History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: October, 1926 Vancouver Medical Association Oct 31, 1926

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 UNIVERSITY OF B.C. LIBRARY
3 9424 04792 216 3      X(
)K
THE VANCOUVER MEDICAL
ASSOCIATION
BULLETIN^
Published monthly at Vancouver, B^>C^ "t/
Subscription $1.50 per v«iW;..
Summer School
cfAbstract of Proceedings
Interstitial Sodium bicarbonate^
(fNLethods of taking Sfooci for ^ests
OCTOBER, 1926
m
Tublished by
<&XCc'tBeath Spedding Limited, 'Vancouver, "23. Q.
>K M(3sH—
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Makes it easy for the patient to establish Habit Time.
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it ready for easy passage.
Petrolagar is NOT a cathartic.
Petrolagar No. 3 (Alkaline) is an ideal treatment during
pregnancy.
Petrolagar No. 1 (Plain) for all ordinary cases of constipation, and for infants and children.
Petrolagar No. 2 (With Phenolphthalein) for the chronic case and to be followed with Petrolagar No. 1.
Deshell Laboratories of Canada, Limited, Dept. V.,
245 Carlaw Avenue, Toronto, Canada.
Please send without obligation, copy of Habit Time and sample of
Petrolagar.
Di
Address
3K3V
Page 2 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. 3.
OCTOBER 1st, 1926
No. 1
OFFICERS, 1926-27
Dr. a. W. Hunter
President
Dr.
A.   B.   SCHINBEIN
Past President
Vice-President
Dr.
J.
A.
Gillespie
Secretary
Treasurer
' Dr. F. W. Brydone-Jack            De
.. W. S.
TURNBULL
TRUSTEES
Dr.
W. F. Coy                Dr. W. B. Burnett
Dr.
J. M
. Pearson
Representative to B. C. Medical Association
Ai
iditor
Dr. A. C. Frost
Dr.
F.
W.
Lees
SECTIONS
Clinical Section
Dr.
F. N. Robertson   -
-
-
Chairman
Dr.
L.   LEESON        -----
Physiological and Pathological
Section
-
Secretary
Dr.
C.   H.  Bastin
-
-
Chairman
Dr.
C. E. Brown	
-
-
Secretary
Eye, Ear, Nose and Throat Section
Dr.
Colin Graham       ...        -
-
-
Chairman
Dr.
E. H. Saunders      -
•   Genito-Urinary Section
-
-
Secretary
Dr.
G. S. Gordon         -
.
-
Chairman
Dr.
J. A. E. Campbell     .   -
-
-
Secretary
Physiotherapy  Section
Dr. G. A. Greaves     ---------     Chairman
Dr. H. A. Barrett     ---------     Secretary
COMMITTEES
Library Committee
Dr. W. F. Mackay
Dr. W. D. Keith
Dr. C. H. Bastin
Dr. W. C. Walsh
Orchestra   Committee
Dr. F. N. Robertson
Dr. J. A. Smith
Dr. L. Macmillan
Dr. W. L. Pedlow
Dinner Committee
Dr. C. F. Covernton
Dr. A. C. Frost
Dr. g. B. Murphy
Credit   Bureau   Committee
Dr. Lachlan Macmillan
Dr. D. G. Perry
Dr. D. McLellan
Credentials Committee
Dr. E. H. Saunders
Dr. B. H. Champion
Dr. T. R. B. Nelles
Summer School Committee
Dr. W. D. Keith
Dr. g. s. Gordon
Dr. Murray Blair
Dr. G. F. Strong
Dr. H. R. Storrs
Dr. R. Crosby The Basis of all Artificial
Infant Feeding
The basis of infant feeding is human milk, and
the principle involved in the artificial feeding of normal infants is the imitation of human milk.
Cows' milk is the basic material used in practically all artificial feedings. It is modified one way
or another to make it better suited to the infant's
digestion, and to have more or less the same proportions of food elements as human milk.
Pediatrists say that fresh cow's milk is, therefore, a logical diet for normal infants, provided that
it is.diluted with water to reduce its fat and protein
contents and that a suitable sugar is added to the
• mixture to give it approximately the same percentage
of carbohydrate as in human milk.
Mead's Dextri-Maltose
is a special sugar to be added to diluted milk, which
has been found to be more easily assimilated by infants and less likely to produce diarrhoea than cane
sugar or milk sugar.
DEXTRI-MALTOSE is advertised only to
the profession in order that the physician may control each case and be the sole judge of the proper
formula to suit the needs of the individual baby.
On request, a Mead's Feeding Calculator, showing usual formulas for normal infants suggested by
the results of pediatrists, will be supplied to physicians, together with samples of Dextri-Maltose.
Mead, Johnson & Company
OF CANADA, LTD.
BELLEVILLE, ONT.
Page 4 nnouncing
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It is portable. When mounted
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A protective carrying case
of fibre, felt lined, furnished on special orders
Sturdily built for real service
Minimum attention to maintenance
A machine that provides for
more than immediate requirements
This Diathermy Machine will keep you
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"DHYSICIANS everywhere are learning the value of diathermy in the treat-
■*• ment of many conditions common to every practice. Therapeutically, for the
generation of heat internally, in bone or tissue, the resistance of the tissues to
the flow of current resulting in accumulated heat. Surgically, to a degree of intensity that is destructive in effect, frequently referred to as electrical coagulation.
In your selection of a diathermy machine, be sure that the design and capacity are such as will enable you to follow out accurately and efficiently the
rapidly advancing technics. Altogether too many physicians have been disappointed in diathermy, simply because the apparatus used proved inadequate.
The Victor Vario-Frequency Diathermy Apparatus represents the accumulated knowledge and experience of a pioneer organization specializing for
30 years in electro-medical equipment.
When designing this outfit Victor engineers were guided by the investigations of our
Biophysical Research Department, which point definitely to a different physiological evaluation being established for certain frequencies or oscillations of the high frequency current.
Consequently, this machine offers a means of selecting the frequency which has been proved
most efficacious for a given condition.
With an unequalled refinement of control permitting selection of frequency, voltage and
intensity, the physician with Victor Vario-Frequency Diathermy Apparatus may adopt the
Mounted on floor cabinet        anticipated new standardized technics as soon as they are established.
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Victor X-Ray Corporation of Canada Ltd., 910 Birks Bldg., Vancouver. VANCOUVER MEDICAL ASSOCIATION
Founded 1898. • Incorporated 1906.
PROGRAMME OF THE 29th ANNUAL SESSION
GENERAL MEETINGS will be held on the first Tuesday of the
month at 8 p.m.
CLINICAL MEETINGS will be held on the third Tuesday of the
month at 8 p.m.
Place of meeting will appear on Agenda.
General Meetings will conform to the following order:—
8:00 p.m.—Business as per Agenda.
9:00 p.m.—Paper of Evening.
1926
Oct.
5.-
Oct.
19.
Nov.
2.-
-General Meeting:
Presidential Address, Dr. A. W. Hunter.
