@prefix edm: . @prefix dcterms: . @prefix dc: . @prefix skos: . edm:dataProvider "CONTENTdm"@en ; dcterms:isReferencedBy "http://resolve.library.ubc.ca/cgi-bin/catsearch?bid=1179642"@en ; dcterms:isPartOf "History of Nursing in Pacific Canada"@en ; dcterms:creator "Vancouver Medical Association"@en ; dc:date "1925-11"@en ; dcterms:issued "2015-03-26"@en, "1925-11"@en ; dcterms:description "'Progress and future of medicine ; Head injuries ; News and notes.' -- Title page"@en, ""@en ; edm:aggregatedCHO "https://open.library.ubc.ca/collections/vma/items/1.0214354/source.json"@en ; dc:format "image/jpeg"@en ; skos:note """ ^^^^^^^^i^^^^^^^^^^S^^^^ THE VANCOUVER MEDICAL |f ASSOCIATION BULLETIN Published monthly at Vancouver, B. C. ^Progress and future of dM^edicine^ ^Kead Injuries Njfws and V\\[gtes NOVEMBER, 1925 Published by (&XCc'Q$eath Spudding Limited, 'Vancouver, "23. Q. *( >K -fs©e n<3sH- Petrolagar Reg. U. S. Pat. Office Some £)uestions ^Answered Many plvysicians have asked us the following questions about PETROLAGAR. For the purpose of general information, we wish to broadcast these answers : 1. How much mineral oil does PETROLAGAR contain? Ans.: Sixty-five per cent, pure mineral oil of high viscosity. 2. What is the bulk-giving constituent of PETROLAGAR? Ans.: The only bulk-giving constituent is agar-agar. 3. Is PETROLAGAR an ethical preparation? Ans.: Every possible effort is made to keep PETROLAGAR strictly a prescription product. It is; not advertised to the public. We do not allow druggists to make window displays of it. It has been passed for New and Non-Official Remedies by the Council on Pharmacy and Chemistry of the American Medical Association. The Deshell Laboratories do not manufacture any product which is advertised to the public in any way. PETROLAGAR is issued as follows: PETROLAGAR CPlain); PETROLAGAR (with Phenolphthalein); PETROLAGAR (Alkaline); and PETROLAGAR (Unsweetened, no Sugar). Send this coupon for an interesting treatise, "Habit Time" Deshell Laboratories of Canada Ltd. DEPT. V., 245 CARLAW AVENUE, TORONTO LOS ANGELES, BROOKLYN, N. Y., CHICAGO, LONDON DESHELL LABORATORIES, INC., Dept. V. Gentlemen: Kindly send me without obligation, a copy of the treatise, "Habit Time." Dr Address ". Page Two THE VANCOUVER MEDICAL ASSOCIATION BULLETIN Published Monthly under the Auspices of the Vancouver Medical Association in the Interests of the Medical Profession. Offices: 529-30-31 Birks Building, 718 Granville St., Vancouver, B. C. Editorial Board: Dr. 3. M. Pearson Dr. J. H. MacDermot Dr. Stanley Paulin All communications to be addressed to the Editor at the above address. VOL. 2. NOVEMBER 1st, 1925 No. 2 OFFICERS, 1925 -26 Dr. J. A. Gillespie President Dr. A. w. Hunter Vice-President Secretary Dr. g. H. Clement Past President Dr. H. H. Milburn Treasurer Dr. A. B. Schinbein TRUSTEES Dr. W. F. Coy Dr. W. B. Burnett Representative to B. C. Medical Association Dr. A. J. MacLachlan SECTIONS Clinical Section DR. W. L. Pedlow Dr. F. N. Robertson ---... Physiological and Pathological Section Dr. G. F. Strong - Dr. C. H. Bastin Eye, Ear, Nose and Throat Section Dr. Colin Graham Dr. E. H. Saunders ...... Genito-Urinary Section Dr. g. s. Gordon - - - - Dr. J. A. E. Campbell Physiotherapy Section Dr. H. A. Barrett - - - Dr. H. R. Ross COMMITTEES Library Committee Dr. Wallace Wilson Dr. A. W. Bagnall Dr. w. D. Keith Dr. W. F. McKay Orchestra Committee Dr. F. N. Robertson Dr. J. A. Smith Dr. L. Macmillan Dr. A. M. Warner Dinner Committee Dr. g. F. Strong Dr. w. A. Dobson Dr. l. H. Appleby Dr. J. M. Pearson Auditor Dr. A. C. Frost Chairman Secretary Chairman Secretary Chairman Secretary Chairman Secretary Chairman Secretary Credit Bureau Committee Dr. Lachlan Macmillan Dr. J. w. Welch Dr. G. A. Lamont Credentials Committee Dr. Lyall Hodgins Dr. R. Crosby Dr. J. A. Sutherland Summer School Committee Dr. Alison Cumming Dr. Howard Spohn Dr. g. S. Gordon Dr. Murray Blair Dr. w. d. Keith Dr. G. F. Strong VANCOUVER MEDICAL ASSOCIATION. Founded 1898. Incorporated 1906. Programme of the 28th Annual Session GENERAL MEETINGS will be held on the first Tuesday of the month at 8 p.m. CLINICAL MEETINGS will be held on the third Tuesday of the month at 8 p.m. Place of Meeting will appear on Agenda. General Meetings will conform to the following order:— 8.00 p.m.-—Business as per Agenda. 9.00 p.m.—Paper of Evening. 1925. OCTOBER 6th- OCTOBER 20 th- NOVEMBER 3 rd- General Meeting. Presidential Address: Dr. J. A. GILLESPIE. "The Progress and Future of Medicine." Clinical Meeting. General Meeting. Paper: DR. HlBBERT WlNSLOW HlLL. "The Part Played by the Laboratory in Clinical Medicine." NOVEMBER 17th— Clinical Meeting. DECEMBER 1st- DECEMBER 15 th- 1926. JANUARY 5 th— JANUARY 19th— FEBRUARY 2nd— FEBRUARY 16 th— MARCH 2nd— MARCH 16 th— APRIL 6 th— APRIL 20th- General Meeting. Paper: DRS. WALLACE WILSON and LYALL HODGINS. "Intravenous Therapy." Clinical Meeting. General Meeting. Paper: DR. G. F. STRONG. "Cardiac Pain." Clinical Meeting. General Meeting. Papers: DR. J. TATE MASON, qf the Mason Clinic, Seattle. "Surgical Treatment of Thyroid Diseases." Dr. Lester J. PALMER, of the Mason Clinic. "Some Phases of the Diabetic Situation." DR. MASON will probably give a Clinic at the V.G.H. on the morning of Feb. 2nd. Clinical Meeting. General Meeting. The OSLER LECTURE. Dr. E. D. CARDER. Clinical Meeting. General Meeting. Urological Evening. DRS. B. H. CHAMPION, G. H Clement, G. S. Gordon, and A. W. Hunter, on "Problems in Urological Diseases." ANNUAL MEETING. Page Four I a "Snook-Special" Combination Diagnostic and Deep Therapy Apparatus for the specialized %-ray laboratory QuartzLamp tor Ultra-Vi- olet Therapy "Of all human ambitions an open mind eagerly expectant of new discoveries and ready to remold con- victions in the light of added knowledge and dispelled ignorances and misappre- hensions, is the noblest and the most difficult to achieve." —James Harvey Robinson in "The Humanizing of Knowledge" Point of View The Victor X'Ray Corporation owes its lead' ership in the manufacture of X'ray and phys' iotherapeutic apparatus to a point of view. This point of view recognizes the fact that roentgenology and physiotherapeutics are ever evolving new methods which must be reckoned with both by the physician and by the manu' facturer of medical apparatus. But what new methods are sufficiently advanced for accept' ance in practice the medical profession alone is competent to decide. Hence, while the Victor X'Ray Corporation keeps abreast of the progress made by medical re' search it introduces only such apparatus as open' minded physicians are convinced they need. Thus both medical progress and medical con' servatism dictate the character of the roent' genological and physiotherapeutic apparatus developed by the Victor X'Ray Corporation. Wantz Multiple Wave (generator for Sinusoidal and Qalvanic Therapy Let us advise with you in the selection ofX/tay equipment that best meets your individual requirements. If there is some phase of physiotherapy on whichyou would l.ke authoritazivereprinted articles, we have tfiem. You donrt obligate yourself to buy when writing us for suggestions or literature. Use the coupon below. VICTOR X-RAY CORPORATION Main. Office and Factory: 2012 Jackson Blvd., Chicago 33 Direct Branches—Not Agencies—Throughout U. S. and Canada . VANCOUVER BRANCH: 910 BIRKS BUILDING VICTOR X-RAY CORPORATION, Chicago Please send me information on X-ray