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History of Nursing in Pacific Canada
Vancouver Medical Association
'Tonsils and appendix ; Hospitals in the antipodes.' -- Title page
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<fl>£ THE VANCOUVER MEDICAL ASSOCIATION BULLETIN Published monthly at Vancouver, B. C. Subscription $1.50 per year » S3 X3 S3 S3 S3 S3 tonsils and cAppendix cs cs a a cs a cs cs hospitals in the cAntipodes |l NOVEMBER, 1926 K *< ^Published by (&YCc<iBeaih Spedding Limited, TJancouiper, <33. (?. >x =s<34- Petrolagar Makes it easy for the patient to establish Habit Time. Emulsified with agar, Petrolagar's 65% oil content mixes intimately with the fecal mass, thoroughly softening it, making it ready for easy passage. Petrolagar is NOT a cathartic. Petrolagar No. 3 (Alkaline) is an ideal treatment during pregnancy. Petrolagar No. 1 (Plain) for all ordinary cases of constipation, and for infants and children. Petrolagar No. 2 (With Phenolphthalein) for the chronic case and to be followed with Petrolagar No. 1. Deshell Laboratories of Canada, Limited, Dept. V., 245 Carlaw Avenue, Toronto, Canada. Please send without obligation, copy of Habit Time and sample of Petrolagar. Dr. <*<ex= Page 34 -»<SSy= THE VANCOUVER MEDICAL ASSOCIATION BULLETIN Published Monthly under the Auspices of the Vancouver Medical Association in the Interests of the Medical Profession. Offices: 529-30-31 Birks Building, 718 Granville St., Vancouver, B. C. Editorial Board:. Dr. J. M. Pearson Dr. J. H. MacDermot Dr. Stanley Paulin All communications to be addressed to the Editor at the above address. VOL. 3. NOVEMBER 1st, 1926 OFFICERS, 1926-27 Dr. A. W. Hunter President Dr. A. B. Schinbein Vice-President Secretary DR. F. W. Brydone-Jack TRUSTEES Dr. W. F. Coy Dr. W. B. Burnett Representative to B. C. Medical Association Dr. A. C. Frost SECTIONS Clinical Section Dr. f. n. Robertson ------ Dr. L. Leeson Physiological and Pathological Section Dr. C. H. Bastin - - - - Dr. c E. Brown - - Eye, Ear, Nose and Throat Section Dr. Colin Graham Dr. E. H. Saunders ...... Genito-Urinary Section Dr. G. S. Gordon ...... Dr. J. A. E. Campbell ..... Physiotherapy Section Dr. G. A. Greaves --------- Chairman Dr. H. A. Barrett __--_--_- Secretary COMMITTEES Library Committee DR. W. F. MACKAY Dr. W. D. Keith Dr. C H. Bastin Dr. W. C Walsh Orchestra Committee Dr. f. N. Robertson Dr. J. A. Smith Dr. l. Macmillan Dr. W. L. Pedlow Dinner Committee Dr. C. F. COVERNTON Dr. A. C. Frost Dr. g. b. Murphy Credit Bureau Committee Dr. Lachlan Macmillan Dr. D. g. Perry Dr. D. McLellan Credentials Committee Dr. E. H. Saunders Dr. B. H. Champion Dr. T. R. B. Nelles Summer School Committee Dr. w. d. Keith Dr. G. S. Gordon Dr. Murray Blair Dr. G. f. Strong Dr. H. R. Storrs Dr. R. Crosby The Basis of all Artificial 111* Infant Feeding The basis of infant feeding is human milk, and the principle involved in the artificial feeding of normal infants is the imitation of human milk. Cows' milk is the basic material used in practically all artificial feedings. It is modified one way or another to make it better suited to the infant's digestion, and to have more or less the same proportions of food elements as human milk. Pediatrists say that fresh cow's milk is, therefore, a logical diet for normal infants, provided that it is diluted with water to reduce its fat and protein contents and that a suitable sugar is added to the mixture to give it approximately the same percentage of carbohydrate as in human milk. ■■.Mead's Dextri-Maltose is a special sugar to be added to diluted milk, which has been found to be more easily assimilated by infants and less likely to produce diarrhoea than cane sugar or milk sugar. DEXTRI-MALTOSE is advertised only to the profession in order that the physician may control each case and be the sole judge of the proper formula to suit the needs of the individual baby. On request, a Mead's Feeding Calculator, showing usual formulas for normal infants suggested by the results of pediatrists, will be supplied to physicians, together with samples of Dextri-Maltose. jgl Mead, Johnson & Company J| OF CANADA, LTD. BELLEVILLE, ONT. Page 36 An ideal equipment for the physician's office or small hospital. Victor "Wantz Jr."X-Ray Machine in combination with Victor Model 9 Table. Results Alone Count THE Victor X'Ray Corporation has never concerned itself with meeting competition. Not the price at which its apparatus is sold, but the professional service that can be ren* dered to the patient is the ideal which has been followed for over thirty years. Thus are to be explained the remarkable results achieved by specialists and general practitioners with Victor X'Ray apparatus. There is a Victor machine for every roentgenological purpose. Tell us the purpose and we will tell you what Victor machine will best meet it. VICTOR X-RAY CORPORATION, 2012 Jackson Boulevard, Chicago 33 Direct Branches Throughout the U. S. and Canada Jr V Victor X-Ray Corporation, Publication Bureau, 2012 Jackson Boulevard, Chicago. You may send me—without obligation—descriptions of the Victor Stabilized Mobile X-Ray Unit and the "Wantz Jr." with Model 9 Table. Name Town.. Address State \, 13 m J? 27-280A Victor X-Ray Corporation of Canada Ltd., Motor Transportation Bldg. Vancouver, B.C. VANCOUVER MEDICAL ASSOCIATION Founded 1898. Incorporated 1906. PROGRAMME OF THE 29th ANNUAL SESSION GENERAL MEETINGS will be held on the first Tuesday of the month at 8 p.m. CLINICAL MEETINGS will be held on the third Tuesday of the month at 8 p.m. Place of meeting will appear on Agenda. General Meetings will conform to the following order:— 8:00 p.m.—Business as per Agenda. 9:00 p.m.—Paper of Evening. 1926. Oct. 5th—General Meeting: Presidential Address, Dr. A. W. Hunter. Oct. 19th—Clinical Meeting: Nov. 2nd—General Meeting: Papers—1. Dr. C. W. Prowd, "An Analysis of Radium Therapy, reporting 600 cases. 2. Dr. J. A. Sutherland, "Pain and disability from lesions about the Anus. Nov. 16th—Clinical Meeting. Dec. 7th—General Meeting: Papers—1. Dr. W. F. MacKay, "Diagnosis and Signifcance of referred Pain in Disorders of Chest and Abdomen." 2. Drs. W. S. Turnbull and J. W. Arbuckle, "Eclampsia." Dec. 21st—Clinical Meeting. 1927. Jan. 4th—General Meeting: Papers—1. Dr. G. A. Greaves, "Physiotherapy in Orthopaedic Conditions." 2. Dr. H. A. Barrett, "Treatment of Infections by Physical Agents." 3. Dr. H. R. Ross, "Physiotherapy in Gynaecological Conditions." Jan. 18th—Clinical Meeting. Feb. 1st—General Meeting: Papers—1. Dr. J. M. Pearson, "Treatment of Hypertension." 2. Dr. C. S. McKee, "The Interpretation of Findings in Blood Chemistry." Feb. 15th—Clinical Meeting. March 1st—General Meeting: Paper — Dr. George Seldon, The OSLER Lecture. Mar. 15th—Clinical Meeting. April 5th—General Meeting: Paper— Symposium, "The Treatment of the Poor Risk Patient," Drs. C. E. Brown, A. B. Schinbein, D. D. Freeze and R. E. Coleman. April 19 th—Annual Meeting. Page 38 PHYSIOTHERAPY SECTION PROGRAMME The following is the programme of the Physiotherapy Section for the coming season: Nov. 10th—"Physics of Radiant Energy," Dr. G. A. Greaves. "Bio-physics of Radiant Energy," Dr. H. A. Barrett. Clinical Cases, Dr. J. W. Welch. "Ultra-violet Energy in Special Disease," Dr. H. R. Ross. Dec. 8th—"Clinical Demonstration of the Uses of Radiant Energy Apparatus. Jan. 12th—"Electro-physics," Dr. G. A. Greaves. "Galvanic Currents," Dr. J. W. Welch. "High Frequency Currents," Dr. H. A. Barrett. "Wave Currents," Dr. H. R. Ross. Feb. 9th—Clinical Demonstration of the uses of Electrical Currents. March 9 th—Regular Meeting. April 13th—General Meeting: CITY HEALTH DEPARTMENT Vancouver, B.C. STATISTICS—SEPTEMBER, 1926. Total Population (estimated) Asiatic Population (estimated) i Total Deaths 105 Asiatic Deaths kj'i 8 Deaths (Residents only) 72 Total Births 345 Male, 182 Female, 163 Stillbirths—not included in above INFANTILE MORTALITY— ~ Deaths under one year of age . Death rate per 1000 Births 37.7 CASES OF INFECTIOUS DISEASES REPORTED 128,366 10,100 Rate per 1000 of Population 9.9 9.6 6.8 32.7 13 13 Smallpox Scarlet Fever Diphtheria Chicken-pox Measles Mumps Erysipelas Whooping Cough Tuberculosis Typhoid Fever _„. Aug., Cases 2 5 11 4 25 3 |fl%- 0 11 0 1926 Deaths 0 0 1 0 0 0 0 0 0 Sept.. Cases 1 16 26 7 15 2 5 4 11 4 1926 Deaths 0 0 1 0 0 0 0 2 ■ 11 0 IN CITY Oct. 1st, to 15, 1926 Cases Deaths 0 Cases from outside city included in above. Diphtheria 3 1 10 0 Scarlet Fever 0 0 3 0 Typhoid Fever 0 0 3 0 0 13 3 38 16 0 4 2 