History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: November, 1931 Vancouver Medical Association Nov 30, 1931

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 Published monthly at Vancouver, B. C, by
McBeath-Campbell Ltd., 326 Pender Street West
Subscription, $1.50 per year. i^mm*Mm
L
'SEY.n-SS
57
|pg ANDERS'        :•:
JCOD LIVER OIL
I*; AND
MALT EXTRACT
Our own make in which rat units, tiger
units and dinosaur units of vitamins are
secondary to clinical potency.
IS "IT   WORKS"
made fresh every few days
CHAS. H. ANDERS, Chemist
GORDON M. CLAY, Associate Chemist
/«,«L.»».U,Tv'l\ 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. M. Pearson
Dr. J. H. MacDermot Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the abov; address.
Vol. VIII.
NOVEMBER,   1931
No. 2
OFFICERS 1929-30
Dr. C. W. Prowd Dr. E. Murray Blair Dr. G. F. Strong
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. W. L. Pedlow
Trustees
Dr. W. D. Brydone-Jack Dr. J. A. Gillespie Dr. J. M. Pearson
Auditors:   Messrs. Shaw, Salter & Plommer
SECTIONS
Clinical Section
Dr. J. E. Harrison Chairman
Dr. A. M. Agnew Secretary
Eye, Ear, Nose and Throat
Dr. N. E. MacDougall Chairman
Dr. J. A. Smith Secretary
Pediatric Section
Dr. C A. Eggert = Chairman
Dr. S. S. Murray Secretary
STANDING COMMITTEES
Library
Dr. D. M. Meekison
Dr. W. H. Hatfield
Dr. C H. Bastin
Dr. C H. Vrooman
Dr. C E. Brown
Dr. H. A. Spohn
Dinner
Dr. J. E. Harrison
Dr. H. H. Pitt
Dr. N. McNeill
Rep. to B. C. Med.
Dr. H. H. Milburn
Assn.
Orchestra
Dr. J. R. Davies
Dr. F. N. Robertson
Dr. J. A. Smith
Dr. J. E. Harrison
Publications
Dr. J. M. Pearson
Dr. J. H. MacDermot
Dr. D. E. H. Cleveland
Credentials
Dr. A. J. MacLachlan
Dr. A. Y. McNair
Dr. T. L. Butters
Summer School
Dr.   H.   A.   Spohn
Dr.  H.  R.  Mustard
• Dr. C E. Brown
Dr. T. L. Butters
Dr. C H. Vrooman
Dr. J. W. Arbuckle-
Hospitals
Dr. W. C Walsh
Dr. F. W. Lees
Dr. A. W. Bagnall
Dr. F. J. Buller
V.O.N. Advisory Board
Dr. Isabel Day
Dr. H. H. Caple
Dr. G. O. Matthews
Sickness and Benevolent Fund — The President — The Trustees VANCOUVER HEALTH DEPARTMENT
STATISTICS, SEPTEMBER,  1931.
Total   Population   (Estimated)
Asiatic Population (Estimated)
per
1000   of
Rate
Total Deaths   ^6
Asiatic Deaths 1  1 °
Deaths—Residents only  157
Births Registrations  •  540
Male        160
Female    180
INFANTILE MORTALITY—
Deaths  under  one  year  of  age  12
Death Rate—Per  1000  births  35.3
Stillbirths   not  included   in  above)       11
CASES OF CONTAGIOUS DISEASES REPORTED IN CITY
242,629
14,227
Population
8.8
15.4
7.9
17.0
Smallpox   	
Scarlet Fever 	
Diphtheria 	
Chicken-pox  	
Measles   	
Mumps   	
Whooping-cough   	
Typhoid  Fever  	
Paratyphoid    	
Tuberculosis   	
Poliomyelitis  	
Meningitis   (Epidemic)
Erysipelas   	
Encephalitis   Lethargica
August,  1931
Cases     Deaths
1
4
■•'vi*
4
1
5
0
4
0
74
0
6
0
September,  1931
Cases    Deaths
0
8
5
3
2
16
4
4
58
9
0
3
0
0
0
0
0
0
0
0
1
17
0
0
0
0
October 1st
to 15th, 1931
Cases    Deaths
0
15
0
6
7
14
7
2
0
20
1
0
1
0
The oral administration of Pyridium in tablet form affords a
quick and convenient method of obtaining urinary antisepsis
when treating gonorrhea and other chronic or acute genitourinary infections. Pyridium quickly penetrates denuded surfaces and mucous membranes and is rapidly eliminated through
the urinary tract. In therapeutic doses Pyridium is neither toxic
nor irritating. Pyridium is available in four convenient forms:
as tablets, powder, solution or ointment. Write for literature.
MERCK & CO. Ltd.,
412 St. Sulpice Street, MONTREAL
Sole Distributors in Canada
B7C9
Page 21 REST HAVEN SANITARIUM
On Marine Drive, near Victoria, B. C.
Practicing Physicians and Surgeons are invited to send
their chronic or convalescent patients to Resthaven. High
Blood Pressure and Diabetic Diets prepared and administered by competent Dietitian. Your instructions carefully
carried   out.     Qualified   physician   and   nursing   staff   in
attendance.
Write, Telephone or Wire
Manager,  Rest Haven,  Sidney,  B.  C.
Telephone Sidney 61L or 95
— Rates are no higher than Hospital Rates  —
67 varieties of hand filled soluble elast'c capsules
will be found in our pocket formulary.
No.   66   may   be   useful   to   you   in   post   Partum
haemorrage  or  subinvolution.
Telephone Seymour 597 for a list.
■■§"     efl©
The B.C. Pharmacal Co. Ltd.
(In Vancouver since 1913) When Medicine or Sick-room necessities are needed late at night the
value of our all-night service is appreciated by doctor and patient.
PHONE SEYMOUR 1050
—anytime.
Open
All  Night
eft©
Ceovgxa
Pharmacy
Granville atCJeort^ia^
W
Prescription
Specialists
THE
Bismuth Therapy of Syphilis
LABORATORY POULENC FRERES
OF CANADA LIMITED
offers these two preparations of Bismuth that have been
carefully selected as the best tolerated and most efficacious.
Both are intended for intramuscular use and are practically
painless to injection.
NEO-LUATOL—Box of 12 ampoules of 2 cc.
An oily suspension of Bismuth Hydroxyde, noted for
its  high  contents in  metallic  Bismuth with  a correspondingly increased therapeutical activity.
RUBENE—Box of 12 ampoules of 3 cc.
A suspension  in  Oil of Quinine and  Bismuth  Iodide.
In this preparation, the beneficial effect of Quinine is
added to the specific action of the  Bismuth.
Write  us  for  literature.
Canadian Distributors:
ROUGIER FRERES,  350 Le Moyne St., MONTREAL VANCOUVER MEDICAL ASSOCIATION
Founded 1898 Incorporated 1906
PROGRAMME OF THE34th 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.
1931.
November 3rd—GENERAL MEETING.
Papers:
Dr. H. A. DesBrisay: "Syphilis in Medical Practice."
Dr. W. T. Lockhart: "Treatment of Syphilis."
