"CONTENTdm"@en . "http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1179642"@en . "History of Nursing in Pacific Canada"@en . "Vancouver Medical Association"@en . "1925-09"@en . "2015-03-26"@en . "1925-09"@en . "'Nervous breakdown (C. F. Barker) ; Acute intestinal obstruction ; Ophthalmic aspects of general medicine.' -- Title page"@en . ""@en . "https://open.library.ubc.ca/collections/vma/items/1.0214343/source.json"@en . "image/jpeg"@en . " THE VANCOUVER MEDICAL\nASSOCIATION I\nBULLETIN\nPublished monthly at Vancouver, B. C.\nU^iervous breakdown\nC. F. Barker\ncZAcute Intestinal Obstruction^\nOphthalmic ^Aspects of Qeneral dTXCedicine^\nSEPTEMBER, 1925\n\"Published by\nQ^fCc^eath Spudding Limited, Uancouver, '23. Q.\nX( \u00E2\u0080\u0094\u00C2\u00BB-je\u00C2\u00A9l-\n;i^BH~-\nPetrolagar\nReg. U. S. Pat. Office\nSome 2}uestions cSAnswered\nMany physicians have asked us the following questions\nabout PETROLAGAR. For the purpose of general infor-\nt mation, we wish to broadcast these answers:\n1. How much mineral oil does PETROLAGAR contain?\nAns.: Sixty-five per cent, pure mineral oil of high\nviscosity.\n2. What is the bulk-giving constituent of PETROLAGAR?\nAns.: The only bulk-giving constituent is agar-agar.\n3. Is PETROLAGAR an ethical preparation?\nAns.: Every possible effort is made to keep PETROLAGAR strictly a prescription product. It is1 not\nadvertised to the public. We do not allow druggists\nto make window displays of it.\nIt has been passed for New and Non-Official Remedies\nby the Council on Pharmacy and Chemistry of the American\nMedical Association.\nThe Deshell Laboratories do not manufacture any product which is advertised to the public in any way.\nPETROLAGAR is issued as follows: PETROLAGAR\nCPlain); PETROLAGAR (with Phenolphthalein); PETROLAGAR (Alkaline); and PETROLAGAR (Unsweetened, no\nSugar).\nSend this coupon for an interesting treatise, \"Habit Time\"\nDeshell Laboratories of Canada Ltd.\nDEPT. V., 245 CARLAW AVENUE, TORONTO\nLOS ANGELES, BROOKLYN, N. Y., CHICAGO, .\nLONDON\nDESHELL LABORATORIES, INC., Depfc. V.\nGentlemen:\nKindly send me without obligation, a copy of the treatise,\n\"Habit Time.\"\nDr ,\t\nAddress ,\t\nPage Two THE VANCOUVER MEDICAL ASSOCIATION\nBULLETIN\nPublished Monthly under the Auspices of the Vancouver Medical Association\nin the Interests of the Medical Profession.\nOffices:\n529-30-31 Birks Building, 718 Granville St., Vancouver, B. C.\nEditorial Board:\nDr. J. M. Pearson\nDr. J. H. MacDermot Dr. Stanley Paulin\nAll communications to be addressed to the Editor at the above address.\nVOL. I.\nSEPT. 1st, 1925\nNo. 12\nOFFICERS, 1925-26\nPresident \u00E2\u0080\u00A2 Vice-President\nDr. J. A. Gillespie Dr. a. W. Hunter\nSecretary Treasurer\n. Dr. G. H. Clement Dr. A. B. Schinbein\nPast President\nDr. H. H. Milburn\nDr. W. F. Coy\nTRUSTEES\nDr. W. B. Burnett\nRepresentative to B. C. Medical Association\nDr. a. J. MacLachlan\nSECTIONS\nDr. J. M. Pearson\nAuditor\nDr. A. C. Frost\nClinical Section\nDR. W. L. Pedlow ......\nDr. F. N. Robertson ......\nPhysiological and Pathological Section\nDr. G. F. Strong -\nDr. C. H. Bastin -\t\nEye, Ear, Nose and Throat Section\nDr. Colin Graham ......\nDr. E. H. Saunders ......\nGenito-Urinary Section\nDr. g. S. Gordon .--...\nDr. J. A. E. Campbell - - - -\nChairman\nSecretary\nChairman\nSecretary\nChairman\nSecretary\nChairman\nSecretary\nCOMMITTEES\nLibrary Committee\nDr. Wallace Wilson\nDr. a. w. bagnall\nDr. W. D. Keith\nDr. W. F. McKay\nOrchestra Committee\nDr. f. N. Robertson\nDr. J. A. Smith\nDr. L. Macmillan\nDr. A. M. Warner\nDinner Committee\nDr. N. E. MacDougall\nDr. A. W. Hunter\nDr. F. N. Robertson\nCredit Bureau Committee\nDr. Lachlan Macmillan\nDr. J. W. Welch\nDr. G. A. Lamont\nCredentials Committee\nDr. Lyall Hodgins\nDr. R. Crosby\nDr. J. A. Sutherland\nSummer School Committee\nDr. Alison Cumming\nDr. Howard Spohn\nDr. G. S. Gordon\nDr. Murray Blair\nDr. W. D. Keith\nDr. G. F. Strong\nPage Three VANCOUVER MEDICAL ASSOCIATION.\nFounded 1898. Incorporated 1906.\n28th Annual Session\nGENERAL MEETINGS will be held on the first Tuesday of the month\nat 8 p.m.\nCLINICAL MEETINGS will be held on the third Tuesday of the month\nat 8 p.m.\nPlace of meeting will appear on Agenda.\nGENERAL MEETINGS will conform to the following order:\n8 p.m.\u00E2\u0080\u0094Business as per Agenda.\n9 p.m.\u00E2\u0080\u0094Paper of Evening.\nThe regular work of this Session will commence on Tuesday, Oct. 6, 1925.\nProgrammes to be announced later.\n% H5 ^ ^\nCITY HEALTH DEPARTMENT\nVancouver, B. C.\nSTATISTICS \u00E2\u0080\u0094 JULY, 1925\nTotal Population (estimated) 126,747\nAsiatic Population (estimated) 9,960\nRate per 1000 of\nPop. per Annum\nTotal Deaths . 111 10.3\nAsiatic Deaths 10 11.8\nDeaths\u00E2\u0080\u0094Residents only 70 6.5\nTotal Births\u00E2\u0080\u0094Male, 1 61\nFemale, 127 288 26.8\nStillbirths\u00E2\u0080\u0094not included in above 9\nInfantile Mortality\u00E2\u0080\u0094\nDeaths under 1 year of age 10\nDeath Rate per 1000 Births 34.7\nCases of Contagious Diseases Reported.\nAug\nJune.\n1st\nto \5th.\nCases. Deaths. Cases. Deaths. Cases. Deaths.\nJuly.\nSmallpox 10\nScarlet Fever 24\nDiphtheria 11\nChicken-pox 12\nMeasles 3\nMumps 21\nErysipelas : $gW;.\nTuberculosis 2\nWhooping-cough __,._ 28\nTyphoid Fever ._ 3\nEp. Cerebro-Spinal\nMeningitis 0\n8\n0\n9\n0\n11\n1\n6\n0\n0\n0\n^\n0\n5\n2\n9\n8\n24\n1\n2\n0\n0\n1\n0\n0 0\n(Cases from Outside City included in above.)\nDiphtheria : 3 1 4 0 1\nSmallpox t. 0 0 0 0 3\nScarlet Fever 3 0 0 0 1\nTyphoid Fever 0 0 2 0 0\nPage Four Truly mobile. The apparatus proper (upper section) may be removed from the cabinet (lower\nsection) and conveniently placed in the auto to\nfacilitate treatment in thepatient's home. In pneumonia cases especially is this feature appreciated\nA Diathermy Machine of Major Calibre\nfor Both Office Use and Treatment at the Bedside\nThe physician who does only a moderate amount of reading.of medical literature js aware of the present wide and\nrapidly increasing use of diathermy in medical practice.\nFor many years the Victor organization has, studied this\ntrend, during which one of the outstanding problems was to\ndesign an apparatus which would be of major calibre and at\nthe same time so compact as to permit its being conveniently\nmoved about, even to the patient's home when necessary.\nWhatever may have been your pafst experience with high\nfrequency apparatus of the portable type\u00E2\u0080\u0094most of which\nhave served only as mere introductions to the full possi-\nIfyou would know of the far-reaching possibi,\nwrite our Biophysical Research Publications\nbilities of this form of therapy \u00E2\u0080\u0094 bear in mind that the\nVictor Two-Section Mobile High Frequency Apparatus\nstands out as an engineering achievement that is destined\nto prove diathermy an important daily factor in the physician's armamentarium.\nThe machine is held down to compact size without sacrifice\nin the quality of currents delivered. In short, this Victor\nmachine is not a toy\u00E2\u0080\u0094rather it incorporates the honest intent of its designers to place in the physician's hands an\noutfit of major calibre with which he may confidently anticipate the best therapeutic results.\nties of high frequency therapy in your practice,.\nBureau for interesting and instructive literature\nVICTOR X-RAY CORPORATION, 2012 Jackson Blvd., Chicago, 111.\nSales Offices and Service Stations in All Principal Cities\nVancouver Branch: 910 Birks Building\n^ X'RAY\nDiagnostic and Deep Therapy\nApparatus. Also manufacturers\nof the Coolidge Tube\nPHYSIOTHERAPY\nHigh Frequency, Ultra'Violet,\nSinusoidal, Galvanic and\nPhototherapy Apparatus\n%,\n(T EDITOR'S PAGE\nThe wise mariner, when his ship is labouring in a storm,\nshortens sail. If she labours still, he sometimes finds it necessary\nto lighten ship by jettisoning cargo. One supposes that, in doing\nthis, he selects that which is least valuable to throw overboard.\nSo the wise man, when he finds income insufficient to meet outgoings, when his financial ship is labouring, shortens sail and\nthrows overboard unnecessary things, and luxuries which he can\nbest spare.\nIn these days of high.overhead cost of living, all of us occasionally feel the need to retrench. Whether we do this in the\nwisest way or not, is another question. The cause of these reflections is the discussion that has been rather frequently heard of\nlate about membership in the various Medical Associations. To\nmany it would appear this seems a luxury, a rather superfluous\naddition to one's burdens, and they adduce arguments for relinquishing it, if not in all, at least in one or two.\nTo such, indeed to all who need a little moral support for\ntheir belief that such membership is a necessity and not a luxury,\nwe would heartily commend a careful reading of a great speech of\nOsier's, \"On the Educational Value of the Medical Society,\" found\nin the collection of Essays known as \"Aequanimitas.