CONTENTdm
History of Nursing in Pacific Canada
Vancouver Medical Association
'Report of hospital committee ; Problems of a primapara ; Unusual uses of common drugs ; Laboratory bulletin.' -- Title page
image/jpeg
PH 1 STRAND THEATRE BLDG. VANCOUVER, CANADA Exceptional Values in All Class Hypodermic Syringes Luer Type of the Famous JENA Glass 1/4 cc. 2 cc. Prices: $ .50 75 ___ 1.00 5 cc. 10 cc. . _ 1.50 2.00 20 cc. 30 cc. -"■ 2.50 50 cc. _ 3.00 Eccentric Tips 25% higher CHAS. H. ANDERS, Chemist GORDON M. CLAY, Associate Chemist 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 and Dental Building, Georgia Street, Vancouver, B. C. ' Editorial Board: Dr. J. M. Pearson Dr. J. H. MacDermot Dr. D. E. H. Cleveland All communications to be addressed to the Editor at the abov; address. Vol. VII. MAY, 1931 No. 8 OFFICERS 1929-30 Dr. G. F. Strong Dr. C. Wesley Prowd Dr. T. H. Lennie President Vice-President Past President Dr. E. M, Blair Dr. W. T. Lockhart Hon. Secretary Hon. Treasurer Additional Members of Executive:—Dr. A. C. Frost; Dr. W. L. Pedlow Trustees Dr. W. B. Burnett Dr. W. F. Coy Dr. J. M. Pearson Auditors: Messrs. Shaw, Salter & Plommer SECTIONS Clinical Section Dr. S. Sievenpiper Chairman Dr. J. E. Harrison •■ Secretary Eye, Ear, Nose and Throat Dr. N. E. MacDougall Chairman Dr. J. A. Smith Secretary Pediatric Section Dr. H. A. Spohn _•, Chairman Dr. R. P. Kinsman | ~ Secretary STANDING COMMITTEES Library Orchestra Summer School n -n r r, t^tdta Dr. R- P- Kinsman Dr. D. F. Busteed Dr. J. R. Davies n w T >»i._._, _._.,., t-> t tt ix t» Dr. w. L. Graham Dr. D. M. Meekison Dr. J. H. MacDermot — n „ _ ■ ^ TOT TT XT T^ T* TVT T> DR. C E. BROWN Dr. W H. Hatfield Dr. F. N. Robertson Qr t l Buttars Dr. C. H. Bastin Dr. J. A. Smith Dr q r Vrooman PR- C- H. Vrooman Dr. J. W. Arbuckle Dr. C. E. Brown Publications Hospitals Dr. J. M. Pearson Dr. J. W. Arbuckle Dinner Uk j. h. MacDermot Dr. J. A. Gillespie Dr. L. H. Webster Dr. D. E. H. Cleveland Dr. W. C. Walsh Dr. J. E. Harrison Dr. F. W. Lees Dr. E. E. Day Credentials VQN Advisory Board n a i d r, ,, j a Dr. W. S. Turnbull Dr. Isabel Day Rep. to B. C. Med. Assn. _. . T „ T n- t-t w r« t,t = Dr. A. J. MacLachlan >~>k. tt. tt. caple Dr. H. H Milburn Dr. P. W. Barker Dr. G. O. Matthews Sickness and Benevolent Fund — The President — The Trustees VANCOUVER HEALTH DEPARTMENT STATISTICS, MARCH, 1931 Total Population (Estimated) Asiatic Population (Estimated) 242,629 14,227 Rate per 1,000 Population 9.7 13.2 8.5 22.4 Total Deaths Asiatic Deaths . ! Deaths—Residents only Birth Registrations Female 237 Male 225 INFANTILE MORTALITY— Deaths under one year of age Death Rate—Per 1,000 births Stillbirths (not included in above) j CASES OF CONTAGIOUS DISEASES REPORTED IN CITY April 1st February, 1931 March, 1931 to 15th 1931 Cases Deaths Cases Deaths Cases Deaths 0 0 0 0 0 17 1 10 199 16 176 462 15 32.5 9 Smallpox : 0 Scarlet Fever 27 Diphtheria 15 Chicken-pox 106 Measles -. 4 Mumps 65 3 3 0 19 0 2 7 0 Whooping-cough Typhoid Fever Paratyphoid Tuberculosis Poliomyelitis Meningitits (Epidemic) Erysipelas Encephalitis Lethargica 3 0 0 0 0 $z 0 19 %9 2 0 0 17 8 107 3 137 6 3 0 65 0 0 9 0 0 1 0 0 0 0 2 0 0 19 0 0 0 0 21 1 46 4 0 0 26 0 0 6 0 in cystitis and pyelitis TRADE PYRIDIUM Phenyl-azo-alpha-alpha-diamino-pyridine hydrochloride (Manufactured by The Pyridium Corp.) MARK For oral administration in the specific treatment of genito-urinary and gynecological affections. Sole distributors in Canada MERCK & CO. Limited I Montreal 412 St. Sulpice St. Page 172 ljust think of the convenience jTwo X-Ray Tubes i in One! (Right) Cathode, showing double filament mounting Roentgenologists acclaim the Double Focus Coolidge Tube DESCRIBED in the simplest terms, the Double Focus Coolidge Tube is, as its name implies, one tube in which either of its two focal spots is instantly available. Which means that the radiographic advantages formerly obtained with the use of two Radiator type tubes, 10 Ma. and 100 Ma., respectively, are now to be had with a single tube. Think of the added convenience with this tube in routine radiography, when you may select as between the use of a fine or a broad focal spot, without the necessity of changing tubes in the holder, nor the attendant danger of breakage. Simply throw the small $175 f. o. b. Chicago GENERAL f| ELECTRIC X-RAY CORPORATION 2012 Jackson Boulevard FORMERLY VICTOR i^ffilll X»RAY CORPORATION Join us in the General Electric program, broadcast every Saturday evening over a nation-wide N. B. C. network VICTOR X-RAY CORPN. OF CANADA LTD. Vancouver Branch: Motor Transportation Bldg., 570 Dunsmuir Street switch at the cathode end of the tube, and you are ready to proceed. In short, here is a tube which covers practically the entire range of routine radiography, as may be seen in the fol' lowing table of its capacity ratings: Kv. P. Ma. Sec. Small 85 30 }k Focal 85 20 4y2 Spot 100 10 45 100 20 2V2 100 50 9y2 Large 85 50 121/, Focal 100 75 3 Spot 100 100 i| 75 100 3 We'll gladly answer your questions Chicago, 111., U. S. A. Phone • • Open All Night Prescriptions To Us . . . We Deliver . Anywhere Seymour 1050 effi Ceovgxa Pharmacy Gro.nville aiCJeortCi^. Prescription Specialists r 11111111111111 ii 111111111111111111111111111111111 Say It 'With Shivers and For SERVICE, QUALITY and SELECTION Phone us at Seymour 1484 or Drop into any of our five convenient shops. 665 Granville St. 691 Broadway W. (At Heather) ! 189 Hastings St. W. 3205 13th Ave. E. j 48 Hastings St. E. (On the Grandview Highway) | BROWN BROS. & co. Ltd. Vancouver's Master Florists Private Exchange, Sey. 1484 connects all Departments. ! i I t t I t t t I t t I ! t 1 1 1 T I 1 I 1 t 1 1 I I 1 1 1 t ! I I I 1 t 1 1 I 1 T I I I T I I I l' 'jm-' EDITOR'S PAGE "Not as a ladder from Earth to Heaven, not as a witness to any creed, But simple service simply given, to his own kind, in their common need." Last month at New "Westminster, a dinner was tendered by the Fraser Valley Medical Society to Dr. G. E. Drew, nominally a medical man practising in New Westminster, but actually, one of the best known and most respected doctors of British Columbia. The occasion was the entrance by Dr. Drew, on his fiftieth year of practice; and those who met to hail this memorable event were filled with wonder at the heartiness and physical vigour of our venerable colleague, for he has deserved the appellation in more ways than one. To look back at fifty years of general practice may not be the lot of many of us—certainly there are times when the prospect of fifty years of it would seem, too terrible to be borne—but it is an achievement, none the less, which all of us must honour. For it needs a rugged constitution to stand fifty years of the grind and drudgery of the general practitioner's life. And, in Dr. Drew's case, this life was not the comparatively cushioned and easy life of the medical man of today, with its cars (and closed-in cars at that), and its telephones, and its ready access to hospitals and ambulances and specialists. It was a life of poor roads, and an open buggy, and long waits at bedsides, and poor light and little or no assistance from other men. It needed more than physical robustness, this general practitioner's life. It needed courage, and initiative, and self-reliance. It needed patience and gentleness and sincerity and self-denial. It needed and took all the qualities that go to the making of a man, and a good man at that. And the man who, many years ago, in a badly-lighted shack, with no help but the simplest, and no resource but his own pluck and determination performed what must have been one of the first Caesarean sections to be done in B. C, and that successfully, showed that he had all these qualities to the full. The child that he then brought into the world, herself has a family today, and so finis coronat opus. There is no life so full of adventure, of its own sort, and of variety and interest, as is the life of the general practitioner of medicine—and in its own way, there is none fuller of reward and satisfaction, even as there is none so full of petty irritations and constant wearing annoyances. But these become second nature after awhile,, and the good remains. Perhaps one has to live and practise some fifty years to be able to get the full flavour, but even for some of the juniors among us, of a mere twenty-five or thirty years' standing, there is a sense of satisfaction to be gained. For the general practitioner of medicine is the man who really represents medicine to the common folk. He is their "famliy doctor," their friend and confidant. The "medical profession" may be all that the "Sun" and Dora Kitto declare it to be—it may be a gang of murderers and poisoners, but to the ordinary man, his family doctor is the man he trusts and believes in, and to whose keeping he entrusts his life, and that of his family. There has been, for a while, a tendency for the public to go straying in search of new things, in the way of specialism. But the pendulum would seem to be swinging back to the general practitioner and medicine, as well as the public at large, Page 173 is realizing more and more, that he must be the backbone of our system of medical practice. We cannot close without adding our congratulations and good wishes to those which Dr. Drew has received in such abundance. May he live long and die in the harness—as we are sure he would himself wish to do. NEWS and NOTES Rain on Thursdays has crimped the Vancouver Team so far this year. As we go to press the storm clouds are gathering for Jupe Pluvius' onslaught on Quilchena for the final work-out before the Seattle match. MJr. Pluvius is a charter member of the Wet and Gloom Society. Every medical man in the City will be canvassed by the Finance and Entertainment Committee of the Canadian Medical Association for contributions to the entertainment of the visitors at the Convention. Jus one more appeal, fellows, and this is only made every ten years. Get ready to dig. St. Paul's new wing is rapidly assuming form in harmony with the main hospital. It will be a credit to Vancouver and