History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: January, 1933 Vancouver Medical Association Jan 31, 1933

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 The
BULLETIN
OF THE
Vancouver Medical Association
<£A ^appy and Prosperous
Js[ew year
to oAll
Published monthly at Vancouver, B. C, by
McBeath-Campbelx Ltd.,   326  Pender  Street  West
Subscription,   $1.50  per  year.
Vol. IX
JANUARY,  1933.
No. 4 iSS'-^l
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We ejXtend
ft ^he 5^^on?5 Qreetings
and
Qood 'Wishes for the New year
57 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. MacDermot
Dr. D. E.  H.  Cleveland Dr.  M.  McC.   Baird
All communications to be addressed to the Editor at the above address.
Vol. IX.
JANUARY,  1933.
No. 4
OFFICERS 1932-1933
Dr. Murray Blair Dr. W. L. Pedlow Dr. C. W. Prowd
President Vice-President Past   President
Dr. L. H. Appleby Dr. W. T. Lockhart
Hon.  Secretary Hon.  Treasurer
Additional Members of Executive:—Dr.  A.  C. Frost;   Dr.  C.  H.  Vrooman
TRUSTEES
Dr. W. D. Brydone-Jack Dr. J. A. Gillespie Dr. J. M. Pearson
Auditors:  Messrs.  Shaw, Salter & Plommer
SECTIONS
Clinical Section
Dr.   A.   M.   Agnew...
Dr. W. H. Hatfield.
Dr.   A.   O.   Brown   ...
Eye, Ear, Nose and Throat
..Chairman
—Secretary
 Chairman
Dr.  R.  Grant  Lawrence Secretary
Paediatric Section
Dr.   J.   R.   Davies Chairman
Dr.   J.   H.   B.   Grant . Secretary
Cancer Section
Dr. A. Y.  McNair Chairman
Dr. A. B. Schinbein Secretary
STANDING COMMITTEES
Library
Dr. W. H. Hatfield
Dr. H. A. Spohn
Dr. D. M. Meekison
Dr.   H.   A.   DesBbisay
Dr. G. E. Kidd
Dr. J. E. Harrison
Dinner
Dr. H. H. Pitts
Dr.  A.   M.  Warner
Dr. A. T. Henry
Rep. to B. C. Med. Assn.     E*R-
Dr.
Dr.  G. F.  Strong Dr.
Sickness and Benevolent
Orchestra
Dr.
P
R. Davies
Dr.
F.
N. Robertson
Dr.
J-
A. Smith
Dr.
J.
E.  Harrison
Publications
Dr.
J-
H. MacDermot
Dr.
D
E. H. Cleveland
Dr.
M
cjrray Baird
Summer School
Dr. J.  W Thomson
Dr.  C. E. Brown
Dr. C. H. Vrooman
Dr. J. W. Arbuckxe
Dr. H. A. Spohn
Dr. H. R. Mustard
Hospitals
Credentials
F.  P.  Patterson
A.   J.   MacLachlan
S. Paulin
Fund -— The President
Dr.
A.
W. Bagnall
Dr.
F.
J. Buller
Dr.
W
.  C.  Walsh
Dr.
S.
B. Peele
"V
r.O.N. Advisory
Board
Dr.
H.
H. Caple
Dr.
E.
Trapp
Dr.
J.
W.  Shier
r —
The Trustees VANCOUVER HEALTH DEPARTMENT
STATISTICS, NOVEMBER, 1932
Total Population  (Census, 1931)           246,593
Asiatic Population  (Estimated)    15,000
Rate per 1,000 Population
Total Deaths 	
Asiatic    	
Deaths—Residents only	
Birth  Registrations  ^	
Male       158
Female 136
INFANTILE MORTALITY—
Deaths under one year of age  .
Deaths Rate—per  1,000 births  .	
Stillbirths  (not included in above)  	
CASES OF CONTAGIOUS DISEASES REPORTED IN CITY
191
9.4
14
11.4
166
8.2
294
14.5
October, 1932
Cases      Deaths
November, 1932
Cases    Deaths
Smallpox     .  0
Scarlet   Fever     12
Diphtheria       0
Chicken-pox    27
Measles     0
Mumps     19
Whooping-cough     11
Typhoid Fever   0
Paratyphoid     0
Tuberculosis    3 7
Poliomyelitis    0
Meningitis   (Epidemic)     0
Erysipelas '  4
Encephalitis Lethargica   0
Influenza      —
0
0
41
1
0
0
35
0
0
0
4
0
18,
0
2
0
0
0
41
9
0
0
0
0
3
1
4'p|&
0
—
12
23.8
8
CITY
Decemb
;r 1st
to 15
th,
1932
Cases
E
eaths
0
0
8
1
1
0
12
0
1
0
15
0
17
0
0
0
0
0
19
-
0
0
0
0
^i-
0
0
0
VANCOUVER MEDICAL ASSOCIATION
Founded 1898 Incorporated 1906
PROGRAMME FOR REMAINDER OF THE WINTER SESSIOX
1933
January 3rd—General Meeting.
Papers:
Goitre—Dr. W. D. Keith, Dr. T. H. Lennie, Dr. H. H. Pitts.
January 17th—Clinical  Meeting.
February 7th—General Meeting.
Ten-minute Talks:
Sterility—Dr. W. S. Turnbull.
Dysmenorrhoea—Dr. J. W. Arbuckle.
Vaginal Discharge—Dr. W. L. Boulter.
Menorrhagia—Dr. J. E. Harrison.
Menopause—Dr. J. P. Bilodeau.
February 14th—Special Meeting.
Dr. Paul Flothow of Seattle.
February 21st—Clinical Meeting.
March 7th—General Meeting; Osier Dinner.
Lecturer—Dt. I. Glen Campbell.
March 14th—Clinical Meeting:
April 4th—General Meeting:
Papers:
Surgical Emergencies—Dr. J. A. Gillespie.
Medical Emergencies—Dr. W. S. Baird.
April 18th—Clinical Meeting.
April 25th—Annual Meeting.
Page 62 Milk>Borne |j
Typhoid Outbreak at Yale
The "Milk Inspector's Letter," from the Michigan Department of Agriculture, Bureau of Dairying, recently
contained the following interesting item:
"A milk-borne typhoid outbreak resulting in twelve
cases   and   one   death   occurred   recently   at   Yale,
Michigan.
The first case developed on February 1st,  1932, and
the last on February 15 th. All but one of the cases
were known to have used the milk of one raw milk
dealer, and the other may have used it.
The milk supply of the city, which had been entirely
raw, was ordered pasteurized. The dealer supplying
the suspected milk, sold milk produced on his own
farm and milk purchased from another farm.
A woman who was staying at the farm from which
milk was bought was found to be a typhoid carrier.
