"CONTENTdm"@en . "http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1179642"@en . "History of Nursing in Pacific Canada"@en . "Vancouver Medical Association"@en . "1942-05"@en . "2015-01-29"@en . "1942-05"@en . "https://open.library.ubc.ca/collections/vma/items/1.0214380/source.json"@en . "image/jpeg"@en . " W_Kc_M\nHI BULLE\nof the\n| I IVANCfcuVER\nMEDICAL ASSOilATION\n\u00E2\u0096\u00A0Vol. xvni\nMAY, 1942\nNo. 8\nWith Which Is Incorporated\nTransactions of the\nVictoria Medical Society\nthe\nVancouve^XSeneral Hospital\nand\nSt^auFs Hospital\nIn This Issue:\nPage\nNEWS AND NOTES WSIlgggB B__ffl___l_iii _^_^_^_^_B\nANNUAL REPORTS, VANCOUVER MEDICAL ASSOCIATION .^-__&2 31\nCLEAR SPINAL FLUID IN MENINGOCOCCI MENINGITIS j^^W^p 3 9\nURETERAL OBSTRUCTION WITH COMPLICATIONS FOLLOWING\nSULFADIAZINE \u00E2\u0096\u00A0\u00E2\u0096\u00A0 . ^fJ%%J^^^^^^^^^M\nTHE USE OF SNAKE VENOMS IN MEDICINE-\u00E2\u0080\u0094 ^^^^^^ . \u00E2\u0080\u0094 '^SM^44\nLAURENCE-MOON-BIEDL SYNDROME .__ \u00E2\u0080\u00A2$ 'V$$k$&8kH*\nC.M.A. AND B.C.M.AS^lNNUAL MEETING\nJASPER \u00E2\u0080\u0094 JUNE 15-19, 1942\nill\nill\n\u00E2\u0080\u00A2in\ni\n*\"\u00C2\u00ABl\nm\nMm\n\u00E2\u0096\u00A0*\n*& i.\nVITAMIN\n'm\n'/<-\nr, I-\nHYPOPROTHROMBINEMI\n:'\u00C2\u00ABf\n11\nt\nMl\n' ''Mm:\n'\u00E2\u0096\u00A0\u00E2\u0096\u00A0 t i\n. f.'1\nI III\n\u00E2\u0096\u00A0t.fl\nTHIS CONDITION results in abnormally long clotting\ntime of the blood. It can be successfully treated with\nVitamin K: E.B.S. The anti-haemorrhagic vitamin has\na place, both as a prophylactic and in supportive therapy.\nAs prophylactic:\nAdministered to the mother before delivery or to the\ninfant shortly after birth, Vitamin K: E.B.S. can prevent\nneonatal haemorrhage by raising the blood prothrombin\nto the normal range.\nDanger to jaundiced patients, who must undergo\nsurgery, can be greatly reduced by administration of\nVitamin K and Bile Salts E.B.S. for several days before\noperation.\nIn supportive therapy:\nWherever there is a low prothrombin level in circulating\nblood, due to Vitamin K deficiency, treatment with\nVitamin K may be of value. Such conditions are most\nfrequent when bile is excluded from the intestinal tract,\nfor various reasons, as common duct stricture, duct stone\nor adhesions in the region of the bile ducts. Similarly,\nVitamin. K may be useful in biliary fistulae, empyemia\nof the gall bladder with sepsis, catarrhal jaundice,\nmoderate liver injury and obstruction due to carcinoma\nof the bile duct, of the gall bladder, of the head of the\npancreas or of the liver. Bile salts are frequently necessary for absorption of Vitamin K in such conditions.\nAVAILABLE FORMS\nFOR ORAL USE s S.C.T. No. 746 Vitamin K (2 Methyl\n1:4 Naphthoquinone^j\u00E2\u0080\u0094-l mg. {25,000 Dam Units),\nC.C.T. Nom 749 Vitamin K (2 Methyl 1:4 Naphthoquinone). \u00E2\u0080\u00941 mg. (25,000 Dam Units); and Bile Salts\n5 grains.\nFOR PARENTERAL ADMINISTRATION: 30 cc.No. A-13Q\nSterile Solution Vitamin K (2 Methyl 1:4 Naphthoquinone).\n1 mg. (25,000 Dam Units) per cc. in Sesame Oil.\n1 cc. No. A-131 Sterile Solution Vitamin K (2 Methyl\n1:4 Naphthoquinone), r\u00E2\u0080\u0094_ mg. (25,000 Dam Units) per\ncc.in Sesame Oil.\n1 ec.No. A-132 Sterile Solution Vitamin K (2 Methyl 1:4\nNaphthoquinone).t0*}4 mg. (12\u00C2\u00A300 Dam Units) per cc. in\nSesame Oil.\nWHEN PRESCRIBING\nSpecify E.B.S. Preparations i\nJUST TO\nBI SURE!\nCC.T Ho. 749\nVlTAMIttift\"\nAND\nBILE SALTH\nB.B.S.\nEach tailtl cifiaitff-i'Si\n\"O,^KJ2S;C>00 Dam Unit*) | \u00E2\u0080\u009E,.\nfeej\u00C2\u00BBethrl_ph_oquin\u00E2\u0080\u009E\u00C2\u00AB>\n___ i \u00C2\u00A7 gra\u00C2\u00BB0\u00C2\u00BB|\n\u00E2\u0080\u00A2^\u00E2\u0080\u00A2cnoii. lor m J\u00E2\u0080\u0094\u00E2\u0080\u0094_\nControl\n'\u00E2\u0080\u00A2*i\u00C2\u00BBoc\u00C2\u00AB.p^ta,W*,l\nMs\n^AMInTiN 1\nm\n(2-_e\u00C2\u00BBhyl napM^\nIUnit,) pei*1 *\nS_nu\n^4_V.-.-.-__V\u00C2\u00AB\u00E2\u0080\u00A2\nTHE E. B. SHUTTLEWORTH CHEMICAL CO. LIMITED\nTORONTO\nMANUFACTURING CHEMISTS\nCANADA THE VANCOUVER MEDICAL ASSOCIATION\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:\nDb. J. H. MacDermot\nDb. G. A. Davidson Db. D. E. H. Cleveland\nAll communications to be addressed to the Editor at the above address.\nVol. XVHI.\nMAY, 1942\nNo. 8\nOFFICERS, 1941-1942\nDb. J. R. Neilson\nPresident\nDb. H. H. Pitts\nVice-President\nDb. C. McDiabmid\nPast President\nDb. A. E. Tbites\nHon. Secretary\nAdditional Members of Executive'. Db. J. R. Davidson, Db. J. A. McLean\nDb. Gordon Bubke\nHon. Treasurer\nTRUSTEES\nDb. F. Bbodie Db. J. A. Gillespie Db. W. T. Lockhart\nAuditors: Messbs. Plommer, Whiting & Co.\nSECTIONS\nClinical Section\n Chairman Db. D. A. Steele Secretary\nEye, Ear, Nose and Throat\n Chairman Db. C. E. Davies Secretary\nDb. Ross Davidson...\nDb. A. R. Anthony\u00E2\u0080\u0094\nPediatric Section\nDr. G. O. Matthews Chairman Dr. J. H. B. Grant Secretary\nSTANDING COMMITTEES\nLibrary:\nDr. F. J. Buller, Db. D. E. H. Cleveland, Db. J. R. Davies,\nDb. A. Bagnall, Db. A. B. Manson, Db. B. J. Harbison\nPublications:\nDr. J. H. MacDermot, Dr. D. E. H. Cleveland, Dr. G. A. Davidson.\nSummer School;\nDr. H. H. Caple, Dr. J. E. Harbison, Db. H. H. Hatfield,\nDr. Howard Spohn, Dr. W. L. Graham, Dr. J. C. Thomas\nCredentials:\nDr. A. W. Hunter, Dr. W. L. Pedlow, Dr. A. T. Henry\nV. O. N. Advisory Board:\nDr. L. W. McNutt, Dr. G. E. Seldon, Dr. Isabel Day.\nMetropolitan Health Board Advisory Committee:\nDr. W. D. Patton, Db. W. D. Kennedy, Dr. G. A. Lamont.\nGreater Vancouver Health League Representatives:\nDr. R. A. Wilson, Dr. Wallace Coburn.\nRepresentative to B. C. Medical Association: Dr. C. McDiarmid.\nSickness and Benevolent Fund: The President\u00E2\u0080\u0094The Trustees.\nM!.l\n[hi\nm\n%8\nft,\n:**\u00E2\u0096\u00A0 >\n'\u00E2\u0080\u00A2& J\\nJohnnie is recovering from a very virulent type of streptococcic\ninfection. A decade ago, before the widespread use of sulfonamides,\nhis chances of recovery would have been slim.\nAnd so it is with many other diseases. Diabetes was often fatal\nbefore Insulin: pneumonia before serotherapy and chemotherapy.\nTyphoid, diphtheria, measles, scarlet fever took their tolls before\nbiologies stemmed the tide. Rickets and pellagra disabled thousands\nbefore vitamins were discovered. No cure was known for syphilis\nbefore the advent of arsphenamine therapy. Surgery was a torture\nbefore ether robbed the operating room of its terror.\nAll these and many other advances in medicine have been made\nsince the founding of the House of Squibb. And in each field\u00E2\u0080\u0094\nanesthesia, biologic therapy, chemotherapy, endocrinology and\nvitamin therapy\u00E2\u0080\u0094Squibb has played a prominent part.\nFor 84 years E. R. Squibb & Sons has been dedicated to the\ntask of furnishing the medical profession with the finest therapeutic\nproducts that manufacturing skill and experience can produce.\nToday, as always, the name \"Squibb\" on a label is an assurance\nof uniformity, purity, and efficacy.\nERiSqjJbb _Sons of Canada.Ltd.\nMANUFACTURING CHEMISTS TO THE MEDICAL PROFESSION SINCE 1858\nThe Priceless Ingredient of every product is the Honor and Integrity of its Maker hm\nVANCOUVER HEALTH DEPARTMENT\n*<\ntt\nSTATISTICS\u00E2\u0080\u0094MARCH, 1942\nTotal Population\u00E2\u0080\u0094estimated 272,352\nJapanese Population\u00E2\u0080\u0094estimated 8,769\nChinese Population\u00E2\u0080\u0094estimated 8,558\nHindu Population\u00E2\u0080\u0094estimated \ 360\nRate per 1,000\nNumber Population\nTotal deaths 330 14.3\nJapanese deaths 4 5.2\nChinese deaths i 17 22.8\nDeaths\u00E2\u0080\u0094residents only 287 12.4\nBIRTH REGISTRATIONS:\nMale, 286; Female, 251 537 23.3\nINFANTILE MORTALITY: March, 1942 March, 1941\nDeaths under one year of age 12 14\nDeath rate\u00E2\u0080\u0094per 1,000 births 22.3 29.6\nStillbirths (not included in above) 4 9\nCASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY\nFeb., 1942 March, 1942 April 1-15,1942\nCases Deaths Cases Deaths Cases Deaths\nScarlet Fever 33 0 28 0 21 0\nDiphtheria 3 0 2 0 0 0\nDiphtheria Carrier 3 0 6 0 3 0\nCChicken Pox 191 0 348 0 115 0\nMeasles 32 0 45 0 17 0\nRubeUa 25 0 54 0 20 0\nMumps 445 0 803 0 408 0\nWhooping Cough 16 0 45 0 36 0\nTyphoid Carrier 0 0 0 0 0 0\nTyphoid Fever 0 0 0 0 0 0\nUndulant Fever 10 0 0 0 0\nPoliomyelitis 0 0 0 0 0 0\nTuberculosis 39 16 41 17 20\nErysipelas 3 0 3 0 3 0\nMeningococcus Meningitis 3 1 4 0 3 0\nV. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH,\nDIVISION OF VENEREAL DISEASE CONTROL\nWest North Vane. Hospitals &\nBurnaby Vancr. Richmond Vancr. Clinic Private Drs. Totals\nSyphilis 0 0 2 1 15 27 45\nGonorrhoea 0 0 0 0 61 12 73\nm\nm\nA DYNAMIC MENTAL AND PHYSICAL TONIC\nINDICATED IN THESE DAYS OF STRESS\nBIOGLAN \"A\nAnother Product of the Bioglan Laboratories, Hertford, England\nPhone MA. 4027\nStanley N. Bayne, Representative\n1432 MEDICAL-DENTAL BUILDING\nDescriptive Literature on Request\nTHE SCIENTIFIC HORMONE TREATMENT\nVancouver, B. C.\n:fii\nPage 225 NEUTRASIL\n(Magnesium Trisilicate B.D.H.)\nMil\n#11\nWhenever an antacid is required by patients of any age, Neutrasil is indicated. Its administration is not followed by an evolution of gas, so that\nnone of the symptoms in a flatulent patient is accentuated. Large doses\ncannot produce alkalosis nor can they so lower gastric acidity as to stop\ngastric digestion.\nNeutrasil is not completely neutralised immediately after ingestion; its\naction is therefore spread over a considerable period. Thus frequent doses\nare not required, and there is no stimulation of secretion of acid such as\nwould necessitate any increase in the size or the frequency of subsequent\ndoses.\n!;\u00E2\u0080\u00A2.\nw\nFurther, Neutrasil produces a soothing, adsorptive gel after neutralisation;\n>_^^^^^^^^^^^^^^^^^^^^ this protects the irritated stomach walls and carries toxins and\nunneutralized acids into the talk m-*\u00C2\u00BB-^. testine for elimination.\nThe shortcomings of antacids\npreviously in use are thus eliminated in Neutrasil, to the use\nof which there are no contraindications.\nStocks of Neutrasil are held by\nleading druggists throughout the\nDominion, and full particulars\nare obtainable fromx\nTHE BRITISH DRUG HOUSES (CANADA) LTD.\nToronto Canada MEASLES\nModification\n\u00C2\u00BB\u00C2\u00AB\nPrevention\nIn 1939 there were 197 deaths from measles in Canada.\nMore than 95 per cent of these were in the age-group 0-5\nyears.\nHuman serum prepared from the blood of healthy adults\nso as to involve a pooling from a large number of persons\nmay be used effectively either for modification or prevention\nof measles. Modification is often preferable in that it reduces\nto a minimum the illness and hazards associated with measles,\nbut does not interfere with the acquiring of the active and\nlasting immunity which is conferred by an attack of the\ndisease. On the other hand, complete prevention of an attack\nof measles is frequently desirable, and can be accomplished\nprovided that an ample quantity of serum is administered\nwithin five days of exposure to the disease.\nFor use in modification or prevention of measles, pooled\nhuman serum is available from the Connaught Laboratories in\na concentrated form. While.the recommended dose of this\npooled and concentrated human serum for purposes of prevention is ordinarily 10 cc, the most usual dose is for\npurposes of modification and amounts to 5 cc. The serum is\ntherefore supplied in 5-cc. vials. Prices and information\nrelating to it will be supplied gladly upon request.\nCONNAUGHT LABORATORIES\nUNIVERSITY OF TORONTO\nToronto\nCanada\nDEPOT FOR BRITISH COLUMBIA\nMACDONALD'S PRESCRIPTIONS LIMITED\nMEDICAL-DENTAL BUILDING, VANCOUVER, B.C. 1 Vehicle that Stimulates Appetite\nOiutott tJCwui U/u^fnk (b.A.\nWYETH'S BEWON ELIXIR serves as\nan excellent solvent and vehicle for\nmany medicaments. Compatible with\nmost drugs, BEWON ELIXIR contains\n18% alcohol and is slightly acid in\nreaction.\nStandardized to contain 500 International Units of Vitamin Bt (thiamin\nchloride) per fluid ounce, BEWON\nELIXIR stimulates the appetite and is\nindicated in Vitamin Bx deficiencies.\nSupplied in 16 11. oz. and 160 tt. oz. bottles.\nJohn Wyeth & Brother (Canada) Ltd.\nWALKERVILLE, ONT. A friend of ours was reminding us recently that the Bulletin has nearly attained\nits majority. The first number was published in 1924, and the Editor was our late\nlamented friend and colleague, Dr. J. M. Pearson of Vancouver. We could never have\nfound a man better fitted to act as the leader of such a venture. Outwardly the least\ndemonstrative of men, he had some deep and ardent enthusiasms\u00E2\u0080\u0094literary effort of any\nkind appealed to him strongly, and the Bulletin rapidly became one of his major\navocations: he invested even the small, apparently insignificant publication it then was,\nwith a dignity and personality which it has, we believe, retained to this day.\nFor many years Pearson guided the Bulletin along a carefully chosen way: conservative and unspectacular, no doubt\u00E2\u0080\u0094but nonetheless, we feel, the best way for such\na publication. He had always a most intense loyalty to the Vancouver Medical Association\u00E2\u0080\u0094and cared little for other organizations. But we believe that he would have\ncordially approved the policy which opened the Bulletin up to a wider \"market,\" and\nhas made it really more of a provincial than a local journal. It was he, in fact, that\ninitiated this policy by opening its columns for the use of the Provincial Board of Health.\nThe Bulletin is today, we modestly believe, a definite personality among the medical\njournals of Canada. It is not big, and most probably it will never be very much bigger,\nunless circumstances change very radically, but it fulfils, we think, the main functions\nof a medical journal of its kind: in that, first and foremost, it affords a means of expressing and recording medical work, thought, and opinion, in an area that otherwise would\nnot have such a medium of self-expression. Much valuable work, many valuable and\nsignificant records and statistics, have been published and made available, which would\notherwise have been lost. In this connection, we think especially of the monthly records\nfrom the Staff of the Vancouver General Hospitals, one of Canada's biggest hospitals,\nwhere an enormous amount of work is done. The records published by the Staff are in a\ngreat many cases of remarkable value and interest, and the Bulletin is fortunate in the\nco-operation of this body. We feel that the Staff deserves our sincerest congratulations\nand thanks for their excellent work.