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1LLIGOIS 





September, 1951 


Citizenship Responsibilities 
of Medical Men 


> 


Unipolar Electrocardiography 


and the 
General Practitioner 





(See page 5 for Table of Contents) 

















Detail of the Labyrinthine Structure 














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New York, N. Y., Aug, 28, 1949. ? 


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INVE 

SEARLE =" 

RESEARCH IN THE SERVICE OF MEDICINE Disabil 

; é P 
Entered as Second-Class Matter July 21, 1919, at the Post Office, Oak Park, Illinois, under the Act of March 8, a 

Acceptance for mailing at special rate of postage provided for in section 1102, Act of October 8, 1917, authorized July 15, 400 Fir 





1918. Office of Publications, 715 Lake Street, Oak Park, Ill. 

















TABLE OF CONTENTS 


A indicates advertising section 


SEPTEMBER, 1951 
Vol. 100, No. 3 





COUNCEL MEETING MINUTES  ..ccccecsess 211 


ORIGINAL ARTICLES 
Medical Men — Their Citizenship Responsibility, 
C. Paul White, M.D., Kewanee .............. 17. 


Unipolar Electrocardiography and_ the General 


Practitioner. B. E. Malstrom, M.D., William 
Johnson, M.D., and E. G. Behrents, M_D., Gales- : 


WARE ISoh f o-o AE RO ES Aa alae diss 8040 LENE SET 78 


X-Ray Findings in Adult Urological Conditions. 
Paul R. atiese. ee; SCORE. . ...4.s va cs cee es 1 


Corrosive Pyloric Stenosis, Ralph Gradman, M. D, 
AC S., Samuel T. Gerber, M.D., and Pocmnk 
Rais, PETA GINCATO sc vcrvesececvetenreneges 


Established Use of the Antibiotics. 
PE OUWMNEE EER SERIGREO XS Sreiadis 00 05 5a Qe keine OES 192 


The Lost Art of Diagnosing with the Eyes and 
Ears. Walter C. Alvarez, M.D., Chicago ...... 197 

An Intramedullary Epidermoid Tumor, Case Re- 
port. Milton Tinsley, M.D., and Archibald D., 
WiC Og,. ae,” CUNCARG ~ 6. so. ewe ee tieet see 


EDITORIALS 


Planning for Emergency Medical Calls .......... 165 


“Doc Schpeiter Dae esccccecivvess pengeeannte 166 

WN IN Oise Ps ced pakcceaen rinceeonsd ees 74A 

MEDICAL ECONOMICS 

The Committee Seeks Advice ............0.0005 17] 

The Counterpart of Hoarding ................... 172 

CORRESPONDENCE 

“Your Mental Hospitals’ — The National Mental 
SONU FU VUNG ANE be 50 0 vines cr eansak Ne ebbaa 168 


President's. Message to the Woman’s Auxiliary 
1951- 


69 
Clinics for Crippled Children Listed for October . 169 


Mississippi Valley Trudeau Society ............-- 170 
Fiske Fund Prize Dissertation ........:ccccecees 170 


Chicago Medical Offers Two Postgraduate Courses 170 
PATHOLOGY CONFERENCES 


Presentation of Three Cases. Edwin F. Hirsch, 
Chicago. 
Reticulum Lymphosarcoma Invasion of the Lung 203 


Acute Caseous Tuberculous Pneumonia ...... 206 
Savings tie: De 5. ogo s wo awa ees eccen 208 
PHYSICAL MEDICINE ABSTRACTS ...... 52A 
NEWS QF. FH sr, wcuceccus ras Lancet nee 





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$25 weekly indemnity, accident and sickness Quarterly 
$10,000.00 accidental death $16.00 
550 weekly indemnity, accident and sickness Quarterly 
$15,000.00 accidental death $24.00 
37S weekly indemnity, accident and sickness Quarterly 
$20,000.00 accidental death $32.00 
$100 weekly indemnity, accident and sickness Quarterly 
ALSO HOSPITAL EXPENSE FOR MEMBERS 
WIVES AND CHILDREN 


Cost has never exceeded amounts shown. 

















85c out of each $1.00 gross income used for 
members’ benefit 


$4,000,000.00 $17,000,000.00 
INVESTED ASSETS PAID FOR CLAIMS 


$200,000.00 deposited —— State of Nebraska for protection 
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Disability need hag oe “incurred in line of duty—benefits from 
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10 49 years under the same management 
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ee 


For September, 1951 








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New York ¢ CINCINNATI e Toronto 


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Harold M. Camp, EDITOR. 


Vol. 100, No. 3 








PLANNING FOR EMERGENCY 
MEDICAL CALLS 

The responsibility of providing emergency 
medical service for the people of this country has 
been assumed in most areas by the county medical 
societies. The various plans developed through- 
out the United States vary according to the 
population and the size of the medical society 
providing the service. 

The Council on Medical Service of the Ameri- 
can Medical Association has prepared a resumé 


-of the plans of sixteen county medical societies 


and published the material in a booklet ‘“Plan- 
ning for Emergency Medical Calls”. 

The three general types of plans included in 
this material are: (1) Society operated tele- 
phone answering services, (2) Emergency Call 
services, (3) Privately operated services. 

Mercer. County, Pennsylvania has set up 
separate systems in each of the four population 
centers in the county at the local hospitals. Lists 
are kept of all physicians willing to be on “call” 
on weekends and holidays, nights and Wednesday 
afternoons. The public is informed by news- 
paper advertisements to call their local hospital 
when they are unable to contact their own physi- 
cian. The hospital switch board operator gives 
the name and number of the physicians, in ro- 
tation. to the person calling, and the individual 
himself calls the physician. Each physician can 





For September, 1951 


ILLINOIS 
Medical 4 Se 


Official Journal of the Illinois State Medical Society 


Theodore R. Van Dellen, ASSOCIATE EDITOR. 


EDITORIAL BOARD — James H. Hutton, Chairman, Frederick H. Falls, Josiah J. 
Moore, Edwin M. Miller, Chauncey C. Maher, Harry Culver, Walter Stevenson, 
Raymond W. McNealy, Arkell M. Vaughn, Edwin F. Hirsch, Charles G. Farnum 





September, 1951 








go on or off the list as he desires — the service 
is purely voluntary. 

The Cincinnati Academy of Medicine has 
maintained a twenty-four hour telephone service 
for the benefit of the public since November 
1933. The charge for the telephone service on 
a flat rate basis, costs the Academy $33.00 a 
month for three independent lines. This con- 
stitutes the maximum cost of the phone servi. 
except a little extra for keys and extensions. The 
physicians frequently will have the line “If no 
answer, call the Academy of Medicine, PA 2345” 
under their names in both the white and yellow 
sections of the telephone directory. ‘The physi- 
cian pays for this printing himself, but pays 
nothing to the Academy for handling calls for 
him. Every active member of the Academy 
automatically is listed as a user and subscriber 
to the Academy’s twenty-four hour telephone 
service without payment of anything extra. 

The Medical Society of the District of Colum- 
bia has a telephone answering service which op- 
erates as a non-profit agency of the Society. 
The Medical Bureau offers two types of coverage 
— listing service and telephone secretarial serv- 
ice. The listing service is on the basis “If no 
answer, call Medical Bureau”. The secretarial 
service consists of a private line connecting the 
physician’s offfice or residence with the Bureau 
and providing complete twenty-four hour cover- 





165 











age. When the physician wishes to transfer his 
calls, he throws a switch on his telephone and 
the call is automatically transferred to the 
Bureau. 'The fee for this service is $8.00 month- 
ly, payable every two months. In both the serv- 
ices there is a charge of five cents for each 
message over sixty per month in addition to the 
fee listed. 

Other systems which are outlined include the 
setups in Cleveland, Toledo, Harrisburg, Mil- 
waukee, San Diego, etc. Emergency call services 
in San Francisco, Indianapolis, Detroit, Erie and 
Sharon, Pa., are outlined. 

Privately operated services as established in 
Los Angeles, and Oklahoma City, are described 
in detail. 

Among the 16 plans perhaps the solution to 
your local problems can be found. The im- 
portance of emergency medical call service can- 
not be stressed too often. Each society, no 
matter how small, should work out some means 
to provide emergency medical care for everyone 
at the time it is needed, without delay and with- 
out fail. This is one of the most important 
phases of public relations between the physician 
and his patients. By solving this problem at the 
local level contributes materially to the public 
relations picture at the national level. 

Has your county medical society established 
such a program for the residents in your area? 





“DOC SCHREITER DAY’”’ 

Savanna, Illinois honored Dr. Joseph B. 
Schreiter on Wednesday, August 8, the day 
being officially designated as “Doc Schreiter 
Day”. Dr. Schreiter, after graduating from 
Rush Medical College, came to Savanna to start 
his practice in 1896 and has practiced contin- 
uously in that city for the past 55 years. He 
was elected Coroner of Carroll County in 1900, 
which position he held for 48 consecutive years. 
He was commissioned as 1st Lt. in World War 1, 
was in France 22 months, and reached the rank 
of Major. He was later retired as Colonel. 

Dr. Schreiter became interested in all com- 
munity activities, served as city health officer, 
member of the Board of Education, and was 
chief of staff of the local hospital. He is an 
cfficer in the Savanna Savings Building and 
Loan Association and also of the National Bank 
of Savanna. During his 55 years in the practice 





166 





Dr. Andy Hall, principal speaker and Dr. and Mrs. 
Joseph B. Schreiter as they appeared on “Doc. Schreiter 
Day.” 


of medicine he has officiated at the birth of more 
than 4,000 babies. 

The city of Savanna and surrounding territory 
participated- in celebrating the “Doe Schreiter 
Day” on Wednesday, August 8, starting with a 
parade in the downtown area, then a two-mile 
parade to the city’s Old Mill Park, where the 
afternoon program was presented. Luncheon 
was served to the many invited guests and there 
was free coffee for all. 
babies were present to pay their respects to their 
doctor. Among these was Wayne King, the 
“Waltz King’, who was in the parade and ap- 
peared as a speaker in the afternoon. 

For the afternoon program, Dr. Edward C. 
Turner, Savanna, and one of Dr. Schreiter’s 
babies, acted as master of ceremonies. A number 
of distinguished guests were introduced who 
spoke briefly. Wayne King paid his respects to 
Dr. Schreiter and the medical profession in 
general for the fine work which has been done to 
alleviate human ailments, and lower mortality 
and morbidity rates. 

C. Paul White, as President of the [Illinois 
State Medical Society, gave the felicitations and 
best wishes to Dr. and Mrs. Schreiter for the 
Society’s official delegates and the 10,000 in- 
dividual members. 






Illinois Medical Journal 


Many of Dr. Schreiter’s- 








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he principal address was given by Andy Hall, 
Mt. Vernon, who had been invited to come 362 
miles from his home to pay his respects to the 
physician he had known for many years, and like- 
wise convince a large audience that a mere 55 
years of practice does not necessarily mean that 
a physician is on his way out. Dr. Hall, in his 
convincing manner, told of the many advance- 
ments in medical knowledge during recent dec- 
ades, improvements in vital statistics, and what 
might be expected in the future, if medicine is 
permitted to be carried on as a private enter- 
prise. 

Business houses in Savanna were closed, so 
the managers and employees alike could be pres- 
ent to aid in honoring their number one citizen 
of the day. It was the general feeling as ex- 


pressed by several speakers, that it is much better 
to honor a distinguished citizen while he is well 
and able to appreciate how highly his services 
were appreciated rather than to eulogize his 
memory after he is gone. 


It was estimated that perhaps 3,000 people 
were present to hear the talks that warm after- 
noon, and it was quite obvious that everyone 
present was prompted by their high regards for 
the physician who has been their friend for so 
many years, 

The Council of the Illinois State Medical 
Society had named the President, C. Paul White ; 
Chairman of the Council, Charles P. Blair; 
Councilor for the 1st District, Joseph S. Lund- 
holm; Vice President, J. Howard Maloney; and 
the Secretary-Treasurer, Harold M. Camp, as 
official delegates, and all of this group of officers 
were present. 

The City of Savanna should be complimented 
for setting aside one day to honor a physician 
who had given good service over a long period of 
years, and who still enjoys good health. The 
business district was well decorated, and as it 
was stated in Savanna that day, everything was 
closed except the post office and the railroad 
station. 





IMMUNIZATION FOR TRAVELERS 


The latest facts on immunization for travelers 
going to every section of the world are detailed 
in a booklet just released by the U. S. Public 
Health Service. The title of the booklet is “Im- 
munization Information for International Trav- 
el.” It includes official information on the 
immunizations required and recommended by 
each country and the immunizations recom- 
mended by the Public Health Service as a pre- 
cautionary measure for persons traveling abroad. 
Other items of importance to the traveler include 
an explanation of the procedure for having in- 
culations recorded on the International Certif- 
icate of Inoculation and Vaccination; a list of 
Publi Health Service facilities where vellow 


For S-ptember, 1951 


fever inoculations can be obtained; and maps 
showing the yellow fever endemic areas of the 
world. 

All changes in immunization requirements 
made after the publication of this booklet will 
be given in the weekly “Communicable Disease 
Summary,” released by the Public Health Serv- 
ice, under the heading “Quarantine Measures.” 
Travelers can obtain this information from local 
and State health departments. 

The booklet may be purchased from the Super- 
intendent of Documents, Government Printing 
Office, Washington, D. C. for 20c a copy. A 
twenty-five per cent discount is allowed on orders 
of 100 copies or more delivered to the same ad- 
dress. 














‘““YOUR MENTAL HOSPITALS” THE 
NATIONAL MENTAL HEALTH ACT 

At the last legislative session a bill was passed 
which was signed into law designating the Illi- 
nois Department of Public Welfare as the mental 
health authority for the State of Illinois. As 
the mental health authority, the Department of 
Public Welfare will .dispense funds which are 
granted to the State by federal appropriation. 
This year the funds will amount to approximately 
$160,000 and, as in the past three years, this will 
be expended for mental health education, out- 
patient psychiatric clinics, and training of 
psychiatric personnel. An advisory committee on 
National Mental Health Funds was appointed 
by the Illinois Department of Public Welfare, 
consisting of the following: Dr. Paul Hletko, 
Chief Medical Officer, Department of Public 
Welfare; Mrs. Margaret Platner, Psychiatric 
Social Service; Representative Bernice T. Van 
der Vries, Illinois Society for Mental Hygiene ; 
Dr. David Slight, Mental Health Clinics; Dr. 
F. G. Norbury, Illinois State Medical Society ; 
Dr. Donaldson F. Rawlings, Illinois Department 
of Public Health; Dr. Groves B. Smith, Super- 
intendent, Beverly Farm Home and School, God- 
frey, Illinois; Dr. Louis Jacobs, United States 
Public Health Service; Mr. Ray Graham, Di- 
rector, Education of Exceptional Children, Of- 
fice of Superintendent of Public Instruction ; Mr. 
Bertram L. Smith, Institute for Juvenile Re- 
search Advisory Board. 


168 


CORRESPONDENCE 








In addition to the advisory board, a committee 
of consultants were appointed consisting of: Dr. 
Lewis Pollock, Chairman of Department of 
Nervous and Mental Diseases, Northwestern Uni- 
versity Medical School; Dr. Nathaniel F. Apter, 
Professor of Psychiatry, The University of Chi- 
cago School of Medicine; Dr. Francis J. Gerty, 
Head of Department of Psychiatry, University 
of Illinois College of Medicine; Dr. John H. 
Madden, Chairman, Neuropsychiatry, Loyola 
University School of Medicine; Dr. H. H. 
Garner, Department of Nervous and Mental Dis- 
eases, Chicago Medical School. 

Several meetings of the advisory committee 
have been held to formulate plans and consider 
requests for funds from various psychiatric 
clinics throughout the State. 

In addition to the above clinics, the Illinois 
Department of Public Health and the Illinois 
Department of Public Welfare will use part of 
the money available for the training of qualified 
psychiatric social workers and other individuals 
in the field of mental health. A certain amount 
of money will also be available to foster pre- 
ventative and educational activities in the field 
of mental health. It is hoped that by this com- 
bined approach, Illinois will forge ahead and ex- 
plore new avenues in the entire field of mental 
health. 


George A. Wiltrakis, M.D. 
Deputy Director 


Illinois Medical Journal 








PRESIDENT’S MESSAGE TO THE 
WOMAN’S AUXILIARY 1951-1952 

During the Vacation Season many have tried 
their luck fishing, others have been mountain 
climbing, still others motored here and there and 
enjoyed themselves in their favorite forms of rec- 
reation. 

Now that our Vacations are over, let us give 
back to humanity some of the accumulated energy 
in service to our Auxiliary and the Public. We 
want to make this a record year for our organi- 
zation. I have felt for some years that we need 
pay more attention to Ethics. We might read and 
study about this for months without effect, for 
it’s something that we must feel and live, in 
other words, it must come from the heart, for the 
basis of Ethics is courtesy; kindness; unselfish- 
ness; honesty; sincerity and justice, and no 
group can succeed “With flying colors” without 
using many, if not all of these factors. How can 
we attain these qualifications? By practicing 
them in our everyday lives; in our homes; 
during our shopping; riding on a crowded bus; 
streetcar or train; driving an automobile and in 
everything we do. 

As we start another year may we as members 
realize the influence that we have in the adjust- 
ment of some of the vital problems of this ever 
changing world. Let us take what knowledge 
we have and use it. There has never been such 
atime as this. Let us try to have misunderstand- 
ing replaced with understanding and distrust re- 
placed with trust. May there be no shadows ; Let 
the candles burn brightly, leading us on. 

An important point to keep in mind always 
is the fact that the Woman’s Auxiliary, at all 
three levels, National, State, County, is one 
organization with one main program to follow. 
This program is given to us by the American 
Medical Association. The main fields are Pub- 
lie Relations, Nurse Recruitment, Legislation, 
Promote the sale of Today’s Health, Civil De- 
fense, Bulletin. Every member should be a 
subscriber, it’s our “workbook”. 

Here in Illinois we have our own Benevolence. 
You have been most generous in previous years 
and I am hoping for a continued support. We 
now have our own Auxiliary news, remember 
this is your edition. Help us make it an out- 
standing publication. We will welcome sug- 
gestions. As you perhaps know the Auxiliary is 
increasing each year in numbers, but Growth is 


For September, 1951 


not in numbers alone; what have we contributed 
individually? A parent takes pride in the devel- 
opment of its child; so our Auxiliary takes pride 
in the development of its members. As your 
President for the coming year I realize fully the 
position which calls for courage, thoughtful 
choices and the will to follow through, with the 
kind thoughts of Auxiliary members and the 
ever helpful Chairmen and Officers and Coun- 
cilors and the sound Council of our Advisory 
Committee, I will do my best to carry on, re- 
membering always the President is a servant of 
all. 


Mrs. James M. McDonnough, President 
Woman’s Auxiliary to the I]linois 
State Medical Society . 


CLINICS FOR CRIPPLED CHILDREN 
LISTED FOR OCTOBER 

Twenty-four clinics for Illinois’ physically 
handicapped children have been scheduled for 
October by the University of Illinois Division of 
Services for Crippled Children. The Division 
will conduct 19 general clinics providing diag- 
nostic orthopedic, pediatric, speech and hearing 
examination along with medical social and 
nursing services. There will be 4 special clinics 
for children with rheumatic fever and 1 for 
cerebral palsied children. 

Clinics are held by the Division in cooperation 
with local medical and health organizations, both 
public and private. Clincians are selected among 
private physicians who are certified Board mem- 
bers. Any private physician may refer or bring 
to a convenient clinic any child or children for 
whom he may want examination or may want 
to receive consultative services. 

The October clinics are: 

October 3 — Joliet, Will Co. TB Sanitarium 

October 3 — Alton, Alton Memorial Hospital 

October 9 — Peoria, St. Francis Hospital 

October 9 — E. St. Louis, St. Mary’s Hospital 

October 10 — Hinsdale, Hinsdale Sanitarium 

October 11 — Cairo, Public Health Building 

October 11 — Springfield, St. John’s Hospital 

October 11 — Elmhurst (Rheumatic Fever), 
Memorial Hospital of DuPage County 

October 12 — Chicago Heights (Rheumatic 
Fever), St. James Hospital 

October 16 — Danville, Lake View Hospital 

October 16 — Pittsfield, Illini Community 
Hospital 





October 17 — Chicago Heights, St. James 
Hospital 

October 18 — Rockford, St. Anthony’s Hospi- 
tal 





October 18 —- Litchfield, St. Francis Hospital 


October 23 — Peoria, St. Francis. Hospital 

October 23 — Flora, Clay Co. Memorial Hos- 
pital 

October 24 — Elgin, Sherman Hospital 


October 25 — Mt. Vernon, Masonic ‘Temple 

October 25 — Normal, Brokaw Hospital 

October 25 — Glenview, Village Hall 

October 26 — Chicago Heights (Rheumatic 
Fever), St. James Hospital 

October 30 — Effingham (Rheumatic Fever), 
Douglas Township Building 

October 31 — Springfield (Cerebral Palsy), 
Memorial Hospital 

October 31 — Aurora, Copley Hospital 





MISSISSIPPI VALLEY TRUDEAU 
SOCIETY 

The annual meeting of the Mississippi Valley 
Conference on Tuberculosis and the Mississippi 
Valley Trudeau society will be held October 4, 
5, and 6 in Chicago at the Sherman hotel. 

The two groups will meet jointly on Thursday 
for the opening of the meeting and a_ public 
health session. The subject of the Friday morn- 
ing Trudeau session will be “A Study of Cases 
Coming to Pulmonary Resection Including Medi- 
cal, Roentgenological, Surgical and Pathological 
Features,” by Drs. J. W. Gale, A. R. Curreri, 
D. M. Angevine, and L. W. Paul. 

At the Friday afternoon session, Dr. Sol Roy 
tosenthal will speak on “Immunization with 
BOG,” and Dr, John Skavlem will discuss 
“Pathogenesis of Tuberculosis.” Following these, 
“Patient Education Regarding Tuberculosis” will 
be diseussed by Miss Elizabeth Kennedy, R.N., 
Miss Lois Plaunt, R.N., and Dr. M. C. Thomas. 

The final session, Saturday morning will in- 
clude the following topics: ““Management of the 
Silicotic Patient”; “Crushing Injuries of the 
Chest”; “The Rationale of Early Surgical Ap- 
proach to Osseous Tuberculosis and Its Compli- 
cations” ; “Genito-Urinary Tuberculosis” ; “Wid- 
ening Front in the Treatment of Tuberculosis”. 
Speakers wil) be: Dr. Frank Princi, Cincinnati, 
Onio; Dr. N. K. Jensen, Minneapolis, Minn. : 


Dr, Edward T, Evans, Minneapolis, Minn. ; Dr. 


170 








William Baum, Ann Arbor, Michigan and Dr, 
James J. Waring, Denver, Colorado. 

All interested physicians are invited to attend 
the sessions. 

Dr. W. J. Bryan, Rockford is president of the 
Conference and Dr. D. F. Loewen, Decatur is 
president of the Trudeau society. 





FISKE FUND PRIZE DISSERTATION 

The Trustees of the Caleb Fiske Fund of the 
Rhode Island Medical Society announce the 
following subject for the prize dissertation of 
1951: “The Present Status Of Adreno-Cortical 
Hormone Therapy — Its Uses And Limitations.” 

