History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: December, 1924. Vancouver Medical Association 1924

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 THE VANCOUVER MEDICAL
H     '    ASSOCIATION   I
BULLETIN
Published monthly at Vancouver, B. C.
cAnnual luinnei
SmallpojK in Vancouver
cAbdominal ciHysterotomy
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DECEMBER, 1924
^Published by
Q^fCc^eath Spedding Limited, 'Vancouver, "SB. Q.  THE   VANCOUVER   MEDICAL  ASSOCIATION
BULLETIN
Published Monthly under the Auspices of the Vancouver Medical Association
in the Interests of the Medical Profession.
Offices:
529-30-31 Birks Building. 718 Granville St., Vancouver, B. C.
Editorial Board:
Dr. J. M. Pearson
Dr. J. H. MacDermot Dr. Stanley Paulin
All communications to be addressed to the Editor at the above address.
VOL. I.
DECEMBER 1st, 1924
No. 3
OFFICERS,  1924-25
President
Dr. H. H. Milburn
Secretary
Dr. O. S. Large
Vice-President
Dr. Stanley Paulin
Treasurer
Dr. A. J. MacLachlan
Dr. W. F. Coy
Past President
DR. F. J. BULLER
TRUSTEES
Dr. W. B. Burnett Dr.
Delegate to B. C. Medical Association
Dr. J. A. Gillespie
J. M. Pearson
SECTIONS
Clinical Section
Dr. Lyall Hodgins
dr. w. l. pfdlow -       - -
Physiological and Pathological Section
Dr. C. H. Vrooman     -        -
Dr. R. E. Coleman	
Eye, Ear. Nose and Throat
Dr. G. C. Draeseke      -        - -        -
Dr. Colin Graham -       -        -
Genito -Urinary
Dr. G. S. Gordon - ...
Dr. J. A. E. Campbell -       - -        -
COMMITTEES
Chairman
Secretary
Chairman
Secretary
Chairman
Secretary
Chairman
Secretary
Library   Committee
Dr. Wallace Wilson
Dr. R. E. Coleman
Dr. w. A. Bagnall
Dr. W. F. MacKay
Orchestra Committee
Dr. L. Macmillan
Dr. F. N. Robertson
Dr. J. H. MacDermot
Dr. W.-D. Patton
Credit Bureau Committee
Dr. L. Macmillan
Dr. J. w. welch
Dr. G. a. Lamont
Dinner   Committee
Dr. N. E. MacDougall
Dr. A. w. Hunter
Dr. F. N. Robertson
Credentials  Committee
DR.  G. E.  SELDON
Dr. D. McLellan
Dr. Neil McNeill
Summer   School   Clinics
Dr. Alison Cumming
Dr. Howard Spohn
Dr. G. S. Gordon
Dr. Murray Blair
Dr. W. D. Keith
Dr. G. F. Strong
Page Three VANCOUVER MEDICAL ASSOCIATION
Founded 1898. Incorporated 1906.
Programme of the 27th 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 p.m.—Business as per Agenda.
9 p.m.—Paper of Evening.
1924.
OCTOBER  7th— General Meeting.
Presidential Address:    Dr. H. H. MILBURN.
OCTOBER 21st—
OCTOBER 28th—
Clinical Meeting.
Special Clinical Meeting.
DR. R. C. COFFEY   (of Portland, Ore.)
Subject:     "The Quarantine Pack in Abdominal Surgery."
NOVEMBER 4th—        General Meeting.
Paper:    DR. J. J. MASON, "Abdominal Hysterotomy."
NOVEMBER 18th—      Clinical Meeting.
DECEMBER 2nd—        General Meeting.
Paper:     DR.   G.  A.   LAMONT,   "The  Early  Weaned
Baby."
DECEMBER  16th—      Clincal Meeting.
1925
JANUARY 6 th—
JANUARY 20 th—
FEBRUARY 3rd—
FEBRUARY 17th—
FEBRUARY 25 th—
MARCH 3rd—
MARCH  17 th—
APRIL 7th—
APRIL 21st—
Page Four
General Meeting.
The OSLER LECTURE by Dr. FREDERIC BRODIE,
"Aphasia."
Clinical Meeting.
General Meeting.
Paper:    DR. W. A. DOBSON, "Neuroses in Everyday
Practice."
Clinical Meeting.
Special Clinical Meeting.
DR. C. E. HAGYARD  (Seattle).
Subject:    "Colitis."
General Meeting.
Paper:    Dr. R. B. BOUCHER, "Inflammatory Diseases
of  the Ear."
Clinical Meeting.
General Meeting.
Paper:    Dr. J. L. TURNBULL, "Differential Diagnosis
of Acute Abdominal Conditions."
ANNUAL MEETING. e^'$^<fS&,£^c?^'3^(^^^(?S&><3^
Luer
Hypodermic Syringes
ll^cc       25 M.
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50 CENTS
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'^Hospital, Physicians' and J\[urses
Supplies
Canadian Surgical Supplies Limited
Cor. Robson and Burrard Streets
Phone Seymour 4802
Vancouver, B. C.
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Page  Five EDITOR'S PAGE.
Among the many activities in public affairs left vacant by
the untimely death of Dr. Mullin, none is more important than
that of Director of Laboratories at the Vancouver General Hospital.
