CONTENTdm
History of Nursing in Pacific Canada
Vancouver Medical Association
image/jpeg
M Mm.w3 • - • ?$8* § MM, B|ULL|ETIp - of the |U I IvANcJlJVER ME|l>§I C§iL ASSOCIATION Sf^ W£k£ Is Incorporated Transactions of the MviCTORfA MEDICAL SQClETTm Vancouver general hospital and ST. PAUL'S HOSPITAL In^This Issue: Page SYMPOSIUM: ^E EAR^OSE AND THROAT —Doctors McLean, Leeson and -Anthony.^76-83 VAGATOMY—Dptyo^H. Apr1eKy^^^^^^^^^^fe || HISTORY OF VANCOUVER MEDICAL^SOCIATION gfeBy Dr. aML XM&M- MW|M^^^^^^^B 86 MODERN TRENDS IN^STETRICS —By Dr. N^pT- i*£iIooti|^MoiitrealE ;^Sl- 88 NEWS AND NOTRS'i'i H^WJ BBHBhS! • VOL. XXIII. NO. 4 January, 1947 til mrm • 5IM{^iWB* Ferrochlor %iqu0&witfiMor without one pound bottles, winchester^'und with orJjinihou^tyitaTninEj^JE.B.$^ are supplied '^IbotUes '^^^^500 andMfiOQMk When prescribing Ferrochlorin any of the above mentioned forms, always insert the identifying letters "E.BJ5" following the word Ferrochlor *£*S J$ Ferrochlor Bi tBiS. Slg.—os directed. 1 3 IN SECONDARE I^NiQiMlii Iii Ferrochlor with Bl, the iron is present in the readily absorbed ferrous statevlfether than the^biologically ^compatibles ferrfcform. In Ferrochlor with Bl, th^Juse of a soluble iron salt obviates the^ieed for using up^S dissolyS- the iro»|^fethei^re- cious acid of the acblorhydric stomach^typical o^^iany anaemias.^ jtfe FerrocMor^vitttS Bl^^the unpleasanb^aste of ferrous chloride is successfully masked, thui| removing one hindrance Ipfchaving patients complete a prescribed course of treatment^ In FeirocMorjgwith Blithe addition^pp? J^iiamin^ chloride ensures that there will; be no. slowing down of jfcon absorp- ppri:v through poor^mtestinal ,i$nus||ploreover, general muscular tone is sojsmp^pved that the patient feels better^^big help in successful treatmettfeS « THE E. B. SHUTTLEWORTH CHEMICAL CO. LIMITED TORONTO MANUFACTURING CHEMISTS CANADA THE VANCOUVER MEDICAL ASSOCIATION BULLETIN Published Monthly under the Auspices of the Vancouver Medical Association in the interests of the Medical Profession. Offices: 203 Medical-Dental Building, Georgia Street, Vancouver, B.C. EDITORIAL BOARD: Dr. J. H. MacDermot Dr. G. A. Davidson Dr. D. E. H. Cleveland All communications to be addressed to the Editor at the above address. Vol. XXin JANUARY, 1947 No. 4 OFFICERS, 1946 - 1947 Dr. H. A. Dbs Brisat Dr. G. A. Davidson Dr. Frank Turnbull President Vice-President Past President Dr. Gordon Burke Dr. Gordon C. Johnston Hon. Treasurer Hon. Secretary Additional Members of Executive: Dr. W. J. Dorrance, Dr. J. W. Shier TRUSTEES Dr. A. W. Hunter Dr. G. H. Clement Dr. A. M. Agnew Auditors: Messrs Plommer, Whiting & Co. SECTIONS Clinical Section Dr. E. R. Hall. Chairman Dr: Reg. Wilson Secretary ^ Eye, Ear, Nose and Throat Dr. Roy Mustard Chairman Dr. Gordon Large .Secretary Paediatric Section Dr. R. P. Kinsman.- Chairman Dr. H. S. Stockton — .Secretary Orthopaedic and Traumatic Surgery Section Dr. K. J. Haig Chairman Dr. J. R. Naden Secretary Section of Neurology and Psychiatry Dr. A. M. Gee Chairman Dr. J. C. Thomas Secretary STANDING COMMITTEES Library: Dr. W. J. Dorrance, Chairman; Dr. D. E. H. Cleveland, Dr. J. E. Walker, Dr. R. P. Kinsman, Dr. J. R. Neilson, Dr. S. E. C. Turvet. Publications: Dr. J. H. MacDermot, Chairman; Dr. D. E. H. Cleveland, Dr. G. A. Davidson, Dr. J. H. B. Grant, Dr. E. R. Hall, Dr. Roy Mustard. Summer School: Dr. L. G. Wood, Chairman; Dr. J. C. Thomas, Dr. A. M. Agnew, Dr. L. H. Leeson, Dr. A. B. MansoN, Dr. D. A. Steele. Credentials: l^$ Dr. H. H. Pitts, Dr. A. E. Trites, Dr. Frank Turnbull. V. 0. N. Advisory Board: Dr. Isabel Day, Dr. J. H. B. Grant, Db. G. F. Strong. Representative to B. C. Medical Association: Dr. Frank Turnbull. Sickness and Benevolent Fund: The President—The Trustees. :j ► • ! x :* :i AQUEOUS SUSPENSION... 2 ing. ESTROGENS LAKESIDE Treatment of menopausal symptoms is greatly facilitated by the sustained estrogenic effects arising from an injection implantation of Aqueous Suspension of Estrogens-Lakeside. More uniform blood levels of estrogen are effected and normal ovarian secretion is more closely simulated than generally is practicable with the more briefly enduring oil injections. 2 m«9* ^ (20,000 I.U.) ...Jf^^^S0i FROM NATURAL SOURCES Each cc. of Aqueous Suspension of Estrogens-Lakeside con-; tains 2 mg. (20,000 I.U.) of estrone and concomitant, naturally occurring, estrogens. This active material is in: fine, highly purified suspension in water. In 1 cc. ampuls at your prescription pharmacy. J-Ltzxatuxs. on <^/\sail&±£ * k Distributors: MARSH, WILDE & CO. Phones: PA. 8818, MA. 0282 628 Vancouver Block Vancouver, B. C. VANCOUVER MEDICAL ASSOCIATION Founded 1898 Incorporated 1906 PROGRAMME OF THE 49TH ANNUAL SESSION pENERAL MEETINGS will be held on the first Tuesday of each month at 8:00 p.m. CLINICAL MEETINGS will be held on the third Tuesday of each month at 8:00 p.m. February 4 GENERAL MEETING. Symposium on Thoracic Surgery. Doctors Elliott Harrison, G. D. Saxton and Ross Robertson. February 18 CLINICAL MEETING. St. Paul's Hospital. March 4 OSLER LECTURE AND DINNER. Lecturer, Dr. Bede J. Harrison. CLINICAL MEETING. Vancouver General Hospital. March 18 April 1 April 15 May 6 GENERAL MEETING. Dr. W. S. Stanbury, National Director, Canadian Red Cross, Blood Transfusion Service. CLINICAL MEETING. ANNUAL MEETING. wjffitel Breaks the vicious circle of perverted menstrua] function in cases of amenorrhea, tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic relief by stimulating the innervation of the uterus and stabilizing the tone of its musculature. Controls the utero-ovarian 1 circulation and thereby encourages a normal menstrual cycle. • MARTIN H. SMITH COMPANY A i^. ISO IAFATITTI STRUT, NIW TOM, N. T. js$k Full formula and descriptive literature on request Dosage: l to 2 capsules 3 or 4 times daily. Supplied in packages of 20. Ethical protective mark MHS embossed on inside of each capsule, visible only when capsule is cut in half at seam. Page 71 I IS' ;. PHYSICIAN'S PHARMACY 1| T. M. MATHESON PHARMACEUTICAL CHEMIST 618 WEST GEORGIA STREET VANCOUVER, CANADA MArine 2241 Agents for: • • AYERST BIOLOGICALS • MULFORD BIOLOGICALS • MARCELLE NON-ALLERGIC COSMETICS • WATSON MICROSCOPES - Suppliers of Stains, Reagents and Volumetric Solutions. • • • This o of pha . We ar . the prt rganization is devoted entirely to the professional pi rmacy. e able to provide efficient mail service to doctors throu ovince. ractise ghout VANCOUVER HEALTH DEPARTMENT STATISTICS—NOVEMBER, 1946 Total population—estimated— Chinese population—estimated. Hindu population—estimated— 323,850 6,566 361 Number Total deaths 369 Chinese deaths 21 Deaths, residents only 318 BIRTH REGISTRATIONS: Male 432 Female . 429 Rate per 1,000 Population 13.9 38.9 11.9 861 INFANT MORTALITY: November, 1946 Deaths under 1 year of age 17 Death rate—per 1,000 live births 19.7 Stillbirths (not included above) 10 CASES OF COMMUNICABLE DISEASE REPORTED IN THE Scarlet Fever Diphtheria 2 Diphtheria Carrier 5 Chicken Pox 43 Measles 11 Rubella 4 Mumps 100 Whooping Cough 0 Typhoid Fever 0 Typhoid Fever Carrier 0 Undulant Fever 0 Poliomyelitis . 1 Tuberculosis 60 Erysipelas 1 October, 1946 Cases Death: 10 0 Meningococcus (Meningitis) 2 Infectious Jaundice 0 Salmonellosis 0 Salmonellosis (Carrier) 0 Dysentery 0 Dysentery (Carriers) 0 Tetanus 0 Syphillis 108 Gonorrhoea 219 Cancer (Reportable) Resident : 81 Non-Resident 45 November, 1946 Cases Deaths 12 0 3 0 CITY December, 1946 Cases Deaths 9 0 1 0 0 0 123 0 163 0 6 0 346 0 11 0 0 0 0 0 0 0 0 0 38 0 8 0 0 0 0 0 6 0 0 0 1 0 4 0 0 0 0 0 0 0 69 0 34 0 Page 72 , j IMMILII PEMIII - COIMHT iff * Available in January Research in the Connaught Medical Research Laboratories now makes available to the medical profession in Canada a highly purified penicillin in crystalline form. Crystalline penicillin has many advantages, among which are the following: HIGH PURITY — This product is supplied as a white crystalline powder. MINIMUM OF PAIN OR LOCAL REACTION — Because of its high degree of purity, pain on injection is seldom reported and local reactions are extremely rare. 4 STABLE AT ROOM TEMPERATURE — Crystalline penicillin is heat-stable, and in the dried form can be safely stored at room temperature for at least three years. No refrigeration is required except when the material is in solution. 1J1 HOW SUPPLIED Crystalline Penicillin will be available from the Laboratories in sealed rubber-stoppered vials of 100,000, 200,000, 300,000 and 500,000 International Units. CONNAUGHT MEDICAL RESEARCH LABORATORIES University of Toronto Toronto 4, Canada DEPOT FOR BRITISH COLUMBIA MACDONALD'S PRESCRIPTIONS LIMITED MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. One of the most valuable, as well as interesting, contributions to the Bulletin, is the history of the Vancouver Medical Association that is being compiled so carefully and painstakingly by our friend, Dr. Geo. A. Kidd, of Vancouver. It is greatly to be regretted that we have to publish it piecemeal and in such small instalments owing to our limitations as regards space. But eventually we expect to assemble it all together and present it in book form, when it will form a valuable record of our history. We do not think anyone could have been found more competent to do this work than Dr. Kidd. He has infinite patience and takes infinite pains—the recognized qualifications of genius. Besides, as he himself has told us, he has become very keenly interested in the work. Probably few of us can realize just how much time and hard work each of these short, absorbingly interesting sections represents on the part of the author. We tend rather to take this sort of thing for granted—but in reality we owe much gratitude to Dr. Kidd for his devotion in this matter. It may seem to some that the history of the Vancouver Medical Association is not. in itself a matter of world-shaking importance, and perhaps of only a limited interest at the best. But, if these articles are read carefully, we should be able, if we read between the lines a bit, to see considerably more than merely the history of one medical group, or even of onecity. There is the history of the growth of a social consciousness of health, of a greater appreciation of the urgent need of preventive medicine, of better milk, of a cleaner city, of medical examination of school children. There is the growing use of immunological methods amongst infants in the pre-school age, in the school years. "We hope to hear more later about the improvements in maternal statistics, in the statistics of the newborn and so on. Even so, this might have been all imposed from without, and so would be of little interest as regards the V.M.A. But Dr. Kidd has shown how most, if not all, of the impetus toward improvement and toward better legislation came from the leadership of the Medical Associations of the Province. Vancouver happened to be the largest single unit, and so to have the largest organized group—but the B. C. Medical Association did its share—as in the matter of tuberculosis, and later of venereal disease—while the Vancouver organization, backed up by the Victoria Medical Society in its own domain, and by the support of others, fought for better milk, for adequate school inspection and so on. It gives us something of which to be rather proud, when we can look back and feel that we have not been content to wait for the authorities to take the steps that were necessary, but that we ourselves were instant in and out of season in these matters. This is, of course, as it should be. We know that the public health authorities in Victoria and in the various municipalities and cities would like to go ahead even faster than they have been able to do, hampered as they so often are by questions of finance, big official apathy or lack of understanding, by public ignorance and even prejudice; the more honour to them that in a short space of thirty-five to forty years, they have accomplished wonders, and have gradually educated public opinion to a demand for, and not merely an acceptance, of adequate public health measures in many of its phases. But there is much yet to do, and w© who work in and among disease and ill- health, must hold up the hands of those in charge. We must do more, we must continue to urge on the government and on the people at large as Dr. Kidd's record shows we have done in- the past, the need for more and more expansion of public health measures along the most modern lines. There is crying need for hospitals, for children's hospitals, for mental hygiene clinics, for psychopathic wards—we have not more Page 73 1: J i 1 •r N • f 1 1 1! i\ (Li • I 1 |$ •I'll' ji 1 t! 1 1 \f 1 1 • 1 |; T: 1 '1- Fjj: I ii I it ■:# v f 1 than touched the fringe of the needs of the mentally and psychically sick—we know the needs and can speak from that knowledge, and as an organized group, it is our duty to keep on speaking. We hope that the history of the past will be an earnest of the future, and that the history of organized medicine in British Columbia will continue to be embellished by records of unselfish and public-spirited action, towards a healthier and happier community. THE LIBRARY LIBRARY HOURS— Monday, Wednesday and Friday 9:00 a.m. to 9:30 p.m. Tuesday and Thursday _.! 