\" While he\ngives it this title, the speech points the way, in his inimitable style,\nto many other profits that accrue from associations of medical\nmen. \"Unity and friendship . . . are essential to the dignity\nand usefulness of the profession.\" It would be hard to put more\ntruth into ten times as many words. The removal of misunderstandings\u00E2\u0080\u0094better yet, the prevention of them\u00E2\u0080\u0094encouragement in\nthe day's work, renewal of enthusiasm and devotion, refreshment\nof mind and recreation\u00E2\u0080\u0094these are some of the blessings, apart\nfrom educational advantages, that Osier found in \"a well-conducted society.\" Everyone of us must know this to be true; in\nfact, the history of our own Association proves its truth. Surely\nin the stress and strain of a busy medical life, perhaps even more\nto the men beginning their career, with their long periods, deadly\ndull, of waiting, and of discouragement, such boons as these are\nbeyond price, are more than mere luxuries.\nAnd then the Library\u00E2\u0080\u0094and one can imagine what Osier\nwould say about this. From a mere dollars and cents point of\nview, this one thing alone repays the yearly subscription a dozen\ntimes a year. Especially is this true of such a Library as ours,\nwith its admirable system of delivery of books, magazines, and\nso on.\nThere is another side to the picture\u00E2\u0080\u0094the necessity for organized action, for union, not merely unity.N The medical man\ncannot be, at any rate he should not be, only a practitioner of\nmedicine. He should be an apostle of public health, of sanitation, of good laws\u00E2\u0080\u0094he should be a citizen, and one of the moral\npolice force of the country\u00E2\u0080\u0094and he can do this most effectually\nthrough association. Again, he has enemies, spoilers, exploiters\nof his good-nature and idealism\u00E2\u0080\u0094and for defence against these he\nPage Six needs a shell of organization, of companionship en masse with his\nfellows. Here comes in the wider type of association, provincial\nand federal. Through these we may preserve intact our identity\nas a profession, may carry weight in the councils of the nation,\nmay find insurance against the perils that do so easily beset us.\nAnd as insurance, it is very cheap.\nNot to do one's share in this, argues a rather small spirit.-\nFor the work must be done, and is done, and everyone benefits\nby it. The least each one can do is to pay his share, or he is accepting charity from those of his fellows who have a better appreciation of their responsibilities.\nMoreover, it gives one the valuable right of every free-born\ncitizen, that of finding fault with one's administration. You may\ndo this justly, if you have paid your tax and cast your vote, but\nthe man who won't pay his taxes, and neglects to exercise his\nfranchise, has no right whatever to complain of the government\nof his country.\nAnd so with us. If the Association, whichever one it may\nbe, is not up to your ideas of what an Association should be, you\nhave your remedy\u00E2\u0080\u0094join it, work in it and for it, and give it the\nbenefit of your own personality. Both of you will gain immensely, yourself perhaps most of all. The cost is trifling, in\nfact it .is an investment, and not an expenditure, but to get the\nmost out of your investment you must look after it yourself.\nNEWS AND NOTES\nIt is with great regret that we hear that Dr. Alison Cum-\nming is still very seriously ill, and has gone back to Montreal for\ntreatment. A large section of the public will join us in our wishes\nfor his speedy recovery.\nDr. R. A. Seymour, of the Vancouver General Hospital,\nis being congratulated on the arrival of a daughter. Mrs. Seymour\nand the new citizeness are doing well.\nOur worthy President, Dr. J. A. Gillespie, has returned from\nCalifornia, where he has been with his family for a month's holiday, in the form of a motoring trip.\nDr. E. H. Funk is the latest addition to the Benedicts' Association. He has our congratulations.\nThe little island of Savary is gradually becoming a very\npopular resort for medical men, many of whom have summer cottages there, and whose purest delight it is to introduce their friends\nto the charms of the island. Latest converts, we understand, are\nDr. F. N. Robertson, who has built there this summer; Dr. T. H.\nLennie, who reports favourably on the place; Dr. W. D. Keith,\nDr. H. H. Milburn, each of whom have taken cottages there for\nthe summer, and others, who have made visits of more or less\nlength. It is an ideal spot from a doctor's standpoint, quiet,\nand far from telephones and automobiles. To many of us, the\nfact that there is no golf, also gives a feeling of change and rest.\nPage Steven It is with great pleasure that we record the return of Dr. A.\nS. Monro to his usual occupations. We can assure him that the\ncorridors of the V. G. H. have seemed unusually quiet and untenanted, without the daily, almost hourly, vision of his white-\nsheeted form flitting about them.\nDr. A. W. Bagnall has left for Boston and New York to\ndo post-graduate work in medicine.\nDr. F. P. Patterson leaves soon for the East to visit orthopaedic clinics.\nIn view of the ever-growing interest in physiotherapy, members will be glad to hear that Dr. H. A. Barrett (Medical Arts\nBldg.) has offered to give a short course of practical instruction\nin this subject to all who care to take it. No charge will be made,\nand out-of-town physicians are especially welcome. The course\nwill be held in the evenings, and any who are interested are requested to communicate with Dr. Barrett at once.\nMembers are again reminded that fees for the current year\nare now due and payable. The work of the Executive is greatly\nimpeded by the tardiness of a good many of our members in this\nrespect.\nWe would again call attention to the obligation we are under\nof supporting the firms who advertise in THE BULLETIN. When\ndoing so, please apprise such advertisers of the fact that you read\ntheir advertisement in THE BULLETIN.\nDr. Geo. Lildon, member of the Dominion Medical Council,\nleft for the East on the 27th August, and expects to be away about\na month.\n^c ^c ={e 5J?\nLIBRARY NOTES\n(The Library is situated in 529-531, Birks Building, Granville Street, Vancouver. Librarian: Miss Ftrmin. Hours: 10\nto 1, 2 to 6.)\nREVIEWS OF BOOKS\nInternational Clinics, Vol. 1. Thirty-fifth Series, 1925.\nJ. B. Lippincott Co. $2.00. \"i\nThe international character of the work is maintained in this\nvolume by contributions from Scotland, Switzerland, and France,\nthough by far the greater part of the material had its origin in\nAmerica. Two articles by Prof. L. F. Barker\u00E2\u0080\u0094on Staphylococcus\nSepticaemia and Treatment of Neuroses, respectively\u00E2\u0080\u0094will be of\nspecial interest to members of this Association at this time. The\nprominence of functional disorders in present day medical thought\nis attested by the fact that three other writers discuss some aspect\nof the psychoneuroses, the articles by Dr. Alfred Gordon, of Philadelphia, on \"Psychoneuroses in Relation to General Medicine,\"\nbeing especially interesting and suggestive.\nSome of the problems of urological diseases are comprehen-\nPage Eight sively dealt with in two articles from the Dorsey Clinic of St.\nLouis. Other surgical subjects considered are diseases of Meckel's\ndiverticulum, mastoid diseases, malformations of the rectum and\nanus, acute osteomyelitis and intranasal lesions. Dr. Max Thorek,\nof Chicago, describes what he styles \"A New and Effective Method\nof Treatment of Clinic Suppurations, Especially of Bones,\" which\nconsists in the application of an aluminum-potassium nitrate solution in a compress of sterilized rolled oats. The claim of the effectiveness of the method is supported by a tabulated report of\n116 cases so treated by the writer and others.\nCommencing with a sketch of the regime of Cornaro, a Venetian, born in 1467, who attained the age of 105, Charles Greene\nCamston, in his article on Macrobiosis, gives an interesting account of some of the methods that have been advocated for * prolonging life, and makes some deductions applicable to our own\ntime.\nA summary of Medical Progress in 1924 concludes the\nvolume.\nW. F. M.\nADDRESS BY DR. BARKER ON\"\n\"NERVOUS BREAKDOWN\"\nDr. Lewellys F. Barker, of Johns Hopkins, addressed a large\naudience of members of the Vancouver Medical Association in the\nUniversity Auditorium on the evening of Wednesday, July 29th.\nDr. A. W. Hunter, Vice-President of the Association, occupied\nthe chair and introduced the speaker. Dr. Barker took as the\nsubject of his address \"The Nature, Causes and Prevention of\nNervous Breakdown.