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History of Nursing in Pacific Canada
Vancouver Medical Association
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SICSAGE XTE& WOODWAS D W.d2- 1 U.B.C. LIBRARY j MB i f rhe . . . BULLETIN of the pi . JVANCOUVER MEDICAL ASSOCIATION With Which Is Incorporated Transactions of the VICTORIA MEDICAL SOCIETY the VANCOUVER GENERAL HOSPJ§iL_ and ST. PAUL'S HOSPITAL 3C ■■ U^^itSlTY jlj IQ/1G In This Issue: Page HISTORlJOF THE VANCOUVER MEDICAL ASSOCIATION 5 B. C. MEDICAL ASSOCIATION- vjllBll, l.-f^^.lO ACUTE PANCREATITIS By John A. Ganshorn, M.D., M.Sc. (in surgery). CASE OFjpNUSUAL MESENTERIC TUMOUR By Paul P. Jackson, M.D.,,and L. H. Appleby, M.D.. 12 20 NEWS AND NOTES 'M$Wi^mm&Bi - ~-~ . -23 VOL. XXIII. NO. 1 OCTOBER, 1946 |focj|>ph^p|.B^ is Triple Acting ANALGESJG^f The fggpmH analgesic^^acetylsalicyliiSacid^ phenacetine and codeine phosphate, ensT|^^|1;he rapid easing of most types of pain. ; ANTIPYRETIC^S|| AcetylsalicyteaGid and phenace- tine are both^familiar agents for phe reductionl§>f feve^l \SEDATIVgW: Codeine phosphate provides saJ§| and sure^elaxation of taut nervesp $wo %trengiIhs cM#260ffodophettt E.BS Ebsal E.B.^fei^^J,J 3 grs. (Acetylsalicylic Acid) Phenacetine MMfy^^ir 2 grs. Caffeine Citrate $|§lir H B*. Codeine Phosphate . M g** These tablets are a pale orange color. C.T. #260A Codophen Stronger, B.B.S. Ebsal E.B.S. -^^^3 grs* (Acetylsalicylic Acid) Phenacetine ijg|£*'. '-^^'2 grs. Caffeine Citrate -:j£vmit&i gr. Codeine Phosphate ?p|§F)4 %*. These tablets are a deep orange color. When prescribing^ speciffp£B.S||| TfiUS: C^-»260 Codophen, E3.S.^^iC.T^peOA Codophen Stronger^ pI.BtS^ #©0@Pti] :-C0ntrs>S CHEMICAL COnPMti.WttUD HE L B.SHUTTLEWORTH CHEMICftiC# LIMITED TORONTO MANUFACTURING CHEMISTS CANADA A wholly Canadian Company Established 1879 BULLETIN of the Vancouver Medical Association V|i Volume XXIII. 1946 - 1947 BULLETIN OF THE VANCOUVER MEDICAL ASSOCIATION VOLUME XXIII. 1946-47 INDEX A Page ABDOMINAL. PAIN IN INFANTS AND CHILDREN, CAUSES OF—Clement A. Smith.... 302 AMERICAN COLLEGE OF SURGEONS—Sectional Meetings - 98 AMERICAN UROLOGICAL ASSOCIATION—Urology Award .67 ANGINA, AGRANULOCYTIC, TREATED WITH PYRIDOXINE HYDROCHLORIDE— E. S. James i 58 ANTHONY, A. R.—Highlights of Ophthalmology 81 APPLEBY, L. H., & JACKSON, PAUL P.—Case of Unusual Mesenteric Tumour 20 APPLEBY, L. H.—Vagotomy 84 —Surgery or Propyl Thiouracill 135 ARTHRITIS, RHEUMATOID—Russell L. Cecil 40 BAKER. H.—Kernicterus '... . .. » 239 BALFOUR. JOHN—Sterility in the Male 112 BLOOD DISEASES—Discussion of some Aspects of Leukemia, Infectious Mononucleosis and Agranulocytosis—^Cyrus C. Sturgis 277 BLOOD BANK SUPPLIES—Growing Deficit 322 BRITISH COLUMBIA MEDICAL ASSOCIATION— Annual Meeting 250 Annual Reports , 252 Benevolent Fund 151 Report of Representative on Executive Committee C.M.A ,—: 320 Southern Interior Medical Association 11- Upper Vancouver Island Medical Association Annual Meeting 51 West Kootenay Medical Association Annual Meeting 11 BURKE MEMORIAL CANCER FUND 9 BURNS, TREATMENT OF—Roy D. McClure . 270 CANTRIL, SIMEON T.—The Use of Radioactive Isotopes in Biology and Medicine 152 CECIL, RUSSELL L.—Rheumatoid Arthritis 40 CHEMOTHERAPY IN INFECTIONS OF THE EARS AND PARANASAL SINUSES— J. R. Lindsay.. ... .. 35 CHEMOTHERAPY IN SURGERY—Roy D. McClure 267 CHEST DISEASE, NON-TUBERCULOUS, SURGERY FOR—Elliott Harrison 121 CHIVERS, N., and VICKERS, K.—Progress in the Treatment of Meningitis 44 CHIROPODY—AN AUXILIARY TO MEDICAL PRACTICE—J. H. MacDermot 296 CLEVELAND. D. E. H.—Preparation of Maru-cripts for Publication :. 137 COLLEGE OF PHYSICIANS AND SURGEONS— Appointment of Dr. F. L. Whitehead ,.r 223 Coroners Act . 322 COLON, POLYPOSIS OF—C. G. Pow ' 17S correspondence:— Moukden Medical College . 186 Pharmaceutical Association of B C 52 Specimens mailed to Provincial Laboratory 218 Vancouver General Hospital Staff Appointments 218 DIRECTION IN WHICH AVE ARE GOING—A. E. Grauer. 224 ELECTROLYTES, RECENT ADVANCES IN ADMINISTRATION OF—A. Ui Hardyment 60 ELLIOT, A. J.—The Treatment of Ocular Injuries in General Practice 333 —Ophthalmic Indications of Systemic Disease .... 336 —Ocular Findings in Important Neurological Conditions 340 —The Differential Diagnosis and Treatment of an Acutely Red Evo 344 EPILEPSY, A CASE OF PSYCHOMOTOR—W. J. Fowler 66 EUSTACHIAN TUBE FUNCTIONS AND ITS RELATION TO DEAFNESS— J. R. Lindsay 1C0 EYE, EAR, NOSE AND THROAT, SYMPOSIUM • 76 INDEX—Continued Page FACE AND JAW, INJURIES OF—Robert G. Langston 168 FAMILY WELFARE BUREAU—The Unmarried Mother 249 FOWLER, W. J.—A Case of Psychomotor Epilepsy J 66 —Tetanus—A Case Report 236 FROST, A. C, and FROST, A. C. GARDNER—Review of 422 Cases of Sterility in Private Practice 103 G GANSHORN, JOHN A.—Acute Pancreatitis 12 GASTROSCOPY, MODERN, and GASTRIC DISEASE—Roger Wilson 272 GEORGE WASHINGTON, UNIVERSITY SCHOOL OF MEDICINE— Post Graduate Course 52 GRAUER, A. E.—The Direction in Which We Are Going 224 HARDYMENT, A. F.—Recent advances in Administration of Electrolytes 60 HARRISON, BEDE J.—Medicine and Some Orthodoxies (Osier Lecture)...£. 197 HARRISON, ELLIOTT—Surgery for Non-Tuberculous Chest Disease 121 HEART AND GREAT VESSELS, SURGICAL CONDITIONS OF—Ross ""Robertson 130 HUGGARD, ROY—Vagotomy 211 HUNT, LEIGH—A Changed Concept of Pelvic Inflammation r, 109 INCOME TAX RETURNS. DOMINION, BY MEMBERS OF THE MEDICAL PROFESSION : '... 99 INTERVERTEBRAL DISCS, LUMBAR AND SACRAL—J. Gordon McPhee 34S JACKSON, PAUL P., and APPLEBY, L. H.—Case of Unusual Mesenteric Tumour 20 JAMES, E. S.—Agranulocytic Angina Treated with Pyridoxine Hydrochloride 5S —A Case of Obstructive Jaundice 175 JAUNDICE, A CASE OF OBSTRUCTIVE:—E. S. James 175 KFLLY. A. D.- KERNICTERUS -Refugee Physicians 328 —H. Baker .'."«: 239 i ► * LANGSTON, ROBERT G.—Injuries of the Face and Jaw..... 168 LEESON, L. H.—Recent Advances in Otolaryngology „..'. 4?1 78 LINDSAY, J. R.—Chemotherapy in Infections of the Ears and Paranasal Sinuses 35 Eustachian Tube Function and Its Relation to Deafness 160 M MANUSCRIPTS FOR PUBLICATION, PREPARATION OF—D. E. H. Cleveland: 137 MEDICAL EDUCATION, PROBLEMS AND TRENDS IN—Edward L. Turner 29 MEDICINE AND SOME ORTHODOXIES—Bede J. Harrison 197 MENINGITIS, PROGRESS IN THE TREATMENT OF—N. Chivers and K. Vickers.. 44 MESENTERIC TUMOUR, CASE OF—Paul P. Jackson and L. H. Appleby 20 MURRAY, STEWART—Acute Anterior Poliomyelitis 221 MACDERMOT, J. McCLURE, ROY Mc H.—Chiropody, An Auxiliary to Medical Practice 296 D.—Chemotherapy in Surgery., s 267 —The Treatment of Burns 270 McLEAN, JOHN A.—Highlights of Ophthalmology , 76 McLEAN, T. K.—Treatment of an Unusual Case of Spontaneous Pneumothorax 176 McPHEE, J. GORDON—Lumbar and Sacral Intervertebral Discs „ _ 34S N NATIONAL NEWBORN, Clement NEWBORN, NEWBORN NEWS AND FILM BOARD 75 DISEASES OF, ASPHYXIA, ATELECTASIS, ERYTHROBLASTOSIS— A. Smith : 311 DISEASES OF. DIARRHEA, PREMATURITY—Clement A. Smith. 316 INFANTS, PHYSIOLOGICAL PECULIARITIES OF—Clement A. Smith 307 NOTES 22, 47, 69. 115, 139, 181, 214, 244, 285, 323, 356 INDEX—Continued OBITUARIES— BLACKWOOD, BERTIE GRAHAM, WILFRED L , GRANT, JAMES F : MacEWAN, S. C -. MOONEY, WILBUR CRAIG SAUNDERS, THOMAS FJSON SCATCHARD, WALTER WALTON, R. A 2 OBSTETRICS, MODERN TRENDS IN—N. W. Philpott OCULAR FINDINGS IN IMPORTANT NEUROLOGICAL CONDITIONS—A. J. Elliot.... OCULAR INJURIES IN GENERAL PRACTICE, TREATMENT OF—A. J. Elliot OPHTHALMIC INDICATIONS OF SYSTEMIC DISEASE:—A. J. Elliot OPHTHALMOLOGY, HIGHLIGHTS OF—John A. McLean —A. R. Anthony » OREGON ACADEMY OF OPHTHALMOLOGY & OTOLARYNGOLOGY— Post Graduate Course OSLER LECTURE:—Medicine and Some Orthodoxies—Bede J. Harrison OTOLARYNGOLOGY, RECENT ADVANCEMENTS IN—L. H. Leeson ■Page .. 243 PAEDIATRICS, SYMPOSIUM ON RECENT ADVANCES - 53 PAEDIATRIC DISEASE, A MODERN RE-EMPHASIS OF THE ROLE OF INFECTION IN—R. A. Wilson 53 PAEDIATRICS, NEO-NATAL, RECENT ADVANCES IN—Harold Stockton 55 PANCREATITIS, ACUTE—John A. Ganshorn 12 PELVIC INFLAMMATION, A CHANGED CONCEPT—Leigh Hunt 109 PHILPOTT, N. W.—Modern Trends in Obstetrics.. 88 PHYSIOTHERAPISTS & MASSAGE PRACTITIONERS ACT : % 213 PNEUMOTHORAX, SPONTANEOUS, TREATMENT OF AN UNUSUAL CASE OF— T. K. McLean 176 POLIOMYELITIS, ACUTE ANTERIOR—Stewart Murray 221 POW, C. G.—Polyposis of the Colon 178 PROVINCIAL BOARD OF HEALTH DIVISION OF V. D. CONTROL— Recent Developments in Venereal Disease Treatment 68, 93 Cardiovascular Syphilis i 210,263 R RADIOACTIVE ISOTOPES IN BIOLOGY AND MEDICINE, THE USE OF— Simeon T. Cantril I : '. 152 RED EYE, ACUTE, DIFFERENTIAL DIAGNOSIS AND TREATMENT OF—A. J. Elliot 344 REFUGEE PHYSICIANS—A." D. Kelly I ] _ 328 ROBERTSON, ROSS—Surgical Conditions of Heart and Great Vessels 130 S ST. PAUL'S HOSPITAL,—Case Reports 20 SAXTON, G. D.—Some Observations on Streptomycin 63 —Surgical Treatment of Pulmonary Tuberculosis 127 SMITH, CLEMENT A.—The Causes of Abdominal Pain in Infants and Children 302 —Physiological Peculiarities of Newborn Infants 307 —Diseases of the Newborn; Asphyxia, Atelectasis, Erythroblastosis 311 —Diseases of the Newborn; Diarrhea, Prematurity .tfc. 316 STERILITY. IN THE MALE—John Balfour _ 112 STERILITY IN PRIVATE PRACTICE—A. C. Frost and A. C. Gardner Frost 103 STREPTOMYCIN IN TUBERCULOSIS, SOME OBSERVATIONS ON—G. D. Saxton 63 STOCKTON, HAROLD—Recent Advances in Neo-Natal Paediatrics 55 STURGIS, CYRUS C.—Discussion of some Aspects of Leukemia, Infectious Mononucleosis and Agranulocvtosis 277 SURGERY OR PROPYL THIOURACIL—Lyon H. Appleby , 135 T TETANUS—A Case Report—W. J. Fowler 236 THORACIC SURGERY—Symposium on . 121 TUBERCULOSIS, PULMONARY, SURGICAL TREATMENT OF—G. D. Saxton 127 TURNER, EDWARD L.—Problems and Trends in Medical Education 29 V VAGOTOMY—Lyon H. Appleby § 84 VAGOTOMY—Roy Huggard 211 VANCOUVER GENERAL HOSPITAL— Case Reports 12, 44, 63, 66, 175, 176, 178, 236, 239, 272, 348 VANCOUVER MEDICAL ASSOCIATION— Annual Reports (1946-1947) \ 1S7 History of—Dr. G. E. Kidd 5, 86, 101, 148, 195, 233, 264, 289 Library 4, 28, 51, 74, 120, 144, 184, 218, 248, 289, 332 New Members 29 53 Summer School , . . "-" 145' 229 VICKERS, K., and CHIVERS. N.—Progress in the *^tni^t^"^lniin"StfeIZS^S .' 44 VICTORIA MEDICAL SOCIETY 11 W 5,rJJJoS^- R- A"—A Modern Re-Emphasis of the Role of Infection in Paediatric Disease 53 WILSON, ROGER—Modern Gastroscopy and Gastric Disease...: ..i 272 umvERsrrr m *»KTSH COLUMBIA THE VANCOUVER MEDICAL ASSOCIATION BULLETIN Published Monthly under the Auspices of the Vancouver Medical Association in the interests of the Medical Profession. Offices: 203 Medical-Dental Building, Georgia Street, Vancouver, B.C. EDITORIAL BOARD: Dr. J. H. MacDermot Dr. G. A. Davidson Dr. D. E. H. Cleveland All communications to be addressed to the Editor at the above address. VOL. XXIII. OCTOBER, 1946 No. 1 OFFICERS, 1946 - 1947 Db. H. A. Des Brisay President Dr. G. A. Davidson Vice-President Dr. Frank Turnbull Past President Dr. Gordon Burke Hon. Treasurer Dr. Gordon C. Johnston Hon. Secretary Additional Members of Executive'. Dr. W. J. Dorrance, Dr. J. W. Shier TRUSTEES Dr. A. W. Hunter Dr. G. H. Clement Dr. A. M. Agnew Auditors: Messrs Plommer, Whiting & Co. SECTIONS Clinical Section Dr. E. R. Hall Chairman Dr. Reg. Wilson Secretary Eye, Ear, Nose and Throat Dr. Roy Mustard Chairman Dr. Gordon Large Secretary Paediatric Section Dr. R. P. Kinsman Chairman Dr. H. S. Stockton Secretary Orthopaedic and Traumatic Surgery Section Dr. K. J. Haig___—-Chairman Dr. J. R. Naden Secretary Section of Neurology and Psychiatry Dr. A. M. Gee Chairman Dr. J. C. Thomas Secretary STANDING COMMITTEES Library: Dr. W. J. Dorrance, Chairman; Dr. D. E. H. Cleveland, Dr. J. E. Walker, Dr. R. P. Kinsman, Dr. J. R. Neilson, Dr. S. E. C. Turvey. Publications: Dr. J. H. "MacDermot, Chairman; Dr. D. E. H. Cleveland, Dr. G. A. Davidson, Dr. J. H. B. Grant, Dr. E. R. Hall, Dr. Roy Mustard. Summer School: Dr. L. G. Wood, Chairman; DR- J. C. Thomas, Dr. A. M. Agnew, Dr. L. H. Leeson, Dr. A. B. Man son, Dr. D. A. Steele. Cjredentials: Dr. H. H. Pitts, Dr. A*E. Trites, Dr. Frank Turnbull. V. O. N. Advisory Board: Dr. Isabel Day, Dr. J. H. B. Grant, Dr. G. F. Strong. Representative to B. C. Medical Association: Dr. Frank Turnbull. Sickness and Benevolent Fund: The President—The Trustees. % Squibb K »»<* rojs*Nf Each capsule contains 50 milligrams of mixed tocopherols, equivalent in vitamin E activity to 30 milligrams of a-tocopherol. Tocopherex contains vitamin E derived from vegetable oils by molecular distillation, in a form more concentrated, more stable and more economical than wheat germ oil. For Literature write-E. R. Squibb & Son, of Conoda, Ltd., 36 Caledonia Road, Toronto fin 170C VANCOUVER MEDICAL ASSOCIATION Founded 1898 : : Incorporated 1906 PROGRAMME OF THE 49th ANNUAL SESSION GENERAL MEETINGS will be held on the first Tuesday of each month at 8:00 p.m. CLINICAL MEETINGS will be held on the third Tuesday of each month at 8:00 p.m. October 1 GENERAL MEETING—Symposium—"Recent Advances in P Doctors E. J. Curtis, E. S. James, W. H. S. Stockton and Reg. Wilson. October 15 CLINICAL MEETING—Vancouver General Hospital. November 5 GENERAL MEETING. Doctors A. R. Anthony, L. H. Leeson and J. A. McLean. November 19 CMNICAL MEETING—St. Paul's Hospital. December 3 GENERAL MEETING. Symposium on Gynecology. Doctors Leigh Hunt and Gardiner Frost. December 10 CLINICAL MEETING—Shaughnessy Hospital. 