D. A. L- CREASE of Essondale  will   discuss   the   treatment   of
Degenerative Types of Neurosyphilis.
Discussion: Dr. J. E. Campbell; Dr. W. L. C. Middleton.
November 17th—CLINICAL MEETING.
December 1st—GENERAL MEETING.
Papers:
Symposium on Fractures to be arranged by Dr. A. B. Schinbein
and Dr. D. M. Meekison.
Discussion: Dr. F. P. Patterson; Dr. J. A. West.
December 15th—CLINICAL MEETING.
1932.
January 5th—GENERAL MEETING.
Papers:
Dr. C. S. McKee: "The Interpretation of Blood Pictures."
Dr.  Murray  McC.  Baird:  "The  Clinical Aspect of  Some Blood
Diseases."
Discussion: Dr. W. H. Hatfield; Dr. A. Y. McNair.
January 16th—CLINICAL MEETING.
February 2nd—GENERAL MEETING.
Papers:
Dr. H. Dyer: "Tracheotomy in Children."
Dr.  C.   Graham:  "Inflammation of the Accessory Nasal Sinuses
in Children."
Dr. E. E. Day: "Indications for Endoscopy."
Discussion: Dr. J. A. Smith; Dr. H. R. Mustard.
February 16th—CLINICAL MEETING.
March 2nd—GENERAL MEETING.
The Osier Lecture Dinner.
March 16th—CLINICAL MEETING.
April 6th—GENERAL MEETING.
Papers:
Dr. J. W. Thomson: "Emergencies in Abdominal Surgery."
Dr. A. W. Hunter: "Diagnosis and Treatment of Some Urological
Emergencies."
Discussion: Dr. G. E. Gillies; Dr. Lee Smith.
April 20th—CLINICAL MEETING.
April—ANNUAL MEETING.
Page 22 EDITOR'S PAGE
Elsewhere in the Bulletin our readers will see a notice of a recent
decision by the B. C. Medical Council to increase the annual fee from
$4 to $6. The explanation is given in the news item. This, we gather,
is no sudden resolve, but is the outcome of several years' deliberation
and discussion. At first sight, many of us may be disposed to cavil at
an action which robs practising Peter to save the pocket of young
and hopeful Paul; but, as is generally the case, a careful consideration
of the historical background will give us a more accurate perspective
on the matter. British Columbia is the only province which has been
receiving this $25 fee, since the Medical Council of Canada became the
examining body for the Dominion. Its payment was a solatium
awarded to B. C. in acknowledgment of the sacrifice she made, peculiar
in some ways to herself, when she agreed to accept the M. C. C. as the
one examining body for Canada. But, and we think it is a generous
move, our Council has decided to come more definitely into line with
the other Provinces, and forego the fee. We feel that all our readers
will think this just and right. Unfortunately this entails a loss of so
much money that our Council, sore beset for funds, is compelled to
distribute the cost over the profession as a whole. If any there be who
still are inclined to dispute the lawfulness of this, we must remind
them that the Council is well within its legal rights, and could, if it
wished, have made the levy even higher. Let us hope that no need
will arise for any further levy. It must not be forgotten that the
B.C. Medical Council has to bear the legal costs of all the work that is
done in connection with medical legislation. These have, for many
years, been very heavy, and we are all convinced of the fact that they
were inescapable.
In this connection, we feel that an effort might well be made
towards consolidation of medical fees of all kinds—council, association
and so on. It is very irksome to be continually called on for fees to
different organizations, and many of us have felt for some time that
if a composite fee could be worked o«t and fixed, which would cover,
not only dues to the Council, but also association fees, both provincial
and local, it would lead to economy and increased efficiency. Alberta,
we understand, has some such arrangement. Could not the Medical
Council devote some attention to this point, and at least attempt to
unify dues under one definite sum?    We commend it to their notice.
Many medical men in B. C. have been approached lately by a
newly organized Benefit Association, with requests to co-operate with
the organization, which proposes to supply medical service to its subscribers on terms which make it practically a Health Insurance scheme.
The Industrial Service Committee of B. C. Medical Association is investigating this suggested plan, and is in close touch with its organizers,
who appear to be earnestly desirous of working in harmony with the
medical profession, along the lines which have been repeatedly laid down
by the latter. We would ask our readers to await the decision of the
B. C. Medical Association before taking any action in this matter.
Page 23 A certain ambulance company, just beginning to operate in Vancouver, has written to some medical men soliciting their business, and
offering as a "consideration" a commission of 15 per cent, on calls
received. If the gentlemen in charge of this company have any friends
among the profession, the latter should warn them that they are going
the sure way to alienate all reputable physicians. The ambulance
companies now in existence have been able for years to run their
business in a straight-forward and business-like way, without resorting
to any such underhand and unworthy methods, and no support, we
feel sure, will be given to any company which asks us to violate the
ordinary rules of decent conduct, to say nothing of medical ethics.
NEWS and NOTES
Professors William Wright and G. A. Buckmaster, travelling examiners for the Royal College of Surgeons, England, passed through
Vancouver on their way from Australia on October 10th. As they
were only in the city for the day and were occupied in transacting
some important private business, they were unable to give the Vancouver
Medical Association any time, although several efforts had been made by
wireless messages to the Aorangi to arrange for a luncheon or dinner
meeting. Victoria Medical Society was more fortunate and was able
to entertain these distinguished visitors on the day of their arrival in
Victoria. Beyond a hurriedly arranged private dinner given to the
visitors, prior to their departure by the evening train, by Dr. A. S. Monro,
President of the Canadian Medical Association, none of the profession in
Vancouver had an opportunity of meeting them.
It is desired to draw the attention of the profession to the new
arrangement between the Medical Council of Canada and the Council
of this Province. Up to date British Columbia has been receiving the
sum of $25.00 from the Medical Council of Canada for each candidate
taking the examination of that body and subsequently registering in
this province. It has been considered for some time that the fees paid
for licence to the Medical Council of Canada and to the Province in
which the applicant intends to practise, constitute a very heavy burden
on the recent graduate and for this reason, and to be in line with the
other Provinces, it is considered desirable that British Columbia should
now give up this $25.00 fee. This, of course, means that the revenue
of the Council is- going to suffer, and in order to meet this it has been
decided to raise the annual dues from $4.00 to $6.00. It was considered
by the Council that the men in practice are in a better position to
meet this extra expense than the recent graduate, in whose interests this
arrangement with the Canada Medical Coucil has been made.
Dr. C. W. Prowd, our genial President, has returned safe and
sound from his travels in Europe. We understand the rumours of his
adventures in Russia are a canard.
Page 24 Dr. Isabel Day is leaving on the first of the month for Chicago
where she has accepted a six months' appointment at the Chicago Lying
In Hospital. Dr. Day expects to resume practice in Vancouver in
the Spring.
The fact that cancer is now a notifiable disease in B. C. may not
be generally appreciated by our readers. During the past few months
the Cancer Committee has done an immense amount of spade work,
all of which will be of great value to the community and to the profession. Are you doing your bit by reporting all your cancer cases? If
you have overlooked any will you kindly report them all up to November
1st. All of which means Do It Now—Today. The Committee wi'l
continue this winter to hold its mettings on the third Monday in each
month.    Particulars of the programmes will be mailed to members.