Canada when it is completed. Dr. H. N. Watson, formerly of Duncan, Vancouver Island, is opening an office in the Medical Dental Building and proposes to limit his practice to obstetrics and gynaecology. Dr. and Mrs. Arbuckle are taking a holiday, motoring in California, and expect to be back at the beginning of the month. The Library Committee will be much obliged if the members who have the following, will return them to the Library: Vol. 171 of the American Journal of the Medical Sciences; the issues of the British Journal of Ophthalmology for July and August, 1930; the 11th edition of Osier and McCrae's Practice of Medicine; the issue of the Archives of Neurology and Psychiatry for March, 1930; Graves' Gynaecology, 1928; Abts' Paediatrics, V. 6; Jnl. State Medicine, Jan. and Dec, 1930. MEETINGS The last general meeting of the winter session was held in the Auditorium of the Medical Dental Building on April 7th. The attendance numbered 78. At this meeting the Special Committee on the Vancouver General Hospital Regulations presented a Final Report. This was adopted unanimously and a vote of thanks was tendered to Dr. Gillespie and his Committee for their, fifteen months' hard work. The report appears in this issue. Other matters discussed were the questions of Birth Control Clinics and Group Automobile Insurance. The meeting went on record as being ESS opposed to any participation in the establishment of Birth Control Clinics in Vancouver. A Committee was appointed to enquire further into the question of Group Insurance, the principle of which was approved by the meeting. Dr. Murray McC. Baird was elected a member of the Association. Dr. C. F. Covernton was the speaker of the evening and his paper on "Problems of a Primipara" appears in this issue. At the close of the meeting Dr. Strong showed the beautiful moving picture prepared by Sir Thomas Lewis to commemorate the tercentenary of the publication of William Harvey's "De Motu Cordis." The Cancer Investigation Committee held its monthly general meeting on Monday, April 20th, in the Medical Dental Building Auditorium. Dr. J. W. Thomson spoke on "Cancer of the Breast" and Dr. L. H. Appleby discussed the "Causes of Cancer." The meeting was very well attended. The closing meeting of the Clinical Section was held at the Vancouver General Hospital on Tuesday, April 21st. A new departure in the presentation of cases was made. Fifteen to twenty cases were presented, each presentation lasting from five to ten minutes. In this way the Officers of the Section hoped to show something of interest to each member of the Association. At the close of the meeting the new Officers for 1931-32 were elected. The unanimous opinion appears to be that the Session just ended was one of the most successful in the history of the Section. As a corollary to the above remarks on the success of this winter's clinical meetings, the following extract from the April issue of the Nova Scotia Medical Bulletin is of interest: "The Bulletin of the Vancouver Medical Association is always wel- "comed to our Bulletin Library. From the March number we get "a suggestion we pass on to the Halifax Medical Society. We have "noticed that the reports of the clinical meetings of the Vancouver "Society have been very complete. A meeting held in December "at one of the hospitals is thus reported with this explanatory "note, "Owing to the courtesy of the authorities of Shaughnessy "Military Hospital we are able to publish the following full report "of the cases presented at the meeting of the Clinical Section held at "Shaughnessy on December 16 th." These case reports are often of "greater value than set papers that are presented at general meetings. The latter are nearly always available for publication in the "Society's official journal," HOSPITAL COMMITTEE Final Report Mr. President and Gentlemen of the Vancouver Medical Association: of the Vancouver Medical Association: This Special Hospital Committee was appointed in December, 1929, to meet the Vancouver General Hospital Board of Directors and to Page 175 oppose certain regulations governing assignment of patients to staff care which went into effect January, 193 0. In presenting this our final report to the Association we wish to briefly summarize our efforts and to state the present situation. • This Committee, which consists of about twenty of our members, most of whom are the older and more experienced members of our profession and many of whom are past presidents of our Association, have spent a great deal of time and effort in an endeavour to convince the Board of Directors that these regulations were unwise, unethical and not in the best interests of the hospital or the community, and in an attempt to get the Board of Directors to rescind or modify them. We believe that those who were responsible for the introduction of these regulations were sincere in their desire to improve the hospital for teaching purposes and desired the segregation of non-pay cases to that end, but they did not foresee the far reaching results that would follow their enactment in their present form. The reasons given for their adoption were that they would give more material for better functioning of staff and house surgeons, and that they would help the hospital financially. They were introduced in haste and were made law without any knowledge of their existence by the medical profession. When our Association learned of them this Committee was appointed for the purpose as previously stated. We ascertained the views of the medical men and found that about 95% of our profession were opposed to these regulations and over 225 of our men signed a request to the Board to rescind or modify them. We met the Board of Directors at a conference in December, 1929, and presented this request and in well prepared arguments we upheld the principle of free choice of doctor by patient and pointed out the dangers and defects in these regulations, and we advised their modification, or at least the postponement of their enactment until more mature consideration had been given them, and until a proper social service department was established. However, all our arguments were of no avail, and these regulations were put into operation unchanged in January, 1930. We sent copies of our arguments and our objections to the Hospital Survey Commissioners and to the Provincial Secretary. We then waited until October, 1930, in order to give plenty of time for our profession to deliberately consider and form their opinions on the operation and effects of these regulations. After this time, October 6th, 1930, we presented a full report of our findings to our Association, and stated that our observation had only strengthened our objections and supported our arguments and previous opinions. We stated that we believed the Board had taken a retrograde step, and were entering on a policy which older and more experienced communities in Britain and elsewhere were now strenuously endeavouring to get away from, and that they had in their haste unwisely chosen a remedy to improve their finances which if judged by the course of subsequent events, was plunging them more deeply into a financial morass and was putting heavier burdens on the Government and the taxpayers; that the public was being gradually pauperized, and that there was no evidence that the community was getting any better service than previously, and we proposed a modification of these regulations which we believed would remove some of their Page 176 SH objections. We also stated that no proper Social Service Department had been established and that no proper classification of indigent cases could be made until this was done. This report of our Committee was adopted at a full meeting of our Association, October 6 th, without a dissenting vote. We sent copies of this report to the Board of Directors, the Provincial Secretary and the City Council. No attention was paid by the Board to our suggested modifications, but we were told verbally that nothing would be done until a new General Superintendent was appointed, but that he would be given an opportunity to bring about an amicable settlement and would be supported by members of the Board in any agreement that he would see fit to make. Dr. Haywood began his duties as General Superintendent November, 1930. In different meetings of our Committee with Dr. Haywood he assured us of his great desire to bring about an amicable settlement with our Association, that he desired to meet the men and learn their objections and their problems, and although he had no power to change the regulations, that he intended to interpret them very broadly to cause as little friction as possible. When we found that we could not get any modification of the regulations we then endeavoured to get the Board to consent to a broader interpretation, and a provision to admit so- called sympathetic cases under their own doctor. Our Committee after conferences with Dr. Haywood decided on a basis of agreement. Dr. Haywood stated that he would present this to the Board and said he would strongly support these proposals. He did so at the March, 1931, meeting and the following answer was sent us by the Board. . . . "Your letter of February 24th, addressed to Dr. A. K. Haywood, General Superintendent of the hospital, was duly placed before the Directors at their regular meeting held last evening, in accordance with your request, in which a better interpretation was requested upon certain By-laws of this institution. The Directors gave very careful consideration to your request and consider that any change of the By-laws would entail difficulties which the Directors do not feel should be made. I was instructed to say, however, that they are satisfied that the interpretation being placed upon the By-laws by the General Superintendent at the present time, will fully meet your wishes. In addition, the Directors are pleased to note the cordial relationship that has been established between the General Superintendent and your Association." . . . We then requested Dr. Haywood to state what his