For the best dissertation a prize of $200 is 
offered. Dissertations must be submitted by 
December 2, 1951, with a motto thereon, and 
with it a sealed envelope bearing the same motto 
inscribed on the outside, with the name and ad- 
dress of the author within. The successful author 
will also agree to read his paper before the 
Rhode Island Medical Society at its Annual 
Meeting in May, 1952. Copy must be type- 
written, double spaced and should not exceed 
10,000 words. For further information write 
the Rhode Island Medical Society, 106 Francis 
Street, Providence 3, Rhode Island. 





CHICAGO MEDICAL OFFERS 
TWO POSTGRADUATE COURSES 

The Chicago Medical Society continues its 
postgraduate program by offering two courses of 
a complementary nature during October. The 
first, Endocrine and Metabolic Diseases, is sched- 
uled for the 15th to 19th and the second, Ob- 
stetrics and Gynecology, the 22nd to 26th. 

The registration fee of $60 includes mid- 
morning and mid-afternoon refreshments. and 
one dinner meeting. 

With an outstanding faculty, and an unusually 
comprehensive program, these courses will appeal 
to all physicians, and since each course is limited 
to 100 participants, early registration is advised. 

A complete program may be had by writing 
Chicago Medical Society, 86 E. Randolph St., 
Chicago 1, Illinois, Checks covering registration 
may be sent to the same address and should be 


made out to the Society. 






Illinois Medical Journal 











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MEDICAL ECONOMICS 


The Medical Economics Committee. Chauncey C. Maher, Chairman, John R. Wolff, Co- 

Chairman, Edwin F. Hirsch, Carroll Birch, Hubert L. Allen, Frederick W. Slobe, Edward 

W. Cannady, Ford K. Hick, W. Robert Malony, Roland R. Cross, Alfred P. Bay, Frederic 
T. Jung. 








The Committee Seeks Advice 


During the depression years of the early ‘30’s 
when the New Deal policies were initiated, each 
physician became acutely aware of how economic 
trends and government planning were effecting 
the practice of medicine. The development. .of 
welfare agencies within the federal government, 
in the state, county and city, all presented hither- 
to unknown problems concerning the patient- 
physician relationship. The trend toward spe- 
cialization, the subjects of preventive medicine, 
industrial medicine, group practice, and the in- 
roads made by the government into the practice 
of medicine were avenues of new thought to the 


busy doctor. 
Our friend, Dr. Edwin 8. Hamilton of Kanka- 


kee, was alert to these problems and envisioned 
the necessity of disseminating information to the 
doctors in the state on these vital economic prob- 
lems. In 1934, the officers of the State Medical 
Society appointed a “Medical Economics Com- 
mittee.” Dr. Hamilton served as the Chairman. 
The purpose of this committee was to provide 
monthly articles on economics in this Journal. 
Through the untiring efforts of Dr. Hamilton, 


the committee served the Society well. We were 


Kept up-to-date on the multitude of changes 


For September, 1951 


occurring in the economic aspect of medical 


practice. Dr. Hamilton continued his excellent 
work through most of the war years. 

In 1944 Dr. Rollo K. Packard of Chicago be- 
came Chairman of the Committee. He continued 
the good work, and in 1945 was succeeded by 
Dr. Chauncey C. Maher of Chicago. Dr. Maher 
stimulated the committee to continue the publi- 
cation of timely articles. Voluntary health in- 
surance programs, the Beveridge report, the 
Wagner-Murray-Dingell bills for compulsory 
health insurance, the relationship of the path- 
ologist, radiologist and anesthetist to the hospital 
and the patient, and many other problems of 
current importance were discussed in this forum. 

Now a new committee has been formed and a 
new chairman appointed. Your new committee 
is greatly indebted to its prodecessors for having 
established the tradition of preparing articles 
on subjects of interest to all doctors, Each 
physician has been aided by the fine work: ac- 
complished by former Medical Economics Com- 
mittees. The responsibility to you is“well rec- 
ognized, and the tradition shall be carried on. 


Your new committee enters its activities with 


a humble realization of what has gone before 





and a hope for a productive future. It is our 
desire to prepare worthy reports on subjects of 
interest to the physicians of Illinois. The sub- 
ject of medica) economics is a very broad one, 
Essentially anything that helps to better the 
care of the patient improves the economy of the 
patient and the doctor. We shall endeavor to 


discuss such matters with you. We have now 
under way discussions on emergency and night 


calls, anesthesiology as a specialty, opportunities 
for service in state mental institutions, country 
practice, group practice, women in medicine, and 
doctors in insurance work, 

Your committee welcomes suggestions and 
criticisms from you. We want to help you with 
your economic problems. Write us, talk to us 
frankly and freely, and we will do our utmost to 


serve you well.—J.W. 





The Counterpart of Hoarding 


‘he American public has been wel) indoctri- 
nated with the idea that hoarding is bad. Hoard- 
ing is now firmly associated in the American 
mind with the idea of profiteering. These are, 
however, negative ideas. It is urgent that they 
be supplemented by something positive. The 
economy of the United States has survived what- 
ever strains it may have suffered during the 
flurry of buying last summer. The time is ripe 
for the development of a program of economiz- 
ing, storing, stock-piling, provisioning, preserv- 
ing, or whatever else on wishes to call the posi- 
tive, constructive, and necessary counterpart to 
hoarding. Some aspects of this problem impinge 
directly on the broad subject of public health. 
Others, as will appear below, have an equally 
direct bearing on the subjects of medica) econom- 
ics and emergency medical service. 

One of the most immediately urgent needs in 
the event of a large-scale disaster is water clean 
enough for drinking and washing. ‘There are 
two reasons for this: the possibility of failure 
of water-pumping systems (especially in large 
cities and in high buildings), and the possibility 
of radioactive contamination of such reservoirs 
as Lake Michigan, Large segments of the popu- 
lation are scarcely aware of the fact that depri- 
vation of water is a much more serious emergency 
for the human body than is deprivation of food. 
Every family unit should have a non-leaking, 
non-corroding clean, covered metal receptacle 
containing 48 hours’ supply of water in a pro- 
tected but accessible place. 


172 


A second most urgent need is an ample supply 
of necessary foodstuffs in accessible places. A 
central storehouse can hardly be called accessible 
when delivery systems break down, private auto- 
mobiles cannot be run for lack of gasoline, and 
frantic people have to spend hours of time (which 
is at least as valuable in wartime as in peace 
time) waiting in line for the inspection and 
punching of ration cards. In this respect the 
government of Switzerland has set a most ad- 
mirable example. Each household must be 
stocked with at least two months’ supply of 
basic foods, and people who need a loan to fi- 
nance this arrangement can obtain one at low 
rates of interest. The American government 
might well go further than this. Using data 
available to the Department of Agriculture it 
would be easy to release, each week, a list of 
those food supplies that happen to be abundant 
and whose purchase is advisable. These weekly 
statements could point out the types of foods 
that are most easily stored or preserved and 
which lend themselves most readily to the prep- 
aration of balanced diets. It is still not gen- 
erally appreciated that some easily kept and 
valuable foods, like sugar, may be pernicious in 
a diet if not balanced by other food stuffs, espe- 
cially those containing nitrogen. The American 
public, perhaps the best nourished on earth, has 
been inclined to feel that fussing about calories 


and vitamins is something for professors and 


over-solicitous mothers; people need to be awak- 
ened to the fact that in wartime the avitaminoses 


Illinois Medical Journal 





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become stark realities. For years the Depart- 
ment of Agriculture has printed information on 
subjects ranging from the best recipe for pretzels 
to the optimum cooking temperature for Brus- 
sels sprouts. Now, by all means, is the time to 
come forward with simple, concrete directions 
for the best foods to store and the optimum 
methods of storage. , 
Finally, there is need for instructions regard- 
ing first aid supplies in the home. The need 
for these has recently been emphasized by reflec- 
tions on the Cocoanut Grove disaster in Boston, 
where the city’s hospitals were found scarcely 
able to cope with a number of casualties that 
seems infinitesimal compared with the number 
that resulted from the single atomic explosion 
over Hiroshima. It is obvious that every house- 
hold must contain some resources for medical 
self-help. The publicity given to the use of 
plasma, while advantageous in some respects, 


has built up in the popular mind a pathetically 
exaggerated faith in the virtues of plasma trans- 
fusion, and the mental picture engendered by a 
reading of newspapers and magazines is that of 
a blast victim gracefully waiting, with only a 


slightly haggard expression on his face, for the 


arrival of a neatly uniformed team of rescuers 


with a flask of plasma. It is time that this no- 


_ purposes sterile. 


tion was offset by a reminder that the patient 
may not need either plasma or cigarettes so 
much as a drink of clean water. 

Likewise a survey of first aid kits reveals a 
distressing predominance of useless antiseptics, 
cathartics, headache tablets, and proprietary 
remedies for stomach ache. Again, this should 
be corrected by emphasis on the usefulness, the 
supreme importance perhaps, of simple materials 
for dressings. Many housewives do not appreci- 
ate the fact that the domestic flatiron, whether 
electric or otherwise, is a remarkably efficient 
sterilizer, and that clean pieces of cotton or 
linen cloth, properly folded during and after the 


ironing, and properly stored, are for practical 
Moveover, they are usable for 


a great variety of purposes — as swabs, pads, 


packs, bandages, tourniquets, slings, and cover- 
ings for less washable bedding. 

There have been complaints about the appar- 
ent apathy of the American public in the present 
situation. This state of mind can result from 
preoccupation with negative ideas like that of 
hoarding. It can be corrected by the inculcation 
of positive ideas and simple plans for action. A 
well-planned program of provisioning for Ameri- 
can homes will give everyone a greater feeling 
of security.—F.T.J. 





AN OLD STORY 


.. -My own belief regarding the position of the 
general practitioner was so ably stated by Sir 
William Osler nearly 50 years ago that I would 
like to quote his words, which are as true today 
as when they were written : 

“Tt is amusing to read and hear of the passing 
of the family physician. There never was a 
time in our history in which he was so much in 
evidence, in which his prospects were so good 
or his power in the community so potent. The 
public has even begun to get sentimental over 
him! He still does the work; the consultants and 
the specialists do the talking and the writing, 


and ivke the fees! By the work, I mean that 


For September, 1951 


great mass of routine practice which brings the 
doctor into every household in the land and makes 
him, not alone the adviser, but the valued friend. 
He is the standard by which we are measured. 
What he is, we are; and the estimate of the pro- 
fession in the eyes of the public is their estimate 


of him. A well-trained, sensible doctor is one 


of the most valuable assets of a community, 
worth today, as in Homer’s time, many another 
man. To make him efficient is our highest am- 
bition as teachers; to save him from evil should 
be our constant care as a guild.” Excerpt: 
Keeping Abreast of Medical Progress, Wallace 
M. Yater, M.D., Washington, D..C., Pa, M.'J., 


May, 1951. 








ORIGINAL 








ARTICLES 








/ 


Medical Men — Their Citizenship 
Responsibility 


C. Paul White, M.D., 
President, illinois State Medical Society 
Kewanee 


In choosing this subject as the caption of my 
remarks this evening, I am not unmindful of the 
danger of being accused as a dictator, or of in- 
vading an individual’s right to form his own 
opinions in controversial questions affecting 
citizenship. 

Let it be understood in the very beginning 
that such is not my purpose, but rather am I 
concerned only with presenting certain historical 
facts and traditions, comparing these with our 
present day pattern of living and thinking in 
order to understand this modern era of govern- 
ment planning, and the paths toward which our 
various political ideologies are leading us. 

I do not care one whit what political banner 
anyone travels under, providing they are en- 
dowed with the spirit of 1776, the Pilgrims, or 
the Jamestown Colony, and are desirous of main- 
taining our country as a place where Liberty, 
Justice and Free Enterprise shall rule. 


Delivered before The Secretaries’ Conference of the 
Tllth Annual Meeting of the Ililineis State Medical 
Seciety, Hotel Sherman, Chicago, May 22, 1951. 


174 


We constantly hear, today, that the men of our 
profession are being attacked as political blun- 
derers, avaricious schemers, and jealous egotists. 
Even some of our colleagues say we should not 
enter politics. Now, in my opinion, they do not 
state the premise correctly. Politics should not 
enter Medicine any more than politics should 
enter the Church. But, if Medicine is going to 
save itself from slander and abuse, or if the 
Church is going to save the citizens of their 
various communities, they must be compelled to 
enter politics, a field where creative legislation 
spells success or failure to all opposing forces. 

Let us see what has happened previously in 
leading nations of the world. The Roman Em- 
pire, in conquest, was strong and united. Vic- 
tory once achieved, the spoils of war and slave 
labor created a lethargy among the people, and 
the ever increasing taxes weakened it until the 
government became an easy prey of the hordes 
from the North. Likewise Germany, France, 
and England — all great nations — finally suc 
cumbed to the fate of wars, taxes, and Bureauc- 
racy. 


IMlinois Medical Journal 





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War may build or it may destroy your national 
wealth, depending on whether you are victorious, 
or whether your own country is invaded. Before 
the last World War, Europe had a wealth in 
things of $900,000,000,000. Through destruc- 
tion, due to war, $250,000,000,000 of that wealth 
was destroyed. No wonder, a Marshall Plan! 

The United States was worth $205,000,000,- 
000 at the beginning of the war (i.e., in things) 
and at the end, $500,000,000,090, because they 
built things and nothing was destroyed. Why 
then, the financial problem? Because, instead 
of receiving homage from conquered nations, we 
had to support and build them up. We are in 
that manner dissipating our own wealth. 

The responsibility which rests on any nation, 
that becomes an outstanding world power, is in- 
deed great. In the past, the leadership of such 
nations became so confused by the complexities 
of government, that they failed to recognize, 
until too late, the pitfalls which were intention- 
ally placed by other nationals for their destruc- 
tion. Today’s leaders are doubly confused. 
Confused by enemies from within and enemies 
from without. They are now seeking solutions, 
which dictated by political expediency, will soon 
become insidious diseases eating at the very 
heart of the nation. 


This confusion of men, high in political af- 
fairs, is appalling when we view it in retrospect. 
Such confusion reminds me of the man who de- 
cided to go downtown for a shave one morning. 
He did so, got into the barber’s chair, the barber 


put an apron on him, tucked towels around his: 


neck, and was lathering his face when suddenly 
a man ran into the door of the shop and cried, 
“Mr. Smith, Mr. Smith, your house is on fire.” 
Like a shot, he leaped out of the chair, through 
the door, and down the street, spitting lather, 
towels falling off, and apron waving. When he 
had gone a couple of blocks, he suddenly stopped. 
“Say, what am I running for? My name isn’t 
Smith.” 


We often hear it said there is no substitute 
for hard work. Likewise, may it be said, that, 
when a citizen ceases to work, he becomes a lia- 
bility to his country. He may be so financially 
sound, that for his own interest, he does not 
need to produce for his own livelihood. But, 
4 nation’s economy is largely dependent on its 
working population. Parasites eventually kill 
the host. 


For Sextember, 1951 


Many people, today, mistake Liberty for Li- 
One may have the liberty to act as he 
wishes, but he does not have the license to act 
in such manner as to harm or destroy his neigh- 
bor. He may have the liberty of free speech, but 
he does not have the license to destroy the fun- 
damental principles upon which this nation was 
founded. A doctor has the liberty to practice 
his profession as he sees fit in accordance with 
his knowledge, but he does not have license to 


take a life. 


Ignorance is the basis of most misunderstand- 
ings, and name me a profession in which this is 
more true than in the medical profession. We 
are maligned by the public, criticized, con- 
demned, and blasphemed ; for the most part, un- 
justly, because we, as a group, have labored under 
the impression that our profession was beyond 
reproach ; that our ideology was like the Rotary 
slogan, “Service before self,” but unlike Rotary, 
we made no effort to tell the world about it. 


cense, 


We now have the reputation of being against 
things. We, myself included, have talked long 
and loud against socialized medicine, osteopathy, 
and other cultists, and have done so before a 
public, which often was not too open-minded on 
the subject. Of course, we are opposed to. 
those things, but instead of building up resent- 
ment in our audiences by being simply against 
something; is it not better that, by comparison, 
we tell the world more about our accomplish- 
ment, more of what we expect to accomplish. 
“Sugar attracts more bees than vinegar.” Let 
us make allies of our neighbors. 


To thus advertise, has always been frowned 
upon by medical men. We seem to think people 
will see our good works, and seek after them. 
Unfortunately, each of us has had our bad 


moments. Through lack of discretion on our 
part, we alienate certain groups in our com- 
munity, and thus practices are built and limited. 
Rarely does the patient condemn the profession, 
but only the individual medico. 


In our opposition to the Osteopathic Bill in 
our legislature, we have spent a great deal of 
time in pointing out the mistakes of osteopaths. 
While we have a century of progress in medicine 
to compare with a practice that to my knowl- 
edge, cannot point its finger to one thing it has 
accomplished to add longevity or lessen morbid- 
ity. 




















































The basic sciences in our schools are taught 
by better qualified men, and in vastly superior 
laboratories. All branches of medicine and sur- 
gery are taught by men whose lives are devoted 
to the study and treatment of the branch, which 
they teach — as compared with the two or three 
medical men, which teach all branches in the 
osteopathic schools. A State Senator speaking 
to another said, “I think I will vote for that 
Osteopathic Bill. The M.D.’s are always op- 
posing them, and they seem to be doing a job, 
and are popular.” My friend asked, “Would 
you want them to take your gallbladder out?” 
“Hell no, is that what they want?” Yes, and 
more too. Here again we see a lack of under- 
standing. Osteopaths can and are licensed now 
for the practice of osteopathy. But, because of 
the advancement in medicine and surgery, they 
are finding it desirable to broaden their field of 
treatment, and seek license for their inferior 
trained men from inferior schools to practice 
medicine in all its branches here in Illinois, just 
as they have been able to do in many other States 
of the Union. 

To defeat vicious legislation takes “personal- 
ized service.” 

To create a favorable opinion for medicine 
takes “personalized service.” 

To become an active citizen takes “personalized 
service.” 

To show appreciation of one’s citizenship is 
to vote in all elections. 

In the beginning of this address, I spoke of 
the patterns of governments. Let us review 
them briefly. An aggressive nation conquers, 
grows strong, seeks to live in luxury, increases 
taxes, creates bureaus, regulates economy, in- 
creases national debt, subsidizes its people, be- 
comes a socialist state, declares a dictator, and/or 
surrenders to some other aggressor. 


Where do we fit? Certainly, at this time, we 
are the most powerful nation on earth, challenged 
by another powerful and aggressive nation, 
Russia. We are probably worth a half a trillion 
dollars. But, to maintain our position, we are 
spending billions of dollars not only to prepare 
for an eventual war, but also to help restore a 
sound economy to the friendly nations of Europe, 
which lost one-third of their entire wealth in 
World War II. Quoting Joe Liston, who was 
Donald Nelson’s assistant in the War Production 
Board of the last war, “Many times have I 


176 











heard Franklin Roosevelt state that ‘the United 
States was through. That it would be impossible 
hereafter to maintain our present economy un- 
less we were at war or preparing for war.’ ” 

Does that statement mean anything to you? 
Can you not understand how, laboring under that 
philosophy, that we are being bombarded with 
such socialistic legislation as socialized medicine, 
Brannan Plan for farmers, Federal Aid to Edu- 
cation — to name a few? 

What we need today is a new conception of 
our destiny. Men like Washington, Alexander 
Hamilton, Benjamin Franklin, Andrew Jackson, 
or Thomas Jefferson, who carved out of a rough 
but rugged people, a government in which free- 
dom was the uppermost principle. Freedom for 
the pursuit of happiness, the pursuit of wealth, 
the pursuit of knowledge, and the pursuit of 
religion. Indeed, a country where free enter- 
prise is the watchword. Not a country that 
would assure “freedom from want — from womb 
to the tomb,” to quote Winston Churchill. 


Men of Medicine, you are a part of this com- 
plex civilization, and you hold the distinction of 
being leaders in your respective communities. 
You hold the power of health in your community, 
and the health of a nation measures the wealth 
of a nation, Since the birth of Christ, it has 
been estimated that there has been born 40,000,- 
000,000 people into the civilized world, and only 
1,000,000,000 less than three per cent has lived 
in a free country. You are among that privileged 
few, and I ask you, is it worth fighting for? 


I do not subscribe to the philosophy that we 
cannot maintain our economy without being at 
war or preparing for war, for under Paul Hoff- 
man, the C.E.D., a non-political organization 
before the outbreak of the Korean war, so or- 
ganized Labor and Industry that there was a 
peak employment of 62,000,000, and that is not 
bad for days of relative peace. 


We hear much said about socialized medicine 
in England. They do not like it, but they know 
that it is the only answer at the present under 
their economy. If our wealth is ever dissipated 
to the same extent, we too must submit to reg- 
imentation. Even before the last national elec- 
tion, we heard from both political parties that 
a change must occur, else we may well be a 
ruined nation. And, if we continue in the pres- 
ent manner, Socialism and Statism is just as 


Illinois Medical Journal 









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inevitable here as it was in Germany, France, 
or England. 

So what! you say. Well, in my opinion, there 
is yet time to do something. You, individually, 
must personally accept your responsibility as 
citizens, as well as doctors. You must talk, you 
must write, you must be informed, and you must 
vote. 

[ have stated that it matters not what your 
political beliefs are. ‘Take an active part in 
your local politics, and see that a man worthy, 
and well qualified, and above all, one steeped in 
the traditions of American Free Enterprise, be 
candidate for office, from the lowest level to the 
highest. Then, we need not fear for our Amer- 
ican way of life, no matter which party is suc- 
cessful at the polls. 

In a recent election, the medical men of IIli- 
nois were really aroused, and contributed in no 
small measure, to the election of a man who will 
have not part in socializing our profession. The 
medical men of Florida were likewise instru- 
mental in electing a man who is against Social- 
ism. And, in other states, the medical men, as 
citizens, not as societies, were able to create a 
favorable public opinion against those who 
seemed to favor the welfare state. 

It can be done if you will do your part. Some- 
one can’t write or speak for you. In union, 





there is strength, and in unity of effort, there 
will be success. 

In the coming year, often referred to as an 
off year, there is great danger that we may rest 
from our citizenship responsibilities. Gentlemen, 
that would be fatal. We must keep ourselves 
informed. We must contact those in authority, 
who do or will hold the reins of political power, 
and above all, we must sell to the people the 
wonders of medicine, and what it promises to the 
health and happiness of our country. We must 
ever hold high, praise for our national organiza- 
tion, the American Medical Association; that 
everyone shall learn how this watchdog of Amer- 
ican Medicine is for the safeguard of all citizens, 
as well as an inspiration to its members. 

Let us not in the year to come, relax in our 
enthusiasms, for the success or failure of ours — 
the most important of all organizations in the 
world, because of their strategic position in con- 
serving the health of the world, depends on you. 

One hundred and sixty thousand doctors in 
the several communities hold it in their hand to 
develop that public opinion, which will protect 
us and the public from any vicious legislation 
that might destroy the present physician-patient 
relationship. 

The challenge is yours. 
individual responsibility. 


Citizenship is an 





BCG FAILURES 

Endless controversies concerning the dangers 
and the effectiveness of BCG have been present 
in the United States for many years. The 
dangers of vaccination can now be considered 
nil. The effectiveness as an immunizing agent 
is still open for discussion. Failures of vacci- 
nation may be due to (1) quantitative conditions 
connected with the preparation of the vaccine, or 
(2) the lack of technique for differentiating be- 
tween allergy and protective immunity. Dr. 
Rene J. Dubos states that it is almost certain 
that the immunity produced by the vaccine is the 
outcome of a limited but definite multiplication 





For September, 1951 


of the attenuated bacilli in the body of the ani- 
mal undergoing immunization, chiefly in the 
regional lymph nodes. The degree of immuni- 
zation probably reflects in a certain measure 
the extent of this multiplication. It is very like- 
ly, on the other hand, that the degree of multi- 
plication depends in turn upon at least four 
independent factors, namely: (1) the number 
of living micro-organisms injected, (2) their 
physiological state, (3) level of attenuation (or 
virulence), (4) susceptibility of the immunized 
individual. Excerpt: The Present Status of 
BCG Vaccination, E. Fenger, M.D., Oak Ter- 
race, Minn., Minn. Med., Jume 1951. 












