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THE VANCOUVER MEDICAL
ASSOCIATION
BULLETIN
Published monthly at Vancouver, B. C.
Subscription $1.50£^year
Indium therapy
c&he Qlucose Qurve^
DECEMBER, 1926
Tublished by
(^KCc'iBeath Spedding Limited, ^Vancouver, <23. Q.
X<  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. Stanley Paulin
AU communications to be addressed to the Editor at the above address.
VOL. 3. DECEMBER  1st, 1926 No. 3
OFFICERS, 1926-27
Dr. A. W. Hunter
President
DR. A. B.  SCHINBEIN Past President
Vice-President DR.  J..   A.   GILLESPIE
Secretary Treasurer
Dr. F. W. Brydone-Jack Dr. W. S. Turnbull
TRUSTEES
Dr. W. F. Coy Dr. W. B. Burnett Dr. J. M. Pearson
Representative to B. C. Medical Association Auditor
Dr,. A. C. Frost Dr. F. W. Lees
SECTIONS
Clinical Section
Dr. F. N. Robertson   -------       Chairman
Dr. Gordon Burke     ------------    Secretary
Physiological and Pathological Section
Dr.   C.   H.   BASTIN -   "     - - Chairman
DR.  C.  E.  BROWN  - - Secretary
Eye, Ear, Nose and Throat Section
Dr. E. H. Saunders    ------------    Chairman
Dr. W. E. Ainley   -------------    Secretary
Cenito-Urinary Section
DR.  G. S. GORDON ....... Chairman
DR. J.  A.  E.  CAMPBELL - - - - - - Secretary
Physiotherapy Section
Dr. G. A. Greaves    ---------    Chairman
Dr. H. A. Barrett     ---------     Secretary
COMMITTEES
Library Committee 1      1 Credit  Bureau   Committee
it w. f. mAckav £ hrgftgr-w
&: c: 1 a DR D MCLELL™
DR. W. C. WALSH ^     1     Credentials Committee
_.  , ^       . Dr. E. H. Saunders
Orchestra   Committee Dr   B. H. CHAMPION
Dr. F. N. Robertson Dr. T. R. B. Nelles
DR. J. A. SMITH Summer School Committee
Dr. l. Macmillan Dr W  D  Keith
Dr. W. L. Pedlow Dr. b. D. Gillies
Dinner  Committee Dr  L. H. APPLEBY
Dr. c. F. Covernton Dr. g. F. Strong
RR- £' £' ?ROST Dr. H. R. Storrs
Dr. g. B. Murphy Dr. R. Crosby VANCOUVER MEDICAL ASSOCIATION
Founded 1898. Incorporated 1906.
PROGRAMME OF THE 29th ANNUAL SESSION
GENERAL MEETINGS will be held on the first Tuesday of the
month at 8 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the
month at 8 p.m.
Place of meeting will appear on Agenda.
General Meetings will conform to the following order:—
8:00 p.m.—Business as per Agenda.
9:00 p.m.—Paper of Evening.
1926.
Oct.     5th—General Meeting:
Presidential Address, Dr. A. W. Hunter.
Oct.   19th—Clinical Meeting:
Nov.    2nd—General Meeting:
Papers—1.    Dr. C. W. Prowd,  "An Analysis of Radium
Therapy, reporting 600 cases.
2.    Dr. J. A. Sutherland, "Pain and disability from
lesions about the Anus.
Nov.  16th—Clinical Meeting.
Dec.     7th—General Meeting:
Papers—1.    Dr. W. F. MacKay, "Diagnosis and Signifcance
of referred Pain in Disorders of Chest and Abdomen."
2.    Drs.   W.   S.   Turnbull   and   J.   W.   Arbuckle,
.eclampsia.
Dec.    21st—Clinical Meeting.
1927.
Jan.      4th—General Meeting:
Papers—1.    Dr. G. A. Greaves, "Physiotherapy in Orthopaedic Conditions."
2. Dr. H. A. Barrett, "Treatment of Infections by
Physical Agents."
3. Dr. H. R. Ross, "Physiotherapy in Gynaecological Conditions."
Jan.    18 th—Clinical Meeting.
Feb.       1st—General Meeting:
Papers—1.    Dr. J. M. Pearson, "Treatment of Hypertension."
2.    Dr. C. S. McKee, "The Interpretation of Findings in Blood Chemistry."
Feb.    15 th—Clinical Meeting.
March   1st—General Meeting:
Paper —       Dr. George Seldon, The OSLER Lecture.
Mar.   15th—Clinical Meeting.
April    5th—General Meeting:
Paper—       Symposium, "The Treatment of the Poor Risk
Patient," Drs. C. E. Brown, A. B. Schinbein,
D. D. Freeze and R. E. Coleman.
April 19th—Annual Meeting.
Page 68 JUU W/JAls
QAreYbuPreparedJor Pneumonia I
'The Greatest Scourge of Winter Diseases"
«'
"At the present time diathermy surpasses any other
physical method for producing temperature rises deep
in the body and may properly be considered a means
of applying internal poultices.
"Stewart surveyed the situation with regard to pneumonia and brought together many important facts. He
knew that those cases showing a low white blood-cell
count generally die, which is not the case when the
count is rather high. Any method which would tend to
increase the cell count, or at least to make more active
such white blood-cells as have accumulated in the defense against the infection, should prove of material
benefit. Many similar considerations pointed to the possibility of deriving much good from the use of diathermy,
which Stewart accordingly tried. It is the opinion of
many who have since followed in his footsteps that the
timely and judicious use of diathermy in correct quantity and quality promises much in the handling of pneumonia, by far the greatest scourge of winter diseases.
' "Therefore, diathermy becomes a method of applying
heat internally and it shares to a much higher degree
the virtues which heat applications have enjoyed for
several centuries. Poultices, fomentations, blisters, hot-
water bags and similar home methods for applying heat
have been in use for ages, and while these rather crude
ways'of furnishing heat have been attended with recognized success, it has not been possible before the introduction of diathermy to administer heat to a considerable depth and for any desired regulation of intensity
over short or long periods of time by means of an ex
ternal physical agency."
—from "Light and Health—A Discussion of Light and other Radiations in
Relation to Life and to Health," by M. Luckiesh and A. J. Pacini.
' I HE diathermy current varies considerably in
■*■ quality and consequently in effectiveness,
depending upon the design of the machine from
which it is derived. In your selection of a diathermy machine, be sure that the design and
capacity are such as will enable you to follow
out accurately and efficiently the present and
rapidly advancing technics.
Don't risk the possibility of disappointment
with apparatus that is inadequate for the purpose, as has been the experience of altogether
too many physicians in the past.
The new Victor Vario-Frequency Diathermy
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When designing this outfit Victor engineers
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In justice to yourself and your patients a
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ancouver /
Vancouver's only exclusive Prescription Pharmacy will be opened at 618 Georgia Street, West,
on Monday, December 6th.
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Sick-room supplies will be stocked. Patent medicines will not be
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Page 70 EDITOR'S PAGE
Inadvertently we neglected to call the attention of our readers—and
we hope that includes all who receive this little publication—to the
end of our second year of issue and the beginning of the third, with the
October number. Anniversaries are as important in the lives of "Bulletins" as of individuals.