\nWe do not know, of course, what percentage of our circulation reads the Bulletin\nthrough from cover to cover: and we are rather hesitant to guess. But we ourselves have\nto read every word, in \"proof\" at any rate, and we assure our readers, or should-be\nreaders, that there is always something from which they could derive benefit, in each\nmonth's copy. At times, the material is very much more than good: it is unique original\nwork\u00E2\u0080\u0094and much of it is worth preserving for continual reference.\nWe could go on for ever\u00E2\u0080\u0094but perhaps we have said enough. The Bulletin has, we\nthink, contributed something of importance to the medical life of British Columbia, and\nfinds a ready and often a vocal welcome in all parts of the province. It is the organ of\nother Associations beside the one whose name it bears; and it gets more than it gives\nfrom those to whom it tries to be of service. It is because it has given of its time and\nenergy to British Columbia rather than Vancouver alone, we firmly believe, that it has\nbeen able to attain its majority, not only in years, but in a far wider sense, in value and\nimportance to those who receive it.\nPage 226 ANNUAL MEETING\nVANCOUVER MEDICAL ASSOCIATION\nMay 5, 1942\nThe Annual Meeting of the Association was held on the above date, the President,\nDr. C. McDiarmid, being in the chair.\nDr. E. D. Braden, well-known clergyman of Vancouver, was our guest speaker. He\nhas a delightful wit, and a wide knowledge of the history of Vancouver from its origin.\nHimself a native son of New Westminster, he has what some might feel is a bit of bias\ntowards that city\u00E2\u0080\u0094but he spends most of his time in Vancouver, and after all, that is\na very fair test. He is the friend and confidant of all the old-timers of the lower Mainland, and so has unique access to sources of original information. His talk was very\ninteresting and inspiring, and we are grateful to him for it.\nThe election of officers then took place, following the reading of reports by the\nChairmen of various Committees. These are published in this number of the Bulletin.\nWe welcome our new officers to their positions of authority. Our new President, Dr.\nJ. Russ Neilson, is well known to all of us, and a very popular choice. He is one of the\nyounger generation, yet quite mature and experienced enough for his position. He is\nenergetic and positive in his outlook, possesses marked ability in his work, and has a fund\nof commonsense and wisdom which will serve him well. We are very glad to welcome\nhis as President. To all the other members of the Executive, we extend our congratulations.\n* * * *\nTwo matters of business were brought up, one by Dr. J. R. Neilson, who spoke of a\nproposed memorial to Dr. Joe Bilodeau, our dear old friend now departed. This matter\nis still in the stages of development\u00E2\u0080\u0094but the suggestion was most enthusiastically received: and immediate steps are to be taken.\nDr. G. F. Strong brought up the matter of narcotic prescriptions, and we feel that\nthere is la great deal in what he said\u00E2\u0080\u0094that the present excessively rigid regulations are\nworking hardship in many cases, and are far more drastic than is necessary. We agree\nwith Dr. Strong that some measure of elasticity should be introduced, always consistent-\nwith the utmost effort to avoid abuse.\nThere was one very sad note in the meeting of last night. This was the resignation\nof Dr. W. Thomas Lockhart as Honorary Treasurer. We are not speaking lightly nor in\nany formal way, when we say that this is a very serious loss to the Vancouver Medical\nAssociation. Dr. Lockhart has been easily the best treasurer we have ever had, and one\nof the most valuable members that has ever been on our nominal roll: He has given\nunstintingly and with unselfish devotion, of his time and energy for many years. His\nreports each year have been models of sanity and wise administration: his counsels have\nalways been productive of good: and his excellent gift of humour has made the manner\nof their presentation wholly delightful. But the real value of these reports has been in\nthe thought and constructive work which has been put into them\u00E2\u0080\u0094so that from them\nwe received a guidance and help in the management of our affairs that were invaluable.\nWe have known Dr. Lockhart for many years\u00E2\u0080\u0094have even played golf with him (and\nthere is no greater test of a man's quality)\u00E2\u0080\u0094and we have all grown to be very fond of\nhim, and to look to him for advice and counsel. We shall miss him very greatly as\nTreasurer\u00E2\u0080\u0094but we hope sincerely that some way may be found to retain him as a sort\nof emeritus advisor. We feel that he deserves from us everything we can give him: a\nLife Membership to begin with, for instance. If any man ever earned it, he did: even\nthough he would probably be the first to deny this: and the only one.\nHe has, too, earned a respite\u00E2\u0080\u0094for this work he did for us took a lot of time, and\nentailed a lot of work. We must all of us feel intensely grateful to him for his services:\nand thank him most sincerely for all he has done for us.\nPage 227 Our attention has been drawn to the recent report (1941) of the British Empire\nCancer Campaign, published in London, S.W.I.\nLooking at this massive volume, in its neutral grey cover, and reading its contents,\nwith long nominal rolls of patrons, governors, members of Grand Council and what not,\none would never think there was a war on, much less that this war's greatest intensity is\ncentred round the very London where these imperturbable British workers and research-\nmen and committeemen and Grand Council pursue the even tenor of their way, and do\ntheir work and research and produce their report. It takes, evidently, more than any-\n; thing Hitler can do to disturb the placid \"sangfroid habituel\" of the British scientific\nworker.\nThey are a marvellous race, and we cannot but wonder at them and admire them,\nand hope that if and when the battle and the stress come our way, we shall be able to\ndo half as well. It is a wonderfully wholesome quality they have, of going on with the\nwork at hand, and not allowing themselves to be turned aside or stampeded or distracted\nunnecessarily from their daily routine and way of life. It is an \"outward and visible sign\nof an inward and spiritual grace\" and power that has always been a notable Anglo-Saxon\ncharacteristic. There is no bravado about it, and no hysteria\u00E2\u0080\u0094merely a truly realistic\nattitude towards life. And after all, it is really a very sensible attitude, and produces\nexcellent results\u00E2\u0080\u0094even if it is a bit difficult for our enemies to understand.\nOne sees, arriving month by month, the copies of the Lancet, the British Medical\nJournal, the Practitioner, and so on: and though they are smaller and thinner, and the\n^contents have a more military flavour, yet the spirit is the same, and the determination\nunchanged, to do with all their might the work that has to be done: and to change as\nlittle as possible, and not till change is unavoidable, the way of doing it. All honour to\nour British brethren, and long may they flourish. After all, these are the qualities of\nmind and heart and soul that really matter, and that will endure and produce fruit and\nadvance the cause of humanity. As long as they last, there is no fear for humanity;\nif they were to perish, life on this planet would no longer be worth the living.\nV \u00C2\u00ABl\n\u00E2\u0080\u00A2If!\nrMl\n\A\nNEWS AND NOTES\nThe Annual Meeting of the College of Physicians and Surgeons was held on Monday,\nMay 4th.\nThose present included: Dr. Wallace Wilson, the President, Dr. H. H. Milburn, both\nrepresenting Medical District No. 3; Dr. W. A. Clarke, Vice-President, representing\nMedical District No. 2; Dr. F. M. Auld of Nelson, representing Medical District No. 5,\nwhich comprises the East and West Kootenay; Drs. Thomas McPherson and F. M.\nBryant of Victoria, representing Medical District No. 1, which extends to Atlin, the most\nnortherly point. Dr. A. J. MacLachlan, Registrar, and Dr. M. W. Thomas, Executive\nSecretary, were present.\nThe election of officers for this year resulted as follows:\nDr. W. A. Clarke, President.\nDr. F. M. Bryant, Vice-President.\nDr. H. H. Milburn, Treasurer.\nThe Executive Committee to be formed of: Drs. Thomas McPherson, F. M. Bryant,\nWallace Wilson, H. H. Milburn and W. A. Clarke, who will be the Chairman.\n\u00E2\u0096\u00A0'*\nDr. T. D. Bain, who has been Chief Medical Officer at Shaughnessy Military Hospital, has been transferred to Christie Street Hospital in Toronto.\nW\ni\nPage 228 ffiii\ni\nM.\nM\nLieut.-Col. H. A. DesBrisay, R.C.A.M.C., has returned to Vancouver. Colonel\nDesBrisay has had many months of service in Great Britain and until recently was Com-i\nmanding Officer with No. 9 Field Ambulance. Latterly he served as Chief of Medicine\nat No. 1 General Hospital, and in addition to this appointment he served as consultant!\nto a large area where it was his duty to visit about 100 hospitals in that large district.1\ni\nDr. and Mrs. Frank A. Turnbull are receiving congratulations on the birth of a\ndaughter.\nFlying Officer H. C. Cooper, R.C.A.F., Medical Corps, and Miss Helen Patricia Leggei\nof New Westminster, were married in April. Flying Officer Cooper was an interne at\nSt. Paul's Hospital.\nCongratulations to Lieutenant M. L. Allan, R.C.A.M.C., upon the occasion of his\nmarriage in April.\nLieut.-Col. S. G. Baldwin is now in Great Britain.\nW are informed that Capt. G. D. Oliver is serving with No. 9 Field Ambulance\nsomewhere overseas.\nCapt. C. H. Beever-Potts, formerly at Lake Cowichan, is now serving with No. 16\nGeneral Hospital.\nFlying Officer Hymie Cantor, R.C.A.F., is associated with Flight-Lieutenant Neil\nStewart at Western Air Command, Vancouver quarters.\n!\u00C2\u00BB<\nCapt. N. C. Cook, formerly doing ear, nose and throat in Victoria, is now stationed\nat Esquimalt Military Hospital.\n*\u00E2\u0096\u00A0'* ;'-\nThe following officers have received promotion in the R.CA.M.C: Major A. L.\nCornish, Major F. E. Coy, Major J. D. Hunter.\nCapt. E. J. Curtis, who has done much outstanding work in the field of infectious\ndiseases, is busily engaged in the R.CA.M.C\nlit!\nSquadron-Leader L. G. C. d'Easum is now at Regina.\n\u00E2\u0080\u00A2S* *r \u00C2\u00BBr \u00C2\u00BBP\nFlying-Officer G. R. F. Elliot, who has been stationed at Williams Head Quarantine\nStation in Victoria as medical officer with the Department of Pensions and National\nHealth, is now serving with the R.C.A.F. Medical Corps.\n&>\u00C2\u00AB_\nDr. G. L. Sparks, formerly at White Rock, is now stationed at Williams Head Quarantine Station.\nReplies from the Health Insurance Questionnaire were received from Capt. G. C.\nJohnston and Capt. T. K. McLean, who are serving with No. 13 Light Field Ambulance\nin Great Britain. Lieut.-Col. C. A. Watson, formerly of Victoria, is the Officer Commanding No. 13 Field Ambulance.\n**\u00E2\u0096\u00A0 St J_* sS*\nSquadron-Leader W. N. Kemp, when last heard of, was stationed at St. Thomas, Ont.\nFormer internes of the Vancouver General Hospital, Drs. J. A. McCaffrey, R. B.\nRowed and A. M. Johnson are now serving with the R.CA.M.C\nPage 229\nm Capt. O. C. Lucas, formerly of Victoria, is now serving with the R.C.A.M.C\nCapt. R. P. McCaffrey, R.C.A.M.C, is stationed at Vernon.\nCapt. J. M. McDiarmid, R.CA.M.C, formerly of New Westminster, is serving with\nNo. 16 General Hospital.\nRecent promotions in the R.CA.M.C. include Lieut.-Colonel R. L. Miller with headquarters M.D. No. 11.\nSurgeon-Lieutenant R. D. Miller, formerly in practice in Vancouver, is now stationed\nat Esquimalt Naval Hospital.\nThe last word of Lieut.-Colonel W. E. M. Mitchell, formerly of Victoria, finds him\nin Malta. He has our sincere good wishes.\nCapt. R. H. L. O'Callaghan, recently of Ganges, Salt Spring Island, and formerly of\nCalgary, is serving with the R.C.A.M.C. at Esquimalt Military Hospital.\nWhen last heard of Surgeon-Lieutenant-Commander W. M. Paton was at St. John,\nNewfoundland, and Major G. C Large is stationed in a Nova Scotia hospital.\nFlying Officer D. B. Ryall, formerly of Alert Bay, is serving with the Air Force.\nCapt. F. H. Stringer has returned from overseas, and is looking very fit.\nMajor J. E. Walker has been in Vancouver on leave and is looking well.\nCapt. W. R. Walker, formerly at Penticton, is now stationed at Vernon.\nDr. T. A. Briggs of Courtenay, President of the Upper Island Medical Association,\n! called at the office to arrange for the Spring Meeting of that Association, which will\nprobably be held on May 27th at Qualicum.\ns8\" sfr sj- :fr\nDr. C. W. Mewhort is now at Lake Cowichan in association with Drs. Watson and\nMcHaffie of Duncan.\n* * * *\nDr. Stuart Daly of Trail has just returned from a meeting of the American College\nof Physicians held in St. Paul. -Tin route home he visited in Winnipeg. Mrs. Daly accompanied him.\nWe are glad to report that Dr. W. A. Coghlin of Trail is back at the office and\napparently rapidly recovering from a recent operation.\nDrs. M. R. Basted, D. J. M. Crawford and William Leonard of Trail and Drs. R. B.\nShaw and Wilfrid Laishley of Nelson attended the Eighth Annual Meeting of the\nSpokane Surgical Society in April.\n\u00E2\u0080\u00A2r *P \u00C2\u00ABr \u00C2\u00BBr\nDr. and Mrs. T. J. Sullivan of Cranbrook are receiving congratulations on the birth\nof a daughter, on April 22nd.\n*\nThe profession in the West Kootenay extend sympathy to Dr. W. H. Ormond of\nSalmo in the loss of his mother.