History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: February, 1929 Vancouver Medical Association Mar 2, 1929

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 Vol. V.
FEBRUARY, 1929
No. 5
The Bulled
ofthe^
Vancouver Medical Associativa
(^Medicine in 'Russia
Empyema
Qallbladder
Tublished monthly atlJancouvcr, ©.(?., by
McBEATH-CAMPBELL LIMITED
"^Tricc $1.50 per years' DESHELL  LABORATORIES  OF
CANADA, LTD., DEPT. V.M.,
Deshell Laboratories of Canada      24Sw£T Ontario.
Limited Gentlemen:     Please   send   me   copy   of
the   new   brochure   "Habit   Time"    (of
ii-'^i « ^ trir bowel movement) and specimens of Pet-
245 Carlaw Ave.    Dept. V.M.        roiagar.
TORONTO, ONTARIO ^r^'ZIZIIIIIIIZZZ THE   VANCOUVER   MEDICAL   ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical  Association in  the
Interests of the Medical Profession.
Offices:
529-30-31 Birks Building, 718  Granville St., Vancouver, B.C.
Editorial Board:
Dr. J. M. Pearson
Dr. J. H. MacDermot Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address.
Vol. V.
FEBRUARY, 1929
No. 5
OFFICERS, 1928 - 29
Dr. T. H. Lennie Dr. W. S. Turnbull Dr. A. B. Schinbein
Vice-President President Past President
Dr. G. F. Strong Dr. J. W. Arbuckle
Secretary Treasurer
Additional members of Executive:—Dr. A. C. Frost and Dr. F. N. Robertson
TRUSTEES
Dr. W. F. Coy Dr. W. B. Burnett Dr. J. M. Pearson
Auditors:    Messrs. Price, Waterhouse & Co.
SECTIONS
Clinical Section
Dr.  L. H.  Appleby Chairman
Dr. J. R. Davies , Secretary
Physiological and Pathological Section
Dr. C. E. Brown Chairman
Dr.  R. E.  Coleman  Secretary
Eye, Ear, Nose and Throat
Dr. W. E. Ainley ! Chairman
Dr. F. W. Brydone-Jack Secretary
Physiotherapy Section
Dr. H. R. Ross Chairman
Dr. J. W. Welch Secretary
Pediatric Section
Dr.  E.  D.  Carder  Chairman
Dr. G. A. Lamont Secretary
STANDING COMMITTEES
Library Orchestra Summer School
Dr. D. F. Busteed Dr. A. M. Warner Dr. B. D. Gillies
Dr. C. H. Bastin Dr. W. L. Pedlow Dr.  l. H.  Appleby
Dr. W. A. Bagnall Dr. J. A. Smith Dr. W. T. Ewing
Dr. Lyall Hodgins Dr. L. Macmillan dr, j. Christie
Dr. S. Paulin Publications dr, \p. L. Graham
Dr. W. A. Wilson Dr. J. M. Pearson dr> r. p. Kinsman
Dinner Dr- J- H- McDermot
Dr. E. M. Blair Dr- D- E- H- Cleveland Hospitals
Dr. L. Leeson Credentials Dr. F. Brodie
Dr. H. H. Pitts Dr. J. T. Wall Dr. A. S. Monro
Rep. to B. C. Med. Assn. Dr. D. D. Freeze Dr. F. P. Patterson
Dr. Stanley Paulin Dr. W. A. Dobson Dr. H. A. Spohn
Sickness and Benevolent Fund   —   The President   —   The Trustees VANCOUVER MEDICAL ASSOCIATION
Founded 1898   Incorporated 1906
PROGRAMME OF THE 31st ANNUAL SESSION
GENERAL  MEETINGS  will  be  held on  the  first  Tuesday  and
CLINICAL MEETINGS on the third Tuesday of the month at 8 p.m. from
October to April inclusive.    Place of meeting will appear on the Agenda.
February     5th—General Meeting:
Paper—Dr. R. P. Kinsman: "Focal Infections in Infancy and Childhood."
X-ray films to be shown by Dr. H. A. Rawlings.
19 th—Clinical Meeting.
February
March
March
April
April
April
5 th—General Meeting.
The OSLER LECTURE—Dr. H. M. Cunningham.
19 th—Clinical Meeting.
2nd—General Meeting.
Paper—Dr. F. P. Patterson: Subject to be announced.
16th—Clinical Meeting.
23 rd—Annual Meeting.
VANCOUVER HEALTH DEPARTMENT
STATISTICS, DECEMBER,  1928
Total  Population   (Estimated) __
Asiatic  Population   (Estimated).
Rate per  1,
177
Total   Deaths    .	
Asiatic   Deaths     20
Deaths—Residents   only            135
TOTAL   BIRTHS :         260
Male       141
Female   119
Stillbirths—not  included   in   above  7
INFANTILE MORTALITY—
Deaths under one year of age  5
Death Rate per  1,000 Births ; 19.2
CASES  OF  INFECTIOUS  DINSEASES  REPORTED  IN
 142,150
 10,940
000 of Population
14.70
21.58
11.21
21.59
November, 1928
Cases     Deaths
December, 1928
Cases     Deaths
Smallpox  36 0 41             0
Scarlet  Fever  14 0 13             0
Diphtheria     101 2 57              1
Chicken-pox  84 0 32             0
Measles '.  0 0 5             0
Mumps       23 0 82              0
Whooping-cough  14 0 1              0
Tuberculosis      14 10 9            19
Erysipelas       10 0 8              0
Poliomyelitis  10 0 0
Typhoid   Fever  3 0 0             0
Cerebral-Spinal Meningitis- — — 11
Cases from Outside City—Included in above.
Diphtheria  36 0 20             0
Scarlet Fever  5 0 0             0
Smallpox .  0 0 0              0
Typhoid   Fever  3 0 0            0
Cerebral-Spinal Meningitis— — — 11
CITY
January 1st
to 15th, 1929
Cases     Deaths
33 0
Page 97 What will your X'Ray equipment be like in 1939?
The following comments are typical of a large number
received concerning the condition and operation of Snook
X'Ray Machines purchased in 1917 and 1918, over ten years
ago. We quote from responses to our inquiries:
"Am perfectly satisfied and
you can use my name when'
ever you wish."
No piece of electrical equip*
intent which. I have ever pur*
chased has given such real
service with as little trouble."
Machine in just  as  good
working order as the day when
installed."
"Do not believe that a new
machine could be any better."
"Working satisfactorily
every day in the year."
"Doing the finest work in
the city."
The more you inquire into records of service, into high
quality of work, into dayin and day'out, troublcfree
dependability, the more you will be convinced, we feel sure,
that Victor offers you the greatest dollar'for'dollar value of
any equipment you can buy.
There is only one Snoo\!
Victor X^Ray Corporation of Canada, LtcL
Manufacturers of the Coolidge Tube
and complete line ofX-Ray Apparatus
524 Medical Arts Building. Montreal
Motor Transportation Bldg., Vancouver
Physical Therapy Apparatus, Electrocardiographs, and other Specialties
2 College Street, Toronto
Medical Arts Bldg.,Winnipeg
A  GENERAL  ELECTRIC
ORGANIZATION A Product is Remembered
By its Label
Because that label stands for the quality and
service of the firm back of it.
"Georgia" on your prescription label instantly calls to your mind the efficiency always
found behind that name.