interpretation would be and the following is his answer. . . . "Your letter of February 24th was duly placed before the Board of Directors at their regular meeting held March 26th and ere this you no doubt have received a reply from the Secretary of the Board stating that the Board was satisfied that the interpretation being placed upon the By-laws by myself would meet your wishes. In view of the discussions that have taken place at our several Committee meetings and as I understand your Committee will have to report to the Association as a whole, I wish to assure your Committee that where possible I will endeavour to interpret the By-laws according to the suggestions contained in your letter of February 24th, in all fairness to both the Hospital and your Association. . . . "We feel that we have exhausted every effort to arrive at an honourable and satisfactory settlement with the Board without resorting to methods which we felt were beneath the Page 177 dignity of our profession. We have given the Board every opportunity to come to a satisfactory agreement and have gone far in offering a very reasonable compromise. The Board, however, have rejected our proposals for even the slightest written modification of the By-laws and have refused to commit themselves in any way beyond giving Dr. Haywood permission to carry out these By-laws according to his interpretation. In conclusion this Committee wishes to reaffirm its conviction that the principles we have stood for during our discussions with the Board of Directors are sound, and in the interests of the hospital and the community, and that they must in the end prevail. We feel, therefore, that as the Board appear wedded to their policy, any further attempts to effect any change in the attitude of the Board, as at present constituted, would be futile and without result, and it is useless to carry on any further negotiations with them. During the last few months our negotiations and discussions have been carried on with Dr. Haywood, and our relations have been very pleasant and agreeable. We believe he has done his best to heal the breach between our Association and the Hospital over these regulations which have now been written into the constitution of the hospital as By-laws. Dr. Haywood has by his diplomacy and personality created a very friendly feeling toward him. He has been given the sanction of the Board to interpret these By-laws broadly and he has given us his promise to do so, as stated in his letter. We feel that the Board has loaded him with a great responsibility and that he is handicapped by the fact that even up to the present no efficient Social Service head has been appointed. It depends now largely on the action of the General Superintendent and his staff and the way in which this interpretation is carried out in fairness to the doctors as well as the Hospital, as to whether ultimately a condition of harmony will be restored. We have endeavoured to fully acquaint our members with the history of these Regulations, and with our efforts to have them changed, and also with the situation as it is at present and while it appears necessary for the present to work under the regulations as they now exist, the efforts of our Association in the future should be to press for its original objective. I move that this report be adopted and the Committee discharged. B. C. MEDICAL ASSOCIATION NOTES Dr. D. P. Hanington is now practising at Ladysmith, B. C. Dr. J. A. Tolmie, late of Vancouver, is now practising at Dawson Creek, Peace River district. Arrangements have recently been made for the incorporation of the B. C. Medical Association. Dr. F. W. Green of Cranbrook, Dr. O. Ingham of Nanaimo, and Dr. A. B. Manson of Cassidy, were recent visitors to Vancouver. Page 178 tttrwiv aW""- Dr. J. H. Carson of Prince Rupert and Dr. A. K. Connolly of Williams Lake are at present patients in Shaughnessy Military Hospital. They have our best wishes for a speedy recovery. Dr. W. Ross Lane of Nanaimo, after two years' post-graduate work at the Bellevue Hospital, New York, has returned to the Coast. He will probably specialize in Ear, Nose and Throat work, in Vancouver. Dr. George A. Charter, late of Alexis Creek, is now practising at Queen Charlotte City, taking the place of Dr. G. A. C. Roberts, who has relinquished practice there in order to take post-graduate work. We are glad to learn that Dr. D. W. McKay of Nelson, who was severely injured in an automobile accident in December, 1929, is now almost well, and hopes to resume practice in Nelson in the near future. The Annual Meeting of the B. C. Medical Association will be held on Tuesday, June 23 rd, concurrently with the Canadian Medical Association Annual Meeting in Vancouver. It is hoped that the profession read carefully the circular letter sent out by the B. C. Medical Association with last month's V. M. A. Bulletin in regard to the increasing cost of Workmen's Compensation Board medical services for the B. C. Loggers' Association. It is gratifying to note that the Provincial Government has wisely agreed, in the interests of public health, to the appointment of a Commission to investigate the claims of the Illegal Cults to become legalized. PROBLEMS OF A PRIMIPARA Dr. C. F. Covernton It is my intention in this paper to try to bring before you tonight some at least of the trials and troubles that a woman must face who is pregnant for the first time. As you know, although this condition is supposed to be a physiological one, it does actually and constantly border on the pathological, and for this reason does deserve our closest attention, and we should always be on the alert and qui vive,. but in so doing I believe that we should not think aloud, as it were. I say this most emphatically, because it is a very simple thing for our patient to misunderstand or enlarge on our words. I know of no condition that will hit the nervous system harder than that of pregnancy. For this very reason I feel that she must be spared any unnecessary worries about her possible troubles that are to come up in the ensuing months. At the same time she should be carefully and explicitly tolcf that, although she is going through what is supposed to be a normal physiological condition for a woman, that it is essential for her to keep in close touch with her medical adviser. Page 179 It has been my rule for years, when I have a primipara, to have quite a lengthy consultation on the first visit. My usual procedure is first of all to get her history. First, the menstrual history; second, her past illnesses, specifically asking if she has ever had scarlet fever, rheumatic fever, T.B.; third, her family history; fourth, her present history, i.e., date of last menstruation, whether she has or has had any nausea or vomiting, her bowel condition, her sleep and amount of rest, her appetite, and generally get her to give me an idea of what her meals consist of, whether she is in the habit of eating between meals and does she indulge in candy, excess sweets, her normal weight; fifth, her normal day's routine, as to housework, exercise. I find that all this is valuable information and it also helps to put the patient at her ease before any examination takes place. If she is unduly nervous I do not make an internal examination on the first visit. One must remember that although pregnancy is so natural, that to this particular individual it is a very big and important function and stage in her life. Some patients are overjoyed and delighted, whilst others are frightened from the start. Many also do not want to go through it. It is our duty to allay any superstitions, and this I may say is a common condition of the mind with pregnancy. Many women have been told dreadful tales of other women and what Mrs. Smith went through and then lost her baby or even how Mrs. Smith lost her life, etc. Now we know that it is impossible to say from any examination at any stage of pregnancy just what kind of labour an individual will have and therefore I feel that the best plan is to keep our eyes open and our mouths shut. Make a note on her card of any possible fears one may have, but do not tell the patient. For instance a small pelvis, unless the measurements are smaller than that in which it is impossible to have a normal birth, and this I may say is a very difficult thing to say, for after all is it not a question of relation of passenger to passage? For instance, on two occasions I have delivered two different patients both primiparae, who had a naegle pelvis (one side of pelvis completely caved in) from old T.B. and these patients were delivered normally without any instruments or turning, or trouble of any kind. Naturally one would expect it would be necessary after examination of such a pelvis, to do a caesarean section. In both these instances the patients asked me if it would not be necessary. I saw them each in the first trimester of their gestation and my answer was that their pelvis being deformed to this extent it was very likely, but that the later months would decide pretty well, and if nature was kind, which, gentlemen, she very commonly is, they might even have a normal labour. Well, in both these instances the patients had a quick, normal and uneventful delivery at full term, nature had smiled on them and given them smallish babies and in a good position, and also on top of this, remember that these patients generally have a poor musculature of the pelvic floor, hence no undue resistance there. Again, I have seen patients, with a perfectly normal or even large measurements and a normal sized baby and in normal position, have an extremely hard labour. This, of course, may be due to a very resistant pelvic floor or to a very bad type of first stage pains which may tire a patient out before the second, or expulsive stage, sets in. In this regard let me state that patients who have been very athletic, who go in for tennis, horse back riding, etc., often have a very difficult labour, whilst the reverse, the girl who has always been delicate (without any necessarily organic trouble) will have a rapid and easy labour if