@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 "1942-01"@en ; dcterms:issued "2015-01-29"@en, "1942-01"@en ; edm:aggregatedCHO "https://open.library.ubc.ca/collections/vma/items/1.0214367/source.json"@en ; dc:format "image/jpeg"@en ; skos:note """ TheteULLETIM of the 1 BVANCOUVER 1 MEDICAL ASSOCIATION Vol. xvni JANUARY, 1942 With Which Is Incorporated Transactions of the Victoria Medical Society the Vancouver General Hospital and &f. Paul's Hospital No. 4- m tip In This Issued ft Page NEWS AND NOTES jjj Jgl06 REGULATIONS—ELECTRO-MEDICAL EQUIPMENT^-^L ffifi*13 ||N[lIGHTER VKTN Ij i —- "#- I 117 STERILITY IN THE FEMALE . /. . ... "fg I . r&jW -M119 EXTRUSION OF INTERVERTEBRAL DISC. || ^fa;125 CASE HISTORY HT?PORT MMPPl flH ^Kl27 it »* I *J*I- ■« i3 &$u? \\t Mm :. it ■ - -' •iSti m\\ &i '1. '!* ■ '■ft .«.• itfl h* %.*. t - m if- Si # *•* i ** '■ ! '• V * n 11 llttl V» 1 ii 1H t Ll' I •»T Hi I •"*' ill !i-! !.- 'ii i* n *Mi it 111 Hi *Dr. Noah D. Fabricant says: "For the most part, 1 find that the pH of nasal secretions in situ during an attack of acute rhinitis or of acute rhino- stnusitis is alkaline—the secretions are more alkaline than normal. This finding has clinical significance, for those . nasal vasoconstrictors which can lower the nasal pH from an abnormal alkaline status to a desirably normal acid status may perform a valuable function." "It is therefore suggested that during an attack of acute rhinitis or acute rhinosi- nusitis the employment of a nasal vasoconstrictor which lowers the alkaline pH to a level between 5.5 and 6.$.—approximating the normal pH status of nasal secretions in situ—is most desirable." •k Noah D. Fabricant, M.D. of Chicago, received the Casselberry Award of the American Laryngological Association for 1941 for the most outstanding nose and throat study of the year. Aquaphedrin—E.B.S. is more effective ... because it is an aqueous isotonic solution of ephedrine. Here is a stable aqueous solution of Ephedrine and being aqueous, Aquaphedrin rapidly diffuses into the natural secretions of the nasal mucosa, without inhibiting ciliary action. Being isotonic, it diffuses rapidly and without osmosis, thus producing more effective absorption of Ephedrine, and permitting it to exert its unique decongestive effect. ' Unlike most Ephedrine solutions, Aquaphedrin E.B.S. is effective without stinging and its application is followed by grateful relief. This freedom .from irritation is achieved both by isotonicity of the solution, and by buffering to a pH approximating that of the nasal mucosa. The pH is so adjusted that, although the solution is not irritating, it conforms with the recent discovery that a slightly acid reaction is much more effective in the treatment of colds and sinus conditions. Aquaphedrin is effective in reducing swollen or congested turbinates and in relieving congestion of the mucous lining in head colds, nasapharyngeal inflammation, sinus blockage, hay fever, asthma and other nasal conditions. AQUAPHEDRIN E.B.S. is packaged in %-oz. and 1-oz. dropper bottles, with detachable labels for convenience in dispensing. Also supplied in bulk for use in an atomizer. E.B.S. alSO Of f GTS for those who prefer it: Phedronol Inhalant E.B.S.—A 1% Solution of Ephedrine Alkaloid in a bland neutral oil, and Phedronol Jelly E.B.S.—Ephedrine.37%,Chlorbutanol .8.2%, combined with Menthol and Sodium Chloride in correct proportions for the reduction of congestion. EQUIVALENT TO A ONI PERCENT SOLUTION OFl EPHEDRINE ALKALOID Specify E.B.S. Preparations on your Prescriptions I THE E. B. SKyTTLEWORTH SCNEMICAI (^LIMITED TORONTO MANUFACTURING CHEMISTS CANADA B-t. iH THE VANCOUVER MEDICAL ASSOCIATION BULLETIN Published Monthly under the Auspices of the Vancouver Medical Association in the interests of the Medical Profession. Offices: 203 Medical- Dental Building, Georgia Street, Vancouver, B. C. EDITORIAL BOARD: Db. J. H. MacDermot Db. O. A. Davidson Db. D. E. H. Cleveland All communications to be addressed to the Editor at the above address. . »»? \\ Vol. XVIII. JANUARY, 1942 No. 4 OFFICERS, 1941-1942 Db. G. McDiabmid Db. J. R. Neilson Db. D. F. Busteed President Vice-President Past President Db. W. T. Lockhabt Db. A. E. Tbites Hon. Treasurer Hon. Secretary Additional Members of Executive; Db. Gobdon Burke, Db. Fbank Tubnbull TRUSTEES Db. F. Bbodie Db. J. A. Gillespie Db. W. L. Pedlow Auditors: Messbs. Plommeb, Whiting & Co. SECTIONS Clinical Section Db. Ross Davidson Chairman Db. D. A. Steele:— Secretary Eye, Ear, Nose and Throat Db. A. R. Anthony Chairman Db. C. E. Davies Secretary Pediatric Section Db. G. O. Matthews Chairman Db. J. H. B. Gbant Secretary STANDING COMMITTEES Library: Db. F. J. Bulleb, Db. D. E. H. Cleveland, Db. J. R. Davies, Db. A. Bagnall, Db. A. B. Manson, Db. B. J. Habbison Publications: Db. J. H. MacDebmot, Db. D. E. H. Cleveland, Db. G. A. Davidson. Summer School: Db. H. H. Caple, Db. J. E. Habbison, Db. H. H. Hatfield, Db. Howabd Spohn, Db. W. L. Gbaham, Db. J. C. Thomas Credentials: Db. A. W. Hunteb, Db. W: L. Pedlow, Db. A. T. Henby V. O. N. Advisory Board: Db. W. C. Walsh, Db. R. E. McKechnie II., Db. L. W. McNutt. Metropolitan Health Board Advisory Committee: Db. W. D. Patton, Db. W. D. Kennedy, Db. G. A. Lamont. Greater Vancouver Health League Representatives: Db. R. A. Wilson, Db. Wallace Cobubn. Representative to B. C. Medical Association: Db. D. F. Busteed. Sickness and Benevolent Fund: The President—The Trustees. * ;•'. :■<* i m ):.«. Hn t* k III m i f i Ii! if W y*'n * c- ci j.*1 :* * 1 The five synthetic factors of the B-Complex — in Therapeutic quantities — in a small capsule your, patients can swallow. Each Syntheplex-B Microcap contains 1 mg. Thiamine Hydrochloride, 1 mg. Riboflavin, 0.5 mg. Pyridoxine, 0.5 mg. Calcium Pantothenate, 10 mg. Nicotinic Acid. N.B. 1 mg.= 1000 micrograms = 1000 gammas. When prescribing B-Complex preparations,specify SQUIBB. For literature on B-Complex therapy write: 36 Caledonia Road, Toronto, Ontario ♦Microcaps and Syntheplex-B are registered trade marks. E-R:Squibb & Sons of Canada, Ltd. MANUFACTURING CHEMISTS TO THE MEDICAL PROFESSION SINCE 1858 4 VANCOUVER HEALTH DEPARTMENT STATISTICS—NOVEMBER, 1941 Total Population—estimated , ,. 