\"\nDr. Barker said that the nervous individual often lacks the\nsympathy to which he is entitled. He cannot think right and act\nright because he is ill, and it does great harm to tell him that his\nsymptoms are imaginary. These symptoms are just as real and as\ngenuine as those produced by definite organic ailments. As to the\nvarieties of nervous breakdown their name is legion. The neurasthenic and hysterical patient we all recognize. The hypochondriacal patient who tries to interpret his own symptoms in\nterms of organic disease: the psychasthenic, who is full of fears\n\u00E2\u0080\u0094fears of himself, fears of place, and fears of people\u00E2\u0080\u0094are also\nfamiliar to us.\nOf the psychoses proper the manic depressive group is one\nof the most important. This cyclic, or circular insanity, is one\nwhich in some form or other is quite widespread. In this condition the patient for a period of time may be greatly depressed,\nclaims everything appears \"blue,\" and is decidedly melancholic.\nAfter a year or two he may begin to see daylight again. The\ngloominess and depression wear off and things may take on a more\nroseate appearance. He feels happy and ecstatic, tends to talk rapidly, and is in a rather exalted state of mind. The trouble is he is\nPage Nine often foo exalted and may become erratic or even maniacal. The\nfirst stage is the depressive and the second the maniacal stage of\nthis malady. We must recognize, too, that there are incomplete\nforms of this disease during which the patient may be only mildly\ndepressed and correspondingly mildly elated. The depression\ngrows, and the disease is quite unaffected by treatment, and the\nphysician in charge of the case may lose or gain credit according\nto the time at which he sees the patient. If at the beginning of\nhis depression it has been said no treatment is of use\u00E2\u0080\u0094if at the\nend, the patient will lose his depression with any or no treatment.\nIn patients with manic depressive psychoses there is no loss of\nmental power.\nAnother variety is the dementia praecox group. These lamentable cases occur in young people. They begin to think their\nfriends are not treating them rightly, they have grievances, they\nare misunderstood, and in general take on the aspect of misfits.\nThey may get paranoid symptoms. The prognosis in this group\nis much worse than in the manic depressive group. Systematized\nparanoid delusional cases are rare.\nOf the organic psychoses there are many. For example, those\nof the toxic infections, as in typhoid fever. Lately a great many\ninstances have resulted from the infection of encephalitis lethargica,\nwhich produces very characteristic symptoms. While it is probable\nthat some cases entirely recover, it must be recognized that most\nhave residual symptoms. About 25% or more of cases will show\nthat variety of sequela known as Parkinson's syndrome. This\nsyndrome may occur early in the disease (in which case recovery\nseems to be possible), but usually six months or even a year elapses\nbefore its onset, and the outlook is then correspondingly bad.\nThis syndrome is well recognized, very closely simulating paralysis agitans, except that the tremor is usually absent.\nSyphilis may be the cause of another form of organic psychosis, either in the form of definite lesions of the brain or meninges, or as one of the parasyphilitic affections producing general\nparesis. Then there are the organic psychoses associated with severe attacks of multiple neuritis, as may occur in arsenical poisoning, known as Korsakoff's syndrome.\nFinally we come to the arterio-sclerotic dementia, which in\ngreater or less degree affects us all if we only live long enough for\nit to do so. Unfortunately this condition may at times be presenile in character, that is, the customary arterial changes associated with advancing years occur (possibly for reasons of heredity) in early life, and symptoms, such as unusual forgetfulness,\nbegin to manifest themselves at this age.\nPsychopathic personalities are distorted personalities.\nAmong them we find a degree of feeblemindedness. These are the\npeople who are unusually quarrelsome. They are the litigious\nvariety of persons. They constitute a large element of those who\nappear in the divorce courts. Rightly considered the circumstances\nleading to divorce mean mal-adjustment, and it is very curious\nthatsdivorce proceedings often run in families. They also con-\nPage Ten stitute the derelicts of society, the ne'er-do-wells, tramps, drug\naddicts, etc. All these have bad nervous systems and tend to be\nantisocial. Rightly regarded all crime and delinquencies are due to\nmal-adjustments, and are the result of bad nervous systems. Society is apt in these cases, for its own protection, to take revenge\nupon these people when, doubtless, the proper way would be to\ntry and reclaim them, if possible.\nThe nervous system is the great organ of integration, and in\nall forms of nervous breakdown there is evident a lack of adiust-\nment to surroundings. The laity recognize this in their very\nfamiliar expressions of the condition. They say of such a person\nthat he is \"all gone to pieces,\" or disintegrated, or is \"all broken\nup,\" and, conversely, when he recovers they will say he has \"pulled himself together.\"\nThe borderline between health and disease is very narrow,\nand it is somewhat difficult to give a definition of what one understands by these terms. The best definition, the lecturer said, which\nhe had been able to arrive at was that health represented an adequacy of response? to environment. What are the conditions leading to inadequacy of response? In these cases we must look for\ncauses to what has gone before. We must consider, for instance,\nthe germ cells,.two in number, which contain all the potentialities\nof the individual, and these potentialities cannot in any instance\nbe transcended. Whether they shall be allowed full development\ndepends upon the environment in which the individual is placed,\nand this development is the forerunner of all that comes afterwards.\nHeredity and environment constitute two important causes in\nthe conditions under consideration. Heredity is probably the more\nimportant of the two, and certain conditions, such as longevity\nand predisposition to disease, are undoubtedly hereditary in character. Identical twins is the name given to foetuses produced in-\nthe same egg-cell by a single fertilization in contradistinction to\ntwins produced from different egg-cells. These latter may be of\ndifferent sex, but identical twins are always of the same. They\nare exceedingly alike, and it is very hard to tell them apart, especially when young, even their parents may have difficulty in doing\nso. Curiously enough, so strong is the part that heredity plays,\ntwins of this nature are apt to sicken of the same disease in later\nlife, although they may be living in entirely different parts of the\ncountry.\nDr. Barker went on to illustrate his point by a reference to\nthe classical case where, as the result of illicit intercourse of an individual with a feebleminded woman, a child was born from whom\nthere have been a great many descendants also feebleminded and\nmany of criminal tendencies. Later the man married, and most\nof his legitimate descendants have turned out extremely well, many\noccupying high positions in various professions and in political\nlife. Dr. Barker thought that as a result of the work being done\nby various societies interested in the problems of eugenics, genealogical histories might some day be available for medical consider-\nPage Eleven ation and for use in the treatment of individual patients.\nIt is probably true that hereditary dispositions may be modified by environment. Nevertheless, hereditary possibilities must be\ncarefully considered, and especially in the adoption of children the\nhistory of the antecedents should be fully investigated.\nIt follows, then, that in the prevention of nervous breakdown\nthere are two prime necessary requirements: (1) the individual\nshall be well-born, and (2) his environment shall be of a suitable\ncharacter. Dr. Barker's opinion was that in the long run more\nwill be accomplished by applying eugenic principles than by modification of environment. He considered heredity was extremely\nimportant. As to the best way of introducing and applying the\nprinciples of eugenics, he had grave doubts as to the wisdom of\nlegislation except so far as such legislation represented the settled\nconviction of the majority of the people. The proper way is by\nmeans of education. Especially should this be applied to young\npeople, who should be taught things concerning the beginnings of\nlife, biological principles particularly. He considered that Mrs.