"Well, we have paid our way, we are glad to say, from the roots upwards; thanks to our advertisers. "We hope they feel that they have got
value for their money. "We are anxious that they should do so. We do
not care to receive advertisements merely because the Bulletin is a medical concern and the vendors of goods of that character feel that they
must patronize us.
We hope our readers are doing their duty by all our patrons as we
know they are by some of them.
We have introduced a few new features, for one thing we are now
numbering our pages consecutively which will enable us to add a short
index to the end of each volume. Improvements, or what we take to be
such, are introduced from time to time, type, arrangements and so forth.
Valiantly our proof readers endeavour each month to cope with the
wily type setter or perhaps we should say with results of bad "copy."
Things will escape us, of course, but we console ourselves with discovering typographical errors in all sorts of places. In fact it is the very deuce,
this being a publisher; we now read with a permanently critical eye.
But we get seasons of joy occasionally. For instance, we are surprised at times to get letters from quite important institutions asking
for back numbers of the Bulletin to complete files—or should it be fyles?
and to be put on the mailing list in future, please.
One such came from "The John Crerar Library" in Chicago today
from Mr. Andrews, chief librarian, whom we had the great pleasure of
meeting, now many years ago. The John Crerar Library, we would have
you know, is one of the great scientific libraries of the United States and
of the world.   Verb sap!
We are greatly indebted to all our contributors who never seem to
fail to come back smiling, in spite of all we do to them. If we may
single out from so many one source of material upon which we have
leaned heavily, we would mention the laboratory department of the Vancouver General Hospital. From their daily system of records we have
gleaned much that we believe has been useful and it is said that gratitude
is a sense of favours to come.
Dr. Norman Keith of the Mayo Clinic sent a very nice letter to the
Executive. This was read at the last general meeting of the Association
and part of it ordered to be printed for wider circulation. This is the part.
In his capacity as Secretary of the Pharmacology Section of the A. M. A.,
he says:
"The section is very much interested in any new work along
therapeutic lines and if you know of anybody in British Columbia
Page 71 WJt
/■ho has some good work which you think you might wish to preserve for our meeting in Washington next May, I wish you would
let me know. One of our objects is to try and give the men who are
doing pioneer work a chance to get their work before the profession
in general."
We hope some of the brethren, (and sisters by the way—because we
note with gratification that we are again to have a lady member of our
Association) will rise to the occasion.
NEWS AND NOTES
The General Meeting of the Association was held on November 2nd
and was well attended. Dr. C. W. Prowd gave an interesting analysis
of results in 600 cases of radium therapy. His paper appears in full in
this issue. Dr. J. A. Sutherland, Proctologist of the Vancouver General
Hospital, was the other speaker and gave a talk on "Pain and Disability
resulting from Lesions about the Anus."
Dr. W. A. Gunn was elected to membership in the Association and
Drs. D. A. Clark and A. S. Lamb were elected Associate members. Applications for membership were received from Dr. Isabel T. Day, Dr. K.
L. Craig and Dr. L. H. Webster.
Drs. B. D. Gillies and L. H. Appleby were appointed to fill the
vacancies on the Summer School Committee.
Drs. F. N. Robertson and C. H. Vrooman were chosen nominees of
the Association for the vacant staff position in Medicine at the Vancouver General Hospital and Dr. William Morris was nominated for the
vacancy in the Tuberclosis Division.
A letter was read from Dr. Norman M. Keith, as Secretary of the
Section of Pharmacology and Therapeutics of the A.M.A. calling for any
new work for presentation at the May meeting of the A.M.A. in Washington, D.C.
Dr. Lavell Leeson left on the 23rd instant for a year's post-graduate
study in Europe. His duties as Secretary of the Clinical Section will be
taken over by Dr. Gordon Burke for the unexpired term.
The Clinical Section of the Association met in the Auditorium on
Tuesday, November 16th; 50 members were present. Dr. Lyall Hodgins
presented an interesting case of a girl who suddenly developed glycosuria
and coma and showed insulin reaction very readily, even with 5 units.
He stated that the easiest way to treat coma is to give insulin—50 units
if the patient can talk, 100 units if unable to talk, to be given intravenously, but this treatment is only successful in acute cases of coma.
Dr. J. M. Pearson presented an interesting case of Hodgkins disease,
the outstanding feature of which was the enormous enlargement of the
spleen.
Page 72 Dr. Appleby reported a case of rupture of the uterus following a
former Caesarean section. He dwelt particularly upon the use of chromic catgut, arguing that this led to a weakening in the uterine wall.
Dr. H. R. Ross spoke upon quartz light therapy and reported several
successful cases.
We extend our congratulations to Dr. and Mrs. T. R. B. Nelles on
the birth of a son on the 3rd November.
Dr. V. E. D. Casselman is expected back shortly from a month's trip
to Lower California.
Dr. D. D. Freeze was appointed President of the Canadian Anaesthetic Society at its recent meeting in Montreal.
The Annual Dinner of our Association was held on November 18th
in the Hotel Vancouver. All who were present agree that this year's
function was a howling success throughout.
After a more or less serious trial for an alleged serious misdemeanor
Dr. Joe Bilodeau, erstwhile member and now residing in an alien land,
was sentenced to Honorary membership in the Association by Mr. Justice
Carder.
The Minstrel performance was hilariously received by the audience,
the middleman especially scoring a hit.
Our own Orchestra gave several numbers during the evening adding
greatly to its already well established popularity.
The party broke up about midnight with the singing of the National
Anthem.
VANCOUVER MEDICAL ASSOCIATION
SUMMER SCHOOL
ABSTRACT OF PROCEEDINGS
Continued from Page 5 0
Tuberculosis of the larynx is not a contra-indication, nor of bone,
if not too extensive.
In carrying out the operation of thoracoplasty rigid asepsis is required. Efficient regional anaesthesia is necessary and a general anaesthetic to the point of analgesia may be desirable in some instances. Generally it is essential to remove the first rib in all cases, at least in part.
Of the other ribs long segments may be removed. The operation is done
as a rule in 3 stages with the excision of parts of 4 ribs in the first stages
4 in the second and 2 in the third stages, but as many as 7 or 8 stages
may be required. Dr. Hedbloom depends on the blood pressure and pulse
to provide indications as to how much the patient can stand.
Page 73
HBH The results in 1159 cases reported by a number of surgeons was:
cured, 36.8%; improved, 24.47c; no change, 2.7%; worse, 2.6%. Within two months the death rate was 14.1% and the later death rate 19.4%.
Dr. Hedblom has had no mortality in his last 15 cases, with improvement in all.
The second paper on the programme for the last day was that by
Dr. R. R. MacGregor on "Intestinal Intoxication in Children." Other
names are "cholera infantum" and "summer diarrhoea." In its acute
form it is usually seen in artificially fed infants and occurs in the late
summer, often following a prolonged dry period. The symptoms are dependent on the toxicosis, the dehydration and upon a condition of acidosis. There is frequently a history of previous digestive disturbance and
the children will often be found to be those fed on patent foods, unusually rich in carbohydrates. Atmospheric or weather influence may
have a direct action, or may act indirectly through the spoiling of food
stuffs. The age periods of maximum incidence are from one month to
six months and from nine months to twelve months. There does not
seem to be any special organism associated with the attack. The symptoms resemble those of acute poisoning and probably depend upon the
food, perhaps upon the decomposition of the protein element. Dr. Brown,
of Toronto, considers that it may be produced by a toxic product from
the mucous membranes of the intestine. The volume of the blood is decreased and the viscosity is greater than normal, which may account
for the impaired circulation. Pathologically there is found hyperaemia
of the mucous membrane of the large bowel. Symptoms: Rise in temperature, frequent diarrhoea, consisting at first of undigested food and
mucous. The stools are alkaline. Later they assume a "rice-witer" appearance. Occasionally the child may succumb to an excessive toxicity
before the onset of diarrhoea. The urine may contain both albumin and
sugar, the presence of the latter shows the alteration in the bowel wall.