The search for a carrier was unsuccessful at first
because the carrier had left the farm, but she happened to come back while the investigation was still in
progress.
The case which proved fatal was a lady of 49, the
mother of twelve children.
This outbreak is another argument against raw milk,
particularly milk produced on a farm having no
sterilizing or other proper equipment for milk handling and transported to another place for bottling
raw.
There are about fifty such arguments each year and
still the use of raw milk continues in many cities, and
occasionally is sharply defended by some members of the
medical profession.
ASSOCIATED DAIRIES
Limited
DISTRIBUTING RICH, SAFE, CLEAN MILK
Phones:
Fairmont 1000—North 122—New Westminster 1445 The New Store
Is A Success!
. . . and we are very grateful to the Medical Profession for continuing to provide us
with many opportunities for service—every
day—of every week.
* * *
We sincerely offer you the
compliments of the season.
Seymour
1050
Georgia
pharmacy
V
LW
777 WEST GEORGIA ST.
Open All
Night
In congestive heart failure
Theocalcin
(theobromine-calcium salicylate)
Myocardial stimulation and a
potent diuretic effect is obtained with 1 to 3 tablets t. i. d.
Tablets  7% grains each,
also  Theocalcin  powder.
Literature and samples upon request
BILHUBER-KNOLL CORP.
154 Ogden Ave., Jersey City, N. J.
Canadian Agents
MERCK 6C Co. Ltd., 412 St. Sulpice St., Montreal EDITOR'S PAGE
To all our readers, we wish a very happy and prosperous New Year.
Perhaps the latter adjective is still somewhat too extravagant a word, in
these days when prosperity is to most of us merely a memory or a hope,
but it does no harm to wish for it, and there are not wanting signs that
the trend of events from now on will be in a rising, instead of a descending scale.
1933 will be a memorable year to us as medical men practising in
British Columbia, in one respect at least. For this year, beginning with
January 1st, the medical profession of British Columbia sets out on a
new course. Following the example of our sister province, Alberta, the
B. C. Medical Council is absorbing the duties of the B. C. Medical Association (the word amalgamation is a misnomer in this respect) and is
becoming the main body of organized medicine in the province, assuming all the duties that are concerned with medical practice, except educational and social duties, which will still be performed by a somewhat
reconstructed B. C. Medical Association.
This is an important move, and has certain implications which it
behooves us all to consider. The move has not been a sudden or impulsive one—it has been taken after a long period of careful thought and
consideration. We believe that it is entirely a move in the right direction,
and that eventually it will mean a great deal to every medical man in the
province.
In the first place, it will unify medical organization, and eliminate
a great deal of over-lapping and waste effort. It has always seemed
rather absurd that there should be two provincial organizations, with
our comparatively small medical population—yet, as things stood, it was
unavoidable. The B. C. Medical Council was a statutory body, with definite powers, but limited scope of action—the B. C. Medical Association had a wide scope of action, but no power, and its membership was
voluntary and limited.
There are too many organizations nowadays, and we believe that
any step which simplifies things will make for economy and efficiency.
Again, this move is, in our opinion, a right one for another reason—
nobody will deny that medical organization in some form is necessary to
protect our interests, and to speak for the whole profession. This however entails expense, which, in the past, has been met by the fees paid
by the members of the B. C. Medical Association. These members paid
too much, and they paid for others who for one reason or another,
failed to join the Association, yet benefited by its work. It is infinitely
fairer to spread these costs over the whole profession.
It will, too, be very much cheaper—and this is a consideration in
these days.
To the B. C. Medical Council, as it assumes its new duties, we wish
every success, and for it we bespeak the support and confidence of every
man in the province.
Page  63 We understand that following the reorganization of the B. C. Medical Association, Mr. C. J. Fletcher, the Executive Secretary of that
organization, is retiring from office, and the Bulletin would like to pay
its tribute to this officer, who for over eleven years has served the medical profession so faithfully and well. Every member of the B. C. M. A.,
and especially those whose practice lies outside the cities, so that to a
great extent they are isolated, and cut off from their fellows, will miss
Mr. Fletcher, who has been to them an ever-reliable friend and counsellor,
has helped them with many of their difficulties and problems, and has
always been a most welcome visitor. What success the British Columbia
Medical Association has been able to achieve, has been mainly due to his
loyal and untiring efforts, and the profession as a whole in B. C. owes
him a debt of gratitude. We wish him all good luck and prosperity in
the future.
REPORTING OF CANCER
Cancer is now a notifiable, disease and every doctor is legally required
to report each case under his care to the Health Authorities. Every doctor who fails to report his cancer cases is withholding from all those who
are interested in the problem of cancer, his individual contribution to the
accumulating mass of data from which will be derived knowledge of
value to all who are treating cancer. The recognition of the fact
that one is himself refusing to aid in the conquest of cancer should alone
be sufficient penalty for the omission.
ANNUAL DUES
We would urge those members who did not accept the drafts recently presented for the annual dues to send in their cheques at an earjy
date as the Association will need the money to "carry on."
MEETINGS
The December general meeting of the Association was held on the
6th instant, in the Medical Dental Building Auditorium. Fifty-seven
members were present.
The Graduate Nurses Association of B. C, represented by Miss Mabel
Gray, of the Department of Nursing of the University of B. C, and
Miss Duffield, District Superintendent of the Victoria Order of Nurses,
outlined to the meeting the proposed scheme for an Hourly Appointment
Nursing Service. After these ladies had retired the Association passed a
resolution approving of the scheme under the administration of the Victorian Order of Nurses.
The National Health Clinic, having an office at 142 Hastings West,
came up for discussion. The Chairman pointed out that the matter had
been under consideration by the Council of the College of Physicians and
Surgeons and read a letter from the Registrar. Dr. T. K. McAlpine produced a printed circular which was being circulated in the public schools
among teachers and pupils and after considerable discussion moved the
following resolution which was unanimously adopted:  "That  the Van-
Page 64
J couver Medical  Association  does  not  approve of  the National  Health
Clinic and that the members of the Association and others be so notified."
Dr. Pitts reported on behalf of the Dinner Committee held on
November 26th, at the Hotel Vancouver. 116 men were present. Dr.
.J J. Mason was the 1932 recipient of the P. G. F. Degree. The dinner
was, as usual, a great success, and the Committee reported a small credit
balance.
Dr. D. L. Dick was unanimously elected to membership in the
Association.
