The BULLETIN OF THE VANCOUVER MEDICAL ASSOCIATION I Vol. XIV. DECEMBER, 1S>37 In This Issue: EMPYEMA AND INTERLOBAR EMPYEMA THE SOURCES AND CLINICAL IMPORTANCE OF THE VITAMINS § NEWS AND NOTES BULKETTS (With Cascara and Bile Salts) . . FOR . . Chronic Habitual Constipation BULKETTS POSSESS ENORMOUS BULK PRODUCING PROPERTIES AND BEING PROCESSED WITH CASCARA AND BILE SALTS PRODUCE BULK WITH MOTILITY. WE WILL BE PLEASED TO PROVIDE ORIGINAL CONTAINERS FOR TRIAL ON REQUEST. Western Wholesale Drug (1928) Limited 456 BROADWAY WEST VANCOUVER - BRITISH COLUMBIA (Or at all Vancouver Drug Co. Stores) THE VANCOUVER MEDICAL ASSOCIATION BULLETIN Published Monthly under tl\p Auspices of the Vancouver Medical Association in the interests of the Medical Profession. Offices: 203 Medical-Dental Building, Georgia Street, Vancouver, B. C. Editorial Board: Dk. J. H. MacDermot Db. M. McC. Baibd Db. D. E. H. Cleveland All communications to be addressed to the Editor at the above address Vol. XIV. DECEMBER, 1931 No. 3 OFFICERS 1937-1938 Db. G. H. Clement Db. Lavell H. Leeson Db. W. T. Ewing President Vice-President Past President Db. W. T. Lockhabt Db. A. M. Agnew Hon. Treasurer Hon. Secretary Additional Members of Executive—Db. J. R. Neelson, Db. J. P. Bilodeau. TRUSTEES: Dr. F. Brodie Db. J. A. Gillespie Db. F. P. Pattebson Historian: De. W. D. Keith Auditors: Messbs. Shaw, Salteb & Plommeb. • ■.'■ — -8ft■ ^ - SECTIONS W--4§l|§' "i^i|: _:H Clinical Section Db. R. Palmeb Chairman De. W. W. Simpson Secretary Eye, Ear, Nose and Throat Db. S. G. Elliott Chairman De. W. M. Paton Secretary Pediatric Section Db. G. A. Lamont Chairman" Db. J. R. Davies Secretary Cancer Section Db. B. J. Habbison Chairman Db. Roy Huggabd Secretary STANDING COMMITTEES I Library Db. A. W. Bagnall Db. S. Paulin Dr. W. F. Emmons Dr. R. Huggard Dr. H. A. Rawlings Dr. R. Palmer Dinner Dr. G. F. Strong Db. R. Huggabd De. D. D. Fbeeze Publications Db. J. H. MacDebmot Dr. D. E. H. Cleveland Dr. Murray Baird Summer School De. J. R. Naden De. A. C. Feost De. A. B. Schinbein De. A.Y. McNaie De. T. H. Lennie ' De. F. A. Tuenbull Credentials Db. A. B. Schinbein Db. D. M. Meekison Db. F. J. Bulleb Metropolitan Health Board Advisory Committee Db. W. T. Ewing Db. H. A. Spohn Db. F. J. Bulleb Representative to B. C. Medical Association—Dr. Neil McDougall. Sickness and Benevolent Fund—The President—The Trustees V. O. N. Advisory Board Dr. I. Day Dr. G. A. Lamont Dr. Keith Burwell Staphylococcal Infections! LOCALIZED— | In treatment and prevention of localized staphylococcal infections such as styes, boils, carbuncles, pustular acne and recurrent staphylococcal abscesses, Staphylococcus Toxoid has proved to be distinctly effective. This product is a non-toxic antigen, prepared by treating highly potent staphylococcus toxins with formaldehyde, and cannot induce sensitization to any antitoxin or serum. EXTENSIVE OR GENERALIZED— § Clinical and laboratory evidence strongly suggests that many of the pathogenic effects of extensive or generalized staphylococcal infections may be attributed to liberation of staphylococcus toxin within the body. The use of antitoxin possessing in high degree the specific power to neutralize staphylococcus toxins is therefore advocated for treatment of those infections. As prepared by methods evolved in the Connaught Laboratories, Staphylococcus Antitoxin has given beneficial results following its being administered sufficiently early and in adequate dosage in treatment of acute, extensive or generalized infections, such as carbuncle, cellulitis, osteomyelitis, meningitis and septicaemia, where staphylococcus has been the infecting agent. Prices and information relating to Staphylococcus Toxoid and Staphylococcus Antitoxin ■will be supplied gladly upon request. CONNAUGHT LABORATORIES UNIVERSITY OF TORONTO Toronto 5 Canada Depot for British Columbia Macdonald's Prescriptions Limited MEDICAL-DENTAL BUILDING, VANCOUVER, B. C. VANCOUVER HEALTH DEPARTMENT STATISTICS—OCTOBER, 1937 Total population—estimated _ 253,363 Japanese population—estimated 8,522 Chinese population—estimated . ,— 7,765 Hindu population—estimated . 352 Number Total deaths . . „__ 214 Japanese deaths £Ljl$ 5 Chinese deaths —.. 8 Deaths—residents only 181 BIRTH REGISTRATIONS— *|. Male, 173; Female, 153 326 INFANTILE MORTALITY— Oct., 1937 Deaths under one year of age 10 Death rate—per 1,000 births . 30.7 Stillbirths (not included in above) 6 Rate per 1,000 Population 9.9 6.9 12.1 8.4 15.1 Oct., 1936 5 16.0 7 CASES OF COMMUNICABLE DISEASES REPORTED IN CITY November 1st Sept., 1937 Oct., 1937 to 15th, 1937 8 2 67 4 0 Scarlet Fever Diphtheria Chicken Pox : Measles Rubella Mumps 13 Whooping Cough 2 Typhoid Fever 0 Undulant Fever 1 Poliomyelitis 3 Tuberculosis 29 Erysipelas 2 0 0 0 0 0 0 0 0 0 0 16 0 21 0 146 4 5 18 6 2 0 0 33 0 0 0 0 0 0 0 0 0 0 0 14 0 19 0 51 3 2 27 8 5 0 0 12 1 0 0 0 0 0 0 0 0 0 0 0 VENEREAL DISEASE CASES REPORTED TO PROVINCIAL BOARD OF HEALTH, DIVISION OF V. D. CONTROL Hospitals Clinic Clinic in Province Syphilis 35 56 4 59 Gonorrhoea 4 82 2 32 HYPERTHYROIDISM—Use Bioglan-"C" HYPERTENSION—Use Bioglan-"H" ffThe most effective therapy available" Made in England by THE BIOGLAN LABORATORIES LTD. Hertford Rep.: S. N. BAYNE | 1432 Medical-Dental Bldg. Phone: Sey. 4239 Vancouver, B. C. References: "Ask the doctor who is using it." Page Jfl UP-TO-DATE TREATMENT for BOILS Up-to-date transportation facilities not only save time for the traveler, but, in addition, afford him greater comfort and safety. This is true also of the up-to- date treatment of boils with Stannoxyl. Days of suffering are fewer and there is greater comfort and safety too. Stannoxyl is the original preparation of chemically pure tin and tin oxide for the oral treatment of boils and styes. In 1917 this chemical combination was shown to be definitely antagonistic to staphylococcus. Results are gratifying. Use of the old-time lance is avoided. i^ourt(.sy Atchison, TopL ka and Santa Be Ry. Co. Pain is relieved, inflammation checked, and there is no draining wound to spread infection, no ugly scar. Soon after treatment is started healing begins and a healthy base is generally obtained in eight to ten days. The only way to find out what Stannoxyl can accomplish is to try it in your next case of boils. Also effective for treating styes, or in chronic osteomyelitis due to staphylococcus. Average dosage is 2 tablets 3 or 4 times daily. Supplied in vials of 80 tablets. Non-toxic. Samples On Request STANNOXYL Chemically pure tin and tin oxide Anglo-French Drug Co., 354 St. Catherine St. East, Montreal, Quebec. EDITOR'S PAGE With this number of the Bulletin go our sincerest wishes for a very merry Christmas and happy ending to the year now drawing to its close. It has been a very eventful year in many ways—in some ways a terrible year, full of threats and danger, full of agony and ghastly suffering, which, fortunately or perhaps unfortunately, we cannot in any true sense realise. Perhaps if we could, we might the sooner do our share towards ending this state of affairs. But even here there are occasional rifts in the gloom: gleams of returning sanity, signs of a return to some sort of goodwill and friendship between nations, and while we can perhaps do little but hope for the best, we may be able to contribute by our willingness to support any move towards a better understanding, and a greater measure of generosity and justice towards those who are not so fortunately placed nationally as ourselves; since only so can we expect to remove permanently the causes of conflict. For us as a profession it has been a year of real gains and steady growth ; we have achieved a greater measure of unity than ever before, and a better understanding of each other's problems. Here is clear profit in our ledger, and for this we may be very thankful. We must go further along this road, however. We must learn to think nationally as well as provincially, and the leaders of our profession are even now breaking new trail for us to follow. So as the season of goodwill to all men approaches, we can take courage and look forward to brighter and happier days to come for the whole world. . ,|, . OBIT It is with a real sense of personal loss that we record the death on October 31st of Dr. Edwin D. Carder, one of the best-known and most widely beloved of our medical men in Vancouver. His sudden death came as a definite shock to us all. Dr. Carder had practised medicine here for about thirty years, and had no enemies and countless friends. This would be an epitaph that all might envy—it would be no misstatement about "Eddie" Carder, by which name everyone knew him. Honest and painstaking in his work, friendly and cordial to all, always full of quiet but genuine humour, shot through from time to time with flashes of the keenest wit, he was an asset to any community, popular with all, welcome in any gathering, an indispensable part of any merrymaking or celebration. We need only refer to the part he took for so many years in our Medical Dinners, which he enlivened so greatly by his positive talent for mimicry and comedy. He had a gift for friendship with his fellow-men. We shall all miss him. The enormous crowd that attended to pay the last honours to him at his funeral is a hint of how widely felt is his loss; it was also a tribute to him as a man and a friend. We offer to his bereaved family our sincere condolences and sympathy. IMPORTANT NOTICE! DELINQUENT DUES Members of the Vancouver Medical Association are reminded that the names of those whose dues for the year 1936-37 are unpaid at the end of December will be posted in the Library. Page 48 NEWS AND NOTES Dr. R. B. White of Penticton, while in Vancouver, called at the College offices. ♦ aN ♦ H* Dr. G. A. Lawson has returned from vacation and visited Vancouver en route to his home in Port Alice. ♦ ♦ ♦ ♦ Dr. Frank S. Macdonald is in practice at McBride and has been appointed Medical Health Officer and School Health Inspector. * # ♦ * Dr. J. B. Swinden has moved from Whonnock to Ucluelet and is Medical Health Officer and School Health Inspector for that district on the West Coast of Vancouver Island. ♦ s|e %z a|c Dr. D. T. R. McColl of Queen Charlotte City has been appointed Medical Health Officer and School Health Inspector in addition to his practice and the post of Superintendent of the Skidegate Inlet Hospital. ♦ ♦ ♦ % Dr. G. A. Charter, who formerly practised at Queen Charlotte City, is convalescing satisfactorily following operative treatment late in September. & ♦ ♦ s|* Dr. A. N. Hason has recently joined Dr. H. G. Burden of the Resthaven Sanitarium at Sidney. * * * * Dr. H. T. Hogan has left for the North and will practise at Tulsequah and the Polaris Taku Mining Company. ♦ ♦ ♦ ♦ Dr. J. C. Poole and Mrs. Poole (formerly Dr. Lois Stephens) had a vacation in October. * * * * Dr. William Morris has left to do three months' postgraduate study. During his absence, Dr. C. E. Derkson will carry on the practice. *j_ Jj. 3|_ 5j» Dr. T. W. Sutherland of Wells has been in Vancouver and called at the office of the College. * ♦ ♦ ♦ Dr. Osborne Morris of Vernon visited the office while in Vancouver recently. * ♦ * * Dr. D. Wayne Davis of Kimberley was a recent visitor in Vancouver. * ♦ * ♦ Dr. P. A. C. Cousland of Victoria and Dr. S. A. Wallace of Kamloops attended the meeting of the Board of Directors of the British Columbia Medical Association on November 12th. * ♦ * # Dr. Norman D. Hall, who was associated with his father, Dr. G. A. B. Hall, in practice at Nanaimo, is now located at Phoenix, Arizona. It is announced that his work in the Clinic which he has joined will be limited to surgery. ♦ sft H* s|s Dr. F. W. Andrews of Summerland called at the office early in November. He was returning from an extended tour of Eastern centres, having attended the meeting of the American College of Surgeons. * * * * Dr. F. M. Auld of Nelson, the Second Vice-President of the British Columbia Medical