such a term can be applied to any labour. The Age of the Patient. This is without question, a factor, but I do not feel that it is nearly as big a factor as we used to think. I have seen women in the early twenties have a much more difficult labour than a primipara in the late thirties or even late forties. I have become very indifferent about asking a woman her age, they don't like it and I feel they often lie about it, but at the time of labour or towards the end of pregnancy, I may enquire, if I do not already know, especially if there are any complications arising on the horizon, e.g. plus B.P. or misfit of passenger to passage. To me I feel that the most important factor is that the patient should not be duly alarmed or given any unnecessary worries. How often do we find that cases in which we anticipate trouble in the delivery come along quite normally or, perhaps, with a low forceps. Well, if we see this, as most assuredly we do, is it not time to have the patient worry only when we know there is actual cause for her worry. For instance, to tell a patient during her pregnancy that she is going to have a hard labour, or that she cannot deliver herself normally, I believe is absolutely wrong, unless naturally this be towards the end of the pregnancy, say from the seventh month or later, when the presenting part has not engaged and when it should be. Then one can inform them in time to give them a chance to have a premature induction, if this should be preferable to a caesarean section. True, caesarean section in the present day is not as hazardous as it was 25 or more years ago, but I believe that one cannot open an abdomen without subsequent adhesions and adhesions may at some later date do a great deal of harm. Notwithstanding this it certainly means a subsequent caesarean section should any further pregnancy take place. Now pregnancy is a load on all the systems. The circulatory: the heart must enlarge to do the extra work thrust on it. The renal: most important to watch this carefully, in the later months, the intake and output, the B. P. frequently and regularly, for this will often give us the first sign of embarrassment. The digestive system: in regard to this, let us consider the vomiting of pregnancy that is so common in the early months. I believe that if this is attended to early and due regard paid to it, we will not often run into the pernicious type. Then it is difficult to say where the neurotic ends and the pernicious vomiting begins, but I do believe that early attention and treatment will in the vast majority of cases bring its reward. This is all the more important in the individual who is pregnant unwilling, and there are many of these. It is important for the doctor to try and observe or learn this early, and generally it is easily elicited, and in such cases I always like to get busy immediately, if there is any Page 181 vomiting. I naturally tell such patients that all vomiting cannot necessarily be stopped, but that with their co-operation and attention to doctor's orders it can be greatly minimized. First, plenty of rest; second, some nourishment before getting out of bed in the a.m., preferably dry soda biscuits; third, freedom from excitement, afternoon teas, and many visitors, and certainly from any that discourage the nervous patient; fourth, not to neglect eating—small meals and more frequent; fifth, strict attention to bowels; sixth, bromide as a medicine I find most valuable, and I give it in 20-30 gr. doses. I have rarely seen any cases that require intravenous injections, and I have never had one of my cases that needed to be emptied for this reason. I believe that one must devote a great deal of time to these patients and encourage them continually. I remember years ago seeing a patient who was extremely ill with vomiting. Her pulse rate was well over 100, her vomiting was after any food she ate, but not necessarily after all water taken; she had lost a great deal of weight. But I did know that she did not want her baby, in spite of the fact that she said she did. I only beat her to it by proving that she could stop. This I did with the husband's consent. I told the patient I would put her under an anaesthetic and relieve her (not empty), she came out of the anaesthetic and for two days she ate everything without any vomiting, when she suddenly realized she had not been emptied and began vomiting again; the alternative was declined and she carried successfully, and in due course was glad of it. Once a woman has been emptied for this condition it makes it very difficult for her in any future conception, even should she wish to carry, for her fear of going through the same procedure and then possibly have to be operated on make a load which is almost impossible to carry. The nervous system as I say, really bears the brunt of a pregnancy, and this is shown in many ways. It is most important that a woman should have fredeom from worry and anxiety if possible, they certainly show the instability of the nervous system readily. I have had them come to my office and cry about nothing, and they will admit it is something the husband has said or omitted to say, or has done which he should not have done. I generally in these cases like to have the husband come and see me, for I find that the husbands are absolutely ignorant of the state of affairs, and once they know, things will be smoother at home. For instance I have had a husband tell me that no matter what he said or did it was wrong, and he was finding it increasingly difficult to get along, but on explaining to him that it was not altogether his wife's fault, that the pregnancy was having this effect on her nervous system, then he would co-operate and understand, and in this way things would improve materially at home. I remember one husband telling me that every time his wife became pregnant (in this case it was the third), she refused to talk to him or even listen to him. I suggested he communicate with her by letter and just try to put up with it, all would be right in the end, and so it was. Of course, we, as men, don't begin to know what a woman has to go through and I believe, we, as doctors, are apt to become callous and in this way make light of some of their troubles at this time. Page 182 ■ss In this same way we are apt to say something which is taken up by them in a very serious way, even Unknown to us, so we want to be very careful. For instance, the other day in the office I said to my nurse when I had a patient on the examining table that she had a bladder tumour, and lo and behold I had quite a time appeasing her, for she was very sceptical of the word tumour, and it took careful explaining on my part and the nurse's later to make her understand that she merely had a distended bladder. Now we come to the problem of the primipara about to enter labour. At this time she is extremely nervous, and also her husband, and very particularly her mother, if she happens to be living with her. The doctor is phoned to immediately, irrespective of the hour, or the minor signs that are then showing. This is our time to show some signs of humanity and a natural interest and consideration for our patient. At this time when I am phoned to, generally speaking by the nervous husband, I specifically ask to talk to my patient direct, I question her as to exactly what is going on, and if, in my opinion, labour has definitely set in, I tell her to go over to the hospital, and that I will phone the hospital direct and give them my orders. These orders, gentlemen, are merely to prepare the patient for labour and have an examination per rectum, and then to ring me back and let me know the exact state of affairs. I also tell them that they are to call me if the patient is asking for me, irrespective of whether I am needed or not. It is our duty, as medical men, to give these patients proper service at this time, and not merely be present at the actual birth. Naturally I have told my patients, in the last month of trieir pregnancy, more or less what they may expect in the actual length of time it may take before the uterus opens up, and that, prior to this time, everything else being normal, there is very little the medical man can do—except alleviate any undue suffering and to know that his patient, or rather patients, because has he not two lives on his hands at this time. Therefore should your patient enter the hospital in the small hours of the morning, even though you know her to have been normal throughout her pregnancy, and the report comes from the hospital that the presenting part is low down, I believe that we should always make an early visit to this patient if for no other reason than to reassure her, and let her know you will be with her in her suffering. This, gentlemen, I think is a necessary duty and does help your patient more than we very often give it credit for. During this first stage of labour, I believe that rest is far the most important thing; to be kept quiet in mind and body, going in to see her as a medical man from time to time to reassure her, and also to che^k up on the progress of labour for oneself. Now to sum up this paper what I would plead is: 1. Remember that this is her party, she is the leading lady, and you are but the managing director. 2. More humanity and sympathy. 3. Give nature every chance, having due regard to the two lives. 