9:00 a.m. to 5:00 p.m. Saturday 9:00 a.m. to 1:00 p.m. RECENT ACCESSIONS TO LIBRARY— The Physician's Business* 1945, George David Wolf. Essentials of Allergy, 1945, by LeoH. Criep. Treatment of Bronchial Asthma, 1946, Vincent J. Derbes. The Physiological Basis of Medical Practice, 1945, Charles H. Best and Norman B. Taylor. The Canada Year Book, 1946. The Royal College of Physicians and Surgeons Hand Book. Medical Clinics of North America, Symposium on Pathology and Cardiovascular Conditions. November, 1946. Electrocardiography in Practice, 1946, Ashton J. Graybiel and Paul D. White. LUNCHEON Monday, February 24th, 12:30 o'clock. Ballroom, Hotel Georgia. Speaker: Dr. T. C. Routley, General Secretary, Canadian Medical Association. A luncheon has been arranged under the joint auspices of the British Columbia Medical Association and the Vancouver Medjcal Association, to afford an opportunity to all members of the medical profession in British Columbia, to hear an address by Dr. Routley on this date. Dr. Routley is the official representative of the Canadian Government both in the World Health Organization and the World Medical Association, and is Chairman of the Organization Committee of the latter. He has returned recently from two visits to Europe, and will speak on the two World organizations as well as on the Health Insurance Plan in Great Britain. Tickets may be obtained from the office of the British Columbia Medical Association, 203 Medical Dental Building, or from members of the Executive Committee of the Vancouver Medical Association. Those planning to attend are asked to telephone MA. 4622 not later than the morning of Monday, February 27th, for reservations. Page 74 CANADIAN AID TO CHINA An urgent appeal is being made to members of the medical profession for medical and hospital assistance to China. Donations may be in the form of cheques, used instruments or medical books, printed not more than eight or ten years ago. Contributions of instruments or books may be turned in at the Library of the Vancouver Medical Association, bjc Medical Dental Building, where arrangements will be made to have them shipped to the National Headquarters in Toronto. Cheques should be made payable to "Canadian Aid to China" and mailed to: Canadian Aid to China, Provincial Headquqarters, 736 Granville St., Vancouver, B. C. This appeal has been backed by the Canadian Medical Association. The need is real and urgent, and all donations will be put to immediate use. It is requested that contributions will be made before February \Bth, when the campaign ends. ETHLYN TRAPP, M.D., President, British Columbia Medical Association. THE NATIONAL FILM BOARD While many of our readers may have heard of the work of the National Film Board, whose headquarters are at 172 Wellington St., Ottawa, we are sure that very few realize what a tremendous thing this really is. The library of the Vancouver Medical Association, in common as we suppose, with other medical libraries throughout the Dominion, has received from the National Film Board a catalogue of its films, with full details as to rentals, etc. This is a large volume and contains lists of films covering every phase of medical activity. Every specialty has its own films and there are films dealing with preventive medicine and so on. Films may be obtained for showing in medical schools, in lectures to nurses, public health workers, in schools generally, in public lectures on matters of health and so on. They are not available, as we understand, to the general public—but may Only be shown under proper supervision. Full details of this may be obtained from the librarian at the Library of the Vancouver Medical Association, 203 Medical-Dental Bldg., Vancouver. Applications for the position of Executive Secretary of the College of Physicians and Surgeons of British Columbia 'will be received by the undersigned. Letters of recommendation, details of experience, qualifications, age, etc., and a recent photograph are requested with application. Salary to commence at $500.00 per month, plus an annual grant towards the establishment of an annuity. Applications must be in hand immediately. A. J. MacLachlan, M.D., Registrar, College of Physicians and Surgeons of B.C. 203 Medical Dental Building, Vancouver, B.C. Page 75 iOi i Vancouver Medical Association President Dr. H. A. DesBrisay Vice-President ! Dr. G. A. Davidson Honorary Treasurer j j Dr. Gordon Burke Honorary Secretary = Dr. Gordon C. Johnston Editor Dr. J. H. MacDermot SYMPOSIUM EYE, EAR, NOSE AND THROAT Paper read before Vancouver Medical Association—November 5, 1946 HIGHLIGHTS OF OPHTHALMOLOGY I By DR. JOHN A. McJLEAN, Vancouver In this paper I hope to be able to give as complete a talk as the time will allow, of some of the more interesting aspects of ophthalmology. Keeping in mind that the remarks are addressed to a general meeting, I shall leave out technical details, but attempt to stress the relationship between eye work and general medicine. One of the most talked of recent discoveries is, the effect of German measles, Rubella, acquired in the first trimester of pregnancy, upon the offspring. An Australian doctor named Gregg in 1941 after a serious epidemic of measles noted multiple severe congenital defects in babies. The author states, "on the available evidence, when a woman contracts Rubella within the first two months of pregnancy it would appear that the chances of her giving birth to a congenitally defective child are in the region of 100% and if she contracts Rubella in the third month they are about 50%." Congenital cataracts, congenital heart lesions, and deaf mutism are the most common disorders. In a series of six cases described by Lang and Danielson in October, 1945, German measles developed in the mothers during the first two to six weeks of pregnancy. Three of the mothers did not know they were pregnant when the exanthem appeared. The disease was mild and regarded as trivial, most of the mothers did not remember any details of the illness. All the babies had congenital cataracts. Some type of cardiac lesion was present in all cases as well. The seriousness, to the offspring, of such a mild disease as German measles in the mother during early pregnancy, cannot be over emphasized. The family doctor and obstetrician must be constantly alert and routinely question the expectant mothers regarding any signs or symptoms of German measles. In my opinion a therapeutic abortion should be done in cases where measles develop in the mother, at least during the first three months of her pregnancy. Ophthalmia neonatorum or gonorrheal conjunctivitis is fortunately a rare disease in B.C. There have been 12 cases reported in the past 3 years of which two cases have been from Vancouver and the rest from outlying districts. ,To illustrate the seriousness of the condition, Duane, in 1923 stated that 89% of all cases of gonorrheal conjunctivitis suffered a severe loss of vision and 17% became blind. Berens states that 30-60% of blind people owe their infirmity to its ravages. The use of Sulfa drugs and Penicillin has practically wiped out the severe complications. To prevent ophthalmia neonatorum we are compelled by law to use 2% AGNOs Page 76 drops in the eyes of new born infants. If properly used, silver nitrate drops can do no harm and in certain cases a lot of good. But if the drops are allowed to overflow into the tear ducts and sac they cause an inflammatory reaction and closure of the lacrimal apparatus. The subsequent tearing is usually transitory but all too frequently ends up with a purulent dacryocystitis which requires operative interference. The use of silver nitrate should not be left to the nurses, but it should be the duty of the obstetrician to see that the job is properly done. The drops may flood the conjunctival sac, but should be prevented, by means of a cotton pledget, firmly pressed on the puncture from entering the lacrimal apparatus and nose. Whether or not the medical profession will recommend to the Government that silver nitrate drops be discontinued is a question which is receiving some consideration now. The use of a suitable substitute must be advocated. Both Sulfa drops and Penicillin have faults which should be corrected before they are able to take the place of silver nitrate. Regarding squints or cross eyed infants. At six weeks an infant has weak binocular vision but deviation of the eyes from parallelism occurs on the slightest excuse up to 5-6 months. After six months fixation begins to be maintained in spite of all obstacles. Thus if the eyes turn after six months of age one suspects either a squint or a pathological fundus condition. In squint cases glasses are usually necessary. They can be fitted and worn without protest at 14 months of age. Frequently glasses alone are sufficient to correct a convergence squint. If not, an occluder is placed in front of the good eye in order to maintain good vision in the squinting eye. The good eye may be covered from one week to three months at a time. At 2 - 5 years of age surgery may be done. The aim is to send the child to school with straight eyes so that he will not be subjected to the cruel ridicule of his class mates. As a rule the earlier a child receives the necessary treatment for cross eyes the better the final result will be. I would like to impress on you the fact that a child must be seen at an early age by the oculist. Glasses and occlusion will maintain good vision in each eye which is absolutely essential if we hope to get binocular single vision and fusion. As soon as the child is old enough to co-operate orthoptic treatments may be started. We are fortunate in Vancouver to have an orthoptic clinic where, under the supervision of the local oculists, trained and competent orthoptists treat cases of eye muscle imbalance. The aim of the treatment is to develop binocular single vision, fusion and to restore normal muscle balance. Congenital cataracts are not uncommon. There are frequently two to three children of one family affected. The treatment is surgical and the time of operation depends upon the amount of visual loss. These children should be seen early in order that an estimation of their visual loss can be made. If the loss is too great operation should be done at once in order that sufficient light may get to the macula and allow it to develop in the normal manner. The operation consists of splitting the capsule of the lens by means of a small knife. The lens material absorbs aqueous, swells up and disappears. Needlings frequently have to be repeated to get a clear black pupil. Corneal Transplants or Keratoplasty is not a new idea. Reisenger in 1824 first operated upon man. He transplanted the cornea of a pig to a human eye, the transplant became opaque. The idea has been modernized and popularized by Tudor Thomas of England, Cas- troveijo of New York and many others, until now the operation is being done with good results in all parts of the world. The opefation undertakes to replace non-refractile or opaque corneas by means of clear whole thickness transparent human corneas. The material used is from the eyes of pre-mature or still born infants, cadavers, or freshly enucleated eyes. Grafts may be taken from donors no matter what relation- Page 77 -I ship exists between haemolysis or agglutination of his serum and that of the host. On the whole, eyes of young people are most suitable