"CONTENTdm"@en . "http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1179642"@en . "History of Nursing in Pacific Canada"@en . "Vancouver Medical Association"@en . "1925-08"@en . "2015-03-26"@en . "1925-08"@en . "'Convention number.' -- Title page"@en . ""@en . "https://open.library.ubc.ca/collections/vma/items/1.0214566/source.json"@en . "image/jpeg"@en . " )K(\n11 m\nTHE VANCOUVER MEDICAL\nASSOCIATION\nBULLETIN\nPublished monthly at Vancouver, B. C.\n(Convention U\[umber\nCX\nex\nex\nex\nex\nex\nex\nex\nex\nAUGUST, 1925\n\u00C2\u00A785\nH\n'Published by\n(fffid^eath Spedding Limited, ^Vancouver, CB. Q.\n>xc PHONE SEYMOUR 2487\nMcBeath Spedding Ltd*\nVancouver, B. C.\nPRESCRIPTIONS\nfilled exactly as written\nPhones: Seymour 1050 -1051\nDay and Night Service\nQeorgia Pharmacy Ltd.\nQeorgia and Qranville Sts.\nVancouver, B. C.\nPage Two THE VANCOUVER MEDICAL ASSOCIATION\nBULLETIN\nPublished Monthly under the Auspices of the Vancouver Medical Association\nin the Interests of the Medical Profession.\nOffices:\n529-30-31 Birks Building, 718 Granville St., Vancouver, B. C.\nEditorial Board:\nDr. J. M. Pearson\nDr. J. H. MacDermot Dr. Stanley Paulin\nAll communications to be addressed to the Editor at the above address.\nVOL. I.\nAUG. 1st, 1925\nNo. 11\nOFFICERS, 1925 -26\nPresident\nDr. J. A. Gillespie\nSecretary\nDr. g. H. Clement\nPast President\nDr. H. H. Milburn\nTRUSTEES\nDr. w. F. Coy Dr. W. b. Burnett\nRepresentative to B. C. Medical Association\nDr. A. J. MacLachlan\nVice-President\nDr. a. W. Hunter\nTreasurer\nDr. A. B. Schinbein\nDr. J. M. Pearson\nAuditor\nDr. A. C. Frost\nSECTIONS\nClinical Section\nDR. W. L. Pedlow\t\nDr. f. N. Robertson ......\nPhysiological and Pathological Section\nDr. g. F. Strong -\nDr. C. H. Bastin\t\nEye, Ear, Nose and Throat Section\nDr. Colin Graham\t\nDr. E. H. Saunders\t\nCenito-Urinary Section\nDr. g. S. Gordon\t\nDr. J. A. E. Campbell\t\nCOMMITTEES\nChairman\nSecretary\nChairman\nSecretary\nChairman\nSecretary\nChairman\nSecretary\nLibrary Committee\nDr.\nDr.\nDr.\nDr.\nWallace Wilson\nA. W. Bagnall\nW. D. Keith\nW. F. McKay\nOrchestra Committee\nDr.\nDr.\nDr.\nDr.\nF. N. Robertson\nJ. A. Smith\nL. Macmillan\nA. M. Warner\nDinner Committee\nDr.\nDr.\nDr.\nN. E. MacDougall\nA. w. Hunter\nF. N. Robertson\nCredit Bureau Committee\nDr. Lachlan Macmillan\nDr. J. W. Welch\nDr. G. A. Lamont\nCredentials Committee\nDr. Lyall Hodgins\nDr. R. Crosby\nDr. J. A. Sutherland\nSummer School Committee\nDr. Alison Cumming\nDr. Howard Spohn\nDr. G. S. Gordon\nDr. Murray Blair\nDr. W. D. Keith\nDr. G. F. Strong\nPage Three VANCOUVER MEDICAL ASSOCIATION.\nFounded 1898.- Incorporated 1906.\n28th Annual Session\nGENERAL MEETINGS will be held on the first Tuesday of the month\nat 8 p.m.\nCLINICAL MEETINGS will be held on the third Tuesday of the month\nat 8 p.m.\nPlace of meeting will appear on Agenda.\nGENERAL MEETINGS will conform to the following order:\n8 p.m.\u00E2\u0080\u0094Business as per Agenda.\n9 p.m.\u00E2\u0080\u0094Paper of Evening.\nThe regular work of this Session will commence on Tuesday, Oct. 6, 1925.\nProgrammes to be announced later.\nHEALTH DEPARTMENT STATISTICS.\nJUNE, 1925.\nTotal Population (estimated) .\nAsiatic Population (estimated)\nTotal Deaths 106\nAsiatic Deaths 18\nDeaths\u00E2\u0080\u0094Residents only 86\nTotal Births\u00E2\u0080\u0094Male, 143\nFemale, 133 276\nStillbirths\u00E2\u0080\u0094not included in above 10\nInfantile Mortality\u00E2\u0080\u0094\nDeaths under 1 year of age 11\nDeath rate per 1000 births 39.9\n 126,747\n9,960\nRate per 1000 of\nPop. per Annum\n10.2\n22.0\n8.3\n26.5\nCases of Contagious Diseases Reported.\nJuly\nJune. to \5th.\nCases. Deaths. Cases. Deaths.\nMay.\nCases. Deaths.\nSmallpox 10 0\nScarlet Fever 49 0\nDiphtheria 9 0\nChicken-pox 42 0\nMeasles 0 0\nMumps 21 0\nErysipelas 4 0\nTuberculosis 34 11\nWhooping Cough |_ 25 0\nTyphoid Fever I . 10\n10\n24\n11\n12\n3\n21\n1\n2\n28\n3\n0\n0\n1\n0\n0\n0\n0\n8\n1\n0\n(Cases from outside City included in above.)\nDiphtheria |__: 10 3 1\nSmallpox 10 0 0\nScarlet Fever 7 0 3 0\n3\n0\n5\n0\n4\n0\n5\n0\n0\n0\n0\n0\n4\n1\n3\n0\n14\n1\n1\n0\n)\n3\n0\n0\n0\n0\n0\nPage Four r~\n-fs\u00C2\u00A9l=\n:i<3sf-\n\"Habit Time\"\nPETROLAGAR is\nissued as follows:\nPETRO L AG AR\n(Plain), PETROLAGAR (withPhen-\nolphthalein), PETROLAGAR (Alkaline), and PETROLAGAR (unsweetened, no sugar).\nIt has been accepted for New and\nNon-official Remedies by the Council on Pharmacy\nand Chemistry of\nthe American Medical Association.\nCreating the habit of a regular bowel\nmovement is undoubtedly the most important\nfactor in the treatment of constipation.\nPETROLAGAR affords a method of establishing the normal function. In this emulsi-\nfication of 65 per cent, mineral oil with agar-\nagar, the action is entirely mechanical; the\ndosage can be gradually diminished and\neventually discontinued.\nIn the bowel, the oil of PETROLAGAR is\nminutely diffused through the fecal mass, giving perfect lubrication and diminishing the\npossibility of leakage.\nPETROLAGAR does not contain any fermentative gums. It is a mechanical emulsion\nwhich has a purely mechanical action on the\nbowel.\nIt does not establish the \"cathartic habit,\"\nbut replaces the habit-forming and irritating\ncathartics.\nSend coupon for interesting treatise on the\nphysiology of the bowel, entitled \"Habit\nTime.\" You may have a copy free, without\nobligation.\nDeshell Laboratories of Canada Ltd.\nDEPT. V.\n245 CARLAW AVE., TORONTO\nLondon, Eng. Los Angeles Chicago Brooklyn\nPetrolagar\nDESHELL LABORATORIES, INC.\nDept. V.\nGentlemen:\nKindly send me, without obligation, a copy\nof the treatise, \"Habit\nTime.\"\nDr\t\nAddress \t\n<=/\u00C2\u00A9(?\n?o\u00C2\u00AE*>\nPage Five EDITOR'S PAGE.\nWe are frequently reminded by those who regretfully regard\nthe past, that the golden age of clinical acumen is slipping away.\nNo longer, we are told, does the modern medical man cultivate\nproperly his powers of observation at the bedside or appreciate\nfully the advantages of the tactus eruditus in the pursuit of diagnoses. On the contrary he neglects these things, rushing after the\nso-called instruments of precision and laboratory methods, with\nthe consequence that the ways by which the fathers of the craft\nenriched the book of knowledge are falling into undeserved disue-\ntude.\nIt may be so. In this world of mutations the old order of\nthings constantly changeth, if it does not pass away. Men have\nused the natural means at their command, but these were used not\non account of their superiority but because they were the only\nones at hand. With the advent of experimental methods and especially with the development in other arts and sciences which\nmay be laid under tribute by the medical profession, quicker and\nmore generally accurate means of diagnosis are now often available. It is true that with this alteration something of romance is\npassing away and more rarely now has the experienced observer\nor bold guesser such opportunities of exercising his powers of\ndivination. What, we may ask, has the world lost by the discovery and perfecting of the Widal reaction as a detector of typhoid infection, or of the Wassermann reaction of the presence of\nsyphilis? Or by the incursion of the radiographer to many dark\nregions of the human form? We confess ourselves wholly on the\nside of the \"instruments of precision\" party. If the X-ray can\ndetect early tuberculosis of the lung for the multitudes when that\nopportunity was formerly the province of the few naturally gifted or as the result of long and arduous apprenticeship, the advantage is surely greater than the loss.\nNor is it any answer to point to the practitioner in remoter\ndistricts and ask where are his X-ray plants and laboratories.\nThese things will follow and are following him. It does not\nneed a prophet to foresee the time when in some centre these will\nbe available to everyone.\nHowever, the use of these instruments of precision may work\nboth ways, and one use of familiarity with their workings in certain instances is the increased ability to recognize by natural or\nclinical methods the very manifestations of disease which these\ninstruments have unmasked. This is notably the case in the use\nof the electro-cardiograph, familiarity with which in time enables\nthe cardiologist to recognize conditions which this instrument has\nin the first instance revealed. Likewise by the frequent use of the\nbasal metabolism recorder many men have acquired facility in\ndetecting at all events the grosser departures from the normal\nstandard without resort to its use. But to the infrequent student\nof these conditions these instruments remain invaluable, and he\nmay and will resort to their use with increasing confidence.