History of Nursing in Pacific Canada

The Vancouver Medical Association Bulletin: September, 1932 Vancouver Medical Association Sep 30, 1932

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'Just An Old Quaker Custom''
PREPARATIONS go into your PA-
I jH THOROUGH TRAINING and EXPERIENCE relieve you of doubt and
anxiety when we fill your prescriptions.
Orders taken for the new B. P.
CHAS. H. ANDERS, Chemist
Published Monthly under the Auspices of the Vancouver Medical Association in  the
Interests of the Medical Profession.
203 Medical Dental Building, Georgia Street, Vancouver, B. C.
Editorial Board:
Dr. J. H. MacDermot
Dr.  D. E. H.  Cleveland Dr.  M.  McC.   Baird
All communications to be addressed to the Editor at the above address.
Vol. VIII.
No. 12
OFFICERS 1932-1933
Dr. Murray Blair Dr. W. L. Pedlow Dr. C. W. Prowd
President Vice-President Past   President
Dr. L. H. Appleby Dr. W. T. Lockhart
Hon. Secretary Hon. Treasurer
Additional Members of Executives:—Dr. A.  C.  Frost;  Dr.  C.  H.  Vrooman
Dr. W. D. Brydone-Jack Dr. J. A. Gillespie Dr. J. M. Pearson
Auditors: Messrs. Shaw, Salter & Plommer
Clinical Section
Dr.   A.   M.   Agnew.-„ Chairman
Dr. W. H. Hatfield  Secretary
Eye, Ear, Nose and Throat
Dr. J. A. Smith Chairman
Dr. A. O. Brown ^ Secretary
Paediatric Section
Dr.   J.   R.   Davies Chairman
Dr.   J.   H.   B.   Grant Secretary
Cancer Section
Dr. A. Y.  McNair   Chairman
Dr. A. B. Schinbein .Secretary
Library Orchestra Summer School
Dr. W. H. Hatfield Dr. J. R. Davies Dr- £ TE- BR°™
Dr. H. A. Spohn Dr. F. N. Robertson Dr- t- l- Butters
Dr. D. M. Meekison Dr. J. A. Smith P*. C. H. Vrooman
Dr.   H.   A.   DesBbisay Dr. J. E. Harrison Dr- J- w- Arbuckle
Dr. G. E. Kidd Dr- H- A- Spohn
Dr. J. E. Harrison ,, Dr- H- R- Mustard
Publications Hospitals
Dinner Dr- J- H- MacDermot Dr> a. ^. Bagnall
Dr. D. E. H. Cleveland Dr. f. J. Buller
SR' V'  w   ^TS Dr' Murray Baird Dr.  W.  C.  Walsh
Dr. A. M. Warner Dr   s   b   Peele
Dr. A. T. Henry
Credentials V.O.N. Advisory Board
r,,.,    d/-.wj    a Dr.  F.  P.  Patterson Dr. H. H. Caple
Rep. to B. C. Mea. Assn.     t-.atwt T->-n*r
Dr.   A.   J.   MacLachlan      Dr.  E.  Irapp
Dr. G. F. Strong Dr. S. Paulin Dr. J. W. Shier
Sickness and Benevolent Fund — The President — The Trustees VANCOUVER HEALTH DEPARTMENT
Total Population  (Census 1931)	
Asiatic  Population   (Estimated)    4-	
Rate per
Total Deaths  ^	
Asiatic Deaths 	
Deaths—Residents only  —	
Birth Registrations 	
Male      154
Female 151
Deaths under one year of age 	
Death rate—Per  1,000 births 	
Stillbirths   (not included in above)
1,000 Population
162 7.8
13 10.2
146 7.0
305 14.6
June, 1932
Cases    Deaths
July, 1932
Cases     Deaths
August, 1st
to 15th, 1932
Cases     Deaths
Scarlet  Fever
Chicken-pox .
Whooping-cough           3 2
Typhoid Fever 	
Meningitis   (Epidemic)   	
Encephalitis Lethargica	
v   :M. BILLON'S m
A  dependable  product  uniting  these   important  factors   in
arsenical therapy:
—Therapeutical activity
—Innocuity of administration
—Uniformity   in   chemical   and   physiological
—Great solubility
Canadian Distributors:
Page 23X Canadian Stand on
We quote the following excerpts from an editorial
which appeared in the January 1932 issue of the Canadian Public Health Journal.
Association Stands for Pasteurization.
"The Canadian Public Health Association stands unequivocally for the pasteurization of ALL milk supplies
as the one and only means at our disposal for the final
safeguarding of the health of the public from the dangers
associated with the consumption of raw milk."
Dr. A. R. B. Richmond, (Toronto)
"The cost is often advanced against the installation
of pasteurization. Btit lei any municipality balance the
cost of pasteurization' against an epidemic such as occurred
at Lee, Mass., in 1928, when 1,000 out of 4,000 popti-
lation were ill at one time and 45 deaths occttrred; or
that at Kirkland Lake, Ontario, in December, 1930, when
there were 500 cases of septic sore throat from the use
of raw milk."
Dr. J. W. Mcintosh, (Vancouver)
"The point raised by Dr. }. W. Mcintosh in the
DISCUSSION in regard to the necessity for a standard
set of specifications for pasteurization equipment, is important. The specifications shoidd clearly stipulate proper
valves, automatic temperature recorders, absence, of dead
ends, etcetera, and should be such that the dairyman cannot be misled into purchasing or erecting equipment that
will not be approved by the health authorities."
Fairmont 1000—North 122—New Westminster 1445 -«
'Way back...
in the 18th Century, Alexander Pope sounded the
keynote of our organization when he said:
"By mutual confidence
and mutual aid, great
things are done . . ."
To be deserving of the
confidence of the Medical
Profession has always been
our aim during our 25
years of efficient, prompt,
dispensing of prescriptions.
We will call for
and deliver . . .
your patients'
prescriptions . .
of the
If there is any formula you would like to have
put up in soluble Elastic Capsules you can have
it done in twenty-four hours.
Our list of stock formula can be had by a phone
message or post card.
IB. C. Pharmacal Co,
329 Railway Street
Vancouver, B. C.
Phone Seymour 597 EDITOR'S PAGE
In the sudden death recently, of Dr. A. S. Monro, Vancouver has lost
a citizen who has been prominent in its activities for over a quarter of a
century. We of the medical profession have lost a colleague whom all
of us have known and loved. He died on his way home from the Annual
Meeting of the Canadian Medical Association at Toronto. As President
of that body, he had attained the highest position open to members of the
Canadian profession, and it is pleasant to think that he was privileged to
end on so high a note.
We shall miss sorely his vivid and genial personality. "Alec" Monro
was one of the most generous and kindly of men and has done kindnesses
to many, who will never forget him. It was not in him to advertise his
good deeds, and only those whom he helped know the full extent of them.
To young medical men, starting on their career, he was especially helpful
and friendly. There was no bitterness in his composition, no room for
grudges or enmity against any one, though he possessed a quick temper,
and could flare up as quickly as he could subsequently cool down and
return to his usual mood of pleasant friendliness.