0 2 1 4 1 0 0 0 0 0 1 0 0 0 0 0 0 Page 39 EDITOR'S PAGE Evidently human nature is not confined to Vancouver, nor small attendances to meetings of the Vancouver Medical Association. If, that is, we may judge by extracts which we print below from an article in the Wayne County Medical Bulletin which reaches us by way of the Bulletin of the King County (Wash.) Medical Society, with its mild, but presumably heartfelt endorsation. The matter is, of course, not to be settled by scolding nor by indignant remonstrance. It is a question of providing the sort of attraction that will "pull." A certain number will always attend a medical meeting no matter what the interest or lack of it, out of a sense of duty. The sense of duty may be kindled by a feeling that meetings are a necessary part of the life of a Society whose work, on the whole, and in numerous ways is of value. This number will always be limited but its members form a reliable basis in any society. Speaking generally, however, the average man looking at each individual programme asks himself what it contains of particular interest to him. The problem, therefore, is how to provide fare suitable to the particular audience and "get it over," which executive and committees doubtless labour strenuously to accomplish. Publicity is necessary. Nothing is of value today unless proclaimed from the housetop. The Medical Society must be sold to its members. Valuable merchandise decays and is thrown away because its owners have forgotten, if they ever knew of, its existence. Here is the plaint. It comes right home to our bosom: "The first meeting of the Society occurred on Tuesday night. The attendance as a matter of record comprised about thirty members. The Wayne County Medical Society during this year has been addressed not only by leaders of the profession throughout the country, but by outstanding leaders, men whose professional reputations are envied by many thousands of physicians. If the members of the Society are so proficient and so satisfied with their knowledge of advanced medicine, may we call their attention to their duty as hosts. The small attendance at the last meeting is a pitiable reflection on the individual loyalty of medical men one to another. "The attendance at the regular meetings of the Society is lamentably small. The programme committee often assumes considerable responsibility in soliciting eminent men to address the Society. A poor attendance is discourteous to the speaker, and places the committee in an embarrassing position. Needless to say it reacts, also, as a reflection on the scientific interest and hospitality of its Society. Page 40 "The members of the Society owe it to the programme committee and future speakers to turn out in generous numbers for the programmes. This is little enough reward for a long season of unremitting activity." OBITUARY Dr. L. N. McKechnie. One of the oldest and best known physicians of Vancouver died at St. Paul's Hospital on October 3rd, 1926. He was born at Paisley, Ontario, on August 19th, 1864, where he received the junior part of his education, later attending Woodstock College. He entered Toronto University Medical School in 1888 and graduated in 1892. He took a postgraduate course in ophthalmology. He went to Victoria, B.C. in 1893 where he practised until 1895 when he came to Vancouver and soon built up a large general practice. He was port physician for the Port of Vancouver for a number of years. A conscientious and skilful practitioner, he inspired confidence in his patients, by whom he was much esteemed, not only for his medical care but for the many little extra attentions which he was constantly giving them. He was uniformly kindly, courteous, generous and ready to help a confrere. There was nothing of meanness or pettiness in his nature. He; was for long at the head of an extensive and active practice but for the last few years he had given a good part of his time to private business. He is survived by his widow, two daughters and one son, Hugh McKechnie, now in his third year of medicine in Toronto University.—F.X.McP. NEWS AND NOTES Under the chairmanship of Dr. A. W. Hunter, President of the Vancouver Medical Association, a dinner at the Shaughnessy Golf Club was tendered to Dr. Norman M. Keith of the Mayo Clinic, on Monday, September 27th. Some 85 members of the Association attended, and after dinner Dr. Norman Keith, who is a brother of Dr. W. D. Keith of Vancouver, addressed the members on cardio-renal vascular4 diseases and outlined the methods now in use at Rochester and the successes achieved by these methods. Dr. Neil McNeill has left for an extended trip to Europe via the Panama and Egypt. After spending the winter months in Vienna in postgraduate work Dr. McNeill intends to proceed to London for further study and hopes to be back in Vancouver in about six months. Meanwhile Dr. G. H. Clement will care for his practice. Dr. F. P. Patterson left about October 1st for his annual trip to the Orthopaedic Clinics of Montreal, Boston and New York and expects to be back in about a month. Page 41 We offer our congratulations to Dr. and Mrs. E. Murray Blair on the birth of a son and heir on September 26th. Dr. W. B. Burnett left in the middle of the month to attend the meeting of the Interstate Medical Association at Cleveland. Among members of the profession who have been enjoying the delights of hunting and fishing in the Upper Country are Drs. R. E. McKechnie, A. J. MacLachlan, C. W. Prowd and G. H. Clement. Dr. W. D. Patton left at the beginning of the month for Montreal and other Eastern cities and expects to be back early in November. We are very pleased indeed to be ablee to report that Dr. J. H. MacDermot, President of the B.C. Medical Association, has left the hospital and the physician in atendance tells us that he is "doing splendidly." The first general meeting of the Winter Session was held in the Auditorium on Tuesday, October 5 th, with Dr. A. W. Hunter in the chair. At this meeting Dr. Hunter delivered his Presidential address which we hope to publish in our next issue. Drs. H. W. Hill, A. Y. McNair and W. J. S. Millar were elected to membership and Drs. W. A. Gunn, H. Wackenroder, A. S. Lamb and D. A. Clark were nominated for election at a later date. Dr. W. D. Keith and Dr. G. F. Strong reported as chairman and secretary respectively of the Summer School Committee and criticized the atttitude of the members of the Association in not extending better support to the 1926 Session of the School. Later in the evening a resolution was unanimously carried that the Summer School Committee be authorized to proceed immediately with plans for a session in 1927. A letter was read from the Secretary of the Vancouver General Hospital calling for nominations to fill the vacancy in Medicine due to the death of Dr. Alison Cumming and the vacancy in Tuberculosis owing to the resignation of Dr. C. H. Vrooman. Dr. Lachlan Macmillan was re-elected a Director of the Credit Bureau. A vote of sympathy with the relatives of Dr. J. W. Good, Dr. Alison Cumming and Dr. L. N. McKechnie was passed by the meeting. Dr. J. M. Pearson reported as Chairman of the Editorial Board and also as Chairman of the Committee appointed to go into the matter of closer co-operation with the B.C. Medical Association. 