{"AggregatedSourceRepository":[{"label":"Aggregated Source Repository","value":"CONTENTdm","attrs":{"lang":"en","ns":"http:\/\/www.europeana.eu\/schemas\/edm\/dataProvider","classmap":"ore:Aggregation","property":"edm:dataProvider"},"iri":"http:\/\/www.europeana.eu\/schemas\/edm\/dataProvider","explain":"A Europeana Data Model Property; The name or identifier of the organization who contributes data indirectly to an aggregation service (e.g. Europeana)"}],"CatalogueRecord":[{"label":"Catalogue Record","value":"http:\/\/resolve.library.ubc.ca\/cgi-bin\/catsearch?bid=1179642","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/isReferencedBy","classmap":"edm:ProvidedCHO","property":"dcterms:isReferencedBy"},"iri":"http:\/\/purl.org\/dc\/terms\/isReferencedBy","explain":"A Dublin Core Terms Property; A related resource that references, cites, or otherwise points to the described resource."}],"Collection":[{"label":"Collection","value":"History of Nursing in Pacific Canada","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/isPartOf","classmap":"dpla:SourceResource","property":"dcterms:isPartOf"},"iri":"http:\/\/purl.org\/dc\/terms\/isPartOf","explain":"A Dublin Core Terms Property; A related resource in which the described resource is physically or logically included."}],"Creator":[{"label":"Creator","value":"Vancouver Medical Association","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/creator","classmap":"dpla:SourceResource","property":"dcterms:creator"},"iri":"http:\/\/purl.org\/dc\/terms\/creator","explain":"A Dublin Core Terms Property; An entity primarily responsible for making the resource.; Examples of a Contributor include a person, an organization, or a service."}],"Date":[{"label":"Date","value":"1947-04","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/elements\/1.1\/date","classmap":"dpla:SourceResource","property":"dc:date"},"iri":"http:\/\/purl.org\/dc\/elements\/1.1\/date","explain":"A Dublin Core Elements Property; A point or period of time associated with an event in the lifecycle of the resource.; Date may be used to express temporal information at any level of granularity. Recommended best practice is to use an encoding scheme, such as the W3CDTF profile of ISO 8601 [W3CDTF]."}],"DateAvailable":[{"label":"Date Available","value":"2015-01-29","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/issued","classmap":"edm:WebResource","property":"dcterms:issued"},"iri":"http:\/\/purl.org\/dc\/terms\/issued","explain":"A Dublin Core Terms Property; Date of formal issuance (e.g., publication) of the resource."}],"DateIssued":[{"label":"Date Issued","value":"1947-04","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/issued","classmap":"oc:SourceResource","property":"dcterms:issued"},"iri":"http:\/\/purl.org\/dc\/terms\/issued","explain":"A Dublin Core Terms Property; Date of formal issuance (e.g., publication) of the resource."}],"DigitalResourceOriginalRecord":[{"label":"Digital Resource Original Record","value":"https:\/\/open.library.ubc.ca\/collections\/vma\/items\/1.0214442\/source.json","attrs":{"lang":"en","ns":"http:\/\/www.europeana.eu\/schemas\/edm\/aggregatedCHO","classmap":"ore:Aggregation","property":"edm:aggregatedCHO"},"iri":"http:\/\/www.europeana.eu\/schemas\/edm\/aggregatedCHO","explain":"A Europeana Data Model Property; The identifier of the source object, e.g. the Mona Lisa itself. This could be a full linked open date URI or an internal identifier"}],"FileFormat":[{"label":"File Format","value":"image\/jpeg","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/elements\/1.1\/format","classmap":"edm:WebResource","property":"dc:format"},"iri":"http:\/\/purl.org\/dc\/elements\/1.1\/format","explain":"A Dublin Core Elements Property; The file format, physical medium, or dimensions of the resource.; Examples of dimensions include size and duration. Recommended best practice is to use a controlled vocabulary such as the list of Internet Media Types [MIME]."}],"FullText":[{"label":"Full Text","value":" Tfeelw\nof the iplll.\nMii|eAf|\nassociation!!\nWith Which Is Incorporated\nTransactions of the\n0ictoria medica^societ^\nVancouver general hospital\nand\nST. PAUI\/S HOSPITAL\nIn This Issue: page\n^S|Li^SUMMER: SCHOOL PttOQRAM .\u25a0 ;^M^^^^p^jJ4s\nTHE USE OI^RADIOACTIvii ISOTOPES IN\nBIOLOGT AND MEDICINE\nBy Simeon llgC*nt^f^M.n. ^^^^^^-' ?1^S^'.IS^-\nEUSTAOHIAlilTUBE FUNCTION ANMfil\nRELATION TO DEAFNESS\nByO|iR. Lindsay, VL.TtJf^^^^^^^M.;. .-gg;-. . 'm^ntU.\nINJURIES OF THE FACE AND^JAW\nBy Robert- G. \\,angst*.p0d.n: ?||||g|||\u00bb^. '. \u25a0 ! jljlg|jj\u00a33rttt\nA CASE OF OBSTRUCTIVl^|AUNDICE\n\u2022 By E*& James, B^^^^^^^^^^^^^B' iiWiiilM\nAN UNUSUAL CASE& SPONTtiNEOUS| jgi\nPNEUMOTHORAX\nBy T. KS^cI^an^ M.n^g^g^^^. Wll^itilP^^^^^P\nPOLYPOSIS OF THE COLON\nBy c g. Pow, ^^mimsmmmmSm \\mmmmm\/^^^m\npANCOUVER MEDICAL ASSOCIATION\n1 SUMMER ICHOOll\nJune 2nd ty 6th, incl.\nHotel Vancouver Vancouver, B. C.\nLv\u00ab\nI 4<\nfa\nhi\nMr >i\nVOLiXXII.. NO. 7\nAPRIL, 1947 NEW\nAPPROACH TO THE TREATMENT 0\nTINEA PEDIS\nf\/ftktete's foot)\n<*^\nE. L. Keeney* has shown the marked lethal effects\nof sodium propionate on dermatophyte fungi.\nFungol E.B.S. provides sodium propionate in\nconvenient ointment and .powder form for combating many\ntypes of dermatomycosis. Epidermophyton interdigitale\nhlete's foot), trichophyton barbae (tinea sycosis), trichophyton\ncapitis (ringworm of the scalp), and numerous other mycotic\ninfections all respond to treatment with Fungol.\n*Bull: Johns Hopkins Hosp. 73:379\nE\\\nFUNGOL\n4 oz. Jars\n|^E^3prinkier j\nFUNOO\nTHE\nHUTTLEWORTH CHEMICAL\nContains 10% SodivmJhrdf^on^\nCOI LTD. \u00a70R0NTd3cAHA THE VANCOUVER MEDICAL ASSOCIATION\n\u00ab\u00bb\nBULLETIN\nPublished Monthly under the Auspices of the Vancouver Medical Association\nin the interests of the Medical Profession.\nOffices: 203 Medical-Dental Building, Georgia Street, Vancouver, B.C.\nEDITORIAL BOARD:\nDe. J. H. MacDermot\nDe. G. A. Davidson De. D. E. H. Cleveland\nAll communications to be addressed to the Editor at the above address.\n%\nI\nvol. xxm\nAPRIL, 1947\nNo. 7\nOFFICERS, 1946 - 1947\nDe. G. A. Davidson De. Frank Turnbull\nVice-President Past President\nDe. H. A. Des Brisay\nPresident\nDr. Gordon Burke\nHon. Treasurer\nDe. Gobdon C. Johnston\nHon. Secretary\nAdditional Members of Executive'. De. W. J. Dorrance, Dr. J. W. Shier\nTRUSTEES\nDr. A. W. Hunter Dr. G. H. Clement De. A. M. Agnew\nAuditors: Messes Plommer, Whiting & Co.\nDr. E. R. Hall.\nSECTIONS\nClinical Section\n.Chairman Dr. Reg. Wilson.\n Secretary\n Secretary\nEye, Ear, Nose and Throat\nDr. Rot Mustard- Chairman Dr. Gordon Labge.\nPaediatric Section\nDb. R. P. Kinsman Chairman Dr. H. S. Stockton\u2014 -Secretary\nOrthopaedic and Traumatic Surgery Section\nDr. K. J. Haig Chairman Dr. J. R. Naden\u2014\n Secretary\nDr. A. M. Gee.\nSection of Neurology and Psychiatry\n Chairman Db. J. C. Thomas.\n Secretary\nSTANDING COMMITTEES\nLibrary:\nDb. W. J. Doebance, Chairman; Dr. D. B. H. Cleveland, Dr. J. B. Walker,\nDr. R. P. Kinsman, Db. J. R. Neilson, Db. S. E. C. Tubvet.\nPublications:\nDb. J. H. MacDermot, Chairman; Db. D. E. H. Cleveland, Db. G. A.\nDavidson, Db. J. H. B. Gbant, Db. E. R. Hall, Dr. Rot Mustard.\nSummer School:\nDr. L. H. Deeson, Chairman; Dr. D. S. Munroe, Dr. L. G. Wood,\nDr. A. B. Manson, Dr. D. A. Steele, Db. J. A. Ganshobn.\nCredentials:\nDb. H. H. Pitts, Db. A. B. Tbites, Dr. Frank Tubnbull.\nV. O. N. Advisory Board:\nDr. Isabel Dat, Dr. J. H. B. Grant, Dr. G. F. Strong.\nRepresentative to B. C. Medical Association: Dr. Frank Tubnbull.\nSickness and Benevolent Fund: The President\u2014The Trustees.\nC\nU\ni v\ni*\nn\n\u00a31\n*\n*****a*0*a*a**^^^\n!i5\n,\u00abi '\nI 1\nX\nli\n1\nI I\nin\nm\nI\n\u00bb 9\nM>.\nis\nKiwi'\nLicuron-B\nLIVER COPPER IRON B-COMPLEX\nEACH LlCUrOn-B TABLET CONTAINS:\nLiver Fraction from 10 Gm. (155 grs.)\nof Fresh Liver.\nCopper Sulfate 0.0025 Gm.\nFerrous Sulfate, Dried 0.084 Gm.\nThiamine Hydrochloride 033 mg.\nRiboflavin 0.62 mg.\nNiacinamide 3.32 mg.\n\u00bb>>\n8898\nMR\n|H\nEfficient therapy in hypochromic Indications: Hypochromic anemia of preg-\nanemia is provided by the definite j\u00a7 ^ convalescence, periods of rapid\n!p| growth, prolonged hospitalization. In-\nratio of copper-iron in Licuron-B. #fe ^L^_ nf jLl-^. ui i .\u201e u\nrr fc:::$ stances of chronic blood loss, such as\nThis reduces the amount of iron re- |#| uterine bleeding.\nquired, and avoids the constipation ||| Dosage: Two tablets three times daily,\nand gastrointestinal upsets caused by ( after meals' until a satisfa<*ory blood\n||j\u00a7 response is obtained. Then as indicated.\nlarge doses of ferrous sulfate alone. \u00a7jj\nP$ Supplied: Licuron-B is supplied as small,\nCopper further assures that the ad- |j easy-to-swa!low, sugar-coated tablets in\nministered dose of iron will be most BK bottles of 100.\nrapidly and properly utilized, thus W$\nf ^ LAKESIDE LABORATORIES INC.\nshortening the period of treatment. Milwaukee, Wisconsin\nrH-inn htn* and\n\nf*\\?\n%\n\u00ab':\n\u00ab\nPage One Hundred and Forty-one\n't *\n\u2022;' I \\t'r\n\u25a0U\nat\n. i\nIk\ni.\nIL\nw\nm\nm\n'\u25a0[\u25a0\n1\";\nl\u00bb\nCRYSTALLINE PENICILLIN IN OIL AND WAX\n(ROMANSKY FORMULA)\nA FURTHER ADVANCE\nThe use of crystalline penicillin in\nthe Romansky formula of penicillin in\npeanut oil and beeswax permits the\nLaboratories to make available to the\nmedical profession an improved\nproduct with distinct advantages.\nEase of Administration\u2014The improved product flows more freely\nthrough a hypodermic needle.\nMinimum of Local Reaction\u2014\nBecause of the high purity of the\ncrystalline penicillin in the mixture, local reactions are reduced\nto a minimum.\nHOW SUPPLIED\nDISPOSABLE PLASTIC SYRINGE PACKAGE\nIncluded in this package Is a sterile B-D*\nDisposable Cartridge Syringe, ready for immediate use with a special cartridge containing\n300,000 International Units of crystalline penicillin in 1 cc. of peanut oil and beeswax. The\nplastic syringe is discarded after use.\nMETAL CARTRIDGE SYRINGE PACKAGE\nThis package includes a B-D* Metal Cartridge Syringe, two sterile 20-gauge needles,\nand a cartridge containing 300,000 International Units of crystalline penicillin in 1 cc.\nof peanut oil and beeswax. The metal syringe\nis designed for repeated use with readily\nchangeable needles and cartridges.\nREPLACEMENT CARTRIDGE PACKAGE\nReplacement cartridges containing 300,000\nInternational Units of crystalline penicillin in\n1 cc of peanut oil and beeswax are obtainable\nseparately from the Laboratories. These cartridges are supplied for use with the metal\ncartridge syringe.\n*T. M. Reg. Bee ton, Dickinson & Co.\nDisposable Plastic Syringe\nMetal Cartridge Syringe\nCONNAUGHT MEDICAL RESEARCH LABORATORIES\nUniversity of Toronto Toronto 4, Canada\nDEPOT FOR BRITISH COLUMBIA\nMACDONALD'S PRESCRIPTIONS LIMITED\nMEDICAL-DENTAL BUIIMNQ, VANCOUVER, B.C.\t <7<4e CdUoAri Paae\nAt a recent meeting of the Vancouver Medical Association, Dr. H. W. Riggs gave\na brief summary of the hospital situation in Vancouver. His remarks are equally\napplicable to other parts of British Columbia.\nDealing with present population figures, the speaker showed that we should, at the\npresent moment, have about one thousand more beds available than is now the case.\nHe reminded us that, even if construction were begun immediately, it would be approximately three years before these extra beds would be available. By that time, the\nnatural increase in population would have presented us with a new problem\u2014the urgent\nnecessity for more beds, to meet the then existing situation.\nIt sounds like something out of Alice in Wonderland, and might appeal to our sense\nof the comic, but as a matter of fact, it is a pretty grim state of affairs. Every medical\nman knows just how grim it is. For today no medical man can practise medicine adequately, unless proper access is given him to adequate hospital facilities. This is axiomatic, and requires no argument to prove it.\nFurther, this is especially true in the case of the man who does general practice; the\nman who, from the public's point of view, is their first contact with the machinery of\nhealing. We tend often to lose sight of the fact that well-trained, keen and competent\ngeneral practitioners are even more important, from the general public's standpoint,\nthan well-trained specialists. From the latter we so often hear comments that cases do\nnot come to them till they have been mishandled, improperly diagnosed, etc., by the\nman in the ranks. This is especially true of certain types of cancer, certain eye conditions, and so on. Thus, if medical practice is to improve at all, if earlier and better\ndiagnosis is to be attained, we must do all in our power to help the general man to keep\nup to date, to keep in touch with advances in his profession, and so on. The very first\nessential in such a programme is to ensure for him constant access to hospital, laboratory,\nand other modern facilities.\nThus we are failing as a community, to give our medical workmen the tools with\nwhich they can finish their job. And any steps which tend to lessen the already far\ntoo scanty supply of hospital beds available to the medical profession as a whole, are, in\nour opinion, greatly to be deplored. We rejoice, therefore, to read in the press that the\nforthcoming Hamilton report on Hospital matters recommends a plan whereby hospital\naccommodation in Vancouver will be considerably increased in the near future. The full\nreport will doubtless be released later\u2014and it is too soon to comment upon it. We hope\nthat, either in this report, or in future hospital developments, rather more attention will\nbe paid to regional needs. We are quite sure that the plan suggested will be an excellent\none, and that the development of the Vancouver General Hospital will make for real\nprogress\u2014but we confess to a desire for a greater degree of decentralization in the\nlocation of future hospital centres\u2014so that all parts of this very rapidly growing\ncity may be more readily and easily in touch with hospital service\nOur readers will find in this issue a brief report of the new Benevolent Fund of the\nBritish Columbia Medical Association. This carries with it an account of the origin\nand purpose of this fund, and we shall not enlarge on this here\u2014except to say that we\nmost heartily endorse this move on the part of the Provincial organization. It is decidedly\na forward step that this body has taken. It must not be forgotten, either, that the\nstep could not have been taken, had not the College of Physicians & Surgeons, which\nafer all, is the body charged with the collection of fees from the medical profession of\nthe Province, made it financially possible.\nAnd we think that another thing should be said, in fairness to the Vancouver\nMedical Association. For many years this body has had a benevolent fund in operation,\nPage One Hundred and forty-two\n*tt\n1 fa\n4k\nand, as all of us know, this fund has been of great help to many who sorely needed\nit. Our historian will no doubt record its early history, and the difficulties that beset\nthose who were charged with its administration, since collections were purely voluntary,\nand all sorts of complications arose from time to time. We were fortunate, however, in\nthe calibre of the men who were our Trustees, and their sound judgment and wisdom\nensured the most advantageous use being made of the fund at their disposal. Still, it was\nan activity and project of the Vancouver Medical Association, and it is the more\nadmirable that this body was willing and ready to submerge its identity in the wider\nscheme: an act which was statesmanlike and wise, as well as being generous. Of the\nfund that was accumulated over the years, the major portion has been handed over to the\nsenior organization, the B.C.M.A., to speed the establishment of its new fund, which\nwill be available, without any local bias or influence to affect its disposal, in all parts\no\u00a3 the Province of British Columbia, wherever it may be needed. Let us hope the need\nfor it will seldom be felt\u2014but it is good to know that the means are there whereby\nwe may ensure that none of our colleagues, and this may include their families too,\nshall suffer hardship or want, through malign chance, without the knowledge that a\nhelping hand will be there for them to grasp.\nThe present scheme is, we think, a great advance on previously existing methods. It\nis, to begin with, provincial in scope, and we shall all rejoice that this is so. Its supplies\nare guaranteed, and every medical man will be doing his share toward its support. This\nis far more equitable than any voluntary system\u2014and, too, removes any possible feeling\nof charity. Since we all subscribe equally to it, nobody who may unfortunately need\nits aid, need feel hesitant about accepting such aid, since he, too, contributed to it in the\ntime of his prosperity.\nHere, however, perhaps it is well to emphasize a point which it touched on in the\nreport. This is not an insurance plan in any sense of the word, nor a finance agency.\nNo member of the profession should feel for one moment that he has any claim, or can\nhave any access, to the funds of the plan, simply because he has contributed over\nthe years to these funds. The use of the money, and the reasons for its use, are matters\nfor the sole judgment and decision of the board that will administer the fund. The\nnames of those who have been chosen, will assure every medical man in B. C. that the\nadministration will be sound and equitable and that the new Benevolent Fund of the\nBritish Columbia Medical Association will be in excellent hands.\n'\u25a0A*\n4U\nANNOUNCEMENT\nRe Messenger Service for Library\nCommencing June 1st the Library will introduce a new service to members in Vancouver whose offices are outside the Medical-Dental Building.\nFree messenger service will be provided from the Library to Doctors' offices for books\nrequested on loan, and also for pickup up volumes to be returned.\nConsent has been obtained from the Executive Committee to try out this plan, and\nyour Library Committee is confident that it will prove to be a popular and valuable\ninnovation.\nJfe\nHi\nRE NEW BOOK RECOMMENDATIONS\nThe Library Committee wishes to remind members that suggestions for new books\nor journals that they feel to be essential to the Library, will always be welcome.\nSuch recommendations may be filed with the Librarian and will be presented for\nconsideration of the Committee at its next regular meeting.\nPage One Hundred and Forty-three\n!| LIBRARY NOTES\nLIBRARY HOURS\u2014\nMondays, Wednesdays and Fridays\u20149:00 a.m. to 9:30 p.m.\nTuesdays and Thursdays\u20149:00 a.m. to 5:00 p.m.\nSaturdays\u20149:00 a.m. to 1:00 p.m.\nRECENT ACCESSIONS TO LIBRARY\u2014\nSurgical Clinics of North America, Symposium on Clinical Advances in Surgery,\nChicago Number, February, 1947.\nThe Diseases of Children, five volumes, 1935, M. Pfaundler and A. Schlossmann,\nEnglish translation, American Editor-in-Chief, M. G. Peterman. (Gift of Dr.\nBen Kanee.)\nNational Research Council of Canada\u2014Fundamentals of Aviation Medicine.\nHistory of Associate Committee on Aviation Medical Research.