Phone Seymour 1050
Nine
Graduate
Pharmacists
Qeovgxa
Cr^nville at CJeortCi©^.
Open
All
Night
in cystitis and pyelitis
TRADE
PYRIDIUM
Phenyl-azo-alpha-alpha-diamino-pyridine hydrochlorides
(Manufactured by The Pyridium Corp.)
MARK
For oral administration in the specific treatment
of genito-urinary and gynecological affections.
Sole distributors in Canada
MERCK & CO. Inc.
Montreal
412 St. Sulpice St.
!E EDITOR'S PAGE
O God! that one might read the book of fate and see the revolution
of the times how chances mock and changes fill the cup of alteration with divers liquors.
We will not complete the quotation though we might note also the
many instances of medical continents of apparently solid firmness which
melt into the sea. Suffice it to say, could the ghost of Detweiler (if
indeed there be a ghost) and the numerous other ghosts and bodily presences of those valiant advocates of rest and air and sunlight and food
as the only way in pulmonary tuberculosis, we say, could they possibly
have conceived that this disease would now seem to be in a fair way to
becoming a surgical problem?
This most cherished stronghold of internal medicine ruthlessly invaded and its practitioners confounded by the unanswerable weapon of
statistical authority.
No one, nothing is safe. Yet as we listened the other day to Dr.
Matson's masterly address to the Vancouver Medical Association on the
Surgical treatment of pulmonary tuberculosis, it all seemed so very
natural, a consistently logical development.
Rest certainly, rest to the body resulting in rest to the lung and
with quiescence an evident, if unexplained, improvement. If rest, why
not more rest, why not complete rest by rendering the affected lung temporarily inactive, why not collapse?
Collapse by the introduction of gas into the pleural cavity, an operative measure which Dr. Matson carefully (and shall we say disdainfully?)
distinguishes from a surgical procedure. Collapse, the production of
which is to be aided, if necessary, by true surgery in the matter of cutting adhesions. Or, if things have gone too far, by securing relaxation of
the diaphragm in consequence of a severance of its nerve supply. Finally,
if there is no hope of recovery in the affected lung, then a permanent
suspension of function by allowing the bony framework of the chest to
fall in and obliterate it.
We hope to print this address in our next issue, or so much of it as
from one source or another we can obtain. Our readers will understand
the difficulty of dealing with lantern slides in a publication like the
Bulletin.
We cannot say that we are over-enthusiastic about the increasing
use of lantern slides in medical lectures. To us seven columns of figures,
fourteen rows to the column flashed on the screen for forty seconds does
not convey much of permanent value. And in the enlarged microscope
preparations, just as we have got the hair follicles sorted out from the
blood vessels and the cells distinguished from the fat globules, the thing
is off, to be succeeded by the portrait of a dog, showing the evil effects
of prohibition (vitamine A).
It is the repercussion of the "movies" or mayhap it is merely our
editorial spleen on seeing so much of our best copy lost when the lights
are extinguished.
Page 98 We wonder what is the effect produced on the mind of an audience
by a mass presentation in the form of a screen picture. It appeals
doubtless to a more primitive faculty. The sight of a mastodon was
enough for our remote ancestor, he would not need to be told much about
it, still less to read of it. The effect on the lecturer is easy. He has
something to point at. "This is the fluid level and here is the fracture
running from the zygoma to the great trochanter, operation 2:11.27;
good recovery.    Next."
NEWS AND NOTES
The Clinical Section had a very interesting meeting on December
18 th in the Board Room of the Vancouver General Hospital with Dr.
Appleby in the chair. It was unfortunate that the very foggy weather
prevented a full attendance, but in spite of the fog thirty members
attended.
Dr. K. D. Panton discussed Suction Drainage for Acute Empyaema
and his address is published in full elsewhere in this issue of the Bulletin.
Dr. W. A. Bagnall presented a case of Non-Myxoedemic Thyroid
Deficiency. He showed a slender, underweight young man of 26 years
with fine skin, clear-cut features nd a beautiful crop of fairly normally
fine hair, with a diagnosis as above, or, as Warfield calls it "masked
hypothyroidism"—masked because whereas myxoedema may be diagnosed
on account of the appearance, this type has to be diagnosed in spite of
appearance. The prominent symptoms were (1) fatigability of marked
degree, enough to have been more or less disabling for 2 or 3 years,
(2) slow pulse, fairly low blood pressure, cold cyanotic extremities,
relative lymphocytosis. The above symptoms merely put him in a large
group from which not a few cases of masked hypothyroidism can be
picked out by three further tests: (1) this patient had lowered basal
metabolic rate, (2) absence of other findings to account for his symptoms and (3) he responded in a remarkably favourable manner to thyroid therapy, including a gain in weight.
This case was shown to emphasize the belief that this type of hypothyroidism is more common than is generally accepted. The symptoms
are more or less disabling and respond favourably to intelligently controlled treatment. The work of Dr. C. H. Lawrence of Evans Memorial,
Boston, in this field was referred to as worthy of careful study. Basal
metabolism readings are becoming more and more common and repay
the effort in disclosing masked and early hypothyroids as well as masked
and early hyperthyroids. This condition is being proved to be not an
uncommon one.
The case shown had some heart symptoms and had been in hospital
elsewhere for some months in 1926 as a cardiac. Later he was treated
as a T.B. suspect in a University clinic. Electrocardiagram and X-ray
examination of heart and lungs and other examinations are negative now.
Through correspondence it was learned that no other diagnosis had ever
been made on him more conclusive than the present one.
Page 99
PSW Dr. G. H. Clement showed some very instructive X-ray plates.of
Paget's Disease of the Bones and Dr. Neil McNeill demonstrated the uses
and the values of Dr. J. R. Atkinson's splint for fractures of the leg.
The January General Meeting of the Association was held on the
8th of the month in the Auditorium, the president, Dr. W. S. Turnbtill
in the chair.
A letter was read from Mir. Hillas of the Health Bureau of the
Board of Trade, and after discussion a motion was passed that the offer
of the Health Bureau to assist in broadcasting medical information
among the general public' be gratefully accepted and the Association
undertook to co-operate with the Health Bureau in their endeavours in
this respect.
The report of the Committee on the Public Health Survey of Greater
again came up for discussion. The Hon. Dr. H. E. Young was over from
Victoria and fully explained the reasons for the proposed secondary plan.
Dr. F. T. Underhill also discussed the report and Dr. Monro moved a
resolution that it be adopted in order that it might be placed before the
Council of Greater Vancouver to form a basis for the future development
of the Health Services of the City.  The motion was carried unanimously.
Dr. Maurice Fox was elected to membership and Dr. J. H. B. Grant
was nominated for election to membership at a later date.
The paper of the evening was given by Dr. Ralph Matson, of Portland, Ore., his subject being "The Surgical Treatment of Pulmonary
Tuberculosis." Dr. Matson's paper, which was profusely illustrated by
lantern slides, was enthusiastically received and was discussed by Drs.
Vrooman, Schinbein, Hodgins and Graham. A full abstract of Dr.
Matson's paper will be published next month.
It is announced that the new Maternity Wing of the Vancouver
General Hospital will be opened about the end of January, if present
plans do not miscarry. At least another month must elapse before the
Private Wards will be ready for occupation.
Dr. T. R. Ponton, late medical superintendent of the Vancouver
General Hospital and later superintendent of the Hollywood (Calif.)
