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History of Nursing in Pacific Canada
Vancouver Medical Association
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The BULLETW OF THE v\ \ v VANCOUVER ASSOCIATION T*x. Sfc Vol. XIV. MAY, 1938 No. 8 In This Issue: ^VANCOUVER MEDICAL ASSCK2IATION|j ANNUAL MEETING | SUMMER SCHOOL CLINICS PROGRAMME PHYSIOLOGY OF THE GALL-BLADDER SUMMER SCHOOL CLINICS: JUNE 21 TO 24 INCL., 1938 BULKETTS (With Cascara and Bile Salts) . . FOR . . Chronic Habitual Constipation BULKETTS POSSESS ENORMOUS BULK PRODUCING PROPERTIES AND BEING PROCESSED WITH CASCARA AND BILE SALTS PRODUCE |BULK WITH MOTILITY. WE WILL BE PLEASED TO PROVIDE ORIGINAL CONTAINERS FOR TRIAL ON REQUEST. I if Western Wholesale Drug (1928) Limited 45 6 BROADWAY WEST VANCOUVER - BRITISH COLUMBIA (Or at all Vancouver Drug Co. Stores) THE VANCOUVER MEDICAL ASSOCIATION B U. L L E T I N Published Monthly under the Auspices of the Vancouver Medical Association in the interests of the Medical Profession. Offices: 203 Medical-Dental Building, Georgia Street, Vancouver, B. C. Editorial Board: Db. J. H. MacDebmot Db. M. McC. Baibd Dr. D. E. H. Cleveland All communications to be addressed to the Editor at the above address Vol. XIV. MAY, 1938 No. 8 OFFICERS 1937-1938 Dr. G. H. Clement Dr. Lavell H. Leeson Dr. W. T. Ewing President Vice-President Past President Dr. W. T. Lockhart Dr. A. M. Agnew Hon. Treasurer Hon. Secretary Additional Members of Executive—Dr. J. R. Neilson, Dr. J. P. Bilodeau. TRUSTEES: Dr. F. Brodie Dr. J. A. Gillespie Dr. F. P. Patterson Historian: Dr. W. D. Keith Auditors: Messrs. Shaw, Salter & Plommer. SECTIONS Clinical Section Dr. R. Palmer Chairman Dr. W. W. Simpson Secretary Eye, Ear, Nose and Throat Dr. S. G. Elliott Chairman Dr. W. M. Paton Secretary Pediatric Section Dr. G. A. Lamont. Chairman Dr. J. R. Davies Secretary Cancer Section Dr. B. J. Harrison Chairman Dr. Roy Huggard Secretary #I? I STANDING COMMITTEES Library Dr. A. W. Bagnall Dr. S. Paulin Dr. W. F, Emmons Dr. R. Huggard Dr. H. A. Rawlings Dr. R. Palmer Dinner Dr. G. F. Strong Dr. R. Huggard Dr. D. D. Freeze Summer School Dr. J. R. Naden Dr. A. C. Frost Dr. A. B. Schinbein Dr. A.Y. McNair Dr. T. H. Lennie Dr. F. A. Turnbull Publications Dr. J. H. MacDermot Dr. D. E. H. Cleveland Dr. Murray Baird Credentials Dr. A. B. Schinbein Dr. D. M. Meekison Dr. F. J. Buller Metropolitan Health Board Advisory Committee Dr. W. T. Ewing Dr. H. A. Spohn Dr. F. J. Buller Representative to B. C. Medical Association—Dr. Neil McDougall. Sickness and Benevolent Fund—The President1—The Trustees V. O. N. Advisory Board Dr. I. Day Dr. G. A. Lamont Dr. Keith Burwell Serumas, Vaccines, Horimomes AND Related Biological Products Anti-Anthrax Serum Anti-Meningococcus Serum Anti-Pneumococcus Serums Diphtheria Antitoxin Diphtheria Toxin for Schick Test Diphtheria Toxoids Old Tuberculin Perfringens Antitoxin Pertussis Vaccine Pneumococcus Typing-Sera Rabies Vavvine Scarlet Fever Antitoxin Scarlet Fever Toxin Staphylococcus Antitoxin Staphylococcus Toxoid Tetanus Antitoxin Tetanus Toxoid Typhoid Vaccines Vaccine Virus (Smallpox Vaccine) Adrenal Cortical Extract Epinephrine Hydrochloride Solution (1:1000) Epinephrine Hydrochloride Inhalant (1:100) Heparin Insulin Protamine Zinc Insulin Liver Extract (Oral) Liver Extract (Intramuscular) Pituitary Extract (posterior lobe) Prices and information relating to these preparations will be supplied gladly upon request. CONNAU G H T LABORATO RIE S UNIVERSIT^OF TORONTO Toronto 5 Canada Depot for British Columbia Macdonald s Prescriptions Limited MEDICAL-DENTAL BUILDING, VANCOUVER, B. C. VANCOUVER HEALTH DEPARTMENT STATISTICS—MARCH, 1938 Total population—estimated Japanese population—estimated. Chinese population—estimated ~ Hindu population—estimated 259,987 8,685 7,808 335 Number Total deaths 256 Japanese deaths ; 9 Chinese deaths 15 Deaths—Residents only 228 BIRTH REGISTRATIONS Male, 185 ; Female, 168.. 353 INFANTILE MORTALITY March, 1938 Deaths under one year of age 15 Death rate—per 1,000 births 42.5 Stillbirths (not included in above) 6 Rate per 1,000 Population 11.6 12.2 22.6 10.3 16.0 March, 1937 15 49.8 3 CASES OF COMMUNICABLE DISEASES REPORTED IN THE CITY January, 1938 Cases Deaths Scarlet Fever r 87 0 Diphtheria 1 0 Chicken Pox 99 0 Measles 13 0 Rubella 1__ 2 0 Mumps 36 0 Whooping Cough 21 0 Typhoid Fever 0 0 Undulant Fever 2 0 Poliomyelitis 0 0 Tuberculosis 48 14 Erysipelas 4 0 February, 1938 Cases Deaths March 1st to 15th, 1938 Cases Deaths 89 0 327 25 9 106 41 1 1 0 38 6 0 0 0 0 0 0 0 0 0 0 17 1 33 0 44 6 1 10 8 0 1 0 23 0 0 0 0 0 0 0 0 0 0 0 0 V. D. CASES REPORTED TO PROVINCIAL BOARD OF HEALTH, DIVISION OF VENEREAL DISEASE CONTROL Vancouver Hospitals and Clinic Private Doctors Totals Syphilis 102 42 144 Gonorrhoea I 97 16 113 A PRESCRIPTION SERVICE . . . Conducted in accord with the ethics of the Medical Profession and maintained to the standard suggested by our slogan: Pharmaceutical Excellence AACGI16 Ormo LIMITED ^-^ FORT STREET (opp. Times) Phone Garden 1196 VICTORIA, B. C. Page 172 Tentative Programme SUMMER SCHOOL LECTURES TUESDAY, JUNE 21 st, 19 3 8 9:00 a.m.—Dr. R. F. Farquharson : "Jaundice, Diagnosis and Treatment." 10:00 a.m.—Dr. Glen Spurling : "Painful Arm and Shoulder." 11:00 a.m.—Dr. O. S. Ormsby : "Mycotic Infections." 12 Noon—LUNCHEON. Speaker: Dr. Andrew Hunter. "Edinburgh School of Medicine: Historical Notes and Personal Recollections." 2:30 p.m.—CLINIC: St. Paul's Hospital. 8:00 p.m.—Dr. Waltman Walters : "Types of Operation and Their Indication in the treatment of lesions of Stomach and Duodenum." 9 :00 p.m.—Dr. Glen Spurling : "Surgical Treatment of Intractable Pain." WEDNESDAY, JUNE 22nd, 1938 9:00 a.m.—Dr. Glen Spurling : "The Epileptic Problem." 10 :00 a.m.—Dr. Waltman Walters : "Obstructive Jaundice." 11:00 a.m.—Dr. Andrew Hunter : "Chemical Blood Changes in Toxaemias of Pregnancy." » CLINIC: VANCOUVER GENERAL HOSPITAL. 2:00 p.m.—Dr. O. S. Ormsby : Subject to be announced later. 3:00 p.m.—Dr. Glen Spurling : "Acute Head Injuries." 8:00p.m.—Dr. Glen Spurling: "Low Back Pain and Leg Pain from a Neurological Standpoint." 9:00 p.m.—Dr. R. Farquharson : "Enlargement of the Superficial Lymph Glands; Diagnosis and Treatment." THURSDAY, JUNE 23rd, 1938 | 9:00 a.m.—Dr. O. Ormsby : "Contact Dermatitis." 10 :00 a.m.—Dr. Andrew Hunter : "Acid-base Balance and Its Disturbances." (Part I.) 11:00 a.m.—Dr. Waltman Walters : "Preparation of Handicapped Patients for Surgical Operations. AFTERNOON: GOLF. 8:00 p.m.—Dr. O. S. Ormsby : "Pre-cancerous Dermatoses." 9:00 p.m.—Dr. R. F. Farquharson : "Diseases of the Liver." I FRIDAY, JUNE 24th, 193 8 9:00 a.m.—Dr. Andrew Hunter : "Acid.-base Balance and Its Disturbances." (Part II.) 10:00 a.m.—Dr. R. F. Farquharson : "Leukaemia." 11:00 a.m.—Dr. O. S. Ormsby : "Cutaneous Syphilis." 2 :00 p.m.—CLINIC : VANCOUVER GENERAL HOSPITAL. Dr. Waltman Walters : Subject to be announced later. 8:00 p.m.—Dr. Andrew Hunter : "Biochemistry of Sulphanilamide." 9 :00 p.m.—Dr. Waltman Walters : "Surgical Treatment of the Diabetic Patient." Graduate Male Nurses1 Association OF BRITISH COLUMBIA Approved by the Vancouver Medical Assn. This organization, the only one of its kind in Canada, has Graduate Male Nurses available in Vancouver, or any part of British Columbia. All Enquiries Carefully Attended to. 110 Vancouver Block Phone: Sey. 5585 Page 173 EDITOR'S PAGE One of the most difficult problems in a doctor's life, and one most full of potentialities for misunderstanding and bad feeling, is the relationship between two men who meet on the same case—especially when one has called the other in to consult with him. It is a matter of everyday occurrence-—one would think that it was a simple matter, capable of control by simple rules, which indeed have been formulated and written down for our guidance, and that it should surely be possible to maintain friendly and cordial relationships between the two men who act in the capacities respectively of attendant and consultant. Yet constantly situations arise where after consultation one side or the other feels aggrieved, and objects to the conduct in some particular of his colleague. We are not referring to wilful or deliberate misconduct on the part of the consultant—we are glad to believe that this very seldom occurs—our own experience of consultations, as a general practitioner of medicine, has been a very happy and profitable one, and we confess to a predilection for them. We believe, again as a result of experience, that it is very rare that a consultant, be he specialist or not, intentionally attempts to undermine, with the patient of his friends, the confidence that they have hitherto had in their medical attendant, or that he does anything calculated to be to his own unfair advantage. Far from it—he much more frequently reinforces and confirms this confidence, and is of inestimable value to the attendant who called him in. But the relationship between attendant and consultant is a very delicate one, and it is almost inevitable that occasionally mistakes will be made, which may lead to very unpleasant consequences. It is because some of these have been drawn to our attention that we feel that perhaps it might be rather a good thing if we all thought about this matter a bit, and discussed frankly some of the things that have been said. One of our colleagues, speaking of this the other day, instanced the action of certain men whom from time to time he had consulted about cases where such consultation seemed advisable or was asked for by the friends. His ground of complaint was that the consultant continued to visit the patient after the consultation was over, to make a point of seeing him daily, of reading the chart, even of proffering advice. Other men have supported his statements by experiences of their own. There have been instances cited where orders of the attending man have actually been changed by the consultant without his knowledge. Even remarks have been made to the patient or his friends rather derogatory to the judgment or ability of their physician. We cannot believe that any man who does these things could excuse them in any way; nothing in his rights or duties as a consultant justifies him in such action. Only oneNthing can result from such conduct: serious injury to the reputation and prestige of the original physician on the case, and transfer eventually of the family's^allegiance to some other doctor, possibly the consultant. We do not think this is common, but we are quite satisfied that it occasionally happens, and there is no excuse for it. When a man accepts responsibility as a consultant, he also undertakes certain obligations to the physician who calls him in. He is bound in honour not to see that case in any other capacity than as a consultant—he must not accept that patient as his own. If he disagrees with the attendant, his duty is to say so, and to withdraw; but he must not, having acted as consultant, pursue that case any further. It must be remembered by him that the reputation and even the livelihood of his colleague are to some