4. Give your patients the same care and attention you would wish your wife to receive. Page 183 THE USE OF SCLEROSING FLUID IN A CASE OF PREPATELLAR BURSITIS By Dr. F. C. Dunlop, Vancouver, B. C. A carpenter, 52, traumatized left prepatellar bursa from kneeling heavily on a large nail while at work. During the week following the bursa became more and more distended with fluid and the knee stiff and uncomfortable. He was much inconvenienced at work by the swelling and difficulty in kneeling, something he had to do frequently. I aspirated the bursal sac, strapped the knee tightly with adhesive, and bandaged firmly. I obtained nearly 19 cc. of fairly haemorrhagic fluid. The sac gradually refilled and aspiration was done weekly for three weeks, but without any diminution in the amount of fluid withdrawn, though it was now straw-coloured, instead of haemorrhagic. Inasmuch as the use of sclerosing fluids in the treatment of various veins has been extended in some cases to the treatment of varicocele and hydrocele with fair results, it was decided to try the effect of injection into the bursa of a small amount of quinine and urethane. The sac was again aspirated with a large syringe, which was then detached from the inlying needle and replaced by a small syringe containing about 2/3 cc of the urethane solution. This was injected, the small puncture closed firmly by pressure with a gauze pad and the front of the knee massaged vigorously to distribute the injected fluid throughout the bursa. The knee was then strapped tightly. A wfek later the swelling was much less and limited to the upper half of the bursa. Aspiration was repeated and about 7 cc of a turbid and somewhat thicker fluid withdrawn. A somewhat larger amount of quinine and urethane, about 1% cc was injected and the knee strapped tightly as before. There was some reaction from this the next day, and the workman complained that his knee was lame and sore. On removing the strapping, however, at the end of a week, the tissues in front of the patella were quite flat and no fluid was apprecabile by palpation. The workman remarked that his knee felt quite well and a telephone message from him four weeks later revealed the fact that there had been no further accumulation of fluid. A second case, occurring in a young housewife, was treated similarly. In this patient the left prepatellar bursa gradually distended with fluid following prolonged kneeling while cleaning and staining floors. The fluid had been present for about a month before aspiration was done. Nine cc of straw-coloured fluid was withdrawn and two cc of quinine and urethane injected. There was a slight reaccumulation of bursal fluid at the end of ten days, but so slight that aspiration was not considered necessary. At the end of three weeks some thickening of the tissues in front of the patella was noticeable, but no fluid could be detected. Carp, of New York, has recently reported 27 cases of "Housemaid's" knee" treated conservatively. His method was aspiration and the injection of several cubic centimeters of half-strength Tr. Iodine. An average follow-up of sixteen months in twenty-four of these cases showed no symptoms or reappearance of bursal fluid. Page 184 New Vancouver Offices Professional men usually find it difficult to devote the time and attention necessary if the best results are to be obtained in their personal investment accounts. As underwriters of and dealers in Government, Municipal, Public Utility, and Industrial securities we offer our services in all matters appertaining to the investment of funds. Without obligation to you our Statistical Department will be glad to report on your present holdings. IN esbitt, 1 Jliomsoii &nA Lompany ILiniatecl 728 Hastings Street West Vancouver, B. C. Telephone: Seymour 1565, 1566, 1567 Head Office MONTREAL BRANCHES Toronto, Quebec, Ottawa, Hamilton, London (Ont.), Winnipeg, Saskatoon, Calgary, Vancouver, Victoria, Paris (France). "Time is short and experiment dangerous; therefore be prompt and apply a sure remedy, avoiding doubtful treatment." —Hippocrates. is peculiarly helpful when treated as a topical application in the treatment of RHEUMATIC PAINS The various classifications and types of Rheumatic conditions, which probably are merely steps in the processes of the same disease, respond favourably to the continuous application of Moist Heat. Antiphlogistine, applied in a hot, thick layer, over the affected area RELIEVES MUSCLE SPASMS AND REDUCES PAIN AND SWELLING. Antiphlogistine is the ideal soothing and antiseptic poultice for conditions associated with Inflammation and Congestion. Sample and scientific literature will be sent upon application. Antiphlogistine is made in Canada. The Denver Chemical Mfg* Company 153 Lagauchetiere Street W. MONTREAL B5S PUBLIC HEALTH BIOLOGICAL PRODUCTS Diphtheria Antitoxin Diphtheria Toxin for Schick Test Diphtheria Toxoid (Anamaine-Ramon) Scarlet Fever Antitoxin Scarlet Fever Toxin for Dick Test Scarlet Fever Toxin Tetanus Antitoxin Anti-Meningitis Serum Anti-Pneumococcic Serum (Type 1) Anti-Anthrax Serum Normal Horse Serum Smallpox Vaccine Typhoid Vaccine Typhoid-Paratyphoid Vaccine Pertussis Vaccine Rabies Vaccine (Semple Method) INSULIN Price List Upon Request CONNAUGHT LABORATORIES University of Toronto TORONTO 5 - CANADA Depot fir British Columbia Macdonald's prescriptions limited Medical-Dental Building Vancouver HOTEL GEORGIA VANCOUVER Now Offers New Low Rates From From #2.50 Daily Single #4.00 Daily Double 320 View Rooms all with Bath or Shower 50c Lunch 75c Dinner In our Popular Coffee Shop NEXT TIME—"TRY THE GEORGIA3 ■m Doctors Must Eat ♦ I ♦ i You are invited to join the doctors at the London! However novel the idea seems at first, doctors must eat. A good many of them now dine at the London Cafeteria and have done so for years, for they know how physical and mental well-being are preserved by the London's wholesome food and French Cuisine. The London (Cafeteria 710 ROBSON, SOUTH SIDE 3 Doors West of Granville Electro Medical Apparatus Repair Specialists $75.00 $37.50 Ultra Violet Twin Carbon Arc Lamps Infra Red Lamps CARROLL ELECTRIC ELECTRO MEDICAL ELECTRICIANS 525 Dunsmuir St. Vancouver, B. C. ♦.♦►^^0-«»(>*^0-.^0-«^(>.«»'0-«^0«^»0*B»0-^»<>^^0^»(><M»0^»0-«B^O'«^0^^<>'^»0* .O^^O-^^O* ESS qp UNUSUAL USES OF COMMON DRUGS By Dr. F. N. Robertson Mr. Chairman and Fellow Members: I wish to apologize for addressing you on so dry a subject as Materia Medica. Even if, by a stretch of the imagination, you would be kind enough to consider it as therapeutics, it still remains a rather dry subject. Moreover, what you will hear tonight, I fear will remind you of a bride's trousseau, "Something old, something new, something borrowed and something blue." There has been some criticism in the Medical Journals about prescriptions containing so large a percentage of proprietary drugs. Certainly these drugs and mixtures have their uses and should be used if they are beter than the ordinary drugs, or if put up as well, or even more pleasantly than we can do ourselves. We should not lose ight of the old form of R/ —To cure quickly (synergists), safely, si pleasantly, e.g., Blaud's Pills. We would not prescribe say, Dr. Black's Cough Remedy, but we would syr. cocillana co., although it might really be better for the patient. The excuses are two. First, it is put up by a reputable firm, and second, the contents is on the label. Of course this is true, but even so I venture to say that very, very few of us could say offhand what sy. cocillana contains and whether its contents meet the need of this particular patient. And when it comes to that what is cocillana? The men before our time did not have these proprietary remedies and yet they got results. They did know their drugs, however, and a great deal of our present knowledge is due to them. The results they obtained by drugs, some of which we have almost forgotten, were astounding, and one of the reasons for this paper is just to bring to your mind some of the forgotten things. It is a well known physiological fact that dilute alkalies applied to the ducts of glands whose normal secretion is acid, will stimulate that secretion. Surely we heard this often enough in our college days, and yet do we make use of the fact? If there is a deficiency of hydrochloric acid do we not immediately remedy that by giving hydrochloric acid after meals? Of course, if the stomach cannot secrete acid then the acid should be supplied, but when the stomach is able to secrete some, although not sufficient, would it not be a more sane thing to do to help and stimulate that stomach to do its own work rather than do the work for it? Formerly it was the custom to give alkalies before meals and thus stimulate the stomach for the work ahead of it. There is of course room for argument here, but it is a little thought I would like to leave with you. The outstanding characteristic of glycerine is its hygroscopic power, or its ability to absorb moisture from substances. So far as I am aware we only make use of this in the vaginal tampon and ear drops. If we would just consider this we could surely find many other uses for it. The manufacturers of Antiphlogistine certainly have turned this principle to capital, for the effect of Antiphlogistine is due to glycerine. If any of you are in doubt as to this just try a piaster of chalk and Page 185 glycerine and see if results do not compare. Now what would be the effects of glycerine on the stomach? If it has this hygroscopic power would it not cause a greater flow of stomach juices? There was a time when glycerine alone was prescribed for indigestion, and many of you have no doubt had elderly patients who were in the habit of taking it regularly. Now I have no doubt that it does increase the flow of stomach juices and does also relieve or cure indigestion of certain types. So much am I a believer of this that I never prescribe hydrochloric acid without glycerine, both to help the taste and for this hygroscopic virtue. I may say that I use it in cough mixtures also, and believe that it increases the bronchial discharges and renders the sputum more fluid and easily raised. It also lessens the amount of sweetness in most cough mixtures. It was said that, "Time, tide and Epsom Salts wait for no man." But our old friend mag. stdph. has risen from this lowly position as a purgative, until now it has become almost panacea. A handful thrown into the bath reduces blood pressure, and applied in hot solution it relieves the pain of rheumatism, gonorrheal complications and cellulitis. Applied cold it cures erysipelas, scalds and burns. Internally it still purges and 50 to 100 cc of a 25% solution by duodenal tube stimulates the flow of bile. It has been used for spinal anaesthesia or for tetanus 1 to 5 cc of 25% solution, which is readily neutralized in the spinal fluid by 5 cc of 5 % solution of calcium chloride, or it is better to give by hypodermoclysis a pint to a quart of l/2 % solution in chorea, 1 to 5 cc of 25% sol. or the same in epilepsy. It is used in encephalitis 4 cc of 25% solution intra-muscularly. In eclampsia it has done valiant service intravenously 10 to 25 cc of 10% solution, or in convulsions of childhood in 10 cc doses of 10% solution interstitially. It is a sedative in mental cases. 