58 members were present. The first meeting of the Clinical Section of the Vancouver Medical Association for the Winter session was; held in the auditorium 10th and Willow, on Tuesday evening, October 19 th, with Dr. F. N. Robertson in the chair. Dr. W. A. Bagnall presented a case of hypertension with tachycard la Page 42 Dr. G. R. Lawson showed a case of hypertension with eye ground changes but without frank renal involvement. A case of amboeic dysentery in a young Greek woman, a recent arrival from Salonica, was shown by Dr. H. L. Turnbull. Three advanced cases of rodent ulcer were shown by Drs. Christie and Riggs. An interesting point of differentiation of Occidental and Oriental newborn was brought out by Dr. H. L. Turnbull. In small Oriental races, babies often have black pigmented areas in the skin in the sacral and lumbar regions. This is observed in Chinese, Negro and other dark- skinned races. Members of the Vancouver Medical Association who wish to receive notice of the meetings of the Physiology and Pathology Section are requested to send in their names to thd Librarian, 530 Birks Building. ANNUAL DINNER Our Annual Dinner will be held on THURSDAY, NOVEMBER the 18th, at the Hotel Vancouver. A programme is being arranged which the Dinner Committee trusts will equal, if not excel, the very excellent entertainment given at past dinners. Tickets will be available several days before the date fixed and the Committee urges the members to secure these early so that definite seating arrangements may be completed. ANNUAL DUES Members are once again reminded that dues for the year 1926-27 were payable on April 1st last. We are still awaiting cheques from some 120 members, and in order to avoid the expense and worry attendant upon the issue of drafts on the 1st of November in conformity with our By-laws, please send along your cheques before that date. VANCOUVER MEDICAL ASSOCIATION SUMMER SCHOOL ABSTRACT OF PROCEEDINGS—Continued. On Wednesday, September 15 th, the morning Session was opened by Dr. R. R. MacGregor who spoke on the "Pyelitis of Infancy." The ordinary route of the infection was an ascending one, more rarely did the kidney allow the infecting organism to filter through. Page 43 An infant suffering from this complaint will be found to be pale and restless. There will be loss of appetite. The abdomen may be tender and indeed it is at times possible to ascertain the affected side by the increased tenderness and muscular rigidity. There is a high temperature and the illness may set in with a definite chill or rigor or the latter may be represented by a cyanotic state, a blue and pink appearance which to the experienced eye is highly suggestive of the condition. The child may be ill several days before the characteristic pus appears in the urine, which is usually acid in reaction, especially when the offending organism is the colon bacillus. In this case the urine is also slightly turbid and does not clear on standing. From 6 to 30 pus cells may be found in one high power field or, if the bladder be involved, of course many more. Enquiries are often made as to a convenient method of collecting a specimen of urine from a female infant. This may be done by strapping on a wide mouth bottle or by attaching a rubber sheet around the buttocks. Pyelitis is one of the commoner diseases of childhood and while in cases of some severity the child may appear to be extremely ill, recovery is the rule. It is to be noted that pyuria may persist after improvement in the clinical condition and also that relapses are not uncommon. Cleanliness is an important prophylactic measure. In children from 6 to 12 months of age it is common to find that the diapers used are too small thus increasing the danger of contamination. In treatment it is of prime necessity that water should be given freely, by mouth if possible. If sufficient is not taken in this way, then sub- cutaneously or intraperitoneally. To alkalinize the urine, and this must be done thoroughly, potassium citrate in doses of from grs. 5 at the age of 4 months every 3 hours up to grs. 20 at 3 years old, is prescribed. Sodii bicarb, may be used if this drug is not well tolerated. The temperature usually falls sharply when the urine is fully al- kalinized. Occasionally the use of urotropin, salol or sodium benzoate may be requiredj» Vaccines, in the speaker's experience, have not been of much value. In obstinate cases lavage of the pelvis of the kidney has been used. The next lecture ^was that of Dr. A. S. Warthin on "Erythroedema." A consideration of this disease is of peculiar interest to Canadians as it was in another British Dominion, Australia, that Swift first described the disease in 1914, and in the same country, in 1920, Wood reported the particulars of 120 cases. Later the disease was further investigated in America and in Switzerland. The speaker himself had fully studied two cases which came to autopsy. Many terms have been used to describe the disease, some twenty-five in all, the common names being "pink hands," "acrodynia" and "erythroedema" which was that given by Swift. The lesions are cutaneous, nutritional, nervous and vascular. As to symptoms, diarrhoea is common. The child is peevish and tends to de- Psge 44 velop an extraordinary irritability and a peculiar habit of wringing the hands or of chewing its fingers and where possible its toes. Photophobia is severe so that the child will bury it$ face in the pillow though all the time extremely restless. Hair pulling is characteristic and there is excessive sweating. Eruptions, military in type and pruritic in character may occur. Erythroedema is not a fatal disease. Recovery may occur spontaneously in from weeks to months; forced feeding is apparently a specific and in some cases tonsillectomy has been followed by a cure. The disease may be preceded by an attack of influenza or bronchopneumonia. Byfield regards it as a deficiency disease resembling pellagra. . There have been only 13 autopsies to date, two of which were done by the speaker. In his opinion also, it resembles a deficiency disease which leads to a sensitization to light. Pathologically there is exhaustion of the lymphatic system and oedema of the central nervous system. He thinks that the peculiar colouration of the hands and feet is the result of a polyneuritis but that the polyneuritis is vascular in character almost as in pellagra in the erythematous stage. X-Ray burns will early show a similar condition. From this point of view, in the speaker's opinion, none of the names proposed for this disease is suitable and he suggested that, pending further investigation and confirmation or otherwise of this view, the name "Swift's disease," after the discoverer, be used. Numerous microphotographs of the skin particularly, as well as of the meninges, the thymus, the spleen, etc., were thrown on the screen during the lecture. Following Dr. Warthin, Dr. Hedblom spoke on the "Differential Diagnosis and Treatment of Acute Abdominal Conditions." In cholecystitis, age, sex and bodily weight have to be considered in arriving at a diagnosis, women in middle age who are overweight being especially liable. Pain is complained of at the costal margin on the right side and is colicky and radiating in character. In this area, too, on examination, tenderness and muscular spasm will be found. There may be nausea and vomiting with a rise in temperature and an examination of the blood shows leucocytosis with an increased polymorphonuclear ratio. In more severe and advanced cases of the gangrenous variety, repeated chills with a septic type of temperature will be present. In the condition of perforated gastric ulcer the patient is often much too ill for a reliable history to be obtained. Where such is available there is generally a good deal of complaint of previous indigestion. Perforation is characterized by a sudden, severe pain in the epigastric region. The expression of the patient is one of marked anxiety. In contradistinction to sufferers with some other varieties of abdominal pain the patient maintains a motionless posture. The muscles of the abdominal wall are contracted to a state of board-like rigidity and with an oncoming peritonitis the liver dullness may be obliterated. Intestinal obstruction has many causes, strangulated hernia, bands and adhesions, especially in patients who have had a previous abdominal Page 45 operation, volvulus, intusseption, carcinoma, generally of the large bowel, intra-abdominal tuberculosis, gallstones, etc. There is colicky pain, vomiting, probably a visible intestinal peristalsis and an abdominal tumour may be felt in about one-half the cases. The onset of acute pancreatitis is signalized by the occurrence of epigastric pain, sudden and agonizing in degree. The pulse will be rapid and feeble with the temperature usually subnormal. Abdominal tenderness, rigidity and distension are present and the abdomen is silent on auscultation. There may be a history of previous attacks of gallstone colic. Mesenteric vascular occlusion. The lecturer used this term because many of these cases, when investigated, show an arterial block and not a venous obstruction. There are present, as leading symptoms, and physical signs, shock, sudden abdominal pain indefinitely localized, tenderness and a muscular rigidity which tends to be diffused. Following this onset, dirrhoea and abdominal distension may supervene with, at a later stage, evidences of toxaemia. It may be possible to discover signs of a pre-existing cardio-vascular disease, which may point the way to a diagnosis but it is rarely that a definite conclusion is arrived at before the abdomen is opened. In diverticulitis of the sigmoid there will be complaint of pain located