apparatus for (.State range of service desired) Descriptive Bulletins and Clinical Reprints on: D Quartz Lamps D Sinusoidal Apparatus D Diathermy Apparatus D Galvanic Apparatus □ Phototherapy Lamps V (A-239-A) Nome. Address. City .State. EDITOR'S PAGE. We have been favoured by Dr. J. W. Mcintosh, M. O. H. for Burnaby, with a review of the present position of the scheme for co-operation in health affairs of a Greater Vancouver and vicinity. A recent meeting of representatives of these municipalities was held under the auspices of the Vancouver Board of Trade, at which resolutions favouring the establishment of such co-operation were passed. Dr. Mcintosh points out that the fields where such co-operation could be utilized are numerous. He shows that the interrelationship produced by the situation of Vancouver and neighboring municipalities is very great. Thus a child might live in one municipality, go to school in another, contract, say, scarlet fever, in a third, members of the family may work in one or more of the municipalities, and finally the only available hospital, we may presume, is in Vancouver. This means that the machinery of the several municipalities concerned has to be set in motion, work is increased and duplicated, much time is lost and the possibility of infection is greater. Again, left more or less to individual control, health standards may, and probably do, vary in different districts: one municipality may be more careless, another acting with vigour finds its work reduced in efficiency by the negligence of its neighbour. Dr. Mcintosh calls attention to the increase in the incidence of typhoid fever in Vancouver, nearly 80% of which cases during the last two years, we find on inquiry, were presumed to be in nonresidents of the city. So far as these were contracted in surrounding districts, it is obvious that proper measures of control (whether the conveyance be by water, milk or other foods, or by carriers) are difficult, under present conditions, to apply. Doubtless, also, the tuberculosis problem is one where municipal health co-operation would find a suitable justification, if such is needed, for its existence. Dr. Mcintosh provides us with some figures which are of interest. The estimated total population of the area in question, which appears to include everything between West and North Vancouver on the one hand, and the city of New Westminster on the other, is given as 237,000, of which Vancouver has 123,000, the remaining 114,000 being divided among the other districts. While on this estimate Vancouver has 52% of the population, its area only amounts to 7% of the whole, the remainder with 48% of the people having 93% of the land. Page Six In the nine municipalities in question, Dr. Mcintosh gives us as the figures for total health administration for 1924 (exclusive of hospital costs) $97,740.56, of which Vancouver contributed 77% and the rest 23%. A comparison of serious import is made between the cost of the other great spending departments and that for health purposes. Dr. Mcintosh, quoting the report of the Inspector of Municipalities, shows that from the year 1916 to the year 1924, on streets and roads there has been an increased expenditure of 61%, on fire protection 61%, on the administration of justice 55% (this sounds like a federal election speech), on schools 44%, while even the humble councillor has had his remuneration boosted 84%. But Dr. Mcintosh points out with all this expansion the expenditure on public health has not only had no increase, but has actually decreased 22%. If these figures are correct, it reveals a state of affairs which calls most urgently for co-operation if this is going to obtain for a matter of such vital importance as the health of the people, its proper share in the disbursements from the public purse. The per capita cost of health administration is very variable —ranging all the way from 61c in Vancouver and 45c in New Westminster, through 26c in Burnaby, 14c in North Vancouver city and Point Grey, to 8c-in the municipality of Richmond. It seems probable that some adjustment may be necessary here. While Vancouver will expect to do her share, and a very liberal share, to contribute 77°/0 of the cost with 52% of the population, seems to be stretching the interpretation of the word. Presumably inadequate supervision in health matters in surrounding districts may be partly responsible for Vancouver's excessive ratio of expense. We do not gather clearly from Dr. Mcintosh's communication whether it is the intention to combine all phases of health work under the proposed Union Board, or whether only the more general aspects of such work would come under its control. Probably at first the latter course might be adopted as a preliminary measure to accustom the various districts to the apparent sinking of their individuality. So far as we have studied the suggestion, it meets with our approval. As we have said before, Vancouver, and Greater Vancouver, are one and the same in the light of most public questions. Expediency and common sense should teach us that the sooner that fact is given practical effect the better. We might express our regret that the ideas of those interested in the proposed amalgamation had not been voiced in time to prevent the erection of the new Infectious Hospital on its present site. Such a scheme makes the location of the building appear Page Seven more unsuitable than ever, and greatly strengthens the arguments put forward by the medical profession in their opposition to it. * * * The annual dinner of the Vancouver Medical Association will be held on Nov. 5th, at 8 p.m., in the Ambassador Cafe. The committee in charge of arrangements is anxious that every member of our Association should make a special effort to be present on this occasion. * * * NEWS AND NOTES. The first meeting of the winter session of the Medical Association was held in the Auditorium, Willow Sts., on Tuesday, October 6th. Vancouver Tenth and The Dinner Committee elected last spring, having resigned, Dr. G. F. Strong was appointed chairman and authorized to reelect his own committee. A report was brought in by the Executive concerning the relations between the Vancouver Medical Association and the B. C. Medical Association, recommending that an endeavour be made to effect a working arrangement between these two Associations and the B. C. Medical Council, with the idea of centralizing the offices and lessening the overhead. A new committee was appointed by the Chair, consisting of Dr. J. M. Pearson. Dr. W. D. Brydone- Jack, Dr. A. W. Hunter and Dr. E. D. Carder, to go further into the matter and report back to the Association. The formation of a Physiotherapy Section was authorized by the meeting. Dr. D. G. Perry was elected a member of the Committee of the Credit Bureau, in place of Dr. J. W. Welch, whose term had expired. On the question of nominations for election to the Vancouver General Hospital Staff, a discussion arose, which was adjourned to be dealt with at a special meeting to be called by the Secretary. The Secretary of the Summer School reported a very successful session, and later the President was authorized to appoint a committee to bring in nominations to fill two vacancies on the Committee of the Summer School. The following were elected to membership in the Association: Dr. D. E. H. Cleveland. Dr. W. W. Bride and Dr. J. A. Mclver. Applications for membership were