Dr. T. M. Jones, a son of the late Dr. O. M. Jones of Victoria, is
commencing practice in Vancouver and is temporarily occupying Dr.
E. E. Day's office while Dr. Day is in the East.
Dr. Hugh Ivie Campbell-Brown, whose home is at Vernon, B. C.
has registered with the College and will practise in Vancouver. His
office is at 1705 Napier Street.
Still another newcomer is Dr. C. E. Tran (Western, 1912) who
has been in practice in Saskatchewan for a considerable number of
years. He has come to reside at the Coast and has taken offices in the
Birks Building.    He will confine his work to general surgery.
Dr. Jack Wright, Canadian Tennis Champion and famous Davis
Cup player, has arrived in Vancouver as second assistant to Dr. A. K.
Haywood at the General. Dr. Wright is a native of B. C. He was
born in Nelson and from there went to McGill. He states he is giving
up tennis except for recreational purposes.
Dr. E. L. Garner, who has been in practice at Duncan for over
seven years, has moved to Vancouver where he will practice general
medicine and surgery. Dr. Garner's office address is 510 Birks Building.
Dr. H. N. Watson, formerly of Chemainus, is now associated with Dr.
Bisset, of Duncan, in Dr. Garner's Place.
Our congratulations are extended to Dr. Hugh and Mrs. MacMil-
lan on the birth of a daughter; to Dr. Stuart and Mrs. Mtarray who
have another daughter, and to Dr. H. R. and Mrs. Ross on the birth of
a son.
And yet one other optimist has arrived in the city, this time from
Calgary and will practise in Vancouver.    Dr. D. L. Dick, who was at
Page 25 St. Paul's Hospital for a time, a year or so ago, has opened an office in
306 Birks Building and will specialize in neurology.
We regret that there are still many members who will perforce
have to be presented with drafts for their annual dues in accordance
with our By-laws. These will be issued about the 5 th of November
so that there is still time to avoid "the draft" by voluntary action.
Dr. Gordon M. Kirkpatrick, well-known at the General Hospital,
has returned from some months in Europe, during which inter alia he did
postgraduate work at the Rotunda and Coombe Hospitals in Dublin.
He left on the 18th of October for St. Michael's Hospital, Rock Bay,
to replace Dr. T. W. A. Gray, who has resigned. Dr. Kirkpatrick says
he found Dublin a delightful city.
MEETINGS
The first General Meeting of the 34th session of the Vancouver
Medical Association was held in the Auditorium of the Medical Dental
Building on Tuesday, Oct 6th., with an attendance of sixty-five members.
In the absence of the President, Dr. C. W. Prowd, in Europe, the Vice-
President, Dr. Murray Blair, took the chair. Dr. L. H. Appleby being
absent through sickness, Dr. Gordon Burke acted as Secretary for the
evening.
Interesting papers on the surgical treatment of Tuberculosis by
Dr. J. A. Burris and on the Home Treatment by Dr. A. S. Lamb, were
read and fully discussed by, amongst others, Drs. Schinbein, Vrooman
and Barker. Several nominations for membership were received and the
applicants will be voted on at the November meeting. Two new
members of the Summer School Committee were appointed to replace
Drs. Kinsman and W. L. Graham whose term had expired. Drs. H. A.
Spohn and H. R. Mustard were elected for the three year term. A
letter asking for an expression of opinion on the proposed campaign
for Daylight Saving was read to the meeting and on motion was ordered
received and filed. It was felt that this was a matter for the Public
Health authorities and not for the Association.
The finst clinical meeting of the session of the Vancouver Medical
Association was held in the Auditorium, Vancouver General Hospital on
the night of Tuesday, October 20th. The large attendance (110), and
the excellent material presented promises well for a very excellent season.
A high standard has been set and we do not doubt that the level will be
maintained.
The first two cases were ones of Vernal Conjuctivitis presented by
Dr. W. M. Paton. This unusual disease was beautifully demonstrated in
the two cases presented, both showing the characteristic symptoms of
photophobia, lacrimation, etc., and the typical papillary structure in the
Page 26 conjunctiva of the upper lid. One case was of only one year's duration
and the other had a history of ten years, untreated. The latter case
showed eosinophilia and the fluid expressed from the inflammatory area in
the upper lid contained numerous eosinophils. The aetiology is not
known, and therapy is rather unsatisfactory. Weak antiseptic solutions
only had been used in the case presented. Radium has been used in
some cases, and Dr. J. B. Harrison in the discussion which followed mentioned that in a series of four cases which he had seen, three had responded
well to unfiltered radiation (with radium).
Dr. Paton also presented a case of Herpes Zoster Ophthalmica. This
case had recovered but still exhibited typical scarring of the supraorbital
region. The history recorded that three months before onset, the patient
had suffered a crushing of the head which was followed by a supraorbital
neuritis, but months later following an acute upper respiratory infection
herpes lesions began to appear in the ophthalmic area. The conjunctiva
was infected and severe pain was a marked feature necessitating recourse
to morphia. It is interesting to note that a child of the patient developed
varicella shortly after its father's zoster.
Dr. J. J. Mason reported a case of Krukenberg Tumour. The patient
was a married woman, forty-eight years of age. The family history was
negative except for tuberculosis. The significant fact in the history was
thatthree years before consulting Dr. Mason, the patient had had gastric
haemorrhage and although X-ray finding were negative following this,
a fastric ulcer was considered. When the patient was seen she had noted
swelling of the abdomen for the past two weeks with a sensation of
pressure and back-ache. Free fluid was present in the abdominal cacity,
there was a mass in the upper abdomen and bi-lateral masses in the lower
abdomen. At laparotomy 125 ounces of pus-fluid were removed. Advanced carcinoma of the stomach was found, involving both orifices.
There was a retrogastric mass but no metastatic growths were found in
in the abdominal cavity. There were bi-lateral, smooth, slatey ovarian
tumours, fixed to the ligaments as if through direct lymphatic involvement. No attempt was made at more than an exploration of the abdomen. Following operation fluid again accumulated, slowly at first,
more rapidly later. It was removed by tapping on several occasions.
Patient's condition steadily became worse till death, and at post-mortem
the abdominal findings made at operation were confirmed and elaborated.
In the interval between operation and death extensive metastatic involvements of lymph nodes had appeared. Dr. Pitts gave a very complete and
detailed summary of the post-mortem findings both gross and microscopic.
Dr. Spohn presented a case of purpura haemorrhagica in a small girl.
Onset of illness two chills at three day intervals upon going in swimming.
Two weeks later small haemorrhage was observed from the oral mucosa
and haemorrhagic petachiae on the chest. Bruises about the knees followed this and were in turn followed by a rapid development of similar
bluish lesions on the front of the legs. These were accompanied by
petechiae which soon were numbered by the hundred. Bleeding was
slight from the mouth and nose.   At this time there was no occult blood
Page 27 in the stool and no haematuria. Exam, of the blood showed an almost
complete absence of platelets. The following day haematuria commenced
together with blood in the stool. Bleeding time was greatly increased.