in the left iliac fossa with tenderness and muscular rigidity in that area, together, possibly, with a palpable tumour above Poupart's ligament. Many other acute intra-abdominal lesions were referred to by the lecturer and the close of the address was devoted to a brief consideration of these lesions as they occur in children. The last lecture of the morning session was delivered by Dr. Fraser Gurd on "Fractures in the neighborhood of the ankle joint." Dr. Gurd emphasized the great importance, where at all possible, of early reduction of these fractures. An attempt at reduction at the hands of one comparatively unskilled within an hour of the injury, may give better results than the most experienced can obtain if six hours have elapsed, so great may be the extravasation and consequent swelling. Partial backward displacement of the foot invariably occurs in some degree and in order to avoid a limited range of dorsiflexion, the foot should be held to at least a right angle. A permanent circular dressing of plaster of Paris is used as by this means the patient wi-1 be able to walk. This is applied in from four to six days after the injury or as soon as the swelling has begun to subside. It is left on for 10 to 14 days. After its removal a casti is put on over stokinette without any padding. To this a heel of felt is attached and the patient is allowed to walk. It will be possible to discard all splints in from 5 to 8 weeks. The first boots worn must be raised on the inner border and the height of the heel increased. In the afternoon Dr. Gellhorn spoke on "Syphilis in Gynaecology and Obstetrics." This lecture which was profusely illustrated with lan- Page 46 tern slides was an important contribution on a little known subject. We hope at a later date to publish this paper in full. The next lecture was one by Dr. George Hale on the general subject of "Dyspepsia." Cases of this disorder fall into one of three groups (1) those which are the result of pathological processes elsewhere than in the stomach or duodenum (2) those cases showing pathology in either stomach or duodenum (3) those cases in which no pathological process exists, so far as can be ascertained. It is necessary to examine the patient in all systems and the use of the X Ray will be found a great help. The principal signs are pain, tenderness, vomiting and flatulence. Pain may occur in functional and organic disease but differs in the time of its appearance. Tenderness is difficult to estimate as far as significance is concerned. If there is definite and persistent tenderness in the middle line of the abdomen above the umbilicus ulceration is probably present. Nausea and vomiting is not part of the picture of ulcer except in cases of obstruction. Loss of appetite is common to both functional and organic forms of disease. The diversity of the condition, its periodical recurrence and the relation of symptoms to the ingestion of food have all to be considered. In neurotic forms of dyspepsia the symptoms tend to be persistent, in organic cases there is often a history of frequent and long intervals of freedom. In carcinoma of the stomach the pain may be increased by eating. Vomiting occurs sooner or later and may show old blood of the "coffee grounds" type. There is a marked distaste for food. Gastric analysis will frequently show an absence of free hydrochloric acid with the presence of lactic acid. Only a very rare normal stomach will show lactic acid as a regular constituent of its contents, usually it means the presence of disease and generally of cancer. The onset of cancer of the stomach is apt to be somewhat abrupt without much previous history/of ill health and occurring in a person who has hitherto had a good digestion. The evening session of Wednesday, September 15 th was opened by Dr. R. R. MacGregor who took as his subject "Chronic Intestinal Indigestion in Children." The lecturer devoted his attention entirely to coeliac disease as first described be Gee in 1888, the name "coeliac" being adapted from the Greek name for belly. Gee's original description cannot be improved upon. The disease is characterized by the occurrence of pale, loose, gruellike stools. Fever is usually absent and in severe cases the course may be long and the termination fatal. At one time it was thought to be due to a shortage or absence of the supply of bile but this has been shown to be incorrect. The pancreatic functiion is also described as normal. Herter Page 47 has termed the condition one of "intestinal infantilism." Brown, at Toronto, has endeavored to show the constant association of a gram positive group of organisms. Miller believes that the essence of the disease results from an inability to utilize and absorb fat even though properly split by the pancreatic juice. There is usually no history of improper feeding, nor evidence of any deficiency in vitamins. The cases may be of the severe, chronic, diarhoeal type described by Gee, or of a less severe, non-diarrhoeal variety to which Miller called attention. Tetany is a frequent complication. Acting upon the evidence of a lack of fat absorption this form of food should be practically eliminated from the diet, which, as Howland has suggested, should consist of little else than protein. The final paper of the day was given by Dr. A. S. Warthin who spoke of his work on "Syphilis of the Heart." Dr. Warthin said that an increase in the number of deaths attributable to myocardial disease has been noted. These were usually regarded as being a sequence of rheumatic infection or as a part of a general arterio-sclerotic process. Rarely has the possibility of syphilis as a causative factor been considered. Yet hi the State of Michigan it seems probable from his investigations, that one third or more of these deaths may be due to this condition. He admitted that it is not easy in all cases to demonstrate the spirochaete. As a rule the average pathologist is not looking for this organism. Since 1905 the lecturer's attention has been called to the subject and he has since been able to show its frequency. In a series of interesting and striking lantern slides made from micro photographs of pathological material Dr. Warthin upheld his contention. He called attention to the areas of degeneration scattered throughout the myocardium and especially prevalent in the left ventricle and the inter-ventricular septum. These are not infarcts and there is no sign of haemorrhage. In and around these areas spirochaetes are found, several slides being thrown on the screen showed the organism unmistake- ably. The degenerated areas showed microscopically as being patches of interstitial oedema with infiltration of cells largely of the polymorphonuclear variety. Reference was also made to syphilis as it affects the aorta. (Those who are interested in this important contribution to our knowledge of cardiac disease are referred to the first number of the new "American Heart Journal" published in October, 1925, where the lecturer gives a good account of his early work on this subject.—Ed.) The programme for the final day, Thursday, September 16th, was opened by a talk from Dr. Fraser Gurd on "The Treatment of Compound Fractures." In speaking of compound fractures Dr. Gurd pointed out that most of them occurred in the lower parts of the extremities and took as his Page 48 example for treatment a compound fracture of the lower part of the tibia. In the fracture service to which he is attached they usually get these cases within a few hours of the injury and they employ a standard method of treatment as follows:— The limb is washed and treated with iodine from groin to toes, then the wound is opened as much as is necessary to enable the soiled parts to be excised and haemostasis assured. In making any necessary enlargement of the wound it should be done by S shaped or tranverse incisions but not by longitudinal incisions. Following haemostasis the whole wound is carefully dried and dehydrated by alcohol and again dried and then the whole wound surface is "bipped" using as small an amount of the paste as is sufficient to place a film over all exposed flesh or bone. Dr. Gurd insisted that Bipp consisted of:- Bismuth subnitrate two parts, Iodoform one part and Liquid (not soft) paraffin one part, so mixed as to make a sticky paste thus ensuring an adhering quality. After bipping each recess of the wound it is packed with a piece of gauze soaked in liquid parraffin (i.e. petrolatum) and also smeared with bipp. When this treatment is completed the