extent at his mercy and in his hands, to injure or preserve intact, and his bounden duty is to do the latter, and by no word or deed to run any risk of the former. Of course, there is much to be said on both sides. The consultant is not always the offender in the relations between the two. All too often the Page 11'4 attending man himself is guilty of practices which cannot be defended. He may use the consultant as a shield where he should not; he may exploit the consultant's superior knowledge unfairly and without undue acknowledgment ; he may seek to defend or explain away his own mistakes by a wrongful use of the consultant; he may deny the consultant adequate access to the patient, and so on. Both sides are equally responsible for the maintenance of good relations, and for seeing that fairness, equity and courtesy are the rules guiding all such transactions. Perhaps one of the best preventatives against misunderstanding and unhappiness is perfect frankness between ourselves. There is not enough of this. Too often we take the word of the patient, of a friend, or of some third party, against a man who is our colleague, who has always been regarded by us as a friend, and who may, after all, be innocent, or may have unwittingly and unconsciously made a mistake in his handling of a case, but meant no wrong at all. In this connection, the words of that wise and humorous old writer whom Osier used to quote occasionally, and whose essays are all worth reading, may help us to a balanced and sane view of things: "Reprove a friend, for it may be that he did it not, and if he did something he will not do it again. Reprove a neighbour, for it may be that he said it not, and if he said it he will not say it again. Reprove a friend, for many times there is slander; and trust not every word. There is one that slippeth, and not from the heart, and who is he that hath not sinned with his tongue?" There is, too, the pressure from relatives and friends, and often the patient himself or herself; the temptation to assume the position of superior knowledge. We have to resist these things; to remember that this is not our case; that the attending man is honestly doing his best, and needs our help, not a substitute; also that some day we may need a consultation ourselves. As men grow older in this game, they grow wiser, more tolerant, more considerate of the other man; and we like to believe that the mistakes that are ma,de, some of which we have cited, are the mistakes of inexperience, and not of malice or deliberate intent. After all, the average man is very much like ourselves, as honest, and as anxious to play the game with his fellows—and we may well give him credit for these qualities. "And the greatest of these is charity." % NEWS AND NOTES Dr. J. S. Burris of Kamloops has been visiting in California. * * * * Dr. J. Stuart Daly of Trail is doing post-graduate work in New York. 9K *js 7ft SIC Dr. J. Bain Thorn of Trail has returned from a cruise to the West Indies. * * * ♦ One cold morning in Victoria with a fall of snow it was discovered that Dr. Anson C. Frost was visiting on the Island. * * * * Dr. Peter L. Straith of Courtenay passed through Vancouver a fortnight ago, returning from Rochester, Minn. He had been looking things over at Mayo's. There must have been some shortage of material, for one morning they removed Doctor Straith's gall-bladder. This interfered with his attendance at clinics for two weeks. He looks well and all pepped up for his work again. Doctors H. A. L. Mooney and A. L. Cornish are still with him in the practice at Courtenay. * * * sjs Dr. E. Howard McEwen of New Westminster has been spending a brief but well-deserved holiday on Vancouver Island. * * * * Dr. W. E. Henderson of Chilliwack is going to New York and Montreal for an extended post-graduate tour. Page 175 Dr. George T. Wilson of New Westminster has been after the fighting rainbows again this spring. It is hoped that his new Hardy rod will stand up against the big ones. * * * * Dr. Alan Beech of Salmon Arm is away on vacation after a hard spell alone in the practice while his brother, Dr. Stuart E. Beech, was on sick leave. Dr. Stuart Beech, we are glad to report, is back in Salmon Arm and able to carry on the practice. Dr. T. W. Sutherland has been doing locum tenens during Dr. Alan Beech's absence. * * * * Dr. Norbert J. Ball and Mrs. Ball of Oliver called at the office while in Vancouver recently. We wished them the best in their newly-married life. Dr. H. A. Whillans relieved Dr. Ball during his absence. * * * * Dr. G. H. Francis and Mrs. Francis left during the past month to take up residence at Pioneer, where Dr. Francis has taken over the practice vacated by Dr. George R. Barrett. Dr. and Mrs. Francis were married in April and they carry with them the best wishes of the profession into their new life and work. * * * * Dr. Andrew Turnbull is now in Victoria in the capacity of roentgenologist at St. Joseph's Hospital. * * # * Dr. J. B. Roberts is assistant to Dr. H. H. Murphy in the Department of Radiology at the Jubilee Hospital, Victoria. * ♦ * * Dr. J. B. Story has commenced practice in Vancouver, with offices on Tenth Avenue West at Alma Road. * * * * Dr. Hubert Dumont is now established in practice at 2242 Fourth Avenue West. * # # # Dr. D. H. Williams, the newly-appointed Director of the Division of Venereal Disease Control of the Provincial Department of Health, has retained his office in the Medical-Dental Building, where he will carry on practice limited to his specialty—dermatology and syphilology. * * ♦ * The profession will be pleased to learn that Dr. S. C. Peterson, who has opened offices in the Vancouver Block, will not sever his connection with the Department of Health, but will serve as consultant in charge of treatment in the Division of Venereal Disease Control. * * * * Dr. J. B. Swinden has returned to Ucluelet, on the West Coast of Van- couver Island. He has made good recovery from an operation last month. *p *P *p 3|C Dr. F. S. Macdonald, formerly of McBride, has moved to the Prairie, where he has re-entered practice. * * * * Dr. L. M. Greene, until recently an interne in the Vancouver General Hospital, has gone to McBride to carry on the practice in that area. * * * * Dr. B. J. Hallowes, who was formerly in practice on Vancouver Island, is now located at Alexis Creek. He has been appointed Medical Health Officer and School Medical Officer for that district. * * * * Dr. H. E. Cannon, formerly of Blakeburn, has moved to Langley Prairie and will be associated in practice with Dr. A. McBurney. Page 176 Langley Prairie now possesses a Medical-Dental Building, built by Dr. McBurney next to him home. It will provide accommodation for Doctors McBurney and Cannon and also Dr. D. W. Beach, and Dr. Simpson, the Dentist at Langley. A large and well equipped operating room will fill a need at that point. $ >£ * . ♦ Dr. A. O. Rose, formerly of Vernon, is now in practice in Langley Prairie, having taken over the interests of Dr. B. B. Marr. Dr. Marr has considerably improved in health but has largely retired from practice. 3ji 3ft 9|C 3|C Dr. R. R. Laird, until recently on the Interne staff at the Vancouver General Hospital, took over the practice at Blakeburn and Coalmont from Dr. H. E. Cannon when the latter moved to Langley Prairie. * ♦ * ♦ Dr. T. H. Lougheed, who has been in practice at Blubber Bay during the past ten years, is now in Vancouver. He has enjoyed this spell of practice in that community and we hope he will have many years in which to enjoy his well-earned retirement. f * 'K *F Dr. C. C. Browne of Nanaimo is feeling quite recovered after convalescing in California. * * * * Dr. H. A. Meneely of Nanaimo, President of the Upper Island Medical Association, has left for California. We are pleased to report that he is making a rapid comeback following his serious illness. * # * * Dr. G. A. B. Hall of Nanaimo has just returned from Arizona, where he visited his son, Dr. Alan B. Hall, who is now established in practice in Phoenix. * # ♦ * Dr. Gordon A. Lawson of Port Alice has returned after several weeks' enforced absence through illness. Dr. E. K. Hough carried on the practice for Dr. Lawson. •F "P "F "|» Dr. J. C. Thomas of Port Alberni is now in Toronto doing post-graduate study. * ♦ # ♦ Dr. Norman H. Jones is now associated with Dr. R. W. Garner in the practice at Port Alberni. * * * * Dr. Frank Turnbull attended the meeting of the Harvey Cushing Society in Memphis, Tenn., during the week of April 17th to 23rd. Dr. Turnbull travelled by airplane both ways. * * * * Congratulations are extended to Dr. and Mrs. E. E. Day on the birth of a daughter on April 12th. J|t 9fC 3|C 9|C We also congratulate Dr. and Mrs. Frank Hebb on the birth of a son, born on April 5th. Dr. Frank Hebb, who has lately come to Vancouver from Montreal, has commenced practice in Vancouver and has opened offices in the Birks Building. *p I* *(• n* Dr. G. D. Saxton has commenced practice in Vancouver. He will be associated with Dr. Wilfred Graham, and will confine his practice to surgery. Mrs. Saxton also holds a degree in medicine. Page 177 We offer our deepest sympathy to Dr. Taylor Henry on the death of his father, the Rev. A. E. Henry, who died on April 19th. * * * * Dr. and Mrs. Hugh Alexander of Vernon are receiving congratulations on the birth of a son at Vernon on April 14th. * * * # All members of the Association were shocked to hear of the serious illness of Dr. W. A. Whitelaw. We earnestly hope that he will make a satisfactory recovery. * * * * Dr. W. T. Lockhart, Honorary Treasurer, has recently undergone an operation for appendicitis. We wish him a speedy and complete recovery at an early date. THE ANNUAL MEETING OF THE f VANCOUVER MEDICAL ASSOCIATION The Annual Meeting of any organisation is usually one of the most important of the year. Every organisation, presumably, exists for the benefit of its members. Dues are charged and collected and spent that the purpose for which the organisation came into being may be fulfilled. Officers are elected to carry out these purposes, to hold meetings, to do executive work, to spend money, and so on. At the Annual Meeting reports of the year's work are given—accounts of how the moneys were spent, programmes for the future discussed. Generally some member rises to protest indignantly the expenditure of $3.98 on a new cuspidor, or of $7.65 for a solid gold cigarette case presented to the retiring Secretary. There is generally a keen and lively discussion on various topics, and very often a banquet opens the proceedings, and over heavy cigars the membership listens gravely to an address on the Banking Systems of the world given, by one of the more prominent members of the Robber-Barons' Union. There is, we are trying to say, a certain amount of interest shown in the proceedings by the members, many of whom attend no other meetings during the year but this one, the Annual Meeting. But in this, as in so many things, the medical profession follows a law of its own. It does not attend the Annual Meeting of its Association. Two hundred