In collaboration with his able assistants, Dr. R. E. Coleman
and Dr. A. W. Hunter, the late Dr. Mullin had built upon the
foundations of his predecessors an institution which satisfied the
varied demands made upon it to a highly efficient degree.
Broadly speaking, we may regard this Laboratory as having
two main objects. One, the care of the work, pathological, metabolic, serological and bacteriological, as it comes in large and increasing amount from the wards of the hospital. The other, more
communal in type, being concerned with the public health, and
comprising such things as milk and water analyses, the bacteriology of infectious disease, serological work in connection with the
Government Clinic and similar work.
We understand that public money, municipal and provincial, has been provided for the erection of buildings, and is being
contributed towards Laboratory maintainence. Value is received
by the help which is given by the Laboratory in the solution of
public health problems.
The situation is further complicated by the fact that, in addition to his work at the Hospital, Dr. Mullin took an active part
in certain teaching and administrative duties at the University of
British Columbia. Though we speak without special information, it would seem probable that in view of the near (or more
near) migration of the University to its permanent quarters at
Point Grey, such an amalgamation of duties may not be acceptable
any longer to either of the parties to the present arrangement.
Such a separation, if it should occur, would of course make
it more difficult for the Hospital alone, financially speaking, to attract a man of the required calibre. The removal also of opportunity for teaching would also militate against the desirability of
the position.
It will thus no doubt seem increasingly important to the
Management of the Hospital to maintain, through the public
health work of the Laboratory, touch with Government departments and the funds which arise therefrom.
While sympathizing with the difficulty of the situation, we
must recognize that, from the point of view of the Hospital, that
is the benefit to the patient and the quality of the work of the
attending doctor, the clinical side of the Laboratory is greatly
the more important. We trust that in their deliberations, the
Hospital Management will give this aspect of the problem its due
prominence. We desire not only that the clinical work of the
Laboratory be maintained at its present high standard of efficiency,
Page Six but that ample facilities and encouragement be given for its further development.
In the occupancy of the position, security of tenure, reasonable remuneration, opportunity to advance scientifically, are indis-
pensible.
Moreover, we might point out that there are in the Laboratory at the present time certain highly trained assistants, who
though not holding medical degrees, are available for research
work under proper direction.
It is needless to say that such work and its publication benefits and enhances the reputation of the institution where it is conducted. In turn this makes it more easy to attract and to keep
the right sort of men for important medical positions which from
time to time occur in the Hospital.
Modern medicine cannot come to full fruition without the
help of sympathetic and clinically minded Laboratory directors.
That it should so flourish is a matter of the utmost importance
to every individual in the community.
NEWS AND NOTES.
The General Monthly Meeting of the Association was held
in the Auditorium of the Normal School on Tuesday, November
4th. The President was in the chair, and fifty members were
present.
The minutes of the previous meetings having been passed,
Dr. Gillespie reported that Dr. W. D. Keith and Dr. G. F. Strong
were nominated for three years, and Dr. E. Murray Blair for two
years to the Summer School Committee. This was confirmed by
the meeting.
Dr. H. A. Rawlings and Dr. S. Bonnell were elected to
membership.
Dr. A. C. Frost presented his report as Auditor for the half-
year ending September 30th, which was adopted.
Dr. J. J. Mason then gave a paper on "Abdominal Hysterotomy," an abstract of which will be found on another page.
sfc 3{e s{c ;|c
Dr. Henry Wackenroder, recently on the Interne Staff of
the Vancouver General Hospital, has gone to Chicago for postgraduate study.
*     *     *     *
Dr. Oliver Large, who has been six weeks on the Empress of
Canada as a medical officer, in its journey to Japan and China,
returned safely about the beginning of November. He reached
China in time for the war, which was suspended by request of
the British admiral, for the twenty-four hours that it took the
Empress of Canada to go up to Shanghai, discharge, and return.
It is not often that one finds combatants so accommodating.
Page Seven ANNUAL DINNER.
The Annual Dinner of the Vancouver Medical Association
was held at the Ambassador Cafe on the 7th of November. The
dinner was attended by some hundred and thirty-five members.
In accordance with the unwritten law which governs these annual
dinners, all the entertainment, both musical and otherwise, was
provided by medical men—there being no laymen present at all.
The Orchestra of the Association, under the able leadership of
Dr. J. A. Smith, rendered a programme of appropriate music—
and several "stunts" and "turns" were given during the dinner,
and after. Dr. E. M. Blair responded in a clever and witty speech
to the toast of "Our Sister Profession." The other toasts, which
were not spoken to, were "The King" and "Our Departed Members."
The degree of "Prince of Good Fellows" (P. G. F.) was
bestowed on Dr. W. F. Coy, Past President of the Association,
and Dr. J. A. Sutherland. The action of the Executive, in choosing these two men, met with the unanimous approval of the gathering. The presentation of this honour was instituted some years
ago, at the suggestion of the then President, Dr. F. Brodie, and
is limited to twenty-five holders at any one time. Two degrees
are granted yearly, and the recipients are chosen by the Executive.