wound is closed as completely as possible with sutures and the whole leg, from groin to toes, encased in a circular applied plaster of paris cast. This is left in place for from 14 to 25 days and not disturbed unless the temperature goes above 102.3 and the pulse over 106. No windows are cut in the plaster. If necessary to open sooner it is considered an operating room job and the patient is taken there for it and almost a repetition of the above procedure is followed. Moderate mustiness of the plaster and dressings alone, apart from clinical symptoms, is not taken as an indication for changing sooner than above stated. The second dressing is done two or three weeks later, with a third after about the same interval. In nine to eleven weeks he removes all packing, cleans the edges and does a secondary suture. At this point the value is appreciated of not having made longitudinal incisions in the first instance—apposition being easier. As soon as possible walking is encouraged and support given to the limb by using Delblet's plaster splint (lateral side pieces) with circular bands at the upper and lower ends of the tibia). Dr. Gurd stressed the value of diathermy in the after treatment. In about 4000 cases in the service to which he is attached they have had only four cases of non-union. The average time required for recovery has been about nine months. Following the conclusion of Dr. Gurd's lecture Dr. Hedblom addressed the meeting on "Phrenicotomy and Extrapleural Thoracoplasty in the Treatment of Pulmonary Tuberculosis." Surgical treatment of tuberculosis of the lung is not intended to replace the usual line of treatment but in suitable cases to supplement it. It has to be recognized that in spite of every care, certain patients do not get well and in order to acquire any degree of health a permanent collapse of the affected lung is necessary. There are a considerable number of these and it has been estimated that in the United States some 30,000 of these cases exist which require this form of treatment. Page 49 What then are the principles on which surgical interference is based? They are that operation produces (1) rest to the affected part (2) it permits permanent shrinkage of the lung (4) it produces a collapse of tubercular cavities (5) it tends to promote healing of other tuberculous lesions and (6) it arrests haemorrhage. The methods of compression at present in use are the production of artificial pneumothorax, phrenicotomy or evulsion of the phrenic nerve and collapse of the bony framework of the chest. The operation of phrenicotomy has the effect of producing elevation of the diaphragm on the operated side (slides of X Ray pictures were shown in illustration). It may be done as a primary or as a secondary procedure. Thus it may be used as a test operation where thoracoplasty is contemplated in order to decide if the other lung is sufficient to carry on. It may be used as an adjuvant to artificial pneumothorax to reduce the frequency of refills by lessening the size of the pleural cavity as in the case of adhesions of the lower lobe to the diaphragm. Technique:- an incision is made under gas-oxygen anaesthesia in the neck along the anterior border of the sterno-mastoid. The nerve is found lying obliquely across the front of the scalenus anticus muscle and is freed from its surroundings. The upper end is severed and the lower part gradually pulled away from its attachments by winding it upon forceps. It is usually from 7 to 10 inches long. The absolute indications for extrapleural thoracoplasty are found in cases of extensive chronic unilateral fibrous tuberculosis of the lung with adhesions, which prevent the application of an artificial pneumothorax; in cases of persistent recurrent effusions; in cases where there is failure of the lung to expand after artificial pneumothorax and in cases of secondary infection of tuberculous empyaemata. The other lung must, of necessity, be functioning well, a progressive lesion here being a contraindication. The relative indications are found in cases showing chronic mixed fibrous and caseous processes; in cases where there is some active disease in the opposite lung; in cases where in addition to the lung involvement there are extra-thoracic tuberculous lesions of mild grade, also in cases occurring in childhood and in advanced age. The contraindications are cases showing early rapidly progressive unilateral extensive fibrosis of the lung, cases having disease though non-tuberculous of the opposite lung, cases showing active and extensive extra pulmonary tuberculosis and general conditions contraindiacting any major surgical procedure. (To be Continued'.) HAIR DYES AND THEIR TOXIC EFFECTS Abstract of Article by Lawrence K. McCafferty, in Arch, of Dermatology and Syphilology. 14:136. (Aug., 1926) The subject of hair dyes is one of interest to profession and laity alike. Many erroneous opinions are held, much false information is cir- Page JO culated and much harm done owing to ignorance of the nature and powers of a large group of cosmetic agents which are in large daily use. Dr. McCafferty's comprehensive paper furnishes a complete and classified list of hair dyes used today. He groups them as (a) Vegetable Compounds; (b) Metallic Preparations; (c) Compound Dye-stuffs with Mordants, a combination of the first two types, and (d) Synthetic Organic Dyes. To these are added two additional groups—Bleaching Agents and Dye Removers. The various dyes are considered in detail in regard to their origin, preparation, method of use, effects on the hair from a cosmmetic standpoint and that of aesthetics, and their capabilities of damaging the hair or skin. Every medical practitioner is consulted from time to time by his patients who either contemplate the use of this class of cosmetics, or are suffering from the effects of harmful dyes. The information in this paper will place him in a position to give rational and accurate answers to such queries as may be put to him by those seeking advice about a matter which he may have hitherto considered of too trivial a nature to inform himself upon. —D.E.H.C. VANCOUVER GENERAL HOSPITAL LABORATORIES THE TONSIL AND APPENDIX By H. H. Pitts, M.D., Pathologist, Vancouver General Hospital Laboratories, Vancouver, B.C. These two structures, the tonsil and appendix, are probably subjected to surgical removal more frequently than any others in the human mechanism and yet relatively little is known as to their true function and place in the human economy. Both are unquestionably vestigial remnants which gradually undergo involution to final fibrosis. In childhood and infancy they are richly lymphoid structures which gradually give way to fibrous tissue. No doubt in childhood the faucial tonsils may act as guardians to protect the body from infections through the oral and nasal routes but that they can be dispensed with is shown by the results after tonsillectomy and indeed they seem all too frequently to be the port of entry for innumerable infections such as the arthritides, cardiac lesions, etc., thus belying their supposed protective function. In Kaiser's recent review and comparison of 1200 cases of tonsillectomy with 1200 nontonsillectomy controls, followed for a period of three years. ( J. A. M. A. 87:1012 September 25, 1926), he shows that in the former group, sore throat, head colds, chronic otitis, malnutrition, etc., were markedly decreasced and in short that this group was infinitely better physically than that which had not had tonsillectomy. Page 51 If, however, the individual retains these structures the latter are found to undergo fibrosis as time goes on, partly from involution and partly from the chronic inflammatory reaction incident to chronic irritation and infection which follow, to a considerable degree, from their location. The appendix is practically the intestinal counterpart of the tonsil and for it many functions are claimed. Some say that its duty is to incite and regulate defaecation; others that it is a guardian against intestinal infection as the tonsil is against faucial infection. Numerous other theories are also propounded. However, the greatest disproof of all these theories seems to lie in the fact that patients who have had appendectomies maintain good or better health than before their operations. This fact, concerning the appendix, paralleling the situation with regard to the tonsil, seems conclusive proof that the former has no special function. That all the fibrosis is not due alone to involutionary