Monro has left his mark on the city he lived in for so long. He was
one of the men who led in the establishment of the Vancouver General
Hospital and was one of those who supported the idea of placing it in
its present site—at a time when Fairview was regarded as the outermost
fringe of the city, too far ever to be accessible by ordinary people. He
was prominent in the designing of the original building, and was a director for many years; serving as well on the staff.
Of later years, he had developed an intense interest in medical economics and was fully alive to the urgent necessity for reform in this. With
characteristic fervour, he plunged into this subject, and in and out of
season was ready to discourse on the problems that confront our profession, and the need for facing and grappling with them He felt that
the medical profession was being exploited and its generosity abused, by
the powers that be, and the public at large, and constantly urged with all
the eloquence at his command, that we must resume the control of our
own affairs that we appear to have partly lost, lest in time to come, we lose
even the part we yet have. His presidential address dealt with this matter
—in fact he was wrapped up in the subject, and had made it his religion
for the time being. We need more men like this, to whom this question
is a burning one, and who are ready to urge it on all occasions, and keep
others aware of it
For many reasons, we shall miss Alec Monro. As a friend first, a
warm-hearted, kindly friend, who never lost his friendship for those
whom he knew, who had no snobbishness in him, no self-seeking in his
friendship, no drop of gall in his angers; a likable, lovable fellow that always had a smile and cheery word for those he knew, with numberless
little eccentricies and quirks that those who knew him will remember with
an amused affection. As a fellow-practitioner who did his work honestly
and well, who loved his profession and worked for it, and as a fellow-
citizen, who served his city, and loved it and believed in it. He died in
harness, and is lucky in that.
Delivered before the Osier Club, by Dr.  W.  H.  Hatfield
I have chosen for discussion tonight the subject of angina pectoris
and coronary thrombosis for several reasons. In the first place these are
two conditions which are becoming more and more common and may
almost be said to be peculiar to western civilization and picking out the
more prominent and valuable members of a community. Secondly, our
ideas of these conditions a few years ago were vague, but are now becoming clarified by the vast amount of careful clinical and experimental work
that has been done of late all over the world. The coronary artery holds
as prominent a place in medical literatue today as any part of the human
anatomy. The problem is still far from settled, but out of the maze
which has always surrounded this subject have come many definite and
interesting facts. Coronary artery disease until a few years ago was
thought to be extremely rare and was associated with death. Angina was
a word that included almost anything giving a pain in the chest, giving
rise to such terms as true and false angina, vasomotor angina, angina
dolore and others. The whole subject was vague. Many cases called
angina were in reality coronary disease. The terms were used loosely and
at times synonymously. We now know that all pain in the chest even
when associated with heart disease is not angina, and that angina pectoris
and coronary artery disease must be looked upon as two separate entities,
each giving a well defined clinical picture.
Let us consider for a moment the blood supply to the heart, as a
knowledge of it must be kept in mind to understand the pathological
processes involved. Contrary to the old belief, we now know that there
is a definite anastomosis between the branches of the coronary arteries.
However it has been shown by Huber and Silverthorn that there is an inadequacy of communicating branches in human hearts for purpose of
complete anastomosis. Following a gradual occlusion of a coronary
vessel there is no myocardial damage. So that gradual occlusion is essential to adequate collateral circulation. Some of the difficulty in understanding coronary disease and its sequence is directly attributable to a
general disposition to regard the coronary arteries and their arterial bed
as an anatomic invariable. Not only are there many normal variations
but a still greater variation is brought about by disease. There have been
shown to exist some interesting anatomic variations between the right
coronary supplying the right ventricle and the branches of the right and
left coronary arteries supplying the left ventricle. The branches supplying the left ventricle pass along the surface of the heart just beneath the
epicardium. Their branches leave at right angles and pass directly through
the myocardium, giving off very few branches until they reach the endocardium, where they again turn at right angles and end in a mass of
fine arterioles. By this anchoring of the branches it can be assumed that
in hypertrophy of the left ventricle, the blood vessels become elongated
and tortuous more readily leading to narrowing and occlusion. The heart
has an enormously rich blood supply, averaging one capillary for each
muscle fibre in the ventricular wall. There are about twice as many capillaries per square millimetre in ventricular muscle as in skeletal muscle.
There is some evidence that there is a direct connection  through the
Page 240 thebesian veins other than that through the capillaries between the coronary arteries and the chamber of the heart, and the capillaries drain directly into the thebesian veins. Under certain conditions as much as 90%
of the arterial flow may escape via the thebesian veins, and in the event
of gradual closure of the orifices of the coronary arteries the thebesian
veins can supply the heart muscle with sufficient blood to enable it to
maintain an efficient circulation. There has been demonstrated lately an
anastomotic blood vessel in the auricular walls, which links up the right
and left coronaries. It also supplies branches to the aortic and mitral
valves and the base of the aorta.
The coronary arteries are subject to many pathological changes such
as atheroma, arteriosclerosis, syphilitic arteritis and the various forms of
chronic endarteritis. Sudden occlusion is due to thrombosis and less frequently embolism.
Angina Pectoris
It was Heberden in 1768 who gave us our first clear cut description
of angina pectoris. He states that "the seat of it and the sense of strangling and anxiety with which it is attended may make it not improperly
be called angina pectoris" and again "in some inveterate cases it has been
brought on by the motion of a horse or carriage or even by swallowing,
coughing, going to stool, speaking or any disturbance of the mind"—
"Angina pectoris as far as I have been able to investigate belongs to the
class of spasmodic, not of inflammatory complaints."
He summarizes as follows:
"In the first place the access and the recess of the fit is sudden.
"Secondly, there are long intervals of perfect health.
"Thirdly, wine and spirituous liquors and opium afford considerable relief.
"Fourthly, it is increased by disturbance of mind.
"Fifthly, it continues many years without any other injury to
the health.
"Sixthly, in the beginning it is not brought on by riding horseback or in a carriage as is usual in diseases arising from
cirrhosis or inflammation.
"Seventhly, during the fit the pulse is not quickened.
"Lastly its attacks are often after the first sleep, which is a
circumstance common to many spasmodic disorders.
He concludes by stating that he has little or nothing to advance in
the way of treatment and that "quiet, warmth and spirituous liquors help
to restore patients who are nearly exhausted and to dispel the effects of
a fit which does not soon go off. Opium taken at bedtime will prevent
the attacks at night." Heberden has thus ably described the clinical picture of this condition.
There have been eighty different theories propounded as to the
causation of angina.    These have varied from tension in a damaged aorta
Page 241 to deficient oxygenation of the heart muscle. The two theories that have
prevailed for several decades are the aortic and the coronary. As increasing number of clinicians are becoming adherents of the coronary
artery theory; assuming that the origin of pain is the heart muscle, the
nerve supply of the heart muscle and its coverings as related to that of
other viscera and adjacent tissues become an important factor in understanding the distribution of cardiovascular pain.