Hospital, has been appointed superintendent of the Illinois Masonic
Hospital, Chicago ,taking up his duties immediately.
We regret to learn of the death in October, 1928, of Miss C. M.
Haskins, formerly librarian of the Vancouver Medical Association, in the
Good Samaritan Hospital, Los Angeles, after an illness of eight months.
The Eye, Ear, Nose and Throat Section of the Vancouver Medical
Association will be honoured at their March meeting by the presence of
Page 100 Dr. S. Hanford McKee, a prominent Oto-laryngologist of Montreal and
member of the Medical Faculty of McGill University. Invitations are
being extended to members of the medical profession interested in his
specialty in Pacific Coast cities on both sides of the border, to be present
to hear Dr. McKee.
Plans are at present in the architects' hands for re-modelling the
old Technical School buildings to adapt it for housing the various Provincial Government offices not quartered in the Court House. Among
these is the Workmen's Compensation Board. The date of the projected
move is not yet known, but believed to be early in March.
Dr. H. M. Cunningham was in Victoria on January l6th and 17th
attending the meeting of the Western Section of the American Laryngo-
logical, Rhinological and Otological Society. Dr. Cunningham is chairman of this section.
The Bulletin extends its congratulations  to Dr.  J.  T.  Wall   who
became the father of a boy on Decerrfber 12 th.
A Sectional Meeting of the American College of Surgeons comprising Washington, Oregon and British Columbia, will be held in Vancouver
on the 27th and 28 th of February. Clinics and clinical lectures will be
given at the hospitals on the mornings of both days and papers by
visiting surgeons will be given in the afternoons. Dr. Charles L.
Scudder of Boston, Dr. Robert Greenough also of Boston, and Dr. Adson
of the Mayo Clinic, will be present and one or more of the following
may also be on the programme: Dr. Frank Lahey, Dr. J. O. Polak, Dr.
George Crile and Dr. Donald C. Blafour. The afternoon meetings will
be held in the Hotel Vancouver, which will be the headquarters of the
meeting. Dr. George E. Seldon is chairman of the local Committee of
Arrangements and Dr. A. B. Schinbein is the secretary. All medical
men in the Province are cordially invited to be present. There is no
fee for registration.
RECENT ACCESSIONS TO THE LIBRARY
Intestinal Tuberculosis Brown & Sampson
Diabetes  Mellitus Elliott  Joslin
Pharmacotherapeutics Solis-Cohen   &   Githens
The Opium Problem Terry & Pellens
Gastro-intestinal Diseases Reports from St. Andrews' Institute
Trnsactions of the Lucerne County Medical Society, 1928	
Medical Clinics North America Chicago Number
Public Health and Hygiene ,W. H. Park, 1928
Blood Supply to the Heart Louis Gross
Surgical Clinics North America Philadelphia Number, Aug., 1928
Gonococcal Urethritis in the Male Pelouze,  1928
Differential Diagnosis French, 4th edition,  1928
Page 101 From Magic to Science Singer,  1928
Medical Essays C. O. Hawthorne, 1928
Extra Pharmacopoeia, 19th edition, vol. I Martindale & Westcott
Post Mortem McLaurin,   1923
International   Clinics September,   1928
Transactions of American Assn. of G.  U.  Surgeons, vol.  XXL,   192.8
Surgical Clinics North America, Nov., 1928 .New York Number
Index Catalogue Surgeon General's Library, vol. VIL, Series 3	
Fungi and Fungous Diseases ...Castellani,  1928
Annual Report Surg. General U. S. P. H. S., 1928	
Vol. IX. Collected papers School of Hygiene, Johns Hopkins University
Heart in Modern Practice. W. D. Reid, 2nd edition, 1928
Report of the Surgeon General U. S. Army, 1928	
Amputation Stumps, Oxford War Primer Huggins, 1918
Surgical Clinics of North America, Dec, 1928 Pacific Coast Number
Local Anaesthesia de Takats,  1928
History of Pathology Long
Radiological  Diagnosis A.   Kohler   (English  translation)
Occupational Affections of the Skin Prosser White, 3rd edition
Pneumonia    Sante
Clinical Aspects of the Electrocardiogram Pardee
The Gallbladder Evarts  Graham
Diseases of Ear, Nose and Throat Logan Turner
SUCTION DRAINAGE FOR ACUTE EMPYEMA
By Dr. K. D. Panton
Read before a meeting of the Clinical Section of the Vancouver Medical
Association, December 18, 1928.
Suction drainage has been used for forty years in the treatment of
empyema, but has never become popular owing to the difficulty in securing a satisfactory air-tight junction between the suction apparatus and
the chest wall. In securing the closure of an empyema cavity two
factors have to be considered; first the expansion of the collapsed lung
and second, the clearing up of the infection. The expansion of the lung
is a mechanical process. In a week or so after rib resection, the opening
in the chest wall is much smaller in area than the opening through the
larynx into the lung. The thoracotomy opening is closed by the dressing, and with each inspiration more air is drawn into the lung than finds
its way into the empyema cavity, and the lung consequently expands.
Then as the infection clears up and the purulent discharge ceases, adhesions form in ever increasing number between chest wall and lung, and
the cavity gradually closes. But if the infection does not clear up for
any reason and the purulent discharge continues, adhesions do not form.
A thick layer of organized lymph over the surface of the collapsed lung
anchors it in its new position, preventing expansion. When finally
the infection subsides the lung is unable to expand and a chronic
empyema results.
Suction drainage is a great aid in clearing up the infection as well
as in promoting rapid expansion of the lung and- the cases quoted here
Page 102 have been cured in from three to five weeks, one case in particular having
a very severe infection. The suction first causes hyperaemia in the
empyema resulting in a flow of lymph from its walls into the cavity.
This diminishes the absorption of toxins and the multiplication of bacteria, acting as a Biers hyperaemia. Fever is lessened, pain is diminished,
cough is stopped and the patient rapidly becomes comfortable and is
able to leave his bed while the suction is continued. The rapid expansion of the lung is readily demonstrated when the apparatus is in use.
Many types of suction apparatus have been devised and have been
attached to the chest wall by collodion or adhesive plaster, by piercing
the chest wall with a trochar and passing a catheter through the opening
or even boring a hole through the rib and screwing a metal connection
into this hole. These methods all irritate the parts in a few days and
have to be discontinued. The apparatus to be described is non-irritating
and can be removed at any time and replaced in a few minutes. The
essential part of the apparatus is a sheet of pure rubber, such as a section
of "inner tube" about six by ten inches which is fastened around the
chest with a tape. A drainage tube one foot in length is run through
the centre of this, one end being just long enough to reach from the
rubber sheeting well into the empyema cavity while the other end is
attached to a one litre wash bottle. From the wash bottle a second
tube is run. To this is attached a manometer or pressure gauge to indicate the amount of suction in use. Suction is made at the outer end
of this tube by an aspirating syringe, a small Biers pump or by a rubber
bulg. I find the rubber bulb to be the most satisfactory. The whole
apparatus must be air-tight and must be tested before application. If
it leaks it is worse than useless and the surgeon must be prepared to give
it his personal attention. Before applying the rubber sheeting to the
chest wall the skin is covered with a thick layer of zinc oxide ointment.
The tape is then tied around the chest, several absorbent cotton pads are
placed on top of the rubber sheeting and the whole is secured to the
chest wall with a many-tailed binder. Very little suction is required
and is applied every two or three hours. The manometer indicates the
degree of suction and whether or not the drainage tube is kinked or
blocked. The apparatus is removed daily and the cavity is washed out
with Dakin's solution. When the patient is able to leave his bed the
apparatus is slung from his neck by a loop of tape.