\nReview of Work of Subcommittee on Protective Clothing of the Associate Committee on Aviation Medicine Research.\n(Gift of the National Research Council.)\nFunctional Neuroanatomy, 1947, by Wendell J. S. Krieg.\nDiseases of the Blood and Atlas of Hematology, 1941, by Roy R. Kracke.\nTransactions of the Association of American Physicians, 1941, 1942, 1944, 1946.\n(Gift of the Association.)\nOperative Gynaecology, 1946, by Richard W. Te Linde.\n\"\u2022ii'\nNOTICE\nThe Executive Committee wishes to draw attention to a regrettable incident in\nconnection with the annual Osier Dinner held on March 4th at the Hotel Vancouver,\nwhen fourteen people were served who did not have tickets. This amount had to be\nmade up from the funds of the Vancouver Medical Association.\nIt is hoped that any members who attended the dinner, and neglected to get tickets,\nwill get in touch with the office of the Association, telephone MArine 4622.\nipi\nRESULT OF ELECTION FOR MEMBERS OF COUNCIL\nTHE COLLEGE OF PHYSICIANS & SURGEONS\nOF BRITISH COLUMBIA\nApril 7th, 1947\nDr. F. M. Bryant.\nDr. G. S. Purvis.\nDr. M. M. Baird.\nH. H. Milburn, M.D.,\nActing Registrar.\nDISTRICT No. 1\nDISTRICT No. 2\nDISTRICT No. 3\nPage One Hundred and Forty-four\n1 J\nIfc\ni\nU1\nit\np\nf\n4\u00bb>\nI\nVANCOUVER MEDICAL ASSOCIATION\nSUMMER SCHOOL, 1947\nJUNE 2nd to 6th, INCLUSIVE\nHOTEL VANCOUVER\n# * \u00bb\nSPEAKERS\nDr. Alfred J. Elliot, Professor of Opthalmology, University of Toronto, Toronto, Ont.\nDr. D. Nelson Henderson, Department of Obstetrics and Gynaecology, University of\nToronto, Toronto, Ont.\nDr. Arnold S. Jackson, Surgeon, Jackson Clinic, Madison, Wis.\nDr. Clement A. Smith, Department of Paediatrics, Harvard Medical School, Boston,\nMass.\nDr. Cyrus C. Sturgis, Professor of Medicine, University of Michigan, Ann Arbor, Mich,\nPROGRAMME\nMONDAY, JUNE 2nd\n9:00 a.m.\u2014Dr. Sturgis: \"Evolution of Our Present-day Theories of the Etiology of\nHypertension and Methods of Treatment.\"\n10:00 a.m.\u2014Dr. Smith: \"The Physiological Peculiarities of Newborn Patients.\"\n11:00 a.m.\u2014Dr. Henderson: \"The Common Disorders of Menstruation.\"\n12:30 p.m.\u2014LUNCHEON\u2014Hotel Georgia, Spanish Ballroom,\nSpeaker: Dr. Clement A. Smith: \"Observations on a Recent Tour of\nEurope.\"\n2:30 p.m.\u2014Surgical Clinic: Vancouver General Hospital, Dr. Jackson.\n8:00 p.m.\u2014Dr. Jackson: \"Traditions in Surgery.\"\n9:00 p.m.\u2014Dr. Elliot: \"The Differential Diagnosis and Treatment of an Acutely Red\nEye.\"\nTUESDAY, JUNE 3rd\n9:00 a.m.\u2014Dr. Smith: \"Diseases of the Newborn, Their Diagnosis, and Treatment\u2014\nAsphyxia, Atelectasis, Erythroblastosis.\"\nDr. Sturgis: \"The Treatment and Diagnosis of the Anaemias.\"\nDr. Jackson: \"Non-drainage and Early Ambulation in Acute Perforated\nAppendicitis\/'\n-Medical Clinic: Shaughnessy Hospital, Dr. Sturgis.\nDr. Henderson: \"Delayed and Difficult Labour.\"\nDr. Sturgis: \"Haemorrhagic Disorders.\"\n10:00 a.m\n11:00 a.m\n2:00 p.m\n8:00 p.m\n9:00 p.m\nWEDNESDAY, JUNE 4th\n9:00 a.m.\u2014Dr. Elliot: \"Ophthalmic Indications of Systemic Disease.\"\n10:00 a.m.\u2014Dr. Smith: \"Diseases of the Newborn, (continued)\u2014Diarrhoea, Prematurity, etc.\"\n11:00 a.m.\u2014Dr. Sturgis: \"Discussion of Some Aspects of Leukaemia, Infectious Mononucleosis and Agranulocytosis.\"\n2:00 p.m.\u2014Obstetrical Clinic\u2014St. Paul's Hospital. Dr. Henderson.\n8:00 p.m.\u2014Dr. Jackson: \"The Diagnosis and Treatment of Hyperthyroidism.\"\n9:00 p.m.\u2014Round Table Discussion: \"Thyroid Diseases.\" Dr. Roy Huggard, Chairman.\nPage One Hundred and Forty-five THURSDAY, JUNE 5th\n9:00 a.m.\u2014Dr. Jackson: \"The Acute Surgical Abdomen.\"\n10:00 a-m.\u2014Dr. Elliot: \"Ocular Signs in Important Neurological Conditions.\"\n11:00 a.m.\u2014Dr. Henderson: \"The Late Toxaemias of Pregnancy.\"\n2:00 p.m.\u2014GOLF TOURNAMENT. Vancouver Golf and Country Club, Burquitlam.\nFRIDAY, JUNE 6th\n9:00 a.m.\u2014Dr. Henderson: \"Ovarian Neoplasms.\"\n10:00 a.m.\u2014Dr. Smith: \"The Causes of Abdominal Pain in Infants and Children.\"\n11:00 a.m.\u2014Dr. Elliot: \"Treatment of Ocular Injuries in General Practice.\"\n2:00 p.m.\u2014Combined Clinic\u2014Venereal Disease and Tuberculosis.\n6:30 p.m.\u2014Final Banquet\u2014Banquet Room, Hotel Vancouver. -1\nGuest Speaker: Rev. E. D. Braden.\nPROGRAMME SPEAKERS\nThe Summer School Committee is again proud of the outstanding medical men who\ncomprise this year's slate of lecturers. The subjects for presentation have been carefully selected by the speakers to interest the general practitioner as well as the specialist.\nIn Medicine, Dr. Cyrus C. Sturgis, Professor of Medicine at the University of Michigan, is outstanding in his profession. The study of blood diseases has been one of bis\nparticular interests, and a field to which he has made valuable contributions.\nIn Surgery we have secured Dr. Arnold Jackson, who is much sought after as an\noutstanding speaker at surgical meetings. He is Chief Surgeon of the Jackson Clinic\nat Madison, Wisconsin.\nThe lecturer in Obstetrics and Gynaecology, Dr. D. Nelson Henderson of the University of Toronto, is a most capable gynaecological pathologist and clinician. He has\nstudied ovarian tumours particularly and will lecture on this subject.\nComing to lecture in Paediatrics is Dr. Clement A. Smith, Department of Paediatrics\nat Harvard Medical School, Boston, Massachusetts. Dr. Smith is outstanding in his\nfield. He has been particularly interested in nutrition and has recently returned from\nEurope where he made up part of a survey, group who studied starvation in Europe. He\nwill address us particularly at the noon-day luncheon on June 2nd on post-war Europe.\nDr. Alfred J. Elliott, lecturer in Ophthalmology, is now Professor of Ophthalmology\nat the University of Toronto. The department under his leadership has planned a postgraduate training centre in Toronto. He is a native of New Westminster.\nA clinic is being held each afternoon, and on Wednesday evening, June 4th, a round-\ntable discussion on thyroid diseases is planned with all speakers participating. It is intended that questions from the audience will be answered by the group.\nFEES\nThe fee will be the same as last year\u2014$7.50.\nHOSPITAL INTERNES\nInternes may also enroll free of charge and may obtain tickets from the Committee\nor at the Registration Desk on the opening day.\nHOTEL ACCOMMODATION AND RESERVATIONS\nA number of rooms have been reserved at the following hotels: Vancouver, Georgia,\nDevonshire, Ritz, Sylvia Court, Belmont, Grosvenor and Alcazar. The Committee\nexpects to have reserved sufficient accommodation for those attending the School from\nout of town. The hotels stipulate that these reservations should be completed two\nweeks in advance and we urge that reservations be sought early.\nPage One Hundred and Forty-six\ntr if\n1\u00bb.\nFINAL BANQUET\nLast year the Summer School Session ended with a successful banquet. Such a banquet is again planned\u2014the Committee would like to see everyone enrolled at the Summer\nSchool attend this final dinner. The Rev. Dr. E. D. Braden has been chosen to speak.\nHe is a most capable and entertaining after-dinner speaker.\nPHONE SERVICE\nA private phone will be installed at the Registration Desk and a special screen in\nthe lecture hall will make transmission of calls a simple procedure.\nGOLF\nThe Golf Tournament will be held on the afternoon of Thursday, June 5 th, at the\nBurquitlam Country Club. The usual worthwhile prizes will be offered.\nREGISTRATION\nIt is hoped that all those who can, will buy their tickets before the School commences.\nThe registration desk outside the Ballroom in the Hotel will be open at 8:30 a.m. on the\nmorning of June 2nd for those who have been unable to register previously. Medical\nofficers in the Services who wish to attend are requested to register at this time, when\nthey will be provided with tickets. Holders of tickets will be requested to show them\nat each session.\n\u2022 ti\nIfe-\n\u25a01*\nm\nW\n* IN\n1*\nCANADIAN MEDICAL ASSOCIATION\nI ANNUAL MEETING f\nJune 23 rd to 27th inclusive, in Winnipeg\nTRAVEL FARE AND TIMES\nTRANS CANADA AIR LINES FARE: $162.00 Return\nLv. Vancouver 6:20 a.m. (Approx. 7l\/z hrs.) Ar. Winnipeg 3:55 p.m.\n12:25 p.m\n11:30 p.m.\n10:00 p.m.\n9:05 a.m.\nCANADIAN PACIFIC RAILWAY COMPANY FARE: $85.50 Return\nplus $13.80 Lower\nBerth each way.\nLv. Vancouver 7:15 p.m. (Two Days) Ar. Winnipeg 6:00 p.m.\n7:45 p.m. 6:45 p.m.\n*\nLv. Winnipeg 10:30 a.m. Ar. Vancouver 8:45 a.m.\n11:10 a.m. 9:20 a.m.\nCANADIAN NATIONAL RAILWAYS\nLv. Vancouver 7:15 p.m. (Two Days)\n7:45 p.m.\nLv. Winnipeg 10:15 a.m.\n11:20 a.m.\nTimes shown: \"Standard Time\".\nFARE: $85.00 Return plus\n$13.80 Lower Berth\nAr. Winnipeg 6:00 p.m.\n6:50 p.m.\nAr. Vancouver 8:45 a.m.\n9:20 a.m.\nPage One Hundred and Forty-seven \u25a0Vancouver Medical Association\nPresident _Dr. H. A. DesBrisay\nVice-President _\u2014 Dr. G. A. Davidson\nHonorary Treasurer Dr. Gordon Burke\nHonorary Secretary Dr. Gordon C. Johnston\nEditor Dr. J. H. MacDermot\nHISTORY OF V.M.A. (Continued)\nIRREGULAR PRACTITIONERS\nThe Charlatan has been with us since the beginning of orthodox medicine, and\nnowhere does he thrive so well as in any district which is passing through the pioneering\nstage. We still have them, but they now tend to be accepted as an unavoidable evil, and\ndo not get under the skin of the modern qualified Doctor as they did in the case of the\nMedical Man of other days. At the earlier meetings of the Vancouver Medical Association tempers often waxed hot, and much time was spent trying to correct the condition,\nbut with little success.\nThe quack came into the Province with the earliest settlers. He was accompanied by\nwhat Dr. Cousland of Victoria called the \"Fly-by-Night\" man. This was the itinerant\nPractitioner who had obtained his degree from one of the many second rate schools\nwhich flourished across the Border during the last century. Previous to the establishment of the Medical Council in 1886 theie was no curb on these gentlemen, and mention\nhas already been made in this history of Dr. Milne's description of how they preyed on\nthe citizens of the early days. In his paper on \"Early Medicine on Vancouver Island\",\nread before the CM.A. meeting at Banff in 1946, Dr. Cousland cites the cases of two\nsuch men who spent some time in Victoria during the 1860's. One of these, Dr. de\nWolf, guaranteed a cure: \"No matter how bad your case, or what the nature of the\nmalady\". Once while in Court on an alcoholic case in which he figured, he admitted that\n150 such patients had died by their own hands while under his care.\nA second case referred to by Dr. Cousland was a Doctor Flattery, who put up at\nthe Colonial Hotel in Victoria: \"to give the afflicted an opportunity to consult with a\ndistinguished Physician and Surgeon from San Francisco\". The editor of the British\nColonist had something to say about this Doctor's habit of borrowing money and forgetting to pay it back, and soon afterwards he left town. From Portland he wrote to\nthe Colonist, promising shortly to forward seven dollars which he owed the paper; but\nhe added as a P.S. \"If I see any impudence in your Journal relative to my unfortunate\ndeparture, I will never pay you and therefore serve you right.\"\nEven with a Provincial Medical Council to protect their interests', the men of the\nVancouver Association, had, during the early years of the century, their troubles with\nthe quack. During the summer of 1906, at a special meeting of the Society, the following resolution was passed: \"Whereas gross irregularities in contravention of the Medical\nAct have existed in the city for some time, and whereas three members of the Association are also members of the Council of Physicians and Surgeons; be it resolved that we\nrequest them to take immediate action against all offenders, specifying the case of Sneffer\nand the Dominion Hospital Company. That in case action has already been taken, that\nthis Association be made aware of the fact. Further, that if no action has been taken\nor contemplated, that our representatives be requested to resign.\"\nThis man Snepper is described as a Russian barber, calling himself a Doctor, and in\nassociation with him were some half dozen others: \"Doctors whose names are either real\nor fictitious\".\nDr. Fagan, who was a member of the Council, pointed out that Snepper claimed to\nbe only the manager of the company, and further that the legal adviser of the Council\nPage One Hundred and Forty-eight\n$\nii\n!%\nV\n1 liB\nJ\nn\nw^\nto\nhad declared that there was absolutely no case against him. In reply the Association\nrequested that the said legal adviser be changed.\nThe question remained as a thorn in the side of the Association for several years.\nMembers of the Council had a difficult time explaining their inability to mitigate the\nevil, owing to the impossibility of prosecuting the culprits under the existing Provincial\nlaws. These explanations did nothing to appease the irate members of the Society, since\nin 1908 we find representatives of the Council referred to: \"In terms of strong condemnation for their ineptitude and inefficiency, mentioning especially the constantly increasing influx of quacks of all descriptions.\" The Society recommended the total abolition of\nthe existing Board.\"\nIn 1912 the incoming president, Dr. Coy, again referred to the question and urged\nmore effective action. Dr. Proctor, a member of the Council, in a lengthy report, defended that body. The discussion of this report was: \"Very free and energetic\", and\nwas climaxed by a resolution that: \"The legal advisers at present employed by the\nCouncil are not satisfactory\".\nMonths later Snepper was still the guiding factor in his Hospitals Association, and\nthe records of the Society leave no doubt as to what its members thought of him and his\norganization, but nothing ever came of their protests.\nNaturopaths and Chiropractors infiltrated into the city just before the outbreak of\nthe first World War. Both groups have since been legalized by Provincial legislation.\nThere are still in Vancouver numerous Irregular Practitioners of Medicine in one form\nor another. Being a new city, we perhaps have more than our share of them. Theirs is\nabout the lowest conceivable form of human activity for gainful purposes, in that they\nprey on the credulity and infirmities of their fellow humans, giving nothing in return.\nOrthodox medicine tends to put up with them as a prevalent evil regarding the removal\nof which little can be done.\nTHE FIRST WORLD WAR\nThe first world war affected the Vancouver Medical Association to a marked degree.\nBy the end of 1915, out of its one hundred and seventeen members, fifty two were\nalready enlisted. Those who remained at home played their parts heroically. Within\nten days of the declaration of war, we find a committee being appointed by the Society\nto look after the dependents of such Doctors among its members who might enlist. It\nwas also agreed that free attendance should be given to dependents of all enlisted men\nwho received less than a stated monthly income. One half of the regular medical\nfee was to be charged those receiving above this amount.\nWhile no distinctly all-Vancouver Medical units went overseas, the Association was\nrepresented on all of the various units which were organized within the Province, in\nmany cases forming a majority of the officer personnel. This was notably so in No. 5\nGeneral Hospital which was staffed largely by Vancouver Medical Officers. Others\nwent as Officers in Field Ambulances or as Regimental M.O.'s, while many were assigned\nto military units after reaching Europe. A few, who are now members of the Association, were then either undergraduates, or had not yet begun their medical courses.\nMost of these served in combat units.\nThe only member of the Association to become a war casualty was. Dr. F. L. de\nVerteuil. He was a Naval Surgeon serving on the battleship Good Hope, and went\ndown with his ship when she was sunk in the South Pacific in the autumn of 1915.\nThe names of those Doctors who served in the armed forces during the first World\nWar, and who were at the time, or who subsequently became members of the Vancouver Medical Association; are listed below.\nAinley, W. E.\nAppleby, L. H.\nAtkinson, J. R.\nBagnall, A. W\\\nBaird, Murray\nPage One Hundred and Forty-nine\nBaird, W\". S.\nBaldwin, S. G.\nBarker, P .W\".\nBastin, C. H.\nBell. F. C.\nBell, C. H. C.\nBilodeau, J. B.\nBlair, E. M.\nBoucher, R. B.\nBoulter, W. L. Brodie, F.\nBrown, C. E.\nBrown, Harold.\nBrown, John.\nCampbell, E.\nCampbell, J. E.\nClarke, W. A. '\nClement, G. H.\nCleveland, D. E. H.\nCoy, P.\nCoy, W. F.\nCurtis, E. J.\nDavis, H. C\nDavis, H. R. L.\nDay, E. E.\nDe Muth, O.\nDes Brisay, H. A.\nDobson, W. A.\nDraeseke, G. C.\nDunbar, D. A\nDuncan, G. E.\nElliot, B. S.\nEwing, W. T.\nFreeze, D. D.\nFrost, A. C\nFunk, E. H.\nGibson, G. H. R.\nGibson, Richard\nGillies, G. E.\nGraham, Colin\nGraham, H. C\nGraham, \"Wilfred\nGray, E. J.\nGreaves, G. A.\nHarwood, R. de L.\nHodgins, L.\nHouston, J. A.\nHunter, A. W.\nKennedy, W. W.\nKidd, G. E.\nLamb, A. S\nLamont, G. A.\nLang, B. E.\nLees, F. W.\nLeeson, L. H.\nLineham, D. M.\nLockhart, W. T.\nLogie, F. C.\nMcAlpine, T. K.\nMcCallum, C. T.\nMcCarley, R. V.\nMacDermot, J. H.\nMcDiarmid, C. A.\nMcDougall, N. E.\nMacEwen, H. B.\nMcintosh, H. H.\nMcintosh, J. W.\nMcKechnie, W. B.\nMcKee, C S.\nMcLellan, D.\nMcNair, A. Y.\nMcNichol, J.\nMcTavish, F. C.\nMcNeil, N.\nMcNutt, L. W.\nMcKenzie, W. J.\nMagee, C. F.\nManchester, G. H.\nMatthews, G. O.\nMeekison, D. M.\nMillar, D. J.\nMonro ,A. S.\nMurphy, G. B.\nMurray, Fraser\nMustard, Roy\nNeilson, J. R.\nPanton, K. D.\nPaton, W. M.\nPatterson, F. P.\nPaulin, S.\nPedlow, W. L.\nPeele, S. R.\nPerry, D .G.\nPerry, Hugh\nPetrie, G.\nPitts, H.\nPlanche, H. H.\nProctor, A. P.\nRawlings, H. A.\nSchinbein, A. B.\nSmith, Lee\nThomas, M. W.\nTompsett, D. A.\nTrites, A. E.\nde Verteuil, F. L.\nWall, J. T.\nWalsh, W. C.\nWarner, A. M.\nWelch, J. W.\nWeldon, R. C.\nWhite, H.\nWilson, Wallace.\nManson, A. B.\nThere were two important problems which confronted the Association about this\ntime. One was the influenza epidemic, which was incidentally associated with the\nwar. The other arose more or less directly as a result of war conditions. This was the\nB. C. Liquor Prohibition Act.\nVancouver's fight against the great influenza epidemic of 1918 probably paralleled\nthat of most Canadian cities. At the time Dr. Carder was in charge of Infectious\nDiseases for the city. He asked that all cases he reported, and that persons suffering\nfrom the disease be treated so far as possible in their own homes, leaving hospital accommodation to those cases coming in from the trains and the boats. Treatment of the\ndisease was discussed at length at the Society's meetings. One report which was given,\ncovered the findings of 38 autopsies. The Association supported the Board of Health\nin putting a complete ban on all public meetings.