Let us consider for a moment the mental and nervous factors in
angina. It is found that the individuals afflicted with angina belong in
one group. It is the busy man working at high tension, burdened with
many responsibilities, pressed for time and given to worry, that falls a
victim. Nervous and mental influences hinge largely on the emotions,
which in turn are related, below to the instincts, and above to the ways
of the intellect. Life is becoming more strenuous. Speed is a paramount
factor. It is difficult to keep pace with the rapid development of things
today. The adjustment to life is becoming more and more complex from
day to day. Competition is more keen. The really busy and ambitious
man has few idle moments mentally. I think we must endeavour in
angina to study the personal pathology of the patient. "Are the waters
of his life calm and deep or wind blown and wave-tossed?" It is difficult
to describe how a mixture of emotion instinct and higher mental control,
all affected by environment and education can, fanned by strain and
worry, angered by injury or injustice, grieved by disappointment, cause
something in the chest which is so severe and disabling, which was described by one author as a veritable epilepsy of the circulation. It is interesting to note that angina is practically unknown in the Negro and
Chinese. Both have a placid nature. It is said the Negro never worries
for very long, as he cannot worry very well when standing up, and on
sitting down falls asleep. In 20,000 negro cases admitted to a southern
hospital angina was not diagnosed in one case. Among 24,000 Chinese
patients in the Peking Union Medical College only 1 per 1000 suffered
from evidence of pain of unstriped muscle. Among the Indian tribes in
Panama there is not a record of a single case. When an individual becomes afflicted with angina, we find not only the disability and discomfort caused by the pain but the added element of fear. All people have
a dread of heart disease, but especially such a one as this which comes
suddenly without warning and creates in many a feeling of impending
death. It is truly said that only the anginous have angina and to have
angina is to be more anginous. Are we doing our duty to the patient
if we only treat the attack, giving the patient something to relieve the
pain? Our attention too often is drawn to the heart where lies the centre
of pain, with consequent neglect of the personal pathology involved.
Thoracic pain is a common complaint, but only a few of these cases
are angina. It is essential in making a diagnosis to have in mind what
may cause pain in the chest.
1. Angina pectoris:—a paroxysmal pain which may or may not be
associated with demonstrable cardiac disease ranging from a
sensation of substernal weight to a severe paroxysm with pain
radiating from the epigastrium down to the finger tips.
Page 2. Coronary thrombosis:—A sudden severe thoracic pain usually of
longer duration than angina and associated with fever, leu-
cocytosis and often a friction rub.
3. Acute Aortitis:—Syphilitic or rheumatic—usually substernal in
location and anginal in kind.
4. Organic heart disease, valvular disease and heart failure.
5. Neurocirculatory asthenia—effort syndrome.
6. Pain involving tissues of left chest wall. This includes hyper-
thesia of skin, panniculitis of adipose tissue, fibrosis of connec-
tice tissue, myalgia of intercostal muscles and intercostal
neuralgia, referred pain from other areas and trauma.
7. Grosser lesions:—Pericarditis, pleurisy, empyema, aneurysm,
mediastinal growths, lung tumours and referred pain from diseases of cord and vertebrae.
8. Rare conditions, e.g., phlebitis of the thoraco-epigastric vein.
If one keeps in mind such a differential diagnosis the final diagnosis
should not be very difficult. It has been shown that pain as such is felt
only in areas supplied by the cerebrospinal system of nerves, and when it
arises in a viscus is perceived as pain, only by means of the connection of
that viscus with the cerebrospinal fibres distributed to the body wall,
corresponding in segmental area to the organ involved, and it comes about
when the contractions are unduly strong or when the organ is poorly
supplied with blood, or when the central nervous system becomes unduly
sensitive. This arises from a damaged heart muscle or secondarily when a
normal stimulus is exaggerated by a hypersensitive nervous system. Therefore, pain brought on by exertion, radiating down the arm and accompanied by anxiety and respiratory oppression and subsiding with cessation
of effort, may be due to coronary disease or aortic syphilis, or may occur
when neither is present. Our attention, therefore, must not be focussed
on the type of pain in an effort to distinguish the underlying pathology,
but rather on other accompanying signs, such as evidence of arterial
disease in retinal vessels or radial artery, blood pressure, hypertrophy of
the heart, X-ray, electrocardiograph and serological evidence of syphilis.
A definite diagnosis must be made to remove the anxiety and fear element
which is such a prominent feature of angina.
Coronary Disease
The problem of angina pectoris and that of coronary disease are
closely linked. Angina may be present alone, i.e., the symptom complex
without any evidence of heart disease, or it may be complicated by change
in the coronary vessels. Coronary thrombosis with cardiac infection has
been recognized for a long time, but it was Herrick in 1912 who made
it known as a clinical entity and showed that it was not always fatal.
A case has recently been reported where a young man received a stab
wound in the chest, the knife severing the left coronary artery. He was
operated upon immediately and the left coronary ligated, thus producing  a  sudden  coronary  occlusion.     He  made  an  uneventful   recovery.
Page 243 Conorary occlusion, however, occurs in those of more advanced years
where the arterial system is not able to readjust itself as readily as in
the young. Herrick in 1919 proposed an appropriate classification of the
clinical forms into four types.
1. Those of instantaneous death.
2. Those in which death occurs in a few minutes or a few hours.
3. Those where death is delayed days or months.
4. A group that is assumed to exist, embracing cases of a mild
type, i.e., due to obstruction in the smaller branches of the
The clinical picture of coronary occlusion has now become so clearly
defined as to permit of its ready diagnosis. The important feature is to
have it in mind. Pain is the outstanding and most characteristic symptom. It is severe and prolonged and not relieved by nitrites. There may
or may not be a history of previous chest pain, but the patient immediately realizes this is something new. It is sudden and agonizing, necessitating large doses of morphia for relief. It may extend into the upper
abdomen, which at times has led to a diagnosis of an upper abdominal
catastrophe requiring surgery. The patient is usually in a state of shock,
the blood pressure drops, the heart sounds are weak and a praecordial
friction rub is occasionally heard, usually between the second and fourth
day, and usually transient. Leukocytosis with fever is a characteristic
response to the cardiac infarction.
The electrocardiograph gives us most valuable diagnostic information in coronary disease. The changes in the tracing are mainly concerned with the QRS complex and the T waves. There is the typical
coronary type T wave ,originally described by Pardee in 1920. This was
present in one-third of his patients who gave symptoms of coronary
narrowing of infarction. It has a high take-off from the descending arm
of the R wave and has a toboggan-slide effect, being sharply inverted,
and thus obliterating the usual ST isoelectrical interval. Pardee has recently called attention to a type of Q wave in lead III. This wave must
. be at least 2 5 % of the greatest excursion of the QRS complex in any
lead and succeeded by a definite upward deflection R and no S wave.
Only those of left axis or normal axis deviation are included. In 63%
of cases exhibiting this one finding there occurred the anginal syndrome.
Willius reports 3 00 cases all but 3 of which had cardiac abnormality.
Although this occurs in some cases of angina, many cases will be found
which show a normal tracing.
Prognosis in Angina
Coronary thrombosis is a frequent complication of angina pectoris
along with other cardiac abnormalities, so that the prognosis depends to
a great extent whether we are dealing with uncomplicated angina or
angina plus some other heart disease. White and Bland report a series of
500 patients of which 213 are dead with an average duration of life of
Page 244 4.4 years after the onset of the disease. Of the ones who died, death was
due to failure of the heart in 82%. 19% had normal hearts on physical
examination, normal blood pressures and normal electrocardiograms. This
combination of findings is found to be unusually favorable. The presence of hypertension did not seem to be of importance.