Association, attended the meeting of the Board of Directors of the Association on Friday, November 12th. While in Vancouver he had a long conference with the Executive Secretary regarding certain contemplated revisions in contracts. Page 49 Dr. G. A. B. Hall of Nanaimo is now on vacation. * * * # Dr. Gordon C. Kenning, President of the British Columbia Medical Association, was in Vancouver on Wednesday and again on Friday attending meetings. Dr. Kenning and Dr. Auld attended the Annual Dinner of the Vancouver Medical Association. ■ft .ft 3ft _f( Dr. W. Allan Fraser of Victoria is doing special work in the East in his specialty of urology. Dr. Fraser has recently been appointed Director under the Department of Venereal Disease Control and will have charge of this work in Victoria. * * * * We are glad to offer our congratulations to Dr. and Mrs. H. H. Boucher on the birth of a daughter on November 22nd. We also offer our best wishes to Dr. and Mrs. George R. Barrett, of Pioneer Mines, B. C, on the birth of a son on November 21st. ♦ ♦ -I- * Dr. Arthur B. Nash of Victoria is in Eastern centres doing post-graduate study. Dr. Alan B. Hall, who has been practising in Montreal during the past four years, has returned to Nanaimo and will be associated in practice with his father, Dr. G. A. B. Hall. ♦ ♦ ♦ ♦ The following Doctors were elected members of the Vancouver Medical Association at the General Meeting held November 2nd: Dr. J. H. Blair, Dr. F. H. Bonnell; Dr. A. W. Bowles, Associate member; Dr. L. S. Chipperfield, Associate member; Dr. C. E. Davies; Dr. G. P. Dunne; Dr. G. W. Knipe; Dr. R. E. McKechnie II; Dr. S. C. Peterson; Dr. Eleanor Riggs; Dr. J. F. Sparling, Associate member. #f_ 3J. 3-jC 5J_ Dr. H. S. B. Galbraith, who has been doing post-graduate work in England, has returned to Vancouver. Dr. Galbraith will open offices in the Medical- Dental Building, and will limit his practice to Eye, Ear, Nose and Throat conditions. . . . s. Dr. D. E. H. Cleveland will be the speaker at the January meeting of the Vancouver Medical Association. H8 'H ♦ ♦ The February meeting of the Vancouver Medical Association will take the form of a dinner meeting, at which the speaker will be Dr. Charles E. Sears of Portland, Oregon. ♦ *fc % H* We are glad to hear that Dr. D. M. Meekison, who was in hospital for some weeks, was well enough to attend the meeting of the American College of Surgeons in Chicago, and is now attending to his practice. IMPORTANT NOTICE APPOINTMENTS AND CONTRACTS Members of the College of Physicians and Surgeons of British Columbia are requested not to apply for any appointment or enter into negotiation with reference to any contract without having first communicated with either or both: DR. A. J. MACLACHLAN, Registrar, College of Physicians and Surgeons of B. C; or/and DR. M. W. THOMAS, Executive Secretary, College of Physicians and Surgeons of B. C. Page 50 LIBRARY NOTES RECENT ADDITIONS TO THE LIBRARY ABSORPTION FROM THE INTESTINE: By F. Verzar and E. S. McDougall. 1937. Concerning this book, the following excerpt is taken from an editorial in the American Journal of Digestive Diseases and Nutrition for July, 1937: "Until last year anyone who turned to the literature for information as to the laws underlying the absorptive processes of the small bowel would have found very little, and that little scattered through highly technical journals. Today at last we can turn to one well-written monograph, a monument to he industry and ability of Fritz Verzar, of Basle. . . . This book should be in the library of every man who practices gastro-enterology, and it should be read and re-read. For years Verzar and his pupils have been studying the intestinal mucosa and the ways in which it absorbs and digests, and here we have a good resume" of their findings, together with a fine review of the literature."—Walter C. Alvarez. In the November number of the American Journal of Digestive Diseases and Uutrition there is an article by Prof. Dr. F. Verzar, giving an account of the recent work done in his laboratory, on "The Adrenal Cortex and Intestinal Absorption." ■ _JC JjC «(C ATLAS OF HAEMATOLOGY: By E. E. Osgood and C. Ashworth. Those men who met Dr. Osgood at the Annual Meeting of the British Columbia Medical Association in September will be interested to learn that his book on Hematology has been purchased. But in any event the book is a valuable addition to the library. There are over three hundred illustrations in colour. A description of the method of history taking and physical examination of patients with disorders of the haematopoietic system is given in the first chapter. A system of tables is included, by which definite identification can be made of any cell. * * * The Library has received a file of the American Journal of Psychiatry for the years 1936-37 from Dr. G. A. Davidson. Dr. Davidson has promised to present the current numbers to the Library as they arrive. Dr. Wallace Wilson has presented to the Library a file of the Bulletin of the Institute of the History of Medicine, from the Johns Hopkins Hospital, for the years 1935 and 1936. NOTICE RE SUPPLIES OF GLASSWARE AND OUTFITS FOR PROVINCIAL LABORATORIES The large annual losses of glassware incurred by the Provincial Board of Health Laboratories under the methods of distribution of specimen outfits hitherto obtaining, are no longer to be accepted as inevitable. A depot for Kahn test and throat culture outfits will be maintained in the Pathology Department of the Vancouver General Hospital for the convenience of practicing physicians, as in the past; but it is requested that supplies obtained from this source be legibly signed for on the printed requisition forms provided. All other supplies may be obtained from the Provincial Laboratories at 763 Hornby Street. Supplies will be sent by post upon receipt of a written requisition, specifying the number and kind of outfits required, or they may be obtained by the doctor or his accredited representative calling in person at the Laboratories. C. E. DOLMAN, Director, Division of Laboratories, Provincial Board of Health. Page 51 VANCOUVER MEDICAL ASSOCIATION ANNUAL DINNER * The Annual Dinner of the Vancouver Medical Association, which was held in the Oak Room of the Hotel Vancouver on November 12th, was notable in a number of ways. The attendance was very nearly a record, 166 sitting down. The dinner marked a break with some old traditions, and some new departures were introduced. The entertainment offered to eye and ear seems to have been a success. There was some dubiety in this regard beforehand. For many years past the burden of furnishing this entertainment has been shouldered manfully and carried off with acclaim by a small group of the members. It is not criticism of their work to observe that in the course of years the programme has tended to become stereotyped. The Old Guard's evolutions, while admirably performed, contained little of the element of surprise. Thus there was expressed by some a reluctance to attend if the old lines were to be followed, and by others a failure—technically a "flop"—was predicted if any change was made. We believe that the new features introduced, which evidently met with favor, have not been developed to the extent of their possibilities. The "Movietone News" represented much hard work and expenditure of time, and the film, the property of the Association, should be regarded as a historical document, the nucleus of a library. The "March of Time" also is a feature containing many opportunities for development: The "Community Singing" proved almost as potent an agency as cocktails for letting down inhibitions and enabling everyone to let themselves go. But we cannot dispense with all of our traditional observances. Two at least must always hold their place. The standing in silence is a tribute, not alone to those who have died in the past year, whose names are read, but to all those gone before who still hold their place in our memories and affections. The President's recitation of lines from Macbeth : That struts and frets his hour upon the stage Life's but a walking shadow, a poor player And then is heard no more; followed by an additional line which we suspect was original, He falls asleep; his memory walks among us. added to its impressiveness. The bestowal of the P. G. F. degree upon Dr. Wallace Wilson indicated a very popular choice. Dr. Wilson had well earned this supreme recognition from the hands of his colleagues and we offer him our warmest congratulations. In concluding on a note of appreciation of the way in which the Dinner Committee accomplished its task, a comment on the menu will not be out of place. This also was a welcome departure from the older and less palatable standard. VANCOUVER MEDICAL ASSOCIATION The General Meeting of the Association for December will be held on Tuesday, December 7th, in the Auditorium of the Medical-Dental Building. A symposium on Mental Conditions has been arranged as follows: The Pre-School and School Child—Dr. Stewart Murray. Psychoneurosis—Dr. A. L. Crease. General discussion of types of psychoses—Dr. G. A. Davidson. Treatment of Mental Disorders—Dr. E. J. Ryan. Page 52 COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA From the Office of the Executive Secretary At the Annual Meeting of the West Kootenay Medical Association, held at Nelson on September 30th, members gathered from all that large district extending from Grand Forks and Greenwood, through by Trail and Rossland, over by way of Nelson to Creston on the east and to Nakusp on the north. Dr. F. M. Auld of Nelson, the President, welcomed all, and with the help of their very energetic Secretary, Dr. Wilfrid Laishley of Nelson, a very fine meeting was arranged. The Programme and dinner were excellent. A report of this meeting appears in this issue. From the viewpoint of a visitor one found an active association happily assembled bound by common interest, imbued with a spirit of friendliness born of confidence and showing a compactness built on neighbourliness which makes unit of thought and action automatic. The sessions possessed a quality not unusual in the Interior and your Executive Secretary shared in this wholesome friendliness and cama- . raderie. It rained that night as we motored to West Robson with Doctors Thorn, Gay ton and Endicott, who were returning to Trail. The Executive Secretary safely embarked on the S.S. Minto, which appeared to be moored half-way up the Arrow Lakes. We walked along what seemed to be a mile of landing. The rain must have improved the low-water level. The evening of October 1st found Dr. H. F. Tyerman at his home in Nakusp, having just returned from one of those round-up drives of a country practice. If you have never visited New Denver, Kaslo or Nakusp you have not sampled the true hospitality of our lake and mountain inland. Dr. Tyerman efficiently serves a wide area and deservedly enjoys the grateful confidence of this scattered community. The Executive Secretary was very grateful when Dr. Tyerman delivered him safely at shipside. Revelstoke, via Arrowhead, was reached on Saturday afternoon. On Sunday, with Johnny Jones, son of Dr. A. L. Jones, as guide and companion, we were driven by Dr. G. A. Watson to 62-Mile Camp on the Big Bend Highway, the completion of which will link Revelstoke with Golden and provide a motor road, wide and well built, along the scenic course of the Columbia. Fresh air, good food in abundance and a bull-cook to build a fire in the tent- house, made us ready to follow Jones (Junior) over the trail to the Falls, many miles away. Dr. Hamilton arranged this trip, and when on Monday at noon the whole party arrived at 58-Mile Camp for luncheon, we gratefully acknowledged the hospitality of the road builders and the excellent arrangements provided by Doctors Hamilton and Jones. The Annual Meeting of No. 4 District Medical Association was held on October 4th, and Dr. A. L. Jones, President, and