Dr. G. F. Strong, representative of the Vancouver Medical Association on the Executive of the B. C. Medical Association, reported that a
merger of the B. C. Medical Association and the Council of the College
of Physicians and Surgeons of B. C, along the lines of the Alberta scheme,
had been arranged and the Council would take over all political and legislative activities as from 1st of January, 193 3. Dr. W. S. Turnbull, as
President-elect of the provincial association, and Dr. H. H. Milburn, as
chairman of the Constitution Committee, also addressed the meeting elucidating several points in detail. Dr. Milburn pointed out that the Constitution and Bylaws of the B. C. Medical Association had been amended
in accordance with the request of the Council and a copy of the revised
constitution will be available for perusal by the members of the Vancouver Medical Association at an early date. He also stated that all the
district local societies will be notified of the changes and if possible a
copy of the Constitution and Bylaws will be published in the Bulletin.
The scientific part of the evening's programme was a symposium on
the Upper Right Quadrant, Dr. G. E. Kidd dealing with the anatomy,
Dr. H. H. Mcintosh discussing it from a radiological view point, and Dr.
R. A. Simpson speaking on the physiology. Unfortunately owing to the
time taken up by the business meeting full justice could not be done to
the excellent addresses, Dr. Simpson only having time to give half his
paper and there was practically no time for discussion.
GEORGE HERBERT GIBSON
(By H. B. Maxwell)
To those of us who were fortunate enough to know George Herbert
Rae Gibson, it came as a great shock to hear of his sudden death in Edinburgh, on July 19th, 1932.
He was born in Edinburgh on April 5th, 1881, the only son of Dr.
George Alexander Gibson, a leading heart specialist of his day. George
(Junior) was a brilliant student at school and college, excelling in athletics as well as in his studies.
The space at our disposal does not permit of a full account of his
very active, tho' short life, so that only the high lights, especially as regards his connection with the Vancouver Medical Association, can be
touched upon.
Page  65 In 1906 he graduated M.D. of Edinburgh, and in 1908 he was admitted a member of the Royal College of Physicians of which he became
a Fellow in 1911. With these splendid qualifications he came to B. C. in
1912, but had to wait for some time before there was an examination of
the college to entitle him to practise in the Province.
Impecuniosity being his chronic condition, and as he was determined
to make his own way without parental assistance, he wandered around in
search of work of some kind. This he at last managed to find in
a town in Northern B. C, where his dress suit and large experience of
dinner tables, enabled him to get a job as waiter in the principal hotel of
the town.
In that capacity he made the acquaintance of one of the leading
doctors and after a time disclosed his identity.
The doctor in question was very anxious to take a holiday and begged
that George would act as locum tenens for him, assuring him that none
would be any the wiser that he was not registered. This he consented to
do as the remuneration was very much more than the waiter's job. So due
notice was given to the proprietor to get another waiter on a certain date.
George left his job on Saturday and on Monday morning was occupying the office of the doctor. His first call was to visit the wife of his
erstwhile employer. Imagine her surprise when the waiter was ushered
into her bedroom, instead of the doctor for whom she had sent!
When, eventually George Gibson was registered, he started practice
in Vancouver. He endeared himself to all with whom he was associated
and soon became a leading figure in all the social life of our Association.
No one who was fortunate enough to have been at the Annual Dinner in 1913, will forget his epoch making speech in proposing the Toast
to the Ladies, a speech scintillating with wit and brilliance of a very high
order.
Soon after his arrival in Vancouver he joined the 72nd Battalion,
of which he became M. O.
In 1914, we find George Gibson amongst the first to join the Canadian Army and he left Vancouver in the first troop train for Valcartier,
crossing the Atlantic with the 1st Canadian Division.
After spending some time in the mud of Salisbury Plain, he arrived
in France on February 14th, 1915.
His book "Maple Leaves in Flanders' Fields" was one of the most
humourous as well as most interesting of the early books of the war and
should be read by every Canadian whether or not he was overseas.
Thus began a distinguished war record of which George Gibson seldom spoke; but we know that, during his time in France, he was present
at every general engagement in which the Canadian Corps took part from
its landing till the end of October 1918. He was with his battalion during the first brutal gas attack at Ypres in April, 1915, also at Festubert
and Givenchy in the same year.
Page 66 After acting as Battalion M. O. for many months he accepted the
invitation of General Sir Arthur Currie, at that time commanding the
1st Canadian Division, to be his personal aide-de-camp. Later he returned
to military medical work of an administrative nature and to a Field Ambulance.
Sir Arthur Currie wrote thus of Lieut.-Col. Gibson: "He went to
France as a Battalion Medical Officer and served as such till September,
1915. At that time he was the sole remaining medical officer of a battalion still serving with his unit ,and had displayed outstanding efficiency
in that work.
"His personal gallantry, his devotion to duty, his tact, his initiative,
and his ability in handling men, were most marked. No officer in the
Canadian Medical Service was better known or better liked, or considered
more efficient, than Leiut.-Col. Gibson, and none have had a wider or
more varied experience."
He was awarded the D. S. O. and the Croix de Guerre—the latter in
1916 in recognition of his courage in rescuing his badly wounded Colonel
in the face of the German fire.
On demobilization in 1919, George Gibson was appointed Commissioner of Medical Services to the Ministry of Pensions, Scottish Region,
which post he held till 1921, when he returned to work on his special
subject—Lunacy, being appointed Deputy Commissioner of the Board of
Control for Scotland.
It was when his battalion was at Estaire that he received a telegram
telling of the birth of his first child, who was, in consequence baptized by
that name.
*
A small incident in connection with this birth is worthy of mention:
It was not until sometime after his departure from Vancouver that his
young wife came to a doctor with the information that she was expecting her first baby and that it was George's wish that she should break the
news to the doctor whom George wished to attend her. Later on the
doctor received a letter from George written in his own inimitable
style in which he expressed his confidence in the doctor and
did not wish to dictate anything, "but that if possible, he desired the heir
to the estate to come into the world without a crown of forceps on his
head!"
In 1925, George Gibson succeeded the late Dr. J. S. Fowler, as Secretary and Registrar to the Royal College of Physicians. (Edin.).
The President, Dr. Robt. Thin, in his obituary notice to the College
wrote:— "He was an ideal secretary, meticulously careful in his work,
resourceful and tactful in business, never flurried by unexpected happenings and sparing neither time nor trouble to serve the highest interests of
the college."
He retained his love for Canada till the end and each month wrote
the Edinburgh letter to the Canadian Medical Journal.
Page  67 At the annual meeting of the British Medical Association last year to
which so many of the members of the Canadian Medical Association went,
it was a great joy to those who knew him before the war to see him again,
and altho' at that time he was far from well, he never-the-less kept
the knowledge of a severe cardiac condition to himself and was the heart
and soul of a dinner party at which he recited some most clever poetry
of his own composition.
A little incident showing his many sided virtues may be of interest
here.
