History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: December, 1935 Vancouver Medical Association 1935

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 The BULLETIN^
[ OF THE
VANCOUVER MEDICAL
ASSOCIATION
Vol. XII.
DECEMBER, 1935
In This Issue:
COLUMBIA COAST MISSION
AGRANULOCYTIC ANGINA
APPENDICITIS BULKETTS
(With Cascara and Bile Salts)
. . FOR . .
Chronic Habitual
Constipation
BULKETTS POSSESS ENORMOUS BULK
PRODUCING PROPERTIES AND BEING
PROCESSED WITH CASCARA AND
BILE SALTS PRODUCE BULK WITH
MOTILITY.
WE WILL BE PLEASED TO PROVIDE
ORIGINAL CONTAINERS FOR TRIAL
ON REQUEST.
Western Wholesale Drugif|
(1928) Limited
456 BROADWAY WEST
VANCOUVER   -   BRITISH COLUMBIA
(Or at all Vancouver Drug Co. Stores) THE     VANCOUVER     MEDICAL     ASSOCIATION
BULLETIN
"Published ^Monthly under the ^Auspices of the Vancouver ^Medical dissociation in the
Interests of the ^Medical "Profession.
Offices:
203 Medical Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. H. MacDermot
Dr. M. McC. Baird Dr. D. E. H. Cleveland
All communications to be addressed to the Editor at the above address
Vol. XII. DECEMBER, 193 5 No.  3
OFFICERS   193 5-193 6
Dr. C. H. Vrooman Dr. W. T. Ewing Dr. A. C. Frost
President Vice-President Past President
Dr. G. H. Clement Dr. W. T. Lockhart
Hon. Secretary Hon. Treasurer
Additional Members of Executive—Dr. T. R. B. Nelles, Dr. F. N. Robertson
TRUSTEES
Dr. V. D. Brydone-Jack Dr. J. A. Gillespie Dr. F. Brodie
Auditors: Messrs. Shaw, Salter & Plommer
SECTIONS
Clinical Section
Dr. J. R. Neilson   i Chairman
Dr . Roy Huggard Secretary
Eye, Ear, Nose and Throat
Dr. H. R. Mustard Chairman
Dr. L. Leeson   Secretary
Pediatric Section
Dr. G. A. Lamont m Chairman
Dr. J. R. Davies  _ \ —  Secretary
Cancer Section
Dr. J. W. Thomson      Chairman
Dr. Roy Fsggard   l  Secretary
STANDING COMMITTEES
Library Summer School
Dr. G. E. Kidd Dr. J. W. Arbuckle
Dr. W. K. Burwell Dinner dr. j. e. Walker
Dr. C. A. Ryan Dr. Lavell Leeson Dr. H. A. DesBrisay
Dr. W. D. Keith Dr. J. E. Harrison Dr. H. R. Mustard
Dr. H. A. Rawlings Dr. A. Lowrie Dr. A. C. Frost
Dr. A. W. Bagnall Dr. J. R. Naden
Publications Credentials
Dr. J. H. MacDermot Dr. H. A. Spohn
Dr. Murray Baird Dr. J. W. Thomson
Dr. D. E. H. Cleveland Dr. W. L. Graham
V. O. N. Advisory Board
Dr. I. T. Day ReP- to B- C- Medical Assn-
Dr. W. H. Hatfield Dr. Wallace Wilson
Dr. A. B. Schinbein
Sickness and Benevolent Fund — The President — The Trustees ?M PUBLIC HEALTH J
BIOLOGICAL PRODUCTS
Diphtheria Antitoxin
Diphtheria Toxin for Schick Test
Diphtheria Toxoid   (Anatoxine-Ramon)
Scarlet Fever Antitoxin
Scarlet Fever Toxin for Dick Test
Scarlet Fever Toxin
Tetanus Antitoxin
Anti-Meningitis Serum
Anti-Pneumococcic Serum   (Type 1)
Anti-Anthrax Serum
Normal Horse Serum
Smallpox Vaccine
Typhoid Vaccine
Typhoid-Paratyphoid Vaccine
Pertussis Vaccine
Rabies Vaccine  (Semple Method)
INSULIN
Price List Upon Request
Connaught Laboratories
University of Toronto
TORONTO 5 - CANADA
Depot for British Columbia
macdonald's prescriptions Limited
Medical-Dental Building, Vancouver, B. C. VANCOUVER HEALTH DEPARTMENT
ST ATISTICS—OCTOBER, 193 5
Total Population  (Estimated)  244,329
Japanese Population   (Estimated) ;f§;    8,0 3 7
Chinese Population   (Estimated)     7,803
Hindu Population  (Estimated) .,  276
Rate per 1,000
Number Population
Total deaths  i  -~ 200
Japanese deaths -'™  7
Chinese  deaths jg|L  - 8
Deaths—Residents  only  —gL  162
Birth Registrations—Male, 154; Female, 164  318
INFANTILE MORTALITY— October, 193 5 October, 1934
Deaths under one year of age           7 11
Death rate—per  1,000  births       22.01 33.8
Stillbirths  (not included in above)         7 3
CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY
November 1st
September, 193 5        October, 193 5
Cases
Smallpox       0
Scarlet   Fever    21
Diphtheria       - g"      0
Chicken Pox JIL     9
Measles        9
Rubella  i     0
Mumps   pL     3
Whooping-cough    _^^^^.     0
Typhoid Fever  2
Undulant Fever  -    0
Poliomyelitis        0
Tuberculosis   JSL  28
Meningitis   (Epidemic) j     1
Erysipelas    2|b     3
Encephalitis Lethargica   '•       0
Paratyphoid     JsL.    0
, 1935
Octob
er, 193 5
to 15th
, 1935
eaths
Cases
Deaths
Cases
Deaths
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High Blood Pressure... i
BIOGLAN "H" I
rtThe most effective therapy available."
Formula—Each 1 cc. Ampoule contains:
Pancreas           .§&  25 grammes of the fresh hypotensive principle
Anterior Lobe Pituitary..^. 2 grammes of fresh substance
Embryonin   J3L Jig 2 grammes of fresh substance
MADE IN ENGLAND BY
THE BOWSHER LABORATORIES LTD.
Biological and Research
Ponsbourae Manor, Hertford, England.
Rep., S. N. BAYNE
1432 Medical Dental Building       Phone Sey. 4239       Vancouver, B. C.
References: "Ask the Doctor who has used it."
Page 46 ANGLO-FRENCH DRUG CO., MONTREAL VANCOUVER MEDICAL ASSOCIATION
Founded 1898    ::
Programme of the 3 8 th 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 the evening.
1935.
October 2nd—GENERAL MEETING.
Dr. G. F. Strong: "Cardiac Pain."
Discussion opened by Dr. H. A. DesBrisay.
Dr. A. M. Agnew: "Vaginal Plastic Surgery."
Discussion opened by Dr. J. J. Mason.
October 15 th—CLINICAL MEETING.
November 5th—GENERAL MEETING.
Dr. J. R. Naden: "Epiphyseal Injuries."
Discussion opened by Dr. F. P. Patterson.
Dr. J. H. MacDermot: "Early Medical History of the B. C.
November 19th—CLINICAL MEETING.
December 3rd—GENERAL MEETING.
Dr. Lyall Hodgins: "Diabetes."
Discussion opened by Dr. Wallace Wilson.
Dr. Frank Turnbull: "The Early Diagnosis of Brain Tu
Discussion opened by Dr. F. W. Emmons.
December  17th—CLINICAL MEETING.
1936.
January 7th—GENERAL MEETING.
Dr. Walter M. Paton: "Tumours of the Head and Neck
Discussion opened by Dr. H. H. Pitts.
Dr. B. J. Harrison: "Roentgenology of Cardiac Diseases."
Discussion opened by Dr. G. F. Strong.
January 14th—CLINICAL MEETING.
February 4th—GENERAL MEETING.
Mr. J. W. deB. Farris: "Medico-Legal Problems."
February 18th—CLINICAL MEETING.
March 2nd—OSLER LECTURE.
April 7th—GE&RAL MEETING.
Dr. C. E. Dolman: "Serum Therapy."
Discussion by Dr. Howard Spohn and Dr. A. Y. McNair.
April 21st—CLINICAL MEETING.
April 28th—ANNUAL MEETING.
Page 47 EDITOR'S PAGE
Human nature would seem to be divided into two classes: the first, of
which the present writer is a notable example, having as its motto "What's
the hurry?"; exemplified, too, by the coloured brother who, when exhorted
by his wife to clean up the back yard, demurred, on the ground that he
"favoured lettin' de wind blow de trash away."
No doubt this is the nobler attitude, but it is not the attitude toward
life of the second class, which is full of energy, restless, always trying to
change things, always, like Father O'Flynn, "helpin' the lazy ones on wid
a stick."
It is, we suppose, a matter of endocrines; at least that is the modern and
scientific explanation. Our fathers had a simpler explanation, based on the
idea of original sin—but for ourselves we prefer to put it down to endocrines.
In any case, it is a good things for progress, and for the world at large,
that we have these uneasy spirits abroad in the land, as otherwise nothing
would get done.
Such an uneasy spirit is the new Director of Anti-Tuberculosis work
for this province, Dr. William H. Hatfield. We do not know his exact title,
but it really doesn't matter; he doesn't need a title anyway. One often
wonders whether this gentleman ever sleeps at all, or whether he simply
closes his eyes, the better to think up new schemes for the morrow.