\nGrundy was a very important factor in the case. If young people\nrealized that it was not the thing to become engaged to an individual because of feeblemindedness or insanity in the family, they\nwould soon learn to nip early manifestations of love in the bud.\nThe immigration problem has also to be faced. In the United\nStates they allowed all and sundry to come in without let or\nhindrance until they found that it seemed likely the native Anglo-\nSaxon stock would be overwhelmed by the influx of peoples of\nless vigorous race, and they had come to the conclusion that in\nfuture more careful selection should be made.\nConcerning environment, we must realize that while, as a\nrule, the germ cells were well protected, nevertheless they might be\naffected by certain poisons. In lead workers, for instance, it has\nbeen found that defects may occur with a good deal of regularity\nin the offspring as the result of the toxic effects of this mineral.\nRegarding alcoholism, the question was quite open. Dr. Pearl,\nof Johns Hopkins, was of the opinion that alcohol tended to kill\noff the poor germ cells and leave the good ones. Then there was\nthe question of pre-natal care and the hygiene of the expectant\nmother. The hygiene of infancy was of great importance, care,\nfood, nursing, and so on. The pre-school age is the important\nformative period of life, both from the physical and mental side.\nAt this age the child is taught obedience, the proper performance\nof tasks, the bearing of small annoyances. The habits of parents\nand the home surroundings are of immense importance at this\nstage in the formation of character, and great differences may result according as to whether such influences are good or bad.\nSchool age is important. The school physician of the future should\nbe able to examine and estimate mental, as well as physical traits,\nbeing thus able to indicate the style of education which is suitable\nto the individual child. If a child of inferior nervous or mental\ndevelopment is placed in a class with more normal children and\nits inability to carry on the work in competition with them is\nPage Twelve made the subject of remark or scorn, an inferiority complex may\ndevelop which the child may never overcome. As maturity is\nreached, vocational guidance is of great importance. Life work\nof an interesting character is one of the greatest safeguards we possess against the likelihood of nervous breakdown. Putting people\ninto a position where all their legitimate needs and requirements,\nsuch as need for healthy parenthood, economic security, and proper social relationships can be satisfied, is another of the defences\nagainst nervous breakdown.\n* * *\nTHE IMPORTANCE of OPHTHALMIC ASPECTS of\nGENERAL MEDICINE\nBy Dr. Edward Jackson, Denver, Col.\nAbstract of an Address delivered before the Vancouver meeting of\nthe Pacific Coast Oto Ophthalmological Society, June, 1925.\nThe situation and constitution of the eye are peculiarly favourable for exact observation of what occurs in it during life.\nWe can see with the ophthalmoscope the first reaction along the\nretinal vessels\" to the tubercle bacillus, or we can watch the appearance of a choroidal tubercle and its passage through the different\nphases of its progress. Tuberculosis with its lesions now recognized in every tissue of the eye is open to continued microscopic\nstudy throughout its course. Syphilis has been more studied and\nis better understood in the eye than in any other organ of the body.\nAll vascular diseases known by their gross effects or recognized\nafter death are to be studied in the eye from incipiency to resolution or to functional or organic destruction of the parts inyolved.-\nThe relations of the eye to the central nervous system are such\nthat this organ might be termed \"the bulletin board for diseases'\nof the brain and spinal cord.\" Of the twelve cerebral nerves six\nare distributed in whole or in part to the eye and its appendages.\nThe four cranial and the sympathetic motor nerves distributed to\nthe intra and extra ocular muscles bring their controlling impulses\nfrom the cortical motor centres. We can think of this elaborate\ndivision of the nervous system as of a telegraph or telephone system capable of bringing information from all parts through which\nit passes, as well as from its more distant terminals. The intelligence thus furnished is published by the symptoms manifest in\nthe eye. To change the metaphor, the ophthalmic physician from\nhis point of vantage watching the eye and interpreting the signals\nit gives, as the forest observer would interpret a distant column of\nsmoke, has command of a great territory of disease.\nIt is time that those who study diseases of the eye should\nunderstand their position of advantage and accept the responsibility it entails in the general struggle of the medical profession with\nthe forces of disease, disintegration and death. Lesions occurring\nin the eye are most favourably situated for the observation and\ndemonstration of the course of such lesions. Pathology has a new\nPage Thirteen meaning for all physicians when it is demonstrated and studied in\nthe living body. Its ophthalmic aspects constitute a whole department of modern scientific medicine. In a few directions these are\nalready somewhat known, but in all directions the boundaries of\nour knowledge show unexplored regions to be studied that stretch\nout beyond the extending horizon of science.\nThe common methods of examining the eye offer a field for\nthe acquirement of a great deal of knowledge, experience and skill.\nIt is important that all physicians should know something of these\nmethods of investigation. They should be regarded as part of the\nfundamentals of medicine. But the special advances in modern\nmedicine that enable us to render our most important services to\nthe community and entitle us to the greater part of the compensation for our services, are only mastered by years of observation,\nand study and application of what has been learned in the conscientious management of cases.\n,,..,* 'He who would qualify for the function of an ophthalmic\nphysician or a consultant in the best sense, must have both the\nbroad outlook on disease in general and the sense of proportion\nobtained by thinking on its general problems, and an exact practical acquaintance with modern methods. He should be able to\ntest visual acuity in different ways and under all sorts of circumstances. He must know that vision of 20/20 may be vision markedly below the normal for a particular person: that visual acuity\nabove standard and entirely normal for the individual patient, is\npossible along with marked papilledema; or great narrowing of\nthe visual field, hemianopsia or scotomata, of various forms and\nlocations and significance. He must have in mind the possible\ncauses of sudden variations in visual acuity; circulatory disturbances with brain tumour, or pituitary disease, toxic amblyopia,\nspasm or paresis of accommodation. The effect of floaters in the\nVitreous, the variations due to posture and adaptation in detached\nretina; besides the ups and downs of glaucoma; or the changes\nin visual acuity with changes in the size of the pupil, in ametropia\nor partial opacity of the crystalline lens. He should know the\nmeaning of each change in the form of the field of vision; the enlargement of the blind spot from disease of parts adjoining the\noptic nerve, the toxic causes of central scotoma, the peripheral\nboundaries of the field for different test objects, different illuminations, different states of adptation, the significance of ring scotoma, islands of retained vision, relative sensitivity to light and\ncolors. The changes of field and visual acuity that characterize\ntobacco, amblyopia or the effects of methyl alcohol poisoning, or\nquinine amaurosis. How the recovering brain cortex may perceive\nmovement in the visual field, before form or moderate changes of\nillumination are able to impress consciousness.\nThe ophthalmic consultant must be familiar with all the\nforms of pain referred to or about the eye, and with the language\nin which they are described and referred to by different patients.\nHe should know that the significance or lack of significance to be\nattached to all kinds of pain, depends as much on the psychology,\nPage Fourteen physical condition and desires of the patient as upon the organic\nconditions with which it is associated. The various forms of\ndysthesia, dryness of the eye ball, \"stiffness\" of the lids, tics that\nare not evident to inspection, sensations of heat or cold. All these\noccur in an organ most delicately sensitive, the sensations in which\nare most sure to be thought about, and talked about, and watched\nfor, and to furnish supposed cause for alarm, of any portion of\nthe body.