\nThe Prohibition Act was a burning question with the Medical Fraternity of the\nwhole Province during the final and immediately succeeding years to the first World\nWar. The act had been passed in 1916 and specified that all alcoholic liquors might\nbe obtained only through Government liquor stores and on prescription issued by a\nMedical Doctor. It was not until the advent of the influenza epidemic in 1918 that the\nabuse of prescription writing, as permitted under the Act, became marked, although\nas early as the summer of 1917 several special meetings of the Association were held, and\nlong and bitter discussions of the question had taken place. The Government accused\nthe Medical Profession of making it impossible for the former to carry out the spirit\nof the Prohibition act. The term: \"Medical Bootleggers\", was freely used. With\nthe influenza epidemic at its height people turned to alcoholic liquors as a preventive and\ncure for the disease. The Association countered by passing a resolution\u2014which was\npublished in the newspapers\u2014to the effect that: \"The value of alcohol as a preventive\nof influenza is non-existent\".\nThe Association held many special meetings to consider the question, and night after\nnight it was the basis of a greater part of the discussions at the regular meetings. It is\nworthy of note that while many resolutions were offered, not a single one was agreed\non. The problem finally solved itself by the Government withdrawing the Act.\nPage One Hundred and Fifty\nmm\n\/*! IIli\n\u2022i-\nu\nM\nii\n\\,\\h\\\nIP\nBENEVOLENT FUND OF THE B. C. MEDICAL\nASSOCIATION\nWithin the past few months, the above Fund, the planning and organization of\nwhich have been under consideration for some years, has become an actuality\u2014and the\nB. C. Medical Association has set up a Benevolent Fund Committee to administer it.\nWe all know, as members of the College of Physicians and Surgeons, that our Annual\nDues include a sum of $10.00, to be donated to this Fund.\nThe purpose of this fund is to ensure assistance to doctors practising in British\nColumbia or their families, where such assistance is necessary for any good and sufficient\nreason.\nThe Fund was started in 1944 by the contribution of $10,000.00 by the College oj|\nPhysicians and Surgeons of B. C. This body then, by virtue of its power to levy annual\ndues, decided to institute an annual levy of $10.00 per member, as stated above.\nCertain moneys held by the.Vancouver Medical Association for a similar purpose,\nhave been donated to the B. C. Fund. The V.M.A. has for many years had a Benevolent\nFund, which has been of great value, but it was felt that this system of aid should\nbe province-wide, and that adequate provision be made to ensure a regular supply of\nmoney\u2014and this has been done.\nThe committee that will administer this fund has been appointed by the B. C.\nMedical Association. It is to be noted that this fund is the property of the B. C.\nMedical Association, and not the College of Physicians and Surgeons, and is administered\nby the former.\nThe present committee is as follows: Dr. W. E. Ainley, chairman; Dr. M* R. Caver-\nhill, secretary; Dr. A. J. MacLachlan, Dr. Ethlyn Trapp, Dr. D. F. Busteed.\nDoctors Ainley, MacLachlan and Busteed will act as Trustees.\nIt is necessary to form a committee from those who would be immediately available,\nand for this reason they are chosen from the Greater Vancouver and New Westminster\narea. It is the Committee's wish however to have \"corresponding members\" throughout\nthe Province, one to represent each District Medical Society, someone who would be\nin the best position to know and to make it his business to know of anyone who might\nneed help, and bring such cases to the attention of the Committee.\nThis Committee will operate under a set of bylaws drawn up by the B:C.M.A.\nexecutive.\nA complete set of bylaws has been drawn up and will be published later.\nIt may be noted that the fund is not to be considered as insurance nor as a source of\nfunds for refinancing purposes. Aid of any sort is not mandatory but entirely at th*\u00a3\ndiscretion of the committee.\nMEDICAL OFFICES FOR RENT\nSuites Consist of Treatment and Examining Rooms, Office, Laboratory\nand Darkroom, General Office and Waiting Room.\nThis Modern Building has automatic Radiant Oil Heating,\nTile-Tex floors, etc.\nApply\nHOULGATE & SUMMERFIELD LIMITED\nMArine 7749 MArine 2655\nPage One Hundred and Fifty-one THE USE OF RADIOACTIVE ISOTOPES IN\nBIOLOGY AND MEDICINE\nBy SIMEON T. CANTRIL, M.D.\nRead at Vancouver Medical Association 1946 Summer School\nThe recent release of information relative to atomic energy has particularly stressed\nthe importance of these new discoveries to the advancement of knowledge in the fields\nof biology and medicine. Official as well as lay journalism described the revolutionary\ndiscoveries in more healthful living shortly to be unfolded as a result of the splitting of\nthe atom. This stress given to the biological and medical uses of atomic energy would\nseem to be founded on a definite need to foster some purpose other than ghastly destruction in the great effort made during the war to produce atomic bombs. It is perhaps\nmore than mere coincidence that the official release of information on the destructive\neffects of the Bikini experiments was made on the same day that the government released\nthe first quantity of radioactive carbon for the study of the causes underlying neoplastic\ndisease.\nThe flood of information and misinformation on the present and future possibilities\nof atomic energy in understanding and controlling disease has resulted only in conf usion\nand false optimism in the minds of most laymen and physicians who have had no opportunity to view for themselves in proper perspective the actual status of our knowledge\nand the devious paths which lead into a distant future. For this reason those of us who\nhave been close to the medical aspects of the atomic energy program feel very strongly\na responsibility to further informed discussion among the profession and to re-educate\nthe public in competition with irresponsible elements of the press, both lay and professional. For this reason I chose to discuss the subject of radioactive isotopes, hoping thereby\nto bring to you some information which can be useful in analyzing your future reading,\nas well as encouraging you to keep abreast of knowledge in the older and established\nfields of medicine, as I do not see within our lifetime the millennium wherein Hippocrates\nwill perform miracles of cure with a radioactive caduceus.\nIt is altogether true that a great advance has been made in giving to science a new\nand very useful tool in biology and medicine. This cannot be questioned, and I shall\ngive you examples of its usefulness to indicate the manifold possibilities of its application to varied problems in research, many of them having already a practical but indirect\napplication to the treatment of disease. This is the field in which we can look for benefits from atomic energy, rather than the more spectacular one of direct application of\natomic energy or its products to the eradication of disease in the patient. In this latter\nfield both caution and perspective are badly needed. We shall later examine the present\npossibilities of its application as a therapeutic agent and try to envisage future possibilities.\nIt is not appropriate here to enter into a description of the physical means whereby\nscientists have succeeded in harnessing the energy which holds matter together, or\ndescribe in any detail the production of artificially radioactive substances. The accomplishment of these wonders is a tribute to man's ingenuity, if in the end it is not his\ncomplete undoing. It is possible now to produce a radioactive counterpart of practically\nall the elements, and by suitable chemistry to make both inorganic and organic chemical\ncompounds which have these radioactive elements in them. This radioactive counterpart\n\u00bbf an otherwise stable element is called an isotope. They are chemically identical, being\nmerely two species of the same chemical element, having the same atomic number but\na different mass number. The chemical and physiologic properties of the two or more\nforms of the element are identical, providing that the radiations from the radioactive:\nisotope are not sufficiently intense to alter the physiologic effect. By using very small\nquantities of these radioactive isotopes\u2014so called \"tracer\" amounts-^the physiological^\neffect of their irradiation can be ignored, and one can thus use them as \"tagged\" or.\n\"labelled\" substance to study the biochemistry or physiology desired. The great ad-i\nvantage of this method is the relative ease with which extremely minute amounts of an\nPage One Hundred and Fifty-two\na\nM II\ni\u00bb;Hj\n\u25a0!\u00bb.\nft.\nm\nI!\nJ*\nit '\nit*\nelement in its compounds can be detected in the organism or its waste, without resorting\nto elaborate and often impossible analytical chemical assays.\nOne other feature of the radioactive isotopes needs mentioning. This is the duration\nof their state of radioactivity. This is spoken of as the \"half-life\" of the element\u2014\nnamely the time required for one half the atoms initially present to disintegrate by\nconversion to energy. The half-lives of radioactive materials range from fractions\nof a second for the very unstable ones to millions of years for those only slightly unstable.\nFor any one element there may be a choice of isotopes of widely varying half-lives for\nuse in biologic research.\nPerhaps it is well at the outset to give some description of the natural radioactive\nenvironment in which the plant and animal kingdoms have lived and evolved. The\nearth, its soil, rocks, water and atmosphere contain small but measurable quantities\nof radioactivity. These are the radium which starts from one isotope of uranium, the\nactinium series from another isotope of uranium, and the thorium series from thorium.\nThe final product of each series, after radioactive decay, is lead. The earth's crust, for\nexample, contains about 2 x 10-12 grams of radium per gram. The air over most land\nmasses contains redioactivity equivalent to about 1 x 10-16 curies per cubic centimeter.\nThe natural radium content of man is of the order of 0.015 microgram, which is derived\nfrom food and water as products of the soil and atmosphere. Furthermore every living\nthing is continuously subjected to bombardment from radiations coming from the\nremote limits of the universe\u2014the cosmic rays which penetrate all living matter. There\nis thus nothing essentially new in subjecting living matter to either internal or external\nirradiation. We have only learned to increase the number and quantities of these\nradiations and radioactive substances on our own planet. They no doubt exist naturally\nin other reaches of the universe, where in their presence life as we know it would be\nimpossible.\n\u2014\u2014The first hinlngiral \/?\u00a5jv\u00bbriinpnfc tn \/Wprminf i4ip effects of radioactive substances\nwere those made in 1905 with the soluble salt of radium. Soon thereafter experimental\nresearch was begun on the biological effects of radon, mesothorium and its derivatives,\nactinium, polonium and uranium. These were all the radioactive elements existing in\nnature and were also naturally the ones which should first be utilized to determine\nwhether or not they had a biological and therapeutic usefulness. From these early\nexperiments as well as from the later industrial and therapeutic experiments with radium,\nconsiderable information has been built up which is a background for interpretation\nof some of the newer biological effects which are now appearing. Some of the techniques which were utilized in these early days are still applicable. It is of interest that\nthe first radioautographs were made as early as 1925 when Lacassagne studied the\nbiological effects of polonium when introduced into animals. A radio-autograph is\nmade by superimposing the microscopic section of tissue previously impregnated with\nradioactive materials onto a photo plate and thereby obtaining a precise definition of\nthe location of the radioactive materials in tissue. This remains one of the most useful\nmethods to determine the specific uptake of radioactive materials when injected. Other\nmethods of radiobiological assay have been perfected, and include predominantly the\nashing of tissues and a determination of the radioactive content by ionization of electronic measurements. In other instances it is necessary to chemically extract the particular radio-element in question and assay its quantity.\nThe early work with the naturally occurring radioactive elements left little doubt\nthat they had no therapeutic application. Radium, for example, is highly toxic by\nreason of its radioactivity. As much as one microgram deposited within the skeletal\nsystem of man can be lethal and the tolerance concentration of radium in the body is\nof the order of .10 microgram. It is of interest that this is ten times the quantity which.\noccurs naturally due to the ingestion of the natural radioactivity of radium through food\nand water. Apart from the failure o\u00a3 these early experiments to indicate a therapeutic\nusefulness they did lay the ground work for a considerable amount of knowledge concerning the biological effects of radioactive substances. The present status of our\nPage One Hundred and Fifty-three knowledge resulting from the great impetus given to it by the atomic energy program\nis therefore much further ahead because of these early experiments.\nWith the discovery of artificial radioactivity by Curie and Joliot in 1934 a renewed\ninterest was taken in the possible biologic and therapeutic applications of radioactive\nsubstances. When it became evident that the number of elements which could be made\nradioactive was considerably greater, the number of attempts to use these new materials\nwas greatly increased. Until the advent of the chain reacting piles which were developed in the recent atomic energy program the artificially radioactive substances were\nlargely manufactured with the use of the cyclotron. The quantities which could be\nthus manufactured were necessarily limited, inasmuch as the output of energy of the\ncyclotron was far less than that which has more recently become available. The discovery of uranium fission and the development of nuclear physics and chemistry have\ncurrently made available radioactive isotopes for almost all elements. These are commonly referred to as \"fission products\" and are actually by-products of the primary use\nto which the chain reacting piles were placed during the war, namely the manufacture\nof plutonium of which atomic bombs are made. It is important to realize however\nthat before the advent of the atomic energy program during the recent war a large\nbiological and medical literature had accumulated on the use of radioactive isotopes.\nIf one will but search the Index Medicus for the years preceding 1940 he will be somewhat amazed at the number of papers published in which radioactive isotopes were the\nsubject of biological investigation. It seems likely that the security regulations will\nshortly be Hf ted which may permit the publication of the biologic work done in connection with the atomic energy program which will considerably augment the past literature. All of the biologic work done in conection with the program of manufacture\nof atomic bombs was undertaken to have a bearing upon the protection of workers engaged in the project. The number of radioactive elements encountered was such that\nno previous experience indicated their possible toxicity or hazards and only by biologic\nexperimentation could these hazards be ascertained and therefore prevented.\nIt is impossible at this time to make any complete summary of the experimental\nwork about artificially produced radio elements. Examples of this work however will\nserve to indicate the lines of research which have been followed, both for the academic\nknowledge which they are intended to give, and for the practical application which they\nmay have in therapeutics.\nThe first of the radio-elements which received wide'study was radio-phosphorus.\nRadioactive phosphorus was first made by bombarding P31 with heavy hydrogen in the\ncyclotron by which mechanism it was converted to P32, or the radioactive isotope of\nphosphorus. The half-life of this isotope is 14.3 days. During its decay it emits beta\nradiation of considerable energy. Since phosphorus itself is an element common to the\norganism tracer amounts could be utilized without in themselves producing a chemical\ntoxic effect. It was found that radio-phosphorus was selectively taken up by bone,\nbone marrow, lymphoid and other rapidly growing tissues. These tissues were therefore\nselectively irradiated. Knowing the energy emitted by the radio-phosphorus during its\nperiod of decay it was therefore possible to compute the dose delivered per cubic centimeter of tissue which selectively deposited the isotope. It was also possible to study not\nonly the absorption but the excretion of radio-phosphorus via the urine, bile, and feces.\nThe selective absorption of radio-phosphorus in tissues concerned with hematopoiesis\nearly suggested its possible application in the treatment of blood dyscrasias and the allied\ndiseases of the lymphoma group. The use of radio-phosphorus in the management of\nthe leukemias and allied diseases is however more complicated than it appears on the surface. Early work indicated that the amount of radiorphosphorus retained by the body\nfrom a given total amount injected is considerably higher when the element is administered in small fractions than when given in a single large dose. The utilization of\nphosphorus depends upon the need of tissues for this metabolite, and the need is greatest\nduring an active mitotic stage of the disease. The body is incapable of utilizing more\nphosphorus than its daily requirement so that small repeated doses result in better utilization than when larger doses are given which may further depress erythropoietic activity\nPage One Hundred and Fifty-four\nii\n\\<\n\u00bb\n3\n\u00ab' 4\n,f\ni*\n\"4\u00ab\nm \u25a0i\">\nm\nwhen anemia may already be a complication of the leukemia. Those who have used\nradio-phosphorus have repeatedly warned that in the presence of anemia the initial\ntherapy may so depress the bone marrow that further improvement is thwarted. The\nmethod of therapy now commonly used, is the so called fractional method, by which\nsmall increment doses of radio-phosphorus are administered intravenously at weekly\nintervals until satisfactory remission is obtained. In this respect the blood picture is\nnot the only guide to therapy, but as in the management of leukemic patients by\nroentgentherapy one relies heavily upon improvement in the general condition of the\npatient irrespective of his leukocytosis. Increment doses range for 500 to 3000 micro-\ncuries, the exact dose depending upon the reaction of the patient and the disease to doses\ngiven. It was not expected that radio-phosphorus would be a curative agent in the\ntreatment of the leukemias or lymphomas. Previous experience with roentgenotherapy\nindicated that considerable improvement could be obtained and that the patient's life\nspan although not appreciably lengthened could be a more comfortable one. Experience\nwith radio-phosphorus has now covered a period of some 10 years. It is evident from\nthe analysis of reports by those groups having the m<\n.1\nof an inflated balloon with the nozzle inserted in One nostril, while holding the other\nclosed to raise nasopharyngeal pressure during swallowing.