He has made tuberculosis the livest issue in public health today. He has
lectured and worked and inspired others to work, without ceasing and
without rest. He has organised displays and tuberculosis clinics, and publicity campaigns. He has made the Clinic for Diseases of the Chest one of
the most efficient to be found anywhere.
His latest achievement has been, in these times of deep depression, to
wring out of a more than reluctant Government an appropriation to build
an addition to the Tuberculosis Hospital in Vancouver.
Working as the guiding spirit of the Tuberculosis Division of the
Greater Vancouver Health League, he has brought home to every citizen of
Vancouver the urgency of this problem.
In the school and other surveys of the city he has been instrumental in
bringing about a result which should be a matter of pride to every one of
us. The distribution and prevalence of tuberculosis have been more and
more completely explored and charted, till we have reached in this city a
level of thoroughness that obtains nowhere else in the civilised world; a
higher level than the one set out as an ideal by the leading health authorities.
Of course, he did not do all this by himself; he has had most able support,
both by health authorities, and by laymen, as well as by other medical men.
Hon. Dr. G. M. Weir, Provincial Secretary, has been quick to recognise and
support Hatfield's work, and with Dr. H. M. Cassidy, Director of Social
Services, has given him indispensable aid. On the lay side, too, such men as
Mr. W. C. Mainwaring have been the all-important links with public
organisations and the laity at large.
Nor is tuberculosis the only field in which outstanding work is being
done. We are singularly fortunate in British Columbia in having a number
of men especially fitted by training and inherent capacity to take the lead
in other public health matters. For example, Dr. B. J. Harrison, Director
of Radiography at the Vancouver General Hospital, who, with Drs. G. F.
Page 48 Strong, H. H. Milburn, H. H. Murphy of Victoria, and others, have done
such excellent work in establishing the B. C. Cancer Foundation, which is,
we believe, destined to be one of the big achievements of the present day.
Again, in Mental Hygiene, the work being done by Dr. A. W. Crease
of Essondale Mental Hospital, and Dr. W. Stewart Murray of Vancouver,
is full of promise. There can be no more important or urgent problem, of
the many that face society today, than this problem of prevention of mental
disease, and no better men could be found to tackle it.
Tuberculosis, cancer, mental disease, venereal disease—the four great
mountains which preventive medicine has to scale and conquer. More, much
more, than a start has been made on the first three—at present in the last
one B. C. is a long way behind—but it will catch up, and Heaven speed
the day.
One word of warning: these are provincial matters, not confined to
Vancouver. While, as the largest centre of population, our responsibility is
very great for initiating and carrying on these various activities, we must
take a wide view, and must, by our willingness to co-operate, and to sink
our individual interests in the wider scheme, shew the way to the Province
at large, secure its widespread confidence and support, and so secure our
object—a greater measure of public safety.
NEWS AND NOTES
The Annual Medical Dinner of the Vancouver Medical Association was
held in the Spanish Grill of the Hotel Vancouver on Friday, Nov. 22, 1935.
There was a record crowd; sometimes it seemed twice as large as it
actually was—an optical phenomenon that is rather hard to explain. Sundry
of the brethren were a bit noisy at times. They had some difficulty, it would
appear, in making themselves heard, with all the clatter going on of speeches,
and the programme arranged by the committee for the entertainment of the
majority. We would meekly suggest that another time they go and tell their
woes to the moon in some other place and leave the "dumb, driven cattle"
to enjoy themselves in their rather more monotonous way.
Still, it was a very good Dinner, and ranks with the best. The efforts of
Dr. Leeson and his committee were thoroughly appreciated, as was shewn
by the happy laughter that greeted the various stunts, which were well
executed in every particular. The political scene was particularly well done,
and was very funny.
Dr. Gordon Large sang, and one can only admire his courage in persevering in the middle of a hubbub that made it impossible for him to be heard.
Turning to more serious topics, the two outstanding features of the
evening were the conferring of the P.G.F. degree, and the presentation of
plaques bearing the bust of Sir William Osier, to the Osier Lecturers of the
Association.
As regards the P.G.F. degree, the recipient this year of this honour,
which is our own unique gift, was Dr. W. T. Lockhart, introduced by the
President, Dr. C. H. Vrooman, in a very neat little speech.
No more happy choice could, we think, have been made, and no man
could better typify the ideals of the degree. If any man ever "deserved well"
of the Association, it is our worthy Treasurer, and as a "good fellow" he in
every way measures up to specifications.
Dr. F. Brodie spoke briefly, outlining the history and purposes of the
Page 49 Osier Lectureship. His speech was altogether too good to have been given
in the surroundings. The hilarious minority referred to above applied closure
to any attempts at speechmaking, and much of Dr. Brodie's really fine
speech was lost.
The plaque given is a very neat thing, and should be seen by everyone.
We regret to record the sudden death of Dr. R. C. Boyle, of Vancouver.
He has been for many years an outstanding figure, not only in medicine, but
in the community at large. For many years he had one of the leading practices, but of late has been far from well, and his death was not unexpected.
We extend to his family our sincere condolences.
Dr. Ingham, of Nanaimo, also died recently. He was a very well-
known medical man on the Island, and had practised in Nanaimo for
many years.
Dr. Pinkerton has recently been appointed Medical 'Officer for the
Imperial Oil Co. at loco.
Dr. C. G. McLean, late of Woodfibre, has returned from an extended
postgraduate trip. We understand that he proposes to start special prac|pl||
in dermatology in Vancouver.
Dr. A. J. McLachlan, Registrar of the College of Physicians and Surgeons, whose arm is now quite well, has recently returned from a trip
through the interior of B. C. He saw practically all the medical men there
were, and discussed medical economico-political topics with them.
We would call to our readers' attention the fact that the sale of Tuberculosis Christmas Seals is now a matter for their earnest thought. This is
an excellent and almost painless way of raising money for anti-tuberculosis
work, and we urge on all the necessity for doing their utmost to promote
the sale of these.
RECENT ADDITIONS TO THE LIBRARY
Bargen, J. A.—Management of colitis. 193 5.
Griffiths, H. W.—Injury and incapacity. 193 5.
Hinman, F.—Principles and practice of Urology. 1935.
Jellife, S. E., and White, W. A.—Diseases of the nervous system. 6th ed. 193 5.
Holmes, G. W., and Ruggles, H. W.—Roentgen interpretation. 1931.
Marriott, W. McK.—Infant nutrition. 193 5.
Piney, A., and Wyard, S.—Clinical atlas of blood disease. 3rd ed. 193 5.
Todd, J. C., and Sanford, A. H.—Clinical diagnosis by laboratory methods. 8th ed. 193 5.
Wechsler, I.—-Textbook of clinical neurology. 193 5.
Whitman, R.—Orthopaedic surgery. 9th ed. 193 0.
NICHOLSON FUND
Albutt, Sir T. C.—Greek medicine in Rome.
Aitken, D. McC.—Hugh Owen Thomas, his principles and practice.
Canneff, Wm.-—Medical Profession of Upper Canada, 1783-1850.
Frazer, J. G.—The Golden Bough.
Newsholme, Sir Arthur—Evolution of preventive medicine.
Power, Sir D'Arcy—Selected writings. 1877-1930.
Watson, F.—Hugh Owen Thomas, a personal study.
Page 5 0 THE EARLY MEDICAL HISTORY OF THE
B. C. COAST
By Dr. J. H. MacDermot
Vancouver, B. C.
The paper I am reading tonight is in a sense a departure from the type
of paper usually presented before this honourable body. It will not advance
your medical or scientific knowledge at all; it will not, perhaps, increase
your ability as medical men; but, however badly I may fail in the telling of
my story, it is one of the stories that needs to be told. It is a human document written with the spiritual ink of a man's lifetime devotion, and will,
I believe, prove a source of interest as well as pride to all of us who as citizens of British Columbia are interested, not merely in its medical history,
but in the development and growth of this great province.
The title is rather a misnomer, I fear, but I had great difficulty in
choosing a title, and this seemed as good as any. Perhaps the word "early"
should be left out and "The Medical History of the B. C. Coast" left as the
title that would describe this paper.
As a matter of fact, I have had grave doubts as to whether I should
write this paper or not, since so much depends on the way in which it is
written, and it has been gradually borne in upon my reluctant soul that
my abilities are somewhat deficient. The paper should have been written,
for instance, by a Kipling, whose vivid journalist's eye and power of pictorial expression would bring before your mental vision living unforgettable
pictures of what is one of the romantic and fascinating stories of our time.
It should have been written by a poet, who, from the thrilling deeds of
patient, quiet, unassuming heroism, could fashion an epic of our western
coast that would stir men's admiration and compel their homage—for there
is an epic quality in the story I have to tell. It should have been written by
a historian who would see and assign to the characters in this account their
proper place in the history which they have helped to make. There are
elements of drama in it—of sea-lore, of humour, of adventure—which
demand a Barrie, a Conrad, a Robert Louis Stevenson, and a W. W. Jacobs
all rolled into one. I apologise sincerely, gentlemen, that instead of all these
you have only me—neither poet, nor playwright, nor historian, nor spinner
of yarns—merely an admirer of the man of whom I write, and erstwhile a
humble participant in the history of his doings. My only excuse is that for
years I have felt that some account should be written of what is a really
significant piece of British Columbia history.
Significant from a sociological point of view, for it has made normal
social and family life the rule up and down the Coast, instead of the exception, and has been the means of eliminating and controlling a great many
vicious and antisocial conditions that existed before it came and made a
festering sore in our body politic.
Significant from an economic point of view. It has led to the establishment of settlements, to normal methods of trade, and has been the means
of bringing many hundreds of thousands of dollars of business to Vancouver and the Coast.