Dr. J. H. Hamilton, Secretary-Treasurer, set another record—a standard which Dr. J. S. Henderson and Dr. R. E. Willets will achieve next year at Kelowna. Dr. Watson is happily located at Revelstoke and his new home was "house- warmed" by a Saturday evening party. More will be heard of this new home after the New Year, I learn. Items of news and notes for publication in the Bulletin are missed occasionally. It is requested that all such news be forwarded to the office. One important item recently was missed entirely. The office was not warned or informed of the wedding in September of Dr. F. L. Wilson of Trail. He and his bride have our best wishes nonetheless. The meeting at Revelstoke was coloured by the visit of Doctors P. A. McLennan and Lee Smith of Vancouver, who appeared to enter happily into the full convention spirit of this district and both contributed largely to the success of its Annual Meeting. Back to Vancouver by rail on October 5th and then by motor to the Cari- Page 53 boo on the 6th, which means that Thanksgiving day was spent on the road. We found some turkey at Clinton. We visited Dr. and Mrs. Ellis on the evening of the 6th and you are warned to brush up on your bridge and be ready for a tough game, especially should you encounter Dr. A. S. Lamb and Dr. A. L. McQuarrie, as was my good fortune. The next night found us at Quesnel, where we fortuitously found Dr. Gerald Baker on the eve of his departure for a four-day trip into the wilds to inspect Indian Reserves ninety miles distant. It being the 7th of October it seemed propitious that he take along a gun. We enjoyed a visit with Dr. G. D. Oliver, who is associated with Dr. Baker at Quesnel, and again we shared these doctors' company with Dr. G. F. Kincade and Dr. F. O. R. Garner of the Tuberculosis Division, who were conducting a travelling clinic, the latter doing special silicosis examinations at the mines. The next morning (October 8th), early, found us in Prince George, and just here a digression to glimpse at the glorious autumnal colorings. The view as we dropped down the winding road showed yellows, golds, rusts and scarlets. These gorgeous effects of early frosts seemed to make us more gladly buy some anti-freeze. At Prince George we found Dr. Carl Ewert and Dr. John G. MacArthur busily providing for all medical needs in the absence of Dr. E. J. Lyon, who was returning that day from his vacation at the Coast. Conditions in practice in the Northern Interior are affected favourably by general improvement. Contracts in this area are under revision and we can report better terms leading to a progressively improved service under the various schemes. Returning by way of Quesnel, we went to Wells and Barkerville on October 9th and there saw Dr. T. W. Sutherland and Dr. George Langley. Dr. Langley went to Wells in July and has been very busy meeting the demands of practice in that mining area. His many friends will be glad to learn that he looks well on that bracing mountain air. He went out to Quesnel to meet Dr. and Mrs. J. C. Poole, who were passing through for a Thanksgiving week-end away from their practice at Fraser Lake. On Sunday, October 10th, we passed through Williams Lake and visited Dr. C. E. McRae, who has a large surrounding countryside under his care. Mileage is a very real problem in providing for the medical needs of such a widely-scattered population. Dr. McKenzie, who also practices at Williams Lake, has shown improvement following a recent illness. These two doctors working from this point have as nearest neighbours Drs. Baker and Oliver at Quesnel in the North, Dr. W. A. Drummond at Ashcrof t to the South, and westerly neighbours at Bella Coola. We visited Dr. Drummond at Ashcroft on October 11th (Thanksgiving Day) and found him, along with our other medical friends en route, enjoying the confidence and gratitude of an increasingly profitable clientele—all areas reporting improvement in general conditions. At this point another digression to tell of the 10-months-old daughter in the Drummond home. Patsy proved to be more interested in the visitors than in her crib even at a late hour. This reminds us that we did not tell you about the lively young person—the five-months-old son of Dr. and Mrs. MacArthur at Prince George. Both babies are vital young persons, reflecting a large measure of good health in their happy faces and well-nourished bodies. On October 12th we stopped to see Dr. Ellis at Lytton and learn something of the many-sided features of practice in that centre, where there is a splendid new hospital and a large Indian School. Arriving home on the evening of October 12th, it seemed that the time for a vacation had arrived, and so on October 13th we left for the Island by the Nanaimo ferry, and that night, having met "the Professor," an ardent angler and friend at Duncan, we were comfortably lulled to sleep by the rushing waters of the Cowichan River and safely away from the telephone. As we extinguished the kerosene lamp we hoped for another day which would bring the joy of a well-filled creel. Page 54 BRITISH COLUMBIA MEDICAL ASSOCIATION The Board of Directors' second meeting this year, held on November 12th and continuing in session during the afternoon, was attended by Dr. G. C. Kenning, Victoria, President; Doctors D. E. H. Cleveland; F. M. Auld, Nelson ; H. Carson Graham, North Vancouver; G. F. Strong, H. H. Milburn; S. A. Wallace, Kamloops; A. Y. McNair; P. A. C. Cousland, Victoria; N. E. McDougall; F. R. G. Langston, New Westminster; W. S. Turnbull, A. H. Spohn, Colin Graham, C. H. Vrooman, Wallace Wilson and M. W. Thomas. Dr. G. F. Strong, representative from British Columbia on the Executive Committee of the Canadian Medical Association, reported fully on many questions dealt with at the recent meeting in Ottawa. Extracts from this report appear elsewhere in this issue. The list of the personnel of the Board of Directors is published and all committees are launched on an active year's work. . BRITISH COLUMBIA MEDICAL ASSOCIATION Board of Directors, 1937-1938 Dr. Gordon C. Kenning, President. Dr. D. E. H. Cleveland, Vice-President. Dr. F. M. Auld, Second Vice-President. Dr. J. R. Naden, Honorary Secretary-Treasurer. Dr. G. F. Strong, Immediate Past President. Dr. M. W. Thomas, ex-officio. Dr. Wallace Wilson; Dr. S. A. Wallace, Kamloops; Dr. P. A. C. Cousland, Victoria; Dr. G. T. Wilson, New Westminster; Dr. H. H. Milburn—Directors at large. Dr. W. E. Ainley, Dr. L. H. Appleby—Representatives of College of Physicians and Surgeons of B. C. Dr. N. E. MacDougall, Vancouver—Representative Vancouver Medical Association. Dr. W. Allan Fraser, Victoria—Representative Victoria Medical Society. Dr. F. R. G. Langston, New Westminster—Representative Fraser Valley Medical Association. Dr. G. A. B. Hall, Nanaimo—Representative Upper Island Medical Association. Dr. C. H. Hankinson, Prince Rupert—Representative Prince Rupert Medical Association. Dr. M. R. Basted, Trail—Representative West Kootenay Medical Association. Dr. J. S. Henderson, Kelowna—Representative District No. 4 Medical Association. Dr. H. Carson Graham, North Vancouver—Representative North Vancouver Medical Association. Dr. H. H. Milburn—Committee on Constitution and By-Laws. Dr. G. F. Strong—Committee on Programme and Finance. Dr. A. Y. McNair—Committee on Study of Cancer. Dr. A. H. Spohn—Committee on Public Health. Dr. D. M. Meekison—Committee on Medical Education. Dr. Wallace Wilson—Committee on Study of Economics. Dr. W. S. Turnbull—Committee on Maternal Welfare. Dr. W. J. Knox, Kelowna—Committee on Credentials and Ethics. Dr. E. Murray Blair—Committee on Pharmacy. Dr. Colin W. Graham—Committee on Osier Memorial. Dr. P. A. C. Cousland, Victoria—Committee on Medical History. Dr. D. E. H. Cleveland—Committee on Editorials. Dr. C. H. Vrooman—Committee on Nominations. Page 55 UPPER VANCOUVER ISLAND MEDICAL ASSOCIATION | The Annual Meeting of the Upper Vancouver Island Medical Society was held at the Sunset Inn, Qualicum Beach, on Thursday evening, November 18th. The meeting was in the form of a banquet, and excellent addresses were given afterward by Dr. D. Murray Meekison and Dr. G. F. Strong of Vancouver. Dr. Meekison spoke on "Low Back Pain." Dr. Strong gave an account of the latest treatment of the various forms of heart disease. Following each address a lively discussion took place—Doctors Higgs, Hilton and Kelly adding a few of their personal experiences in dealing with such cases. Doctors Strong and Meekison answered numerous questions. The following doctors were present besides the speakers: Doctors Campbell Davidson, Qualicum; W. F. Drysdale, E. D. Emery, S. L. Williams, Alan B. Hall, A. H. Meneely, C. C. Browne, Nanaimo; J. McKee, T. A. Briggs, Courtenay; J. C. Thomas, C. T. Hilton, W. D. Higgs, Port Alberni; E. R. Hicks, Cumberland; B. J. Hallowes, Casa del Mar; and M. W. Thomas, the Executive Secretary of the College of Physicians and Surgeons of B. C. Dr. J. K. Kelly was visiting. Dr. Thomas gave a short but stimulating talk on Medical Practice. The following officers were elected for the ensuing year: President, Dr. A. H. Meneely; Vice-President, Dr. Campbell Davidson; Secretary-Treasurer, Dr. E. D. Emery; Reporter, Dr. C. C. Browne; Representative on the Board of Directors, Dr. C. T. Hilton; Member of the Committee on Cancer, Dr. S. L. Williams. ANNUAL MEETING OF WEST KOOTENAY H MEDICAL ASSOCIATION The Annual Meeting of the West Kootenay Medical Association was held in Nelson, B. C, on September 30th, 1937. The following were present: Doctors W. J. Endicott, J. Bain Thorn, M. R. Basted, D. J. M. Crawford, F. L. Wilson, Wm. Leonard, J. L. Gayton and L. N. Beckwith of Trail; Dr. H. R. Christie of Rossland; Dr. D. J. Barclay of Kaslo; Dr. J. V. Murray of Creston; Dr. A. Francis of New Denver; Dr. N. E. Morrison of Salmo; Doctors F. P. Sparks, H. H. McKenzie, F. M. Auld, B. L. Dunham, R. B. Shaw, D. W. McKay and Wilfred Laishley of Nelson; Dr. M. W. Thomas, Executive Secretary of the College of Physicians and Surgeons. The afternoon was spent in viewing motion pictures presented through the co-operation of Smith and Nephew, and also a presentation of clinical cases. In the evening a banquet was held in the Kootenay Lake General Hospital, followed by the business meeting. Dr. Thomas gave a very interesting talk on the problems of our profession. The officers for the ensuing year are as follows: Hon. President, Dr. C. M. Kingston, Grand Forks; President, Dr. M. R. Basted, Trail; Vice-President, Dr. Arnold Francis, New Denver; Secretary-Treasurer, Dr. Wilfrid Laishley, Nelson; Reporter, Dr. J. Stuart Daly, Trail. Page 56 MEDICAL RELIEF REGULATIONS Internists.—Internists' accounts for special examinations, such as x-ray or metabolic test, will not be allowed, except in emergency cases, unless consent of Committee is first obtained. X-ray of Teeth.—X-ray of teeth not allowed, as this may be secured at the Vancouver General Hospital. Venereal Diseases.—In cases where it is impossible or difficult for the patient to attend the Government Clinic, salvarsan may be obtained gratis from the Government Clinic, but payment for medical attention will not be allowed unless permission of the Relief Committee is previously obtained. Toxoids.—Administration of toxoids to children under one year of age will be allowed at the rate of $1.00 per visit. Staphylococcus will be allowed at the rate of $1.00 per visit, the doctor to provide the staphylococcus toxoid himself. Serums for Colds.—Payment for injection of serums for colds will not be allowed. Varicose Veins and Ulcers.—Injections for varicose veins will be allowed the maximum charge: for one leg $15.00, for both legs $25.00. This includes treatment of varicose ulcers. Smallpox Vaccination.—Smallpox vaccination to be allowed at the rate of one office visit. Glandular Extract.—Charges for the use of glandular extract not allowed (including amniotic injections) except on the ruling of the Relief Committee. Actinic Rays.