\nPage Six We have passed through the period when the experienced\nclinician claimed to have estimated a patient's temperature by\nmeans of a hand on the forehead. Or later to estimate blood pressure by a finger upon the pulse. The clinical thermometer and\nthe blood pressure machine have passed into daily and habitual\nuse, nobody now regretting their advent. In like manner we may\nhope to see the increasing perfection of a large number of similar\naids to diagnosis, each of which in its turn will ultimately take\nits place in halping the inerun-- development of our art.\nThe Life of Sir William Osier. By Dr. Harvy Cushing. In two\nvolumes. Oxford University Press. 1925. 37s. 6d.\nDr. Cushing has provided us with a fascinating book, every\npage of which is of interest. Osier touched life at many points\nand warmed both his hands with an enviable gusto. The development of this book has been internal rather than external, and\nDr. Cushing has said in his preface that \"Little pretence is made\nto do much more than let his story, so far as possible, tell itself\nthrough what he puts on paper.\" Fortunately for the world,\nOsier put a great deal on paper, most of it very well worth while,\nand most fortunately, almost from his early days, the recipients\nof many of his personal communications appear, with admirable\nand almost uncanny foresight, to have carefully filed these\naway for our present delectation. The work of connecting up\nand amplifying these written statements has been excellently done,\nand if we may say so, Dr. Cushing seems to have caught up some\nof Osier's whimsical spirit into his own work.\nVolume I. opens with the customary ancestral account which\nin this case is more than perfunctory in that Osier's forbears were\nof unusually vigorous and distinctive stock. His early teachers,\nwhose names are carried in the dedication of his text book in\nmedicine, receive careful and sympathetic handling. Tracing his\ncareer through youth and early manhood, it is not long before we\nfind Osier established at Montreal as Professor of Medicine at Mc-\nGill. In 1884 he is called to Philadelphia and his cosmopolitan\ncareer is fairly begun. Five years later we find him at the newly\nestablished medical school of Johns Hopkins. In 1904, Osier\nwas appointed Regius Professor of Medicine at the University of\nOxford, and here, after a lively account of the strenuous leave-\ntaking ceremonies on this side of the Atlantic, the first volume\nleaves him.\nSays the New York Evening Post at the close of its review:\n\"How does it happen that this man .... was able to do so much\nfor his day and generation? The answer is so simple it will scarcely be grasped by a rising generation of wise men From\nPage Kei'en. his beginning Willie Osier had to work and work hard for\neverything he got.\"\nTo which we say \"Amen,\" the mere reading of his strenuous activity leaving us somewhat breathless.\nThe second volume of Dr. Harvey Cushing's work carries\nus with the Osier family\u00E2\u0080\u0094father, mother and son Revere\u00E2\u0080\u0094-to\nOsier's third transplantation, that of Oxford. As Regius Professor of Medicine in that ancient seat of learning, he enters into\nthe medical life of the three Kingdoms.\nTo a far-off observer at that time one felt that Dr. Osier's\nremoval to Oxford seemed to mean a retirement from the actualities of medicine, that it would give him time for meditation, for\nassembling all his observations which he had stored away and\nwhich fugitive time had not permitted him to gather into a useful\nform. Also one felt sensitive as to whether in his new sphere,\nDr. Osier would have the opportunity of making a personal impress on medicine within the British Isles. However, Dr. Harvey\nCushing soon shows us that a change of location does not alter a\nman's character. Soon we find Dr. Osier leading a more active life\nthan ever. Clinics are instituted at the Radcliffe Infirmary for\ngraduates as well as undergraduates. He immediately took a live\ninterest in Oxford's remarkable library\u00E2\u0080\u0094Bodley\u00E2\u0080\u0094and he allowed\nhis hobby for collecting rare old medical works to have full play.\nFor Osier believed in and taught all his students to have a hobby.\nFor giving addresses to medical students on special occasions,\nOsier seemed to be ever on call. He threw all his energies into\ngetting anti-tuberculosis work in England and Ireland on a new\nfooting.\nHe also took a leading part in helping Sir J. W. G. Mac-\nalister to unite the medical profession of London and to bring\nto that great medical centre its proper position for postgraduate\nstudy.\nNew duties and new interests seemed to be thrust upon him\nalmost daily. Then the war came. Here our author shows what\na noble part Sir Wm. Osier played, in keeping the amenities of\nBritish, Canadian, and American medicine on a happy footing.\nThe migration to Oxford did not rob him of that great gift he\npossessed to a rare degree\u00E2\u0080\u0094the knack of getting in touch with\nyoung people; young children were his particular joy, and young\nstudents felt the friendliness of a kindred spirit, that met them\non terms of mental equality. None of these students left his contact with Osier without feeling that he also could make something tell for righteousness in his life's work.\nWe of the Vancouver Medical Association have a special interest in the second volume of Dr. Cushing's work, since portions\nof two letters written by Sir William to our Society are included.\nHis interest in our library and the practical encouragement he gave\nus by a donation of $100.00, will be cherished always.\nDr. Harvey Cushing has performed a great and loving task\nPage Eight in giving to the profession and to the world such an intimate\nretrospect of the life of his great friend, William Osier. The task\nhas been a huge one, for Osier's idle moments were rare, and to\ncrowd even into two volumes anything that would adequately\nrepresent the activities of Dr. Osier is a memorable feat.\nB. C. MEDICAL ASSOCIATION NEWS FOR \"BULLETINS\nThe Annual Meeting of the B. C. Medical Association was\nheld in the lecture room of the Wesley Church, Vancouver, on\nFriday, July 3rd, 1925.\nDr. Vrooman, president, in the chair. There was a good\nattendance, with a large number of out-of-town members.\nIt was decided, unanimously, that the honorary membership\nof the Association should be extended to Dr. G. L. Milne, of Victoria, in recognition of the fact that he has been in practice in the\nprovince for fifty years, and has performed eminent services to the\nmedical profession.\nThe auditor's report for last year was read and adopted.\nThe finances of the Association are in sound condition, and the\nreduction of the fee has been justified by results.\nThe report of the secretary-treasurer gave an account of the\nactivities of the Association during the past year. A gratifying\nincrease in paid-up membership over this date last year was reported. The work of the Association shows steady growth in\nbulk and importance, and the methods in which it serves the individual medical man as well as the profession at large, were described at some length by the secretary-treasurer.\nDiscussion of the report elicited some questions as to the\noperating expenses of the Association. This was taken up later\nby the executive, which appointed a small committee to investigate\nthe comparative costs of our Association and those in other provinces, and to report at an early date, as a first step to a complete\nenquiry into the subject. As an outcome of the discussion it was\ndecided that steps should be taken to hold a conference between\nthe B. C. Medical Association, the B. C Medical Council and the\nVancouver Medical Association, with a view to discovering methods of economy both in money and time, and increased efficiency\nof work.\nReports were read as follows:\u00E2\u0080\u0094\nLegislative Committee.\nIndustrial Service Committee.\nPublicity and Educational Committee.\nConstitution and Credentials Committee.\nEthics and Discipline Committee.\nHealth Insurance Committee.\nPage Nine A dinner was held at the Ambassador Cafe, in the evening,\nat which Sir Henry M. W. Gray, of McGill University; Dr. Hugh\nCabot, of Boston: and Dr. Carr, of Chicago, were the guests of\nhonour. Each of these gentlemen spoke after dinner, and a delightful evening was spent, until it was time to return to the\nSummer School meetings at the Wesley Church. At the close of\nthe dinner the officers for\" the coming year were elected as follows:\u00E2\u0080\u0094\nDr. W. B. Burnett, Vancouver, President-elect.\nDr. W. A. Clarke, New Westminster, Vice-President.\nDr. J. H. MacDermot, Vancouver, Secretary-Treasurer.\nDr. M. G. Archibald, Kamloops; Dr. F. W. Andrew, Sum-\nmerland; Dr. T. A. Briggs, Courtenay, Members at Large of\nExecutive Committee.\nThe following letter is self-explanatory:\u00E2\u0080\u0094\nThe British Columbia Medical Association.\n927 Vancouver Block,\nVancouver, B. C,\nJuly 10th, 1925.\nOpen Letter to the Past President of the Vancouver Medical Association.\nDr. H. H. Milburn,\n1190 Granville Street,\nVancouver, B. C.