and living persons the best. The technic used is to secure a round knife by using a trephine or a square graft by using parallel knives. In either case the same instrument is used in both eyes and by means of sutures the graft is firmly held in place in the recipient's eye. To insure a take it is necessary for the recipient to have some areas of clear cornea and not be totally opaque. The operation is hazardous and postoperative complications are numerous. In spite of its limited application the corneal transplant operation has stimulated popular fancy, and has made good material for many popular magazines and newspapers. Eye Injuries. There are many injured eyes enucleated each year which could easily have been saved if it was not for the constant danger of sympathetic ophthalmitis. It is true that many of the enucleated eyes have useful vision but neither the patient nor the surgeon wishes to risk the remaining good eye in the hope of securing doubtful vision in the injured one. Duke Elder defines sympathetic ophthalmitis as "a specific bilateral inflammation of the iris, ciliary body and choroid of unknown etiology characterized by an insidious onset, progressive course and a disastrous termination . . . which almost invariably follows a perforating wound involving iris, ciliary body and choroid." In general terms sympathetic ophthalmitis is excited by perforating wound in 65% of cases, operative wounds 25% of cases while remaining 10% is made up of contusions with ruptured sclera, perforating corneal ulcers and intraocular malignant tumors. The commonest exciting condition is that of a subacute inflammation in a soft shrunken eye in which delayed healing of the perforating wound is present. The incidence of sympathetic ophthalmia after perforating wounds is given by Duke Elder at 2% whcih is a high estimation in my opinion. Formerly the incidence was much greater—American Civil War 16%, Franco Prussian War 55%. World War I the Germans reported 13 cases while the U. S. Army had no cases and none were reported by the British Army. The interval between the injury and onset of sympathetic ophthalmia may be from nine days to fifty years. The greatest incidence was between one to six months. In eye injuries the doctor must always consider the possibility of an intraocular foreign body. It must be removed at once in order to save the eye and prevent pqssible sympathetic ophthalmia. The location of the penetrating wound in the eye is most important. One which goes through the ciliary region and causes only slight loss of vision is much more serious than one which goes through the lens causing a traumatic cataract. Injured eyes which heal slowly, especially with perforating wounds of the globe, must be viewed with alarm. In conclusion I would like to emphasize two points in this short talk. First, the damages of German measles in the first trimester of pregnancy, to the baby. Second, the damage due to penetrating wounds of the eyeball. RECENT ADVANCEMENTS By DR. LEESON (Read at Vancouver Medical Association Regular Meeting, Nov. 6, 1946.) Tonight it is my purpose to bring to you a few thoughts about the new drugs used in diseases of the Ear, Nose and Throat. The rapidly changing therapeutic world is giving us many new drugs and drug combinations to aid in the treatment of these diseases. Page 78 r our use, mu ch ln- By the time these drugs reach the market and are available fo preliniinary work has been done in the laboratory and clinic. Too often we are prone to follow the easy course of allowing ourselves to be fluenced by what we read in advertisements. We do not seek the results written by the pioneers in these new drug therapies although this material is readily available in medical journals. These reports are the results of patient and painstakingly close attention to details over months and years, on many patients. We pass over these pages and accept a new drug, hoping in our blind faith in advertisements that we can obtain as good results as we are told will be the rule. We may be delighted with our treatments, obtain good results, then find that the next series of cases does not respond to the drug, as did the former ones. The day of trial and error has passed. In the use of drugs certain definite factors must be considered: (1) An adequate dosage must be given. It is understood that the reaction of diseased tissues to a particular dosage varies with the individual. (2) The probable sensitivity of the patient must be determined. We may be confronted by patients who have an idiosyncrasy to a drug, or who have developed a sensitivity as in treatment with sulfonamides and penicillin. (3) The patient's ability to purchase expensive drugs must be established. If he cannot afford them, a less costly alternative must be found. These are physiological and economic problems which face all of us at times. For the purposes of reviewing therapy in the diseases of the upper respiratory* areas, the Ear, Nose and Throat will be taken as separate anatomical regions. EAR. I. One of the most recent operations for the recovery of a percentage of hearing is the fenestration "window-stopple" operation, developed by Lempert. His screening of "hard of hearing" patients suffering from otosclerosis, with the operation performed, has resulted in benefits to the patients in a fair percentage of the cases. It is a long and tedious procedure requiring detail and immaculate technique. This treatment is available in Vancouver. There are classical criteria for cases suitable for fenestration. A patient (1) who is young (adolescence to forty-five years of age), (2) who has a progressive loss of hearing, (3) whose air conduction curve on audiometry is generally flat or rising in the high tones, and (4) whose bone conductive loss is not more than 20 db from 200-4000 cycles. II. In the treatment of aural conditions which are characterized by inflammation and discharges, topical applications are used for the local treatment. Preparations containing benzocaine, procaine, chloral hydrate, antipyrin, camphor or menthol, alone or in combination are useful for symptomatic treatment but have little or no germicidal effect. The germicidal substances which may be used are phenol, formaldehyde, iodine, the sulphonamides, urea and hydrogen peroxide. Although phenol has an antiseptic action in painful ear infections, its disadvantages are listed as extreme toxicity, and pyrexia. McCulloch says "the use of glycerine to dilute phenol is irrational; other mildly germicidal dressings should replace phenolized glycerine." A new product is "Glycerite of Hydrogen Peroxide", a new hygroscopic, bacteriostatic and bactericidal agent for the treatment of aural infections. This preparation contains H202+Urea+8 Hydroxyquinoline dissolved in anhydrous glycerol. In Chronic Suppurative Otitis Media, if cholesteatoma is a possibility, local instillation of an aqueous solution of penicillin is contraindicated. If there is a large drum' perforation, no signs of cholesteatoma and no granulations, penicillin drops in the middle ear will in some cases control the local infection temporarily. If granulations are present and cannot be destroyed by local caustic therapy, penicillin drops are useless. Page 79 ft j I > NOSE: I. Local applications for establishing airways in acute rhinitis with swelling of the nasal mucous membranes are many, have varied actions and reactions. We are not satisfied that agents containing sulfonamides are the best, because of side reactions. The topical application of sulfa drugs to inflamed mucosa may cause a sensitivity, which to say the least is inadvisable and unnecessary. Our time honoured Ephedrine in weak solution along with Prothricin are two of the best known and most widely used drugs. Proetz believes that Ephedrine by mouth exerts as much lasting benefit to the patient as when instilled in the nasal passages. Too often the incorrect method of application to the nasal mucosa results in little benefit, and waste. The head back, nose pointing to the ceiling and breathing through the mouth, then instillation of the drops into the nasal orifices, bathes the tissues producing the maximum effect. In this method the fluid encouraged by gravity fills the nose, thus coming in contact with the whole of the accessible nasal mucosa, and is kept in contact a sufficient time to have an effective action. II. "Post-nasal drip"—this term leaves nothing to the imagination. Only the term is new, the symptom is ancient. Our older patients call it "catarrh". Because patients of all walks of life, and levels of intelligence have lately elevated a disagreeable symptom to a serious affliction and seek relief, one must consider post-nasal discharges and their effect, if any, when swallowed. Proetz has discussed the possibilities of gastric disturbances from post-nasal drip and has found that the gastric juices destroy any bacteria present in the secretions; so bacterial growth in the average stomach is problematical and unlikely. III. Penicillin therapy in nasal conditions is now in universal use. Intramuscular injections or a slow continuous intravenous drip and topical applications are used. In giving intramuscular injections the patient is more comfortable if isotonic saline is used in place of the usual distilled water, especially in the more concentrated preparations of penicillin. Drops and sprays containing penicillin have proven of no particular value in acute nasal conditions. In acute purulent infections tamponage with penicillin cream or ointment have a limited value. Furunculosis at the anterior nares, in the vibrissae, is controlled and in most cases results in a cure, by the application in contact with the furuncle of an ointment containing salicylic acid and sulphur. A new drug, Benadryl, is now coming into use for the rapid clearing of nasal congestion as in vasomotor rhinitis. It is administered by mouth, intramuscularly and intravenously. Intramuscular injections are used sparingly, due to muscle irritation. Benadryl is of some benefit in treatment of some oedema problems. The results of treatment of children suffering from hayfever, asthma, vasomotor rhinitis, urticaria and serum reactions with Benadryl suggests that this is a useful drug, if an adequate dose is employed. It is suggested that 2 mg. per pound of body weight daily is an effective dose in most cases. MOUTH AND THROAT In a recent paper on the oral administration of penicillin, Finland, of Boston, has concluded that from two and one-half to five times as much penicillin is required by mouth as by intramuscular injection in the treatment of oro-pharyngeal diseases. It is also indicated that penicillin has greater effect when given before a meal. Ordinary commercial penicillin powder when given in saline solution before a meal gives serum levels which are at least as high and as well sustained as the various preparations which contain buffers and stabilizers in tablets or capsules. Page 80 Effective penicillin levels are fairly well maintained with several oral preparations given in 90,000 of 100,000 unit doses, every two hours. With the use of penicillin by mouth for any minor acute infection there is always the possibility of a "penicillin-fast" condition arising, so that when a major disease arises one may fail to secure good results. If the treatment by oral penicillin of oropharyngeal or laryngeal infections is contemplated, it must be recognized that an adequate dosage is to be provided to produce the results desired. Small doses are not justified. Many new drugs are available for treatment of diseases of the upper respiratory system. Some of them product beneficial results. They have been tried and within reason- abl elimits are recommended by clinicians of undeniable repute. However, it is the individual patient with his signs, symptoms and his laboratory findings which guide us in our administering the proper medicine, in an adequate dosage, for the required period to produce the result for which we are aiming. Mr. President and fellow workers, I wish to thank you for the opportunity to present this evening this short paper on newer developments, on behalf of the Ear, Nose and Throat Section of this Association. HIGHLIGHTS OF OPHTHALMOLOGY By DR. A..R. ANTHONY It is my belief that up to the present time there has been far too little