changes is evident for at one time I sectioned something over 100 supposedly normal appendices, obtained at autopsy from various age periods, and examined them microscopically. Even in very young children in a number of instances these showed fibrosis to an almost obliterating degree. These facts led me to believe that a truly normal appendix does not exist, and that practically every appendix will show fibrotic changes varying, of course, in degree. The appendix must be subjected to a considerable degree of trauma, chiefly because of two facts, viz.: (1) its small lumen, (2) its position in the intestinal tract, where dehydration of the intestinal contents is fairly well advanced and particles of somewhat inspissated intestinal contents or foreign bodies such as seeds, spicules of bone, etc., entering the appendix cause it to set up a fairly vigorous peristalsis in order to rid itself of the invader. The muccosa may be abraded in this process, then healing processes are instituted and fibrous tissue increased. This may be repeated innumerable times provided the irritation is not sufficient to set up a frank, acute infection. How few of us but have experienced indefinite right lower quadrant pain at times which shortly subsided leaving no untoward sequelae. Each of these irritations is nevertheless duly registered in the appendicial coats by a little more fibrosis chiefly in the submucosa and muscularis with a fairly consistent fatty infiltration in the former. With the increased fibrosis, peristaltic action of the muscularis is impaired and to overcome this the waves (when a substance enters the lumen) are increased in number, the blood vessels become engorged and colicky pains result. It seems to me that these appendices are analogous to the infantile type of uterus where fibrosis is extensive and where with the increased peristalsis and engorgement at the menses dysmenorrhea results. These patients may have quite severe attacks of pain, probably the neurotic and introspective type suffering the most; and due to their complaints of sudden acute pain, probably gastrointestinal disturbances, Page 52 probably actual, although exaggerated, tenderness, etc., they come to operation. What is found? The appendix in situ is reddened, due to the engorgement of its vessels incident to the vigorous peristalsis; it may be tense due to spasm of the muscularis. It is to all intents and purposes an acutely inflamed appendix yet microscopically one finds only fibrous tissue increase in the submucosa and muscularis, with fat replacement in the former. Should the surgeon feel that he has committed an error of surgical judgment? No, for these patients unquestionably will be free from further symptoms of this nature after operation. It is a point for deliberation on the part of the surgeon whether or not these patients, with symptoms, of a subacute or even acute nature but not clear cut, should have surgical intervention or on the other hand be put at rest With the usual palliative measures. In many instances the latter would suffice but nature does not always speak, by signs and symptoms, quite clearly, and like the oracle at Delphi her message is often a riddle or ambiguous. But what; of the appendix in which the inflammatory condition by means of rest and palliation, has subsided? The fibrosis continues, with gradual narrowing of the lumen, until eventually it becomes completely occluded and the hitherto existing port of entry for irritating substances is forever closed; hereafter no further symptoms will ensue. Of course, the frank acute appendix with ulcerated or necrotic mucosa,, and rich inflammatory cell infiltration, is another story; but in nearly all even of these acute appendices evidences of previous chronic inflammatory fibrosis can be traced. In these cases a foreign substance may be retained in the appendix by oedema or turgescence of the mucosa caused by its presence and the ostium is thus narrowed or closed, prohibiting its escape. The retained bacteria rapidly multiply, ulceration, etc., occurs, with the usual sequelae. Such, at least, is my own viewpoint. CONCLUSIONS (1) The appendix and tonsil are counterparts and apparently of little use in the human economy, as shown by the fact that their removal causes no ill effects. (2) The appendix that has undergone numerous mild irritations with consequent fibrosis is like the infantile type of uterus with its dysmenorrhoea syndrome. (3) The difficulty presented to the surgeon's judgment regarding palliation or operation exists in this type of case. SOME STATISTICS FROM THE V.G.H. LABORATORIES WASSERMAN From the begining of the year 1921 until the end of 1926 (5 years) there were 25,530 Complement Fixation tests made for syphilis. Of these 24,783 were made on the blood sera. The balance (839) .were spinal Page 53 o/. fluids, consisting of 176 or 21% positive reactions and 663 or 79' o negative reactions. The positive arid negative reactions on blood sera have not been tabulated.—Mabel M. Malcolm. DIPHTHERIA From September 1st to September 27th, 116 swabs for dipththeria were examined, 64 of which were positive. This shows the marked increase (453) over last month, as is usual with the re-opening of schools which commenced on September 7th. Since that time seven classes have been swabbed for contacts, and only two contacts were positive, these being from the Lord Kitchener School. Fifty Japanese men from the Immigration Shed were swabbed because of a case of diphtheria developing in a man working on a steamship in port. Three of these contacts were positive and are in Ward Q awaiting release from quarantine, though not themselves sick. —Doris Harraway. BLOOD TRANSFUSIONS Of the last fifty blood transfusions performed in the V.G.H. three patients are reported to have suffered severe reactions after the transfusion. Two of these had chills only, the third had marked urticaria. In all three cases a cross agglutination had shown no agglutination. For three very urgent cases the donor and recipient were grouped, but no cross agglutination was done, and for three others, the donor's serum gave a-slight agglutination with the patient's cells. None of these patients experienced chills or other bad effects.—Grace Wilson. B.C. MEDICAL ASSOCIATION NEWS Dr. J. A. Street, of Port Alice, has been taking a three-weeks' leave of absence. Dr. H. C. Wrinch, of Hazelton, has returned home after an absence of about three months. It is With regret we hear that Dr. J. E. Affleck, of Penticton, is sick. His many friends wish him a speedy recovery. The August meeting of the Victoria Medical Society was addressed by Dr. Georgine Luden of the Mayo Clinic. She spoke of the recent work in "Cancer Research" and dealt very interestingly with carbon monoxide poisoning especially in connection with the chronic poisoning developed in some private houses or other places where gas leakages is responsible for the presence of carbon monoxide. Dr. W. M. Carr, Radiologist of the Jubilee Hospital, Victoria, has been on extended vacation visiting old friends in Winnipeg and other eastern points. Page 54 It is reported that Dr. Charles Duck, anaesthetist at the Jubilee Hospital, put a large "Buck" to sleep on Sunday last and they say that venison now forms a large part of his diet. Jasper Park has become very famous as a mountain holiday resort and Drs. Thomas McPherson, Gorden Kenning, George Hall, W. T. Barrett, M. J. Keys and Stuart Kenning report favourably on the excellent golf course maintained at Jasper. It is not true that Dr. Keys struck a "Bear" with a golf ball and narrowly escaped capture (by the Bear). Dr. W. H. Mclntyre, formerly of Nanaimo, B.C., is now practising in Victoria. The recent Extra Mural Post-Graduate tour throughout B.C., held under the joint auspices of the Canadian Medical and B.C. Medical Association was a decided success. At the time of going to press the tour has only just been completed and a full account cannot be given until the next issue of the Bulletin. It is understood that this year 150 speakers have been on tour throughout the Dominion and there is a strong feeling that if the lecturers in other provinces came up to the same standard as the distinguished Winnipeg doctors who have visited B.C., there can be no question as to the value of these post-graduate tours, especially to the country practitioner. It is gratifying to learn that a second grant of $30,000 has been made to the Canadian Medical Association by the Sun Life Assurance Company, and arrangements