Unipolar Electrocardiography and the 


General Practitioner 


(An Analysis of 1000 Consecutive Electrocardiograms) 


B. E. Malstrom, M.D., William Johnson, M.D., 
and E, G. Behrents, M.D. 
Galesburg 


















The purpose of this paper is to evaluate the 
place of unipolar electrocardiography in the prac- 
tice of the general practitioner. Eighty-five per 
cent of the doctors in the United States are in 
general practice and it is our belief that a large 
majority of the work in electrocardiography is 
done by this group. 


The literature is replete with excellent articles 
on the value of electrocardiography for the in- 
ternist and cardiologist, but to our knowledge 
very few articles can be found which stress the 
value of electrocardiography and especially the 
unipolar leads to the general practitioner. One 
is perfectly aware that purchasing a machine does 
not make one an electrocardiologist but we believe 
that the general practitioner who is honest and 
is trying to do a good job feels that he must have 
some working knowledge of electrocardiography, 
and that he is striving to work this into his 
armamentarium the same as he would a blood 
count or an urinalysis. We also feel that men 
like Katz,®* Wilson,?° Burch,!® and Winsor,*® 
are attempting to bring to the average electro- 
cardiographer, fundamental principles which will 
benefit him in his interpretation of a complete 
survey for his cardiac patients. 


In the literature there are many definitions 
and limitations of the electrocardiograms and 
the statement is made that many doctors over- 
read their tracings.? The purpose of this paper 
is to show the place and value of the unipolar 
electrocardiogram in the every day practice of the 
general practitioner. For this reason, 1000 con- 
secutive electrocardiograms taken by unipolar 
and augmented unipolar extremity leads were 
used for analysis. We have attempted to show 
the following: 


1. Main pathological patterns encountered. 
2. Age by decades. 
3. Sex. 













































178 





4. Why taken in general practice 

a. Specific cardiac checkup. 

b. Routine in an over-all checkup. 

c. Referred by other doctors. 

d. Pre-operative (patients over 50 under- 

going major surgery). 
5. Cardiac deaths with special reference to 
bundle branch blocks. 

During the past decade we have seen radical 
changes in the field of electrocardiography. As 
so ably stated by Pruitt,? one of the penalities 
of progress is the painful necessity of abandoning 
old and comfortable ideas for new conceptions 
which laboratory investigations bring forth. The 
confusion which has existed for the past twenty 
years has been brought more to a head during 
the last ten years through the work of the Ameri- 
can Heart Association in standardizing leads, 
mainly the precordials. Wilson?**?° and his 
co-workers have brought forth the belief that uni- 
polar leads are a distinct advantage over the old 
bipolar leads and this has been corroborated by 
such outstanding men as Bayley’, Gold- 
berger,??-1? Katz,** Burch,’* and Winsor’. Burch‘ 
has shown that the use generally of precordial 
leads is governed by empiricism rather than by an 
appreciation and application of the present day 
knowledge of the processes of depolarization and 
repolarization. He has shown, the same as 
Wilson,”"* that the basic principles of depolariza- 
tion and repolarization enable one not only to 
locate but to limit cardiac pathology better than 
a single precordial and limb lead, the use of 
which is still widespread. 

Electrocardiographic patterns are becoming ob- 
solete and vector analysis as shown by Ashman,’ 
and Bayley’, is becoming necessary for the proper 
evaluation of the electrocardiogram. It must be 
emphasized that the electrocardiogram is purely 
a Tecord of the site of an impulse initiation and 
of the spread and retreat of electrical activity of 


Hlineis Medical Journal 















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the various chambers of the heart. Infarcts can 
be present in the center of the ventricles and still 
not be shown in the electrocardiogram. To be 
shown they must be near the endocardial of 
epicardial surface®. As stated by Schwartz,° the 
electrocardiogram represents the result of the po- 
tential variation between recording electrodes 
wherever they are placed. In taking the standard 
limb leads, two extremities are connected to the 
galvanometer of the electrocardiograph machine 
in pairs, thus in taking lead one the right arm 
is connected to the negative pole and the left arm 
to the positive pole of the galvanometer. The 
right arm and the left leg and left arm and the 
right leg are connected similarly in taking leads 
two and three. The two extremities are equidis- 
tant from the heart and undergoing potential 
variations of equal magnitude. These leads may 
be considered bipolar or the result of two uni- 
polar limb leads. They represent a compound of 
the potential variations of each of the two ex- 
tremities. 


In 1934, Wilson? and his associates realizing 
the disadvantages in employing one of the ex- 
tremities as an indifferent electrode, described 
a new type of electrocardiographic lead in which 
an exploring electrode with a central terminal 
connected through equal resistance to the elec- 
trodes on the right arm, left arm, and left leg was 
employed. They were able to show that the po- 
tential in the central terminal was negligible and 
nearly constant throughout the cardiac cycles. 
This central terminal consists mainly of 5,000 
ohm resistors which are connected in each lead. 
However, in most of the newer machines the 
central terminal is built in and it becomes very 
simple to use V-leads and more recently, the 
Goldberger 11-1 leads which record unipolar leads 
in the extremities. These leads have fifty per 
cent more voltage than the first unipolar leads 
described by Wilson. The basic principles are 
the same whether V or Goldberger’s augmented 
wnipolar leads are used*®. As Goldberger’? has 
pointed out, electrocardiography as routinely used 
may be compared to a sphygmomanometer which 
instead of recording the actual systolic and dia- 
stolie pressure would merely indicate the differ- 
ence between them as the pulse pressure. The 
more extensive use of the vector and augmented 
unipolar leads gives one an extra yardstick not 
only to locate but to delineate cardiac lesions. 


For September, 1951 


There is actually no limit to the areas that could 
be evaluated by the indifferent electrode. We 
have found that the number of leads which con- 
sistently give us the most complete knowledge 
are V-1 to V-6 inclusive, routine limb-leads, 
ioldberger’s augmented unipolar extremity leads 
and, depending on the transition across the pre- 
cordium, V-7 and V-8. Occasionally it is neces- 
sary to go higher in the precordium to elicit high 
infarctions. VE and V;R for the right precor- 
dium, posterior and posterior basal infarctions 
should be used. 


It has been shown that the electrical potential 
of any part of the body surface depends upon 
the potential on the surface of the heart facing 
it; further, the magnitude of the potential of any 
point outside of the heart would depend upon its 
distance from the heart since the extremities for 
all practical purposes are equidistant from the 
heart; the potential variations exhibited by each 
will depend upon the potential at the portion of 
the heart surface facing the extremities. 


From the foregoing it is clear that the posi- 
tion of the heart within the thorax will have a 
marked influence upon the ventricular deflections 
observed in the standard limb leads. It has been 
shown that the rotation of the heart upon its 
anteroposterior axis or long axis will produce 
changes in the grades of axis deviations. The 
diagnostic lead patterns may be altered consider- 
ing the unusual rotation of the heart upon one 
or more of its axes; this is accomplished by 
changing the spatial relationship of the heart 
surfaces to the extremities. It is also important 
to note that all parts of the heart contribute to 
the electrocardiographic pattern observed in the 
standard limb leads. Therefore, one may fail 
to reveal small infarcts or localized lesions be- 
cause the effects are over-balanced by those of 
the surrounding myocardium. It is readily seen 
that while a routine can be set up for taking 
tracings, the ingenuity of the electrocardiogra- 
pher is often taxed in finally deciding what other 
areas should be explored to correctly find the 
existing cardiac -Jesion. 


It is becoming more apparent that a basic 
knowledge of the electrocardiographic position 
of the heart is necessary to properly interpret 


electrocardiograms. According to Goldberger”, 
the main positions of the heart are: 








1. The long avis of the heart may be vertical 
or horizontal. This is accomplished by rota- 
tion around the anteroposterior axis of the 
heart. 

2. Heart may rotate around its long axis. This 
can occur in two ways, clockwise when the 
right ventricle becomes more anteriorly and 
the left ventricle more posteriorly and coun- 
terclockwise in which the exact opposite 
occurs. 

3. The apex of the heart can rotate forward or 
backward on the transverse axis. 

It can be seen that the electrocardiographic 
positions of the heart are essential in order to 
know whether special leads are necessary. For 
example, if the heart is vertical with marked 
clockwise rotation and transition to the right, 
and the left precordial area is being specifically 
scrutinized, it wi!l be necessary probably to use 
V-? and V-8. A working knowledge of this 
principle will lead to more focal pointing of the 
precordium and the finding of lesions that have 
been missed previously. 

Main Pathological Types. For simplicity in 
determining the main pathological types, it was 
decided to divide 1000 tracings into six classifica- 
tions (‘Table 1A). Each of the five pathological 
groups was further subdivided as shown in Table 
1B. It is admitted that the division into six 
classifications is far from complete but certainly 
this grouping will include 98 per cent of the trac- 
ings taken in general work. The criteria used are 
those of Wilson, Goldberger and other exponents 
of unipolar cardiography. It is seen that there 
is an overlapping of approximately 100 due to 
the fact that where, for example, hypertrophy 
and coronary disease were present both were 
listed. We were surprised to find that over half 
of our tracings were normal. This is best ex- 
plained by Table 1A where it is seen that over 
50 per cent of the electrocardiograms were taken 
on those patients who were seen in a routine 


TABLE 1A 
MAIN PATHOLOGICAL TYPES 





DORMNEE Soc wiltiv pec ws oF wads CACO, es 507 
0 OS Eee mae Pom very die Penna a cee Tt ee 185 
Parente CFE. eI, SS cd 125 
Ne NSE cre ek Gres Had whic sigh ROK se eee 60 
NR Is a a sinh g ke ant 178 
PRGNOCRU) RNG «5 osc cca ces vases ste 73 

1128 








TABLE 1B 
MAIN PATHOLOGICAL DIVISIONS 


I. Coronary Disease 
a. Occlusion (with and without infarction) 
b. Chronic coronary insufficiency 
c. Transitory coronary insufficiency 
II. Heart Block 
a. Prolonged AV conduction 
b. Incomplete AV block 
c. Complete AV block 
d. Intraventricular block 
1. Right bundle branch 
2. Left bundle branch 
ITI. Arrhythmias 
a. Extrasystoles 
1. Nodal, ventricular, auricular 
b. Tachycardia and bradycardia (sinus) 
Supraventricular tachycardias and 
tachycardias 
c. Auricular fibrillation and flutter (combined, and 
pure and impure types) 
d. Nodal escapes and rhythm 
e. Interference and dissociation 
IV. Left and Right Ventricular Hypertrophy and Strain 
Patterns 
V. Myocardial Involvement 
a. Auricular 
b. Ventricular 
c. Pericarditis 
1. Acute 
2. Chronic 





ventricular 





check-up. In the arrhythmias, sinus tachycardia 
and bradyeardia were included but not sinus 
arrhythmias. Less than 20 per cent were in the 
coronary group although it is commonly felt 
that most tracings are taken for coronary disease. 
The myocardial group is a weak group as the 
criteria here is still debatable by many men. 
Slurring of all complexes with low voltage, Q-T 
prolongation, and abnormal forms with focal ab- 
normalities (abnormalities limited to one lead) 
were of use in defining this group. Left and 
right ventricular hypertrophy as well as strain 
was a prominent classification. Left and right 
axis dexiation were excluded. Here the criteria 
of Ungerlieder and Gubner?’, Myers et al’, Soko- 
low and Lyon’ were used. ‘Twenty per cent 
were in this group. Sixty heart blocks were pres- 
ent. The percentage of bundle branch block in 
the dead survey will be discussed more thorough- 
ly. 

Incidence According to Age. The majority 
of tracings were taken as one would expect be 
tween the fourth and seventh decades (Table 2). 
It is in this span of life that coronary disease is 


Illinois Medica! Journal 

















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TABLE 2 
INCIDENCE ACCORDING TO AGE 











most prevalent ; and that changes of hypertension 
are seen in the myocardium. It is interesting 
to note that 40 tracings were taken under twenty 
years of age. In our analysis most of these were 
taken in rheumatic hearts. It should be ex- 
plained why 119 tracings were taken in patients 
over seventy years of age and fifteen in those 
over eighty. We have felt for years that in 
patients over fifty years of age undergoing major 
surgery a tracing should be taken routinely to 
properly evaluate the myocardium and coronary 
tree. Many of these 119 tracings were taken in 
patients with fractured hips and in men under- 
going prostatic surgery. It is true that the 
findings of a bundle branch block or severe 
coronary disease does not deter us from doing 
surgery since it is usually non-elective surgery. 
However, we felt that the patient could be han- 
dled best from the surgeon’s as well as the 
anesthetist’s standpoint, if a tracing were taken. 
We have done this for the last five years and feel 
that it is as valuable an adjunct as non-protein 
nitrogen or blood sugar in old people. 

Incidence by Sex. There were 538 males and 
462 females in our series. (Table 3). 


TABLE 3 
INCIDENCE BY SEX 











Although it is an accepted fact that coronary 
lisease is more prevalent in males than in fe- 
males, especially in the fourth to the seventh 
lecades, we were surprised to find more males 
than females requiring, in our opinion, electro- 
tardiograms. This is of interest particularly 
‘ince in our practice many more females are 
ven than males and female surgery far outpoints 
male, 


for September, 1951 


Why Electrocardiograms Were Taken. There 
was bound to be some overlapping in deciding to 
evaluate them in this section for many reasons 
(Table 4). Often a patient was referred for 
routine check-up and occasionally for a specific 
cardiac evaluation, as well as for a routine check- 
up preceding surgery. In our practice patients 
are referred by doctors merely for an electro- 


TABLE 4 
WHY ELECTROCARDIOGRAMS WERE TAKEN 








Routine 

Referral 

Pre-operative 

Specific cardiac check-up 





cardiogram to determine the presence or absence 
of coronary involvement. Nevertheless, we see 
that most of the tracings were taken in a routine 
check-up. By a routine check-up is meant that 
in the course of examination, whether by the 
patient’s request or in our opinion, electrocardio- 
gram is indicated for proper evaluation. 
Mortality Statistics at Survey. In the 1000 
consecutive tracings taken (Table 5), 62 patients 
were dead when the survey was made, but in 
analyzing the deaths and subtracting those who 
had died from causes other than cardiac, it was 
found that the corrected total number of deaths 


TABLE 5 
ALIVE AND DEAD AT SURVEY 








Death rate corrected 
(21 deaths were due to other causes) 





was 41. The dead were then divided into age, 
sex, and the number of bundle branch blocks. 
Our main interest in eliciting the number and 
types of bundle branch blocks was that we felt 
it would give us 2 good index as to the number 
of bundle branch blocks that one could expect 
in a thousand cases. 

It is seen in Table 6 that the fifth to eighth 
decades contain the majority of deaths, as one 
might expect according to national statistics. 
One died in the third decade from cardiovascular 
renal disease. ‘There was one death in the 
fourth decade which is of interest because the 
patient, a white man aged 40, who had a tracing 
taken which was interpreted as normal and the 





TABLE 6 
INCIDENCE OF DEATH ACCORDING TO AGE 


30-40 Years 








70-80 Years 
80-90 Years 





opinion confirmed by an outstanding electro- 
cardiographer, died suddenly the following day. 
It is recognized that this happens but certainly 
not commonly at this age. This case emphasizes 
once more the limitations of an electrocardio- 
gram. 

Twice as many males were dead as females 
(‘Table 7), confirming again that women have 


more longevity than the stronger sex. 


TABLE 7 
___ INCIDENCE OF DEATH BY SEXES 
MONS cosscccsenese: tees 


Female 











In the death survey nine bundle branch blocks 
were seen (Table 8). Here again many of the 
old S-type blocks were actually right bundle 
branch blocks as seen in the unipolar leads. We 


have found that one cannot depend on the limb 
leads to determine the type of blocks. Approxi- 
mately an equal number of right and left blocks 
were present which substantiates other findings 
that they occur in equal frequency and one 


cannot say that one type offers a better prog- 


nosis than the other. 


TABLE 8 
INCIDENCE OF BUNDLE BRANCH 
BLOCK IN 1000 TRACINGS _ 
Right bundle branch block .......++.565 Fav sasean ve 5 
Left bundle branch block .............seeeee 4 


SUMMARY 

1. One thousand consecutive 
grams were taken from our files (this was over 
a year and one-half duration) for critical analy- 
sis in a practice which is cousidered to be typical 
of a general practice. No means were taken to 
exclude any type of tracing. 

2. Unipclar electrocardiography and the con- 
cepts of Wilson and Goldberger were used in 
analyzing these electrocardiograms. 


electrocardio- 


3. It was demonstrated why these tracings 


were taken. 


4. Five hundred seven out of 1000 tracings 
were normal, 

5. The main pathological types. encountered 
were coronary disease, arrhythmias, blocks, hy- 
pertrophy and myocardial damage. 

6. Out of 1000 tracings, 41 were dead due to 
cardiac pathology, and these were further divided 
into age group and sex. 

7. Nine bundle branch blocks were found in 
the dead group, five of which were right and four 
left. 

8. In the dead group by sexes, there were 28 
males and 13 females. 

9. Analysis by age group shows that the fourth 
to seventh decades were the ones in which elec. 
trocardiograms were most frequently taken. 

CONCLUSIONS 

1. Unipolar electrocardiography is practical 
and necessary for the general practitioner to 
enable him to evaluate properly his cardiac pa- 
tients. 

2. More than 50 per cent of the tracings taken 
by the average general practitioner may be ex- 
pected to be within normal limits. 

3. The concepts of Wilson and Goldberger 
enable the general practitioner to locate and 
delineate cardiac lesions more accurately than 


with the old system of limb leads and one bi- 


polar precordial lead. 

4, The majority of tracings were taken in the 
fifth to seventh decade and the death rate in 
the male was double that in the female. 


5. From the number of bundle branch blocks 


{ound in this series, 0.009 per cent bundle branch 
blocks can be expected. For practical purposes 


the death rate was the same in this series. 
6. Electrocardiographic positions of the heart 
must be understood for taking unipolar leads. 


7. Limb leads, V-1 to V-6, and augmented 


unipolar leads were taken routinely and, depend- 


ing on the rotation of the heart, V-7, V-8, VsR 


and VE leads were considered useful and at 


times necessary. 
320 N. Kellogg Street 
REFERENCES 
1. Pruitt, R. D.: Electrocardiography in the Analysis of 
Clinical Problems, Postgraduate Medicine, Feb., 1949. 
2. Wilson, F, M., Johnston, F. D., Lacleod, A. G., and 
Barker, P. S.: Electrocardiograms that Represent the 
Potential Variations of a Single Electrode, Am. Heart J. 
9: 447, 1933. 
- Camp, Paul D.: 
1944, 
. Burch, G. E.: Need for Better Appreciation of Value of 
Multiple Precordial Leads, New Orleans M. and S. J. 


98; 491-496 (May) 1946, 


Southern Med. and Surg. 106: 473, 


Iinels Medical Journol 





Th 
logic: 
Servic 
its uw 
fully 
Th 
scout 
ureth 
abdon 
prelir 
ing ¢ 
and | 
muse] 
forma 
ahdon 
ities, 


scout 


‘e 28 


yurth 


elec. 
1, 


tical 
r to 
2 pa- 


‘aken 
e ex- 


erger 
and 
than 
e bi- 


n the 


te in 


locks 


ranch 


‘poses 


heart 
1s. 
ented 
pend- 
VR 
id at 


. Bayley, Robert H.: Medical Diagnosis and Applied 
Physical Diagnosis, Pullen, Chapter 11. W. B. Saunders 


Co., Phila. 

. Ashman, R. and Hull, E.: Essentials of Electrocardi- 
ography, Second edition, New York, The Macmillan Co., 
1941, 

. Bayley, R. H.: 
Electrocardiographic Theory to the Interpretation of 
Electrocardiograms which Indicate Myocardial Disease. 
Am, Heart J, 26; 769, 1943, 

. Katz, L. N. and Koplan, L. G.: Value of Electrocardi- 
ography to the General Practitioner. Clinics 5: 235-247, 
1946, 

9. Schwartz, M.: Trends in Electrocardiography; Bipolar 
Standard Limb Leads Versus Unipolar Precordial Leads, 
Northwest Med. 46: 43-47, 1947. 

. Wilson, F. N. et al: The Precordial Electrocardiogram, 
Am. Heart J. 27: 19-85, 1944, 

. Goldberger, E.: Unipolar Electrocardiography, Lea and 
Febiger, Phila, 1947, 

. Goldberger, E.: A Simple Electrocardiographic Elec- 
trode of Zero Potential and a Technic of Obtaining 
Augmented Unipolar Extremity Leads, Am. Heart J. 
23: 483, 1942. 


On Certain Applications of Modern 


. Wilson, F. N., Johnston, F. D. et al: On Ejithoven 
Triangle Theory of Unipolar Electrocardiographic Leads 
and Interpretation of Percordial Electrocardiography, Am. 
Heart J. 32: 277, 1946. 

. Katz, Louis N.: Electrocardiography, Lea and Febiger, 
Phila., 1947. 

. Burch-Winsor: A Primer of Electrocardiography, Lea 
and Febiger, Phila., Second edition. 

. Sokolow, Maurice, Lyon, T. P.: The Ventricular Com- 
plex in Left Ventricular Hypertrophy as Obtained by 
Unipolar Precordial and Limb Leads, Am. Heart J. 37: 
No. 2 (Feb.), 1949. 

. Gubner, R. S. and Ungerlieder, H. E.: Electrocardi- 
ographic Criteria of Left Ventricular Hypertrophy, Arch. 
Int. Med., 72: 196, 1943. 

. Rappaport, Maurice B. and Williams, C.: Analysis of 
the Relative Accuracies of the Wilson and Goldberger 
Methods for Registering Unipolar and Augmented Uni- 
polar Electrocardiographic Leads, Am. Heart J. 37: 982 
(May) 1949. 

. Myers, Gordon B., Klein, H. A., and:Stofer, B. E.: 
The Electrocardiographic Diagnosis of Right Ventricular 
Hypertrophy, Am, Heart J. 35: No. 1, 1-40, 1948, 

. Goldberger, E.: The Differentiation of Normal from 
Abnormal Q Waves, Am. Heart J. 30: 341, No. 4, 1945. 





X-Ray Findings in Adult Urological 


Conditions 


Paul R. Dirkse, M.D. 
Peoria 


This represents a review of the range of uro- 
logical conditions in which radiography can be of 
service and a partial list of the indications for 
its use. It is intended primarily for those not 
fully familiar with these procedures. 

The principal radiographic procedures are the 
scout film, the pyelogram, the cystogram and the 
urethrogram. ‘I'he scout film should include the 
abdomen and pelvis. This film is an essential 
preliminary step in radiography. Besides show- 
Ing calcareous shadows, it shows the size, shape 
and position of the kidneys and of the psoas 
muscles, It frequently yields other useful in- 
formation about the size and position of other 
abdominal organs, tumors and skeletal abnormal- 
ites. The information obtained may warrant 


scout films in other positions. 