\n* * * *\nDr. W. J. Endicott of Trail is having a well-earned holiday.\nDr. H. H. Milburn flew East last month to attend the 100th celebration of his\nmother's birthday. All members of the family foregathered for this outstanding event,\nwhich, all will agree, was something worth celebrating.\nPage 230\ndpi\n;\n\u00C2\u00ABn\n\"M?\n; f \u00E2\u0080\u00A2 'w\nrim\nit\nII\nu\nDr. H. Ostry, now associated with Dr. Irving of Kamloops, has been doing postgraduate work in Chicago.\ns!\u00C2\u00BB *_ *5. *_\nThe officers of No. 13 Reserve Field Ambulance, R.C.A.M.C, comprise a number\nof medical practitioners in Victoria: Officer Commanding, Capt. A. B. Nash; Next Senior\nOfficer, Lieut. W. H. Moore; Acting Adjutant, Lieut. G. B. B. Buffam; other officers:\nLieuts. R. C Newby, A. Herstein, L. W. Cromwell, W. A. Trenholm, V. W. Smith and\nV L. Annett.\nDr. David Berman of Victoria has been suffering from a painful ankle which he\ntwisted when he slipped on a piscatorial party.\nCaptains O. C. Lucas, D. B. Roxburgh, N. C. Cook and L. L. Ptak, all formerly of\nVictoria, has just returned from R.C.A.M.C. instruction course in Eastern Canada.\nDr. R. A. Hunter of Victoria made a hurried trip to Winnipeg to see his mother,\nwho is seriously ill.\nDr. Hugo Emanuele, formerly of Pioneer, is now associated with Dr. H. McGregor\nin Penticton. Dr. Emanuele will take the place of Dr. McGregor's son, Flight-Lieut.\nMcGregor, who is serving with the Air Force.\nCapt. W. H. White, formerly of Penticton, visited his home en route to Vernon,\nwhere he is now stationed.\nIIS\nLIBRARY NOTES\nRECENT ACCESSIONS TO LIBRARY:\nTransactions of the American Proctological Society, 1941.\nTransactions of the American Ophthalmological Society, 1941.\nTransactions of the 47th Annual Meeting of the American Laryngological, Rhino-\nlogical and Otological Society, Inc.\nMedical Clinics of North America, Symposium on Medical Emergencies and Tuberculosis, St. Louis Number, March, 1942.\nPhysical Medicine, 1941, by Frank H. Krusen.\nThe Management of Obstetric Difficulties, 2nd ed., 1941, by Paul Titus.\nMISSING\nWill members please check this list carefully and return to the Library any\nof the books and journals listed below which may be in their possession:\u00E2\u0080\u0094\nAmerican Journal of Medical Sciences, January, 1942.\nAmerican Journal of Surgery, January, 1942.\nArchives of Surgery, January, 1942.\nBritish Medical Journal, July 12 th, 1941.\nCanadian Medical Journal, February, 1942.\nEndocrinology, May and July, 1940.\nPost Graduate Medical Journal, December, 1940.\nPractitioner, January, 1941.\nQuarterly Journal of Medicine,, October, 1941.\nSurgery, Gynaecology & Obstetrics, v. 73, 1941.\n\"Behind the Mask of Medicine,\" by Miles Atkinson.\n\"New Electrocardiography,\" Graybiel and White.\nPage 231 *m\n' !K*>\nVancouver Medical Association\nANNUAL REPORTS FOR 1941-1942\nREPORT OF THE HONORARY SECRETARY\nMeetings.\u00E2\u0080\u0094Seven General Meetings of the Associations were held during the year,\nat which a number of excellent and very interesting papers were presented. It is\nregretted that the Osier Lecture was not given, owing to the illness of Dr. D. E. H.\nCleveland, the appointed lecturer. A special luncheon was arranged in December, at\nwhich Surgeon Rear-Admiral Gordon-Taylor was guest speaker.\nFourteen meetings of the Executive Committee were held, one in conjunction with\na special committee from the Metropolitan Health Board, for the purpose of making\nplans for the organization of the medical profession in case of a military emergency.\nMembership.\u00E2\u0080\u0094The total membership of the Association, including applications for\nmembership which are pending, is 311. This is made up as follows:\nLife Members 10\nActive Members 251\nAssociate Members 43\nPrivileged Members 7\nTen new members were elected through the year and Life Membership was bestowed\nupon Dr. Dallas Perry.\nForty-five members of the Association are on active military service.\nThe Association has lost four members since the last Annual Meeting, namely:\nDr. P. W. Barker; Dr. D. J. Bell, Life Member; Dr. E. H. Bolton, Dr. G. W. Knipe.\nThere were three resignations from the Executive Committee during the season,\nbecause of pending active service, which necessitated the appointment of new officers\nto the Executive to fill the vacant positions.\nAttendance.\u00E2\u0080\u0094The average attendance at meetings was 49, being a considerable\ndecrease as compared with the previous year. This drop in attendance may be explained\nin part by the absence of members on active service, and also by the fact that no dinner\nmeeting was held last year.\nIt is the hope of the Executive that the attendance may be increased in the year to\ncome, since it is felt that the quality of the papers presented warranted a larger audience.\nRespectfully submitted,\nA. E. Trites, Honorary Secretary.\n*\n'\u00E2\u0080\u00A2m\nmi\nf.P 4\n!f\u00C2\u00AB\n\u00E2\u0096\u00A0JHm\nHONORARY TREASURER'S REPORT\nMr. President and Members:\nI present the Auditor's Report for the fiscal year ending March 31, 1942.\nThe various trust funds have been well maintained.\nTrust Funds: The Historical and Ultra Scientific fund shows a savings account\nfrom interest of $17.49, having been drawn on by the Library Board for $125.00. The\nStephen Memorial Fund, drawn on for $90.00, shows a balance in savings account of\n$5.48. The Sickness and Benevolent Fund savings account, $274.02, paid in grants in\naid of members during the year $350.00. Benevolent Endowment Fund, $700. The John\nMawer Pearson Fund savings account, $291.99, in addition to the principal of fund,\n$3018.75.\nGeneral Fund Bonds: The investments of the General Fund apart from current\naccount and savings account show a present value of $9350.00. $3,017.00 of this prop-\nPage 232\nm\nm l%*>\nw\n\u00C2\u00BB!?\n1\nm\nerly belongs to the Summer School, for during the year the current bank account and\nsavings accounts were invested in War Loan by the Trustees to the fullest extent consistent with maintaining sufficient liquid cash.\nLibrary: The Library has been well maintained, the committee having expended in\nall $1360.00, which includes the $215.00 from the special funds.\LTnfortunately the\nproblem of increased room urgently required for library purposes is still unsolved.\nIncome: The statement of income and expenditure for the year shows:\nIncome from members' annual dues $4,314.50\nInterest on invested funds 217.76\nTotal $4,53 2.26\nIn addition there accrues the compensation derived from the Relief Committee of\n$600.00 and a small credit balance from Bulettn, $4.66.\nExpenditure :\nThe expenditure for salaries $2,782.97\nThe expenditure for rent 1,377.00\nTotal __ j I $4,159.97\nReceived from C P. S. of B. C, their share 1,860.00\n$2,299.97\nOther running expenses 719.86\nTotal expenditure apart from Library maintenance $3,019.83\nExpended from General Fund by Library Con_mittee_ 1,145.00\nTotal \u00E2\u0096\u00A0. . $4,164.8 3\nBalance of income over expenditure $ 368.00\nMembers: Of 251 active members still on the roll 41 have volunteered for service,\nleaving 210, of whom some four or five have resigned or been struck off. Four Associate\nMembers of 43 have volunteered, leaving 39 liable for dues.\nForecast: Our gross income for the present year should be in the neighbourhood of\n$4500.00, which would provide a library fund equal to that expended last year, or about\n$1200.00, allowing a small margin further enlistments in the army.\nStatements: The statements already sent out include the $1.00 assessment for the\nSickness and Benevolent Fund the same as last year.\nIt would be appreciated if members would send in their cheques promptly and did\nnot deduct this mdest dollar when drawing the cheque.\nAll of which is respectfully submitted.\nW. T. Lockhart, Hon. Treasurer.\n* * * *\nEDITOR'S REPORT\nThe history of the Bulletin for the past twelve months has been one of progress:\nnot rapid or sensational in any way, but definite, though in a small degree.\nThe circulation has been increased from 1000 to 1100 copies monthly. We receive\nmany requests to be put on mailing lists, from many parts of the continent: even from\nSouth America. How it happens that within a month after the publication of a certain\narticle, a request comes from a small town in Pennsylvania for a reprint of this article,\nis hard to understand\u00E2\u0080\u0094but we feel flattered all the same.\nThe actual number of pages printed has increased considerably. We have published,\nin twelve issues, the actual equivalent of thirteen complete Bulletins. We are finding\nit hard, in fact, to squeeze in all the material that we want to publish. If some of our\ncontributors, therefore, find that their contribution is delayed, we can only ask for their\nPage 233 indulgence and assure them we shall do our best for them: and that we are very grateful\nto them for their efforts.\nOur advertising has increased during the year, and we now have a much more stable\nlist of advertisers.\nAs regards our balance sheet, the Auditors say that we show a small profit of some\nfour or five dollars. We regret that we have not done better\u00E2\u0080\u0094but feel sure that the\nAssociation will be satisfied that our profits should go into larger issues and increased\ncirculation. In this connection, it must be remembered that these increases in number\nand size mean a large increase in postage: and this cuts heavily into our income.\nWe owe a great deal to our various Sections. The Vancouver General Hospital has\nbeen particularly good. Its articles arrive regularly, are well edited and written, and\ncontain excellent material. Some of them are of especial value, but all are good. Miss\nRoss of the V. G. H. Staff has been most helpful in this regard.\nSt. Paul's has also given us several excellent contributions. The Victoria Medical\nSociety sends articles and papers which are of excellent quality, and we value them\ngreatly. Our Cancer Section has also been well taken care of.\nLastly, the B. C Medical Association Section has been a tower of strength to us.\nThe regular contribution of news and notes, the aid in distribution, and so on, have meant\na great deal to us, and we again thank Dr. M. W. Thomas and his staff for their most\nvaluable help.\nOur publishers have always been most patient and loyal, and this really means Mr.\nW. E. G. Macdonald, our business agent. Working with him has been a great pleasure,\nand I do not see, personally, how we could have got on without him. The improvements\nin our status, economically at least, are entirely due to him.\nReported on behalf of the Publications Committee.\nJ. H. MacDermot.\nREPORT OF TRUSTEES\nThe President, Vancouver Medical Association:\nHerewith a report of the Trustees and Sickness and Benevolent Fund Committee for\nthe fiscal year ending March 31st, 1942. During the year there were sundry meetings\nof the Trustees and also of the Sickness and Benevolent Fund Coinmittee.\nThe sum of four hundred and fifty dollars ($450.00) was expended from the Sickness and Benevolent Fund. This expenditure was in the nature of a gift and it is not\nexpected that it will ever be returned.\nFour thousand dollars ($4000*00) was invested in War Bonds during the year, of\nwhich amount $3500.00 was in the General Fund and $500 in the Ultra-Scientific Fund.\nThe Trustees note with satisfaction that a small levy has been made in the past year\nin behalf of the Suckness and Benevolent Fund. It is to be hoped that demands on this\nfund will be curtailed in order that the new assessment may build up the capital structure which at present is much too small.\nAll of which is respectfully submitted.\nSigned on behalf of the Trustees.\nFrederic Brodee.\nmm\nANNUAL REPORT OF LIBRARY COMMITTEE\nBooks Added to Library:\nGeneral Collection:\n39 new. books at a cost of $ 349.79\n9 gifts.\n5 gifts, Nicholson Collection, at a cost of 17.43\nTotal\u00E2\u0080\u009453 Books added, at a cost of $ 332.36\nPage 234\n'H lm\n!-:M\n:\n:M\u00C2\u00BBJ\nBi\nH\nm\nNicholson Fund:\n5 books purchased at a cost of $17.43, leaving a balance on hand of 99.91\nMedical Journals:\n71 Journals subscribed to at a cost of 690.47\n43 Journals are received as gifts.\n114 Journals are received in Library.\n102 volumes bound at a cost of 267.70\nOther Expensess\nSubscription to Medical Library Association $ 16.83\nSpecial Labels for reduced mailing rate 3.78\nSundry Expenses , 32.29\n 52.90\nTotal $ 1,360.86\nCredit\u00E2\u0080\u0094By withdrawal from Ultra-Scientific Fund $125.00\nStephen Memorial Fund 90.00 215.00*\n$1,145.86\n*The $215.00 credited by withdrawal from the two special funds mentioned was\napplied to the subscription and binding costs of certain journals which were considered properly to fall within the classifications for which these funds were intended.\nDuring the past year one evening and nine luncheon meetings of the Library Com-j\nmittee were held.\nSeveral books on Industrial Medicine have been purchased and the librarian has prepared a bibliography on the subject which is now in the Library and which will enhance\nthe usefulness of this section.\nThe Post Office Department has granted our request for a special reduced postal rate\nfor mailing books from the Library going on loan to associate members resident in the\nProvince.\nAfter investigation into the frequency with which these various journals in the\nLibrary are used, it has been decided in the interests of economy to discontinue the following six journals:\nEndocrinology Journal of Infcetious Diseases\nJournal of Anatomy Physiological Reviews\nJournal of Immunology Science.\nThrough the Library the Association has become a subscriber to the microfilm service\nof the Friends of the Army Medical Library at Washington, D.C This service and its\nadvantages were described in a recent number of the Bulletin. Fortunately it became\npossible to purchase locally an iUuminated microfilm projector of American manufacture, at a price believed to be considerably less than it would have cost to import it under\npresent conditions. This apparatus, which is in excellent order, not only makes it possible for the individual user to read microfilm at east and in comfort, but can also be\nused satisfactorily to project diagrams, etc., on a screen such as we use in the Auditorium.