and seventy-seven members we have, and besides the officers of the Association, and our faithful coadjutor Dr. M. W. Thomas, not more than fifteen or twenty other members were there. A deep religious silence, a most funereal gloom, brooded over the lugubrious and melancholy congregation, none of whom laughed or as much as smiled at any time during the entire proceedings. The gloom deepened perceptibly as the Treasurer's report, announcing a credit balance, was read; it lifted somewhat when it was announced that many of our bonds were in default of interest, but deepened once more when the membership learned that the entertainment fund had been depleted by $100 or so. A min, melancholy sound of applause greeted the announcement of the new officers' election. There was no voting; no competition. Hitler never had a more complete unanimity in Austria. At this point the present scribe could stand it no longer. Bursting into tears, punctuated with anticipatory hiccoughs, he left the room, and, seizing John Naden's hat and coat, made for the Hotel Georgia Beer Parlour. He knew that with that disguise he was safe not to be recognized. But, so-called jesting aside, this is a sad state of affairs. Year by year, the attendance at meetings in general dwindles, while the membership grows; year by year the Annual Meeting grows duller and duller, more and more apathetic, till it resembles the Mad Hatter's Tea Party, where the Dormouse Secretary must continually be shaken to wake him up. Page 178 This is not right; excellent work is done all year, and nobody cares. Money is collected and spent, and nobody gives a hoot. New officers are elected and charged with the control of our business for a year, and not a soul gives a tinker's dam. Why is this? and how can we hope for the best in work and organisation and unification of our profession when things are like this? It is high time that some attention was paid to this matter, and definite steps taken to make meetings attractive, and above all to make the Annual Meeting one of the events of the year. Why should it not be a dinner meeting, with an outside speaker, with music, and a cocktail before and some sort of poisonous drink to follow? We should, perhaps, utilise this occasion to fraternise with our sister professions—law, the Church, the engineers, good fellows all; even a chiropractor might do a little readjusting of our mental outlook. It is no good reproaching men for not coming; just to sit and listen to reports is not going to attract the rank and file. But the rank and file pay the bills, and their tastes should be considered, and their interest aroused by features which will attract them. As a neighbour said to us at the meeting: "We need a little more ballyhoo in our profession." We need to relax a bit, to get together more, to play the fool together. "Dulce est desipere in loco" says the old sage, meaning, it's a lot of fun to play the fool on occasion. We urge on the incoming Executive that its members take this under advisement; that they study this situation, and try to find the causes, if they can, of this lack of interest, and remedy these causes. It is not the lack of good work, of well-prepared and well-given papers; it is the drabness and lack of colour, the lack of controversial topics, the absence of ritual and ceremony and surprise. The shade of John Mawer Pearson must have looked sadly on at last night's meeting, as he recalled the years gone by: even in the pre-war years a hundred members at a meeting were not uncommon, and there were some great old rows and dogfights in those days. Now it takes an Osier Dinner or a speaker from an outside city, or a Health Insurance meeting. The programme committee may well analyse these meetings and see what it is in them that attracts men, and apply the knowledge to future gatherings. Verbum sap! VANCOUVER MEDICAL ASSOCIATION SUMMER SCHOOL NOTES § f The Vancouver Medical Association Summer School Clinics will be held in June, from the 21st to the 24th inclusive. Lectures will be given as usual in the Oval Room of the Hotel Vancouver in the mornings and evenings. Clinics will be held at the various hospitals. It is to be hoped that all medical men in the city and district, and as many from the Province as possible, will make every effort to attend this year's School. The quality of fare to be offered will be of the same high standard as at former schools and should not be passed up. A tentative programme is set out in this number of the Bulletin, and following are a few brief notes concerning the lecturers who will be here. Dr. Ray Farquharson, Associate Professor of Medicine at the University of Toronto, is well known to graduates of the University of Toronto. Dr. Andrew Hunter, Professor of Pathology; University of Toronto, is no stranger in Vancouver, as he has lectured at Summer Schools here in the past. In addition to giving lectures at the Summer School this year, he will give the address at the luncheon to be held on June 21st. His subject will be "The Edinburgh School of Medicine: Historical Notes and Personal Recollections." Dr. Oliver S. Ormsby, Clinical Professor of Dermatology at the University of Chicago, will come to the Summer School Clinics from the meeting of the American Dermatological Association in San Francisco. He has recently Page 179 published the fifth edition of his book, "Practical Treatise on Diseases of the Skin." Dr. Ormsby is outstanding in his special field. Dr. Glen Spurling, whose specialty is neurosurgery, is Associate Professor of Surgery at the University of Louisville, Louisville, Kentucky. He will deal with the problem of Low Back Pain, Painful Arm and Shoulder, and Intractable Pain, in his lectures here. Dr. Waltman Walters, Associate Professor of Surgery, Mayo Clinic, Rochester, is well known to many medical men who have met him at the Mayo Clinic. The subjects on which he has chosen to speak promise to be of great interest. The programme has been designed to meet the needs of the general practitioner, but will also contain much that will interest the specialists. The topics will deal with matters which are of current interest among medical men. BRITISH COLUMBIA MEDICAL ASSOCIATION The Annual Meeting of the British Columbia Medical Association will be held in Victoria, with headquarters at the Empress Hotel. The dates set are September 15th, 16th and 17th. Committees are now preparing programme, which will be published as soon as possible. Several outstanding speakers have already been provided. The ladies' entertainment will provide an attraction that should assure a large attendance. COMMITTEE ON CANCER Dr. J. S. McEachern of Calgary, Chairman of the Committee on Cancer of the Canadian Medical Association, attended a meeting of the Committee on the Study of Cancer of the British Columbia Medical Association on April 11th. Dr. McEachern told of the development of the National Society for the Control of Cancer. The British Columbia division is in process of formation. COMMITTEE ON CONSTITUTION AND BY-LAWS Dr. H. H. Milburn, Chairman of the Committee which has in hand the effort to increase the membership from this Province in the Canadian Medical Association, reports that the survey of the whole provincial profession is progressing with excellent promise of caching its objective. Dr. Milburn believes in organized medicine and prizes it by this loyal support and his. generous contribution of time and effort. More power to him. THE VICTORIA MEDICAL SOCIETY The Committee in charge of meetings and programme in Victoria has conceived a novel idea in securing a comfortable arrangement which may encourage attendance at meetings. A light supper was served at 7: 30 in the large private dining room of the Union Club at the regular meeting on Monday, April 11th. The programme commenced punctually and business transacted expeditiously, and the members comfortably listened to the paper of the evening on "Allergy," presented by Dr. P. A. Clyde Cousland of Victoria. The success of this venture will be watched with interest. "Bleeding after the Menopause—in the majority of cases—is due to Cancer." Page 180 DR. AND MRS. SCATCHARD OF CHASE CELEBRATE GOLDEN WEDDING Clipping from an English Paper:— SCATCHARD—DONNE.—On April 10, 1888, at Faver- sham Church, Kent, by the Rev. W. Cowper Johnson, M.A., Rector of Yaxham, Norfolk, assisted «by the Rev. R. F. Smith, M.A., Minor Canon of Southwell Minster, Walter Scatchard, M.R.C.S. (England), of Boughton-sub-Blean, Kent, to Ada Kemble, youngest daughter of the Rev. C. E. Donne, M.A. Present address: Box 2, Chase, B. O, Canada. During over thirty years Dr. W. Scatchard of Chase has been practising in this province. The medical profession joins the many friends of Dr. and Mrs. Scatchard in heartiest congratulations and sincere good wishes on the occasion of their Golden Anniversary. Visiting their friendly fireside one feels the influence of all these happy years. The whole community participated in the celebration of this event at a huge party on April 16th. Dr. R. W. Irving of Kamloops was asked to make the presentation on behalf of the people at this function. Dr. and Mrs. Scatchard were the guests of honour at an at-home given at Salmon Arm by the members of the Masonic Order and the Order of the Eastern Star. Our much-respected colleague is a real sportsman in every way and enjoys an outstanding reputation as a marksman—he is hard on the birds. Dr. Scatchard obtained his degrees in England and Ireland and has made a fine contribution to medical practice in British Columbia. We wish Dr. and Mrs. Scatchard many further crowded years of happiness. a OBITUARY DR. JAMES HENRY HAMILTON Dr. J. H. Hamilton of Revelstoke died suddenly on April 3rd. He was a graduate of Toronto University in 1903. The profession in British Columbia again mourns the loss of one of its outstanding and loyal members. The late Dr. Hamilton graduated at the age of 21 and came at once to British Columbia and settled in practice in the Kootenays, where he spent his remaining 3 5 years. He first practised in Nelson and Arrowhead, and then moved to Revelstoke in 1906, where he was associated with Dr. W. H. Sutherland for many years, and, except for war service, he practised in Revelstoke for 3 2 years. He served as Medical Officer to the 54th Kootenay Overseas Battalion. Always a good citizen, he served in many and varied capacities, having been Mayor and Police Magistrate, holding as well other positions of honour and trust. His only son Jack, who is also a graduate in Medicine, now holds an appointment in research in Pathology at Cambridge University. Dr. Hamilton possessed a rather unique and very forceful personality. He was friendly and kindly' and supported strongly what he believed. The large representation of all walks of life at his funeral conveyed in some slight degree the esteem in which he was held by all of the people. For many long years there will be large numbers who will remember with regret the passing of "Doc Ham," as he was always lovingly called. The profession recognizes its loss in the passing