When the cavity is closed and nothing remains but the sinus holding the drainage tube, suction is stopped and the sinus is filled with ten
per cent, bismuth paste. It closes with one application and the patient
is cured.
The following is the total number of cases treated to date. There
have been no failures. The details of these cases are given only as they
concern suction drainage.
CASE REPORTS
Case 1. Boy aged 14 years. Large right-sided empyema with
pneumococcal infection. Many large masses of organized lymph were
removed at rib resection.    Suction drainage was commenced the follow-
Page 103 ing day but was unsatisfactory for two days, when it was discovered
that the drainage tube did not penetrate far enough into the cavity
and the movements of the patient withdrew it partially. On a larger
tube being used drainage was good but the tube became plugged with
masses of lymph and required frequent changing . Dakin's solution
was used daily to irrigate the cavity but did not liquefy these masses.
On the eighth day the cavity was irrigated with a Caroid solution and
no further interference with drainage occurred. On the tenth day
after rib resection the patient felt well. On the sixteenth day he was
out of bed. On the eighteenth day the cavity had closed and a sinus
only remained. This was filled with 10% bismuth paste and the
patient was discharged cured on the twenty-third day after rib resection.
Case 2. Male, aged 38. Large left-sided empyema with pneumococcal infection. At rib resection one pint of thin purulent fluid
was evacuated. Suction was started in two days. After the fourth day
the temperature remained normal. On the seventh day patient was up
in a wheel chair. On the fourteenth day the apparatus was removed
and the sinus filled with 10% bismuth paste. On the twentieth day
patient left the hospital cured.
Case 3. Male, aged 30; a drug addict. Right-sided empyema.
Chest was aspirated twice and finally rib resection was done. Open
drainage was carried on for six days with daily irrigation of Dakin's
solution, but patient did badly, running a temperature of 101° with
cough and pain. Immediate improvement followed the commencement
of suction drainage and in a few days the discharge changed from a
profuse purulent character to a free, thin sero-pus. In two weeks the
cavity was gone and a sinus remained still discharging a thin sero-pus.
It closed promptly with one injection of bismuth paste. This case was
treated in the orthodox manner for one week and gave every indication
of taking a long time to clear up until suction was commenced.
Case 4. Female, aged 30. Empyema followed right-sided pneumonia. Open drainage was carried on for ten days after rib resection
and patient still had slight temperature, cough and pain. Suction drainage was then commenced but was unsatisfactory until leaks in the
apparatus were repaired. It was continued for three weeks when a sinus
only remained, which closed at once with an injection of bismuth paste.
In this case also open drainage was not satisfactory.
Case 5. Female, aged 55. Empyema followed excision of an
osteomyelitic rib. The whole right pleural cavity was infected and
there were no limiting adhesions. Patient rapidly became very ill with
high fever, delirium, etc., and the prognosis was bad. Suction drainage
was introduced through the original incision in the anterior axillary
line, a position considered very poor for open drainage of empyema.
In spite of this the patient made rapid improvement and a quick recovery.
Case 6. Male, aged 33, developed a small area of pneumonia in the
right lower lobe with mild symptoms. To this was soon added a
pleurisy with effusion and his condition became much worse with high
temperature  and   toxic   symptoms.    Aspiration   disclosed   an   empyema
Page 104 containing thin pus, a streptococcal infection. At rib resection a moderate sized empyema cavity was opened full of thin foul-smelling pus.
The walls of the cavity were not smooth as is usual, but were covered
with a very adherent shaggy membrane. Suction drainage was commenced at once. For one week the patient did only fairly well, running a slight temperature while the empyema cavity discharged large
quantities of thin pus with the odour gradually getting less. Daily
irrigations with Dakin's solution were done. In two weeks he was feeling much better, the temperature was normal, and the cavity had reduced to three ounces in size. Temperature and pain again commenced
and an abscess developed in the chest wall above the thoracotomy opening. Suction was stopped for one week while the abscess was drained
and was then started again. Improvement was now rapid and in two
weeks suction was stopped and the sinus closed with bismuth paste.
He left hospital cured five weeks after rib resection. This case had the
most virulent infection of the series.
Case 7. Male, aged 32. A large left-sided empyema followed
pneumonia. Open drainage was carried on for three weeks but the
cavity remianed very large with no promise of decreasing and suction
drainage was commenced. In one week the cavity had reduced in size
to four ounces and was soon reduced to a sinus with a free discharge.
This was the first case of the series and suction was continued too long.
It was not recognized that the infection has practically cleared up when
the empyema cavity is gone and that the discharge from the sinus stops
when a bismuth paste injection is made. Bismuth was finally used and
the sinus closed.
A LAYMAN'S IMPRESSIONS OF MEDICAL AFFAIRS
IN SOVIET RUSSIA.
By Victor Holm
(editor's note—Mr. Holm, who was a student at the University of Upsala, Sweden, has recently come to Canada from
Russia, where he lived for two years).
When the great October Revolution in the year 1917 turned over
everything that belonged to the old system in Russia, it also crashed all
the former medical organizations and their activity, and not till after
some months of terrible civil war and terror did the new Government
slowly commence to reconstruct the Russian medical apparatus. There
,is a great difference between the medical staff and all other officials in
Soviet Russia of today, for most of the former officials, belonging to all
the different branches of the State's Government, save the medicals,
have been dismissed as "not trustworthy from the political point of
view." Only physicians are happy enough to be permitted to work
without danger of political suspicion. The only reason for the Government's leaving them to live in peace is that the Communist Party
cannot find sufficient doctors, dentists, veterinarians and apothecaries
amongst their own party members, i.e. not yet. For there is no doubt
that if the Bolshevics remain in power for some ten or twenty years
Page 105
mem more they will have brought up a big number of the medical staff
amongst their own members. The medical schools in Russia, as well as
all other universities and high schools, prefer to take sons and daughters
of workers and farmers as their pupils and it is especially easy to obtain
entrance for Communists and members of "Uamsamalts," the Communist youth organization. The education in Medical Arts schools is
free, but because money is lacking there as everywhere in S. S. S. R., the
schools can only take in a part of those who want to become physicians,
and therefore it depends on the would-be doctor's political relations if
he will be received as a pupil or not. In Leningrad the "Gybsduov,"
the department of health has got some houses at its disposal as homes for
the medical students, where these get free furnished rooms and sometimes
they also get their board free, but in general the Government seems to
prefer to pay support from about 16 to 28 roubles a month.
The question is now, is it possible to say that the Russian medical
students really get their education free? I consider the answer to be
"no;" first because only a part of the students get support, and secondly,
because those who do get maintenance do not get sufficient. And that
is a very serious matter in a country where all are poor and a student
very seldom can get any help from his parents.