This dinner is undoubtedly a most valuable function,  in
promoting and maintaining a friendly and brotherly spirit in the
profession of Vancouver.    At it the little foibles and harmless
weaknesses of men are brought out, and held up to gentle, and
friendly, ridicule.    No personalities are allowed which will cause
pain, or make fun of any infirmity.    But, in the words of a prologue to one of the performances, given some years ago:
"We may make fun of one another,
As brother often does of brother."
Everyone takes his medicine like a sport, and gets his fun out of
the spectacle afforded by the administration of the salutary dose
to the next man—and a laugh does more to blow away the cobwebs, and clear the air of the clouds of grouchiness and sore-
headedness, than anything else can do.
In our opinion the dinner is one outstanding function in our
medical life in Vancouver which should receive the support and
help of every man in the Association. If the manner of it is not
quite what you like, say so, and your objections and suggestions
will all receive the most sympathetic consideration from the Committee in charge, whose only wish it is that everyone should have
a good time.
Page Eight CITY HEALTH STATISTICS.
(The following is from information supplied by the Health Department of the City through the courtesy of Dr. Underbill.)
During ten years ending December 31st, 1922, there were
reported to the Health Department of the City 184 cases of Smallpox, an average of a little over eighteen each year.
In 1923 the reported cases almost reached the total of the
previous ten years, while during the first ten months of the present
year no less than 413 cases have occurred. This alarming increase
seems to have taken place chiefly among school children and those
coming into direct contact with them. Thus during the present
year, 221, or 53.5%, of the cases have occurred among children
mostly of school age, a few of pre-school age, and at least one
hundred adult cases were directly traceable to contact with these
children.
The experience of this Department points to the efficacy of
successful vaccination and re-vaccination in the control of smallpox.
Of the adult cases mentioned above there were no successful
vaccinations within twenty years, and only twenty-three had been
vaccinated even then. The health authorities believe that if all
school children in this city were vaccinated, few cases would occur.
At present it appears from a census of the city public schools that
about one-half the children attending are unvaccinated.
The full statistics are as follows:—
Total number vaccinated  10,522
"Conscientious  Objectors"     4,947
Those claiming insusceptibility   1,176
No action taken   3,221
Number of children vaccinated at School Board
Office this year  1,297
The enforcement of the Smallpox regulations requiring the
vaccination of pupils, would undoubtedly result in a great number
of vaccinations, but the Conscience Clause in the Health Act, permitting parents to substitute a statutory declaration of conscientious objection to vaccination, would allow a loophole for many
to evade the regulations, and nullify the intention in a large
measure.
By arrangement between the Health Department and the
School Medical Department, following a meeting between the City
Council, the School authorities, and Dr. H. E. Young, Provincial
Health Officer, delinquent parents are now being pressed to comply
with the provincial regulations.
Page  Nine LIBRARY NOTES.
Additions to the Library.
Physiotherapy Technic.    C. M. Sampson.
Physical Diagnosis.    W. D. Rose.
Gynaecology and Pelvic Surgery.    R. E. Skeel.
Cosmetic Surgery.    C. Miller.
Rubber Injections.    C. Miller.
International Clinics.   Three volumes.
Modern Methods of Treatment.    L. Clendinning.
Basal Metabolism.    J. T. King.
Calorimetry in Medicine.    J. S. McCann.
Blood Pressure.   L. F. Barker.
.Race Hygiene and Heredity.    Siemens.
Internal Derangements of the Knee Joint.    Timbrell Fisher.
Pharmacology and Therapeutics.    A. Cushny.
Angina Pectoris.   Sir J. Mackenzie.
Diagnosis  of Nervous Diseases.     6th £d.     Sir J.   Purves
Stewart.
Nostrums and Quackery.    Vol. II.    Am. Med. ^Assn.
Colt. Papers of School of Hygiene and Public Health, Johns
Hopkins University.    Vol. V.
Diseases of the Arteries.    Sir Clifford Allbutt.
Surgical Clinics of North America.    Aug., 1924.    Cleveland
Clinic number.
Lead Poisoning.   Hutton.   Prov. Board of Health, Ontario.
BOOK REVIEWS.
Basal Metabolism. Determination of the Metabolic Rate in
the Practice of Medicine. John T. King, Jr. 1924. 112 pages.
Williams & Wilkins Company.    Price $2.50.
As the sub-title indicates, this book is written for the practitioner. From this standpoint the entire field is covered. In his
effort to make an important adjunct to modern medicine practical,
the author disposes of the variety of methods of making the determination by recommending that familiarity with the results of one
method be attained. In the discussion of the interpretation a normal range from minus 10 to plus 15 is taken, and the various
factors affecting this rate are referred to, with their probable interpretation in the light of present knowledge. Controversial subjects are clearly stated, followed by the personal opinion of the
author, a good bibliography enabling the reader to pursue any
special point. Though easily read in an evening, the detail of the
book makes it a "vade mecum" to anyone who has to do with the
making or interpretation of basal metabolic data. This feature is
particularly enhanced by a good index.
R. E. C.
Page Ten Calorimetry in Medicine. By Dr. William S. McCann.
1924.    98 pages.   Williams 8 Wilkins Company.    Price $2.25.
This monograph differs materially from the purpose of the
preceding book. It is designed for the advanced thinker who
wishes to follow the development of a new tool. The writer holds
that the standards are sufficiently reliable now for us to take stock,
that calorimetry may soon be placed alongside the thermometer
and the blood count in the interpretation of diseases in general.