—— 


Presented before the General Assembly, Illinois 
State Medical Society, 110th Annual Meeting, Spring- 


field, May 24, 1950, 


For September, 1951 


When a retrograde pyelogram is done the pa- 
tient is first cystoscoped and opaque catheters 
are introduced into the ureters. Additional films 
are exposed at this time before or after the con- 


trast medium is injected, or both. The films with 


the catheters only in place are particularly valu- — 
able when the preliminary film has shown a 
shadow suspected of being a calculus in one of 
the ureters. Antero-posterior and oblique views 
will confirm the suspected diagnosis by demon- 
strating the shadow to lie immediately adjacent 
to the shadow of the catheter in both positions 
and by showing displacement of this shadow 
proximally along the course of the ureter by 
the introduction of the catheter. These criteria 
(lifferentiate a calculus from a phlebolith and 
other pelvic and abdominal calcifications. The 
retrograde pyelogram regularly will provide 
more reliable information concerning the anat- 
omy of the upper urinary tracts than any other 


radiographic procedure. 





The excretory pyelogram has proven safe with 
the use of modern opaque media containing 
stable radiopaque organic iodine molecules, The 
technique of the examination and the precautions 
to be used can be obtained from any modern 
treatise on urology or radiology. Visualization 
frequently is less satisfactory than by retrograde 
pyelography. ‘This method has an advantage, 
however, in that it provides a fairly good renal 
function test by observing the concentration and 
especially the time of appearance in and clear- 
ing from the urinary tracts. It is used when 
retrograde pyelography is contra-indicated or 
impossible, and also frequently when the symp- 
toms do not seem to warrant cystoscopy. 

A high blood urea nitrogen and other evidence 
of marked renal insufficiency by function tests 
are considered contra-indications to the use of 
both methods of urography. They may be contra- 
indicated also in an acute nephritis. 

The cystogram consists of antero-posterior and 
oblique radiographs made after injection of an 
opaque solution into the bladder. This solution 
is then withdrawn and air injected, and one or 
two additional views are exposed. A special up- 
right film or a view made while the patient 
strains as if to urinate while the bladder is 
filled with the opaque material may be used to 
demonstrate a cystocele in the female. 

The urethrogram consists of antero-posterior 
and oblique or lateral views of the urethra after 
filling it with an opaque substance. 

Developmental anomalies.—These are very 
common in the urinary tracts. Many of the 
minor anomalies are compatible with a healthy 
existence and produce no symptoms. In general, 
however, it can be stated that malformation pre- 
disposes to acquired forms of disease. Since 
infection is more prone to develop in anomalous 
urinary tracts than in the normal, a common 
finding is a recurrent pyuria with the attendant 
symptom of fever. Some anomalies produce 
obstruction at some level and the obstruction 
may cause pain, although not invariably. It does 
result in urinary stasis which also is a factor in 
producing infection. 

Unilaterai absence of the kidney or a super- 
numerary kidney is quite unusual. Fusion an- 
omalies of various types have been described. 
The horse shoe kidney is the best known and 
most common type. In such a case the renal 
pelves appear rotated. so that the calyces are 


184 


superimposed, or to the extent that the calyces 
point medially. Also the pelves are tilted so that 
their lower poles are nearer the midline than 
their upper poles. The outline of the kidney, 
of course, is lost in its lower medial quadrant 
in the scout film. Rotation anomalies without 
fusion are fairly frequent. 

Duplication anomalies of the urinary tracts 
are fairly common radiographic findings. They 
vary from a partial duplication of one renal 
pelvis to a complete duplication of the pelvis 
and ureter on one or both sides. Anomalies in 
position include the ectopic kidney and the hy- 
permobile kidney. The former has never reached 
its normal level and frequently has a short ureter. 
It rarely lies on the opposite side of the midline 
from its normal positions. The hypermobile kid- 
ney is normal except that its attachments are 
unusually long and loose. 

Congenital hypoplasia of a kidney, as well as 
an acquired atrophy of the kidney, are important 
to recognize since cither may be insufficient to 
sustain life if the other kidney is removed or 
destroyed. It can be identified by pyelogram 
and renal function tests. 

Congenital polycystic disease of the kidney is 
nearly always bilateral. ‘he most common symp- 
tom is pains Hematuria or pyuria may occur 
and a palpable mass is frequently present. The 
pyelogram is very important. It shows the en- 
largement of the kidney, elongation, narrowing 
and distortion of the renal pelves and calyces, 
especially in the longitudinal direction. The 
pelvis and calyces remain smooth and are not 
dilated unless obstruction of the ureter is present. 
It is very significant that both kidneys show 
these changes. (Figure 1). 


Anomalies of the renal vessels are quite varied 
and may produce symptoms as well as radio- 
graphic findings by compressing the ureter. 
There are many anomalies of the urinary tract 
but the above are the most important and com- 
mon seen by the radiologist in adults. 


Calculi.—Urinary calculi vary in their radio- 
graphic density according to their chemical com- 
position. Fortunately, the great majority are 
sufficiently dense to cast a shadow on a plain 
radiograph. The other means of eonfirming the 
location of these shadows with pyelograms and 
oblique or lateral views have already been men- 
tioned. Pure uric acid calculi are not radio- 


Illinois Medical Journal 





paque 
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A 
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Figure 1 


paque. ‘These are not common and they may be 
seen as negative shadows in a pyelogram. 

A caleulus or multiple calculi may develop 
and grow to large size in the renal pelvis or a 
calyx before causing symptoms. A small calculus 
in the ureter, on the other hand, often causes 
severe pain of the characteristic type. Repeated 
scout films may be necessary to trace the progress 
of a calculus down the ureter. If calculi in the 
pelvis or calyces reach a size that prevents their 
dislodgement and continue to grow, they will 
produce damage to the kidney by direct pressure 
or obstruction. This may proceed to a condition 
of calculus pyonephrosis or autonephrectomy. 


Infections. Some common infections pro- 
duce little or no radiographic changes, such as the 
acute nephritis. The chronic form produces 
fibrosis and scarring which deforms the pelvis 
and calyees and may alter the contour of the 
kidney, 


The carbuncle of the kidney and multiple ab- 
scesses also may produce no changes in the pyelo- 


gram in the early stage. If a calyx is invaded 
by granulation tissue. it will appear irregular or 


for September, 1951 


obliterated on the pyelogram. Calyces may ap- 
pear narrow due to spasm. A calyx may be dis- 
torted by an adjacent parenchymal abscess mass, 
without communication. 

Perinephritis or perinephrie abscess will de- 
velop when a parenchymal focus of infection 
penetrates the kidney capsule. The radiographic 
changes depend upon the extent of infection and 
the direction of spread. 
shown on plain roentgenograms provided they 
ere of good quality and not obscured by intestinal 
shadows. The outline of the kidney shadow will 
be indistinct or lost. Motion of the kidney with 
respiration and with changes in position is im- 
paired. If the infection spreads down the posoas 
muscle its lateral outline wii! be lost and a scolio- 
sis will often develop. A perinephric abscess may 
become so large as to displace the kidney. 

Tuberculosis of the kidney is a large chapter 
which we are able only to mention briefly. Foci 
of infection form in the renal pyramids and 
break down to rupture into the calyces. During 
this stage of caseation necrosis and ulceration 
deposits of calcareous salts often form in the 
renal parenchyma. These, when recognized, are 
an important radiographie sign. The localized 
abscess cavity communicating with a calyx is 
also important. Ulceration and fibrosis extend 
along the calyces and pelvis producing irregulari- 
ty and contracture which are visible on the 
pyelogram. The later extension down the ureter 
produces a short, straight, but irregular shadow 
of the ureter on the urogram. Sometimes no 
symptoms occur until the bladder is involved, 
resulting in pain or dysuria. At any stage a 
calyx or the ureter may become so contracted 
as to cause obstruction. Then dilatation devel- 
ops proximal to the obstruction and this may 
cause pain. Pain and pyelographic signs of hy- 
dronephrosis or calyectasis may also develop from 
calculi. (Figure 2). 

A chronic non-tuberculous pyelitis or pyelone- 
phritis will often he recognized on the pyelogram 
only by dilatation of the pelvis and calyces. The 
necks of the minor calyces frequently become 
narrowed and their tips “clubbed”. 


These changes may be 


Pyonephrosis is a sequela of pyelitis and is 
frequently associated with calculi. The renal 
pelvis contains pus and there is more or less 
destruction of kidney parenchyma and loss of 
function. The roentgen signs are calyectasis, 
hydronephrosis, irregularities in the outline of 


185 





the pelvis and calyces, and sometimes irregular 
contraction. When a calculus occludes a calyx 
the shadow of the calyx may be obliterated due to 
non-filling with the contrast medium even though 
it may be dilated. 

Traumatic lessions. Rupture of the kidney re- 
sults in hemorrhage. A small subcapsular hema- 
toma may develop and be absorbed. Bleeding 
into the perirenal tissues provides a_ possible 
source of suppuration and especially if urine 
escapes. The radiographic findings depend upon 
the extent of damage to the kidney and the 
amount of hemorrhage. ‘The escape of blood or 
urine obscures the renal outline as does a perine- 
The kidney outline may be deformed, 
Bleeding may be sufficient to displace 

There may be distortion of the pel- 
(Figure 3). 
These are classified in two 


phritis. 
if visible. 
the kidney. 
vis and calyces. 
Renal tumors. 
groups, as arising in the kidney parenchyma and 
in the pelvis. Of the benign parenchymal tu- 
mors the congenital polycystic disease has already 
been discussed. The solitary cyst is probably 
congenital and may enlarge one part of the kid- 


Figure 2 


Figure 3 


ney and produce distortion of the outline of one 


or more calyces and the renal pelvis depending 
on size and location. Benign tumors of the 
pelvis are usually papillomas and show as non- 
opaque defects in the opaque pyelogram. 

It is sometimes possible only to identify a 
tumor and state its location. Usually one can 
state whether it arises in the parenchyma or 
pelvis and whether benign or malignant. The 
malignant parenchymal tumor will enlarge the 
kidney shadow, frequently at one pole, and it 
may displace the kidney and exhibit calcification. 
The pyelogram shows elongation and narrowing 
and often displacement of calyces adjacent to the 
tumor. The terminal cups are distorted, often 
linear in appearance. The pelvis may be com- 
pressed and displaced. When a parenchymal 
tumor invades a calyx or the pelvis a filling de- 
fect is shown, often irregular. 

Such a defect is the most important and fre- 
quently the only finding in a carcinoma or 
epithelioma arising within the renal pelvis. In 
an advanced case distortion of the pelvis and 
calyces may occur but this is less prominent 
than in a parenchymal tumor. A filling defect 
of the pelvis can occur from a blood clot and it is 


Ilinois Medical Journal 





one 
ding 

the 
non- 


fy a 
can 
a or 
The 
the 
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ving 
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indistinguishable from a carcinoma of the pelvis, 
except by repeating the pyelogram later, to show 
disappearance of the defect. 


Tumors of the ureter are not common and 
appear as small defects within the lumen, fre- 
quently producing obstruction and pain. Tumors 
of the bladder are often recognized as local filling 
defects in the cystogram, attached to one wall. 


The symptom of hematuria is the most im- 
portant symptom of a tumor of the urinary tract, 
and it is often the only symptom. Although 
hematuriah occurs also in non-neoplastic condi- 
tions it is a symptom which must never be passed 
over lightly, but rather should always be investi- 
gated thoroughly. 


Miscellaneous.—1. Ureteral obstruction. This 
may occur from a number of causes, such as cal- 
culus, neoplasm, infection, trauma and stricture. 
A stricture may be congenital or acquired. An 
acquired stricture may arise from causes within 
the ureter such as calculus, or outside of it, such 


For September, 1951 


as infection and trauma. The ureterogram, either 
retrograde or orthrograde, is a most important 
source of information as to its location and cause. 


2. Prostatism. Of the obstructions at the blad- 
der outlet the most common by far is prostatic 
hypertrophy. The urethrogram and the cysto- 
gram are very valuable aids to cystoscopy in this 
condition. They help in determining pre-opera- 
tively the size of the gland, the relative enlarge- 
ment of its various lobes, the degree of intravesi- 
cal protrusion, subvesical enlargement, and 
elevation of the bladder, in identifying prostatic 
calculi and other complicating factors, and in 
differentiating between benign and malignant 
changes. 

The benign prostatic hypertrophy appears in 
several forms, which lack of space prevents de- 
scribing in any detail. A common type is illus- 
trated by the case in which the cystogram shows 
2 large, smoothly rounded defect of the floor 
of the bladder. (Figure 4). The urethrogram 


shows marked elongation and some total elevation 
of its prostatic segment. Its contours are smooth- 
ly curved, turning anteriorly in its upper portion. 
Often it is narrowed or flattened transversely and 
spread somewhat in the antero-posterior direc- 


tion. The carcinoma of the prostate, on the 
other hand, produces characteristically a rigidly 
straight posterior urethra, often with small ir- 
regularities but otherwise concentrically nar- 
rowed. ‘There is usually not such a marked 
elongation of the urethra nor as large an intra- 
vesical portion. 

3. Naturally, the study of the urethra in cases 
of strictures, extravasations, and the like is not 
complete without the urethrogram. 


CONCLUSIONS 


There are several other special radiographic 
procedures used in this field which we have not 
included in the above. Obviously we have been 
able to cover only sketchily and very incompletely 
the wide range of pathological conditions in 
which the radiologist is able to assist in diagnosis 
in the field of adult urology. We have tried to 
mention the most important and those which 
are met most frequently in the practice of roent- 
genography. Unfortunately we are not able to 
include most of our illustrations in this publica- 
tion. 

St. Francis Hospital. 








Corrosive Pyloric Stenosis 


Ralph Gradman, M.D., F.A.C.S., Samuel T. Gerber, M.D. 
and Jerome Kaiser, M.D. 
Chicago 


Knowledge of the early manifestations and 
late esophageal complications of an ingested 
corrosive agent is well known to practitioner 
and surgeon alike; however, the late gastric 
sequelae of corrosive poisoning, as evidenced by 
the paucity of American case reports, would lead 
one to believe that stomach complications are 
rare. Perusal of the foreign journals, to the 
contrary, reveals many interesting case reports 
pertaining to the subject in question. We wish 
to report an interesting case of pyloric stenosis 
without esophageal involvement secondary to lye 
ingestion, which was managed surgically and re- 
evaluated clinically and radiologically seventeen 
months following operation. 

Various corrosive agents have been known to 
cause late gastric stenosis, the most common be- 
ing those available commercially, as hydrochloric 
acid, nitric acid, sulfuric acid, trichloracetic acid 
and carbolic acid. Other agents reported as 
causing cicatricial pyloric stenosis are lye, for- 
maldehyde, potassium hydroxide and zinc chlo- 
ride. 

Extrinsic and intrinsic factors play a dominant 
role in the pathological deformity resulting from 
an ingested corrosive. The extrinsic factors are 
the type, quantity and concentration of the in- 
gested chemical, while intrinsically the gastric 
contents at the time of ingestion and the degree 
of pylorospasm and antral spasm are significant. 

Acids are more prone to involve the stomach. 
The squamous cell lining of the esophagus is 
only superficially destroyed by acids, whereas, 
the delicate, simple columnar epithelium of the 
stomach is involved in a deeper coagulative- 
necrotic process, Alkalis, on the other hand, 
have a tendency to involve both the esophageal 
and gastric mucosa. Heindl*, in an analysis of 
116 cases of esophageal stricture due to lye 
ingestion, found an associated pyloric stenosis 
in only twenty percent of the cases. Statistics 
show that late involvement of the stomach with- 


from the Department of Surgery, Chicago Medical 


School, Manor Hospital. 


188 


out esophageal stricture is a rather rare oc- 
currence following lye ingestion. Our case of 
primary pyloric stenosis, without esophageal in- 
volvement, secondary to lye ingestion is therefore 
significant. Small amounts of dilutely concen- 
trated agents are more likely to result in late 
gastric sequelae than are higher concentrations. 
The latter cause early perforation and death due 
to peritonitis while the former, being better 
tolerated, remain in the stomach for a prolonged 
period of time causing more extensive gastric 
damage. 


The most constant site of stricture formation is 
the pylorus, antrum and lesser curvature. Nor- 
mally, stratification and storage of ingested foods 
occurs in the fundus. Fluids entering a full 
stomach rapidly appear in the duodenum without 
the admixture of solid gastric contents. The 
lesser curvature (Magenstrasse) acts as a com- 
mon pathway for the passage of fluids from the 
esophagus to the pylorus. Experimental inges- 
tion of a caustic-barium mixture revealed radio- 
logically the rapid passage of the mixture via 
the Magenstrasse to the pylorus where sudden 
pyloric and antral spasm halted its further prog- 


Tess. 


Boikan and Singer’ have shown that the 
status of the stomach, whether full or empty, 
plays an important role in the extent of the 
gastric damage. When the corrosive enters the 
full stomach, it rapidly reaches the pylorus via 
the magenstrasse, spreading out fanwise in a 
triangular-shaped area with the base adjacent 
to the pylorus and the apex towards the cardia. 
Pylorospasm maintains the corrosive in pro- 
longed direct contact with the pylorus and lesser 
curvature with the subsequent stricture confined 
to these areas. With marked and persistent 
antral spasm, the corrosive destroys a rim of 
gastric mucosa proximal to the spastic segment, 
thus explaining the rare occurrence of hour-glass 
deformity. The retained food partially dilutes 
the corrosive as well as preventing its. contact 


with the greater curvature. 


IMlineis Medical Journal 











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Ingestion of a corrosive on an empty stomach, 
however, results in a more generalized mucosal 
destruction. Pylorospasm again maintains pro- 
longed contact of the mucosa to the retained cor- 
rosive. The absence of dilution and neutraliza- 
tion effect of food results in extensive gastric 
involvement. The end result may be any of the 
following: pyloric stenosis, antral stenosis, hour 
glass deformity or total gastric scarring resem- 
bling a linitis plastica. In four of Boikan and 
Singer’s cases, correlation of the status of the 
stomach and the eventual pathology were in 
accord with the above concept. 

Gross pathological antral and pyloric changes 
have been variably described in the literature as 
a tumefaction with a cartilaginous swelling. 
Moynihan’® likened the changes to a normal cer- 
vix and uterus — “walls are thickened and un- 
yielding, the cavity small.” Following the initial 
corrosive gastritis with slough of the mucus 
membrane, the gastric wall becomes edematous, 
indurated and friable with surrounding perigas- 
tric adhesions. With progression of the in- 
flammatory process, the edema subsides, the 
friability decreases and the wall becomes firmer 
and narrower with the contraction of the residual 
scar tissue. The depth of the gastric wall necrosis 
depends on the concentration and duration of 
contact with the corrosive. Microscopic examina- 
tion may reveal destruction of the mucosa, 
sub-mucosa and muscularis layer with their 
intrinsic plexuses of nerves. The acute inflam- 
matory process characterized by polymorphonu- 
clear infiltration, hyperemia and edema are later 
replaced by round cell infiltration and fibrosis. 

Pathological physiology is related to the 
destruction of the antral and gastric mucosa 
with decrease in the gastrin hormone and acid 
secretion respectively. This apparently explains 
the low acidity in these cases and the infrequent 
development of anastomotic ulceration following 
gastro-enterostomy. Defective gastric motility 
may result from the destruction of the intrinsic 
herves as well as fibrosis of the musculature. 

The usual history is that of a patient hos- 
pitalized during the acute phase of corrosive 
poisoning responding to treatment, discharged as 
cured, only to return at a future date with 
obstructive manifestations. The onset of the 
obstructive symptoms following ingestion of a 
corrosive varies, the most frequent interval being 


three to six weeks; however, cases have been 


for Septc mber, 1951 


reported as long as six years later. Anorexia 
and a sense of fullness after meals are common, 
usually relieved by vomiting. Cramping epigas- 
tric pain, mild to moderate in severity, are 
frequently present. Intractable vomiting, con- 
taining old retained food, is the most persistent 
symptom and is associated with a notable weight 
loss. With persistent organic obstruction, inani- 
tion, emaciation, dehydration and alkalosis soon 
follow. 

Physical examination reveals evidence of 
weight loss. Gastrectasis is manifested by a 
notable epigastric fullness. Visible peristaltic 
waves may be noted as well as a succussion 
splash. The radiological findings vary with the 
extent of the gastric involvement, revealing any- 
thing from simple pyloric stenosis, antral con- 
tracture, hour-glass deformity, to total gastric 
involvement. The above gastric pathology may 
co-exist with an esophageal stricture. Differenti- 
ation from carcinoma of the stomach may be im- 
possible without a previous history of corrosive 
ingestion. Carcinoma may be diagnosed radio- 
logically in spite of an accurate history. Fluoro- 
scopy may reveal motility disturbances, varying 
from a dilated-atonic stomach to one that is con- 
tracted and hyperactive. In the early phase of 
gastritis, marked antral and pyloric spasm are 
evident. Changes in the mucosal pattern occur 
later, and are limited to the areas of involvement. 


The treatment of corrosive pyloric stenosis is 
surgical; the ultimate aim is restoration of 
gastro-intestinal continuity. The operation of 
choice will depend on the general condition of 
the patient and the pathological status of the 
stomach. Operative procedures used in the past 
have been digital dilitation of the pylorus, py- 
loric resection and pyloroplasty, all of which 
have proven unsatisfactory. Modern choice of 
therapy varies from jejunostomy, gastro-enteros- 
tomy to partial resection of stomach. If the 
patient manifests early obstructive symptoms 
during the acute phase of corrosive gastritis, 
parenteral feedings with adequate decompression 
followed by laparotomy may be indicated. As 
emphasized by Meyer and Steigman’, the stomach 
at this early stage may be edematous and friable, 
precluding surgery involving manipulation and 
suturing of the gastric wall. Preliminary 
jejunostomy, under these circumstances, is the 


procedure of choice, since it permits enteral tube 





feeding with maintenance of the patients nu- 
tritional status, while the local inflammation 
subsides. Performance of gastric surgery while 
the stomach is edematous and friable, entails the 
danger of poor healing, leaking anastomosis and 
peritonitis, 

If laparotomy reveals, as it usually does when 
performed in the later stages, a normal appear- 
ing stomach above the pylorus and antral con- 
striction, the operation of choice is a gastro- 
enterostomy. Partial gastrectomy® has recently 
been advocated in young patients in view of the 
possibility of malignant degeneration, stoma} 
uleer formation and difficulty of accomplishing 
a satislateory gastro-enterestomy in the presence 
of diseased gastric tissue. Four cases of partial 
gastrectomy for benign stenosis have been re- 
ported in the literature. We feel that a gastro- 
enterostomy is the simplest and safest procedure 
providing the condition of the gastric wall at 
the site of anastomosis is normal: however, if at 
exploration, a more extensive involvement of the 
stomach is discovered, which would preclude an 
adequate and safe gastro-enterostomy, and if 
the condition of the patient permits, then a 





Figure 1. Roentgenogram taken six weeks after in- 
gestion of lye solution with almost complete pyloric 


obstruction and marked gastric retention. 








partial gastric resection may be the procedure 
of choice. 

Case Report:—Mrs. M. D., a white woman, aged 
twenty-nine years, was in good health until six weeks 
prior to admission to the hospital, when while despon- 
dent, she took four ounces of concentrated lye solu- 
tion. This was soon followed by vomiting and epigas- 
tric distress. The next day she developed a diarrhea, 
having a medicinal odor. Epigastric soreness and 
vomiting of a blood tinged, foul smelling material, 
persisted for a week. She responded to medical man- 
agement and was asymptomatic for a period of five 
weeks when she returned with complaints of persistent 
vomiting, containing food ingested the previous day. 
This was accompanied by epigastric cramping pain 
and a peculiar sensation as if something was moving 
in the upper abdomen. During the past six weeks, 
she had lost twenty-six pounds. 