Significant from a medical point of view, since it has established a chain
of hospitals, well equipped and staffed, ready for practically any work, in
Read before the Vancouver Medical Association, November 3 rd, 193 5.
Page SI an area which cannot be served ||l any other way. The operation of these
will be explained later, but it is obvious that if the Coast was to be settled
at all the first essential was a good medical service.
Significant from what might be termed the spiritual point of view, and
here I am not referring to the religious aspect of the work—at least I do
not limit my application to that. A brief story will illustrate my point.
On board the Mission ship Columbia a priest of the Church of England,
robed and vested, had just commenced his sermon when an urgent call for
help came through—some man was badly hurt in the woods miles away.
The service was over. Throwing off his cassock and surplice, the skipper
dashed to the pilot house, rang up the engines, and was off within a few
minutes. "That," came the gruff remark from a hardened old sinner of a
logger, who in some manner uncomprehended by himself had been cajoled
into coming to the service, "is the best damned sermon I ever heard."
There is a vast significance in this, and would that all our clerical friends
saw as clearly.
The coast of B. C. as one goes north and west from Vancouver is one
of the richest as well as one of the most beautiful areas in Canada. It has
been compared to the coast of Norway, but it is in no need of comparison
to any other coast—it is sni generis. Great inlets, at intervals along its
length, burrow deep into the mainland, and multiply greatly the total
length of shore line. This has made its treasures of forest, mine and sea,
which are extremely great, much more accessible, and for many years men
have hewn trees and dug ore, and netted fish, to their exceeding profit.
But these are hazardous occupations and one does not gather wealth
along this coast without great risk to life and limb, and when accidents
happen it is a long way to Vancouver or Victoria and the weather is not
always calm and conducive to quick and easy travelling. It is a great country
for wind and contrary tides and fog and snow, and sometimes it is a matter
of days before a boat can reach town with the injured man. Similarly, it is a
hard country for women and children—in the absence of doctors, hospitals
and nurses it is more than hard, it is dangerous, almost impossible. Before
the Columbia Coast Mission came, the only medical supply was the hospital
ticket sold by St. Paul's Hospital, which entitled the holder to care in case
of accident.
And so in the days before the Columbia Coast Mission began its work,
the Coast of B. C. was a very hard place for men to live in. For a man
requires more than work and a bunkhouse to which to return for his meal
and to sleep.
So that any organization which has made home life possible and reasonably secure, and has mitigated the horrors of the serious accidents that
happen so easily when a Douglas fir playfully rolls over you, or a dynamite
charge hangs fire and waits for you to come within easy reach before going
off, is a contribution to the life of the Coast which cannot be measured in
terms of money, but of human life and happiness, and must be reckoned
among the great constructive factors of the development of the province
of British Columbia.
It was a realization of this need and these facts that led the Rev. John
Antle, in 1905, to make his first start on what has since materialised into
the Columbia Coast Mission, an organisation which serves the Coast from
Jervis Inlet to Queen Charlotte Sound with hospitals, doctors and nurses,
as well as with help and comfort in their spiritual necessities, and in putting
this last I do not in any way attempt to belittle it. For there can be no doubt
Page 52 that even from our point of view as medical men, and that is the view I
am compelled to take at present, the omission of the spiritual side of the
service performed by this magnificent organisation would militate greatly
against the success of the physical and medical side. For not only material
aid, not only religious services have been supplied, but social service, efforts
towards culture and education; steps have been taken of incalculable value
in the removal of anti-social and degenerative agencies which were injuring
the life of the Coast, and higher standards of living have been made possible.
For there were various grades of men who went up the Coast in those
old days. There were those who went to secure wealth and to this end hired
men and invested money and did great service by so doing. The Hastings
Saw Mill, the International Timber Co., and many others, have developed
the Coast greatly, and led to the employment of thousands. They have been
public-spirited, too, and have contributed to the health and happiness of
their workmen, but they were and had to be stern taskmasters and they
drove men hard, and there was little softness or mercy in the lumber camp
or the mine stope, beyond a rough kindliness and comradeship. These men,
however, appreciated the work of Antle and helped to make it possible,
more or less unwillingly at first, till they saw its value.
Then there were those who went as workers, and one sees easily their
need of Kelp.
Then there were those who saw in these\inen a source of easy and malodorous gain. The saloonkeeper, the brothel-keeper, the tinhorn gambler—
these bloodsuckers found an easy prey in the lumberjack and the miner.
A chain of saloons in the guise of the so-called hotels—which had rooms
mainly because only by having a hotel to which to attach it could one obtain
a liquor license—fined the Coast and plundered-these men of their hard-
earned money. This is in no way a prohibition address—but one need not
have been a fanatic on mis subject to condemn and deplore the state of
affairs in this regard. The logger and miner makes his money hard, and in
conditions and surroundings of discomfort and danger and dreariness which
leave him, more than most men, open to the allurements of those who batten
on his weaknesses.
Much has been said and written about the wildness of life, the swashbuckling, rip-roaring habit of the logger, the miner, the pioneer in general.
These men are like ourselves, and of like passions, as also of like virtues.
But there was nothing in. their life to sublimate these perhaps irregular and
even dangerous instincts. As I remember the Coast in the early days, about
the only outlets a man had through which to release his pent-up steam, which
through long, dangerous, exhausting days in woods and stope and fishing-
boat, had slowly risen in his boilers, mental and physical, were drink and
poker and the companionship of some light o' love. These men were young
and vigorous and demanded a satisfaction, not only of bodily wants, but
of spiritual needs, and this not in terms of preaching or conventional religion,
but of companionship and the satisfaction of that instinct which for want
of a better word we call domestic—the instinct that clamours for a home,
with Its fun and affection and ease of body and mind and soul. Not being
able to get these they slaked their thirst at unauthorised and impure sources.
Because the potion was not in the long run really satisfying, and was even
dangerous, they the more loudly proclaimed its virtues.
But there was one man who went up the Coast for other reasons—not
to make or earn or steal money, but to help those who needed help, physical,
moral or spiljtual. I do not say he was the only man who had wanted or
Page 53 tried to do this, but up till that time he was the one man who had combined zeal for men's spiritual welfare with vision, wisdom, tolerance and
practical commonsense. He saw and said frankly that to approach this
problem from a purely religious standpoint, as we use the word religious,
would be futile. These men were impatient and intolerant of the time-
honoured church methods, and would not listen to sermons or religious
services. He got his clue from a sight that moved him very deeply, while
waiting on the dock for a boat to land. In his own words:
"One day along about 1903 the little Cassiar steamed into port from the
logging route with four dead men on board, victims of a careless method of
logging and an absence of safety devices which today seems unbelievable.
The papers, which otherwise ignored the logger—the passenger list would
read Mr. So and So and Mr. and Mrs. So and So and twenty loggers—
featured the circumstances of this particular killing. It was good copy. One
had bled to death in an open boat trying to get to the mail boat and Vancouver. Another had died in his bunk for lack of surgical aid, while waiting
for the boat's arrival, and so on. It was not very unusual to the average reader
of the local papers, but to me it seemed incredible. Four thousand men in
the camps, working in the most dangerous calling in Canada, and the nearest
doctor from fifty to three hundred miles away. What was to be done?"
This gave him a definite focus for his energy and he started on the road
on which he has never paused and from which he has never turned aside.
Only a man of high idealism, indomitable courage, and warm human
sympathy, could possibly succeed in such a venture. Many might see the
vision, but to carry it out meant dreariness, drudgery, discomfort, discouragement, not only from one's enemies, but from one's friends and supporters. It meant hardship and self-denial of the comforts of home; it meant
constant, relentless opposition by the reactionary forces of greed and vice—
so courage was needed, beyond the ordinary degree, the courage that holds
on "though thre is nothing in you except the will that says to you, hold
on!" But idealism and courage would alike have been wasted if there had not
been sympathy and understanding and tolerance that were so urgently
needed. The priest and the Levite had idealism and courage—but they lacked
the human warmth and sympathy which could be translated into helpful
action. They saw only the interruption to their high thoughts and the
danger of soiling their hands with the grime of the gutter. The Good
Samaritan turned in and helped.
Rabindranath Tagore, speaking to the priest, says:
"Leave thy chanting and singing and telling of beads . . . What dost
thou do in this dark temple, with its incense? Open thine eyes, and see that
thy God is not before thee.
"He is there where the tiller is tilling the soil . . . come down and
stand beside him in his toil and the sweat of his brow."
Antle took this advice, and thereby proved his fitness for the work.
No other course of action would have been of the least value and mere
good intentions and high ideals would have been of little or no avail. The
success of Antle in his field can be understood by anyone who has ever
worked with him. No call, however trivial or serious, ever found him unready or unwilling to go. No difficulty, personal discomfort or danger ever
daunted him for a moment. No fog was too dense, no wind too high, no
seas too rough to hold him back when a message came for him to go—and
the present deponent can testify to his uncanny sense of direction and his
amazing skill in navigation—^inherent, no doubt, in the man as the legacy
Page 54 of a long line of Newfoundland forebears. And the trip by water was only
part of it. Often doctor and skipper and engineer had to accompany a guide
over a rough trail, sometimes in tip black of night, to the place in the woods
where some unfortunate logger lay too badly hurt for removal, until bones
had been roughly set, morphine given and some steps taken to prevent too
serious shock. The skipper always took his full share, and more besides.
Nor was it all smoothness of sa|J|ng in. the other departments of the
work. If there had been only these physical difficulties with which to contend, things would have been far easier, but there were wars without and
fears within—opposition from those on whose toes this newcomer trod,
fire from the jaws of the dragons who stood in the path of this St. George—
not to speak of financial lions in the path, and the innumerable problems of
administration. How did he win through?