\nThe visual sensations to be classed as dysthesias are numerous\nand important, and the patient's story of them often puzzling.\nScintillating scotoma and the sudden disturbances of the visual\nfield that belong with it, are always alarming when they first occur, and more often depend on other than .ovular disturbances.\nMuscae volitantes cause more annoyance, unjustified disquiet and\nalarm, than almost any other symptom we are asked about. The\nvarious interferences with vision, due to after images, usually entirely a mystery to the patient, are often confusing to the physician. He who would interpret their effects must be familiar with\nthem, in both health and disease: must be on the lookout for\nthem when testing visual acuity, or mapping fields, or considering\napparent improvement or deterioration in acuteness of vision.\nSo much for the subjective evidences of general function. But\nthe ophthalmic aspects of disease are of greater importance because\nthey are so largely objective. Let us recall the breadth of their\nsignificance by consideration of a very few. The ophthalmoscope\nopened the modern era in ophthalmology. The power it gave or\npushing our investigations to the depths of the eye, was not greater\nthan the power it gave of discrimination as to the character, origin\nand outcome of conditions heretofore thought of as identical. We\nno longer deal with \"inflammation of the uveal tract\"; we have\nto consider the inflammatory reactions to syphilis, tuberculosis,\nfocal infections of the uveal tract, or involvement of the uveal\ntract by the attacks of pyogenic bacteria, its invasion from adjoining parts or by metastasis through blood channels. The influence\nof innervation in the causation and modification of uveal disease\nstill challenges our ability for original research. Through symptoms of herpes zoster, and acute glaucoma we know it may be extremely important.\nNot only has the ophthalmoscope made us acquainted with\natrophy of the optic nerve during life. Not only has it enabled us\nto discriminate between inflammation and atrophy, between primary and secondary, beginning and advanced atrophies; it has\nplaced upon us the burden of correlating the visible changes in appearance of the nerve head, with the nature of the pathogenic\nagent, the progress of the disease process, the possibilities for recovery, the influence of therapeutic agents in checking disease and\nin bringing about recovery. Not only has the ophthalmoscope\nrevealed the existence and course of optic nerve oedema and optic\nnerve inflammation. Not only have physicians like Allbutt, Hugh-\nlings, Jackson, and Gowers, and surgeons like Jonathan Hutchinson and Victor Horsley, demonstrated the flood of light it throws\nPage Fifteen on diseases of the central nervous system, making diagnosis certain,\nprognosis probable and therapeutics more definite. Swiftly accumulating observations of many workers in ophthalmoscopy show\nthe very wide range of conditions, ocular and extra-ocular, in\nwhich this method of examination is giving new light on the character and presence of general disease. It is a modest inference, going little, if any, beyond what individuals have already achieved,\nto claim that the ophthalmoscopic examination of the optic nerve\nwill, in the very near future, play as important a part in the observation of general disease as the feeling of the pulse did up to 70\nyears ago.\nWith reference to the circulation of the blood, it might be\nsaid in all soberness and restraint of enthusiasm that the use of the\nophthalmoscope has doubled the clinical value of Harvey's great\ndiscovery. The changes in the color of retinal vessels in conditions\nof anaemia, polycythemia, altered haemoglobin or lipaemia retin-\nalis, should all be recognized by the ophthalmoscopist. The widening of veins by collapse, or by distension; the irregular calibre\nof the blood stream due to spasm, or to endarteritis; the change\nof color or hiding of veins crossing behind them, due to changes\nin the arterial walls, should be familiar ophthalmic aspects of general disease. The exudates and haemorrhages of various forms\nhave a wide range of significance, in connection with circulatory\nconditions. That significance can only be discovered by the skilled ophthalmoscopist. He should have the knowledge of pathology, the interest in different possible causations to interpret their\nsignificance. These are refinements of observation and judgment\nthat can only be expected of the experienced ophthalmic physician.\nThe recognition of early departures from health in the small\nretinal vessels is more definite, more significant than any observations on the blood pressure. The warning it should convey\nwould be of the highest value to a large proportion of people who\nhave reached middle age. If such information were at the disposal\nof every patient for whom a physician prescribed correcting lenses,\nhow many intelligent, well-to-do people would go to the nonmedical optometrist for relief from presbyopia? If members of\nthe general medical profession understood these things, how many\nof them would send their patients to the optometrist for glasses?\nMicroscopy of the living eye is likely to be as fruitful of important facts as ophthalmoscopy, and it is waiting for students\nto explore and map out its most important domain. Koeppe,\nVogt, and their followers, have observed and pointed out many\nthings, that are to be seen by this means; but their significant relations to general conditions of the body and their clinical value\nin diagnosis, prognosis and indications for treatment, are still to\nbe worked out. It is quite likely that in another generation biomicroscopy will be found more fruitful and more important than\nophthalmoscopy. I\nThere are other methods of examination that promise results\nof great interest in general medicine. The study of epithelial\nPage Sixteen parasitism in the eye by Lindner, Graef, Gifford, McKee, Howard\nand others, opens up a field of great promise in bacteriology and\npathology, and for this, as for other things, the eye is the peculiarly favourable portion of the body for clinical experiment and\nobservation. Here the various anaphylactic reactions are best\nstudied locally; and such studies must help to fix their general\npractical importance.\nThe staining of living tissue in the eye and the effects of\nsuch staining, are worthy of our most careful attention. In our\nsearch for corneal ulcers and foreign bodies we have been using a\nmethod that can throw light on many questions of cell physiology,\nnormal and morbid and pharmacology.\n* * *\nACUTE INTESTINAL OBSTRUCTION\nAbstract of Address delivered by Sir Henry M. W. Gray before the\nVancouver Medical Association Summer School.\nAfter referring to the lessening incidence of obstruction- following abdominal operations due to improvements in technique\nand to the variation in symptoms produced by obstruction, the\nlecturer proceeded to consider the etiology of the condition. In\ninfants and young children intussusception is by far the most frequent cause. Beginning possibly as the result of excessive peristalsis, as the process develops the bowel becomes more and more\ninfolded, with the result that congestion, swelling, occlusion of\ngut and vessels, traction on nerves, haemorrhage and shock assert\nthemselves. Needless to say in such cases symptoms are severe and\npersistent unless and until their severity is marked by the exhaustion of the bowel and of the patient. Intussusception in older\nchildren and in adults is usually due to some pathological condition, most frequently a polypus, more rarely a stricture. At this\nage; however, the most usual causes of intestinal obstruction are\nfibrous bands, internal hernia. Meckel's diverticulum, volvulus,\nimpaction of concretions, sudden blockage of a chronic stenosis\nbrought on by tubercle, cancer or pressure from a tumour outside\nthe bowel, and old or recent adhesions causing acute angulation\nof the bowel. Finally we must remember the so-called adynamic\nor paralytic ileus, which may possibly occur after any abdominal\noperation, but especially where the bowel has required much handling or where over-distension has existed previous to operation.\nThe most frequent and serious form is that caused by peritonitis,\nwhich may affect both small and large bowels. Hence Sampson\nHandley's name of \"ileus duplex.\" In this connection one may\nmention the acute toxaemia which occurs especially when the obstruction is situated high in the small intestine. It would appear\nthat the poisons absorbed from the upper jejunum and especially\nfrom the duodenum, exert profound metabolic changes which can\nbe easily appreciated in the blood. These are evidenced by great\ndiminution in the chloride content, increase in blood urea, and in\nPage Seventeen I\nthe capacity of the blood for carrying carbon dioxide. In the\nlater stages this toxaemia exerts an evil effect on the kidneys, producing an acute inflammation with changes in the tubular epithelium or a more diffuse nephritis.