are now on the way for further tours in B.C. A well attended luncheon meeting of the B.C. Medical Association was held on October 6th, when our guests of honour were Drs. D. S. MacKay, B. J. Brandson and D. Nicholson, of Winnipeg. Dr. B. J. Brandson, Professor of Surgery, University of Manitoba, gave an inspiring address on "Professional Optimism." Dr. Wallace Wilson, Vice- President of the B.C. Medical Association, was in the Chair. A TRIP TO THE ANTIPODES By M. T. MacEachern, M.D., CM., D.Sc, Chicago Associate Director American College of Surgeons Director of Hospital Acitivities My recent trip to the Antipodes, at the invitation of the State Governments of Victoria and New South Wales, Australia, the New Zealand Branch of the British Medical Association, and the Dominion Government of New Zealand, was one of great pleasure and enriching Page 55 experience. The visitor is continually thrilled with these great countries, with their delightful climates, magnificent scenery, vast resources, and above all, a charming people—courteous and kind in the extreme to the visitor. Even a Canadian soon adopts the characteristics of the Antipodean. One soon acquires the habit of eating seven to nine times daily, and soon becomes proficient in mastering breakfast, morning and afternoon teas and evening suppers in addition to the standard three* meals a day which we have been accustomed to since childhood. Indeed, you will not reside long in these countries until you unconsciously adopt their delightful accent. But notwithstanding all these minor differences, seldom do you realize just how far you are from home. Medical and hospital conditions in these countries are quite different in some respects to those in Canada. Like the Canadian profession, the New Zealand and Australian professions are of high type. Generally speaking, almost all of them further their fundamental education and experience by post-graduate work abroad, acquiring English or American degrees for advanced study. Up to the present, at least, I feel certain that a greater number relatively of the medical profession of Australia and New Zealand take up post-graduate work than those in America. The Medical Practice Acts of these countries are rigidly carried out. there is no parleying or lobbying with the irregular in any form. His case is soon dealt with and he finds himself out of business. High standards of practice are strictly adhered to. In Australia, however, and in New Zealand possibly to a lesser degree, the herbalist is the greatest pest. He is cunning and difficult to catch, but perhaps less harmful than certain other forms of irregular practice of medicine with which we in America have to contend. The State of Victoria presents rather interesting hospital and medical conditions. The hospital system is voluntary in type, subsidized by governmental and municipal aid as required, in addition to fees from patients, earnings from hospital departments, endowments, and other sources. In this connection financial support is received as follows: Voluntary contributions, one-third; fees from patients and earnings from hospital departments, one-fourth; government subsidy, one-sixth; municipal subsidy, one-fortieth; other sources as endowments, rentals, etc., nine-fortieths. Each institution has a carefully selected board or committee of management with full autonomy operating under a general policy as laid down and controlled through a representative non-political state board. There is no attempt at nationalization of medicine or hospitals in Victoria—as in New Zealand. In fact, Victoria appears to have an antipathy for nationalization of this kind. The hospitals of Victoria are created according to purposes and community needs. These are as follows: metropolitan, base, district, cottage, and Bush nursing centres. Distribution is made according to a well-thought-out plan, carrying hospital service right into the back blocks of the country. The entire system is very thoroughly coordinated and characterized by those fundamental principles so essential to hospital progress, namely: co-operation, Page 5 6 efficiency, economy, and service. There are, however, certain drawbacks to medical practice in Victoria. These may be summarized as follows: (1) The great public hospitals have no pay or part-pay wards, and not infrequently patients who are able to pay part or full cost are admitted. They are cared for by the honorary medical staff and no charges can be made for professional services. (2) The profession is obliged to send pay patients to nursing homes, of which there are 473 in the State of Victoria, 207 of which are in the City of Melbourne, with a population equal to Montreal. These nursing homes, with very few exceptions, are inefficient and do not provide in any way whatsoever a modern scientific environment in which the doctor may work. (3) The extensive outpatient departments attached to all hospitals, large or small, provide free treatment for many more than the necessitous. In Melbourne, for instance, an up-to-date, well-to- do city, I found 1 out of every 5 patients attended the outpatient department of the hospital annually, and in Sydney, a city of 1,250,000, 1 out of every 4/4 patients did likewise. (4) The professional and hospital care of the industrially injured or ill is not well regulated under smooth-working Workmen's Compensation Laws as we find in Canada and the United States. In these countries such laws generally apply to the patient, without regard to the hospital or doctor's fees. (5) In medical education they have not yet adopted the compulsory year internship, and owing to not limiting the number in each class, for the time being, at least, they are turning out more internes than they have places for in their hospitals. The existing conditions above referred to were dealt with in my report, and acceptable remedies suggested. As a result of my efforts I hope there will be a better control of who shall and shall not receive free treatment. Pay and part-pay wards will be added to all public hospitals, and improved Workmen's Compensation Laws to provide for compensation of patient, doctor, and hospital will be developed. There will be definite standards of physical and professional requirements applied to all private hospitals which today are unregulated, with the exception of sanitary requirements. A most outstanding, commendable feature of the Victorian system is the fine research work carried on by several of the institutions, particularly the metropolitan. It is a strongly supported principle that the greatest field open today in research is that of clinical research, or the kind that may be carried on at the bedside of the patient. In this they considerably excel us in America. In New South Wales, which I next visited, I found the hospital policy in the melting pot. Here you find great institutions doing high- grade scientific work but generally under considerable financial embarrassment, due to the falling off of voluntary support as it has been Page 57 gradually supplemented by state aid. While no definite solution of the hospital policy in the State was evident when I was there, yet I believe there was a tendency towards nationalization of hospitals especially as a Labor government was in power. In my report, however, I urged the community voluntary hospital, subsidized by government and municipal aid, in addition to fees from patients, earnings from departments, endowments, etc., managed by a board of trustees representative of the best interests, and providing accommodation for the various sections of the community, namely: free, part pay and pay patients, the latter acceptable to the hospital management. There was considerable favour aroused in support of this type of institution and no doubt this would receive consideration when the policy was being formulated. My sojourn in New Zealand was extremely interesting from the standpoint of the task which I had undertaken. I was invited by the New Zealand Branch of the British Medical Association with the approval and support of the government of the Dominion to make a survey of the hospitals of the Dominion, dealing particularly with policy. The system in New Zealand differs considerably from that in America. The whole Dominion is divided into hospital districts under the management and control (subject to the department of health to a great extent) of elected boards, each district having a definite set-up of base and secondary institutions. The hospitals are maintained