First he identified himself with the life of the Coast. He was no sideline
coach—no theorist—he was a part of all that he met, like Ulysses. In the
words of Chaucer, writing of his good old priest in the Canterbury Tales:
The life of Christ and his Apostles twelve
He taught, but first he followed it himself.
He met the problems of the Coast as a man living amongst them. He knew
the Coast, every inch of it, and he knew the conditions under which men
and women lived there. The only place one could never find him (and this
is still true) was in Vancouver, where his headquarters were. He has always
left it to others to look after administration, while he himself has been out
in the thick of things.
He has been everything by turns, pilot, cook, nurse, engineer, parson,
ambulance man, first-aid expert. He has helped to pull teeth and give
anaesthetics.
He has not been at all burdened by his cloth—professional dignity had
to take its chance. His attitude is best expressed by a story told of him
once: When in a tight spot he and another man were in a small boat, leaky,
and in a storm. The other man, feeling that perhaps the presence of a clergyman made it incumbent on him to think of religious matters, suggested
that they offer up prayer. "You can't do that now," said Antle. "You
never prayed when you were safe, and anyway that's not your job now—
your job is to bail out this boat, and never mind praying."
His first step was to make a complete survey of the Coast, which he
did in a small open boat fourteen feet long which he had built himself in
his back yard two years before. Installing a "i/A h.p. gas engine, he started
out with his small son. There is no room here to detail his adventures, which
mieht well have furnished forth a tale in the case of a man more conscious
of the charms of publicity; but occasionally in the pilot-house at night with
pipes going and all lights out, the skipper could be induced to spin a yarn,
as of when in the whirling Seymour Narrows he and his little boat cruised
round and round the whirlpool in company with a big cedar log. The boat
had an engine, the cedar log had none—so after a while the cedar log was
drawn into the centre, upended and disappeared. The man in the boat kept
his" cockleshell on the outer rim of the whirlpool and prayed grimly that
the engine would keep on firing—his small son slept peacefully in the
bottom of the boat—well, the engine kept on and after a while the tide
slacked and so the skipper went on. This reminds me of a story told by
Antle about himself.
Someone heard that he was going to take up this work, and as part of it
run a boat equipped with a gasoline engine. "Aren't you a parson?" he said.
Page 55 KKIL
1 III
"Well, you won't be one very long if you are at all intimately connected
with a gas engine." "That," says Antle, "was 28 years ago, and I am still
rated as a clergyman, but it has been so sore a struggle at times that I can
quite understand what St. Paul meant by his 'thorn in the flesh'."
He had chosen a parish which extends from Pender Harbour on the East
to Queen Charlotte Sound on the West, takes in the northern coast of
Vancouver Island, myriads of islands and the long inlets of the mainland
with their lumber camps and fishing stations and small ranches and mining
camps. The parish had a population then of some 5000 souls, mostly loggers,
fishermen and miners, with their families. Powell River was a good place
to fish and to shoot goat and deer—but there was no mill there then and
no hospital.
It is a difficult parish to cover. There are no cities, no roads except trails,
no large settlements. Like Venice, its highways are the sea—but it is a
trapped and dangerous sea, always chafing at its restrictions and at the
bounds which, as the Psalmist has it, "Thou hast set it its bounds that it
may not pass." But it never gives up trying, and tides rise high and struggle
mightily with contrary winds in long narrow guts and channels, and water
boils white and foaming in Hole in the Wall, and the Yuculta Rapids and
the Skookum Chuck. These things do not matter much where one has time
to wait for slack water, and a skilled pilot, and a crew, and can choose
one's time of day. But when one has an urgent call from some poor wight
who lies with a smashed leg or a broken body, or from a woman in childbirth, when the red gods of disease and death call, one must go, and stand
not upon the order of his going. Day or night, slack or full tide, calm of
storm, the hospital ship must go the shortest way and keep moving. Fogs,
too, do not add to the ease of navigation and they are common in these
parts. Snowstorms perhaps are the worst foe the sailor knows, worse than
fogs or winds, in these narrow crooked water ways, and it needed more than
an enthusiastic amateur to tackle their job in the only way it could be
tackled.
For Antle saw clearly and at once how to meet his problem. He had
first to have fixed stations, bases, where he would have well-equipped hospitals, and competent doctors and nurses. Then he must have a mobile
collecting agency—a hospital boat. This must be staunch and seaworthy,
moderately fast, and well-engined, yet within his means, which were somewhat limited. It must be a floating hospital, for life or death would hang on
the first-aid given to the casualty. It must carry a doctor, and be adequately
equipped.
There is perhaps no more fundamental law of the universe than that
which decrees that there is always a man to meet the need. Thomas a
Kempis gives the obverse: "Opportunity does not make a man frail, it
merely shows us what men are." So opportunity does not train men to be
good; it merely shews a man what he has in him.
One could hardly, in the length and breadth of Canada, have found a
man who would more adequately and exactly meet the needs of this particular situation. Antle is a Newfoundlander, born and brought up in the
crow's nest of a fishing schooner. He could, as a youngster, sail and handle
a boat in fog, in snow, in wind—three things that make the Newfoundlander one of the best seamen the world has ever known. The navigation of
our coastal waters, which to the ordinary landsman seems well-nigh miraculous, and to the deep-sea sailor, especially if he be recruited from His
Majesty's naval forces, as he so often is, is a matter for everlasting objurga-
Page 56 tion and damnation, came quite natural to Antle. He has a very remarkable
sense of location and is quite infallible if he depends on his own judgment,
and does not ask advice. I should have liked, if time had permitted, to
recount an anecdote or two concerning this. So he was ideally suited for the
navigation part of it.
Then he is an able ship designer and builder—and himself designed the
first hospital ship, as well as the second. Having been M.O. on the first, I
can testify to its beauty, its comfort, its safety, and its amazing roominess
for such a small craft.
So the second difficulty was overcome. Then came one of the major
lions in the path. How was this to be financed? When Antle first broached
the matter to the Synod of his church, they threw up their hands in horror.
Where could we find bread to feed so many that everyone might have a
share? It was the same question with which the Apostles faced the Master,
when he bade them feed the multitude. It was answered in much the same
way. Antle has a simple faith, simple and in some ways child-like. He
believed God had commissioned him to do this work, and he believed, like
Abraham of old, that God would provide. The answer lies in the following
figures.
There have been three hospital ships built, and three mission boats for
the purely missionary part of the enterprise.
Five hospitals have been built at various times, and a sixth at Van Ancla
was made from a building already there.
All these hospitals and ships have been completely equipped, mannc 1
and staffed. They stand ready to tackle any emergency and this is said practically without reservation. This is a fundamental principle with Antle, whc
will not have any cheapness about his enterprise.
The budget of the Mission amounts to some $60,000 annually; some
years as high as $65,000.
It has been in existence since 1905, a matter of thirty years. During that
time the ravens have never ceased to feed this Elijah.
He has proceeded according to a simple and, to him, logical and sufficient
method. This has been always the same. He has built the ship, opened and
equipped the hospital, bought the supplies, first, and collected the money
afterwards. This is not, we may remark, the usual method, even of the
organised Church, which usually likes to have the money in the hand before
it starts building. But it is the method that Antle has adopted, and thirty
years is quite a good stretch of time.
I have asked him where he got his money—he does not himself know
exactly or even approximately. Not from the patients treated—that is quite
definite. He has made trips every year or so to the East and to England and
has always come back "with the bacon." He is the most inarticulate man
in the world when it comes to talking of his own share in the work, and I
have never heard him utter a single noble ideal or high-sounding phrase—
but he has, in some magic form, the gift of convincing people that this
work is the work of God, and the money comes.
In later years the Columbia Coast Mission has been to some extent
reorganized (a vile word) and put on a more practical basis—methods of
financing of a more business-like nature are being adopted. I do not think
the skipper likes this, and I do not believe myself that it is the right way.
Of course, there have been times when the wolf was not so far from the
door. One hospital in which I worked in the far-off days of 1907-8—the
busiest of the lot—was scandalously short of the most elementary necessi-
Page 57 ■I ■.■•»! I
ties. It was a hard winter, and night after night the temperature was below
zero, not only outside but in the main ward, where it fell frequently as low
as 3° below, though a red hot stove (outside the door) threatened destruction of the building. It was a small stove and might have been more useful
inside the ward. We had an acute rheumatic case who needed heat. There
were only three hot-water bottles in the place and one leaked. There were
only six sheets (three flannelette) for 13 patients, and blankets had to do.
The water in the pipes froze, and the sanitary arrangements were plugged.
It was a tough spot and one had to forget all one's dignity as a doctor of
medicine and become a plumber and water carrier. It was very good for
one's soul.
To return to our history. The first effort was a hospital boat, designed by
Mr. Antle and built according to his plans. Dr. Hutton was the first doctor.
He came from Winnipeg. He was a victom of the accident which befell the
boat on which he was in Burrard Inlet and was drowned.
The first hospital was built at Rock Bay by the Hastings Saw Mill Co.
who had big timber limits there and maintained several logging camps. The
nursing was provided by the Victoria Order of Nurses and the first nurse
in charge was Miss Kate Franklin, an Englishwoman trained at St. Bartholomew's Hospital. She has recently died.
Miss Franklin was an exceptional woman and pat to the occasion. At
first there was no doctor, and she had to be first-aid expert as well as nurse.