Prognosis in Coronary Thrombosis
The patient often survives coronary thrombosis for many years in
good or fair condition. A careful history and physical examination and
electrocardiogram often reveal evidence that such an event has occurred
in the past. Of a series of 200 cases reported by White & Bland, 101 are
dead with an average duration of life following the attack of 1.5 years.
The younger patients as a rule live longest Conner & Holt in reporting
287 cases give an immediate mortality in the first attack of 16.2%. In
62% of their cases the attack supervened without antecedent circulatory
symptoms. The sex appears to be of little importance. The previous
occurrence of angina irrespective of its duration seems to have little bearing. Hypertension is of little or no importance and syphilis is encountered
rather rarely. Cardiac enlargement of considerable degree is to be looked
upon as unfavourable. There are few diseases in which the prognosis in
any individual case is more difficult to predict than in coronary thrombosis.
To treat a disease implies diagnosis. There is nothing in medicine
that we have to be more definite about than heart disease. To the lay
mind anything referable to the heart implies impending death and gives
to the individual an outlook of hopelessness. In angina we must not only
give relief to the attack but consider the interval. The patient must be
viewed not physically only, but as a personality. To increase the tension
of the nervous system in an aging vascular system is in many people to
bring on the pain. We must not only ascertain the physical condition
of the individual, but discover what he is doing to life. All people have
two businesses, i.e., their vocation, the other is just living, their ambitions,
endeavours and problems and particularly their reactions. Dr. James
Stewart in speaking of cardiac drugs said "But the greatest of these is
hope"—Let us therefore study our patients, re-assure them, and lift the
added burden which heart disease has come to mean to them. Many of
these patients with angina have either lost or have never learned the art
of relaxing. An emotional upset is all they need to throw them into an
attack. As John Hunter has said "His life was in the hands of anyone
who chose to annoy him." The cellular pathology in many is to be ignored
and stress placed on the personal pathology. As Roberts in a recent
article states concerning a case, "Each weekly visit was spent in psychotherapy which is nothing more than clinical power, presence and personality flowing through conversation, explanation and encouragement. Written instructions are often necessary concerning rest, habits, etc. Long
periods of bed rest have not been dramatic. Relative rest by starting later
in the morning, a longer noon hour and stopping earlier at night with a
Page 245 longer night's rest in bed and with no exertion immediately after meals is
of more benefit.
For medication the theobromine derivative metaphyllin or emphyllin
O.l gm. three times a day is useful. It would be impossible of course to
get along without the use of the nitrites which were first introduced in
In coronary thrombosis morphine in large doses is essential. The
nitrites are not only useless but may even be harmful in the acute attack.
The relief of pain is very necessary, for while in pain rest is impossible and
there is nothing more important than rest. Special nursing is essential
and the patient should not even be allowed to feed himself for several
The use of digitalis is dependent upon the development of signs of
myocardial failure. It is often advisable to give digitalis soon after the
onset of coronary occlusion. After the acute symptoms subside, signs of
myocardial failure may develop and it is here that digitalis has its main use.
It has been shown that the heart is extremely sensitive to changes
in blood supply. The experiments of Smith and his co-workers indicate
that the rate of coronary flow is greatly altered by the change in diastolic
pressure, so that the maintenance of an efficient coronary circulation is
dependent on the height of the diastolic pressure. Drugs which produce
an increased coronary flow increase diastolic pressure.
It has been shown by perfusion experiments in cats that caffeine in
dilution of 1 to 25,000 and 1 to 50,000 increased coronary flow 41%
and theophyllin in the same dilution 25% to 45%, while emphyllin increased the rate from 40% to 90%. Theobromine, itself, may be employed and recently theocalcine has been recommended. The manner of
action of these drugs in producing an increased coronary flow and their
diuretic action is not yet properly understood.
After the acute stage in coronary thrombosis, a period of weeks in
bed is essential to enable the establishment of a maximum collateral circulation. The management after the patient is allowed out of bed is
also of great importance. All activities must be carefully regulated and
graded exercises have an important function. The patient must not be
allowed to extend himself to the point of shortness of breath.
In a number of cases medical treatment has been of little avail, as
the patients have frequent and severe attacks of pain.
The field of surgery was opened to these cases and now operative
treatment has become a necessary and most valuable aid in treatment.
Operative treatment of praecordial pain was first practised by Jonnesco
in 1916 with the idea of abolishing the nervous arc between the heart and
the sensorium. It is analogous to the treatment of tic douloureux. Alcoholic
paravertebral injection gives relief in approximately 50% to 75%. It is
apparently free of most of the ill effects of operation. This of course
gives only symptomatic relief, and special care is necessary to avoid unnecessary effort, as the warning signal has disappeared.
Page 246 GASTRIC
?he sad but interesting Case of Mme. de Sabh
The Marquise de Sable loved gooc
things, was something of a gour
mande, and enjoyed a reputation as
a "veritable gastronomic authority.'
La Rochefoucauld praised highly
her potage with carrots, capoi
stuffed with prunes, and rated hei
truffles above his own "Maximes.'
But Madame de Sable sufferec
from the venerable disease o:
hypochondria. Her morbid anxiety to safeguard her health, whicl
finally became the ruling passion of her life, began innocentb
enough in a healthy appetite. But careful as the Marquise was tc
avoid disease, she let her appetite rule and her stomach suffer
The ideas of Madame de Sable have found many imitators sinct
the 17th century. The gastric neurasthenic is with us and his
phobias with him. There is nothing better for his overworked
stomach than CAL-BIS-MA because it neutralizes gastric hyper
acidity quickly, soothes the irritated mucous membrance, anc
relieves the discomfort of gas formation.
Cal-Bis-Ma is a combination of calcium and magnesium carbonates, sodium bicarbonate, bismuth and
colloidal kaolin, blended into a palatable powder...
We will gladly explain the therapeutic merits of
Cal-Bis-Ma and send a professional trial package
for the asking. . . Send for it.
The scientific dressing for the relief
St! of    *     I
Inflammation and Congestion
Silicate of
Glycerine )   ^    ,
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MONTREAL Jonnesco first removed the upper three cervical and first thoracic
ganglia on both sides. The whole innervation of the heart comes from
the vagi and sympathetic nerves. In the sympathetic sensory fibres run
as high as the middle cervical ganglion. There are no sensory fibres found
above this level. All the sensory fibres, irrespective of whether they run
into the middle or inferior cervical or stellate ganglion, eventually end in
the stellate ganglion from which run direct sensory fibres to the spinal
cord. Coming from each ganglion toward the heart are the superior
middle and inferior cervical nerves. Thus to arrest the passage of sensory
impulses from the heart there must be a destruction of the nerves which
reach the lower and middle cervical ganglion and the stellate ganglion.