\nDear Dr. Milburn:\nIn the course of discussion at the recent Annual Meeting of the B. C.\nMedical Association, I made certain remarks, which I learn since, have been\ninterpreted by yourself and by others who were present, as a reflection on the\nwork of the Executive of the Vancouver Medical Association, of which you\nwere President last year.\nI wish to express my sincere regret to you for having made these remarks,\nwhich I can now see now were capable of this interpretation, though I assure\nyou that I did not mean to make any personal reflection on you, or any of the\nmembers of your Executive, who all worked hard and loyally for the good of\nthe Association, as shown by the year's record and the good work accomplished.\nI am sure that any suggestions that you made at any time were made for the\ngood of both Associations and of the profession as a whole.\nI would ask you to accept this as a retraction of anything I may have\nsaid of a disparaging nature.\nI remain,\nYours sincerely,\nW. B. Burnett.\nThe Thirteenth Annual Meeting of the Pacific Coast Oto\nOphthalmological Society was held in Vancouver, June 18th.\n19th and 20th, under the Presidency of Dr. H. M. Cunningham.\nThere was a large attendance and many excellent papers were presented.\nAfter welcoming the visitors, Dr. Cunningham touched briefly on the many unsolved problems in Eye, Ear, Nose and Throat\nPage Ten work, referring particularly to the etiology of glaucoma, trachoma\nand cataract. He reported a case of congenital atresia of the post\nnasal choanae with complete obstruction in which the sinuses were\nfully developed. He considered a case of this kind absolutely disproved the pneumatic pressure theory of development of the sinuses. Dr. Cunningham also dealt with recent advances in the\nstudy of cardiospasm, referring to the work of Plummer of the\nMayo Clinic, Jackson of Philadelphia, and Mosher of Boston. He\nmentioned some work he was doing on this subject in conjunction\nwith Dr. H. H. Mcintosh of the Vancouver General Hospital, on\nwhich he had hoped to make a preliminary report, but they had\ndecided it would be premature to do so at the present time.\nIt had been confidently anticipated that Dr. George Piness, in\nhis paper on \"Allergies of the Upper Respiratory Tract,\" would\ngive results of the work carried on by him during the past few\nyears, but Dr. Piness, beyond stating that they had cases relieved\nover a period of seven years, would not make any statement as to\nfinal results. He outlined the symptomatology and methods of\ndiagnosis of these conditions. Most'allergies of the upper respiratory tract gave a history of onset early in life. Every case of\neczema and allergic coryza in infancy and childhood must be considered a potential asthma. All asthmas must be classed as chronic\nexcept those due to the introduction of a foreign protein. Angioneurotic oedema is an allergic condition similar to the disease'produced in a patient who eats foods to which he knows he has an\nidiosyncrasy, but who does not react when tested against such\nfoods. Another type of oedema definitely allergic is that accompanied by an urticaria. Methods of diagnosis include a complete\nphysical examination\u00E2\u0080\u0094X-ray, blood, urine and sputum examinations\u00E2\u0080\u0094 and studies against proteins, also in certain cases personal surveys of the environment and botanic surveys. He advised the cutaneous method of testing. The interpretation of reactions is important. Reactions may occur that are not true, but\npseudo or skin reactions. The true reaction is the one with a\nwheal with pseudopodia and an erythema regardless of size. An\nanalysis of reactions is the final criterion for determination of\ntreatment. With regard to surgery in allergies of the upper respiratory tract, Dr. Piness said that out of a series of 854 cases not one\nhad been cured by operative measures. No man should promise\nan allergic individual relief by surgery. Obstructive interference\nshould be removed regardless of the allergy. He was firm in his\nbelief that Dr. Sluder's work on Meckel's ganglion was absolutely\nwrong, and he urged upon the members present to. be more conservative in their treatment of the allergic individual by surgical\nmeasures.\nDr. Gordon B. New, of the Mayo Clinic, gave three lantern\nslide demonstrations, the first dealing with advances in the treatment of congenital and acquired deformities of the face and neck,\nparticularly saddleback and luetic noses and rhinophyma. He advocated the use of full thickness skin grafts rather than Thiersch\ngrafts in the plastic repair of these cases, bringing the flap down\nPage Eleven i_f c\nfrom the forehead. In cleft palate and hare lip operations he recommended the two stage operation with the use of lead plates to\nprevent post operative flaring of the nasal alae. In his second\nlecture on \"Malignant Tumours of the Nose and Throat,\" Dr.\nNew drew special attention to nasopharyngeal tumours, the most\ncommonly overlooked of all growths of the head and neck; 25%\nto 30% of these cases have neurological symptoms only; forty\ncent, come primarily to the Internist, only a very small percentage\ncome primarily to the Laryngologist. The results of treatment\nare not good, as patients are seen so late in the disease. He discussed the relative merits of radium, diathermy and surgery in\ntreatment of these tumours. In his third lecture on \"Unusual\nLesions Seen First by the Laryngologist,\" Dr. New drew attention\nto cases of acute and chronic leukaemia which were easily mistaken\nfor malignant conditions, and in which very close co-operation is\nnecessary between pathologist and laryngologist. He referred to\nthe value of the differential blood count in diagnosis of these conditions. Other unusual lesions seen by the Laryngologist are\npemphigus, thrush and actinomycosis. In 107 cases of the last\nnamed condition examined at the clinic, only seven had been correctly diagnosed beforehand.\nDr. Harry Wurdemann, discussing Dr. H. G. Merrill's paper\non \"The Light Sense\" and its test by means of Percival's rotating\ndiscs, referred to it as one of the most important papers presented.\nAviation was making rapid strides in the industrial world, and it\nwould be their duty as ophthalmologists to decide what men could\nsafely fly. The test was simple, easily and quickly made, and\nshould be done as a routine test by all ophthalmologists.\nThe value of the blood count as an aid in early diagnosis and\ndeciding for or against operative interference, was emphasized by\nDr. L. Klemptner in his paper on \"Bezold's Mastoiditis.\" He\nagreed, however, that a leucocytosis was not certain evidence of\nacute mastoiditis, and the number of his cases was as yet too small\nto draw definite conclusions. The X-ray had proved a disappointment, as plates very often showed no visible bone destruction, yet\non operation very considerable destruction was found.\nDr. Colin Graham, of Vancouver, in the discussion on Dr.\nG. F. Chase's interesting paper on \"Thrombosis of the Sigmoid\nSinus and Blood Stream Infection,\" mentioned several cases in\nwhich he had used exsanguination transfusion with success. One\nof these was a double mastoid with a temperature of 106 per rectum at time of operation. He thought exsanguination transfusion\na valuable procedure in these cases, as it helped to wash out the\ninfection.\nDr. Edward Jackson, in describing the eye as \"the laboratory\nand clinic of the living body,\" said that from observations made\nin this laboratory were coming some of the great advances in modern medicine. The eye is peculiarly favourable for exact observation. It may be termed the bulletin board for diseases of the\nbrain and spinal cord. As the observer on the mountain top gives\nPage Twelve fire protection to thousands of miles of forest, .so the ophthalmologist, by interpreting the signals given by the eye, has command of a great territory of disease. The study of the living eye\nwith the ophthalmoscope has bridged the gap between the studies\nof the dead house and the laboratory. The ophthalmoscope has\ndoubled the clinical value of Harvey's great discovery, and training in its use by the general practitioner should, in the very near\nfuture, play as important a part in the observation of general disease as feeling the pulse did 70 years ago.\nDr. Martin D. Icove, speaking on \"Intra Orbital Anaesthesia\nin Ophthalmic Operations,\" said the reason so many men were\ndisappointed in its results was because they did not allow sufficient\ntime to elapse after induction before commencing to operate. They\nshould wait at least half an hour. Dr. A. S. Green said the dangers were practically nil. The method had been in use in Paris\nfor six years with no ill effects. He considered it the anaesthetic\nof choice in all cases where the eye had to be pulled upon or cut.\nDr. F. P. Hyde reported a case of ligation of the external\ncarotid with recovery in a case of simple uncomplicated epistaxis.