\nThe clinical symptoms of obstruction vary according to the\nsite and cause, but there are certain phenomena common to all\nvarieties. In some cases there are premonitory symptoms in the\nform of recurrent colicky pains usually in the same part of the\nabdomen. If a loop of bowel becomes suddenly strangled, very\nsevere pain, with manifestations of shock, occurs. After this preliminary storm may come a more or less pronounced calm, though\nconsiderable steady pain usually persists. This, when the small\nintestine is the seat of trouble, is usually referred to the umbilical\nregion, and to the hypogastric area when the lower bowel is affected. In some cases the respite may be so definite that the patient drops off to sleep. Very soon, however, the characteristic\nturmoil begins. The persistent pain becomes more intense. It is\naccompanied by spasms of colic, more frequent and more intense\nwhen the small intestine is affected. Vomiting soon sets in. At\nfirst remnants of food are evacuated, then bile, followed by more\nor less clear watery material as the contents of the small intestine\nregurgitate into the stomach. Finally as congestion and decomposition increases, the vomitus becomes brownish; it is described as\nbeing faeculent in character. The higher the obstruction, the\nmore severe usually is the persistent pain, the more frequent the\ncolics and the earlier the onset of vomiting. In some cases localized bulging of the abdominal wall, accompanied by the sensation of a tumour mass on palpation, may develop quite early and\nbefore general distension occurs.\nOne can frequently make out a succussion splash in the distended coils above the point of strangulation which sometimes give\nclear indication of the site of obstruction. This is also at times\nindicated by an area of greater tenderness.\nWhile general distension occurs fairly regularly if the lower\npart of the small intestine is affected, it may not occur in strangulation of the upper part. It is stated that distension occurs much\nlater in obstruction of the lower part of the colon or rectum.\nObstruction in the small intestine has been shown to render\nthe bowel more permeable so that imperfectly digested proteins,\netc., gain entrance to the blood, which may explain the excess urea\nfound therein. Constipation is a very prominent feature in these\ncases, and should always be impressive, because when colic occurs\nwithout obstruction it is always accompanied, sooner or later, by\nthe passage of gas or faeces. But here, after the bowel has become\nemptied of its contents below the site of obstruction, constipation becomes absolute, neither flatus nor faeces being passed.\nIf the obstruction is not relieved the muscular coats of the\nbowel become exhausted, and on that account pain may be relieved\nto some extent. At this stage the nervous mechanism of the bowel\nis liable to become poisoned by toxins manufactured in the stagnating contents. This may result in paralysis or at least paresis\nPage Eighteen of the bowel. Very soon one finds that organisms penetrate the\nwalls of the bowel at or above the obstruction, and cause peritonitis.\nThe picture presented by the patient at this time is a very\nmiserable one. Some describe it as a condition of secondary shock.\nIn large part the symptoms are due to loss of fluid, from persistent\nvomiting and sweating, but it is really also a condition of profound toxaemia. The face is drawn and pale, often dusky, the\neyes are sunken, the skin is cold with clammy sweat. The nose,\nears and fingers may be mottled and blue, with stagnating capillary\ncirculation. The pulse is feeble, thready, rapid; respiration is\nrapid, often sighing, and temperature is subnormal. There is persistent, insatiable thirst. There is only occasional colicky pain.\nVomiting becomes of an overflow character. The patient may be\nunusually alert mentally. He often does not realize the seriousness of his condition. The end may come quite rapidly.\nTreatment\nThere is usually so great urgency in many of these cases that\n1 think one does the patient an injustice if one waits for results of\nspecial laboratory examinations. Please do not think that I do\nnot appreciate the value of these findings. The abnormal conditions of the urine and blood may give most valuable indications\nfor both operative and post-operative treatment. But the questions, whether blood urea is or is not present in large excess, and\nwhether chlorides have or have not largely disappeared from the\nblood, does not, or ought not, to influence the operative procedure.\nThere are certain necessary procedures which are accessory to\noperation, and which become increasingly important as the case\ndevelops in intensity.\nFirst, it is necessary, if the patient has been vomiting at all,\nto wash out the stomach, especially before giving a general anaesthetic, otherwise he runs the risk of being drowned by his own\nvomit, or of inhaling vomited material and bringing on septic\npneumonia. Spinal or even local anaesthesia does not entirely\nobviate these risks. I remember many years ago being called to a\nremote village to find the patient, a large, heavy man, in a very\npitiable and distressed state owing to neglected chronic obstruction which had suddenly become acute. In my innocence of those\ndays I thought that while he would not stand a general anesthetic,\nhe would be able to control his vomiting so that it would not\nchoke him, if we gave him a spinal anaesthetic. I wanted to avoid\nfor him the further distress of having his stomach washed out.\nHe was very nervous and had a bad heart. I neglected to tell him\nthat his legs might become paralyzed temporarily. When the\nspinal anaesthetic took effect, he suddenly realized that he could\nnot move his legs. He took fright, became greatly excited, fainted, vomited profusely and really drowned himself, although his\nenfeebled heart failed him also.\nIn some cases where vomiting had persisted and was tending\nto become overflow in character, I have left the stomach tube in\nPage Nineteen situ during the operation, or if the stomach and upper intestine\nwere found distended when the abdomen was opened, have had\nit passed again.\n\"The next big indication is to restore as far as possible the\ndepleted body fluids which have been extracted from the tissues\neverywhere. Recent investigations have shown that, as the case\ndevelops, the chlorides of the blood become increasingly diminished, and this fact has apparently a great deal to do with the recuperative powers of the patient. We must make up for the loss of\nthese chlorides by supplying him with more, but not in overwhelming amounts. Therefore give, according to the size of the\npatient, the state of his heart, and the effect on his pulse and general condition, intravenous, subcutaneous and rectal infusions of\nsaline solution. His tissues will tend to drink it up rapidly, so\nencourage absorption by making the solution isotonic.\nI think it is better not to give active aperients after operation\nuntil the bowel has had time to recover its tone. Such a stimulus\nmay, I believe, have the opposite effect to what is desired and\nmake the debilitated bowel \"throw up the sponge.\" I prefer to\ngive enemata to empty the bowel from below so that less strain is\nrequired to push on what may come along from above, and at the\nsame time I try to coax back vitality and vigour and co-ordinate\nmovements in the injured part by such simple remedies as belladonna by the mouth, or, if sickness threatens, atropine or eserine\nhypodermically in small doses. The first enema is usually given\non the day after operation. When evidence of activity becomes\nmanifest, by spontaneous passage of flatus or faeces or even by\ndesire to go to stool, then I give, for example, small repeated doses\nof cascara or even a dose of castor oil and laudanum. As soon as\nthe patient feels desire for it, I give him ordinary food so as to\nstimulate peristalsis .and prevent noxious adhesions. The part of\nthe bowel which has been strangled tends to form adhesions. On\nmore than one occasion I have had to open the abdomen again on\naccount of fresh obstruction from this cause. Sometimes, if the\nbowel has been severely congested and dilated, although it may\nrecover its colour quickly at operation it may require several weeks\nbefore ft works properly. In these cases one finds the pulse remains abnormally rapid. In such cases both feeding and the exhibition of medicinal intestinal stimulants may have to be carefully regulated.