She had a strong will and a firm way with her, and she kept these unruly
children in good order. They gave her an obedience that no doctor could
secure.
Rock Bay Hospital soon became the active centre of the hospital system
of the mission. Geographically, it is in a particularly favorable position,
being about central for all logging camps in the area, and with good harbourage for any boat. One of its first doctors, in fact the first resident doctor,
was Dr. D. P. Hanington, late of Kimberley, and now at Ladysmith. He
married later one of the nurses, Miss Riddoch, who followed Miss Franklin
as matron, and did excellent work. Dr. Alan Beech, of Ashcrof t, also served
at Rock Bay, and Dr. C. T. McCallum of this city was there for a while.
Van Anda was the next hospital, and I was the doctor there for a year
or more. The building used there was a schoolhouse, and when made over
became a comfortable and roomy small hospital. The village of Van Anda
at that time had some three to five hundred souls, and an active mine, Marble
Bay, employed some hundred or more miners, and contributed to our support. When Powell River became a town later on wit|| its own hospital, the
Van Anda institution became superfluous and was closed. Dr. G. E. Gillies
of this city and Dr. B. B. Marr of Langley were at Van Anda at various
times.
Alert Bay was the next site for a hospital, and was perhaps most needed
for Indians, fishermen, and also loggers. There is an Indian village here and
a great showing of totem poles. The outside of an Indian village with its
gaudy totem poles is quite the most attractive part. The Coast Indian is not
exactly the most pleasant of patients. For one thing, he always arrives with
the whole clan or tribe in tow. The prevailing wind, when an Indian is
around, is always in one's own direction, and is always loaded ,#fbh an ancient
and fishlike smell of Shakespeare's Caliban. One Indian is bad enough; a
whole tribe sitting in the waiting-room is unspeakable. I can remember yet
one aged squaw who consulted me on account of what her alleged husband
spoke of as a bad stink. I feared that if it was too much for his hardened
Page 5 8
MB-fa olf actorium, it would be bad—and it was. It was a case of carcinoma of the
cervix—and it was the quintessence of all cases of carcinoma of the cervix—
and you all know how bad that dan be.
TheygBave, however, sheetli|ied interiors. One man came with a skin
condition of some kind, I forget what. I gave him twelve large sized bichloride tabletSfctelling him most emphatically not on any account to drink them
but describing in meticulous detail how they were to be used. I also
instructed all his relatives to the same effect. But I did not know what I
learned later, sibat an Indian only has one use for medicine of any kind, and
that is to drink it. Well, I hardly expect you to believe it, and I find it hard
to believe myself, but some days later they brought back a very emaciated
Indian who, they declared, had drunk three or four of the tablets (in the
solution I had described). He recovered nicely, though I have known one
of these cause death in a white person. He refrained, apparently, from drinking the lot, because it gave him a lot of pain in his middle every time he
drank a j&um of the mixture, and caused an almost continuous diarrhoea,
which undoubtedly saved his life.
Speaking of Indians brings up one of the ways in which Mr. Antle was
able to help these people. The "Potlatch" is an old religious custom of the
B. C. Coast Indians, and amounts to the choosing of a chief for the coming
year. The original idea of the "potlatch" was a very good one. The man who
gave away the most wealth, in blankets, canoes, fish, and other gear, was
the best chief—perhaps because it meant he was the richest and most
important person—but partly because it meant he was the most generous
person, and the greatest benefactor of the tribe. But elections have a demoralising effect, it would seem, in all countries and amongst all peoples. The
campaign fund is a source of great possibilities for corruption, as we have
often been told, and it was so here as with the white people. For in order to
secure votes and become chief, it became necessary, as the years went by,
to bid higher and higher. Competition became very keen, and the sinews
of war had to be found. So they accepted the ad/vice of Horace, in reverse
as it were, who said: "Get rich—honestly if you can, but at any rate get
rich." So they felt that they had to have plenty to give away, honestly
acquired if possible, but that at any rate they must get the stuff. So they
acquired it in ways that hardly commend themselves to the strictly honest
mind. They stole—at least we should call it stealing; they gambled, and they
prostituted their women-folk. So they became badly demoralized, and the
pllaian population became a menace to themselves and to others. At this
point the Government, as guardian of the Indians, stepped in, and stopped
"potlatch" altogether. Their motive was the right one, but it was wrongly
carried out, with a complete, almost brutal lack of sympathy and under-
|l||inding. The Government failed to remember that this was more than
simply an election, that back of it lay a tribal religion and an old custom
that had deep roots and profoundly affected the life of the people. Its
withdrawal was too sudden and too complete, and left the Indians unhappy
and resentful. One Chief spoke to Mr. Antle about it, and found in him a
sympathetic friend who has been trying since then to mitigate the rigour
of legalism with some of the mercy of understanding.
As regards the medical work itself—this is of the most varied order.
Naturally, the hospitals have to deal chiefly with emergencies, and they are
admirably equipped for this purpose. But they are by no means first-aid
stations. For example, on the list of one hospital's work for one month, we
find a blood transfusion given to a very serious case of haemorrhage follow -
Page 59 ■r
m\
ing an accident, a spinal anaesthesia administered to another, two obstetric
cases, a fractured skull with middle meningeal artery operated on, several
teeth extracted, a woman severely ill (it does not say with what) and
"maniacal cases."
The total for a year, 1931 say, is as follows:
Medical  cases,   287;   surgical,   338;   out  patients,  2978;   child
clinics, 64. Total, 3664.
The hospital ship travelled 19,716 miles this year, of which 1300 miles
were for emergency long-distance runs; it attended to 1112 cases.
You will notice the child clinics. The attitude of this organization
towards medical matters is to keep absolutely up-to-date. Its superintendent
will have nothing less. Preventive medicine is to him an important feature
of the work, and his hospitals, doctors and nurses act as educational agencies
in the community in which they work.
There can be no question of the value of such an organization from a
medical point of view. It is an excellent scheme. But there were and are
other needs to be filled.
The Columbia Coast Mission was established primarily to give to the
settlers of the Coast conditions whereby their life might be safer, fuller,
happier, and more nearly normal life. Its work was not intended to be merely
medical—though this was perhaps the first step that had to be taken. There
is a great deal between birth and death besides being sick and having accidents happen to one, and the Columbia Coast Mission saw that all needs had
to be supplied. Mere human fellowship is sometimes quite useful—dances
and concerts and Christmas trees for the children all have a vital place in
life; books are a primary necessity of life, and the C. C. M. established
libraries and carried papers and magazines by its ships to logging camps and
villages and so on.
There have been weddings to be performed, christenings and funerals,
and this is all part of the routine work of the C. C. M.
The Mission ships attend, too, to the spiritual needs of the parish, in the
form of services and pastoral visits.
But this has not all been done without considerable friction and at
times open war. The forces of reaction and greed did not lightly yield to
this new and disturbing broom—and for many years Antle had to wage
quite a fight. I cannot go into this here—there is no time—but in those
early days everything was done to block and interrupt Antle's work; even
political departments were enlisted against him. Antle, however, never lacked
courage and persistency, and he stayed with it. He found in Mr. Bowser, then
Attorney-General, an invaluable ally and a wise counsellor. He succeeded,
partly too, I always think, because he had a sort of sneaking sympathy for
the sinners he was dislodging. They fought him and he fought them, but
he always had a grin on his face when he was doing it, and his method of
direct approach and his habit of never shirking an issue or going behind an
opponent's back, won him affection and respect even from the men he was
out to dispossess.
History will give a truer perspective to this work; its value will appear
in years to come—not in money, nor notoriety, nor even perhaps in Good
Citizenship medals or recognition of any great amount—but in the lives of
men and women. After all, this is what the founder of this organization was
aiming at—not the other things—and he has been fortunate in living long
enough to see his work crowned with true success. He is 70 years old, still
Page 60
w-m as active as ever; he brought his last ship, the John Antle, out from England
a few months ago.
I think, though he would be the last to countenance the saying, that
John Antle will be one of the great names of our British Columbia history.
He has no words—he cannot talk or preach worth a cent, from a rhetorical
point of view; he cannot capitalize his personality; he will not appear where
there is any danger of personal display. I had hoped he would be here tonight
—he says he cannot come. The only thing that I know him to be afraid of
is any notoriety or publicity. Otherwise, he deserves to be regarded as one
of our heroes, in the terms of Kingsley's definition of a hero, as a "man who
has helped his country." Or as Bacon has it, "I take goodness to be this,
affecting the weal of men, which the Greeks call Philanthropia."
Philanthropia—the love of men—such a motive forgives many mistakes, and excuses many errors.
Epilogue.
A certain king, the ancient legend has it, had for long been musing on
three questions which worried him a great deal. They were:
"Who is the most important person in the world?"
"What is the most important time?"
"What is the most important thing to do?"
None of his wise men could answer this. At last an underling told him
that there was an old hermit living on the confines of his kingdom that was
very wise and very saintly, and might be able to answer these questions.
Thither with his retinue he hied him, and at last came to the hermit's
humble domain. Here he found an old, feeble, bent man digging in his
garden.
The king sprang down from his horse and went over to where he was
in£
md
trie
d to
engage nun in conversation; tne old man went on
Id
work
digging.
"Look here," said the king, "that work is*too hard for you, let me help."
So he picked up a spade. "Oh no," said the hermit, "come again some other
time." "No," said the king, "that's no use, I'll give you a hand now." So
he fell to digging; and they worked on, the king in wonder at the stubbornness and apparent lack of interest in the old man's attitude.