Nine cases of complete ablation of the sympathetic ganglion on both
sides are reported with complete relief in all cases with no mortality. In
18 cases of left sided ablation there was complete relief in 8 cases, improvement in 5 and no results in 2 with three deaths. Posterior nerve
root procedures have been reported in 26 cases with doubtful results in
all. In the procedure of alcohol injection, there occasionally develops distressing hyperaesthesia. Lasting 2 to 6 weeks after anaesthesia has worn
off, improvement has continued 6 to 7 months after injection and a number of patients have returned to work. Operative procedure has produced
some dramatic results, but the results are not uniform and there has been
a fairly high mortality. It is to be used as a last resort, but as time goes
on and more work has been done from the surgical angle the procedure
may become more valuable. Alcoholic injection is still preferable to
The treatment of a case of angina pectoris or coronary thrombosis is
more or less an individual matter. It is impossible to lay down any definite rules applicable to all cases.
(An abstract of paper delivered by Dr. Wm. E. Lower at a recent meeting of the V.M.A.)
It has long been known that the growth and development of the
prostate gland was influenced by the testes. In order to determine the
physiological relationship between the gonads and the prostate and to
ascertain the source of the hormones which govern prostatic activity,
various studies were made on castrated animals and eunuchs. Following
bi-lateral orchidectomy the prostate became small, firm and fibrotic. In
our series of ten eunuchs the prostates were all small and atrophic. However, castration is an undesirable clinical procedure from the psychogenic
point of view, and it, therefore, seems necessary to develop some method
by which testicular function can be inhibited without the removal of
the gonads. We found ligation of the vasa deferentia in rats did not
change the prostate, testicles or seminal vesicles, but when the spermatic
vessels were ligated there was pronounced degeneration of the interstitial
and testicular cells of the gonads with generalized fibrosis of the prostate.
Experimentally we were able to abolish testicular function by the implantation of massive doses of radium seeds into the testes or by subjecting
Page 24/ the glands to destructive doses of the X-ray. In animals so treated the
prostate became small and atrophic. The tubular tissue of the gonads was
very sensitive to radiation, while the interstitial cells were quite radioresistant. To determine the influence of the tubules, therefore, we subjected the testes of rats and dogs to small doses of radium and X-ray. In
all animals the testes were decreased in weight and size by fifty per cent.
There was a complete destruction of the tubular tissue with an increase
in the number of the interstitial cells, and both the prostate and seminal
were hypertrophied. Thus it is apparent that the testicular tubules, germinal epithelium and spermatogonia do not exert a regulatory control over
the prostate. The interstitial cells of the gonads, not being injured, were
able to produce sufficient hormone to maintain prostatic growth.
The testis is not a self-contained functioning organ, but is in turn
dependent on secretions from the anterior lobe of the hypophysis for its
power to provide male hormone. In order to study the influence of the
hypophysis on the secondary sex organs and eliminate any extraneous factors, we carried out a series of experiments by parabiosis, joining two
animals together by a common opening of their peritoneal cavities. This
union, we found, did not disturb the normal physiology. When castrated
male rats were twinned with normal males the prostate and seminal
vesicles of the castrate became small and atrophic and the pituitary gland
increased in size. In the normal partner the testes, prostate and seminal
vesicles were hypertrophied but the pituitary remained normal. When
the rats were permitted to live for thirty days the prostate was increased
both in size and weight from three hundred to five hundred per cent. The
gland was quite firm and had a preponderance of glandular tissue, and
the enlargement was uniform. After ablation of the gonads the hypophysis increases in size and function. The excessive prehypophyseal
hormone passed from the castrated animal over into its normal partner
and caused the testes to secrete an excess of the sex hormone which resulted in hypertrophy of the prostrate. That the hypophysis of a castrated
male is hyperfunctioning can be demonstrated by twinning a castrate
with a normal female. The pituitary secretion passed into the female
and stimulated the ovaries and produced a protracted oestrous cycle and
enormous enlargement of the horns of the uterus and vagina. Similar
results were obtained by injecting anterior pituitary extract directly into a
normal female.
Thus by merely altering the endocrine system so as to cause hyper-
function of the pituitary gland and permit the hormone to pass into a
normal rat, we have obtained a prostatic hypertrophy. A control of this
regulatory mechanism of the influence of the hypophysis upon the sex
glands may furnish the solution for the prostatic problem.
* * *
Diary of Dr. A. Gibson (Member of Tour)
We have Dr. Gibson's kind permission to publish the following,
which explains itself. It was written with no thought of publication,
but it is so vivid and fresh an account of impressions gained by a visitor
to B. C. that it is with great pleasure we publish it.— (Ed.)
Page 248 M>y 22nd, 1932—Left Winnipeg at 9:45 a.m. Dust storms all the
way through Saskatchewan.    Changed at Medicine Hat, 2:15 a.m.
23-5-32—Met Pope at Crow's Nest. On the train talked with Dr.
Corson of Fernie. At Cranbrook we arrived at 2:30 p.m., and went off
at once to the Nurses' Home, St. Eugene Hospital. There were 11 doctors, two medical students and about 12 nurses. Pope spoke on Disorders
of Sensation. I gave a clinic on a case of injury to the back of four
years duration with all the hall-marks of Hysteria. Pope demonstrated
the sensory changes. I spoke on Injuries to the Back, and emphasized
the point of hyperextension. Hunter of Vancouver spoke on Urological
Emergencies, shewing lantern slides. Adjourned to the hotel where had
dinner, and after that we returned to the Hospital where I spoke on some
fractures, with special reference to Colles' fracture. General discussion
was good.    To bed about 1 a.m.
24-5-32—Up about 7 a.m. Breakfast and out to the Sullivan Mine
at the invitation of Dr. Hazard of Kimberley. Were met by Montgomery, Mine Supt., also Mr. Archibald and Mr. Lindsay. We went
through the mine under their guidance; went in the tunnel at the 3900
foot level. Goes straight in for 9000 feet. From there we walked
through different drifts, cross-cuts and saw all sorts of processes. They
have their tool-shops, electric light, electric furnace for sharpening the
drill points, excellent water with drinking fountains through the mine.
There is a model of the ore body which shows the developed portion and
some of the undeveloped, also the prospects for further excavation. We
brought a small specimen shewing zinc and lead. Had lunch with Dr.
and Mrs. Hazard, then drove back the 20 miles to Cranbrook and caught
the train with practically nothing to spare.
The Sullivan Mine is evidently being thought of as not for the next
few years but for an indefinite time. Tremendous concrete pillars are
being put in to support the roof where the ore has been removed. The
ore body is in places over 200 feet across. The richness of the mine is
apparently almost inexhaustible.
Some of the men came a great distance to hear the papers. One
came from Invermere, a distance of about 120 miles.
Train to Nelson. Arrived at the Hume Hotel and found opposite
it a group of tents, the temporary abode of a number of the arrested
Doukhobors. The meeting was held in the Nurses' Home of the Hospital. There were present 15 doctors and about 23 nurses. Refreshments were served afterwards and we got back and to bed about midnight. Three men had driven from Trail a distance of 48 miles and one
from Nakusp 100 miles distant. I spoke again on Fractures of the Spine.
Pope spoke on Disorders of Sensation, and Hunter on Urological Emergencies.