When the young medical student is ready to go out as a doctor
his only chance lies in State employment. There are some private physicians but very, very few, and all of them are famous specialists. Certainly most of the doctors want to remain in the big centres, hoping to
complete their education while working in the hospitals, and also hoping
to get bigger salaries than the district country doctor gets, which is about
45-60 roubles a month. In Leningrad and other great cities the average
physician is working at two or three different places. A part of the
day he may be busy as a surgeon in a hospital and the other part he
may practise at any industrial "ambulatoria." In Leningrad all the big
factories have physicians for their workers, day and night. As an
example I will take the "ambulatoria" of "Krasnaya Gazietta," a big
printing house with over 1,000 workers. A whole floor, containing
several rooms was at the medical staff's disposal. There seven doctors,
amongst them a female doctor—a specialist in women's diseases,—
and a dentist, took care of the workers' health. If a worker got ill he
had to send a message to his foreman who thereupon immediately informed the medical department of the factory about it. The same day one
of the doctors went to the sick man's home and examined into the
matter. If it was necessary he sent the worker to a hospital. When
at the sick man's house the doctor had to write out one of the Medical
Health Department's forms for sick patients and make the diagnosis,
and also write out a prescription to the apothecary. All medicine is free.
That form of the Medical Health Department's which the doctor had to
write out is the document through which the worker gets his compensation from the State's "Strachkassa" (the Government's Insurance
offices). When the convalescent feels himself able to work again and
is considered fit to do so by the doctor the latter has to (under) sign the
form which also must be countersigned by some other factory authority and then the worker goes to the district "Strachkassa" offices, gives
it over and can come back to get his compensation after  some  three
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618 Georgia Street West - Vancouver days. The Bureaucracy is ruling in Russia and forces the doctors to
spend hours every day writing out forms sent from the Medical Health
Department. The compensation amounts to about 4/5 of the wages
and in general cannot be given to one person for more than six months.
A council of physicians also has to decide which workers will be
sent to the "dom oldicha," resting houses, the former palaces of the
Russian nobility which now are taken over by the Bolshevics and
changed to convalescent homes. I myself was living half a month in
such a resting house at New Peterhof, formerly belonging to the Russian
Empress. The food there is much better than the Russian worker can
afford to get and the measurements before and after the stay there
showed that all the guests had increased in weight. A doctor visited
the resting house every day.
I said that the Russian doctors had almost no opportunity to get
private patients but there is one exception, and that is in the case of
venereal diseases. The doctor employed at the factory does not care
about this sickness and the worker has to go to a private physician to be
cured.
I think Russia is the only country in the world where abortion is
allowed and also is very common. There are some rules and laws for
the performance of abortion and they are as follows: If the prospective
mother is living in distress and the birth of a child would be very
burdensome for her and make it difficult to earn her living, if she
already has some children and the bringing up of one or more would be
difficult, and if the birth of a child would be dangerous for the mother's
life, these are all reasons for abortion, which have to be decided by a
council of physicians. As there is a big number of women awaiting
abortion, the wives of workers and farmers have precedence.
One of the biggest hospitals in Leningrad "Boljmittza um Vera
Slytsky" had about 800 beds and was clean and very convenient for its
purposes, but it cannot be compared with Canadian hospitals. As a
doctor told me the need of modern instruments is great, and also the
Russian doctors of today are separated from relations with the doctors
of foreign countries.
A Russian doctor's salary very seldom exceeds 150 roubles a month
and it is only the famous specialists and the venereal disease specialists
that can earn up to some thousands of roubles a year.
The advancement must depend entirely on political relations and
I sometimes saw former chief physicians work under young Communist
doctors. All treatment is free but you will soon find out that it is
fitting to pay the doctor if you want good treatment. And sooner or
later the Russian Government must change their policy as regards the
medical staff and allow them to charge their patients for treatment, and
also give medical men opportunities to go abroad and work in foreign
hospitals. If not the Russian medical profession will come to be inferior
to the profession of other countries.
Page 107 CLINICAL ASPECTS OF GALLBLADDER DISEASE
John M. Blackford, M.D.
Seattle, Wash.
Much experimental work has been done in the last few years in
connection with the liver and the gallbladder. Certain well-known facts
have been finally established on experimental evidence and new facts
have been added. Whipple, some years ago, was able to sidetrack entirely
the circulation of the liver in the experimental animal and was surprised
to find that the animal developed jaundice. Mann and his co-workers,
beginning in 1921, were able to completely remove the liver from the
experimental animal by an ingenious series of operations. The technique
of complete hepatectomy is given in his writings and will not be reported
here. He has shown that the blood sugar level rapidly falls after
removal of the liver and that the glycogen content of muscles decreases,
but not as rapidly as the blood sugar level. Such animals give a very
characteristic chain of symptoms, practically identical with that seen
in recent years in connection with insulin shock, Le., the symptoms of
hypoglycemia. Intravenous injections of glucose immediately restore
the experimental animal to essentially a normal condition for a few
hours. Animals can be kept alive up to forty hours after complete
hepatectomy if glucose, intravenously, is given freely. Removal of the
pancreas, after removal of the liver, has ne effect on the fall of the blood
sugar level, a very interesting observation.
The urea formation ceases entirely after removal of the liver and
the urea level remains constant. In other words, the amino acids are
no longer broken down to urea and the amomnia metabolism is very
seriously distributed.
Bile pigment becomes very evident in hepatectomized animals.
Jaundice develops within a few hours after removal of the fiver, proving
conclusively that the main formation of bile pigment is not in the fiver.
After ligation of the common duct it takes several days before jaundice
is evident in the experimental animal or the human, whereas jaundice is
recognizable in a very few hours after complete hepatectomy. Photometric study has shown that the bile pigments are increased in venous
blood returning from the long bones and spleen and liver; but likewise,
it has been discovered that bile pigments are formed at the same rate
without the presence, in the animal, of either spleen or liver. If haematin
be injected, the formation of bilirubin is increased.
Uric acid destruction ceases after hepatectomy. If uric acid be
injected into the animal it may be quantitatively recovered. Uric acid
is not normally present in the urine of the dog, but after injection it may
be recovered in large amounts from the urine and is passed in the urine
even without injection. These facts would seem to prove conclusively
that the liver is a necessary organ in the handling of uric acid in the
organism.
The muscle glycogen decreases slowly after hepatectomy. However,
a hypoglycemic level is reached long before the glycogen of the muscles
is exhausted.    It would seem conclusively proven that Brown-Sequard
Page 108 was right when he considered that the liver is the source of the glucose
in the blood.
Deaminization ceases after hepatectomy and no glucose is formed
from amino acids injected. The detoxicating action of the liver seems
to be entirely removed by hepatectomy.
Liver functional tests have not met with great success down to the
present. It has been experimentally proven that as much as 80 per
cent, of the dog's liver may be removed without affecting the excretion
of the liver as shown by dye tests. Hypertrophy of the liver rapidly
goes on after removal of a considerable portion of th liver and the remaining portion may take on rapidly the function of the whole organ.
Much interesting work has been done in the last three or four
years by Maclndoe and Counsellor. They have worked with corrosion
preparations made by the injection of celloidin into the circulation and
the ducts of the liver and have shown quite conclusively that the right
and left lobes have an entirely separate circulation. They have shown
the normal biliary tree beautifully and have shown, in very conclusive
fashion, the remarkable dilatation and destruction that takes place in the
liver duct as the result of disease. The most remarkable destruction
takes place in connection with gallbladder disease, cholangitis, and
cirrhosis.
The function of the gallbladder has been studied very carefully
in the last few years. The gross anatomy is so well known that it needs
no description here. However, the presence of Hartman's pouch, the
dilatation usually present above the common duct, has resulted in many
surgeons doing an incomplete cholecystectomy, dissecting down to the
constriction above Hartman's pouch and removing the gallbladder at this
point, leaving in a portion above the cystic duct. The valves of Heister
have been re-studied quite carefully in recent years. These spiral valves
were described more than a century ago. Frequently gall-stones are
found in the pockets of these valves.