272,352 Japanese Population—estimated . ] ■ 8,769 Chinese Population—estimated 8,558 Hindu Population—estimated 360 Rate per 1,000 Number Population Total deaths 254 11.3 Japanese deaths 7 9.7 Chinese deaths 12 17.1 Deaths—residents only 1 218 9.7 BIRTH REGISTRATIONS: Male, 227; Female, 215- 442 INFANTILE MORTALITY: Nov., 1941 Deaths under one year of age 16 Death rate—per 1,000 births 36.2 Stillbirths (not included in above) 10 19.7 Nov., 1940 14 37.3 5 CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY October, 1941 Cases Deaths November, 1941 Cases Deaths Dec. 1-15,1941 Cases Deaths [Scarlet Fever 15 Diphtheria , 0 | Chicken Pox . 107 [Measles 4 Rubella 2 [Mumps 23 Whooping Cough 5 Typhoid Fever 0 Undulant Fever 0 Poliomyelitis 1 Tuberculosis 25 [Erysipelas 1 [Meningococcus Meningitis 0 [Paratyphoid Fever 5 | Flexner Dysentery 0 Syphilis Gonorrhoea V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH, DIVISION OF VENEREAL DISEASE CONTROL West North Vane. Hospitals & Burnaby Vancr. Richmond Vancr. Clinic Private Drs. Totals 0 0 0 2 16 27 45 0 0 0 0 80 28 108 ««i ft' A DYNAMIC MENTAL AND PHYSICAL TONIC INDICATED IN THESE DAYS OF STRESS << A " BIOGLAN "A Another Product of the Bioglan Laboratories, Hertford, England Phone MA. 4027 Stanley N. Bayne, Representative 1432 MEDICAL-DENTAL BUILDING Descriptive Literature on Request THE SCIENTIFIC HORMONE TREATMENT Vancouver, B. C. •>*■ # V • >. IrJi •M i I*' ii Page 103 tn . otf Lil- ti W i Ml it I! i w*t ki * an- *: »i *>' I 4\\ in! I'm i Pi r *HI i * — an ideal adjuvant in Respiratory Congestions Sample and literature on request The Denver Chemical Mfg. Co. - 153 Lagauchetiere St. W., Montreal Made in Canada •«r * VANCOUVER MEDICAL ASSOCIATION Founded 1898 Incorporated 1906 Programme of the Forty-fourth Annual Session (Winter Session) GENERAL MEETINGS will be held on the first Tuesday of the month at 8:00 p.m. CLINICAL MEETINGS will be held on the third Tuesday of the month at 8:00 p.m. Place of meeting will appear on the Agenda. General meetings will conform to the following order: 8:00 p.m.—Business as per Agenda. 9:00 p.m.—Papers of the evening. 1942 January 6—GENERAL MEETING. Dr. F. N. Robertson: "A Simple Test for Cancer." January 20—CLINICAL MEETING. February 3—GENERAL MEETING. Dr. J. H. MacDermot: "Epi-Sacro-Iliac Lipomata—A small cause of much trouble." February 17—CLINICAL MEETING. March 3—GENERAL MEETING. Osier Lecture. March 17-^LLNICAL MEETING. April 7—GENERAL MEETING. Dr. L. H. Appleby: "The Use of Snake Venom in Medicine." April 21—CLINICAL MEETING. Ifi ,.♦ .f : i i n D Vice-President Miss M. E. Harvey 678 Howe Street MArine 2015 ysioiespy President Miss A. E. Markham 610-11, 718 Granville St. MArine 6735 n O U U Secretary-Treasurer Miss J. M. Law 610-11, 718 Granville St. MArine 6735 The Vancouver Branch of the above Association, in wishing the Medical Profession a happy 1942, and thanking them for their co-operation and support in past years, wishes to call their attention again to the salient features of our Constitution. The Association is incorporated by Dominion Charter and has members working in all parts of the Dominion of Canada. The members are pledged to work only under Medical Supervision and the Association is acknowledged by the Workmen's Compensation Board. Signed on behalf of C. P. A. ADA E. MARKHAM President, Vancouver Branch. Page 104 N •■ • , d* !», Mil *t iM ft: m 0 It! m Mr Rli i'. # ft; ,.€ -.1 '.'I Ml m if n SI t: .*. *% Mm **' u * Lyerst "10-D" Cod liver Oil maintains the sa high standards of potency and purity, despite manufacturing difficu resulting from the War. Richer in "Sunshine Vitamin D" ... biologfc tested and standardized • • • possesses a fine, wholesome flavour. AYERST, McKENNA alHARHISON flMITED Biological and. Pharmaceutical QltemUU MONTREH CANADA PRESCRIBE CANADIAN MADE PRODUCTS HELP WIN THE WAR BUY WAR SAVINGS CERTIFICA1 S k * »: M *M Once more we wish to all our readers a Happy and Prosperous New Year. Just what meaning those words will have for each individual one of us in this fateful year of our Lord 1942, only each one of us can know. But there will be nothing carefree about our happiness—full well we know that—and nothing blatant about any prosperity that may come our way. Perhaps we shall have to find new meanings for happiness—a new prescription for prosperity. The old ones no longer exist as we know them in an age already sharply cut off from the one in which we now live—still more the one into which we are moving, inexorably and with ever-increasing speed. A new world is coming into being —perhaps it had to come. The one now gone, like the fabled Atlantis of old, was doomed, perhaps, to sink under the weight of its own failures and sins and shortcomings —selfishness, indifference to each other's rights and wrongs: wilful refusal to see and heed the red signal that has so clearly and persistently stood against our path of so-called progress, unheeded. A thoughtful and interesting paper read by Dr. Wallace Wilson of Vancouver, "Whither Medicine," deals with the trends of medicine in a changing world: and as medical men we shall do well to take stock, and consider what these trends will be, and what we can and should do to direct them aright. One thing that seems beyond doubt, when one contemplates the very indistinct and speculative future, is that things are never again going to be the same as they have been. Germany, with all her faults, has taught us one thing—that a nation can and should be a unit, working collectively—and that there is no social necessity7 which cannot be met and satisfied, if the only obstacle is financial. Health, education, social organisation, adjustments of human intercourse and interrelation, are going to undergo very radical and searching scrutiny and re-casting in the next few years. We cannot doubt that—because only by very drastic control and reorganisation can they begin to meet the enormous calls that are going to made on them. So it is high time that we began to look to our gear: and to consider in what way we can most wisely, and with the greatest profit and benefit to all concerned—not only ourselves—meet these changes, solve these problems, provide leadership——probably needed and so utterly vital. Thre can be little doubt that one of the trends of the future will be toward more definite collectivism: and this will inevitably affect us. We must avoid a reactionary attitude, nor attempt to cling too closely to traditional patterns