0 li^^^M^^^^^^B^^^^^^^s Breaks the vicious circle of perverted menstrual function in cases of amenorrhea, tardy periods (non-physiological) and dysmenorrhea. Affords remarkable symptomatic relief by stimulating the innervation of the uterus and stabilizing the tone of its musculature. Controls the utero-ovarian k circulation and thereby encourages a J Ik normal menstrual cycle. ^ £^§ j V • MARTIN H. SMITH COMPANY ^ lH&^. ISO lAFAYITTISTUlt. NEW TO«K. N. T. ^^^ Full formula and descriptive literature oft request Dosage: l to 2 capsules 3 or 4 times daily. Supplied in packages of 20. Ethical protective mark MHS embossed on inside of each capsule, visible only when capsule is cut in half at seam. IJ % Page 1 ince we cannoi send ihewi a d lk< ropics RJie444HciiC jfeoeSir the scourge of the -temperate zones occurs 10 to 20 times* more frequently in the northern stormy belts than in the calm warmth of the tropics. From January to March every year in the United States alone, in the neighborhood of 100,000 new cases of rheumatic fever appear. The remarkable benefit to these patients of salicylate therapy long has been appreciated. More recent is our knowledge that intense salicylate therapy induces prothrom- binopenia and other changes in the physiologic balance of the blood which tend in the direction of a hemorrhagic state. Lakeside's MENACYL Tablets maintain these factors of physiologic equilibrium while providing therapeutic blood levels of salicylate. Menacyl qiaei PmtecUcm When a Salicylate is indicated, MENACYL is doubly indicated. (1) Salicylate Therapy: (0.33 Gm. acetylsalicylic acid) (2) Anti-prothrombinopenic: (0.33 mg. menadione) (3) Capillary protection: (33.3 mg. ascorbic acid) Available through your Prescription Pharmacy in Bottles of 100 and 1000 Tablets. *Mills/ C. A.: J. Lab. and Clin. Med. 24:53, 1938. For Literature, Write MARSH, WILDE & CO. Distributors 628 Vancouver Block Vancouver, B. C. VANCOUVER HEALTH DEPARTMENT STATISTICS—JULY, 1946. Total population—estimated — Chinese Population—estimated Hindu Population—estimated . 323,850 6,566 361 Number Total deaths 290 Chinese deaths : 22 Deaths, residents only 243 BIRTH REGISTRATIONS: Male 285 Female 385 Rate per 1,000 Population 10.5 39.5 770 INFANT MORTALITY August, 1946 Deaths under 1 year of age 17 Death rate—per 1,000 live births 22.1 Stillbirths (not included above) - 3 28.0 August, 1945 27 42.4 17 CASES OF COMMUNICABLE DISEASE REPORTED IN THE CITY Scarlet Fever Diphtheria Diphtheria Carrier Chicken Pox Measles Rubella Mumps 3 2 Whooping Cough Typhoid Fever Typhoid Fever Carrier Undulant Fever Poliomyelitis Tuberculosis Erysipelas Meningoccus Meningitis Infectious Jaundice Salmonellosis Salmonellosis (Carrier)) Dysentery Tetanus Syphilis . Gonorrhoea Cancer (Reportable) Resident , Non-Resident July , 1946 Cases Deaths 7 0 1 1 0 0 7 0 2 0 1 0 32 0 2 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 6 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 August, 1946 Cases Deaths Sept. 1-15, 1946 4 0 0 29 6 3 26 3 0 0 3 0 43 3 4 2 20 6 0 1 107 261 0 122 54 3 0 0 0 0 0 0 0 0 0 0 0 22 0 0 0 0 0 0 0 1 1 0 0 0 Cases 2 1 0 13 3 0 21 7 0 0 2 1 0 3 0 1 11 0 0 ■ 0 0 0 0 0 0 Deaths 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 B I O G L A N "C" Prepared separately for male and female. Composition: Anti-thyroid principles of the pancreas, duodenum, em- bryonin, suprarenal cortex, tests (or ovary). Each 1 cc. ampoule contains the equivalent of approximately 29 grams of fresh substance. Indications: Graves's disease, hyperthyroidism, exophthalmic goitre, thyrotoxicosis. The most effective therapy available. Stanley N. Bayne, Representative Phone MA. 4027 1432 MEDICAL-DENTAL BUILDING Vancouver, B. C. Descriptive Literature on Request THE SCIENTIFIC HORMONE TREATMENT Page 2 PENICILLIN INJECTIONS REDUCED TO ONE OR TWO IN TWENTY-FOUR HOURS Since the first publication by Romansky of the satisfactory blood levels of penicillin obtained and maintained for a period of eighteen hours following the intramuscular injection of 300,000 units of calcium penicillin in beeswax and peanut oil, both laboratory investigations and collaborative clinical studies in the treatment of gonorrhea and pneumonia have been made by the Connaught Medical Research Laboratories. It has been widely confirmed that penicillin prepared according to the Romansky formula maintains the blood levels which are required in the treatment of gonorrhea and certain other conditions, and permits of one injection every twelve to twenty-four hours. The Connaught Medical Research Laboratories have prepared a suitable produce" which can be readily administered with the use of a disposable plastic syringe provided in each package. This syringe, with sterile, built-in needle, is ready for immediate use with a special cartridge containing 300,000 units of calcium penicillin in 1 cc. of beeswax and peanut oil. Other Penicillin Preparations Available from these Laboratories For Injection SODIUM PENICILLIN in sealed rubber-stoppered vials containing: 100,000 International Units 200,000 300,000 500,000 For Oral Use CALCIUM PENICILLIN in suitably buffered tablets in tubes containing: 12 tablets each of 25,000 International Units 12 tablets each of 50,000 International Units CONNAUGHT MEDICAL RESEARCH LABORATORIES University of Toronto Toronto 4, Canada DEPOT FOR BRITISH COLUMBIA MACDONALD'S PRESCRIPTIONS LIMITED MEDICAL-DENTAL BUILDING, VANCOUVER, B.C. The Bulletin is in receipt of a letter from the Committee in charge of the University of B. C.'s campaign, conducted by the student body, to raise funds for the building of their War Memorial Gymnasium. This Committee has asked us to draw attention to the fact that this campaign will begin on November 4th and will be continued till November 13 th. During this time doctors will be canvassed by students of the pre-medical group which is taking the pre-clinical years at the U.B.C. We are asked to receive these student canvassers, and to contribute as liberally as we can to the fund. A sum of $500,000 is the goal set for the Fund. Of this, some $150,000 has already been raised, and it is hoped to secure at least a large part of the remainder by this campaign. In these days of constant appeals from worthy causes for our financial support, we are apt at times to feel that it would be easy to become weary of well doing, and to find it difficult to incline our ear to all of them. But this, we feel, is one of the worthiest, and deserves our utmost sympathy and support. In the first place, it appeals to us as men who have all, at one time or another in our lives, been intimately associated with a University of our own. To this University we owe an almost incalculable debt. We owe it our education and training for our profession—and we must remember that when we paid our fees, we discharged only a minor part of the actual cost of that education. The balance was met in various ways —but the chief cost was borne by the University, and not by us. We owe much more than this, however. We owe a debt that can scarcely be put into words. Stephen McKenna, in one of his novels, makes the remark that the chief value of a University education lies, not in the actual knowledge and training that we acquire there, but in the mental contacts that we make with other minds—both those of our teachers, and of the other active, growing and striving minds that we meet in our associates in College. There are, too, the social and athletic contacts that we make. Nothing is more barren than a stay at a University, where these are missing or unsatisfactory— and the mere fact that we gain a certain amount of knowledge and technical training does not begin to prepare us for the larger life that we have to face when we leave our Alma Mater. Freely we have received, freely let us give. That University of ours out on the Point Grey Hill is at a stage in its development in which it needs our help and support. And fortunately, it is just at this stage that we can be of help. This campaign gives us all an opportunity to contribute to the growth and true progress of a young, virile University, which is doing great work in its field. We are not asked to found chairs and endow scholarships—though some of us might perhaps do more in that direction than we have done—but we are asked to help the students there in a way that is of very great value and importance. In the second place, these students are not asking us to do anything for them that they have not themselves done to the best of their own capacity. From its inception, the U.B.C. has had a very fine record of achievement on the part of its students. Class after class, year after year, they have given of their own means, and conducted campaigns, towards buildings and memorial funds which they felt were necessary for their college life—and we cannot offhand think of any other Canadian University with a like record. If we are not mistaken, the Brock Memorial Hall, the present stadium, and other buildings now in existence at the U. B. C, owe their inception, and at least a substantial part of their actual cost, to these efforts on the part of the students. It is a magnificent spirit that can achieve these things, and it is this spirit that will ultimately make a great University of the U.B.C. Perhaps we say this badly— perhaps it is already a great University, because of this spirit of determination to have the best, and go on building a still greater University, in the face of limitations and Page 3 difficulties that might daunt less courageous souls. These boys and girls of British Columbia are doing a great job, and it is up to us to back them to the limit. Some day, and send it may be soon, we hope to see another great Faculty at the University. of British Columbia, a Medical Faculty. Those students, too, will need the Gymnasium that is being planned now. We, as medical men, take a special interest in the formation of this Faculty, and we can, even now, begin to help the men and women who will be in it. We can start, now, to build for their future. This University belongs, not to Vancouver, but to the whole province of British Columbia. Every citizen of B.C. has a stake in it, and students come from every part of the province—so that this appeal must arouse the interest, and enlist the support, of all of us who practice medicine in British Columbia. It is a challenge to all of us. The Bulletin, we are sure, speaks for the entire medical profession of British Columbia, when we endorse this project most earnestly, and wish the utmost success to the students who are behind it. THE LIBRARY LIBRARY HOURS: Monday, Wednesday and Friday: 9:00 a.m. to 9:30 p.m. Tuesday, and Thursday: 9:00 a.m. to 5:00 p.m. Saturday: 9:00 a.m. to 1:00 p.m. RECENT ACCESSIONS TO THE LIBRARY: Collected Papers of the Mayo Foundation, vol. 37. 