\nIn order to prevent inconvenience and disability to passengers the rate of descent\nhas been limited to 500 feet per minute on commercial lines, and because of the\nfact that the tubes open less easily in the lying than in the erect position, and swallowing\noccurs only about once a minute during sleep, passengers should be awakened during\ndescent.\nThe presence of any known chronic difficulty in opening the tubes or any acute\ninflammatory condition involving the nasopharynx should serve as a warning either to\nremain at normal pressures or to be prepared for difficulty by having various means\nat hand to aid in opening of the tubes.\nPractical methods for testing Eustachian tube function objectively are of value,\nboth in clinical practice and in the selection of personnel for occupations at abnormal\nbarometric pressures.\nTests which have long been available are:\n1. Valsalva's manoeuvre using the auscultation tube to hear the click as the tube\nopens or observing the drum for the bulging that occurs as air is forced into the middle\near. The pressure normally required is 20 to 40 mm.. Hg. with the individual in erect\nposition. Exercise causes the tube to open more easily and while in the lying position\nthe resistance to inflation is increased.\nThe pressure can be measured easily by attaching a nasal bulb and tube to the\nmanometer used in reading blood pressures, the pressure exerted by the Valsalva test\ncan then be read off on the manometer. This simple test is of especial value where\nthe complaints suggest an abnormally patent tube, since the tube would then be either\nconstantly open or open on slight pressure.\n2. By observing the drum through a Siegel's speculum it can be seen if the bulge\ncaused by the Valsalva test is relieved by swallowing.\n3. If the bulging isn't relieved by simple swallowing Toynbee's manoeuvre may be\ntried.\n4. If these methods fail Politerization may be tried during phonation or swallowing.\nWhile these methods have been of practical value in experienced hands the demands\nof aviation in particular have demonstrated a need for more accurate methods, and the\nfollowing have been developed.\n1. Zoellner's method of measuring the pressure necessary in the nasopharynx to\nopen the tube during swallowing, as compared to the normal of 0.5 to 4.0 mm. of\nmercury.\n2. The pneumophone (Van Dishoeck) by which the middle ear pressure can be\nestimated and the presence of an abnormal pressure detected, thereby indicating a\nfailure of tubal function.\n3. A combination of these two principles in an apparatus devised by Perlman, which\nallows for making either of these determinations as well as the pressure necessary to open\nthe tube by Valsalva's manoeuvre. This apparatus also provides for inflation of the\ntubes during swallowing and is useful for therapy, particularly in children.\nClinical Application\nWhile these methods have a place in evaluating the degree of abnormal function the\ninformation gained from the clinical history, hearing tests and observation of the drum\nprovide the most practical indication of the existence of tubal dysfunction.\nA convenient method for classification of clinical states based upon disturbances\nof tubal function is as follows:\n1. Disease due to failure to compensate for rapid changes in barometric pressure,\na. Acute aero-otitis media or acute barotrauma.\nThis term refers to the changes in the middle ear resulting from failure of the tube\nto open during the increase of external air pressure, for instance during descent in an\nPage One Hundred and Sixty-three aeroplane or compression in a pressure chamber. It may occur in the presence of normal\ntubal functions if the tubes are not opened voluntarily, or in tubes with impairment of\nfunction of an acute or chronic nature.\nWhen the pressure difference reaches about 80 mm. Hg. the tubes cannot be opened\nvoluntarily, and pressure can only be equalized by returning to the former altitude\nor by Politzerization. Great pressure differences tend to cause haemorrhages in the middle\near mucosa and accumulation of fluid in the air spaces. Rupture of the drum and middle\near infection are infrequent.\nTreatment consists of equalization of pressure by the Eustachian catheter or Politzerization and the use of vasconstrictors in the nasopharynx.\nAbout two weeks are required for complete recovery.\nb. Repeated attacks of aero-otitis or barotrauma apparently lead to chronic\nchanges in the middle ear with symptoms of blockage, head noises and difficulty in\nclearing the ears by opening the tubes. The type of deafness is usually a combination\nof inner ear and conduction types. The inner ear component may be due in part to\nacoustic trauma, but may also occur in caisson workers who have not been exposed to\nacoustic, trauma, apparently as an effect of caisson disease.\n2. Disease occurring at normal barometric pressures:\na. Abnormal patency.\nJago5 of Cornwall in 1867,. Rumbold11 of St. Louis in 1873 and Perlman12 of\nChicago in 1939 have presented accurate observations on abnormal patency. The condition may vary in degree from a tube which opens more easily than normally to one\nwhich is continuously open while patient is in the erect position.\nSuch a tube fails to protect the middle ear from noises and pressure changes during\nrespiration, sneezing, coughing and phonation.\nThe continuously open tube may be diagnosed by observing movements of the drum\non respiration, facilitated by use of a Siegel's speculum and by autophony (nasal sounds\nmay be clearly heard through an auscultation tube from the patient's ear). Hearing\nis impaired.\nOne patient was observed to keep the nasopharynx closed involuntarily during\nspeech (rhinolalia clausa) apparently to protect the ears and as soon as the tubes were\nclosed the speech became normal.\nSuch patients hear well when in the lying position. Lesser degrees of abnormal\npatency may be detected objectively by measuring the pressure necessary to inflate the\ntubes by Valsalva's method. Pressures of over 15 mm. Hg. are normally required.\nAbnormal patency is not common. It has been observed in women who have lost\nweight rapidly, also in some stages of a subacute pharyngitis, and following retrogas-\nserian neurectomy.\nTreatment by insufflation of a small amount of boric and salicylic powder, equal\nparts through a Eustachian catheter gives immediate relief lasting several days. Attention to the predisposing factor such as loss of weight is indicated.\nb. Obstruction of the Eustachian tube.\nVarying degrees of obstruction may occur. Complete obstruction to the degree\nwhich resists all attempts at producing a passage by inflation or bouginage is rare, but\ndoes occur.\nEtiology. In childhood the common predisposing cause for tubal obstruction is\nhypertrophied pharyngeal tonsil (adenoids). The obstruction is due mainly to apposition of the mass of lymphoid tissue to the torus tubarius and to the tubal orifice. Lymphoid tissue within the tubal orifice is also reported to be a frequent occurrence, by the\nJohns Hopkins group. Less frequently tubal blockage may be caused by an allergic\nreaction in the upper respiratory tract and also any chronic inflammatory reaction due\nto the purulent drainage from the nose and sinuses. The occurrence of cleft palate\nand primary atrophic rhinitis also predispose to interference with tubal function.\nIn the adult, tubal obstruction is usually of the chronic variety and can be traced\nPage One Hundred and Sixty-four\nt%\nI: ftHl\n1?\nIS\ni\nft\nti'*'\nIk.\n-9\nW\nback to an origin in childhood. The degree of obstruction may gradually increase over\na period of years, and only in adult life reach the stage of producing serious impairment\nof the auditory apparatus.\nObstruction may also develop first in adult life. It is a characteristic accompaniment of tumors in the nasopharynx and may appear during a prolonged allergic reaction\nor sinus suppuration, or may follow a severe acute inflammatory episode.\nLymphoid tissue has been thought to occur in adult tubes also and produce obstruction. The presence of such tissue in adult tubes has not been satisfactorily demonstrated although the obstruction caused in childhood years may persist after the lymphoid tissue has regressed.\nClinical Course. A mild degree of obstruction produces a lowering of air pressure in\nthe middle ear and impaired hearing due to the tension exerted on the drum and ossicular\nchain. Such a degree of obstruction is never complained of by a child and will rarely\nbe detected without a careful and skilled examination.\nIn the adult, acute obstruction of this degree causes subjective sense of blockage\nand hearing impairment whereas in the chronic state there may only be mild symptoms.\nA further degree of obstruction results not only in failure of admitting air but in accumulation of fluid in the middle ear and its connecting air cell system. Such fluid is in\npart mucus secreted by glands of the tube and the epithelial lining and may be transparent and viscous, or it may have more characteristics of an exudate, with a yellowish\ncolor and a high-protein content. A small amount of fluid may be easily detected by\nthe appearance of fluid lines through the drum, but as obstruction increases all air\ndisappears and the middle ear and cell system become completely filled with fluid.\nThe presence of chronic tubal obstruction appears to be associated in many cases\nwith decreased resistance against invasion by infection from the pharynx.\nThe obstruction is always increased during infection at the nasopharyngeal orifice\nand fluid is likely to accumulate in the middle ear cell system at that time. Regression\nof the infection may allow the fluid to be removed and the middle ear again become\naerated in a period of two to four weeks, but with.repeated attacks or with increasing\nobstruction aeration of the middle ear may not return. The middle ear system may\nremain filled with sterile fluid for months or even years.\nFibroplastic changes are likely to occur in such ears leading to permanent impairment\nto the action of the conclusion mechanism, so that eventually removal of the fluid and\nimprovement of tubal function will fail to bring the hearing back to its former level.\nThe tendency for recurrent attacks of either non-suppurative or suppurative otitis\nmedia to occur in such ears also predisposes to fibro-plastic changes in the middle ear\nresulting in irreversible hearing impairment.\nChronic tubal obstruction predisposes to formation of an attic cholesteatoma, through\nprolonged retraction of Shrapnel's membrane and accumulation of desquamated epithelium in the pocket thus formed. During an acute exacerbation of middle ear inflammation the process of desquamation speeds up, the accumulation increases, becomes secondarily infected, attic suppuration occurs and the beginning of an attic cholesteatoma\nis established.\nDiagnosis. In the adult the early degree of chronic obstruction causes subjective\nimpairment of function which is most noticeable with upper respiratory infections and\nmay cause difficulty during flying. Objectively there may be retraction of the drum\nand measureable impairment of hearing for low tones. The pneumophone reading\nshows decreased middle ear pressure.\nImpairment of ability to open the tubes may be demonstrated on such tests as Valsalva, swallowing, Toynbee, and the pressure required to inflate during, swallowing.\nIn a later stage when the middle ear is filled with fluid there is hearing loss for high\nand low tones, middle ear pressure may be normal (pneumophone) and the patient\ncannot inflate the tubes.\nPage One Hundred and Sixty-five Wi\n'rema\/rm\n.AT THE MENOPAUSE\nHIGHLY POTENT\nORALLY ACTIVE\nNATURALLY OCCURRING\nESSENTIALLY SAFE\nWATER SOLUBLE\nWELL TOLERATED\nIMPARTS A EEELING\nOF WELL BEING\nconjugated oestrogenic substances (equine)\nsupplied in two strengths:\nNo. 866\u2014 1.25 mg. per tablet\nNo. 867 \u2014 0.625 mg. per tablet\nBoth strengths are supplied in bottles of 20 and 100\nAYERST, McKENNA & HARRISON LIMITED\nBiological and Pharmaceutical Chemists\nMONTREAL CANADA LABORATORIES OF CANADA, Ltd., 64-66 Gerrartl Street, East, Toronto, Ontario TOPICAL CHEMOTHERAPY\nin oropharyngeal infections\nPrompt and long sustained in effect, the sulfonamide is\nmaintained in intimate therapeutically effective concentration\nthroughout the entire oropharyngeal area.\nSystemic absorption is negligible even in maximal dosage,\ntherefore likelihood of systemic toxic reactions is virtually\nobviated.\nFull stability, and therefore potency, is retained under all\nconditions.\nIts clinical value in the topical treatment of oropharyngeal\ninfections has been established by longer professional use\nthan any other local chemotherapeutic or antibiotic agent.\nEach tablet contains 3% grs. (0.25 Gm.) of sulfathiazole.\nSupplied in packages of 24 tablets, sanitaped, in slip-sleeve\nprescription boxes.\nIMPORTANT: Please note that your patient requires your prescription\nto obtain this product from the pharmacist.\nulfathiazoleoum\n\u2022' J\nt';\n\u25a0 '- .\n1 ,\n' H t]\n- 1\n> \u00a7 -.\ni \u25a0>.\n\u25a0 \u25a0' '\u25a0\nt '\nI ii i\nf *\nSK|\n' $ j I\nW i\nu i\n*\n1 ,\nH1 *\n*,\n5 L (\ni\n* \u25a0 i\n' i\". ^\ny >\n' ?*1\n\u00bb... ,i\nj 119\nir\n**#\n\u2022'\n1! 'V\nill\ni\n: i I\n17,\nK A i\n^ ji\n\u2022:(?\n^H\n<\u00bbi\n> \u25a0\n> fe j\nu '\nJ. f i\nr>\n*fi!\nr\n\u25a0 a\n\u25a0 i\nMi!\nH i *\n$4 * '\n\u25a0? . *\u2022\nJ '^\nr\u00abM\n* ' *\ni\ni\n-\nm\nt \u00bb\n\u25a0\n\u2022 i\ne *\n'5\ni\n\u2022'*\nf(\nv 1\nJ** \u00bb\u25a0'\nj\u00a3\nlb\ni\n\u00abi|\nL (i\ni\n|i^\n\u2022 i\n< ii\nL\n^^^ Ji.\nannouncing.\na New\nChemotherapeutic\nAgent\nThe nitrofurans, a new class of antibacterials,\nare a recent discovery of Eaton Laboratories1:\nOne, especially, is highly effective. This has\nbeen named Furadn,\n,n\nCHNNHCONH,\nFuracin is bacteriostatic and bactericidal to\nmany gram-positive and gram-negative bacteria, and remains effective in the presence of\nbody fluids It is stable and low in toxicity\nit\n,o,\nW\nFirst Available in\nFURACIN\nSOLUBLE\nDRESSING\nIndications:\n.ft^\n1.\nDodd, M. C and Still man,\nW. B., J. Pharmacol. & Ex-\nper. Therap. 82:11,1944.\n2. Snyder, M. L., Kiehn, C. L.\nChristopherson, J. W., Military Surgeon P7:380, 1945.\n3. To be published.\nDissolved in a bland, water-soluble base,\nFuracin is first presented in Furacin Soluble\nDressing, for topical treatment of wound and\nsurface infections. This preparation liquefies\nat body temperature and is soluble in blood,\npus and serum, which aids penetration to all\nparts of wounds. It is non-irritating, has a low\nindex of sensitization and does not interfere\nwith healing processes.\nThe outstanding results of clinical trials in\nboth military2 and civilian3 practice indicate,\nthat it possesses important advantages in comparison with sulfonamides and penicillin used\ntopically.\nInfected surface wounds, or for the prevention\nof such infection\u2014infections of third and\nfourth degree burns\u2014carbuncles and abscesses\nafter surgical intervention\u2014infected varicose\nulcers\u2014superficial ulcers of diabetics\u2014secondary infections of eczemas\u2014impetigo of infants\nand adults\u2014treatment of graft sites preparatory to skin grafting, and later, to prevent\ninfection\u2014osteomyelitis associated with\ncompound fractures\u2014secondary infections of\ndermatophytes.\nFor * further information,\naddress: Canadian Office,\n77 Wellington Street West,\nToronto, Ontario. Attention\nMedical Director.\nNow available in Canada, through your regular source of supply. 3-47 The diagnosis of fluid filling the middle ear space is made on the transparent, faintly\nyellowish appearance of the drum with the narrow chalky appearance of the handle of\nthe malleus. Such a drum, if not retracted or distorted and not reddened is invariably\nthought to be normal by the inadequately trained observer. An X-ray examination\nshows diffuse clouding of the cell system.\nThis is the characteristic condition in tubal obstruction due to tumor and in obstruction due to adenoid hypertrophy in children. In the child it is unfortunately the fact\nthat all degrees of tubal obstruction up to, and including, complete filling of middle\near space with fluid, if affecting only one ear, produce no complaint and require for\ndetection unusual care and skill on the part of the examiner. The child makes no\ncomplaint unless pain occurs and hearing impairment is only detected by the parents\nwhen both ears are involved. As the child gets old enough to respond the hearing test\nwill confirm the diagnosis.\nWhen fibrotic changes have developed in the middle ear the diagnosis is made more\neasily by the presence of distortion, retraction and possible scars due to former suppurative episodes but this represents an advanced stage of the condition when restitution\nto normal function is no longer possible.\nSimple tubal obstruction with decreased air pressure in the middle ear produces\nimpaired hearing for air conducted sounds of frequencies up to about 2000. The stiffness of the conducting mechanism has been increased by the unequal pressure on the\ndrum. Tubal obstruction with complete filling by fluid causes both a low and high\ntone impairment. The middle ear pressure may become normal as the air is all displaced\nby fluid. >J.ti;\nFibrotic changes in the middle ear are accompanied by conduction impairment for low\nand high tones.\nTreatment. Once the diagnosis has been made the treatment is relatively simple.\nHypertrophied adenoids are removed surgically. When the tubal obstruction is in\nthe early stage the tubes usually open up within a month afterwards and if the child is\nold enough to respond to tests the hearing will be shown to be normal.\nFailure of the tubes to open, or recurrence of lymphoid hyperplasia, common in\nthe young child, is usually an indication for radiation therapy. When tubal dysfunction\nis associated with fibrotic middle ear changes radiation may be tried as well as adenoid-\nectomy and inflation of the tubes.\nThe type of radiation therapy which has met with greatest approval is the radium\napplicator applied by way of the nose to the mouth of the tube as developed by Crowe13\nand co-workers of Johns Hopkins Hospital. Since obstruction usually occurs at the\npharyngeal orifice this method is more direct than deep X-ray therapy. The dosage\nworked out at Johns Hopkins Hospital appears to be safe and satisfactory.\nThe results depend upon the nature and stage of tubal occlusion. Simple occlusion\nwith middle ear system filled with fluid may exist for several months and yet restitution\nto almost normal hearing be possible. The presence of fibrotic changes in the middle\near may however permit only partial restoration.