His continual smile and never-ceasing wit would give one to think
that he had no serious thoughts, so when, a few days before his passing,
he greeted his wife with the information that he had thought of a new
motto for the family, she was expecting something humourous and was
naturally taken by surprise when he informed her that the motto he was
going to adopt was, "In quietness and in confidence shall be your
strength."
He left home on the morning of July 19th, in his usual spirits,
was taken suddenly ill in a street car later in the morning and passed into
the larger life without suffering.
His life was not insured and his appointment carried no pension for
his widow and two children who are left in great financial straits.
A fund is being formed to invest for their benefit.
[If any of George Gibson's friends can see their way to subscribe towards this fund the Editor will gladly receive it and forward it to the
proper quarter.   Ed.]
LIBRARY NOTES
REVIEW
A Text-Book of Pathology—an introduction to medicine by William Boyd,
M.D., M.R.C.P. (Ed.), F.R.C.P. (Lond.), Professor of Pathology in
the University of Manitoba; Pathologist to the Winnipeg General
Hospital, Winnipeg, Manitoba. Lea & Febiger, Phila, 1932.  $10.00.
In the completion of his Textbook of Pathology, Dr. Wm. Boyd,
Professor of Pathology at the University of Manitoba, has produced a
trinity of books dealing with pathology that has probably enjoyed the
widest sale and mental digestion of any on that subject during the past
decade or more. In it there is that attention to detail, and clarity of description in the author's own pleasing individual style that make it so
readable and bespeak the scholarly mind that penned it.
In the preface of his latest work, Dr. Boyd states that it is essentially a textbook for the student of pathology, either undergraduate or
post-graduate, and not for the pathologist and professional laboraory
worker.   On this point one might take issue with him, for there is much
Page 68
J to stamp it as a reference book even for those whose particular field lies
in the realm of pathology. He has introduced physiology into several of
the sections which make for a more lucid understanding of the various
pathological processes that are discussed in those sections.
The author has followed the principle he adopted in his "Pathology
of Internal Diseases" of assembling the leading clinical and pathological
findings under the "Relation of Symptoms to lesions," at the end of the
discussion of the various lesions, which gives the reader a firmer mental
grasp and clearer mental picture of the whole process.
The volume is divided into General and Special Pathology, these being
again subdivided into sections according to the various causes of disease, etc., in the first instance, and the various anatomical sections in the
second. In all there is the presentation of facts from the most recent
literature and the author's own wide experience and knowledge, and a
well chosen bibliography is presented for the reader at the end of each
chapter.
The book can be highly recommended, both to student and practitioner, for its clear cut presentation of the newer concepts of pathologic
anatomy, pathologic physiology and internal medicine.
H. H. Pitts.
ABSTRACTS
Kupfer Cell Migration—Dudley A. Irwin, M.B., Can. Med. Assn. Jnl.,
Vol. 27, Oct., 1932, pp. 353-356.
Following injection thorium dioxide is found stored in liver, spleen,
bone marrow, lymphatics and in small amounts in adrenal and ovary. No
change occurred after four months in tissues other than the liver. In
the liver the following changes were observed:
1. Kupfer cells gradually acquired the thorium. (2) Kupfer cells
migrated to the central vein. (3) Kupfer cells entered the blood
stream. (4) Kupfer cells caught in the lung capillaries. (5)
Kupfer cells were found in the mucous membrane and mucus of
the trachea indicating the method of excretion of thorium.
L. H. Appleby.
Blood Sedimentation Test—J. W. Cutler, Am. Rev. of Tuberculosis, Vol.
26, 1932, p. 134.
In this article 131 patients receiving artificial pneumothorax treatment were studied and the sedimentation test was regularly applied as an
indication of activity. Physical and X-ray findings were obscured by the
treatment but it was found that the sedimentation rate was a very sensitive indication of activity in the compressed lung and that it was not safe
to allow patient to resume exercise until the sedimentation rate was normal
or nearly so. A normal sedimentation rate indicated quiescence of the
lesion but not necessarily healed stability. An increasing sedimentation
rate should always be respected and patient warned of the danger of relapse.
Pan
69 Observations on the Red Cell Sedimentation Test in Pulmonary T. B.—
J. Kaminsky et al, American Rev. of Tuberculosis, Sept., 1932, Vol.
26, p. 282.
The writers report results of red cell sedimentation test in 500 cases.
The technique used is that described by Cutler (Am. Rev. T. B., 1929,
XIX., 549). They show by graphs and tables that there is a very close
parallelism between activity of the lesion and the sedimentation rate in
pulmonary tuberculosis. There were no cases with active pulmonary
tuberculosis which showed normal sedimentation rates. Except in dying
patients activity of the T. B. process was indicated, and in some anticipated before other clinical signs of activity, by the sedimentation test. A
single test is of some help but tests at intervals serve to some extent as
a guide to effectiveness or otherwise of the treatment.
C. H. Vrooman.
TRANSURETHRAL PROSTATIC RESECTION
By. Dr. W. L. C. Middleton
The marked development of the various electro-surgical units during the past few years has brought some pronounced changes and advancements in several surgical fields, chief among which is the handling
of bladder-neck obstructions by transurethral prostatic resection.
At the Mayo Clinic it is startling to see how completely and how
rapidly the transurethral method of resection has taken the place of
prostatectomy. Dr. H. G. Bumpus has been developing his method of
operation and his instrument during the past seven or more years, at first
doing only those cases thought to be in too poor a physical condition to
stand protatectomy. His results were so good that is was soon being asked,
why if transurethral resection was successful in poor operative risks,
it should not be used in all cases having bladder-neck obstruction. How
quickly and how decidedly this was realized is shown by the figures.
From January 1st, 1932 to October 1st, 1932, 205 cases of transurethral
resection were done, as against 37 prostatectomies. No prostatectomy was
done during the last 3 months of this time, and only one has been done
since then, while the number of transurethral operations will number, by
the end of the year, well over three hundred.
When one thinks of the mortality rate of prostatectomy, the
long uncomfortable stay in hospital, the too often poor functional after-
results, and the total cost of such an operation to the patient (and in
the case of staff patients to the hospital) and compares these with the
results that are being obtairfed by Drs. Bumpus and Thompson during
the past year, one is again startled by the comparison.
Up to the time of my leaving Rochester there had not occurred
one death following transurethral resection since the beginning of this
year. Most of the patients are up on the 3rd or 4th day and voiding
freely. The majority is out of hospital under two weeks, many under
seven days.
In examining some 400 charts of patients operated on during the
past three years I was struck by the fact of how little the operation affects
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VANCOUVER MEDICAL ASSOCIATION the majority of patients. The post-operative temperature chart shows a
rise of temperature of usually less than one degree; in over 75% of those
I examined it rarely reached 103 degrees during any time following the
operation.