1945. Recent Advances in Neurology and Neuropsychiatry, 5th ed., 1946, by W. Russell Brain and E. B. Strauss. Surgical Clinics of North America, Symposium on Pain in the Arm and Shoulder. Mayo Clinic Number, August, 1946. Transaction of the American Ophthalmological Society, vol. 43, 1945. Transaction of the American Laryngological, Rhinological and Otological Society, Inc., 1942, 1943, 1944 and 1945. EVENING HOURS: Attention is directed to the library hours listed above. On October 2, evening hours were resumed and will be continued during the winter season. These hours have been arranged for the convenience of those doctors who are unable to read during the day, and it is hoped that the library will be used sufficiently during the evening to justify this additional service. ANNUAL DINNER The Annual Dinner of the Vancouver Medical Association will be held on Thursday evening, November 28th, in the Banquet Room of the Hotel Vancouver. The hour "will be 6:30 o'clock— -the tickets $4.00. Page 4 Vancouver Medical Association President ! Dr. H. A. DesBrisay Vice-President \ Dr. G. A. Davidson Honorary Treasurer Dr. Gordon Burke Honorary Secretary Dr. Gordon C. Johnston Editor Dr. J. H. MacDermot HISTORY OF THE VANCOUVER MEDICAL ASSOCIATION Continued from the August Issue By DR. G. KIDD Following the incorporation of Vancouver as a City, the Council appointed a Board of Health, headed by a Chairman, who was a physician and was known as the Medical Health Officer. He was nonsalaried. This Board of Health was assisted by a Health Inspector, a member of the police force. He looked into people's back yards and dealt with emergencies as they arose. Dr. A. M. Robertson was the city's first Health Officer, followed in turn by Dr's. LeFevre, McGuigan and A. H. Thomas. When the Medical Association was organized in 1898, the position was occupied by Dr. I. M. Mclean, who took an active part in the founding of the society, but died two years later. Dr. McAlpine succeeded Dr. McLean, being Health Officer from 1901 until 1904. During this latter year the city got its first full time, salaried head of the Health Department —Dr. Underhill. He was succeeded in 1930 by Dr. Mcintosh who served until the time of his death in 1939. Since that time the position has been filled by Dr. Mufray, who now heads the Metropolitan Board of Health. The Milk Commission Previous to its advent, and during the earlier years of the Vancouver Medical Association, the provision of a pure milk supply to the City constituted a major problem. As early as 1889 we find the Matron of the City Hospital, Miss Cricknay, complaining of milk supplied to that institution. The Health Inspector was authorized to make tests, and as a result all contracts were cancelled and new tenders called for; but following this, conditions seem to have not at all improved. Reviewing the situation at this time, Dr. J. H. MacDermot writes: "I remember milk delivery from door to door, with a thick layer of mud in the bottom of the can, in which live worms were frequently encountered. The dairies supplying the city were in the main indescribably filthy. No regulations for inspection existed. In summer children died like flies, and the only safe food for them was canned milk." Such was the situation during the early days of the Medical Association. There being no one else to do so, that small group of men comprising the Society undertook to correct it. Dr. Kendall first broached the subject in 1907 by asking that the Association extend its patronage to a cerain dairy company which was being organized at Matsqui, in the Fraser Valley; and which, by modern sanitary methods, guaranteed a supply of pure milk to the City. As a result the Society appointed a Milk Committee, whose duty it was to keep in touch with matters pertaining to the milk supply, and to report to the Society from time to time. For the following fifteen months this was done. In 1909, Dr. Kendall, the chairman, reported that at the time two dairies were supplying the city with first- class milk, and that the M.H.O. had' stated that its quality in general had greatly improved. In the mind of Dr. C. S. McKee, bacteriologist at the General Hospital, Page 5 I - ( iu? things were still far from satisfactory. He recommended that the Association undertake monthly examination of samples of milk supplied by such dealers as would voluntarily submit them; the results to be published in the city papers. Dr. McKee's suggestion was adopted, while at the same time there was substituted for the Milk Committee a Milk Commission, consisting of Dr's. Underhill (M.H.O.), Brydone-Jack and Weld, with Dr. McKee as Secretary. The scheme was tried out during the summer of 1909, but only three dealers responded to the request for voluntary inspection. Nevertheless the action had the effect of improving the quality of milk supplied to the city. Meanwhile the Association never ceased in its efforts to enforce municipal action, advocating legislation empowering cities and municipalities to make their own regulations controlling the sale of milk. Things moved slowly, but steady progress was reported. The Commission had printed its own milk bottle caps which it issued to approved dairies, and in 1912 we find Dr. McKee asking that it be authorized to have these caps copywrited, since their use was being abused by unauthorized dealers. A year later we find the Doctor advising patience in dealing with the milk problem, as the present state of affairs was: "Very satisfactory, and too drastic legislation might do harm". By 1915 it was declared that the Commission, which had now been serving for five years, had accomplished its purpose, since civic authorities had now an efficient control over milk supply. Dr. McKee being absent on active service, Dr. Brydone-Jack accordingly moved its dissolution. However the question of pure milk had not ceased to interest the Association. It was linked with their fight against tuberculosis. In 1921 the Milk Committee was revived, and during the succeeding years reported annually to the Society. By 1923 a new "Pure Milk" bylaw was in course of preparation by the City Council, and we find the Association pressing for a bacterial count of milk samples; such a clause to be incorporated in the proposed bylaw. Approximately two hundred thousand milk bottles are left on back porches throughout Greater Vancouver every morning. They contain milk from dairy farms on which the cows have been tested for disease, and whose barns are regularly inspected for cleanliness. No farmer whose cattle sheds fall as low as category C may send out milk for human consumption. In the City, officials check on the distribution plants, and board incoming milk trucks from which samples are taken whose bacteria counts are ascertained by the Provincial Laboratory. The modern mother knows nothing of that dreaded "Second Summer" of fifty years ago when so many children were carried off as a result of contaminated milk. The Campaign Against Tuberculosis The fight against tuberculous disease was one of the first undertakings of the young Society. At the turn of the century the White Plague was at its height. Accepted modern methods of diagnosis and treatment were then unknown; but the recent discoveries of Koch as to the relationship of the human and bovine types of the bacilli had stimulated interest in the disease, especially in preventive measures against its spread. Action was forced on the Medical Association since there was then in existence no other local organization which might deal with the problem. A Dominion Anti- Tuberculosis Association had functioned for some time, but not until 1906 was a similar but independent Provincial body formed, under the supervision of Dr. Fagan, who was at the time Secretary of the Provincial Board of Health. This organization to a great extent relieved the Vancouver Medical Society in its fight againlst the disease, and was responsible for the opening of the Tranquille Sanatorium. Meanwhile the Association carried on alone. At the second regular meeting follow- Page 6 ing its organization, which was held in January, 1899, Dr. Brydone-Jack read a paper on Tuberculosis. Before adjourning, the meeting adopted the following resolutions, with a request that they be forwarded to the City Health Officer, Dr. McLean: 1. That tuberculosis be made a notifiable disease. 2. That the milk supply of the City be subjected to a more strict supervision. 3. That there be a supervision of dairies and dairy cattle. 4. That there be a supervision of slaughter houses, and inspection of meat offered for sale. 5. That there be a disinfection of homes in which persons have been ill with tuberculous disease. 6. That spitting on the streets and in public conveyances be prohibited. Nine months later a second meeting was set aside for the discussion of Milk Supply and Tuberculosis. Quotations were made from a recent statement by Koch that milk from tubercular cows was the most common source of tuberculosis in the human subject. Means adopted by the Dominion Government for the destruction of tuberculous cattle were referred to; a law which the Society's president, Dr. Wilson, claimed to be a dead letter in so far as B.C. was concerned, owing to the high cost of carrying it out. Sterilization of all milk used in the city was recommended by one speaker, who described in detail how this might be done. At that time most of these recommendations were somewhat revolutionary. Not until 1918 was Tuberculosis made a notifiable disease by the Provincial Board of Health. In 1913 we find the Medical Association supporting a resolution for tests for tuberculosis in cattle, and as late as 1914 representatives of the Anti-Tuberculosis Society of B. C. requested the support of the Medical Society in action to prevent spitting on sidewalks, and for the disinfection of public conveyances. The establishment of a Sanatorium at Tranquille was under consideration for a long time previous to its accomplishment. Back in 1901 the Vancouver Medical Association received a letter from "The Health Committee of the Inland Board of Trade of Kamloops", referring to a proposed building in the Kamloops area of a Sanatorium for the treatment of Tuberculosis. The local Society gave the plan its endorsation and asked to be kept informed of its progress. Not until 1908 was anything accomplished. In that year Dr. Fagan, acting for the B.C. Anti-Tuberculosis Association laid the foundation for the present Tranquille Sanatorium. Dr. Keith tells how the site came to be chosen: "A party headed by Dr. Fagan searched the vicinity of Kamloops for a suitable location. In a steam launch they explored the shores of the lake without finding anything which was satisfactory. The main body then returned to town leaving behind one member, Dr. Wm. Stephen of Vancouver. He went ashore at a farm known as the Fortune Ranch. He recognized that this ranch was just the location for which they had searched, and before leaving he obtained from Mrs. Fortune an option on the farm. Dr. Fagan and the others agreed and forthwith the Fortune Ranch was purchased from funds supplied by the Anti-Tuberculosis Society of B. C, and erection of a- Sanatorium was at once undertaken. Dr. R. W. Irving, who is still in practice in Kamloops was the first Superintendent, carrying on for a time with only six patients. Although the Hospital is eleven miles from the town of Kamloops, its citizens at first bitterly opposed the scheme, and Dr. Fagan bore the brunt of their dissatisfaction. They argued that dust blown by the wind might distribute disease germs throughout the district and be harmful to the town. For the next fourteen years the Provincial Anti-Tuberculosis Society supplied the funds by whcih the Sanatorium was supported as a private institution, assisted to some extent by government grants. In spite of this a deficit kept piling up, and when in 1920 the Federal Government built a one hundred-bed wing for the accommodation of returned soldiers, the Society asked the Province to pay off this deficit. The Legislature, however, was of the opinion that it would be more economical to take over the institution entirely than to assume responsibility for the debt, and contrary to the Page 7 wishes of the Anti-Tuberculosis Society, this was done. In 1921 a two hundred and thirteen-bed hospital was opened for patients. The story of the fight for pure milk which was made by the Vancouver Medical Association in its earlier days, is told elsewhere. The Society never ceased to stress the importance of milk supply in relation to tuberculous disease in the Human. As far back as 1909 a policy of tuberculin tests for all dairy cows in the province had been adopted by the Provincial Government. It was carried out in a rather half hearted manner, and when in February of 1925 the Provincial Minister of Agriculture, the Hon. E. D. Barrow, addressed the Fraser Valley Cow Testers' Association, he was inclined to be pessemistic about the results obtained. He maintained that the compensation costs, together with expenses connected with making the tests, were too high for the Province to bear. He implied that the scheme scarcely justified expenditure. It fell to Dr. C. H. Vrooman to answer the Minister's arguments. Two weeks later, in an address to the B.C. Stockbreeders' Association he reviewed the whole question. He showed that even with a limited number of B. C. cattle having been tested and destroyed (one sixth of the total) during the previous fifteen years, the number of glandular tuberculosis admitted to the General Hospital had been reduced in the ratio of from four to one. Dr. Vrooman proved his case to the satisfaction of the Stockbreeders, with the result that the testing of dairy herds was intensified, and has since continued to be a routine. As a result of this, and together with the pasteurization of milk for use in the cities; glandular tuberculosis, with its associated disease of joints, etc., has practically disappeared from our Province. So long as the City Hospital remained on Cambie Street, local provision for the hospitalization of tuberculous cases was non-existant. When in 1906 the hospital was moved to Fairview, such patients were for a time housed in tents on the grounds of the Institution, with a few huts for individual cases. In 1913 the Provincial Anti- Tuberculosis Association arranged to set up a clinic in Vancouver. A ward was set aside and an attending Physician appointed. Erection of a new concrete structure, to be known as ward O, was undertaken. Before its completion the war broke out and the building was taken over by the University as its administration centre. It continued to be used for this purpose until the University moved out to Point Grey in 1924, at whcih time it was returned to the Hospital and became a hundred-bed ward for T.B. cases. Meanwhile in 1919 funds were raised by the local branch of the Rotary Club for the erection of a building, located