If symptoms of acidosis occur the case assumes a graver aspect.
The prognosis in pale-complexioned, sugar-fed babies is not good,
but no case should ever be considered hopeless. Meningitis is at times
suggested as a possible diagnosis, on account of the very pronounced
nature of nervous symptoms, but on examination the fontanelle will
be found always depressed.
As a means of prevention, breast milk should be used where possible,
or, if not possible, suitable cow's milk mixtures. Any slight digestive
disturbances should be treated early. As soon as possible in the disease
all food should be withdrawn. If there is no vomiting, saccharine and
water may be used by mouth to prevent dehydration. Ringer's solution
or glucose 10% may be given intravenously or intraperitoneally and repeated as often as necessary, say 200 to 300 cc. twice daily in an infant
of six months. Blood transfusions may also be used and are often the
best treatment in weakly children. Food is withheld until the temper-
Page 74 ature has returned to normal which may be even as long as seven days.
On resuming feeding small amounts of protein or lactic acid milk may
be tried. Sugar must not be too long withheld, dextri-maltose being
used.
Warmth and quiet are necessities as these children tend to tire very
easily and for that reason attempts to wash out the colon should not be
made. Collapse is likely to occur in the early hours of the morning, say
bttween 4 and 5 a.m. If it occurs it must be combatted with warm
mustard baths.    Adrenalin in M2 to M3 may be required.
Acute perforated appendicitis was the important subject considered
by Dr. Gurd. This extension of the inflammatory process beyond the
walls of the appendix might lead to a walled-off abscess or to a more or
less diffuse suppurative peritonitis. In the retrocaecal type of appendix,
a phlymonous variety of inflammation of the posterior abdominal wall
and of the adjacent caecum might occur. A form of cellulitis of the
caecum, terminal ileum and particularly of the mesentery might be found
which was probably the result of a thrombosis of the vessels supplying
these areas.
In every case of acute appendicitis there are three aims or ideals to
be considered: (1) to save the life of the patient which is in jeopardy
(2) to conserve a normally strong abdominal wall and (3) to shorten
the period of the stay in hospital.
Dr. Gurd advised the use of Bipp in the abdominal wound before the
peritoneum is opened in all cases where it is considered probable that
infection of the wound may occur.
The incision the lecturer uses is transverse or almost so through the
skin and subcutaneous tissue. The anterior sheath of the rectus muscle
is cut transversely and the muscle displaced towards the middle line. The
posterior sheath is likewise cut transversely. When haemostasis is complete, alcohol is applied to the wound followed by Bipp. This application consists of bismuth subnitrate two parts, powdered iodoform one
part and liquid paraffin to form a paste.
In the severer cases of infection Dr. Gurd does not attempt to suture
but packs the whole infected area tightly with gauze, parafinned and
containing a little Bipp. This may remain in situ 4 to 7 or even 10
days, the outside dressings being changed as necessary.
Under gas anaesthesia the packs are removed and the abdominal
wall sutured in layers. If obstruction occurs it can be relieved by puncture through the incision through tissues which are already protected.
Following the conclusion of TJ)r. Gurd's lecture Dr. A. S. Warthin
addressed the meeting on the "Nature of the Inherited Susceptibility to
Cancer."    The lecturer said that any theory of a specific infection as a
Page 75
■■■MMiiiata cause of neoplasia could be discarded. All of the known facts oppose
such a possibility. On the other hand there has been great reluctance
by the medical mind to accept evidence of hereditary susceptibility because such evidence is necessarily concerned with genetics, germ plasms
and the constitution, which are all somewhat intangible things. But all
the evidence goes to show that the development of cancer depends on' a
constitutional susceptibility of the germ plasm and is really a question of
genetics.    Many forms of neoplasm show a very definite family history.
While cancer of the lip occurs chiefly in men and in those who
smoke, the speaker having seen only eight cases of it in women, not every
smoker develops cancer of the lip.    There must be some other factor.
Slides Were shown illustrating the familial character of the disease,
especially striking where the offspring are descendants of ancestors exhibiting cancer occurring in the same part of the body.
Many families show a definite tendency for neoplasm to occur in
one organ alone. There is also considerable association between cancer
and tuberculosis. There is a case of art individual with cancer of the
stomach in Ann Arbor, Michigan, where of 147 descendants, 33% have
died of cancer. The last generation appears to be contracting the disease
at an earlier age. Three have a diffuse mucoid form of carcinoma which
was mistaken for appendicitis. The males in this family tend to develop
cancer of the stomach or intestines, the females cancer of the uterus.
Dr. Warthin said that the cancer mortality throughout the world
exceeds 10% and the predisposition must be greater than this as many of
those who would ultimately develop cancer die earlier of other causes.
Cancer susceptibility, or cancer resistance, may be dominant in one
animal's family, recessive in another, as shown by Maude Slyde in families of rats susceptible to cancer. The nearer the animals are related the
easier is the transference of the tumour. By crossing Japanese dancing
mice, which are susceptible to a neoplasm, with ordinary mice, the liability to neoplastic growth is produced, but not the ability to dance.
Dr. Warthin's paper was profusely illustrated with lantern slides
showing numerous genealogical tables of families carrying hereditary
cancer predisposition.
The first lecture of the evening session of September 16th was by
Dr. George Hale, who took as his subject "The Diagnosis of Pulmonary
Tuberculosis."
The lecturer said that physical signs indicative of moderately advanced pulmonary tuberculosis might be overlooked if the patient was
not stripped for examination and if he was not made to cough during the
inspection.
Early haemoptysis might be overlooked or might be attributed to
some more simple cause. Excluding active pulmonary infection such as
pneumonia   and   excluding   thoracic   aneurysm,   bronchiectasis   or   new
Page 76 growth, nose bleed, or oozing from spongy gums, haemoptysis was generally due either to a mitral stenosis or to pulmonary tuberculosis. Haemoptysis may be a very early symptom.
In deciding upon the presence or absence of pulmonary tuberculosis
careful temperature observations should be made at four-hourly intervals.
The patient should be examined in a sitting posture and not lying down.
Any difference in expansion between the two sides of the chest should be
noted or a tendency of one side to lag. It must be remembered that there
may be a natural asymmetry.
In the diagnosis of early tuberculosis, percussion is not of great
value and in any event we must remember to compare the note over the
equivalent rib or interspace on both sides. There may not be any rales
on ordinary or even on deep breathing, they may require to be brought
out by coughing at the end of expiration. The reasons for this are two:
(1) such action gets rid of the reserve air and (2) raises the internal
pressure. Broncho-vesticular rales are not necessarily evidence of pulmonary tuberculosis. Repeated sputum examinations, by modern concentration methods, may be required. As to clubbing of the finger ends,
it is probable that this phenomenon is more common in bronchiectasis
than in all other conditions put together.