Examination was essentially negative except for 
upper abdominal distention, with evidence of visible 
peristaltic waves. A fullness in the left upper abdomen 
with hyper-resonance on percussion was noted. Lab- 
oratory findings: Kahn negative; Urine: straw colored, 
acid, specific gravity 1.027, albumen negative, sugar 
negative; Blood count: Hemoglobin 78%, RBC 4,010,- 
000, WBC 6,100, Color index .97; Differential count 
normal. 

Radiological examination was as follows: (Figure 
1) The esophagus filled well showing no evidence of 





Roentgenogram taken seventeen months 
after gastroenterostomy revealing a functioning stoma 


Figure 2. 


and complete pyloric obstruction. (Photos by T. Scan- 


lan). 


Ilinois Medical Journal 














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stricture or diverticula. The stomach showed definite 
retention with a rather marked narrowing and almost 
complete obstruction at the pyloric antrum. The 
duodenal bulb could not be adequately filled, Four hour 
examination showed only a small amount of barium in 
the terminal ileum, the remainder of the barium is 
still in the stomach. Conclusion: Marked gastric re- 
tention due to almost complete obstruction at the pyloric 
antrum. No evidence of esophageal stricture. 

Patient was admitted to the hospital on June 28, 1948 
with a tentative diagnosis of benign pyloric stenosis due 
to lye ingestion. Pre-operative preparation consisted 
of continuous gastric suction, parenteral fluids, vitamins 
and amino acids to restore. electrolyte and nutritional 
balance. Operation was performed on July 6, 1948 
under spinal (pontocaine-glucose) anesthesia through a 
right upper rectus incision, The stomach was dilated 
but only slightly edematous. The pylorus was firm and 
thickened, having the consistency of the uterine cervix, 
The antrum was thickened and indurated and was sur- 
rounded by many adhesions. Operation consisted of an 
anterior, short-loop, isoperistaltic gastro-enterostomy. 
Patient made an uneventful recovery and was dis- 
charged on July 13, 1948. During the past year, she 
gained thirty pounds. On November 19, 1949, patient 
was re-examined radiologically with the following re- 
port. (Figure 2.) The barium bolus passed readily 
through the esophagus, revealing it to be of normal 
caliber. No areas of narrowing, stricture formation 
or ulceration are present. The gastric mucosal pattern 
of the upper half of the stomach is intact. The gastro- 
enterostomy stoma is located anteriorly on the pars 
media near the greater curvature. Barium passed read- 
ily through the gastro-enterostomy stoma, There is no 
evidence of tenderness, spasm or of an ulcer niche. The 
upper half of the stomach was never adequatly visual- 
ized, Its outline is constantly fixed and shows no dis- 
tensibility. The duodenal bulb and curve was not 
visualized. The proximal bowel appears normal. No 
evidence of stenosis or clumping is seen. Conclusion: 
Functioning gastro-enterostomy without evidence of 
tenderness, spasm or niche formation. The pyloric end 
of the stomach is organically fixed. The esophagus is 
free of evidence of organic narrowing. 

Comment :—Our case is of interest in that it 
represents a pyloric stenosis secondary to lye 
ingestion without esophageal involvement. Radio- 
grams taken seventeen months after surgery re- 
vealed a progression of the stenosis from partial 
to complete obstruction. Patients presenting 
themselves with symptoms of vomiting, weight 
loss, achlorhydria and roentgenological evidence 
of pyloric obstruction with a filling defect may 


easily be mistaken for carcinoma unless an ac- 





curate history of previous ingestion is obtained. 
This is especially significant if the onset of 
symptoms occurs many months or years follow- 
ing the acute episode. ‘I'he possibility of late 
gastric sequelae following the ingestion of a 
corrosive should be kept in mind, in spite of the 
fact that the esophagus may be norma). 


SUMMARY AND CONCLUSION 


1. A case of pyloric obstruction without esophag- 
eal involvement occurring six weeks after lye 
ingestion is reported. 

2. Corrosive alkalis, when ingested, commonly 
cause esophageal stricture alone or in combi- 


nation with a gastric stricture; rarely do they 
cause a solitary gastric stenosis, 

3. Acids more frequently cause pyloric stenosis 
without esophageal involvement. 

4. The pathogenesis of the lesion varies with the 
character of the ingested agent (acid or alka- 
li), and the state of the stomach (full or 
empty). 

. The onset of obstructive symptoms after the 

acute phase of corrosive poisoning subsides usu- 

ally occurs Within four to six weeks, but may 
rarely be delayed as long as six years. 

Differentiation from carcinoma of the stom- 

ach may be impossible without an accurate 

history. 

%. Preoperative preparation with decompression 
and parenteral feeding is essential for good 
results. 

8. Therapy is surgical with a choice between je- 
junostomy, gastro-enterostomy and partial re- 
section depending on the pathological condi- 
tion of the stomach and the nutritional status 
of the patient. 


BIBLIOGRAPHY 


. Boikan, W. S. and Singer, H. A.: Gastric sequelae of 
corrosive poisoning. Arch. Int. Med. 46: 342-357, (Aug.) 
1930. 

2. Gray, Howard, K. and Holmes, Chester, L.: Pyloric 
stenosis caused by ingestion of corrosive substances. Re- 
port of case. Surg. Cl. North America, 28: 1041-1056 
(Aug.) 1948. 

3. Heindl, D.: Quoted by Boikan, W. S. and Singer, H, A. 

4. Meyer, Karl, A. and Steigman, Frederick: The Surgical 
Treatment of Corrosive Gastritis. S.G.O. 79: 306-310 
(1944). . 

5. Moynihan, Berkeley: Abdominal Operations, ed. 4, Phila- 

delphia, W. B. Saunders Company, 1: 342-344, 1928. 


ct 


> 


6. 


_ 








For September, 1951 






Established Use of the Antibiotics 


Harry F. Dowling, M.D. 
Chicago 


Sometimes it seems to me that a physician 
trying to keep up with the status of antibiotic 
therapy today is like a fielder trying to catch a 
dozen fly balls at once. New antibiotics and new 
facts on old antibiotics are coming at us so fast 
that sometimes we have that feeling that all we 
can do is close our eyes and duck. Before we 
give up entirely, however, let us see whether we 
can’t reduce the number of balls we have to 
handle. At the risk, therefore, of appearing 
arbitrary I shall try to group together certain 
of the methods of dosage and treatment, hoping 
thus to simplify the matter sufficiently so that 
we can all keep the important principles in mind. 

First, in considering dosage, I have divided 
the infections responding to penicilllin into two 
groups according to how readily they respond to 
the antibiotic. Among the infections which re- 
spond well are pneumococcic pneumonia, strepto- 
coccic sore throat and scarlet fever, localized 
abscesses and gonococcic infections. As shown 
in Table I, this group of infections may be 
treated with 300,000 units of aqueous penicillin 
intramuscularly at 12 or 24-hour intervals, with 
300,000 units of procaine penicillin every 24 
hours or with 500,000 units of oral penicillin 
every eight hours. Studies by Dr. Paul Bunn’s 
group and ours’ have shown that these oral doses 
result in detectable concentrations of penicillin 
in the blood approximately half of the time for 
all persons and for more than half of the time 
in many individuals. Furthermore, it is much 
simpler to administer penicillin orally at eight- 
hour intervals because meals can easiy be spaced 
so that they do not interfere. 

Whenever infections are caused by organisms 
which are more resistant to penicillin or where 
penetration of penicillin into the site of the 
infection is impaired, the disease has been placed 
in the less responsive category. ‘This includes 
infections with resistant staphylococci as well as 
meningitis and endocarditis. For these infec- 


From the Department of Preventive Medicine, Uni- 
versity of Illinois College of Medicine, Chicago. 

Given before the Ninth Annual Meeting of the New 
England Postgraduate Assembly, Boston, on Novem- 
ber 8, 1950. 


192 


tions penicillin is recommended in doses of 2 
ce. to 8 cc. every six to 12 hours, or in frequent 
intramuscular injections, or by continuous intra- 
venous injection in doses up to 40 million units a 
day. Higher serum concentrations of penicillin 
may be obtained if carinamide or benemid is 
employed in addition. 

Aureomycin and terramycin can be given in 
oral doses of 1 gm. initially and 0.5 gm. every 
six hours. Children may be given 25 mg. per 
Kg. initially, followed by 50 mg. per Kg. per 
day divided into three to six equal doses. Chlor- 
amphenicol is given in double these amounts. 

Intravenous aureomycin is recommended in 
doses of 7 mg. per Kg. every 12 hours. 

In Table 2 are listed the drugs of first and 
second choice for various infections. Penicillin 
is preferred for infections caused by hemolytic 
streptococci, although aureomycin and terramy- 
cin have been found to be satisfactory. In pneu- 
mococcic pneumonia or empyema, aureomycin, 
penicillin, or terramycin may be employed. It 
is possible that aureomycin or terramycin may be 
superior to penicillin because they control in- 
fections with gram-negative rods also. Chlor- 
amphenicol has also been found to be satisfactory 
in these infections but has not as yet received 
extensive trial. In pneumococcic meningitis or 
endocarditis, reliance should be placed on peni- 
cillin because the dose can be increased almost 
ad infinitum if necessary. Staphylococcic in- 
fections are quite responsive to aureomycin and, 
except in the rare case of very highy resistant 
organisms, to penicillin also. Chloramphenicol 
and terramycin have not as yet received exten- 
sive trial. 

Penicillin is the main stand-by in endocarditis 
caused by alpha and gamma streptococci, al- 
though aureomycin and streptomycin have been 
found to be preferable in certain individual in- 
stances. Where the organism is highly resistant 
to the individual antibiotics, combination ther- 
apy should be tried. 

In gonococcic infections, aureomycin, chlor- 
amphenicol, penicillin and terramycin are all 
effective. For meningococcic menigitis nothing 


Illinois Medical Journal 





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TABLE 1 


Recommended Doses of Antibiotics 








Antibiotic 


Route 


Preparation and Dose 


Interval 





Penicillin 


(very responsive infections) 


(less responsive infections) 


Aureomycin 


Terramycin 


Chloramphenicol 


im. 
im. 


oral 


oral 
(adults) 
oral 


(children) 


iv. 


oral 
(adults) 
oral 
(children) 


oral 
(adults) 
oral 
(children) 
rectal 


aqueous crystalline 300,000 units 

procaine aqueous or in oil 
300,000 units 

tablets 500,000 units 


procaine aqueous 600,000 to 
2,400,000 units (2 to 8 cc.) 

aqueous cryStalline 1 to 2 
million units 

aqueous crystalline % to 40 million 
units per day 


1 gm. 

0.5 gm. 

25 mg./Kg. 

50 mg./Kg./day 
7 mg./Kg. 


1 gm. 

0.5 gm. 

25 mg./Kg. 

50 mg./Kg./day 


2 to 4 gm. 

1 gm. 

50 mg./Kg. 

100 mg./Kg./day 
25% greater than oral 


12 or 24 hrs. 


24 hrs. 
8 hrs. 


6 to 12 hrs. 
2 hrs. 


continuous 
infusion 

initially 

6 hrs. 

initially 

6 hrs. 

12 hrs. 

initially 

6 hrs. 

initially 

6 hrs. 

initially 

6 or 8 hrs. 

initially 

6 hrs. 





has been found to be superior to sulfadiazine. 
Gantrisin may be used instead because of its 
greater solubility. Penicillin should be used in 
addition if the Waterhouse-Friderichsen syn- 
drome is suspected. 

Chloramphenicol is the drug of choice in ty- 
phoid and paratyphoid fevers and probably in 
other salmonella infections. Aureomycin is effec- 
tive but to a lesser degree. 

Sulfadiazine has been shown by comprehensive 
studies to be superior to the other sulfonamides 
in bacillary dysentery. Until similar studies 
have been carried out with the newer antibiotics, 
I believe sulfadiazine should be the drug of first 
choice, 

Since so many urinary infections are mild and 
easily controlled, it seems wisest for the physi- 
cian to use sulfonamides initially in these condi- 
tions and to reserve the newer antibiotics for 
those cases where there is no response. Where 
the infection is still recalcitrant, combinations of 
antibioties may be effective. 

When proteus or pseudomonas (pyocyaneus) is 
the causative agent, aureomycin and terramycin 
are rarely efficacious. In some of these cases, 


For September, 1951 


streptomycin or occasionally chloramphenicol 
may clear up the infection. 

Klebsiella (Friedlander) infections respond 
well to aureomycin or chloramphenicol. Strepto- 
mycin is not recommended as the drug of first 
choice because the duration of treatment is often 
so long that eighth nerve damage may develop. 

The course of pertussis is apparently shortened 
by the use of aureomycin, chloramphenicol, or 
terramycin. In Hemophilus influenzae infec- 
tions, on the other hand, I do not believe that 
these drugs have been demonstrated as yet to be 
superior to streptomycin. At present, therefore, 
1 would advocate streptomycin in all cases, com- 
bined with one of the newer antibiotics or with 
sulfadiazine. 

Brucellosis responds to all three of the newer 
antibiotics, but animal studies and preliminary 
investigations in patients, indicate that a com- 
bination of aureomycin and streptomycin gives 
the best results. 

In tularemia, aureomycin, chloramphenicol, and 
streptomycin are all effective. Streptomycin is 
listed as less desirable because of its tendency to 
involve the eighth nerve. 





TABLE 2 
Antimicrobial Agents Recommended in Various Infections 








Infection — 


First Choice Second Choice — 


Coccal Diseases 





Beta hemolytic streptococcic infections 
Pneumococcic pneumonia and empyema 
Pneumococcic meningitis and endocarditis 
Staphylococcic infections 

Alpha and Gamma streptococcic endocarditis 
Gonococcic infections 

Meningococcic meningitis 


A or T 


ce 


? 


C.-f. on Se 


| Nn 
_ 





Typhoid and salmonella infections 
Shigellosis 

Coli, aerogenes and related urinary infections 
Proteus infections 

Pseudomonas infections 

Klebsiella infections 

Pertussis 

H. influenzae 

Brucellosis 

Tularemia 

Gas gangrene 

Tuberculosis 


° 
| 
4 


AN>>p 
aa 
° 
ca 
~ 


wn 
oo 
me. 
= 
wn 
7 
o 


St plus A, C, T, or Su 
A plus St 


P plus specific serum 


St plus paraminosalicylic 
acid or promizole 


Rickettsial and Viral Diseases 





Rickettsial infections 
Lymphogranuloma venereum 
Primary atypical pneumonia 
Herpes zoster 

Psittacosis 





Syphilis 
Amebiasis 





*Combination therapy may be desirable. 


Designation of Symbols 





A — Aureomycin 
C — Chloramphenicol 


The results of the treatment of gas gangrene 
are none too satisfactory. At present a combina- 
tion of specific serum and penicillin is the best 
method available. In tuberculosis the addition 
of para-aminosalicylic acid, promizole or a re- 
lated sulfone, to streptomycin gives better results 
than streptomycin alone. 

All of the rickettsial infections apparently re- 
spond equally well to aureomycin, chlorampheni- 


194 


AOC sor 





P — Penicillin 

St — Streptomycin 
Su — Sulfonamides 
T — Terramycin 


col and terramycin. The same is true of primary 
atypical pneumonia and herpes zoster. In 
psittacosis, aureomycin and penicillin are effec- 
tive. 


Until long-term studies can be carried out 
with the newer antibiotics, penicillin remains 
the drug of choice in syphilis, although aureomy- 
cin and chloramphenicol have been demonstrated 


Ilinois Medical Journal 





to be effective. All three of the newer antibiotics 
are recommended in amebiasis. 

Combinations of Antimicrobial Agents.—On a 
priort grounds it would seem likely that if bac- 
teria were susceptible to each of two different 
antimicrobial agents, the combination of the two 
would be more effective than either agent alone. 
That the matter is not so simple as this, will 
appear when we examine the evidence. Let us 
consider first some of the reasons why combina- 
tions of therapeutic agents might be desirable: 

(1) In the case of infections containing a 
mixture of bacteria, one therapeutic agent might 
be effective against one group of bacteria and 
another agent might be effective against another 
group. 

(2) Penetration into the area of infection 
might be different for the different antimicrobial 
agents. 

(3) By giving similar amounts of two thera- 
peutic agents the side effects which would re- 
sult from the use of large amounts of one of the 
agents alone might be prevented. 

(4) Employment of a second antimicrobial 
agent might prevent or delay the appearance of 
bacteria which would be resistant to the first 
agent if it were used alone. 

(5) A synergistic or additive action might re- 
sult from the use of two antimicrobial agents 
if one agent would kill only a portion of the 
bacteria, if used alone, and the second agent 
would account for the remainder of the bacteria. 

The presence of mixed infections is advanced 
as the reason for the use of penicillin and strep- 
tomycin, or penicillin and sulfonamides, in the 
peritonitis which results from the rupture of a 
viscus. The action of streptomycin (or sulfon- 
amides) on the gram-negative rods complements 
the action of penicillin on the gram-positive 
cocci. The work of Yeager and is associates,’ 
however, makes it likely that aureomycin, which 
includes both groups of organisms in its anti- 
bacterial spectrum, gives results as good or better 
than combinations of penicillin and streptomy- 
cin. 

Staphylococcie infections may develop in pa- 
tients during treatment with streptomycin for 
other infections. Administration of sulfonamides 
or antibiotics effective against gram-positive coc- 
ci, along with the streptomycin, may prevent this 
complication from developing. 


An example of the second reason, penetration 


For September, 1951 


into a focus of infection, is the advocacy of com- 
binations of sulfonamides and penicillin in the 
treatment of pneumococcic meningitis on the 
theory that penicillin would not cross the blood- 
brain barrier in sufficient amounts. Many ob- 
servers have shown, however, that if penicillin 
is given in large enough doses penetration into 
the cerebrospinal fluid does occur. Furthermore, 
my associates and I have found* that when large 
intramuscular doses of penicillin are given to 
patients with pneumococcic meningitis it is not 
necessary to give sulfonamides in addition. 

In considering reason Number 3, we should 
bear in mind that while the dose of penicillin 
can be raised enormously without any ill effects, 
this is not true of streptomycin, since the toxic 
action of this drug on the eighth nerve is more 
pronounced when large doses are employed. Con- 
sequently, in tuberculosis it is advisable to com- 
bine streptomycin and promizole or para-amino- 
salicylic acid. Another reason for the concomi- 
tant use of two drugs in tuberculosis is the fact 
that strains of tubercle bacilli which are re- 
sistant to streptomycin do not make their ap- 
pearance so soon when another inhibiting drug, 
such as para-aminosalicylic acid, is used in ad- 
dition. The employment of this combination in 
tuberculosis, is therefore, also an example of the 
fourth reason, namely, the fact that the employ- 
ment of combinations of agents may retard the 
development of resistance to those agents. 
Pulaski and Baker* have shown that combina- 
tions of streptomycin, penicillin, and sulfona- 
mides retard the development of resistance in the 
case of the gram-negative rods. Klein and Kim- 
melman' had the same results when they worked 
with Staphylococcus aureus and other organisms. 


Perhaps the most challenging problem today 
is whether there is a synergistic effect which 
makes it possible to treat infections with com- 
binations of antimicrobial agents when they will 
not respond to either drug alone. It has been 
shown that streptomycin and sulfonamides are 
effective in brucellosis when one of these drugs 
alone has little or no effect. Aureomycin or 
chloramphenicol alone appear to be more effec- 
tive than the combination of streptomycin and 
sulfonamides, but recent studies make it likely 
that a combination of aureomycin and strepto- 
mycin is still better.° 7 * In the case of entero- 
cocci, Jawetz, Gunnison and Coleman’ have 
demonstrated in vitro that penicillin and strep- 


195 





tomycin were much more effective than either 
drug alone. Eagle and Fleischman’® demon- 
strated a definite synergistic effect of penicillin 
and bacitracin in rabbit syphilis. In a case of 
staphyloccic endocarditis my associates and I"? 
were able to show in vitro that a combination of 
aureomycin and penicillin exerted a synergis- 
tic effect upon the staphylococcus. When these 
two antibiotics were adminis‘ered simultaneous- 
ly, the patient recovered from the infection, al- 
though each of these therapeutic agents, when 
given alone, had been effective. 

This brings up a most important point, name- 
ly, that the value of combinations of drugs must 
be tested in vivo, in animals, and eventually in 
patients. In vitro studies are not enough. Sev- 
eral investigators 1° 1* ' have shown, for in- 
stance, that the addition of sulfonamides to 
penicillin retards the action of the penicillin for 
several hours. Jawetz and Speck’® found this 
to be true when chloramphenicol was added to 
penicillin in vitro, 

These findings accentuate the need for clinical 
trial in the patient and are the basis of the fol- 
lowing recommendations for practical use of 
combinations of antimicrobial agents in clinical 
practice today. 

(1) These combinations should not be used 
in a shotgun fashion, on the theory that if one 
antibotic will accomplish something, two or three 
will accomplish more. Frequently a single anti- 
bietic may be found with a broad enough spec- 
trum to take care of a mixed infection. Aureo- 
mycin in peritonitis due to a ruptured viscus is 
an example of this. Likewise, there is some evi- 
dence that aureomycin and terramycin may be 
superior to penicillin in the treatment of the 
pneumonias because the former antibiotics are 
effective against gram-negative rods and the 
causative agen‘s of primary atypical pneumonia 
as well as against gram-positive cocci. In other in- 
stances, the dose of a single antibiotic may be in- 
creased rather than adding another therapeutic 
agent. The successful employment of large doses of 
penicillin in bacteria endocarditis caused by rel- 
atively resistant organisms is an example of this. 


(2) Where combinations of antimicrobial 
agents have been demonstrated to be of value in 
a certain disease, these combinations may be 
used routinely in all cases of that disease. At 
present the combined use of streptomycin and 
aureomycin in brucellosis appears to be the opti- 


196 


mal method of therapy for that disease. 

(3) Where antibiotics have been found un- 
successful in the treatment of a given patient’s 
infections, or where the in vitro resistance of 
‘he organism makes it unlikely that any individ- 
ual antibiotic will be successful, in vitro tests for 
effective combinations of antibiotics should be 
tried. If a synergistic effect is produced by any 
combination of agents, that combination may 
then be used. Endocarditis and recalcitrant 
urinary tract infections are examples of condi- 
tions in which this method is likey to produce 
results, 


REFEKENCES 

1—Bunn, P.; Caldwell, E. R.; Adair, C.; Lepper, M., and 
Dowling, H.: Absorption & Clinical Use of Penicillin Prepara- 
tions Given in Large Oral Doses. A Cooperative Study 
Utilizing Discontinuous Therapy, J.A.M.A. 144:1540-1543 
(Dec. 30) 1950. 

2—Yeager, G. H.; Ingram, C. H.; and Holbrook, W. A., 
Jr.: Comparison of Effectiveness of Newer Antibiotics in Ex- 
perimental Peritonitis: A Preliminary Report, Ann. of 
Surgery, 129:797-809 (June) 1949, 

3—Dowling, H. F.; Sweet, 1.. K.; Robinson, J. A.; Zeller, 
W. W.; and Hirsh, H. L.: The Treatment of Pueumococcic 
Meningitis with Massive Doses of Systemic Penicillin, Am. 
Jr. Med. Sc. 217:149-156 (Feb.) 1949. 