down town, in which to house a T.B. dispensary and outpatient clinic. Dr. Chas. Vrooman was placed in charge. After the first year the City Council provided the money to support the Institution and administered it under a Board of Directors. Dr. Vrooman resigned in 1923 and his place was taken by Dr. Rawlings who continued in charge until 1932. In 1933 Dr. Mcintosh who was then the City Medical Health Officer, decided to segregate about ward O at the General Hospital, all existing facilities in the City connected with the treatment of tuberculosis. Dr. W. H. Hatfield was placed in charge. The downtown dispensary was closed. In 1935 the Provincial Minister of Health, Dr. Weir, combined within one organization, to be known as the Division of Tubercular Disease Control, all the various units scattered throughout the Province, which were engaged in the diagnosis or treatment of the disease. The administrative centre was placed in Vancouver with Dr. Hatfield in charge. This organization today reaches into every part of the Province of B. C. Stationary units are dotted here and there at strategic points within the more thickly populated areas, while a series of five mobile units are constantly on the move to serve more outlying parts. This history would not be complete without reference to the work of the Late Dr. Alex Lamb, who was the first travelling T.B. Officer in the Province. Appointed to the position in 1921, his work was of a pioneer variety. Until the time of his death he continued to visit every corner of B.C., doing X-Ray and associated work in those areas where no other attendance was available. Page 8 We publish below, a letter received from Mrs. Frank Stead of the Imperial Order of the Daughters of the Empire. This should have been published sooner, but was unfortunately mislaid. The letter speaks for itself and needs little comment from us. We should, however, like to say that we consider this a magnificent contribution on the part of this great organization, and we think our readers will agree with us thoroughly in this. The aid offered will be of incalculable benefit to the community at large, and especially in the more remote parts of the Province, and we hope to see the fullest advantage taken of this most generous offer. The Bulletin is very happy to publish this announcement.—Ed. THE JESSIE R. BURKE MEMORIAL CANCER FUND Sponsored by the Imperial Order Daughters of the Empire, in British Columbia It is written into the Charter of the Imperial Order Daughters of the Empire that they shall among other things "forward every good work for their country and people." To this end, they have helped the poor, provided education for many Canadians through their War Memorial Scheme, and worked unceasingly in the fight against Tuberculosis. A few years ago, yet another Fund was founded in British Columbia. The Jessie R. Burke Memorial Cancer Fund. This Fund was dedicated to one who had given outstanding service to the Order— and to all the others in the Order who had died of this dread disease. It was felt that so large a body of women could help in the fight against a disease which was taking such a toll in the lives of women. It was also felt that women often neglected early treatment because of the lack of necessary funds, and that this was particularly true in cases where women lived in outlying districts away from the centres of treatment. With this in mind, when the Trust was set up it was decided to make available the interest from the principal sum, to assist women having cancer, or suspected to be suffering from cancer, (who were not indigents, as these come under Government assistance) with travelling expenses, and/or shelter while receiving examination or treatment at the British Columbia Institute in Vancouver. As the object of the Fund is to do preventive work, it is the desire of the I.O.D.E. to help cases as soon as they are discovered, so that there can be hope of cure. At the present time the Fund stands at over $15,000.00. Initial sums were donated by members and Chapters of the Order throughout the Province, and during the past two summers these amounts were augmented by the sale of "Vacation Stamps". The interest now available is definitely limited, but the Order wishes to put the money to work if only a few cases are helped this year. Should a patient be accepted by the B. C. Cancer Institute, and her physician be aware that she is in need of money for travel or shelter, he may so indicate to the Superintendent of the B. C. Cancer Institute, who has kindly consented to refer the matter to the Jessie R. Burke Memorial Cancer Fund Committee. In this way, the Daughters of the Empire hope that doctors in British Columbia will make use of this Fund, which can be used to the limit of the interest available. >■ • MRS. FRANK STEAD, Chairman, Jesse R. Burke Memorial Cancer Fund Committee. Page 9 British Columbia Medical Association (Canadian Medical Association, Britsih Columbia Division) President ! ^___Dr. Ethlyn Trapp, Vancouver First Vice-President j Dr. E. J. Lyon, Prince George Second Vice-President I Dr. L. H. Leeson, Vancouver Honorary Secretary-Treasurer ! 1— Dr. J. C. Thomas, Vancouver Executive Secretary Dr. M. R. Caverhill, Vancouver WEST KOOTENAY MEDICAL ASSOCIATION jg. ANNUAL MEETING The Annual Meeting of the West Kootenay Medical Association was held in Trail on Wednesday, October 2, 1946". Dr. W. Laishley of Nelson, president, presided over the sessions. Through the kind offices of the Matron of the Hospital and her staff, the facilities of the Nurses' residence were made available for the meeting. During the afternoon session papers were given by Dr. Ethlyn Trapp, "Cancer of the Skin", and Dr. Karl Haig, "Shoulder Injuries". Dr. D. W. Johnstone of the Department of Veterans Affairs, addressed the meeting on matters pertaining to the treatment of veterans under the "Family Doctor Scheme". At the close of the afternoon session the meeting adjourned and enjoyed a very pleasant social hour followed by an excellent dinner which had been arranged by the staff of the Hospital. Dr. Laishley carried out the duties of toast-master in his own inimitable manner. Chief speaker of the evening was Dr. A. E. Archer, Consultant in Economics of the Canadian Medical Association, who spoke on. current trends in the field of medical economics. Dr. Ethlyn Trapp, President of the British Columbia Medical Association, and Dr. M. R. Caverhill, Executive-Secretary, also spoke. Election of officers resulted as follows: Dr. W. A. Coghlin of Trail, Honorary President; Dr. N. E. Morrison of Nelson, president; Dr. W. Leonard of Trail, vice-president; Dr. W. Laishley, Nelson, secretary-treasurer. Dr. F. M. Auld of Nelson was elected as representative to the Committee on Medical Economics of British Columbia. Dr. N. E. Morrison, as President, will represent the West Kootenay Medical Association on the Board of Directors of the British Columbia Medical Assciation. EAST KOOTENAY MEDICAL ASSOCIATION ANNUAL MEETING . ' %: if The 1946 Annual Meeting of the East Kootenay Medical Association was held in Cranbrook on September 30th, 1946. During the afternoon a scientific programme was held in the lecture room of the St. Eugene Nurses Training School. Dr. Ethlyn Trapp gave a paper on "Cancer of the Skin", followed by Dr. Karl Haig on "Shoulder Injuries". Both papers were well received and followed by interesting discussion. In the evening members and visitors sat down to a fine dinner held at the Cranbrook Hotel. The President, Dr. J. Vernon Murray of Creston, was a capable chairman. Dr. A. E. Archer, Consultant on Economics of the Canadian Medical Association, discussed the present state of Medical Economics. Dr..p. W. Johnstone of the Department of Veterans Affairs outlined the objects and operation of the Department of Page 10 Veterans' Affairs "Family Doctor Scheme". Dr. Ethlyn Trapp, President of the British Columbia Medical Association, and Dr. M. R. Caverhill, Executive Secretary, dealt with several matters of interest within the Province. Election of Officers for the coming year resulted as follows: President: Dr. T. J. Sullivan, Cranbrook; vice-president, Dr. M. McRitchie, Fernie; secretary-treasurer, Dr. W. O. Green, Cranbrook; representative to the Board of Directors of the British Columbia Medical Association, Dr. F. W. Green, Cranbrook. SOUTHERN INTERIOR MEDICAL ASSOCIATION ANNUAL MEETING The twenty-fifth annual meeting of the Southern Interior Medical Association (formerly known as District No. 4 Medical Association) was held at Penticton on October 4th, 1946. There was a good attendance of doctors and their wives from all parts of the District. Visitors at the meeting were Dr. A. E. Archer, Consultant in Economics of the Canadian Medical Association; Dr. Ethlyn Trapp, President of the British Columbia Medical Association; Dr. E. J. Lyon of Prince George; Dr. D. W. Johnstone of the Department of Veterans Affairs; Dr. Karl Haig; Dr. A. J. MacLachlan and Dr. M. R. Caverhill of Vancouver. The afternoon session was devoted to scientific and provincial association matters. Papers were given by Dr. Ethlyn Trapp and Dr. Karl Haig. Dr. E. J. Lyon and Dr. A. J. MacLachlan dealt with activities of the Council of the College of Physicians and Surgeons of B. C Dr. Trapp and Dr. Caverhill discussed some points concerning the British Columbia Medical Association. In the evening a mixed dinner was held in the Incola Hotel. A feature of the evening was a resume of the past history of the Association ably presented by Dr. R. W. Irving of Kamloops, and the appearance of a Silver Anniversary cake, the cutting of which was done most professionally by Dr. J. R. Parmley, the President. Dr. A. E. Archer gave an address on the "Present Status of Medical Economics in Canada", and Dr. D. W. Johnstone outlined the D.V.A. "Family Doctor Scheme". Election of officers placed the following in office for 1946-47:— President, Dr. T. W. Sutherland, Revelstcke; vice-president, Dr. H. J. Alexander, Vernon; secretary-treasurer, Dr. H. E. Hamer, Revelstoke. Following a cordial invitation from the new President, it was decided to hold next year's meeting in Revelstoke. At the conclusion of the evening session, members and visitors enjoyed the gracious hospitality of Dr. and Mrs. Hugh Barr. ♦'1 .* ' / <■ «< VICTORIA MEDICAL SOCIETY The annual meeting of the Victoria Medical Society was held on the evening of October 7, 1946. Attendance was good and the meeting was marked by the presence of a large number of new mmebers who have recently been discharged from the Armed Forces and have taken up practice in Victoria. Elections placed the following in office for the ensuing year:— President, Dr. D. M. Baillie; vice-president, Dr. "W. E. M. Mitchell; honorary secretary, Dr. L. W. Bassett, honorary treasurer, Dr. E. L. McNiven. During the evening the meeting was addressed by Dr. A. E. Archer, Consultant in Economics of the Canadian Medical Association, and by Dr. Ethlyn Trapp, President of the British Columbia Medical Association. Page 11 fyanc&uAAen, Qenesial JtoAfutal £ectLa+t ACUTE PANCREATITIS Diagnosis and Treatment with Brief Review of Cases at the Vancouver General Hospital in the Last 7 Years JOHN A. GANSHORN, M.D., M.Sc. (in Surgery) Three conditions are included in the diagnosis acute pancreatitis. 1. Acute haemorrhagic pancreatitis or acute pancreatic necrosis. 2. Acute interstitial pancreatitis or acute pancreatic oedema. 