25-5-32—Up at 6 a.m. Breakfast at 7 a.m. with Hunter. Hunter
drove with Laishley, I with Shaw to Trail. We spent the whole morning in the Plant of Consolidated Mining and Smelting. It is a wonderful place.    The chief metals produced are Zinc and Lead; there is also a
Page 249 certain proportion of cadmium, silver and gold. We saw all the processes, but were unable to see the whole of the plant on acount of the
shortness of the time. We passed the Fertiliser Plant up on the hill, but
it would take at least a whole day to make even a cursory examination
of the place. In the afternoon played golf with Thorn; played badly.
Evening supper with Dr. and Mrs. Thom at their home. Am greatly
surprised at the beauty of the gardens. Evidently the smoke nuisance
has been pretty well overcome. After supper saw the Hospital at Trail,
and then was driven by Leonard to Castlegar where I joined up with
Pope who had spent the day resting. I did not mention how interesting
was the drive to Trail in the morning. We saw the hydro-electric developments of the West Kootenay Power Co., at Bonnington Falls. The
Columbia River is almost at high water, and the scenery is striking. We
also passed through the midst of the Doukhobor settlement where there
is so much trouble. No nude parade was staged for our benefit. Apparently these people work hard and cultivate the ground, but they spend
very little, and in no sense mingle with the general interests of the community as a whole. Their interests are concentrated on their own community. We saw the grave and monument of Peter Veregin, who was
blown up by a bomb. The monument has been partially destroyed by
his enemies. They are at variance among themselves; the recalcitrant
party are the Sons of Freedom, and their quarrel is not against the ordinary
inhabitants but against another sect of their own persuasion. Their religion forbids them to go to law, so they obey the Scriptural Command,
"If any have taken from thee thy coat, give him thy cloak also." Hence
the nude parades. It appears to be noteworthy that the parades are always
staged on a Sunday when there is likely to be a fairly large gathering of
spectators. The problem appears to be a very grave one to the good
people of Nelson. I also forgot to mention that we brought away a
small piece of ore from the Sullivan mine which gives some idea of the
richness of the mine and from the C. M. and S. a small ashtray of zinc
99.9% pure.   They make interesting little souvenirs.
26-5-32—Arrived at Penticton at 8:30 a.m., and had two hours
to wait for the bus to Kelowna. We spent most of the time in the Hotel
In col a; I was able to finish a skeleton of the paper on Arthritis. It was
rather pathetic to see the large dining-room set out for perhaps a hundred
people for breakfast, and not one person to patronize it. We had already
rushed our breakfast on the train or we might have lent a little patronage.
The stage drove along the west side of Okanagan Lake for about 27
miles and then was transported over a ferry from Westbank to Kelowna.
It was a warm day with pitiless sunshine. At Kelowna we put up at the
Royal Anne Hotel, a new building run on the American plan and quite
up-to-date in every respect. We spent the afternoon playing golf, a threesome; the course was potentially very attractive, but the ground was
hard and parched and the greens were of sand. I found the round very
tiring and was relieved when it was finished. The evening meeting was
held in the Oddfellows Hall and was attended by some 3 5 members of
the B. C. Association. I spoke on Arthritis and there was some discussion.
Evidently there is a good deal of interest in this condition. Pope spoke
on Medical Emergencies and put in a plea for the special teaching of these,
to counteract the idea that practically all emergencies are surgical.
Page 250 27-5-32—Up at 6:30 a.m. Had a walk before breakfast at 7:30.
After that to the Hall, where Hunter spoke on Haematuria, a good paper,
and after that a paper from Williams, of Trail, on the Pelvis. It was
very practical and devoted a good deal of time to the Anatomy of the
pelvic floor. This paper was enthusiastically received. I next spoke on
the Mechanism of the Foot. There was some discussion but I rather think
the paper is a little too anatomical to make much of an appeal to the
general practitioner, and I doubt if I did much to convince them of the
question of springs as against arches. It is so simple (although so ineffective) to send patients to get "foot supports" instead of making them
work out their own salvation that I feel doubtful if the presentation was
worth while. In the evening there was a public meeting. Pope spoke on
the subject of "Sleep" and I followed with "The Craft of Surgery; then
and now." Both papers went faily well. We then went to a dance in
Scout Hall and got back to bed about 1:30 a.m. The Public meeting
was attended by about 125 people.
We had lunch as the guests of Dr. Knox, The President. I sat next
to R. E. McKechnie. He is the doyen of the Coast Surgeons and made
an interesting dinner-companion. He told of homesteading in Southern
Manitoba about fifty years ago. He has seen the West grow up from the
time of the arrival of Steel. In the evening midway through the Dance,
Purvis and myself went to Dr. Knox's home and saw a number of pictures
of the progress of his brother who had had an excision of a good part of
the cheek on account of a malignant growth. This was followed by a
whole thickness transplanted from the forehead and he seems to be doing
well. Also met Underhill, a former student now in practice in Kelowna;
seems to be doing well; he had charge of the arrangements for the meeting. Went with him to the High School Auditorium to look over arrangements for the Public Meeting.
28-5-32—Felt a little tired this morning and did not get up until
8 a.m. F. M. Black came to the Hotel and we had a chat. The Mayor,
Dan Gordon, a good Scot from Beith, Ayrshire, also came down to invite
us to lunch and after that to have a drive around the district. This was
the alternative to taking part in the- Golf Tournament, and as the day
was hot, it seemed the better plan. Pope and myself had lunch at his
home, and then with T. Norris, a lawyer and apparently a very good
fellow, drove around the vicinity for about 70 miles. We saw the orchards
and the vineyards which are somewhat of a new venture. Down in the
flats the soil is chiefly suited for truck gardening, but on the "Benches,"
i.e., former lake shore levels, the apples, cherries, plums and grapes flourish
best. There were also remains of a former trade in tobacco, but this has
largely disappeared owing to mismanagement and cupidity. We next went
to one of the fruit packing plants, but of course on account of the season
there was no work going on. However, we went through a cold storage
part of the warehouse, and were treated to some apples of the "Delicious"
variety which had been in cold storage since the previous September. Cool
almost as ice they were good indeed on a warm afternoon. An attempt
to see if any of the wine of the country were available for appraisal was
frustrated by the building being closed, and we went to the Club for a
little refreshment.    Later in the evening the Banquet was held.    Both
Page 251 Pope and myself spoke in appreciation of the hospitality we had received.
After that there was dancing and so to bed.
29-5-32—Nothing much to do to-day until leaving for Kamloops
about 3 p.m. The way lay north through Vernon; on the way we passed
Long Lake a very attractive sheet of water. We bowled along in Wallace's
new Auburn car and made Kamloops shortly before 6 p.m. We had
dinner and then went for a drive to the Sanatorium at Tranquille. This
was about ten miles distant. Kamloops is situated at the junction of the
Thompson and the South Thompson rivers. The Indian name Kamloops
is said to mean "Meeting of the Waters." We loafed around the Plaza
Hotel until train time 11:50 p.m. and then got aboard the main line train
for Vancouver. We reached this spot at 9 p.m. and had breakfast. Fred
Bell came to see us and arrange for our entertainment to-day, and again
when we return on Friday next.