Dr. Hale was of the opinion that it is not wise to depend too much
on the X-Ray examination in doubtful cases. Non-tuberculosis cases
are more liable to show rales in the lower two-thirds of the chest.
The final paper of the evening and of the session was provided by
Dr. C. A. Hedblom, who spoke on the "Differential Diagnosis and Treatment of Chronic Pulmonary Suppurations."
It has been the lecturer's experience that haemoptysis is often the outstanding feature of bronchiectasis. Positive sputum is the one criterion
of tuberculosis. Cough, with abundance of purulent sputum, is indicative of pulmonary suppuration which includes abscess, acute or chronic,
bronchiectasis, unilateral or bilateral. It is, the lecturer considers, a dangerous procedure to demonstrate the presence of abscess of the lung with
a needle.
The treatment of abscess of the lung may be expectant and about
10% of the cases may be expected to recover; bronchoscopic lavage and
aspiration may be done; collapse of the lung produced or lobectomy performed. The above procedures may be followed in absecess of the central
variety; those at or near the periphery of the lung can be drained through
the chest wall.
In draining abscess of the lung the great danger is in the production
of an empyaema. If the visceral pleura is adherent to the chest wall, all
well and good. If not the visceral and parietal layers should be sutured
together, the pus located by the needle and the cavity opened by means
of the cautery.
Page 77 A bronchial fistula may occur after abscess. The question of the
presence of foreign bodies in cases of persistent cough and sputum must
be considered.
Of a series of 416 cases 59, or 14% occurred on the left side; 91, or
22% on the right side. The findings were bilateral in 114 cases or 28%
and questionable in 152, or 36%.
The intrabronchial injection of lipiodol is a very important addition
to our means of diagnosis of diseases of the chest, probably the most important since the discovery of X-Rays.
In the treatment of bronchiectasis, collapse of the lung may be
produced. Excision of a lobe carries a mortality of 50%. It may be
combined with thoracoplasty, or the latter operation alone may suffice.
Dr. Hedblom's lecture was extensively illustrated by lantern slides
showing reproductions of X-Ray pictures of the various diseases discussed
and numerous tables of the two procedures under consideration.
SOME OBSERVATIONS AT THE MAYO CLINIC
By Dr. B. H. Champion.
Exophthalmic Goitre.—Preoperative cases are only kept in bed for
three or four days. They are often let up for two or three hours daily to
conserve their strength.
From ten to eighty min. of Lugol's solution are given daily, depending on the severity of the case. This is supplemented by Luminal
in very nervous cases.
In very bad cases only is ligation done. This is preceded by injecting
2 cc. of warm sterile water into the gland substance and the reaction
noted. If very much reaction ligation of one superior thyroid artery is
done. The other lobe is resected at a later date. Drainage is carried out
at side of wound instead of centre. This prevents scar becoming attached to trachea.
Digitalis is not given. On the day of operation forty mins. of Lugol's solution are given.
Post-operative treatment.—10-30 min. Lugol's daily for six to eight
weeks. Then 10 mins. daily for four weeks longer. Murphy drip for
several days, or until water is taken freely by mouth. No saline is given
at operation. Morphine is used freely for first two or three days in
nervous cases following operation.
Post-operative abdominal cases.—Enemas are given p.r.n. after the
third day up till the 6th day. Laxatives are not given until the 6th day.
Water in limited quantities by mouth for three days, then fluid diet up
till 6th day, when soft diet is given.
Page 7% In toxaemia with vomiting there is lack of chlorides. 500 to 1000
cc. of 10% glucose with 1% saline is given daily by the Murphy drip,
until vomiting ceases.
Spinal punctures.—In all spinal punctures the patients are kept in
hospital over night and instructed to lie on the face. This prevents
leakage of spinal fluid.    They use a very fine needle—number 19.
Swift Ellis technique is used, without reinforcement (Ogilvie) in
neurosyphilis.
The mixed treatment is employed in syphilis. Salvarsan and bismuth or salvarsan and mercury are injected at the same time.
Prostate and bladder.—Sacral and regional anaesthesia are employed
in all operations upon the prostate and bladder. The cystogram has replaced cystoscopic examinations in hypertrophy of the prostate.
• Prostates are enucleated by the suprapubic route, under the eye,
through a wide bladder incision well retracted. The enucleation is done
by means of a blunt instrument. The finger is only used to separate the
posterior surface of the prostate. No finger is inserted in the rectum.
All available bleeding vessels in the bladder are sutured with plain catgut. Pilcher's bag is used in all cases. In 24 hours the water is let out
but the bag is not' removed for two hours longer because bleeding recurs
in 4% of cases.    Suprapubic drainage is used.
In chronic prostatitis, dilatation occasionally of posterior urethra is
very important along with daily massage.
Blood transfusion is freely used in pre-operative cases. Not much
good in post-operative cases.
CYSTIC GLIOMA
WITH SECONDARY HAEMORRHAGE
Case report by Dr. C. D. Moffatt.
W.Mc.I.—Male.    Age 10 years.
Admitted to the Vancouver General Hospital September 23, 1926
in a semiconscious condition and with recurring muscular spasms.
He had not been well on September 21st, and had been kept from
school. Chief complaint headache. First seen by me on the evening of
the same day. T. 104. P. 130. R. 24. Abdomen slightly distended
and tender. Irrational. Next morning he seemed better, stood up in bed,
wanted to eat. T. 99. P. 86. That evening he was again irrational
T. 104. P. 140. R. 28. Pupils dilated. Knee jerks slightly exaggerated, Kernig's sign not present, no stiffness in neck. Next morning his
condition was worse. Spasms were more marked and frequent affecting
all the extremities and apparently painful in character.   The pupils were
Page 79 dilated and there was some neck rigidity present. At the hospital 10 cc
of a turbid spinal fluid under pressure were removed. Later in the day
a second puncture was done and 20 cc of blood-stained fluid removed,
a similar amount of anti-meninogoccic serum being injected pending a
report from the laboratory.  Patient died two hours later.
The cell count on the first specimen was 400 Polymorphs predominating with globulin increased, and Fehling's positive.
The brain was removed at autopsy which was performed by Dr. H.
H. Pitts, pathologist to the hospital, to whom I am indebted for the following report:
"There was some congestion at the base, but otherwise no evidence of any exudation of either a purulent or plastic nature. On
opening the brain the left lateral ventricle was found to be filled
with a quantity of blood, and th,e right apparently quite clear.
On coronal section of the brain a large rather cystic markedly degenerated cavitation, the size of a duck egg, was found in the preoccipital region (left), just below the basal ganglia and not involving them. In it are large masses of clot, and degenerated mushy
brain tissue. The edges of the cystic cavity show a rather yellow
gliomatous appearance, but there appears to be no definite infiltration in the surrounding tissue. In the aqueduct of Sylvius further
portions of clot were also found.
"Microscopical findings.—A number of sections were taken
through the edge of the cystic cavity and all show a very marked
degree of degeneration in the brain tissue, with complete loss of cellular differentiation and structure. Through this degenerated tissue
and along the border of junction with more normal tissue, there is
a diffuse but rather slight, deeply chromatic, round, rather large
cell infiltration. These cells appear to be of the glioma type of cell,
while here and there polymorphs are scattered in slight numbers,
with also a considerable degree of haemorrhagic extravasation
throughout. Diagnosis: Cystic glioma with secondary haemorrhage."