3. Acute suppurative pancreatitis (a relatively rare condition.) This paper deals almost entirely with the first two conditions. There are good reasons to believe that these two conditions are merely the milder and the more severe forms of the same condition. Acute pancreatitis is an uncommon condition. There were only 36 cases in the Vancouver General Hospital from 1938 to 1945. Because it is uncommon, the diagnosis is not thought of and hence is missed or comes as a surprise at the operating table. Because of recent advances in the diagnosis of this condition and a change in treatment, the subject seemed worth presentirig at this time. Pathogenesis—The immediate cause of acute pancreatitis is the escape of normal pancreatic secretion into the "substance of the pancreas. The lipase of the secretion digests fat giving the typical fat necrosis seen as greyish white spots on the fat. The trypsin, resulting, as has now been proved, from activation of the trypsinogen by intercellular juices without the presence of enterokinase, causes a digestion of the tissues and vessel walls with necrosis and haemorrhage. The mildness or severity of the disease depends upon the amount and nature of the escaping pancreatic juice. In the milder type i.e. acute pancreatic oedema, there is a small leak, the secretion contains little trypsin, there is oedema from irritation and some fat necrosis but no necrosis of the pancreas and no haemorrhage. In the severe haemorrhage type there is an escape of scretion rich in trypsin, a secretion such as is found after a large meal or after an alcoholic bout; the escape of this secretion causes a greater digestion and necrosis. If large arteries or veins are in the vicinity, their walls rapidly become necrotic and there is extensive haemorrhage into the gland, around the gland and into the peritoneal cavity. The condition may be so severe that the entire pancreas becomes necrotic or there may be only patches of necrosis and haemorrhage in the pancreas. The secretion, together with blood, and products of digestion of the pancreas escape into the peritoneal cavity, entering the lesser sac and then the general peritoneal cavity. Etiology—There are two main theories as to what causes the pancreatic juice to escape into the pancreas: 1. Bile or reflux theory:— About 50% of cases of acute pancreatitis are associated with chronic biliary disease, usually chronic cholecystitis with stones. In about 5% of cases there is a stone in the common duct. The theory is that there is a blocking of the ampulla of Vater by stone or more commonly by spasm of the sphincter of Oddi with a reflux of the bile into the pancreatic duct. The bile salts have a necrotizing effect upon the pancreatic ducts and this allows the escape of pancreatic secretion. Reflux of bile is of course impossible in certain cases of acute pancreatitis where the pancreatic duct opens separately into the duodenum. Page 12 2. Obstruction of pancreatic ducts:— This theory states that there is a partial obstruction of the pancreatic duct or its branches with a dilation of the ductules and acini distal to the obstruction. The patient eats a large meal or drinks considerable alcohol and there is a sudden excess of pancreatic juice secreted. The pressure caused by this excess bursts the dilated ductules or acini and an escape of secretion occurs. Rich and Duff in 1936 described a metaplasia of the epithelium of the pancreatic ducts, with dilated ductules and acini distal to the partially obstructed duct. They found this in cases of acute pancreatitis and in cases with no pancreatic disease. They felt that metaplasia of the duct epithelium was the commonest cause of acute pancreatitis. A stone in the ampulla or spasm of the sphincter of Oddi could also be considered as causing a partial or complete obstruction of the pancreatic duct. Less common causes: 1. Trauma—severe accidental trauma or on rare occasions surgical trauma, has given rise to acute pancreatitis. It was not often seen in war injuries of the pancreas. 2. Infection—this is a rare cause and gives rise to a suppurative pancreatitis. The infection may be blood borne or may arise from direct or indirect extension from neighboring organs. 3. Vascular accidents—on rare occasions it is believed that arterial occlusion from emboli or thrombosis may give rise to the disease. Diagnosis The signs and symptoms parallel in severity the pathological process. The onset of acute pancreatic necrosis and acute pancreatic oedema may be very similar but the clinical course of the two are very different. The diagnosis on clinical grounds alone is difficult. Perhaps half the difficulty has arisen from not having the condition in mind. Today, if one is suspicious of the condition it may be diagnosed with excellent degree of certainty by finding an elevated blood or urinary diastase. The condition is most frequently misdiagnosed as perforated peptic ulcer, acute cholecystitis or acute intestinal obstruction and at times is mistaken for coronary occlusion. In its typical severe form the disease has a sudden onset with very severe and usually crampy pain. The pain is in the epigastrium. Nausea and vomiting follow immediately. The condition when most severe is an upper abdominal catastrophe, the patient is prostrate with the severity of the pain, he becomes shocked and hais a greyish cyanosis. The pain may radiate through to the back, to the left or right scapula and there may be retrosternal pain suggestive of coronary occlusion. The patient usually tends to obesity and will often have had. a good meal or drunk considerable alcohol before the onset of the pain. In recent literature slight and massive haemorrhages have been described occurring early in the disease. With the use of blood and urinary diastase estimations in the last eight years, the diagnosis of acute pancreatitis is more commonly made and in recent large series of cases in the literature it is stated that shock and severe symptoms are not so common. These series will include more cases of the milder pancreatic oedema. The severity of the disease cannot always be judged by the severity of its onset. Cases with the severest type of onset, indeed some cases described as almost moribund at the end of 24 hours, will be well in 7 days; only an acute interstitial pancreatitis could recover so quickly. ^ On examination there is upper abdominal tenderness and rigidity. The rigidity is never a true board-like rigidity as in a perforated ulcer. A mass may be felt in the epigastrium; this has been taken as an "acutely distended gall bladder more than once. There may be" abdominal distension, though this usually follows after 24 hours, and is first noted in the upper abdomen. There is only a slight elevation in temperature (99°) Page 13 and a fast pulse. This disproportion between temperature and pulse is fairly constant in the early stages, and helps to rule out inflammatory conditions of infectious origin. The temperature never tends to run very high unless infection occurs; usually 100°-101°. The leukocyte count is high; 15-20 thousand with an increase in polymorphs. The condition may be so severe that the patierit expires within 24-48 hours, of toxaemia. If the condition is not so severe the patient continues to have severe abdominal pain which radiates to the flanks and often down the right side. Distension from ileus develops as the pancreatic secretion and blood spread over the peritoneal cavity. Nausea and vomiting continues and the picture suggests in some respects an acute intestinal obstruction. No peristaltic sounds will be heard. The patient remains very ill for a considerable time, with a moderately high fever and marked leukocytosis. There is usually an albuminuria, 11% of cases show sugar in the urine with a elevated blood sugar and jaundice may be seen early or later in the disease. Some series put the incidence of jaundice as high as 30%. Cullen's and Grey Turner's sign, ecchymotic discoloration about the umbilicus or in the flanks is a relatively late sign occurring three days or more after the onset. The discoloration is from blood tracking out from the retroperitoneal space. In about 50% of cases there will be a history of previous indigestion. This is usually of a type associated with chronic cholecystitis, a chronic gaseous indigestion, occasionally with more severe attacks suggestive of colic. This has often been present for years. In some there is a history of previous attacks fo sudden severe epigastric pain, the illness lasting only 2 or 3 days, and suggestive of a previous milder attack of pancreatitis. In the less severe type of disease, the onset may be less acute with gradually increasing crampy or constant epigastric pain and nausea and vomiting. It may be on the 2nd or 3rd day that the doctor is called because the pain has become very severe, and nausea and vomiting have continued. In these cases there is abdominal tenderness, but the abdomen is not tense, and palpation of a tender swollen pancreas may be quite possible. Peritoneal irritation is much less pronounced. Progress— The mortality in acute pancreatitis is high, averaging about 50%. In recent literature the rate is lower. The cases with acute interstitial pancreatitis recover quickly in 7-14 days and the mortality rate is low. It is generally considered that cases with only pancreatic oedema recover completely. They may have future attacks, but do not tend to develop chronic pancreatitis. In acute haemorrhagic pancreatitis, the mortality is high: 60%-90% in different series with a mortality rate of about 10% in the first 48 hours. The illness in the acute haemorrhagic cases which survive is always prolonged and recovery slow. They may develop a pseudo-cyst of the pancreas, infection may occur and an abcess develop in and around the pancreas or subdiaphragmatically. The pancreas becomes scarred and 3%-10% become diabetic and a much greater percentage have a disturbed carbohydrate metabolism. There is little in the literature dealing with late pancreatic insufficiency in these cases. AIDS TO DIAGNOSIS Blood and urinary diastase tests— These tests are of great value in establishing the diagnosis, particularly in the early stages when with an uncertain diagnosis laparotomy is uppermost in one's mind. There are several methods of diastase estimation used. As the Vancouver General Hospital Winslow's method is used for both blood and urine. The test is not elaborate. It requires l/z hour of time and can be done at any hour of the day or night. It does not require a highly trained technician. The result is given in units, a unit being the amount of .1% starch solution 1 cc. of urine or blood digests in J4 hour at 37° to 380° C. Page 14 The normals are blood diastase 16-64 units, urine diastase 8-32 units. In acute pancreatitis the blood diastase is found elevated 6-8 hours after the onset. The reading may be quite high, 256-1024, and tends to return to normal in 24-48 hours. The urinary diastase lags behind about 12-24 hours. It is found elevated from 128-2048 in 36 hours to the 6th or 7th day of the disease, when it usually again reaches normal. Because of this difference in blood and urinary diastase, it is advisable to test both blood and urine diastase early in the disease. If only one test is done it should be the urinary diastase. Though these figures are what is considered the usual in acute pancreatitis, they are by no means the only figures obtained. The blood diastase may remain elevated much longer or with exacerbations of the disease, may rise again after reaching normal. The urinary diastase also may remain elevated much longer or show fluctuations above and below normal later in the disease. The diastase values cannot be used in prognosis or as a guide to progress, excepting that as long as values are elevated recovery is not complete. Increased values of blood and urine diastase occur in: 1. Mumps with or without complicating pancreatitis. 2. Some cases of perforating peptic ulcers. 3. In some cases of cancer of pancreas. 4. Cases with severe renal impairment. X-Ray Examination— A film of the abdomen or better a fluoroscopic examination of the abdomen may give assistance in making the diagnosis in the early stages of acute pancreatitis. Many of the severe cases are examined by X-Ray to determine the existence of free air in the peritonal cavity, because of a tentative diagnosis of perforated peptic ulcer. The findings which may indicate an acute pancreatitis are: 1. Evidence of localized ileus; gas in the stomach and duodenal bulb; gas loculated in the transverse colon or in the ascending colon. Gas in loops or upper jejunum. 2. Evidence of crowding of the stomach by an enlarged pancreas. The greater curvature of the stomach may be crowded upwards. 3. By fluoroscopic examination (applicable in the less severe cases) an almost pathognomonic finding may be made, the detection of a tender tumefaction of the pancreas. Electrocardiogram— In some cases of acute pancreatitis changes occur in the electrocardiogram suggestive of coronary thrombosis or myocardial infarction. One of the 36 cases here at the Vancouver General Hospital was diagnosed as coronary thrombosis in the electrocardiographic record, but at post-mortem a haemorrhagic panceatitis was discovered and there was no evidence of myocardial or coronary disease. Gottesman recently stated in a paper that a diagnosis of acute pancreatitis could be made with certainty where the following triad of findings were found. Is Electrocardiographic changes suggestive of coronary disease. 2. Signs of upper abdominal peritoneal irritation. 