We had dinner in the Vancouver Hotel as the guests of Dr. Murray
Blair. Present were Drs. Gillies, Turnbull, Fred Bell, Vrooman, Seldon
and ourselves. At 8 p.m. we went to the Auditorium of the Medical-
Dental Building, and gave our papers. Pope spoke on a Simplified System
of Spinal Neurology, and I on fractures of the Spine. There were about
80 men present. Discussion by several. After the meeting we went with
Dr. George Seldon to the home of Dr. Gillies, where light refreshments
were served.   At midnight we sailed on the S. S. Princess Elizabeth.
31-5-32—Had a good night's sleep and got up after the boat had
reached the dock at Victoria. We decided to have breakfast aboard, and
after his meal went to the Empress. The morning bright and rather warm.
Had a visit from Dr. Moore, the president of the Victoria Medical
Association. He took us to St. Joseph's Hospital and to the Jubilee Hospital.    No clinical work was done but we chatted with some of the men.
We went to the home of Dr. Herman Robertson for refreshment or
medicamentum restitutkmis as it was called, and then to the Union Club
for lunch. After that Baillie, Pope and myself went to the golf course
at Oak Bay for a round. This was' exceedingly sporting. Baillie played
our best ball and we were a shade the better. We left for Victoria about
6:30 p.m., and got ready for dinner. This was a rather formal affair held
in the Empress. There were 3 8 present, and all had taken the trouble to
dress for the occasion. After dinner Pope spoke on Scoliopathexis, and I
followed with "Some Knee Joint Conditions." There was a little discussion afterwards but all were keenly interested or at least appeared to
be so.   Tomorrow we leave shortly after 9 a.m. for Nanaimo.
1-6-32—Up about 7 a.m., after rather a poor night's sleep. We did
not get to bed until about 2 a.m. and the morning arrived too soon.
Visited by Dr. Barrett and his son regarding the condition of the latter's
feet. Says I saw the boy in 1926. Double Claw Foot but manages to do
his work and play rugby. Suggested exercises, no operative measures.
Breakfast in the Empress, then on the road. MacPherson had very kindly
set the time aside to drive us to Nanaimo, about 80 miles, rather than
have us go on the bus.
Page 252 On the way stopped at the Solarium at Mill Bay. Shown around by
Dr. Wace. Arrived Nanaimo about 2 p.m. and found a gathering of
about 14 awaiting us. Had lunch, then Thomson and Pope spoke while
I went with Dr. Eakins to see the big primeval timber at Cameron Lake
about 40 miles north. It was a fine drive and we came back through
Qualicum Beach of which I had heard so much. Got back to find dinner begun; joined in, made a speech of sorts and then went out to see the
Bastion, a relic of the Indian fighting days, of which the inhabitants of the
city are very proud. Thereafter to another meeting when I spoke on the
subject of Arthritis (by request), Pope followed with Scoliopathexis, and
afterwards I spoke shortly on Treatment of Fractures of the Spine by
hyperextension, a matter of topical interest. Meeting finished with the
usual vote of thanks. To bed after 12 p.m. Some of the Doctors had to
drive 70 or 80 miles after 11 p.m. It makes one feel that one has not
done enough for these fellows. They are thirsting for information and
are willing to give of their best in recognition of a very moderate offering.
Some 14 of them were at the meeting.   A fair amount of discussion.
2-6-32—Up at 7 a.m. Fletcher, Thomson, Pope and I travelled by
boat to Vancouver, arriving about 10:30 a.m. Walked up from the boat,
called in at the C.N.R. and arranged about validating our tickets over the
Union Steamship Co.'s boat. Back to the Hotel and arranged our pied
a terre. At noon met Dr. Mackay and was taken out by his care to
Hollywood Private Asylum where Dr. John Robertson received us and
provided lunch. We saw over the place and Pope spent some time examining a case of doubtful Tabes. At 3 p.m. we made our way to the
hospital and found a large gathering of Doctors (45 to 50) to hear us.
Five cases were present for clinic by myself; arthritis and two accident
cases, both Finns, in whom the physical element was overwhelming. It
is very instructive to see how prominent the factor of fear is when times
are bad and the prospects of work are doubtful.
After the clinic, Thomson spoke on the after treatment of abdominal cases, while I saw one or two more cases for individual men,
including an interesting fracture of the humerus with rather slow union.
Dinner was appointed for 6:30 at the golf club, but we were as usual a
bit late on account of going to "Number 9" to see especially a family,
five brothers who had been brought in from Round Top, B. C, all of
whom were imbeciles; three others are at home who have just sufficient
intelligence to escape being certified. The family had come to B. C. from
Alberta, so it may be imagined that the opportunity of teasing Pope was
not lost. There was another family of five in the same mental state.
This matter of the preservation of mindless pets by the state is one of the
utmost seriousness. Dinner at the Club was accompanied by the customary speeches. Pope suggests that whereas at the beginning of the
trip it was a bit of a punishment to be forced to make a speech, by the
end of the tour it will be looked upon as rather a dirty trick if we do not
get an opportunity to orate. Perhaps he is right. In any case it is not
nearly so much of an ordeal as it was at first.
{To be continued).
Page 253 INDEX
Abdominal Operations, Emergency, J. W. Thomson  157
Abstract, W.  K. Burwell   29
American Urological Association  Meeting  233
Angina Pectoris and Coronary Thrombosis, W. H.  Hatfield   240
Annual  Dinner     46
Annual Meeting, B. C. Medical Association X 156,  198
Appleby, L. H., "Recent Surgical Advances"  j 176
Associated Clinics of Physio-Therapeutics   -'-  42
B. C. Medical Association Annual Meeting    156, 198
B. C. Medical News  ! 147
Baird, M. McC. "Clinical Aspects of Some Blood Diseases"   89
Birchard, C. C, "Heart Signs and Symptoms"     7
Blood Diseases, Clinical Aspects of Some, M. McC. Baird   89
Burris, J. S., "Surgical Treatment of Pulmonary Tuberculosis"   68
Burwell,   W".  K.,  Abstract   29
Cancer of the Breast, J.  W\ Thomson  15
Cancer Meetings 67,  88
Challenge of Status Lymphaticus, W. N. Kemp 141
Clinical Aspects of Some Blood Diseases, M. McC. Baird 89
Clinical   Meetings    26,  67,  8 8,  155
Coleman, R. E., "Medical Economics
Coleman, R. E., "Medical Economics
Coleman, R. E., "Medical Economics
Coleman, R. E., "Medical Economics
Coleman, R. E., "Medical Economics
Coleman, R. E., "Medical Economics
Day, E. E., "Indications for Endoscopy"  136