\nHe thought this treatment should be included in the text books as\nan emergency operation of great value in severe idiopathic nasal\nhaemorrhage.\nDr. Ira E. Gaston's paper on \"Milk Injections in Ophthalmic\nDiseases\" led to a spirited discussion as to whether better reactions\nwere obtained by whole milk than by the use of preparations, such\nas aolin, kaseosan, etc., and whether any therapeutic results could\nbe attributed to the injections. Dr. Wurdemann thought if any\ngood was accomplished it was by the reaction of the system to\nthe bacterial products, and the general opinion appeared to be that\nthe more contaminated the milk the better the results obtained.\nDr. A. C. Jones said the fulminating character of the acute\nethmoiditis which breaks through into the Orbit led him to believe that there may be a chemical action produced by the bacterial\ngrowth which leads to the formation of carbon dioxide under\ngreat pressure, and that the etiology is not always a defect in the\nosseous boundaries. The theory of the formation of carbon\ndioxide under pressure is the probable explanation of the bulging\neye and meningeal complications in this type of ethmoiditis.\nOther interesting papers were \"Sinus Infection in Children,\"\nby Dr. F. M. Shook; \"Mucocele of the Frontal Sinus,\" by Dr.\nMearle C Fox; \"Central Retinal Haemorrhage Synchronous with\nOnset of Menstruation,\" by Dr. E. Nelson Neulin; \"Fibroma of\nthe Larynx in a Child of Three, with Operation and Recovery,\"\nby Dr. Chester Bowers; and \"The Value of the Ultra Violet Ray\nin Eye, Ear, Nose and Throat Field,\" by Dr. H. F. McBeth.\nOn Friday morning Dr. A. S. Green gave a clinic at the Vancouver General Hospital when he operated on five cases of cataract\nby the Barraquer method. Demonstrations by Dr. Lewis of his\ntest for differentiation between Stapes Fixation and Obstructive\nPage Thirteen Deafness; by Dr. Pischel of a test for localization of foreign bodies\nin the eye by means of markers in the conjunctiva; and presentation of a case of \"Jaw Winking\" in a little girl, by Dr. Spencer\nHowe, concluded the scientific programme.\nAt the business meeting held on Friday, the 19th, Dr. Kasper\nPischel was elected President, and San Francisco was chosen as the\nplace of meeting in 1926.\nTHE PACIFIC NORTHWEST MEDICAL MEETING\nAT PORTLAND.\nThe meeting of the Pacific Northwest Medical Association,\nheld in Portland, June 29th, 30th, and July 1st, was well attended and was enjoyed by all present, among whom were eight\nVancouver medical men.\nSir Henry M. Gray was present and gave three interesting\npapers which he later presented at the Vancouver Medical Association Summer School. These are abstracted in the account of that\nmeeting.\nDr. Geo. N. Stewart, of Cleveland, presented three papers,\nrespectively on the \"Physiology of the Suprarenal Glands,\" \"The\nThyroid,\" and \"The Islands of Langerhans.\" In speaking of\nthe suprarenals he pointed out that we are dealing with two separate and distinct glands, the cortex and the medulla. Most is\nknown about the medulla, whose secretion\u00E2\u0080\u0094epinephrin\u00E2\u0080\u0094is entirely under the influence of the nerves and can be detected in the\nblood qualitatively and quantitatively, being present in a dilution\nof 1-100,000,000, although even to a strength of 1 in 1 to 5\nmillion in the blood of the adrenal vein. He estimates that a good\nsized man daily produces the equivalent of one P. D. & Go. one-\nounce bottle of adrenalin. Dr. Stewart found that the medulla\nexperimentally is not indispensable to rabbits, rats and dogs, and\nthe blood pressure is not affected by removal, either together or at\ndifferent times. We do not know what the cortex produces, but\nwhen it is removed (with the unimportant medulla) certain definite things happen, although 50% of white rats live indefinitely\nand have bred young after such complete removal. Deprival of\nvitamins and other nutritional deficiencies also make the operative\nresults less good. Dogs, however, live from six to seven, or even\nsixteen days, without any treatment and are apparently well, but\nthey all die, and probably suddenly, after one, two or three days\nof anorexia, with sometimes nervous symptoms and spasms, \"but\nasthenia is not the prominent symptom, if at all.\" Coupled with\nthe anorexia is a well marked condition of the alimentary canal\n\u00E2\u0080\u0094congestion\u00E2\u0080\u0094present from the cardiac end of the stomach to\nthe anus, with bloody stools and even vomit, reverse peristalsis,\nwith bile also, and concurrently a highly congested pancreas. Dogs\ncan be kept alive four or five times as long by injections of Ringer's\nsolution containing some sugar, beginning preferably 24 hours\nafter operation, lessening the general concentration, which is also\nshown by considerable increase of the red blood cells.\nPage Fourteen Dr. W. McKim Marriott, of St. Louis, gave an instructive\npaper on \"Some Newer Viewpoints Concerning the Nature and\nTreatment of Nephritis.\" He described the tubular type (nephrosis) and the glomerular or haemorrhagic type. In the tubular\nvariety (nephrosis) there is a gradually decreased secretion of\nurine with small amount of blood, if any, but large amount of\nalbumen and casts; no acidosis or increase in blood pressure;\nN. P. N. not increased and no true uraemia; also the eye grounds\nand skin capillaries are normal. There is, however, marked general oedema and anaemia, and the patient's nutrition is such that\nresistance is poor and death not infrequently follows infection.\nPost mortem the kidneys are found to be large and white, the\ntubules being filled with degenerated cells. However, the majority recover completely. Nephrosis in childhood is most frequently due to a staphyloccocus infection of nasal sinuses, the successful treatment of which clears up the kidney condition. Blood\ncultures are mostly negative, but the general condition seems due\nto a toxaemia. Phthalein tests do not show lack of kidney function, but the tissues retain salts and water. The protein of the\nblood serum is lowered and oedema increases as this occurs. This\nis apparently coincident with lowering of the surface tension of\nthe serum, which can be measured by weighing a drop of serum.\nThe smaller the drop the lower is the surface tension. In cardiac\noedema or that due to glomerular nephritis, the surface tension\nof the serum is not lowered. In these cases there is apparently a\nsubstance in the blood which changes the permeability of animal\nmembrane and acting on the kidney epithelium causes the latter\nto pass albumen freely. This substance has been isolated from\nurine of these cases by Clausen and experimentally has produced\nalbuminuria.\nTreatment.\u00E2\u0080\u0094Examine nose and throat carefully, remove enlarged tonsils and adenoids to improve drainage, and prevent reinfection. Treat sinus infection if present. Diet is important,\ndue to large loss of albumen. They need a high protein diet (2 to\n4 grms. per kilo of weight per day), milk, eggs and meat, also\ngreen vegetables and those containing protein. Salt and water\nneed not be limited. Sweating is of no value. Intravenous injections of blood are useful. Theobromine occasionally produces\nmarked diuresis and may increase the surface tension, thus lessening oedema. Heliotherapy also may aid patient.\nIn contrast to preceding variety is acute glomerular or haemorrhagic nephritis, coming on acutely with diminution or suppression\nof urine, which is of a smoky colour from contained blood. Microscopically large numbers of red blood cells and some white\nblood cells are seen. A moderate amount of albumen is present\nand casts may be seen at first. Here a definite inflammatory condition of the glomeruli exists which may cause permanent fibrosis,\nbut in most cases also the damage is not too extensive and recovery\nmay occur. The kidney function is much altered. Non-protein\nnitrogen, urea and chlorides are all retained. Acidosis is present\nand phthalein excretion is diminished. The serum protein is not\nPage Fifteen reduced and the surface tension of the blood is not diminished,\ntherefore oedema is rarely marked. The capillaries are definitely\nnarrowed and beaded and blood pressure increased. Dr. Marriott\nstated that by simply examining the capillaries at the base of the\nnail with a microscope it is possible to diagnose this form of nephritis. True uraemia may occur, and, if late, is grave. These cases\nare also due to an infection, probably of a haemolytic streptoccus,\nmost frequently following a sore throat or tonsillitis, but may be\nfrom elsewhere. There is no definite evidence of septicaemia, but\nthe capillaries in general are damaged and the result in the severer\ncases may be chronic nephritis with high blood pressure.\nThe Treatment.