ophthalmology taught to our medical students. As a result, the general medical man and specialist in other fields fee lthat ophthalmology is a peculiar little branch of medicine in itself with a strange nomenclature and peculiar disease seldom seen in the general field of medicine. Owing to this lack of education in our medical schools,^the general practitioner and those practicing in other specialties have little or no interest in this field. As a result, in the last forty years, the general public have in a large majority of cases, gone to opticians or optometrists to have their eye examinations. Even today, approximately fifty percent of eye examinations are conducted by non-medical men. We, as ophthalmologists, have no quarrel with the opticians or optometrists. If these men have been well schooled in optometry we do not deny that in certain age groups their refractive examinations are satisfactory; but medicine has fallen down on the job. No one of any age should have a refractive examination without a proper medical inspection of the eyes. The general public believe that an optometrical examination of the eyes is medical, and that these people who examine them are qualified to tell them to existence of any eye disease. This fallacy is brought home to us as ophthalmologists very tragically and on frequent occasions when patients, who had a curable disease, are seen in our offices in an incurable state. It is also a recognized fact that no one can have a proper refraction under the age of forty without the aid of cycloplegic drops, and here again, it is saddening to see young children or young adults with amblyopia, or myopia, or strabismus or other muscular imbalance, who have for years received improper care of the eyes resulting in a permanent disability. While it is true that in patients over forty years old, the optometrist, if well qualified, can do an adequate refraction, the importance of medical examination of the eyes is obvious; for it is in this age group of patients that there is the greatest incidence of eye diseases. All too frequently we see patients with advanced glaucoma who have been refracted and their glasses changed two or three times in the past six months. It is very obvious that medicine has let the general public down. How we can correct the present situation, it is difficult to say. It might possibly be solved by insisting that all eye examinations be medical, but that optometry be allowed to practice under medical direction. Page 81 *< 1 Hi £1 One of the greatest problems in ophthalmology is glaucoma. This insidious disease, which, like diabetes, can be effectively controlled, is the greatest cause of blindness today. It should be the duty of every medical man to have a good general understanding of this very important eye disease. At the present time, the general practitioner, and those in other specialties, have only a vague idea as to the nature of symptoms of this disease. The only reliable symptoms are blurring of the vision, usually in the morning, and haloes about lights. Most cases of glaucoma are of the chronic type and have only these two vague symptoms combined with loss of field of vision, which is not noticeable until the disease is in the later stages. Pain is not a factor in chronic simple glaucoma. The two important clinical signs in glaucoma are increased intraocular tension and cupping of the optic disc. However, in cases of glaucoma where there is obvious cupping of the disc, the patient is practically blind, for it represents a very advanced state of glaucoma. The idea of palpating the eye-ball to estimate the intraocular tension is obsolete. It is my contention that every medical man should have a proper tonometer for measuring the intraocular pressure and have it available in his office just as he carries his stethoscope. It should be part of the routine physical examination in any patient, as the procedure does not take any more than forty-five seconds. If the symptomatology of glaucoma was part of every medical history and if the taking of the intraocular hundreds of cases of blindness would be avoided. As it is today, it is unusual for a general medical practitioner to diagnose a case of glaucoma and refer it to the oculist. With the early diagnosis of chronic glaucoma, the prognosis is excellent for vision for the remainder of life. The treatment of cataract has been revolutionized in the past twenty years, and it might be of interest to you to briefly mention the modern surgical treatment of cataract. The general public still believe that the patient must go blind, and as the old expression goes "allow their cataracts to ripen". The old-fashioned operation was done in three stages. First, a preliminary iridectomy was done in which the pupil was notched to allow extraction of the cataractous lens. This meant at least one week in hospital. Some weeks later, the cataract extraction was done by incising the cornea, breaking the lens capsule, extracting the lens nucleus, and washing out as much of the lens material as possible. This meant two to three weeks more in hospital with the great discomfort of sand bags constantly to the head, and lying prone in bed, and with the not inconsiderable risk of hypostatic pneumonia in older patients. Some weeks later, a needling operation was done to incise the after membrane which formed, and allow a clear pupil. All this made a cataract operation a tremendous expense, and one not without risk to life, and the result uncertain due to many possible complications. The modern operation is done in one stage. The cornea is incised, the iris keyholed by iridectomy, and the lens grasped by its capsule, and dislocated* and extracted intact. Sutures are used to close the eye. The patients are in bed and blindfolded only two days. Hospitalization is approximately five to eight days. In the modern method of cataract surgery, the cataract, or opaque lens, is removed self-contained in its capsule: the so-called intracapsular cataract extraction. This method of cataract surgery, while it is more difficult to perform, is today a standard method. It has great advantages over the old method in that patients can now be operated on as soon as their vision makes work impossible, or inconveniences their life. As well as this great advantage, the eye heals in a remarkably short time; usually two to six weeks after operation the vision is restored to normal. Also the number of complications are minor compared to those with the old-fashioned operation. The intracapsular cataract operation can only be performed in people over forty, as in people under forty the fibres holding the lens to the ciliary body are so tough that it is impossible to dislocate the lens without breaking the capsule. There are many claims made for the medical treatment of incipient cataract, but to this day there is no known medical treatment which really postpones the development of cataracts. For some reason not yet known, incipient Page 82 cataracts frequently disappear spontaneously, but once the vision has been reduced more than fifty percent, the cataract progresses to ultimate maturity but with a wide variation of time interval, depending usually on the type of cataract. In the past two or three years, there has been a great deal of general interest in contact glasses. Glass contact lenses have been available for the last thirty or forty, years, but with the recent advances in the development of plastics, and the final development of the plastic contact glass ,the public interest has increased tremendously. The glass contact lens was fitted from a trial case of lenses by trial and error to get a fair approximation of fit, but the plastic contact lens is molded to make a perfect fit of each eye. A jelly is used which when poured on the eyeball, solidifies in one minute. From this mold a plaster case is made and sent away to" the manufacturer. The semi- finished lens is returned and minor alterations in fit made and a refraction is done. The lens is then returned to the manufacturer to have the optical correction ground on the lens. The finished lens is then returned and the patient taught how to apply and use the lens. A great deal of time is necessary experimnting in each case with various fluids to be used in the application of the contact lens, for as you know, the space between the lens and the eye must be filled with liquid. Various combinations are used with a wide variety of pH as each patient requires a slightly different solution. Unless the correct solution is found, the fluid between the contact glass and the patient's eye becomes foggy and clouds the vision in a short time after applying the lens. You can appreciate that there is much technical work involved in the successful getting of these lenses. You might say that there are roughly two classes of patients that wear contact glasses. The most important class of patient is one with a deformity or disability in the eye that contact glasses will correct and give better vision than with the spectacle lens. Patients who have deformities of the cornea, such at keratoconus, or young people who have had cataract operations, are the cases which are more successfully fitted with contact lenses. The other class of patients that wears contact glasses are people who are extremely short-sighted and wish to wear contact glasses so as to get away from the disfigurement and discomfort of the heavy spectacle lens. Artists in the theatrical profession often desire contact glasses for stage performance where spctacles are undesirable. This latter group of patients wearing contact glasses usually wear the glasses for short periods only. Contact glasses, no matter how skilfully fitted, do cause* some irritation to the eyes, and are definitely more uncomfortable than wearing the ordinary spectacle lens. For this reason, it appears doubtful if the wearing of contact glasses will ever replace the spectacle lens. As oculists, we are constantly besieged with patients requesting us to fit them with contact glasses, but for the reasons mentioned above, we do not recommend contact lenses for a person who can wear spectacle lenses with comfort. The odd patient of this type who insists on having contact lenses is usually disappointed when they receive them. Due to the irritation of the contact lens, the patient seldom will wear the lens for any length of time and eventually the contact lens is discarded and the patient returns to their former spectacle lenses because they are more comfortable and the vision just as good. ! i NOTICE ! American College of Physicians and Surgeons will hold their Sessional Meeting in Vancouver on April 21st and 22nd. Programme will appear in next issue. Page 83 1 t1 I! 1 m VAGOTOMY (Presented Before the Clinical Section of The Vancouver Medical Association, November, 1946.) By DR. LYON H. APPLEBY, VANCOUVER. In discussing Vagotomy it is well to recall that a belief in the neurogenic basis of ulcer has been current for many years. I recall many articles written shortly after World War I stressing the incidence of ulcer in those times of stress. Similar observations were made during the depression of the early thirties and to Crile we owe the cryptic observation: "When stocks go down in New York, diabetes goes up in Cleveland." The disastrous effects upon digestion of emotional stress, worry and anxiety are well known through the ages. The neurogenic basis is commonly referred to in articles commenting upon the marked frequency of ulcer in the armed forces. The fact that emotional upsets and stresses cause disturbances in the automatic nervous system is fully authenticated. As Sherrington has said, "Emotion moves us—hence the name." Long ago Dr. Harvey Cushing made the observation that many more cases of subthalamic tumors were developing gastric ulcers and perforated ulcers than could possibly be explained on the grounds of coincidence alone. The functions of the vagus nerve within the abdomen are motor to the masculature of the bowel down to where the pelvic parasympathetic takes over, and secretory to the pancreas, stomach, liver, gall bladder, etc. While actual preistalic movement is intrinsic to the bowel through the Meissnerian plexus, the function of the vagus is that it acts as a starter, the vagal thrust instituting the wave which the intrinsic plexus