Comments.—An interesting feature in this case is the child's previous history: For the last three months he has had frequent bouts,
lately several in a week (parents thought they were billious attacks).
Child would be out playing, would come in and say he had a headache,
would be quite feverish, then in a couple of hours after lying down child
would be quite normal and would ask to go out and play again. He attended school regularly until the morning of September 21st, 1926. Was
very bright and got along very well at school.
A further matter of interest lies in the cell count of the spinal
fluid, unexpectedly high in such condition, and, in conjunction with
the high temperature, giving rise to a suspicion that a suppurative
meningitis might be present.
Page SO VANCOUVER GENERAL HOSPITAL LABORATORIES
THE DOSE FOR A GLUCOSE CURVE
By K. E. Coleman, M.B., Assistant Director,
Vancouver General Hospital Laboratories.
In the study of human metabolism there are three food stuffs which
are closely associated, namely, proteins, fats and carbohydrates. Of these
three food groups the study of the carbohydrates has presented the fewest difficulties to the investigator. The relative simplicity of the problems presented by the carbohydrates, as compared with the proteins and
fats, is in part due to the relatively greater uniformity of their chemical
structure and also in part to the fact that, in the human body, they are
almost exclusively present as glucose and glycogen. As a result it has
been possible to follow the sequence of events between the ingestion
of the carbohydrates and the oxidation of the carbohydrates as glucose
or glycogen in far greater detail, than in the parellel reactions of proteins and fats. In the food the carbohydrates may be grouped as:
sugars, which are usually quite soluble in water; starches, which are relatively insoluble in water but which may give colloidal solutions when
dissolved in water; and finally celluloses, etc., which are quite insoluble in
water. In the processes of digestion and absorption the water-soluble
sugars are readily absorbed into the blood; the water-soluble starches are
split by ferments into water-soluble sugars and then absorbed as such;
the celluloses, etc., not being attacked by the digestive juices, are lost,
unchanged, in the faeces. After the sugars have been absorbed they are
either converted into glucose or, if their chemical constitution is such
that this is impossible, they are treated as "foreign" sugars and excreted
in the urine.
In the study of carbohydrate metabolism much use has been made
of a functional test, in which a quantity of carbohydrate is ingested and
the effect upon the blood sugar observed. Though various carbohydrates and varying doses have been used, the commonest dose has been
about 100 grams of glucose for an average man. As might have been
expected, cases with extreme degrees of disturbed carbohydrate metabolism will show marked deviations in the blood sugar following the ingestion of different carbohydrates even in small doses; but, as the disturbance of function fades into the normal, the deviations naturally become less marked; and therefore their interpretation becomes correspondingly difficult, especially when the attempt is made to correlate the effects found on different individuals. In the attempt to render such comparisons more uniform, the uniform dose of 100 grams of glucose for
average men (150 pounds) has frequently been used; and sometimes
the dose has been made to vary with the weight of the individual to be
tested. But allowing for weight alone, in comparisons of metabolic functions, introduces numerous sources of error. For instance, a pound of
fat weighs as much as, but is not as metabolically active as, a pound of
muscle; while a pound of a child's (growing) tissue is metabolically more
active than a pound of adult (non-growing) tissue. Also the metabolic
rate of a pound of tissue in the male is greater than that of a pound of
Page 81 tissue in the female. Clearly then accurate comparisons of the same metabolic functions in different individuals cannot be made through their
relative weights, but require also allowance for other factors than weight.
Nevertheless, the rate of metabolism is very closely related to the
body weight; for any increase of weight would of necessity increase the
total amount of metabolizing tissue. On the other hand, the weight at
any given time is but the product of the total metabolism up to the time
when the weight is measured; that is the weight and the metabolic rate
are mutually interdependent. Similarly the height of an individual is
also a product of the preceding metabolism. The surface area of an individual is evidently related to both the weight and height; in fact the
surface area can be accurately calculated from the weight and height.
Thus we see that the metabolic rate, the weight, the height and the surface area of an individual are all closely related, though no one of these
features can be considered as independently producing any of the others.
To put it otherwise, each of these features has factors in common with
each of the other features but since no one feature directly determines the
magnitude of any of the others, no single one can be calculated from any
one of the others. If then a large number of individuals were to be measured
as to their weight, height, and surface area and the numerical relationship
between these features calculated, it is to be anticipated that the values
obtained would be found to be closely related to a figure which would
not be exactly any one of them but some intermediate figure, which we
could call the metabolic rate. By just such a method it has been found
that the relationship is such that the surface area can be deduced from
the height and weight, and from the surface area a rate of heat production can be fairly closely predicted for standard conditions (the so-called
basal metabolic rate.) Because this relationship exists it was once
thought that the relationship between surface area and heat production
was one of cause and effect, determined by the laws of cooling; but such
is now known not to be the case, both on theoretical and experimental
grounds.
Though it is true that the rate of heat production can be approximately predicted from the surface area under standard conditions, (which
entail complete muscular relaxation, preceded by a period of muscular
rest and a sufficiently long abstenan'ce from food to ensure the complete
absence of post-digestive processes) still even then certain allowances
must be made for special factors, such as age and sex. If, however, there
is any deviation from the standard conditions of such a nature as to require the performance of work, then it is found that such deviations in
the rate of heat production bear little or no relation to the surface area.
Apparently then the agreement found to hold between the various structures does not apply equally well to comparisons made between structures
and functions. In fact such an agreement could not have been expected;
for a function, such as the rate of heat production, must be capable of
variation from minute to minute; while a structure such as the surface
area must of necessity vary at a much slower rate, representing as it does
more or less the resultant sum of the average rate of change of the immediately preceding functions.
Page 82 Considered in a general way then, we would expect to find that the
height, the weight, the surface area, the diameter of the aorta, and the
diameter of the trachea would tend to vary together, since they are subject to the same influences and so would tend to change at the same rate.
Similarly a function such as the vital capacity, being largely determined
by structural formation, would be expected to vary with the structures.
On the other hand we would expect to find that the rate of heat production, the rate of nitrogenous metabolism and the rate of carbohydrate
metabolism would also tend to vary together since they too are subject
to influences common to their group; but these influences fluctuate more
rapidly, as a class, than the influences acting on the structures. Therefore, it is obvious, that, since the rate of variation of the structural
group is slower than the rate of variation of the functional group, the
two rates cannot vary together exactly. Nevertheless, it would naturally
be anticipated that, since both the structures and functions dealt with
are those of the same successfully surviving individuals, the two groups,
if compared over a sufficiently long period of time, would show a certain
parallelism and that, given certain factors, approximate predictions could
be made, from one group to the other. Such has been found to be the
case, as mentioned above. For instance, from the surface area, it is possible to predict the rate of heat production, within certain known limits;
and corrections are known by which the accuracy of the predictions can
be materially increased. It is also possible from the surface area to predict
the nitrogenous metabolism but sufficient measurements have not been
made to determine the accuracy of such predictions as compared with the
accuracy of the prediction of the rate of heat production.