The monograph is therefore a compilation and a discussion of
known facts concerning the heat exchange and gaseous metabolism
in the various diseases. The practitioner cannot fail to be impressed by the keenness with which this new tool is biting into
some old problems.
R. E. C.
Internal Derangements of the Knee Joint. Their Pathology
and Treatment by Modern Methods. By A. G. Timbrell Fisher,
M.C., F.R.C.S. (Eng.) 1924. Pages 144. The Macmillan
Company.    Price $4.00.
This is one of the most interesting and instructive monographs published for some time. Mr. Fisher has spent the years
since the war largely in a study of joints and joint pathology, with
the knee joint as his particular hobby. Most of the research work
was done in the Museum of the Royal College of Surgeons, with
the collaboration of Professor Sir Arthur Keith and Professor
Shattuck. Mr. Fisher has turned out a masterpiece of surgical
pathology, and it is from this aspect that the book will prove
most valuable. The book is divided into two equal parts of about
seventy pages each. The first part deals with the physiology and
pathology of the semilunar cartilages. The author describes an
operation of his own for the exposure of the semilunars, designed
to give the maximum of exposure with the minimum of trauma.
The second part of the book deals with conditions other than
semilunar cartilages, and goes very fully into the development
and pathology of foreign bodies. The various forms of chronic
arthritis are described and a new nomenclature, based on the pathological findings, is suggested. The remainder of the book is taken
up with a consideration of other important conditions found in
and around the knee joint. Mr. Fisher describes a new operation
of his own for exploring the knee joint, the patella-displacing
method, designed to replace the patella-splitting method of Sir
Robert Jones. There is a foreword by Sir Arthur Keith, who
refers to the methods at present in use by the bone-setters, and
suggests that a more active interest in, and study of, their methods,
utilizing the good and discarding the bad, might be helpful. There
are numerous short footnotes by Sir Robert Jones, all of which
are helpful and interesting. There are forty excellent plates, including eighty figures; but the book is certainly deserving of a
better paper and binding. It is recommended to student, practitioner and specialist alike, all of whom will here find much that
Page Eleven is useful in understanding and treating derangements of the knee
joint.
L. H. A.
^C 3JC jjc Sjc
Diagnosis of Nervous Diseases. Sir James Purves-Stewart,
K.C.M.G., C.B., M.D., F.R.C.P. Sixth edition. Edward Arnold
& Co.    London.
This work is—or should be—so well known that a detailed
review appears almost superfluous. The final chapters, viz., War
Neuroses and Organic War Lesions of the Nervous System, which
appeared in the fourth and fifth editions, have been deleted, and
a short chapter on Delirium added. In spite of this the volume
is considerably larger than the preceding editions, a circumstance which the author, in the preface, appears to lament, but
which, after all, is no drawback, since all the recent work has
been included. The chapters on Anatomy and Physiology have
been advantageously elaborated, while in the third chapter details
of intelligence tests have been inserted, adding much to the value
of the work. The subjects of Aphasia and Cerebro-Spinal Fluid
have been completely re-written, including all the recent developments in these important fields. It is gratifying to read the chapter on Psycho-neuroses, for it deals with the subject from the
rational standpoint of the neurologist, giving a logical picture
rather than floundering in the nebulous meanderings of the many
"analytical" schools, which are so frequently lost in a maze of
theorizing and fallacious hypotheses. Although the work is primarily intended for those more particularly interested in neurology,
it is equally useful to the general practitioner. There is scarcely
an unusual symptom or abstruse point in diagnosis which is not
mentioned, and all signs and syndromes are succinctly but graphically described. The text is adequately illustrated by suitable case
histories and excellent cuts. A complete index adds much to the
convenience of the book.
F. B.
*     *     *     *
THE DICK TEST IN SCARLET FEVER.
The definite identification of a specific haemolytic streptococcus as the causative agent of scarlet fever has opened up new fields.
Quite similar to the Schick test in the study of diphtheria, we have
the Dick test, which is a reliable index of susceptibility or immunity to scarlet fever. Using heated toxin as a control 0.1 to 0.2CC
of the unheated standardized toxin is injected intradermally. Four
different reactions can be distinguished similar to the Schick readings.
Positive: Appear within 4 to 6 hours, reaching a maximum
by third or fourth day, with a marked area of redness and local
induration.    This shows patient is susceptible to scarlet.
The negative reaction: No local effect either at site of test
or control.    Therefore not susceptible to scarlet.
Negative pseudoreactions: Due to other proteins in the serum.
Both control and test sites show similar reactions.    The positive
Page Twelve combined shows a more pronounced redness at the site of the test
than the control.    This shows also susceptibility to scarlet fever.
The reliability of this test has produced interesting figures
as to susceptibility to scarlet at different ages and under different
conditions. The earliness of the reaction permits of early immunization of exposed persons, and it is also a control of the
effectiveness of active immunization with scarlet fever toxin. It
permits of diagnosis of doubtful cases of scarlet, as the Dick test
soon becomes negative as the disease progresses. Similarly a definite
negative reaction at the outset makes the diagnoses doubtful.