—Actinic rays, light treatment, etc., allowed at the rate of $1.00 per treatment where considered necessary by the Relief Committee. Abortions.—For abortions $10.00 will be allowed for the first visit, and subsequent visits at the regular rate, the total not to exceed $25.00. Pregnancy.—No charge will be allowed for treatment after the case has been reported as a maternity cases, maternity cases being looked after by a separate fund. Specialists.—A specialist cannot be paid for work outside his own specialty. Circumcision.—The fee for circumcision, when necessary, will be allowed at the rate of $15.00. Cauterization.—The fee of $5.00 per treatment will be allowed for electric cauterization of the cervix. Examination for Pension.—The fee for physical examination for pensions is not payable from relief funds. Post-operative Treatment.—Each case of post-operative treatment must be judged on its merits, cases in doubt to be referred to the Committee. Minor Operations.—Minor operations will be paid for with relief funds; all others should be referred to the hospital. Peptic Ulcer.—Four visits per month for two months will be allowed for the treatment of peptic ulcer and two office calls per month thereafter, except in the case of emergency complications. Submucous Resections.—No fee will be paid for submucous resections, as this could be done in the Vancouver General Hospital. Needling Cataract.—No payment will be made for needling of cataract. Accounts will not be allowed unless relief number is given, and dates of visit, also diagnosis and treatment. Page 51 EMPYEMA AND INTERLOBAR EMPYEMA Dr. Harold Brunn (Presented at Vancouver Medical Association Summer School, June, 1937) I might say that there are two parts to this talk. One is general empyema of the pleural cavity, which you know all about. In searching for interlobar empyema I was astounded to find that nobody has written on this subject. This should be talked about more. I got one fellow to search this subject and he was very successful. On a wax model of the lungs he produced an interlobar empyema similar to what one would find in humans. So I am going to take up first the question of this subject. First, I want to say that in a study of the lobes and of the fissures we find one interesting thing—the lower lobe on both the right and the left sides should be divided into two parts: the lower part of the lower lobe and the upper part of the lower lobe, and the upper part of the lower lobe we call the superior part or apex of the lower lobe. The lower lobe has three or four bronchi coming down from the lower bronchus. This bronchus branches off and goes posteriorly. Pneumonia occurs very frequently in the apex of the lower lobe. If the fissures are not sometimes made more definitely—and when you have four lobes on the right side or three lobes on the left side, the superior lobe makes a fissure and sometimes there is a dimple there and an adhesion there. (Slides were then shown.) When a picture is taken in the A.P. view, with some disease in that lobe it looks like this: a dense area of shadow in front. If you wanted to puncture this you would be making a great mistake. If you take the patient in deep inspiration it appears differently in the chest. You can get atelectasis here. This is an embryo of the fifth week, viewed from behind. Very often a fissure forms with this bud. Here is a case of a woman of 53 years. She had a hernia operation for a ventral hernia. The third day after she developed lung signs. We found dullness—a central pneumonia— and we had this picture taken. When you take the lateral plate it always appears as a triangular shadow. Depending on the inspiration or expiration, this is below or above the diaphragm. Now this woman died and was posted, and she had an abscess near that area which was overlooked. Here is another case about midway between inspiration and expiration. You see the same shadow but it looks a little different although it is the same thing. Here is a little child that had an area in here and it looked like fluid— all of this disease of the superior part of the lower lobe. It is an anatomical lobe very often invaded by inflammatory disease, a central pneumonia, abscess formation. If you want to drain these patients, you put the patient on his face. We have never seen a carcinoma of the lung in the upper part of that lobe. I don't know, why—I would like to ask Dr. Boyd. Here is a woman that was sent to me and she had pneumonia. She was not improving 25 days after and her doctor took a picture and you see this shadow. Here we find it again. Her doctor wanted me to tap this, but I said, "No; that's the superior part of the lower lobe and I won't tap it"; and I didn't tap it. She cleared up. It was just a slow process but no fluid. We have many, many plates of the interlobar fluid in the different fissures. If you put fluid between the lower and the upper lobes and take a picture, you get a view in the A.P. position like that—somewhat convex on the top. When you take the A.P. view they are very diffuse, but in the lateral view they are more defined. When you go to puncture that, where do you do it? You go behind, you tap posteriorly near the spine between the fourth and fifth vertebrae. If you approach that from the axilla you have to go through lung about 4 inches to get your fluid. These things are very important, both in Page 58 getting your fluid and in the operation. Here is fluid between the lower and middle lobe. If more pictures were taken medically of pneumonia and patients suffering from heart disease, you would find fluid. Medical men don't like to take pictures. In the A.P. view you have this peculiar triangular shadow. When you take your picture laterally this fluid is found between the middle and the lower lobe. Here is another picture showing that diffuse shadow, very much more dense. It is very important for you to take a lateral picture. You see the fluid between the middle and lower lobe. The upper lobe will be alright. Of course, you have to make modifications. Here we have the whole fissure between the lower lobe and the middle of the upper. It makes a kidney-shaped shadow. This next slide was a case of a little child 4^ years old. His brother had pneumonia and had gone home, and this child began to cough about a week later. They found he had a temperature every afternoon and he was sent to the Children's Hospital. They took a picture and were astounded to find this dark shadow in the A.P. view and they said "interlobar fluid." I know it is not interlobar fluid. So we had a great discussion as to what it was and I said that I would put a needle in it. As I drew my needle out, it dropped some pus—perhaps a broken-down dermoid. It might have been one of those hard neurofibromata, but we didn't know. So we didn't get anywhere. So we put some air in the chest and we dropped this tumour down from high up, down almost to the diaphragm. I sent the patient home, built him up and brought him back. About four months ago we took out this tumour. Chest surgery in children is much easier than in adults. It was called a lymphogranuloma, but I am not so sure. I am going to send it back east for examination. It is a soft tumour, red and yellow-streaked. However, this child is now well. This next boy was brought down from the country. He had this shadow here on this side, and when we took a lateral it was over the heart shadow in the middle lobe. Whether it was an abscess or whether it was fluid, or whether it was both, we didn't know. He had been sick for 1% years with cough, expectoration, temperature, rapid pulse, etc. We went in anteriorly and found a lung abscess and also an interlobar empyema between the middle and lower lobes. There was no fluid in the pleural cavity. This picture shows how dense that shadow was. He developed multiple cavities. After the operation he went right along, but after that his temperature went up and he got an empyema of his cavity and had to be drained. He improved and was discharged, with this thing all healed up. He came back and was very sick again, had a temperature, etc., and when we did a lipiodol we found he had bronchiectatic cavitations. We operated and I took a cautery and burned the thing out and he is now perfectly well. This next is an interesting case. This boy had serious trouble with his kidney; he had a double kidney. He was operated on and half of the kidney was taken away. Immediately after his temperature went up. He got pneumonia and was very ill. Following the pneumonia there appeared a shadow in the left axilla. I tried to tap this and I did and got a lot of pus out. We put a tube in and drained the general pleural cavity. He improved for a while and then his temperature went up again. We took a needle and two or three times we tapped this. He had multiple empyema cavities. Here was another interesting case. This woman was very sick following pneumonia. She came in and said she had had a tumour in 1929 which was right over the heart. She came in to us and we made a puncture and found a little pus. We also found we had to drain the general cavity. The woman died and we had a postmortem on her. She had an old empyema which had been there since 1929, and through that infection which was there she had these other infections at this late date. This next is a boy who had a tube in for three years. A tube is only good for a short time, so don't leave tubes in the chest for any length of time. The tube continues to make discharge. Page 59 If you have a picture and you don't know whether it is pus or something else, look for thickening of the ribs, which means that probably there is chronic pus. Here is another picture of a child who was tapped by a fellow who then put a tube in and pushed it in. In this picture we see that the tube is curled up^q. the cavity. Here is a tube that went under the diaphragm instead of above it. This happens fairly often and has been known to cause a liver abscess. We have found that we have not diagnosed fluid in the pleural cavity because the heart and the mediastinum were not pushed to the other side. However, they are usually found displaced to the affected side. One thing about children—don't be afraid about them, for they are wonderful subject!, for chest surgery. This man had a perinephritic abscess, and when they put a tube in they put it into the pleural cavity and produced an empyema. In this next case, a tube was put in for empyema and it was put right into the pericardium. However, he went in again and put the tube right into the abdomen this time, and in this picture we see the tube gradually coming out from the appendiceal fossa. And this little child got well! Professor Bourgeois is a fine man. Most of these empyemas are postpneumonic. He had a wonderful paper on this subject, and they have cut down their mortality tremendously. His charts are astounding. With these cases you must be more definite in your diagnosis. You can't be too careful. If you have an empyema resulting from an abscess that breaks from the periphery or into the pleura, you have one thing; if you have an abscess, that is another thing. Then we have the empyemas that are interlobar, those that fill an entire cavity. And then you have the empyemas which have air above. And just to say that this method or that method of treatment is good with empyema, that's no good. The treatment of empyema is simple. People don's die from empyema; they die from the concurring infections; they die from the complications; and when the mortality of the pneumonia is high then the mortality of the empyema is high. In treatment you don't need a lot of apparatus. What you need is brains, and good brains at that. Let me talk about treatment for a moment. Bremerton made out some statistics as to treatment. Many of our cases are bad cases with mixed infections, etc. Now aspiration with the needle every day or every other