\u00E2\u0080\u0094Removal of focus of infection, as operation on acute mastoid, may clear up case. Do not remove acutely\ninflamed tonsils. Keep in bed for some time after subsidence of\nacute condition. On account of possibility of uraemia a low protein diet is necessary\u00E2\u0080\u00941 gram per kilo of weight or less in older\nchildren or adults. Milk protein is the best, but one must give\nsufficient calories with the milk to maintain nutrition by using\nfats, cream and carbohydrates, especially arrowroot. Salt-free\nfood is indicated. Curds and eggs may be given in the more chronic\nstages, and meat may be given after the blood has disappeared from\nthe urine. If the blood persists, or is marked, put on free sugar\ndiet, giving 10 grams of sugar per pound of body weight, give in\nwater. A large intake of water is useful. Diuretics, especially\ndiuretin, are contra-indicated in this form. Alkalies may cause\nalkalosis and tetany. Acidosis, if present, is due in these cases to\nretention of acid sodium phosphate, and is best treated by calcium\nlactate in large doses by mouth\u00E2\u0080\u0094even 15 to 30 grains every four\nhours. Sweating is contra-indicated. Hypertonic solution of\nglucose, 20%, is good\u00E2\u0080\u00941 oz. of solution per kilo given intravenously.\nDr. Nathaniel Allison, of Boston, gave two addresses which\nwere of great interest. He dwelt mostly upon the pathology of\narthritis, stressing the fact that the disease may originate in either\nthe synovial membrane or in the bone contiguous to the joint,\nand spread to it. In the former the structures become swollen,\nopalescent and loaded with exudation products. Granulation tissue spreads out over the cartilage, which loses its natural bluish\"\nwhite and polished surface and becomes dull, yellowish and\nopaque. Pits form which coalesce and completely destroy portions of cartilage, which are thrown off into the joint. Or the\ndisease begins in inflammatory foci in the bone beneath the cartilage. As these become larger, they coalesce and approach the\ncartilage, which is raised from its source of blood supply, becomes\nnecrosed and cast loose. In similar manner all the structures about\nthe joint are invaded with granulation tissue and disorganized.\nDr. Hugh Cabot gave two papers on \"The Management of\nSmall Stones in the Kidney and Ureter\" and on \"Renal Tuberculosis,\" which were enjoyed by everyone present.\nDr. L. F. Barker gave papers on \"The Medical Aspects of\nPage Sixteen Gastric Ulcer,\" \"Psychic Factors in General Medicine,\" and on\n\"The Present Status and Future Prospects of Endocrinology.\"\nDr. Henry Woltman, of the Rochester Clinic, gave two comprehensive lectures on \"The Syndrome of Compression of the\nSpinal Cord\" and \"The Significance of Pain as a Symptom in\nDiagnosis of Diseases of the Nervous System.\"\nDr. Jas. B. Herrick, of Chicago, read three papers of interest\non \"Angina Pectoris,\" \"Diseases of the Coronary Arteries,\" and\non \"Syphilis of Heart and Aorta.\"\nDr. Reginald Fitz, of Harvard, gave two papers on \"The\nAction of Insulin\" and \"The Importance of a Routine Wasser-\nmann Test in Private Practice.\"\nDr. R. L. Benson, of Portland, lectured on \"The Pathology\nof Coronary Artery Sclerosis.\"\nDr. R. W. Te Linde, of Johns Hopkins, gave two papers on\nthe \"Present Status of Adenomyoma and Endometrial Growths\"\nand on \"Diseases of the Endometrium.\" In his second paper\nhe gave some interesting results of recent research in the physiology\nof the endometrium before and during menstruation.\nThe Pacific Northwest Urological Society and the North\nPacific Paediatric Society met during the same time. At the latter\nmeeting Drs. H. A. Spohn and R. E. Coleman, of Vancouver, read\na paper on \"Some Metabolic Observations in Cases of Herter's\nDisease,\" which was very favorably received and commented on\nby those at the meeting.\n* 3)C H= s(:\nLIBRARY NOTES.\n(The Library is situated in 529-531, Birks Building, Granville Street, Vancouver. Librarian: Miss Firmin. Hours: 10\nto 1, 2 to 6.)\nDr. Alan U. Drury, from the Medical Research Council of\nEngland, gave four interesting and instructive papers. In his paper on \"Clinical Signs in Cardiological Practice,\" he began with\nmethod of examination. Has the patient cardiac failure of the\ncongestive type or not? If present, rest over long period is necessary. Cases with ascites, oedema and small urinary output are\neasy of diagnosis, but we should get them sooner. In the borderline cases there is a reliable and certain sign\u00E2\u0080\u0094first the right side\nof the heart is engorged, then the veins become engorged\u00E2\u0080\u0094in a\nnormal person the veins of the neck are flat when in the upright\nposition, but if his neck veins are full the heart is failing; similarly the liver becomes enlarged and rales are heard at base of\nthe lungs.\nNo enlarged heart is healthy, and not all normally sized\nhearts are healthy. The maximal impulse marks the border of\nthe heart.\nPage Seventeen This maximal impulse is small and definite and pushes the\nfinger out and holds it. It may or may not be surrounded by a\ndiffuse impulse. Sustained and forcible movement of the ribs indicate an enlarged heart. Gross cardiac displacement must be excluded. Percussion of the left border will give ventricular enlargement, but does not say which ventricle. If this sign does not\nagree with maximal impulse, then take the latter. The right border is more difficult. Heart sounds alone are not taken as evidence of heart trouble unless this fits in with other symptoms.\nGallop rhythm can occur in effort syndrome.\nValves\u00E2\u0080\u0094If affected it is most likely that heart muscle also\nhas been injured by the same process.\nCardiorespiratory systolic murmur \u00E2\u0080\u0094 best heard during inspiration\u00E2\u0080\u0094is probably only a broken up breath sound, but this\nis not certain; it is not important.\nSystolic murmur over pulmonary is of no prognostic significance, but if there is a thrill present it may be pulmonary stenoses,\nwhen cyanosis either transient or permanent will be present.\nThere may be a long systolic with a thrill from a patent\nDuctus arteriosus.\nAortic systolic murmurs with thrill are not necessarily stenosis, unless with evidence of regurgitation also, which is probably\nalways present, and one finds a slow-rising flat topped pulse.\nApical systolic murmurs may be:\n(a) Position murmurs\u00E2\u0080\u0094heard only in certain positions.\n(6) Inconstant murmurs.\n(c) Constant murmurs, mitral regurgitation, it must be decided whether it is from diseased valve or relaxed ring.\nTricuspid murmurs may be unimportant, as this ring dilates\neasily under stress.\nAortic regurgitation: A diastolic murmur at base, heard best\nat left of sterinum, is a reliable sign in early stages. Later there is\nthe water hammer pistol shot pulse with throbbing.\nMitral Stenoses: There is almost always a diastolic rumble\n(occasionally a thrill only), an accentuated first sound or increased secondary pulmonary sound alone are not sufficient evidence. Raise the rate of the heart-beat and place patient on the\nleft side, when you can get the diastolic rumble necessary for\ndiagnosis.\nRhythm.\u00E2\u0080\u0094There may be no enlargement or murmur, but\na disturbed rhythm, which may have significance; e. g., if bradycardia is present it may be:\n(a) Physiological; or (b) due to heart block.\nThere is a ^good clinical sign which indicates heart block\u00E2\u0080\u0094\nwhen the auricle and ventricle go off together (synchronize) there\nis a definite increase in the heart sound at that time.\nPage Eighteen Auricular fibrillation may occur in the normal, but usually\nin a damaged heart\u00E2\u0080\u0094as also is the case in extra systole. If the\nheart rate is raised by amyl nitrite or exercise to, say, 120 and\nthe irregularity persists, it is fibrillation; but if irregularity ceases\nit is due to extra systole.\nTachycardia.\u00E2\u0080\u0094 (a) Physiological; (b) Paroxysmal, which\nmay occur in a healthy or damaged heart and is not affected by\nexercise; (c) Flutter, which occurs in a damaged heart, the rate\nis about 160, which is not affected by mild exercise, but violent\nexercise may even double the rate and the patient faint.\nSpeaking of the use of the galvanometer, Dr. Drury insisted\nthat to-day this instrument could give diagnostic information beyond that procurable by clinical examination in only from 5 to\n10% of cases. It will disclose:\n(a) Mild heart block, which cannot be diagnosed clinically\nwith certainty.\n(b) Arborization block or some disorder of conduction in\nthe ventricle, splitting of the R. or widening of the\nQ. R. S. wave.\nThe T-wave, whether up or down, has at present no known\nsignificance.\n:je ^c ^c 3jc\nTHE SUMMER SCHOOL OF THE VANCOUVER MEDICAL ASSOCIATION, JULY 2-4, 1925.