Active immunization is accomplished by giving three injections at weekly intervals, using 100, 250, and 250 skin test doses
(slightly higher for adults), diluted in saline, making the dose
.2cc, .5cc, and 5cc. The local reaction is very mild and constitutional symptoms are rare, but may consist of a slight scarlat-
iniform rash.
G. A. L.
Following is a list of some of the articles in the Library
available for reference:—
Dick, G. F.    J. A. M. A.    Vol. 83, p. 1450.
Zingher, A.    J. A. M. A.   Vol. 83. p. 432-443.
Gatewood, W. E.    J. A. M. A.    Vol. 83, p. 494.
Dick, G.    Am. Jnl. Dis. Childn.    Vol. 28, p. 484.
Dick and Dick.    J. A. M. A.    Vol. 83; 84-86.
Dick and Dick.    J. A. M. A.    Vol. 82: 1246-47.
Dick and Dick.    J. A. M. A.    Vol. 82: 544-545.
Dick and Dick.    J. A. M. A.    Vol. 82: 301-302.
Branch and Edwards.    J. A. M. A.    Vol. 82: 1260-1261.
Gordon, M. H.    Brit. Med. Jnl.    1.632.    Apr. 30, 1921.
Tunicliff, Ruth.    J. A. M. A.    74:  1396.
Bliss, W. P.    Bull., John Hopkins Hosp.    31.   173.
Zingher, A.    Am. Jnl. Dis. Childn.    May, 1923.
Mair, W.    Lancet.    Vol. 2.    1390.    Dec. 29, 1923.
3Jt 3|C 3JS 3fC
ADMISSIONS TO ESSONDALE.
The following letter has been received by the Secretary of
the Association:—
"Public Hospital for the Insane,
"New Westminster, B. C, October 7, 1924.
"Dear Sirs:
"Will you please be advised and inform those who may be
interested, that on and after November 1, 1924, all patients for
admission to the Mental Hospital will be received in the new Acute
Building, Essondale, B. C the Hospital at New Westminster being closed as an admission Hospital from that date. All new
patients must be taken to Essondale for admission.
"Asking your co-operation in making this change operate
with the least annoyance to all concerned, I am,
"Yours very sincerely,
"H. C. HIMES,
"Medical Superintendent."
Page Thirteen B. C. MEDICAL ASSOCIATION.
Dr. Walter Bapty has been appointed to the Executive of
the B. C. Medical Association, as representative of the Victoria
Medical Society, of which he is President.
Dr. W. T. Lockhart left on the Blue Funnel liner Achilles
on Oct. 23rd for the round trip to the Orient, and expects to return about the end of January, 1925. We occasionally have requests for a physician to act as medical officer on a boat, and any
medical man who thinks that he would like to take such a trip
might be well advised to send his name to Mr. C. J. Fletcher, our
Executive Secretary, who will be able to keep a list and notify
them whenever an opportunity occurs.
We have received several letters from medical men throughout
the province, congratulating us on the production of THE BULLETIN, and stating that they specially appreciate the B. C. Medical Association pages, as it enables them to keep in touch with the
work of the province as a whole. We shall be glad of items of
news and interest, at all times, and will also welcome letters for
publication in THE BULLETIN on any topic of general interest;
such letters to be short and to the point.
The second luncheon of the B. C. Medical Association was
held at the Ambassador Cafe, on the 7th of November, with Dr.
W. B. Burnett, Vice-President, in the chair. The speaker of the
day was Dean H. T. J. Coleman, M.A., Ph.D. Dean Coleman
gave a very thoughtful and interesting address on "Experimental
Education." Dean Coleman is always a delightful speaker, and
has the gift of suggestiveness. We consider ourselves fortunate
that we were able to secure him for the luncheon. The orchestra
of the Vancouver Medical Association played several numbers,
which were very helpful in enlivening the proceedings.
The Health Bureau of the Board of Trade received an address
from Dr. W. A. Dobson of this city, on the 5 th of November,
dealing with "Some Aspects of Psycho-therapy from a Community Point of View." At the next meeting, to be held on November 19th, Dr. W. B. Burnett will speak on "The Teaching of
Sex Hygiene in Schools." In dealing with this question, it is of
the greatest importance that this vital subject be approached in
the proper way, so that a wide and comprehensive understanding,
from a biological standpoint, be inculcated in the child's mind,
rather than specific references to the problems of sex, the teaching
of which would be extremely difficult, if treated as a separate subject. Some years ago, the Vancouver Medical Association appointed a committee to consider this subject, under the able chairmanship of Dr. Brodie, and this committee came to the conclusion
that biology should be taught in a carefully graded series of lessons, rather than' that the sex problem should be dealt with as
such.
We record, with regret, the death of Dr. George deB. Watson, of Edmonds, B. C, who died very suddenly on the 24th of
Page  Fourteen October, at the age of 72. Dr. Watson was a valued member of
the B. C. Medical Association, and a greatly respected member of
the community. He had been Medical Health Officer for Burnaby
for many years, and has a long and honourable record of professional service. He leaves a wife, three daughters, and two sons,
and we respectfully extend our deepest sympathy to his family.
Dr. S. Bonnell, of Fernie, has moved to Vancouver, where
he will specialize in eye, ear, nose and throat work.