The pre-operative care is similar to that of prostatectomy, though the
majority of cases are operated upon within 5 days of admission, if there is
good kidney function and a fairly clean urine.
Severe post-operative haemorrhage rarely occurs though occasionally
cases start to bleed from 10—20 days following the operation, especially
if they have been very active during this time. This occurred in 5% of
the 205 cases mentioned above. In this series, perforation of the bladder
or any other mishap requiring a suprapubic operation did not occur.
There has been no incontinence following the operation. Epididymitis
has occurred in 8% of the cases. A preliminary vasectomy is done very
seldom.
About 90% of the cases required one resection. Two, and in a few
cases, 3 resections were needed in the other 10%, due chiefly to the large
amount of obstructing tissue present. Five of these patients had undergone a previous prostatectomy.
Recurrences do and will occur. The aim of the operation is to remove only that portion of tissue obstructing the free flow of urine and
allowing a complete emptying of the bladder. Unless this is done a poor
result or a recurrence of the patient's symptoms is bound to occur. The
fault here is not in the method but in the technique. In the 205 cases,
only five of the number can be classed as recurrences, 3 benign hypertrophies done 3, 6 and 7 years previously, and 2 prostatic carcinomoas
done 8 and 12 months previously. The carcinomatous prostatic cases
naturally show a tendency to recur, but any procedure that will allow
these unfortunate patients to pass their remaining years in comfort, both
physically and socially, is invaluable.
Spinal anaesthesia is used as a routine and is very satisfactory. 25 to
50 milligrams of ephedrine is given just previous to the spinal injection
to counteract the usual drop in blood pressure. Novocaine is the anaesthetic most generally used, from about 60 to 100 milligrams of the drug
being required, depending upon the operator's estimate of the time the
operation will take.
After studying the instruments and methods of men such as
JBumpus, McCarthy, Davis, Alcock and others over this past year, and
after a recent study of the technique of the method used by Bumpus, I
cannot help but think that he has something that the others lack, probably due to the fact that he can do the operation with less coagulation
and subsequent sloughing than the others. Anyway his results studied
from any angle are excellent, especially when one realizes that his patients
are not picked and include many patients of advanced age 87 being the
oldest, and many with serious lesions such as heart blocks, angina pectoris,
.severe coronary sclerosis, severe diabetes, hypertension and various nerve
lesions.
Page 71 TYPHOID IN THE OKANAGAN
Dr. G. A. Ootmar
On October 6, a case of suspected typhoid fever was admitted to
the Kelowna Hospital. As soon as the case was reported to the laboratory, diagnosis was confirmed by Widal, blood culture, faeces and urine
examinations. At the same time the patient's movements prior to his
admission to hospital were investigated.
The patient was a young man, who came from eastern B. C. in July
to work on a farm near Kelowna. He left this farm to work on another
farm on October 5 th and two days later was admitted to the Kelowna
Hospital with a diagnosis of possible typhoid.
We investigated conditions on the farm where he worked first and
found many families living together in one house. There was a Japanese
family with six children, a German family with seven children, and a
Hindu married (?) to an Indian squaw in possession of three children,
and also an old Hindu bachelor—altogether 23 people living in overcrowded conditions. We did a complete Widal test on all the people in
the house, although we had difficulty in convincing this cosmopolitan
family of the necessity. Not by any means the least troublesome was the squaw, who hid in the attic and only after telling the husband that not one apple nor one onion might leave the farm if we did
not discover the source of the disease did she consent. They
all proved to be negative, except the squaw, who was positive in
Ty. up to 1/60, and admitted that she had had typhoid in 1924 and was
cared for in the Vernon Hospital. The patient stayed only two days on
the other farm, where a family with seven children lived, but as the danger of infection there was a very grave one, we were faced with the fact
that thirty-one persons had to be "inoculated for typhoid. As the latter
family was French we had many races of the earth together, and it was
without doubt hopeless to put a needle 31x3 times in white, brown and
amber coloured arms ranging from 65 to 1 year of age. Moreover the
farm was far away—we faced the prospect of bad roads in the coming
winter and who knew if the roads would even be passable, when the time
came to give our last immunization? So all things seemed to justify the
administration of an oral vaccine. We have made oral vaccines in this
Laboratory for the past two years and the results reported by the doctors
justified their use.
To the many other reasons for giving an oral vaccine, we add still
another one.
We know how a doctor far away from a laboratory has not always
on hand an oral vaccine for typhoid prepared in a laboratory, and we
thought that if we gave orally the triple vaccine used for subcutaneous
inoculation, many Doctors would be able to give oral vaccine at once by
using this combined typhoid paratyphoid preparation. It contains 1000
millions B. Typhosus, 750 millions Para A and B and though our previous oral vaccines contained many times more than this amount, we felt
Page 72 the benefits of using this vaccine to be so great, that we decided to give
every person 1 cc. of the vaccine in a glass of water on three successive
mornings. As 1 cc. is not understood by the people we diluted the 3 cc.
with 5 times normal saline and told them that quantity was the amount
they had to take in three doses, each dose being about one teaspoonful.
We tested the vaccine for sterility and when we were certain about
this we tried it first on the Hindu bachelor (honi soit qui mal y pense)
and, 4 days after the last dose, we found a very slight agglutination in
his blood. All the remaining 3 0 adults and children with the exception
of the squaw, were ordered to take it and did in fact take it, as agglutination tests later on showed.
We have the history of two adults whose blood we tested every
seven days. It was not probable that we would get the consent of many
of the people to repeated blood examinations, nor was it possible to visit
them, but the two men came regularly to town and were willing to offer
their blood on the "alter of Science."
The question of an oral vaccine against typhoid is not one of recent
date. In 1904, Wright used a heat-killed suspension of typhoid germs
and treated seven individuals by mouth. Metchnikoff fed heated typhoid
bacilli to chimpanzees.
Recently Rachel Hoffstadt and Randal L. Thompson vaccinated orally several students (93). The vaccine consisted of one billion
typhoid B. (Hopkins and Patton strain), 7 million Para A. (Rogers
strain) and 7 million Para B. (Rossland strain) per cc. and came to the
conclusion that agglutination and complement fixation can be produced
by oral inoculation and that there is no delay in appearance of these agglutinins over that of the subcutaneous method. Our results with the oral
use of the triple vaccine made for subcutaneous inoculation are as follows:
Hindu—
October 11—Negative for Typhoid, and Para A and B in dilutions
1/20, 1/40, 1/80.
October 14-15-16—Oral vaccine administered.
October 23—Positive in dilutions  1/20 and  1/40, negative  1/80,
for Typh. and Para A and B.
October 31—Positive for Typh. and Para A and B dilution 1/20 and
1/40, negative for all in 1/80 and 1/160.