perpetuates. This self-starting mechanism is operative until the hormonal control becomes established later in digestion. I shall not burden you with a dissertation upon the' aetiology of ulcer; suffice it to say that the high acid of the empty stomach at night unbuffered by the presence of food, is one of the actual exciting factors and the whole symptom complex of the disease is described in two words, hypersecretion and hypermobility. Both of these phenomena are under direct vagal control. While, in a discursive way, much has been done about nervous influences on peptic ulcer, it remained for Dr. Lester Dragstedt to do the first extensive surgical work on the division of the vagus as a remedial surgical procedure. His observations on about four hundred cases are to the effect that as a result of the division of all fibres of both vagi, hydrochloric acid is markedly reduced or abolished in the stomach and remains so. There is an immediate decrease in gastric tonicity and motility, pain is abolished, craters slowly become invisible, and the pnatient becomes symptom free. These cases are checked postoperatively to confirm the division of all vagal fibers, either with a histamine response or an insulin tolerance test. If fibers are not completely divided secretion will occur under this stimulation. This has stimulated quite a lot of research into the anatomical structure and variations of the vagus which are by no means constant. Each of the vagi may enter the abdomen as a separate trunk, they may branch out considerably or they may form a regular fretwork without any established order. Dr. Waltman Walters, recently reporting on this point, stated that there was no regularity to their irregularity. For some time vagotomy was usually done by the transthoracic approach, but this has been slowly abandoned, and now nearly all are done abdominally, mobilizing the left lobe of the liver, splitting the peritoneal ligaments of the lower oesophagus and dragging the oesophagus down an inch or so into the abdomen from the thorax, placing the vagal fibers on the stretch as tense cords like fiddle strings, materially facilitating their recognition and division. Quite a wave of enthusiasm has developed, and nearly every surgical conference has Page 84 included several papers, a round table conference, or some other recognition of the acute iLterest of the surgeon in the possibilities offered by vagotomy. There are several questions which at once come to mind as far as I'm concerned. First, should vagotomy be accepted as a remedial procedure, purely on its own account? If you had a perforating duodenal ulcer and had your abdomen opened, would you be content to have a vagotomy without the removal of demonstrable and removable pathology? I have done a great many gastric resections for ulcer and, taken by and large, they are amongst the happiest postoperatives that I have and the operative mortality is under three per cent. From two to three per cent have jejunal ulcer recurrence even in the presence of complete postoperative achlorhydria. I cannot help but wonder what the side effects may be and what the remote after effects will show. I believe there is an analogy to be drawn with the present position of the radioactive isotope of iodine in thyroid disease. Eighty per cent of this iodine isotope concentrates in the thyroid and literally fries the gland in situ; however, the other twenty per cent locates itself elsewhere and I cannot help but wonder what other fish are being fried and what the after effects may be. Similarly with gastric neurectomy; the vagus also supplies secretory powers to the pancreas, succus entericus, liver, etc., and one cannot help being interested in what collateral effects may become evident due to loss of vagal control through the years. The fact that these cases show much more postoperative distention and atony is already well-established. What is not yet so well established is the possibility of the development of megacolon, static phenomena, sphincteric spasms, etc., as a remote sequel to its performance. We are inclined to forget in our enthusiasm that this is a "peptic" ulcer, not an acid ulcer, yet no word has been forthcoming as to the effects of vagotomy upon'pepsin or trypsin production or the effect upon its activity. We know that pepsin works at its optimum at a certain established pH, and that increases in acid must stimulate its action and decrease of acid concentration slow it down. What does vagotomy do to the production of pepsin and other intestinal enzymes? I am not opposed to vagotomy, nor am I so adamantly committed to any particular type of therapeutic procedure that I am unable to listen to any form of reasoned persuasion to the contrary. Nevertheless, I feel that vagotomy is still in a highly experimental phase. Much research remains to be done on its side effects, and more reports are needed regarding the possibility of re-establishment of control through other channels. I believe that vagotomy has a place, but that place is as an accessory to established and long proven procedures, in those cases where trouble and subsequent difficulty may be anticipated from past experience. Such cases as recurrent marginal ulceration following Finsterer or Devine types of exclusion resection or continued haemorrhage from such excluded ulcers, particularly in those cases which show that acid is still high, and that total achlorhydria has not been produced. It is also quite possible that other medical cases with high degrees of hyperacidity but with no demonstrable lesion may be cured by neurectomy, whereas, in the past nothing but disaster has followed surgery in the absence of demonstrable lesions. In the complicated procedures incident to the repair of secondary ulcerations and the primary approach to high difficult ulcers in cases otherwise burdened by disease and in the gross hyperacidities of purely functional and neurogenic origin, neurectomy will ultimately find its useful place. There are numerous evidences of pylorospasm causing food retentions necessitating gastroenterostomy as an accessory procedure to neurectomy. Fluid stools and diarrhoea have been commonly observed as a remote sequel so that it is to some extent the irrevocability of the procedure that makes one hesitate. I think the present position of vagotomy is much like a left handed club in a golf bag—it may be an invaluable thing in times of certain types of trouble, but not one which one hopes to have to use frequently—furthermore, it will be used most frequently by the higher handicap players and Page~S5 * I am, with a limited experience of vagotomy, convinced that the more experienced the surgeon in gastric surgery, the less frequently will it be required. There is real wheat ia vagotomy and while waiting for it to be separated from the chaff in those ordinary cases where gastric resection has so long assured success, such established procedures should not be forsaken. A knowledge of the effect of nervous influences upon digestion and the diseases of the stomach has been gathered down through the ages. Possibly, it was with a foreknowledge of Dragsted's work that the Good Book has said: Better a dish of herbs where love is; than a stalled ox and hatred therewith. HISTORY OF VANCOUVER MEDICAL ASSOCIATION SMALLPOX IN VANCOUVER By DR. G. A. KIDD Smallpox, which today is a disease rarely seen by a medical practitioner, was prior to and during the first decade of this century, a routine experience. Vancouver, being a seaport, with ships from the Orient entering her harbour, was of necessity constantly on the alert against the diseasee being introduced by infected sailors and passengers from these ships. Most of the city's epidemics came from this source. In the city there always has been, and still is, an organized opposition to vaccination against smallpox. While at the present time this may be disregarded, in earlier days such was not the case. During the epidemics of 1920 and 1924 this agitation against vaccination was very marked. The brunt of the attacks was borne by the permanent medical officials of the health and school services departments. Many times these doctors faced hostile audiences which had no desire to listen to reason. The Medical Association held several special meetings at this time to consider the problem, and did all in its power to counteract the insidious propaganda. It backed the City Council in its fight for the vaccination of all citizens. As recently as the spring of 1946, just 150 years after Jenner inoculated his first case with the serum of cowpox, an epidemic of the disease across the border threw Vancouver into a fright. Thousands of persons iri the city were found never to have been vaccinated, and for a few days the vaccination centre set up by the Health Department, were crowded. Incidents arising out of small pox epidemics in the early days of Vancouver, are many, and might be amusing if they were not tragic. We are indebted to the City Archives for the. stories connected with the more serious of these. In 1882 a ship called "The Charmer" came into the Port of Vancouver, having touched at Victoria. It had a case of smallpox on board. Its crew and passengers broke quarantine and left the ship. A riot ensued. A certain reporter named Lang, from the staff of a Victoria newspaper, was among those who quit the ship. He was thrown into, jail where he spent the night. The incident gave rise to much ill feeling between the two towns. In 1883 we find the residents of Brockton Point under quarantine. They were mostly half breed squatters. Again in 1888 while Dr. Robertson was health officer for the city, trouble broke out in the same vicinity. This latter epidemic originated among the Indians whose village at the time clustered about the present site of Lumberman's Arch. As a result of these repeated outbreaks Dr. Robertson ordered the entire village Le burned to the ground, and the natives cleared from the area. The first three years of the nineties were the worst in the history of the city, so far as smallpox is concerned. An article in the News Herald of February, 1944, written by Cromar Bruce, gives the following picture: "On Dominion Day of 1892 Vancouver Page 86 was decorated with flags, but they were all yellow. On street after street a traveller would see only yellow colours, denoting that within the house so marked, there was a case of smallpox. July of that year was the most dreadful month) oldtimers can recall. Mrs. J. Z. Hall remembers that from her home in the West End, the yellow emblems of the dread disease could be seen everywhere. Said Mrs. Hall: "It was the custom to put,the stricken patient in an express wagon and rush him to the quarantine hospital on Dead Man's Island. Using a warning bell, the driver of the wagon kept the track clear for himself as he drove his patients to the dock where they were put on board the boat and taken to the hospital." The disease had been brought from the Orient by one of the Empress boats and almost every Vancouverite who visited the shop contracted it. The late Dr. Langis was at the time one of the best known practitioners in the city. In his memoirs he recalls that in 1893 he was in charge of a tent isolation hospital at Cedar Cove. The tents were pitched on rafts. He had under his care eighteen cases, of whom three died. A story is told by a certain Mr. Chaldecott of Chaldecott Park, in England: '(In the nineties the City of Vancouver had an isolation hospital on Dead Man's Island. A young man from my home, a remittance man, had the misfortune to be a patient there. He wrote to his mother in England giving his address . as 'Pest House, Dead Man's Island, Vancouver, B.C.' You can imagine the feelings of his aristocratic, Victorian parent as she considered this address. She at once communicated with her London bankers who for a time kept the Atlantic cable humming until they found out what it was all about." During these years there was continuously bad blood between Victoria and Vancouver. The latter blamed the former for its repeated epidemics, claiming that they were due to infection carried by the boats entering the harbour from the Island City. Mrs. LeFevre, widow of the late Dr. Lefevre, describes what she calls "The battle of the Hoses," which occurred about this time. "We had small pox and blamed it on