The recent contributions to the pathology of the gallbladder have
been interesting. It is apparently conclusively shown that inflammation affects the muscular coat of the gallbladder and the submucous
coat before the intima is affected. In inflammatory disease this must
be a tremendous factor in the continuation of symptoms after removal of
the gall-stones.
On the other hand the gallbladder suffers from two general types of
disease, first, chemical and second, bacterial. Cholesterosis has been
shown in many gallbladders and undoubtedly gives clinical symptoms.
Cholesterosis is typically the strawberry gallbladder and every surgeon
knows how often cholesterin can be found on the papillae of the mucosa.
Filling of the gallbladder depends on an intact sphincter of Oddi.
Backward pressure is necessary for the distension of the gallbladder by
the bile and it has been found that the gallbladder bile will concentrate
by the extraction of up to 90 per cent, of its water during fasting.
When food enters the stomach the first gush of this concentrated solution
Page 109 of bile salts in the intestine may very definitely be the stimulus that
throws the liver into high gear, as it were, and increases the flow of bile.
The work of Graham and his co-workers has shown that fat ingested
will rapidly cause the gallbladder to empty.
The van den Bergh test has recently come into clinical use. Van
den Bergh hypothesized that some slight chemical change takes place
in that bilirubin which has gone through the liver and then been reabsorbed, in other words he hypothesized that we have two kinds of
bilirubin responsible for jaundice; that bile which has gone through the
liver and been reabsorbed due to obstruction in the gut gives the
direct van den Bergh reaction, whereas bile which has not gone through
the liver gives an indirect reaction. Heyd and Killian have recently
added something to this hypothesis. They have felt that probably the
bile salts excreted by the liver and reabsorbed with that waste portion
of bilirubin which has gone through the liver was one variety of bilirubin.
A second variety was that bilirubin which represented the whole substance, without any waste portion having gone through the liver. This
bilirubin is found in connection with catarrhal jaundice, jaundice due to
sepsis and jaundice due to poisons which have blocked the action of the
liver in passing off bile. The third variety of bilirubin is that retained
in the circulation in excess after the waste portion has been split off and
passed through the liver in normal fashion. This bilirubin, functional
bilirubin as it were, is that which gives jaundice in the family types of
jaundice and in certain of the anemias. Whether this be true in detail,
it does give us an excellent working hypothesis for the interpretation of
the van den Bergh test.
Strange to say the bile salts have never been successfully studied
with clinical disease. Their reabsorption, however, is probably responsible for the marked pruritus found in connection with obstructive
jaundice and not present in other types of jaundice.
Manifestly there may be mixed types of jaundice as when obstruction of the common duct gives a pure obstructive jaundice and, later,
the destruction of liver tissue gives an impermeability to the liver with
retention in the blood of large quantities of bile which has not gone
through the liver at all.
Bile pigment is never present in the veins from the intoxication of
hemolytic jaundice, because there is always a demonstrably high renal
threshold for bilirubin with this type of disease. The high renal threshold
is as definite a symptom of the disease as is the lowered fragility of the
red blood cell.
The quantitative van den Bergh gives us, of course, the milligrams
of bilirubin present in the blood. Two to five milligrams indicates a
latent jaundice, whereas jaundice is usually evident clinically if more
than five milligrams is found in the blood.
The icterus index is a simpler test for quantitatively estimating the
color of the patient's serum as compared to a one to ten thousand solution
of potassium bichromate. The normal index is three to six units and
latent jaundice gives an icterus index of six to fifteen units.    Above
Page 110 fifteen units we have clinical jaundice. This test is quantitative only
and is of no assistance differentiating the character of the pigment
present. We have used it only occasionally as a check on the van den
Bergh test.
Clinically we have found gallbladder disease to be the most common
of any cause of dyspepsia in adults. A review of one thousand case
histories of patients suffering from cholecystitis have shown that two-
thirds of them came for relief from chronic dyspepsia as their main
complaint, whereas only one-third came complaining as their major
complaint of acute attacks of colic. On the other hand it is interesting to note that the average duration of chronic symptoms was eleven
years before the patients came to see us, whereas the average incidence
of suffering from acute colic was only seven years; in other words
patients seek relief from acute pain earlier than they do from a chronic
complaint.
We have laid great stress on the importance of an accurate clinical
history. Typically, the patient suffering from gallbladder dyspepsia complains of gas, bloating, heart burn, distress coming on with a full stomach
and tending to be relieved as the stomach empties, and complains of certain articles of food which usually will make trouble. We have found
that often raw apples, friend foods, high seasoning, beer and spirituous
liquors, will provoke trouble. The seeking in the history for the history
of acute attacks of colic is very important because many patients, in
spite of the severity of colic, will forget about such attacks until they
are very closely questioned.
It is interesting to note that in 200 consecutive gastric analyses of
patients suffering from cholecystitis that in no instance was there a high
acidity present in the gastric contents. Approximately one-third had
normal acids, one-third had low acids and one-third absent acids. Hyperacidity is, manifestly, not a symptom of gallbladder disease except in
isolated instances.
The differentiation of ulcer symptoms from gallbladder dyspepsia
is remarkably important and in a certain percentage of cases these two
diseases cannot be differentiated from the clinical history alone.
Many cases, probably most cases,. diagnosed as cholecystitis are not
surgical at the time of the diagnosis. Milder cases may be given great
relief by advice regarding diet, increasing the amount of the patient's
exercise, regular habits, avoidance of constipation, etc. The administration of bile salts to stimulate liver function is frequently of great assistance to these patients. A small morning dose of a saline is likewise very
efficient in relieving symptoms.
jf
The surgical treatment is remarkably satisfactory although we have
only operated upon about 25 per cent, of those on whom the diagnosis
of cholecystitis had been made.. Surgical end results show remarkable
figures, more than 80 per centreing entirely relieved following cholecystectomy. The mortality in our hands of surgery on patients in reasonable condition has been less than 3 per cent. On the other hand, the
mortality of acute complications of gallbladder disease has been extremely
Page 111 high. We are now loathe to undertake emergency gallbladder surgery
because of the high mortality rate. The present methods of systematic
medical treatment of acute conditions of the gallbladder is so satisfactory
that the mortality of expectant treatment is certainly vastly less than the
surgical mortality. Unless the gallbladder be actually ruptured, it is
rare for the patient to die from the attacks. They can usually be gotten
in shape for operation at a later time with vastly less risk than if the
operation be done with the patient very acutely ill.
X-ray examinations of the gallbladder before the advent of chole-
cystogt»nhy occasionally gave very definite information but usually was
very disappointing. Gastro-intestinal studies have a valuable place in
the diagnosis of gallbladder disease on account of their importance in
excluding organic gastro-intestinal disease. Cholecystograms will frequently give very definite and accurate information.