2 cc of 50% solution. It reduces cerebral pressure when given by mouth. It prolongs the action of morphine, and bathing in it keeps away mosquitoes. Lo! What a drug! To the many uses of sodium chloride has been added its uses in paralytic ileus, several hundred cc intravenously of 6% solution acts miraculously in time and effect, and I may add that the relief to the attending doctor as he listens to this real music of escaping gas is almost as great as the relief to the patient. Another drug, the salicylates, has become almost a panacea, so much so that one can almost say, "When in doubt use salicylates." Aside from the well known effect upon rheumatism, in the bowel it is antifermentative, and antiputrefactive. It reduces temperature, it is useful in tonsillitis, typhoid, neuralgia, diarrhoea, fever, influenza, fibrositis, cystitis, urticaria, sciatica and chorea. It produces sweating, and is a cholagogue and very useful biliary antiseptic. Locally it is used in stomatitis, sweating feet, for removal of tattoo marks, warts and pruritius ani, and it is now being used in the cure of varicose veins. When the stomach rebels, as in time it is sure to do, don't forget the drug can be used equally well by rectum. In these days, iodine has come much to the fore, especially in treatment of goitre, and I wish to draw your attention to another use of it. Page 186 We all have had cases of persistent vomiting. I am not referring to the persistent vomiting of pregnancy, but cases where nothing will remain in the stomach. Even water is rejected. In these cases we feel so helpless, because if water will not remain down how will our pet remedies fare? In these cases I have found the ordinary tr. iodine very useful. I.m. in drs. 1 water every 10-30 minutes will usually control the vomiting, and your other treatment may then be started. For some time now yeast has been used internally with the idea of changing the intestinal flora. If you will believe the advertisements it will cure everything from falling hair to ringworm or spavin. It occurred to me that if the intestinal flora could be changed in this way, then so could the buccal flora. When swab after swab comes back "positive" in your convalescent or diphtheria carriers, yeast will sometimes clear them up, when all else fails. It is not my custom to use this in all cases, but only when cases are too slow in clearing up. I then either dissolve a small piece in water and use it as a spray, or better, make it into a paste and smear it over the tonsils. I do not recommend this a sure cure, but as a useful procedure. About 1919 Weaver brought forward a cure for pneumonia in the form of sodium citrate. This was at the time of the influenza epidemic, and perhaps in those busy times many men failed to notice the article. At any rate very little has been written about this treatment either for or against it. Probably the idea was pooh-poohed without even giving it a trial. Since that time I have used this treatment in a great many cases, giving grs. XX o.h.i. for a period of from 36 to 48 hours. On looking over my records I find this treatment was successful in a little over 88% of cases. By successful I mean that within 36 hours of starting treatment the crisis came. Perhaps you will say that the crisis was due in any case. Perhaps it was in some cases, but certainly not in 88% of cases. But cut my figures in half if you will and even then, I think you will agree, that a form of treatment which is successful in 44^ cases is well worth a trial. Its mode of action I cannot explain. The citrate would become a Carbonate in the blood and would thus reduce the acidosis, always present in pneumonia. It certainly liquifies sputum and being a diurestic would thus help elimination. Certainly the lung clears up more quickly by this treatment than by any other method I have used, even in the cases where a crisis did not occur in 36 hours. But how this treatment produces an early crisis I cannot explain. In pneumonia there is a retention of chlorides till after the crisis. This has always seemed to me to be the results of the disease, but maybe it is nature's method of fighting, and sodium citrate would be decomposed, the citrate burned up and the sodium left for holding more chlorides. If this were the case it would look as though sodium chloride would be even better than sodium citrate. Or is the citrate, in such massive doses, not absorbed as the carbonate, but actually enters the blood as citrate. If so the coagulability of the blood would be reduced and one would suppose the hepatization of the lungs would not be so dense nor firm. Or has the citrate some in- habitory action upon the growth of the pneumococcus? Page 187 The question of the action of sodium citrate I leave with you to decide or to investigate, but would once more urge you to give it a trial in your pneumonia cases. If doubtful of it just combine it with your present treatment. It is not incompatible and can be used with any other form of treatment you wish. In post-operative cases where a pneumonia seems to be developing I have found it exceedingly useful, apparently, in aborting pneumonia. And influenza is with us once more. Most satisfactory results are being obtained by its use in this disease also. Carbon or charcoal, like glycerine, has had it most outstanding characteristics seriously neglected. This characteristic is its power of absorption. Now and again we hear of it being used to keep down offensive odours as in malignancy. Internally it is seldom or never used, and yet in cases of flatulency what a help this can be. Another characteristic is its colour and on occasion this has been useful to me in determining the length of time required for food to pass through the alimentary canal. The length of time required for the black powder to appear in the stool is a very good indication as to whether there is stasis or not. Lactic acid milk is now a very common thing in infant feeding. Here we have a growing organism as in yeast and in cases of diphtheria carriers it has been almost as useful but not so pleasant. In cases of erysipelas I have applied it in cold solution. It appears to work very well but I have given up this treatment in favour of the cold Epsom salts. I would like to put in a plea for the use of rye whiskey in medicine. Some of you object to the use of alcohol in disease, especially pneumonia. Personally, I am in favour of it, for the action which lends its value in therapeutics is not so much its stimulant as its narcotic action, which allays the anxiety and distress of the patient, promotes rest and sleep, and thus aids towards healing, or at the worst renders illness more tolerable. Small quantities of other narcotics might be substituted for alcohol but none of them perhaps excel it in producing that spirit of hopefulness and restful confidence which contributes so much to recovery. If alcohol is to be used, what kind? The old standby is brandy. Now it is not flavour, but alcohol that is wanted, and brandy contains 36.5% alcohol while whiskey, contrary to the general belief, contains much more, 51 to 59%. Therefore I am in favour of whiskey as compared with brandy, and of the whiskies I prefer rye. Experinece has proved to me in many cases that the smoky smell and taste of Scotch whiskies will cause nausea and vomiting, where rye whiskey will not. This is an important item in a seriously ill patient, especially if the alcohol must be kept up for some days. Pertussis is a rather hopeless thing to treat, and perjbtaps I am rather reckless in suggesting anything in the way of treatment. However, I have found adrenaline by mouth in 1M does for each year of age, to be very useful. I am well aware that it is supposed to be useless when given by mouth, but practical experience with results outlive good theories which fail. Maybe since ephedrin has come in I would be wise to change over to it, but so far I have not done so. Page 18t Another treatment is ether. Gluteal injections of M5-10 every day or every second day, or given by enema drs. 1 to olive oil drs. 1 per year of age. Ether appears on the breath in about 5 rninutes. Sometimes the cough is worse after the first injection so it is always wise to give belladonna also. By this form of treatment you may expect cures in 25% of cases, improvement in 50% and failures in 25%. Here are three little uses for collodion I picked up somewhere, just where I cannot say. In maternity cases where the nipple is short or retracted, if a ring of the non-flexible collodion be painted around the areola, the contraction of this ring causes the nipple to be forced outwards. In herpes zoster if painted over the vesicles it prevents their rupture and infection, and by more or less splinting the part tends to relieve pain. In cases of toothache in a bed ridden patient, if the cavity of the tooth be painted with collodion the air is shut out from the tender nerve. Then if cotton soaked in collodion be packed into the cavity, a temporary filling is the result. Hexamethylene tetramin or urotropin or whatever else you may wish to call it, has had an enviable position as a urinary antiseptic. It has been found useful elsewhere, but there always arises someone who says it cannot be useful because it requires an acid medium to liberate the formaldehyde and the body secretions are largely alkaline, except the urine. In answer to this I would ask what happens to urotropin when it is mixed with benzoic acid and taken in the effervescent form. Is not the formaldehyde liberated and dissolved in the water before it ever reaches the lips? What happens to it when it