received from the following: Dr. J. W. Arbuckle, Dr. A. Y. McNair, Dr. H. R. Ross and Dr. W. F. Shaw. Dr. J. A. Gillespie delivered his Presidential Address, subject being "The Progress and Future of Medicine." the Page Eight A special meeting of the Association was held on Monday, the 12th October, to consider the question of Staff appointments to the Vancouver General Hospital. After considerable discussion, a committee consisting of Dr. H. H. Milburn, Dr. D. Freeze, Dr. A. S. Monro, Dr. Geo. Seldon and Dr. O. S.. Large, was appointed to go into the matter and report back to the Association at an early date. B. C. MEDICAL ASSOCIATION NEWS. A full Executive meeting of the B. C. Medical Association was held in Vancouver on October 15th, 1925, when several important matters were discussed. The first matter taken up was the question of closer cooperation between the various medical bodies now existing in British Columbia, with a view to increasing efficiency of the work done, and diminishing cost to the individual practitioner. Both the B. C. Medical Association and Vancouver Medical Association have been working on this problem during the past two or three months, and the Executive authorized the present Committee of the B. C. Medical Association to continue in office, add to its numbers, if necessary, and endeavour to develop a concrete plan to be submitted to the Executive, for their future action. It is felt that a great deal will depend upon any help the B. C. Medical Council may see fit to give us, in bringing about a solution to this question. In accordance with a previous resolution of the Executive, it has been decided to publish, herewith, comparative tables of cost of the work done by the Provincial Associations in the various provinces. So far, Alberta is the only province from which we have obtained a full statement, which is appended herewith, but other lists will doubtless be obtained from time to time. It may be noted that in Alberta the College of Physicians and Surgeons is amalgamated with the Provincial Association, and the place of our Executive Secretary is filled by Mr. Hunt, who is known as Assistant to the Registrar of the Council. Alberta. Assistant $3,600.00 Printing and Stationery 1,223.40 *Law Costs 2,507.56 Audit Rent Travelling Expenses. Interest and Exchange 65.00 240.00 839.04 34.02 British Columbia. Executive Secretary $3,600.00 Printing and Stationery 118.80 Audit 75.00 Office Rent 240.00 Travelling Expenses, Exec. Sec. 880.00 General 503.00 Stenographer 900.00 $8,509.02 $6,316.80 * Largely no doubt debited to Council. Page Nine A financial report was made by the Secretary - Treasurer, showing that the Association is solvent, and that membership is keeping up well. The Executive then received reports from its committees. Dr. Lennie, Chairman of the Industrial Service Committee, gave a report, dealing with various aspects of industrial medicine, notably, our relations with the Workmen's Compensation Board, with whose Chairman he reported a very satisfactory interview. The matter of Physio-Therapy was referred to, and negotiations are still proceeding with the Board, with a view to putting the question of who shall be recognized by the Board as doing this work, on a definite basis. The question of Lodge Practice was also brought up, and it was arranged that this matter should be gone into more thoroughly with the local medical societies. The Publicity and Educational Committee was reported on bv Dr. McNeill, the Chairman, who has done a great deal of work in the matter of laying out a plan of campaign for the coming months. A fuller account of the work of this Committee will be given as soon as a full report is available. The following gentlemen were elected to membership: Drs. H. Winslow Hill, Kingsley Terry, C. D. McBride, George F. Young, R. G. Large. The Executive had arranged for a luncheon to be held at which Dr. T. C. Routley, General Secretary of the Canadian Medical Association, was to have addressed us. Unfortunately, the dislocation of the steamship service, occasioned by the recent dense fogs, made it impossible for Dr. Routley to reach Vancouver before the evening, and the luncheon had to be cancelled. The subject of his address was to have been: "Extra Mural Post- Graduate Work in Canada," and it is greatly to be regretted that the Association as a whole has not had an opportunity to hear Dr. Routley on this matter. We will not give details of the scheme in this number of THE BULLETIN, but it is intended to publish in the next number a concise account of the whole plan, as outlined by Dr. Routley, and of our share in it. ^^ Page I en CITY HEALTH DEPARTMENT Vancouver, B. C. STATISTICS—SEPTEMBER, 1925 Total Population (estimated) 126,747 Asiatic Population (estimated) 9,960 Rate per 1000 of Pop. per Annum Total Deaths 114 10.9 Asiatic Deaths 13 15.9 Deaths—Residents only 80 7.7 Total Births—Male, 172 Female, 166 338 32.4 Stillbirths—not included in above 8 Infantile Mortality— Deaths under 1 year of age 9 Death Rate per 1000 Births 26.6 Cases of Contagious Diseases Reported August. September. October 1 to 15 Cases. Deaths. Cases. Deaths. Cases. Deaths Smallpox 6 1 2 0 0 0 Scarlet Fever 9 0 13 0 7 0 Diphtheria 9 4 2 0 10 2 Chicken-pox 8 0 5 0 16 0 Measles 0 0 10 10 Mumps 8 0 29 0 32 0 Erysipelas 4 0 2 0 2 1 Tuberculosis 10 8 11 11 3 0 Whooping Cough 6 0 9 0 10 Typhoid Fever 7 0 3 1 10 (Cases from outside city included in above.) Diphtheria 2 0 10 2 0 Smallpox 6 1 0 0 0 0 Scarlet Fever ..-. 10 7 0 10 Typhoid Fever 7 0 3 0 10 Page Eleven "PROGRESS AND FUTURE OF MEDICINE." Presidential Address of Dr. J. A. Gillespie, before the Vancouver Medical Association, at the first meeting of the Twenty-eighth Annual Session, October 6th, 1925. In his opening remarks Dr. Gillespie gave a brief sketch of the early days of medicine, touching, as he went, on some of the peaks which marked the progress of the art during the earlier part of its existence. Coming to later times, the lecturer proceeded: There is no more fascinating story in the history of science than the story of the progress of medicine during the last fifty years, which has ■been greater than in all the previous ages. In making an attempt to trace this progress, I find there is such a wide field to cover that it is impossible, in the time at my disposal, to give more than a short sketch of the principal advances in some of the branches of medicine. This progress is due to the discovery of the causes of disease and the use of methods of precision in diagnosis of disease, clinically and mechanically, due to the development of bacteriology and pathology, the perfection of the microscope and the invention of many other scientific instruments, the invention of laboratory methods and Roentgenology, etc., and the assistance of chemistry and the allied sciences. Progress of Bacteriology. In 1857 Pasteur discovered germ life in lactic acid fermentation, but it was not till 1876 and 1878 that Koch discovered organisms of anthrax and wound infection. From that date (less than fifty years ago) to the present has followed a series of discoveries, with bewildering rapidity, of the great majority of germ diseases, including typhoid, tuberculosis, malaria, syphilis, diphtheria, bubonic plague, down to scarlet fever and mumps. These discoveries have revolutionized the treatment of germ diseases and lowered the death rate enormously. One of the latest discoveries