—Clinical Meeting.
—General Meeting:
Papers—1.    Dr. C. W. Prowd, "An Analysis of Radium Therapy, reporting 600 cases.
2.    Dr.  J.  A.  Sutherland,  "Pain  and disability from
lesions about the Anus.
Nov. 16.—Clinical Meeting.
Dec. 7.—General Meeting:
Papers—1.    Dr. W. F. MacKay, "Diagnosis and Significance of
referred Pain in Disorders of Chest and Abdomen."
2.    Drs. W. S. Turnbull and J. W. Arbuckle, "Eclamp-
sia.
Dec. 21.—Clinical Meeting.
1927.
Jan. 4.—General Meeting:
Papers—1.    Dr. G. A. Greaves, "Physiotherapy in Orthopaedic
Conditions."
2. Dr. H. A. Barrett, "Treatment of Infections by
Physical Agents."
3. Dr. H. R. Ross, "Physiotherapy in Gynaecological
Conditions."
Jan. 18.—Clinical Meeting.
Feb. 1.—General Meeting:
Papers—1.    Dr. J. M. Pearson, "Treatment of Hypertension."
2.    Dr. C S. McKee, "The Interpretation of Findings
in Blood Chemistry."
Page 6 Feb. 15.—Clinical Meeting.
March 1.—General Meeting:
Paper —       Dr. George Seldon, The OSLER Lecture.
March 15.—Clinical Meeting.
April 5.—General Meeting:
Paper — Symposium, "The Treatment of the Poor Risk
Patient," Drs. C. E. Brown, A. B. Schinbein, D. D.
Freeze and R. E. Coleman.
April 19.—Annual Meeting.
The following is the programme of the Physiotherapy Section for the
coming season:
October 13 th—Regular Meeting.
November 10th—"Physics of Radiant Energy," Dr. G. A. Greaves.
"Bio-physics of Radiant Energy," Dr. H. A. Barrett.
Clinical Cases, Dr. J. W. Welch.
"Ultra-violet Energy in Special Disease," Dr. H. R. Ross.
December 8th—"Clinical Demonstration of the Uses of Radiant Energy
Apparatus.
January 12th—"Electro-physics," Dr. G. A. Greaves.
"Galvanic Currents," Dr. J. W. Welch.
"High Frequency Currents," Dr. H. A. Barrett.
"Wave Currents," Dr. H. R. Ross.
February 9 th—Clinical Demonstration of the uses of Electrical Currents.
March 9th—Regular Meeting.
April 13 th—Regular Meeting.
Page 7 EDITOR'S PAGE.
We publish in another part of this issue a portion of an abstract of
the proceedings of the recent Summer School which is so important a
feature of the scientific work of the Vancouver Medical Association.
The Committee in charge, with Dr. W. D. Keith as Chairman, Dr.
G. F. Strong as Secretary, and in addition Dr. G. S. Gordon, Dr. Murray
Blair, Dr. H. R. Storrs and Dr. Robt. Crosby, are indeed to be congratulated on the quality of the speakers secured for this year. Seldom,
if ever, has such a uniformly good programme been presented.
The working arrangements of the meeting passed off with a quiet
smoothness and celerity which only those who have ever been connected
with such an organization realize meant a lot of hard work and planning
before hand, behind the scenes.
We regret that this particular week should have been the focus or
culmination of the hectic political weeks that had preceded it and of the
lethargy which followed, because it was probably one factor in accounting for a registration which was seriously and ominously small.
But when every allowance is made for the disturbing political atmosphere, for the possible though remote effects of the meeting of the
Canadian Medical Association in Victoria in June and for other meetings
in Spokane or elsewhere, it is nevertheless a matter for very serious
thought.
With five years of well earned reputation for successful meetings
behind them and with a programme in the formation of which neither
trouble nor expense had been spared and which had been further fortified
by the speakers furnished through the generosity of the Canadian Medical Association—with these, we say, that the Committee had every right
to expect a record registration.
It becomes, then, an important problem to ascertain the cause of
this failure in attendance and to consider what steps can be taken to meet
it.
We shall not at present discuss this further for no doubt the Executive, and indeed the whole Society whose venture it is, will give it careful consideration during the coming winter.
The Committee, of course, will be faced with a considerable deficit.
Fortunately there is, we believe, a moderate surplus accumulated in the
past which may be drawn upon and thd Committee need feel no compunction or stigma in balancing its accounts this way.
The bad must be taken with the good and; we feel that everything
to contribute to the success of the meeting was the work of the Committee and we thank them for it.
Page 8 NEWS AND NOTES.
Dr. Vrooman left on the 18 th September to attend the International
Congress on Tuberculosis to be held in Washington, D.C.
We are very glad to report that the doctors in attendance on Dr.
J. H. MacDermot state that he is improving slowly and gradually and
by the time this Bulletin is in print it is hoped that he will have been able
to return to his home.
Dr. H. A. Spohn has been elected President of the Canadian Society
for the Study of Diseases of Children.
We are informed by Dr. Underhill that the Vancouver Health Department has now arranged to supply free scarlet fever antitoxin for the
immunization of scarlet fever contacts (residents of city only). The
antitoxin may be obtained free of charge from the Georgia Pharmacy by
signing an order, as in the case of diphtheria antitoxin.
VANCOUVER MEDICAL ASSOCIATION
SUMMER SCHOOL
ABSTRACT OF THE PROCEEDINGS
At nine o'clock on Monday, September 13 th, the members present
were called to order by the Chairman of the Summer School Committee,
Dr. W. D. Keith. After a few introductory remarks, Dr. Keith presented the first speaker of the session, Dr. Carl A. Hedblom, Professor of
Surgery in the University of Illinois.
The title of Dr. Hedlom's address was "A Study of End Results
following Radical Amputation of the Breast for Carcinoma" and the following is a summary of his findings and conclusions:
1.    22% of 1792 cases of carcinoma of the breast gave a family history
of carcinoma.
2. The breast was the organ affected in 34% of these female relatives.
More than one relative was affected in 12.2%. ■
3. The left breast was involved in 62 % of the cases. The upper hemispheres of the breasts were involved in upwards of two-thirds, the
lower hemispheres in less than one-quarter of the cases.
Page 9 4. The carcinoma had involved the axillary glands at the time of operation in 68% of 1792 cases.
5. The incidence of axillary gland involvement bore no relation to the
age of the patients, which ranged from 20 to 80.
6. The incidence of axillary gland involvement is in direct relationship
to the lymphatic drainage, being greatest in cases with involvement
of the upper quadrant.
7. Involvement or absence of involvement of axillary glands was recognized clinically in 52 '/< of early cases, representing the five
to 8 year cures and in 75c/c of the cases that died of recurrence.
8. Discharge from the nipple occurred in \l% but malignant papilloma was found in only one-tenth of these cases. In half of the
cases with malignant papilloma there was no history of nipple discharge.
9. Of 623 patients traced 3 5.6r/'c are alive 5-8 years after operation.
43% are known to have died.