November 7—Positive for Typh. 1/20 and 1/40, positive for Para
A and B up to 1/320.
German—
October 11—Negative for Typh. and Para A and B in dilutions 1/20,
1/40, 1/80, etc.
October 14-15-16—Oral vaccine administered.
October 23^^Positive for Typh. and Para A and B in 1/20 and 1/40.
October 31—Positive for Typh. 1/20 and 1/40, positive for Para A
and B up to 1/160.
Page November 7 Positive for Typh. 1/20 and 1/40, positive for Para A
up to 1/320, Para B up to 1/160.
The other persons were not tested regularly.
Have we then an easy method at hand for immunization against
typhoid, etc.?   Many questions yet remain to be answered.
In our 5-year plan to free the Okanagan Valley of typhoid there
are many points requiring further investigation. First of all, we have
our own carriers well in hand and Under proper control and no epidemic
of typhoid has occurred in the last 3 years—Why is it that in the sporadic
cases (4, in 1932) among 10,000 inhabitants it is always the newcomer
who falls ill first and then the inhabitants are endangered? Is it because
although they have some immunity against the disease, it is not sufficient
to protect them when the germs have increased in virulence by passing
through a susceptible body?
Secondly: Whence do these inhabitants get their immunity? Are
there still many carriers roaming around, giving slight infection and immunity and may not the load of blame borne by the carrier be offset by
the benefit of the immunity given to contacts? In that case we
have to find out whether weak dilutions of oral vaccine are able to give
some immunity, however slight it may be.
We still know so little about the life history of the disease. Between
the theory of Virchow (1857) who attributed the disease to fermentation
of faecal matter poisoning the air and the very latest ideas about the
disease, lies a long trail: on it we find the detection of typhoid germs—we
find their specific behaviour in different media . . . we were able to grow
typhoid strain which coloured litmus milk blue within 10 hours, which
shows decreased agglutination and decreased motility. It is true we passed
them through plants, but who can tell if this does not happen in nature
also? Watercress, lettuce, all raw vegetables, are perhaps to be looked
upon as intermediate hosts. Intermediate hosts between the motile bacillus
we know and the nearly non-motile bacillus which can be cultivated
from the sap of plants and recultivated to the classical typhoid
germ with all its known properties.
When our 12x16 laboratory has moved to larger quarters (3 rooms,
we can hardly believe it) we will start our researches again. Now it is
too dangerous to grow plants containing living typhoid bacilli in such a
small room. Then we will remember Reynault, who in view of his findings in 1898, in Baltimore, in the John Hopkins Hospital, a patient
with typhoid fever and intestinal haemorrhages showed a culture of para
coli bacilli) suggested that the para bacilli formed a sort of chain between
coli bacilli and the typhoid bacilli.
Then perhaps the short history of the agglutination we got in our
laboratory, the culture of urine and faeces of a carrier, will be better
understood. The tests vary as the phases of the moon, waxing and waning, present, non-present.   Do typhoid germs change their classic proper-
Page 74 ties after a long stay in the urine as they do when they pass through
plants, and do the Inhabitants of the Valley where watercress is a favorite
vegetable in the spring, where lettuce is raised and consumed (to mention
but a few vegetables) get a slight immunity against typhoid from these
vegetables, containing in their sap modified typhoid germs?
Are the slight intestinal indispositions we so often see occurring in
mild epidemics and in which we never were able to find typical germs,
perhaps due to a typhoid bacillus, very decreased in virulence, not following the classic cultural properties of the Eberth bacillus?
Is the life history of the typhoid bacillus then written in a book
closed with seven seals and moreover printed in hieroglyphics?
I will not end this article without expressing my hearty thanks to
my assistant Mr. F. Smith for his many suggestions and for the careful
way in which he performed the tests. It is certainly due to his high interest in the matter—his large experience with vaccines in the Public
Health Laboratory, Auckland, and other laboratories in New Zealand,
and elsewhere, that we were able to study the influence of the oral vaccines on prevention of typhoid.
SALT-FREE DIET IN TUBERCULOSIS
In the past two years a great deal has been published in the European dermatological Journals about the use of salt-free diet in tuberculosis
of the skin, especially lupus vulgaris. No original articles on the subject
have yet been noted in English language medical journals.
The diet, which not only is distinguished by being salt-free, but is
also low in protein and high in fat and vitamin content is commonly
spoken of as the Garson-Sauerbruch diet. Most continental dermatologists wrote of its effects with enthusiasm. Some clinics seem to be relying upon it as the chief or almost the exclusive agency for treating lupus.
From the Charite-Hauptklinik, of Berlin, a book of menus for 365 days,
with lists of permitted and forbidden articles, cost-estimates and cookery
receipes as used in the dietetic department, has been issued at a normal
price of R M 3-60.
Naturally the applicability of this diet in the treatment of pulmonary and bone and joint tuberculosis has been the subject of inquiry
and experiment. The theory underlying the method appears to arise from
the alleged effect of excess sodium in causing liquefaction of colloids, in
turn affecting reception and conduction of stimuli, and the connection
between salt and vitamin assimilation. This in turn is supposed to have
profound effects on the living medium provided by the fluids and tissues
for growth of the tubercle bacillus. While much of this rests upon a
basis containing a very small amount of proved scientific fact, there has
been a large amount of data collected from properly controlled clinical
Page 75 experiment over a considerable period of time under conditions which
appear ideal for such study.
So far the therapeutic effect appears very definite and encouraging
in lupus vulgaris, less so in bone and joint disease, and in pulmonary disease the reports so far have been drawn from comparatively few cases
and give much less cause for satisfaction.
The writer of this brief review has had one experience with this diet
in a case of lupus vulgaris, observed over four years. Response to local
and general measures was very slow and only mildly encouraging. About
ten months ago a strict salt-free, meat-free, high fat and vitamin diet
was instituted with no other change in the treatment or environment.
Very marked improvement was observed within three months and this
has continued. It is felt that this view is shared by the patient, that the
advance in six months was greater than in the whole three years preceding.
D. E. H. Cleveland.
LEAVES FROM A CONSULTANT'S NOTE BOOK
By Dr. J. M. Pearson
(Conclusion)
It is interesting to compare these figures, which are in white children,
with those in Japanese. Of 260 Japanese school girls in Vancouver, ages
six to fourteen years (schools in comparable localities and the same year
1929) the percentage of enlarged thyroids was 3.07, of 285 Japanese boys
1.7.
An even more interesting feature is that all cases of goitre in both
sexes occurred in Japanese children born in Canada, none being observed
in those children born in Japan.
That there is or has been a comparative racial immunity to thyroid
enlargement and disease among Japanese living in Canada has long been
the common opinion of observers here. It must be remembered that
rarely not only the simple goitre but also the toxic variety does occur.