Returning now to the selection of a dose of glucose for a functional
test, the above considerations indicate that a dose related directly to a
structure, such as the surface area of the individual, would not be indicated, but rather should the dose be related directly to a function, such as
the rate of heat production or of nitrogenous metabolism. To which of
these, the rate of heat production or the rate of nitrogenous metabolism,
the dose should be related, would depend upon whether the rate of change
of the glucose metabolism most closely approximates the rate of change
of the heat production or the rate of change of the nitrogenous metabolism. Numerous studies of glucose metabolism have shown that its rate
of change is to be measured in minutes, while the rate of nitrogenous
metabolism must be measured in hours, so that tests of glucose metabolism
should be compared through the rate of heat production, rather than
through the rate of the nitrogenous metabolism. Thus it would seem
that for comparative results the dose of glucose should be related by a
constant factor to the rate of heat production of the individual under
standard conditions, i.e., to the so-called basal metabolic rate.
Having decided to relate the dose of glucose to the rate of heat production, it is necessary to determine the factor by which a given dose of
glucose must be multiplied, to give equivalent metabolic doses in different
individuals. In the absence of any definite metabolic unit of glucose,
we might with advantages choose a dose which would give results comparable with the already existing data.   As mentioned above much of the
Page 83 available data applies to doses in the neighborhood of 100 gms. of glucose
for an average man of about 150 pounds. It would be desirable then to
choose a factor which would yield about 100 grams for an average man
of 150 pounds.
A man of 67 kilos (148 pounds), height 160 cm., would have a surface area of 1.70 sq. meters. If he were given 100 grams of glucose he
would be receiving (100 divided by 1.70 equals) 58.8 grams per sq.
meter of body surface, or in round numbers 60 grams per sq. meter. Our
dose of glucose then will be obtained by multiplying the surface area of
the individual in sq. meters by 60 and the result will give in grams the
weight of glucose required. This relationship, however, will only parallel
the rate of heat production for men between the ages of 20 and 50 years;
4%; and if between 60 and 70 years deduct 7%; if the individual to be
tested is a female it will be necessary to add 10%.
The dose of glucose for ingestion in the performance of a Glucose
Curve is discussed. Reasons are advanced for relating the dose of glucose
to the so-called basal metabolism. The proposed dose is therefore calculated not from the weight but from the surface area of the subject; corrected for age and sex as is the custom in predicting the basal metabolism.
HIGHEST AND LOWEST VALUES
Highest and lowest values obtained to date in the V.G.H. Laboratories.
Value per Patient
10Ore. blood
1460 mg. Glucose Mr. W. A.
28 mg. Glucose Mrs. D —
485.6 mg. N. P. NMr. K	
19 mg. N. P. N. Mr. A	
42 mg. Creatinine Chinese
230 mg. Urea N. Mr. K-
10 mg. Urea N. Mr. A -
5.6 mg. Calcium Miss A
per 100 cc. serum
Doctor
Date
Kemarks
-Dr. Baird    Oct., 192 5 Patient in coma
Dr. Pearson Nov., 1925 Patient in coma
Dr. PearsonMay, 1922
Dr. Pearson Nov., 1925
Dr. Monro Apr., 1926 Highest
Creatinine
Dr. PearsonMay, 1922
Dr. Pearson Nov., 1925
Dr. Keith    Sept., 1926 Lowest
Calcium
—Bessie Carter.
DELAYED TYPHOID BACTEREMIA
It is usual to find B. typhosus in the blood stream during the first
few days of the disease. After the tenth day a positive blood culture is
rarely found and a Widal reaction is usually positive.    A blood culture
Page 84 and Widal are seldom both positive at the same time.    A case varying
from this rule has come to our notice.
History; A young Japanese girl, a patient of Dr. H. Spohn, was admitted into the hospital September 7th, 1926. A blood culture was ordered
September 14th; this culture was positive for B. typhosus, the Widal reaction was positive the following day. Upon enquiry it was discovered
that the patient had been ill five or six days before admission. Thus the
blood culture was still positive after 14 days' illness.
Myrtle Kilpatrick, M.A.
LIBRARY NOTES.
(The Library is situated in 529-531 Birks Building, Granville Street,
Vancouver.    Librarian: Miss Firmin.   Hours: 10 to 1, 2 to 6.
In the issue of the Lancet for September 12th, 1926, one case of
post-operative tetanus is reported, and another case is reported in the
same journal for October 9th. In both of these cases the tetanus organism was isolated from the catgut after death. This is noteworthy as
being two of the few instances in which the organism has been isolated
in post-operative cases.
SOME RECENT ADDITIONS TO THE LIBRARY
"Medical Clinics North America," July and September, Philadelphia
numbers.
"Surgical Clinics of North America," June, 1926, Lahey Clinic number; August, 1926, Chicago Number; October, 1926, Mayo
Clinic number.
"Recent Advances in Obstetrics and Gynaecology," Alex. Bourne.
"Recent Advances in Medicine and Allied Sciences," Beaumont & Dodds.
"Recent Advances in Biochemistry," Pryde.
"Recent Advances in Physiology," Lovatt Evans.
"Chronic Rheumatic Disease," Thomson & Gordon.
"Clinical Syphilology," Stokes.
"Clinical Paediatrics," J. L. Morse.
"Carbohydrate Metabolism," J. J. R. MacLeod.
"Intracranial Physiology," Harvey Cushing.
"Harvey Lectures for 1924-25."
"Physiology and Biochemistry in Modern Medicine," 5th edition, J. J.
R. MacLeod.
"The Diabetic Life," R. D. Lawrence.
"U.S. Treasury Public Health Reports," Part 1 for 1926.
Dr. J. G. A. Lugol was one of those great physicians who carried on
the leadership of French medicine almost a century ago. His researches
on scrofula were published in book form and a copy of an English trans-
Page 85 lation by A. Sidney Doane, A.M., M.D., published in New York in 1845,
is in our library.
Dr. Lugol's clinical investigations and observations led him to very
definite conclusions regarding Tubercle. He taught that the various
manifestations of Tubercle, whether involving the lungs, glands, eyes or
skin, were all one disease due to a common cause.
He advocated the use of iodine in many forms for scrofulous diseases. In the last fifteen years iodine has hit the crest of another therapeutic wave and today Lugol's Solution is probably the most common
iodine preparation prescribed.
Section IV of the "Edinburgh Stereoscopic Atlas of Anatomy" has
been missing from the library shelves for some months. Will the member who has this kindly return it to the librarian.
B.C. MEDICAL ASSOCIATION NEWS
Merry Christmas! May the Yuletide bring to you, and yours, a
Christmas of unalloyed pleasure and a New Year of happiness and success.
May the spirit of the holiday season be just as infectious during the
coming twelve months as during its brief week, with fulfillment of your
hopes and aspirations throughout the year of 1927.
Christmas is symbolic of fraternalism, of good will, and tranquillity
among the races of the world. It is the one time during the year when
the universal spirit of fraternalism, unselfishness and thoughtfulness grips
humanity.
Dr. and Mrs. A. W. Vanderburgh, of West Summerland, are happy
to announce the arrival of a baby girl (Mary Elspeth) on November 5th.
Our congratulations to Dr. and Mrs. A. M. Menzies of Britannia
Beach on the birth of a daughter on October 2nd.
Dr. Wm. Sager has relinquished his practice at Port Simpson and is
now at Port Coquitlam.
Dr. R. G. Large, who has for some time been assisting Dr. Wrinch
at Hazelton, has taken over Dr. Sager's practice at Port Simpson as from
November 1st.