10. Of 167 cases operated early before the axillary glands had become
involved 73.6% are alive after 5-8 years. Of 397 patients operated
after the axillary glands had becme involved only 22.1% are alive
after 5-8 years.
11. In both groups the highest percentage of cures follows operations
for cancer involving the upper outer quadrant of the breast.
12.    Most of the post-operative deaths in this series occurred in cases in
which  radical   operation  was   performed  in   the  presence  of   un
recognized visceral metastases.
13. 8% of those who died of recurrence lived more than five years.
14. Of 86 patients alive 3-8 years after the development of recurrence
56 not operated on for recurrence have lived approximately as long
as 30 who were operated on for recurrence.
15. Family history of carcinoma was present in 26c/i of the patients
alive more than five years and in 23% of those who died of recurrence. There was a history of trauma in 5.9% of those who
are alive and in 11.5% of those who died of recurrence.
16. All patients in whom supraclavicular triangles were dissected, all
those operated during pregnancy and lactation and all patients operated on for simultaneous bilateral involvement of the breast are
dead.
Page 10 17. Swelling of,- the arm occurred in 50%   of 575 patients now living
but in only 4.8% of 666 patients who died of recurrence.
18. Radium therapy was used in 64%   of those who are alive and in
74% of those who died of recurrence.
CONCLUSIONS
1. Radical operation for carcinoma of the breast before the axillary
glands are involved results in a five-year cure in about 3 out of 4
patients, whereas radical operation after the glands are involved results in a five-year cure in one out of five.
2. Approximately the same proportion of patients present themselves
for surgical operations after glands have become involved as 6-9 years
ago.
3. Life is prolonged from one to 3 or 4 or more years in cases of patients
who died of recurrence and is made more comfortable.
4. Radium therapy in competent hands is of great value as an adjunct
to surgical treatment. The exact appreciation of its indications,
limitations and value, particularly with respect to the high tension
radium therapy, remains to be determined.
The next speaker on the Programme was Dr. George Hale, Professor
of Medicine. Western University, London, Ontario, who took as his
subject "Nephritis from the Standpoint of the General Practitioner."
After a few observations on the physiology of the kidney Dr. Hale
said that a working classification might be made of nephritis into types
which were (1) acute and (2) chronic. The chronic kind could be
divided into two varieties—one with oedema and the other without, being respectively the hydraemic and the azotaemic varieties.
The patient suffering from an acute nephritis is usually pale, puffy
about the face, with more or less oedema of the extremities and ascites.
He complains of severe headache and general malaise to a greater or less
degree.
The urine is reduced in quantity, of high specific gravity, contains
a large amount of albumin and shows both red blood cells and casts.
'There is no tendency to nitrogen retention but salt retention is present
and probably the blood pressure is high. In this variety, therefore, uraemia is not part of the picture and the convulsions which may occur are
not those of uraemia, being probably dependent upon the cerebal oedema.
The chronic variety of nephritis may be the result of a previous
acute attack or may be due to other forms of toxaemia. In the
oedematous variety the syndiome presented is similar to that of acute nephritis but milder in character. There is the same pasty appearance, considerable oedema, diminshed urine showing albumen and casts. Here
again there is no tendency to nitrogen retention.
Page 11 The azotaemic variety is the next form, and regarding its origin,
the lecturer said, we have not much definite information. It is generally
a silent disease discovered by accident, or on account of the patient
consulting a doctor because of symptoms associated with other organs,
usually the heart, or the circulatory system. These patients will complain, in addition, of lassitude, headache and insomnia and often the
only real complaint is that of nocturia. There is no oedema except that
of secondary cardiac origin, and a greater or less degree of cardio-vascular
changes is always present. The albumin in the urine, when present, is
usually small irj amount. In this vlariety there is a definite tendency to
retention of nitrogen but none of sodium chloride.
In such a case, then, how do we differentiate as to the cardiac or
renal origin of the symptoms? This differentiation is made largely from
laboratory data and here very ordinary tests are sufficient, such as can be
applied by any physician. Those upon which the lecturer said he
relied are (1) the urea concentration test in which 15 gms of urea are
administered in 100 cc. of water and the urine collected at the end
of one and two hours. This is tested in the usual way for the amount
of urea present. If this is found to be 2% or over the function of the
kidney may be regarded as sufficient. The second test is fixation of the
specific gravity. Here the urine is taken at two hourly intervals during
the day and less often during the night and the specific gravity of each
specimen determined. There should be at least 8 points difference in
the specific gravity in normal cases in which also the urine during the
night hours should be less in quantity and of a higher specific gravity.
If these conditions do not obtain it is evidence of deranged function.
In addition the phenolsulphonephthalein test may be used. The
dye in normal cases is excreted to the amount of 60-8 5% at the end of
two hours.
The oedema present has a very definite relation to salt retention.
It is apparent that the salt contained in the body is maintained at a fixed
concentration, therefore, said the lecturer, if more salt remains water is
retained in order that the concentration may be maintained. Fischer, on
the contrary, takes a somewhat different view. He regards the body
tissues as being of the nature of hydrophilic colloids in which there is
a tendency to take up water. In acid conditions- of the body this
tendency is more rapid and he considers there is a definite relationship
between acidosis and oedema. The salt he regards, contrary to the general opinion, as being more or less of a defensive agent.
Dr. Hale said one thing is certain—oedema is not due to inability
of the kidney to excrete water. This is clearly shown in cases of poisoning by bi-chloride of mercury where the secretion of urine from the
kidney may be reduced to a minimum and yet there is no tendency to
oedema.
Albuminuria is not necessarily evidence of nephritis. There is,
for instance, postural albuminuria and the albuminuria of adolescence
and the occurrence of albuminuria in a great many sick persons where
there is no other indication of kidney involvement.
Page 12 As to treatment.—In acute nephritis the important element is
time. At least three months are required before conditions can be expected to return to normal and the presence of red blood cells occurring
in the urine is an indication for continued rest in bed. Diuretics are of
very doubtful value in cases of any acuteness. As to diet, some patients
improve on a protein diet and others do not. On the whole the old
established prescription of a milk diet may be the most advantageous and
is certainly a wise thing to use in the early stages.
In a chronic nephritis without oedema it is important to remove from
the diet nitrogen-producing products. The main part of the treatment is
concerned with the associated cardiac and vascular changes, chiefly high
blood pressure and cardiac enlargement.
Dr. R. R. MacGregor, Professor of Paediatrics, Queen's University,
Toronto, spoke on "Common Nutritional Disturbances of Infancy Observed in Practice."
Feeding difficulties in infants, said Dr. MacGregor, may be due to intolerance to protein, to intolerance to sugar or to intolerance to fat on
the part of the infant. In protein intolerance the stools are pale and
show curd-like particles and in this form of disturbance a butter flour
mixture which is low in protein and high in fat is of value. In cases
of intolerance to sugar the infant is restless and there may be vomiting or
watery regurgitation. The stools are loose, green and acid. In these
cases protein milk is of value. There are at times very obstinate cases
which do not respond to the use of the protein milk only, and in these
cases it has been found that the addition of the butter flour mixture
to the protein milk has given better results. In fat intolerance the infant
is usually pale and oedematous. The stools are hard, white and crumbly.