\nIn beautiful weather, with the city decorated and en fete for\nthe Dominion Day celebrations, the Annual Summer School of the\nVancouver Medical Association opened on July 2, under brilliant\nauspices, which the progress of the meeting did not belie. The\ncommittee in charge is to be congratulated upon the smooth working arrangements it had perfected. It is quite safe to say that,\ndespite the many successful meetings which have been held, none\nhas exceeded, if indeed any has reached, quite the perfection of\nthe one which has just closed.\nWe hope that the registration of attendance measures up to\nthe deserts of the programme. If it has not, it should have done\nso, for nobody could afford to miss so comprehensive and sound\na series of lectures, so well presented and so full of information.\nThe meetings for the first time were held down town, and\nthe change in venue was, we think, amply justified and a pronounced success.\nThe proceedings were opened by a short address of welcome\nfrom Dr. W. D. Keith, acting president of the committee during\nthe regretable illness of Dr. Alison Cumming. Dr. Hugh Cabot,\nProfessor of Surgery, University of Michigan, gave the first address on the subject of \"Non-tuberculous Infections of the Kid-,\nney.\" These infections were in general of two types, those pro-\nPage Nineteen duced by the colon-typhoid group of organisms which do not\nreadily produce suppuration, and those produced by the pus producing cocci. Dr. Cabot discussed in an amusing and instructive\nmanner the supposed methods of infection, but thought the only\nprobable one was by way of the blood stream. He referred to the\nlesions produced and considered that the pyelitis generally present\nwas really a pyelonephritis. A large proportion of these cases was\nproduced by organisms of the b. coli type. Coccal infections, on\nthe other hand, tended more to lodge in the kidney substance, producing cortical abscesses, the rupture of which was probably responsible for the occurrence of perinephritic abscess.\nThe next paper was presented by Dr. Alan Brown, Professor of Paediatrics, University of Toronto, whom the audience\nrecognized as an old acquaintance. Dr. Brown devoted this lecture\nand the one delivered on the evening of the same day, to a consideration of the nutritional disturbances of infancy and childhood. These disturbances he regarded as those of quantity and\nthose of quality. Considering the various food stuffs, Dr. Brown\nsaid that children absorbed 85% of the fats. Calcium soaps were\nan end product of their digestion and were present in large amounts\nwhen fat was in excess. By virtue of this calcium soap the tendency of fats was to constipate rather than produce diarrhoea. The\ndigestion of carbohydrates took place by way of acids of fermentation, such as lactic and succinic, with the formation of CO 2.\nIt is the carbohydrates which are largely responsible for the\ndiarrhoea and the CO 2 \"gas\" which so often produces colicky\npains. In cases of artificially fed babies on patent foods, the excess carbohydrate is stored in the liver and tissues as glycogen.\nEach molecule of glycogen requires two molecules of water and\nleads to the production of the over-fat \"water-logged\" baby. The\nprotein of the diet rarely causes any nutritional disturbances except\nthe occasional cases of anaphyl actic sensitization. The lecturer\nconsidered that all (even certified) milk should be boiled before\nbeing fed. Boiling for the short period necessary in no way interferes with the digestibility and renders the liability to infection\nof tubercular nature much more remote. He said that practically\nall the milk in Toronto was pasteurized and that in eleven years\nout of 60,000 cases not a single instance of abdominal tuberculosis had occurred in the Sick Children's Hospital. Nutritional\ndisturbances were by no means limited to artificially fed babies.\nBreast fed babies were not exempt. In these, disturbances might\nbe due to mechanical defects, such as hare lip, cleft palate or adenoids, or the babies might be weak or indolent or awkward nurs-\ners. Again, overfeeding was at times a factor, whether due to\nparenteral disturbance or to the constitutional peculiarities of the\nbaby. Finally there might be underfeeding, which might be detected by careful weighing before and after feeding. Dr. Brown\ndistributed various formulae and instructions as used in the Sick\nChildren's Hospital, Toronto, for the preparation of foods, their\ncare and administration. Lactic acid milk was found to be a very\nacceptable article of diet in a great many instances, and both the\nPage Twenty natural and artificial methods of preparation were described. Butter soup (which no doubt tastes better than it sounds) was useful\nwhen a high, easily assimilable fat diet was required.\nThe concluding paper of the first session was presented by\nDr. J. G. Carr, Associate Professor of Medicine, Northwestern\nUniversity, Chicago. Dr. Carr was invited on the recommendation of Dr. M. T. McEachern, and the audience evidently heartily\nendorsed that recommendation. The condition of auricular fibrillation, though apparently first recognized in 1835, was more\nfully described by Cushing in 1899 without attracting much attention. In 1907 another paper by the same author firmly established it as a clinical entity. At one time it was presumed that\nfibrillation once having occurred was permanent, but to-day the\nexistence of paroxysmal auricular fibrillation is well recognized.\nAmong diagnostic features the usually rapid and always irregular\ncardiac rhythm was important, while \"pulse deficit\" was characteristic. The lecturer referred at some length to the use of Quinidine\nwhich had been used on about 100 cases at the Cook County\nHospital, Chicago. The opinion there was favourable to its use\nand no untoward results had been experienced. Abolition of the\nirregular rhythm had been maintained in selected instances for as\nlong as two years.\nAfter the lunch interval, during which Dr. Cabot was entertained by and spoke at the Kiwanis luncheon, Dr. A. J. Pacini\nlectured on \"Diathermy and the Violet Ray.\" Dr. Pacini, who\nhad attended the meeting of the Canadian Medical Association in\nRegina, had already addressed a large meeting of the Vancouver\nSociety on Monday, June 29. At this lecture he took as his subject \"The Relation of Light to the Growth and Development of\nAnimal Life Upon the Earth,\" reviewing in an interesting way\nthe work of Moore and Bailey on irradiation of inert material and\nthe production of synthetic sugar substances in that manner.\nThe next paper of the busy afternoon session was by Dr.\nRoscoe Graham, of the Surgical Department of the University of\nToronto. Referring to the question of simple colloid goitre, Dr.\nGraham said that in view of the possibility of later toxaemia the\nquestion of removal should be placed before the patient, the mortality of operation in this variety being about 0.25%. The average length of time that an adenoma was present before being\nbrought to the attention of the surgeon is 16 years, the patients as\na rule being much older than those with diffuse hyperplasia. In\ntoxic cases the blood pressure reading showed a fairly high systolic\nwith a diastolic remaining unchanged, while the metabolic rate\nmight be high or low and was only of value in connection with\nclinical symptoms. In diffuse hyperplasia the blood pressure runs\nin cycles: (1) a high systolic with a normal diastolic which in a\nfew weeks may fall to (2) a low systolic with diastolic unchanged.\nThis again to be followed by (3) a high systolic and a rising diastolic which if it reached 100 m.m. or more indicated a dangerous\nrisk. They had had unsatisfactory results with X-ray therapy,\nPage Twenty-one and preferred surgical measures with or without the use of iodine.\nDr. Hugh Cabot took as the subject of his afternoon lecture\nthe very practical one of the so-called \"Catheter Cystitis.\" This\nannoying complication was one which particularly dogged the\nfootsteps of the gynaecologist and the obstetrician. Usually when\nafter an interval of hours the patient had not urinated and distension was becoming obvious, the catheter was passed\u00E2\u0080\u0094by some\none else. When and if cystitis later developed, the catheter and\nits manipulator were blamed for the occurrence. Dr. Cabot reviewed experimental work which showed the extreme difficulty of\ninfecting a normal bladder in animals, with or without trauma in\naddition. Practically it could not be done. Something additional\nwas required, and that something was overdistension. Given\noverdistension, infection was easy to produce. Instructions in his\nclinic were that when an amount of urine was present, estimated\nat ten ounces, the catheter was passed regardless of the time which\nhad elapsed.\nThe first lecture of the evening session was given by Sir\nHenry Gray, Surgeon in Chief to the Royal Victoria Hospital,\nMontreal, on \"Developmental Abnormalities Affecting the Colon.