and systems, even though at the same time we do all we legitimately may and should do to safeguard our own interests. One way we must explore, even if it is unfamiliar to us, and we have so far studiously avoided it, is the way of publicity: of arriving at a better and clearer understanding at least, between ourselves and the public at large. We feel strongly that one of the greatest handicaps under which we labour is the complete lack of this understanding. We do not advocate propagandising or lobbying—but we do feel that our traditional and bewhis- kered attitude of monkish silence has not only done harm to ourselves, but has been a disservice to the community at large, who, knowing little of the truth about medicine and public health, have had to depend largely on one-sided, and often misleading information. We rejoice to see that the Canadian Medical Association has established a Committee on Public Relations, and consider this a notable step in the right direction. MEDICAL SERVICES ASSOCIATION In a recent issue of the Bulletin, letters from firms to their employees, urging them to join the M-S-A, and detailing benefits, etc., were published. A similar letter from the Mohawk Handle Company of New Westminster to its employees is of interest. This Company has helped by assuming one-half the cost and the registration f ee—ninety per cent of the employees and their f amilies are participating. This will, we are sure, be a matter of interest to our readers. —Ed. Page 105 i j.; % ■\\9\\ "•■* i -} m !». [f f|; '.'Wi ft' Ifj 5i:i^i NEWS AND NOTES We announce the arrival of five sons to members of the profession: Flight-Lieut. Neil A. Stewart, Dr. R. E. McKechnie II, Dr. T. F. H. Armitage, Dr. W. W. Simpson and Dr. B. F. Bryson. MEDICAL EXAMINATION OF WOMEN Doctors will please note that a special form has been provided for use in the examination of women for the Services. In some cases the men's form has been used in error. The profession extends sympathy to Dr. D. E. H. Cleveland in his recent bereavement, his father having passed away. Congratulations to Dr. A. M. Johnson, Interne at the Vancouver General Hospital, upon his marriage to Miss Marjorie McCullough. Doctor Johnson is awaiting appointment with the R.C.A.M.C. * * * * Dr. D. J. M. Crawford of Trail has recovered from a recent operation and is spending a vacation at Medicine Hat. * * * * Flight-Lieut. A. S. Underhill spent Christmas with his family in Kelowna. *C «f *c Capt. L. G. Wood spent Christmas with his f arnily in Vancouver. Lieut. Col. S. G. Baldwin, O.C. No. 12 Field Ambulance, returned to Vancouver for a Christmas vacation. * * * * Flying Officer H. B. McGregor spent a week-end at his former home in Penticton. *L *5. •*. A *F *e *r *e Dr. J. Stanley Archibald, son of Dr. M. G. Archibald of Kamloops, a graduate of McGill, 1939, has served as interne at the Montreal General Hospital and Children's Memorial Hospital. He is visiting his parents before entering the Naval Medical Service. *t *(. *t. *t *r *? *«* •«• Dr. R. W. Irving of Kamloops spent Christmas with relatives in Montreal and Toronto, and will return to Kamloops.early in January. SURGICAL INSTRUMENTS Please note that surgical instruments for Great Britain need not necessarily be in good repair. They will be renovated at headquarters in Toronto. Local Red Cross Units will accept instruments for trans-shipment to Provincial Red Cross Depot. The Red Cross enjoys special shipping privileges. Page 106 It is reported that the Municipality of West Vancouver has arranged to make payment in respect to medical care for relief recipients. There has been some delay in their acceptance of this responsibility. There are very few municipalities in the Province which do not accept their obligation with regard to relief cases and take advantage of the contribution of the Provincial Government of I6J/2C per individual per month, in consideration of a similar or larger amount having been contributed by the municipality. Dr. J. B. Swinden of Ucluelet spent Christmas with his family at Whonnock. Dr. H. Cantor, formerly of Atlin, is awaiting action on his application for appointment as Medical Officer with the R.C.A.F. Dr. G. E. Bayfield, who has been Medical Officer in the logging area on Moresby Island, spent a vacation at his home in West Vancouver. Lieut. W. S. Huckvale of the R.C.A.M.C., late of Kimberley, called at the office before leaving for an Eastern training centre. Dr. John Brown of Sooke Harbour, Vancouver Island, dropped'in on us on Christmas Eve. He reports that he is too busily engaged in medical practice to do all the fishing which he planned when he took up residence at Sooke. Dr. H. F. Tyreman of Nakusp was down in Vancouver in December. We had Christmas greeting cards from:—Colonel Lavell H. Leeson, A.D.M.S., 3rd Canadian Division—he is very busy, and as cheery as ever; from Squadron Leader D. Murray Meekison—he is with the R.A.F. and is very busy and apparently happy about it, doing surgery in a special hospital; and from Major G. H. Clement, who is located in Ottawa, Officer in Charge of a Hospital—apparently happily busy. The Frost family is all busily engaged in some form of war work. Capt. A. C. Gardner Frost is now Medical Officer with the 6th Field Regiment of the R.C.A. and is located somewhere in Britain. Surgeon-Lieut. John W. Frost has now joined the Naval Medical Services—ovearseas. William David Frost is a Sergeant Wireless Navigator with the R.C.A.F. and is serving with Squadron 455—overseas. Dr. Max Frost is completing his internship at the Montreal General Hospital and has made application for appointment to the R.C.A.M.C. Mrs. A. C. Gardner Frost left some time ago for overseas and is now serving with the Women's Transport Division somewhere in Britain. SPECIAL NOTICE No. 16 GENERAL HOSPITAL NOW BEING MOBILIZED Colonel G. C. Kenning, O.C., will require seventy-five non-commissioned officers and men at once. Doctors who know of possible material should recommend their application to Capt. F. E. Coy, Medical Board, 214 Vancouver Barracks. Page 107 tr i-i '* »«i **■ Hj» M m m * ■* II - 2 M\\ »," «'■% ¥* ffl £;.1 \\w* Lieut.-Col. J. F. Haszard, O.C. No. 8 Field Ambulance, and Lieut.