Thus in the last twelve years I have records of six definitely toxic cases
in Japanese, five of which were in men. As I shall show later Basedow's
disease is not known in Japan itself.
An obviously possible prophylactic is the wide-spread use of seaweed as an article of diet or as a condiment. This has frequently been
referred to.
In a personal communication from the Home Department of the
Imperial Japanese Government in 1922 my correspondent says that "some
kinds of seaweed are quite freqently used as food" in Japan. He proceeds
to mention seven varieties and the amount of iodine therein contained.
Of these I believe two are in more common use. The Laminaria Japonica
and the Ecklonia Bicyclis. In the dry state the former (known colloquially as Kombu) contains from 0.138 to 0.295% of iodine while the
latter (called commonly Arame) has 0.232%.
In the ash 0.619 to 1.312% of Iodine is shown by the Laminaria
and 0.414% by the Ecklionia.
Page 76 Just what the average daily intake of this article of diet is I do not
know but it is evident that from early life and probably through the
maternal connection in embryo, a small but persistent absorption of
nascent iodine occurs and the exponents of this theory will doubtless
feel satisfied as to its prophylactic effect.
There is however, the question of water supply, the effect of which
on the incidence of simple goitre in the human has been demonstrated
by McCarrison in India and in animals in British Columbia by Keith.
Whether this is a question of pollution, as may be inferred from the
Indian work, or whether it is due to the presence or absence of chemical
content of vegetable or mineral origin is not clear to me.
In particular parts of the Japanese Empire this problem apparently
occurs. In the mountainous districts of the Island of Formosa which
lies some 700 miles south and west of Japan proper, goitre (presumably
of the simple form) is endemic. An article in the Tokyo Medical News
of May 1922 from the medical department of the University of Kyushu
(which is the southernmost island of the Japanese group) refers to the
many cases of goitre occurring among those living in Formosa on a
certain stream, while people living in adjacent districts but using water
from another stream are free.
The sources of water used by the inhabitants of Japan are various.
Seventy per cent of the population used water from wells at the time of
my information, only some 12% being supplied through water works.
I am unable to get any figures as to the prevalence of any form
of goitre in Japan much less to correlate its incidence with any source
of water supply.
Evidently its toxic forms are not entirely unknown, for Basedow's
disease figures in the mortality statistics.
In 1914 it ia reported that 198 deaths occurred from this disease
in a population which, including Korea and Formosa, was then 77,500,-
000. The number increased to 310 in the year 1918, females being in a
majority of about 4 to 1.
Having received such kind consideration in these and other matters
at the hands of the Japanese Government in 1922, I again made application last year for a revised set of answers to my questions brought
up to date.
Several letters direct having elicited no reply I made enquiry from
the Japanese consulate here only to receive the information that his
Government did not communicate with private individuals except
through official channels.
Before I leave this subject of toxic goitre may I say a word as to the
use of digitalis in this condition? Digitalis has a very definite place in
cardiac therapy and that place is certainly not the cardiac disability of
thyro-toxicity. To give the futile doses which seem to be a routine in
some clinics is a mere obeisance to superstition.
If, on the other hand, it is pushed to its physiological effect it
is positively harmful and I have seen a fatal termination hastened by
such procedure. In any event I am not much alarmed by the cardiac
Page 77 bugaboo in this condition, whether as a danger in the acute variety or
as an argument for operation in the more chronic condition. A general
rule may be stated, to control the thyroid disfunction and the heart no
matter how bad it may appear to be, will take care of itself.
So much for the thyroid gland. I fear that your patience and may
time are both nearly exhausted. I had intended in this paper to have taken
more of an "airplane" survey of medical practice instead of the more
detailed exposition of a few subjects into which I have been led.
Such as it is it has at least one merit. I have endeavoured to place
before you the conclusions at which I personally have arrived and the
methods I have used.
There is much I wanted to speak to you about even without going
into the region of the unusual. I should like for instance to have considered diabetes. The question of diet in this disease is a romance in itself.
Beginning in modern times with the oatmeal diet, the potato diet
and other special fads, followed by the starvation treatment of the French
school which was systematized by Allen and his co-workers at the Rockefeller Institute, down through various modifications including that of
high fat, low carbohydrate, until at last in the gospel according to
Rabinowitch we seem to have returned about to the place where we
began.
Another subject which I should like to have discussed with my
surgical colleagues is the management of acute gastric and upper intestinal haemorrhage. This is an occurrence which seems to be little regarded
in our literature and concerning which one might say that the number
of opinions is as the number of men. Yet life or death may wait upon
a proper and resolute course of action and I fear that among the more
severe cases the mortality must be high.
I wanted also to point out to you the success which may at times
be obtained in the worst type of thoracic aneurism by the revival and
patient application of an old treatment first laid down by Tufnell. The
chief features of this are the most careful and prolonged restriction of
all movement and the most drastic reduction in solid and fluid intake.
The treatment is onerous both to patient and physician but the
reward may be most brilliant.
I observe that my colleagues, on hospital staffs here and elsewhere
are concerning themselves with the increased and increasing incidence
of tuberculous infection among nurses and other attendants on such
patients.
Some years ago when I was doing a great deal of work among the
nurses of one of our large institutions I was deeply impressed with the
all to frequent form of tuberculous meningitis.
This disease as I have seen it is far from uncommon, is generally more
rapid in its course than is usually recognized and is invariably fatal.
It is interesting therefore to note the occasional reference to recoveiies
by eminent British authorities such as Purves Stewart and Farquhar
Buzzard among others.
Page 78 The whole of our knowledge of the heart, its physiology and its
pathology has been re-cast and reduced to something like order within
the period of my medical life.
No more brilliant chapter in the history of medicine has ever been
written and one is tempted to say that no more brilliant chapter will
ever be written. And the writing was in the main the work of a general
practitioner. The name of James Mackenzie should be an encouragement
and an inspiration to every young physician.
Without special training, without great hospital facilities, without
laboratory assistance, without university backing, immersed in a busy
general practise by day and by night, active in surgery, skilled in midwifery—in true Baconian style.and with an open mind Mackenzie followed his quest.
Like Harvey he searched out the secrets of nature with no equipment save his fine intellect and his stout heart.
And there are still fields to be tilled and by the same methods.
Though the harvest may not be so rich the yield will be bounteous
enough.
In a sense the manner in which Mackenzie worked appears anachronistic. Today we have somewhat lost sight of the means of research by
clinical observation which is obscured by our modern fashion in laboratory methods.
It is well to have been shown that the ways of the clinician are still,
if not ways of pleasantness, yet ways of profit.