\nWe desire to acknowledge with thanks the gift of $10.00 from Dr. C. A. Eggert,\nand books from Dr. G. H. Clement, Dr. S. G. E'lliott, the Division of Venereal Disease\nControl, and others.\nAll of which is respectfully submitted,\nD. E. H. Cleveland, Chairman.\nREPORT OF THE RELIEF ADMINISTRATION COMMITTEE\nPresenting the 9th annual report of the Relief AdWnistration Committee.\nDuring the past year there has been a decrease in the number of people on relief and,\nconsequently, a decrease in the amount of work for medical relief. The gross amount of\nPage 235 i_ ^ '\naccounts for the year ending March 31st, 1941, amounted to $128,293.00, while those\nfor the year ending March 31st, 1942, amounted to $74,897.00. Percentages paid during\nthe past twelve months have ranged from 3 8 % in September last to 45 % in April and\nMay, an average of 41.579%.\nThe total of net accounts for the year was $59,590.34\nThe total amount paid to doctors 24,957.25\nDr. L. W. MacNutt, who has been a member of the Relief Adrninistration Committee\nfor several years, found it necessary to resign and Dr. Gordon Burke kindly consented to\nact as a member of the Committee, which now consists of:\nDr. W. T. Lockhart, Chairman; Dr. J. A. Sutherland, Secretary; Dr. Colin McDiar-\nmid, Dr. D. F. Busteed, Dr. Gordon Burke, Dr. J. R. Davies, Dr. A. O. Brown\nAll of which is respectfully submitted.\nJ. A. Sutherland, M.D., Secretary.\nmm\n\u00E2\u0096\u00BA' Wi \u00E2\u0080\u00A2'\nCLINICAL SECTION\u00E2\u0080\u0094ANNUAL REPORT\nFive meetings of the Clinical Section were held during the year\u00E2\u0080\u0094three at St. Paul's\nHospital, one at Shaughnessy and one at the Vancouver General.\nOwing to \"blackout\" regulations, two meetings were cancelled, which somewhat\ncurtailed the activities of this Section.\nRespectfully submitted.\nJ. R. Davidson, Chairman.\nm\\nREPORT OF PEDIATRIC SECTION\nSince the last annual meeting of this Society the Paediatric Section has held seven\nmeetings. Attendance at these meetings was very good.\nDuring the year we have been hosts to the North Pacific Paediatric Society, holding a\nvery entertaining meeting in Vancouver last June.\nDuring the winter we made a short study of nervous diseases in children, including a\nvisit to the Provincial Hospital for the Insane in New Westminster.\nWe have lost to the Army one of our foremost members, Dr. E. J. Curtis.\nRespectfully submitted,\nJ. H. B. Grant, Secretary.\nsun\nREPORT OF EYE, EAR, NOSE AND THROAT SECTION\nThe Eye, Ear, Nose and Throat Section of the Vancouver Medical Association held\nthree luncheon meetings and three clinical meetings during the course of the past year.\nThis section met less frequently this year owing to the increasing demands on the\ntime of our members in connection with A.R.P. work in the hospitals and with the\ngreater burden of public practice.\nWe have lost two more members of this section to the Armed Forces. We look forward to the day when we can again all meet as one, and to the early return of all those\nmembers who are now on active service.\nA. R. Anthony, Chairman.\nREPORT OF HISTORICAL COMMITTEE\nMuch groundwork requires to be done in compiling a history of the Vancouver\nMedical Association before any tangible results can be shown.\nDuring the year work has been continued in the synopsizing of the minute books of\nthe Association. The completion of this, up to the present date, seems to me to be the\nfirst essential in task in getting together historical data.\nG. E. Kidd, Chairman.\nPage 236\n\u00E2\u0096\u00A0 r. L m\n;wn\nw\nfh\nREPORT OF V. O. N. ADVISORY COMMITTEE\nThere is nothing to report, as it has not been necessary to call a meeting of this committee throughout the year.\nL. W. MacNutt, Chairman.\n* * * *\nREPORT OF GREATER VANCOUVER HEALTH LEAGUE\nREPRESENTATIVES\nAs one of your representatives on the Board of Directors of the Health League of\nGreater Vancouver I wish to submit the following report:\nI have attended over half of their meetings and taken part in their discussions regarding:\n1. Compulsory pasteurization of milk.\n2. Control of the city rat menace.\n3. Nutrition.\nI was received with hospitality and enjoyed my participation in their business.\nR. A. Wilson.\nREPORT OF REPRESENTATIVE TO B. C. MEDICAL ASSOCIATION\nI report that I have attended all meetings of the Board of Directors of the B. C.\nMedical Association. No special matters to report, as all matters have been reported in\nthe Bulletin.\nD. F. Busteed.\nEl!\nCANADIAN MEDICAL ASSOCIATION\nSEVENTY-THIRD ANNUAL MEETING\nJASPER PARK LODGE\nJune 15th-19t_i, 1942\nMm\nBRITISH COLUMBIA MEDICAL ASSOCIATION\nCanadian Medical Association, British Columbia Division.\nA Message from the \"President of the British Columbia Medical Association\nA definite need for our annual meeting has been demonstrated in the past by the\nincreasing enthusiasm of those taking part. Our attendance shows a gratifying yearly\nincrease.\nA general stimulus to the whole profession has resulted from the excellence of the\nprogrammes arranged for the benefit of those desirous of improving their knowledge and\nservice to humanity.\nI believe that this year we have a great opportunity to get a real measure of fellowship injected into our gatherings. This is the hour when we must build solidly and\nsoundly: first, our faith in each other; secondly, our faith in the efficacy of our healing.\nCome to Jasper\u00E2\u0080\u0094every one who can be spared. Come and have a real week of enjoyment\u00E2\u0080\u0094come in numbers large enough to give our Alberta colleagues a real boost and\ngenuine encouragement. Remember their problems are similar to ours and we have much\nto learn of them.\nWelcome to Jasper.\nCecil H. Hankinson.\nPage 237 British Columbia Medical Association\n(CANADIAN MEDICAL ASSOCIATION, BRITISH COLUMBIA DIVISION)\nPresident. . Dr. C. H. Hankinson, Prince Rupert\nFirst Vice-President Dr. A. H. Spohn, Vancouver\nSecond Vice-President : Dr. P. A. C. Cousland, Victoria\nHonorary Secretary-Treasurer Dr. A. Y. McNair, Vancouver\nImmediate Past President Dr. Murray Blair, Vancouver\nExecutive Secretary Dr. M. W. Thomas, Vancouver\nANNUAL BUSINESS MEETING\nJasper, June 16th, 1942\n8:00 p.m.\u00E2\u0080\u0094Annual Meeting of the'College of Physicians and Surgeons.\n(All doctors should attend.)\nFollowed by:\nAnnual Meeting of the British Columbia Medical Association.\nThose travelling to Jasper from the Coast should plan\nto leave Vancouver on Monday evening, June 15 th, arriving\nas Jasper at noon on Tuesday, June 16th.\nMembers of General Council, CM.A., should arrive on\nSunday. Sessions of General Council commence early Monday morning.\nGolf on Tuesday afternoon.\nAnnual Meetings on Tuesday evening.\nLecture Programme begins on Wednesday morning.\nBe sure to bring golf clubs and enter the competition for\nthe Trophy of the British Columbia Medical Association.\nDr. C. E. Davies is the present holder of the Trophy,\nwhich he wrested from Dr. H. H. MacKenzie in 1941.\nBuy a ticket from the Canadian National and reserve accommodations on the train\nand at Jasper Lodge.\nAccommodation on Train: (War tax has been included)\nVancouver to Jasper (each way)\nLower Standard Berth $ 5.80\nCompartment for one passenger $14.85\nCompartment for two passengers $16.50\nDrawing Room for one passenger $17.60\nDrawing Room for two or more passengers $20.90\nCanadian National Offices accept reservations for Jasper Lodge.\nSUMMER SCHOOL\nOwing to the fact that the Canadian Medical Association and the British\nColumbia Medical Association are holding their Annual Meetings at Jasper in\nJune, the annual Summer School will be held September 15 th to 18 th, inclusive,\nat the Hotel Vancouver.\n\u00E2\u0080\u00A2*\nPage 231 -*-\u00E2\u0080\u00A2-\n:W\nR'i,\nlf.ll\nm\nM\nc\no lege o\nf pk\nysicians a\nnd Su\nrgeons\nPresident\u00E2\u0080\u0094__ Dr. W. A. Clarke, New Westminster\nVice-President Dr. F. M. Bryant, Victoria\nTreasurer Dr. H. H. Milburn, Vancouver\nMembers of Council\u00E2\u0080\u0094Dr. F. M. Auld, Nelson (District No. 5); Dr. F. M. Bryant, Victoria\n(District No. 1); Dr. W. A. Clarke, New \"Westminster (District No. 2); Dr. Thomas\nMcPherson, Victoria (District No. 1); Dr. H. H. Milburn, Vancouver (District No. 3);\nDr. Osborne Morris, Vernon (District No. 4); Dr. \"Wallace Wilson. Vancouver (District\nNo. 3).\nRegistrar Dr. A. J. McLachlan, Vancouver\nExecutive Secretary Dr. M. \"W. Thomas, Vancouver\nMEDICAL ECONOMICS\nThe loss of time in industry due to disabling sickness is becoming a live topic,\nespecially with the scarcity of manpower and the necessity of measures to conserve the\nhealth of workers and keep them on the job. It has always been recognized that the\ncontrol of disease in its incipient stages, advice on diet, rest, exercise, and so on, provide\nan extensive field for the doctor in co-operation with industry. The magnitude of this\nproblem is perhaps better illustrated in the following table, which indicates as well the\nlines of demarcation of medical practice as they exist today. Now more than ever employers are finding it necessary to guard the health of their employees. The pressure of war\ndemands has demonstrated the need to study actively the introduction into their plants\nof some such plan as the M-S-A.\nMEDICAL SERVICES FOR EMPLOYEES\nDivision\nFunction\nAgency\nComparison of\nProduction Time Lost\nPUBLIC HEALTH\nSanitation.\nFood Inspection, etc.\nCare T.B., V.D. and Mental Diseases \u00E2\u0080\u0094 Employee\nmay use own doctor at his\nexpense.\nHealth Officers\nNo Estimate.\n\u00E2\u0096\u00A0\nOCCUPATIONAL\nMedical Aid including\nEmployee's own\nONE worker out of every\nACCIDENTS AND\ncomplete care for all such\ndoctor\u00E2\u0080\u0094Workmen's\n100 will be disabled by\nDISEASES\ninjuries or compensatory\ndiseases.\nCompensation\nBoard\noccupational injury.*\nONE worker out of every\n3000 will be disabled by\noccupational illness.*\n\u00E2\u0080\u0094\nINDUSTRIAL\nSafeguarding places of\nDoctor remuner\nAllows reduction of pro\nMEDICINE\nwork.\nated by employer\nduction time lost and\nPre-employment examina\n\u00E2\u0080\u0094by arrangement\nplacement of handicapped\ntions.\nworkers.\nPeriodic examinations.\nProper placement of\nworkers.\n\u00E2\u0096\u00A0\nNON-OCCUPA\nAll ordinary medical care\nEmployee's own\nPersonal sickness will dis\nTIONAL ACCI\nincluding diagnosis T.B.,\ndoctor\u00E2\u0080\u0094M.S.A.\nable ONE worker out of\n1\nDENTS AND\nV.D., and Mental Dis\nevery 10\u00E2\u0080\u0094and the aver\nDISEASES\neases, home, office and hospital visits; consultations;\nX-ray and diagnostic aids;\nspecialists' services; surgery or operations.\nage amount of time lost\nin each case will be 40\ndays.*\nONE worker out of every\n50 will be disabled by\nnon-occupational injury.*\n1\n\u00E2\u0096\u00A0\n* Dr. C. D. Selby, Medical Consultant to General Motors Corporation.\nPage 239 ancouver\neneral\nHospita\n}_&\nCLEAR SPINAL FLUID IN MENINGOCOCCIC MENINGITIS\nCase Keport\nR. A. Palmer, Capt., R.C.A.M.C, and F. D. Sinclair, M.D.\nThe purpose of this paper is to report a somewhat confusing clinical experience with\na case of meningococcic meningitis in which the initial lumbar puncture revealed a\nclear spinal fluid and a cell count of 16 cells. In his series of 50 cases of epidemic\nmeningococcus meningitis, Curtis12 refers to this cases, and reports two others in which\nthe initial spinal fluid cell count was under 100.\nCase Report:\nA robust schoolboy of 16 years suffered a mild \"flu\" October 10th, 1941, lasting\nfive days, but was then well till October 23 rd, 1941, when he developed malaise, chills,\nheadache and sore throat, taking to bed. Vomiting began in about eight hours, in twelve\nhours a generalized spotted rash appeared and his temperature was 103\u00C2\u00B0, though his\nheadache was better. General muscle aches became prominent and photophobia was\npresent. He was seen by Dr. F. D. Sinclair, who admitted him to the Vancouver General\nHospital, October 24th, 1941. Family history and past history are insignificant, though\na carious tooth without gross infection was extracted October 21st, 1941.\nExamination (2 hours after onset)\u00E2\u0080\u0094A fair-haired, slender but well developed boy\nof 16 years; looks ill and toxic, some photophobia is present, and he does not like to\nmove due to general muscle aches. Temperature 99\u00C2\u00B0 and considerable hoarseness but the\nthroat is unremarkable. There is a generalized fine purpuric rash, with some petechia; in\nthe conjunctiva and soft palate, but none in the fundi. One tooth recently extracted,\nbut no gross infection is obvious. A few small post cervical glands are palpable. Heart\nrate is 120, regular, B.P. 110/50; otherwise the chest, abdomen, genitalia are negative.\nDeep and superficial reflexes are normal, there is no definite stiffness of the neck, but\na well marked Kernig is present bilaterally.\nUrinalysis\u00E2\u0080\u00941020 albumin 2 plus, W.B.C. 2 plus, hyaline casts 2 plus.\nBlood count\u00E2\u0080\u0094R.B.C. 4,410,000, W.B.C. 33,800, haemoglobin 89%. (S) Diff count:\npolys 44, staff (young polys) 44, lymphs 3, mon. 1, disint. 8.\nClotting time\u00E2\u0080\u00944J4 minutes.\nHess capillary test\u00E2\u0080\u0094negative.\nSpinal puncture (23 hours after onset)\u00E2\u0080\u0094Clear fluid. Pressure 200 mm. of spinal\nfluid. Cell count: 15 (60% polys, 40% lymphs). No organisms found. Protein 28\nmgm.\n%\nBlood culture\u00E2\u0080\u0094Subsequently reported, no growth.\nInitial Impression\u00E2\u0080\u0094A fulminating septicaemia of undetermined aetiology. Blood dys-\ncrasia not finally excluded.\nClinical course\u00E2\u0080\u00944 grams of sulphadiazine were given by mouth, with 2 grams repeated in 2 hours, but absorption was uncertain due to vomiting, and it became apparent\nthat parenteral adrninistration would be required. In the first seven hours of admission\nthe patient was obviously failing, becoming stuporose though apparently perceiving light.