These infants show an increased tendency to infection. In this condition skimmed milk is used with a high sugar content. The sugar may
be in the form of malt sugar to correct constipation. In cases showing
intolerance to cow's milk there is apt to be oedema of the mouth and
tongue in extreme cases, and at times one is forced to resort to the use
of whey, adding cereal later. Attempts have been made to desensitize
these babies with milk injections, but no important results have been obtained.
Dr. MacGregor discussed the question of diarrhoeas as producing
nutritional disturbances. We have (1) the cases of fermentative diarrhoea where the stools are watery, green and acid and in which the use
of protein milk is indicated: (2) putrefactive diarrhoea, where the stools
are yellow and watery with bad odour and in which lactose, 10%, or maltose is of value: (3) infectious diarrhoea which runs a febrile course
and where there is mucous, pus and blood in the stools. This last is a
self-limited disease as in typhoid and lactic acid milk, with a moderate
sugar content, is indicated: (4) intestinal intoxication or cholera infantum, in which food is either excluded or reduced until the temperature returns to normal.
Page 13 Babies showing nutritional disturbances in the way of eczema do best
on a lactic acid milk with a low fat content, say about 2%. In these
cases evaporated milk is also of value.
The question is of ten asked as to whether the return of menstruation
in the mother affects the baby. Dr. MacGregor advised that the baby
should not be weaned on this account, as after the period is over the milk
will return to normal in the majority of cases.
The afternoon session was opened by Dr. Gellhorn, Professor of Obstetrics and Gynaecology, St. Louis University, who spoke on the "Causes
and Treatment of Vaginal Discharges." This paper, which will appear
in full at a later date, discussed the various forms of vaginitis as they
appear from childhood to old age. The speaker's views were exceedingly
practical and in many instances of a novel character. He condemned
unsparingly the use of the douche and curette. He showed an extensive
series of lantern slides demonstrating the various forms of vaginitis and
in many instances the means employed for their cure.
The next speaker was Sir Henry Gauvain who came to Canada under
the auspices of the Canadian Tuberculosis Association. Sir Henry
is a very charming, cultured speaker and made many friends during his stay in Vancouver. He spoke before an enthusiastic audience
at the Canadian Club on some aspects of his work among crippled children, introducing to a lay audience a subject which requires for its proper
development the enthusiastic support of all sections of the community.
In his talk to the Summer School Sir Henry showed numerous and most
interesting slides illustrating his work among crippled children in all
its aspects. He began with a general view of Lord Mayor Treloar's
Home for Crippled Children at Alton in Hampshire, explaining the
general plan of the buildings and their arrangement with regard to the
facilities for the work and the availability of a maximum sunlight ex-
posure. "Heliotherapy," under which term he included, not only exposure to the rays of the sun, but the effect of the circulation of air on
the naked body and also the use of the sprays and sea bathing which
latter was conducted at a branch of the Home situated on Hayling
Island. He emphasized the importance of using these things not as the
only means of treatment employed, but as a valuable adjuvant to other
and more direct forms of therapy. He showed numerous illustrations
of the various forms of splints in use, those used for caries of the spine
being particularly ingenious in form and application.
This lecture which, as we have said, was profusely illustrated, was
largely introductory to Sir Henry's next lecture which will be abstracted
in due course.
The last speaker of the first day's Session was Dr. Aldred S. Warthin, Professor of Pathology at the University of Michigan, Ann Arbor,
Page 14 who spoke on "The Causes of Renal Insufficiency." Dr. Warthin said
that there is continual dissension between clinicians and pathologists on
account of the very great difference which is found between clinical
diagnosis and pathological findings. Only too often, in fact in the majority of cases coming to autopsy, it is impossible in those who, during
life, have been labelled as suffering from nephritis, for the pathologist to
demonstrate the effects of inflammation in the kidney. He also pointed out
that patients dying of uraemia show no constant post mortem kidney
findings. There is, in fact, no kidney of uraemia. It is, perhaps, the
pathologist's reluctance, or may be his inability to confirm the diagnosis
of a nephritis which has led to a great deal of modern controversy and
research on this subject. In fact Dr. Warthin said he would go so far as
to state that he could not recall a case clinically diagnosed as chronic interstitial nephritis which had received pathological  confirmation.
What then may be the causes of renal insufficiency? There are
many. Congenital cystic kidneys, for instance; neoplasms of the kidney
or of adjacent structures; obstruction of the ureters occurring from
within or without; and many more such conditions in the absence of inflammation may produce inadequacy. There are, in addition, a large
number of kidneys the state of which is the effect of circulatory disturbance, which have been regarded as the kidneys of chronic interstitial
nephritis. Such are the amyloid kidney, the product of prolonged suppuration, the kidney of heart disease, especially that form which affects
the aortic orifice, the chronic cyanotic kidney and the kidney of infarction.
Other causes of inadequacy are directly concerned with degeneration of the tubular epithelium. There are also various forms of continued
degeneration as found in the kidney of pregnancy, the kidneys of acute
exophthalmic goitre and diabetes. Toxic conditions produced by substances such as mercury cause also degeneration of the epithelium of the
tubules and consequent inadequacy of function.
True nephritis, that is kidneys showing an inflammation which is a
real defensive phenomenon, may be either purulent or non-purulent in
character and it is to the non-purulent variety that the term Bright's
disease is applicable. The etiology of Bright's disease is purely infective
and the streptococus in one or other of its forms is the chief agent of
infection. It has long been considered that there is a protein diet origin
to this disease—in other words, that prolonged or excessive indulgence
over a long period of years in a diet excessively rich in proteins may result in a true nephritis. Dr. Warthin said that he did not think any
such connection exists, nor between excess protein ingestion and arterial
sclerosis.
As to focal infections, that is, residual latent infective foci as
usually understood occurring in various parts of the body whether it be
infected teeth or tonsils or a chronic gallbladder or a latent prostatitis or
whatever else is usually regarded as a chronic focus of infection, all these
in Dr. Warthin's experience do not seem to show any definite relationship with kidney changes leading to inadequacy or insfficiency. But a
severe active streptoccic infection is a different matter;  a definite in-
Tage 15 fective endocarditis or say a streptococcic empyaema, or abscess of the
lung, or pneumonia or acute tonsillitis or even prolonged and severe
attacks of boils—all these may be very closely associated with the commencement of a true nephritis leading to what we know as chronic
Bright's disease and are fruitful causes of the conditions leading to renal
inadequacy.
The speaker showed a remarkable and most interesting series of slides
in which he demonstrated his views of this condition.
The next day, Tuesday, September 14th, being the day of the Federal elections, only a morning session was held. At this session Dr. George
Hale was the first speaker, "Functional vs. Organic Disease of the Heart"
being the title of his very excellent address.