-Col. H. A. DesBrisay, O.C. No. 9 Field Ambulance, often see one another and apparently both are in good health, and somewhere in Britain. » '&'• m Si". h M'li I > ■ ■■■ '■■!' \\f 9 «l M * L % Jk«, An interesting report on the activities of Capt. C. H. Gundry finds him doing work for which he is admirably suited. When Capt. Gundry left the Metropolitan Health Services in Vancouver, where he was doing special work in mental hygiene, the wisdom of his entering the Service was the subject of comment in that there seemed to be some wastage of his special qualifications. Capt. Gundry is now at Headquarters in London and is working with others on a special board in the nature of a Psychiatric consultant. The duty of this group is to aid in the classification of men dealing with such matters as mental health, categorization of intelligence, and advising in the question of vocational training. From Colonels Leeson and DesBrisay we often hear of Capt. H. R. L. Davis, Major W. L. Boulter, Capt. A. R. J. Boyd, Capt. J. A. MacMillan, Capt. J. A. Wright, all of whom are busily engaged with the R.C.A.M.C. in Britain. When last heard of, Surgeon-Lieut. Commander W. M. Paton was in the Maritimes, and Major Gordon Large was in a special hospital in an eastern port. Major Roy Huggard is now overseas, and doing surgery. While it has not been the policy of the Bulletin to announce movements of variow units, we feel that some notice should be paid to the fact that No. 12 Field Ambulance is now located at an eastern camp. The various officers in this Unit are: Lieut.-Col. sr G. Baldwin, O.C, Captains M. R. Caverhill, D. B. Collison, G. D. Oliver, L. G. Wood, B. T. Dunham, late of Nelson, and Captains W. F. Bie, R. L. Whitman and T. S. G. McMurtry, who were formerly internes at the Vancouver General Hospital. Lieut.-Col. Baldwin and Capt. L. G. Wood were in Vancouver on short vacation at the New Year. "fr St *C *r No. 13 Light Field Ambulance is now overseas. The officers of that Unit are: Lieut.-Col. C. A. Watson, Captains J. S. McCannel, G. L. Stoker, W. M. G. Wilson, G. C. Johnston and T. K. MacLean. Lieut.-Col. Roy Mustard, who mobilizes the Unit, is now doing special work in Toronto, according to latest reports. Recent additions to the Medical Services of the R.C.A.F. are Flying-Officers J. L. Parnell, A. W. Vanderburgh of Summerland, G. S. Rothwell and H. G. Cooper. •L. *fc *C •£. Lieut. M. Share, who is now serving with the R.C.A.M.C., will be remembered as a former interne at the Vancouver General Hospital. *F *r *P "? Flight-Lieut. T. C. Harold, formerly of Ladysmith, is now with the R.C.A.F. There has been considerable interest shown in the Officer personnel of the new 16tn Canadian General Hospital and present reports would indicate that British Columbia will be represented very creditably in this new Unit. Col. G. C. Kenning is the Officer Commanding. Major R. Scott-Moncrieff has been in Vancouver enlisting non-commissioned officers and men who will accompany the advance party. Major T. W. Sutherland, O.C, Prince Rupert Military Hospital, called at the office. Page 108 i H : ;i LIBRARY NOTES RECENT ACCESSIONS TO LIBRARY "extbook of Ophthalmology, 2nd ed., 1941, by Sanford R. Gifford. lody Mechanics in Health and Disease, 3rd ed. 1941, by Joel E. Goldthwaite, et al. Medical Clinics of North America, Symposium on Military Medicine, November, 1941. rhe Doctors Mayo, 1941, by Helen Clapesattle. fhe Doctor and the Difficult Child, 1940, by William Moodie. Nelson Loose Leaf Medicine, refills including— Chemotherapy of Meningitis (Recent progress) by W. W. Herrick. Toxicology, by Henry G. Barbour. The Pneumoconioses, by Leroy U. Gardner. Pulmonary Abscess and Gangrene, by Brian Blades and Evarts A. Graham. Public Health—Completion of revision of this volume. Vancouver Medical Association *» ;.? i.i , ^ A. R. P. COMMITTEE—V. M. A.—INTERIM REPORT Since the Japanese blitz a committee of the Vancouver Medical Association has con- erred with Dr. Stewart Murray of the Metropolitan Health Board regarding organiza- ion of local medical men for action in the event of an air raid on the city or neighbor- ng municipalities. This organization will eventually be correlated with a Province-wide jcheme. At the beginning only local activities could be arranged because of the confusion in respect to responsibility that existed between Civic, Provincial and Federal Officials in other branches of A.R.P. work. The city is divided into twenty-three A.R.P. districts, each with an A.R.P. post. \\\\t the present time these posts are nearly all located in schools, unsuitable though they pay be. A medical officer-in-charge of each A.R.P. district has been appointed. In most Instances a medical officer has been chosen whose home is in his A.R.P. district and at a tonvenient distance from the A.R.P. post. In a few of the outlying districts it has been necessary to appoint medical officers who live close by but not actually within their K.R.P. area. The medical officers-in-charge are now meeting with the Senior and Deputy ! hardens of their district to survew the local situation. It is not necessary for them to littend their post unless there is an air raid alert. Medical officers-in-charge are requested po survey the list of doctors in their neighborhood and enlist the tentative support of a imall group who will act in a relief capacity during a blitz period. In the outlying dis- :ricts where there are few doctors the personnel committee will help to arrange for relief doctors from adjacent areas. In addition to the twenty-three A.R.P. posts throughout the city, six Divisional Posts are being organized. These Divisional Posts will have reserves of personnel and pquipment, and will be mobile. They will be used to supply A.R.P. posts in harassed .ireas, and to set up emergency posts at the scene of any major disaster. The medical personnel of these Divisional Posts has not yet been brought up to strength. A.R.P. [posts in the city have already been equipped with necessary medical supplies and a mini- pium of blankets, stretchers, etc., by the Red Cross and St. John's Ambulance Associations. These supplies will be augmented in a short time. The chief purpose of the A..RJ*. posts is to sort out the casualties, separate the badly scared from those who are really injured, commence the treatment of shock, and arrange for immediate transfer of casualties to hospital. All of the existing arrangements will be subject to change from tune to time. At present it is imperative that every doctor in Vancouver should register Page 109 '?