Daily platelet counts were taken varying from 15-20,000 in spite of
intramuscular blood interjections. After about a week improvement
commenced and in three days more all symptoms ceased although the
platelets numbered only 32,000. The spleen had never been palpable, the
liver was barely palpable, the abdomen was flaccid and there was no
lymphadenopathy. R. B. C. numbered 4 millions Hg. 70%, w. b. c. 600,
poly's 54%, large monos 11 and small monos 29. There was slight variation in the size of the red cells and a few were stippled. Afted a week's
interval slight oozing of blood from the gums again took place. This
continued with increased vomiting of blood. Two days later headache
and twitching preceded a convulsion. Patient was seen in a semi-conscious condition. The C. S. F., of which 26 c. c. were removed under
pressure, contained blood. The following day pain and swelling occurred
in the right eye. She received further intramuscular blood and on the
next day was drowsy and complained of headache, and pulse was intermittent. After a consultation it was decided to do a splenectomy. This
operation, which was performed by Dr. Wilfred Graham, was preceded by
450 c. c. of intravenous blood. Her condition, which was almost moribund, immediately before operation, improved after operation very rapidly.
Nevertheless the platelet count did not show the anticipated rise. Four
days after operation the platelet count was 82,000 and two weeks after
operation, at time of discharge the platelets were 345,000. The patient,
as presented before the meeting looked very well, but Dr. Spohn and those
who contributed to the discussion did not feel that it could be definitely
stated that nhe last word had yet been spoken in this history. The question as to whether the patient improved as a result of the splenectomy
or the blood transfusion was not settled. Drs. G. O. Matthews, W. L.
Graham, Stuart Murray and A. Y. McNair contributed much of value
in the discussion which followed. Dr. McNair stated that on the day
of presentation the platelet count was over 500,000, the w. b. c. 46,000,
of which 46 per cent, were granulocytes and the remainder large lymphocytes of the type commonly associated with lymphatic leukaemia. He did
not however think this presaged a leukaemia and felt optimistic as to
the patient's future.
Dr. Murray Baird presented a case of idiopathic oedema. The patient
—a young female adult, presented a generalized oedema of the head,
trunk and limbs and also free fluid in the serous cavities. She was first
seen on May 24th. Although she looked pale her Hg at that time was
84 per cent, and the urine was normal. The one significant fact in the
history was an acute rheumatism one year previously with a tonsillectomy
performed as part of the treatment. Swelling had been noticed first in
the feet and ankles three weeks before first being seen. There was a
family history of rheumatism. Since admission to hospital the condition
had fluctuated, sometimes as a result of treatment. Ammonium chloride
and salyrgan were successful in reducing the oedema and increasing the
urinary output, but this effect was only temporary. Two abscessed
molars were removed and a smear from the roots showed streptococci.
Page 2S Treatment has been augmented by the use of a vaccine of this organism
but the results have not been satisfactory. The patient has suffered from
joint pains since being in hospital. Pulsus paradoxus has also been observed. Haemoglobin has been down as low as 42 per cent. At time
of presentation r. b. c. were 2l/2 millions: hg. 52 per cent., w. b. c. 12,000.
Blood calcium 9.9 mgms: B.M.R. plus 2 and N.P.N. 30 mgms. She
has recently been slightly jaundiced and the blood bilirubin was 2.2 mgms.
per 100 c. c. Dr. Baird felt that this was probably a case of rheumatic
infection with special involvement of the mediastinum and the oedema
was due to mechanical interference with the venous return. The question
arose "Can infection of this type produce oedema without kidney damage
as in nephrosis?" Dr. Baird was subjected to a veritable barrage of
questions, particularly from the internists, from which he emerged
tails up.
Dr. F. P. Patterson presented two cases of spondylolisthesis, both of
them in men 24 years of age. In one the disability was traumatic in
origin, in the other non traumatic. The second is the more common
type—most cases are congenital and show typical clinical findings. The
first case developed after a fall of 50 feet, landing in a sitting position.
This case did not show the clinical findings usual in non-traumatic cases
and furnished a problem in diagnosis. Certain unusual features were
introduced due to the patient having sustained a cord injury which had
picked up the nerve supply to the gluteus medius and minimum with a
compensatory overdevelopment of the gluteus maximus. Dr. Patterson
gave a very elaborate and scholarly dissertation on the mechanism of
posture and locomotion and parturition with special reference to the
pelvic girdle and lumbo-sacral articulation. When he had finished there
was nothing left to be said, not even by the gynaecologists.
Dr. A. W. Hunter presented pyelograms of a very interesting case
of horseshoe kidney discovered in the course of an investigation of a
calculus in the right renal pelvis.
Although there were other numbers on the programme the lateness
of the hour obliged the chairman to adjourn the meeting at 11 p.m.,
following which the audience refreshed itself with coffee and cakes provided through the courtesy of Dr. Haywood.
ABSTRACT
An article by Dr. W. Keith Burwell of this city, in the August
issue of the American Journal of Obstetrics and Gynecology reviewing
five hundred consecutive blood transfusions, from the Clinic of the
Woman's Hospital in the State of New York, is interesting and well
worth perusal.
The immense fillip given this form of treatment by the lessons
learned in the War is well illustrated by the fact that the first recorded
blood transfusion in this Clinic was as late as 1917.
Dr. Burwell covers the field of post-transfusion reactions particularly well. The majority were transfused by the Unger direct method,
using the Scannell machine; and from a study of the tables of reactions
Page 29 published with the article, it would appear that minor reactions were at
least as common, if not more so, than with the gravity citrate method
most commonly used in this country.
Dr. Burwell sounds a note of warning against transfusing anaesthetized patients who are unable to exhibit the early signs of incompatibility, which, if recognized, might permit an immediate stopping of
the transfusion—preferring in these anaesthetized cases the use of gum
saline, pending a return to consciousness.
This paper is well worth study.
HOSPITAL RECORDS
An open letter to the Medical Profession attending the Vancouver
General Hospital.
Gentlemen:—
A few weeks ago a circular was distributed by the Hospital stating
that a copy of the International List of Causes of Death had been placed
on every ward of the V. G. H., and asking that this booklet be your
guide when recording a death in the Hospital. A copy of the 1931
revision of this booklet has since been distributed to individual physicians
and surgeons through the medium of the Provincial Department of
Health.
This intrusion into your pages, which is by kind permission of
your Editor and with the sanction of Dr. Haywood, is the object of
bringing to your notice the new Nomenclature of Deases which has
been introduced into the V. G. H., and of which copies are now to be
found, for daily reference, on every ward of the Hospital.
Medical terminology is an arbitrary factor and there are diagnoses
whose nomenclature is possible of interpretation in divers terms, each
of which may, nevertheless, be both precise and correct.
To the professional mind such variations may not be productive
of a great amount of misconception but, to lay people whose duty it
is to faithfully record, there sometimes arises an uncertainty as to
whether the variations imply alternatives or ambiguities.
It is evident that the profession at large, as focussed in its leading
minds, is awake to the necessity of a common Terminology; hence the
Decennial International Conferences, the labours of which have established uniformity in the description of the many ills which beset the
human structure, as set forth in (1) The International List of Nomenclature of Diseases, and (2)  The International List of Causes of Death.