is that of Dr. W. E. Gye and Mr. J. E. Barnard, published in the Lancet, July, 1925, of a filterable virus of cancer, an organism spheroid in shape, previously non-visible, which they have cultured, and photographed by use of ultra violet light. This virus is not infective alone unless combined with a chemical "specific factor" which is present in the tumor and which they have isolated from the growths, but by the combination of virus and "specific factor" they have produced tumors of the same species. It would appear that this chemical substance must attack the cells before the organism can produce the disease. This opens the door to further research along an enormous front, for if these chemical "specific factors" can be isolated it offers a wonderful field for preventative measures, and will explain the causes of lessened resistance to infection in individuals and families' which we have called "Diathesis." It also offers a great hope for the discovery Page Twelve of other filterable viruses in such diseases as small-pox, measles, etc. Roentgenology. Roentgen made his first announcement in 1895, just thirty years ago, and yet to-day Roentgenology is established as one of the most valuable aids to diagnosis at our command, as well as being of great value in treatment and an inseparable helpmate to medicine and surgery. A radiologist to-day is one of the specialists of whose necessity or value there can be no question. Since its first adoption, advance has been wonderful, due to improvement in apparatus, tubes, intensifying screens, and in the technique, time of exposure, etc. I remember well the crude machines and methods in use over twenty years ago, when it was common to see exposures of five to even thirty minutes for skiagraphs, and burns were quite frequent. The improvement in fluoroscopy and use of stereoscopic images marked another advance. Then came the use of opaque contrast materials, as bismuth and barium, for the intestinal tract, and the silver salts and iodides for urological work; also its use for diagnosis of chest conditions, as tuberculosis, lung abscess, hypertrophied thymus, aneurysms, mediastinal tumors, etc.; in face and head conditions to diagnose obscure fractures, disease of the sinuses (mastoid, etc.), hypophyseal and brain tumours. Some recent advances have been: The visualizing of the gall bladder by intravenous and oral administration of tetrabrom-phenolphthalein; the method of "Rubin" of injecting air through the fallopian tubes in diagnosis of sterility and to render pelvic organs visible; the visualizing of brain ventricles by injection of air; in obstetrics the diagnosing of the position of the foetus at term and the presence of twins, monstrosities, etc.' It seems to me its more general use in obstetrics would be of considerable value in doubtful and difficult cases. There has also been a marked improvement in the diagnosis of bone disease. The use of the Roentgen ray and of radium in the treatment of malignant conditions, has marked another step in progress of great value, although it has not fulfilled all the hopes expected of it in this line. The use of X-rays in skin diseases and in gynaecological conditions, as fibroids and menstrual disturbances, has been a distinct gain in treatment. Anaesthetics. Morton first used ether in operations in 1846, but it was only after Lister's principles of antisepsis were accepted in surgery that anaesthetics came into general use, about 1880. Since that time the use of anaesthetics—general, spinal, regional, and local— has become so common for major and minor operations and obstetric work, that this might almost be called "the painless age." To-day the miracles of modern surgery would be impossible without modern anaesthesia. The marked advance in anaesthetics has Page Thirteen been in the greater safety and greater freedom from post-operative complications. There has been considerable improvement in the materials used, as well as in the apparatus and in the technique. The use of pharyngeal anaesthesia and suction apparatus in throat and head operations has been a distinct gain and a great help to the surgeon. The improvement in the use of nitrous oxide and oxygen machines, with the addition of ether or ethylene, has brought general anaesthesia close to perfection. However, there is still some room for improvement, and the ideal anaesthetic has yet to be discovered which will give one hundred per cent, safety with good relaxation of muscles and absence from nausea and postoperative complications. The enthusiasm which marked the introduction of spinal anaesthesia, which I well remember, over twenty years ago, has passed away, but with improved technique the objections to its use are being overcome, and spinal and regional anaesthesia are again coming into use, and are an invaluable addition to our anaesthetic armamentarium, especially in a certain class of cases. Internal Medicine. J The greatest advance in internal medicine has been in the improved ability to diagnose disease and the more rational and more scientific treatment. This has been due to the use of accumulated clinical knowledge, combined with all the extra aids to diagnosis. To-day the laboratory, with all its equipment, the X-ray, basal metabolism, electrocardiagraph, blood and spinal fluid examinations, etc., has made such short and easy cuts to diagnosis that it is feared by some the art of clinical diagnosis is in danger of being lost. I do not think there is much danger. If quicker and more accurate and scientific methods are available, why should we not take every advantage of them? Clinical methods of diagnosis may even tend to be improved when it is known we are being checked up by laboratory findings. What must be impressed on us more and more is that laboratory methods are only aids to diagnosis which must be tested by clinical findings, and our diagnosis made from all the combined information at our command. A number of years ago the statement was made by a prominent man that fifty per cent, of hospital cases were not correctly diagnosed. To-day, with the present methods in well-equipped hospitals, I think I am safe in saying that eighty to ninety per cent, of cases are being correctly diagnosed after careful study. The most outstanding discovery in medicine has been that of the internal secretions and the functions of the ductless glands. Attention was celled to the action of ductless glands by Claude Bernard and Addison, but it was not till the latter third of the nineteenth century that any real progress was made. Since then the functions of thyroid, parathyroid, pituitary, adrenal, pan- cieatic and other glands have been discovered and gland extracts and preparations, as pituitrin, adrenalin, and insulin, made avail- Page Fourteen able, which have been of wonderful value in treatment. No greater miracles have been performed than those wrought by thyroid in cretinism, or insulin in diabetes. The proofs of the interaction of these gland secretions, and their effect on disorders of metabolism, has been a fairly recent advance. It is a source of pride that one of the greatest of these discoveries (insulin) was made by Canadians, Drs. McLeod and Banting. It is also interesting that a recent discovery has been made by other Canadians, Drs. McDonald, James, and Laughton, in Ontario, to the effect that there is present in liver extracts a certain chemical substance which has the effect