Cholecystograms, to give normal findings, require and establish
several points. If the oral method be used, the dye must be absorbed
from the intestinal tract. Nocmal cholecystograms further show that
the dye has passed through the liver, that the back pressure of the
sphincter is intact in order to allow the gallbladder to fill, they show
that the concentrating ability of the gallbladder is norrrfal, they likewise
show the position of the gallbladder and establish its presence. In other
words, the rare anomaly of congenital absence of the gallbladder, or its
removal at previous surgical operation may give embarrassment with
cholecystograms. Studies of the X-ray may be very- definitely interpreted by the roentgenologist. Positive findings are practically conclusive evidence of the disease. On the other hand we have seen a
considerable number of cases in which cholecystograms. were normal
and operation has shown definitely a diseased gallbladder. Our estimate
is that approximately 20 per cent, of diseased gallbladders will give
normal cholecystographic findings. It is interesting to note that our
percentage of diagnosis of gallbladder disease had not risen perceptibly
in the last ten years. In other words, a careful clinical study is still
indispensable in accurate diagnosis but, on the other hand, cholecystograms frequently give excellent and surprising evidence.
It is well worthy of mention that certain people may have diseased
gallbladders with cholecystographic evidence of stones or an absent
shadow and yet the main complaints of the patient may not be due to
the gallbladder. Clinical study is, of course, necessary before advising
removal of the gallbladder because it is found diseased.
Cholecystograms occasionally have shown some remarkable anomalies. We have had one instance of a transposition of abdominal viscera
only, with the presence of gall-stones in a left-sided gallbladder. In
one or two other instances we have demonstrated that a previous operation has been incomplete because the stump of the gallbladder still showed
through the X-ray after the dye had been taken. A series of cases has
been studied after cholecystectomy.and we have found that uniformly
there is no shadow whatever present if the gallbladder has been properly
removed. A single instance in our series has shown beautifully the outline of the common duct in the cholecystogram.
Page 112 In operations upon the gallbladder we have found that about 8 per
cent, of cases have associated gastric or duodenal pathology. Correspondence with the Mayo Clinic has shown that 8.4 per cent, of the benign
lesions of the stomach and duodenum operated there have had definite
gallbladder pathology.
Three and five-tenths per cent, of our gallbladder cases have been
diabetics. We are emphatically of the opinion that diabetics with
gallbladder disease should have the gallbladder removed. Following the
surgical procedure, which is reasonably safe if the diabetic be under
skillful treatment, the diabetes is much easier to handle.
In conclusion we would emphasize that the gallbladder is the most
common cause of organic dyspepsia and that its surgical removal in
suitable cases gives a very high percentage of complete symptomatic
relief. On the other hand the majority of cases diagnosed as suffering
from gallbladder disease may obtain great relief from medical treatment.
If medical treatment fails to relieve the patient then, certainly, surgery
should be called in for the relief of the disease.
THE FAMOUS WILL OF DR. WILLIAM (TIGER) DUNLOP.
From "The Signal," Goderich, Ont., of Dec. 13, 1928.
Perhaps no other testamentary document that has ever been produced
in any debate court in Canada is so famous as the will of Dr. William
("Tiger") Dunlop, that stalwart of the early days of settlement in
Huron. It has been published and republished all over Canada times
without number. It is familiar to many readers of The Signal, but as
there are some who have never seen it, and as a wish has been expressed
that it should once more be published, we give it herewith:
IN  THE  NAME  OF  GOD,  AMEN.
I, William Dunlop, of Gairbraid, in the Township of Colborne,
County and District of Huron, Western Canada, Esquire, being in sound
health of body, and my mind just as usual (which my friends who
flatter me say is no great shakes at the best of times), do make this my
last Will and Testament as follows, revoking of course all former Wills.
I leave the property of Gairbraid and all other landed property I
may die possessed of to my sisters Helen Boyle Story and Elizabeth Boyle
Dunlop, the former because she is married to a Minister whom (God help
him) she henpecks—the latter because she is married to nobody nor
is she like to be, for she is an old maid and not market-rife; and also I
leave to them, and their heirs, my share of the stock and implements on
the farm, provided always that the enclosure round my brother's grave
be reserved, and if either should die without issue then the other to
inherit the whole.
I leave to my sister-in-law, Louisa Dunlop, all my share of ths
household furniture and such traps, with the exceptions hereinafter
mentioned.
Page 113 I leave my silver tankard to the eldest son of Old John as the
representative of the family. I would have left it to Old John himself,
but he would melt it down to make temperance medals and that would
be sacrilege—however, I leave him my big horn snuff-box, he can only
make temperance horn spoons of that.
I leave my sister Jenny my Bible, the property formerly of my
great-great-grandmother, Bethia Hamilton, of Wood Hall, and when she
knows as much of the spirit of it as she does of the letter, she will be
another guise Christian than she is.
I also leave my late brother's watch to my brother Sandy, exhorting
him at the same time to give up whiggery, Radicalism, and all other sins
that do most easily beset him.
I leave my brother Alan my big silver snuffbox, as I am informed he
is rather a decent Christian with a swag belly and a jolly face.
I leave Parson Chevasse (Maggy's husband) the snuffbox I got from
the Sarnia Militia, as a small token of my gratitude for the services he
has done the family in taking a sister that no man of taste would have
taken.
I leave John Caddie a silver teapot, to the end that he may drink tea
therefrom to comfort him under the affliction of a slatternly wife.
I leave my books to my brother Andrew, because he has been so
long a Jungley Wallah that he may learn to read with them.
I give my silver cup, with a sovereign in it, to my sister, Janet
Graham Dunlop, because she is an old maid, and pious, and therefore
will necessarily take to horning, and also my Granna's snuff mull, as it
looks decent to see an old woman taking snuff.
I do hereby constitute and appoint John Dunlop, Esq., of Gairbraid;
Alexander Dunlop, Esquire, Advocate, Edinburgh; Alan C. Dunlop,
Esquire, and William Chalk of Tuckersmith, William Stewart, and William Gooding, Esquires, Goderich, to be the Executors of this my last
Will and Testament. In witness whereof, I have set my hand and seal
the thirty-first day of August, in the year of our Lord, one thousand
eight hundred and forty-two.
(sgd) W. Dunlop (Seal)
The above instrument of one sheet was at the date thereof declared
to us by the Testator, William Dunlop, Esquire, to be his last Will and
Testament, and he then acknowledged to each of us, that he had subscribed the same, and we at his request signed our names hereunto as
attesting witnesses.
(sgd) James Clowting (seal)
(sgd) Patrick McNaughton
(sgd)  Elizabeth Steward
I have perused the above Will. It is eccentric, but it is not, on that
score,  illegal  or  informal.    To  a  mind  who  knows  the mind  of   the
Page 114 Testator, it will remain a relic of his perfect indifference (an indifference
to be admired,- in my opinion) to what is called "Fashion" even in
testamentary matters. I conceive it to be a just and a proper Will, and
no person can question its legality in point of form or substance.
(sgd) John Prince, Q.C.
Montreal, 5th July, 1847.
Dr. W. S. Turnbull; who formerly practiced in Goderich, has contributed the following interesting particulars:
Dr. William Dunlop the author of the foregoing will, practiced
for a number of years in Goderich, Ontario, a beautiful spot on the
shores of Lake Huron and among the pioneers of that district many
quaint and interesting stories are told of the eccentricities of this unique
but honorable character. The cairn under which Dr. Dunlop is buried
is situated three miles from the town upon what is known as Dunlop
Hill, commanding a view of the town and harbour. It has been well
preserved and the property immediately surrounding it remains intact
in the possession of his heirs. The brother Andrew is buried under the
cairn with the Doctor. The nickname "Tiger" Dunlop was derived
from a military unit with which the Doctor had been connected early
in his career.