\" This paper, which was illustrated by lantern slides, dealt in\na very thorough manner with the whole question of the development of the intestinal canal and the manner in which it came to\noccupy its final position. The work of Arbuthnot Lane was considered and the affect of the various bands and kinks in the production of symptoms. Sir Henry detailed his methods of examination in these cases and gave the steps of the operation he used\nfor the fixation of the ascending colon and caecum.\nDr. Alan Brown's continued paper on \"Nutritional Disturbances,\" which has already been referred to. brought to a close\nthe first interesting, albeit strenuous day of the School.\nOn Friday, July 3, the meeting was called to order at 9 a.m.\nand Sir Henry Gray delivered his second lecture, taking as his subject the important one of \"Cancer of the Breast.\" He showed by\nmeans of lantern slides the various ways in which cancer might\nspread from this area. While lymphatic fermention as demonstrated by Handley might account for local dissemination, blood\nor lymph migration must be called for to explain more distant\nmetasasis. Generally regarded as a disease of later life, of 311\ncases 27.3% were under 40 years of age. He referred to the large\nstatistical material of 24,800 cases gathered from all parts by Dr.\nJanet Lane Claypon, and read from an article published as long\nago as 1867 in which the modern operation is very closely detailed.\nThe second paper of the morning session was by Dr. Alan\nBrown, on \"Eczema.\" This, as the lecturer explained, was really\na discussion of the exudative diathesis, which is a very definite\nthing. These children may be restless, irritable and excitable,\nmay suffer from itching, intertrigo, eczema and subcutaneous\nPage Twenty-two abscess. They vomit easily and frequently. Catarrhal infections\nare frequent, and later asthma may develop. There is a tendency\nto general hyperplasia of the lymph glands. A high fat diet is a\nsort of function test of the exudative diathesis and may produce\nany or all of these reactions. There is also a susceptibility to certain foreign proteins and some of the profounder reactions produced by the injections of sera occur in children of this type. In\nthe treatment of eczema the immediate causes had to be considered.\nThese were excess fat or sugar in the diet or the use of some unsuitable form of protein. No irritating clothing should be allowed next to the skin. Water should not be used for cleansing\npurposes, oil being substituted. The urine should be kept alkaline, Sod. Bicarb, grs. 30 to 40 daily being used. Scratching\nshould be eliminated if necessary by means of jacket and mitts.\nFor the acute weeping type of eczema affecting chiefly the face,\napply crude coal tar as obtained from the gas works. May need\nto be used on three or four successive days. Later, bismuth paste\nwas applied; this is a mixture of bismuth subcarb., lime water\nand lanoline. For the acute intertrigenous form exposure to the\nair in a warm room was recommended and the use of 4% resorcin\nointment in the seborrhoca type.\nFollowing the conclusion of Dr. Brown's lecture, Dr. James\nG. Carr took up the subject of the \"Intrathoracic Complications\nof Pneumonia.\" It is to be remembered that in the large majority of cases which hang over, there is no such thing as unresolved pneumonia, which is a diagnosis that should never be made\nin the early stages of a complication, and also that in a large proportion there is pus in the chest. In cases of empyema following\npneumonia the pneumonia may not have disappeared and the alteration of the breath sounds consequent upon this may be transmitted through the pus. Tactile fremitus is invariably absent and\nis, the lecturer considered, the best sign of the presence of fluid.\nWe must continue to look for pus in every patient with pneumonia who does not do well. Lung abscess was found to be less\ncommon in lobar pneumonia than in the broncho-pneumonic variety, most of the cases he saw being post-operative. Treatment\nof these acute abscesses was often disappointing.\nThe afternoon proceedings were opened by Sir Henry Gray\nwith a paper on \"Acute Osteomyelitis.\" Sudden attacks of pain\nin bone should always make one think of osteomyelitis. The\ndisease may affect a joint by direct spread, and this secondary suppurative arthritis was as dangerous as the primary variety. Multiple lesions are common. As to diagnosis it is important to remember that the X-ray will very rarely show changes in the early\nstages; it is not until two or three weeks have elapsed that alteration in bony structures takes place. The question is often asked\nas to whether if the periosteum be left at operation the formation\nof new bone can be looked for. In children it can, but not in\nadults. The disease may be cut short by drilling or by gouging\nthe bone so as to give vent to the pus. Several lantern slides were\nshown illustrating the conditions and the means for its relief.\ny\nPage Twenty-three The next lecture was that of Dr. Alan Brown, on \"Deficiency\nDiseases.\" Out of the number of diseases which have been shown\nto be of this variety, the lecturer confined his remarks chiefly to\nrickets. Interest in this subject had been re-awakened by Mel-\nlanby of Sheffield, in 1918. It was very widespread and was\nprobably present in some degree in every artifically fed baby, while\neven breast fed babies were by no means immune if the mother's\ndiet was not well balanced. Rickets was produced by defects in\ndiet, by lack of radiant energy, and by undue confinement. In\nthe diet it is the lack of phosphorus rather than the absence of\ncalcium which, together with the absence of the anti-rachitic factor, produces the disease. Symptoms are restlessness, excessive\nperspiration, cranio tabes, beading of the ribs with flaring out of\nthe lower ribs, enlargement of the ends of bones, etc. Numerous\nlantern slides were here shown illustrative of the experimental variety of rickets in animals and of the natural variety in children,\nradiographs showing the mushroom-like appearance of the ends\nof the bones, with micro-photographs showing the process of\nhealing under the administration of cod liver oil or by means of\nultra violet radiation. Of all cod liver oils Dr. Brown considered that the Newfoundland oil as prepared by Mead, Johnson &\nCo. was the best.\nThe rest of the afternoon was given up to the annual meeting of the B. C. Medical Association. An account of the proceedings will be found on another page of this issue. This meeting was followed by a dinner under the auspices of the same Society at the Ambassador Cafe, at which Sir Henry Gray and other\nguests spoke.\nThe evening session of July 3rd was opened by Dr. Carr\nwith a paper on the \"Treatment of the Anaemias.\" Referring\nespecially to pernicious anaemia, the speaker considered that nothing was so likely to produce improvement as prolonged rest in bed.\nArsenic in some form should be used, usually as Fowler's solution\nor sodium cacodylate. Forced feeding with a diet high in protein was important. As to removal of foci, while he considered\nthat any gross or evident foci should be removed, he did not think\nthat the results had come up to what was hoped for. Transfusions were useful, but pernicious ^anaemia was not cured by these\nproceedings. The results after splenectomy were not very encouraging, though there was considerable difference of opinion on this\npoint. Dr. Carr thought that the blood picture of a pernicious\nanaemia might be simulated by a severe secondary anaemia following cancer, syphilis, tuberculosis or nephritis.\nThe final paper of the day was presented by Dr. Hugh Cabot,\nwho had selected \"Ulcer of the Stomach and Duodenum\" for his\nsubject. Regarding etiology Dr. Cabot reminded his hearers that\nthis was the day of \"foci,\" but while he thought they were of\nsome importance that importance had been greatly over-rated. As\nto hyperacidity he was at a loss to know whether the acidity produced the ulcer or the ulcer the acidity. In diagnosis he considered that history was of great value, though at times the disease\nPage Twenty-four was very closely simulated by appendicitis or by disease of the\ngall bladder or ducts. The X-ray was important, though these\nuseful members of the profession\u00E2\u0080\u0094the radiographers\u00E2\u0080\u0094came in\nfor a good deal of good humoured criticism by the lecturer. Treatment, Dr. Cabot considered, should be combined medical and\nsurgical. The economic factor had to be carefully considered.\nFor ulcers of the duodenum gastro enterostomy was the most useful procedure, while for ulcers of the stomach he was coming\nmore and more to rely on the operation of partial gastrectomy.\nNothing daunted by the strenuous work of the last two\ndays and nights, lecturer and audience turned out betimes on Saturday morning for the final session of the School.