For in medicine the tree has many branches—the river has many
tributaries. It is this diverse nature of our calling which enables medicine to employ so many types of intellect, so many specialties and such
various cognate pursuits. Lonely men in obscure laboratories in distant
parts of the world are at work on unrelated problems from which in due
course medicine will extract its necessary modicum of information for
practical use.
At once the most conservative and most radical of callings, it is
this catholicity which makes of medicine the interesting and absorbing
occupation so beloved of its disciples.
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Phone Seymour 597 Relative Values of Carbohydrates
New Findings     ^
Confirm Old Truths
Recent scientific investigations in
rats (tabulated at the right) are in
accord with many years of clinical
observations on babies, as shown
by the following excerpts from authoritative medical literature reflecting the consensus of three
decades  of pediatric  experience.
CHART OF CARBOHYDRATE HYDROLYSIS3
MILK  SUGAR  GROUP
Lactose**
(Milk Sugar)
Dextrose*
CANE  SUGAR  GR
Saccharose**
(Cane Sug;
Dextrose*
MALT SUGAR GROUP
Starch
Amylodextrin***
Erythro-
de*ffl*i***
Achro-
dextrin***
laltose**
Dextrose*
end   prod-
The
of maltose is all'dex-
e, which means quicker
milation than end products    from    other   carbohydrates.
*MonosaccharicVV**Disaccharide    ***PoIysaccharide
Maltose splits int<rwo molecules of dextrose. Sucrose and
lactose split into one molecule of dextrose and one of levu-
lose or galactose respectively. It is no doubt due to the
simpler structure of maltose that it is more readily absorbed than other sugars. It must also be considered that after assimilation the levulose of sucrose and the galactose
of lactose must undergo conversion into dextrose, which is
the only form in which sugar is present in the blood. It is
reasonable to suppose that this conversion requires an expenditure of metabolic energy not required when carbohydrate is absorbed entirely in the form of dextrose.
3MorseJ.L.&Talbot,F.B.BoslonMed.&Surg.Jl.,tt9:852.
RELATIVE ASSIMILATION VALUES
OF  VARIOUS   C ARBOHYDRATESi
Average   per   100
(OB. body weight
1 MALTOSE  1.50
2 DEXTRIN + MALTOSE 1.32
3 Glucose -f- dextrin 1.32
4 Glucose + sucrose 1.32
5 Glucose   1.04
6 Sucrose + maltose j^i^N. 0.98
7 Fructose + glucose _.[Q-^Ao.98
8 Sucrose + dextrin, .y^^y^y-jlo.76
9 Sucrose f\.\j-7r.-J/o.76
10 Fructose pb>M. \ls\ - - - °-5
11 Glucose + lacpSse^^. - ly^- 0.26
12 Lactose h^^J-VL-r. 0.16
13 Galactose,_A^r^.J/ 0.1
These authors have atecw~stated: "Maltose, fructose, glucose, starch aVo dextrin lead in nutritive value, followed by galactose, mannose, ara-
binose, xyiose, lactose, sucrose and glycogen. 2
1H.  Ariyama and K.  Takahasi:  Biochem.  Z.,  216:269
(1929) and «./. Agr. Chem. Soc. Japan 5; 674 (1929).
RATE OF SUGAR ABSORPTION IN NEWBORN*
°/o  mcniASt it Alow aucMt
* FLOOD, R. ©.. J A.M  A. 82   159s
MALTOSE OR LACTOSE IN INFANT FEEDING'
Answer—The superiority of one form of carbohydrate over another in artificial feeding of infants has
been much discussed during recent years. It is generally
accepted that cow's milk without modification is not a
satisfactory infant food. So far as the carbohydrate is
concerned, about one-fifth to one-eighth ounce per pound
of infant's body weight is required daily. To supply this
amount it is necessary to add carbohydrates m some
form. Admitting that .lactose is the sugar
human milk, it does not follow that it i j he/
tolerated in another medium, such as c o\ r's I
generally believed that lactose is mon: ax»tiv<s> Inbn
sucrose—that it must be fed with a cei t£ in amoui/tr of
caution, as fermentative upsets are lil ely to
amounts approximating that found in liuntan rwTlk are
fed; There is cause for disagreement among clinicians,
as it is important to consider the other food elements;
i.e., the amounts of fat and protein fed as well as the medium in which they are fed. For example, when lactic
jjpid milk is used, more added carbohydrate seems to be
tolerated than when sweet milk mixtures are fed. Sucrose
has the advantage of being much cheaper and is always
available. Evidence has not been presented that it should
not be used in infant feeding. With its general use in
large infant welfare clinics where supervision is a matter
of routine, there is less to be said against it as far as clinical results are concerned. The complaint that it is too
sweet is not often encountered when the usual amounts
are fed. The dextrin-maltose preparations possess certain advantages. When they are added to cow's milk
jxtures, we have a combination of three forms of carbo-
be, dextrin and maltose, all having differ-
the intestinal tract and different absorp-
ause of the relatively slower conversion of
tnan tho
maltose and then to dextrose, fermentative
less likely to develop. Those preparations
lelatively more maltose are more laxative
containing a higher percentage of dextrin
(unless alkali salts such as potassium salts are added).
It is common experience clinically that larger amounts
of dextrin-maltose preparations may be fed as compared
with the simple sugars. Obviously, when there is a
lessened sugar tolerance such as occurs in many digestive disturbances, dextrin-maltose compounds may be
used to advantage. & Queries and Minor Notes,
J. A. M. A., 88:266.
MEAD JOHNSON 8b CO.,OF CANADA,LTD. .BELLEVILLE, ONT.,Specialists In Infant Diet Materials Qknter & ^amta, ^St5.
Established 1893
VANCOUVER, B. C.
North Vancouver, B. C.
Powell River, B. C.
Unequalled  intensity  of action—prolonged  effect—effective
by   injection   and   local . application—advantageous   price
characterize   the   new  non-narcotic  local   anaesthetic
NUPERCAINE "CIBA"
POWDER TABLETS AMPOULES
(A compound Nuper'caine Ointment under the name of
PERCAINAL, "CIBA" has recently been introduced for
the treatment of painful conditions of the skin and mucous
membranes.)
CIBA COMPANY LIMITED
MONTREAL
Messrs.   Macdonalds   Prescriptions,   Ltd.       -       Vancouver,   B.   C.
Messrs.  McGill & Orme, Ltd.      -      Victoria,   B.   C.
keep a full range of "CIBA" specialties. 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.
B. C STEVENS CO.
Phone
Seymour 698
730 Richards Street
Vancouver, B. C. NEW WING
Hollywood Sanitarium
LIMITED
For the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference—B. C. Medical Association
For information  apply  to
Medical Superintendent, New Westminster, B. C
or 515 Birks Building, Vancouver
Seymour 4183
Westminster  2 81

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