\nIn discussing actual operative measures I wish first to lay\nstress upon the situation and manner of the incision. I almost\ninvariably make a long, at least 6-inch paracentral incision on the\nright side a good inch from the midline, and displace the rectus\noutwards. I like to infiltrate the area of incision with J4 % novo-\ncaine solution so. that I may, if necessary, carry the making of the\nincision under local anaesthesia alone, at least as far as the peritoneum and at the end of the operation be able to close the abdomen without more general anaesthetic than may have been required for intra-abdominal manipulation. This reduces the length\nand strain of general anaesthesia very greatly, and it is a much\nPage Twenty more simple business than making, for example, paravertebral injections. A short gas and oxygen anaesthesia will not harm the\npatient unless his condition is absolutely desperate. I think that\nthe long incision, by permitting easier examination and handling,\nmore than makes up for the extra time expended on it. When\nsutured in layers, post operative hernia is avoided more by this\nthan by any other method of making a long incision.\nHaving opened the abdomen, the hand is inserted into the\nlowest part of the pelvis and pulls up any collapsed coils there.\nThe bowel is then followed upwards until the point of obstruction is reached. If no collapsed bowel is found in the pelvis, the\ncaecum is examined. If the caecum is collapsed the obstruction\nmust be above it, if distended, then the obstruction is below it,\nso the sigmoid is next inspected. If it is collapsed the obstruction\nlies between caecum and sigmoid. If there is much difficulty in\narriving at a diagnosis of the site of obstruction, I do not scruple.\nto allow the distended coils of bowel to come out of the abdomen.\nI cover them carefully with warm dry towels and gauze strips to\nprevent undue cooling. I prefer dry material to moist material.\nThe latter by its evaporation fosters the cooling process of the\nbowel. If warm lotion is continuously poured over it, in order\nobviate cooling, there results a sloppy mess, besides introduction\nof extra risk otherwise. I do not think that evil results follow the use of dry material so much as when moistened packs are\nused.\nWhen the obstruction has been located the character of the\ncausative factor and the condition of the bowel decides further\nproceedings. These vary from the mere snipping of a band to\ndifficult and tedious separation of adhesions or actual excision of\na gangrenous loop, followed by entero-anastomosis. In the last\ncase I prefer to make end to end anastomosis whenever possible.\nIf the patient is in very bad shape, it may be compulsory, after\ndealing with the cause of the obstruction, simply' to bring the\ngangrenous loop well out of the abdomen, fix the viable proximal\nand distal parts of the bowel to the edges of the wound and open\nthe loop. One or more enterostomies should be made above the\naffected loop through separate small wounds. Multiple enterostomies, reserved for the worst cases procure the advantage of\ndraining different parts of the bowel and at the same time permitting the introduction of saline solution. Every surgeon of\nexperience knows how inert the bowel may become, and though\ndrainage effectively empties one loop, adjacent loops may remain\ndistended. The bowel kinks very readily in such circumstances.\nThe saline solution must be introduced at very low pressure\u00E2\u0080\u0094\nover-distension prevents recovery of tone, besides tending to cause\nkinking. I believe that the performance1 of enterostomy gives\nbetter results than emptying the proximal bowel during operation.\nThe latter procedure demands too much handling of the bowel\nand tends to increase shock. The same remark applies of course\nto wide excision of bowel.\nIt is sometimes difficult to decide when to make enterostomy\nPage Twenty-one I\nas already indicated. I feel that if strong, colicky pains have persisted right up time of operation, and if, at operation, the bowel\nresponds by local contraction to local stimulation, e. g., by pinching, it will likely recover without enterostomy. If, however, the\ncolicky pains have become feebler, if general distension of the\nabdomen is present, and if, at operation, the coils are found to be\nflaccid and floppy, and do not respond to local stimulus, enterostomy is compulsory. In cases of doubt, rather make an enterostomy than not. If the obstruction has been in the large intestine,\nI like to make a caecostomy as well as an enterostomy.\nI think a Pezzier's catheter is quite a suitable tube to use,\nand of a medium size, but an ordinary catheter does equally well,\nand is easier to remove. The latter has to be fixed by suture.\nOnly exceptionally are there solid particles in the small intestine,\nso that the contents drain through comparatively small tubes. I\nlike, when multiple enterostomy is done, to remove one tube at a\ntime, the upper before the lower, so as to try to obviate distension\nwhich is liable to occur from adhesive kinking. I have an impression that the higher the enterostomy the longer it takes to heal.\nThe tubes may be removed and the stomata allowed to close, as\nsoon as the patient is established in convalescence, that is, really,\nwhen vomiting has stopped and the bowels have \"moved' satisfactorily. A simple application for preventing excoriation of\nthe skin round an enterostomy is ethereal rubber cement solution\n(1 in 4). This is applied several times a day. The ether evaporates and leaves a thin film of rubber over the skin.\nIt is sometimes almost impossible to tell, from the appearance of the bowel alone, whether the colour and swelling is due\nto intense congestion and subperitoneal or interstitial haemorrhage\nalone, or whether gangrene has actually occurred. The presence\nof the haemorrhagic effusion constitutes the difficulty. The purple\ncolour of mere congestion soon gives way to more normal appearance when strangulation is relieved, but effused dark blood does\nnot dissipate and there may be no change of colour, or only in\npatches. Of course, the flaccid, inert and often brittle state of the\nreally gangrenous bowel is easy enough to distinguish\u00E2\u0080\u0094but there\nare all gradations. One must remember also that interstitial extravasation of blood has probably taken place before gangrene occurred. I have never found the following test to fail, and I have\nused it for very many years. I incise, with a sharp knife, the\nperitoneum and very superficial fibres of the muscular coat of the\nsuspected part of intestine. If circulation be intact, definite bleeding, although possibly in small amount, will occur. One finds\nthen that each time a clean piece of gauze is pressed lightly on the\nincised part, it will be stained with fresh blood. Still more certain can one be of the viability of the bowel if blood can be seen\noozing out steadily from the cut. If gangrene has occurred the\nfirst or second piece of gauze may be definitely stained, but not\nmore. There is practically never any doubt in actual experience.\nIf the gut is viable, the small incision is closed by a mattress suture\nof fine linen or catgut.\nPage Twenty-two B. C. MEDICAL ASSOCIATION NEWS\nDr. Wm. T. Kergin, of Prince Rupert, has returned home\nfrom his European trip, having been away three months.\nDr. Graydon Hume, of London, England, was a visitor in\nVancouver for a few days, in the early part of July. He was\ngreatly impressed with our wonderful scenery, well equipped hospitals, and last, but not least, the work of the B. C. Medical\nAssociation.\nThe holiday season is in full swing, weather perfect, and\nmany doctors, being very human, are taking advantage of the\nbusiness office of the B. C. Medical Association to obtain locum\ntenens, so that they may get away for a well earned rest.\nDr. J. W. Lang, late of Hutton, B. C, and Mrs. Lang are\nto be congratulated on the birth of a daughter.\nDr. D. J. Barclay, who quickly recovered from his recent\nautomobile accident, was able to resume his holiday, which, with\nMrs. Barclay, was spent on the coast, where they renewed many\nold friendships.\nAt a recent meeting of the B. C. Medical Association, the\nfollowing doctors were appointed Chairmen of Standing Committees for the coming year:\u00E2\u0080\u0094\nLegislative\u00E2\u0080\u0094Dr. M. J. Keys, Victoria.\nIndustrial Service\u00E2\u0080\u0094Dr. T. H. Lennie, Vancouver.\nPublicity and Educational\u00E2\u0080\u0094Dr. Neil M. McNeill, Vancouver.\nEthics and Discipline\u00E2\u0080\u0094Dr. I. Glen Campbell, Vancouver.\nCredentials and Constitution\u00E2\u0080\u0094Dr. A. W. Bagnall, Vancouver.\nDr. A. A. King, of Ladner, returned to his practice on\nAugust 1st, after doing six weeks' strenuous post-graduate work\nin eastern cities.\nDr. D. G. Morse, of Port Haney, is taking a month's holiday\nfrom August 8th. His practice will be taken care of by Dr. H.