Improvement of the medical records of the V. G. H. has been under
consideration for sime time. The System of Nomenclature at present
in use has held the unqualified approval of the American College of
Surgeons and the American Hospital Association, but we are now adopting the interpretation of International List which is issued by the
Massachusetts General Hospital and which is likewise approved.    This
Page 3 0 will bring into conformity, in this respect, the two hospitals of this
city and afford the attending phfysicians a common basis for diagnosing
their cases in either hospital.
The change, when suggested, had the immediate support of the
administration and the use of the new nomenclature was authorized.
Delay in execution was the result only of the fact that the findings
of the International Conference of 1929 would not be published by
the authorities of the Massachusetts Hospital until July,  1931.
It remains now to be seen whether, with the facilities thus provided, your members will place the proper value on their own work
and afford themselves, by conforming to the "Massachusetts," the means
of securing a greater measure of that value which they hope (but sometimes fail) to find in the records which are compiled at their instigation.
To summarize: The responsibility for completion of the case
history of hospital patients continue to rest with the attending physician but, with the facilities afforded by an increased interne service and
the history stenographer, this question is no longer a nightmare. As a
logical complement to this, will you make it your duty and our pleasure,
to give us, in terms of the "Massachusetts," (1) a statement of the
pre-eminent diagnosis of your cases, (2) an indication of all accompanying and/or complicating conditions, (3) an acceptable Cause of
Death.
The duty of this Records Department will then be to faithfully
record your decisions.
BOOK REVIEW
"The Home Care of the Infant and Child"
by Dr. F. F. Tisdall, |
Physician to the Hospital for Sick Children, Toronto
J. M. Dent and Sons Ltd., Toronto
pp. 292, 58 Illustrations, price $3.50.
An experienced critic has said that it is the business of reviewers
to think not of themselves but of their author and thus exclude all
chance of formal or original disquisitions on the part of the Journalist.
Uncertain whether we can attain to this excellent advice we turn to the
book in question. Dr. Tisdall has produced an exhaustive work, and if
he has omitted consideration of any part of his subject we are unable
to supply the omission. From the care of the expectant mother to a
chapter on toys all has been duly discussed and a sufficient index completes the whole.
Nor should mention of the illustrations be forgotten. These are
reproductions of photographs taken, we presume, under the direction
of the author. Many of them are quite charming pictures and all most
apt to the text. Dr. Tisdall believes that "impressions conveyed by
pictures are more vivid and lasting than those produced by the printed
Page 31 Government, Municipal, Public Utility,
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Vancouver,  B. C. word" and in these days when the screen has achieved such a universal
popularity, who shall gainsay him. With the contents we have little
quarrel. The tone, as is unavoidable, is dogmatic but we venture to
say that there is little with which any physician would disagree. Dr.
Tisdall writes as a paediatrician and an experienced parent—evidently.
The make up is good. For a fair sized publication it is light in the
hand. The printing is clear, the illustrations, as we have said, excellent,
the errors minimal. The table of contents clearly shows the division
of the book into sections and the division of each section into chapters,
each with its appropriate heading. The subject matter of each chapter
is then set forth in sufficient detail as almost to constitute an additional
index.
In a book avowedly intended for lay reading the question of how
much or how little is advisable must as surely exercise conscientious
writer as it will do a professional reader.
What can reasonably and properly be told to mothers, especially
young mothers, without inducing a state of continued nervous apprehension or an indigestion of ill-understood information?
It is a tribute at once to the development of educational methods
and to Dr. Tisdall's confidence in the efficacy of the curriculum that he
has seen fit to produce a work of such a technical, not to say scientific
character. Even thirty years ago such a book, could it have been
written and could it have been read—but why speculate on its effect
when it could have been neither. The "Chevasse" of the period was
more homely. Today we are inclined to think that the clientele to
which it is presumably addressed, young women with high school or
college education, will for the most part assimilate it.
Non-paediatric doctors in general practice might be advised in
self defence to look over this book. Otherwise, as is the case with the
modern diabetic, who is now admitted so freely into the art and mystery
of the craft, the doctor may be confronted with the same awkward
questions by a determined young woman full of calories and vitamins,
and just how many ounces per day or per week a male or female infant
should, or should not gain.
Canadian made text books are not too common and we commend
Dr. Tisdall's work to our readers and their patients.
J. M. P.
CASE REPORT
A case of Purpura Haemorrhagica
Reported by Dr. W. A. Moffat
J. M., a boy of 12 years of age, was admitted to St. Paul's Hospital,
Vancouver, on September 21st, 1931. On September 18th, having for
some days previously been a little out of sorts, (which was attributed
to a cold) he pulled out a loose tooth. The socket oozed continuously.
On the two following days petechiae and ecchymoses appeared on the
skin and in the conjunctivae, blood was noticed in the urine and in the
Page 32 stools and vomiting of blood occurred. The first blood count showed
2,500,000 red cells and 58 per cent haemoglobin, 13, 275 white cells
of which 77.5 per cent, were polymorphonuclears. There were 305,000
platelets per c.m.m. The spleen was not palpable and there was no
special gland enlargement. The tonsils were not inflamed. Temperature
normal or slightly raised and pulse rate 110. Bleeding and coagulation
time were both prolonged. He was transfused with 350 cc of his
father's blood. There was no reaction following the transfusion but next
day the platelet count had fallen to 130,000 and the urine still looked
like pure blood. Vomiting had ceased and he was able to retain fluids.
By September 24th, three days after transfusion the platelets had fallen
to a low count of 21,000, and the red cells to 1,765,000.
In spite of this, the urine was slightly clearer, the socket of the
extracted tooth had ceased bleeding and there were no evident fresh
ecchymoses. He was again transfused, the blood of the donor containing 430,000 platelets per c.m.m. Two days later the urine became perfectly clear and by September 29th, the platelets count had reached
86,000. The boy was taking food freely and appeared well on the way
to recovery.
The relationship of the platelet count to acute purpuric manifestations is not clear. Bleeding may occur when the count is high, low or
normal. In this case by the time the count had reached its lowest,
bleeding had begun to lessen. In the more chronic cases the count is at
least a valuable index and after splenectomy, in the successful cases, will
show a rise, while the symptoms improve.
THE HOME TREATMENT OF TUBERCULOSIS
By Dr. A. S. Lamb, of the Provincial Board of Health, Victoria, B. C.
I consider it an honour as well as a privilege to be asked to address
the Vancouver Medical Association. The privilege I consider all the
greater as it gives me an opportunity to say a few things to my confreres
that I feel need to be said.
May I say in the beginning that I am not one of those who think
the only cause of late diagnosis in tuberculosis is the neglect on the part
of the General Practitioner in making the diagnosis when cases are first
presented for examination, but rather the insidious nature of the disease,
and the difficulties of being positive in the early stages.
My reason for making bold to say some of the things I may say is
my eight years of continuous diagnostic work as Travelling Medical
Health Officer, and my very cordial relations during this time with almost
the entire membership of the profession of the Province, a privilege that I
esteem very highly.
I have chosen as the title of the paper "The Home Treatment of
Tuberculosis." I know you will pardon me if I do not adhere too closely
to my text.