Victoria. Capt. John Irving brought his boat into the harbour from that city and the police would not let him dock. They called out the fire department who turned their hose on the ship's crew. Capt. Irving retaliated byturning the steam hose on them. He finally had to take his boat up the Inlet." Another incident occurred when in 1892 the S.S. Yosemite, out of Victoria, tried to tie up along the C.P.R. dock. The mayor swore in special police to hold it in check. The boat then made its way towards Hastings Park to try for a landing there. The City Council commandeered the hotel omnibus and galloped madly up the Inlet to head off the ship. The latter finally anchored in mid-harbour. Next day—Sunday —the City's pulpits referred to the incident as: "An attempted outrage." In 1892 we find vaccination which was free to the public being carried out. The vaccine was supplied by the City Council who that year purchased one thousand points. Drs. Robertson, Ferguson, Tunstall, Herald and Brydone-Jack were appointed public vaccinators and were allowed a fee of fifty cents for each operation. I In 1900 the Medical Association concerned itself with the vaccination of Indians as carried on throughout the Province. The following resolution was passed by the Society: "Whereas it has come to the knowledge of the Society that it is the practice of various/ agents throughout the Province to vaccinate the Indians under their charge, and whereas this practice is fraught with many instances of serious consequences to the said Indians, such as the conveyance of various diseases as syphilis, tuberculosis, etc., and whereas it is universally recognized among the Whites that a qualified Medical Man is the proper person to perform this operation; be it resolved that this Society respectfully requests that the Department of Indian Affairs make arrangements whereby vac- . cination of the Indians be performed, by qualified Medical Men." Their request was granted. Fortunately the term "Pest House" is no longer found in the vocabulary of the Health Department. Formerly it was thought that such a quarantine hospital for Page 87 smallpox cases must be removed some distance from all dwelling houses—the law of the day mentioned 150 yards. As late as 1910, it would appear from its discussions that the medical Association considered smallpox an airborne disease. One member stated that in his opinion: "The influence of smallpox can be felt for a mile around." Hence the use of Dead Man's Island, Cedar Cove and a boat house purchased by the Council for four hundred dollars from a certain Mr. Linton, for use in isolating cases of the disease. Later, an isolation hospital was opened on Turner Street, but in 1910 the Medical Society insisted that it was out of date and urged the opening of a new one. It suggested the making use of an island in Burrard Inlet, opposite Barnet. Patients might reach it either by boat from Vancouver, or by carriage to Barnet and thence by ferry to the island. After much opposition the plan was endorsed by the Association. It was never carried out, although a beginning of clearing the island was made, some trees being cut down. In 1912 the present Preventorium building was opened as a quarantine hospital, and the Turner Street.institution was ordered burned. In 1931 Dr. Mcintosh decided that it was too expensive a proposition to keep a separate smallpox hospital equipped to handle the odd case of the disease which occurred, and the building has since been used as a Preventorium. Smallpox cases are now isolated and treated in the Isolation hospital on Twelfth Avenue, which was opened in 1926 as a part of the General Hospital. (To Be Continued) MODERN TRENDS IN OBSTETRICS By DR. N. W. PHILPOTT, MONTREAL. Sir Halliday Croome was well known as the pioneer of obstetrics in Scotland. He was world-renowned on account of his famous saying, "parturition is a physiological process identical in the countess and in the cow." But modern social customs and present ways of living have made child-bearing less physiological. What previously was considered a normal process may now be justly termed an "ordeal." Owing to this progression of things the care of the expectant mother has changed considerably throughout the different age periods. In Biblical days a woman was about to give birth was considered "unclean" and for several days before her appointed day had arrived she was put by herself. Thus she stayed throughout her labour and for several days following delivery. And even today this custom is still followed in certain parts of uncivilized India. But as civilization progrssed so did midwifery proceed. In the Grecian period we find definite interest of the male doctor in the field of midwifery. It was at this stage when the medical man first made a concentrated effort to usurp the rights of the female midwife. This fight was furious and the midwife won for a time. A law was passed to the effect that no male person could attend a woman during labour. Some of the aristocracy broke this law and they had doctors in attendance. However, most medical men lost heart and the interested medical personnel moved to Rome where much progress was being made. Obstetrics was developed in a most definite manner. We read of Version and Extraction—somewhat different to present technique. Also the first definite report in the literature of a Caesarean operation where the result was successful for both mother and baby. In the year 1500 a Caesarean was performed by one, Jacob Nufer, a sow-gelder; he operated upon his own wife. The story goes that the good woman subsequently bore him several other children and that she lived to the ripe age of seventy-seven. Sow- gelders apparently were the surgeons of that time. For history also records that a man of this sow-gelding profession performed the first oophorectomy. (This case should interest you.) Page 88 FOR PROLONGED ACTION—EASIER ADMINISTRATION Sqijibb Tj^Ml^ Wkm^m^^^ 114 OIL AND WAX PROLONGED ABSORPTION". . . penicillin- beeswax-peanut oil mixtures provide an effective and safe method of prolonging the action of penicillin in the body."' HIGH PENICILLIN BLOOD LEVELS Peak blood levels of 0.06 to 1.00 unit are attained in six to twelve hours with at least 0.03 unit at twenty- four hours.2 EASIER ADMINISTRATIONS single daily dose of 300,000 units in 4.8 percent beeswax by weight in peanut oil contained in 1 cc. should be adequate for all but overwhelming infections."3 EASIER INJECTION The new Squibb Penicillin in Oil and Wax is less viscid and flows more readily. Preheating is unnecessary if cartridge is kept at room temperature for 12 to 24 hours. If to be used directly when removed from refrigerator, it is readily liquefied by holding under hot water tap (not over 140° F.) for 3 to 5 minutes. SAFETY AND ECONOMY The new double- cell cartridge contains 300,000 units of penicillin in one 1 cc cell; the second cell contains Aspirating Test Solution to prevent accidental intravenous injection. The metal syringe and replaceable needle can be used repeatedly. Squibb Penicillin in Oil and Wax is also available in 10 cc vials. 1. Kirby, W. M. M.; Leifer, W.; Martin, S. P.; Rammelkamp, C H.# and Kinsman, J. M.s J.A.M.A. 729:940 (Dec 1) 1945. 2. Nichols, D. R., and Haunz, E. A.: Proc. Staff Meet. Mayo Clinic 20:403 (Oct. 31) 1945. 8. Romansky, M. J., and Rittman, G. E.: New England J. Med. 233.577 (Nov. 15) 1945. FOR LITERATURE WRITE E. R. SQUIBB & SONS OF CANADA, LIMITED 36-48 CALEDONIA ROAD TORONTO 186A LABORATORIES OF CANADA, Ltd., 64-66 Gerrard Street, East, Toronto, Ont at the focal point of oropharyngeal infection HIGH LOCAL CONCENTRATION—Prompt and long-sustained in effect; the sulfonamide is maintained in intimate, therapeutically effective concentration throughout entire oropharyngeal area. NEGLIGIBLE SYSTEMIC ABSORPTION—Even in maximal dosage, absorption is negligible; therefore likelihood of systemic toxic reactions is virtually obviated. STABLE—Full potency is retained under all conditions. CLINICALLY ACCEPTED—Established by long and extensive clinical use. Supplied in packages of 24 tablets—3^ grs. (0.25 Gm.) per tablet—sanitaped, in slip-sleeve prescription boxes. <* * important Please note that your patient requires your prescription to obtain this product from the pharmacist. ulfathiazole gum I .11 I M "BUT THEY WILL NOT EAT THE RIGHT KIND OF FOOD..." • Appetite-appeal and instinct are too often accepted as sound nutritional guides, despite general recognition of the fact that health and' well-being depend on adequate nutrition. The need for professional guidance in nutrition is therefore obvious. DIETARY SUPPLEMENT VITAMINS each capsule contains Vitamin A 1,500 int. units Pro-vitamin A (Beta-carotene) 1,500 int. units Vitamin D 600 int. units Thiamine Hydrochloride (Vitamin Bi) 1.2 mgm. Riboflavin (Vitamin B2) 1.0 mgm. Nicotinamide 10.0 mgm. Ascorbic acid (Vitamin C) 2 5.0 mgm. MINERALS each tablet contains Ferrous Sulphate Exsiccated B.P 2.0 grains Calcium Phosphate B.P 2.0 grains To preserve the thiamine hydrochloride from the known destructive action of iron salts, Dietary Supplement B.D.H. is presented in two parts— the vitamins in capsules and the minerals in tablets. B.D.H. One Capsule and One Tablet Constitute a Single Dose • Dietary Supplement B.D.H. is designed to provide a convenient method of supplementing the diet of those who "will not eat the right kind of food." Issued in cartons containing one bottle of 100 capsules and one of 100 tablets. THE BRITISH DRUG HOUSES (CANADA) LIMITED TORONTO CANADA 69A Unfortunately this man had a wayward daughter and this young lady was most difficult to control. The father rightly diagnosed her condition as being caused by too much ovarian stimulation. He therefore operated and removed both the ovaries—for the express purpose of keeping his daughter home at nights. The operation proved successful Midwifery in an organized manner spread to France, to Germany and to England. Different forceps were invented and the use of forceps became quite frequent. But during this period—the 17th century—Caesarean Section fell into disfavour. This was due to the accompanying high maternal mortality. Mortality was primarily caused by the fact that suitable suture material was not known. The open wound would become septic and the patient usually succumbed to this complication. Thus in Paris, the Caesarean operation was banned by law for nearly one hundred years. The development of asepis and anti-sepsis then occurred. In the field of midwifery Semmelweis was the guiding hand. At this time, in Germany, they found that the old idea of isolating the maternity case was really sound. Not because she was unclean but for her protection. They realized that maternity cases should be isolated from the general medical and surgical patients. This was the prime factor in the creation of the "FRAUENKLINIK." In more recent years Colebrooke at the Chelsea Hospital in London has gone further. He found that contacts frequently caused mild or severe sepsis in the maternity patient. For this reason all attending personnel on a materity ward are obliged to have their own nose and throat cultures examined. This is relative to eliminating the "Streptococci Carrier," also other patients who show evidence of any septic condition are immediately isolated. Today, in America, we have tended more or less along these lines. As a result the General hospitals in the various cities have their maternity wings with case-room facilities^—also reserved exclusively for obstetrical work. And the community hospitals have maternity wards and case-rooms separated from the general medical or surgical patients. For many centuries parturition had been considered a normal process. The policy had consequently been—"let nature follow its own course." But times have changed. We now realize that the parturient woman may confront a real hazard. She would be treated with the same meticulous care as one would treat any surgical case. She is susceptible to infection, haemorrhage or toxic manifestions. Any of these complications may prove fatal. In addition, one can never neglect the fact that we are dealing with two lives. It is essential to have the mother and her baby alive—they should also be alive and well. There has been, in years gone by, much controversy relative to the safety of