While the speaker acknowledged at the outset that the differential
diagnosis was not an easy one, he deprecated what he described as the
tendency of the doctor to "play safe," to protect, as he thinks, his
patient in case of doubt, as well as his own reputation. The consequence
is that there are too many cardiac neurasthenics, people whose lives,
owing to some overcautious warnings, have been rendered miserable.
Three factors are necessary to good function: (1) strong heart
muscle (2) efficient valves and (3) proper sequence of the heart beats
and of these by far the most important is the first one. Irregularities
of heart beat may be due to disease or dysfunction at th4 starting point
or in the conducting system or may be due to the presence of irritable
foci, usually in the auricles, producing, if there, the form of irregularity
known as auricular fibrillation.
There are two types of irregularity which are distinctly of functional origin. The first of these is sinus arrythmia which is of common
occurrence and of significance only in that it may at times be mistaken
for auricular fibrillation. It is common, especially in children ar.d particularly in those recovering from acute illness. This is a respiratory
irregularity and purely functional in character. The other type or example of functional irregularity is that produced by the extra systole.
This is the interpolation, of a premature and partial beat arising in some
part of the heart other than the usual site of origin of the beat. Extra
systoles may occur, of course, in conditions of true organic disease of the
heart, but in itself it is probably a condition without serious import. The
late Sir James Mackenzie followed patients exhibiting this feature for
as long a period as 25 years without finding any who developed cardiac
disease.
Regarding the integrity of the heart valves the speaker said that it
is important to remember that murmurs do not necessarily mean heart
disease, unless associated with other signs. This is especially true with
regard to systolic murmurs but with diastolic murmurs the case may be
quite otherwise. These must be looked upon as definite evidence of disease in the case, for instance, of mitral stenosis, or as evidence of actual
or possible myocarditis, or they may be due to damage around the aortic
orifice in which case there may be associated disease., involving the orifices of the coronary vessels, possibly leading to pathological changes in
the cardiac muscle.
Page 16 How are we to recognize whether the heart muscle is healthy or
not? In the first place it may be laid down that cardiac enlargement
means diseased cardiac muscle. All experimental work goes to show that
with exertion the healthy heart tends to contract and not to dilate. In
the second place we are able to test the response of the heart to effort.
No' standard form of test has been devised and certainly we should not
apply the same variety of test, whatever it is to every individual, to the
elderly individual leading an ordinary sedentary life as to the hard working artisan.
It must also be remembered that there is a type of healthy heart
which shows a poor response to effort. This is the so-called soldier's heart
or the condition of cardiac neurasthenia.
Pain, cardiac pain, is a difficult symptom to differentiate as be-
tweeii the important and the less important. Even when of serious import the physical signs of cardiac disease may be few and not easy of interpretation. If the history is that of sudden, acute, agonizing pain
occurring during or after exertion, and if, with a recurrence of such attacks, there is good unimpaired health between, then the aiagnosis will
probably be one of angina pectoris and such a history we are bound to
consider seriously.
There is another form of heart disease which, while real and serious
may be regarded unwittingly as only a functional manifestation, and that
is chronic infective endocarditis. Early cases at all events are often
overlooked and are indeed difficult to distinguish. Like many other
disorders the diagnosis may be made by thinking of its possibility. We
miss these cases because we do not keep them in mind. Once the possibility occurs to the physician, physical signs and symptoms may be
found in plenty.
Finally to all those patients apprehensive of heart disease in whom
such disease is not definitely proven, or, on very substantial grounds,
suspected, give a clean bill of health.    Less harm will be done.
Following Dr. Hale's lecture Sir Henry Gauvain spoke on "Some
Aspects of Surgical Tuberculosis." Commencing, the lecturer insisted
that the use of heliotherapy must be regarded only as a valuable aid in
treatment, not as a means of cure.
Sunlight is composed of many different rays, violet, indigo, blue,
green, yellow, orange, red, and, beyond these, at either end come those
numerous and invisible rays referred to as ultra violet and the infra red.
Far along among the infra reds are found the waves known as "wireless," while among the ultra violets occur those of the X-Ray and radium.
It has been said that if the actual spectrum, the visible rays, were
represented as one foot in length, the invisible rays would in proportion
represent millions of miles.
One of the most important effects the speaker has noted as the result of heliotherapy, is the effect on the mind.- In suitable doses it acts
as a most exhilarating tonic but conversely, if excessively or too suddenly
Page  17 applied, it is exhausting. It has been found that the mental intelligence
of the crippled children undergoing this form of treatment, handicapped,
as so many of them are, by disabling, confining disorders, is yet, on an
average, one year ahead of the average mentality of normal children. This
was a most unexpected observation and one which has excited a great
deal of interest. Secondly, heliotherapy has a direct or local physical action due largely to the ultra violet rays on which pigmentation of the
skin depends. As to the value of this pigmentation there is considerable
difference of opinion. Sir Henry said he considers it to be of great
importance and protective in effect in that good pigmenters will stand
longer exposure to light and to cold air and tend to improve more rapidly
than poor pigmenters. He has also noticed that patients who do not
pigment well or rapidly and develop another tuberculous lesion in some
remoter part of the body, will often pigment rapidly. He considers
that children who pigment badly are very apt at some later date to
show other lesions and in these cases the prognosis should be guarded.
Finally there are certain remote or indirect effects produced by
heliotherapy due, again, especially to the ultra violet rays. These have
the power of increasing the bactericidal power of the body, of the
blood. This increased immunity lasts for 2 or 3 hours only and may be
renewed by subsequent exposures. Conversely and particularly in elderly
patients, the bactericidal power may be lowered if the amount of exposure is at all excessive. Radiation should therefore be used with great
caution. If blood is removed from the body and subjected to radiation
this increased bactericidal effect is not noted, but if the blood so exposed is then re-injected, the increased bactericidal power is then found
in the whole blood of the individual. Light also increases the iron content of blood and is found to be very beneficial in combatting the anaemia of the tubercular patient.
A very considerable increase in the basal metabolism of the patient
is constantly noted as the result of exposure to light or rather as the
result of exposure to light and air and is common both in pigmenters
and non-pigmenters. Moreover the increase is found to be greater in the
winter than in the summer.
There is also a marked analgesic effect to be obtained from light
especially in abdominal cases, such as mesenteric tuberculosis, which may
at times be of such severity as to simulate, and even be operated upon as
appendicitis. Whlie useful in cases of tuberculous glands, the effect of
the X-Rays is here more satisfactory*
At the conclusion of the lecture, which was his last appearance before the School, Sir Henry Gauvain was tendered a hearty vote of thanks
and in reply expressed his great appreciation of the hospitality he had
enjoyed and of the attention with which his remarks had been received.