"Well," said the old man at last, "what did you want?" "I wanted an
answer to three questions," said the king, and propounded them. "Hm,"
said the hermit, "you don't need me to answer those; you have answered
them yourself." The king could not see how? and at last the hermit said,
"The most important time? I urged you to come back again later; you said,
eNo, now'; the most important person? the man in contact with whom you
find yourself,
now
and the most important thing? just to helt
THE TREATMENT OF AGRANULOCYTIC
ANGINA WITH  NUCLEOTIDES
Report of Two Cases
Gordon C. Large, M.D.
Vancouver, B. C.
Agranulocytic angina was described first as a clinical entity by Schultz1
in 1922. His definition of the condition was "an acute disease with high
fever, necrotic processes in the oropharyngeal tract and characteristic
changes in the blood, namely a marked leucopenia of 1,200 or less and a
very marked agranulocytosis of 20 per cent to complete absence."
Page 61 i   I
Previously many cases of similar nature had been reported in the literature under a variety of names. A very complete history has been presented
by Pepper2 in his "History of Agranulocytic Angina." Following the
description by Schultz this clinical entity has been recognized throughout
Europe and in this country. At the present time over two hundred cases
have been reported, ninety-six of which are from this continent. The mortality in the cases reported has been about 80 per cent. Since 1922 a great
deal of interest has been shown in this disease and many theories as to its
aetiology and treatment have been advanced. Unfortunately, there is still
much confusion regarding both the aetiology and the proper treatment of
this type of case and more detailed study will be necessary before satisfactory
results can be hoped for.
At onset, the clinical picture of agranulocytic angina is somewhat similar to that of many acute throat infections such as diphtheria, streptococcic
throat, but the symptoms are more pronounced. The patient complains of
general lassitude, severe sore throat, and chills. The collapse is very marked
and many authors describe a typical gray, drawn f acies. The throat and in
some instances the gums and hypopharynx appear acutely inflamed and
ulcerations of these areas occur early and are typified by a punched-out area
with sharply defined margins covered by a grayish, membranous exudate
which does not bleed when removed.
The blood examination reveals typical findings. The erythocytes and
haemoglobin usually are within normal limits. The white blood count is low,
ranging from 1,200 to complete absence of leucocytes. A differential count
shows absence or almost complete disappearance of the granulocytic group
of cells. The predominating leucocytes are lymphocytes and large mononuclear cells.
The course of the disease usually is very rapid. The condition is comparatively rare but not uncommon and occurs most often in females. The
age incidence is greatest from the fourth to the sixth decades of life, only
three cases having been reported in children.
Of the aetiology very little is known. Many aetiologic agents have been
blamed but the multitude of theories as to the origin of the disease only
prove that the true cause is as yet obscure.
Pathologic examination in agranulocytic angina shows a destruction of
the red bone marrow of the short and flat bones. This occurs about two days
prior to the appearance of clinical manifestations. The bone marrow becomes
hypoplastic and the granular cells found are in process of rapid destruction.
Ulcerations occur in the mouth, pharynx, gastro-intestinal tract and sometimes in the genital areas. Cervical adenopathy constitutes the only glandular
involvement.
The therapeutic measures have been many and varied. Perhaps the most
common and one of the most valuable measures for improving the general
condition of the patient is the repeated administration of transfusions. However, roentgen irradiation, neo-salvarsan, quinine, the formation of sterile
abscesses and many other agents have been employed, but none seem to
benefit consistently. Perhaps the most encouraging results have been obtained just recently from nucleotide therapy. Before reviewing an interesting case history I shall recount briefly the sequence of events which led
to the rise of this method of treatment.
In 1872 it was observed by Lewis and Cunningham that organisms
injected into the circulation rapidly disappeared, and in 1877 Altman isolated nucleic acid from Miescher's nuclein, a product obtained from pus of
Page 62
i±— infected wounds, and suggested that this was the germicidal substance of
the blood. This material, nucleic acid, was rich in phosphorus and was
believed to be derived from the nuclei of the pus cells; hence the name.
Ames and Huntley3 studied this material and found that a nuclein solution
from yeast injected into the circulation of dogs caused an actual leuco-
cytosis. Nuclein was found to be an albuminoid related to the proteins and
to be rich in phosphorus and soluble in weak alkali. Nucleinic acid from the
thymus gland of calves when treated with dilute mineral acid yields adenin.
For a considerable period there were many reports in the literature of the
results of the injection of nuclein and its derivatives into the circulation of
animals and in general it was shown that a considerable, though temporary,
leucocytosis resulted. In 1924, Henry Jackson, Jr.4, showed for the first time
that pentose nucleotides exist in the human blood. In 1928 Mary V. Buell
and Marie E. Perkins5 showed the presence of adenin nucleotide in the blood
of a pig and also in man in amounts varying from 10 to 20 milligrams per
hundred cubic centimeters. They also isolated another nucleotide guanin
a compound very similar to adenin. Doan, Zerfas, Warren and Ames in
19286 reported the results of the intravenous injection of sodium nucleotide
into animals. Transitory leucopenia occurred, followed by leucocytosis.
Guanin and adenin nucleotide also were used in rabbits and it was observed
that they did not cause primary leucopenia, and that the toxic symptoms
often occurring with sodium nucleotide were absent. In 1930, ReznikofF
first reported considerable success with the use of guanin hydrochloride and
adenin sulphate in cases of agranulocytosis. Doan reported experiments
showing marked hyperplasia of the myeloid tissue in the bone marrow following intravenous injections of pentose nucleotides. In 1931 Jackson et al.s
reported twenty patients with agranulocytic angina treated with adenin
sulphate and guanin hydrochloride and a commercial product designated as
Nucleotide K-96. This is a mixture of the sodium salts of the pentose
nucleotides derived from nucleic acid. This product was used in treating the
patient with agranulocytyic angina whose history is as follows:
The patient, a married woman, aged 32, was seen in consultation at her home on April
1, 1932.
She gave a history of having had an illness which had been diagnosed as influenzal
encephalitis a. month previously, which was followed a week later by sore throat and an
enlarged gland on the right side at the angle of the jaw. An ulceration below the anterior
pillar on the right tonsil had been observed at that time. Smears of the throat had been
taken by the family physician at the onset of the illness, and a blood count had shown a
marked reduction of polymorphonuclear neutrophils. Tne patient's temperature had ranged
from 100° to 104° F.
When the patient was admitted to the hospital on April 3, 1932, she was acutely ill,
in marked collapse, and the skin was moist and clammy with grayish pallor. The gums,
tongue and pharynx were inflamed acutely and there was a large ulceration on the right
side of the throat below the right tonsil which had a punched-out appearance and a deep,
ulcerated base. The general physical examination otherwise was negative. Her temperature
was 103° F., the pulse rate 100, and the respiration rate 20.
The blood count showed 4,550,000 erythrocytes, with marked anisocytosis and poikilo-
cytosis. Packed red cells were 80 per cent of normal, the volume index was 0.87, the colour
index was 0.74, the saturation index 0.85, the haemoglobin 68 per cent, and the leucocytes
numbered only 550. The differential count showed 24 per cent neutrophils and 7 per cent
lymphocytes with a nonfilament count of 80 per cent. The platelets were normal. Sedimentation time was 44 mm. in one hour. Urinalysis was negative.
The patient was given two transfusions of 500 cc. of whole blood, group
IV to group II, 0.2 gm. of neosalvarsan intravenously and two courses of
Nucleotide K-96.
The blood study and the results of treatment are shown in figure 1.
Page 61 BJ^r   ^^^m ■
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The patient's condition remained quite alarming for several days after
admission, the leucocyte count changed very little, the temperature was as
high as 105° and there was but little hope for her recovery. Following the
administration of nucleotide for four days, her temperature fell to 98.6° for
one day and the leucocyte count rose to 1600 but dropped again. After the
second course of nucleotide the blood count rose steadily. The throat was
treated locally with a 2 per cent solution of methylene blue and also neo-
arsphenamine and was completely healed after eighteen days. On the
eleventh day in the hospital the temperature again rose to 105° and continued septic for six days. This Was due to a phlebitis which developed about
the sites of injection of the nucleotide. On the seventeenth day in the hospital the temperature receded to normal and remained so until her discharge
twenty-four days after admission.
Although this patient showed a marked decrease in her white blood
count two months after discharge from the hospital, there was no clinical
change in her condition and the blood picture improved after removal of an
abscessed tooth. Since the mortality in the cases of agranulocytic angina
reported has been about 80 per cent, a patient who has recovered merits
careful study in an effort to find some clue as to efficient treatment. Probably
at the present time, repeated transfusions and the administration of nucleotide offer the best hope for satisfactory results.
The second case was a woman aged 5 8 who gave a much similar history
and was suspected of having diphtheria. The patient was seen in consultation
and was in every way similar to the previous case but of a lesser degree of
intensity. The white blood count was 900 with 10% polymorphs; red
blood count 4,000,000 and Hb. 60%.
Treatment instituted was one 500 cc. transfusion whole blood and a
course of Pentnucleotide. After six days the W.B.C. began to rise as did
the percentage of polymorphs.
Both these cases have remained well—the first for three years and the
second for two years.
REFERENCES
mm
1. Schultz, Werner—Ueber eigensartige Halserkrankungen. A. Monozytenangina.
Dtsch. Med. Wchnschr. Nr. 44:149 5-1496, Nov. 3, 1922.
2. Pepper, O. H. P.—History of agranulocytic angina. /. A. M. A., 97:1100-1101, Oct.
10, 1931.
3. Ames, Delano and Huntley, A. A.—The nature of the leucocytosis produced by
nucleinic acid; a preliminary experimental study. /. A. M. A., 29:472-478, Sept. 4,
1897.