*•> ; m I*r? •>"U-; - *. m * - * ft) llti ,sH -Hf ^ :i U hi I I ii m I % Vk ;* S' i ti t* JV .-,, ; j I Ifi fl> :* 'i ■l* *>*'• if It' p Eye Section Please Note—'The principal parts of the eye are the pupil, the moat, and the beam. Some vitamins prevent beri beri; some prevent scurry scurry. If you are sick, a physician should be insulted. Doctors say that the increased birth rate shortens lives. The way people contract consumption is as if a well man spits and the sick man sees the well man spit, well the sick man thinks he has a right to spit as the well man has to spit so he spits, so it is not well for anyone to spit. I- n« .•■:!' THE GOOD OLD DAYS rf When Quackery No Harm Meant" Our readers will be interested in the following extracts from the advertising columns of the Victoria Colonist of the date September 29, 1876. It is hardly necessary, perhaps, to say that there was no Medical Act in British Columbia in those days. Nor was there any of the absurd modern nonsense about limiting one's practice. You specialised in everything. (For the matter of that, we have one or two lineal descendants of that type even now.) Nor was cancer the dread plague that it is now—one expert even disdained the use of the knife in its treatment. Office hours were longer, however, and few of us today have the Spartan constitution which would enable us to practice from 9 a.m. till 9 p.m, daily. Probably time out was taken for visits to the neighbouring pub. DR. JAMES Has removed to Broughton street opposite the City Chambers. Philip James, M.D., Diplomatized Eclectic Physician. Extracts Polypus and Cancer without the use of the knife. Rheumatics cured in one hour without pain." He is now using the Electric Magnetic Machine with good effect in many diseases of Rheumatic, Palsy or Paralysis and Fits. N.B.—Special attention given to all diseases of women and children. DR. R. PRICE (Late of Virginia City, Nevada) Homeopathic Physician and Surgeon, Graduate of-the Universities of Berlin and Warburg, German Empire. Office one door below Mr. Lowenberg's Real Estate office, Government street, between Fort and Broughton. Office hours from 9 a.m. till 9 p.m. Eye and Ear, Chronic Diseases, Obstetrics Specialty. References—Hon. ex-Governor Barsdell, Gold Hill, Nev.; Hon. Wm. Patterson, Dist. Attorney, Carson City; Hon. Judge C. C. Goodwin, of the Enterprise, Virginia City, Nev.; Capt. H. H. Day, late Superintendant of the Raymond & Ely Mine, Pioche, Nev. DR. MA CHOO TSUNG (From Canton) Surgeon and Physician Cormorant St., opp. Orleans Hotel. Certified by English and American Consuls at Canton as being duly qualified, respectfully solicits the attention of the afflicted. Copied from Daily British Colonist, Victoria, British Columbia, Friday morning, September 29, 1876. Page 118 M STERILITY IN THE FEMALE F. E. Saunders, M.D. (Read before Vancouver Medical Association Dec. 2, 1941) Starting with Biblical times the problem of sterility in the female has occupied a position of importance in the scheme of life which has never failed to receive constant attention. The processes of treatment in olden times are amusing, to say the least, but I suppose our efforts of today will also supply a few smiles in the future. Still the ancients have recorded in their writings many points of interest.. The most usual method of treatment was divorce, or its equivalent, always of course putting the onus of the problem on the female. Never for a moment did the male submit to such a degrading thought or insult to his ego as that he might be the offender. It is interesting to note that these mores have carried over into the present day, and it is not at all uncommon for the male to refuse to submit himself to a proper examination by a competent man. The notable progress made in the last twenty years has demonstrated not only that the husband carries a considerable share of the responsibility, but also that constitutional states are causative factors, almost if not quite as important as are local genital disorders. A complete investigation and treatment of sterility must therefore involve work in several non-gynaecologic fields of practice, particularly in urology, internal medicine and endocrinology. The gynaecologist by himself sees only a limited aspect of the problem. Definition of Sterility Sterility is best defined as inability to initiate the reproductive process. This definition is in one sense narrow and in another particularly inclusive. It is narrow in that it denotes only the failure of conception and does not include the many accidents which may prevent the fertilized ovum from completing a normal career. Ectopic gestation and uterine miscarriage are important types of failure of the reproductive system, but they are not sterility, however, as here defined, and in practice should be regarded as separate though related problems. In another way this definition has a broad application. It refers equally well to the individual of either sex, or to a mating. It covers unfruitfulness due to social circumstances as well as sterility due to normal or abnormal incapacities. It includes the special clinical meaning of sterility, which is inability to initiate the reproductive process on the part of a couple who have desired and attempted to reproduce for a reasonable length of time—ordinarily at least one year. Absolute fertility means physiological perfection of the mechanism of conception. Happily this state only exists in a small minority of human matings. In the clinics in the East it was not uncommon to be asked if it was natural to have a period after marriage. This person I am thinking of had been married for 16 years and the pregnancies were so close together that it left no time for such a commonplace happening as denudation of the endometrium at menstruation. Infertility is an inconclusive term covering all grades of fertility short of absolute and all grades of sterility. Absolute sterility denotes the state in which the initiation of the reproductive process is, at any rate for the time being, definitely impossible. This results from conditions of two general sorts. First, those suppressing entirely the production of gametes, and secondly those entirely preventing the access of the male gamete to the