\nHe was restless and breathing tended to be of the Biot periodic type. Stiffness of the\nneck was still only questionable, but the Kernigs were definite as before. Tmperature had\nrisen to 102\u00C2\u00B0. Dr. G. F. Strong was asked to see the patient, and concurred in the general findings. Intravenous sulphathiazole 2 grams were given and repeated every four\nhours. A blood transfusion of 250 cc. was given and repeated in 24 hours. Parenteral\nfluids were given. In another seven hours (14 hours after admission) the patient was\nf>:l Page 240\n_*<:\nIB\n_ . ! _ \u00E2\u0080\u00A2\n\"% I\ntt\nm\nm\n|f 11\nm\n1\nconscious and talking rationally, and his clinical course thereafter was uneventful. Eighteen hours after admission the lumbar puncture was repeated (40 hours after onset).\nThis revealed a cloudy fluid under pressure of 35 mm. of Hg., with a cell count of\n14,500 and Gram negative intracellular diplococci resembling meningococci. This\nappeared to establish the diagnosis. The sulphathiazole was continued, changing in a few\ndays to the oral route with a gradual reduction in dosage, a total of 76 grams being\ngiven. Sixty cc. of anti-meningococcic serum in divided doses were given, but the value\nof this seems questionable. Sulphathiazole concentration in the blood was 7.3 mgm.%\non October 26th, and on October 29th it was 4.9 mgm.%, at which time the spinal\nfluid concentration was 1.0 mgm.%. Spinal fluid, blood and general clinical findings\nrapidly returned to normal, and the patient returned home November 7th, fifteen days\nafter the onset of the disease.\nAn unusual complication in this case is the fact that the professional blood donor was\nfound to be syphiHtic, apparently an early infection, as the routine blood Kahn three\nmonths previously was negative. This blood must be presumed to be highly infectious,\nbut it is hoped that the high dosage of sulphathiazole would assist the natural irnmunity\nof the recipient to prevent transfer of the disease. At the present time our patient retains\na negative blood Kahn but is being rechecked periodically and the outcome of this\naspect will be reported on subsequently.\nIn Cecil's Textbook of Medicine1, Herrick points out that meningococcic meningitis\nusually proceeds through three stages:\n1. Carrier\u00E2\u0080\u0094with meningococci in the nasopharynx.\n2. Generalized invasion\u00E2\u0080\u0094menmgococcaemia, organisms in the blood stream without\nlocalization in the meninges or other sites. Clear spinal fluid and normal fluid cell\ncount.\n3. Metastatic stage\u00E2\u0080\u0094localization in some body site, usually in the meninges.\nThese stages vary considerably in duration and intensity and frequently it is not possible\nto distinguish them clinically. Murray5 summarizes the disease in these words: \"It would\nseen that the sensitiveness to injury of the C.N.S. has caused a metastatic localization so\nto overshadow a true condition that the disease is often regarded as a primary meningitis, whereas in reality it is a pharyngitis with occasionally a generalization in the form\nof a septicaemia, which, in turn, is usually complicated by localization in the meninges\nand occasionally in the skin, and much more rarely in serous cavities, joints, endocardium\nand other sites.\" He refers to the records of six cases in which the meningitis was a late\ndevelopment in meningococcal septicaemia. The careful study of twenty-six cases by\nTillett and Brown6 affords significant clinical evidence of the pathogenesis of the disease; it is of interest that in one case meningococci were cultured from spinal fluid that\nwas otherwise normal, and in another case there was evidence of a mild generalized\nmeningococcic infection for two months before development of meningitis. Nichols8\nreports a case with meningococcic septicaemia for fourteen weeks before the development\nof meningitis. Recent papers10'13 record cases with normal cell counts in the first\nexamination of the spinal fluid, and in another reported case11 there was a clear spinal\nfluid throughout the whole course of the disease. It seems established that in the stage\nof generalized invasion (meningococcaemia) the spinal fluid is not a reliable measure of\nthe presence or severity of the disease, and Herrick points out4 that some undiagnosed\ncases of overwhelmingly fatal infection associated with purpura are likely to be meningococcic septicaemias. In the Waterhouse-Frederickson syndrome (fulminating meningococcaemia with adrenal haemorrhage) frequently the spinal fluid is not abnormal9, the\npatients dying (12-18 hours) before there has been time for local involvement of the\nmeninges.\nWhen first presenting a problem for diagnosis our case was passing through the\nstage of meningococcaemia, and illustrates the importance of remembering the established\npathogenic sequence of events. This point is still insufficiently stressed in some of the\nstandard texts of medicine, though, as noted above, it has been reported frequently since\nHerrick emphasized it2, 3 in 1918. At that time, after an experience with an epidemic\nPage 241 of 208 cases in an army camp2 he stated that \"the diagnosis can be made in at least\nfifty per cent of cases in the premeningitic stage of sepsis\" (meningococcaemia). Often\nin these cases the meningococcus can be recovered in the spinal fluid \"before the characteristic clinical picture develops, or cellular increase and cloudiness occur in the spinal\nfluid.\" In doubtful cases he recommends that lumbar puncture be repeated every three\nto six hours3. A variation of this is suggested by Hoyne13'14, who takes an immediate\nblood culture, but in cases with petechias delaying lumbar puncture the meningeal signs\nof clinical examination are clearly present.\nSummary:\u00E2\u0080\u0094Report is made of a case of severe meningococcic infection in which the\ninitial lumbar puncture revealed a clear spinal fluid with only sixteen cells. Some similar\nexperiences in the literature are referred to. The importance of remembering that\n\"meningococcic meningitis\" is a generalized disease, and that in early cases the spinal\nfluid may show no inflammatory response, is apparent.\nREFERENCES:\n1. Herrick, W. W.: Cerebrospinal Fever, Cecil, R. L., Textbook of Medicine, Saunders (W. B.) Company, 1941.\n2. Herrick, W. W.: The intravenous serum treatment of Epidemic Cerebrospinal Meningitis. Arch. Int,\nMed., 21:541, 1918.\n3. Herrick, W. W.: Epidemic of Meningitis at Camp Jackson, J.A.M.A., 70:227, 1918\n4. Herrick, W. W.: Case of Purpura Fulminans. J.A.M.A., 76:55 (Jan. 1), 1921.\n5. Murray, E. G. D.: The Meningococcus. Medical Research Council, Spacial Report Series No. 124, 1929.\n6. Tillett, W. S., and Brown, T. M.: Epidemic Meningococcus Meningitis. Johns Hopkins Hospital\nBulletin, 57:297, 1935.\n7. Craster, C V., and Simon, H: Meningococcic Meningitis and Acute Meningococcaemia. J.A.M.A.,\n110:1069 (April 2), 1938.\n8. Nicholls, J. V. V.: An unusual case of Meningococcus Meningitis. Can.M.A.J., 35:161 (August), 193 6.\n9. Aegerter, E. E.: Waterhouse-Frederickson Syndrome: Review of the Literature and Report of 2 cases.\nJ.A.M.A., 106:1715 (May 16), 1936. MM\n10. Rathery, F., and Bolzinger, R.: Apropos d'un cas de meningite cerebrospinal meningococcique a debut\nchinique et cyto-bacteriologique atypique. Bull, et mem. Soc. med. des hop. de Paris. 56:553-557,\nOct. 29, 1940.\n11. Hillemand, P.: Un cas de meningite cerebro-spinal a liquide cephalo-rachidien clair et lymphocyte\"\nrachidienne. Bull, et mem. Sqc. Med\", des Hop. de Paris. 56:712-714, Jan. 6, 1941.\n12. Curtis, E. J.: Meningococcus Meningitis. Bull. Van. Med. Assoc, 18:93 (Dec), 1941.\n13. Hoyne, A. L.: Epidemic Meningitis. J.A.M.A., 115:1852-1855 (Nov. 30), 1940.\n14. Hoyne, A. L.: Intravenous Treatment of Meningococcic Meningitis with Meningococcus Anti-toxin.\nJ.A.M.A., 107:478 (Aug. 15), 1936.\nPage 242 M\n11\nm\nCASE OF URETERAL (BI-LATERAL) OBSTRUCTION WITH\n|\u00C2\u00A7ffi|| COMPLICATIONS FOLLOWING SULFADIAZINE\nEarle R. Hall, M.D.\nFrom reports in the literature during the past few years it is evident that disturbances\nof the renal tract may occur following therapy by use of any of the \"Sulfa\" drugs.\nRecently, at St. Paul's Hospital, we had a case developing severe complications following\nthe administration of sulfadiazine. As this is considered to be one of the safest of the\nsulphonamides, it is deemed a case worthy of report.\nCase\nA. K., male, age 31, was admitted to St. Paul's Hospital on Feb. 22, 1942, with\ninfection involving the right hand. This was the result of a small wound of the hand\nsustained while at work five days previously. Upon admission to hospital a diagnosis of\ncellulitis of the hand was made, and in addition to local treatment he was given sulfadiazine gms. II for the initial dose, and then gm. I q.4.h. with soda bicarbonate grs. X.\nDischarge from the wound in the hand showed Staphylococcus Aureus. On Feb. 27,\n1942, the hand had improved, and his temperature was normal. He was discharged\nfrom hospital. It is interesting to note that urine which he had passed shortly before\nleaving hospital microscopically showed R.B.C 4-f-.\nThe day following hospital discharge, patient consulted his physician, complaining\nof pain at the right lumbar region associated with nausea and vomiting, and also stating\nthat he had passed very little urine since leaving hospital. Catheter was passed and about\n2 oz. of blood-stained urine obtained. He was re-admitted to hospital on Feb. 28, 1942.\nHis temperature upon admission was 98.3, pulse 60, and a few hours later he passed 6\noz. or urine in the hospital, this showing gross haematuria.\nMarch 1, 1942\u00E2\u0080\u0094He has been passing urine since readmission, but 24-hour output has\nnot exceeded 10 oz.\nMarch 3, 1942\u00E2\u0080\u0094I was called in consultation to see this case, with the above history,\nand in addition to oliguria since his hospital admission, there has been no urine voided\nfor the past 24 hours.\nExamination of the patient showed definite cyanosis\u00E2\u0080\u0094appeared to be very much\ndehydrated'\u00E2\u0080\u0094respirations were very rapid and shallow. Patient is complaining of considerable pain in both lumbar areas. These were also very tender on palpation. Cystoscopy and catheterization of ureters was carried out. This disclosed no urine in the\nscopy and catheterization of ureters was carried out. This disclosed no urine inthe\nbladder, which was somewhat inflamed, with considerable oedema involving both ureteral\norifices. Catheters would not pass up the ureters\u00E2\u0080\u0094meeting apparent obstruction a few\nc.c.'s within, this being greatest on the right. Small bougies were finally passed by the\nobstruction, .which appeared to be due to old blood clots and small reddish crystal-like\nformations which could be seen passing out of the ureteral orifices. Catheters were then\npassed on both sides to the renal pelvis, and immediately there was ,a free flow of bloodstained urine from the pelvis of each kidney. The urine appeared to be under great\npressure. A few minutes following the free flow of urine through the catheters, the\npatient felt very much improved\u00E2\u0080\u0094the cyanosis disappeared, his respirations returned to\nnormal, and the pain at the back receded and finally disappeared. The catheters were left\nin on each side for about half an hour, and the renal pelves were washed out with warm\nsaline.\nPage 243 March 4, 1942\u00E2\u0080\u0094Following cystoscopy and ureteral catheterization, his intake was\n2100 c.c; output, 1740 c.c. N.P.N, was 67 mgs., and Creatinine 3.7 mgs.\nMarch 7, 1942\u00E2\u0080\u0094Following the ureteral catheterization, his general condition has\nimproved. Patient has been passing urine in normal quantities. Cystoscopy and\npyelography were carried out.\nX-Ray report\u00E2\u0080\u0094\"Negative for opaque calculi. Marked pyelonephritis with dilatation\nof pelvis and ureter bilaterally. Destructive change most marked at bases of calices.\"\u00E2\u0080\u0094\nC W. Prowd, M.D.\nMarch 10, 1942\u00E2\u0080\u0094Patient's condition has been improving. N.P.N. 43 mgs.\nMarch 12, 1942\u00E2\u0080\u0094Temperature has been normal for the past 48 hours. He is apparently free of symptoms except for occasional pain in the right lumbar area.\nUrine\u00E2\u0080\u0094S.G. 1010. pH. 7.0. Albumin\u00E2\u0080\u0094Trace. Sugar\u00E2\u0080\u0094None.\nMicroscopic\u00E2\u0080\u0094Occasional hyaline .cast. Triple phosphates.\nPatient was discharged from hospital.\nMarch 23, 1942\u00E2\u0080\u0094Patient was re-admitted to hospital complaining of pain commencing in the right lower lumbar area and radiating anteriorly and downward to the lower\nright quadrant and involving the right testis.\nTemperature, 98; pulse, 80; respirations, 20.\nUrine\u00E2\u0080\u0094S. G. 1010. pH. 6.0. Albumin\u00E2\u0080\u0094Trace. Sugar\u00E2\u0080\u0094None.\nMicroscopic\u00E2\u0080\u0094Few pus cells. Occasional R.B.C\nN.P.N.\u00E2\u0080\u009429 mgs.\nFlat X-ray was negative for any evidence of calculus.\nMarch 29, 1942\u00E2\u0080\u0094The pain had disappeared 24 hours after hospital admission. He\nwas feeling quite well. Discharged from hospital.\n\u00C2\u00A3\n'**\nComment:\nThis man apparently developed an acute pyelonephritis, presumably from the effect\nof sulfadiazine, the earliest symptom being haematuria, which appeared on the fifth day\nof sulfadiazine treatment. This was gross haematuria which he voided just before his\nhospital discharge, though, unfortunately, the true significance of this was not realized\nuntil he left hospital. At this time his hand injury was well and his general condition\nwas apparently normal. Within twenty-four hours, however, other symptoms suggesting pyelonephritis developed\u00E2\u0080\u0094pain in back, oliguria, fever, and continuation of the\nhaematuria. He was re-admitted and his general condition was daily becoming more\ncritical until he reached a point of twenty-four hours without having passed any urine\nwhatever. The relief from this by ureteral dilatation and catheterization was almost\nmiraculous\u00E2\u0080\u0094as a matter of fact, it recalled to mind the impression of a patient's dramatic recovery from hypoglycemia following adnxtnistration of glucose.