Page We have to admit that tuberculosis is on the increase, not only in
British Columbia, but pretty generally throughout the Dominion. We
want the hearty co-operation of every member of the medical profession,
realizing at the same time that the task of leadership must fall upon those
doing this work specially, and on Public Health Departments, both
Provincial and Municipal.
We want your assistance particularly in the early diagnosis and segregation of cases. There is a decided falling off in the death rate among
children, but between the ages of 18 and 25 years not so great a reduction
has taken place.
Tuberculosis is not only more prevalent, but it is of a different type,
many more cases being of the acute type.
Pottenger of Monrovia, believes that when tuberculosis appears with
an acute onset, as frequently seen, the resultant disease is the product
of a relatively large reinoculation, the acute onset many times following
other acute infections, as respiratory colds, pnemonia, influenza and
children's diseases.
I have seen cases myself go on to cavity formation in a few weeks.
Tuberculosis is essentially a disease in the treatment of which a great
deal of rare judgment and experience is required, rather than any set
.rules.
Treatment of tuberculosis, as in nearly all diseases, is divided into
preventative and curative. In this particular disease especially, I believe
that the former is very much the most important, for in prevention we
are dealing with the matter from the standpoint of the community as
well as the individual; and while the individual patient requires every
consideration we are able to give, the protection of the community is
the larger matter. In other words, tuberculosis must be treated by the
medical profession as a whole as a Public Health problem.
When we speak of Home Treatment we are necessarily speaking of
this form in contra-distinction to other forms. These other forms are
"Treatment in our General Hospitals, and Sanatoria or Institutions suited
for treatment of this particular disease."
While we believe that Sanatorium treatment is the best form for
all cases, we know from experience that even were sufficient beds provided
at Sanatoria there would always be a certain number of cases which would
be unable or would refuse to take such treatment, for various reasons
which we need not go into here. Probably the greatest benefit from
institutional treatment is the education of the patient in the carrying
out of the "cure."
In this Province general hospitals are required to make provision for
advanced cases of tuberculosis, thus removing a source of infection from
the family and ensuring that a patient in the terminal stages may receive
adequate care.    Our larger hospitals generally have fulfilled this require-
Page 34 ment but very little has been done in the smaller institutions. However,
patients can always be taken into the private wards of these hospitals for
a short time.
As Hospital Inspector, I have pointed out to the general hospitals
that it is also their duty from a humanitarian standpoint, if for no other
reason, occasionally to take in early cases in order that they may be on
the "cure" while waiting for admission to the sanatorium. For I have
found that with the ingrained idea among the laity that if they are infected with tuberculosis they must get to a different climate for treatment, it is difficult to induce the patient to take the "cure" at home,
especially in the coast districts. There has been very good co-operation
on the part of the hospitals in this way. More will be said on this subject
later.
However, until such accomodation in sanatorium and in general hospitals is provided, we must instil into the minds of the people that
rest is the greatest essential of treatment, and that rest can be carried out
in any climate and in any locality. As referred to above, many patients
have lost their chances of recovery by not taking the "cure" because
they could not be transferred to an institution or to, as they think, a more
congenial climate.
In what kind of a home then can the "cure" be carried out? Unfortunately, it has to be carried out in every type of home, but in a
home where the patient can be segregated from the balance of the family
and can have ordinary nursing care, with all the comforts that a good
home can provide, providing the patient and the people are of average
intelligence, and will follow instructions, the "cure"in many cases can
be carried out as satisfactorily as in an institution. There must, bowever,.
be some means of educating the people along proper lines and the patient
must be under the close and continuous observation of a competent
physician.
The economic question enters into the disposition of these cases at
all times as it does in every case of tuberculosis. Where the family is living
on the bare necessities of life, with no reserve for emergencies, the development of a case of tuberculosis in the family may make the load too great
to carry, and these are the cases for which institutional treatment
should be provided.
There must be sufficient space in the home, or in the close proximity,
for the segregation of the case. It is almost impossible to prevent infection if the infective case has to live in close proximity to the other
members of the family, especially young children, who are much more
liable to infection than adults.
Home treatment then includes a great many things of a preventative
nature. The family must be trained as to the danger of infection and the
methods of avoiding it. The right atmosphere for the patient must be
provided; the family and friends must assume an attitude toward the
patient and the "cure."    Anyone who has had anything to do with the
Page 3 3 treatment of sanatorium patients knows very well the difficulties that
a patient discharged, even for a holiday, has to meet. The laity generally
cannot seem to absorb the fact, well known to us, that a patient may be
ill with tuberculosis, requiring absolute bed rest, and still look perfectly
healthy. Usually the friends of patients are their worst enemies in that
they do not recognize the seriousness of the condition, and encourage the
patient to take too much exercise and too many liberties.
In the last three or four decades there has been a great deal of discussion and theorizing as to how infection is carried from one person to
another. Out of this discussion I think we have fairly definitely arrived
at the conclusion that the most serious source of infection comes from
direct contact. As in many of the other infectious diseases, it is often
the carrier who is to blame.
A case develops in a family. The time has passed when we are
satisfied to treat this case only as an individual patient. We must study
the ramifications. It is not only our privilege, it is now recognized as
our bounden duty, to seek out the source of the infection. It may be
found in some very unexpected places, always remembering that infection
generally proceeds from the older to the younger generations.
We must also be on our guard for any contact infections that may
have taken place from this individual case. If the doctor does not wish,
or has not the time to do this himself—and I realize in many cases he
will not—he must then delegate this duty to some one who will. This
some one will generally be a Public Nurse or a clinic.
A great deal of my time at the present is taken up with the examination of contacts, and it would surprise you to learn the number of well
marked cases that have been discovered in that way.
It takes a great deal of patience, intelligence and determination to
take the "cure" at home. The patient must be taught a great many
things, and who is going to do it but the doctor? There is first the
prevention of infection of others by proper precautions as to cough and
sputum and other excretions from the body. It is best to assume in all
cases that the patient knows nothing about these things. One telling
is not sufficient. It is only by iteration and reiteration that results can
bt obtained. The amount of rest and exercise that is necessarv must be
decided upon and specifically stated, and always make your directions
a little stronger for rest than you think necessary, as the tendency is to
take less rest than prescribed, and patients will often boast about disobeying instructions. Relaxation, the cultivation of a habit of composure, the
provision of adequate supply of fresh air day and night are necessary.
Many patients are still fearful of night air. The taking of pulse and
temperature must be arranged. To the right type of patient all these
things and many others may be taught.
The selection of the part of the house that the patient should occupy
is often very important.    The room should be separated from the rest
Page 36 of the house as much as possible and provided with cross ventilation by
means of two or more windows or one window and door. It should be
seen to that this plan is not nullified by the pushing of the bed back into
the most remote corner of the room, away from the window and doors,
as is very often the case.
Porches, if properly protected from the bright sunshine and also
from wind and storm are very efficient locations for the treatment of
the patient. An added advantage is the fact that any germs that escape
our vigilance are soon killed by exposure to light and air.
Proper tents, I say proper advisedly, can be substituted when space
in the house is at a premium. Tents, however, if not properly constructed
and attended to, may be, and often are very much less well-ventilated
than rooms with only one window.