DesBrisay, H. A., "Syphilis in Medical Practice"  : 47
"Diseased" Buildings, from Mental Hygiene Bulletin   98
Dyer, H., "Tracheotomy in Children" 110
Early Colonial Hospitals, A. S. Monro 226
Emergency Abdominal Operations, J. W. Thomson  157
Endoscopy, Indications for, E. E. Day  136
Etiology of Status Lymphaticus, W. N. Kemp 210
Fractures, Modern Management of Some Common, D. M. Meekison 77
Fractures, Modern Management of Some Common, D. M. Meekison  (Cont.)   . 99
Fractures, Principles in the Treatment of, A. B. Schinbein '. 72
General   Meetings    26, 47,  67,  88,  134,  155
Gibson,  A., Diary on Post-Graduate Tour 248
Gibson, A., "Injuries to the Spine" , = : 199
Graham, Colin, "Inflammation of the Nasal Sinuses" _117
Hatfield, W. H., "Angina Pectoris and Coronary Thrombosis"  248
Heart Signs and Symptoms, C. C. Birchard     7
Home Treatment of Tuberculosis, A. S. Lamb  . 1 33
Hospital   Records : 30
Hunter, A. W., "Urological Emergencies" £ 206
Indications for Endoscopy, E. E. Day J 136
Inflammation of the Nasal Sinuses, Colin Graham 117
Injuries to the Spine, A. Gibson . 199
Kemp, W. N., "Challenge of Status Lymphaticus" 141
Kemp, W. N., "Etiology of Status Lymphaticus" 210
Kidd, G. E., "Tumour Metastasis"  , : 164
Laboratory  Bulletins  -. 12 6
Laboratory Specimens, Collection and Delivery of  '.      9
Lamb, A. S., "Home Treatment of Tuberculosis"  ; 33
Library News, Abstracts, Additions  89, 214, 224
Library News, Book Reviews : 31, 216, 224
Lockhart, "W. T., "Treatment of Syphilis" . 54
Lower, W. E., "A Discussion of the Prostatic Problem"  247
Medical Economics  (1), R. E. Coleman  121
Medical Economics (2), R. E. Coleman  144
Medical Economics (3), R. E. Coleman  ! : 168
Medical Economics (4); R. E. Coleman 191
Page 254 Medical Economics (5), R. E. Coleman •  .201
Medical Economics  (6), R. E. Coleman  ~222
Meekison, D. M., "Modern Management of Some Common Fractures" 77
Meekison, D. M., "Modern Management of Some Common Fractures"   (Cont.) 99
Meetings: Cancer     _67   88
Clinical     _.  26, 67,  88, 'l55
General       26, 47,  67,  88,  134,   155
Special     _5   jjq
American  Urological Association      233
B. C. Medical Association Annual Meeting  156,  198
Moffat; W. A., Case Report of Purpura Haemorrhagica    32
Monro, A. S., "Early Colonial Hospitals"   226
Monro,   A.   S.,   Obituary     239
MacKay, Fred, "Poliomyelitis"   5
Nasal Sinuses, Inflammation of, Colin Graham            117
Ootmar, G. A., "Undulant Fever in the Okanagan Valley"  _■ 126
Osier  Dinner  _ 134
Physio-Therapeutics, Associated Clinics of   42
Poliomyelitis,  Fred MacKay        5
Pope, E. L., "Simplified Spinal Neurology"  199
Post-Graduate  Tour,  Diary  of Dr.  A.   Gibson   248
Principles in the Treatment of Fractures, A. B.  Schinbein   72
Procter, A. P., "Struggle to Maintain the Educational Standards of the
Country in the Treatment of the Sick"  148
Prostatic Problem, A Discussion, "W. E. Lower   247
Purpura Haemorrhagica, Case Report, W. A. Moffat   32
Recent Surgical Advances, L. H. Appleby    176
Schinbein, A. B., "Principles in the Treatment of Fractures"   72
Simplified Spinal Neurology, E. L. Pope  199
Special Meetings   5,  199
Spinal Fluids, Provincial Board of Health Laboratories  110
Status Lymphaticus, Challenge of, W. N. Kemp  141
Status Lymphaticus, Etiology of,  W. N.  Kemp  210
Struggle to Maintain the Educational Standards of the Country in the
Treatment of the Sick, A. P. Procter  148
Summer  School   = 176, 200, 234
Summer School Programme    2 3 6
Surgical Advances, Recent, L. H. Appleby  176
Surgical Treatment of Pulmonary Tuberculosis, J.  S.  Burris   68
Syphilis in Medical Practice, H. A. DesBrisay   47
Syphilis, Treatment of, W. T. Lockhart   54
Thomson, J. W., "Cancer of the Breast"   15
Thomson, J. W., "Emergency Abdominal Operations"  157
Tracheotomy in Children, H. Dyer  110
Tuberculosis, Home Treatment of, A. S. Lamb L  33
Tuberculosis, Surgical Treatment of Pulmonary, J. S. Burris   68
Tumour Metastasis, G. E. Kidd . 164
Undulant Fever in the Okanagan Valley, G. A. Ootmar  126
Urological   (American)   Association Meeting  233
Urological Emergencies, A. W. Hunter  206
Vital    Statistics     1,  21, 43,  63,  83,  106,  131,  152,  173,  196, 218,  238
laic optical €o.
Our Entire Interests are Devoted to
Scientifically Dispensing Your Optical Prescriptions.
Suite 631 Birks Bldg. Seymour 9000
Page 255 Miss R. A. Backett, r.n.
Rooms 503-504 Birks Building
Phone Trinity 2004 Residence Seymour 4679
Sun Ray
Quartz lamp
Cabinet Baths
and Shower
Swedish or
Weir Mitchell
Superflous Hairs
Per Electric
Specializing in Physio-Therapy
Patients may be visited in homes
(Qualified Physicians invited to visit)
Nu-Kor Belt
/ wE&k
Complete  line of
surgical belts, fitted by expert
For further
information call
Sey. 7258
445   Granville   St.
Vancouver, B. C. Not a baby food, but part of a flexible system of infant feeding
Mead's  Dextri-Maltose  owes   its   wide   use   and   acceptance   by   physicians   to   its   inherent merit as a carbohydrate well tolerated by infants, and to the fact that it is
a part of a flexible system of infant  feeding in  which   the  art  and  science of  the
physician,  rather  than  the  artifices  of   any   manufacturer,  predominate. fetter & ^|arara, ^2t&
Established 1893
North Vancouver, B. C.
Powell River, B. C.
Unequalled  intensity  of action—prolonged  effect—effective
by   injection   and   local   application—advantageous   price
characterize  the   new  non-narcotic  local  anaesthetic
(A compound Nupercaine Ointment under the name of
PERCAINAL, -CIBA" has recently been introduced for
the treatment of painful conditions of the skin and mucous
Messrs.   Macdonalds   Prescriptions,   Ltd.       -       Vancouver,   B.   C.
Messrs.  McGill & Orme, Ltd.      -      Victoria,  B.  C.
keep a full range of "CIBA" specialties. 536 13th Avenue West Fairmont 80
Exclusive Ambulance Service
"St. John's Ambulance Association"
R. J. Campbell J. H. Crellin W. L. Bertrand
is a handy, convenient, clean commodity
for the bag or the office.
Supplied in one yard, five yards and
twenty-five yard packages.
phone 730 Richards Street
Seymour 698 Vancouver, B. C. *^l
Hollywood Sanitarium
For the treatment of
Alcoholic, Nervous and Psychopathic Cases
Reference—B. C. Medical Association
For information apply to
Medical Superintendent, New Westminster, B. C.
or 515 Birks Building, Vancouver
Seymour 4183
Westminster 288  University of British Columbia Library
|        DUE DATE  f
^»iw W   ^"* *-*
DEC   9 19801H
■Mfel  ,1 b Ud> mfm
StP 1 8 IQftl 4 PI
FORM  310S
\ (sio^o v
§ Columbia T


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