of a true and loyal friend and wishes to express its sincere sympathy to Mrs. Hamilton and the family. —A. L. J. Page 181 District No. District No. o- -Dr. -Dr. COLLEGE OF PHYSICIANS AND SURGEONS OF BRITISH COLUMBIA The result of the recent election of members of the Council of the College of Physicians and Surgeons of British Columbia shows Dr. Osborne Morris of Vernon as a new member. He replaces Dr. Frank P. McNamee of Kamloops, who is the retiring member, having represented No. 4 Medical Electoral District during the past three years. The six other members of Council were re-elected by acclamation. The following will comprise the new council: District No. 1—Dr. T. McPherson, Dr. Gordon C. Kenning. District No. 2—Dr. S. C. MacEwen. District No. 3—Dr. W. E. Ainley, Dr. L. H. Appleby. Osborne Morris. J. Bain Thorn. * * * * Attention of all members of the profession in the province is again directed to the request regarding applications for appointments and the procedure to be followed in entering into negotiations leading to all contracts. It is gratifying to know that doctors find it possible to discuss these matters with the office and in many instances very profitably. The office has received many evidences of the confidence it enjoys and attempts to deserve. The doctors who use the office freely find its service helpful. Appointments and contracts of all.kinds can be freely discussed with the Executive Secretary, Dr. M. W. Thomas, 203 Medical-Dental Building, Vancouver. The request as published includes the name of Dr. A. J. MacLachlan, Registrar, whose help and advice is always available to the profession. The key-word of service must be: "Keep in touch with the office of your College." PROTECTION BY AUTOMOBILE INSURANCE: PERSONAL LIABILITY A member of the profession has had heavy damages assessed against him arising out of injuries to persons in an automobile collision which was adjudged an accident in which equal blame was placed on both drivers. We would submit that the slightly increased premium cost of heavier protection under insurance would make it appear advisable that our members should attempt to fully protect themselves against such exigency. On medium-weight cars the difference in annual premium between $5,000-$10,000 and $20,000- $40,000 coverage is approximately $5.00. Doctors require protection. IMPORTANT NOTICE Appointments and Contracts Members of the College of Physicians and Surgeons of British Columbia are requested not to apply for any appointment or enter into negotiations with reference to any contract without having first communicated with either or both: DR. A. J. MACLACHLAN, Registrar, College of Physicians and Surgeons of B. C. and/or DR. M. W. THOMAS, Executive Secretary, College of Physicians and Surgeons of B. C. 203 Medical-Dental Building, 925 W. Georgia St., Vancouver, B. C. Members are reminded that it is incumbent upon them to notify the office of change of address. This is simply done and very helpful. Page 18 30 SYMPOSIUM ON LIVER AND GALL-BLADDER [Read before the meeting of the Vancouver Medical Association, April, 1938.] PHYSIOLOGY OF THE LIVER AND GALL-BLADDER Dr. Evelyn Gee. Mr. Chairman, Ladies and Gentlemen:—The portion of this Symposium which it is my privilege to place before you tonight includes a vast amount of medical experimentation. Even avoiding the more controversial aspects, it is impossible to give anything but the briefest outline; and I offer this in apology for not giving you the history of the work, nor even, in many instances, the names of the workers, but only the most generally accepted theories, as if they were merely my own, in this respect failing to give credit where credit is due. The liver, the largest gland in the body, receives blood from the splanchnic area through the portal vein, and from the aorta through the hepatic artery. The portal vein differs from other veins in that it divides into numerous branches to form a rich capillary network within the liver substance, but differs from an artery in that it is interposed between two capillary beds, one in the liver, the other in the splanchnic area which it drains. Next it divides into vessels which run between the hepatic lobules. These give rise to capillary-like vessels called hepatic sinusoids, lying between the liver cords and separated each from a bile capillary by a single layer of hepatic cells. The Kuppfer cells (reticulo-endothelial) are found within the sinusoids, attached by delicate strands to their walls. The sinusoids converge towards the centre of the lobule, where they enter into the central vein. These unite to form the hepatic veins, which empty into the vena cava. The hepatic artery is distributed mainly to the fibrous tissue of the capsule and septa, but its terminal branches join the hepatic sinusoids. The blood conveyed to the liver by the hepatic artery constitutes only about 25% of the organ's total blood supply. Upon this fraction the liver depends for its oxygen ! In the dog and probably in man, the muscular coat of the hepatic veins near their entrance into the vena cava is highly developed, and when contracted may cause a marked resistance to the hepatic blood flow. Through this arrangement the hepatic veins serve as an adjustable sluice by means of which the quantity of blood in the liver varies under different conditions. At one time the blood may be pooled in this reservoir, and at another an extra quota may be delivered into the general circulation. The blood here, however, is not in a cul-de-sac, as in the case of the spleen. This so-called "hepatic sphincter" is constricted by peptone and histamine and relaxed by adrenalin or sympathetic nerve impulses. The great engorgement of the liver and splanchic area in dogs in histamine shock, or in anaphylactic or peptone shock, is apparently due to constriction of the hepatic veins and damming back of blood in the portal system. Adrenalin, on the other hand, causes the immediate delivery into the general circulation of a weight of blood equal to half the weight of the liver itself. The blood flow through the liver is also varied through influences acting upon the intrahepatic vessels and upon the vessels of the splanchnic area. Variations in the calibre of the former will alter the resistance to the flow through the liver; variations in the diameter of the latter will increase or diminish its supply: e.g., in cirrhosis of the liver of the portal type the compression of the intrahepatic vessels by fibrous tissue raises the resistance and we observe the development of a collateral circulation between the portal and systemic veins. The Ech Fistula, "A negative Schiller's test almost certainly excludes Cancer." (See Bulletin, 193 6, Vol. 13, Page 50.) Page 183 a communication between the portal vein and the vena cava produced experimentally to exclude hepatic function, accomplishes this return more directly. This is, I think, a fairly comprehensive list of the hepatic functions. The first, namely the secretory function, we will consider presently in some detail. The remainder must be passed over lightly. Hsematopoiesis in the embryo is soon localized in the liver, spleen, bone marrow and lymph glands. Later in prenatal life the liver loses its power to produce stem cells. Fibrinogen is markedly reduced in various clinical conditions involving the liver, e.g., phosphorus poisoning and acute yellow atrophy, and evidence points to the liver1 as the site of its production. Heparin, antithrombase, the most powerful of all anticoagulants of animal origin, is obtained experimentally from liver tissue. Iron, absorbed to the greatest extent in the upper part of the small intestine, rapidly disappears from the blood stream, being stored chiefly in the liver. Being the essential constituent in the haemoglobin molecule, it must be available in adequate amounts in order that normal blood regeneration shall occur. Copper, which is believed to act as a catalyst in some stage of haemoglobin synthesis, is also mainly stored in the liver. The part played by the liver in blood volume regulation has been touched upon in our discussions of the vascular mechanism. By this mechanism it also serves in the regulation of body temperature to encourage or minimize heat loss. The reticulo-endothelial cells are phagocytic for foreign particles, this being one of their chief functions. In this they constitute one of the most powerful means by which the defense of the body is maintained. Their action, though similar to that of the neutrophilic leukocytes, is less mobile and more localized in character. They, however, contribute towards repair processes and may change into wandering cells, or they may lose their phagocytic powers and be converted into ordinary connective tissue elements or into epithelioid cells. Their ability to take up ingested thorium dioxide, which is opaque to the x-rays, is made use of to delineate the liver in the living subject. The epithelioid and giant cells of certain specific inflammatory processes, e.g., the tubercle, are derived from such cells. The elements of the reticulo-endothelial system situated in various parts of the body, as well as these Kuppfer cells, are' the responsible site of bilirubin formation. Small quantities of indol, skatol and phenol are absorbed into the bloodstream from the intestinal tract and undergo detoxication in the liver. The liver is an important site of protein metabolism. The reduction of all food protein to its amino-acid constituents enables the body to choose assortments peculiar to its own protein structure. Those which are not required intact for building body protein are broken up. Deamination in dogs and most probably in man occurs only in the liver. In deamination the incombustible amino group is split from the amino-acid molecule, and the ammonia so produced is combined with carbon dioxide to form urea which is excreted in the urine. In dogs this urea production has been proven to be exclusively a hepatic function. That these results apply also to man is indicated by the observations of Rabinovitch. He has reported that, in a case of acute yellow atrophy with extensive damage to kidneys and liver, the excretion of urine was almost suppressed, yet the blood was urea-free. The appearance of leucine and tyrosine in the urine in acute yellow atrophy may also be ascribed to failure of deamination of these amino acids. That the body, given the necessary amino-acids, can link them together and so synthesize protein, is unquestioned. The extent to which amino-acids can themselves be synthesized is a more difficult problem. It can, apparently, synthesize the simplest one, glycine. In man, uric acid is formed in part from purines taken in the food and in part from body purines. In man, the liver is, apparently, the only tissue which Page 184 contains xanthine oxidase, which suggests the possibility that uric acid production in the human subject is essentially a hepatic function, and the liver is also probably the site of uric acid destruction. Galactose and fructose are converted in the liver to glucose, which