\nThe pyelograms in this case are extremely interesting in exhibiting the amount of\nactual destruction in the kidneys themselves. It will be of interest to obtain pyelograms\nat some future date to study the amount of repair or permanent disability of the renal\norgans.\nPage 244 w\n\u00C2\u00AB\u00C2\u00A3_\u00E2\u0080\u00A2\n:'\n\u00C2\u00A3\n(\u00E2\u0080\u00A2\n%\nM\nTHE USE OF SNAKE VENOMS IN MEDICINE\nLyon H. Appleby, M.D., F.R.CS.(Enc)\nRead before the Vancouver Medical Association April 2, 1942.\nThere are but four venomous snakes in America, and it is perhaps not a useless bit\nof information to know what they are, and where they are to be found. The first of\nthese is the common rattlesnake, widely distributed from coast to coast, but most\ncommon in the Prairies and foothill states and spreading into Canada through the tip\nof the dry belt of America in the region of Kamloops, and the areas close to the Montana\nborder. The second venomous snake of America is the water Moccasin, widely distributed in the deep southeast and south central states, particularly abundant in the\nsteaming marshes of Florida. The next snake is the common copperhead, found in the\nAtlantic seaboard states and extending up into southwestern Ontario. The fourth snake\nis the beautiful coral snake from the keys of Florida, and the islands adjacent thereto.\nFrightfully poisonous, this beautiful snake is cream coloured, slender as a pencil, with\nvivid red bands encircling its body. It is much less frequently seen than its other\npoisonous relatives.\nIf I were asked to describe the features distinguishing venomous from non-venomous\nsnakes, I should mention two at the onset. First, the poisonous snake is almost always a\nthick chunky snake of fairly large size, whereas the slender slithery snakes are largely\nnon-venomous. The two glaring exceptions are perhaps the two most deadly of all\nsnakes\u00E2\u0080\u0094the small coral snake, slender and beautiful, and the black momba, of British\nEast Africa, slender as a finger, fourteen feet long; but on the whole they are thick-\nbodied snakes. The second distinguishing feature is the slit pupil of poisonous snakes\nas opposed to the round pupil of the non-venomous snakes. This, of course, is not a\nuniversal attribute, but in North America at least, it obtains.\nThe constituents of snake venom are very interesting, and are allied to the veratrine\nand aconitine-like action of these drugs in medicine, in many instances. Roughly speaking, the venom of all poisonous snakes is the same, and is a great mixture of substances,\nmost of them imperfectly understood, but which might come under the heading of\nproteolytic enzymes. Roughly these are as follows:\nProteins haemorrhagins cytotoxins\nmucus agglutinins haemotoxins\nenzymes precipitins neurotoxins\nhaemolysins\nThis also, I might say, obtains for all of the scorpions, Merry Widow spiders, wasps,\nhornets, and other venomous insects, bugs, bees, lizards, and reptiles.\nBut venoms differ radically in themselves, just as the blood films of individual humans\nshow marked differences in content. Certain reptiles have a predominance of the coagulant element, others are largely haemolytic, still others are neurotoxic, and as-each species\nof snake varies from other species, so the action of the venom varies from species to\nspecies depending upon the particular ingredient which is dominant.\nTo the student of pharmacology, the use of snakes and their venoms is not new:\nthere are to be found many references to them in the Cacodylic pharmacies of the dark,\nages. They are particularly popular even today in the medicaments of the Chinese, and\nthe Hell's broth of the Witch's Cauldron is not so many years old. The medicinal use\nof serpents in classical'literature is too common to need comment. Nowadays the mysticism and empiricism of the past is giving way to a more rational use, based on accurate\nclinical observation, planned and controlled laboratory experimentation, and modern\npharmacosynthesis. The greatest difficulty in the past has been the collection and distribution of a venom in sterile form, containing the particular glucoside whose action is\ndesired to the exclusion of remaining elements which may be highly undesirable, and no\nless toxic. That remains to this day the main difficulty. Sterilization may destroy the\nelement we most desire; or such an element may be dominant but undesirable; and in\nbut a few instances has science succeeded in synthesizing the active principles of certain\nPage 245 venoms. The similarity of American venoms led to the belief that polyvalent sera could\nbe easily prepared, and the Antivenom Institute of America was instituted at Glenolden,\nPenn. This organization has since been taken over by Mulfords, who make much of the\nantivenom used in this country. However, it was soon found that sera developed against\na snake of one species was nearly useless against certain others, largely because the varying content of venoms differed so widely in concentration. Roughly speaking, there are\nthree classes of snake venom, all three of which are useful in medicine for widely differing pathological states. These three are the Crotalidae as represented by the rattlesnake,\nwhose venom among the other proteolytic enzymes contains an anti-convulsant factor;\nthe Ancistrodon piscivorus or water Mocassin, representing the preponderance of the\ncoagulating factor; and the cobra, Naia Naia, whose venom contains a large quantity of\nneurotoxin. Pharmacological products are usually put up representing so many mouse\nunits per cc, the mouse unit representing the amount of venom which will kill a white\nmouse of a certain weight in a specified time. Venom is usually collected by pressing the\nfangs into a rubber capped test tube and expressing the venom from the pit by massage.\nVenom is then usually evaporated into crystals and as such is stable, whereas in the liquid\nstate it becomes highly unstable. When one stops to consider, the whole question of snake\nvenom has been seriously neglected. I know of no other biological product of a fraction\nof its potency which has not been extensively developed.\nRattlesnake Venom\nRattlesnakes have quantitatively rather a large amount of venom: as much as 250\nmgm. may be injected at a single bite from a large diamondback. Rattlesnake venom\ncontains a high degree of haemotoxins and a relatively speaking low degree of neurotoxins.\nThere are in addition numerous other proteolytic and cytolytic enzymes. Unfortunately\nthere are many ^inseparable fractions in the venom and these have militated against its\nuse. In addition, rattlesnake venom cannot be sterilized, which makes its use precarious.\nThe nature of the desirable element in rattlesnake venom is wholly unknown, but is\ndescribed as an anti-convulsant, and is undoubtedly a fraction of the neurotoxic content.\nThe literature of the early years of the present century between 1904-14 contained\nmany references to the uses of rattlesnake venom in the treatment and control of epileptiform seizures. Most of this was, of course, based upon purely empirical observation.\nThe difficulties attendant are three: the effects of by-products all too frequently overshadowed the neurotoxic effects which were desired, many haemotoxic properties could\nnot be isolated, and extensive haemolysis complicated the treatment, and in addition the\nunsterile product gave rise to serious infections, so that on the whole one feels the\nphysicians who used these early products were lucky indeed not to kill their patients. The\nproduct used was, I bleieve, marketed under the name of Crotalin, and a comprehensive\nreview was published in 1914 by Dr. A. Thom of Boston1. While it has gradually passed\ninto disuse, a recent revival of snake venom in epilepsy has recently taken place, using,\nhowever, cobra venom. This will be discussed later.\nSnakes of the Coagulant Group:\nThe three snakes in this group to which I wish to make reference are the Mocassin\nsnake, Russel's viper, and the Fer-de-Lance. The development of Moccasin snake venom\nas a therapeutic agent was largely due to the work of Peck and Rosenthal2 at Mt. Sinai\nHospital, New York, who published a series of cases in 1935. Once again the pharmacodynamics of Moccasin venom is not wholly known. It is, however, fairly well established\nthat it acts by making the capillary wall less pervious, and so makes it more difficult for\ncapillary escape. The original paper reported a series of cases of functional uterine\nhaemorrhage with excellent results. Moccasin venom is put up in 1-3000 dilution in\nampoules with a mercuric preservative. The dosage is 0.4 cc. twice weekly, increasing\nto 1 cc. doses maintained for a couple of months. About the fourteenth day a local\nreaction of sensitivity begins to develop, the site of injection becomes inflamed, hot and\ntender, and while only minor general reactions occur, the local reaction which invariably\noccurs makes it important to give enough venom in the first two weeks to tide the\nPage 246\nm\n. m\niftnW '\nl'I\nm\\nilffl\niH-y\npatient over a period of desensitization. These reactions of hypersensitivity occur usually\nafter the fourth or fifth injection, desensitization with small doses of 0.05 cc. slowly\ndevelops, and the dose can then be increased without danger up to 1 cc. twice weekly.\nThis moccasin venom is apparently of no value in \"picture\" cases, frank hematological cases with blood pictures such as thrombocytopenic purpura, haemophilia, are not\naffected by it, and its use should be confined to the types of haemorrhages in which\nhaematological findings do not depart from normal, except in so far as the picture may\nbe changed by previous haemorrhages. Peck uses moccasin venom as a test in thrombocytopenic purpura by intracutaneous injection of venom in a dilution so weak as not to\naffect normal individuals, but which causes a frank haemorrhage in these cases. It can\nbe used as a supplementary test to the better known tourniquet test. C H. Watkins3,\nreporting in Mayo Clinic staff proceedings, reports seven cases of menorrhagia described\nas of a functional type with excellent results. In all of these cases antuitrins, dilatation\nand curettage, and other standard methods such as ergot, styptics, X-rays, radium, etc.,\nhad failed, and hysterectomy was considered. Numerous other references are to be found\nin the literature where its use in similar cases has been equally satisfactory. I have three\ncases to report, in two of which marked alleviation of symptoms occurred.\nMOCCASIN\u00E2\u0080\u00943\nNature Time Treated Result\nCase 1. Metrorrhagia _ . 4 months Unrelieved\nCase 2. Metrorrhagia 7 months Relieved\nCase 3. Metrorrhagia 9 weeks Cured 66%\nI wish now to discuss the use of Russell's Viper, and the venom of the Fer-de-Lance,\nas topical applications for the control of the oozing types of capillary haemorrhage. I\nhave used B. & W. Russell viper venom about equally with Lederle's preparation of the\nFer-de-Lance. It is to be remembered that neither of these two preparations are to be\ninjected. These are two of the most powerfully coagulant snakes known. The venom\nof Russell's viper, for instance, will in a dilution of 1-10,000 coagulate the blood of a\nhemophilic with a bleeding time of 35 minutes, in 15 seconds; furthermore, its action\nis equally efficacious on citrated blood, heparinized blood, or blood plasma. That such a\npowerful coagulant should not have been more widely exploited is remarkable. It has\nbeen stated that the venom of Russell's viper retains its coagulant properties, and does\nnot vanish until dilution of 1.000,000,000,000,000,000 is reached, which I think is 1 in\na billion billion*. Recently Lederle's have succeeded in synthesizing the venom of the\nFer-de-Lance, and this preparation is valuable and available.\nThe uses to which this may be put are almost too varied to be described. In general,\nit has proven of the greatest value in dental practice for stopping the difficult haemorrhages sometimes following extraction; epistaxis, uterine bleeding, surface oozing of all\nkinds. Barnett4 reports its use in a case of purpura haemorrhagica with a platelet count of\n60,000, bleeding time of 30 minutes, with a positive tourniquet test in which the arrest\nof haemorrhage was immediate. He reports Gask has used it to stop liver haemorrhage\nafter surface damage from separating adhesions, after tonsillectomy, after prostatectomy,\netc., where the use of local styptics and adrenalin had failed. Baker and Gibson5 report\narrest of haemorrhages from a transfusion wound. Russell's viper presents a wide margin\nof safety; true, the venom as used contains a large number of unwanted fractions, but\nwhile these cannot be isolated, they are apparently inactive in the dilutions in which it\nis used: 1-10,000. It would require several litres of this concentration to have a lethal\neffect on humans. It is put up in dried crystals in a tiny bottle which requires only the\naddition of water to make it usable. In dried form it will preserve its activity apparently\nindefinitely. Pharmacologically, Fer-de-Lance and Russell's viper venom may be considered to be identical with the substance thrombin, and indeed it may actually prove\nso to be when chemically isolated in pure form. The venom of the Fer-de-Lance as prepared by Lederle's is perhaps theoretically a more stable preparation, being a synthetic\nproduct and put up in liquid form. Cranbrook reports that Russell's viper venom\n* A million billion? or trillion? [Ed.]\nPage 247 1-10,000 will coagulate 10 times its bulk of hemophilic blood in less than 20 seconds,\nneither irritant nor toxic, and does delay healing.