It is not necessary for the patient to be uncomfortably cold; in
fact in many cases it is of great detriment, our own former opinion and
that of the laity still, to the contrary. We have dismissed that idea,
and now have our patients comfortable in any case.
In the absence of a nurse, either full time or visiting, the attendant
must be instructed in all these matters, also in the preparation of food
in the best way, and if economy is necessary, the preparation of inexpensive foods in a palatable manner.
The proper making of beds and care of bedding should be taught
—also fumigation and treatment in case bedding becomes soiled.
While a great deal can very well be done by a visiting nurse, the
instruction of the patient can best be accomplished by at least a short
stay in the sanatorium.
Where nothing else is possible, I have found it a great aid to furnish
literature that all may read, the best form being one of the books published on "How to get well of Tuberculosis." The written word, accompanied by a little talk is much better than either alone.
. I have nothing definite to say about the medical treatment of tuber
culosis either at home or elsewhere. Practically every drug has been given
at various times throughout the ages. Nothing is known to be of any
specific value, and any drug administration that is done is purely empirical.
HELIOTHERAPHY
This method of treatment has been fairly extensively investigated
within the past few years.    While its original indications appeared to be
Page 37 only for the so-called surgical forms of tuberculosis, as advocated by
Rollier in Switzerland, it appeared that a method which acts almost as
a specific in some tuberculous lesions should also exert a beneficial influence on other forms. This has not altogether been borne out by results.
I believe that the time has arrived when a note of warning is necessary as regards the use of the sun treatment, either natural or artificial,
especially as regards pulmonary tuberculosis.
Any treatment that does more harm than good is not a treatment.
This, I believe, to be the case as regards heliotherapy in pulmonary
tuberculosis. Even the most enthusiastic exponents of this treatment in
the non-pulmonary form do not consider it the be-all and end-all of
treatment. At most an aid to other forms of treatment, at the same
time carrying out all the recognized methods that have existed so long,
such as rest, fixation, good nursing, hygienic living, etc.
|
That being the case, can there be any excuse for simply telling a
patient to get out in the air and expose the body to the sun, without any
specific instructions as to dosage, time of exposure—both actual time
and time of day—as seems to be so frequently done? Practically every
article published, that I have seen, stresses the necessity of very imall
dosage in the beginning with very gradual increase and close observation
of the effects of even the small dosage. Then how can it be possible
to treat a case at home where a patient is seen only at infrequent intervals, and then probably not at the proper time to estimate the effect?
I have known many cases that were making very satisfactory progress, we will say throughout the winter and spring months, then as
summer approaches, especially the holiday season, they have gone off to
the beach to lie out in the sun for longer or shorter intervals, returned
in a short time with their latent lesions whipped into activity, from
which they may never recover.
This is the experience of Dr. Vrooman, I know, and of other men in
the city, I am sure. It is so common that when asked advice about sun
cure I advise air baths by all means, but avoidance of direct exposure
to the sun. After giving advice on request, I am often faced with the-
statement that the Doctor in charge had recommended exposure, and
without any specific directions as to the precautions to be taken.
Our Sanatoria authorities are very much divided as to its efficacy,
many believing as they do about tuberculin, that it should not be used
at all because of its danger, others believing that if used with great
caution it is a valuable aid to treatment; but all stress the necessity of
great caution in the selection of cases as well as in the dosage. The case
that seems to be the most favourable is the same type of case in which
Tuberculin is likely to be useful.    That is the chronic case that has been
Page 3 8 very much at a standstill; which seems reasonable enough, as the physiological reaction is similar to that produced by tuberculin.
As regards the non-pulmonary forms, sunlight seems to be of great
benefit in most bone cases, especially chronic types, and in peritonitis.
Dr. Jardine of Edinburgh says that it is not only not useful in hip cases,
but is definitely harmful, as it causes sufficient hyperaemia to interfere
with the circulation to the part involved.
Years ago in the East it was very common practice to advise patients
to go West. Now it is about as common to advise Sun Cure, and I
believe with about equal results; a small percentage are benefitted, the
balance, about 95 per cent, or more, are hurried to an untimely end.
CLIMATE
I believe that one can speak about climate today with much greater
authority than in the past. While years ago opinion varied greatly,
today it has become reduced to this: "That climate is not a determining
factor in a patient's recovery except in a very small percentage of cases,"
that is if the patient assumes the right attitude towards it. It is because
of the incorrect attitude that I feel justified in discussing it here.
Our teaching years ago was "get away to a high and dry locality."
This gradually took hold of the minds of the laymen and by the time we,
as a profession, were discarding that attitude it was just nicely fixed
in theirs. Again, our Sanatorium being situated as it is at Tranquille,
our patients often interpret our anxiety to get them there as a desire to
have them removed to the dry belt, instead of for the special care snd
training they would get. Immediately a diagnosis is made, the first
thought of the patient is to get away to a more favourable climate and
some doctors still encourage this action instead of making provision for
bed-rest, which is the first essential. If such transfer cannot be made, it
is difficult to get the patient to take the "cure" at home, as climate has
such an important place in his idea of treatment.
Again, if patients cannot be admitted to the Sanatorium they are
often sent on the advice of their physician, to some town in the Interior,
without any very definite idea as to what they must do when they get
there, not even being advised to place themselves under medical caie.
Those who can afford it may spend their time and money looking
for a climate in which they will be more comfortable and can live out of
doors more, but these cases rarely do as well as those without the funds
for chasing the "cure." Let us then, advise our patients that climate
plays a very small part in the treatment of tuberculosis and thus undo
some of the harm that we ourselves have brought about by our teaching
in the past.    It has already served its purpose in that in the early Sana-
Pa^ 39 torium days it enabled us to get some cases to that institution who would
not otherwise go.    Now our only difficulty is in keeping them away.
If patients must go to a different climate, as is quite often the case
to satisfy his or her mind, then do not prevent them from going but see
to it that they are at once under the care of the most competent physician available. I am sure that the doctor will very much appreciate a
letter from you about the case and treatment already adopted. It is
unwise to trust to what a patient tells you about his feelings in judging
progress he has made, nor by the pounds he has gained in weight. May I
say right here that I believe we are inclined to put altogether too much
trust in gain in weight. It is an important sign, but do not be deceived
by it; many patients put on pounds in weight but still have progressive
disease. True it cannot be very active, but it may be progressive just the
same.
Temperature also is very deceptive in estimating progress if taken
alone but pulse rate, (eliminating nervous or other disease) is a better
guide. A patient with a persistently rapid pulse is not doing well
whatever his or her general appearance.
REST AND EXERCISE
One could say so much about these two that in a short paper such
as this one doubts whether one should say anything. They are, however,
very closely related, for what for one patient is rest, for another is exercise.
Talking, even thinking, having visitors, writing notes, are examples
of exercise that may be disastrous to some patients.