day, taking out as much as you can, will cure a great number of pneumococcic empyemas in children, but when they get older the very thought of a needle frightens them. You should make four or five aspirations to see if they get well. Then you have to put a tube in the chest to close drainage. And don't leave tube drainage in too long. Don't leave it in for more than three weeks. We like to get it out in 10 or 12 days, because if they are going to get well they will do it almost overnight. Sometimes you can't draw all the fluid with *the tube. We don't persist in that, but we take out a rib; make a little opening first but take off enough ribs. We put in no stitches, because you know how rapidly a child will collapse. We go in there with a light and see that no loculi are left. We then pack the cavity with iodoform gauze usually, or argyrol gauze. We pack it in very tight, and the child is perfectly well the next day. You leave that in three to five days, and then they have no discharge any more and you have the cleanest pleura. They close up very rapidly. The fault we had was that we kept on packing them. Page 60 f NORTH PACIFIC SURGICAL ASSOCIATION The Annual Meeting of the North Pacific Surgical Association met in Vancouver November 18-20, at the Hotel Vancouver. The meetings were well attended, and concluded with a dinner on Saturday evening at which Dr. Gallie, Professor of Surgery at the University of Toronto, was the speaker. Dr. Gallie was also the speaker at the meeting on Friday evening, which was open to all the medical men in the city and which was well attended. Officers for the coming year are: President, Dr. A. A. Matthews, Spokane; First Vice- President, Dr. G. Kenning, Victoria; Second Vice-President, Dr. R. Forbes, Seattle; Secretary, Dr. Martzloff, Portland; Treasurer, Dr. Otis Lamson, Seattle; Councillor, Dr. F. Brodie, Vancouver. CANADIAN MEDICAL ASSOCIATION Extracts from Report of Proceedings of the Executive Committee of the Canadian Medical Association Dr. G. F. Strong, the representative from British Columbia on the Executive Committee of the Canadian Medical Association, presented to the Board of Directors of the British Columbia Medical Association a report covering the many actviities of the national organization from matters discussed at the recent Executive Committee meeting in Ottawa, which he attended. In the matter of the Rowell Royal Commission, a memorandum is being presented by the Canadian Medical Association which will be prepared after consultation with the various Provincial medical associations. This will probably cover such subjects as Public Health Services, medical care of indigents and fixing responsibility for financial contributions thereto. The Department of Cancer Control of the Canadian Medical Association is being developed with a strong Central Committee, with representatives from each Province and Provincial committees to provide for local organization. A book is being published and will be the product of the Canadian profession, being written and reviewed by the various Faculties of Medicine in the Canadian Universities. This Canadian Book on Cancer will be sent to all members of the profession in Canada. The Canadian Medical Association is aiding in the organization of the Canadian Society for the Control of Cancer, a lay-medical organization which will be of great benefit to the Dominion. Federation, which when accomplished will unify the Canadian profession in one organization, is in process of development, and in British Columbia will progress under the guidance of Dr. H. H. Milburn, Chairman of the Committee on Constitution and By-laws of the British Columbia Medical Association. It is hoped that before long it will be possible for all who so desire to be members of the Canadian Medical Association at the reduced fee of eight dollars per annum. We have ample proof in B. C. of the value of medical organization. The matter of pasteurization of milk is being studied by both the National and Provincial Committees on Public Health, and some action providing for safer handling, distribution and consumption of milk pressed for. Already plans for the 1938 meeting of the Canadian Medical Association, to be held at Halifax, are well under way and the programme is in process of preparation. Page 61 A SYNOPTIC OUTLINE OF THE AIMS AND ACTIVITIES OF THE DIVISION OF I I VENEREAL CONTROL § Prepared and Presented by the Director. The policy of the Division of Venereal Disease Control may be defined under three headings: 1. What we should like to do. 2. What we have done. 3. What we are doing. The objectives of an ideal programme would be: 1. To find venereal disease. 2. To treat venereal disease. 3. To teach venereal disease. Let it be definitely understood that these ideals are not at present capable of fulfilment by reason of the limited resources of the Division of Laboratories, restricted hospital accommodation and the general inadequacy of available funds. To find venereal disease: 1. Routine blood tests: (a) at the first consultation with the doctor; (b) on every admission to hospital; (c) at every life insurance examination. 2. Contact tracing—examinations of: (a) Husbands, wives, parents and children of known cases; (b) all other exposures. 3. Routine spinal fluid examinations: (a) At the end of 12 or 18 months treatment in every case of early syphilis; (b) before any treatment in every case of syphilis of over two years' duration; (c) in any patient, even without known syphilitic infection, who is suffering from headaches, dizziness, vague symptoms, spasmodic attacks of pain, character changes, etc. To treat venereal disease: 1. Adequate facilities for treatment convenient and available to every patient. 2. Universal adoption of recognized modern standards of treatment in all classifications of syphilis and gonorrhoea. 3. Adequate hospital accommodation for infectious cases, incapacitating complications, specialized therapy. To teach venereal disease: 1. To graduate and undergraduate physicians. 2. To the general public. 3. To educators, including teachers, preachers, group leaders, etc. These are the ideals toward which we strive. Hence they represent our policy. Specifically our policy is: 1. Treatment in clinics: (a) To treat every case that presents itself to us regardless of his or her social or economic standing, but to discourage further attendance of all those who can afford treatment by a private physician. 2. Diagnostic services: (a) To offer to the general practitioner the services of our staff of experts for any special examination of patients unable to pay private specialist's fees. Page 62 2. 3. Drugs: (a) To supply anti-luetic drugs free to all doctors where there are not clinics for all their patients, pay, part-pay and non- pay, if in return the doctor will agree to administer the drug to patients who cannot pay and also in special instances in places where clinic service is available. 4. Social Service (a) The personnel of this section will be glad to assist any physician in respect to contact tracing, follow-up or case holding. 5. The Division of Venereal Disease Control is definitely determined to avoid disturbing in any way the relationship between the physician and his private patient. What we are doing: 1. The number of active cases under treatment at the Vancouver Clinic comprises 922 cases of syphilis and 291 cases of gonorrhoea, making a total of 1213 cases. New admissions in August, 1937, were as follows: Syphilis, 66, and gonorrhoea, 72. Anti-luetic injections given in August, 1937: Arsphenamines, 712; bismuth, 1449; tryparsamide, 508. It is estimated that 12,225 ampoules of arsphenamines and 22,500 cc. of bismuth will be distributed gratis to physicians in 1937. Patients receiving malarial therapy in August, 1937: Adults, 20; children, 2. The clinic in Victoria is in the process of reorganization, and other clinics are proposed in the near future for Trail, Nanaimo and other focal points. 7. The central office at 2700 Laurel Street is the headquarters for provincial records, statistics and drug distribution. A special consultative service is available to any doctor wishing to secure advice on particular problems which arise from time to time. An average of 100 consultations monthly is given by correspondence. Advice by telephone and personal interview is also willingly given to any physician. The Division has been in existence scarcely a year. We are proud of the progress to date. We appreciate the co-operation which we have enjoyed from the medical profession. With their continued support we hope to be able to accomplish the aims and objectives which we have here briefly outlined. o. 6. THE CARE OF THE NEUROTIC PATIENT IN THE GENERAL HOSPITAL Maurice H. Rees, M.D. Dean and Superintendent, University of Colorado School of Medicine and Hospitals and E. G. Billings, M.D. Director Psychiatric Liaison Department, Colorado General Hospital, Denver, Colorado. (Hospitals, Aug. 1937) During the last decade through the progress made in that prominent and promising "advancing edge" of medicine, namely, psychiatry, the non-psychiatric physician and hospital administrator have been brought face to face with the sane, sensible and scientific consideration of the ever present problem—the care of the neurotic patient in the general hospital. Page 68 In this discussion we are not in any measure using the term "neurotic patient" with any of the formal psychiatric connotations. We are using the term, as do many of the older general physicians, in the incorrect sense of indicating any person afflicted with any of the many psychogenically determined disorders. In the days past the so-called "neurotic patient" in the average general hospital was a clinical case scorned, at times ignored, more often, through ignorance, mistreated and as frequently subjected to useless, mutilating surgical procedures and discouraging pseudo-medical therapies. The total result was commonly an individual submerged in a rut of chronic invalidism and sociologic incompetence, a loss of confidence in the well meaning medical profession, and a financial loss either to the patient, his family, or his community, while, in the case of a charity or semi-private hospital, he became a monetary and time forfeiture of no little significance. The psychiatrists, internists and surgeons, working in a co-operative fashion, have shown us that the days of seeing, examining and treating a patient merely in terms of his stomach, heart, skin, reproductive organs, endocrines, etc., are past. We have learned that man is an organism with organs and structures and individual physiologic functions of those parts which, working together, give rise to new and higher functions resulting in so-called mentally integrated activity. Thus worries, remembrances, anticipations, insecure feelings, certain misunderstandings, etc., may affect the person all over and not merely the abstract mind separated from a body. Certain trials and strains of life may make for depression with all the body participations, such as lacrimal gland activity, spasm of the pylorus, disturbed functioning of the bowels, loss of appetite, rapid pulse, etc., which are common concomitants of such a mood. Competent internists, particularly, tell us that from one-third to over one-half of the aches, pains and disturbances in physiology they are called to understand and treat are but body repercussions to the strain of life. We can no longer speak glibly of every patient ill in such a way as being a "neurotic." Nor can we any longer treat him with optimism by those still existent, archaic measures arising from focusing on some one of the many body protests to life strains, making that particular innocent organ or function the scapegoat for the whole trouble. During the past two and one-half years the studies of the Psychiatric Liaison Department of the Colorado General Hospital have shown that out of every 28 admissions to the