The final lecture of the day was delivered by Dr. Fraser Gurd, Associate in Surgery, McGill University, the subject being "Empyaema,
acute and chronic."    As chronic empyaema, the speaker said, was to be
Page 18 later discussed by Dr. Hedblom, whose experience in that disorder was
probably unequalled, he, Dr. Gurd, would confine his remarks almost
wholly to the acute variety under the following headings: (1) post
lobar pneumonia (2) post lobular pneumonia (3) empyaema occurring
in infants and young children and (4) tuberculous empyaema. It was
important to differentiate the first two varieties as both treatment and
prognosis varied in each.
Following lobar pneumonia empyaema occurs as a sequel, not as a
complication. It occurs following an inflammation when the immunological state of the body is highly elevated. Moreover, the surrounding
lung is fixed by fibrinous exudate to the neighbouring chest wall, which
fixation prevents not only the diffusion of the pus but the collapse of
the lung when the1 cavity is opened.
The treatment, therefore, is correspondingly simple and easily carried out. Exploratory aspiration is made and pus being found, thick
and creamy, it is safe and proper, in adult patients, immediately to operate. Rib resection is the operation of choice under local anaesthesia
if preferred, though there is no reason, the speaker said, why nitrous oxide
and oxygen should not be used, for the possitive pressure produced by
the anaesthetic may aid against collapse of the lung.
Three centimetres of rib should be removed, usually the 7th or 8 th
about the posterior axillary line. There is, however, no definite site
and the appearance of a prominence or bulging in the chest wall is an
indication for the choice of that area. The opening should not be too
low as elevation of the diaphragm may occur when pressure is released
and block the opening.
The incision should be large enough so that two fingers at least may
be introduced, as fibrinous coagula are often found, which must be removed at the time of operation if drainage is to proceed satisfactorily. So
far as possible, too, the fibrinous exudate is gently sponged off the walls
of the cavity. The drainage tube, of a lumen of 1 to \l/z cm., should
be fish-tailed at the end to avoid possible erosion of a vessel.
There is a tendency for necrosis to attack the exposed ends of the
rib and in order to lessen the frequency of this occurrence, the wound,
prior to opening through the pleura, receives an application of Bipp.
Since adopting this procedure such infections have been rare.
The outer dressings only are changed during the first day or two,
but at the end of 48 hours the Carrel-Dakin system of irrigation is instituted and carried on hourly during the day and two-hourly during
the night for 3 days. At the end of this time the tube is removed and
daily irrigations carried on through a soft rubber catheter until, at the
end of 7 days, the cavity may be found obliterated. Air and sun are
valuable adjuncts. To encourage an occasional coughing spell is a better
means of expanding the lung than the use of blow bottles.
Post lobular pneumonia empyaema is a real complication and not
a sequel. The patient has shown his immunological inability to deal
with the infecting organisms and, moreover, there is entire absence of
Page 19 fixation of the lung to the chest wall, such as is often found following
lobular pneumonia. Empyaema in these cases is caused by the rupture
of a subpleural abscess infecting a previous serous effusion. The infecting organism is often a haemolytic streptoccccus, rarely a pneumococcus. Operation must be delayed. Aspiration may and should be
done one or many times for a period of 7 to 10 days until the exudate
assumes a definitely purulent character. In this condition airtight intermittent drainage may have certain advantages as there are no fibrinous
coagula to be removed.
In this variety coincident spontaneous opening of the empyaema
into a bronchus is frequent. Therefore, if irrigation of the cavity is
contemplated, Dakin's solution must be used with caution, or only after
preliminary irrigations and filling of the cavity witr\ saline.
Empyaema in infants and young children is always of this lobular
pneumonia type and closed methods of treatment must be used exclusively. Three days is the longest time this form of drainage can be
maintained. At the end of that period the tube must be withdrawn and
the wound sealed. If the fluid reaccumulates the whole process must be
repeated.
Tuberculous empyaema was only referred to as time did not permit
of further consideration.
VANCOUVER GENERAL HOSPITAL LABORATORIES.
BLOOD SPECIMENS FOR ANALYSIS.
The following points  are to  be  noted when procuring  blood  for
chemical examination in the laboratory:
Table of Chemical Tests of Blood.
No.
Test
Form
Amount
1
2
Non-protein nitrogen
Urea nitrogen
Unclotted blood fluid
cc                       cc               cc
6 cc.
6 cc.
s&£.
Creatinine
cc                       cc               cc
6 cc.
4
Uric acid
cc                       cc               cc
6 cc.
5
6
7
Sugar
Fragility
Van Slyke C02
cc                       cc               cc
cc                       cc               cc
3  cc
1  cc.
determination
cc                       cc   .           cc
7 cc.
8
9
10
11
Calcium
Phosphorus
Van den Bergh
Wasserman
Serum from clotted blood
cc               cc               cc               cc
cc               cc               cc               cc
cc               cc               cc               cc
6 cc.
6 cc.
6 cc.
5  cc.
(Although each test by itself requires 6 cc of blood any two different tests may be made on the same 6 cc. If more than two different
tests are required, 11 cc. will prove sufficient.)
Tests 1-6 require an anticoagulant to keep the blood fluid. For
specimens taken in the hospital and laboratory, potassium oxalate (20%)
is used.    One drop of this solution (from a dropping bottle) is sufficient
Page 20 for 6 cc. blood. The blood is expelled immediately from the syringe
into a tube containing the oxalate and the tube inverted several times
and complete mixing insured, except when the blood is for a Van Slyke-
determination. Specimens required for N.P.N., creatinine, urea and uric
acid should be examined as soon as possible, preferably within an hour;
but if kept on ice over night the result is sufficiently accurate for clinical
purposes. The blood for sugar determination on the other hand must not
be left standing, for within half an hour an appreciable loss of sugar
may occur. The blood for fragility determination should be examined
immediately. It is therefore imperative that such samples of blood be
procured only when the determination can be proceeded with at once.
When the specimen for tests 1-5 are to be taken outside the hospital
a preservative must also be added; but for this a mixture of thymol and
sodium fluoride (thymol, 1 part; sodium fluoride, 9 parts) is used. One
cubic centimetre of blood requires 0.011 gms. of this mixture, which will
preserve blood for 5-6 days and the value for N.P.N., urea nitrogen,
uric acid, creatinine and sugar will have the same clinical significance
as those values obtained from immediate analysis of the blood. The urea
nitrogen, uric acid, creatinine and sugar content of the blood can thus
be held constant .for at least two weeks; but the N.P.N, tends to increase.
The blood for the Van Slyke determination must be taken without
the use of a tourniquet and with as little restriction to the circulation
as possible. The puncture needle is attached to a glass tube reaching to
the bottom of a test tube in which has been placed 2 to 3 cc. of paraffin
oil and a pinch of powered potassium oxalate. No suction should be
used to withdraw the blood, or C02 will be liberated from solution in
the blood. When sufficient blood has been obtained, mixing of the blood
and oxalate can be accomplished by stirring gently* with the glass tube.
Fresh serum is required for the calcium and phosphorus determinations, though we have found that an hour's standing has no apparent
affect. The Van den Bergh Test also calls for fresh serum; also special
care must be taken to obtain serum free from haemoglobin for a parallel
test, (the Icterus Index) which is merely a determination of the depth
of colour of the serum.