THE PAN-PACIFIC UNION
Most of our readers have some knowledge of the Pan-Pacific Union
whose purpose and function is best described by the following extract
from its letter-heads:
"An organization directed by representatives of all Pacific faces,
supported in part by Government appropriations, co-operating with
Chambers of Commerce, scientific organizations, Boards of Education and kindred bodies working for the advancement of Pacific
interests. It brings together through frequent conferences at the
ocean's cross-roads leaders in all lines of thought and action in
Pacific lands, organizing them into friendly co-operative effort."
During the last few years many notable conferences have been
organized by this body and it is of special interest to medical men that
this year's chief activity is the Pan-Pacific Surgical Conference, which
will be held at Honolulu, Hawaii, August 14th to 24th. Medical men
from all parts of Canada and the United States are invited to enroll.
The meeting will be specially attractive to those on the Pacific Coast.
Dr. George E. Swift of Seattle, is the Chairman of the West Coast
Section and has circularized all the cities of the States and Canada bordering on the Pacific. A special steamship "Malolo" will be chartered
from Seattle to take any who may care to travel by her, and this will
probably be a delightful feature of the trip.
Paeg 115 The programme that is being arranged has^'nnjL yet been published
but is evidently going to be a very good one judging by the names that
have already been mentioned. Representatives from the Mayo Clinic
are among these, and special attention is to be paid to anaesthesia.
Japan is sending at least twelve of her leading surgeons and many
representatives from Australasia are expected. One notices prominently
displayed in the list of Committees some devoted to golf and entertainment. Men are expected to take their wives and daughters and complete
arrangements are being made to take care of these.
This conference will not clash in. any' way with the main medical
meetings that are being held during the summer. Those who wish to
attend the American Medical Association meeting at Portland can do
so and yet be in plenty of time for the Pan-Pacific Conference.
Further information will be available at an early date and will be
published in the Bulletin, or any man interested may write direct to
Nils P. Larsen, Honolulu Chairman Surgical Conference, Honolulu.
B. C. MEDICAL ASSOCIATION NEWS
Dr. P. M. Wilson of Lytton has returned to the city for a holiday
after taking post-graduate work in the East.
Dr. Murray Baird is now at the Vancouver General Hospital, where
he has charge of the new Private Ward wing.
A luncheon meeting of the local Executive of the B. C. Medical
Association was held at the Georgia Hotel on January 9th. A number
of matters of importance were dealt with. It was decided to hold a
full meeting on January 26th, at the Georgia Hotel, commencing at
6:30 p.m.
Out-of-town visitors to the office of the Executive Secretary last
month included: Dr. H. B. Maxwell of Ladysmith; Dr. A. Francis of
Hedley; Dr. E. L. Garner of Duncan; Dr. A. R. Wilson of Port Alberni;
Dr. G. A. Minorgan of Britannia Beach; Dr. G'. E. Darby of Bella
Bella; Dr. R. Nasmyth of Powell River; Dr. H. E. Young of Victoria;
and Dr. D. W. McKay of Nelson.
Dr. J. E. Knipfel, late of West Vancouver, is now practising in
Extension, V. I.
Twelve applications for membership in the B. C. Medical Association
were approved last month by the Credentials Committee.
Page 116 Dr. R. E. Ziegler of Campbell River is taking two months postgraduate work in Chicago, during which time his practice is being cared
for by Dr. W. H. Moore of Victoria.
It will not be out of place to congratulate Mr. P. Walker on his
recent appointment as Deputy Provincial Secretary in the new government. Mr. Walker, during his many years as Chief Clerk in that Department, was ever sympathetic to the profession, and many doctors in
country districts now receiving government grants, who have Mr.
Walker to thank for his influence on their behalf, will join in our hearty-
congratulations to him.
The convention of the American Laryngological, Rhinological and
Otological Society held recently in Victoria was atended by the following British Columbia specialists: Dr. H. M. Cunningham, Chairman of
the Western section; Drs. W. E. Ainley, Lavell H. Leeson, Glen Campbell, E. H. Saunders of Vancouver; Dr. B. A. Hopkins of New Westminster, and Dr. M. J. Keys of Victoria.
Reception arrangements for the convention were in the hands of
Dr. M. J. Keys.
Dr. Lee Smith of Princeton has left for Europe to take post-graduate
work. A farewell reception was held for the doctor by representative
residents of the Similkameen district, when he was presented with a
handsome gift as a slight appreciation of his many valuable services to
the community.
Dr. Smith will be succeeded in his practice by Dr. R. S. Manson
of Hatzic, a graduate of Edinburgh University, who is known to many
in the district, as he relieved Dr. Smith for a time during the past
summer.
Page IV, Say it with Flowers
Cut Flowers, Potted Plants, Bulbs, Trees, Shrubs,
Roots, Wedding Bouquets.
Florists' Supplies and Funeral Designs a Specialty
Three Stores to Serve You:
48 Hastings St. E. One Phone:
665 Granville St. Seymour 8033
151 Hastings St. W. Connecting all three stores.
Brown Bros* & Co* Ltd.
VANCOUVER, B. C.
Office: Residence:
Seymour 2996 Bayview 5194
Medical Phone Service:
Seymour 2062
R. E. COLEMAN, M.B.
Office Hours:
2 to 5 p.m. and by appointment
Clinical Laboratory:
201 Vancouver Block, Vancouver, B.C. <5Very 'Diphtheria Case
Should ^covert
// diagnosed EARLY
and if enough Diphtheria Antitoxin is used
FREQUENTLY the physician is not called until dangerously late. Then, especially,
a most dependable Diphtheria Antitoxin is required and repeated injections may even
be needed.
Under such circumstances select Diphtheria Antitoxin, P. D. & Co. It is highly
concentrated and purified; limpid ana water-clear, with a minimum content of protein
substances. The syringe contains 40% more antitoxin units than the label calls for.
This provides for possible lessening of activity with lapse of time, assuring full label
dosage up to the date stamped on the package.
Diphtheria Antitoxin, P. D. & Co., is supplied in syringe packages of latest improved
type, ready for instant use.
.+. ~f
1,000 UNITS   ■*   3,000 UNITS   ■*   5,000 UNITS   -\   10,000 UNITS   »■   20,000 UNITS
•+< —♦•
r% Parke, Davis & Company
License No. 1 for the Manufacture of Biological Products
DIPHTHERIA ANTITOXIN, P. D. & CO., IS INCLUDED IN N. N. R. BY THE COUNCIL ON PHARMACY AND
CHEMISTRY OF THE AMERICAN MEDICAL ASSOCIATION
McBeath-
H Campbell
Limited
Printers and
Publishers
Vancouver, B. C.
The Owl Drug
Co*, Ltd*
All prescriptions
dispensed by qualified
Druggists.
You can depend on the
Owl for Accuracy
and despatch.
We deliver free of
charge.
5   Stores,   centrally   located.
We would appreciate a call
while in our territory.
SHSBSSSra 536 13th Avenue West Fairmont 80
Exclusive Ambulance Service
FAIRMONT 80
ALL ATTENDANTS QUALIFIED IN FIRST AID
"St. John's Ambulance Association"
WE SPECIALIZE IN AMBULANCE SERVICE ONLY
R. J. Campbell J. H. Crellin W. L. Bertrand
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
hCENTURY^    "    ~
B. C. STEVENS CO.
phone 730 Richards Street
Seymour 698 Vancouver, B. C. 

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