of markedly lowering blood pressure over long periods of time. This promises to be a discovery of considerable value. The recent discoveries of the different vitamines, and their effect on nutritional diseases, has also been a step in advance. I will only mention another advance in therapeutic measures. The use of intravenous therapy and blood transfusions. This will be subject of a paper in the near future. The use of serums and vaccines may be considered an advance; some of them have proved of value, but I think they are still somewhat on probation. In preventive medicine and the treatment of infectious diseases the progress has been simply revolutionary. To do justice to it would almost require a paper on this subject alone. The foundation was laid by the discoveries of bacteriology, as already mentioned, combined with the study of entomology along with animal experimentation, pathology and laboratory methods. The wonderful experimental and detective work by the men who discovered that insects were the carriers of disease, when the louse and the flea, the mosquito and the fly, were traced as the culprits in the spread of many of these diseases, makes very interesting reading. Fifty years ago the infectious diseases played havoc in all countries and among all races, practically uncontrolled with the exception of small-pox, which was being successfully checked by vaccination, owing to the work of Jenner. Plague and cholera, malaria and yellow fever, typhus and typhoid, tuberculosis and diphtheria, venereal diseases and septicaemia, demanded their fearful toll of millions of the human race, sometimes yearly. Today they are practically all under control, and some of them have been almost completely eradicated from civilized countries. If the knowledge which we have of the prevention and cure of these diseases could be properly applied, the results would be even greater. In our own land, typhoid is now a rare disease compared to what it was in our student days, when the wards of our hospitals were full of cases. Tuberculosis is being gradually brought under control and the death rate reduced very materially. That the.nations of the world are fully aware of the value of preventative medicine is shown by the fact that there is a health committee of the League of Nations which keeps itself informed of the prevalance of epi- Page Fifteen demic diseases in different part of the world, and takes measures to prevent their spread. A year or so ago they voted two million dollars to prevent spread of typhus from Russia and Europe. Probably one of the reasons for the formation of the committee was the demonstration to the nations of the remarkable results of preventative medicine during the Great War and during the building of the Panama Canal. In the treatment of some of these preventable diseases there has also been great progress, notably, in malaria and tuberculosis, diphtheria and syphilis. In syphilis the use of the Wasserman test in diagnosis, and the use of the arsenical preparations, along with mercury and- iodides, and quite recently bismuth, has been a wonderful advance. In diphtheria the result of antitoxin treatment has been almost miraculous. Treatment by antitoxin began about twenty-five years ago. During these years the death rate has been lowered from forty per cent, to about seven per cent. The change in recent years from small to large doses has lowered the death rate materially, and the statement is made that if large doses of antitoxin were used when first diagnosed, both intravenously and subcutaneously, the death rate could be reduced to less than one per cent. Surgery. It is in the realm of surgery that the progress has been so spectacular, and the "miracles of modern surgery" are largely responsible for bringing the medical profession into greater prominence during the last ten or fifteen years. Surgery, at the time of Lister, compared to the surgery of to-day, is as a new-born babe compared to an adult man. Lister's original paper was given in the Lancet in 1867, but it was some years before his teaching became generally accepted and his principle of antisepsis acted upon. It is almost beyond the power of the present generation to realize that forty-five years ago surgery was only an infant in swaddling clothes. Few surgeons had ever seen a pathological organism, as Koch only announced his discovery of organisms of wound infection in 1878. Previous to this time, although anaesthetics had been used for some years, surgeons were afraid to operate. It was an unusual thing for a wound to heal without pus formation. Practically all wounds, traumatic and operative, suppurated; and erysipelas, septicaemia, and puerperal fever were common and often spread through whole hospital wards. The operative mortality was very high, most operations on the upper abdomen were fatal, and cerebral surgery and chest surgery, as well as many other branches of surgery done regularly to-day, were hardly dreamed of. However, with the adoption of the principles of antisepsis, with the development of bacteriology and pathology, and with all the improvements in sterilization and in diagnosis, and in methods of operating, and in instruments, the progress has been phenomenal. Asepsis has taken the place of antisepsis; technique has been simplified and improved; modern Page Sixteen hospitals have been equipped with efficient sterilizing apparatus, and nurses are specially trained in surgical technique, until to-day thousands of major operations of all sorts are done daily all over the civilized world with comparative safety and a great measure of success. The immense amount of surgical work done can hardly be appreciated. Last year, in Vancouver hospitals, about ten thousand operations were performed. If the same per cent, to population was done in other hospitals on this continent, there were between nine and ten million operations done last year on the North American continent alone. To-day any trained surgeon can open the abdomen and do major surgery in our modern Class "A" hospitals, with little fear of sepsis. Operative wound infections are rare, and the per cent, mortality in all branches of major surgery, with good operators, is between one and five per cent. The realm of surgery to-day is so great and embraces so many different departments, that it would be impossible to trace the progress, excepting in a very general way, in a paper of this sort. I can only briefly mention some of the important advances that I have noticed during the last twenty to twenty-five years. There has been a wonderful improvement in technique and in the practice of the principles of asepsis. Doctors are trained to-day to have an aseptic conscience. Rubber gloves were just beginning to be worn as a routine measure then. No operation is performed without them to-day, and this same principle of thorough asepsis is carried through all surgical technique. In recent years a great deal of absolutely new work has been done. These are only a few of the lines in which progress has been made. I have not time to mention many other branches, such as: Diseases of children, neurology, eye, ear, nose and throat work, etc., psycho-therapy, heliotherapy, and many other therapy's. I can simply say there has been improvement and much new work in practically all of these. Results of our progress on the human race can hardly be estimated. Osier says: "The average working life of the