Dr. T. L. Butters, of Courtenay, V. I., has been called East
by the serious illness of his father. His practice is being cared for
by Dr. H. C. MacKenzie.
Dr. W. D. MacKay, of New Westminster, has gone to Salmon Arm to assist Dr. A. K. Connolly in his practice.
Dr. W. W. Chipman, of Mayo, Yukon, has recently moved
to Vancouver, where he will engage in general practice.
We would like to remind our readers of the existence of two
committees, the Publicity and Educational Committee, and the
Industrial Service Committee, which are at their disposal at all
times. For most men, the latter will be found to be a very valuable help in time of trouble. Any difficulties with W. C. B. cases,
questions of contract, etc., should be reported to this committee,
which, under the very energetic chairmanship of Dr. A. B. Schin-
bein, is carrying on the good work of its predecessors in office,
and has been able to be of assistance to a great many men.
(The following article is taken from the Toronto Daily
Star of Oct. 1, 1924. A non-professional opinion on professional
activities of any kind, if genuine, and given without malice or
bias, is interesting and valuable. With that idea in view, we have
much pleasure in printing this article dealing with a subject of
perennial interest known to the public as "The Family Doctor.")
THE FAMILY DOCTOR.
It is highly probable that if you were to meet to-night a
young fellow who is taking his first year in medicine at Varsity,
and were to question him as to his purpose, he would tell you that
he is going to be a specialist. Although he has only begun to
receive instruction in the A, B, C's of medicine, he will tell you
just what sort of specialist he is going to be. He is going to be a
nose and throat, or an eye and ear, or a nerve, or a blood, or a
brain, or a knee and elbow, or a toe and finger, or a baby or an
old-folks, or some other sort of specialist.
The layman used to suppose that the doctor who became a
specialist was one who in practice had disclosed a special skill in
one branch of medicine until he stood out among his brethren as
an acknowledged authority, to whom other physicians turned
when in doubt—a man who with unusual enthusiasm and a particular aptitude, prosecuted deeper studies in a special direction,
Page   Fifteen until it became a waste of time for him to engage in those tasks of
the physician which all alike could do.
It seems, however, that youths who stand as yet only in
the porch that leads into the halls of medical learning, are already
ticketing themselves through as specialists in any line to which
their fancy turns. One would suppose that even if we have got
past the old-fashioned notion that a specialist is a general practitioner who has gradually revealed a superior skill, knowledge,
intuition and industry of research in a special line of work—even
if we have got past that, one would suppose that the students
would at least be expected to show some special aptitude in the
course of their years of study before presuming to decide upon
being specialists at all, or being particular sorts of specialists. Or
is the profession merely being subdivided so that a patient, instead
of having a doctor, will require half a dozen of them, each treating his own particular section of the human anatomy?
The president of the British Medical Association, in a recent
address to that body, denounced the present craze for specialists.
He said it was a bad training for the newly qualified student of
medicine that he had, during the war, to deal with "cases," not
patients, and it tended to impair his usefulness as a physician in
civil life. Laymen were being taught that only a specialist could
be depended on. He regretted this and believed that the most important of all specialisms was the specialism of general practice,
for without it clinical observation was threatened with becoming
a lost art. Some of the new methods of diagnosis were good servants, but bad masters.
In line with this was an address delivered the other day by
Dr. S. E. Earp, president of the Indiana Medical Association, in
the course of which he said:
"There are those among us who feel that something could
be learned from the life work of the old family physician, who
had rare qualities of mind and heart, who managed his case well.
We must not fail to realize the advantages of to-day as compared
with twenty years ago, but we must confess that it would be a
very great advantage, both to doctor and to patient, to accept
some of the methods of the old family doctor."
On the 21st of August, Dr. James C. Wood, of Cleveland,
was in Huntsville on his way to Bigwin Inn. He tells in an article
in the Cleveland Topic, how he saw the town idle and the streets
crowded, so he asked the cause, and was told that the funeral of
Dr. J. W. Hart was about to take place. Dr. Hart had come to
Hunsville thirty-five years ago, and ever since had practised medicine in the town and over the country far and near. He had not
grown rich, but had led a life of rare usefulness and been a man
of influence. He worked hard, he served his kind, but he had a
bully good time hunting and fishing when he got a chance. And
the Cleveland doctor who saw his funeral wonders who among
physicians is more worth while than the strong and competent
man in general practice in small towns in the country.
Page Sixteen No doubt specialists are all right if they possess knowledge
and skill superior to that of the general practitioner. But this
world will be the poorer if the family doctor loses his place in
the scheme of things.
GENERAL HOSPITAL ITEMS.
One thousand one hundred and twenty-six patients were admitted to Vancouver General Hospital during the month of October, of which number 89 were new born.
During this month there were given 2,250 patient days'
treatment over and above the corresponding month for 1923.
The Department of Physiotherapy exceeded all previous
months in its records of examinations or treatments. A new air
cooled quartz lamp has been added to the equipment of this department, and a portable high frequency machine has been acquired to
facilitate this form of treatment for patients unable to be moved
from the wards.
As a result of a survey made during this summer, the American College of Surgeons announces the inclusion of this Hospital
in its approved list for 1924, with grading "A."