\nDr. Carr, who had previously held a clinic at St. Paul's Hospital, opened at 9 a.m. with a lecture on \"Coronary Sclerosis,\"\nwhich we hope to reproduce in full in a later number of the\nBULLETIN. Dr. Carr said that arterio sclerotic hearts showed\ndiminished reserve and a lack of recuperative power. One of the\ncommon occurrences in these hearts was anginal pain, due, according to one theory, to disease of the coronary vessels; according to\nanother theory, to disease of the aorta. Coronary thrombosis was\noften overlooked and but rarely was the diagnosis made. A description of the symptoms of this complication was given.\nFor his final address Dr. Hugh Cabot spoke on \"Disease of\nthe Gall Bladder.\" For the diagnosis of gall bladder conditions\nit was difficult to get assistance from any instruments of precision.\nClinical methods had to be used, and it was safe to say that a\ncorrect diagnosis could be arrived at in this way in some 80% of\ncases, and in stone even higher. Recently, however, there had come\nto our aid a new method in which substances were introduced\ninto the blood which were absorbed by the liver and secreted into\nthe bile. They passed into the gall bladder and there produced\na shadow under the X-ray. It seemed possible that an estimate\nof the density of this shadow might be of value in determining\nthe absorptive properties of the mucous membrane of- the gall\nbladder, and therefore its condition as affected by disease processes. Removal of a gall bladder has certain outstanding objections, and there seems to be at present a reaction against its removal in many cases. There are borderline cases when it is very\ndifficult to know what is best. Drainage may tend to increase\ninflammation. In some instances when stones have been removed\nand the wall of the gall bladder has seemed reasonably good, Dr.\nCabot has sewn it up without drainage.\nAt the close of his lecture Dr. Cabot received an ovation.\nHis various lectures deeply interested the large audiences present.\nSir Henry Gray, with his final address on \"Acute Intestinal\nObstruction,\" brought the session to a close. This address has\nbeen left with the Committee, and will be published in another\nissue.\nPage Twenty-five =Ksfc\u00C2\u00BB\nTHE ORIGINAL\nPITUITARY\nEXTRACT\nL)ITUITRIN was the first preparation of its kind ever\nused in obstetrics as an aid in labor. It is a standard\nproduct employed the world over in uterine inertia, and\nfor other definite indications as well.\nAmong pituitary extracts Pituitrin should be preferred\nbecause it is always the same. Every lot is doubly tested\u00E2\u0080\u0094\nfor its effect on blood pressure and for its effect on uterine\nmuscle. What the physician wants in a preparation of\nthis kind is not excessive activity, but uniformity so that\nhe may avoid both the danger of an overdose and the\nembarrassment of ineffectiveness.\nIn addition to the security afforded by double standardization, every package of Pituitrin is dated.\nThese advantages are yours if you specify on your orders\nfor pituitary extract \"Pituitrin, P. D. & Co.\"\nIf Surgical Pituitrin is wanted specify Pituitrin \"S.\"\nThis preparation is twice the strength of Pituitrin\u00E2\u0080\u00941 cc\nequivalent to 2 cc of the latter. Pituitrin S\" is not\nrecommended for obstetrical use.\nPITUITRIN and PITUITRIN \"S\" are supplied in liquid form\nonly, in ampoules, six to the box\u00E2\u0080\u0094Pituitrin in 1 cc and %-cc\nampoules; Pituitrin S\" in 1-cc ampoules only.\nAsk for our booklet \"Pituitary Therapy\"; requests from\nphysicians are welcomed and gladly complied with.\nPARKE, DAVIS & COMPANY\nPITUITRIN IS INCLUDED IN THE N. N. R. BY THE COUNCIL ON PHARMACY\nAND CHEMISTRY OF THE AMERICAN MEDICAL ASSOCIATION\n= ma* I\nSHIRTS\nGenuine English Broadcloth\n\"Loomed in England.\"\n$2.95\nCoat Model, Negligee Style, Soft Cuffs. Beautiful Lustrous\nFabrics, light in texture and weight, but will wash like a linen\nhandkerchief. For Business or Sport.\nTo out-of-town Doctors we will send two, three or six\nof these Shirts on approval, along with half a dozen selections\nof Neckwear. You may select what you like from lines sent,\nI\nreturn any you do not like, and send us a cheque for the ones\nyou keep. We will pay mailing charges each way.\nJust let us know your preference as to color and price.\nD. K. BOOK LIMITED\n!\nCorrect Clothes\n1\n137 HASTINGS STREET WEST\nVancouver, B. C.\n\u00E2\u0096\u00A0Slss^--'s\nNurses' Central\nDirectory\nPhone Fairmont 5170\nDay and Night\nOrthopedic\nAppliances\n1\nHourly, Institutional and Private Nurses\nSupplied\nExtensions for short limbs,\n1\nRegistrar-'Miss Archibald, R. N.\nTrusses, Arch Supports\n601 13th Ave. West, Vancouver\nAbdominal Belts,\nSacroiliac Supports and\nArtificial himbs,\nmanufactured and made\n\u00E2\u0096\u00A0\nby Experts and guaranteed\nPatronize the\nby\nBULLETIN\nA.LundbergCo.\nadvertisers.\n938 Pender Street West\nVancouver, B. C.\nh\nPage Twenty-sever\n. B. C. Pharmacal Co. Ltd.\n329 Railway Street,\nVANCOUVER.\nManufacturers of Hand-made Filled Soluble\nElastic Capsules.\nSpecimen Formulae:\nNo. 20a\u00E2\u0080\u0094\nCascara Liq. Ext., 30m\nEuonymin, 1 gr.\nPodophyllin, J gn\nSpecial Formulae Made on a Few Hours' Notice.\nPrice Lists and Formulae on\nApplication.\nNo, 29\u00E2\u0080\u0094\nCod Liver Oil, 25m.\nQuinine, 1 gr.\nCreosote, Beech wood,\n2m.\nGuaiacol, Pur., 2m.\nSay it with Flowers\nCut Flowers, Potted Plants, Bulbs, Trees, Shrubs,\nRoots, Wedding Bouquets.\nFlorists' Supplies and Funeral Designs a specialty.\nThree Stores to Serve You:\n48 Hastings St. E. Phones Sey. 988 and 672\n665 Granville St. Phones Sey. 9513 and 1391\n151 Hastings St. W. Phone Sey. 1370\nBrown Bros. & Co. Ltd.\nVANCOUVER, B. C.\nPage Twenty-eight Prescription Service'\u00E2\u0080\u0094\u00E2\u0080\u00A2\nThat merits your confidence.\nFree Delivery Service anywhere in the city\nfrom 8 a.m. to 11 p.m.\nDistributors i\nMulford's Biologicals Fraisse Serum\nCapitola Pharmacy Ltd*\n(FRED G. BROWN)\nSeymour 158 New Address: Davie and Bute Sts.\nStevens\nPink Back Z* O. Adhesive\n\u00E2\u0080\u00A2-; Plaster\nMade in England\nAdheres to the limit, yet will not irritate.\nA Perfect Plaster.\nFully Guaranteed.\nStocked in Rolls 12 in. by 5 yds. and in Spools of\n5-yd. and 10-yd.\n1 in., 2 in., 2y2 in., 3 in. widths.\nTHE B. C. STEVENS CO., LTD.\n730-732 Richards Street,\nu^\nPage Twenty-nine To the\nMEDICAL PROFESSION\nDesire to announce to the Medical Profession that they have\nopened for business at\nQranville Street and 12th Avenue\nand will specialize in Prescription Service. Our Prescriptions\nare filled as ordered, without deviation and our delivery\nservice is decidedly prompt.\nOur Prescription Department\nwill at all times be in charge of a graduate.\nGORDON FROST\n(Formerly of the V. Q. H.)\nPhones: Bay. 540 and 1720 Qranville at Twelfth\nThe Ou?l Drug\n' Co., Ltd.\nJl\\ prescriptions dispensed\nbvj qualified Druggists.\nIJou can depend on the Ou?l\nfor ^Accuracy, and despatch.\nIDe delber free of charge.\n5 Stores, centrally located. We\nwould appreciate a call while\nin our territory.\nAmbulance\nService\nTELEPHONE\nFair. 58 & 59\nMount Pleasant\nUndertaking Co. Ltd.\nJR. F. Harrison W. E. Reynolds\nCor. Kingstvay and Main\nPage Thirty 110,000 Policyholders in the\nMutual Life of Canada\nrTUE MUTUAL LIFE OF CANADA is a Company\nof approximately 110,000 policyholders bonded\ntogether for mutual protection and support in time of\ntrouble. They obtain the insurance practically at cost.\nSurplus profits over and above provision of necessary\nreserves are divided among participating policyholders.\nLast year, the sum of $2,689,000 was thus distributed to Mutual policyholders as dividends.\nMutual Annual Dividend policyholders have three options:\u00E2\u0080\u0094\n1. To reduce the second and future premiums, or,\nLeft- with the Company to accumulate at compound interest and applied to shorten the premium paying period.\nTo Purchase Bonus Additions.\nThe Mutual Book tells you the whole story. Write\nor call on\n2.\n3.\n402 Pender St. W.\nWILLIAM J. TWISS\nPhone Sey. 1610.\nVancouver, B. C.\nBurns Drug Company\nlimited\n732 Qranville Street, Vancouver\n\u00E2\u0096\u00A0 TELEPHONE\nSEYMOUR 606\nTo the Doctor out of town:\nWe will look after any Mail Order Prescription\npromptly.\nINSULIN DEPOT FOR B. C.\nDispensary Specialists.\nPage Thirty-one -~Hs\u00C2\u00A9e\nPI\n'\u00E2\u0096\u00A0\u00E2\u0080\u00A2\u00E2\u0096\u00A0\nsai^N-\nHollywood Sanitarium\nLIMITED\ntyor the treatment of\nAlcoholic, Nervous and Psychopathic Cases\nExclusively\n\"Reference I \"23. Q- (fM.ed.ical Association\nFor information apply to\nMedical Superintendent, New Westminster, B. C.\nor 515 Birks Building, Vancouver\nSeymour 4183\nWestminster 288\n<*\u00C2\u00A9(\u00E2\u0096\u00A0\n;\u00C2\u00AB<5V\nPage Thirty-two"@en . "Periodicals"@en . "W1 .VA625"@en . "W1_VA625_1925_08"@en . "10.14288/1.0214566"@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: August, 1925"@en . "Text"@en .