English speaking man has been doubled and the age of life expectancy lengthened ten to fifteen years, while the blessings to the whole race, but especially to child life, old age, and to the female sex, have been immeasurable." What of the future? We have made great progress in the last fifty years, but we need not pride ourselves that we know it all. We have much yet to learn. I can hardly say there are many unexplored fields, but I can say: there is room for much progress yet in some lines. "Knowledge is proud that she has learned so much. Wisdom is humble that there is so much yet to know." There are two' or three lines in which I see hopes of much progress. One is in the realm of blood chemistry and biochemistry. The progress in the future will, I believe, be largely along that line of laboratory work, as the study is just in its infancy, al- Page Seventeen though clinical research is also needed. Another line is that of psycho-therapy. Although the study of mental processes has made an advance, and there has been a lot of work done in psychology during and since the Great War, still the medical man's lack of knowledge of psychology and psycho therapeutics is simply scandalous. Our treatment to-day of the neurotic and of the functional neuroses is neither scientific nor sensible. As a rule 'we examine him and find no pathology as we know pathology. We say, "O there is nothing the matter with you. It is only your nerves and your imagination. Forget it, we can't do much for you," and we send him off. He goes to the quack, the chiropractor or sano- practor, or Christian Scientist or unchristian scientist who knows more practical psychology than we do, and we later hear that he has been wonderfully cured, of what we said was nothing, but what he felt was a great ailment. There is nothing more amusing in the history of medicine than the cures (real cures too often) that have been accomplished from the time of the Egyptians to the present day, from the days of the oracles to the time of Coue- ism. Perkins' tractors and animal magnetism, and sympathetic powders and electric belts, and other faith methods, have all been equally successful, and the twentieth century shows the same proneness to be cured by anything that acts on the mind rather than the body. It is interesting to read of these methods in J. Walsh's book, "Cures." As we have gone on in practice, we have found that much of the good we have done has been by our suggestions rather than our drugs. Practically all that we older men know of psychology and suggestion has been rubbed into us by observation and hard knocks, and I do not see that the younger men are getting any more training than we did. I do not think that as a profession we have made much progress in this line since the days of the ancients, and I can see a wonderful field for progress by a scientific study of mental processes and practical methods of treatment. One line which I can only mention to-day is the lack of progress in the medical education of the public. The standing of the medical profession to-day with the public is nothing like what it should be, and the fault is largely our own. Little knowledge of the facts, we know, are in the possession of even the so-called educated public. One of the continuous surprises of my life is to find the little knowledge, even intelligent people display, of the body and its functions. One of our great tasks to-day is to give the public some of this knowledge. They need it for their own protection against all the quacks and charlatans who prey on the public to-day. It is the duty of medical men, through public speaking (of which most men seem to be afraid) and of pur medical societies, to educate the people and get more medical facts into school education. With our progress have also come our problems. We have many which I cannot attempt to solve. One is the problem of Page Eighteen the specialist and the general practitioner. Specialism is growing by leaps and bounds, and it is only rational that it should. One head cannot hold all the knowledge of medicine to-day, but the general practitioner is being put in the background. Is he to become the clearing house for the specialist, the carrier of grist to his mill, content with a laborer's wage, while the specialist operates with a spectacular flourish and collects a big fee? What is the solution of this problem? In Vancouver to-day there are about 33 per cent, of the profession specialists, some of the Simon pure variety, and some of the mixed hybrid type, and the number is increasing daily. There is a widespread desire to practice some form of specialty. Perhaps the solution is for every general practitioner to also have a specialty of some line. This is done in some places with success. Another solution is group medicine, and another is that the general practitioner and men in internal medicine must increase their fees, which, in my opinion, are not adequate for the work done, or it may be that a rational and workable form of health insurance will help the solution of this problem. Another problem which we seem to have always with us, and which does not seem to be much lessened in spite of the progress we have made, is that of the fads and cults, the irregular practitioner and the quack, who carry on their business generally contrary to the laws of our land, and continue to fleece the public often undisturbed by the powers that be. They have appropriated the name of "doctor" because that name has always carried with it the idea of scientific knowledge and is a name that carries influence and prestige. At present in our province any old "corn parer" or "spine jarrer" can tack "doctor" to his name, and the general public, in many cases, has not sufficient knowledge to differentiate between the irregular and the qualified man, unless it is impressed on them when they need a death certificate signed or some evidence in the courts. A very good suggestion, which is done in some places, and which would be for the protection of the public, is to have a law passed making it illegal for the name of "doctor" to be used by anyone who is not a graduate of a recognized medical or dental college, or unless he has had the degree conferred on him as a recognized university degree. This might help the public to tell the difference. However, I think that this problem would solve itself largely if the public were educated to the necessity of scientific medical diagnosis by the publicity programme, as I have before suggested. I am not afraid of the future of the medical profession, and as far as I have been able to ascertain from medical history, even from the Greek age down, there were irregulars, and Sydenham, in the seventeenth century, complains of all the quacks who attempt to treat the public, and I think it is no worse now than it ever has been. Fads may come and fads may go, but the regular recognized medical profession will go on forever, because, more especially due to the progress of the last fifty years, it is now a definite science founded on the rock of truth and the solid foundation- of proven facts. Page Nineteen rfi Referring again to the question of specialism, I think it will be a bad day for medicine when the day of the well-trained medical practitioner is past (if it ever happens). He is the man who has to meet the public, the man to whom the public look for advice and guidance in their sickness, and even for his opinion