meets the hydrochloric acid of the stomach? How then is urotropin absorbed, as urotropin or broken up? But even granted that it is absorbed as urotropin, it is excreted not only by the kidney but by all the mucous membranes, although mostly by the kidney. Now bacterial growth will change the normal alkaline secretions of mucous membranes to acid. This you have all seen happen in the vagina. Even the ordinary cold renders the nasal secretions acid to litmus paper, as I have proved on numerous occasions. If urotropin is excreted by mucous membranes and there meets an acid medium, formaldehyde would be libterated and acts. I have no doubt that the infected biliary tract may also have some acid present or else how could urotropin be useful as a disinfectant after typhoid? On these grounds I would like to advocate its use in the ordinary cold or in sinus involvement. senna and rhubarb have fallen very much into disuse, yet they are both very valuable cholagogues. They are the only two purgatives which act directly upon the colon, with special action on the colon muscles. In cases of dilated colon these two purgatives are the only ones of use and with their continued use much improvement in the muscle tone of the colon may be expected. In countries where eucalyptus grows they say certain diseases are not found. Whether the odour keeps mosquitoes and flies away, I cannot say, but on several occasions I have made use of this idea, apparently successfully. Page 189 I have had cases of scarlet fever, measles, etc., in small houses where quarantine of the patient was impossible. In these cases I have had the patient rubbed daily with equal parts of oil of eucalyptus and olive oil. In no cases where I have used it was any other member of the family taken ill. Silver nitrate is practically never given internally now and yet was once used extensively for gastric ulcers. Occasionally you will find painful ulcers not responding to diet and alkalies. Silver nitrate precipitates albumen, coats the ulcer and also stimulates healing in an indolent ulcer. Hence in some of these cases very good results are obtained. Strychnine held a very lofty place amongst the older men, but it is not thought much of nowadays. "Is it any good?" is constantly asked. Well, in myocarditis following diphtheria what else would you use? It seems never to have failed us there, nor as a general tonic. In these cases it is the best we have. Strychnine is never pushed, like digitalis, to the physiological limit, the twitching of muscles. If we did this we might expect some dramatic results, but most of us give grs. 1/60 and expect wonders. If afraid to give it in heroic doses, then we must be content with prolonged dosage and slower results. But strychnine is an old tried friend and will not be found wanting when needed. Castor oil in these days has two uses. It is known as a most excellent purgative and an excellent thing with which to frighten a child. It has had other uses, however. It is absorbed by the blood, as can be readily noted by its action upon a nursing infant. The absorption of the ricinoleic acid was formerly made use of in neuritis, and is useful where the patient can take castor oil daily. The same may be said in cases of colitis where excellent results are sometimes obtained. How many of us have seen patients with a bad burn from a sinapism? The delicate skin of a child is often blistered by an ignorant mother who has the handling of a sinapism. Or the individual who thinks if a little is good, a lot must be better, he too is liable to be blistered. And yet this danger can be obviated by incorporating drs. 1 soda bicarb, in the sinapism. Mustard contains an acid which! think is responsible for the blistering, and the soda neutralizes this acid. Parkinsonism is another disease where one feels helpless. Stramonium has come into use here and in a few cases has been attended with considerable improvement. The patient's tolerance must be first ascertained. Grs. 7, t.i.d. of the powdered leaves are given. The dose is increased by a grain a day up, to grs. 2 and hour. This soon produces symptoms of blurred vision, dry mouth, diarrhoea, incontinence and rapid pulse. The dose is then reduced to about grs. 3 t.i.d. and maintained at this. In these days of crashing stocks, vanishing fortunes, unemployment, and poor collections, it is no wonder that some poor individuals become nervous, irritable and highly strung. No wonder that their digestive systems are upset and in multitudinous forms. In these cases of indigestion the exhibition of bromides or luminal will work wonders. And after this ordeal a few doses to myself will not come amiss. Page 190 British Columbia Laboratory Bulletin Published irregularly in co-operation with the Vancouver Medical Association Bulletin in the interests of the Hospital Clinical and Public Health Laboratories of B. C. Edited by The Vancouver General Hospital Laboratories Financed by The British Columbia Provincial Board of Health COLLABORATORS: The Laboratories of the Jubilee Hospital and St. Joseph's Hospital, Victoria; St. Paul's Hospital, Vancouver; Royal Columbian Hospital, New Westminster; Royal Inland Hospital, Kamloops; Tranquille Sanatorium; Kelowna General Hospital; and Vancouver General Hospital. All communications should be addressed to the Editor as above. Material for publication should reach the Editor not later than the fifteenth day of the month of publication. Vol. V. MAY, 1931 CONTENTS Bacteriological Examinations in Typhoid Fever, etc. BACTERIOLOGICAL EXAMINATIONS IN TYPHOID FEVER, UNDULANT FEVER, ETC. By H. W. Hill, M.D., D.P.H. Director, Vancouver General Hospital Laboratories The routine bacteriological diagnosis of typhoid fever (also of the paratyphoids, undulant fever, the dysentries, etc.), contrasts with that of diphtheria, gonorrhoea and tuberculosis, in depending less upon the detection of the causative organisms than upon the detection of physiological (or pathological) reactions set up in the patient by the causative organisms, such as the agglutination test (Widal), and the skin-sensitivity test.* (Even in the typhoid-dysentery group, as in diphtheria, gonorrhoea and tuberculosis, the finding of the causative organism alone is more conclusive clinically than the finding of serological or skin reactions alone.) Diphtheria, gonorrhoea and tuberculosis all present reactions apparently analogous mutatis mutandis with the agglutination test and/or the skin-sensitivity test. In tuberculosis (as in the others), the skin-sensitivity test (with tuberculin) indicates only infection, not necessarily active; and this tuberculin reaction is too widespread in the general population to be by itself of much value in clinical diagnosis. In undulant fever, here, we are beginning to believe that the same is somewhat true of the skin-sensitivity test, and even of the agglutination test. But the typhoid and paratyphoid agglutinations are not at all so widespread in British Columbia, and have therefore at present here a much greater clinical significance. *The skin-sensitivity test for typhoid fever, undulant fever, etc., is made by proceeding exactly as in vaccination against small pox or in making a Von Pirquet skin tuberculin test (puncture method), except that typhoid vaccine or B. abortus vaccine, etc., is used instead of the smallpox vaccine or tuberculin. The positive reaction appears within twelve to twenty-four hours as a rule, resembling closely the positive "immune" reaction in small pox vaccination (doubtless itself a skin-sensitivity test) or the positive Von Pirquet tuberculin reaction. The clinical significance of this at present would appear to parallel that of the agglutination test pretty closely. As Ootmar has pointed out in this Bulletin, the physician can perform this test at the bedside as easily as the tuberculin (Von Pirquet) test. Page 191 A further contrast between these two groups consists in the relative ease of recognition of the organisms of the former (diphtheria, gonorrhoea and tuberculosis) by simple morphological (including staining) features; and the necessity for cultural tests in the recognition of the organisms of the second group, since the morphological tests alone are practically useless. It is for this reason that senological and skin-test methods have become so prominent in this second group as rapid methods of diagnosis, because the relatively slow cultural methods required by the absence of ready morphological distinctions delay cultural bacteriological reports. It is, of course, true that such delay in this group is less disastrous than in diphtheria or gonorrhoea; since the diseases included in it are not as acute or rapidly damaging; but delay is also unnecessary after the tenth day of illness because after this date the relatively rapid serological methods are fairly dependable, if properly interpreted. For the sake of greater clarity this article deals chiefly with the type disease, typhoid fever. During the first eight or ten days from onset of symptoms in a clinically suspicious case, search in the blood stream for the organism itself is indicated. Typhoid fever at this stage tends to bacteremic— hence the likelihood of blood cultures revealing the organism. Feces cultures would also be proper, but blood cultures are simpler, and the causative organism is likely to be present in the blood in pure culture, while in the feces it will be associated with a great variety of contaminants; moreover, a negative result from blood, if obtained, is of more significance than a negative result from feces (or urine). Hence, during the first ten days of symptoms, the blood culture is the test of choice, giving a very bigh percentage of positive results, in typhoid patients. After the first eight or ten days, however, the bacteremia lessens (perhaps due to agglutination of the bacilli in the blood stream, with their subsequent removal or destruction), and the chances of securing a positive blood culture become much less. Hence, feces culture after this first stage is more likely to be successful than blood culture in yielding