\nI am not a student of homoeopathy, but I am indebted to Dr. Beeson7 of Portland,\nOregon, for pointing out to me some interesting facts in connection with the philosophy\nof similes, especially as evidenced by the use of snake venom. It is well known that\noxalic acid in the test tube prevents coagulation. Steinberg and Brown8 have isolated\nthis substance in pure form from Shepherd purse, citrus fruits, rhubarb, etc. This\nis a powerfully coagulant substance which has been used for promoting blood\ncoagulation under the trade name of Koagamin. Here is an instance where the doctrine\nof similes works in an unexpected way. Koagamin has been biologically assayed and a unit\nrepresents the amount which will reduce the coagulation time of a five-pound rabbit\n50% in 15 minutes. Following along the doctrine of similes, the Chinese use ground\ntiger bones to make them strong. Highly cellular structures such as liver rarely bleed\nwhen crushed, as the liberation of tissue extracts promotes rapidly developing coagulation; and yet from this same liver, extracts of which promote coagulation, heparin,\nwhose action is purely anti-coagulant, has been developed. Again, the headache following\nthe libations of the night before is quite a familiar topic, and I believe is best remedied\nby, as Oliver Wendell Holmes has expressed it, \"a little bit of the hair of the dog that\nbit you.\" And now we find such a powerful blood and capillary disintegrator as snakes'\nvenom made, by dilution, to subserve a curative function in the very conditions which\nthey themselves create. I wish to report 22 cases of arrest of hemorrhage from topical\napplications of either Russell's viper or Fer-de-Lance. I strongly recommend that oozing\ntypes of hemorrhages, difficult to control in patients with or without blood dyscrasias,\nbe treated with one or other of these two highly potent preparations.\nRUSSELL'S VIPER CASES\u00E2\u0080\u009414\nNature No. Result Immediate No Result\nDental haemorrhage 9 8 1\nTonsillar fossa 3 3 0\nCarcinoma of bladder ; 110\nCircumcision:\u00E2\u0080\u0094hemophilic 1 3 mins. 0\n93%\nFER-DE-LANCE\u00E2\u0080\u009422 Result\nNature No. Immediate Slow Negative\nDental haemorrhage 10 8 2\nTonsillar haemorrhage 2 11\nPost-transurethral 2 2\nCarcinoma of bladder 2 2\nRectal polypus ___ 1 1\nPost op. gastric 1 (90%) 1\nPurpura/transfusion cuts j 2 2 1\nPancreatic oozing = 2 2\nIn my college days my old Professor of Medicine used to say the three chief needs of\nmedicine today are: an accurate method of measuring the severity of pain, a purgative\nwhich is safe and active hypodermically, and a drug which will safely relieve pain without narcosis or addictions. As far as I am aware these needs remain unfulfilled. Dr.\nDavid Macht, Director of Research Dept., Hynson Westcott and Dunning of Baltimore,\nin 1935 presented to the profession of this country: Cobra venom as an analgesic for the\nrelief of pain. The late Dr. Joseph Coll Bloodgood of Johns Hopkins, whose work in\ncancer research is gratefully remembered by all of us, was an interested co-worker in the\noriginal series of published cases involving its use. Macht reported 200 cases in which\n70% showed definite relief from pain.\nIt so happens that the venom of the cobra is particularly rich in neurotoxin, which\nfraction is the desirable element in the relief of pain; years of painstaking work on the\npart of Macht has resulted in a product which is comparatively pure neurotoxin, and\nfrom which all the other constituents of a toxic nature have been removed. It has been\nsterilized, most of the protein content has been removed, so that what is now marketed\nis almost pure cobra neurotoxin. The preparation of Cobra venom has a rather interesting history. Originally the snakes were imported, milked in this country, and the product\nPage 248 '-..\u00C2\u00BB\u00E2\u0096\u00A0\nSi!\nMM\ntm\n*:\n\u00E2\u0080\u00A2!!..\n1!K\nw\nused in a liquid state. This became highly unsatisfactory, as not only the snakes died,\nbut the nature of the venom actually changed, and came more nearly to approximate\nthe venom of native venomous reptiles with a marked reduction in the neurotoxin content. At the present time the venom is now imported direct from India in bottles of\ndried crystals. In considering the extreme toxicity of cobra venom, one is reminded of\nthe couplet from Omar Khayyam: \"One wonders what the Vintner buys, one half so\nprecious as the goods he sells\": one wonders what the serpent eats, one fraction as potent\nas the venom he produces.\nWhen we consider the progress of Medicine in the March of Time, the treatment of\npain seems to have been one of the laggards of the profession; apart from certain highly\nspecialized neurological procedures, the relief of pain by the general practitioner remains\nas twenty years ago, largely a matter of adequate morphine. While we must remain\ngrateful for morphine, it possesses many disadvantages. Morphine and its derivatives\nhave a rapid action, developing their activity within a few minutes, its action is central\nand unfortunately a double one, acting both cortically and on the hypothalamic area,\nhence it becomes at once both hypnotic and analgesic: the effect of analgesia is purchased only at the cost of hypnosis. The effect even when supported by catalytic substances is transient and vanishes in a few hours at most. Continued use requires constantly increasing dosages until addiction becomes an established fact, and most of us,\nfaced with the question of exhausting pain on the one hand, and morphine addiction on\nthe other, unhesitatingly accept the latter, and order that the pain of chronic cancer be\nassuaged even at the cost of addiction. Unfortunately intelligence is undermined and all\nfunctions depressed, the sense of smell, hearing, taste and vision are all depressed, appetite\nis destroyed, nourishment becomes a problem, constipation is an increasingly formidable\nfactor; until at length the patient is reduced to the status of an animated vegetable living\nfrom one hypo to the next.\nIn presenting Cobra neurotoxin as one of the newer therapeutic agents for the relief\nof pain, I do not at all acclaim it at the present time as a panacea. But the prime purpose of any new drug must be that it shall at least do no harm, and that during the\nstages of its development a substantial percentage of good results is all that surely can\nbe asked.\nWho actually did the initial work on Cobra venom I do not know, but in the Pasteur\nInstitute in Paris, Calmette9 and his co-workers are among the earliest with which I am\nfamiliar, this in 1933. Undoubtedly, however, the pioneer in this country has been\nMacht of Baltimore10, whose publications have now become quite numerous. Almost all\nof my information in this regard has been received direct from Dr. Macht, a fact I here\ngratefully acknowledge.\nThe effect of Cobra venom pharmacologically is a central one, its action being a\npurely hypothalamic one. It does not cause any local analgesic action, nor does it relieve\npain through any local anesthetic action. It does not paralyse nerve endings in either\nmucus membrane or skin, and it does not block impulses in either ascending or descending fibres. It does not depress special senses of hearing, smell, vision, taste; in fact, all of\nthese, are stimulated and visual fields as measured by perimeter tests are found to be\nincreased. Cobra venom has a distinctly stimulating effect on mental performance, and\nthis stimulation effect is actual and not a matter of relativity.\nThe action of cobra venom requires a building up period of several days. Its action\nis slow to develop, but once developed, persists over a period of days or weeks, instead of\nhours as in other analgesics. There is not the slightest suggestion of addiction, and the\nrelief from pain is accomplished without the benumbing of intelligence; the appetite and\nmetabolism are improved, weight is usually gained in consequence. Cobra Venom does\nnot affect pregnancy, gestation or labour, or the well-being of the offspring of a mother\nunder its influence. Red cell and hemoglobin estimations remain unchanged even after\nmonths of ^administration. There is occasionally a mild leucocytosis. Blood sugar,\nblood N.P.N, are unaffected, cerebro-spinal fluid, and electrocardiograms have remained\nnormal, urine has been unaffected. In many instances, however, there has been a material\nPage 249 4*'1\ndegeneration of the patient from the inexorable advance of the disease from which they\nsuffered, and for which the venom had been given.\nThe use of cobra venom, in which I am interested largely for its relief of pain in carcinoma cases, has gradually spread into other realms of medicine. Macht11 reports its\nuse in tabes, Cancer of the skin, X-ray burns, herpes zoster, post herpetic neuralgias. Its\nanticonvulsant properties have been reported upon by Gaugh and Williams12 in connection with paralysis agitans. Lowell Thomas13 of New York reports complete relief\nin his own case' of migraine. These are substantiated by marked improvement by other\nwriters. Parsonette and Bernheim14 report its successful use in stenocardia and angina.\nChopra and Chowan15 report 70% of relief in a great variety of cases, while its use in\nneuritis, arthritis, tic douloureux, Berger's disease, fibromyositis, tabes, and the neurological manifestations of leprosy, is building an extensive literature. Recently its use in the\ntreatment of epileptiform seizures has been reported by the French-Canadians Barbeau\nand Laurendeau16.\nA word about the margin 'of safety in the use of Cobra venom. In morphine we\nwork on about a 1:8 ratio\u00E2\u0080\u0094if a quarter of a grain is an average dose, and two grains an\naverage lethal dose. - In Cobra venom the lethal dose is about 15 mgm.; there is 1/20\nmgm. in 10 mouse units, so that the margin of safety is roughly 1:300. This wide margin\nof safety has in recent months caused toe to alter my dosages radically, and I now usually\ngive 10 mouse units the first day, 20 the second,30 the third, 20 the fourth, 10 the fifth,\nand 10 every seend day thereafter of the Hynson Westcott and Dunning preparation.\nI have found this new product entirely unpredictable. In my experience it either works\nmagically or it simply does not act at all. Originally I believed that the apparently\ncompletely inert character of certain phials of venom was due to a labile product which\nhad Suffered deterioration; now, however, I have so many instances in which one set of\nphials was inert in one case, and perfectly active in others, that I believe we must look\nmore deeply for the explanation of this rather baffling phenomenon. In one instance a\nman with stenocardia has been taking 5 mouse units every second day for eight months\nwith complete relief, then a box arrived which was inert. His sister, with a carcinoma\ninvolving the spine, had had complete relief for three months, and at the same time\nreceived a supply which seemed to be completely inert. At her suggestion they traded\nboxes of ampoules with excellent relief in both instances. In about 60% of my cases,\nbriefly, nothing happened, and were it not for the fact that in the great majority of the\nremainder almost complete relief was obtained, I am afraid I should have lost interest.\nI wish to report 78 cases who during the past two years have had Cobra venom for\nthe relief of pain.\nCOBRA VENOM\nCases Good Results No Result\nCarcinoma in general 60 26 34\nCardiac pain 4 2 2\nTic douloureux 7 2 5\nPost-herpetic neuralgia 1 1\nArthritis 2 11\nMigraine :\u00E2\u0080\u0094 1 1\nDysmenorrhcea .\u00E2\u0080\u0094. 2 2\nBuergers \u00E2\u0080\u0094-\u00E2\u0080\u0094 \u00E2\u0096\u00A0 1 1\nUntoward Effects\n1\nTotals : 78 15 43 2\nI wish to present these successful cases in more detail in order to show that even if\n60% have not been successful, that three such as these well justifies a continuation of\nthe experiment. First a woman, 58, cancer of the breast, 19 months' history, with\nmetastases in her spine and skull, is coming now to her death in St. Paul's Hospital, and\nhas never had a fraction of a grain of morphine or any of its derivatives at any time.\nHypnotics have been routine at night. Second a woman, carcinoma of the stomach,\neleven months history, died without ever having had a dose of morphine. Third a man,\ncarcinoma of stomach, extensive visceral metastases, taking two grains of morphia by\nhypo every three hours with 3 grains of nembutal hs., and grs. 1/16 of Dilaudid,\nPage 250\n..:\u00E2\u0096\u00A0.. r\nJi-\n&m\n*4\nE? >j Vi\n\u00E2\u0096\u00A0\nIt was explained to this man that morphia was not being denied him, but that we wished\nto test a new drug. He co-operated, asked for morphine only when he really required it.\nOn the fifth day he cut his morphia 50%, on the eleventh day he discontinued it, and\non the seventeenth day he died without having had any for six days, and with\ngreat improvement in his general outlook, and he was almost entirely freed from the\ndepression which a knowledge of his hopelessness up till then had seemed to engender. It\nwas a voluntary requital.\nIn conclusion I ask you once again to look at this slide outlining the constituents of\nsnake venom. Why are we so interested at this time? Today as never before the hema-\ntologist is invading the surgical field to our great advantage, the work of Selyea has made\nthe surgeon conscious of hypoproteinemias, hematocrit observations, and the rational\nuses of plasma serum and whole blood. Heparin has swept across the horizon the past\nfew years: costly, expensive, dangerous and cumbersome. Who can say that in that list\nof hemotoxins in snakes' venom will not be isolated a hemorrhagin or hemolysin fraction which will provide the answer for which heparin at present gropes? The work of\nSteinberg and Brown has presented an entirely new conception regarding the mechanism\nin the treatment and control of hemorrhage in the discovery of the oxalic acid fraction\nof Shepherds purse; who knows but among the powerful coagulants, cytotoxins and\nagglutinins of snakes' venom, some tie-up with oxalic acid may not revolutionize the\ntreatment of hemorrhage?