\nAdults with blockage due to nasopharyngeal carcinoma usually have restoration of\ntubal function and normal hearing after deep X-ray therapy although obstruction was\nof many months duration.\nAn exudative catarrh (middle ear system filled with fluid) may be brought on by\nan allergic state or by upper respiratory infections. In such cases a chronic tubal impairment is usually a predisposing factor.\nFailure of tubes to open up in the adult is an indication for direct treatment.\nRemoval of the fluid from the middle ear by myringotomy and inflation may be necessary. Myringotomy is seldom required in the child. In advanced obstruction in adults\nthe use of a bougie in skilled hands may give definite improvement.\nThe state of tubal function and the future welfare of the ear as an organ of hearing\nPage One Hundred and Sixty-six it\nt-i\n4 \\n\nA\ni.i\nI\nit'\nII\nis often decided in early childhood years, at a time when no subjective complaint will\nbe offered short of actual pain.\nThe detection of impaired function in early years usually depends upon the examiner's ability to detect certain signs of tubal blockage on otoscopic examination. Unfortunately these signs are likely to escape detection except by the specially trained observer.\nAs the child becomes old enough to respond reliably the hearing test becomes an important part of the examination.\nThe cessation of aural discharge, with healing and disappearance of redness of the\ndrum which occurs almost universally under adequate chemotherapeutic treatment is\nnot a reliable indication that tubal function has been restored.\nCare must always be taken to detect and correct those conditions which produce\ntubal impairment and predispose to slowly developing middle ear damage and irreversible\nimpairment of hearing.\nBIBLIOGRAPHY\n1. Politzer, Adam: Geschichte der Ohrenheilkunde, Stuttgart, S. Enke, 1907-13.\n2. Rich, Arnold Rice: Physiologic Study of the Eustachian Tube and Its Related Muscles, Bull. Johns\nHopkins Hosp. 31: 206, (June) 1920.\n3. Toynbee, J.: Proc Roy. Soc. London, 6: 286, 1853.\n4. Politzer, A.: Textbook of the Diseases of the Ear. Ed. 3, translation by O. Dodd, p. 63. Philadelphia:\nLea Brothers and Co., 1894.\n5. Jago, J.: Brit, and For. Med. Chir. Rev., 34: 175 and 496, 1867.\n6. Hartmann, A.: Experimentelle Studien uber die Funktion der Eustachischen Rohre. Leipzig: Vert. u.\ncomp., 1879.\n7. Zoellner, F.: Archiv. f. Ohren-Nasen-u Kehlkopfh., 140: 137, 1936.\n8. Van Dishoeck, H. A. E.: Negative Pressure and Loss of Hearing in Tubal Catarrh, Act. Oto-laryng.,\nbt: 303, 1941.\n9. Perlman, H. B.: Quantitative Tubal Function, Arch. Otolaryng. 38: 453-465, 1943.\n10. Armstrong, H. G., and Heim, J. W.: Effect of Flight on the Middle Ear, J. A. M. A. 109: 417\n(Aug. 7) 1937.\n11. Rumhold, T. E.: The Function of the Eustachian Tube. St. Louis: Southwestern Book and Publishing\nCo., 1873.\n12. Perlman, H. B.: The Eustachian Tube, Abnormal Patency and Normal Physiologic State, Arch.\nOtolaryng., 30: 212-238, 1939.\n13. Crowe, S. J. and Burnam, Curtis F.: Recognition, Treatment and Prevention of Hearing Impairment\nin Children, Ann. Oto. Rhin. & Laryng., 50: 15-31, (March) 1941. and Crowe, S. J.: Local Use\nof Sulfadiazene Solution; Radon, Tyrothricin and Penicillin in Otolaryngology, Ann. Otol. Rbin.\n& Laryng. 53: 227-241 (June) 1944.\nPage One Hundred and sixty-Seven INJURIES OF THE FACE AND JAW\nBy DR. ROBERT G. LANGSTON\n(at V.M.A. Meeting of January 7th, 1947)\nThe title that I have taken for my paper tonight\u2014\"Injuries of the Face and Jaw\",\nmay better have been \"War Injuries to the Face.\" It is based upon cases treated personally in the past five years as a member of a Maxillo-Facial division of the Ministry\nof Health of Great Britain and later of the Department of Veterans' Affairs.\nAfter some thought, I discarded the academic approach to the subject, dispensing\nwith the usual form of a rigid classification\u2014physical signs, examination, treatment\nand prognosis, etc. I decided rather to treat the subject more from a practical clinical\nview point. In this way, I hope that I may give those having a face wound to treat,\na practical point or so that will be of use. If I can share with you some of the methods\nof procedure that have evolved during the past 5 years, I shall be pleased. After all, it\nmakes little difference whether the wound was caused by a shell splinter or a splinter\nfrom a shattered windshield\u2014they are both mutilating to human tissues and require\nalmost identical treatment.\nIn round figures there were 600 faces to draw from, with 1100 operations\u2014averaging almost 2 operations to the case. Of this number there were 240 fractured mandibles\nand 75 fractured maxillae\u2014not including the simple malar fractures. In reviewing the\ncase histories, one can see a gradual change in method of treatment with a much more\nmarked improvement in the results\u2014both in the time of convalescence and the final\ncosmetic result. I believe this improvement was accomplished by:\n1. Acquired knowledge and familiarity with injury and complications.\n2. Standardization of procedures in conjunction with one's fellow surgeons in the\nsame unit, as well as a competitive spirit with other units.\n3. Newer methods of treatment, particularly the introduction of Penicillin\u2014advance in methods of anaesthesia and development of better means of fixation in case of\nfractures.\nFacial surgery has some aspects and principles that are peculiar to itself. Being so\nclose to the oral and nasal orifices, it must at all times be considered an infected area\u2014\nOccasionally there is an exception to this axiom. Practically, all wounds involve the\nmuscles of expression\u2014in repair, this must be considered as well as some appreciation\nof the final cosmetic result. Where a wound enters the oral or nasal cavity, one must\nrealize that it is very important to close the wound on the inner side as well as on the\nouter. The abundant blood supply, and especially the excellent venous return, make it\npossible to carry out procedures impossible elsewhere in the body. Finally, the close\nproximity of vital structures, eye, nerves, large vessels, parotid, etc must be remembered.\nIf the sight of one eye has already been lost, the other eye appears to be particularly\nvulnerable to mishap.\nIn starting a discussion of this kind, it is usual to get everything down in an orderly\nclassification. This can be done and there are several ways of classifying face wounds.\nBut I think little can be gained by such a system, so I am going to proceed with a\ndescription of what I think is the best procedure in the treatment of a compound comminuted fracture of the face. This can then be modified to cover any lesser type of\nfacial injury. There is one exception and that is fracture of the jaws, which will be\ndealt with separately.\nOn initial examination, one attempts to assess the magnitude of the injury. I think\nit is safe to say that one almost invariably underestimates the amount of damage done.\nX-ray is of some aid, but not as much as elsewhere in the body, certainly one does not\nwait for it, if there is a suspicion of continuing haemorrhage. However, should there be\nsigns of skull or brain damage, the value of x-ray increases. The ability of the patient\nto stand operation should be estimated, haemorrhage and\/or respiratory embarassment\nbeing the more important factors. The latter is usually relieved by the anaesthetist. And\n\u25a0r^w~ Page One Hundred and Sixty-eight\n'<* .Xh\nfe.\nI \u2022\nthis brings me to an important part, the role of the anaesthetist in facial injury. His\nwork is equal to that of the surgeon and at times is more life-saving. As soon as the\ndecision is made to operate, the patient is turned over to the anaesthetist. He examines\nheart, lungs, B.P. and haemoglobin and makes his decision on the type of anaesthetic.\nA big percentage of facial cases have swallowed and inhaled blood-, mucous and sometimes foreign bodies. If the chin or upper neck has been lost, or the tongue badly\nlacerated, the patient will be having respiratory embarrassment. The usual anaesthetic\nis Pentothal induction followed by Cyclopropane and oxygen until the patient is relaxed.\nThen laryngoscopy is done, a McGill endo-tracheal tube inserted, and larynx and\nbronchi cleaned of all mucus and blood. Occasionally it is necessary for the anaesthetist to do a bronchoscopy at this stage to get the lungs dry. As soon as this toilet\nis done, the pharynx is packed tightly and the anaesthetic continued away from the\nvicinity of the head on a closed circuit. If his condition was poor to start with, the\npatient now greatly improves. Heart and respirations become normal almost immediately. Also the surgeon is able to proceed deliberately with his work, with perfect\nfreedom and relaxation.\nI want to pause here a minute to pay my respects to the anaesthetist.\nTry to picture a face that feels and looks like a bag of jelly with an odour which is\npeculiarly nauseating because it is 48 hours since wounding, a patient that is apprehensive\nand sick of himself because of this B. Coli odour and the fear that he will never look\nlike a human being again. His lungs and bronchi are full of pus and blood and you can\nhear his rales all over the ward, saliva is streaming down his torn lips and \"his chin\nis resting on his sternum, his colour is terrible and he is begging for a drink.** In this\ncondition, he is taken to the operating room and the anaesthetist takes over. In about\nhalf an hour, he is breathing quietly, dry and of a healthy pink colour, ready for operation.\n\"All open face wounds, regardless of age or condition of infection, should be treated\nby surgery**. That is a sweeping statement to make, but I have yet to see one that\nhas been improved by waiting. If blood is urgently needed, it can be given while the\noperation proceeds; most surely a severe infection or cellulitis needs adequate and radical\ndrainage and the anaesthetist invariably benefits the case of respiratory embarrassment.\nIn operating, one should proceed with despatch and thoroughness. First, the face\nand open part of the wound should be thoroughly cleaned, removing all foreign bodies\nin the skin and the wound. There should be no hesitation in using a brush and excision\nif necessary to rid the wound of powder marks, road dirt, pieces of wood or other\ndebris. There is a commercial demulcent\u2014called C. tab\u2014cetyl-tri-methyl ammonium\nbromide that is much superior to soap. It cleans better, is less irritating and is far\nsuperior as a skin antiseptic There is no danger in using this around the eyes or nose.\nAfter this scrubbing, the wound is flushed with saline and debridement done. The\nlatter should be minimal and confined to entirely devitalized tags of tissue. About the\nface, one is safe to save as much as possible because of the vascularity. This, however,\ndoes not apply to bone fragments. The bones of the face are thin and fracture like\nan egg-shell. A concerted effort must be made to remove all loose pieces. At times,\nwhen getting up into the region of the ethmoids, sphenoids and palatine bones, one\nwonders when to stop. But, unless a complete removal of all loose fragments is made,\na draining sinus is most surely to result which will be traced to a sequestrum or a catgut\nsuture. There is quite an effective way to remove small fragments of bone. Pack the\nwound with dry gauze and then twist it as it is removed. The pieces of bone catch in\nthe cotton meshes.\nAfter this is done, the next step is to identify and separate the different layers.\nThe skin edges must always be undercut and sometimes fairly widely undermined. It is\nwise, also, to loosen the edges of the muscle layers, so that they may be brought together.\nWhen the wound involves the mucous membrane, it should be treated as one does\nthe skin layer and be undermined fairly widely.\nPage One Hundred and Sixty-nine Haemostasis. Bleeding is usually profuse at first and should be controlled as one goes\nalong, by haemostats. But I think it is a mistake to put a ligature around every bleeding\npoint immediately. I like to leave the haemostats on until just before starting to\nclose; and then take them off\u2014often twisting them while doing so. I believe that\n90% of the bleeding can be controlled this way. Those that continue to bleed are\ncaught a second time and ligatured with 4 or 5'0' plain catgut. The less catgut that one\nleaves in an infected wound, the less likely it is to break down. This is important, as\nalong with pieces of dead bone, catgut is an arch offender as a cause of a persistent\ndraining sinus.\nJust before the closure is started, a dusting of the wound with 50,000 to 100,000\nunits of Ca. Penicillin is made. I have used sulpha compounds alone, later incorporated\nwith Penicillin powder, but I am firmly of the opinion that sulpha used locally does\nno good and may cause some harm. If sulpha therapy is indicated, it should be confined\nto systemic administration and never used locally.\nAlso, before starting closure, one should attempt to orientate all separate flaps and\nfind out where they belong. The axiom of Sir Harold Gillies, to return normal to\nnormal as a first step in facial repair is a good way to proceed. First the mucous\nmembrane layer is sutured, putting the catgut suture knots on the oral side. This layer\nshould be tightly closed, draining if necessary, outwards. After the mucous membrane,\nthe muscle layers come next. These should be accurately approximated and as far as\npossible, returned to their normal position. This is often impossible, if the wound is\nragged and lacerated. The muscle layer is held in position by the minimum number\nof fine plain catgut sutures, tied loosely so as to accomplish approximation without\nseriously cutting off blood circulation. At this stage, it is wise to insert a Penrose\ndrain below the layer of the sutured muscle.\nThe next layer is the skin. Those edges that can be returned to their normal positions are first sutured and the remaining defect will be a measure of the skin loss. For\nclosing this defect, one of the methods presently to be discussed should be used. The\nskin suturing should be carefully done, using fine braided silk or stainless steel wire\non a fine cutting needle. Care should be used to see that all edges are everted. Better\nresults will be obtained by using many fine stitches close to the skin edges rather than\nheavier sutures with skin edges gaping between them. Another precaution, is to avoid\nbruising or pinching the skin edges. Small minute haematomata form\u2014followed by\noedema and finally a minute gangrenous area, at a place where healing by primary intention is important. Another drain is inserted below the skin layer along with the deep\nlayer drain. Finally a firm elastic pressure dressing is applied. The patient is turned\nback to the anaesthetist, who uses particular care to clear the pharynx and bronchi of\nany blood or secretion, so that he returns to the ward, in good color, breathing quietly\nand with all wounds closed. The drains are only safety valves and can be removed in\n24 hours. One is always surprised at how well and appreciative the patient feels the\nnext day.\nMethods of replacing skin losses at the time of the initial operation. After one has\nestimated the amount of skin loss\u2014there are several recognized ways of dealing with\nit. One should never succumb to the temptation to cover the defect with a sterile\ndressing with an idea of returning later or allowing it to granulate. It is much better\nto shave off a piece of split skin from upper arm or leg and apply it as a dressing.\nShould the defect prove small, it may be possible by widely underniining of the\nskin, to suture it directly. This is often possible, but care should be taken that there\nis very little tension on the skin sutures. The wound is potentially infected and this\ntype of wound edge does not hold if there is tension. The second method of procedure\nis the rotation flap and this, on the face, can be very successful. It needs careful\nplanning before execution and it requires a certain amount of experience to execute.\nEssentially, the principle is to utilize skin that is available in excess, and adjacent to the\nwound, and then to close the secondary defect by undermining and under tension. The\nPage One Hundred and Seventy\n?*\n\u25a0I\n\u25a0;;* ,\u00ab\nI'\ni i\nI\nIf\n1\n*Hf\ni\nii\nt\u00bb\n.\u00bb\nflt\nmoving picture to follow will show one of these flaps. A third method is the use of\na pedicle flap\u2014usually brought from the forehead down. These are particularly valuable when the defect is m the region of the nose or the upper cheeks. A fourth method\nof temporarily closing a defect where it involves a cavity, such as lips, lower cheek or\nnostril, is the mucous membrane to skin suture. Here, both the skin and >mucous membrane are undermined and then pulled over the edge of the wound and sutured. This\nis a most valuable procedure, especially where a complete lower lip is lost and one does\nnot feel equal to, or the patient cannot stand, a double rotation flap from .the cheeks.\nIt is also valuable when a complete nasal ala is lost and until a lined forehead flap is\nprepared. And finally, there is the method already mentioned, of filling the defect\nwith a split skin graft. This will be a permanent dressing until one is able to plan\nand prepare a more pleasing and satisfactory repair.\nWhere there has been a great loss of muscle and bone, it may be impossible to fill\nthe defect. The best procedure is to pack the cavity with vaseline mesh unless there\nis skin available, when a pack of Whitehead varnish may be packed into the cavity\nwith some protruding into the mouth where it is later removed. Later, bone grafting\nmay be done or the cavity filled by a tantalum plate. This latter is especially applicable\nto the forehead or skull.\nThis closed treatment of infected and granulating face wounds has proven a big\nadvance over the open treatment. One who has been brought up in the \"drain*', if in\ndoubt*' school had many sleepless nights when he first tried it, along with his colleague, in our unit. But the results have justified the method. There is much less scar\ncontracture and the patients have been much more comfortable. They feel better immediately, the temperature comes down and the swelling comes down rapidly. The\nsnug elastic, well-padded dressings are important. I do not wish to convey that all\nthe stitches hold\u2014usually some give away. But there is very little gaping, and healing\nis rapid. The sinuses, where the drains were removed, discharge for a few days and\nthey may need closure 10 to 14 days later. But this is usually excision and suturing\nonly. A secondary, but important consideration, is the mental effect upon the patient.\nHe comes in acutely distressed, physically and mentally; and very much depressed. His\nface is a large, fungating, stinking cavity with saliva drooling away uncontrolled.\nBreathing is difficult because of blood, mucus and secretion in the throat and bronchi.