the bacilli. But it is not necessary to turn for diagnosis from blood culture to feces at this period; because just about the time the germs disappear from the blood-stream, the agglutination reaction appears in the bloodstream, and the latter is again ordinarily preferable to the feces culture, as is the blood culture in the early stage. The agglutination test of a patient's blood is in some of its procedures the converse of the culture test. In the culture test, the bacteriologist seeks to recognize as specific an organism isolated from the patient's blood or feces, by (amongst other procedures) testing its agglutinability with known anti-typhoid sera kept in stock for the purpose. In the agglutination test of the patient's blood the bacteriologist seeks to recognize a specific agglutinating ability in the patient's blood by testing the agglutinating ability of that blood upon a known typhoid organism kept in stock for the purpose. Page 192 In general, under present conditions in British Columbia, a report of typhoid blood culture positive is almost always conclusive of the presence of the disease. A negative culture report on a suspected typhoid blood, like all negative reports, is less conclusive; it should always be considered in correlation with the time since onset as above described. A positive feces or urine culture is likewise fairly conclusive of the disease, especially if the patient's history shows that he is not likely to a typhoid carrier. A negative feces or urine culture is less conclusive and the test should be repeated in apparent clinical cases. (In suspected carriers, a long series of feces or urine cultures may yield but one or two positives. Release of typhoid convalescents by feces and urine cultures is therefore a tedious and doubtful process.) A careful consideration of the above will show that while blood cultures are likely to be positive up to the eighth or tenth day, and agglutination tests thereafter, it is quite possible in making tests just about this time to find that the blood cultures have dropped out and that the agglutinating power has not yet developed, i.e., that both culture and agglutination are negative. In such cases, especially if feces and/or urine also are negative, it would not be difficult to consider this apparent array of evidence as conclusively eliminating a diagnosis of typhoid fever. But of course such an array of negative evidence at this stage in the disease is by no means conclusive. A case which would have yielded a positive blood culture earlier, and will yield an agglutination test later, may show neither just at this time. Nevertheless, an early agglutination test, i.e. in the first few days of illness, has a value, even though it is unlikely to be positive,—thus, if positive, it suggests the carrier state; if, as usual, negative, it helps to rule out the carrier state, thus giving more significance to any positive obtained later. Suspected cases should therefore be examined by blood culture and agglutination early (before the tenth day); by agglutination later. This sequence is unfortunately sometimes reversed, the agglutination test alone being asked for early when it is seldom yet developed, and the blood culture alone late, when it is unlikely to be still positive. Granting a typhoid blood agglutination positive report,, what is the clinical significance? This question, as already related for diphtheria, gonorrhoea and tuberculosis, only the physician can answer. Has the patient been inoculated against typhoid fever? When? What symptoms does he present? Has he had typhoid before? Is he a typhoid-immune "carrier," well, or perhaps suffering from an intercurrent infection of some other organism? (If the tests made were strictly confined to typhoid agglutination, it is possible that the patient might be a typhoid-immune carrier, suffering from paratyphoid or undulant fever or other infection. In this Laboratory, however, this situation Page 193 can hardly arise, as all typhoid-suspicious bloods are tested for agglutination with both of these organisms, not with typhoid bacilli alone.) A positive agglutination test, then, is diagnostically conclusive only if a previous attack of typhoid (or inoculation against typhoid) within say five years, and the carrier state, can be ruled out. A negative agglutination test before the tenth day after onset is of no diagnostic significance, except as helping to rule out a pre-existing carrier state; and after the tenth day should not be accepted in the face of good clinical evidence to the contrary; such tests, if negative, should be repeated at least weekly—sometimes becoming positive only late in the attack. The following figures are from Park—W.H.: Public Health and Hygiene, P. 135. In typhoid fever, blood cultures may be positive in the first few days of illness, diminishing in frequency to the end of the attack. Feces cultures may be positive from the 6th day on; about 25% are positive on the first examination, 75% later. Urine cultures may be positive from the 14th day on; positives are found in only about 25% of cases. Agglutination may be positive in 20% of cases in the first week; in 60% in the second week; in 80% in the third week; in 90% in the 4th week. Ninety-eight per cent, of cases show positive at some time during the illness. SUMMARY 1. The ordinary bacteriological tests for typhoid, the paratyphoids, etc., include: (a) blood cultures, (b) feces and urine cultures, (c) agglutination tests, and (d) skin-sensitivity tests with the corresponding vaccine. 2. The ideal sequence of these tests during the progress of a case would be: before the end of the first ten days (and the earlier the better), a blood culture, with an agglutination test at the same time. (The latter, it is true, is likely to be negative, but if so, at least it clears the air by indicating the absence of a pre-existing carrier state; and if later agglutination tests are positive, double assurance that such positive agglutination relates to the present clinical condition is had.) Skin- sensitivity may also be tested with advantage. ' 3. Should blood culture, agglutination test and skin-sensitivity test all be negative up to the tenth day, repetition of the two latter may be continued with advantage, but the blood culture is unlikely to be positive after that date. 4. Feces or urine cultures (the latter after the second week) need be tried for diagnosis only if the other tests are all negative. In the case of suspected carriers, showing agglutination and/or skin-sensitivity, feces and urine cultures are essential—but not so much for diagnosis as to determine infectiveness. 5. Release of convalescent cases by feces and urine cultures requires a long series of examinations, and even numerous consecutive negatives are not really conclusive of permanent non-infectiveness. Page 194 We do not hesitate to affirm that SSI. iBILL0N'S/»<- NOVARSENOBENZOL possesses the essential qualitites requested of *an arsenobenzene, that are: —Therapeutic efficiency —Innocuity of administration —Uniformity in chemical and physical particularities It permits the most effective and intensive treatment of syphilis LABORATORY POULENC FRERES OF CANADA LIMITED Canadian Distributors: ROUGIER FRERES, 350 Le Moyne St., MONTREAL Massage Medical Electricity Medical Gymnastics C. S. M. M. G., London, England C. A. M. R G, Montreal, Canada MISS O. G. HARDING Seymour 7613 825 VANCOUVER BLOCK Vancouver, B. C. Office Sey. 2855 Res. Doug. 4682Y MISS BEATRICE GALLOP C. G. A. M. R. Graduate McGill University School of Massage and Remedial Exercises 419 VANCOUVER BLOCK Vancouver, B. C. Office Doug. 908 Haafrumrth & Utroitumrth 3Itb. COLLECTION SPECIALISTS Telephone Sey. 3296—3297 407 RANDALL BUILDING, 535 Georgia Street West Vancouver, B. C. Telephone Sey. 3334 MRS. E. M. PARR Chartered Society of Massage and Medical Gymnastics, England Canadian Association of Massage and Remedial Gymnastics 430-431 BIRKS BUILDING Vancouver, B. C. Res. Doug. 908 MISS A. E. MARKHAM Chartered Masseuse, England Canadian Association of Massage and Remedial Gymnastics 924 BIRKS BUILDING Vancouver, B, C. r I VHE use of cow's milk, water and carbohydrate mixtures represents the one **■ system of infant feeding that has consistently, for three decades, received universal paediatric recognition. No carbohydrate employed in this system of infant feeding enjoys so rich and enduring a background of authoritative clinical experience as Mead's Dextri-Maltose. Surgical Supplies Sterilizers Surgical Dressings Fisher & Burpe Ltd. X-Ray and Physiotherapy Apparatus Phone Trinity 6253 536 SMYTHE STREET VANCOUVER, B. C. <JM/2}t one Therapeutic Corsetry Nu-Bone Corsets and Surgical Belts, boned with the soft, pliable Nu-Bone Patented woven wire stay, gently yet firmly support the frailest body with comfort. Nu-Bone Corsetieres are specially trained in Therapeutic Corsetry, and will study the individual requirements of the patient under direction of the physician. Nu-Bone — Nu-Trend — Nu-Zip Office—455 Granville St., Vancouver, B.C. Sey. 7258 Seamless[lasticStockings Relieve, a" Prevent Swollen Limbs Sprains Dislocations and VaricoseVeins w No Other Can Give Such Cbmftir?* Canadian Surgical Supplies Limited 775 Burrard Street - Vancouver, B. C. Telephone Douglas 600 B* CX Pharmacal Co. Ltd* 329 Railway Street - Vancouver, B. C. Phone Seymour 597 Manufacturers of filled Soluble Elastic Capsules. SPECIMEN FORMULAE No. 20A— Cascara Liq. Ext 30 m. Euonyrnin 1 gr. Podophyllin % gr. No. 29— Cod Liver Oil 25 m. Quinine 1 gr. Creosote Beech 2 m. Guaiacol pur 2 m. Completet formulary on application. Capsules containing special formulae can be obtained within 48 hours. A Professional Pharmacy PROFESSIONALLY CONDUCTED Special Depot Mulford's Biological Products Free Motor Cycle Delivery Anywhere Between 8 a.m. and 11 p.m. Daily Capitola Pharmacy Ltd. H FRED G. BROWN ^^ML^H Davie at Bute Dunbar at 27th West (Hotter & ^arara, ^fftft Established 1893 VANCOUVER, B. C. North Vancouver, B. C. Powell River, B. C.
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: May, 1931
Text