1936.
No. 937 "TRICEPIOL" — a palatable preparation containing, in each average teaspoonful, 35 grains of hydrated magnesium trisilicate associated with pectin and
glucose.
No. 938 "TRICEPIOL" COMPOUND — has a similar basic formula to "Tricepiol" but
contains, in addition, 1/500 grain of atropine sulphate and 1/8 grain of phenobarbital
per average teaspoonful.
872
AYERST,
MONTREAL
Available in bottles containing 5|4 ounces.
McKENNA   &   HARRISON
Biological and Pharmaceutical Chemists
LIMITED
CANADA ANACARDQNi
Cardiovascular and Respiratory Stimulant
Diethylnicotinamide (commonly known as pyridine-s-carboxylic acid diethylamide) has won an established position in the treatment of cardiac and respiratory
weakness, or failure.
Diethylnicotinamide is now available in a 25 per cent solution under the name
Anacardone.
Anacardone is indicated in all cases of surgical or obstetric shock, collapse due
to narcotics or disinfectants, and in prostration, hypotension and respiratory
difficulty following, or during, bacterial infections such as pneumonia and
influenza.
Anacardone is issued in ampoules containing 2 cc. and 5 cc. for subcutaneous,
intramuscular or intravenous injection and in bottles containing 15 cc. and 100 cc.
(flavoured)  for oral administration.
Stocks of Anacardone are held by leading druggists throughout the Dominion,
and full particulars are obtainable from:
THE BRITISH DRUG HOUSES (CANADA) LTD.
Terminal Warehouse Toronto 2, Ont.
Amofi/r?a/n/395
flfoount pleasant XHnbertalunQ Co. 2Lto.
KINGSWAY at 11th AVE. Telephone Fairmont 58 VANCOUVER, B. C.
R. F. HARRISON W. R. REYNOLDS PAINFUL SHOULDER • NEURITIS
FOCAL ARTHRITIS  • FIBROSITIS
GOOD hot and thick applications of Antiphlogistine,
which may be left in situ for hours, is one of the
most efficient methods of applying prolonged moist heat
locally. It is valuable, also, as a complementary measure
to electrotherapy. It aids in the dissipation of metabolic
toxins, thus helping to reduce functional disability.
Sample and literature on request
THE DENVER CHEMICAL MANUFACTURING CO.
153 La gauche tiere St. W. Montreal
Made in Canada m
The baby's first solid food always excites
the parents' interest. Will he cry? Will he
spit it up? Will he try to swallow the spoon?
Far more important than the child's "cute"
reactions is the fact that figuratively and
physiologically this little fellow is just
beginning to eat like a man.
CUSIIM
IF H H ® B!!NI <S
Tj A "D T     1\ A is now being fed
1  /kDJLLJlVl  to infants as early
as the third or
fourth month because it gets the baby accustomed to taking food from a spoon, but,
more important, Pablum early adds essential
accessory food substances to the diet* Among
these are vitamins B i and B 2 and calcium and,
equally essential, iron. Soon after a child is
born its early store of iron rapidly diminishes
and, as milk is poor in iron, the loss is not
replenished by the usual bottle'formula.
Pablum, therefore, fills a long-felt need, for
it is so well tolerated that it can be fed even
to the three-weeks'-old infant with pyloric
stenosis, and yet is richer than fruits, eggs,
meats, and vegetables in iron. Even more
significant, Pablum has succeeded in raising
the haemoglobin of infants in certain cases
where an iron-rich vegetable failed. Pablum
is an ideal "first solid food." Mothers apprc
date the convenience of Pablum as it needs
no cooking. Even a tablespoonful can be pre*
pared simply by adding milk, or water of any
temperature.
Pablum consists of wheatmeal (farina), oatmeal, wheat embryo, cornmeal,
beef bone, alfalfa leaf, brewers' yeast, sodium chloride, and reduced iron. :
Mead Johnson & Co* of Canada, Ltd.. Belleville, Ontario
MEAD   PRODUCTS   (Including   PA&LUM)   ADVERTISED   ONLY   TO   PHYSICIANS
Please enclose professional card when requesting- samples of Mead Johnson products to cooperate in preventing their reaching; unauthorized persons d-
TAKING NOTHING FOR GRANTED
EVERY Carnation evaporating
plant has a fully equipped laboratory for testing the quality of
Carnation Milk at every step. But
the photograph above shows the
pentral laboratory, which receives
samples daily from all plants*—for
a final control-check, to make sure
that the same high standard is
maintained everywhere ... That is
one of the reasons why pediatricians can always depend on the
uniform purity and goodness of this
accepted milk, no matter when or
where it is purchased.
A BOOKLET FOR PHYSICIANS
—Write for "Simplified Infant
Feeding", an authoritative publication treating of the use of
Irradiated Carnation Milk in
normal and difficult feeding cases
. . . Carnation Company Ltd.,
Toronto, Ontario.
X""^!   IRRADIATED
Gbnattirt
IRRADIATED*
CltitiADlATED    Tk       JT kMK
arnation Milk,
A CANADIAN PRODUCT - "from contented cows 7 Graduate Pharmacists
to serve you:
Leslie Henderson, O.C.P. '06; Ph.C, B.C. '08
Harry Rogers, O.C.P. '92; Ph.C, B.C.'13
Russell Hewitson, Ph.C, B.C '23
Owen Bingham, Ph.C, Man.'24; Ph.C, B.C'29
Henry Richards, Ph.C, B.C '32
Gibb Henderson, B.A.; B.A.Sc; Ph.C, B.C. '37
Douglas Wilson, B.Sc, Sask.; Ph.C, B.C '36
DAY OR NIGHT
SEymour 2263
(Urntn $c ijamta IGik
Established 1995
VANCOUVER, B. C.
North Vancouver, B. C,   Powell River, B. C. "■*                                                                                                                                      *"                                                                                                                                         '^•j^c-'
, ^Sfc'Vv^"^                                                                                           y                                                                         J     i j;
Hollywood Sanitarium
Limited
For Me treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference—B. 0. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183                                            Westminster 288
ROY WRIGLEY PRINTING ujjiiffifo ft PUBLISHING CO.  LTD.

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