ward, at least one patient is suffering with an illness requiring the services of a physician well trained in psychiatric procedures. We know that on an average, at least two other patients of the 28 require the aid of a physician with some psychiatric understanding. A recent survey has shown that in Colorado during 1936, 87,770 patients were admitted to the general hospitals alone. Using these figures, it becomes evident that between 3,000 and 9,000 patients (as compared to the 1,580 patients admitted to the tuberculosis institutions of the state) admitted to the general hospitals of Colorado last year were cases, in part or in whole, ill as a result of personal difficulties. The significance of these figures if viewed only from the financial point of view is astounding, and if considered in more broad medico-sociologic terms, may be considered as indicating that one of the most pertinent problems of the general hospital staff is the understanding, care, and treatment of the medico-psychiatric case. It is frequently said that in order to treat adequately the so-called "neurotic patient" many elaborae facilities not common to the average general hospital are needed. In our experience this is not true. In so far as the physical aspects of the hospital are concerned, there should be available: (1) One room per thirty-bed ward, equipped with windows that cannot be opened wider than six inches top and bottom and preferably made of small Page 64 1 panes set in steel casements. This simple and inexpensive precaution makes it possible to protect the delirious, depressed, and possibly suicidal patient from accidentally or impulsively precipitating himself from the room. In 1934-35 six patients were injured as a result of such falls in the Colorado General Hospital. During the last two years, with the installation of such rooms and the additional education of our staff, no accidents have occurred. (2) Apparatus for giving of continuous neutral baths, though not an absolute prerequisite, is a necessary adjunct to the treatment of the psychiatric case and is very valuable in the symptomatic therapy in many organic disorders. (3) Opportunities for the patient to have direction in constructive activity such as craft work, assisting in the upkeep of the hospital ward, yard, etc., are indispensable. Occupation for the patient of this category is of paramount importance in aiding the patient to sublimate his more personal difficulties, thus making him more amenable to symptomatic and causal therapies. Besides the few physical aspects of the general hospital necessary for the adequate treatment of the medico-psychiatric case, by far the most important requisite is that the nursing and medical staff understand personality functioning in health and disease. To illustrate this point without indulging in a lengthy discussion, a clinical case admitted to the Colorado General Hospital will suffice. R. S. (House No. 28684), aged 30, five years married and the mother of a 1-year-old child, was admitted 11-30-35, complaining of pain in the abdomen, discomfort in the neck, and precordium, fatigue, weakness, "chills," and inability to do her work. This woman, at great expense to her and ultimately to several physicians and hospitals, was treated over a period of five years for gastric ulcer, appendicitis, and pelvic disorders that nexer existed. She was operated on twice, threatened with a thyroidectomy, and as a result had become an insecure, chronic invalid, unable to care for her child and home. This woman, for the first two and one-half weeks in the hospital, because of the traditional methods of history taking, was never given a chance to explain her symptoms or to elucidate the development of her illness. A few complaints were taken and then a long and expensive series of x-ray, laboratory examinations, and special consultations ensued, but revealed no explanation of the problem. Two hours of the time of a physician willing and able to understand personal difficulties as well as organ dysfunction, revealed that this woman was reacting to some simple problem of ordinary life, that the symptoms referable to certain body segments were only manifestations of physiologic participation in emotional tension. Following the historical development of the illness in terms of life situations she, without any other aid, was capable of understanding her complaints for the first time. A few simple and non-time-consuming discussions regarding more healthy means of managing her life, and for the purpose of clearing up some misunderstandings leading to uneasiness and tension, returned this woman to a healthy status. She has remained well for two years except for an occasional cold, accidental or common intercurrent infection. Only one week and a half was required by the physician last in charge of her to work out the problem and send her home "under her own power." This case points to the most important item in the care of the psychiatric case in the general hospital. This very pertinent integrate is simply that the nursing and physician staffs of our hospitals have an understanding of human nature, the physiology of the person as a whole, and not to be too obsessed with the need to explain everything first or only in terms of diseased organs. To date, no hearts or stomachs! have applied for admission to our hospital. Some living, thinking, remembering, anticipating man, woman or child Page 65 walked in with those misbehaving viscera. Often the viscera were at fault, but nearly as frequently they were only participants in a sociologic, economic and personal drama of everyday life. It therefore seems imperative that in our medical schools today we teach the future physician (1) to take a complete history of the complaint in terms of the setting in which the complaint became apparent, evaluate the personal and situational factors modifying or amplifying it; and (2) how to treat the person as a total person with biologic, temperamental and intellectual attributes capable of modification. The increase in mental sickness in the United States is resulting in a dilemma of great significance. If this coming year some plague should incapacitate 3,000 to 9,000 individuals in the State of Colorado, we would do something about it. Yet next year there will be that number of psychiatrically incapacitated persons admitted to our general hospitals in the state. To wait until these individuals are so profoundly invalided that they can never pull themselves up to an efficient level again, or to wait until ten years hence they are admitted to our mental hospitals, is not an economcial or common- sense approach, to say the least. The prevention of the so-called "neurotic" syndromes is to be found in the general hospital that recognizes the true nature of the disorder, treats it judiciously, and through these procedures teaches the people of the community a workable mental hygiene. THE EXECUTIVE SECRETARY RELAXES m ON THE COWICHAN "There is much comfort in high hills, And a great easing of the heart."—Young. The Cowichan River was in low water when we arrived on the 13th of October for a few days' respite from duty and the office. The whole picture changes with the rise of water which usually comes in October. It was rising on the 20th. The restful fluent mirror with sparkling ripples breaks into a bouncing whitened stream as it playfully hurries along to the sea. The partly submerged willow branch tirelessly waves farewell to the sculling leaves gliding on, as this never-ending river ceaselessly rushes by. Everything is relentless in the October spate—the salmon are in the river and, suffering Nature's urge, struggle on to their fate. The Rainbows are there too, and hence the Angler. The Fisherman wades into the shallows and surveys the scene—the river, the eddies, the deep silent water, the broken rushing stretches, the haze and blue on the hills, the whole framed in rusts and yellows. The Spring brings inspiration, but the Autumnal colourings lure the Nature-lover and the artist to the river. The fishing is good and provides an excuse to live by the river, and thus it is that the Angler casts his fly into the edge of the roughened current and— splash and a flash (as emphatic as a Lowrie wham or slam)—he is into a three-pound rainbow; what to do—why a fighting bundle of muscle can be so stubbornly resistant—stupidly insistent on swimming in rapid water— fast water and a whirring reel—the rod in a perfect ellipse—the line humming as the captive strains and sulks, shunts and slacks, spurts and sallies; it seems to have an idea—to break a too-light leader. The fight is on—the breeze that strums on the tautened line seems warmer—the sport of kings—the fish to net—and then again. A partly filled creel and a fuller day. The days are short in October and perhaps it is well. One must needs rest and sleep—dream of another day on the Cowichan—white water and the Rainbow. "J will life up mine eyes unto the hills, whence cometh my help." Page 66 THE SOURCES AND CLINICAL IMPORTANCE OF THE VITAMINS J § W. N. Kemp, M.D., Vancouver. (Read before the Vancouver Medical Association, November, 1937) Before entering on our subject this evening a word of explanation may be in order. Many of you have wondered or even enquired concerning the rationale of a paper on vitamins by one specializing in endocrinology. The truth of the matter is that it is practically impossible to separate endocrine and vitamin or dietary therapy. Vitamins may well be called "plant hormones" whose clinical importance is second only to the glandular hormones. In matters of growth, thyroid and parathyroid function, reproductive function, diabetes and other endocrine conditions, a working knowledge of both vinamin. and mineral requirements is essential. Since 1911, when Funk coined the word "vitamine" (a word since proven to be a misnomer except in its application to vitamin B), great progress has been made in the elucidation of the rdles played by the now well-known and accepted chemical entities to which the modified term vitamin is still applied. The classical vitamin-deficiency diseases of xerophthalmia, beri-beri, pellagra, scurvy and rickets are well known. My purpose in reading this paper tonight is to direct attention to and discussion of the probable r61e played by avitaminosis in latent or sub-clinical conditions of vitamin deficiency which are not sufficiently complete or advanced to give the classical picture of vitamin deficiency. . Thanks to the recent clinical and pathological studies of Eddy and Dal- dorf, whose recent treatise "The Avitaminoses" has been an invaluable vade mecum in the preparation of this paper, we are now in a position to appreciate the fact that there exists in most "civilized" people many instances of subclinical or latent forms of deficiency disease. In directing your attention to a consideration of these newer facts and hypotheses concerning partial or latent avitaminosis, and in summarizing our present knowledge of the occurrence, stability and other important properties of the vitamins, it is hoped that some service may be rendered. That partial vitamin deficiency is a potent factor in the etiology of many of the "ills that flesh is heir to" is highly probable in the light of the recent experimental work of McCarrison and Rinehart. The former, a pioneer in the pathological study of avitaminoses, has recently shown some startling effects by giving healthy rats diets similar to those followed by humans in parts of India and England. His rat colony, fed whole-wheat flour, unleavened bread lightly smeared with fresh butter, freshly-sprouted "gram," fresh raw carrots and cabbage, fresh milk, a small ration of raw meat with bones once a week and plenty of water, showed no illness during a period of two and one-half years. From this group 1189 animals were examined postmortem without the discovery of any disease other than an occasional tape worm. In striking