is apparently formed in appreciable amounts only in the liver, hypoglycemia soon developing when the organ is removed. Sugar is also made from protein in the liver, and if sugar formation from fat does take place, all the evidence suggests that the liver is the principal site of the change. In carbohydrate metabolism the liver forms a unit in the Cori cycle which shows the glucose molecule in the blood, changed to muscle glycogen, which breaks down to lactic acid, carried by the blood stream in part to the liver, where it is built up into glycogen, which may again be released as glucose. It also plays a large part in blood sugar regulation, providing glucose from liver glycogen, protein, muscle lactic asid and absorbed carbohydrates. The liver apparently plays a particularly important part in the metabolism of fat. The fatty acids combined as liver phospholipids or glycerides are more unsaturated than fatty acids found in other tissues, suggesting that double bonds have been introduced into the fatty acid molecule in the liver. Also, under a great variety of conditions neutral fat or cholesterol esters may accumulate in the liver to a very much greater extent than any other tissue. There is an increase in the fat of the liver wtihin a few hours after ingestion of a meal containing .large amounts of fat. Under other conditions, when no fat is fed the liver becomes intensely fatty. The liver is also the principal if not the only site of formation of the ketone bodies. The liver, wherein numerous chemical reactions are carried out, is one of the main sources of the body's heat. We will now return to the secretory function of the liVer. Bile is secreted continuously by the polygonal cells, by passing along bile capillaries through the hepatic and cystic ducts to be stored in the gall bladder. Its expulsion and passage along the common duct into the duodenum is intermittent, related in time to the arrival of food in the intestine, quite independent of the actual secretion by the liver. Its various constituents may be considered briefly. As a result of absorption of water and inorganic salts, gall bladder bile is several times more concentrated than liver bile. The bile salts, sodium glycocholate and sodium taurocholate, are formed from glycocholic and taurocholic acid respectively, these being formed from glycine, the simplest amino acid synthesized by the body, and taurine, both of them being plentiful within the body, and cholic acid, the supply of which is limited, the quantity available determining the level of bile acid secretion. This conjunction is performed only in the liver and is its specific function. The site of origin of cholic acid is not known. It appears to be related to cholesterol and the sex hormones, oestrin, progestin and the male sex hormones. Bile salts continue to be discharged from biliary fistula during long starvation. After their passage into the intestine they undergo reabsorption and are carried back into the portal blood stream to the liver for re-excretion. Under ordinary circumstances comparatively small amounts of bile salts are formed afresh by the liver, their concentration in the bile being maintained largely as a result of their being circulated over and over again through the portal and biliary systems. Nevertheless, if bile be withheld from entering the intestine by drainage, its concentration in bile salts does not become materially reduced, this indicating the existence of some mechanism controlling their production, the nature of which is obscure. The chief bile pigment, bilirubin, is formed by hydrolysis from haemoglobin, being the porphyrin fraction of the haemoglobin molecule, i.e., globin free and iron free. By oxidation, the various other pigments, biliprasin, bili- verdin and bilicyanin, are formed, and by reduction .urobilinogen, and by oxidation of this, urobilin. The elements of the reticulo-endothelial sys- Page185 tern through the body, chiefly in the bone marrow, are the responsible site of its formation, the transformation yielding, from each gram of haemoglobin liberated from broken down red cells, 40 mgms. of bilirubin. .1 to .5 mgms. of bilirubin is normally present in each 100 cc. of human serum, the freed iron being stored chiefly in the liver. When fresh red cells are cultured with reticulo-endothelial cells the former are rapidly destroyed, crystals of bilirubin being formed within the phagocytes, showing the transformation to be an intracellular process, and there is no evidence that the true secretory cells of the liver play any part in its formation, merely excreting the pigment that reaches them preformed. Next, bilirubin, when it reaches the intestine in the bile, undergoes reduction by bacieria to form urobilinogen. This is in part excreted by oxidation as urobilin and in part absorbed through the portal circulation to be almost completely re-excreted in the bile. Thus the urobilinogen normally present in bile represents re-excretion of this pigment After reabsorption from the intestine. Complete experimental obstruction of the common bile duct causes an accumulation of urobilinogen in the blood and excretion in the urine only, until the pigment disappears from the intestine. After the intestine is cleared the urine may contain bilirubin but is free from the derived pigment. Should infection of the biliary tracts occur, however, bacterial action at this site may cause its formation. Depression of the excretory functions of the liver by poisons such as chloroform, phosphorus, etc., will cause urobilin to appear in the urine though the injury be slight and there is no bilirubinuria, and when bilirubin formation is increased by haemolytic agents urobilinogen production is also increased, and the liver though functioning normally is unable to re-excrete the excess pigment formed in the intestine and urobilin appears in the urine. The percentage of lecithin and cholesterol is higher in gall-bladder bile than in liver bile due to the absorption in the former of water and salts. The ratio of concentration of cholosterol in bile to that of the bile salts is normally 1: 20 to 1: 30, the ability of the bile to hold cholesterol being dependent upon the bile salts, and if the ratio falls to 1:13 precipitation of cholesterol occurs. Little is known regarding the origin and function of biliary cholesterol. It does not vary with changes in the total blood cholesterol and is also not raised by increasing the cholesterol content of the diet, continuing to be excreted upon one cholesterol-free. A biliary portal circulation has been shown to occur. The bile has two important functions in the body, firstly as a vehicle for the excretion of pigments and other waste products, and secondly it plays an important role in fat digestion, being essential for its efficient digestion by the pancreatic and intestinal juices. Its coadjutant action with the pancreatic secretion is shown in obstruction of the common duct, in which case fat digestion is imperfect. The important aid is due to the bile salts which aid emulsification to a marked degree, the fat globules being reduced in size and the total surface area of the fat exposed to the action of' the pancreatic lipase being enormously increased. The bile acids also lower the surface tension. Also the cholic acid radicle is a specific activator of pancreatic lipase, the latter enzyme having only a weak action in its absence, and to a lesser degree upon gastric lipase, but none upon the fat-splitting enzyme of the intestinal juice. Bile is of even greater importance for fat absorption than for fat digestion, the latter being carried out to a considerable extent by the lipase of the intestinal juice. In obstruction of the bile ducts, over 80% of the fat in the faeces is in the form of fatty acids, but only a small proportion of ingested fat is utilized. The fatty acids unite with the bile salts to form complex compounds and as such the fat is absorbed. Bile salts also have a solvent action on cholesterol and are apparently necessary for the absorption of vitamin D. Taylor, Weed and Sykes have shown that a rise in serum calcium cannot be induced in dogs with biliary fistulae by administration of irradiated ergosterol but that this substance exerts its usual effect if combined with bile or bile salts. Page 186 Other functions of the bile are less clearly understood. As an antiputrefactive agent its action is probably secondary, the protective covering undigested fats afford to protein material encouraging the growth of proteolytic bacteria, and as a laxative also secondary, unsplit fats inhibiting intestinal motility. Apart from all of these functions it is probably essential to life. Of cholagogues, substances which stimulate biliary secretion, bile salts are the natural and most powerful ones. Secretin and a meat diet are others. Sugar is definitely inhibitory, and drugs such as salicylates have little effect. Bile is capable of being secreted under the pressure of from 250 to 300 mm. of water, secretion ceasing and jaundice appearing when the pressure reaches this height. Under ordinary physiological conditions the sphincter surrounding the opening of the common duct into the duodenum is kept tonically closed. The duct system fills with bile and when the pressure rises to from 50 to 70 mm. of water the fluid passes along the cystic duct into the gall bladder. The pressure regulating function of the gall bladder will be touched upon presently. The maximal pressure in the biliary canal system is not attained after obstruction of the common duct until a considerable time has passed—in dogs, 48 to 72 hours. Before discussing the liver function tests we will consider briefly the various types of jaundice. Bile pigment present in excessive amounts in the blood escapes into the tissues, staining them a yellow tint, and bilirubin may appear in the urine. Jaundice may be due to the production of bile pigment in excess of the amount with which the excretory power of the normal liver can cope or it may result from the failure of a damaged liver to excrete the bilirubin produced in normal amounts, and in either case it accumulates in the blood and when it reaches a certain degree of concentration diffuses into the tissues. Jaundice due to increased production of pigment is called hemolytic jaundice, and is of the non-obstructive type; that due to depressed or suppressed excretion of pigment by the liver, called hepatic jaundice, being further subdivided into obstructive jaundice, due to obstruction of the bile passages, and toxic or infective jaundice, due to damage of the liver cells by toxic agents or infections. Any condition which increases red cell destruction increases the formation of bile pigment, but unless the overproduction is very great the healthy liver, which possesses large functional reserve, is able to meet the extra demand. When disintegration of red cells is such that the balance between production and excretion of pigment cannot be maintained even by the normal liver, the bilirubin concentration of the blood rises above normal limits and a true haemolytic