A new Heidbrink gas-oxygen anesthetizer, complete in all
its details, has replaced equipment in the O. R. which is less efficient.
At the request of the city authorities an additional ward
for the reception of twenty-five female scarlet fever patients, was
opened on Nov. 8th as an emergency measure, in Heather Street
Annex.
Pending an appointment to be made by the Board of Directors, Dr. R. E. Coleman is acting Director of Hospital Laboratories, occupying the position made vacant by the death of Dr.
Mullin.
ABDOMINAL HYSTEROTOMY.
Dr. J. J. Mason.
Dr. Mason opened his paper on "Abdominal Hysterotomy"
by stating that the operation could be performed on either the
pregnant or non-pregnant uterus. He dealt first with the technique
of the operation on the non-pregnant organ where the indications
are fairly well defined.
Hysterotomy is performed for (1) the removal of myomata.
These can usually be shelled out without opening the endometrium. If perchance the cavity be opened there is little added risk
unless there has been a recent sounding or curettage. A danger in
myomectomy is the tying of the coapting sutures too tightly. A
further element of danger in these operations is the leaving of dead
Page Seventeen spaces in the bed of the removed myoma. The incision in the
uterus for the removal of a myoma should be made, if possible, in
the anterior wall as low down and as near the centre line as feasible, so that by sliding the bladder peritoneum over the closed
uterine incision the wound can be completely peritonized. The
operation might well be extended to many of the cases in younger
women who were previously submitted to hysterectomy, and nowadays are fashionably treated with radium or X-rays. The danger
of rupture of the uterus during pregnancy and labour after a previous myomectomy is infinitesimal, especially if clean healing has
resulted from the operation. In this connection the lecturer reported an interesting case of acute red degeneration of a uterine
fibroid complicating pregnancy.
The great field of usefulness for abdominal hysterotomy is
in pregnant conditions. It is the ideal operation in the interruption of pregnancy after the third month when complicated by
some constitutional or local disease which makes an abortion necessary, and where vaginal delivery seems more difficult on account
of a rigid, undilated cervix, particularly if sterilization of the
patient be desirable at the same time.
Two such cases were for hydatidiform mole, one of which
was fully reported by the lecturer. Other indications in this group
were:
One case of chorea with endocarditis and a four
months' pregnancy.
One case of advanced chronic nephritis with marked retinal haemorrhage and a three months' pregnancy.
In this case the patient was sterilized as well.
One case of pregnancy with marked increasing
crippling rheumatoid arthritis, in which case also sterilization was done.
One case of five months' pregnancy with increasing
pyelonephritis.
Two cases of early marked hepatic toxaemia, getting worse under conservative treatment.
Two cases of pregnancy with advanced heart disease.
Two explorations of the uterine cavity.
The speaker then took up the indications for, and technique
of, full term abdominal hysterotomy or Caesarian section.
(1) In contracted pelves: As a primary postulate it might
be said that the pelvic measurements practically remain as they
are during labour, but the foetal head varies greatly. The measurements taken by the speaker were the following: The anterior
superior spines, intercristal, external conjugate or Baudeloque, the
transverse diameter of the outlet, the antero-posterior of the outlet, the point on the centre line in relation to the anus, where the
transverse diameter of the outlet crosses the antero-posterior diameter. If the patient be in the early months of pregnancy, an internal examination is made.    If the promontory of the sacrum can
Page Eighteen be felt easily, the true conjugate is estimated. The intercristal
measurement is of more importance than the interspinous, and
should be 27 cm. or more. If the external conjugate be below
18 cm. there is contraction. Since the painstaking work of Williams, of Johns Hopkins, some years ago, on funnel pelves, the
speaker has carefully examined the outlet of every pregnant patient who has consulted him, and has been surprised at the frequency of outlet contraction, and is convinced of the baneful results of marked outlet contraction to the babe and to the mother
in the greater incidence of deep tears.
In the latter weeks of pregnancy the behaviour of the presenting part to the pelvis should be watched. A floating head in a
primipara in the last weeks of pregnancy is suggestive of disproportion. If the head should have been in the pelvis and at the
next weekly examination is riding out of the pelvis, it suggests disproportion. The speaker here made a plea for a weekly or at least
bi-monthly examination of patients in the last weeks of pregnancy
especially if primiparae or with a history of previous stormy passages. Each individual case should be a law unto itself. Foetal
heads vary in pliability, in size, in presentation and degrees of
flexion. The uterine contractions vary in strength in different
patients. The nervous system in one may withstand pain well,
in another relinquish the task. The amniotic sac may rupture
early in one and in another remain intact throughout the labour.
It might be asked, "Why measure the pelvis at all?" The pelvic
measurements themselves are only suggestive of the difficulty or
ease of labour. It is the relative action of that particular head to
that particular pelvis which is of greater importance. If these observations be true, the vast majority of cases of contracted pelvis
must have a test of labour. The speaker said he saw no danger
in a test of labour if vaginal examinations are withheld and the
amniotic sac be not ruptured. If the sac be broken, every hour
that elapses to the Ceasarean, if such be done, increases the risk
to the mother. If the sac be unruptured, four or fourteen hours
of labour are of little moment. Before a pelvic delivery be decided against, a thorough examination under full anaesthesia, using
Kerr's method of estimating the relative disproportion of head to
pelvis, should be made.