contrast are the postmortem findings of 2243 autopsies of animals fed on diets copied from those followed by some people in India and England. In these rats disease was found to be very common. The most frequently appearing lesions were pulmonary infections, gastric ulcers, enteritis, pyelonephritis and renal calculus. It is probably significant that these lesions are also commonly found in the humans who follow such experimental diets. The work of Rinehart is most interesting in this respect also. He observed changes in experimental scurvy which were suggestive of rheumatic fever. By superimposing streptococcal infection he produced identical cardiac and joint lesions to those found in humans following rheumatic fever. If vitamin C were adequately supplied heinvariably failed to produce any characteristic lesions, regardless of the kind of bacteria introduced. If, however, the diet Page 67 was deficient in vitamin C, warty growths could be found on the heart valves, inflammatory lesions in the myocardium, and degenerative and granulomatous lesions in the joints. "The term vitamin connotes a group of substances having a regulatory action on the utilization of food stuffs, such substances being preventative of certain pathological consequences of their omission or inadequacy in the dietary. As such they are closely allied to the hormones produced by our endocrine glands, but differ from them by the fact that our source of vitamins lies mainly in ingested foodstuffs and not in human manufacture. Furthermore, the vitamins affect the function of the glands of internal secretion. "The tendency of civilized man to eat less of the natural unrefined food products and more of the ultra-refined (and hence vitamin-deficient) foods has led to a condition of dietary habits in which many persons from habit or necessity are chronically short of some of the essential vitamins. J. B. Orr has recently published a study of the relation of dietary adequacy to income in England. His study showed the startling fact that fifty per cent of the English population follow a diet inadequate in vitamins. Partial group studies in the United States by the U. S. Bureau of Labor Statistics and the Bureau of Home Economics show that American diets are also commonly deficient in vitamins and minerals." A further aspect of the deficiency diseases which is only recently receiving recognition is the r61e of abnormal metabolic processes or gastrointestinal function in making inadequate, either through faulty absorption or excessive destruction, what might otherwise be an adequate dietary vitamin intake. We have learned that beri-beri may occur because intestinal lesions prevent absorption of vitamin B or because the heightened metabolism of fever increased the requirements of this vitamin. We know that vitamin C may be destroyed in the body by toxins or in the intestines by bacterial action; that vitamin D functions best in an acid medium and is ineffectual in the absence of bile salts. VITAMIN A This fat-soluble vitamin is produced by nature in plant tissues as a pigment called carotene. This pigment is really provitamin A because it serves as the source of vitamin A to animals, the formation and storage of the latter taking place in the liver. Beta-carotene, the best known source of vitamin A, has been selected as the basis of the International Unit of vitamin A. This unit is the growth- promoting activity of 0.6 micromilligrams (0.006 mgm.) of pure beta-carotene. Let us note here that one gram (3.6 grams to a teaspoonful) of U.S.P. standard cod liver oil must contain 600 International Units (I.U.) of vitamin A. A teaspoonful will therefore contain 2160 I.U. of vitamin A. The human requirements of vitamin A range from 4000 I.U. in infancy to 9000 I.U. during pregnancy. Adolescents require 8000 I.U. and adults approximately 5000 I.U. The natural dietary sources of provitamin A are the green leafy vegetables and the pigmented vegetables and fruits. The vitamin A content of milk varies directly with the character of feed that the cow receives, succulent greens increasing the A content of the milk. It is interesting to note that even the method of curing the hay or alfalfa is important in relation to its vitamin A content. It has been found that alfalfa artificially dried in a modern hay drier has about seven times the potency in vitamin A of field-dried alfalfa. The stability of any vitamin is of prime importance to us. Vitamin A is stable even at high temperatures if oxygen is excluded. Hence there is little destruction of A in commercial canning provided soda is not added to the product for purposes of softening the fibre and the color. All plant and animal sources of vitamin A show progressive destruction of the vitamin during storage unless measures are taken to prevent fermentation, oxidation and rancidity. Frozen products retain vitamin A well. Page 68 The Equivalence op Vitamin A Sources Source of vitamin A : Int. Units per oz.: Beta-carotene .47,000,000 Cod liver oil (U.S.P. standard 6,800 Egg yolk 9,800 Spinach 6,500 Beef liver 3,920 Calf liver 2,860 Apricots (fresh) . 1,500 Sweet Potatoes 1,000 Green lettuce 1,000 Carrots (raw) 1,600 Butter 2,120 to 100 Milk (per pint) 1,200 Cheese 980 Eggs 900 Vitamin A is essential to (1) growth, (2) vision and (3) the health of specialized (epithelial) tissues. In vision, vitamin A has a dual part to play; a deficiency produces morbid changes in the cornea leading to loss of sight or ophthalmitis; secondly, it is a necessary chemical constituent of the retina. The stimuli that produce the sensation of vision do so through a chemical change in the retina induced by the action of light waves on the pigment commonly known as the visual purple contained in the rods and cones. To produce a nerve impulse in the optic nerve light must bleach the visual purple to visual yellow. To restore sensitivity to light visual yellow must be restored to visual purple continuously and instantly. For this process of sensitivity restoration the presence of vitamin A is absolutely essential. Retardation of the process results from deficiency of vitamin A and is called hemeralopia or night-blindness. It is now possible, with an instrument such as the Birch-Hirschfeld photometer, to determine the presence and degree of night-blindness. In this locally made example of the instrument a target with five holes is unequally illuminated by a light of constant electrical voltage. The inequality of illumination is accurately progressive by means of varying thickness from 1 to 5 of a photographic film of uniform density. The procedure is to determine the intensity of light required by the patient to enable him to see three of the holes in the target immediately after coming from a brilliantly illuminated room and again after ten minutes' rest in the darkness or with the eyes blindfolded. A modification of this type of instrument is sometimes called the "biophotometer." Since the development and use of such instruments as the photometer the presence of hemeralopia in sub-acute form has been found to be far more prevalent than was formerly supposed. Jeans and Zentmire, at the University of Iowa, located in a rich agricultural district, have announced that by using this test they had found relative night blindness to be very common among children entering the University Hospital. Many people with apparently normal day vision, when exposed to the sudden glare of advancing automobile headlights, show relative retardation in the restoration of normal vision because of slow visual purple regeneration due to circulatory deficiency of vitamin A. It therefore follows that vitamin A deficiency can be an important factor in the safety of night driving. Hemeralopia preceeds xerophthalmia and affords warning of vitamin A deficiency. This early criterion of vitamin A deficiency is obviously of great importance, since ocular lesions frequently develop so rapidly that, even with prompt diagnosis, vision may be irreparably damaged. Although hemeralopia is the first early sign of vitamin A deficiency in adults, it is of course undetectable in infants, the commonest victims of A deficiency. Here the deficiency usually manifests itself by a dry scurfy skin Page 69 frequently showing infections, and sometimes with loss of hair. In Ceylon the condition is called "mandama" and there the four cardinal signs are xerophthalmia, stunted growth, diarrhoea and a toad-like skin which Nicolls calls ' 'phr y noderma.'' The specific anatomic effect of vitamin A deficiency in the rat, guinea pig, monkey and other experimental animals is the loss of the ability to maintain various specialized epithelial surfaces. As a result of lack of vitamin A these specialized epithelial tissues are replaced by squamous celled epithelium which is much less adapted to maintain the health of the organism. The specialized tissues thus adversely affected by avitaminosis A include the respiratory mucosa, the salivary glands, the eyes, the glands of the intestinal tract, the pancreas and the parocular glands. In the rat, for instance, all epithelium undergoes metaplasia, including that of the genito-urinary tract and the enamel organs of the teeth. In the early stages of the deficiency "nests" of darkly staining germinal epithelium may be seen to undergo rapid growth. At is grows, the overlying secretory or duct epithelium degenerates and sloughs. The aforementioned nests or foci of germinal cells continue to grow to form islands of stratified squamous epithelium. These first extend laterally to undermine the adjacent surfaces, and eventually, if the lack of vitamin A is sufficiently prolonged and severe, they extend to replace the entire surface of the affected organ. With moderate deficiency, alternating areas of normal and replacement (squamous) epithelium occur side by side. What are the consequences of these anatomical changes? The first effect is loss of function of the affected epithelial surface. In the case of the trachea, the loss of cilia precludes proper cleansing of that part of the body, and in the conjunctiva the loss of mucus-secreting cells has an adverse influence on the health of the eye. In addition to the loss of function of the affected surfaces, two other major sequelae have been repeatedly emphasized. One is the blockage of gland ducts, leading to stasis of secretions and ipso facto to infection. The other major consequence of these epithelial retrograde changes lies in the interference with the function of the glands and organs involved. The lesions in the teeth are equally striking and characteristic. Wolbach and Howe consider that they are the most important dental defects resulting from any of the dietary deficiencies. Here the avitaminosis shows itself in the atrophy and metaplasia of the enamel organ. Enameloblasts are replaced by* stratified squamous epithelium. As a result there is loss of enamel and exposure of dentin which gives the teeth a chalky appearance. Simultaneously the odontoblasts within the tooth atrophy, thus leading to cessation of tooth growth. When a considerable lack of vitamin A occurs in pregnant animals, intrauterine death and resorption of the foetuses occurs. In contradistinction of avitaminosis E, the maternal decidua becomes necrotic and infected, leading to foetal death. By increasing the vitamin A intake just sufficiently to keep animals on the border line of the earliest lesions of deficiency, a variety of other abnormalities may be produced, including prolonged gestation, difficult labor, with, often, maternal or foetal death and retained and diseased placentae. Avitaminosis A causes in man histological tissue changes similar to those experimentally produced in animals with one notable exception: the skin lesions of this deficiency are limited to man. They may consist of dryness and scaliness of the skin and possibly furunculosis. The follicular lesions that may occur are described as being hard, deeply pigmented