home or hospital delivery. Interested individuals can find arguments on either side. The chief argument in favour of home delivery was relative to infection. A woman in her own home became immune to her own germs and she did not come in contact with many outside influences. This was not true in hospital. However, the situation has entirely changed with the advent of the sulphonamides, penicillin and streptomycin. Arguments in favor of hospital delivery, especially with reference to a primipara, far outweigh any deficiencies. Trained personnel and modern facilities swing the balance. Operative procedures, treatment of haemorrhage and even the treatment of sepsis are more efficiently executed in an institution. Today there is an added feature. This is, the social side of family circumstance. People would rather have their babies in hospital. It is more convenient for every social level in the community. The poor person has not adequate help at home. Another patient might be fortunate in having a maid, but maids do not relish child-bearing in their place of abode. At the present time, in city or in town practice, patients insist upon hospital delivery. During recent years, conditions have changed in our institution, the Royal Victoria Maternity Hospital. Previous to war time we delivered over 500 -cases each year in the home. This was a fine service rendered the community. In addition, it was Page 89 !! * an U excellent teaching material. During 1945, we delivered only 59 patients in their homes. In 193 8, L'Assistance Maternelle delivered over 5000 home cases; this has dropped to less than 2*5% of that figure. The Boston Lying-in Hospital had a large outside service in pre-war days. Last year they disbanded this service because patients demanded hospital delivery. Our results in the Royal Victoria Maternity Hospital are quite significant relative to good hospital care. You might well ask—why the introduction relative to the midwife—and why these facts which give results in the Royal Victoria Maternity Hospital? This Is the Situation: Maternal and foetal mortality generally throughout Canada are well over twice as high as I have shown in figures for this hospital. It is true we have ideal circumstances in which to work. In addition, we have trained personnel to handle every type of case. To counteract these assets, however, we are obliged to handle over 150 emergency cases each year. Some of these individuals have never seen a doctor during pregnancy, others are referred from outside doctors or from smaller hospitals on account of a complicated pregnancy or labour, and still others are referred on account of sepsis or haemorrhage following delivery. In spite of this we have mortality and morbidity which are conspicuously low in comparison with those of the whole of our Dominion. But they are no lower than was found in pre-war days for the whole of Holland, Denmark or Sweden. Here: mMj- wives were the attendants in most cases. We are led to believe that midwives are nojt so skilful—not so good as the doctor. But in these countries they have developed a system and this system works efficiently. It includes the combined services of the midwife, general,practitioner, consultant, social service worker and policeman. Perhaps it can't happen here! But some*- thing similar should be developed. A cooperative plan: (1) General practitioner. ^$4 Home delivery and community hospital. (2) Consultant for complicated cases such as: (a) Placenta Praevia. (b) Pelvic Disproportion, (c) Toxaemia, (d) Special Studies: Endocrines. Rhesus factor. Anaemias. (3) Public Health Doctor and community nurse. (Victorian Order). (Child Welfare.) Preventive care: antenatal, postnatal, blood bank. (4) Place of the University — training of students in the proper direction, general practitioner, specialist, investigative work, new procedures, new drugs and anaesthetics. But we should never lose our perspective. Our course is always best in the middle of the road. The first duty of the obstetrician should be directed to the welfare of the patient. I have been most interested in the influence exerted by example—Dr. Potter of Buffalo was an interesting character but a self-labelled, radical obstetrician. Owing to his example, version and extraction become much more frequent than forceps delivery in the environment surrounding Buffalo, Northern New York State and Ohio. This was not the case elsewhere. As you know Potter, thought, at one time, that no woman should have a .normal labour. Those who did not have a Caesarean would be induced—a manual dilatation of the cervix—and the grand finale of a version and extraction—to say nothing of the occasional grave consequences to mother and child. In my opinion, there should be no place for the radical obstetrician. This is not a political speech but may I be allowed as an obstetrician to advocate—Progressive Conservatism! Do not trade old lamps for new, unless the newer product,will have a reasonable chance to stand the wear and the tear of time. "If it is important for us to.be in this world at all, and indeed we think it is, surely the matter and the manner of our arrival is of first concern." Page 90 New* and Mote* It is reported that the British Columbia Branch of the Canadian Cancer Society, together with the B. C. Cancer Foundation, are initiating plans for another joint cancer campaign in April. This will be part of the international campaign against cancer. Initial meetings of the joint campaign committees have been held, and it is hoped to complete the campaign organization throughout the Province at an early date. Dr. M. R. Caverhill, till now Executive Secretary of the College of Physicians and Surgeons of B. C, and British Columbia Medical Association, has resigned this post and is a senior medical officer with the Workmen's Compensation Board. While his resignation is felt as a severe loss to the Council of the College, and B.C. Medical Association, we feel that the Workmen's Compensation Board is to be congratulated on the acquisition of this very capable executive officer. The regular monthly meeting of the Westminster Medical Association was held on January 13th. Paper of the evening was presented by Dr. Jack Naden, his subject being, "New Hips for Old". This was followed by a large dance which was reported very successful, and enjoyed by all present. From the staff of Christie Street Hospital, Toronto, comes Dr. J. A. C. Thomson who has joined the Burris Clinic in practice at Kamloops. Dr. Thomson spent five years with the R.C.A.M.C., serving in Canada, England, and Northwest Europe. Dr. F. H. Davis of Vancouver has been discharged from the Services and is spending a year at the Ontario Hospital in London, after which he expects to return to Vancouver to practice. Dr. F. W. Tysoe, a new registrant in the Province, has commenced practice at Britannia Beach, B. C. Dr. John Brown, formerly of Bralorne, is now practising in Vancouver. A recent visitor to the College office in Vancouver was Dr. V. St. John of Alert Bay. Dr. G. Stonehouse, formerly of Tranquille, is now located in Vancouver. Dr. G. E. Trueman, also from Tranquille, is now practsing in Kamloops. Dr. C. J. Treffry, formerly of Toronto, is now practising in association with Dr. Howard Spohn of Vancouver. Congratulations to the following doctors and their wives on their recent good fortune: Dr. and Mrs. Sidney Evans, London, England—a daughter. Dr. and Mrs. J. H. Stapleton, Vancouver,—a daughter. Dr. and Mrs. Paul Phillips, Princeton—a daughter. Dr. and Mrs. F. A. Olacke, Vancouver—a daughter. Dr. and Mrs. M. W. MacCrostie, Vancouver—a daughter. Dr. and Mrs. H. K. Atwood, Vancouver—a son. Dr. H. K. Hall, of Vancouver, has gone for a period of post-graduate study to the Payne Whitney Psychiatric Clinic at the New York Hospital. Dr. Hall expects to return to Vancouver to practice. . * I Dr. G. E. Little has commenced practice in Bralorne, B. C. Page 91 We regret to record the recent passing of Dr. J. F. Grant of Victoria. Deepest sympathy of the profession is extended to Dr. and Mrs. Maxwell Evans of Vancouver in the loss of their baby daughter. Deepest sympathy is extended also to Dr. Howard S. Tyerman of Ashcroft, in the loss of his brother, Dr. Wesley W. Tyerman, at Milestone. It has been announced that Dr. A. K. Haywood, who, for many years was superintendent of the Vancouver General Hospital, has resigned from this post but will remain at the Hospital until a successor is appointed. The Board of Directors of the Royal Jubilee Hospital, Victoria, have announced that Dr. T. W. Walker, who has been superintendent for the past thirteen years, is retiring. Dr. Walker will be succeeded by Dr. Morely Beckett, who has been assistant director of the University Hospital at Ann Arbor, Michigan. It is reported that Dr. Phillip Bailey has commenced practice in Penticton in association with Dr. H. B. McGregor. Dr. John Caldwell has returned from Des Moines, Iowa, to practice in Vancouver. Dr. Caldwell, one of our new registrants, was stationed in Vancouver with the R.C.A.F. during the last war. Dr. D. W. Johnstone of the Department of Veterans Affairs in Vancouver has advised us that his office has received extra copies of the new D.V.A. Schedule, and will send them to any doctors in the Province requesting same, who have not previously received copies. MI if! "COURAGE AND DEVOTION BEYOND THE CALL OF DUTY" Through the co-operation of Mead Johnson & Company $34,000 in War Bonds are being offered to physician-artists (both in civilian and in military service) for art works best illustrating the above title, as applied to physicians in war and peace. This contest is open to members of the American Physicians' Art Association and will be judged June 9-13, 1947, at the Atlantic City Session of the American Medical Association. For full details, write Dr. F. H. Redewill, Secretary, Flood Building, San Francisco, Cal., or Mead Johnson & Co., Evansville 21, Indiana. Page 92 ■ ••'••••••••• inters RECENT DEVELOPMENTS IN VENEREAL DISEASE TREATMENT j|§ -M New Drug—BAL—Available The Division of V.D. Control, Provincial Board of Health, wishes to announce that there is on hand a supply of a new drug, BAL, for the treatment pi serious complications arising from the use of arsenicals in the treatment of syphilis, namely, (1) generalized exfoliative dermatitis (2) haemorrhagic encephalopathy It is important to note that the above complications are extremely serious and often fatal, so that prophylaxis is urged. It is recommended that: (1) Always question your patient before each arsenical injection as to the development of pruritus, dermatitis, and headaches (warning signals). (2) Always examine the arms, forearms and chest for evidence of rash before each injection. Development of any of the above demands caution, reduced dosage, change of arsenical (i.e., from neoarsphenamine to mapharsen) or the stoppage of all arsenicals. Penicillin Therapy for Syphillis Penicillin therapy for syphilis is STILL EXPERIMENTAL and the schedules for treatment outlined in our bulletin of April 3, 1945, have recently been revised and are still subject to change. Your attention is again drawn to the fact that this Division is sill limiting the use of penicillin to the following exigencies: (a) Serious reacions to routine arsenic-bismuth therapy. (b) Relapsing, resistant or fulminating forms of early infection. (c) Early syphilis in asocial promiscuous persons. (d) Early syphillis in persons unable to obtain regular weekly treatment (remote rural areas, merchant seamen, fishermen, loggers, miners, etc.) (f) Persons with "difficult" veins—addicts, obesity. (g) Combined with therapeutic malaria for neurosyphilis. Consultative service available. (h) Syphilis in pregnancy—if not treated before 7th month of pregnancy. Requests for BAL or Penicillin should be accompanied by a complete history of the case and forwarded to the Director, Division of V.D. Control, 2700 Laurel St., Vancouver, B. C. Follow-up after Penicillin Therapy for Gonorrhoea or Non-specific Urethritis It is recommended that patients receiving penicillin therapy for gonorrhoea or non-specific urethritis be asked to return for a blood test in four months, since it has been found that penicillin may mask symptoms of syphilis for a period of four months. Page 93 i* * J» •.It t k, I* Brand of chorionic gonadotroph in in ^ *W * potent * economical m painless on injection ■^^3- STRENGTHS w^^\ is For the treatment of cryptorchidism, Frohlich's syndrome, hypogonadism, menorrhagia and metrorrhagia. AYERST, McKENNA & HARRISON LIMITED 426 Biological and Pharmaceutical Chemists • MONTREAL, CANADA 43-ACRE REMEDY TOR GROWING PAINS We think it's a healthy sign when a 51-year-old organization has growing pains. And our remedy is the purchase of a new 43-acre plant located in Milwaukee. It includes adequate provision for expanding production and accelerating engineering research and development of radiographic and therapeutic apparatus. Important to you is the fact that the move from Chicago to Milwaukee will mean no interruption of the production schedules established to meet present delivery promises. Our Chicago plant will continue to run at full capacity. The Milwaukee plant, already in operation, will gradually assume an increasing share of the manufacturing load. Here, in this modern manufacturing facility, is concrete evidence of our plans to meet present and future demands of your profession. And your demands will be met without sacrificing the high quality and efficiency that have always characterized the products of this organization. General Electric X-Ray Corporation. 