4. Jackson, H., Jr.—Studies in nuclein metabolism; isolation of a nucleotide from human
blood. /. Biol. Chem., 59:529-51,4, 1924.
J.    Buell, M. V., and Perkins, M. E.—Adenine nucleotide content of blood with micro-
analytical method for its determination. /. Biol. Chem., 76:95-106, Jan., 1928.
Doan, C. A., Zerfas, L. G., Warren, S., and Ames, O.—Study of the mechanism of
nucleinate-induced leucopenic and leucocytic states with special reference to relative
role of liver, spleen and bone marrow. /. Exper. Med., 47:403-43 J, March, 1928.
7. Reznikoff, Paul—Nucleotide therapy. /. Clin. Investigation, 9:381-391, Dec, 1930.
8. Jackson, H., et al.—Diseases of lymphoid and myeloid tissues; treatment of malignant
neutropenia with pentose nucleotides. /. A. M. A., 97:1436-1440, November 14, 1931.
Page 66
6. APPENDICITIS
By Dr. R. I. Harris
Appendicitis constitutes a most important surgical problem. It is the
most common surgical emergency. Every practitioner of medicine is called
upon to deal with it comparatively often. As a cause of death in the United
States it is second only to cancer (Metropolitan Life Insurance Company).
In spite of its frequent occurrence and serious nature, there still remain
unsolved many important problems associated with this disease. Of these
the most urgent are its increasing incidence and our failure to secure material
reduction in the death rate in the last twenty years. It is worth our while
to spend some thought on this problem.
The incidence of appendicitis seems definitely to be increasing. This
statement is based upon the mortality tables of various countries. While
these only take into account the number of individuals who die from appen-
dicitMper 100,000 population, they do constitute a rough index of the incidence of the disease since, the death rate has not been greatly changed in
many years. The figures for Canada are as follows:
DOMINION BUREAU OF STATISTICS
Death Rate per 100,000 Population in Appendicitis
Year
1921
1922
1923
Rate
12.7
12.9
12.9
Year Rate
1927       13.8
1924  13.9
1925   14.0
1926   13.5
1928
1929
1930
1931
14.1
14.0
14.4
12.7
Rate
13.4
15
15.1
1932    12.
Those for the United States of America are similar:
UNITED STATES BUREAU OF CENSUS
Death Rate per 100,000 in Appendicitis
Year Rate Year
1907-1910       11.2 1919-1922   	
1911-1914     .    11.9 1923-1926    .	
1915-1918       12.5 1927-1930*   	
* Excluding 1930.
It will be seen from these figures that in twenty-five years there has
been a 3 J % increase in the disease in the United States of America.
The incidence of appendicitis seems closely related to a diet of meat.
In a recent number of the Canadian Medical Association Journal, Dr. J. A.
Urquhart, writing of "The Most Northerly Practice in Canada," states that
appendicitis is very common amongst his Eskimo patients. Their diet is
exclusively fat and meat. On the other hand, Professor Cruikshank of Beirut
University in Syria states that appendicitis is almost unknown amongst his
Arab patients. Their diet is largely vegetable and to this he attributes their
freedom from the disease. In fifteen years he has not seen more than fifteen
cases and these mostly in sailors touching at the port. Changes in diet may
well be a most important factor in the increased incidence of appendicitis.
Be the cause what it may, it is certain that appendicitis is becoming
more common and hence it is a problem of increasing importance.
In spite of the vast amount of experience we now have had in the treatment of appendicitis and in spite of the great improvement which has taken
place in surgical methods, the mortality rate from appendicitis is still high.
Read before B. C. Medical Association, September, 193 5.
Page 67 Iii1!
I
•.■It
II
Some improvement has been attained but it is not as great as might reasonably have been expected.
A glance at the following figures will indicate that the great bulk of
the mortality occurs in those cases in which perforation has taken place.
ACUTE APPENDICITIS — TORONTO GENERAL HOSPITAL
1931-1932-1933
All Cases
Total Number Deaths Mortality
583       .     25             4.4%
Acute Unperforated                                       Acute Perforated
Total Number         Deaths             Mortality    Total Number         Deaths Mortality
405           4     _ --    1.0% 178    —*_—     21     11.8%
ACUTE APPENDICITIS — HOSPITAL FOR SICK CHILDREN
1931-1932-1933
Total Number Deaths Mortality
725                 15         --      2%
All Cases
Acute Unperforated                                       Acute Perforated
Total Number        Deaths             Mortality    Total Number         Deaths Mortality
566       0               0% 159       15           10%
Of the other factors influencing mortality, the age of the patient and
the abuse of cathartics are the most important. Though the chief age incidence of acute appendicitis is in childhood and young adult life, its mortality is much greater after the age of forty. In Urban Maes' 2229 cases,
87% were below the age of forty and in them the mortality was 0.8%;
13 % were over the age of forty and in them the mortality was 10%.
Pathology of Appendicitis.—There is a close parallelism between the
sequence of pathological changes in acute appendicitis, the clinical state
and the mortality rate.
The great majority of cases of acute appendicitis are based upon obstruction of the appendix. The dictum "no appendicitis without obstruction" is
not quite true, but it is so close to the facts that we may accept it as a
useful guide. In a series of acutely inflamed appendices which I have carefully examined for the presence or absence of obstruction, 66% showed
definite evidence of obstruction. In this series every appendix which was
perforated or gangrenous was obstructed save one. The dictum becomes
more nearly correct if we state it "no gangrenous or perforated appendicitis
without obstruction." I propose to discuss the problem of obstruction later.
In an appendix which possesses the potentialities of obstruction (faeco-
lith, ring of fibrosis, or angulation) a variety of circumstances can precipitate the actual obstruction. Inflammation and swelling of the lymphoid
tissue or the displacement of a f ajcolith so that it becomes a ball valve on a
ring of fibrosis are common initiating causes. Once obstruction is established,
the sequence of events marches on in definite order. The products of inflammation and the secretion of the appendix accumulate behind the obstruction and give rise to a tense inflamed distended appendix. Recall how
frequently you have seen an appendix acutely inflamed, distended, tense and
gangrenous in its distal half and perfectly normal in its proximal half.
Such an obstructed and inflamed appendix may manage to break down
the obstruction and discharge its contents into the csecum. If it does so, the
attack subsides. If the obstruction is not overcome, distention continues
until the blood supply to the wall of the appendix is interfered with and
gangrene occurs. Perforation follows with discharge of the highly toxic and
infective contents into the peritoneal cavity.
Page 68 The course of the disease now enters upon a new phase. No longer are
we dealing with acute appendicitis but with appendicitis complicated by
peritonitis. If the circumstances are favorable, if perforation has taken some
time to occur and if no cathartics have been given, the area of disease may
already be walled off. In this case a local abscess will occur. But if rupture
occurs rapidly, or if by disturbing the stillness of the intestine with cathartics no opportunity has been given for the formation of adhesions, widespread infection of the peritoneal cavity will occur.
Signs and Symptoms in Relation to Pathology.—The signs and symptoms of appendicitis march with the pathology. The earliest pain is visceral
pain due to increased tension within the appendix. Like all visceral pains it
is vaguely localized, not over the involved viscus but in the midline; in the
case of the appendix, about the umbilicus. An accompanying sign of some
importance is the presence of hyperassthesia of the skin in the triangle
bounded by the midline, the inguinal ligament and the spino-umbilical line.
As inflammation progresses, pain, soreness and marked tenderness manifest
themselves over the involved appendix wherever it may be. Hence a pelvic
appendix or a retrocascal appendix is less easily recognized than one in the
usual situation.
When perforation or gangrene occur, there is a sudden abatement of
the pain; "the treacherous period of calm." The patient thinks himself
better though he probably looks worse. The reason for the disappearance
of the pain is obvious. When the perforation occurs, the tension subsides and
with it the pain it causes. If the appendix becomes gangrenous, this also can
result in diniinution of the pain. A dead appendix is like a dead patient. It
cannot speak.
With the occurrence of perforation, the clinical picture changes. Peritonitis dominates the picture. This point needs strong emphasis. The
•patient's appendicitis is now a small part of his troubles. Indeed, as far as
the appendix is concerned, the battle is over and the reparative stage has
begun. Removal of the appendix at this stage is not the life-saving measure
it is before perforation occurs. Indeed, the operation for its removal may
actually do more harm than good. First and foremost the patient requires
treatment for peritonitis. The best and most successful treatment of peritonitis (whether or not it involves removal of the appendix) is the treatment the patient should have.
Whether the resulting peritonitis will be localized or generalized is
depedent upon a variety of circumstances. The position of the appendix
often favours the formation of a local abscess. Thus a pelvic appendix or a
retrocecal appendix which perforates will usually form an abscess. The
length of time which elapses between the onset of acute appendicitis and
perforation is a factor of importance; a relatively long period favors localization. The administration of cathartics is pernicious in that it does not
permit the rest of the intestines necessary for the formation of adhesions.
(To be concluded next issue)
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300 WEST
PENDER STREET
VANCOUVER, B. C. PYRIDIUM ii<™-*»*■"'■**
EST
CYSTITI
[ administration of Pyridium
usually is followed by amelioration
of distressing symptoms, a decrease
or disappearance of the turbidity of
the urine, and a subsidence of the
bacterial infection. Outstanding advantages of Pyridium in the treatment of cystitis as in other urinary infections, are, oral administration in
tablet form, gratifying clinical response, and the non-toxic and non-
irritative properties in therapeutic dosage. The average dosage of Pyridium
consists of two tablets of 0.1 Gm. (grain 1/4) each three times daily.