as to the need of a specialist. The reason for the esteem in which the profession is held to-day is only partly due to our knowledge and skill, but mostly due to the character of the men in our profession in the past. The old genial family practitioner with his sterling character and his human qualities, has done more to make the profession of medcine honored than all our advance in knowledge— Men of the type of Ian McLaren's old Dr. McClure, or our Canadian poet, Dr. W. H. Drummond's character, "Le Docteur Fiset," "De ole fashion kin'," Who don't mak much monee; Doin' good was de only ting on hees min', So he got no use for de politique." We all know that the practice of medicine to-day is not an easy life. It is a hard life and the financial returns are not commensurate with the time spent on education and the work we do (sometimes twenty-four hours' duty along with considerable physical and mental strain, if one takes any interest in one's patients) . If a young man to-day has not high ideals and cannot look past the financial side and the desire for wealth, I do not think the profession of medicine offers him a chance of "getting rich quick." However, it has always been called "a noble profession" and has •contained men of the highest character, and all our experience tells us that men without high character in our profession (of which, fortunately, we have very few) go to the wall sooner or later. We have all seen examples of this. However, there are compensations in the medical life, and there is no profession that has the same opportunities for service and for doing a bit of good in the world. Not even the clerical profession, because medical men are brought closer into touch with the lives of the people than any other class, and understand better their weaknesses and their need of help and sympathy. So if one wishes for an opportunity to do service to his fellow men, there is still lots of room in the ranks of the medical profession. Some of us have been a long time in the profession, many of us twenty-five years or more. I myself have been nearly twenty-five years, and I notice many grey heads among Vancouver medical men. We have lived busy lives, and the day may come to some of us soon when we will have to lay down our tools, but if we have tried to "play the game" squarely and to do what good we could in our humble way, we shall go down at least honored if not rich. In the words of the poet: "We shall rest, and faith we shall need it, Lie down for an aeon or two; Till the Master of all good workmen Shall set us to work anew." Page Twenty HEAD INJURIES. Dr. H. W. Riggs. The importance of head injuries lies in the fact that the skull contents are of such soft, yielding structure. The skull cap itself may be severely injured; multiple fractures with or without an open wound, depressed areas of both tables, or of inner table only, or, only a linear fracture, are evidence of the severity of the force producing the injury. Yet the degree of skull injury is not necessarily in direct ratio to the vital effect on the skull contents. This is demonstrated by the X-rays, which show a closed linear fracture with symptoms of concussion, which are of short duration and the patient is ready for duty in a few days, while another linear fracture may result in the death of the patient. A large compound radiating fracture of the vault may result in recovery, while a linear radiating fracture of the base causes death. Yet in a large series of cases it may be said, with certain reservations, that the more severe the injury to the bone, the greater the damage to the contents. However, from the clinical standpoint, the fracture (excepting the compound or depressed variety) is only the concomitant circumstance in a case of brain injury. The lines of treatment are guided by the symptoms resulting from the latter. In considering these it is interesting to note that such dissimilar diseases as tumours, inflammations, hydrocephalus and concussions, have such similar manifestations, as slowing of pulse, vomiting, headache, changes in respiration, in B. P., disturbances of consciousness and pupillary changes. This points to similar mechanical or chemical effects upon the same portions of the brain. When we begin to seek the explanation of these similar effects we must go back to the embryological development. The vital centres which first make their appearance in the neural development are found in what later become the basal ganglia. As seen in the lower forms of life, these are all that is necessary for the continuance of life. As the expression of power increases, it is found that there is a corresponding development of the cerebrum. So when we consider the parts of the brain involved in any injury we find that much damage may be done to the cerebrum without causing damage to the vital centres, which are in the basal ganglia- pons and medulla. War experiences have substantiated this, in the number of cases where severe injuries, with even loss of brain tissue, have occurred and the patient has survived—possibly with loss of power, but still alive. On the other hand, any severe injury to the medulla, or pons, has been followed by death. The results of injury to the brain tissue are lacerations, haemorrhage, and oedema. The effect of these will vary with the location. For instance, a severe laceration with haemorrhage occurring in the frontal lobe, is quite compatible with consciousness, while the same lesion at the base of the brain results in unconsciousness and rapid death. Page Twenty-one In recent literature much has been written regarding cerebral pressure in head injuries. In this connection it is interesting to recall Breslauer's experiments as to consciousness. He found that pressure on the cortex did not cause loss of consciousness, but that it did occur with great regularity when there was pressure on the posterior fossa, particularly around the medulla oblongata. It was also shown that the disturbances in circulation and respiration are due to pressure at the part. If these results are valid, then the amount of pressure on the cerebrum is not of such immediate importance in dealing with head injuries. It means that as far as the ultimate outcome of life is concerned, it is the pressure on the posterior fossa which counts. Pressure over the cerebrum only becomes dangerous to life when, through venous congestion or spreading oedema, the centres in the medulla are interfered with. The pressure on the medulla may be due to haemorrhage from injury to brain tissue, as the cerebellum, or, again, the injury may be severe enough to cause more or less extensive haemorrhages in the medulla and pons. These, of course, mean not only pressure but destruction of tissue. Even where there has not been manifest haemorrhage there is a resulting oedema. This is probably the result of mechanical injury to the medulla at the time of the blow, caused by being driven against the border of the foramen magnum, or it may be hydrostatic— from the sudden changes in the shape of the skull under the force hitting it. In any case, it seems as if the condition of pons or medulla were of chief concern following any injury. Corroborative of the above conclusions are the clinical course and the pathological findings in head injury cases. As a rule it will be noted that the cases which have blows to the side of the head run a more favourable course. True, unconsciousness