4—Pulaski, E. J. and Baker, H. J.: In Vitro Effects on 
Gram-Negative Bacteria of Streptomycin Combined with 
Penicillin and/or Sulfadiazine, Jr. Lab and Clin. Med, 34: 
186-198 (Feb.) 1949. 

5—Klein, M. and Kimmelman, L. J.: The Correlation be- 
tween the Inhibition of Drug Resistance and Synergism in 
Streptomycin and Penicillin, Jr. Bact. 54:363-370 (Sept.) 1947. 

6—Heilman, F. R.: The Effect of Combined Treatment 
with Aurecmycin and Dihydrostreptomycin on Brucella In- 
fections in Mice, Proc. Staff Meetings Mayo Clinic 24:133- 
137 (Mar. 16) 1949. 

7—Herrell, W. E.: The Combined Use of Aureomycin and 
Dihydrostreptomycin in the Treatment of Brucellosis, Proc. 
Staff Meetings Mayo Clinic 24:138-145 (Mar. 16) 1949. 

8—Knight, V.: Chemotherapy of Brucellosis, Ann. New 
York Acad. Sc. 53:332-344 (Sept. 15) 1950. 

9—Jawetz, E.; Gunnison, J. B.; and Coleman, C. R.: The 
Combined Action of Penicillin with Streptomycin or Chloro- 
mycetin on Enterococci in Vitro, Science 111:254-256 (Mar. 
10) 1950. 

10—Eagle, H. and Fleischman, R.: Therapeutic Activity of 
Bacitracin in Rabbit Syphilis, and Its Synergistic Action 
with Penicillin, Proc. Sec. Exp. Biol. and Med, 68:415-417, 
1948, 

11—Spies, H. W.; Dowling, H. F.; Lepper, M. H.; Wolfe, 
C. K.; and Caldwell, E. R., Jr.: Aureomycin in the Treat- 
ment of Bacterial Endocarditis: A Report of Nine Cases to- 
gether with a Study of the Synergistic Action of Awreomycin 
and Penicillin in One Case, Arch. Int. Med. 87:66-78 (fan.) 
1951. 

12—Hobby, G. L. and Dawson, M. H.: The Effect of 
Sulfonamides on the Action of Penicillin, Jr. of Bact. 51: 
447-456 (Apr.) 1946. 

13—Klein, M. and Kalter, S. S.: The Combined Action of 
Penicillin and the Sulfonamides in Vitro: The Nature of the 
Reaction, Jr. Bact. 51:95-105 (Jan.) 1946. 

14—Poth, E. J.; Wise, R. I.: and Sattery, M. P.: Peni- 
cillin | Phthalysulfathiazole Antagonism, Surgery 20:147-149 
(July) 1946. 

15—Jawetz, E. and Speck, R. S.: Joint Action of Penicillin 
with Chloramphenicol on an Experimental Streptococcal In- 
fection of Mice, Proc. Soc. Exp. Biol. and Med. 74:93-96. 
1950. 


Ilinois Medical Journal 








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The Lost Art of Diagnosing With 
the Eyes and Ears 


Walter C. Alvarez, M.D. 





SEMINAR 
of the 
Department of Medicine 
and 
Cooperating Departments 


° 

The University of Illinois 
Edited by: 

William R. Best, M.D. 








Max Samter, M.D. 





Dr. Alvarez: Today I feel great need for 
pointing out that, although of late medicine has 
been advancing and developing wonderfully well 
along certain lines, along one line it has been 
going badly. There is too great a tendency, 
especially among young physicians, to rely main- 
ly on the laboratory and the x-ray departments 
for the making of their diagnoses. 

Thus, at the Mayo Clinic, where I studied this 
problem for 25 years, I found that while most of 
the brilliant young doctors who came from our 
great universities knew more than I did about 
diagnosing rare diseases with the help of labora- 
tory reports, often my older colleagues and I, 
with the help of only our eyes and ears, were 
able to make a diagnosis that was more pertinent 
than the one made in the laboratory. Thus, 
while a young colleague was keenly studying a 
high blood cholesterol or a somewhat abnormal 
sugar tolerance curve, or some diverticula of the 
colon, he might be failing to look at the man 
keenly enough to see that he was ill only because 
he had had a little stroke or an attack of enceph- 
alitis, 

Most of the patients who are seen at a place 
like the Mayo Clinic have already been studied 
thoroughly elsewhere, and by able internists. 
Often, of course, the diagnosis the patient brings 
is correct, but when it is wrong or, more often, 
inadequate to explain all the symptoms, one 
usually finds that the mistake made was due to 
the failure of the physicians to look shrewdly 
at the patient or to talk with him. In many a 
case, even one question would have shown that 
the diagnosis was inadequate, or it would have 
led to the making of a more pertinent one. 


For September, 1951 


To illustrate what I mean: not infrequently 
I see a patient, sent with the diagnosis of a 
duodenal ulcer made by a roentgenologist. A 
Sippy treatment for ulcer did not help. If only 
the local physician had asked one question he 
would have seen that his diagnosis was wrong. 
If he had only asked the man, “When did you 
have hunger pain in the pit of your stomach, re- 
lieved by eating?” the fellow would have said 
“Oh, that was 20 years ago. I haven’t had any 
of that trouble since!” ‘Then the doctor would 
have known that what the roentgenologist saw 
was only a scar, and that the cause of the symp- 
toms being complained of had yet to be found. 

To show the extremes to which the modern 
lack of observation of patients can now go: the 
other day I saw an elderly man who complained 
of abdominal pain. Gastro-enterologists had 
tried to relieve this, and had had his digestive 
tract roentgenographed several times, hoping to 
find an ulcer. When the man came in and I 
shook his hand I was immediately impressed by 
the fact that it was clumsy and clammy. It did 
not feel right. Looking down at it, I saw a 
shiny red hand, the skin of which, evidently, had 
suffered marked trophic changes. A few ques- 
tions brought out the facts that the abdominal 
pain had come suddenly, with a bad dizzy spell. 
With this there had come the changes in the 
hand and an inability to concentrate on work. 
Obviously, the man had had a little stroke which 
had injured the center for the hand and in some 
curious way had sent a storm down the vagus 
nerves to the stomach. 


A while ago I saw another man like this who 
had been examined by several internists, all of 
whom had been concerned only with a slight in- 
crease in blood pressure, a left bundle branch 
block, which was not producing symptoms, and 
some minor disturbances in renal function. 
When I saw the fellow I was impressed by the 
fact that something must have hit his brain and 
hit it hard. He did not look like the sort of fel- 
low who could be a prominent attorney, and that 
is what he said he had been. His answers to 
questions were slow, and his face was expression- 


197 





less and uninterested. His eyes did not light 
up. He had a slight weakness and tremor of 
the muscles on the right side of his face. He 
had a little drooling of saliva at one corner of 
his mouth, and he had a little egg on his chin. 
As I could not get much of a history out of 
him, I took his wife into the next room and 
asked her if her husband had changed. She said, 
“Yes, he is a very different man since he had 
that spell in October in which he fell down.” 
I was much impressed by the fact that he could 
not work any more; he couldn’t even read as he 
used to do. Obviously he had had a stroke. 
One difficulty in university medical schools 
today is that most of the teachers are so highly 
interested in rare diseases that they are con- 
stantly showing cases of these diseases to the 
students. As a result, a student comes to know 
much about such rare diseases as Ayerza’s syn- 
drome, pheochromocytomas or potassium defi- 
ciency, but he doesn’t know the commonly seen, 
frail little constitutionally inadequate type of 
woman the minute he sees her. He is not able 
to recognize common hysteria at a glance. He 
cannot recognize on sight a mildly psychotic 
patient, and often he doesn’t even notice that a 
patient is walking in a curious way. He is not 


able to recognize the different gaits or postures 
which can be so helpful diagnostically. 

I often say that so long as a psychotic patient 
does not punch his doctor in the jaw, he can go 


through the man’s office or through a great 
diagnostic clinic and come out on the other side 


with the report that he is perfectly well. Many 
a time I have seen this happen. I remember the 
melancholiac, much depressed wife of a professor 
who came from a university hospital with a 
diagnosis of amebiasis! The medical head of a 
big life insurance company once asked me to see 
one of his branch office heads, who, formerly, 
had been a very able and successful man. But 
for a year his office had been going down hill. 
His chief had sent the man to several internists 
but he had always come back with a clean bill 
of health. When I saw him I immediately recog- 
nized hypomania. The man was too talkative 
and pally and excitable. I went out to the wait- 
ing-room, found his wife and had a chat with 
her. She said “Yes, he is now in one of his 
excitable stages, but soon he will be down in 
tre depths, crying and wringing his hands and 


talking of suicide.” Evidently, here was a manic 


depressive man who should have been in an 
asylum, getting shock treatments, but when in 
a doctor’s office he behaved so well that his 
hypomania was not noticed. 

Today one of the greatest difficulties with 
medicine is that often the consultant does not 
take the patient’s history. He lets his nurse or 
an assistant do that. Then the patient is sent 
for a lot of tests and x-ray studies, and finally 
the Chief sees him or her for ten minutes. Dur- 
ing this time the doctor just looks through the 
laboratory reports and accepts any diagnosis that 
appears to have been made for him. As I 
pointed out, he hardly looks at the man, and, 
of course, has no time in which to get acquainted 
with him. It probably never occurs to him, also, 
to talk to the family to see what the patient’s 
psychic situation is. 

A few times in my life, when, in a hurried 
day, I have tried to practice this type of what I 
call decerebrate medicine, I promptly got myself 
into serious trouble or nearly made a bad mis- 
take. For instance, one day while hurrying so 
that I could leave on a train, I found a stout, 
nice-looking woman of 45 who, from the record, 
had given a typical story of a common duct 
stone. I was all set to refer her to a surgeon 
when I said to myself, “No, here I am, practic- 
ing the typé of medicine which I am always de- 
crying.” Accordingly, I started taking my own 
history. It had already been taken on several 
occasions by three young physicians who all 
agreed that after years of suffering “gallstone 
colies”, the woman had been operated on and a 
gallbladder full of stones had been removed. 
Following this, she had gone on having the 
“colics.” It was stated also, that once she had 
been jaundiced; sometimes she had had chills; 
and sometimes fever. Obviously, this was the 
typical story of a common duct stone. 

But when I said to her, “How bad is your 
pain during a colic? Do you need morphine?” 
I was startled to hear her say, “Why, I have no 
pain; I never had a pain in my life.” I asked 
then what she did have, and she said she had 
spells in which she vomited for a day or two. 
I asked, “Does the vomiting spell begin with a 
headache?” “Yes,” she said, “over my right 
eye.” In a minute I had the typical story of 
migraine, and of gallstones which had never 


given her any pain or distress. That is why 


their removal had had no effect on the syndrome. 


Ilinots Medical Journal 





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Her migrainous attacks came because she was 
married to a man twenty years older whom she 
did not much like. Why did the young doctors 
write “colic?” Doubtless because, knowing from 
x-ray work that she had gall stones, they as- 
sumed that her spells must be colics. 

I asked her then, “How about the jaundice?” 
She said, “Oh, your assistant was so determined 
that at some time I must have had jaundice that 
I finally said that I had it in order to get rid 
of him!” The “chills” turned out to be a ner- 
vous chill which she had once after an argument 
with her husband; and the fever turned out to 
be an insignificant 99.6 on some days when she 
was nervous. How grateful I then was that I 
had not sent her in for a useless operation. 

I am often greatly interested to see what 
nowadays able physicians do not notice. Thus, 
I was asked to see an elderly man whose feeling 
of great fatigue had appeared to be inexplicable, 
even after many examinations. On coming into 
the room I noticed that he was wearing big rub- 
ber winter galoshes. I asked him what he was 
doing with those on, on a hot day in July. “Oh, 
I’m so cold,” he answered. The diagnosis then 
was obvious, and a test showed a basal metabolic 
rate of minus 38 percent. 

Another patient was referred to me by a 
distinguished professor of medicine for an 
“amoebic dysentery” which had not been re- 
lieved by much treatment with emetin and car- 
barsone. On shaking hands with the man, my 
assistant noticed a hand which felt feverish ; and 
on looking into the man’s eyes, he saw a rather 
frightened look of a person with exophthalmic 
goiter. Actually, the man had a basal metabolic 
rate of plus 65, and removal of most of his thy- 
roid gland brought instant relief. In this case, 
if the professor had only asked the man one 
(uestion he would have realized that he was not 
dealing with dysentery. I said to the man, 
“What do your bowl movements look like? Are 
they bloody, or mucous, or watery or mushy?” 
He said, “They consist of little, round, hard 
balls!” This so-called diarrhea stopped the day 


the thyroid gland was removed. 

It is unfortunate that today a tremendous 
amount of the laboratory and x-ray work which 
is done is wasted. For instance, as I was writ- 


ing the notes for this talk, I was called to see a 
man who, because of abdominal discomfort, had 


had soveral x-ray studies made of the digestive 


for September, 1951 


tract. A glance at him showed that he was 
depressed and schizoid. On talking to his 
family, I found that for some time he had been 
in a depression. He was a man forty years of 
age who had never married or showed any in- 
terest in girls. More questioning of the family 
showed that his aunt is in an insane asylum. 

I said to the brother who was giving me the 
information, “Why didn’t you tell your doctor 
all this before you left Virginia to come to Chi- 
cago?” He said, “I tried to tell him but he was 
so busy that eventually he got angry with me and 
told me not to bother him.” Each time the 
brother got worse the doctor sent him for more 
x-ray studies. 

In the clinic in which I used to work, the older 
members of the Staff each year used to cancel 
bills for around a quarter of a million dollars 
worth of laboratory and x-ray work which they 
felt had not been necessary and should not have 
been ordered by the assistants. For instance, 
one evening I saw a young woman who had been 
given orders for over two hundred dollars worth 
of laboratory work, when her only complaint was 
insomnia! Just one question showed that her 
trouble was all due to the fact that her fiance 
had started going out with another girl. In an- 
other case an old man with a fixed tumor in his 
epigastrium and the story of a loss of 30 Ibs. in 
weight had been given almost every conceivable 
test by the brilliant young graduate of a great 
university medical school. The patient brought 
with him an x-ray film showing an inoperable 
carcinoma of the stomach! When I asked the 
assistant why he had spent ten days studying the 
man with many tests his answer was that he had 
been trained to do that to every patient. 

All of this can be summed up in one sentence. 
What we need in medicine today is more obser- 
vation and more taking of histories and less 
ordering of useless tests. They are useless when 
the diagnosis can be made without them. 

Dr. Robert W. Keeton, Professor of Medicine: 


One problem which we frequently meet is the 
reluctance of the psychoneurotic patient to accept 


the diagnosis. Sometimes some laboratory tests 
can be of great help in convincing the patient 
of the correctness of the diagnosis. 

Dr. Alvarez: That is very true. Often the 
hardest job I have is to sell the diagnosis of a 


neurosis to the patient. She doesn’t want that 


diagnosis. 








CASE RECORDS OF THE 
COOK COUNTY HOSPITAL 


KARL MEYER, LEO M. ZIMMERMAN, DEPT. EDITORS 














An Intramedullary Epidermoid Tumor 


Milton Tinsley, M.D.* and Archibald D. McCoy, M.D.** 
Chicago 


The diagnosis of primary tumors involving 
the spinal cord can sometimes be very confus- 
ing, especially in those patients who have many 
complaints and just enough objective findings 
to substantiate at least a significant portion of 
their subjective difficulties. Frequently the dif- 
ferentiation between metastatic and primary 
tumors of the spinal cord is an added diagnostic 
difficulty. The arrival) at a correct diagnosis 
therefore requires a continuation of repeated 
neurological examinations, amplification of the 
history, and exhaustion of all laboratory methods. 
Even at the arrival of a presumptive diagnosis 
which may explain most of the objective phe- 
nomena we are always harrassed by a few un- 
explainable findings, Just such a problem con- 
fronted us recently when a patient who had been 
under treatment for a gynecological disorder 
presented neurological findings, portions of 
which were eventually explained by verified path- 
ological specimen as an intramedullary epider- 
moid cyst of the dorsal cord. There were, 
however, other findings which strongly suggested 
a degenerative disease of the central nervous 


**Resident in 


*Sentor Attending Nevuro-surgeon. 


Neurology. 


200 


system such as multiple sclerosis. 

J.J., a 37 year old white single female was 
seen by the Neurosurgical Service of the Cook 
County Hospital on Sept. 15, 1949 at the re- 
quest of the Gynecological Service who had been 
treating her for a tubo-ovarian abscess. Her 
complaints were those of headaches, fatigue, dif- 
fieculty in maintaining equilibrium, numbness of 
the right foot, and weakness of the left leg. ‘There 
was a history of “shooting pains” two years pre- 
viously which started in the right groin and 
radiated to the right knee and foot. The pain 
was not aggrevated by movement and subsided 
without treatment. 

Neurological examination revealed the follow- 
ing; (1) horizontal nysatgmus on lateral and 
upward gaze, (2) hyperactive deep tendon re- 
flexes especially in the left knee and ankle, (3) 
left Chaddock and Babinski responses, (4) 
spastic weakness of all muscle groups of the left 
lower extremity, (5) diminished position sense 
on the right, (6) absent vibratory sense bilater- 
ally up to the level of the xiphoid, (7) bilateral- 
ly diminished sensation to pin-prick with a level 
just above the nipple line, (8) bilatera) impair- 
ment of light touch in the lower extremities, 


(9) markedly positive Romberg sign with falling 





Ilinols Medical Journal 














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to the left, (10) bilateral ataxia of finger-to- 
finger and finger-to-nose movements. A lumbar 
puncture showed clear, colorless spinal fluid un- 
der normal pressure with a negative Pandy re- 
action, no cells, and a total protein of 8 mgms. 
percent and a glucose content of 20 mgms. per- 
cent. Pantopaque myelography was then carried 


out which illustrated a crescentic defect in the 
column in the region of T, and Ts. 


It was felt at that time that her difficulties 
might represent a syringomyelia or a spinal cord 
tumor. However, in considering a spinal cord 
tumor it was deemed essential to rule out a pri- 
mary pelvic neoplasm with metastasis, and for 
this reason cervical biopsies were made which 
revealed nothing unusual. Since the patient had 
an adnexal mass a total hysterectomy and a left 
salpingectomy was done as treatment for a 
chronic salpingitis and endometritis with pelvic 
adhesions. his ruled out the likelihood of the 


cord tumor being a metastasis from the pelvis. 


With the neurological picture confirmed by 
the myelographic findings it was elected to do a 
thoracic laminectomy. On opening the dura the 
cord was swollen and yellowish in appearance, 
filling the entire intradural space. The cord 
was needled but no fluid was obtained. A longi- 
tudinal incision was made at the posterior raphe 
and a large tumor mass encountered which con- 
tained yellow granular material. ‘This was evac- 
uated with a spoon, leaving a glistening mem- 
brane. The membrane was then picked up and 
dissected from the spinal cord in its entirety. 
This left the cord completely decompressed. The 
pathologist reported the specimen to consist of 
numerous fragments of tissue, greenish-gray to 
brown-gray and somewhat calcareous in appear- 
ance. The largest fragment measured 15 x 15 x 
)mms. On sectioning the tissue it appeared to 
be laminated and of a brown-gray coloration. 
Microscopic examination revealed a degenerated 
epithelial cyst composed of degenerated epithelial 


cells, calcium, and cholesterol. (Figure 1) 


Following surgery our patient developed a 
wound infection which responded promptly to 
penicillin therapy. At the time of discharge she 
had return of position sense, and her pyramidal 
tract signs had subsided along with the bowel 
and bladder difficulty. She was re-admitted on 
May 1, 1950 because of persistent pain, especially 
at the operative site, which radiated down her 


For September, 1951 











Figure 1. This illustrates the structure of the walls of 
the degenerated epithelial cyst which are composed 


of degenerated epithelial cells along with calcareous 
and cholesterol deposits. 


arms and lasted from two to three hours at a 
time. A lumbar puncture was done and the 
cerebrospinal fluid was seen to contain the 
normal chemical constituents and to be under 
normal pressure and exhibit normal dynamics. 
A course of x-ray therapy over the incision was 
given without significant relief of pain, A pro- 
caine intercostal block was done during one of 
her episodes of pain which gave her complete 
temporary relief. She was subsequently sub- 
jected to a posterior rhizotomy of D4,5 and 6 
roots, bilaterally. At this time the spinal cord 
was observed to have a normal appearance with 
the exception of some arachnoidal adhesions 
which were divided. From this time on she was 
free of her radicular pain and was able to return 


to her work as a waitress. 


This -patient’s findings suggested the possi- 
bility of three pathological conditions. These were 
multiple metastatic cord lesions, because of the 


nystagmus, muscular weakness and contralateral 





201 









root pain along with a pelvic mass which had not 
been pathologically diagnosed ; secondly, multiple 
sclerosis because of the nystagmus, difficulty in 
maintaining equilibrium, fatigue, weakness of 
one leg, and headaches; thirdly a primary cord 
tumor, which she really had, as evidenced by 
myelographic findings at T,-T., level and varified 
at the operating table. ‘The laminectomy was 
performed only after a primary malignancy of 
the pelvis had been ruled out by gynecological 
procedures. 

In 1939 Boldrey and Elvidge, analyzed the 
literature on dermoid cysts of the vertebral canal, 
and in 1943 Craig, further classified the litera- 
ture and added his own case of a subpial epider- 
moid tumor of the spinal canai in the lumbo- 
1949 
presented a classical analysis of the subject and 


sacral region. In Sachs and Horrax; 


found 27 reported cases of intraspinal epider- 


moids, with only six reported as intramedullary 
tumors. 
SUMMARY 

This case illustrates that in spite of the pres- 
ence of nystagmus, normal cerebrospinal fluid 
protein and dynamics, we were led to believe 
that an intraspinal tumor was present and this 
was verified by myelography. We decided 
against a diagnosis of multiple sclerosis because 
of the character and severity of the patient’s 
pain, which spoke more for a spinal cord tumor. 
Recovery followed removal of the intramedullary 
epidermoid tumor. 

Bibliography 

. Boldrey, Edwin B., and Elvidge, 

Cysts of the Vertebral Canal: Ann. 

and ten: 273-284 1939 
2. Craig, Robert L., A Case of Epidermoid Tumor of the 

Spinal Cord. Surgery Thirteen: 354-367 March 1943 
. Sachs, Ernest Jr., and Horrax, Gilbert, A Cervical and a 


Lumbar Pilonidal Sinus Communicating With Intraspinal 
J. Neurosurg. Six: 97-112 1949 


Arthur R., Dermoid 
Surg. One hundred 


Dermoids. 





THE RESEARCH PHYSICIAN 


We are all familiar with the attitude of many 


practicing physicians toward their colleagues 
They them- 
selves are intensely busy men, dealing constantly 
with practical matters, carrying a heavy load of 
responsibility and exposed to all the buffets and 
anxieties that a man must face when he practices 
We can- 


who spend their lives in research. 


his profession in a competitive world. 
not, therefore, be surprised if the practitioner, 
although paying lip service to the intellectual 
attainments of his colleague in research, regards 
him in his heart as rather a poor fish. There the 
research man sits, he thinks, with a secure salary, 
protected in his ivory tower from the rough-and- 
turnble of the world and with nothing to do but 


the work of his own choice; has not such a man 
chosen the easy way? 