In chronic cystitis the oral Pyridium treatment may be effectively combined with bladder irrigations, using the 1% Pyridium aqueous stock
solution diluted 1:8 with distilled water (weaker dilutions may be
effective). The 1% aqueous solution may be applied topically to vesical
lesions through the cystoscope.
Pyridium, orally administered, has proved to be an effective chemothera-
peutic agent for the alleviation of symptoms and for the production of
clinical betterment in the treatment of Cystitis—Pyelitis—Urethritis
-Prostatitis-
-Vaginitis.
-k NORMAL BLADDER. Showing the bladder in fully distended position with thej
body at an angle qj 45°, the course of the ureter across the vaginal vault and itsj
enirance into the bladder, normal vesical mucosa, ureteral orifice, bladder musculature, and the peritoneal reflection and relations.
• CYSTOSCOPIC   VIEW   OF;
CYSTITIS. Note inflamed mucosa
and dilated vessels, most marked
in the trigone, mild bullous
edema, and flakes of pus.
W/
MERCK & CO. Ltd. Manufacturing Chemists MONTREAL, Que iPil
iii
ll
.'■>:., A Service to the Profession    m
FOR some while the Medical Profession has felt the need of a local
institution giving treatments in COLONIC IRRIGATION.
COLONIC IRRIGATIONS are valuable in such cases as Constipation,
Impaction, Worms, Colitis, Cholecystitis, Stomach Disorders, Acne,'also in
diseases where the primary cause is found to be improper elimination of the
contents of the Colon, such as Rheumatism, Rheumatoid Arthritis, Neuritis,
Bright's Disease, Nephritis, Nervous Disorders, etc.
Obstetrical cases are benefitted by internal baths at measured periods,
as advised by their physician.
We take pleasure therefore, in announcing to the Medical Profession
an institution to which they may send patients whom they know would
benefit thereby.
View of the Treatment Room, -which shows the Irrigation Table
to advantage.
Colonic Irrigation Institute
Superintendent: E. M. LEONARD, R.N., Post Graduate, Mayo Bros.
631 Birks Bldg., 718 Granville Street, Vancouver, B. C.
  Telephone:  Seymour 2443 frank answers
i to questions
kS on bran     1
Millions of people know of
Kellogg's ALL-BRAN, so it is natural that questions are raised from
time to time. To discover the
scientific facts about bran, the
Kellogg Company has sponsored
years of research in leading nutritional laboratories. Here are some
of the results of these studies, in
question and answer form:
1. Is the "bulk" in bran Irritating to
the Intestines?
ANSWER: No, not for the normal
person. There are some individuals with highly sensitive intestines who should not eat "bulk" in
any form—either in fruits, vegetables or in bran.
2. Is bran effective in relieving constipation due to insufficient "bulk"?
ANSWER: Laboratory tests in universities with adult people substantiate the effectiveness of
Kellogg's All-Bran.
3. Does bran continue to be effective
over a period of months ?
ANSWER: Yes. Moreover, dosage
does not have to be increased, as
with cathartics. In four laboratory studies on a group of healthy
women, in which four tablespoon-
fuls of bran per person were eaten
daily, the laxative effect was as
satisfactory in the second month
as in the first.
4. Is the "bulk" in bran more effective than that found in fruits and
vegetables ?
ANSWER: Yes, with many individuals. Laboratory tests indicate
that, with certain people, the
"bulk" in fruits and vegetables
breaks down in the intestinal
system. So bran is often more
effective.
5. Is all bran more effective than part-
bran products?
ANSWER: Yes. It's the actual
amount of bran in the cereal that
provides the "bulk" to promote
regular habits. The greater amount
of "bulk" in Kellogg's All-Bran
makes it more effective.
Kellogg's All-Bran provides
gentle "bulk" to correct common
constipation. Suggest its use to
your patients wherever advisable.
Sold by all grocers. Made by
Kellogg in London, Ontario. A PRESCRIPTION SERVICE . . .
Conducted in accord with the ethics of the Medical
Profession and maintained to the standard suggested by
our slogan:
Pharmaceutical Excellence
AAcGiII 6 Ormc H
L.I MITED v-^
FORT STREET (opp. Times)      Phone Garden 1196      VICTORIA, B. C.
Nmttt Sc ©JjnmBfltt
2559 Cambie Street
V
ancouver
,B.C
For the Oral Treatment of Syphilis
■HHHi
A SUPERIOR BRAND OF ACETARSONE
In the prophylactic and curative treatment of congenital syphilis,
STOVARSOL by mouth is advised because of its ease of administration and the resulting co-operation of the parents.
For adults, STOVARSOL is most useful as a form of "follow-up" or
supporting therapy between courses of Arsphenamine compounds
or Bismuth.
Tablets of 0.25 Gm., 0.05 Gm. and 0.01 Gm.
STOVARSOL   POWDER.—Insufflation   of   STOVARSOL.   in   powder
form is used successfully in the treatment of Trichomonas Vaginitis.
Offered in bottles of 4 and 12 grams.
LABORATORY POULENC FRERES
OF CANADA LIMITED
Distributors: ROUGIER FRERES, MONTREAL PNEUMONIA
IN THE treatment of the pneumonias, an application which will help to sustain the natural
defensive and healing powers of the body, promote bodily comfort and encourage symptomatic
relief, is an important factor in the treatment.
Antiphlogistine is widely employed in the
treatment of the pneumonias. The prolonged
moist heat which it supplies and its hyperasmic
action on the tissues whereby the blood and
lymph circulation are stimulated, help to encourage symptomatic relief with resultant improvement in the clinical picture.
It is a valuable adjuvant to the routine treatment and does not conflict with other forms of
therapy.
It is best applied as hot as the patient can
comfortably bear and renewed at the end
of 24 hours.
ANTIPHLOGISTINE
Made in Canada
The Denver Chemical Mfg. Co
153 Lagauchetiere Street W.
MONTREAL STEVENS' SAFETY PACKAGE
, STERILE  GAUZE
is a handy, convenient, clean commodity for the bag or the office.  Supplied
in one yard, five yards and twenty-five yard packages.
B. C. STEVENS CO.
Phone Seymour 698
73 0 Richards St., Vancouver, B. C.
S. BOWELL & SON
DISTINCTIVE  FUNERAL
SERVICE
Phone 993
66 SIXTH STREET
NEW WESTMINSTER, B. C.
»i^<»SM^^^^^ra^^^^^^&^^^®^j^^^^!^®^^^^^^^^^^^^:^^^^
Breaks the vicious circle of perverted
menstrual function in cases of amenorrhea,
tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic
relief by stimulating the innervation of the
uterus and  stabilizing the tone of its
musculature. Controls the utero-ovarian
circulation and thereby encourages a
normal menstrual cycle.
Ik     MARTIN H. SMITH COMPANY      ji
ISO lAMYim STIIII. NIW TOIK. N. T.
Full formula and descriptive
literature on request
m
Dosage: 1 to 2 capsules
3 or 4 times daily. Supplied
in packages of 20.
Ethical protective mark MHS
embossed on inside of each
capsule, visible only when capsule  is  cut  in  half  at seam.  i! f
! ill
fc^^^^K
If this tired, worried, over-worked mother were using Pablum for her babies' cereal feedings, she could have^j
slept that extra much-needed hour instead of losing her temper while her children ciamor for breakfast.
For she can prepare Pablum in an instant, directly in the cereal bowl, simply by adding water or milk of
any temperature—salt, cream and sugar for the older child and herself.
Getting up an hour earlier in the morning is an inconvenience for most persons,
but for the mother of young babies it is
a hardship, sometimes almost tragic,
frequently nullifying the best-planned
pediatric advice.
This is especially true in the case of
the nursing mother whose supply and
quality of breast milk are affected by
emotional shocks resulting often in agalactia and sometimes giving rise in the
baby to diarrhea, colic, and even convulsions. Furthermore, the mother's
emotional stress brings about a train of
behavior on her part which is reflected in
the child's psychologic reactions so that
a vicious circle of bad habit formation is
set up.
From this angle, the recent introduction of the pre-cooked form of Mead's
Cereal, known as Pablum, assumes new
importance in the doctor's psychological
handling   of   both   mother   and   chil|l
quite aside from its nutritional value.*
Because Pablum can be prepared in a
minute, the mother can sleep the extra
hour she would otherwise be compelled
to spend in a hot kitchen cooking cereal.
Added rest means better poise, so that
petty annoyances do not bring jaded
nerves. Prompt feedings prevent many
childhood tantrums, and a satisfied baby
usually eats better and enjoys better
digestion and growth.
*Like Mead's Cereal, Pablum represents a
great advance among cereals in that it is richer
in a wider variety of minerals (chiefly calcium, phosphorus, iron, and copper), contains
vitamins A, B, E, and G, is base-forming and
is non-irritating. Added to these special features, it is adequate in protein, fat, carbohydrates, and calories. Pablum consists of
wheatmeal, oatmeal, cornmeal, wheat embryo,
yeast, alfalfa leaf, beef bone, iron salt and
sodium chloriSliBj
Mead Johnson & Co. of Canada, Ltd., Belleville, Ont.
t'iease enclose professional card when requesting samples of Mead Johnson products to cooperate in preventing their reaching unauthorized persons  ■M
i^j
Hollywood Sanitarium
Limited
For the treatment of
Alcoholic, Nervous and Psychopathic Cases
Exclusively
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288
^SRSSS^^SSS^S^^SSSSSSS^

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