At the annual meeting of the No. 4 District (Okanagan) Medical
Society, branch of the B.C. Medical Association, held at Kamloops on
September 30th, the following officers were elected for the ensuing year:
President, Dr. S. G. Baldwin, of Vernon; Vice-President, Dr. G. L. Campbell, Kelowna; Secretary-Treasurer, Dr. J. E. Harvey, of Vernon.    The
Page 86 retiring President, Dr. M. G. Archibald, and Secretary-Treasurer, Dr. A.
L. Jones were heartily thanked for their services. There was an excellent
attendance at the meeting.
The annual meeting of the Victoria Medical Society was held on the
16th October. Dr. Thomas McPherson was elected President for 1926-
27, following the retiring president, Dr. J. W. Lennox into office after a
strenuous year. Dr. M. W. Thomas was chosen as Vice-President and the
office of Secretary-Treasurer was filled by Dr. R. L. Miller.
On reviewing the work of the Society through the past year Dr.
Lennox referred to the splendid support the profession had accorded the
Executive during the Canadian Medical Convention in June and the full
attendance at the Post-Graduate lectures in October. The library committee was elected as follows: Dr. Forrest Leeder, Dr. George Hall Dr.
H. M. Robertson.
Dr. M. W. Thomas was appointed as the Victoria representative on
the Executive of the B.C. Medical Association.
The Society passed, a hearty vote of thanks to tils' retiring president,
Dr. J. W. Lennox, and to Dr. R. B. Robertson, retiring secretary-treasurer.
Owing to the large territory covered by the old Kootenays District
Medical Society, (branch of the B.C. Medical Association), difficulties of
transportation, etc., it was recently decided to divide the district into two
local societies. The first meeting of the East Kootenay Society was held
at Cranbrook on Saturday, September 25th, when the following officers
were elected:
Dr. Douglas Corsan, Fernie, President.
Dr. G.   E. L. MacKinnon, Cranbrook, Vice-President.
Dr. B. Asselstine, Fernie, Secretary-Treasurer.
Dr. Douglas Corsan, Fernie, Representative of Executive Committee, B.C. Medical Association.
Dr. F. W. Green, Cranbrook   ^
Dr. M. E. Tiffin, Kimberley       > Members of Local Executive.
Dr. F. E. Coy, Invermere        J
The West Kootenay District Medical Society, (branch of the B.C.
Medical Association), held its first meeting at Nelson on September 27th,
when the election of the following officers took place:
Dr. J. Bain Thom, Trail, President.
Dr. W. A. Truax, Grand Forks, Vice-President.
Dr. C. S. Williams, Trail, Secretary-Treasurer.
Dr. J. Bain Thom, Trail, Representative to Executive Committee,
B.C. Medical Association.
Dr. A. Francis, Greenwood       "]
Dr. D. J. Barclay, Kaslo > Members of Local Executive.
Dr. W. O. Rose, Nelson J
The recent extra mural post-graduate tour through the province of
British Columbia, held under the auspices of the Canadian Medical and
Page 87 B.C. Medical Associations, and made possible through the generosity of
the Sun Life Assurance Company, proved a decided success. One cannot
speak too highly of the three distinguished Winnipeg doctors selected for
the tour: Dr. B. J. Brandson, Professor of Surgery; Dr. D. S. MacKay,
Professor of Gynaecology and Dr. Daniel Nicholson, Assistant Professor
of Pathology, all of the University of Manitoba.
They were wonderful in every way; able and convincing speakers,
practical as-teachers, untiring in their efforts to impart knowledge of
their respective subjects and answer the numerous questions which followed each paper; ever ready to attend the hospitals and give valuable
help to the local doctors in difficult cases, holding clinics on same, and,
in general, leaving behind a strong feeling among the local men that out
of the 150 doctors who have been engaged in this work during the past
year the speakers chosen for B.C., were surely of the best. It is pleasing
to note that 37 new members joined the Canadian Medical Association
on this tour.
Whilst lectures and clinics were given in nine towns, as per itinerary,
five additional towns were visited en route and cases seen in hospital at
the request of the local doctors. The follov/ing are two instances: On
the way from Vancouver to Prince Rupert the visiting doctors, at the
request of the doctor at Ocean Falls, saw a difficult case in this hospital,
a courtesy which was much appreciated. Again whilst travelling from
Prince Rupert to Prince George the Canadian National Railway Co. held
the train back at Smithers an extra ten minutes whilst the doctors visited
the hospital and diagnosed a case which had been puzzling the local doctor. Dr. Hankinson, the local doctor, expressed his appreciation of this
courtesy in no measured terms. The attendance at the respective meetings was excellent, in some cases 100%, the only absentees being those
men who found it impossible to leave their practices. B.C. is a province
of magnificent distances and it is worth noting that, at Cranbrook one
man motored 102 miles each way, another 86 miles, one 68 miles and
three men 63 miles. For the Nelson meeting one man 150 miles, another
125 miles, whilst other men motored over 50 miles each way. At Kamloops the men came from places ranging from 40 miles to 150 miles
away, and similar long distances were travelled by the men in the remainder of the districts.
ANALYSIS OF RADIUM TREATMENT—600 CASES
Malignant-
By Dr. C. W. Prowd.
Classification Total    1921-24  1925-26       Ase
Intraoral    84 57 27 30-76
Post-operative   48
Primary, that is, not previously treated, 36
Thirty-three cases had palpable glands
Of those dead the majority (60%) are post-operative cases.
Dead
39 or 47.6r/
10
24 or 50 %
15 or 41.6%
21 or 64   %
Page 88 Treatment—(a)     Palliation in advanced cases.
(b)     Curative in early and border line cases.
Palliative treatment is given only in the absence of sepsis. Even then
in the far advanced cases the beneficial effect is questionable. With the
best results pain is relieved, growth is retarded and life may be prolonged.
The final phase of the disease is rapid and the end thus made easier.
In all metastasized cases the prognosis is certain, the patient eventually dies from cancer.
The early case only, promises permanent cure wtih excellent cosmetic
results.
Syphilis is hard to differentiate and in many cases there is a mixed
infection.
We now give potassium iodide in conjunction with radiation in all
intraoral cancers.
Epithelioma—
Classification Total   1921-24  1925-26      Age Dead
Epithelioma     219 114 105 34-87 9 or 4.1%
Squamous 65%.
Basal 3 5 %.
72 of above cases were lower lip involvement, only 8.2% of which
had glandular metastases.
We have found radium most efficient in practically all cases of epithelioma. If the growth is fungating, the cancer mass is electro-coagulated but this we find to be seldom necessary. Surgery, we believe, is indicated if cartilage or bone is involved, followed by plastic replacement of
tissue.
Radiation alone in lip cases with glandular metastases is equally as
good as surgery alone, while a combination of both surgery and radiation
does not give a permanent cure in more than 15% of such cases.
The cosmetic result in epithelioma is exceedingly gratifying. As a
rule it is difficult to identify the original site of the lesion.
UTERINE-CERVICAL CANCER
Total   1921-24  1925-26      Age Dead
Uterine-Cervical    93 66 27 37-68 39 or 42%)
Advanced 69.
Post-operative 21.
Primary  3.
In 1921-22 there were 23 treated cases, of these 18 or 80% dead.
Three of the twenty-three only, were post-operative.
The above report of 93 cases includes all classes,—operable, border
line and advanced,—the great majority being in the last category.