female. Absolute sterility may be temporary or permanent, in the case of the former when inhibiting conditions are removed by nature or science, and the latter of the gonads are removed or atrophied. The exact incidence of voluntary sterility is difficult to determine. Vital statistics provide a record of births in relation to marriages and to population, but do not distinguish the failure to conceive or the accidents of early pregnancy, and take no account of the use of contraceptives. A conservative analysis of the best available data indicates that somewhat more than 10% of modern marriages are barren. There are therefore in the United States today at least two million childless couples who are still at the age of potential reproduction. The magnitude alone of this situation offers sufficient evidence of its importance. Not nly is sterility a matter of supreme personal concern in the Page 119 >» ,1 m tip % n l\\ ll M '-« iK & ifc'- » " riPiPI 8 Mr Nfc flu II ; r life of a very large number of individuals, but it is also a point of importance in the social and economic factors of a nation. As has been very aptly said, a fruitless union is one of Nature's saddest tragedies, and from whatever point of view it is considered the result is detrimental to the best interests of society. The following points may be mentioned as requisites of absolute fertility or physiologic perfection of the conceptive mechanism: (1) Production of normal spermatozoa. (2) The male genital tract must allow free passage of sperm from testicle to urethral meatus. (3) The prostato-vesicular secretions must be favourable to the sperm. (4) Ejaculated sperm must be safely delivered to and received by the cervix. (5) The endo-cervical secretion must be favourable to the sperm. (6) The uterus must allow the free passage of sperm from the cervix to the ostia uterina. (7) The tubes must allow the free ascent of sperm and descent of ova. (8) The ovario-tubal hiatus must allow the free passage of ova from the ovaries to the ostia abdominalis. (9) The ovaries must produce normal ova. Factors of Infertility If any of these nine conditions fail the result is some depression of the reproductive capacity below the level of physiologic perfection. The degree of such depression is in direct proportion to the details iri which the requisites of absolute fertility are unfulfilled. Conversely, when any degree of infertility exists it is obvious that one or more of the requisites above named must have fallen short of complete fulfilment. The factors of infertility may therefore be conveniently grouped according to a physiologic classic fixation under nine major headings. The first four dealing with the male I shall leave with a G.U. group for discussion later. The fifth, concerning the hostility of endocervical mucus, starts the group set aside as gynaecologic disturbances. This mucus, normally a favourable medium for sperm, may become so altered as to become definitely antagonistic, and this hostility may be listed as chemical, bacterial, serologic and mechanical. Chemical hostility has been thought to occur in the form of acidity on the one hand, and excessive alkalinity on the other. Recent studies, however, have shown that endocervical mucus is always moderately alkaline. Bacterial hostility is of small importance, as any direct harm done to the sperm by the organism or its toxin is negligible. The ■serologic type presents itself as an interesting theoretic possibility. Experimentally the subcutaneous injection of semen will sensitize the female against sperm so that temporary sterility results. There is, however, no direct evidence to show that natural sperm immunity ever exists because of inherent incompatibiUty, or that it ever develops as a result of repeated vaginal inoculations. Machanical sterility is the most common and only important type. Abnormal vis-|l cosity of the endo-cervical mucus may result primarily from perverted secretory action. This is particularly likely to happen in chronic passive congestive conditions in which the background is often a fault of sex hygiene. Secondary factors are infection and inadequate drainage, especially the latter. If the internal os is small the secretions do not escape freely and instead become thickened and inspissated within the canal. Ultimately the mucus forms a tenacious plug, the endo-cervical glands are affected, the secretion becomes more and more abnormal and thus a vicious circle is obtained. Subsequently to fertilization of the ovum the uterus plays a major role in the process of reproduction. Prior to fertilization the function of the supracervical uterus is simple —it serves only as a passage-way by which the sperm may .ascend. If infertility be understood to be diminished ability to produce a conception then the only directly uterine factors are those of blockade which may prevent free transit of Page 120 < I* * spermatozoa. The commonest of such conditions is pregnancy—a pregnant woman is, of course, temporarily sterile so far as the possibility of another conception is concerned. Other sorts of blockade result from congenital absence of the uterus, from its surgical removal, from complete atrophy, and from obliteration of the uterine cavity by tumour. Thus, as far as infertiUty is concerned, the uterine causes are of more academic than practical importance. There are numerous uterine abnormalities more or less related to the sterile state which in the past have erroneously been regarded as causes. For example, pregnancy fails to occur in the infantile uterus not because of the maldevelopment of that organ but because the associated infantile ovaries fail to ovulate. Retro-displacement of the body of the uterus does not by itself impede conception, but it may be complicated by other conditions such as cervical anteversion, which prevents proper insemination, or inflammatory damage to the tubes, or congestive changes in the ovary. The frequent coincidence of fibromyomata and sterility has oben been noted. It now appears that these tumours are the result of the nulliparous state rather than the cause of sterility. Defects of tubal patency may be of any degree from the simple temporary blocking by mucus, to the complete and permanent obliteration of the tubal lumen. It is convenient to distinguish partial and complete impermeability by using