jaundice results. The jaundice resulting from blockage of the hepatic or common duct is not due to the reabsorption of bile which has been secreted into the obstructed passages but to the suppression of secretion. In this type the bile pigment is believed to pass from the blood into the liver cells, but instead of being secreted into the capillaries it is absorbed into the hepatic veins and lymphatics. The so-called white bile, a fluid free from pigment and bile salts which fills occluded ducts, is secreted by the membrane lining the ducts. The excretory mechanism has a large reserve. In dogs jaundice does not develop until 90 to 95% of the excretory ducts have been occluded. Liver damage and consequent depression of the secretory functions of the liver to produce the toxic and infective type of jaundice is due to a variety of conditions. Jaundice possibly seldom falls into one of these pure types, being more frequently due to a variety of causes, e.g., in the hemolytic type, in pernicious anemia an associated hepatic insufficiency may be a factor and many hemolytic substances are hepatic poisons as well. In the obstructive type, the liver cells suffer damage from pressure and the retention of bile salts may give a certain amount of hemolysis; and in inflammatory conditions of the bile ducts and obstructive.element due to plugging of the intrahepatic ducts by bile thrombi may be present. "A positive Schiller's test demands further investigation." (See Bulletin, 193 6, vol. 13, page 5 0.) Page 187 The clinical tests commonly employed in the study of jaundice are the Van den Bergh reactions, qualitative and quantitative, the icteric index and the galactose tolerance test of liver function. The Van den Bergh test used to detect bile in serum has two types of colour reaction, the direct without the addition of alcohol and the indirect in which alcohol is essential. The direct reaction occurs in three forms, the immediate or prompt reaction, the delayed reaction and the biphasiq reaction, which is prompt but requires a variable time for completion. Normal bile and the serum in obstructive jaundice give the prompt direct reaction. Normal serum, the serum in hemolytic jaundice and the bilirubin formed in old blood extravasations, give only the indirect. The sera in types of jaundice due to liver damage give a direct reaction usually of the delayed or biphasic type. All sera which give a direct reaction also give the indirect. This indirect reaction is used as the basis for the quantitative estimation of bilirubin in all types of sera. By comparison with a standard colour solution the units of bilirubin, or as seems preferable the mgm. per 100 cc. of serum, may be estimated. The bile pigment concentration may also be estimated by comparing the colour of the serum with that of a standard solution. This estimation is called the icteric index. The method which we are using, developed by Ernst and Forster, because of its ease of determination, and because hemolysis does not interfere with its accuracy, provides a convenient means for following the course of patients with jaundice of any type. Values for the icteric index above 5 obtained by this acetone method are regarded as abnormal, although occasionally a normal serum will show an icteric index 1 or 2 units higher. When a slightly but definitely increased icteric index is unconfirmed by the Van den Bergh test, the latter is regarded as probably being in error. This has been substantiated repeatedly by clinical observations. It has also been found that when serums contain over 5 mgm. per cent of bilirubin the icteric index does not bear a constant relationship to the Van den Bergh. In cases where differential diagnosis is required the qualitative Van den Bergh is essential. When the abount of serum bilirubin is small, the determination of the acetone icteric index at frequent intervals provides more accurate information than the quantitative Van den Bergh. When the amount of circulating bilirubin' is high the. quantitative Van den Bergh is more reliable than the icteric index. The galactose tolerance test is used to distinguish jaundice due to liver damage from that due to obstructive jaundice. Galactose is converted into glycogen, though with considerable difficulty, by the normal liver. The patient is made to fast, then given 40 gms. of galactose. Normally or in jaundice of the obstructive type 3 gms. or less are excreted in the urine within five hours. In jaundice due to liver damage the excretion amounts to from 4 to 5 gms. or more in the same time. In obstructive jaundice plasma phosphotase is increased and bradycardia, pruritus and reduced coagulability of the blood referable to the retention of biliary constituents other than pigment may be evident. Serum calcium may be lowered in obstructive jaundice, but the reduction in blood coagulability is apparently not due to this factor but rather, it is thought, to the retention of some anticoagulant substance. The recent work of Ivy and his associates strongly suggests that the reduced coagulability of the blood is in some way associated with vitamin D deficiency. The subcutaneous administration of irradiated ergosterol in cases of obstructive jaundice was found definitely to shorten the coagulation time. The actual cause of the pruritis and bradycardia is not definitely known. The different Van den Bergh reactions, namely the direct in the obstructive and liver injury types of jaundice and the indirect in the hemolytic type, are believed to depend upon some physical or chemical difference between the serum bilirubin in these two instances. It has been supposed that the differences depend upon whether or not the pigment has passed through the liver cells. In the obstructive and liver injury types, which give the direct reaction, Page 188 the pigment apparently takes this course. In the hemolytic type, which gives the indirect reaction, the retained bilirubin is that which the liver cannot dispose of and probably therefore does not enter the secretory cells. Several theories have been put forward in an attempt to explain the different behaviour of the two types of bilirubin towards the diazo reagent, but though extremely interesting time does not permit their review. Several of the specific functions of the liver have been utilized as tests for the investigation of the functional capacity of the liver as a whole, i.e., as a means of detecting the presence of hepatic damage or, in some instances, of gauging the extent to which such damage has occurred. Tests based upon the excretory functions, the icteric index and the quantitative Van den Bergh we have mentioned. Since the excretion of bilirubin is an essential hepatic function, a determination of the quantity of circulating bilirubin is a valuable means of estimating the extent of liver damage associated with jaundice, provided the hyperbilirubinemia is not the result of biliary obstruction or of blood destruction. The galactose tolerance test we have also mentioned. The estimation of the quantity of urobilinogen excreted in the urine may also be used, but increased blood destruction, as in pernicious anemia, quite apart from liver damage, will cause urobilinogenuria, and infection of the biliary passages may increase urobilinogen output out of all proportion to the reduction of liver function. Various materials, notably bromsulphalein, bilirubin and rose-bengal, are used as intravenous injections, the rate of excretion estimated from the quantity retained in the serum after the lapse of a specified time, the concentration being determined colori- metrically. These three are excreted practically entirely, no significant amounts being taken up by the reticulo-endothelial cells. They are of no value if obstruction of the bile ducts is present. Damaged or not, the liver cannot excrete them. Colorimetric difficulties render dye test inapplicable in the presence of hyperbilirubinemia and obviously the bilirubin injection could not be employed. Tests based upon the metabolic functions of the liver have also been devised. Here we may also mention the isoiodeikon injection test used by Evarts Graham. By not operating on cases which show a 50% retention he claims to have reduced his mortality in gall-bladder surgery .2%. The levulose or fructose tolerance test, a blood sugar curve determination, is made after levulose is fed after a fast. The greater quantity of sugar converted by the liver into glycogen, the less pronounced will be the rise in blood sugar, and characteristic curves have been charted to indicate the absence or presence of hepatic injury. This and the galactose tolerance test are of value because applicable in the presence of jaundice. Tests based upon the functions of the liver to deaminate the amino acids with the production of urea and upon its detoxicating functions have also been devised but are seldom used in practise. These tests are purely functional tests and a negative result does not necessarily indicate the absence of liver damage. It may be seriously damaged without its condtiion being revealed by any of these means. We have left little time for a discussion of gallstones. They are composed of constituents of bile which have been thrown out of solution and are classified according to their composition. The mechanism of their formation is not clearly understood, but the most important factors generally recognized are injury, especially of an infective nature, to the gall-bladder wall, disturbances in cholesterol metabolism, stasis of bile and reaction of bile. Though we cannot deny the importance of gall-bladder injury, it has been proven that this is not essential to the formation of calculi and that certain types, especially the solitary cholesterol stone, can arise in the absence of any diseased condition of the lining membrane. The multiple cholesterol-pigment- calcium stones are usually looked upon as typical infection stones. The inflammatory exudate is rich in protein material derived from the blood as 5All irregular bleedings signify danger:—Cancer?'' Page 189 well as in cholesterol and calcium. It has been pointed out that this protein carries an electric charge of opposite sign to that held by the cholesterol, pigment, etc., and that as a result of these physico-chemical reactions the deposition of the various constituents is effected. The typical metabolic calculus is the large single pure cholesterol stone. The common mixed stones, cholesterol-pigment-calcium, are also composed largely of cholosterol and probably, in many instances, are metabolic rather than infective in origin. In certain conditions, e.g., in pregnancy, in which gallstones are prone to develop, there is evidence of disturbance in cholesterol metabolism, not necessarily a hypercholesterolemia, probably not common in pregnancy, but an alteration in the proportion of free cholesterol to cholesterol esters, the former increased, the latter reduced. Abnormalities in cholesterol metabolism leading to such changes are probably of more importance in the production of gallstones than a rise in total blood