occurs, and there is some disturbance of respiration and circulation, but never of a serious nature unless there is haermorrhage at the base of the brain, which may involve the posterior fossa. On the other hand, antero-posterior blows give very serious results, either from direct injury or by contrecoup to the parts contained in that fossa. An interesting case, illustrative of this, is the following: Mrs. H., age 60, brought into hospital with a head injury, the result of being knocked down by a motor. There were signs of injury to the right occiput. She was conscious when she arrived at hospital. Pulse was 60, respiration 20. After one hour she became unconscious with increase of respiration and weak pulse, and died within five hours. At autopsy there was found a linear fracture running vertically through the occipital bone on the right side—to the foramen magnum. There was an extensive laceration and destruction of tissue at the left frontal lobe, with considerable haemorrhage subdurally over the left hemisphere. But probably more significant were the small haemorrhages in the pons and upper part of the medulla. Page Twenty-two That death in this case was not due to pressure from the haemorrhage in the cerebrum, may be inferred when we consider the amount of pressure which exists in an extra dural middle meningeal haemorrhage, and the patient still lives. I do not wish to minimize the question of pressure, but to show that it is primarily not pressure on the cerebrum, but pressure or injury to the medulla and pons which kills, as I believe this view has some influence on treatment. However, before dealing with the question of treatment, I wish to emphasize the necessity of a careful and frequent examination of the patient from the time he first comes under observation. The condition of pulse, respiration, and pupillary changes, should be recorded at least every hour. The question of blood pressure is a debatable one. Personally I have never found any advantage from the taking of it, but still have it done as a matter of routine. As soon as the symptoms of shock, if such exist, are over, the spinal fluid pressure should be taken, and if there is any change later in consciousness, pulse or respiration, it should be again taken. In the early stages of the case the examination of the eye fundus does not give any help. In some cases, after 48 hours, or even later, there may be signs of congestion which are corroborative of other signs of pressure and may indicate the side most involved. In regard to treatment, it follows from descriptions of pathology that the main line is to reduce pressure on the posterior fossa. Daily spinal puncture with withdrawal of 10-15 cc. of fluid may assist, although from experiments on healthy individuals the withdrawal of fluid is followed in a short time by reaccumulation. Probably more effectual is the withholding of fluids by mouth, and the frequent administration of concentrated magnesium sulphate solution. This will tend to prevent the accumulation of spinal fluid, and of oedema in the brain tissue. It may also tend to the absorption of the diffused blood. If, in spite of the above, the cerebral pressure as indicated by the spinal manometer, is still high, i. e., above 20 m.m. with definite pressure symptoms, there must be a decompression done. If the injury has been an antero-posterior one, I believe an occipital decompression to be more effective than a subtemporal. Possibly in some cases both forms would be indicated, certainly I believe much more effective than a bilateral subtemporal. In spite of all that can be done, many will die, because the blow has so disturbed the brain cells, or caused haemorrhages and pressure in the vital centres that no form of treatment will avail, but in cases where pressure is continuously higher than normal the above line of treatment is indicated, and will result in an increasing number of patients recovering, because close attention has been paid to the question of pressure. Page Twenty-three THE UNIVERSAL CAR housands of Medical men from coast to coast are finding in the FORD closed car the solution of their transportation problem from the standpoints of ECONOMY, COMFORT and SERVICE. WHY NOT YOU? We offer you a 24 hour shop service. Leave your car at night and it will be ready in the morning. 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Page Twenty-seven Prescription Service'—- Jj That merits your confidence. Free Delivery Service anywhere in the city from 8 a. m. to 11 p. m. Distributors: Mulford's Biologicals Fraisse Serum Capitola Pharmacy LtcL (FRED G. BROWN) Seymour 158 New Address: Davie and Bute Sts. Nearly A CENTURY OF SERVICE The STEVENS Companies have supplied four generations with HIGHEST GRADE SURGICAL INSTRUMENTS STEVENS English Hand-Made OPERATING KNIVES of finely tempered surgical steel are warranted to give long and satisfactory service. Special prices during run of this advertisement. Write for quotations B. C. STEVENS CO., LTD., 730 Richards Street Page Twenty-eight Frost's Pharmacy LtcL (Gordon Frost) C*J> Bayview 540 Bay view 1720 C+J> GRANVILLE ST. AT TWELFTH AVE. The Owl Drug Co., Ltd. Jti\\ prescriptions dispensed bn qualified Druggists. l]ou can depend on the Ou»l for Jlccuracu and despatch. IDe deliuer free of charge. 5 Stores, cenlrally located. We would appreciate a call while in our territory. Ambulance Service TELEPHONE Fair. 58 & 59 M.ount Pleasant Undertaking Co. Ltd. R. F. Harrison W. E. Reynolds Cor. Kingsway and Main Page Twenty-nine -4 Silver Foxes For Sale We have stilt a limited number of Selected Breeders from best Prince Edward Island Strains Buy from men who know. Price and literature on application. Owners: DRS. CHAMPION AND DUNBAR (Two ranchers in B. C.) B. C. Silver Fox Breeders Ltd. 327 Vancouver Block, Vancouver, B. C. Nurses' Central Directory Phone Fairmont 5170 Day and Night Hourly, Institutional and Private Nurses Supplied Registrar-Miss Archibald, R. N. 601 13th Ave. West, Vancouver I Patronize the BULLETIN advertisers. Orthopedic Appliances Extensions for short limbs, Trusses, Arch Supports Abdominal Belts, Sacroiliac Supports and Artificial Limbs, manufactured and made by Experts and guaranteed by A, Lundberg Co. 938 Pender Street West Vancouver, B. C. Page Thirty Our ^Advertisers Use this journal for the purpose of procuring business from the Medical Profession. Are you assisting in the publication of The Bulletin by patronizing our advertisers? C^R S?^> Page Thirty-one «@^- Hollywood Sanitarium ^or the treatment of Alcoholic, Nervous and Psychopathic Cases Exclusively Reference ~ <\\B. Q. cPttedical ^Association For information apply to Medical Superintendent, New Westminster, B. C. or 515 Birks Building, Vancouver Seymour 4183 Westminster 288 =K3V Page Thirty-two"""@en ; edm:hasType "Periodicals"@en ; dcterms:identifier "W1 .VA625"@en, "W1_VA625_1925_11"@en ; edm:isShownAt "10.14288/1.0214354"@en ; dcterms:language "English"@en ; edm:provider "Vancouver : University of British Columbia Library"@en ; dcterms:publisher "Vancouver, B.C. : McBeath Spedding Limited"@en ; dcterms:rights "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 ; dcterms:source "Original Format: University of British Columbia. Library. Woodward Library Memorial Room. W1 .VA625"@en ; dcterms:subject "Medicine--Periodicals"@en ; dcterms:title "The Vancouver Medical Association Bulletin: November, 1925"@en ; dcterms:type "Text"@en .