\nI believe that snake venom therapy is more interesting than factual, more hopeful\nperhaps than actual, but I believe that in such a potent preparation there must lie a\npowerful factor for good; a factor which it is not for me to isolate\u00E2\u0080\u0094this is a problem\nfor the synthetic chemist; and when the separate fractions of snake venom are before\nus, each synthesized to their own purpose and supplied to us, potent, sterile and dependable, then I think will have arrived one of the things to which I look forward in Medicine.\nBIBLIOGRAPHY\n1. Thom, D. A.: Present status of Crotalin in Treatment of Epilepsy. Boston Med & Surg. J., 171:933,\n1914.\n2. Peck and Tosenthal: Mt. Sinai Hosp., N.Y. J.A.M.A., 1935, vol. 104, p. 1066.\n3. \"Wat-ins, C H.: Proceedings of Staff Meeting of Mayo Clinic, 1936, 261, vol ii, No. 17.\n4. Burgett Barnet\u00E2\u0080\u0094Proceedings of Royal Soc. of Med., 1935, vol. XXVIII, No. 11.\n5. Baker and Gibson: Lancet, vol. 1, 1936.\n7. Besson, John H., Portland, Ore., personal communication.\n8. Steinberg and Brown: Amer. Jour, of Physiology, 1939, p. 638.\n6. Cambrook, I. Dieper: Proc. of Royal Soc. of Med., 193 6, vol. XXLX, No. 3.\n9. Calmette, A.: Treatment des Algies et des tuneurs par le venim de Cobra. Bull. Acad, de Med.,\nParis, 109:373:1933.\n10. Macht, David I.: Therapeutic uses of snake venom. Medical Record, Dec, 1936, etc.\n11. Macht, David I.: Cobra venom in Dermatology and Syphilology. Urological and Cutaneous Review,\nFeb., 1940.\n12. Gogh and Williams: Southern Med Journal, 1938.\n13. Thomas Lowell: Migraine. Medical Record, 1940.\n14. Parsonette and Berheim: Stenocardia and Angina. American Journal of Medical Sciences, Nov., 1940.\n15. Chapra and Chowan: India Medical Gazette, 1940.\n16. Barbeau and Laurendeau: Union Med. du Canada, 68:363, 1939. 2. Journal de l'Hotel Dieu de\nMontreal, 9:114, 1940.\nPage 251 LAURENCE-MOON-BIEDL SYNDROME\nBy J. H. B. Grant, M.D., and J. A. Smith, M.D.\nIn 1866 two English ophthalmologists, Laurence and Moon, described four cases in\nwhich were present some or all of the following syndrome: obesity, hypogenitalism,\nmental deficiency, polydactylism and pigmentary disturbance of the retina (Retinitis\npigmentosa). Although they intimated that this peculiar combination of clinical signs\nmight be more than coincidence, the fact was not fully appreciated until comparatively\nrecent times that its various components make up a unit syndrome and that its familial\ncharacter is of fundamental importance.\nBiedl, in Germany, in 1922, placed appropriate emphasis on the significance of these\nfactors and his name has come to share with the original authors the title by which this\ncondition is now commonly known.\nThe first case was reported in America in 1925.\nUp to 1937, only twenty-four instances of the complete syndrome were found\nreported in an exhaustive survey of medical literature undertaken by Mitchell and coworkers at the University of Cincinnati, although they found one hundred and two cases\nreported under im\nm\n\u00C2\u00BB>!\nit had been unavailing. Examination of the hip-joint and spine revealed nothing. His prostate was moderately enlarged and moderately tender. After massaging the gland, the shortness of that right leg disappeared instantly and he walked without a limp. But unfortunately both signs came back in a day or\ntwo. However, this showed us that we were on the right track and we kept the treatment up for a few\nweeks. The signs, however, kept on returning. So in addition to the massages, I had him put on all the\nheat he could bear on the lower pelvis and the hip-joint, and this cleared up the condition. This was\nabout four years ago. He is still .working around here, but the condition has not returned.\n4. Married man, age 32, farmer, complained of pain at the tip of his penis. Examination locally was\nnegative. A few prostatic massages cleared up the condition. That was about three years ago, and it has\nnot returned.\n5. Married man, about 40, electrician, had recurrent attacks of numbness about the buttocks. A\nfew massages cleared them up but they keep coming back every 8-10 months.\n6. Married man, age about 50, farmer, had no \"pep,\" no ambition, no strength. He did not care\n\"whether school kept\" or not. If he forced himself to work he was tired in a very short time. No pain\nanywhere. Heart was good, blood pressure within normal limits, urine negative. A few massages restored\nhis vigour. This was last summer, and I have not heard from him since.\n7. Married man, age 35, farmer, was almost dead from the hips down. When he tried to work his\nlegs and hips got so tired he could hardly move them. When he walked with other people they all walked\ntoo fast for him. He used to live in the interior of B. C. and went from place to place for help. Then\nhe moved into this valley hoping a change of climate might be of benefit. He had all his teeth out on the\nadvice of a doctor. He was minus his teeth and minus a lot of money but still plus his wooden legs.\nImprovement set in after the first massage, and he recovered completely in about a month. That was last\nJanuary. He is working now.\nThis variety of cases should be sufficient to illustrate the complexity of conditions\nthat yield to prostatic massage and have no apparent relation to that gland. It is beyond\nmy ability to give any pathological reason or even hazard a substantial guess, but the\nresults spek for themselves.\nDiagnosis of these conditions is mostly a hit-or-miss affair. Sometimes it is arrived\nat by the process of elimination, sometimes diagnostic therapeutics, i.e., give a few treatments (they will never do anybody any harm), and if the condition the patient complains of shows signs of improvement, the prostate is considered the causative factor of\nthat condition. If there is any pain present anywhere, as in the case mentioned above,\npain at the tip of the penis, or pain in the midsacral region, this pain is greatly intensified\nduring the process of massaging. If this intensification of pain occurs, it can be assumed\nwith a high degree of certainty that the pain is caused by the prostate. In the case of\nthe patient with the \"wooden legs\", he assured me definitely, after the first treatment,\nthat he could feel that that was where his trouble came from. In the case of the patient\nwho felt \"pepless\" all over, wtihout any symptoms of pain, discomfort or urinary interference, massage was performed just as a shot in the dark with gratifying results. I\nhave had men come in without any definite complaints or symptoms but all hunched up\nlike \"old mother Hubbard\", and walk out as erect as a major, after one massage.\nAnatomically, the prostate gland surrounds the confluence of the urinary tract and\nthe genital tract, but physiologically and histologically belongs only to the genital system. The glandular tissue occupies comparatively small areas in each of the three lobes.\nFunctionally, the only work this gland is called upon to do is to secrete a fluid which is\npoured into the urethra at the time of the ejaculation of the semen and imparts motility\nto the spermatozoa. It also contains such a large number of lymphatics that the gland\nhas been termed a lymphatic sponge. Whether the gland secretes any endocrine substance\nis not known, but the possibility is there.\nIs it possible that the conditions enumerated above, and similar ones, could be brought\nabout by a congestion in the gland of the glandular secretion or of the lymph stream or\nboth? The fact that massage relieves the conditions seems to indicate that there is some\nsort of congestion present, rather than an inflammation. Furthermore, the fact that this\ngland belongs to the genital system causes one to wonder whether that is the reason why\na slight disorder in that gland affects the entire body, as it does in some cases. However,\nthese are only speculations and have to be investigated.\nThe prostate gland appears to be the poor neglected orphan in our art of healing, in\nspite of the fact that it belongs to two entirely different systems, the urinary and the\ngenital, with the possibility of its secreting a hormone of some sort, which influences\nthe entire body. In many cases it will be a well repaid effort on the part of the physician\nPage 255 to examine that gland closely, even in the absence of any signs or symptoms pertaining\nto that gland.\nMassaging the prostate is quite an art in itself. Frequently, digital massage through\nthe rectum is performed by having the man lie on the side and moving the straight index\nfinger to and fro. With the patient in that position, it is very awkward for the masseur\nto get at the gland properly and exert the required, graduated pressure. Furthermore,\nwith the inserted index finger in a straight position it is impossible to put the pressure\non the places desired. I find it much more satisfactory to have the patient stand up,\nwith the feet slightly apart, knees straight, bent over with the elbows resting on the\ntable or the hands on a chair for support. I take my position on the left side of the\npatient with my hip against his hip. After spreading the buttocks apart with the fingers\nof my left hand, to facilitate the insertion of the gloved and lubricated right index\nfinger into the rectum, I put my left hand over the patient's right hip, so as to steady\nhim.\nThis procedure is followed by an examination of the gland. Its size is determined by\ngently moving the finger, first over and around one lateral lobe and then the other. The\nsize of the isthmus is also nted. The size of the lateral lobes is compared. Quite frequently\none is found to be considerably larger than the other, or one is much more tender than\nthe other. The contour, consistency and tenderness of all the lobes is also carefully noted.\nIn massagin, a radial movement is employed from the periphery of the lateral lobes\ntoward the isthmus, with a slightly flexed finger, so that only the tip of the finger is in\nclose contact with the tissues. Very often one or the other or both of the lateral lobes\nare found to be very tender, even if there is little enlargement. Massage, therefore,\nshould be done very gently the first tiro. As the treatment progresses the tenderness\nbecomes less, and more pressure may be used in subsequent treatments. Two treatments\na week is usually sufficient, because there is always danger of causing undue irritation\nand hence doing more harm than good.\nIn addition to these massages, astringent rectal suppositories are prescribed occasionally, directing the patient to insert on once or twice daily.\nCANCER SECTION\nWHEN AND HOW TO BIOPSY A TUMOUR OF THE BREAST\nThere have been many learned articles written on the early diagnosis of cancer of the\nbreast and most of these articles emphasize the late clinical signs of fixity of the tumour\nto deep structures of the breast, dimpling and fixation of the skin over the growth and\npalpable glands in the axilla. However, these are now considered to be relatively late\nsigns and as such are unwelcome.\nWhat, then, are the signs of early cancer of the breast? If one wants to get down to\nbasic facts without much ado, the answer comes promptly\u00E2\u0080\u0094there is no accurate clinical\nmethod of diagnosing cancer of the breast early. The only way to be certain is to remove\nall hard lumps of the male or female breasts for biopsy. When one of those lumps is\nmalignant, then the life of that patient is saved. If it is benign, little harm is done. In\none eastern centre, a statement was made recently that two-thirds of the cancers of the\nbreast coming to operation were diagnosed by biopsy and biopsy alone in recent years,\nwhereas previously only one-third had been diagnosed by microscopic study. This is a\nsignificant trend and should have its effect on the mortality rate of carcinoma of the\nbreast.\nHow and when to take a biopsy of the breast is another problem. The ideal set-up,\nof course, is an operating room with a pathologist in attendance, where, immediately\nafter the removal of the tumour, the pathologist examines the tissue and pronounces on\nits malignancy or benignity. Unfortunately, a pathologist is not always available and\nthe patient may not have sufficient funds to enable her to travel to a centre where the\nspecimen-can be taken in that manner.\nThe next best method, although definitely the second best method, is the wide\nexcision of the tumour en masse. The removed specimen should be placed in a solution\nPage 256\nw\nA \u00C2\u00BB\u00E2\u0080\u00A2>.\n!4 6 4\nof five per cent formahn and sent to the nearest pathologist with a specific history as\nto the name of the patient, age, sex, duration and site of the tumour. If the tumour is\nremoved completely, and in one piece, there is less danger of spreading the malignancy\ninto the surrounding tissues and stimulating its growth, than if a wedge-shaped piece is\nexcised from the tumour mass itself. This method should be used with caution and\npreferably only in those cases where the tumour is small and lends itself readily to complete excision. This type of biopsy is better than no biopsy at all. Following immediately\non a positive report, a radical amputation with thorough dissection of the glands of the\nglands and stripping of the vessels should be promptly undertaken.\nii -.\n'\nI\n'\nI, !,\nNmttt Sc \u00C2\u00A9ffmnsfltt\nt\n2559 Cambie Street\nIS THERE M\u00C2\u00BB\niRTHRmS-EKElj\nSflftRO'*-?*\nBoth are claimed to be 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 \u00E2\u0080\u0094 a potent\neliminator of endogenous toxic\nwaste.\nSince the best evidence is clinical\nevidence, write for literature and\nsample.\nL-16\nCanadian Distributors\nROUGIER FRERES\n350 Le Moyne Street, Montreal\nanc ouver\n, B. C\nColonic\nIrrigation\nCentre\nUp-to-date scientific treatments\nCOLONIC IRRIGATIONS, SHORT\nWAVE DIATHERMY, COLD QUARTZ\nULTRA VIOLET RAY, STEAM\nSWEATS, SHOWER AND\nMASSAGE.\nGraduate Nurses Only in Attendance\nSuperintendent\nE. M. LEONARD, R.N.\nPost Graduate Mayo Bros.\n1119 Vancouver Block\nVANCOUVER, B. C.\nMArine 3723\n314 Scollard Building\nVictoria, B. C.\nPage 257\n::!"@en . "Periodicals"@en . "W1 .VA625"@en . "W1_VA625_1942_05"@en . "10.14288/1.0214380"@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: May, 1942"@en . "Text"@en . ""@en .