Indeed he has not, as anyone who has had 
personal experience in research very well knows. 
It is true that he is sheltered from the world, 
but his task is an exacting one. Much of his 
effort ends in frustration and disappointment, 
and he is largely denied the immediate satisfac- 
tion that comes from the visible result of a prac- 
tical task well done. It is indeed not uncommon 
to find men for whom the psychologic strain of 
full-time research becomes too great and who 
seek refuge in work of which the immediate 
results are more apparent. Excerpt: The Shat- 
tuck Lecture: The Role of the Basic Sciences 
in Medical Research, Sir Charles Harington, 
M.A., Sc.D., F.R.S., N.E.J.M., May 24, 1951. 


Ilinois Medical Journal 








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PATHOLOGY CONFERENCES 


EDWIN F. HIRSCH, DEPARTMENT EDITOR 








Presentation of Three Cases 


Edwin F. Hirsch, M.D. 
St. Luke’s Hospital 
Chicago 


RETICULUM LYMPHOSARCOMA 
INVASION OF THE LUNG 

A white woman aged 50 years entered St. 
Luke’s Hospital for the sixth time on July 31, 
1950 in the care of Doctor R. M. Galt. Her 
right middle and ring fingers became swollen, 
stiff and painful in 1943 and again in 1946. 
Simple remedies relieved this. The right knee, 
the right shoulder and neck in 1947 became 
painful but were not stiff or swollen. External 
heat and active motion gave relief. Later in 1947 
a cholecystectomy was done. In 1948 the patient 
noted difficulty in breathing and had a produc- 
tive cough. Roentgen films had mottled regions 
of density in the lower lobe of each lung. These 
changes were thought to be pneumonia. A severe 
cold in November of 1949 was attended by 
hoarseness and shortness of breath. The hoarse- 
ness remained and the dyspnoea grew worse. 
Her complaints were summarized in March 1950 
as shortness of breath for 9 months, hoarseness 
for 5 months and paroxysms of coughing for 
2 months. Then enlarged cervical and axillary 
lymph nodes were found. A cervical node re- 


For September, 1951 


moved for examination had many large and 
small hyaline scars (Figures 1 and 2) and 
moderate numbers of large mononuclear retic- 
ulum cells. These hyaline masses were the 


conspicuous changes. In crevices and along 
the margins of the hyaline material were a 
few large mononuclear cells, considered to be 
atypical reticulum cells and different in struc- 
ture from other mononuclear phagocytes. Some 
of these atypical cells were in mitosis. The 
changes in the lymph nodes were interpreted as 
an unusual variant of reticulum lymphosarcoma. 
An axillary lymph node removed for diagnostic 
confirmation, had similar changes. During the 
patient’s admission in March 1950 her tempera- 
ture ranged to 100.2°F., the pulse was 120 and 
the respirations 38 per minute. The lungs were 
flat by percussion, had loud rhonchi, rales and 
bronchial breathing. The cervical and axillary 
lymph nodes were large. The leukocytes of the 
blood ranged between 1,200 and 2,400 per cu. 
mm., the erythrocytes were 4,840,000 per cu. 
mm. and the hemoglobin was 12 grams per cent. 
The sputum had no acid-fast bacilli, the sedi- 


203 





Figures 1 and 2. Photomicrographs illustrating the 
hyaline masses observed in the enlarged cervical and 


mentation rate of the blood was 17 mms. in one 
hour, and the urine had nothing noteworthy. 
Deep roentgen ray therapy and nitrogen mustard 
gas were given without improvement. Finally 
the patient had chills and fever ranging to 
102°F., occasionally to 104°F. and death oc- 
curred on September 18, 1950. 

The main portion of the anatomic diagnosis 
of the complete necropsy are: 

Marked diffusely infiltrative reticulum 
lympho-sarcoma of the lungs, and of the 
axillary, tracheobronchial, mesenteric, 
periaortic, biliary and inguinal lymph 
nodes ; 

Hyperemia of the lining of the larynx, 
trachea and bronchi; 

Bilateral hydrothorax 
pleuritis ; 

Marked emaciation ; 

Old surgical scars of the neck, left axilla 
and abdomen; etc. 

The emaciated body of this adult white woman 
weighed 78 pounds. The lymph nodes in the 
right and the left axilla ranged to 4 cms. max- 
imum diameter. Those along the common iliac 


and focal fibrous 


204 


axillary lymph nodes removed surgically. X-198 


vessels formed masses 5 by 3 by 3 cms. and were 


continuous with others about the abdominal 
aorta. The surfaces made by cutting these nodes 
had firm granular hyaline grey regions of tissue. 
Adventitious fibrous adhesions bound together 
bowel loops and other viscera of the peritoneum. 
The lining of the oesophagus distally had small 
superficial ulcers. Below the tracheal bifurca- 
tion thé oesophagus was displaced to the right 
by a mass of lymph nodes 6.5 by 4 by 4.5 cms. 
(Figure 3). These were firm, elastic, grey 
mottled with carbon and had opaque hyaline 
regions 1 to 4 mms. dia. Similar firm lymph 
nodes were in front of the trachea. The lining 
of the trachea and main bronchi was hyperemic 
and edematous. At the hilum of the lungs the 
channel of the bronchi was narrowed by fibrous 
thickenings. The shrunken firm right lung 
weighed 630 gms., the similar left 770 gms. 
The pleura of the right lung was smooth except 
for torn ends of fibrous tissue. The lung tissues 
beneath were firm, cyanotic and mottled with 
grey tissues ranging to 2 cms. dia. Surfaces 
made by cutting the right lung had a diffuse 
grey consolidation, especially marked in the 


Ilinois Medical Journal 





Figure 3. Photograph of a large parabronchial lymph Figure 4. Photograph of a surface made by cutting 

nede. Note the masses of hyaline material, like the lower lobe of the left lung. Note the diffuse con- 

boiled sago. solidation of the lung tissues and the discrete grey 
tumor nodules. 


Figure 5. Photomicrograph illustrating the structure Figure 6. Photomicrograph illustrating the hyaline 
of the large hyaline masses in lymph nodes obtained _fibrous tissue replacement of the lung. X-198 
during the necropsy. X-198 


For September, 1951 











upper lobe, but all portions were firm and non- 
crepitant. Scattered through the consolidated 
lung were small firm grey nodules ranging to 
0.8 cm. dia. The pleura of the left lung also 
was roughened by torn fibrous adhesions. Sur- 
faces made by cutting had a diffuse grey tissue 
infiltration, most marked in the upper lobe, and 
in the lower lobe was a discrete nodule of grey 
yellow tissue 4 by 3 by 3 cms. (Figure 4). 
Other similar but smaller nodules were scattered 
in the lung tissues. The lining of the bronch- 
ioles was hyperemic, that of the branches of the 
pulmonary veins and artery was smooth. The 
heart with 2 cms. each of aorta and pulmonary 
artery weighed 230 gms. There were no changes 
of the valves and myocardium. The right kidney 
weighed 90 and the left %0 gms. The liver 
weighed 1260 gms., the spleen 230 gms. and 
each had a few grey tubercles 1 to 2 mms. dia. 
The head and neck structures had no significant 
changes. The various lymph nodes had the 
changes observed in the biopsy tissues (Figure 
5). The lungs had remarkable changes. Ex- 
tensive portions were replaced by large masses 
of hyaline material with slits and oval spaces 
(Figure 6). These masses replaced or markedly 
distorted the alveolar tissues and bronchioles. 
The bronchioles and alveoli remaining contained 
leucocytic exudates and had flattened or colum- 
nar cells, Along the edge and in crevices of the 
hyaline masses were large reticulum cells with a 
pale acidophilic cytoplasm. Other alveolar spaces 
contained polynuclear leucocytes and mononu- 
clear phagocytes or masses of fibroplastic tissues. 
Around the blood vessels of the Malpighian 
bodies of the spleen were large and small de- 
posits of the hyaline material. The portions of 
bone marrow examined had no _ significant 
changes. 


COMMENT 

Kundrat many years ago recognized lympho- 
sarcoma as a cancerous disease of lymph nodes 
and clearly distinguished this growth from other 
forms of lymph node enlargements. He stated 
that the lymphosarcomas arise in a group of 
lymph nodes and spread to other groups. Ghon 
and Roman specified the basic tissues in lymph 
nodes from which different forms of lympho- 
sarcoma arise, the small and large lymphocytes, 
and the reticulo-endothelial cells. Sarcomas of 
reticulum cells, at first, were not recognized, and 
lymphosarcomas were classified as small or large 











lymphocytic. Later when the reticulum cell form 
received more general acceptance, the range of 
variation in the cell structure of these tumors 
was not fully understood. Thus, patients with 
enlarged lymph nodes which in biopsies were 
diagnosed lymphogranulomatosis (Hodgkin’s 
Disease) had a subsequent clinical course like 
the lymphosarcoma. The lesions in the biopsied 
lymph nodes had eosinophilic leucocytes, large 
mononuclear cells with lobed nuclei, and a fibro- 
plastic stroma, in brief, all of the details of 
tissue structure described for Hodgkin’s Dis- 
ease. However, careful search in these tissues 
revealed foci of large atypical cells, some in 
mitosis, which provided evidence of sarcomatous 
growth rather than granuloma tissues. The 
exudate cells thus had secondary significance. 
The structure of the reticulum cell lymphosar- 
comas therefore, ranges from cellular tumors 
with small amounts of stroma to growths with 
large amounts of hyaline fibrous tissues and with 
relatively few atypical reticulum cells, as in this 
patient. 





ACUTE CASEOUS TUBERCULOUS 
PNEUMONIA 

A white woman aged 64 years entered St. 
Luke’s Hospital on August 19, 1950 in the care 
of Doctor W. Van Hazel. Concretions of the 
gallbladder had been removed in 1920 and after- 
wards she had had occasional attacks of pain in 
the right upper quadrant. These became more se- 
vere, more frequent and in July of 1950 the 
gallbladder was removed. She recovered prompt- 
ly from the operation and in two weeks went 
home for further convalescence. At home she 
developed a productive cough, and had chills 
and fever. She returned to her local hospital 
and was treated with penicillin. A roentgen 
film revealed a lesion in her left lung. She did 
not improve and was transferred to St. Luke’s 
Hospital. Her chief complaints were a produc- 
tive cough of 2 or 3 weeks duration, anorexia 
and frequent emesis. She was a well developed 
woman without pain or distress. Her blood 
pressure was 130/80 mms. Hg. and her temper- 
ature was 98.8°F. The chest had diminished ex- 
pansion on both sides and dullness to percussion 
on the left side. The left lung had a rough in- 
spiratory and expiratory wheeze. The erythro- 
cytes of the blood were 3,900,000 and the leuco- 
cytes 12,400 per cu. mm., the hemoglobin was 


IMlinois Medical Journal 















10.5 gms. per cent; 76 per cent of the leucocytes 
were neutrophilic, 15 were band forms, 5 were 
lymphocytes and 4 were monocytes. The urine 
had 50 mgms per cent of albumin. The sputum 
had many acid-fast bacilli. Her temperature 
rose to 102° to 104°F. and penicillin, streptomy- 
cin, para amino salicylic acid and aureomycin 
were given. The temperature dropped to near 
normal, but without clinical improvement. A 
roentgen film on September 1 disclosed extension 
of the lesion in the upper lobe of the left lung, 
and a mottling of the right considered to be 
miliary tuberculosis. Her respirations became 
shallow and rapid. Death occurred on Septem- 
ber 3, 1950. 

The essentials of the anatomic diagnosis of 
the necropsy (trunk) are: 

Extensive caseous tuberculous pneumonia of 
the upper lobe of the left lung; 

Miliary tuberculosis of the lungs, liver, 
spleen, ileum, rectum, uterus, and peri- 
cardium ; 

Fibrocaseous tuberculosis of the para bron- 
chial lymph nodes ; 

Left hydrothorax ; etc. 

The body of this adult female weighed 135 
pounds and was 154 cms. long. The right upper 
quadrant of the abdominal wall had an old 


Figure 7. Photograph illustrating the extensive case- 
ous tuberculous pneumonia ef the upper lobe ef the 
left lung. 


For September, 1951 


Figure 8. Photograph illustrating the multiple caseous 
and ulcerated tubercles in the lining of the rectum. 


cholecystectomy scar. The general nutrition of 
the body was good. Opposite the second left rib 
in the anterior mediastinum was a fibrocaseous 
lymph node 1.5 cms. in dia. The left pleural 
space contained 600 cc. of a clear yellow fluid, 
the right 500 cc. The epicardium was hyperemic 
and the posterior surface had many firm grey 
nodules 2 mms. in dia. The pericardial sac had 
similar nodules. The left parietal pleura was 
roughened by fibrous adhesions, the right had a 
few near the apex. The lymph nodes at the bi- 
furcation of the trachea were enlarged and had 
fibrocaseous regions. The lining of the trachea 
and of the main bronchi was hyperemic. The lu- 
men had a large amount of purulent exudate. 
The right lung weighed 650 gms. and had a 
smooth pleura. Surfaces made by cutting had 
hyperemic tissues with many grey and yellow 


207 





nodules ranging to 5mms. dia. The left lung 
weighed 1510 gms. and the pleura of the upper 
lobe was rough and granular. Surfaces made by 
cutting the upper lobe had a grey consolidated 
region 13 by 15 by 8 cms. (Figure 7). The 
hyperemic lower lobe had many grey tubercles 
ranging to 4 mms. dia. Many acid-fast bacilli 
were found in caseous tissues of the upper lobe. 
The kidneys, ureters, and urinary bladder had 
nothing significant. The spleen weighed 270 
gms. The tissues beneath the wrinkled capsule 
were dark red and had many grey tubercles 2 
mms. in dia. The liver weighed 1750 gms., had 
a smooth capsule and the lobular tissues beneath 
had many yellow nodules 1 to 3 mms. in dia. 
The terminal 12 cms. of the ileum had numerous 
mucosal nodules 2 mms. in dia., some of them 
ulcerated. These extended into the caecum and, 
where coalesced, formed yellow plaques 1 by 2 
ems. in dia. The appendix had been removed 
surgically. The lining of the rectum had many 
ulcerated nodules, 2 to 6 mms. in dia. (Figure 
8). The myometrium of the uterus also had 
many grey tubercles ranging to 3 mms. dia. 


COMMENT 

Probably the most striking feature in this case 
is the short duration and the minimal clinical 
manifestations of the extensive tuberculosis 
which the postmortem examination of the body 
disclosed. The consolidated upper lobe of the 
left lung cast shadows in roentgen films which 
simulated those of a neoplasm. This extensive 
tuberculous pneumonia of the lung probably 
initiated the disseminated systemic miliary tu- 
berculosis and the tuberculous enteritis, proctitis, 
and metritis. 


SARCOMA OF THE RECTUM 


A white male aged 64 years was admitted to 
St. Luke’s Hospital in the care of Doctor Chester 
Coggeshall for the third time on September 15, 
1950 and died two days later. His first admis- 
sion in August of 1949 to the service of Doctor 
G. Pontius was for rectal bleeding of two years 
duration. Blood in the stools at first was as- 
sociated with attacks of diarrhea, and later a 
sensation of incomplete evacuation followed def- 


Protoscopic examination disclosed a 
A small piece 


ecation. 
polypoid tumor of the rectum. 


removed for examination was diagnosed as sar- 
coma. On August 16, 1949 the sigmoid colon and 


rectum were removed by Doctor Pontius. A 


Figure 9. Photograph illustrating the polypoid sarcoma 
of the rectum... 


lobed, tan-brown polypoid tissue 8 cms. in dia. 
and 3 ems. thick was attached by a short pedicle 
2.5 ems. in dia. at a level 5 ems. above the anal 


ring (Figure 9). The external surface was hy- 
peremic and had shallow fissures. Another nod- 
ule 8 mms. in dia. was in the base of the pedicle. 
The regional lymph nodes were not involved. 
Surfaces made by cutting the polypoid mass had 
soft grey-red fibrillar tissues. These in histolog- 
ical preparations were highly cellular atypical 
mesoblastic tissues. Portions were elongated 
spindle cells with a little fibrillar cytoplasm, 
other places had large angulated cells in a sup- 
porting stroma and mingled with the spindle- 
shaped elements, Among the tumor cells were 
some in mitosis. The sarcoma tissues had in- 
filtrations of polynuclear leucocytes and lympho- 
cytes (Figure 10). A year later he was admitted 
again to St. Luke’s Hospital because of cough, 
weakness and dyspnea. He then received radia- 
tion therapy to the chest for metastases of the 


IMlinois Medical Journal 





Figure 10. Photomicrograph illustrating the structure 
of the sarcoma tissues. X-198 


lungs. When admitted finally on September 15, 
1950 he was dyspnoeic and edematous, his tem- 


perature was 98.6°, the pulse was 90 and the 
respirations were 28 per minute. The erythro- 
eytes of the blood were 3,000,000 and the leuco- 
cytes 11,000 per cu.mm. The non-protein nitro- 
gen of the blood was 31 mgms per cent, the 


Figure 11. Photograph of a 
surface made by cutting the 


lungs ond illustrating a large 


metastatic sarcoma nodule. 


fer September, 1951 


serum albumin was 2.31 and the globulin 3.47 
gms. per cent. His respiratory distress in- 
creased despite oxygen, aminophyllin and digi- 
talis. He suddenly became unresponsive, cyano- 
tic and died. 
The main portions of the anatomic diagnosis 

of the necropsy (trunk) are: 

Sarcoma of the rectum — old surgical recto- 

sigmoidectomy ; 
Metastatic sarcoma of the lungs and jeju- 
num ; 

Old surgical colostomy of the abdomen; 

Edema and emphysema of the lungs; ete. 
The symmetrical body of this adult male weighed 
135 pounds and was 166 ems. long. The ab- 
domen had four healed surgical scars, one 7 ems. 
to the left of the umbilicus had a functional 
colostomy. The abdomen had nothing signifi- 
cant except surgical rectosigmoidectomy scars. 
There were no changes in the left pleural space, 
in the right were 300 ccs. of a pale yellow fluid 
with fibrin clots. The heart and the pericardium 
had no significant changes. Each lung weighed 
670 gms. The pleura of both lungs was smooth 
and in each were many metastatic nodules of 
grey tumor tissues ranging to 5 cms. dia. (Fig- 
ure 11). The lining of the proximal portion 
of the jejunum had a metastasis 2.5 cms. in dia. 
and 1.2 ems. thick (Figure 12). It extended to 
the serosa and the mucosal surface had a super- 
ficial ulcer. The viscera otherwise had nothing 


significant. 





COMMENT 
The usual cancerous tumors of the rectum are 
carcinomas; sarcomas are rare. The one ob- 
served in this patient arose from the lining and 
grew into the lumen. Despite this location, 
metastasis had occurred into the lungs at the 


time the growth was removed. The histologic 


Figure 12, Phetegraph iiivs- 
trating the metastatic sarcoma 


ef the jejunum. 


structure of this sarcoma favors the opinion that 
the growth originated in the supporting and not 
in lymphoid tissues. ‘The clinical course follow- 
ing surgical removal was brief, but according to 
clinical history, symptoms of the tumor had 
existed for at least two years before the surgical 


rectosigmoidectomy. 





FEMALE FRIGIDITY 


Women with problems involving frigidity 
seem to fall into two general groups: (1) those 


who seek the physician’s help complaining of 
frigidity; (2) and those who present themselves 
with symptoms which appear totally unrelated 


to sex. 


Among the first group are many young 
women, married a short time, who have found 
themselves either unable to have intercourse or 
to reach an orgasm. Opportunity to talk over 
the problem, and simple explanation and re- 


assurance from the physician usually help these 


women to reach some kind of a superficially 
satisfactory adjustment. 

The second group will usually be women who 
have been married several years and who will 
complain of severe headache, backache, alcohol- 
ism or some bizarre hysterical symptom. These 
patients will seldom consciously admit any sexu- 
al problem, but under hypnosis or sodium amytal 
will usually readily give a history of sexual mal- 
adjustment. Often it will be found that they 
have strong sexual desires which they are 
attempting to deny. Many of these patients 
too can be relieved by simple psychotherapy. 
Excerpt: Human Behaviour: Importance of 
Frigidity, Thomas FP. Coates, Jr., M.D., Rich- 
mond, Southern M. and Surg., May, 1951. 


Ilinols Medical Journal 








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COUNCIL MEETING MINUTES 








The regular meeting of the Council held in Chicago 
on Sunday, August 5, was attended by the following: 
Chairman Blair, White, Sweeney, Maloney, Muller, 
Camp, Lundholm, Greening, Stone, Oldfield, Vaughn, 
Reichert, Peairs, Newcomb, Hulick, English, Fullerton, 
Montgomery, Hamilton, Hedge, Hopkins, Hutton, Cole- 
man, Cross, George Hellmuth, R. H. Hayes, Wayne 
Slaughter, Limarzi, Neal, Leary and Frances Zimmer. 
Note from Harker who has been ill reporting satis- 
factory progress and expects to attend next meeting. 
Minutes of last meeting approved. Secretary discussed 
financial statement, and referred to his report mailed in 
advance of meeting to members. Chairman stated in- 
dividual items in report would be acted upon under new 
business. Blair announced new personnel for several 
committees. 

WHITE gave report as President, telling of his at- 
tending A. M. A. meeting in Atlantic City, and spending 
some time discussing mutuai problems and projects in 
other societies, as given by their presidents. Recom- 
mended that medical schools, employment agencies, the 
press, schools, and other organizations and groups be 
informed that Secretary’s office act as clearing house 
for communities seeking physicians and physicians seek- 
ing locations, Also believes same information should 
be given to pharmaceutical organizations whose sales- 
men know much concerning these needs, Recommends 
that occasional meetings be held with representatives 
of the press, radio, TV, and Hospital Association per- 
sonnel; to consider ways and means for a better spirit 
of cooperation between these groups. 

WHITE recommends that component societies select 
someone to counsel with prospective medical students 
télative to medical schools and medical education, hos- 
Pitalization and locations, Believes more physicians 


should become interested in psychiatry and psychoso- 


For September, 1951 


matic medicine, especially when we note the number of 
people in the several state hospitals needing expert 
care. 

SWEENEY, as President-Elect commented on some 
current problems, in a short report. STONE reported 
recommendation of the Executive Committee that the 
Council sponsor the publication of the Auxiliary Bul- 
letin for the current fiscal year. Approved by proper 


action. Several Councilors reported problems and func- 
tions in their respective districts. Councilor O’Neill 


on vacation, wired his regrets at missing the meeting; 
unable to obtain plane reservations from Traverse City, 


Michigan to get to Chicago in time. 
VAUGHN told of talks being made at Loyola to 


upper classmen on medical organization, and student 
A. M. A.: also told of C, M. S. endeavoring to get 


more intern members. Believes this should be done in 
all schools and for interns, A motion was unanimously 


approved that medical schools be urged to schedule talks 
on organized medicine and its work. HAMILTON 


told of the student work the A. M. A. is doing, be- 


lieving it can be started in the freshman year; with 
28,000 students in the country, believes this should be 


encouraged in Illinois as elsewhere. 


BLAIR stated that the Committee on Medical Service 
and Public Relations will be asked to aid in the work 


among students. Blair told of two recent meetings. in 
his district, at whicd he presented the usual certificate 


and emblem; told of the interest and attendance at the 
meetings. Urged Councilors to tell members in counties 


with no component society that wives of physicians may 
join the Auxiliary as “members at large’. Several 


Councilors told of problems in their respective districts, 
and their solution, or what is being done to alleviate 


them. 