through a district levy or tax, supplemented by government aid. The government, through the Minister of Public Health, has definite control and power of veto over the hospital boards, thus tending greatly to nationalization of hospitals. There are no private or semi-private patients treated in the public hospitals; they must go to the so-called private hospitals or nursing homes which, with a few exceptions, are meagerly equipped and inefficient. In most of the hospitals outside the metropolitan areas a medical superintendent also assumes the role of chief surgeon, with a limited staff of internes or residents—to the exclusion of all other doctors in the community—doing all the clinical work of the institution. Under this tendency towards nationalization certain conditions or problems have arisen which today threaten to break down the system unless remedied. These are mainly: Through politics there has been an unnecessary increase in the number of hospital districts from less than 20 to 52, thus making it impossible to maintain a standard set-up in each district, and increasing the burden on the taxpayer. Opening of the public hospitals to all persons, rich, poor or otherwise, has placed an increased burden on the taxpayer and done an injustice to the medical profession. There are no private or semi-private wards attached to any public hospital. The dispensing with the honorary medical staffs and the engaging of a full time medical superintendent as chief surgeon to do all the clinical work and administer the institution, with a limited staff, has also tended to lower efficiency. Page 58 Some of the recommendations which I made were as follows: That the voluntary community hospital catering to all classes of patients, subsidized by governmental and municipal aid, or philanthropy, represents the most desirable type of institution the world over, and is the most adaptable to community needs with the least burden on the taxpayer and the most efficient. That the elective system of choosing trustees of the hospital does not always ensure the best type of citizen. That under the present system in New Zealand it would be advisable to have a non-political Dominion board to counteract the present tendency to too much governmental and bureautic control, thus offering opportunity for political interference. That effective efforts be made to confine the use of public wards to necessitous case only. That the superintendent of the hospital should limit himself entirely to administrative functions. That every effort should be made at the earliest opportunity to promote better co-operation between the doctors of the community and the hospital boards. That part pay and pay wards for those able to contribute more than nine shillings a day for treatment should be established. Such a system would involve freedom of choice of various grades of accommodation best suited to the patient's finances, and retention of the services of the patient's own doctor, if desired and if eligible to practice in the institution. This scheme would increase revenue of the hospital and community interest, and improve the general proficiency of the medical profession. That the hospitals of the Dominion be placed under competent constructive inspection by an officer of experience in all phases of hospital administration. That there should be a re-distribution of the hospital districts so as to permit of a proper set-up in each, with the least expense or burden on the taxpayer. I was particularly impressed in New Zealand with the great interest manifested by the medical profession, the hospital boards and the government in the care of the sick, and particularly hospitals. There was not always, however, the very best of co-operation. In many places I felt it my duty to bring these three groups together to discuss freely and frankly certain problems of common interest. The climax in this regard was reached on April 7, when for the greater part of a day I was able to meet these three groups in large number in the parliament buildings at Wellington, and there lay before them my findings and recommendations. Needless to say, it was a strenuous day, but resulted in the stimulating of greater co-operation among these three groups in working together for the best interests of the patient. Page 59 One cannot visit Australia and New Zealand without carrying away lasting impressions—great countries with great resources yet undeveloped; wonderful scenery at every turn which rather dissatisfies the traveller inasmuch as he cannot look at it long enough, he cannot take it with him and he knows that he cannot return frequently to see it; but above all and of greater importance indeed, a wonderful, courteous and hospitable people, whose friendship is real and lasting. LABORATORY 1200 Fifteenth Avenue West Telephone Bayview 268 OFFICE 206 Vancouver, Block Telephone Seymour 2996 Private Clinical Laboratory §§^St^m Service WM$M We are prepared to undertake all the work usually done in a well equipped Clinical Laboratory. Blood Chemistry, Wasserman Tests, Vaccines, etc. C. S. McKEE, M.B. MISS M. M. McKEE Page 60 B* Q Pharmacol Co. Ltd. 329 Railway Street, VANCOUVER. Manufacturers of Hand-wade Filled Soluble Elastic Capsules. Specimen Formulae: No. 60— No. 61— Blaud Pill, 10 gr. Blaud Pill, 10 gr. Arsenious Acid, 1/50 gr. Arsenious Acid 1/50 gr. Ext. N " Vomica, | gr. Ext. Nux Vomica, | gr. Phenolpthallin, J gr. Phenolpthallin, \ gr. Special Formulae Made on a Few Hours' Notice. Price Lists and Formulae on Application. PRESCRIPTIONS filled exactly as written Phones: Seymour 1050 -1051 Day and Night Service Qeorgia Pharmacy Ltd. Qeorgia and Qranville Sts. Vancouver, B. C. Page 61 SPECIAL OFFER Doctors9 Bags I Of Exceptional Value Manufactured in England Solid Cowhide Leather Hand-sewn and rivetted frames Adjustable bottle loops and pocket Orders will be filled in sequence We have a stock on hand and another shipment coming Special price during run of this advertisement: CLUB STYLE 16 inch - $12.00 18 inch ' $13.50 A saving of about 25% B. C. Stevens Co. Ltd. 730 Richards Street Vancouver The Ow\ Drug ' Co., Ltd. ^11 prescriptions dispensed bu qualified Druggists. IJou can depend on the Ou?l for tAccuracu and despatch. IDe deliuer free of charge. 5 Stores, centrally located. We would appreciate a call while in our territory. Ambulance I Service | TELEPHONE Fair. 58 & 59 Mount Pleasant Undertaking Co. Ltd. R. F. Harrison W. E. Reynolds Cor. Kingsway and Main Page 62 v©o- i<m> PROTEIN EXTRACTS, DIAGNOSTIC, P. D. & CO., ARE STANDARDIZED, |1§ STABLE, CONVENIENT |. <*"% >f~ANY obscure conditions, in addition to hay OS VX. ^ever5 asthma, and some of the commoner dermatoses, are the result of protein sensitization, and their successful treatment will depend in no small measure on the accurate determination of the offending protein or proteins. For this purpose there is no diagnostic agent superior to Protein Extracts, Diagnostic, P. D. & Co. These are extracts concentrated in glycerin and mixed with pure boric acid powder in sufficient quantity to make a paste. The only instruments required for their application are a needle and a few ordinary sterile flat wooden toothpicks. These Extracts are economical, non- irritating, soluble in the body fluids, and the time consumed in making the tests is much shorter than that required when either powdered or liquid extracts are employed. Protein Extracts, Diagnostic, P. D. & Co., are supplied in collapsible tubes, each tube containing approximately 1.5 grams—sufficient material for about fifty tests. The tubes contain single proteins of food, pollen, animal hair, feathers of fowls, bacteria, serum, etc.—or groups of three to six mixed extracts in one tube—the same amount of the finished product in each tube, that is, 1.5 grams. We invite the correspondence of physicians; complete literature is available Parke, Davis & Company PROTEIN EXTRACTS, DIAGNOSTIC, ARE INCLUDED IN N. N. R. BY THE COUNCIL ON PHARMACY AND CHEMISTRY OF THE AMERICAN MEDICAL ASSOCIATION Page 61 ••••♦—£^£*)J_ "lit* -*3sf-»~ Hollywood Sanitarium LIMITED tyor the treatment 0} Alcoholic, Nervous and Psychopathic Cases Exclusively Reference - <23. Q. eMedical Association For information apply to Medical Superintendent, New Westminster, B. C. or 515 Birks Building, Vancouver Seymour 4183 Westminster 288 v«e>tf =«SV Page 64
Periodicals
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Medicine--Periodicals
The Vancouver Medical Association Bulletin: November, 1926
Text