3. Elevated urinary diastase. Blood Calcium— The process of fat necrosis utilizes calcium ions to form a calcium soap with the fatty acids. Edmunson found in 35 of 50 clinical cases, serum calcium below 9 mgms. Sometimes between the 2nd and 15th day and that the value tended to be lowest about the 6th day. He found that a value of 7 mgms. indicated a fatal prognosis. TREATMENT The treatment of acute pancreatitis, both the mild and the severe types, is now considered by the majority of authors to be medical and not surgical. Operation is lndi- 111 '-. Page 15 i-V cated only in the later stages of the disease, when complications occur. The treatment of acute interstitial pancreatitis has always been considered medical, but because of the difficulty of diagnosis, many cases were and still are being operated upon to make a diagnosis. The older teaching was that in cases of acute haemorrhagic pancreatitis operation was indicated as soon as the diagnosis was made. There is an immediate mortality in these cases of about 10%. The patient dies of an apparent overwhelming toxaemia in 24 to 48 hours from onset and to date no treatment has been of avail in these cases. Many are never fit for an operation. The operative treatment which is still advised by some surgeons is directed 1st—at draining the necrotic pancreas and the peritoneal cavity. This is done by exposing the pancreas in the lesser peritoneal sac by traversing either the gastro-colic or gastro-hepatic omentum or on rarer occasions through the transverse mesocolon, whichever presents itself for incision. The peritoneum over the pancreas is incised to allow escape of dammed up fluid and debris. The pancreas itself is not to be interefered with. Some authors have also drained the pancreas retro-peritoneally through stab incisions in the back. 2nd—at draining the biliary tract. Some surgeons advocated drainage of the gall bladder in all cases. Others advised it only in cases where biliary pathology indicated interference. Chronic cholecystitis with stones is common in this condition and removal of the stones and drainage of the gall bladder was advised. In cases with evidence of common duct obstruction with dilated common duct or stone in the common duct, theoretically exploration and removal of stones was considered advisable, but rarely is a case with acute pancreatitis in a fit condition to withstand such a surgical procedure. Most surgeons now feel that early operation for acute haemorrhagic pancreatitis is contra-indicated. There are no large series of cases yet reported in the literature, whereby a comparison of results can be made. I was very much impressed by a series which Payne reported in Los Angeles in May, 1946, and which will appear in The Journal of Surgery, Gynaecology and Obstetrics at a later date. He presented a series of 307 cases from the Los Angeles County Hospital. 103 were operated on with 45% mortality. 16 were moribund and got no treatment. 166 were treated medically with 13% mortality. Payne was convinced that none of the cases should be operated upon in the early stages of the disease. From the understanding of this disease which we now have it would seem that early operation can offer nothing. Severe toxaemia is what kills the patient in the early stages and it is this severe toxaemia that is the problem in all the cases. We know from clinical and experimental evidence that pancreatic secretion in the peritoneal cavity is not the cause of this toxaemia; we know similarly that the products of digestion of living or dead pancreas by pancreatic secretion do not cause this great toxaemia. Dragstedt has suggested that the toxaemia arises from toxins produced by bacteria proliferating in the neurotic and digested tissues. He considered that these bacteria originated in the gland itself. Cultures from cases are usually sterile but study of this particular aspect has actually been very incomplete. Infections certainly occur in some cases and occasionally B. WelchH septicaemia occurs. Hence we are still unable to say where the toxaemia arises from and for the same reason unable to state that drainage is a rational procedure. It is also a question how adequately we can drain the pancreas. Certainly the necrotic pancreatic tissues cannot be removed. When we solve the problem of this severe toxaemia we shall then see a marked decrease in mortality. Draining the biliary tract by cholecystostomy would not seem to have much of combating the toxaemia. Cholecystostomy is likened to locking the barn door after Page 16 the horse has been stolen. The biliary tract disease should certainly be treated surgically after the attack of pancreatitis has subsided. Ogilvie and others have recently pointed out that if non-surgical treatment of acute pancreatitis becomes established, certainly cases of perforated ulcer and intestinal obstruction due to strangulation will die, who might have been saved by operation. If there is reasonable doubt of the diagnosis, laprotomy is advised, but having opened the abdomen and found an acute pancreatitis the wisest procedure would now seem to be to close the abdomen again without drainage. Medical Treatment:— This is aimed primarily at putting the pancreas completely to rest. 1. Continuous gastric suction by Levine tube. 2. Intravenous fluids—there are several warnings in the literature about the use of glucose intravenously. Glucose by mouth stimulates pancreatic secretion.. I have read nothing to contra-indicate amino-acids by intravenous injection. 3. Reversed Trendelenburg position. 4. Morphine sedation. 5. Atfophine sulphate. This was used in some of Dr. Payne's cases. In pancreatic fistula cases atropine sulphate decreases the amount of pancreatic secretion and the lipase content of the secretion. As long as symptoms persist, the temperature remains elevated or the diastase is above normal the patient cannot be considered well. Surgery is indicated later in the disease if suppuration occurs. This will be necessary in all cases of the rarer acute suppurative pancreatitis. Review of Cases. At the Vancouver General Hospital in the seven years from January, 1938 to January, 1945, there have been 36 cases of acute pancreatitis. In gathering and analysing these cases I did not include in the series two case of acute pancreatitis complicating mumps, one case of diabetes with an additional diagnosis of acute pancreatitis in which I could find no evidence to support the diagnosis of acute pancreatitis. I also did not include several cases diagnosed sub-acute pancreatitis, which I think might well have been included in the series, since it would seem that these are but milder forms of an acute pancreatitis. The analysis of the 36 cases revealed the following data: 1. Sex incidence— There were an equal number of male and female patients. 2. Age incidence— The age incidence in males was from 27 to 79 years with an average age of 56. The age incidence in females was from 25 to 86 years with an average age of 56. This age incidence is higher than usual as most cases occur in 3rd, 4th and 5th decades. In this series there was a considerable number of cases over 70 years of age. ^ 3. Diagnosis on admission— »These data give a clue to the presenting symptoms: Perforated peptic ulcer 1.^ 10 Acute pancreatitis — 6 Acute cholecystitis 5 Acute intestinal obstruction 3 Acute abdomen J 3 Acute appendicitis . 2 Coronary occlusion 2' Toxic hepatitis 2 Page 17 cases / i- J t i\ * >* m H Generalized infection 1 No diagnosis 2 The last two diagnoses do not usually enter into the differential diagnosis of acute pancreatitis. The diagnosis of toxic hepatitis was favored in one case because the patient had worked with explosives for 10 years. There was a sudden onset of severe abdominal pain with jaundice ©n 4th day and chills and fever on 6th day. A urinary diastase on the 20th day was 128. Recovery occurred in two months. In the second case, the diagnosis was favored because the patient, a paraplegic of 12 years, had been recently treated with arsenicals for syphilis and had become very ill with jaundice prior to admission. He died soon after admission and acute haemorrhagic pancreatitis, yellow atrophy of the liver, cystitis and hydronephrosis were found at the autopsy. The diagnosis of generalized infection in a third case proved correct at autopsy. The patient had been ill three months with subacute bacterial endocarditis, which at post-mortem, showed an acute necrotic pancreatitis, due to infarction from emboli. 4. Type of onset— I Sudden and severe in 22 cases. Gradual onset with increasing pain in 10 cases. Unknown in four cases. 5. Associated biliary disease occurred in 18 cases—50%. Chronic cholecystitis 8 cases Chronic cholecystitis with stones I 6 Cholecystectomy previously 1 Stone in common duct, cholecystectomy previously 1 Stone in common duct with cholecystectomy and stones 1 Dilated common duct with hypertrophied ampulla 1 In one case with stone in the common duct it was found post-mortem that the pancreatic duct opened separately into the duodenum about 1 cm. from the ampulla of vater. The biliary disease in this case could not have been directly responsible for the acute haemorrhagic pancreatitis. Past Illness— There was a history of one or more previous attacks ujsually resembling attacks due to cholecystitis in 50% of cases in which past illnesses were recorded. (13 of 25 cases in which past illnesses were recorded.) (3 of these 13 cases proved at post-mortem or operation to have no biliary tract pathology.) Jaundice— ' Early in the disease, clinical jaundice occurred in 1 case (4th day), clay stools in 1 case (3rd day) and bile in urine in 3 cases on 1st, 2nd, and 3rd days of the disease. Later in the disease clinical jaundice occurred in 2 cases on 5th and 7th days. Glycosuria— This occurred in 3 cases, one on the 2nd day with fasting blood sugar of 112, one on the 4th day and one on the 5th day with a fasting blood sugar of 183. Urinary diastase— The urinary diastase estimation was done in only 18 cases of the series and one of these cases had a blood diastase. If one notes the diastase readings which were obtained early in the disease, i.e. the first 3 days of the disease, one finds that in 12 of the 13 cases where it was done early, the test was diagnostic. The elevation of the diastase is no indication of prognosis; case 8 with a reading of 2048 units on the 1st day had recovered in 10 days' time. Page 18 111 URINARY DIASTASE Case Day from onset Recovered Died 1 2 3 4 5 6 Longer 1 256 2 128 3 512 1024 4 256 5 6 1024 7 Blood 256 Urine 32 8 2048 9 128 10 64 11 512 12 2048 13 512 14 365 1024 32 15 16 17 18 256 64 32 8 64 16 16 64 (12th day) 128 (20th day) z X X X X X X X X X X x X X (10th day 1st day 12th day 4th day Normal Urinary Diastase: 8-32 units. Type of disease and mortality Acute haemorrhagic pancreatitis Acute interstitial pancreatitis Unknown Cases Deaths 17 15 3 0 16 1 TOTAL : 36 16 (44%) Treatment— Type of disease Haemorrhagic Interstitial Unknown TOTAL Operation Recovered No Operation Recovered admission 6 2 8 0 3 3 3 0 0 0 3 3 13 12 0 12 8 21 12 3 Operations— 1. Early operations (lst-4th day of disease) WILBUR CRAIG MOONEY The passing of Doctor W. Craig Mooney, so soon after his embarkation upon a promising career in Public Health Service, has come as a great loss to those who knew him and to the field of preventive medicine in which his chosen interest lay. Those who enjoyed the pleasure of a close personal association with Doctor Mooney will remember hint with affection for his friendliness, sincerity, and kindly humor. Following graduation in 1939, Public Health became his field of endeavor. He served in the R.C.A.M.C. four and a half years. After two years Overseas, upon request of the Provincial Board of Health and because of his special training and qualifications in the field of V.D. Control, he returned to British Columbia to assume the position as Director of the Division of V.D. Control. The duties related to this difficult task he performed well. Doctor Mooney is very much missed by a devoted staff at the Division and by the medical profession of British Columbia 'whose members always enjoyed their personal associations with him. To his wife and two sons, John and Donald, we all extend our deepest sympathy on their sad loss. '•* % Page 19 CASE OF UNUSUAL MESENTERIC TUMOUR By PAUL P. JACKSON, M.D. L. H. APPLEBY, M.D. This 40-year-old white male was referred by Dr. J. J. Gillis of Merritt, B.C., in September of 1945. His chief complaint was a dull gnawing epigastric pain, present more or less constantly, but made worse by eating. This pain had been of almost a year's duration. He gave a past history of having been operated on in an Eastern Canadian hospital one year previously for a perforated duodenal ulcer. He made an unremarkable recovery from that operation. History previous to that episode was essentially negative. He has worked on a ranch for many years. Physical examination shows a well developed white male who shows evidence of recent weight loss. Head, neck and chest were negative. The abdomen had a mass in the right lower quadrant about the size of a grapefruit. It was moderately tender, anterior abdominal wall was freely movable over it, but the mass was only slightly movable. Had slight tenderness in the epigastrium. Laboratory work: R.B.C. and W.B.C.