\nC MacKenzie.\nDr. E. W. Ewart has relinquished his practice at Terrace,\nB. C, and is now acting as assistant to Dr. Moffat, of Vancouver.\nInteresting communications are received from time to time\nby the B. C. Medical Association, from Dr. Carl M. Eaton, of\nAtlin, B. C, who has now been isolated in this most northern\ntown in the province, for nearly three years. His many friends\nin Vancouver will be glad to see Dr. Eaton, when he passes through\nthis city in the fall, on his way east to take post-graduate work.\nDr. Lewellys F. Barker passed through Vancouver towards\nthe end of July, and the members of the Vancouver Medical Association turned out in force to hear an address by him on the\nPage Twenty-three \"Nature, Causes and Prevention of Nervous Breakdown.\" In his\naddress Dr. Barker touched on some of the burning topics of the\nday, such as the community's responsibility to criminals and delinquents, the teaching and application of the principles of Eugenics, and the need for departments of mental hygiene in the public\nschools and colleges.\nMiss Johns, Professor of Nursing at the University of British\nColumbia, has resigned that position to take up work for the\nRockefeller Institute in the organization of nursing in Czechoslovakia. Miss Johns will be very much missed in nursing circles\nin Vancouver.\nThe University of British Columbia, at the close of the holidays, will open its doors in the new (temporary) buildings at\nPoint Grey. The only permanent building completed at present\nis the Science Building, which will house the Library. The temporary buildings erected are of stucco and will probably be in use\nfor some years. The old University buildings, in Fairview, will\nbe taken over by the Vancouver General Hospital to meet the\nneed for increased accommodation.\nOn July 27th the Victoria Medical Society met in the Library\nroom to hear a most interesting and instructive address by Dr.\nDavid McKenzie, of McGill University and the Royal Victoria\nHospital, Montreal. Dr. McKenzie dealt with \"Tumours of the\nBladder.\" Again the Victoria profession found itself enjoying\ninstruction from a teacher from one of the educational centres,\neven though it was necessary to encroach on Dr. McKenzie's well\nearned vacation, from which he so graciously spared an evening.\nThe Victoria members are pleased indeed to note that arrangements are being made for a programme ofN post-graduate courses\nunder the Canadian Medical Association.\nAt the meeting of the Victoria Medical Society, held on July\n27th, Dr. Raynor gave a short but interesting resume of the proceedings of the Canadian Medical Association annual meeting at\nRegina. This was well received, as the members of the Victoria\nprofession feel that they must be fully informed of the exact\nnature of the details to which they must attend, to ensure the comfort and success of the meeting at Victoria next year. Dr. Forrest\nLeeder, President-elect of the Canadian Medical Association, was\npresent, and a meeting will be held in the near future to commence\nactive planning for the 1926 meeting. If Victoria can duplicate\nthe weather of this and past years, we can safely promise those\nwho attend a very busy time enjoying a full programme under\ntemperate weather conditions.\nDr. Gordon C. Kenning is holidaying with his family at\nChemainus, where the big salmon have been running.\nDr. J. W. Lennox and family are again at Parksville, on\nVancouver Island.^ Dr. Lennox, who is the popular Vice-President of the Victoria Medical Society, returned to Victoria with\nhis complexion ruined by sunburn. He reports the bathing as\ngood.\nPage Twenty-four THE UNIVERSAL CAR\nH c/housands of Medical men\nfrom coast to coast are finding\nin the FORD closed car the\nsolution of their transportation\nproblem from the standpoints of\nECONOMY, COMFORT and\nSERVICE. WHY NOT YOU?\nWe offer you a 24 hour shop\nservice. Leave your car at night\nand it will be ready in\nthe morning.\nSTONEHOUSE MOTORS LTD.\ntyord IDealers\n418 GEORGIA STREET WEST\nVANCOUVER, B.C.\nc^c\nsopra\nPage Twenty-five PHONE SEYMOUR 2487\nMcBeath Spedding Ltd*\nVancouver, B.C.\nPRESCRIPTIONS\nfilled exactly as written\nPhones: Seymour 1050 -1051\nDay and Night Service\nQeorgia Pharmacy Ltd.\nQeorgia and Qranville Sts.\nVancouver, B. C.\nPage Twenty-six B. Q Pharmacal Co. Ltd.\n329 Railway Street,\nVANCOUVER.\nManufacturers of Hand'-made Filled Soluble\nElastic Capsules.\nSpecimen Formulae:\nNo. 20a\u00E2\u0080\u0094\nCascara Liq. Ext., 30m\nEuonymin, 1 gr.\nPodophyllin, \ gr.\nNo, 29\u00E2\u0080\u0094\nCod Liver Oil, 25m.\nQuinine, 1 gr.\nCreosote, Beechwood,\n2m.\nGuaiacol, Pur., 2m.\nSpecial Formulae Made on a Few Hours' Notice.\nPrice Lists and Formulae on\nApplication.\nSay it with Flowers\nCut Flowers, Potted Plants, Bulbs, Trees, Shrubs,\nRoots, Wedding Bouquets.\nFlorists' Supplies and Funeral Designs a specialty.\nThree Stores to Serve You:\n48 Hastings St. E.\n665 Granville St.\n151 Hastings St. W.\nPhones Sey. 988 and 672\nPhones Sey. 9513 and 1391\nPhone Sey. 1370\nBrown Bros, & Co. Ltd*\nVANCOUVER, B. C.\nPage Twenty-seven Free Delivery Service anywhere in the city\nfrom 8 a. m. to 11 p. m.\nDistributors:\nMulford's Biologicals Fraisse Serum\nCapitola Pharmacy Ltd*\n(FRED G. BROWN)\nSeymour 158 New Address: Davie and Bute Sts.\nNearly\nA CENTURY OF SERVICE\nThe STEVENS Companies have supplied four generations with\nHIGHEST GRADE SURGICAL INSTRUMENTS\nSTEVENS\nEnglish Hand-Made\nOPERATING KNIVES\nof finely tempered surgical steel are warranted to give long\nand satisfactory service.\nSpecial prices during run of this advertisement. Write for quotations\nB. C. STEVENS CO., LTD., 730 Richards Street\nPage Twenty-eight To the ]\nMEDICAL PROFESSION\nThe Frost Pharmacy Ltd.\nDesire to announce to the Medical Profession that they have\nopened for business at\nQranville Street and 12th Avenue\nand vuill specialize in Prescription Service. Our Prescriptions\nare filled as ordered, without deviation and our delivery\nservice is decidedly prompt.\nOur Prescription Department\nwill at all times be in charge of a graduate.\nGORDON FROST jf\n(Formerly of the V. Q. H.)\nPhones: Bay. 540 and 1720 Granville at Twelfth\nThe Ou?l Drug\nCo., Ltd'\nJWl prescriptions dispensed\nbu. qualified Druggists.\nIjou can depend on the Ou?l\nfor Jlccuracy and despatch.\nVJe deliuer free of charge.\n5 Stores, centrally located. We\nwould appreciate a call while\nin our lemlory.\nAmbulance\nService\nTELEPHONE\nFair. 58 & 59\nIS/Lount Pleasant\nUndertaking Co. Ltd.\nR. F. Harrison W. E. Reynolds\nCor. Kingsuiay and Main\nPage Twenty-nine 110,000 Policyholders in the\nMutual Life of Canada\nHTHE MUTUAL LIFE OF CANADA is a Company\nof approximately 110.000 policyholders bonded\ntogether for mutual protection and support in time of\ntrouble. They obtain the insurance practically at cost.\nSurplus profits over and above provision of necessary\nreserves are divided among participating policyholders.\nLast year, the sum of $2,689,000 was thus distributed to Mutual policyholders as dividends.\nMutual Annual Dividend policyholders have three options:\u00E2\u0080\u0094\u00E2\u0096\u00A0\n1. To reduce the second and future premiums, or,\n2. Left with the Company to accumulate at compound interest and applied to shorten the premium paying period.\nM To Purchase Bonus Additions.\nThe Mutual Book tells you the whole story. Write\nor call on\n402 Pender St. W.\nWILLIAM J. TWISS\nPhone Sey. 1610.\nVancouver. B. C.\nNurses* Central\nDirectory\nPhone Fairmont 5170\nDay and Night\nHourly, Institutional and Private Nurses\nSupplied\nRegistrar\u00E2\u0080\u0094Miss Archibald, R. N.\n601 13 th Ave. West, Vancouver\nPatronize the\nBULLETIN\nadvertisers.\nOrthopedic\nAppliances\nExtensions for short limbs,\nTrusses, Arch Supports\nAbdominal Belts,\nSacrO'Iliac Supports and\nArtificial Limbs,\nmanufactured and made\nby Experts and guaranteed\nby\nA.LundbergCo.\n938 Pender Street West\nVancouver, B. C.\nPage Thirty Bn\nOur\n^Advertisers\n^\,\nUse this journal for the purpose\nof procuring business from the\nMedical Profession.\nAre you assisting in the\npublication of The Bulletin by\npatronizing our advertisers?\n\nPage Thirty-two "@en . "Periodicals"@en . "W1 .VA625"@en . "W1_VA625_1925_09"@en . "10.14288/1.0214343"@en . "English"@en . "Vancouver : University of British Columbia Library"@en . "Vancouver, B.C. : McBeath Spedding Limited"@en . "Images provided for research and reference use only. Permission to publish, copy, or otherwise use these images must be obtained from the Digitization Centre: http://digitize.library.ubc.ca/"@en . "Original Format: University of British Columbia. Library. Woodward Library Memorial Room. W1 .VA625"@en . "Medicine--Periodicals"@en . "The Vancouver Medical Association Bulletin: September, 1925"@en . "Text"@en .