There is no part of the treatment of tuberculosis that requires such
rare discrimination and good judgment as does the matter of rest and
exercise. I know it gives the doctor of limited experience more anxious
minutes than any other part of the treatment. In my work I am more
often consulted about when a patient should get up, and the various
steps in resuming active life, than for anything outside of diagnosis
itself. The patients, too, are very much worried about whether they are
taking too much or too little exercise, especially the latter. In a general
way I tell them not to worry about taking too little. Not much, if
any, harm can be done by not exercising enough, but great and irreparable harm can be done by being too active. Conversely, at a certain
period in treatment, it is of inestimable value to patients both physiologically and psychologically, to increase their exercise even up to the point
of resuming their former duties.
Rest is the great essential in treatment in the early and acute stage,
ranging from absolute bed rest without any privilege during the acute
febrile toxic stage, up to some minutes or hours of exercise as the disease
becomes quiescent and later arrested. In this line of treatment experience
and sound judgment are essential.
Page 40 The auto-inoculation method of Dr. Marcus Patterson has fallen
into disuse, although many British experts are hearty exponents of greater
exercise than any advocate in this country.
Specfiic treatments have this far proved a failure. The only one
outside of tuberculin that has any advocates is sanocrysin, and it could
hardly be classed as a specific.
B. C. G. is still in the experimental stage.
Pleurisy with effusion is still being treated by tapping, and peritonitis
opened up altogether too frequently; in the latter, often, no doubt, because of mistaken diagnosis. Jardine's dictum "Leave alone when tight,
tap when very tight" I approve of.
The old idea that letting air into a tuberculous abdominal cavity
was what was beneficial is now pretty well discarded. It never had any
scientific basis, improvement where it followed was rather due to the
rest after operation.
Finally do not make examinations too frequently. One thorough
examination physically and by X-ray at the beginning—for nothing but a
complete examination is of much value. If too often repeated, examinations may stir up trouble.
DIET  IN  TUBERCULOSIS
Three meals a day should be enough
J. R. Harvey says "eggnogs are an invention of the Devil." Raw
eggs may be given in moderation, if they are well borne, especially if
the patient is underweight.
One quart of milk, daily, is sufficient. A glass of milk with each
meal is usually enough.
Limitation of carbo-hydrates, moderate protein, and relatively high
fat content, with sufficiency of vitamines.
There is no certain evidence that excess of vitamines is beneficial.
SUMMARY
Early diagnosis is very essential. To get it we must examine contacts with known cases.
Prevention of spread of disease by searching for spreaders or carriers.
Close and constant supervision by physicians is imperative.
Heliotherapy is of doubtful benefit in pulmonary tuberculosis,
especially in the absence of close supervision and regulation of dosage.
Climate is not a determining factor in the recovery from tuberculous in but a small percentage of cases.
Page 41 ASSOCIATED CLINIC OF PHYSIO-THERAPEUTICS
A circular letter accompanied by a small booklet has been received
by most of the doctors in Vancouver during the last few days. Both
bear the above heading. In place of signature the letter bears an undecipherable combination of initials, but no other names are attached to
either document.
The point is emphasized in the letter that no patients are accepted
for treatment excepting those referred by physicians. The booklet
consists of what purports to be a resume of the physics of ultra-violet
rays and a few of its therapeutic uses and indications. It is difficult to
believe, however, that such a collection of pseudo-scientific statements,
half-truths and extravagant claims, closely resembling the "scientific
articles" in the Sunday newspaper supplements, can make any appeal
whatever to any physician practising in Vancouver.
The opening statement, "No tonic is known to build up the general
system like the ultra-violet rays," is a fair sample. Among the specific
therapeutic indications we find the remark that impetigo is "very often
contracted from bathing in impure water .... if the disease becomes
widespread enough it becomes fatal .... sores dry up and disappear after
about six exposures under the quartz lamp." Also "Ringworm is similar
to impetigo, though less serious. It is eradicated by four or five exposures." Again we are told that in eczema ("a dermatitis") ....
chronic inflammation is due to several acute cases .... forming crusts
under which secretion from the gland collects .... No bacteria can live
thirty seconds under the quartz lamp . . .Eczema soon disappears when
exposed to the rays." Further that "Feruncle (sic), if caught before
the formation of pus they (boils) can be prevented from coming."
Among other indications for the quartz lamp mentioned are—Mastoids
(infection of the mastoid bone), impotency, falling hair and "many
female disorders." The ray is said not to penetrate much deeper than
the skin, but it should "enrich and purify the blood; banishing face
pimples and sallow complexions, build up and fortify one's system against
colds and diseases."
All the above sounds much more like the advertising matter of
entirely unethical "health institutes," etc., of which Vancouver already
has sufficient. This impression is not weakened by the offer made in the
same circular of three free trial treatments, to be obtained by presentation of a coupon.
If this concern is intending to operate on strictly ethical lines as
claimed, then its method of approach is sufficient to dispel the confidence
and affront the intelligence of any physician. If it is at the same time
advertising itself to the general public, for whom its printed matter
seems specially prepared, then it has already forfeited its right to any
support from the medical profession.
Page 42 The new reduced price of Mead's
Viosterol in Oil 250 D in the
original 50 cc. bottle now makes
vitamin D available to the patient at a cost of only 2 to 2\
cents per day. This economic
phase is important at all times
but is especially important during
times of unemployment and financial stress
miiiiiimimmimminimiinniiiiiiiimimmimimimimmimmimimiimiii
Not only has the price of Mead's Viosterol
been reduced, but the bottle has been improved As packed, it is capped with the
metal cap shown at the left. The patient
with the combination dropper-and-stopper shown in
has a screw thread and fits tightly when not in use.
I"1 or vitamin D therapy, the new reduced price of Mead's
Viosterol when prescribed in the original 50 cc bottle, makes
it less expensive to the patient than Mead's Standardized
Cod Liver Oil or any cod liver oil concentrate. For vitamin
A therapy, Mead's Standardized Cod Liver Oil continues
to be 4 to 11 times as economical as cod liver oil concentrates.
Mead Johnson & Co. of Canada, Ltd., Belleville, Ont. vit™»^e^ch
MiiitiiimiimiimiiiiimiiiiiiiiimiimiiniiiniiiHiiliiiitiiiiiiiJJiMii "We shall continue to supply Ventriculin in packages of  12  and  25  10-gram  vials  for those  who
prefer to obtain the product in this form.
Specific in pernicious anemia... Developed by the Parke-Davis research
staff in co-operation with the Simpson
Memorial Institute, University of Michigan. . .Accepted by the Council on
Pharmacy and Chemistry of the A.M.A.
PARKE, DAVIS & CO.
The world's largest makers of pharmaceutical and biological products
WALKERVILLE, ONTARIO
WINNIPEG, MANITOBA MONTREAL, QUEBEC (Hatter & ^arara, ^fftfr.
Established 1893
VANCOUVER, B. C.
North Vancouver, B. C.
Powell River, B. C.
DIGIFOLINE "CIBA"
Digitalis—100% of it
Contains  all   the   therapeutically   desirable   constituents   of
digitalis leaves—
Free from irritant substances of the saponin group—
Promptly  and  uniformly  absorbed from the  gastro-intestinal  tract—
Liquid
Ampoules    —   Tablets
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.  -»-»H
=««^^^ra«s
M0sf-»~
NEW WING
Hollywood Sanitarium
LIMITED
^or tKe treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference ~ <23. Q. c£M.edica\ ^Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
W0tS
"«3V

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