the term obstruction for the former and occlusion for the latter. The chief causes of patency fall into three groups—developmental, malformation, inflammatory damage and spasm. Of these three the inflammatory type is the most important. G.C. produces the most common, and from the viewpoint of fertility the most serious of tubal inflammations. Even the slightest degree of G.C. salpingitis causes some damage to the tubal mucosa, and if complete closure of the lumen does not occur at once there is still a great possibility of strictures, kinks, and adhesions later. In the more severe cases the tubes are, of course, hopelessly destroyed. Tubercular infections in this area progress more slowly, but in the end produce results similar to the extensive G.C. type. It is remarkable, however, how severe some of these inflammations may be without destroying tubal function. Peritonitis of non-pelvic origin, the exanthemata, and anaemia are a few of the many diseases which have been known to seal the fimbriated ends of the tubes. The ovary is unique among the endocrine glands in that it has no direct connection with its duct. Among lower animals the passage of the ovum is facilitated by various arrangements, such as an ovarian bursa, ciliated peritoneal epithelium, prehensile fimbria, and a capacious tubal infundibulum. In the human these structures are at the best vestigial, and, moreover, the erect posture renders conditions even more unfavourable. Ovarion underdevelopment is usually only one detail of a more extensive state— female genital hypoplasia—which affects all the pelvic organs. True infantilism is rare, but juvenilism, a developmental arrest at the pre-pubertal or early adolescent stage, is exceedingly common. Neither the frequency nor the importance of this condition has been generally appreciated. The cause of the female genital hypoplasia is some depressing influence which operates during the adolescent years at the time when the organs of reproduction should be undergoing their most rapid differential development. Many different depressions seem to be able to produce these genital retardations. Among the most important are transient endocrine failures, chiefly the anterior lobe of the pituitary, and less often of the thyroid. Congenital syphiHs, anaemia, rickets, malnutrition, and all types of dietary fault, poor hygiene, and particularly forcing, which makes excessive demands on the strength of the adolescent girl. Functional under-activity of the ovary, normally developed, results on the one hand from certain local abnormalities which act as mechanical impediments to ovulation, and on the other hand from various constitutional and endocrine disorders. The maturation and rupture of a Graafian follicle is a delicate process easily deranged by adverse mechanical conditions. A thickening of the tunica albuginea, or the presence of persistent retention cysts or corpora lutea, may raise the intra-ovarian pressure to a degree which renders normal ovulation impossible. Chronic passive congestion is another unfavourable condition. The development of a perfect fertile ovum is likely to be Page 121 ti> fl w sh $ prevented by depressed constitutional states which have already been mentioned in relation to deficient spermatogenesis, chronic intoxications, unbalanced nutrition, conditions of debility and faulty hygiene. Endocrine failure of a major gland usually results in deficient dovogenesis. As a matter of fact a wife who has some demonstrable endo- crinopathy usually has a primary focus of failure in the anterior lobe of the pituitary, less often in the ovary, and least often in the thyroid. Associated symptoms such as obesity and anaemia are not in themselves causes of sterility as may be thought; they are concomitant results of the same underlying cause, a metabolic depression which is usually, but not always, in the nature of an endocrinopathy. Clinical Diagnosis In the past the clinical investigation of a case of sterility started with examination of the female pelvic organs and progressed only to a point where the first real or fancied cause was identified. The normality of all other items was then taken for granted, investigation ceased and treatment began. From what is now known about the distribution and causative factors of human infertility it becomes evident that the adequate diagnostic study of a sterile mating is necessarily a complex procedure. It must deal with the husband no less than with the wife, and must consider the general health of both partners as well as the condition of their reproductive organs. The essential feature of such an investigation is always completeness in the sense that every etiologic possibility is surveyed. Thus it can be stated in each case not only that certain factors are present, but also, and with equal certainty, that all other demonstrable factors are absent. The advantages of complete diagnostic study are threefold. In the first place it makes a research contribution. In the second, it eliminates much worthless and harmful treatment, and in particular, such disasters as operations done for sterility upon the wives of absolutely sterile men. In the third place complete diagnostic study identifying every factor in the etiologic sum total points the way to treatment which is complete and therefore most efficient. The following details of a gynaecologic history are of particular importance in cases of sterility: (1) A former marriage; pregnancies in that or the present marriage; abnormal features of pregnancy, labour or puerperium. (2) Venereal disease; appendicitis; "inflammation of the bowels", or any other trouble suggesting pelvic inflammation. (3) Leukorrhcea, past or present. (4) Urinary symptoms, past or present. (5) Pelvic or abdominal operations of any sort. (6) Menstrual behaviour, age of onset, behaviour during adolescence, subsequent changes in habit, present type of menstruation with details of periodicity, duration, amount and dysmenorrhcea. (7) The sex life from the viewpoint of the wife, which does not always coincide with that of the husband. All deviations of female genital organs from the normal status are naturally of interest if the function of reproduction is under consideration. Experience has shown that certain items deserve special notice where sterility is the complaint. (1) Malformations