Blood for Wasserman tests should be collected in clean tubes, with
aseptic precautions, and placed on ice soon after clotting. Undue agitation or marked contamination may render the serum anticomplementary.
SODIUM BICARBONATE FOR INTERSTITIAL
ADMINISTRATION
It has long been a problem to obtain neutral solutions of sodium
bicarbonate for medical purposes. The solution during sterilization, and
even on standing at room temperature exposed to the air, loses C02
leaving in solution sodium carbonate. The sodium carbonate hydrolyzes
giving'a solution which is physiologically strongly alkaline. Dry sodium
bicarbonate is extremely stable at ordinary temperatures but begins to de-
tPage 21 compose at 70 deg. C. The decomposition is slow at 100 deg. C. and rapid
at 120 deg. C. (Dry sterilization is usually carried on between 150 deg.
and 160 deg. C for one hour). In solution, and exposed to the air, it decomposes slowly until an equilibrium is reached with only 12% of the
original bicarbonate present. Raising the temperature lessens the proportion of sodium bicarbonate which can exist in such solutions in
equilibrium with air. The solution is only stable when an excess of C02
is present and when saturated with C02. Under such conditions only
0.04% of the salt decomposes.
The loss of C02 from a solution of bicarbonate is conditioned by:
1. The weakness of the H2C03  (carbonic acid)  as an acid.
2. The acid character of the NaHC03  (sodium bicarbonate).
3. The ready dissociation of H2C03   (carbonic acid).
4. Low solubility of C02 in water.
Several suggestions have been made to prevent the decomposition of the
bicarbonate in solution.
Urbain found that dissociation is retarded when the solution contains sugar or gum. R. Henderson and O. Black, found that the addition
of sodium hydrogen phosphate (Na2HP04 NaH2P04) helps to maintain
the neutrality for medical purposes.
Some time ago we tried different methods of sterilization and tested
various solutions with a view to determining some method of preparing
sterile neutral sodium bicarbonate in solution.
SOLUTION
METHOD   OF         TIME   STANDING
STERILIZATION      AT   ROOM   TEMP.
DECOMPOSITION
Solution from
Operating Room
Solution made
up freshly in
Laboratory
Solutions made
up freshly in
Laboratory
Operating Room
Autoclave             Some D^s
33%
Not Sterilized
0
No decomposition
Not sterilized
Not over
3 hours
7/0
Solutions made
up freshly and
put in bottles
with ground
glass stoppers
Laboratory
Autoclave
Not over
3 hours
227c
Solutions placed
in flask with
cotton plug
Laboratory hot
air sterilizer
200 deg., 1 hr.
Not over
3 hours
89%
Solutions placed
in flask with
cotton plug
Laboratory hot
air sterilizer
150 deg.-160 deg
1 hour
Not over
3 hours
74%
Page 2: Solution freshly
made up and
saturated with
C02
Operating Room
Autoclave
Not over
5 hours
32%
Solution freshly
made up and
saturated with
C02
Laboratory
Autoclave
Not over
3 hours
29%
Powder in
ampoules
Laboratory
Autoclave
Immediately
21%
Powder in
j        ampoules
Laboratory
Autoclave
12 hours
6% or less
The solutions tabulated were all analyzed by means of the Van Slyke
C02 apparatus which proved very satisfactory. The C02 was liberated
from solution by an acid and the amount of gas measured. In this way
the volume of C02 lost could be accurately measured. The solutions
were also checked by titration.
Hence, the method of sterilizing in ampoules was the only satisfactory method tried. Test tubes were taken, drawn out to a narrow neck
with the blow torch, and a weighed amount of the sodium bicarbonate
introduced, using the top as a funnel. The tube was then sealed without
heating the salt. These ampoules were sterilized in the autoclave at 120
deg. C (15 lbs. pressure). The heating decomposed sufficient of the salt
to make this a wet sterilization, as evidenced by the water of condensation apparent on removing the ampoules from the autoclave. Strings
containing spores were enclosed in several ampoules and cultures of them
showed no growth. If these ampoules are opened immediately they show
considerable pressure and about 25% of the salt is decomposed. If left
for twelve hours the water of condensation disappears, and on opening
there is no pressure and less than 6% of the salt is decomposed.
—DONNA E. KERR.
B.C. MEDICAL ASSOCIATION NEWS.
Dr. and Mrs. George E. Darby of Bella Bella, B.C., are to be congratulated on the birth of a son, September 13 th.
"Holiday House" is the form of the memorial planned in memory
of the late Dr. Alison Cumming by the Vancouver Graduate Nurses'
Association. This institution will be for the use of nurses and mothers
in need of rest.
Dr* L. A. Patten, of Chilliwack, is taking his usual annual "hunting" vacation as from September 20th. His practice will be taken care
of by Dr. H. H. Caple.
Pace 23 There was an excellent attendance at a luncheon meeting held by
the B.C. Medical Association on the 15 th of September, in honour of
the visiting speakers to the Vancouver Medical Summer School, when
Dr. T. C. Routley (General Secretary of the Canadian Medical Association) gave an able and particularly instructive address on the value of
"Organization in Medicine." Dr. Wilson (Vice-President of the provincial Association) took the chair.
These luncheon meetings have become very popular and it is hoped
to hold them more frequently in the future. Another will be held in the
Hudson's Bay Store (Private Dining Room) on Wednesday, October 6th,
when our guests of honour will be Drs. D. S. MacKay, B. J. Brandson
and D. Nicholson, all well known Winnipeg doctors who are touring
British Columbia in connection with the Extra Mural Post-Graduate
Scheme.
The following information re the forthcoming Post-Graduate Tour
should be noted by "out-of-town" doctors. Cranbrook meeting will be
held at the St. Eugene Hospital at 2 p.m., Saturday, September 2 5th.
Nelson meetings in the afternoon and evening of September 29th. Kamloops (including the annual meeting of the Okanagan Medical Society)
on September 30th. Victoria on October 2nd and 4th, with luncheon
on October 4th. Nanaimo on October 5 th. New Westminster October
6th. Luncheon, Vancouver, (B.C. Medical Association), October 6th.
Prince Rupert October 9th.    Prince George October 12th.
The lecturers will be prepared to take the following subjects:
Dr. D. S. MacKay—
1. Uterine Haemorrhage.
2. Pelvic Congestion.
3. Pelvic Infection.
4. Septic Uterus.
Dr. D. Nicholson on—
1. The Prevention of Contagious Diseases. Diphtheria (Schick
Test), Scarlet Fever (Dick Test), Smallpox, etc. (New methods
of Vaccination).
2. Laboratory procedures for office and bedside.
Haemorrhagic disease of the newborn with demonstrations.
Bleeding time and coagulation time.     Gastric analysis—smears
of pus.    Renal Function, etc.