\nHe is thirsty, and to drink makes him worse. . Then he is operated upon. When he\nawakes, he is dry, breathing easily and he has some semblance of a face. His nightmare\nhas passed.\nFractures of the Jaw\nThis is one type of injury of the face that, I feel, we as medical men have sadly\nneglected. It is so often our policy when we are presented with a fractured jaw, to\nrefer them to a dentist for whatever fixation they see fit. The dentist does the best\nhe can in his own way without the benefits of a surgical approach to the problem. The\nresult often is indifferent and the dentist continues treatment of the case after the\nfracture is set, by adjustment of the biting surfaces, extraction and\/or plates. In\nnormal civilian life, fracture of the mandible is a fairly common occurrence and I think\nwe should be prepared to accept and to handle it competently.\nYears ago, a fracture of a bone was not considered an emergency, and was often\nallowed to go for several days before treatment. The Orthopaedic section of our profession has proven that a fracture is an emergency, and by treating it as such with early\naccurate, rigid fixation, has shown results far superior to those of a by-gone day.\nExactly the same holds true for a fracture of the jaw. It should be set immediately,\naccurately and firmly fixed. If this is done, union is primary, the results are excellent\nand the patient is left with a mandible as good as before his accident.\nAs is the case with fractures elsewhere, those of the mandible must be diagnosed\nas simple or compound, and then treated accordingly. This is important, if one is to\nprevent the ever present complication of infection of the area\u2014which if left or in-\nPage One Hundred and Seventy-one completely treated so often leads to chronic recurring osteo-myelitis. When the fracture\noccurs in a dentulous (tooth-bearing) area of the bone it should be considered compound. The mucous membrane is so closely attached to the bone at the tooth junction\nthat it splits with the slightest displacement and infection from the mouth is introduced. With an edentulous mandible, this occurs somewhat less frequently.\nWhen one can be certain that he is dealing with a simple fracture with no break\nin the mucous membrane around the tooth, treatment revolves itself into rigid fixation\nalone. These cases, when teeth are present, can be safely referred to a dentist. But\nthe percentage of this type is usually small and the majority of fractures must be placed\nin the compound class. One is firmly convinced, after treating many hundreds of fractured jaws, that the problem is solely a surgical responsibility\u2014calling in the help of\nthe dentist when intra-oral fixation is decided upon; for tooth extraction, when necessary; and for oral hygiene during the period of fixation. This view is held by the\nBritish, Canadian and American Armies. All units dealing with fractured jaws, placed\nthe responsibility on the shoulders of the surgeon. As I proceed with my outline of\nwhat adequate treatment is, I think you will agree with me.\nA fractured jaw should be treated and fixed as soon as possible after being first seen.\nCertainly within 12 to 24 hours. The only contra-indication that I can see for immediate operation, is a recent meal which may cause post-anaesthetic vomiting, or some\nmore serious injury elsewhere which contra-indicates anaesthesia and operation\u2014such\nas severe head injury. An accurate diagnosis of the extent and position of the injury\nbefore operation gives one a good idea of the best method of fixation. This should\nbe by X-Rays and examination. Unless the fracture is just a crack or definitely a simple\nfracture, the case should be hospitalized and a general anaesthetic given. The experience of the Army units, was that pentothal induction followed by cyclopropane and\noxygen was much the best, to prevent post-operative vomiting. This is important if\nfixation is inter-dental wiring or cap splints where the jaws are fixed together. In this\nrespect, there was always a wire cutter at the bedside of the post-operative patient\nuntil he was fully awake, but I cannot remember a time that they were ever used.\nTo start the operation, the jaw is examined to check diagnosis. Any teeth that appear to be in or adjacent to the line of fracture are removed, and should any loose\nsmall pieces of bone be found, they should be removed as well. The question of sacrificing teeth in the line of fracture has often been a controversial one, especially with our\ncolleagues, the dentists. It is true that occasionally a loosened tooth may re-establish\nits root socket. But so often, non-union or localized infection can be traced to a tooth\nthat has been allowed to remain in the line of fracture. Again, such a tooth is sometimes needed to maintain position, and it is allowed to stay. But almost without exception, it has to be taken out before union will proceed. This usually means that the\npatient has to remain wired up for a second six-week period and that is always embarrassing and unsatisfactory.\nShould there be a haematoma in the floor of the mouth, under the tongue, it should\nbe drained. Such a haematoma presses the tongue upwards and may cause difficulty\nin swallowing after the jaws are fixed together.\nThe next question is one of establishing through and through drainage. There has\nbeen much pro and con discussion for this procedure. I think that the tendency is\ntowards more early drainage at the fracture line prophylactically. I feel that, should\none suspect that infection could have entered into the fracture line, drainage should\nbe done. Certainly if there is any swelling below the jaw in a fracture 24 or more\nhours old, drainage is needed. A small stab incision is made well under the ramus of\nthe mandible\u2014taking care to avoid the facial vessels, a pair of forceps or scissors is\nthrust up to the bone and the fracture line identified; the forceps is continued up\nalong the inside of the ramus and brought out into the mouth and a piece of hard\nrubber drain inserted. This is removed in 24 to 48 hours and very little scarring is\nleft. I cannot remember seeing the complication of infection or osteo-myelitis in a\nPage One Hundred and Siventy-two t*\n* ft\nIB\nHI\nV\nk\nrit\niV*\n1 .\"\njaw that was drained when first fixed. Whereas, I would think one sees it in 20%\nof cases of compound fracture when not drained.\nAfter these points are taken care of, fixation of the jaw is the next problem. There\nare many ways of fixing a broken mandible, and different sets of conditions call for\ndifferent methods. As a general rule, the simplest type should be used as long as it\neffectively fixes the broken bones with fair comfort to the patient. To ascertain and\nmaintain proper position, use is made of the maxilla\u2014thus some type of inter-dental\nfixation is the usual method. This may be by wiring the lower teeth to the uppers by\none of several methods. A much more comfortable, effective, but elaborate means is\nthe construction of cap splints. These are made by casting silver to a mould of the\nteeth, one plate in the uppers and one in the lowers. These are cemented on the teeth\nand then held together by small plates and bolts. It is possible to make these cap splints\nto the normal position of the pre-fractured mandible, so that when they are cemented\nonto the teeth, position of the fragments must be correct. In a well run maxillo-facial\ndepartment, where there is complete coordination between the surgeon and the dentist\n\u2014such as we have at the Army and D.V.A. hospitals, these cap splints are ready for\nsetting 8 to 12 hours after the patient is admitted. Other methods are or should be\nentirely surgical. They involve open reduction where much comminution is present\nand wiring the fragments together. A method of fixation, which is practical and\nextremely effective is the use of the Roger-Anderson type of pinning. This involves the\nplacing of stainless steel pins in the bone from the outside and conncting them by\nadjustable bars and locks. Just as the success or failure of the Roger-Anderson type of\nfixation depends upon asepsis, in Orthopaedic Surgery, so does it apply to Maxillo-facial\nSurgery.\nWhen one decides to pin a jaw, the pins should be put in before the oral cavity is\nexposed or the fracture examined from inside the mouth, that is at beginning of\noperation. When all the aseptic precautions are used, the incidence of pin infection is\nvery low. One has seen a 30-bed ward devoted to fractured jaws with at least 50%\npinned\u2014go for several weeks without an infected pin in the lot. One has also had the\nopportunity of seeing at least 35% of the pins infected and loose when used indiscriminately by operators who did not really understand surgical orthopaedic asepsis.\nI have not discussed the advantages of pin fixation. The main advantage is the\nmobility of the mandible which may be allowed at once or usually within a week. This\nis important and allows a working man to get back to some sort of work early. With\njaws wired together, the average loss of weight due to a fluid diet is 15 lbs. in the 6\nweeks of fixation. These are also quite uncomfortable, are unable to speak distinctly and\nneed to have a meal every 2 hours. With the pinning, the feeding is not a problem,\nneither is the oral hygiene. They also are quite comfortable after the first few days.\nI have only covered a few of the many methods of fixation. Some others are practical\noccasionally\u2014others are almost bizarre\u2014and have been conceived in the desperation of\nattempting to get fixation of some particularly difficult fracture in the days before a\nrational surgical approach was considered. I must here make note that it is entirely\npossible that the use of the sulpha group of drugs and penicillin may have made possible\nthe progress in the surgical approach. However, of this one is not entirely convinced,\nas of late I have used less penicillin with what appears to be just as favourable results,\nI would urge in treating fractures of the jaw, that they be done as soon as possible,\nthat fixation be complete and adequate, that teeth in the line of fracture and small\ndetached pieces of bone be removed and that when one is in any doubt as to infection,\ndo a through and through drainage.\nThe complications, non-union, infection, osteo-myelitis, mal-union and arthritis\nof the temporo-mandibular joint or a detached head of the mandible are separate problems and need treatment suitable to the individual case.\nFractures of the Maxilla\nThe incidence of fractures of the superior maxilla is much less than that of\nPage One Hundred and Seventy-three the inferior mandible. It is less exposed than the protruding chin which goes with\nthe mandible and also is much stronger because it is fixed to the cranium. However,\nblows to the face or the upper teeth may cause it to fracture. This break is much\nless likely to be compounded and more apt to be comminuted. It may involve only a\nsegment of the tooth-bearing area or it occasionally may crack completely around about\nthe tooth prominences from one maxillary tuberosity to the one on the opposite side.\nThis allows the fractured bone to behave much like a loose dental plate\u2014that is to be\nmoved up or drop down. Again, the break may extend up into the floor of the orbit,\nin the maxillary antrum or the floor of the cranial vault.\nThe diagnosis of this fracture is often quite difficult even when x-ray plates are\ntaken. Usually the face is swollen and there is some disturbance of the bite. The upper\nteeth are often anaesthetic and the patient is not certain exactly what is wrong. The\ndisplacement may be minimal, and as the lower jaw is brought up, it reduces the fracture\nso that one is apt to conclude that no fracture is present. With a fracture of the\ninfra-orbital margin, diplopia, conjunctival haemorrhage and a flatness of the cheek\nis noted. I think the best method is the use of stereo. X-Rays when an appreciation\nof the extent of the break is best visualized.\nAs to treatment, reduction should be done as early as possible. If more than a week\nelapses, reduction becomes most difficult and requires a great deal of force or even\nopen cutting along the fracture lines. The trouble lies in the fact that the deformity\ndoes not become very evident until after the facial swelling has subsided. The deformity is due to impaction of the thin facial bones with shortening of the longitudinal\nlength of the face. After reduction is done, fixation is maintained by inter-dental\nwiring or cap splint utilizing the mandible as a splint. If the mandible is fractured\nas well, one has to go further afield to get a point of fixation. This is usually the skull.\nIt is possible to put a Plaster of Paris band around the head so that it is fixed to the head\nand yet remain comfortable. In the Plaster of Paris headcap is embedded an attachment\nto steel rods which can be formed and carried to any position of the face. Then an\nattachment is made to the loose fractured maxilla. This can be done by inserting an\nordinary bone screw into the fragment or if a straight pull is needed to attach a wire\nto an upper tooth and bring it out through the cheek. And, here again, the moulded\ncap splint can be utilized. This is cemented to the teeth and connected by a steel rod\nto the rod attached to the headcap. Any one of these methods give fairly rigid fixation.\nIn the case of the fractured mandible as well, the fixation can be made to include\nthat bone as well.\nI admit that all of this sounds very much like building with a mechano set or\na Heath Robinson fantasy, but when properly applied and well adjusted the results are\nvery good and the patient is very comfortable.\nTo reduce the fracture, it is often necessary to expose the fracture line. It may be\ncompounded and the approach already there. If not, a modified Caldwell-Luc approach\nis excellent, going through the anterior wall of the maxillary antrum from the superior\nsulcus of the mouth. It may be necessary at times to use this approach in an old unreduced malar zygomatic fracture. Position is maintained in this case by packing the\nantrum.\nI have covered my subject very sketchily. I hope that you may be indulgent if at\ntimes I have seemed dogmatic. But I feel that all too often injuries of the face and\njaw could be treated with more care. Except for superficial lacerations, I do not think\nthat satisfactory repair can be made in an office or under local anaesthetic. Surely, the\nface, with its cosmetic importance, should rate extreme care when it comes to repair of\ninjury to it. Too often one sees road dirt or tar tattooed into a face or nose that could\nhave been scrubbed out easily at the time of the accident. This may never be removr-\nable later, or if so, only with extensive plastic procedures. And surely a fractured jaw\nrequires as urgent and complete treatment as a fractured arm.\nPage One Hundred and Seventy-four fyoHcotuAen, QenesixU cftaifUtal Section\n*>\nA CASE OF OBSTRUCTIVE JAUNDICE\nBy E. S. JAMES, M.D.\nJaundice of the newborn as in adults may be classified as hemolytic, infective, and\nobstructive. The commonest types of haemolytic jaundice are physiological icterus,\nicterus gravis, or congenital haemolytic disease as it is now called, and familial haemolytic\nicterus.\nThe second group, infective jaundice, may be due to sepsis, or congenital syphilis.\nIn sepsis, the portal of entry is most commonly the umbilicus and the skin; the most\ncommon offending organisms are the streptococcus, staphylococcus and colon bacillus.\nObstructive jaundice at this age is due to atresia or stenosis of the bile ducts. In\ncomplete obstruction the icterus comes on shortly after birth and the skin becomes\nprogressively more jaundiced until it is dark green. The stools are white. The serum\nbilirubin is very high and the Van den Bergh, direct. Mechanical obstructions are\noften asociated with atresia and other lesions in this region of the duodenum. Some\nof these abnormalities can be attributed to arrested development, but others in which\nabnormal bile ducts communicate with one another cannot be explained in this way.\nThe obstruction may be complete or partial.\nRolleston and McNee suggest that congenital obliteration of the bile ducts may\nbe caused by a localized peritonitis. Obstruction may involve the larger passages or\nthe intra-hepatic ducts. Occasionally unilateral obstruction of a hepatic duct occurs.\nBaby W. was a full term infant born on July 20th, 1946. Birth \"weight was 7\npounds, 3 oz. The baby lost weight for 4 days then began to gain on a formula of whole\nmilk, water and dextro-maltose. The baby appeared normal and on the 6th day was\ntransferred to the Infant's department to await adoption.\nPhysical examination at this time was negative. The following day the baby was\nnoticed to be slightly jaundiced. On July 31st the jaundice began to fade and it was\nthought to be physiological jaundice. A few days later it was thought that the jaundice\nwas becoming deeper. The stools were pale yellow.\nThe W.B.C., R.B.C., and Hb. and differential count were within normal limits. The\nblood Kahn was negative. The Van den Bergh was direct and the serum bilirubin was\n12.5 mgm. Bile was present in the urine but no urobilin. The fragility of the red\ncells was normal, hemolysis beginning at 0.4%.\nDuring the following month the infant's general condition remained good and the\nchild gained weight, so that by the middle of September she weighed over 10 pounds.\nThe jaundice varied from slight to moderate from week to week while the stools varied\nfrom light to light yellow to white in colour. The baby was given bile salts by mouth\nduring this period.\nA surgical consultation was requested with the possibility of an exploratory laparotomy in mind. Dr. Neilson saw the infant and suggested that this should be done as\nthe obstruction was obviously only partial and the variability of the intensity of the\nicterus suggested that the obstruction might be due to pressure from without on the\nextra-hepatic ducts. This might possibly be caused by an aberrant vessel or band which\nmight be removed surgically. Moreover, the longer obstruction was unrelieved the\ngreater danger of biliary cirrhosis.\nOperation was performed on October 7th. Under ether anaesthesisia the abdomen\nwas opened through a right rectus muscle splitting incision. The presenting liver was\nenlarged slightly beyond what would be normal for this child's age. It was finely\ntrabeculated with greyish colored strands and finely lobulated, presumably the early\nstages of a cirrhotic liver. There was no free fluid in the abdominal cavity.\nPage One Hundred and Seventy-five The biliary tract was exposed by elevating the liver and retracting the viscera downwards. After division of a few fine adhesions it was found that the biliary tract was\npractically surrounded by hypertrophied glandular tissue in a fairly dense mass. The\ndoudenum was mobilized to a small degree. Structures taken to be the gall-bladder\nand common duct were visualized but the surrounding tissue seemed to be so firmly\nadherent that it was thought to be poor judgment to dissect out these structures. In\nother words much harm could be done and it was thought that the separation would\nonly become adherent again and that the glandular hypertrophy, if it subsided, would\nallow patency of the tract to re-establish itself. The other abdominal viscera were in\nnormal position and the spleen was not enlarged.