cholesterol. The ratio of bile to bile salts is also an important factor in the formation of gallstones, and when infection is a factor it may act through reducing the bile salt concentration, bile salts possibly passing through the inflamed mucosa. Pure pigment stones also occur apart from infection and may be the result of the precipitation of bilirubin from a bile which contains an excessive amount of the pigment. Stasis or slowing of the biliary flow within the bile passages may be responsible for the formation of small stones of pigment- calcium and stasis of bile in the gall-bladder is an important feature in the production of gallstone here. One of the functions of the normal gall-bladder is apparently the acidification of the liver bile. So long as this occurs, the calcium carbonate of the bile remains in solution. The functions of the gall-bladder, though important, are not indispensable, since it can be removed with impunity. After such an operation, however, the large bile ducts undergo dilatation, which may in part compensate for its removal. Its rhythmic contractions are capable of producing a pressure of from 250 to 300 mm. of water. Its functions are the concentration and storage of bile and the secretion of mucus. Water and inorganic salts are absorbed; bile salts and cholesterol are not absorbed to any appreciable degree under normal circumstances. The gall-bladder contains 3 to 10 times more bilirubin than the liver bile, experiments showing absorption to occur with remarkable rapidity, the mere passage of bile through a gall-bladder having been shown to increase its concentration nearly 5 times. Inflammation reduces or abolishes its concentrating power. The mucosa also adds to the viscosity of the bile by the secretion of thick mucus, little or none of which is formed by the bile ducts, the latter serving to dilute the bile with a thin watery fluid. If the gall-bladder is healthy and left in communication with the obstructed system, biliary stasis causes thick bile to collect in the ducts and bladder, due to the latter's concentrating activity. Uultimately the activity of the ducts overcomes that of the gall-bladder, the.biliary constituents disappearing, to be replaced by a thin simple secretion of the ducts and mucinous material from the gall-bladder. It is evident, therefore, that obstruction of the hepatic ducts is not likely to form calculi, aj's they are situated proximal to the concentrating power of the gall-bladder, and that jaundice will develop more quickly in obstruction of the common duct after the gall-bladder has been removed. Other functions of the gall-bladder are reduction of the alkalinity of the bile and equalization of pressure within the biliary system. Without the ability to absorb fluid and reduce the bulk of the bile, its power to equalize pressure would be negligible. The gall-bladder is evacuated due to contractions of its wall, the times of emptying related to gastric digestion. The sphincter of Oddi can normally withstand a pressure of 100 to 120 mm. of water. The duodenal muscle surrounding the oblique intramural portion of the common bile duct, however, is capable when contracted of offering a resistance of over 750 mm. of water, accounting for the fact that during evacuation of the gall-bladder and active duodenal movements the bile may be observed to enter the duodenum in Page 190 spurts. The most effective stimulus for the discharge of bile is a meal of fatty material, particularly egg yolk or cream; the products of fat digestion, hydrochloric acid of a strength comparable to that of chyme, or magnesium sul- phase, placed in the duodenum, also cause its evacuation. Bile salts injected intravenously cause relaxation. The mechanisms controlling evacuation are nervous and hormonal, acid or other substances placed in the duodenum acting apparently by liberation of a hormone related to but not identical with secretin. Cholecystography is performed by making use of the fact that certain dyes, sodium .tetraiodophenolphthalein or the corresponding bromine compound, are excreted selectively by the liver. These compounds, after concentration in the gall-bladder, are opaque to x-rays. Cholesterol stones, relatively transparent to x-rays, show up against the gall-bladder shadow. Those containing more than .5% of calcium are visible without the aid of an opaque-dye. B. C. PHARMACEUTICAL SOCIETY We would call our readers' attention to the following, contributed by the B. C. Pharmaceutical Society. We feel that these requests on the part of our very good friends the druggists are very timely and very reasonable. These things work both ways; and what is bad for the goose in this case is equally bad for the gander; so let us ponder over these things, and then, in the words of that immortal soul, Wackford Squeers, let us "go and do it." PLEASE DO NOT ORDER NARCOTICS SPg BY TELEPHONE! Any pharmacist who allows narcotics to leave his stock before receiving a written order covering same, is liable to a fine of not less than $200.00 or to imprisonment, or both. BE FAIR TO YOUR PHARMACIST! PLEASE DO NOT QUOTE PRESCRIPTION PRICES! The price of a prescription to the patient includes not only the charge for material, but includes also the pharmacist's charge for his professional services. The physician should therefore refrain from discussing prescription prices with the patient, for the same reason as the pharmacist should refrain from entering into discussion regarding the physician's fee. BE FAIR TO YOUR PHARMACIST! PLEASE BEWARE OF INADVERTENTLY ADVERTISING Many of the patent-medicines enjoying a huge sale owe their present position to having been introduced to the public by word-of-mouth prescribing, and to liberal distribution of samples, on the part of physicians. Pharmacists have seen the reaction of patients towards their physician on discovering that he has prescribed a "patent-medicine"! BE FAIR TO YOUR PHARMACIST AND YOURSELF ! PATENT-MEDICINES! PLEASE PRESCRIBE WITH CARE! "Train orders must be written." The same precaution might well be applied to prescriptions, or as an alternative, except in the case of narcotics, prescriptions should be telephoned direct to the pharmacist. Directions for the label should be ordered with the same care as are the ingredients. BE FAIR TO YOUR PHARMACIST AND YOURSELF! Page 191 UPPER ISLAND MEDICAL ASSOCIATION Dr. E. D. Emery, the Honorary Secretary of the Upper Island Medical Association, announces to the membership the Spring Meeting, to be held at Qualicum on Friday, May 27th. The ladies are especially invited to accompany the members. It is planned to make a day of this session, with Golf, Lectures, Dinner, Cards and Dancing. The papers will be provided by Doctors D. H. Williams, Director of the Division of Venereal Disease Control; S. C. Turvey, Neurologist, and J. A. Wright, Clinician, all of the Division of Venereal Disease Control. Dr. Turvey will deal with "Neuro Syphilis." Dr. Wright will present a report on "The Results of Newer Treatment in Neisser Infections." Programme: Golf tournament, 2 to 4 p.m.; meeting, 5 to 7 p.m.; dinner, 7: 30 p.m.; cards and dancing, 9 p.m. Those arriving earlier in the day may use the golf links, and luncheon will be arranged by the hotel. Members are asked to notify Dr. Emery if they will be accompanied by ladies and will require luncheon. This should prove to be a very excellent meeting. LIVER AND GALL-BLADDER We are publishing in this issue one of the papers read in the form of a Symposium at the general meeting on April 5th. The paper by Dr. Pitts will follow in due course. As regards the paper read by Dr. W. L. Graham, it will also be published later, with some of the figures and statistics omitted, as they are based on a series of cases reported by his brother, Dr. Roscoe Graham of Toronto. "Cancer of the Cervix is not uncommon in young women." THE SUPERIOR VEHICLE VALUABLE FOR | ACUTE INDIGESTION FERMENTOL H\0 RNER DISTINCTIVE COLOUR DISTINCTIVE FLAVOUR Page 192 w Improved Forms of SULPHONAMIDE MEDICATION for Streptococcal Infections SEPTAZINE The Benzyl derivative of p. aminophenly sulphona- mide. AN IMPROVED SULFANILAMIDE Better tolerance Less toxicity Tasteless In tablets each grs. 7^4, for oral use. SOLUSEPTAZINE contains the p. aminoben- zene sulphonamide in the most concentrated form available. A colourless solution, will not cause any colouration of the skin or mucous membranes. In ampoules of 5 cc. and 10 cc. for intravenous or intramuscular injections. SEPTAZINE and SOLUSEPTAZINE are ethical products advertised solely to the Medical Profession. ^^§^H)S^Hi- \ I xxuJ^Lc:m/^^^ SS*0 N'■ T U E A L Distributors: ROUGIER FRERES, 3 50 Le Moyne Street, Montreal. MEMBERS of THE GUILD of PRESCRIPTION OPTICIANS of AMERICA Always Maintain the Ethical Principles of the Medical Profession Guilder aft Opticians 430 Birks Bldg\ Phone Sey. 9000 Vancouver, Canada. VITAMIN Bi for IMPROVED INTESTINAL TONE Because recent studies have shown that vitamin Bx has a beneficial effect on the tone of the intestines, this vitamin is receiving more and more attention as an aid in treating atonic constipation. A good source of vitamin Bx is Kellogg's All-Bran. Notice how the vitamin Bx content of All-Bran compares with that of other foods. The presence of this vitamin, in such plentiful quantities, in a food which also contains natural "bulk," is being recognized as a further reason for recommending this laxative cereal. IT TAKES !:"' 2 OZ. Z OF SPINACH, OR 2i| OZ. OF WHOLE EGG OR m 2| oz. OF WHOLE ORANGE, TO SUPPLY THE AMOUNT OF Bt CONTAINED IN 1 OZ. OF ALL-BRAN *G ALL-BRAN A Natural Laxative Cereal [<"» <v *s A a ■■ AND NOW-I'D LIKE TO INTRODUCE A NEWCOMER TO OUR HERD-MRS. 8L0SS0M- WHO WILL WORK WITH VS TO UPHOLD 80RDEN IDEALS- V/« TEAM -WO R K —The milk arriving daily from every farm herd must conform to certain Borden standards, or it won't be admitted to Borden plants. Laboratory tests of every milk batch are part of the strict system of control that safeguards the purity of the milk we use. Perhaps we're too fussy about the freshness, flavour and quality of our milk. But only by these high standards can such a uniform, safe milk be made*— the Irradiated Evaporated Milk which is labeled "Borden's." Doctors often write "BORDEN'S" when prescribing evaporated milk for infants. Doctors know, as many mothers do not, the extra safeguards that surround all Borden products. Borden's Evaporated Milk was accepted in 1930 by the American Medical Association Council on Foods. If you are not familiar with Borden's St. Charles Evaporated Milk, unsweetened, write The Borden Company Limited. Yardley House. Toronto, Ontario, for professional literature and samples. ftcticti&tlA ■MP ^syll When Urogenital Symptoms Harass the Patient More *«. decade of ex . ^ % *. oraJ mm i Mij nistration of (Phenylazo-Alpha-Alpha-Diamino-Pyridine Mono-Hydrochloride) References to published medical literature on symptomatic relief from Pyridium in Cystitis, Pyelonephritis, Prostatitis, and Urethritis, will be furnished on request. MERCK & CO. LTD., Manufacturing Chemists, Montreal