and surrounded by a zone of pigmentation. In humans, pneumonia has always been a common associate of vitamin A deficiency. In seven cases in which Blackfan and Wolbach were able to recognize vitamin A deficiency only after autopsy, five had died of broncho-pneumonia. Pneumonia was frequently present in Sweet and King's series of vitamin A deficient cases. It would appear from the experimental and clinical Page 10 p*a evidence that avitaminosis A predisposes to pulmonary infection, probably through the regressive changes that it causes in the respiratory epithelium. It is not impossible that some instances of postoperative pneumonia are due to a combination of factors, of which avitaminosis A is not the least important. Experimental studies are, in general, in agreement on the frequent presence of renal and cystic calculi in vitamin A deficient rats. The calculi are usually of the calcium-magnesium variety and disappear when the diet is corrected. In some cases in humans, a dietary deficiency may be responsible for the formation .of kidney stone. It is probable, however, that other dietary factors are involved in stone formation. In the year 1800 forty-five per cent of all bladder stones occurred in the young. The almost complete disappearance of urinary bladder calculi in children in the past hundred years suggests the beneficial effect of the dietary improvements that have been made during the past century. One must agree with Eddy and Daldorf when they state the opinion that the highly suggestive experimental studies require continued clinical examination of the effects of decreased and increased vitamin A intake. It must be admitted that many of the discouraging results of vitamin A experimental clinical therapy are based on very unsatisfactory clinical experiments. Very few clinical tests have duplicated the experimental laboratory conditions, and this is particularly important because the effects of avitaminosis A may often be delayed. For example, there is nothing in the experimental evidence to indicate that large doses of vitamin A will ward off or modify the course of a respiratory infection, the early signs of which are already manifest; nor to indicate that a few days' treatment with the vitamin will have any effect in a patient with lobar pneumonia. (Continued in January issue) 536 13 th Avenue West Fairmont 80 E t xclusive Ambulance FAIRMONT 80 Service || ALL ATTENDANTS QUALIFIED IN FIRST AID "St. John's Ambulance Association" WE SPECIALIZE IN AMBULANCE SERVICE ONLY R.J. Campbell J. H. Crellin W. L. Bertrand Page 71 A PRESCRIPTION SERVICE . . . Conducted in accord with the ethics of the Medical Profession and maintained to the standard suggested by our slogan: Pharmaceutical Excellence McGiI 6 Ormo FORT STREET (opp. Times) Phone Garden 1196 VICTORIA, B. C. MEMBERS of THE GUILD of PRESCRIPTION OPTICIANS of AMERICA Always Maintain the Ethical Principles of the Medical Profession Guildcraft Opticians 430 Birks Bldg". Phone Sey. 9000 Vancouver, Canada. PREVENTION Detecting foot weaknesses and defects in youths will check defects unrecognized by parents before they become serious. Direction as to the shape and fit of a shoe counts while the foot is in the formative stage, far more than in later years when the bony development is completed. Your Patients Fitted with Made-to-Meastjre and Corrective Shoes Subject to Your Prescription and Recommendation lPlE%%E \Pi axt± 51 WEST HASTINGS STAREET VANCOUVER, B. C. i^%(i@Li. ANNUAL The Official Publication of the Royal North West Mounted Police Veterans' Association. Price $1.00 Postpaid. Mail Subscriptions to: Circulation Manager 300 West Pender Street Vancouver, B. C. ™ MANDECAL (Compound Calcium Mandelate, B.D.H.) MANDECAL. is a light, pleasantly-flavoured powder containing 75 per cent of pure calcium mandelate; it is issued as an alternative preparation to Mandelix for use in the treatment of urinary infections. Its administration causes no unpleasant after-effects such as nausea and dyspeptic discomfort, whilst similar good results are obtained with it as with other preparations of mandelic acid. MANDECAL possesses an outstanding advantage accruing from its ready miscibility with water. It is necessary merely to measure the required dose and to stir it into about two fluid ounces of water in a glass; immediately an even suspension is formed ready for administration. MANDECAL is available in bottles containing approximately 130 grammes, sufficient for treatment lasting seven days. Stocks of Mandecal are held by leading druggists throughout the Dominion and full particulars are obtainable from:— The BRITISH DRUG HOUSES (Canada) LTD. Terminal Warehouse Toronto, 2, Ont. Mncl/Can/3712 'i _H>ount peasant XKnbertal. ino Co. % to. KINGS WAY at 11th AVE. Telephone Fairmont 58 VANCOUVER, B. C R, F. HARRISON W. R. REYNOLDS t Prognosis in ARTHRITIS and CHRONIC RHEUMATISM is much brighter when treatment combines sulphur, iodine, calcium and lysidine (ethylene-ethenyl- diamine) in the form of LYXANTHINE ASTIER It relieves pain and numbness, reduces swelling and infiltration, increases muscular and joint motility, improves blood and lymph circulation, promotes elimination of toxic waste. Administered Per Os Non-toxic, non-irritant, chola- gogue, agreeable and convenient to use. Clinical evidence justifies the use of Lyxanthine Astier in severe as well as mild cases. Renders use of salicylates or any form of analgesics unnecessary. DOSE: 1 teaspoonful, well dissolved in a glass of water, on an empty stomach, every morning for 20 days. Best 10 days. Repeat, if necessary. DR. P. ASTIER LABORATORIES 36-48 Caledonia Road, Toronto. Please send sample and Literature of Lyxanthine Astier. Dr Address City L7BVMA .Prov. t 2559 Cambie Street ancouver , B. C. Colonic Irrigation Institute Superintendent: E. M. LEONARD, R.N. Post Graduate Mayo Bros. Up-to-date treatment rooms; scientific care for cases such as Colitis, Constipation, Worms, Gastro-intestinal Disturbances, Diarrhoea, Diverticulitis, Rheumatism, Arthritis, Acne. Individual Treatment $ 2.50 Entire Course $10.00 Medication (if necessary) $1 to $3 Extra 631 BIRKS BUILDING, VANCOUVER, B. C. Phone: Sey. 2443 506-7 CAMPBELL BUILDING VICTORIA, B. C. Phone: Empire 2721 STEVENS' SAFETY PACKAGE STERILE GAUZE is a handy, convenient, clean commodity for the bag or the office. Supplied in one yard, five yards and twenty-five yard packages. ESTABLISHED NEARLY A B. C. STEVENS CO. Phone Seymour 65*8 73 0 Richards St., Vancouver, B. C. S. BOWELL & SON DISTINCTIVE FUNERAL SERVICE Phone 993 66 SIXTH STREET NEW WESTMINSTER, B. C. Breaks the vicious circle of perverted menstrual function in casesjbf amenorrhea, tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic relief by stimulating the innervation of the uterus and stabilizing the tone of its musculature. Controls the utero-ovarian circulation and thereby encourages a k normal menstrual cycle. |§|§|||| Kit ¥ • MARTIN H. SMITH COMPANY K;. ISO lAfATITTI ST-IIT. NIW YORK, N. Y. Full formula and descriptive literature on request Dosage: l to 2 capsules 3 or 4 times daily. Supplied in packages of 20. Ethical protective mark MHS embossed on inside of each capsule, visible only when capsule is cut in half at seam* ..tt$yZ6v.-y.-:*:«v: m m A summary of the scientific facts on BRAN What are the advantages of bran as a laxative? Leading nutrition laboratories have made many studies of this product. Here are their scientific findings: I (1) Bran relieves constipation due to insufficient "bulk." (2) Continued use does not reduce its laxative effect. (3) Bran is a good source of vitamin B (which aids intestinal activity). (4) Bran supplies iron for the blood. (5) The "bulk" in bran is not broken down in the alimentary tract as much as the f^^^mmgm^? ALL-BRAH ©tll-IOUSW lUVOMO WITH MALT, SUGAR AND MIT y \\ CONSTIPATION \\ m M "bulk" in fruits and vegetables. So bran is often more effective. Within the body, Kellogg's ALL- BRAN absorbs at least twice its weight in water, forms a soft mass, and gently exercises and cleanses the intestinal tract. It may be used wherever "bulk" is permitted in the diet. Kellogg's ALL-BRAN may be served as a cereal with milk or cream, or cooked into appe- tizing muffins, breads, etc. Sold by all grocers. Made by Kellogg in London, Ontario. _ft_» W w/ __K. _r/*_ WA W 1 Laxative Effects of Wheat Bran and "Washed Bran" in Healthy- Men, pages 1866-1875, /. Am. Med. Assn., May 28,1932. 2 The Influence of Bran on the Alimentary Tract, pages 133-156, J. Am. Dietetic Assn., July, 1932. 3 Wheat Bran as a Source of Vi' tamin B, pages 368-374, J. Am. Dietetic Assn., March, 1932. 4- Factors in Food Influencing Hemoglobin Regeneration, pages 593-608, J. Biological Chem., June, 1932. 5 Further Studies on the Use of Wheat Bran as a Laxative, pages 795-802, J. Am. Med. Assn., March 18,1933. HB ~^& "The average gain in weight of the children fed on the buffered lactic acid evaporated milk for the first ten days of life was 110.5 Gm., which surpassed that of any other group. In this period the infants fed on buffered lactic acid milk showed approximately seven times as great an increase in weight as the other artificially fed infants. This increase in weight was reflected in the excellent tissue turgor and muscle tone of these infants. Furthermore, the morbidity in the group was almost as low as that recorded for breast-fed infants."—■ SMYTH, FRANCIS SCOTT, and HTJRWITZ, SAMUEL: J. A. M. A., Sept. 7, 1935. In any formula The ready digestibility, safety, convenience, economy and availability of Irradiated Carnation Milk specially recommend it for use in the construction of all types of feeding formulas. Enrichment with vitamin D is an important added factor, further justifying the marked favor with which Irradiated Carnation Milk is regarded by pediatrists generally. The Dionne Quintuplets have been using Carnation Milk since November, 1934. CARNATION COMPANY LIMITED, 128 Abbott Street, Vancouver. C IRRADIATED arnation Ghnaficfi .L, A (AHADIA* PaOOVCl mm WRITE for "Simplified Infant Feeding," an authoritative publication for physicians. 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Research, Constant Research continues to improve the quality of Mead's Brewers Yeast* in the following respects, without increased cost to the patient: 1 Vitamin B potency raised to not less than 25 Inter* national units per gram* 9 Bottles now packed in light-proof cartons, for better protection. § 3 Improved bacteriologic control in harvesting and packing. ; . jf • ffcfl' -i ': 1 4# And NOW, since August i,1936, all bottles are packed in vacuum. This practically eliminates oxidation. Mead's Yeast stays Eresh longer, as you can tell by its improved odor and flavor! ;| § * A dietary accessory for normal persons, for the prevention and treatment of conditions characterized by partial or complete deficiencies of vitamins Bi and G, as in beriberi, pernicious vomiting of pregnancy, anorexia of dietary origin, alcoholic polyneuritis, pellagra* Mead's Brewers Yeast Tablets in bottles of 250 and 1,000. Mead's Brewers Yeast Powder in 6 oz. bottles. Not ad* vertised to the public. Samples to physicians, on request. MEAD JOHNSON & CO. OF CANADA, LTD., Belleville, Ont i The Increasing Need of Accuracy and Speed are shown these winter days in the Prescription Department. But we are ready for your most exacting orders day or night. Telephone Seymour 2263 OHM ML MIOMT GEORGIA PHARMACY MIXED W.OIOROIA STRUT <&mtn $c ijatttta ICiiX Established 1893 VANCOUVER, B. C. North Vancouver, B. C. Powell River, B. C. published Monthly at Vancouver, b. C. by ROY WRIGLKY LTD.. 300 west Pender street ■ 5g£S3j@Sg-_$^^ Hollywood Sanitarium Limited For the treatment of Alcoholic, Nervous and Psychopathic Cases Exclusively Reference—B. G. Medical Association For information apply to Medical Superintendent, New Westminster, B. C. or 515 Birks Building, Vancouver Seymour 4183 Westminster 288 ^^£5S^_^^^S^^_5?3_^£?3_2§