\nThe ileocaecal angle was exposed and a considerable number of glandular masses found\nia the mesentery similar to those found about the biliary tract. A biopsy was not taken\nbecause they were of the usual mesenteric adenitis type so far as appearance was concerned and removal of one from the biliary tract would entail considerable dissection. No\nfurther manipulation or exploration was done and the wound was closed with interrupted\nfine silk sutures in three layers.\nThe conclusion was reached that the diagnosis as to the cause of jaundice was pressure\nfrom an enlarged gland. Treatment is suggested with this child to be given general\nsupport, possibly the use of iodides and quartz lamp, all of which may cause the glands\nto disappear and allow the biliary tract to function.'*\nThe post operative course was uneventful and the child is receiving 5 grs., of potassium iodide t.i.d. If no improvement is noticed in two or three weeks it is suggested\nthat radiation therapy be given a trial, in the hope that the adenopathy may regress.\n7\nTREATMENT OF AN UNUSUAL CASE OF\nSPONTANEOUS PNEUMOTHORAX\nBy T. K. McLEAN, M.D.\nThis is the history of J. B., a twenty-year-old white male, who is 6f eet, 3 inches tall,\nand broad-shouldered. His past history is essentially negative, except for the usual\nchildhood illnesses, and infantile paralysis at the age of three, which involved his right\nleg.\nDuring the last week of February, 1946, he had a loose cough, mainly during the\nday. On February 28 th, he had a chest survey. On March 1st, after coughing, he developed a pain in the epigastrium which he described as \"indigestion-like'* in character. This\nlater radiated up to the right shoulder, causing several severe bouts of coughing.\nFollowing this, it was noted that he was somewhat short of breath. I saw him that\nevening, at which time he had a right-sided pneumothorax. He was admitted to hospital\nwhere he remained for twenty days. His treatment during this time consisted of bedrest, and on one occasion, sixteen days after admission, 300 cc. of air were removed\nfrom the chest, leaving a slight negative pressure. He was discharged to his home where\nhe remained in bed for a short time. On March 27th, he developed a mild upper respiratory infection with cough which lasted approximately one week. From April 13 th\nto April 20th, two lots of 500 CC. of air were removed from his chest at home. On\nApril 30th, he was re-admitted to hospital where he remained for fifty-five days.\nOn this second admission, it was decided first to remove air* in frequent small\namounts of 200-300 cc. From May 1st to May 11th, 930 cc of air were removed\nfrom his chest. He was given codeine, grs. J4, every four hours, to suppress a mild\nirritating cough. On May 18 th, he was bronchoscoped by Dr. Harrison. On May\n22nd, it was decided to remove larger amounts of air at a time, and from May 22nd to\nMay 26th, 2000 cc of air were removed. On May 30th, Dr. Harrison operated upon\nhim, repairing the leak in the lung which was due to a ruptured emphysematous bleb.\nTwenty-four days later he was discharged to his home.\nSince that time he has been well, has resumed his work, has been out shooting, and\nhas recently gone by air over the Rockies. gfe>\nPage One Hundred and Seventy-six\n'if\n.ii \u2022ft\nForty years ago it was considered that all spontaneous pneumothoraces were due to\ntuberculosis, but gradually it came to be recognized that there was a form which\noccurred in healthy, young adult males that did not carry such a grave prognosis. These\ncases were first thoroughly described by Kjaergaard1 in 1932, who, after a laborious\nsearch of the literature found reports of nine autopsies, in six of which emphysematous\nblebs were found protruding from the pleural surface, usually in the region of the\napex of the lung. In five of the six, rupture of one of the blebs had occurred. In the\nother three cases, no cause was found for the pneumothorax, the lungs having been\ndescribed as normal. None of Kjaergaard's fifty-one personal cases came to autopsy;\nbut in some he thought he could demonstrate by X-Ray emphysematous blebs. He\ncalled this condition \"pneumothorax simplex'* but it has been more commonly described\nas \"idiopathic spontaneous pneumathorax\".\nIn 1933, Kjaergaard2, after further investigation concluded that all cases of spontaneous pneumothorax due to ruptured vesicles resulted from one of three causes: .\n1. Localized emphysematous changes in the lung.\n2. Scar tissue in the lung or pleura.\n3. Congenital cystic disease of the lungs.\nIn 1939 Hamman3 suggested a fourth cause, namely, rupture of the mediastinal\npleura when there is mediastinal emphysema present.\nThe presence of emphysematous and other blebs of the pleura is now thought to be\nthe cause for the occurrence of idiopathic spontaneous pneumothorax. Kirchner4,\nhowever, in 193 8, called attention to the fact that the disease will \"occur in young people\nwho rarely show emphysema and spare the aged, in which emphysema is fairly common,\"\nand suggested that ideopathic pneumothorax may be the result of a \"congenital pleural\ndefect or an acquired pleural defect with a congenital analogy\" and that the formation\nof pleural blebs may be a secondary manifestation of a primarily weakened pleura.\nLorge5, agreeing with Kirchner, states \"the primary cause of idiopathic pneumothorax is to be found in a constitutional inferiority of the pleural structure\" and\ngives the following factors in support of this theory:\n1. Age incidence, usually below 40.\n2. Sex distribution, practically all male.\n3. Adhesions, usually absent.\n4. Fluid, usually absent.\n5. Recurrences, common.\n6. Familial occurrence, recorded several times.\n7. Re-expansion rate, possibly slow.\nIn regard to this last point it is here that our case presented the greatest anxiety.\nMost cases make steady progression after the first week and usually are completely re-\nexpanded at two months, although it would be safe to say that the majority are re-\nexpanded at a month. LeWald6, in 1928, reported two cases, one of which was a year\nre-expanding and the other had not re-expanded at the end of eleven years. This second\ncase may have been congnital absence of the lung. The other case, he did not state the\ndegree of collapse of the lung. You will note, in our case, that the lung seemed to be\ntotally collapsed and our problem was to know how long an apparently healthy lung\nmight remain collapsed and not develop fibrosis which might in later years leave a lung\nan easy prey to disease. Gun-shot wounds of the chest, in as short a time as six weeks,\nmay give sufficient fibrosis to make re-expansion almost impossible, but here we are\ndealing with damaged lung. In our case the lung re-expanded well under anaesthesia\nalthuogh it was somewhat slow coming up the first time.\nBibliography:\n1. KJAERGAARD, H.\u2014Spontaneous Pneumothorax in the Apparently Healthy Acta Med. Scand.\n43: 1. 1932.\n2. KJAERGAARD, H.\u2014Pneumothorax Simplex Acta Med. Scand. 80: 93. 1933.\n3. HAMMAN, Louis\u2014A Note on the Mechanism of Spontaneous Pneumothorax, Ann. Int. Med.,\n13: 923. 1839.\n4. KIRCHNER, J. J.\u2014A. J. Med. Sc, 196: 708, 1938.\n5. LORGE, H. J. The Etiology of Idiopathic Pneumothorax, A. J. Med. Sc, 199: 635, 1940.\n6. LEWALD, L. T.\u2014Persistent Nontuberculous Pneumothorax, Arch, of Surg,, 16: 426, 1928.\nPage One Hundred and Seventy-seven POLYPOSIS OF THE COLON\nBy C. G. POW, M.D.\nSenior Interne in Surgery, Vancouver General Hospital\nBy definition, this condition consists of the presence in the colon, caecum to rectum\ninclusive, of polypi, pedunculated or sessile tumours of the mucosa, whose essential component is glandular tissue and whose supporting structure is fibrous tissue with a\nvascular supply.\nI would classify these polypi as follows:\n(1) Pseudo polypi, in reality hypertrophic folds in the mucosa on an irritative or\ninflammatory basis, arising in cases of Ulcerative Colitis, Amoebic Dysentery or Chronic\nBacillary Dysentery which I will mention just to dismiss with the statement that they\nare never malignant and disappear with the cure of the disease.\n(2) Multiple or Familial Polyposis, a fairly rare condition in which the polypi occur\nin large numbers, often obscuring or replacing the mucosa from the ileo-caecal valve to\nthe ano-rectal junction. There are about 100 cases of this reported in the literature\nand in most of them there is a strong hereditary predisposition. The incidence of\nmalignant changes in one or more of these polypi is very high.\n(3) Single or at any rate few polypi. The incidence of malignancy in these varies\ngreatly with the criteria employed to assess malignancy, but in most large series the\nmalignancy is placed at from 20% to 35%. These vary in size from a few millimeters\nto two centimeters in diamtter for the stalk, while the head may be any size up to\nthe size of a man's fist.\nThe incidence of polyposis as reported from various centres varies greatly. .1 will\nnot bore you with numerous statistics, but three or four of the reports from the literature\nwill illustrate the frequency of this condition. Lawrence in 7000 autopsies performed\nin the Cook County Hospital reports 2.37% of the polypi in the colon and 0.42% in the\nrectum. Susman in 1,110 autopsies reports 6%. These can be reconciled by the fact\nthat in the latter case fewer children were included in the autopsy material. In the\nlarger clinics where proctoscopic examinations were performed routinely on large numbers of patients, the incidence of rectal polypi has been variously reported in the neighborhood of 3% to 6%.\nThe presenting symptom or symptoms in patients with polypi or polyposis varies\nwith the keenness of observation of the patient. First in appearance is the presence\nof red blood on the outside of the stool at defaecation. This has to be differentiated\nfrom that caused by haemorrhoids. In every case of haemorrhoids the possibility of\npolypi should be kept in mind and the condition ruled out, as in many cases the two\nconditions occur simultaneously in the same patient. Connected with this is the complaint of anaemia, due to the persistent loss of blood. A second early complaint is\nthat of a sense of something protruding on defaecation when there is a polyp on a long\npedicle near enough to the anal orifice. A third presenting symptom is chronic persistent\ndiarrhoea with the passage of six to eight stools per day. A fourth symptom is an\nearly morning urgency to defaecate. A fifth symptom that is generally a little later\nis the passage of white mucus on defaecation. Lastly, in the case of a large polyp,\nobstruction may be the present symptom.\nDiagnostic methods for polyposis are as follows:\n(1) Digital examination. This simple procedure will reveal a surprising number.\n(2) Anoscopic Examination.\n(3)\u2014Sigmoidoscope\u2014after adequate preparation with castor-oil and cleansing\nenemas. (May just precede the radiological examination).\n(4) Radiological Examination\u2014after adequate preparation as above; it should include post evacuation films and double contrast films.\nPage One Hundred and Seventy-eight\nJ I The danger from polyposis may be due to:\n(1) Malignancy.\n(2) Diarrhoea.\n(3) Anaemia.\n( 4) Obstruction.\n(5) Intussusception.\nTreatment:\nThe treatment of polyposis is entirely surgical, but the method varies with the\noperator, the location of the polyp, whether single or multiple, and finally whether\ncancerous or precancerous.\n(1) If single and below the peritoneal reflection of the rectum: (a) Method of\nchoice\u2014excision with the electro-cautery and fulguration of the base, (b) Some\noperators favor the paracoccygeal approach with surgical excision of the polyp and its\nbase, and repair of the rectum.\n(2) If single and above the peritoneal reflection of the rectum: (a) Excision of the\npolyp and the base with repair of the colonic wall, (b) Local resection of that section\nof bowel. (The previous two operations are done with an abdominal approach after\nadequate preparation of the patient with sulfasuccidine and a non-residue diet.)\n(3) If multiple (a) If few polypi are in the rectum subtotal colectomy with an\nilio-sigmoidostomy and fulguration of the remaining polyps in the rectum, (b) If\nmany polypi are in the rectum down to the ano-rectal junction, total colectomy with\nan ileostomy.\nd\u00abS\n\u25a0ii\nn\nJ'4:\n4U\nif)\nCAMERA SALON TO HOLD THIRD ANNUAL SHOWING\nThe third annual showing of the Canadian Physicians* Fine Art and Camera Salon\nwill be held in the Hudson's Bay Auditorium in Winnipeg during the week of the\n23 rd to 27th of June, in conjunction with the Convention of the Canadian Medical\nAssociation. The Salon will play an important part in the Convention and many\ndoctors are expected to submit entries.\nThe Canadian Medical Association Salon Committee\u2014a committee of Canadian\ndoctors\u2014is composed of Dr. G. E. Tremble, Dr. J. L. Notkin, and Dr. A. Jutras, of\nMontreal; and Dr. Harvey Agnew, of Toronto. Dr. Tremble has been elected Chairman\nof the Committee.\nThe judges of the Salon this year will be Mr. Alex Musgrove, D.A., Curator of\nthe Winnipeg Art Gallery Association, Professor W. Leach and Mr. Newton Brett,\nof Winnipeg.\nSince its inception, the Salon has been met with increasing enthusiasm, as there are\na surprising number of doctors who have adopted painting and photography for hobbies\nas a welcome relief from the constant strain and overwork of the past few years.\nAt the request of Canadian doctors, the Salon this year will be divided into three\nsections: the Fine Arts and monochrome photography of last year will be retained while,\nan additional section for Kodachrome transparencies has been added. The Fine Arts\nsection includes: paintings in oil, water colours and tempera, charcoal drawings, pastels\nand etchings.\nTwo bronze plaques, sculptured by Miss Eugenia Berlin, S.S.C., will be presented,\none to the winner in the Fine Arts section, and one to the winner in the Photographic\nsection.\nAwards of merit will also he presented.\nThe prizes and awards will be made at a meeting of the Medical Council on Thursday, June 26.\nThe Salon is sponsored by Frank W. Horner Limited, of Montreal.\nPage One Hundred and Seventy-nine DR. WILFRED L. GRAHAM\nObitt 6 February, 1947\nIn the sudden death of Dr. Wilfred Graham, at the comparatively early age\nof 51 the medical profession of Vancouver lost a man who promised to become\none of its most distinguished surgeons. In fact, one might say that he had\nalready qualified in this capacity. His ability as a surgeon and especially as\nan abdominal surgeon, was well-known, and his work in gastric surgery particularly was rapidly bringing him into the front rank of Canadian surgeons in\nthis department alone.\nDr. Graham came to Vancouver from Toronto in 1927. He had served\nwith distinction overseas in the first war, in the C.A.M.C, as it was then\ncalled, and held the rank of Lieut.-Colonel. Shortly after his arrival in Vancouver, he joined the attending staff of the Vancouver General Hospital and\nwas a member of that staff till his death. His work and qualities as a surgeon\nsoon brought him to the front, and he became established as an authority in\nhis subject. To those who sought his opinion and advice as a consultant, he\nwas unfailingly cordial and helpful, generous with his time and attention.\nWe extend our deepest sympathy to his wife and family.\nDR. WALTER SCATCHARD\nM.D., M.R.C.S. (Eng.), L.R.C.P. (Ireland), L.M.\nMObiit 13 April, 1947 l-f\nBorn in Yorkshire, England, January, 1861. Obtained his M.D. at London\nUniversity, and was made a Member of the Royal College of Surgeons in 1882,\na Licentiate of the Royal College of Physicians of Ireland and of Midwifery in\n1892. He was for some time house surgeon of Leeds Hospital in Yorkshire,\nwith the late Mayo Robson. Married at Faversham, Kent, England, April,\n1888, to Ada Kemble Donne. Around 1887 he purchased a practice at Bough-\nton, Kent, which he conducted until 1907, when, on account of ill health, he\nwas advised to come to Canada.\nHe settled at Armstrong, B.C., and practised there until 1910 when he\nmoved to Chase, which town was then in the making. Besides his general\npractice, he was company physician and surgeon for the Adams River Lumber\nCo. Ltd.; also under the Department of Indian Affairs at Ottawa he was physician and surgeon to the Indians of the Adams River, Squilax, Chase and Shuswap\nReserves He practised at Chase continuously fromi 1910 to February of\nthis year, when on account of ill health he was forced to discontinue his work.\nDuring his forty years of practice in Canada, he had only four days holiday\nwhich were spent on a week end trip to Banff with his eldest son who was\nvisiting him from Ascension Island. During the serious 'flu epidemic of 1918\nonly one of his scores of patients so afflicted died.\nHe was a member of Salmon Arm Lodge No. 52, A.F. & A.M. Was an\nexcellent sportsman, one of his greatest thrills being when after a two-hour\nstruggle he landed a 19-lb. trout on a 9-oz. rod and light fly tackle at Adams\nRiver. He was an excellent wing shot also, a year or so ago bringing down\n13 ducks with 11 shells. It was very seldom that he did not make every shot\ncount.\nHis wife died 27 July, 1940, also a son, Mowbray, died April, 1912, at the\nage of 17.\nHe has one daughter, Mrs. Mildred Gating, living at Chase; also 4 sons,\nCharles Edward of Kent, England; Walter Kemble of Rossland, B.C.; Gerald\nCowper of Kamloops, B.C., and Geoffrey Howard of Millet, Alta. There are\n9 grandchildren and 2 great grandchildren.\n*s\nit\nm\nPage One Hundred and Eighty ji\n'i r\nm\n44 *t\nm\n1\n-j,\n4*1\nif\n1\nBl L\n1%\nAe\u00ab*f. a\u00abf^ Ao^W\nThe profession extends to Miss Vera Smith, for a number of years Secretary for the\nBritish Columbia Medical Association, best wishes for happiness in her new life as Mrs.\nPaul Keating.\nCongratulations to Dr. R. W. Irving, of Kamloops, on his recent election to senior\nmembership in the Canadian Medical Association.\nDr. J. S. Kitching has left the Metropolitan Health Committee to join the Health\nDepartment of the City of Hamilton, Ontario.\nDr. O. O. Stromberg has left Vernon and is now residing in North Battleford, Sask.\nDr. T. J. Speakman has joined the Montreal Neurological Clinic, Montreal, Quebec.\nDr. P. W. Hudson has moved from New Westminster and is now practising in\nTrail, B. C.\nDr. K. P. Sunderland has left Essondale and is now with the Provincial Mental\nHospital at New Westminster, B. C.\nDr. Don Wah Lim has left St. Paul's Hospital and has taken residence at Beattie\nAnchorage, B. C.\nDr. B. D. Prosterman is now practising in Ladysmith, B. C.\nDr. A. R. Hicks has left Vancouver to practise in Princeton, B. C.\nDr. Robert H. Gourlay is, at present, doing post-graduate work in Surgery at\nMcGill University.