—within normal limits. Urine—normal. Gastric acidity—fractional test meal showed only a moderate elevation of free Hcl and combined acid. Radiological Investigation: G.I. series—considerable oedema of stomach, suggesting chronic ulcer with some associated decomposition of stomach wall and beginning residue. Barium Enema—was negative. There was no suggestion of small bowel pathology by X-Ray. The patient was operated on September 11, 1945, by one of us (L.H.A.) The abdomen was opened by an upper right rectus incision. This mass was found in the small bowel mesentery, surrounded by considerable firm adhesions. With great difficulty it was dissected free and found to be in the mesentery of the terminal ileum about the level of a Meckel's diverticulum. The mass was cystic, involved several loops of ileum looped over on itself, firmly adherent. About two feet of bowel were resected with the mass. There was a penetrating ulcer in the second part of the duodenum into the pancreas. The pylorus was partially obstructed. Since the tumour was thought to be a malignancy and the gastric acidity was not unusually high, a resection was not attempted, but instead a posterior gastroenterostomy was done. wm The abdomen was flooded with 100,000 units of penicillin in 2 oz. of Saline and closed, using fine stainless steel wire in the fascia. The patient made an uneventful recovery, and was dismissed on the 11th postoperative day. Page 20 The tumour mass was opened by the Pathology Department and found to contain in the cyst cavity. a full sized laporotomy sponge, well preserved for the past year. The sponge was causing partial obstruction and strangulation of the small intestine. Since thi sman had only had one previouis operation, there is only one way the sponge could have gotten into the abdomen. However, the abdominal organs had arranged to protect themselves very nicely from the foreign body invasion. Copy of Pathological Report: Specimen: Section of colon. Gross: Piece of bowel, approximately six inches in length, with a large tumour mass embedded within a fold of the bowel. This mass is about the size of an orange. There is also a piece of omentum attached, measuring 6x4 inches. The bowel wall has a dark gray appearance, and there is one area covering the tumour mass which is quite black. On section of this tumour, several folds of bowel are seen wrapped around it. On opening into the interior, there is a piece of folded gauze discovered completely filling the interior of the tumour mass. Microscopic: Section of the wall of this piece of intestine shows a congested mucous membrane with some increase and round cell infiltration. The muscle coat is free, but there are extensive areas of extravasated blood in the subserous layer. The entire mass is deeply engorged and there is some edema. Focal areas of regional lymphoid hyper- lasia are seen. This has the appearance of intestinal obstruction and partial strangulation secondary to a foreign body distending the lumen of the intestine. There is marked edema and extravasation of blood. A. Y. McNAIR, M.B., Pathologist. Copy of X-Ray Reports: Region to be examined: Colon. Barium passed without obstruction to the caecum. Bowel contour and haustral markings, normal. Accessible parts movable and non-tender. Laboratory conclusions: Negative findings. Region to be examined: Gastro-intestinal. Preliminary—rPreliminary film was negative. Chest and oesophagus negative. Stomach—Stomach appears to be rather atonic and although peristalsis is present there appears to be some retained secretion. This is consistent with probable early decompensation stomach. The distal end is not well visualized, owing to oedema and retained secretion. Intestines—In six hours there is a moderate residue in the distal end of the stomach, probable ulcer, which is probably becoming slowly obstructive due to stagnation, although it has not yet reached the point of a large residue. Twenty-four observation no special features. Laboratory conclusions: Findings are not entirely conclusive, owing to a large amount of retained edema of the stomach but findings suggest chronic ulcer with some associated decompensation of the stomach wall and beginning suggested residue. C. W. PROWD, M.D. Page 21 * > V A very successful re-organizational meeting of the local branch of the Defence Medical Association was held following dinner at the Hotel Vancouver on Wednesday, October 9 th. The meeting was under the chairmanship of Dr. Roy Mustard and the turnout was excellent, some sixty-five ex-medical officers of the three armed services being present. Speaker of the evening was Major General B. M. Hoffmeister, C.B.E., D.S.O. Numerous resolutions affecting the post-war organization of the medical services of the armed forces, were proposed, discussed and passed for presentation to the Executive of the National Association at its meeting in November. Election of officers resulted as follows: President, Dr. Roy Huggard; vice-president, Dr. D. W. Johnstone; secretary, Major H. A. Simmons, C.D.C.; treasurer, Dr. Wally Brewster. Dr. Roy Huggard will represent the local branch at the Executive Meeting of the National Association to be held in Ottawa in November. Dr. Lavell Leeson will also be attending this meeting as a member of the National Executive. The profession extends sincere sympathy to Dr. G. S. Purvis of New Westminster, in the loss of his wife. Heartfelt sympathy is extended to Dr. M. L. Gaudin in the recent tragic death of his wife. Flight-Lieut. A. B. Watson has recently been discharged from the R.C.A.F. and is now practciing in Dawson Creek. Dr. Roy Fraser who served as Hygiene Officer of Pacific Command, has been discharged and is enjoying a holiday in Vancouver. Dr. A. L. Buell has been returned to Civvy Street from the forces, and is entering practice in Port Alberni. Doctors J. M. Mackenzie and C. T. Standish also recently discharged, have left Vancouver and expect to be at the Boston State Hospital for three years. Both plan to return to practice in Vancouver. Dr. J. W. Green who has been at Salmon Arm is moving to Vernon to enter practice there. Dr. Arnold Francis, formerly of New Denver, has recently acquired a boat, and thereupon has found that interior centre too far removed from the sea. Thus we find him settling in Ganges to practice. *t *t »t *t Dr. F. H. Davis is another who has recently been discharged from the R.C.A.M.C. and is now practicing in Vancouver. • sf- Sj- 95- s{. Dr. A. J. MacLachlan and Mrs. MacLachlan have recently returned from a well earned holiday spent in the Interior. While there Dr. MacLachlan was a welcome visitor at the Annual Meeting of the Southern Interior Medical Association held in Penticton. Our congratulations are offered to the proud parents on their recent good fortune: Mr. and Mrs. L. T. Maxwell of Prince George, a daughter; Dr. and Mrs. Fergus Johnston of Vancouver, a daughter; Dr. and Mrs. S. P. Findlay of Fraser Lake, a son; Dr. and Mrs. G. I. Theal of Vancouver, a daughter; Dr. and Mrs. V. W. Pepper of New West- Page 22 minster, a son; Dr. and Mrs. A. H. Campbell of Vancouver, a son; Dr. and Mrs. M. D. Wall of Vancouver, a son; Dr. and Mrs. R. L. Whitman of Vancouver, a son; Dr. and Mrs. Sid Hobbs of Vancouver, a son. We learn with a great deal of satisfaction of the appointment of Dr. John Drennan Hamilton as Professor of Pathology at Queens University. Dr. Hamilton is a son of the late Dr. Harry Hamilton who practiced at Revelstoke for over thirty years. His mother, Mrs. J. H. Hamilton resides in Vancouver. Dr. Hamilton attended U.B.C. and the University of Toronto, graduating in Medicine in 1935. He studied at Toronto, Cambridge and Baltimore before joining the R.C.A.M.C. early in the War. He served with distinction in North Africa and Italy. After discharge he was appointed assistant professor of Pathology at McGill, a post he held until the present appointment. The congratulations and best wishes of the profession of this Province are extended to Dr. Hamilton in his new post. With recent marked expansion in the number of subscribers covered by the Medical Services Association, it has been found necessary to increase the staff. Dr. G. L. Watson will act as Assistant to the Medical Director, Dr. S. C. MacEwen, and Mr. H. Jones will assist Mr. A. L. McLellan, the Secretary-Treasurer. Dr. D. A. Campbell, formerly at Creston, has been discharged from the R.C.A.F. but will remain at Deer Lodge Hospital for a time before returning to Creston. *& %L %& *L *r *r *P *r Dr. W. T. Hall, formerly at Princeton, has left for California to take special postgraduate training in Orthopaedics for three years. Dr. P. G. Margetts has left practice in Yellowknife and is enjoying an extended holiday prior to relocating. He is at present living in West Vancouver. 9£* 9fr »s* Sfr Dr. V. J. Freeman is on the staff at U.B.C. following discharge from the R.C.A.M.C. s$» A sfr sfr The best wishes of the profession are extended to Dr. D. J. Millar at North Vancouver, (and Horsefly P.O.) for a speedy and complete recovery from his recent serious illness. * * * * Recent visitors to Vancouver have been Dr. and Mrs. L. W. Kergin of Prince Rupert, Dr. C. T. Hilton of Port Alberni, Dr. H. F. P. Grafton of Kamloops. «C »t st *fc *r *P *r *T A recent marked increase in the wear of the reading-room chairs is explained when we find that Dr. Jim Endicott of Trail is spending two months in Vancouver doing postgraduate work in Paediatrics. He is most enthusiastic about the facilities available and believes that the reading-room needs new chairs anyway. 5fr i£ 5fr 3fr Dr. R. W. Garner of Port Alberni is holidaying at present. Dr. John E. Ross has recently joined Dr. Garner and Dr. Jones in practice in that centre. * * * * Dr. M. E. Krause has returned to Trail after two months post-graduate work taken at Toronto. s£ sfr s£ sfr The many friends of Dr. E. S. Hoare will be pleased to know that he has now returned to work following his recent illness. * * * * It is with regret that we record the sudden passing of Dr. K. L. Craig on October 8 th, at Campbell River. Deepest sympathy is extended to his wife and family. Dr. Craig registered in the Province in 1924 and practiced for many years in Vancouver. He served in the R.C.A.M.C. and had but recently been discharged. %t «L *t **- *e V *r ~F Sympathy is extended to Dr. W. A. Moff att and Dr. D. W. Moff att, and to Dr. R. B. Brummitt of Nelson in their recent bereavements. Page 23 ■ We report with regret that Mrs. C. G. Bender, who has been for so many years the very foundation of the College and Association office, has at last seen fit to take life a bit easier, and will no longer be seen regularly in the College office. Having delegated most of her duties to Miss Vera Smith, Mrs. Bender was last seen heading for Buccaneer Bay laden with picks, shovels, axes, fishing gear, and assorted paraphernalia, and a determination to enjoy a life of leisure. It is very doubtful if anyone was as well known to all the profession in the Province as Mrs. Bender, and we are certain that every doctor in the Province joins in expressing regret at her departure, but best wishes for many long and happy years in which to enjoy the relaxation she has so well earned. ARTHRITIS and ECZEMA of endogenous origin claimed to be allergic, may be favored or induced by calcium and sulphur deficiency, impaired cell action, and imperfect elimination of toxic waste. LYXANTHINE ASTIER administered per os, brings about improved cell nutrition and activity, increased elimination, resulting symptom relief, and general functional improvement. Write for Information L-17 Canadian Distributors ROUGIER FRERES 350 Le Moyne Street, Montreal Colonic and Physiotherapy Centre Up-to-date Scientific Treatments COLONIC IRRIGATIONS, SHORTWAVE DIATHERMY, SINNEWAVE GALVIN- ISM, IONIZATION, ULTRA VIOLET RAY, STEAM BATHS AND SHOWERS Medical and Swedish Massage Physical Culture Exercises STAFF OF GRADUATE NURSES Superintendent: E. M. LEONARD, R.N. Post Graduate Mayo Bros. 1119 Vancouver Block MArine 3723 Vancouver, B.C. Nuttn $c 3tlf0m00tt 2559 Cambie Street Page 24 t Vancouver, B. C. I \_yne ^j uuiumn OF MAN'S LIFE With the beginnings of senility, man's life is usually complicated by a variety of disturbing symptoms referable to diminished testicular function. Such complaints as benign prostatic hypertrophy, premature impotence, sexual neurasthenia, and related disorders of the "male sexual decline" have been treated with PERANDREN, the synthetic, chemically pure androgenic hormone. PERANDREN (testosterone propionate) is also of marked value in the treatment of many cases of cryptorchidism, hypogonadism, sexual impotence, certain types of sterility, eunuchism and gynaecomastia. In gynaecology, PERANDREN is useful in selected cases of menopausal symptoms, menorrhagia, merorrhagia, dysmenorrhoea and certain mastopathies. *Trade Mark Reg'd. Send for up-to-the-minute medical literature on indications and dosage mmmiWk * & lkfrtNTRK * di MONTREAL, CANADA TOMORROW'S MEDICINE from TODAY'S RESEARCH til &p Happen Here icii i j^fijifcp Lest we forget—we who are of the j vitamin D era—severe rickets is not yet eradicated, and moderate and mild rickets are still prevalent. Here is a white child, supposedly well fed, if judged by weight alone, a farm child Example of severe rickets in a sunny clime* apparently living out of doors a good deal. This boy was reared in a section having a latitude between 37° and 42°, where the average amount of fall and winter sunshine is greater than that in the major portion of Canada. And yet such stigmata of rickets as genu varum and the quadratic head are plain evidence that rickets does occur under these conditions. How much