Page 89 It is generally conceded that radiation is the only logical treatment
in advanced cases. In many clinics radiation alone is now given in border
line cases with an increasing number of the early operable type.
In the report of The American Journal of Obstetrics and Gynecology, July, 1925, Polak credits surgery with 30% 5-year cures in operated
cases and a 10% primary mortality and radiation will give 15-25%
five-year cures, including all cases with no primary mortality, and he
further concludes "that the great success of radium in border line cases
of the epitheliomatous type justifies its acceptance as a curative measure
without recourse to subsequent surgery."
Classification Total   1921-24  1925-26      Age Dead
Thyroid ...-.'.  6 2 4 28-62 3 or 50%
CarcifSbma,   Breast 36 27 9 28-79 18 or 50   %
Post-operative 27.
Primary  6.
Sarcoma  3.
Bladder    12 8 4 51-68        4or331/3%
Prostate   6 3 3 60-68        2 or 33   1/3%
Colon    --14 9 5 25-47 8 or 57.1%
Rectal 12.
Colon  2.
Brain   2 2 2 or 100    %
Partoid     6 3             3 51-68 3 or   50   %
Stomach     6 2             4 55-58 4 or   66%
Oesophagus   2 2 2 or 100%
Classification                Total 1921-24  192 5-26 Age Dead
Sarcoma    27 12           15 11-62 15 or   55.5%
Benign—
Nevi  24 18 .6
Urethral Polypus  5 3 2
Thymus    12 2 10
Actinomycosis     4 2 2           24-28
Keloid   4 4 3-20
Goitre—
Exophthalmic      6 5 1 45-51
Moles—
Pigmented     3 2 1
Sarcoma    27 U 15 11-62 15 or 55.5%
Fibroids—
Classification Total 1921-24  1925-26
Fibroids    r 27 12       15
Fibrosis Uteri  15 3       12
Page 90 To date the fibroids treated have without exception shown cessation
of bleeding and reduction in size of tumor mass. We believe radiation the
treatment of choice in selected cases. Kelly, of Baltimore, states: "In
uncomplicated fibroids, especially when associated with excessive bleeding, there is no treatment as satisfactory as radium."
In myopathic haemorrhyic uteri, radium is a specific. We have
never had to repeat a single treatment and the results have been 100%
cures. One case registered 30% haemoglobin, another 28% and many
were markedly exsanguinated.
Again quoting Kelly: "The use of radium in haemorrhagic uteri is
so far the greatest triumph in surgery since this century began."
CITY HEALTH DEPARTMENT
Vancouver, B.C.
STATISTICS—OCTOBER, 1926
Total Population (estimated) 	
Asiatic Population  (estimated)   	
Total Deaths  119
Asiatic Deaths   6
Deaths (Residents only)   89
Total Births   305
Male,       159
Female,  146
Stillbirths—not included in above  ,_„ 13
Deaths under one year of age  13
Death rate per 1000 Births  42.6
CASES OF INFECTIOUS DISEASES REPORTED
 128,366
  10,100
Rate per 1000
of Population
10.9
7.0
,8.2
2*8.0
Oct.,  1926
Cases Deaths
Sept., 1926
Cases Deaths
Smallpox  .          1 0
Scarlet Fever        16 0
Diphtheria           26 1
Chicken-pox           7 0
Measles        15 0
Mumps    ,          2 0
Whooping Cough           4 2
Erysipelas             5 0
Tuberculosis          11 11
Typhoid Fever           4 0
Cases from outside city included in above.
Diphtheria          10 0                 7           1
Scarlet Fever          3 0                  9           1
Typhoid Fever          3 0                 10
IN CITY
Nov. 1st, to
15,  1926
Cases Deaths
0
26
13
70
116
2
3
8
7
2
0
1
1
0
0
0
0
4
14
0
0
20
17
40
70
11
0
4
3
1
4
5
1
0
0
3
0
0
0
0
0
0
0
1
0
0
Page 91 SPECIAL OFFER
Doctors9 Bags
Of Exceptional Value
Manufactured in England
Solid Cowhide Leather
Hand'sewn and rivetted frames
Adjustable bottle loops and pocket
Orders will be filled in sequence
We have a stock on hand and another shipment coming
CLUB STYLE
Special price during run of this advertisement:
16 inch     \      $12.00
18 inch      -      $13.50
A saving of about 25%
B. C. Stevens Co. Ltd.
730 Richards Street Vancouver
The Ou?l Drug
Co., Ltd.
lAU prescriptions dispensed
bu qualified Druggists.
l]ou can depend on the Ou?J
for ^Accuracy and despatch.
U?e deliuer free of charge.
5 Stores, centrally located.    We
would appreciate a call while
in our territory.
Ambulance
Service
TELEPHONE
Fair. 58 & 59
^Aount Pleasant
Undertaking Co.   Ltd.
R. F. Harrison    W. E. Reynolds
Cor. Kingsway and Main
Page 92 B* Q Pharmacol Co. Ltd.
329 Railway Street,
1 VANCOUVER.
Manufacturers of Hand-made Filled Soluble
Elastic Capsules.
Specimen  Formulae:
No. 60—
Blaud Pill, 10 gr.
Arsenious Acid, 1/50 gr.
Ext. Nux Vomica, \ gr.
Phenolpthallin, \ gr.
No. 61 —
Blaud Pill, 10 gr.
Arsenious Acid 1/50 gr.
Ext. Nux Vomica, \ gr.
Phenolpthallin, \ gr.
Special Formulae Made on a Few Hours' Notice.
Price Lists and Formulae on
Application.
PRESCRIPTIONS
filled exactly as written
Phones: Seymour 1050 -1051
Day and Night Service
Qeorgia Pharmacy Ltd.
Qeorgia and Qranville Sts.
Vancouver, B. C.
Page 93  Standard Medical Books
Gynecology, Anspach   $10.00
Obstetrics,  Shears  8.50
Pharmacology, Meyer and Gottlieb   7.50
Diseases of New-Born, Foote   6.00
Infant Feeding, Dennett   5.50
Human Pathology, Karsner, just issued  11.00
Anatomy, Spalteholz, 3 vols.   18.00
Applied Anatomy, Davis, new edition  10.00
Fractures and Dislocations,Wilson & Cochrane 11.00
International Clinics, per year   12.00
Annals of Surgery, monthly  10.00
Pediatrics,  Feer   9.00
Lippincott's Quick Reference Book  16.50
You can get all these books and pay $5.00 a month.
J* B* Lippincott Company
P. O. BOX 1443, MONTREAL
Apparatus for Laboratory
Practise
as used and recommended in his B.C. post-graduate lectures
by Dr. Daniel Nicholson, University of Manitoba.
GASTRIC ANALYSIS—
Ewalds Stomach Tube and Bulb.
Hollanders H.C.L. Scale.
Dimethyl Indicator 1 oz.
BLEEDING TEST—
Spring Lancet.
HAEMOGLOBIN ESTIMATION—
"Non-fade" Haemoglobinometer.
SUGAR IN URINE, Quantitative-
Benedicts Solution 16 oz.
Luer Syringes, iy2 and 5 cc.
Test Tubes, ^x.6 inches.
RENAL FUNCTION, Estimation-
Salivary Urea Apparatus.
The above can be obtained at
B»C» SteVetlS CO.       730 Richards St. Vancouver.
Page 95