3. What remedies should we use?
4. Inflammation.
5. Recent advances in the treatment of malignancy.
6. Cures (Popular).
Dr. B. J. Brandson—
1. Appendicitis and some of its problems.
2. Management of duodenal ulcers.
3. Sarcoma of bone.
Page 24 A cordial invitation is extended to the members of the Vancouver
Medical Association to attend the Post-Graduate Meeting at New Westminster on the evening of October 6th.
Dr. H. H. Murphy fo Kamloops will represent the B.C. Medical
Association at the Cranbrook, Nelson and Kamloops Meetings. Dr. H.
E. Ridewood at Victoria and Nanaimo. Dr. Lyall Hodgins, Chairman
of the B.C. Medical Publicity and Educational Committee, at New Westminster,. Prince Rupert and Prince George.
Dr. H. B. Rogers of Chemainus, is taking a month's vacation from.
September 10th.
Dr. Alan Beech has left Cowichan Lake to engage in practice with
his brother at Salmon Arm. Dr. K. I. Murray, of North Vancouver, has
gone to Cowichan Lake as assistant to Dr. E. L. Garner.
Dr. G. F. Young, of Michel, B.C., spent two weeks' holiday on the
coast in September.
Dr. L. W. Kergin, of Prince Rupert, recently made one of his rare
visits to Vancouver where he was kept very busy renewing old friendships.
At a recent meeting of the Prince Rupert District Medical Society,
Dr. J. P. Cade was elected President and Dr. L. W. Kergin, Secretary.
Dr. R. C. Weldon, late of Natal, B.C., has started practice in Vancouver. Dr. Weldon has been absent from the province during the last
two years, taking Post-Graduate work in Europe.
Dr. Carl Ewert, of Prince George, is in the east taking Post-Graduate work. He will be away for about two months. His colleague at
Prince George, Dr. E. J. Lyon, is taking care of his practice.
ANNUAL DUES.
The Treasurer desires to again call the attention of the members
to the fact that fees for the current, year were due and payable
last April. The early remittance of these fees would much facilitate
the work of the Executive, and avoid the. necessity of issuing drafts
later, at a time when, perhaps, money is less readily available.
Diagnostician and criminal detective have this in common: that for
each the discovery of a clue is a first and an essential step in the train
of reasoning. Each in his own field must be quick to sense the possibilities suggested by the infinitesimal deviation from the normal; the detective by a blood stain or a bit of ash, the medical man by a tiny gland or
a barely palpable spleen.     (Freemont Smith)
Page 2J STATISTICS — AUGUST, 1926.
Total Population (estimated)  128,366
Asiatic Population  (estimated)      10,100
Rate per  1000
of Population
Total Deaths   100 9.1
Asiatic Deaths   18 21.0
Deaths   (Residents only)     69 6.3
Total Births   277 25.4
Male,       150
Female, 127
Stillbirths—not included in above         11
INFANTILE MORTALITY—
Deaths under one year of age  7
Death rate per 1000 Births    15.3
July,   1926 Aug.,  1926
Cases Dearhs Cases Deaths
Smallpox   0 0 2 0
Scarlet Fever          4 0 5 0
Diphtheria        11 0 11 1
Chicken-pox         16 0 4 0
Measles          69 1 25 0
Mumps     10 3 0
Erysipelas     2 0 10
Whooping Cough   1 1 0 0
Tuberculosis           9 12 11 7
Typhoid Fever          10 0 0
Cases from outside city included in akove.
Diphtheria ——  10 3 1
Scarlet Fever  3 0 0 0
Typhoid Fever   10 0 0 )lknt XRay Supplies PDQ "9
There are over 30 Direct Branches now established by the Victor X-Ray Corporation
throughout U. S. and Canada. These branches
maintain a complete stock of supplies, such as
X-Ray films, dark room supplies and chemicals,
barium sulphate, cassettes, screens, Coolidge
tubes, protective materials, etc., etc. Also
Physical Therapy supplies.
The next time you are in urgent need of supplies place your order with one of these Victor
offices, conveniently near to you. You will appreciate the prompt service, the Victor guaranteed quality and fair prices.
Also facilities for repairs by trained service
men. Careful attention given to Coolidge tubes
and Uviarc quart? burners received for repairs.
VICTOR X-RAY CORPORATION
OF CANADA, LTD.
Vancouver Branch   -   910 Birks Bldg.
Victor Radiograph Illuminator
A distinct  improvement  in  negative .
observation  apparatus
All Metal and Glass
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Quality   Dependability   Service    Quick I Delivery
^ ^ I <PriceJfpp]Jes to Ml ~ ~	
Portable Remington
«rf©M©fc»
There are very many doctors who are
enthusiastic owners of the Remington Portable
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same four bank standard keyboard and other
up-to-date features of the large typewriter.
Can be supplied with medical or drug
keyboard without extra charge.
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Remington Typewriter Co.
of Canada, Ltd.
556 Seymour Street, Vancouver, B. C.
Page 27  LABORATORY      •
1200 Fifteenth Avenue West
Telephone Bayview 268
OFFICE
206 Vancouver, Block
Telephone Seymour 2996
Private Clinical Laboratory
Service
We are prepared to undertake all the work usually
done in a well equipped Clinical Laboratory. Blood
Chemistry, Wasserman Tests, Vaccines, etc.
C. S. McKEE, M.B.
MISS M. M. McKEE
Miss R. Backett, R.N.
y c^ftasseuse^
| PRIVATE   HOSPITAL
1436 Harwood St.,Vancouver, B.C., Phone Sey.3147
Overlooking English Bay
^->cQreatments<^.
SWEDISH and MEDICAL  GYMNASTICS, London, England, Certificate
ELECTROTHERAPY, HYDROTHERAPY, and ACTINOTHERAPY
Patients attended in own homes.    Special Dietary.   Graduate  Nurses  in
Attendance.    Visited by Qualified Physicians
Page 29 SPECIAL OFFER
Doctors9 Bags
Of Exceptional Value
Manufactured in England
Solid Cowhide Leather
Hand'sewn and rivetted frames
Adjustable bottle loops and pocket
Orders will be filled in sequence
We have a stock on hand and another shipment coming
Special price during run of this advertisement:
CLUB STYLE
16 inch $12.00
18 inch     -      $13.50
A saving of about 25%
B. C. Stevens Co. Ltd.
730 Richards Street
Vancouver
The OipI Drug
Co., Ltd.
J\\\ prescriptions dispensed
brj qualified Druggists.
IJou can depend on the Ou?l
for Accuracy and despatch.
U?e deliuer free of charge.
5 Stores, centrally located.    We
would appreciale a call while
in our territory.
Ambulance
Service
TELEPHONE
Fair. 58 & 59
Mount Pleasant
Undertaking Co.   Ltd.
R. F. Harrison    W. E. Reynolds
Cor. Kingsway and Main
Page 30 r
Our
^Advertisers
CX.
Use this journal for the purpose
of procuring business from the
Medical Profession.
Are you assisting in the
publication of The Bulletin by
patronizing our advertisers?
c^is
ajo
Page 31 

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