PETROLAGAR "Agreeable and Effective" As an aid to establishing "Habit Time" of bowel movement Petrol- agar has proved to be both agreeable and effective. Petrolagar mixes intimately with the bowel content, both increasing and softening the easily passed mass. Petrolagar—liquid petrolatum 65 cci emulsified with 0.4 gm. agar in a menstruum to make 100 cc. JOHN WYETH & BROTHER, Inc. WALKEBVILLE, ONTARIO IN ARTHRITIS m AND RHEUMATISM Short Wave Therapy and Comfortable Footwear Are Indicated • The use of modern Electrical and Orthopaedic Equipment enables us scientifically to carry out your prescription. • IN ATTENDANCE: PIERRE PARIS, D.S.C. GEO. P. PARIS, D.S.C. O. Xu STONG-, D.S.C. Pierre Paris Foot Clinic Phone: Sey. 3778 Vancouver, B. C. The Purified ACTIVE PRINCIPLE OF SANDALWOOD OIL *••«•» ECONOMICAL Dosage Form Doctor, why use ordinary sandalwood oil when you can just as easily administer the active principle of the oil with the irritating and therapeutically inert matter removed—and at a cost to your patients of only a very few pennies more? You can do this by prescribing the new, economical 50-centigram capsules of lARHEOL (ASTIER) now obtainable in bottles of 12, 24 and 100 capsules at $1.00, $1.75 and $6.00 a bottle respectively. ARHEOL is the purified active principle of sandalwood oil. It is a uniform, standardized product with which prompt and dependable results may be expected. Undesirable sequelae often associated with sandalwood therapy are either absent or reduced to a negligible degree. A3-BVMA Dr. P. Astier Laboratories 36-48 Caledonia Rd., Toronto. Please send me a sample of ARHEOL (Astier) in the new economical dosage form. ...M.D. Street City Prov Dr. P. ASTIER LABORATORIES 36-48 Caledonia Road, Toronto The New Synthetic Antispasmodic Trasentin "Ciba" (Diphenylacetyldiethylaminoethanolester-hydrochloride) SUPPRESSES SPASMS OF THE GASTRO-INTESTINAL TRACT, GENITO-URINARY SYSTEM AND OTHER SMOOTH MUSCLE ORGANS Tablets—bottles of 20 and 100. Ampoules—boxes of 5 and 20. 1 tablet or 1 ampoule contains 0.075 grm. of the active substance. CIBA COMPANY LIMITED MONTREAL (■WOOOO'&Ow&OC'ww'WH 13 th Ave. and Heather St. Exclusive Ambulance Service FAIRMONT 80 PRIVATE AMBULANCES AND INVALID COACHES WE SPECIALIZE IN AMBULANCE SERVICE ONLY W. L. BERTRAND T^""T?:-:^-"-:rry"'~-~^~ .-^- p ■_■ rr----v .^y-v |..^..-.^-rr^—~r--- ■ ■.p>7>v>^???zr-.----rr-???rr->--.. I ] GREATER SAFETY In the Arsenical Treatment of Syphilis ■ 11, His ■ 3m ' / INJECTIONS C? MAPHARSEN HAf E BEEN ADMINISTERED WITHOUT ANY FATALITIES HAVING IbEENi REPjORfED Mapharsen (meta - ammo-para - hydroxy - phenylarsine oxide hydrochloride) is available in single dose ampoules containing 0.04 and 0,06 Gm., each in individual packages with or without distiiled water. It is also supplied in ten-dose ampoules, containing 0.4 and 0.6 Gm., for use by hospitals and clinics. PARKE,DAVIS&CO.,Walkerville,Ont. World's Largest Makers of Pharmaceutical and Biological Products STEVENS' SAFETY PACKAGE STERILE GAUZE is a handy, convenient, clean commodity for the bag or the office. Supplied in one yard, five yards and twenty-five yard packages. ESTABLISHED NEARLY A .CENTURY* !COMPANIE B. C. STEVENS CO. Phone Seymour 698 730 Richards St., Vancouver, B. C. S. BOWELL & SON DISTINCTIVE FUNERAL SERVICE I Phone 993 66 SIXTH STREET NEW WESTMINSTER, B. C. '•X't'X'M^^wxiX'WX^i't^^r't'ft-;*:-:*1 Breaks the vi^p^i circle of perverted menstrual function il|cases of amenorrhea, tardy ^riods(non-physiologica^^d dys- menorrhe||£Af]ford^^ relief by stimulating the ihhefei|Ki^Mfethe utelus afi$ s^biif^g,:^t|^^^^^^fc;its musculatuo^Controls the litero ov|;|rian circulation and |nereby encourages a normal menstrual cyeleftp^S # MARTIN H. SMITH COMPANY fek.. ISO I AT AYETTf STRUT. NEW YORK. N. T. w Full formula and descriptive literature on request Dosage: l to 2 capsules 3 or 4 times daily. Supplied in packages of 20. Ethical protective mark MHS embossed on inside of each capsule, visible only when capsule is cut in half at seam. >Wwt>.*Wv.Krti>wi!»*.:: mmzi mm* I m 1 1 H m 1 ism -I in §1 >»#;**.*!&«&«&£ t 2559 Cambie Street Vancouver/ 6. C. For Colonic Irrigation Institute Superintendent: E. M. LEONARD, B.N. Post Graduate Mayo Bros. Up-to-date treatment rooms; scientific care for cases such as Colitis, Constipation, Worms, G-astro-Xntestinal Disturbances, Diarrhoea, Divert!colitis, Rheumatism, Arthritis, Acne. Individual Treatment $ 2.50 Entire Course $10.00 Medication (if necessary) $1 to $3 Extra 631 BIRKS BUILDING, VANCOUVER, B. C. Phone: Sey. 2443 506-7 CAMPBELL BUILDING VICTORIA, B. C. Phone: Empire 2721 Arthritis and Chronic Rheumatism Prescribe Ly xanthine Astier • Its formula — iodo- propanol-sodium sul- phonate, lysidin bitar- trate, calcium gluconate, sodium bicarb, tartaric and citric acids—supplies calcium, iodine and sulphur, -with a powerful uric acid solvent. LYXANTH1NE ASTIER CrRANTJLAR EFFERVESCENT clinically effects rapid disappearance of tissue infiltration, relieves pain, promotes protein- waste elimination, exerts cholagogue action. DOSAGE, 1 teaspoonful well dissolved in a glass of water every morning, on an empty stomach, for 20 days. Rest 10 days. Repeat if necessary. Please send Sample and Literature of Ikyxanthine Astier Dr. 1 Address City Province.....™—.—....——......-.—.—. L1BVMA Dr. P. ASTIER LABORATORIES 36-48 Caledonia Road, Toronto ANAHiSMIN B.D. In the treatment of pernicious anaemia In the majority of cases of pernicious anaemia treated with Anahaemin the response is so certain that, in the words of one well-known physician, "it is possible almost to guarantee a rise of a half a million in red blood count weekly from a weekly 2 cc. injection . . . indeed, this dose seems usually to be too large. . . ." On the other hand,, some physicians arrange their own scheme of dosage ; one such physician states, "I give 4 ex. in a week, leaving off all treatment for about six weeks ... 7 have had excellent results . . .Anahaemin has never let me down . . . it is easily the best liver preparation." Stocks of Anahasmin B.D.H. are held by leading druggists throughout the Dominion and full particulars are obtainable from:— The BRITISH DRUG HOUSES (Canada) LTD. Terminal Warehouse Toronto, 2, Ont. An/Can/385 flDount pleasant TUnbettakino Co. %tb. KINGSWAY at 11th AVE. Telephone Fairmont 5 8 VANCOUVER, B. C. R. F. HARRISON W. R. REYNOLDS In Dermatological Conditions, Such as Eczema Psoriasis Urticaria Herpes Zoster Boils Varicose Ulcers Acne Vaccination Prescribe either alone, or, in cases where radiological or other treatment is instituted, as an adjuvant thereto. Osmotic - Decongestive - Bacteriostatic Antiprtiritic - Detert/ise Antiphlogistine is not the result of a "chance" prescription—its formula was evolved only after much scientific research. Sample on Request. Made in Canada. THE DENVER CHEMICAL MFG. CO. 153 Lagauchetiere St. W., MONTREAL &10&0* ^^ *# Arc the Neuritic Symptoms of Pregnancy due ta a dejfUUeMxuf SUCH common neuritic symptoms of pregnancy as pains in arms and legs, muscle weakness, and (less frequent but more serious) paralysis; of the extremities may result from a shortage of antineuritic vitamins recent investigations appear to show. Although neuronitis of pregnancyj has long been considered a toxemia, no toxins have ever been identified. Clinical observations of Strauss and McDonald lead to the conclusion! that the condition is a dietary deficiency disorder similar to beriberij caused by lack of vitamin B,, complicated by symptoms which may be 1 traced to shortage of vitamin G. They report recovery in their cases receiving this therapy, including dried brewers' yeast. Hyperemesis as Cause of Avitaminosis Wechsler observes that all cases of polyneuritis of pregnancy recorded in the literature were preceded by long periods of severe vomiting. "It would seem," he adds, "that because of actual starvation these patients suffered from avitaminosis and consequent neuritis," a view likewise held by Hirst, Luikart, and Gustafson. Plass and Mengert observe that the practice of giving high carbohydrate feedings for hyperemesis gravidarum is still more likely to cause avitaminoses B and G. Dried brewers' yeast, as it is far richer than any other food in vitamins Bi and G, is being used with benefit both in the prevention and treatment of polyneuritic symptoms of pregnancy. Lewy found that additions of yeast to the diet reduced electric irritability of the peripheral nerves and brought clinical improvement. Vorhaus states that he and his associates, after administering large amounts of vitamin Bi to 250 patients having various types of neuritis, including that of pregnancy, observed in about 90% of cases "varying degrees of improvement, i.e., from partial relief of pain to complete disappearance of all symptoms." Need for Vitamins B and G in Lactation Tji,„i_ i t» . n j ji c j i j ut Since the management of polyneuritis of preg- Jivans and Burr, Hartwell, Sure and co-workers, and Macy ^ey ls difficult at best, It would appear logical ct al are among numerous authorities who find that the *° supply those dietary substances which may i ■« .i i j i . j? «. • t» i lafeguard against It. One of the richest and nursing mother also needs supplements of vitamins Bx and m0st convenient sources of the anti-neuritic G, from 3 to 5 times the normal requirement. Tarr and factors, vitamins Bi and G, is Mead's Brewers TV/f^XT^;i« «^^^«4. 4-u j. a l i '/-I i i Yeast Tablets. Consisting of nonviable yeast, McJNeile report that the physical, mental, and emotional they offer not less than 25 International vita- status of 120 pregnant and lactating women receiving m'n Bi U|d** an<' ** Sherman vitamin G unltt I Mead's Brewers Yeast and other foods high in vitamin B P" *"*"*? - ... u~**i^ «* -inn „• . .-i . e i » ,,„ Supphed in bottles of loui was superior to that of a control group of 116 women. ££d 25Q ^Meto, also in 6-oz. bottles of powder. Please enclose professional card when requesting samples of Mead Johnson products to cooperate in preventing their reaching unauthorized persons. Mead Johnson & Co. of Canada, Ltd., Belleville, Oat. The Name "GEORGIA" is our guarantee! When you send or phone a prescription to us, it is compounded by men and materials beyond question. The name "Georgia Pharmacy" is never placed on the outside of box or bottle unless the inside is absolutely accurate, TELEPHONE: SEYMOUR 2263 OWN All WIOHT GEORGIA PHARMACY W.OEOROIA STREET tifcttfrr & Hjatma IGfiX Established 1893 VANCOUVER, B. C. North Vancouver, B. C. Powell River, B. C. published monthly at Vancouver, b. C. by roy wrigley ltd.. 300 west Pender street f^^^lS^lS^^^6^S^S^iS^S^S^?f^^ Hollywood Sanitarium Limited For the treatment of Alcoholic, Nervous and Psychopathic Cases Exclusively / 1 Reference—B. G. Medical Association For information apply to Medical Superintendent, New Westminster, B. C. or 515 Birks Building, Vancouver Seymour 4188 Westminster 288
Periodicals
W1 .VA625
English
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Medicine--Periodicals
The Vancouver Medical Association Bulletin: May, 1938
Text