more likely, then, that rickets will develop among city-bred children who live under a smokepall for a large part of each year. True, vitamin D is more or less routinely prescribed nowadays for infants. But is the antiricketic routinely administered in the home? Does the child refuse it? Is it given in some unstandardized form, purchased from a false sense of economy because the physician did not specify the kind? A uniformly potent source of vitamin D such as Oleum Percomorphum, administered regularly in proper dosage, can do more than protect against the gross visible deformities of rickets. It may prevent hidden but nonetheless serious malformations of the chest and the pelvis and will aid in promoting good dentition. Because the dosage is measured in drops, Oleum Percomorphum is well taken and well tolerated by infants and growing children. EXIGENCY OF WAR: Oleum Percomorphum 60% is now known as Oleum Percomorphum with other Fish-Liver Oils and Viosterol. The potency remains the same; namely, 60,000 vitamin A units and 8,600 vitamin D units per gram. It consists o fthe liver oils of percomorph fishes, viosterol and fish-liver oils, a source of vitamins A and D in which not more than 60% of the vitamin D content is furnished by viosterol. Supplied in 10 cc and 60 cc bottles; and as capsules in bottles containing 60 and 260. MEAD JOHNSON & CO. OF CANADA, LTD., Belleville, Onf. Please enclose professional card when requesting samples of Mead'Johnson products to cooperate in preventing their rnarhtmi; unauthorized nersons. PENICILLIN FOR ORAL USE *t CILLE TABLETS at a, neat 4tne*tyt& 50,000 International Units per tablet In keeping with the trend to prescribe larger doses of penicillin and as a measure of convenience to physician and patient, Ayerst now offers "Cillenta" (No. 852) in tablets of 50,000 International Units. This is in addition to "Cillenta" Tablets (No. 851) of 25,000 International Units. Both strengths are supplied in tubes of 12. —ISSI1 AYERST, McKENNA & HARRISON LIMITED • Biological and Pharmaceutical Chemists • MONTREAL, CANADA Oral administration o! Tablets Estrogenic Hormones, R & C, on daily dosage schedule, minimizes fluctuations of therapeutic blood estrogen levels, and assures sustained relief of. menopausal symptoms, in most cases. Severe symptoms should first be brought under control with injections of Estrogenic Hormones, R & C, in oil. In mild cases, the Tablets may be effective as initial therapy. ^ Tablets Estrogenic Hormones, R & C, contain natural estrogens, extracted z, from the urine of pregnant mares by a special process and rigidly standardized to assure uniform potency. Available: 1000 LU. per tablet, in bottles of 50, 500 and 1000; and 5000 I.U. per tablet in bottles of 30 and 100. The prices of this clinically dependable oral estrogen are gratifyingly low. H m REED & CARNRICK Jersey City 6, N. J.-Toronto, Ont., Can. DESIGNED £* PROFESSIONAL GUIDANCE. . . fi^j-g?^©* DIETARY SUPPLEMENT B.D.H A new presentation resulting from progressive nutritional research and eliminating the disadvantages of older products. Dietary Supplement B.D.H. is will prove of especial value by designed for prevention and reason of its carotene content correction of common nutri- as it has recendy been shown tional deficiencies resulting by Lund and Kimble* that caro- from faulty dietary, poor appe- tene is transmitted from the tite, impaired digestion and mother to the foetus much absorption, or increased re- more readily than Vitamin A. quirements. The increased prenatal requirements of iron and calcium will During pregnancy particularly, also be provided by Dietary Dietary Supplement B.D.H. Supplement B.D.H. *Lund, Curtis J., Kimble, Marion S.: Plasma Vitamin A and Carotene of the Newborn Infant. Amer. J. Obs. & Gynec. 46:207, 1943 (August). One capsule and one tablet constitute a single dose VITAMINS MINERALS each capsule contains each tablet contains Vitamin A 1,500 int. units Ferrous Sulphate Pro-vitamin A Exsiccated B.P 2.0 grains (Beta-carotene). 1,500 int. units Calcium Phosphate Vitamin D 600 int. units B.P ..2.0 grains Thiamine Hydrochloride (Vitamin Bi) 1.2 mgm. To preserve the thiamine hydro- Riboflavin chloride from the known destruc- (Vitamin B2) 1.0 mgm. tive action of iron salts, Dietary Nicotinamide 10.0 mgm. Supplement B.D.H. is presented in Ascorbic Acid two parts—the vitamins in cap- (Vitamin C) 25.0 mgm. sules and the minerals in tablets. Issued in cartons containing one bottle of 100 capsules and one of 100 tablets. THE BRITISH DRUG HOUSES (CANADA) LIMITED TORONTO CANADA 66A f< SiS-maSJiSfcS&fefo; ♦ ♦ .the characteristic response The prompt symptomatic relief provided by Pyridium is extremely gratifying to the patient suffering with distressing urinary symptoms such as painful, urgent, and frequent urination, tenesmus, and irritation of the urogenital mucosa. Pyridium is convenient to administer, and may be used with complete safety throughout the course of cysitis, pyelonephritis, prostatis, and urethemia. The average oral dose is 2 tablets t.i.d. More then a decode of ' service ir* urogenital Infections PYRIDIUM TRADE MARK REGISTERED (Phenyloio-alpha-olpha-diamino- pyridine mono-hydtochloiid.) PyddiutB h tke Canadian Registered Trade-Ma tit afjhe. Product Man ufac*ured by rbe ryridium Corporation MERCK & CO. LIMITED '<JL*mfatm*y Wmua* MONTREAL TORONTO VALLEYFIELD flfoount pleasant Tanbertaktno Co. %tb. KINGSWAY at I lth AVE. Telephone FAirmont 0058 W. E. REYNOLDS VANCOUVER, B. C EKCLUSIVE RfliBULflnCE SERVICE VANCOUVER: 13th Avenue and Heather Street fflir. 0080 NEW WESTMINSTER: 814 London Street ||UJ. 60 We Specialize in Ambulance Service Only J. H. GRELLIN W. L. BERTRAND D 0 s a ami Teaching patients how to relax is a primary consideration in the management of arterial hypertens on. In many instances thispSj&f'a simple task, but it can often be made easier By supplementing commorlsense instructions WithTTKeominal. Tfiis^slq.w-acting|vasodi^p>Sedative helps to bring about a gradual reduction of;blood pressure dnd through' its,; gentle sedattv^ effect, reinforces, ^taxation.-. The customary dose of Theominal is 1 tablet two or three times daily* when improvement sets in, the dose maysbe reducedSEaeh tablet contains theobrorpn&£$ "grains and Luminal* ■.■J4i;grair6< * . ISIS *Luminal (trademark), Wlp|irop Chemical-Company, Iric., brand of phe%b%irbital. Trademark!!eg. U.S. Pot. Off. & Canada S U PllffE D IN BOWL,ES' OF 2 S-Jl 0 0 AND 500 T* A B|i E T S |fe H T§ R 0 V C H E^AuY A^'to M P A N \, I N C . Pharmaceuticals|t^1^^^pr the physician • New York 13, N. Y. • Windsor, Ont. THE RATIONALE "For research work, the corrected sedimentation rate has been considered the most reliable single test for determining activity in rheumatoid arthritis." DR. BERNARD I. COM ROE, A.B., M.D., F.A.C.P. ARTHRITIS AND ALLIED CONDITIONS, p. 66. THE FACTS "One hundred cases were given myochrysine. Of these 78 showed reduced sedimentation rates to the amount of 1,083 mm. or an average of 13.8 mm." -* i DR. DEAN ROBINSON, BANFF, ALBERTA. C.M.A. JOURNAL — VOL. 55, No. 2. LABORATORY ettc tetCS OF CANADA. LTD. MONTREAL WYETH AN EXCELLENT VEHICLE! • A therapeutically useful vehicle, compatible with most medicaments, its delicious sherry flavor tempts patients with poor appetites; provides Vitamin Bi when needed. Elixir Bewon Wyeth contains 500 International Units of crystalline vitamin Bi (thiamin chloride) per fluidounce- Pharmacists dispense any quantity as prescribed. ELIXIR BEWON TRADE MARK REG; IN CANADA JOHN WYETH & BROTHER (CANADA) LIMITED WALKERVILLE, ONTARIO SAFE * Four years of intensive clinical research, with more than 1,400 published cases, have established Demerol analgesia in labor as a safe procedure. Demerol analgesia is harmless to mother and baby. It does not weaken uterine contractions or lengthen labor. There are no post-partum complications due to the drug. it >n* < SIMPLE AND EFFECTIVE * Demerol hydrochloride is administered orally or by intramuscular injection. Average dose: 100 mg., when the pains become regular, repeated three or four times at intervals of from 1 to 4 hours. In analgesic power Demerol hydrochloride ranks between morphine and codeine; it also has a spasmolytic effect comparable with that of atropine, as well as a sedative action. It may also be used in conjunction with scopolamine or barbiturates for amnesia. U\ WRITE FOR LITERATURE DETAILED [HERIL Trademark Reg. U. S. Pat. Off. & Canada HYDROCHLORIDE BRAND OF MEPERIDINE HYDROCHLORIDE (Isonipecaine) (Subject to regulations of the Canadian Narcotics Division) WINTHROP CHEMICAL COMPANY, INC. Pharmaceuticals of merit for the pbyiscian GENERAL OFFICES: WINDSOR, ONTARIO Quebec Professional Service Office: Dominion Square Building, Montreal, Quebec TRADE MARK i[gS]j REG. IN CANADA CAROTENE SAFEGUARDS BOTH MOTHER AND. CHILD* Vitules m ,-Fne On/y\Mu/ffyifomln"'^^S^Lf^ Containingi CAROTENE M&m MOTI)li^tr-;d geiiy^6ussupply:o^jaff^$seiiitial vitafiins, well above the minimum daily'requirements.^ FOR BAIJ^~an "adequate su|^ysat^gAJ^f^E^tjT(6| impafe. Rant source of'vi^im^i A ^^tP^Jp^^S* Vr'ell^as^substantfbl ^^^^^^^^^^^^^rtttal^it^riiins. ■•'/" ^Trade Marie Reg. in Canada gMPROVED FORMULA, VITAMIN CAf SULE WfcpfiW in bottles of 30 and 100 <etf TRADE MARK RES. IN CANADA JOHNWYETH |^pkGTHERf(CANlDA^ ONTARlfl m Clinical Studies Show Why All-Bran Aids Normal Laxation • Recent clinical studies of various foods, to compare their crude-fiber content with their influence upon laxation, indicate that previously held theories, supported by analytical technique, are no longer tenable. Analytical investigation did not explain how Kellogg's All-Bran achieves its laxative results. It has now been demonstrated that the cellulosic content of bran supports the action of beneficent symbiotic flora which help produce soft, spongy wastes for easy elimination. Thus, All-Bran does not activate the colon itself, but stimulates the contents of the colon. Furthermore, All-Bran does not work by soaking up water, nor does it produce excessive colonic distension. It neither sweeps out nor interferes with normal digestion. Reprints covering recent clinical investigations, from which these conclusions have been summarized, are available upon request: write Kellogg Company of Canada, Ltd., London, Ontario. A Food Type Laxative »'*t ate. sSBFrrr? i@ 5^ HI i§ ^ io& m mm \j&* m ane it Unwilling to reveal, even to a physician, the presence of any abnormal rectal condition — and too often dreading surgery—those who suffer from hemorrhoids do so in silence. Whenever nonsurgical treatment is indicated Anusol will be found a safe, sane and effective therapeutic treatment. onusoL HEMORRHOIDAL SUPPOSITORIES relieve pain and discomfort, and by softening the contents of the rectum and lubricating their passage, make evacuation easy and painless. Anusol Suppositories reduce congestion, control hemorrhage, soothe and protect traumatized tissues, promote healing. Their action is rationally effective. lOMNlS ORBIS The Hall-mark of Excellence WARNE&1 ESTABLISHED 1856 William R. Warner & CO LTD. 727 KING ST. W.# TORONTO ORTHO-GYNOL Vaginal Jelly possesses the highest degree of effectiveness—toler- ability and stability. It is the most widely prescribed vaginal jelly, and has received the A.M.A. seal of ORTHO PHARMACEUTICAL CORPORATION (CANADA) LIMITED TORONTO <rr> VlTANlMftlNCfHE^S^ JittPORATEl Pi ILK m Vitamin D Increased to 400 INT. UNITS PER RECONVERTED QUART "DOR optimal growth in normal infants and children, for good bone and tooth development, and for additional protection against rickets, the vitamin D potency of Carnation Milk has been greatly increased by irradiation. Now a reconverted quart (half Carnation, half water) supplies 400 International units as against the 162 units formerly introduced by irradiation. The revised label shown above identifies this nutritionally improved milk, which is now nationally available. CARNATION COMPANY, LIMITED, TORONTO Carnation "FROM CONTENTED COWS" £11 LIP Milk A Canadian Product Aithe Right Hand of%ie Doctor |!| stands ''qjj^. modernl|ed prescription department — spaciouspefficlenjffind available — ^th potent medrcinals and a trained staff of pharmacists. Phone MArine 4161 ^^^.J&*«M4*n\ GFGRGIA PHARMACY <E? ttter S^mvm Hi& « ESTABLISHED 1893 VANCOUVER, B. C. North Vancouver, B. C. Powell River, B.^Cfc pMSi &*** WHM <£a. HxtmUb p'a New Westminster, B. C. For the treatment of NEUROPSYCHIATRY DISORDERS Reference—B. C. Medical Association For information apply to Medical Superintendent, New Westminster, B. C. New Westminster 288 or 721 Medical-Dental Building^ Vanco^er, B. CJJK PAcific 7823 PAcific 8036 27 ^■B ."CTI*T
Periodicals
W1 .VA625
English
Vancouver : University of British Columbia Library
Vancouver, B.C. : McBeath Spedding Limited
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Original Format: University of British Columbia. Library. Woodward Library Memorial Room. W1 .VA625
Medicine--Periodicals
The Vancouver Medical Association Bulletin: October, 1946
Text