\nDr. Grant A. Gould attended the Washington State Medical Association course in\nSurgery, in Seattle during the month of March.\nDr. G. I. Theal is visiting in Ontario until July when he will return to British\nColumbia to take up practice in Courtenay.\nDr. and Mrs. J. S. Henderson of Kelowna are enjoying a three months holiday in\nEastern Canada and the United States.\nRecent visitors to aVncouver from outlying points:\nDr. F. M. Bryant and Dr. T. McPherson of Victoria.\nDr. H. F. P. Grafton and Dr. J. S. Burns of Kamloops.\nDr. V. G. Goresky of Castlegar.\nAt the monthly meeting of the New Westminster Medical Society, Dr. D. E. Starr\ngave an interesting illustrated talk on \"Backache\".\nCongratulations to the following parents on the birth of daughters:\nDr. and Mrs. A. R. Anthony.\nDr. and Mrs. C. H. Hankinson (Prince Rupert).\nDr. and Mrs. G. H. Stephenson.\nand on the birth of sons:\nDr .and Mrs. T. F. H. Armitage.\nDr. and Mrs. Gordon H. Francis.\nDr. and Mrs. . O. R. Garner.\nDr. and Mrs. J. A. Ireland.\nDr. and Mrs. F. E. Kinsey.\nDr. and Mrs. G. A. Nicolson.\nDr. and Mrs. Donald Starr.\nDr. and Mrs. John P. Wellwood (New Westminster).\nPage One Hundred and Eighty-one sS*^\nWRrfExFOR DETAILED\nLITERATURE\nNorton* blank reqvind\nSMOOTH LABOR\nDemerol, the potent, synthetic analgesic,\nspasmolytic and sedative, relieves labor pains\npromptly and effectively without danger to\nmother and child. There is no weakening of\nuterine contractions, lengthening of labor, or\npostpartum complication due to the drug.\nBad effects on the newborn are practically\nnil: no respiratory depression or asphyxia\nfrom too much analgesia of the mother.\nSimplicity of administration is another commendable feature.\nAvailable in ampuls (2 cc, 100 mg.);\nvials (30 cc, 50 mg. \/ cc).\nWarning: May be habit forming.\nHYDROCHLORIDE\nBrand of meperidine hydrochloride (isonipecaine)\nCHEMICAL\nCOMPANY,\nINC\nNew York 13, N. Y. \u2022 Windsor, Out.\nDEMEROL, trademark Reg. U. Sf^trt. Off. & Canada \u00a5\nit\nh\nI\nW Qibti In GcMada*\nPoulenc presents aminothiazole therapy\nwith\nBASANTINE\n(2921 RP)\na new antithyroid substance in the\nform of acid maleate of 2-aminothiazole\nINDICATIONS\nGraves-Basedow's Disease\nPreoperative Treatment\nof Thyrotoxicosis\nPRESENTATION\nBottles of 100 tablets\ncontaining each 0.1 Gm. of\naminothiazole -\nDocumentation on request\nJLaJro*uitxnjj I (mJjznjc -fx&ueA\nOF CANADA LIMITED- MONTREAL\n\u2022 II\n^\u00bb\n* f\n1 j\n\u25a0i 1\n*\u25a0 r\n1\n1. \u00bb'i\ni'.f\n\u25a0\u25a0* ' \u2022\n, t\n.* r .\n'< if.\n{ pi'\ni.'i\nM\n\u2022fj\nMf\nf\nii\n, , '\n-i j \u2022\u2022\n?\n1 1\n\u00ab > 1 -\nI r'j ' 1\n11>\n\\ 8 \u2022\n\u25a0t \u2022\nj v>\nii\n' **\u25a0 *\n*\nil\ni\n.' f\n* \u2022.\n. V\n; >,\n( h'\n!'\u25a0' >>\n'\u00ab\\\n\u25a0\n> 1\nid \u25a0\/*\n\u00bb j\n: i\nji,\n1\ni\u00bb\n& '\u25a0\"\n'1\n1 *\n1*1\n#\nt\nll'(J\n'\/'\nifr* ''\n'1\n[it \u2022\u25a0: \u2022\nc\nt,\/\ni'v\nl M ,,,'.\n\u2022 ^\ni -\nj Si\n\u00a5 *;*\nIndicated in Postpartum Haemorrhage\nPostpartum Atony etc.\n\u25a0<**'\n\"Our experience with Methergine has convinced us\nthat it is a useful, potent oxytocic of great value.\"\nRoberts*\nAmpoules of 1 cc. ( = 0.2 mg. of d-lysergic acid-d-l-hydroxybuty-\nlamide-2) for i.m., i.v., or s.c. injection. Boxes of 6 ampoules.\n3*\n\u2022 \u2022 \u2022\n*P. C. Roberts: W. Jnl. Surg., Obs. & Gyn. 52, 380, 1944\nD. G. Tollefson: Ibid 52, 383. 1944\nA. C. Kirchhof ef ah. Ibid 52,197,1944\nE. P. Farber: Am. J. Obs. & Gyn. . . 51, 859, 1946\nSANDOZ\nPHARMACEUTICAL DEPARTMENT\nThe WINGATE CHEMICAL Co. Ltd.,\nMontreal .\/\nffl\nM\nK\n_1_\nU\n\u2022\n>%\u2022\u00ab\u00bb\nSI\nI >\n^eO'S^n^Aune\ntfPenecelUn\ngfreciai \u00ae\u00abffi* Meon\nPciGUte\nSrtyt\/UieJ\nTWO FAMILIAR COMPOUNDS\u2014COMBINED TO WORK TOGETHER\nNeo-Synephrine with Penicillin\nFOR VASOCONSTRICTION AND ANTIBACTERIAL EFFECT\nIN ACUTE AND CHRONIC SINUSITIS\noutstanding among vasoconstrictors...in a new solution\u2014especially prepared and buffered for use with penicillin.\n\"the best of the antibacterial drugs we now have for the local\ntreatment of chronic sinus... infections.\"'\ncontaining one vial each of dried, calcium penicillin and specially\nbuffered Neo-Synephrine Hydrochloride Solution '\/&%...to be\nmixed just prior to dispensing. When mixed, each cc contains\nnot less than 1000 units of penicillin at pH 6.0.\nholds the pH at 6.0\u2014optimal pH for maximum stability of penicillin in solution ... physiologically approximating the slightly\nacid pH of normal, healthy nasal secretions.\nin the treatment of acute and chronic sinusitis, by displacement,\nirrigation or tampon ... full strength or diluted with one part\nnormal saline..\nas combination package containing one vial each of dried\ncalcium penicillin (approximately 15,000 units) and specially\nbuffered Neo-Synephrine Hydrochloride Solution %% (15 cc).\nAvailable on prescription only.\n&i*a\/ 6u\/t\/i\/y teflon teowe&f\nNew York\nS-77A\n\u2022 Kansas City \u2022\nWINDSOR e ONTARIO\nSan Francisco \u2022 Atlanta B Detroit \u2022 Sydney, Australia \u2022 Auckland, New Zealand\n1 Ann. Otol., Rhin. & Laryng. 52:541,1943.\n\u2666Trade-Mark Registered ih\n\\US3\nzZP\nPi\n!W\nm\n-!---S\n\u2022fliif]\nTABLETS\nNATURAL CONJUGATED ESTROGENS\n(equine)\nORAL THERAPY WITH CONE STRON provides safe, dependable control of\nmenopausal symptoms and restores the patient's sense of well-being.\nORAL THERAPY WITH CONESTRON is relatively free from undesirable side effects.\nORAL THERAPY WITH CONESTRON is most desirable from the standpoint of convenience and time economy.\nCONESTRON TABLETS\nMay be prescribed in any quantity. Available at all\npharmacies in two strengths.\n.625 mg.\nTABLETS\n1 1.25 mg.\nTABLETS\nWget\/i\nRegistered Trade Mark\nJOHN WYETH & BROTHER (CANADA) LIMITED \u2022 WALKERVILLE, ONTARIO\n\u2022\u00bb;\n:(!\n'}.\nn\n,';\n\u2022l t\n1\n4.\n1\n\u2022 ft\n.\nft\nM\nI\n*\u2022\n*\u2022\ntlDount pleasant TUnbertaRino Co. %tb.\nKINGS WAY at 11th AVE. Telephone FAirmont 0058\nW. E. REYNOLDS\nVANCOUVER, B. C.\nexclusive nmeuLnncE\n\" SERVICE I\nVANCOUVER: 13th Avenue and Heather Street f Air. 0080\nNEW WESTMINSTER: 814 London Street ||UJ. 00\nWe Specialize in Ambulance Service Only\nJ. H. GRELLIN W. L. BERTRAND NEXT IN IMPORTANCE TO DIGITALIS\naea&frjadkte...\nSalyrgan-Theophylline\nMersalyl and Theophylline\nm\nIn many cases of congestive\nheart failure, mercurial diuretics,\nare next in importance\nto digitalis in maintaining\nthe patient's comfort\nand prolonging life.\nFollowing an injection of\nSalyrgan-Theophylline in patients\nwith marked edema\nthe urinary output frequently\namounts to three or four liters\nin twenty-four hours.\nAmpuls of 1 cc and 2 cc\nfor intramuscular or intravenous\nadministration. Also tablets\n(bottles of 25, 100 and 500),\nfor oral use as an adjunct\nto decrease the frequency of\ninjections and when parenteral\ntherapy is impracticable.\n'%\n\"Salyrgan\" trademark\nReg. U. S. Pat Off. & Canada\nCHEMICAL COMPANY, INC.\nNow York 13, N. Y. Windsor, Ont. im\nt\nI\n'.M\nI\ni.\nI\nti\ni*\ni,\nd&\nJvl\nt\"\njr.\njs;\nS C CE I C jj A T THE SERVICE OF JLE D I GIB E\nij\nD 1 C 1 N E Um\nC3\nCO\nCO\nILANTJrTSOII\nthe champing teeth,\nthe tonic and clonic\ncontractures, the\nincontinence\u2014all may yield to\nDILANTIN SODIUM. The E.E.G.\ncan trace the pathologic brain wave, yet the\nepileptic may be spared bis terrifying episodes.\nPowerfully anti-convulsant rather than\ndullingly hypnotic, DDLANTIN SODIUM\nKAPSEALS* offer to the epileptic a\nsense of security and an opportunity to\nlead a more normal and useful life.\nflffPj\nDDLANTIN SODIUM KAPSEALS\u2014another product of\nrevolutionary importance in the treatment of a specific disease;\nanother of a long line of Parke-Davis preparations whose service to\nthe profession created a dependable symbol of significance in\nmedical therapeutics\u2014MEDICAMENTA VERA.\nDILANTIN SODIUM KAPSEALS (dtpnenylhydantoin sodium), containing 0.03\nGm. (% grain) and 0.1 Gm. (1% grains), are supplied in bottles of 100, 500\nand 1000. Individual dosage is determined by the severity of the condition.\n* Trademark Reg. r-V-\nC A A?\nPARKE, DAVIS & COMPANY, LTD., WALKERVILLE, ONT.\n\u00a3 B\n(8\ni|$\nT\n<'\/1\nk\"'\n4\ni \u25a0\u25a0\u25a0\n\\u ,\n>jl\n*\nT\n111\nH\n\u25ba T\" '\n'-I\n\u2022f.\n\u2022r .\nV\nris\nM\n' .\u25a0\ni\ndi?\n| v\"\n'iii\n3 V'\n\u2022l\nSi \"'\ni\n\u25a0rl\n\\\n!\n\\$ '\n2 -' \u2022\nf\n,\/\nt,\n*u\nt\n*\u25a0\u25a0* ' r*\n!i'\nill j\n!\u2022' J\n\u2022 4$ '\nf #:\u2022 <\n\"THE SUPER-CONCENTRATE \"...\nYet possesses all the Erythropoietic properties\nof relatively-unrefined Liver Preparations\nANAHAEMI\nB. D\n(Liver Extract Injectable 15 units per cc.)\n^ The principal indications for Anahaemin B.D.H. are the\ntreatment of pernicious and other macrocytic anaemias, and,\nthe prevention of the onset of subacute combined degeneration\nof the cord as well as the correction of all the remediable symptoms of this syndrome if it has become established.\n^ A third important application of Anahaemin B.D.H. is for\nthe treatment of debility, diminished vigour and undue 'fatigu-\nability'.\n\u25ba In all these indications Anahaemin B.D.H. is unsurpassed by\nthe less highly refined liver products, in efficacy, volume, frequency of dosage and in economy.\nAvailable in: 1 cc ampoules 15cc. vita's 2 cc ampoule*\nTHE BRITISH DRUG HOUSES\n(CANADA) LIMITED\nTORONTO\nCANADA\n\u2022*\u2022\n77A-47 Laxative A d ion of Kellogg's All-Br an\nNOT\nMECHANICAL\nrecent research indicates\nREASONS for the laxative properties of bran have\nlong been debated. Some have held that the\nlaxative effect of bran is due to mechanical action.\nEvidence now indicates that this action is biological,\nrather than mechanical.\nRecent studies conducted by Reynier (1) now\nshed more light on the reason for bran's action.\nReynier succeeded in rearing axenic, or germ-free\nanimals\u2014animals lacking intestinal flora. They were\nbora through Caesarian section, and continuously\nmaintained in aseptic environment. From different\ntypes of feeding, research workers were able to make\nthe following observations:\n1. Animals in a non-axenic (natural) state usually\nobtain a definite laxative effect from bran.\n2. Axenic (germ-free) animals become constipated\nwhen sterile bran is included in their diets.\n3. When axenic animals are inoculated with certain multiple flora, bran then exerts its characteristic laxative effect.\nThe investigators concluded that the laxative effect\nof bran is not due to mechanical action on the intestinal mucosa, since it failed to act in axenic animals.\nThe investigators also concluded that the laxative\neffect Of bran is due to a biological reaction in the\nintestinal tract, and that this effect is imparled lo\nthe bran by symbiotic intestinal flora which feed\nupon it.\nAs shown in earlier research, these beneficial\n\u25a0microorganisms evidently produce gases occluded in\nthe colonic content and thus help to fluff up the mass\nand prepare it for easy elimination.\nKellogg's, makers of Kellogg's ALL-BRAN, will be\npleased to send you reprints of the articles from which\nthis report has been summarized. Use coupon below.\n(1) Reynier. J A.. GERM-FREE LIFE APPLIED TO\nNUTRITION STUDIES. Laboratory of Bacteriology, University\nof Notre Dame.\nPLEASE SEND:\n1. Germ-free Life Applied to Nutrition Studies Q\n2. Mode of Action of ALL-BRAN in Laxation D\n3. ALL-BRAN and Intestinal Flora . . . D\nT\u00ab\nCAMPBELL\n& SMITH\nQDjjecixve C\/rtnftno\"\nAll types of Social, Commercial\nand Magazine Printing.\nPI. 3053\n820 RICHARDS ST., VANCOUVER, B.C\n(Mail to Kollogg Company, London, Ontario, Canada)\nBoth are claimed to bo allergic\nBoth suggest mineral deficiency and\nimpaired elimination. Clinically,\neach is symptomatically improved\nby the oral use of\nLYXANTHINE ASTIER\nwhich combines the therapeutic\nactions of iodine, calcium, sulphur,\nand lysidin bitartrate \u2014 a potent\neliminator of endogenous toxic\nwaste.\nWrit* for Information.\nL-M\nCanadian Distributors\nROUGIER FRERES\n350 Le Moyne Street, Montreal\nJ i\nif\nt&\nA\ni , * *1\nhjji\nt\nIf\n\u2022 . I\nft\n.1 1\nr\nIt fl\n\u2022:' I-;\nr r \u25a0\nT H\nk\n|\n. fr\n.ill 1\n4 'I '\n.\n\u00bb*. j\nf\nI \u25a0 .\nL *\nr\n\" ( 4\n1 !|\nr \u00a7 #!\nv. a \u2022\n. :\n('\u2022i-\nu\n\u25a0\u2022' 1 ! ...\nIf\n\u2022 \u25a0,\nr \u00bb\u25a0\n,'\u25a0 *lji-\n\u2022f1!\n!*\nI\u00ab\nti1 \u25a0\n1,. I \n4i 1\n1 C**\n: ^\n\u2022 i rj\n! '\nT '\nv P t\n; 6'\n' JJV\nip T$ *\u00bb\n* i < \u25a0\n<\nt r:' '\u25a0\n[.' I jj\nH It\n- \"-T\n\/|&f\n' \u2666 1\n1 '\nt\nFEEDING UP\nthe wasted patient\nand convalescent\n' Pronutrin' provides a readily absorbed source of\nnitrogen for use in all cases conditioned by a\nprotein deficiency. It is both a natural antacid and\na rich source of nutriment. Containing all the\namino acids necessary for human nutrition,\n\"Pronutrin' is indicated where there is inability to\ntake or digest protein, and where there is a protein\ndeficiency. For example, in peptic ulcer; before\nand after operation; in colitis; gastro-enteritis,\ndysentery, chronic sepsis and burns; convalescence.\n1 Pronutrin' is an enzymic digest of casein. The\ncasein is broken down into smaller units of amino\nacids and polypeptides. ' Pronutrin' is soluble in\nwater, and may be given in hot, cold, or iced water,\nstirred into milk or soups, or combined with\nmeat extracts.\n'PRONUTRIN'\nSI\nA booklet giving\nfuller details of\n' Pronutrin' will\ngladly be sent on\nrequest.\nTRADE MARK\nCASEIN HYDROLYSATE\nBRAND\n1 LB. TINS\nHERTS PHARMACEUTICALS LTD., WELWYN GARDEN CITY. HERTS, ENGLAND\nDistributing Agents:\nMESSRS. VANZANT & COMPANY. 387 COLLEGE ST., TORONTO. ONTARIO\n(M.28) Constant Carefulness\nOnly an|Junderstanding professional\nskill coj|4ld maintain the confidence of\nthe Medical Profession which we enjoy.\nPhone MArine 4161\nLeslie G. Henderson\nGibb G. Henderson\n:\u25a0*:-\u25a0 MIOHT\n(GEORGIA PHARMACY\nLIMITED\nW.OSOROIA\nSTRUT\n\u00aetvfci.:&%wm\nESTABLISHED IMS\nVANCOUVER. B. C.\nNorth Vancouver, B. C.\nPowell River, B. C.\n\/\nV\nii\n,i.\n\u25a0'Pi v*\nH\nm\nI\n\u25a0\n*\u25a0\nMl\nI f\n\u00bbt|\"\n*\u25a0:\n\u25a0\nli\nJJ\nif\nI\nIff\nI\nA*\u00bb\n:\n>\n#\n#\n** WWf\n(to- Xitmtti.\n*\n1\nNew Westminster^ B. G.\nFor f&# treatment of\nNEUROPSYCHIATRY\nDISORDERS\nRfferenca\u2014B. C. Medical Association\nFor information apply to\nMedical Superintendent, New Westminster. B. C.\nNew Westminster 288\nor 721 Medical-Dental Building,[Vancouver, B. C.\nPAcific 7823 PAcific 8036\nZ1","attrs":{"lang":"en","ns":"http:\/\/www.w3.org\/2009\/08\/skos-reference\/skos.html#note","classmap":"oc:AnnotationContainer"},"iri":"http:\/\/www.w3.org\/2009\/08\/skos-reference\/skos.html#note","explain":"Simple Knowledge Organisation System; Notes are used to provide information relating to SKOS concepts. There is no restriction on the nature of this information, e.g., it could be plain text, hypertext, or an image; it could be a definition, information about the scope of a concept, editorial information, or any other type of information."}],"Genre":[{"label":"Genre","value":"Periodicals","attrs":{"lang":"en","ns":"http:\/\/www.europeana.eu\/schemas\/edm\/hasType","classmap":"dpla:SourceResource","property":"edm:hasType"},"iri":"http:\/\/www.europeana.eu\/schemas\/edm\/hasType","explain":"A Europeana Data Model Property; This property relates a resource with the concepts it belongs to in a suitable type system such as MIME or any thesaurus that captures categories of objects in a given field. It does NOT capture aboutness"}],"Identifier":[{"label":"Identifier","value":"W1 .VA625","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/identifier","classmap":"dpla:SourceResource","property":"dcterms:identifier"},"iri":"http:\/\/purl.org\/dc\/terms\/identifier","explain":"A Dublin Core Terms Property; An unambiguous reference to the resource within a given context.; Recommended best practice is to identify the resource by means of a string conforming to a formal identification system."},{"label":"Identifier","value":"W1_VA625_1947_04","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/identifier","classmap":"dpla:SourceResource","property":"dcterms:identifier"},"iri":"http:\/\/purl.org\/dc\/terms\/identifier","explain":"A Dublin Core Terms Property; An unambiguous reference to the resource within a given context.; Recommended best practice is to identify the resource by means of a string conforming to a formal identification system."}],"IsShownAt":[{"label":"DOI","value":"10.14288\/1.0214442","attrs":{"lang":"en","ns":"http:\/\/www.europeana.eu\/schemas\/edm\/isShownAt","classmap":"edm:WebResource","property":"edm:isShownAt"},"iri":"http:\/\/www.europeana.eu\/schemas\/edm\/isShownAt","explain":"A Europeana Data Model Property; An unambiguous URL reference to the digital object on the provider\u2019s website in its full information context."}],"Language":[{"label":"Language","value":"English","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/language","classmap":"dpla:SourceResource","property":"dcterms:language"},"iri":"http:\/\/purl.org\/dc\/terms\/language","explain":"A Dublin Core Terms Property; A language of the resource.; Recommended best practice is to use a controlled vocabulary such as RFC 4646 [RFC4646]."}],"Provider":[{"label":"Provider","value":"Vancouver : University of British Columbia Library","attrs":{"lang":"en","ns":"http:\/\/www.europeana.eu\/schemas\/edm\/provider","classmap":"ore:Aggregation","property":"edm:provider"},"iri":"http:\/\/www.europeana.eu\/schemas\/edm\/provider","explain":"A Europeana Data Model Property; The name or identifier of the organization who delivers data directly to an aggregation service (e.g. Europeana)"}],"Publisher":[{"label":"Publisher","value":"Vancouver, B.C. : McBeath Spedding Limited","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/publisher","classmap":"dpla:SourceResource","property":"dcterms:publisher"},"iri":"http:\/\/purl.org\/dc\/terms\/publisher","explain":"A Dublin Core Terms Property; An entity responsible for making the resource available.; Examples of a Publisher include a person, an organization, or a service."}],"Rights":[{"label":"Rights","value":"Images provided for research and reference use only. 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Recommended best practice is to use a controlled vocabulary."}],"Title":[{"label":"Title ","value":"The Vancouver Medical Association Bulletin: April, 1947","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/title","classmap":"dpla:SourceResource","property":"dcterms:title"},"iri":"http:\/\/purl.org\/dc\/terms\/title","explain":"A Dublin Core Terms Property; The name given to the resource."}],"Type":[{"label":"Type","value":"Text","attrs":{"lang":"en","ns":"http:\/\/purl.org\/dc\/terms\/type","classmap":"dpla:SourceResource","property":"dcterms:type"},"iri":"http:\/\/purl.org\/dc\/terms\/type","explain":"A Dublin Core Terms Property; The nature or genre of the resource.; Recommended best practice is to use a controlled vocabulary such as the DCMI Type Vocabulary [DCMITYPE]. 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Recommended best practice is to use an encoding scheme, such as the W3CDTF profile of ISO 8601 [W3CDTF]."}]}