175 West Jackson Blvd, Chicago 4, Illinois. VICTOR X-RAY CORPORATION of CANADA, Ltd DISTRIBUTORS FOR GENERAL <M? ELECTRIC X-RAY CORPORATION i': 1 111 ; 1 <* 1 1 j ii ■ 1 B {] ft: 4 |.| i|j I1 • W 1" jj • jj 1; |!i«| 1ST i t y mill I If if iV '' 1 || * |; '«: WRITE FOR DETAILED IflWAtURE-f Narcotic blank required |||||P ## SMOOTH LABOR Demerol, the potent, synthetic analgesic, spasmolytic and sedative, relieves labor pains promptly and effectively without danger to mother and child. There is no weakening of uterine contractions, lengthening of labor, or postpartum complication due to the drug. Bad effects on the newborn are practically nil: no respiratory depression or asphyxia from too much analgesia of the mother. Simplicity of administration is another commendable feature. mi HYDROCHLORIDE Brand of meperidine hydrochloride (isonipecaine) DEMERc^-tjt^e^irk Reg. UJ^Pot'Off. feCcmbckj Available in ampuls (2 cc, 100 mg.); vials (30 cc, 50 mg. / cc). THERAPEUTIC APPRAISAL: Prompt, prolonged nasal decongestion without appreciable compensatory recongestion; virtual freedom from local and systemic side effects; sustained effectiveness on repeated use. INDICATED for symptomatic relief of the nasal congestion of common colds, ffinmntiH and allergic rhinitis. S-17A To restore nasal patency in colds and sinusitis. Neo-Synephrine decongests promptly... clears the nasal airways for greater breathing comfort... promotes sinus drainage. Relief lasts for several hours. Virtual freedom from compensatory vasodilatation precludes development of dependency symptoms. NeoSynephrine t * 4 m e o/f put* y\l t * H & I M e HYDROCHLORIDE For Nasal Decongestion {"io.$tmiph»"':- |«»»tociiioii»,iji ADMINISTRATION may be by dropper, spray or tampon, using the X % in most cases, the 1% when a stronger solution is indicated. SUPPLIED as M% and 1% in isotonic saline and M % in an emulsion, bottles of 1 fl. oz; Yi% jelly in convenient applicator tubes, % oz. •^^otearn &*&*&- c/- (^anac/a, ,-/-£/. WINDSOR ONTARIO NEW YORK KANSAS CITY SAM FRANCISCO DETROIT SYDNEY, AUSTRALIA AUCKLAND, NEW ZEALAND NeoSynephrine Trade Mark Registered hi T h ow is sup ITALIS The average maintenance dose of Purodigin is 0.1-0.2 mg. The average maintenance dose of digitalis is 100-200 mg. (1.5-3 gr.) ^ The patient on digitalis can be changed to Purodigin merely by substituting 0.1-0.2 mg. Purodigin for 100-200 mg. (1.5-3 gr.) digitalis. Purodigin is identical with digitalis in therapeutic effect, rate of cumulation and rate of excretion. Purodigin has the advantage of constant potency and complete absorption— it differs from digitalis in that it contains no unabsorbable or nontherapeutic components to irritate the gastrointestinal tract. if 140 1 B >'"fW --m^r 130 «d ~i HfBHL - DtClTOXiM I.2.S tk^^ ce 120 -. "^^•;Ni^-t. "■ JKK' < /^W K =J 110 m ^MrRAveso^^ffl "^. !5fMiS ,J^* JJ 100 2 w -* 90 ^&" '^tm&m -. 1 ■r*3» 60 %Ai: 1 «»«W t 111 w»- •"■t 1 i imlm&mm. HOURS 0-1 025 0.5 I 2 3 4 5' 678910 24 DAYS I 2 » 4 5 ilStOUW PURODIGIN TRADE MARK REG* IN CANADA DIGITOXIN WYETH 0.2 mg. tablets, vials of 30 and bottles of 100 e 0.1 mg. tablets, bottles of 100 JOHN WYETH & BROTHER (CANADA) LIMITED • WALKERVILLE, ONTARIO v. I OSIDES A&B &iBBtt&ft; FOR ATO CONSTIPATIO ADULTS: 2 to 4 tablets daily CHILDREN: 1 to 2 tablets daily Samples and literature on request PHARMACEUTICAL DEPARTMENT THE WINGATE CHEMICAL COMPANY LTD. MONTREAL : i M Photograph: H. S. HAYDEN, F.R.P.S. For the Treatment of ARTHRITIS. // For those cases where the normal diet is adequate in Vitamin B factors and Vitamin A. "OSTOFORTE" (S. E C. No. 651 "gtttf) Each capsule contains 50,000 Int. Units of Vitamin D. IMPORTANT: Ostofotie Compound and Ostoforte should not be administered to patients with "impaired kidney function", nor fo children in repeated doses. Ostoforte Compound (S. E. C. No. 671 "iwwf) Many patients suffering with arthritis are of necessity confined indoors. They are often physically inactive and their appetites may be diminished, or their diet may be restricted for therapeutic reasons. Ostoforte Compound Capsules, in addition fo supplying massive doses of Vitamin D, found effective in many arthritics, will supply adequate amounts of the other essential vitamins, thus making up for deficiencies in their diet in these respects. FORMULA: In Average Daily In each Capsule Dose [4 capsules) 50,000 Int. Units 200,000 Int. Units 1,666 Int. Units 6,664 Int. Units 0.67 mg. 2.67 mg. 1.00 mg. 4.00 mg. 6.67 mg. 26.67 mg. 15.00 mg. 60.00 mg. Vitamin D ■ * Vitamin A - • Vitamin B (Thiamine HC1) Riboflavin (Vitamin B2) Niacin (Nicotinic acid) Vitamin C (Ascorbic add) MODES OF ISSUE: Boxes of 50 and 100 capsules for your prescription. DOSE: Up fo six capsules daily. Complete dosage table on request. MONTREAL CANADA si »«L. THE BATTLE IS ON ... t, L d. A disrupted household and a harassed family usually attend "medicine time" of the acutely ill youngster. No such problem exists when treating acute tonsillitis with Laryngobis. One suppository daily is all that is needed for simple yet effective therapy. Laryngobis is the bismuth salt of heptadiene-carboxylic acid in cocoa butter. Available for adults or children in boxes of 2 or 12 suppositories. Observe dosage recommendations for age groups. LARYNGOBIS SUPPOSITORIES ! 4 t O R O N t O «if«iiictf c LABORATORIES LTD MONTKEAt Exclusive agents: INTRA MEDICAL PRODUCTS, 999 Dovercourt Rd., Toronto (Ont.) .* I- ■111 IT THE SERVICE OF MED I C I N E Physicians know the dramatic results in respiratory failure through the use of Coramine intravenously. Of equal value in ambulatory patients with chronic cardiovascular disease is CORAMINE LI Wl w I Wew This form of Coramine is indicated where drastic action is not required, but where maintenance and progressive improvement are sought. Taken orally, Coramine Liquid enables the patient to move about freely and to carry on moderate normal activities with an easy mind— in itself an important factor in management of cardiac conditions. ISSUED: Liquid, for oral use—bottles of 15,45 and 100 cc. For intravenous or intramuscular use, ampoules of 1.5 ex.— cartons of 5,20 and 100 5 ex.—cartons of 3 and 12 C I BA C 6 MTA NY LIMITED -MONTREAL ORTI designed by gynecologists and engineers The ORTHO DIAPHRAGM represents a new high standard of efficiency and convenience in vaginal diaphragms. Its design, materials and construction are the result of careful planning to achieve the requirements of an effective mechanical barrier, and affords comfort for the patient through extended use. Available in sizes ranging from 55 to 95 millimeters. PHARMACEUTICAL CORPORATION (CANADA) LIMITED TORONTO 1947... czrf ^yVztv ^Usxvi during which Pharmaceutical Research will again bring to Medical Science its unfailing co-operation to conquer ill- ness and alleviate suffering. The Medical Profession will recall the record of the LABORATORY POOLENC FRERES OF CANADA LTD. in the fields of Anti-Luetics and Gold Therapy and Sulphonamide Derivatives, This record constitutes a guarantee of a promising future which will put once again at the disposal of Canadian Physicians the results of the outstanding work of our international research facilities. JLalroxcUjcruf I cthJl£Hjc -fl£/ijeA OF CANADA LIMITED- MONTREAL flDount pleasant IKnbertakinQ Co. %to. KINGSWAY at 11th AVE. Telephone FAirmont 0058 W. E. REYNOLDS VANCOUVER, B. C. EXCLUSIVE flAIBULflnCE u it. SERVICE i ill 1,9; t if T 11* VANCOUVER: 13th Avenue and Heather Street f Air. 0080 NEW WESTMINSTER: 814 London Street |)UI. 60 We Specialize in Ambulance Service Only J. H. GRELLIN W. L. BERTRAND »l -i Amphofel gives excellent results In the prophylaxis and treatment of peptic ulcer because: • it relieves pain promptly and hastens healing • It enables the patient to take a -well balanced diet without aggravating ulcer symptoms—weight gain during treatment is frequently reported • it buffers gastric chyme within physiological limits and without risk of producing secondary hypersecretion Of acid • it prevents peptic digestion by immediately precipitating pepsin • it is an amphoteric, unabsorbahle substance and will not disturb the acid* base balance of the body Bottles of 12 fl. ox. AHIDhOld * ^um'na Gd • Wyeth Trade Mark Reg. in Canada JOHN WYETH & BROTHER (CANADA) LIMITED e WALKERVILLE, ONTARIO 1 Nttnn $c 2559 Cambie Street Vancouver, B.C. ARTHRITIS and ECZEMA of endogenous origin claimed to be allergic, may be favored or induced by calcium and sulphur deficiency, impaired cell action, and imperfect elimination of toxic waste. lyxanthinFastier administered per os, brings about improved cell nutrition and activity, increased elimination, resulting symptom relief, and general functional improvement. Write for Information Canadian Distributors ROUGIER FRERES 350 Le Moyne Street, Montreal III? CAMPBELL & SMITH LIMITED 820 Richards Street : : Vancouver, B.C. : | PAcific 3053 echve Cy mnhng n W1 .', j 1- I ' ■> i -^- ^-^.-^- .^BM. --■ ■-. - n >.f ---j- ---- - - ■-- --- -»- .^_ -^ -^- -»--».->. ^. **. ■ «■ ■«. Ar- ;ff M: DELTA DELTA BRAND \ «■ ■ .Jj; 7 Concentrated Partly Skimmed Milk FOR INFANT FEEDING At the request of a number of Physicians, particularly those in the Pediatric Section of the Vancouver Medical Association, our organization packs a special Evaporated milk with a low butterfat content, known as DELTA BRAND. DELTA BRAND MILK is Irradiated, Evaporated, Vacuum Packed, with 4% butterfat which, when diluted with water, presents a milk with 2% butterfat. Every stage in its manufacture and packing is carefully, scientifically controlled. DELTA BRAND MILK makes available to the medical profession another important milk food in the field of Pediatrics. (Snelling, E. C. "The Uses of Evaporated Half Skimmed Milk in Infant Feeding/7 C.MA Journal, 1943, 48, 1, P.32.) - '-- Composition of DELTA BRAND MILK Fat 4.0% Total Solids 22.0% Vitamin D.324 International Units per Imperial Quart. Calorific value per ounce (avoirdupois) 31.5 PACIFIC MILK COMPANY 425 West 8th Ave. VANCOUVER, B. C. Manufacturers of the well-known PACIFIC Brand Evaporated Milk WLt the Right Hcpd ofmheM)octoA — stands our modernized||rescription department —ISpaciousJffeffiaen^snd available — with potent medicinals and a trained staff of pharmacists^! Phone MArine4161 ~*i£m&^j&hM$*i\ GEORGIA PHARMACY Gfrttfer $C i ESTABLISHED 189S VANCOUVER, B. C. North Vancouver, B. C. Powell River, B. C. ma .m. & ft New Westminster, B. C. For the treatment of N^i^SYCHl|TRIC DISORDERS Rjtference^fB. C.i Medical Association For information apply to Medical Superintendent, New Westminster, B.. v**!~|)|| New Westminster 288 or 721 Medical-Dental Buildin^Vancouver, B. <^3; PAcmc 7823 PAcific 8036 27
Periodicals
W1 .VA625
English
Vancouver : University of British Columbia Library
Vancouver, B.C. : McBeath Spedding Limited
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/
Original Format: University of British Columbia. Library. Woodward Library Memorial Room. W1 .VA625
Medicine--Periodicals
The Vancouver Medical Association Bulletin: January, 1947
Text