and deformities interfering with normal coitus. (2) External vestiges of old G.C; chronic infection of Skene's glands; inflammation of Bartholin's ducts. (3) Urethrocele; vulvar or anal lesions productive of dyspareunia. (4) Positions of the cervix interfreing with normal insemination. (5 ) Stenosis of the external os. Page 122 (6) Chronic endocervicitis. (7) Evident stigmata of hypoplasia; a long and conical cervix; a small uterus. (8) Fixed retrodisplacement of the uterus. (9) Chronic passive congestion of the pelvic organs. (10) Indications of pelvic inflammatory disease. (11) Palpably pathologic conditions of the tubes. (12) Palpably pathologic conditions of the ovaries. Ordinary methods of examination are not always adequate to detect in the ovaries retention cysts and similar minor abnormalities, which are unimportant enough in most other respects but in relation to sterility are factors of the first magnitude. Accordingly, considerable effort, if necessary, should be made to palpate the ovaries. This may require a repetition of bimanual examination under anaesthesia. The endocervical mucus is routinely subjected to three tests; its chemical reaction is determined, a stained smear is examined microscopically and viscosity is noted. This endocervical mucus is invariably found to be alkaline when normal, ranging in hydrogen ion concentration between 8 and 9. Moreover, these findings are not modified by parity, menstrual cycle, or viscosity. The microscopic examination may reveal leukocytes, bacteria and thick mucus in addition to epithelial cells. The uterine index is a quantitative expression of the degree of differential development which the womb has achieved. In a truly infantile uterus the cervix constitutes about two-thirds of the organ and the corpus one-third. In the normal adult uterus these proportions are reversed. Accordingly, the ratio of corpus to cervix is a fair gauge of the extent to which a given uterus has progressed from infantilism toward adult perfection. Thus infantile ratio is 1:2—in the adult it is 2:1. In the various degrees of juvenilism the ratios fall between these extremes. It is understood, of course, that these observations apply to conditions developmental and not hypertrophic in character. Next in the list of importance is the Rubin's test. For testing the patency of tubes there are now two well established procedures—the insufflation of gas and the injection of iodized oil. In most cases of sterility a complete evaluation of tubal conditions requires two insufflations at least. Trans-uterine insufflation involves the introduction of a gas under pressure, usually carbon dioxide. If at least one tube is patent some of the gas passes through into the peritoneal cavity. The occurrence of this phenomenon is evidenced in several ways: the gas pressure within the closed system of the apparatus drops as the tubes are forced open; the passage of a gas can be heard with a stethoscope applied to the lower abdomen; a subdiaphragmatic pneumo-peritoneum is demonstrable by X-ray when the patient assumes the erect posture, and the resulting irritation of the subdiaphragmatic peritoneum gives rise to characteristic shoulder pain. In eases of bilateral non-patency all of these evidences are lacking. If two insufflations are done with an interval of at least one day, the first after a large dose of some anti-spasmodic drug, and the second without preliminary medication, a comparison in the two results often reveals additional information. Patency demonstrated at a lower gas pressure on the first occasion than on the second indicates a factor of tubal spasm. If on the other hand a second test demonstrates patency at lower pressure than does the first, one may draw the conclusion that some pre-existing factor of partial obstruction was mechanically removed by the first test. Hysterosalpingography is the X-ray visualization of the uterine and tubal cavities after injection of a medium opaque to roentgen rays, most commonly a compound of iodine and oil. This procedure gives certain information about tubal patency not always obtainable by gas tests. It differentiates unilateral from bilateral permeability. It also locates accurately any point of obstruction, and in that way shows what may be expected from surgical intervention. Apart from patency and occlusion of the tubes many other pelvic conditions can be demonstrated by this method.. Important amongst •these with reference to sterility are utering hypoplasia and malformation. Page 123 'M •$. > I J. j l * -.1 ■*ZM Inf'ri JS ff 5? S! ft « fPl *M •. f?' [fMly 1 m.ii ^ '#!'! 4 1 if.' CANADIAN MEDICAL ASSOCIATION 194 2 — MEMBERSHIP — 1942 FEE OF $8.00 INCLUDES JOURNAL OF C. M. A. TO BE PAID THROUGH THE OFFICE OF THE REGISTRAR College Dues for 1942 $15.00 C M. A. Membership, 1942 8.00 This will make your cheque total for 1942 $23.00 New Members are reminded that prompt response will assure receipt of the January number of the Journal. THE JOURNAL SPEAKS FOR CANADIAN MEDICINE THE C.M.A. MEMBERSHIP FEE INCLUDES THE JOURNAL SPECIAL NOTE: MEDICAL OFFICERS CAN SECURE THE JOURNAL FOR $4.00 PER YEAR. Nmttt Sc SlfflttLSfln 2559 Cambie Street Vancouver, B. C Colonic Irrigation Centre Up-to-date scientific treatments COLONIC IRRIGATIONS, SHORT WAVE DIATHERMY, COLD QUARTZ ULTRA VIOLET RAY, STEAM SWEATS, SHOWER AND MASSAGE. Graduate Nurses Only in Attendance Superintendent E. M. LEONARD, R.N. Pest Graduate Mayo Bros. 1119 Vancouver Block VANCOUVER, B. C. MArine 3723 314 Scollard Building Victoria, B. C. IF ARTHRITIS and ECZEMA I ARE ALLERGIC ETIOLOGICALLY effective treatment suggests the use of agents to correct mhwwl deficiency, increase cellular activity, and ■enure adequate elimination of toxic waste. LYXANTHINE ASTIER -^ orally given, supplies ealeium, sulphur, iodine, and tysidln bl tartrate — an effective solvent. Amelioration of symptoms and general functional improvement may be expected. Since the best evidence is clinical evidence, write for literature and sample. L-15 J Canadian Distributors ROUGIER FRERES 350 Le Moyne Street, Montreal"""@en ; edm:hasType "Periodicals"@en ; dcterms:identifier "W1 .VA625"@en, "W1_VA625_1942_01"@en ; edm:isShownAt "10.14288/1.0214367"@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: January, 1942"@en ; dcterms:type "Text"@en ; dcterms:description ""@en .