If the pregnancy be overdue, the abdomen should be examined even oftener than every two weeks. Remember that in the
latter weeks of pregnancy the baby gains one pound in weight
and a third to a half inch in cranial development every two weeks.
The pioneer work of Ballantyne on the post-mature foetus has
never been sufficiently highly valued.
(2) Eclampsia. A second class of cases that Caesarean
section is done for is eclampsia and allied toxic states. As a general proposition it might be said that eclampsia should be an uncommon reason for the performance of hysterotomy. An eclamptic is not a good surgical risk. The speaker said he would limit
the indications for hysterotomy in pre-eclamptics to patients in
Page Nineteen whom a rigid eliminative treatment had failed to reduce B. P. and
albumen, to increasing signs otherwise of impending storm, retinitis, severe headaches, restlessness, vomiting, epigastric pain, in
whom the cervix was not taken up, and especially to those cases
where some disproportion seemed to exist between foetal ovoid
and pelvis, and to cases of eclampsia where the soft parts were
such as had been mentioned. They must be careful not to sacrifice the interests of the mother to the potential interests of a
child liable to be overwhelmed with toxaemia. The speaker said
he had done Caesarean six times for eclampsia and severe toxaemia
with one death.    The foetal mortality was nil.
(3) Placenta Praevia as an indication for abdominal
hysterotomy. In this complication of pregnancy the speaker said
he was more radical than the majority of writers, while in the
condition of eclampsia he was less radical. He had done Caesarean
in three cases of placenta praevia, with no infant x>r maternal
mortality.
(4) Premature separation of the placenta will provide a
rare but life-saving indication for abdominal Jiysterotomy.
Other indications for Caesarean section seen by the speaker
were postmature large foetus in a normal pelvis; previous extensive vaginal repairs; previous Caesarean where the healing was not
clean or where the patient definitely decided on another Caesarean
rather than take the risk of a ruptured uterus.
The technique of abdominal hysterotomy was then fully
described. If the patient were potentially infected by long rupture
of the membranes or vaginal examinations, the speaker said he
preferred the low cervical incision, the so-called Beck operation,
the technique of which he then described.
Summarizing results in the cases on which he had personally
operated, Dr. Mason gave the following figures:—
21 Hysterotomies (?) for myoma—so-called myomectomies.
Mortality nil.
12 Hysterotomies for non-viable cases.    Mortality nil.
10 So-called extra-peritoneal Caesarean sections.    Mortality
nil. "
64 Classical Caesarean sections.    Two deaths.
A complete report of all cases operated on, completed the
paper.
Page Twenty The M.edical Profession is United
in recognition of the fact that the MOST IMPORTANT
FACTOR IN THE LIFE OF A CHILD is the Milk supply.
MlLK is the first and only food the new-born child receives, and when—as is frequently the case—cow's milk has
to be substituted for the natural mother's milk, too much care
cannot be taken to secure the best and purest milk obtainable.
THE BEST AND PUREST MILK can come only from
the MOST SANITARY AND EFFICIENT DAIRY. Therefore, when recommending a supply of Milk, for either BABY,
INVALID, or HEALTHY PERSON, REMEMBER that the
VALLEY DAIRY
holds the record score for SANITARY, MODERN, and EFFICIENT DAIRY EQUIPMENT, and PURITY OF PRODUCTS.
VALLEY DAIRY LIMITED
"The Children's Friend"
569 Sixth Avenue West.
Bay view 553.
Burns Druq Company
LIMITED
DISPENSARY    PHONE
SEYMOUR   606
The Dispensing Department is an entirely separate
unit of our business. >
We stock all the  leading  manufacturers'  lines.
Don't forget — Dispensary  Phone,   Seymour   606
Page Twenty-one  PRESCRIPTIONS
filled exactly as written
Phones: Seymour 1050 -1051
Day and Night Service
Qeorgia Pharmacy Ltd.
Qeorgia and Qranville Sts.
Vancouver, B. C.
Doctors—
Your stationery is
always neat and
attractive when
entrusted to
McBeatK Spedding
Limited
569 Howe St.     Seymour 2487
A New Service
We desire to announce to the
TsA.ed.ical Profession that a twenty-
four hour phone service is now
available,
The patronage of all practicing
licensed physicians and surgeons
is respectfully solicited.
For further information apply
to
Medical Phone Service
Seymour 2062
Page Twenty-three Rest Haven Sanitarium
Medical and Surgical
No Tubercular or Mental Cases
Strictly Ethical
iJwK'
C7 *\ ^E cordially invite the  medical profession  to visit Rest
LVJHaven.    Here, beautiful surroundings, kind and cheerful
attendants, with liberal but carefully prepared diet, furnish an environment favorable to recovery.
Hydrotherapy, massage and other physio-therapy treatments
are provided under careful medical supervision.
Your own program for patient carried out, including special
diet for diabetics, etc. Reports and laboratory tests sent to physicians referring patients to us.
Don't miss an opportunity, Doctor, to see our place, and if
possible enjoy a day or two here with your family as our guest.
O. S. PARRETT, M.D.,
Medical Superintendent.
SIDNEY, B.C., near Victoria
Phone 95-0
Page  Twenty-four

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