HOPKINS reported as chairman of the Committee 
on Medical Service and Public Relations. Referred to 
city of Savanna having a holiday, Wednesday, August 
8, to hohor a highly respected citizen, Dr. Joseph B. 
Schreiter, who has practiced 55 years. Committee recom- 
mends that the State Society be officially represented 
by the President, Chairman of the Council, Secretary 
and Councilor Lundholm of that district. By proper 
action it was unanimously voted that the officers as 
named be the official representatives at this interesting 
meeting, at which Andy Hall is to be the principal 
speaker. Referred to some other meetings at which 
his committee recommends the society be officially rep- 
resented. Favorable action was taken on these requests. 
Referred to Public Relation meetings in various parts 
of the state, which have been arranged for fall months; 
these not to interfere with post graduate conferences, 
or other official meetings or conferences. 

LEARY, as Director of Public Relations, told of the 
plans for a Society booth at the Illinois State Fair in 
Springfield. This is to be operated by the Auxiliary to 
the Sangamon County Medical Society. Hopkins be- 
lieves Leary should go to Springfield to arrange and be 
present at the opening on the first day of the fair. 
Action taken approving the request. NEAL discussed 
some legislation approved at the recent legislative ses- 
sion in Illinois. Will have his report ready for distri- 
bution soon. 


HEDGE told of recent conferences of the Interpro- . 


fessional Committee, which has been functioning princi- 
pally so far in perfecting its organization, developing 
Constitution and By-Laws. Chairman shall serve one 
year only, and chairmanship shall rotate among the 
participating groups. Later in this meeting WAYNE 
SLAUGHTER, Chairman of Society committee, came 
in and continued the report, supplementing remarks of 
Hedge, who had attended the meetings. 

COLEMAN reported as Ci:airman of the Advisory 
Committee to the Illinois Public Aid Commission. Told 
of meeting of committee with officials of the I. P. A. C. 
the previous evening, and what had been accomplished 
at this conference. Three visitors were present, as it 
is the custom to invite at least two members of county 
advisory committees to be present, as well as one mem- 
ber of the Council. Told of some recent increases in 
medical fees for services to I, P. A. C. clients. It is 
now believed that direct payment to physicians will 
begin about October 1. 

HAYES reported as Chairman of the Committee on 
Medical Benevolence, reporting on actions taken and 
payments made to beneficiaries by the Committee. 
Recommended some changes in current method of 
approving applicants for benefits, in keeping with 
other organizations, Committee to meet in near future 
to discuss some minor changes in procedure, which will 
be reported at the next meeting of the Council. 

HUTTON told of a recent meeting of the Editorial 
Board, at which time some 68 papers received for 
publication had been reviewed. It was the usual pro- 
cedure to review some papers during the meeting, then 
al.ocate others to individual members, or occasionally 
have several give their recommendations relative to 


212 


the approval of papers. It has been the policy in 
considering some highly technical papers to return same 
to the writer with the request that they be submitted 
to journals considering only that specialty. Referred to 
the necessity of having shorter papers so that more 
can be published in each journal issue. Stated that 
approval was given to regular publication of minutes 
of Council meetings, as many members desire this 
information. Told why they have not been published 
during the past year, but will be resumed in the 
September issue of the Journal. Hutton told of the 
discussion by the Editorial Board of the publication of 
the transactions of the House of Delegates, now being 
published in the July and August issues of the Journal. 
Board recommends this be changed to publishing same 
as a supplement, then members will have the trans- 
actions in one booklet instead of in two journals, 
After some discussion the Secretary was asked to in- 
vestigate the cost of separate publication of the minutes, 
and report at the next meeting in October. 

LIMARZI reported as Chairman of the Committee 
on Scientific Service, telling of some meetings to be 
serviced in the fall, Purposes to have an early meeting 
of his committee. Would like to have speakers on the 
subject of nutrition who can fill some requests recently 
received. Will ask Committee on Nutrition to assist 
in listing speakers and subjects. 

LIMARZI also referred to work of Committee on 
Blood Banks of which he is chairman. There are 
now four blood bank committees in Cook County, and 
believes they should work jointly in getting data from 
the various hospitals, rather than to submit four dif- 
ferent questionnaire forms. Believes better results may 
be obtained fhrough one survey and requests Council 
approval for adoption of plan as recommended. By 
proper action the combined project survey as proposed 
by Limarizi was approved. There was considerable 
discussion on the subject of blood banks, Lundholm 
told of the Rockford area developing a “walking blood 
bank”, listing citizens according to their blood types, 
having names and addresses recorded so that any of 
them may be called in an emergency to donate blood, 
of the desired type. There are now some 50,000 mem- 
bers in the Rockford area. Waukegan now developing 
a similar set up, which will permit an exchange of rare 
types in the respective districts. 

SLAUGHTER supplemented the report previously 
given by Hedge on the Interprofessional Committee 
giving more details on their accomplishments, and what 
they propose to do. He asks Council approval of their 
actions, and will have a complete report for the next 
meeting. 

HELLMUTH reported as chairman of the Post 
Graduate Committee, telling of a recent meeting of the 
committee, and handing out mimeographed copies of 
their proposed conferences to be conducted during the 
fiscal year. Told of the necessity of using greater care 
in scheduling the conferences, to be sure there is less 
conflict with other meetings, as has been too often the 
case in recent conferences. Some new ideas were 
presented relative to the length of the conferences, 
number of speakers to be scheduled and types of 


Illinois Medical Journal 





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presentations to be made. After much discussion it 
was decided that Hellmuth would meet following the 
close of the Council meeting, with the Executive Com- 
mittee, and members of the Post Graduate Committee, 
to discuss the proposal, and adopt a definite plan. This 
was done, and it was proposed that a trial program be 
arranged for September, to be reported in more detaii 
later. 

NEWCOMB reported for Hoyt as Chairman of 
Committee on Nutrition; meeting held in Chicago June 
22 to coincide with Annual Convention on Nutrition and 
Health of the Friends of the Land. Committee presents 
certain recommendations for Council approval. Meet- 
ing with Deans of Medical Schools in Chicago in the 
effort to get improvements in curricula and research 
departments in field of nutrition; endeavor to impress 
upon physician’s importance of subjects of soil fertility, 
nutrition and health at meetings, including post gradu- 
ate conferences, and recommending publication of 
articles on these subjects in Illinois Medical Journal; 
cooperation with lay committees on nutrition and health, 
and making qualified speakers on the subject available 
through the facilities of the Educational Committee. 
Also recommends that an outstanding speaker be se- 
lected to make the address on nutrition and health at 
the next annual dinner, during the Annual Meeting. 
The report as presented, was approved by the Council. 

The Council members from Chicago were asked by 
the Chairman to suggest the member to be selected as 
the General Chairman, Committee on Arrangements 
for the 1952 annual meeting. This to be done within 
the next week, if possible. Date of the 1953 annual 
meeting was considered, agd as the A.M.A. is scheduled 
to meet that year in New York City and on June 1-5, 
it was deemed advisable to set date for the Society 
Annual Meeting earlier than usual in May. By proper 
action the date set is May 12-14, 1953, place, Chicago. 

CROSS, as Director, State Department of Public 
Health, told of recent actions taken by the state legis- 
lature pertain to the subject of health. These to be 
published later in the Journal. Handed out mimeo- 
graphed report with factual data concerning new 
hospitals constructed under the Hospital Construction 


Act. Also discussed the present poliomyelitis situation 
in Illinois and the controversial subject of immuniza- 
tions during the polio season. 

BLAIR reported as Chairman of the Educational 
Committee: TV Health Talk was off the air from 
April 10 until July 3, and is now being presented over 
Station WGN-TV at 7:30 P.M., Tuesday of each 
week. Tells of investigations being made by other 
societies and thein interest in the programs which have 
been presented under the auspices of his committee 
during the past two years. Referred also to recent 
and proposed radio health talks, as arranged by his 
committee. 

SECRETARY told of proposal to send an informa- 
tive letter to new members reported to his office, and a 
package of data including Constitution and By-Laws, 
Code of Medical Ethics, A.M.A. Handbook, Veterans 
Administration Home Town Care Program, application 
for participation and copy of fee schedules; the book- 
let “Doctor and Horses”, telling of the need of phy- 
sicians and nurses, and data concerning the Illinois 
State Medical Society, Illinois Agricultural Association 
Joint Student Loan Fund, information on Illinois plan 
for prepayment medical and surgical care, and the 
Illinois Medical Service, now operating in most II- 
linois counties. This can be modified if desired, and 
would be an excellent indoctrination for new members. 
By proper action the proposal was approved and will 
be started soon from the Secretary’s office. 

Several actions were taken on matters presented by 
the Council Executive Committee, as presented by 
Councilor F, Lee Stone. Several State and Nation 
Wide organizations requested a medical advisor as a 
member of their respective Advisory Committees, each 
of which was favorably acted upon. A list of applicants 
for Emeritus, Past Service and Retired Membership 
classifications were presented, and as they had been so 
recommended by the local component societies; all were 
approved as presented. 

Meeting adjourned at 2:30 P.M. 


Harold M. Camp, M.D. 
Secretary 





For September, 1951 














CARROLL 


Carroll County Honors Its Veteran Physician.— 
Carroll County’s 19,000 people, with substantial help 
from nearby counties in Illinois and Iowa, turned 
out August 8 to honor Dr. Joseph B. Schreiter of 
Savanna, who has been “Doc” to them for fifty- 
five years. 

The party began with a parade at 11:30 a.m., 
moved on to a picnic at noon in Old Mill Park, 
and closed with oratory and the bestowal of various 
surprise honors on the 76-year old physician. Every 
shop in town closed between noon and 2 p.m., the 
American Legion band led the parade, and the Lions 
Club, which started the idea, expressed on behalf 
of the community just how much they all appreciate 
“Doc’s” lifetime of serivce. 

A general invitation was issued to all the 4,000 
babies over whose delivery Dr. Schreiter has pre- 
sided in his 55 years of practice. Wayne King, 
famous band leader, best known perhaps of all 
“Doc’s” crop, also attended. 

The Illinois State Medical Society, to whose 
Fifty Year Club Dr. Schreiter belongs, sent Dr. 
Andy Hall of Mt. Vernon, 86-year old veteran who 
was chosen the outstanding general practitioner of 
the nation for 1950 by the American Medical As- 
sociation, as principal speaker for the party. 

Also representing the organized medicine of the 
state were Dr. C. Paul White of Kewanee, presi- 
dent of the Illinois State Medical Society, Dr. 
Harold M. Camp of Monmouth, its secretary; Dr. 
Charles P. Blair of Monmouth, chairmen of its 
council; and Dr. Joseph S. Lundholm of Rockford, 


214 


NEWS OF THE STATE 








state councilor. Many other physicians, old friends 
of the veteran, joined the 16 other members of the 
Carroll County Medical Society in honoring him. 

Dr. Schreiter was born in Darlington, Wis., 
January 4, 1875, and was graduated from Rush Med- 
ical College,” Chicago, in 1896, and immediately 
settled in Savanna. He married Miss Bess Beaver 
of Mt. Carroll and they have one son, Jesse, a 
mathematician at the University of Ohio. 

Dr. Schreiter was elected coroner in 1903 and still 
serves in that post, having been re-elected eleven 
times, which is believed to be a record. In World 
War I he served 22 months in France with an Army 
hospital and later became the Savanna American 
Legion’s first commander. He is chief of staff of 
the Savanna City Hospital and was formerly the 
Burlington Railroad’s physician for the county and 
surgeon to the big federal ordnance plant. 

Dr. Schreiter is vice-president of the Savanna 
Savings, Building and Loan association and of the 
National Bank of Savanna. He is a member of 
Sigma Chi and of numerous lodges and medical 
societies. Despite his age and many activities, he 
still takes care of a substantial practice, making 
house calls and keeping evening office hours, though 
he no longer does major surgery. 


CHAMPAIGN 


Society News.—At a joint meeting of the Cham- 
paign County Medical and Dental Societies recently, 
William Neiswonger and Robert W. Mayer, mem- 
bers of the staff of the University of Illinois College 
of Commerce, discussed “Personal Financial Man- 
agement for the Professional Man.” 


Illinois Medical Journal 





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For Se; 














CLINTON 


Physician Honored.—Citizens in the town of 
Hoffman gathered together to give honor to Dr. 
Andrew Fischer, July 29, in recognition of his forty- 
five years of practice in their community. To 
commemorate the occasion, a plaque was presented 
to Dr. Fischer. 


COOK 


James Campbell Goes to New York.—Dr. James 
Allan Campbell, assistant professor of medicine, 
University of Illinois College of Medicine, has been 
appointed dean of Albany Medical College, succeed- 
ing Dr. R. S. Cunningham. 

Dr. Herrick Honored.—Dr. James B. Herrick, 
Chicago, was among three persons honored with 
Gold Heart awards at a meeting in Atlantic City 
by the American Heart Association. Dr. Louis N. 
Katz, Chicago, president of the association, in mak- 
ing the presentation referred to Dr. Herrick as 
“the most distinguished living student of the cardi- 
ovascular disorders.” 

Dr. O’Brien Heads Department of Medicine.— 
Dr. George F. O’Brien has been appointed chairman 
of the department of medicine at Stritch School of 
Medicine of Loyola University. Formerly associate 
clinical professor of the department, Dr. O’Brien 
fills the vacancy caused by the death of the late Dr. 
Italo Volini. 

Francis Mullin Heads Committee on Internships. 
—Francis J. Mullin, Ph.D., dean of the Chicago 
Medical School, has been named charman of the 
newly formed National Inter-Association Committee 
on Internships. This is a central clearing body that 
will put into operation a plan proposed by Dean 
Mullin for arranging internship appointments by 
matching perference of students with preference 
of hospitals. The committee is composed of rep- 
resentatives from the American Hospital Associa- 
tion, American Protestant Hospital Association, the 
Catholic Hospital Association, Association of Amer- 
ican Medical Colleges, Council on Medical Educa- 
tion and Hospitals of the American Medical As- 
sociation, and liaison members from the Air Force, 
Navy, Public Health Service and Veterans Admin- 
istration which are the federal agencies offering 
internships. 

Loyal Davis to Give Lecture at Oxford.—Dr. 
Loyal Davis, professor of surgery and chairman of 
the department at Northwestern University’s Med- 
ical School, has been selected to give the Earl of 
Litchfield lecture at Oxford University October 10. 
Dr. Davis will talk on “The Physiological Principals 
Underlying the Treatment of High Diastolic Hyper- 
tension by Thiocyanates and Sympathectomy.” 

Named the first Grunow Professor of Surgery at 
the University, Dr. Davis is a graduate of Knox 
College, Galesburg, and of the Northwestern Medical 
School. He has been a member of the Northwestern 
faculty since 1925 and chairman of the department of 
Surgery at the University since 1932. He is a 
regent of the American College of Surgeons. 


For September, 1951 








Woman Physician Heads Health Service.—The 
appointment of Dr. Evelyn Adams to the director- 
ship of the employees health service at the Univer- 
sity of Chicago marks the first time a woman has 
held this position at the Midway university. An- 
nouncement of the appointment was made by Dr. 
Lowell T. Coggeshall, dean of the division of bio- 
logical sciences. A 1949 graduate of the University 
of Chicago medical school, Dr. Adams interned at 
the university clinics. Last year she held a surgical 
residency at the University of Iowa. Dr. Adams 
also received her bachelor of science degree from 
Chicago and is a member of Phi Beta Kappa. Born 
in Georgetown, Illinois, she attended schools in 
Lenoir City, Tennessee. 

New Abbott Professors.—Four members of the 
faculty of Northwestern University’s Medical School 
have been appointed Abbott Professors for the 
academic year 1951-52. 

The four men will engage in medical research 
made possible by a $1,500,000 gift Northwestern 
received in 1939 from the estate of the late Clara 
A. Abbott, widow of Dr. Wallace C. Abbott, founder 
of Abbott Laboratories in North Chicago. 

Named Abbott Professors were Dr. Carl Drag- 
stedt, professor and chairman of the Department of 
Pharmacology; Dr. Henry Bull, professor in the 
Department of Chemistry; Dr. Fred Grodins, pro- 
fessor in the Department of Physiology; and Dr. E. 
Albert Zeller, associate professor in the Department 
of Chemistry. 

Carroll Birch Goes to India.—Dr. Carroll L. Birch, 
professor of medicine at the University of Illinois, 
has been appointed dean of the Lady Hardinge 
Medical College for Women at New Delhi, India. 

Dr. Birch left Chicago in August. She will re- 
main in New Delhi for a period of one year. 

Lady Hardinge Medical College for Women is 
the only Indian medical institution for the training 
of women. The school which is endowed by a 
British noblewoman is more than 100 years old. 

Dr. Birch is assuming the position at the New 
Delhi school at the request of the Department of 
State, which has received requests from Near 
Eastern and other Asiatic countries for technical 
assistance in the health and medical sciences. 

Her specific assignment well be to train a replace- 
ment to take over the duties of dean of the college. 
She also will prepare recommendations for the 
reorganizations of the teaching methods and cur- 
ricula of the school in order to raise its standards 
to meet those of modern medical educational 
institutions. 

The experience gained in India is expected to 
add to Dr. Birch’s knowledge of tropical medicine 
and to enrich the course in that subject which is 
currently offered by the University of Illinois Col- 
lege of Medicine. 

Dr. Birch, a specialist in blood diseases and tropi- 
cal medicine, has made previous visits to Africa, the 
Central American countries, Puerto Rico, and 
Europe for research studies in her specialty. 









Personal.—Dr. James P. Simonds, professor emer- 
itus of pathology and former chairman of the de- 
partment, Northwestern University Medical School 
was recently awarded an honorary degree of laws 
by Baylor University, Waco, Tex. The degree 
was presented to Dr. Simonds on the fiftieth an- 
niversary of his graduation at Baylor—Roman L. 
Haremski, Ph.D., has been appointed director of 
the Division of Child Welfare of the Illinois De- 
partment of Public Welfare, succeeding Miss Ruth 
Dana, acting superintendent since March, 1950, 
resigned.—Dr. Jules H. Masserman, associate pro- 
fessor of nervous and mental diseases, Northwestern 
University Medical School, and scientific director, 
National Foundation for Psychiatric Research, has 
been appointed consultant to the secretariat of the 
United Nations and designated by the World Health 
Organization to present a series of lectures at vari- 
ous universities throughout Europe and Scandinavia 
in October and November of this year. During his 
stay in England, Dr. Masserman will also address 
the Britain Royal Society on his research studies 
and their significance to dynamic concepts of per- 
sonal and social behavior. 

Special Society Elections —At a recent meeting 
of the Chicago Neurological Society the following 
officers were elected: Dr. John Martin, president; 
Dr. Hugh T. Carmichael, vice president; Dr. Joseph 
A. Luhan, councilor, and Dr. Leo A. Kaplan, secre- 
tary. Dr. Charles K. Petter, Waukegan, was 
recently elected president of the Illinois Chapter of 
the American College of Chest Physicians. Other 
officers are Dr. William J. Bryan, Rockford; and 
Dr. Abel Froman, Chicago, secretary-treasurer. 

Student Prizes Awarded.—Robert J. Maganini, 
third-year medical student, has been awarded the 
1951 Leo F. Miller Prize at the University of 
Illinois College of Medicine for his presentation of 
an essay in the field of orthopaedic surgery. 

Awarding of the prize, which carries a $50 
stipend, was anounced by Dr. Fremont A. Chandler, 
professor and head of the department of orthopaedic 
surgery. The prize-winning essay was entitled 
“Solitary Unicameral Bone Cyst.” 

A second place award of $15 was presented to 
William S. Johnson for his paper on “Traumatic 
Injuries of the Menisci.” George A. Hart received 
the third place prize of $10 for his essay on “Spon- 
dylolisthesis.” 

Honorable mention was awarded to Hyman L. 
Cohen, Martin E. Blazina, and Frank L. Meyer. 


Grants for Research.—Northwestern University 
has received a $38,000 grant from the Office of 
Naval Research for the study and development of 
materials and techniques to aid in the neuropsy- 
chiatric selection of Navy personnel. The project, 
which was to have begun September 1, will be 
under the direction of Dr. William A. Hunt, North- 
‘western professor of psychology. Associated with 
him will be Dr. Cecil L. Wittson, professor of 
neurology and psychiatry at the Medical College 


of the University of Nebraska. The two research 
workers will seek to devise new techniques to de- 
termine what men will not be able to adjust to 
military service, and also to aid marginal men in 
making the adjustment.—Three Chicago organiza- 
tions and companies have awarded grants to the 
University of Illinois College of Medicine in sup- 
port of research investigations. The grants are as 
follows: 

Asthmatic Children’s Aid, $10,000, in support of 
histochemical and immunological studies to be con- 
ducted under the supervision of Dr. 'B. Z. Rappaport. 

Swift and Company, $8,250, for a study of the 
relationship of bile to cholesterol to be conducted 
under the direction of Dr. A. C. Ivy. 

G. D. Searle and Company, $5,540, in support of 
a study of the effect of banthine on the motility 
of the small and large intestines which is being 
undertaken by Dr. Michael H. Streicher.—Three 
new grants have been received by the University 
of Illinois in support of research investigations. 
These grants are as follows: 

Bristol Laboratories, Syracuse, N. Y., $2,500, for 
the establishment of a research fellowship under 
the supervision of Dr. S. B. Binkley. 


Winthrop-Stearns, Inc., New York City, $2,400, 
for a study involving the screening and the in- 
vestigation of new anesthetic drugs. Dr. Max S. 
Sadove will conduct this study. 


The Upjohn Company, Kalamazoo, Mich., $1,000, 
representing a new grant entitled “Intravenous 
Gelatin” to be supervisd by Dr. C. W. Vermeulen, 
—Four subsidiary scholarships of $10,000 each have 
been awarded by the David, Josephine and Winfield 
Baird Foundation, Inc., of New York City to the 
Chicago Medical School this year, according to an 
announcement issued by President John J. Sheinin. 


A subsidiary scholarship, President Sheinin ex- 
plained, makes up the difference between the amount 
a student pays in tuition and what the school must 
expend for his four years of medical training.—Five 
subsidiary scholarships of $10,000 each, making a 
total of $50,000 for the five year period 1950-54, 
have been given to the School by Isadore Leviton, 
President of the Leviton Manufacturing Co. of 
Brooklyn, N. Y.—A research grant of $5,635 has 
been made by the Public Health Service of the 
Federal Security Agency to Dr. Harold Koenig, 
assistant professor of gross anatomy, Chicago 
Medical School. Dr. Koenig’s research project is 
a morphologic and quantitative study of neucleo- 
protein in developing nerve cells grown in tissue 
culture—Grants for research totaling more than 
$18,000 have recently been received by the Chicago 
Medical School. The Eli Lilly Research Labora- 
tories gave $6,000 for work in experimental diabetes 
under the direction of Dr. Piero P. Foa, associate 
professor of physiology and pharmacology. The 
Chicago Heart Association, for the year July |, 
1951 to June 30, 1952, made grants of $2,000 and 
$6,800 for studies to be conducted under the direc- 


IIlineis Medical Journe! 





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tion of Dr. Aldo A. Luisada, program director of 
cardiology and assistant professor of medicine; and 
$4,000 for research directed by Dr. George J. Scheff, 
associate professor of microbiology. 

Biophysical Aspects of Virology.—A series of 
lectures and demonstrations in the biophysical 
aspects of virology will be given by Dr. Max A. 
Lauffer, professor of biophysics at the University 
of Pittsburgh, on Sept. 20, 21, and 22. These lec- 
tures are part of the Gehrmann lecture series 
sponsored by the Department of Bacteriology of 
the University of Illinois College of Medicine. 

The following program will be presented: 

Thursday, Sept. 20. 

Lecture: Ultracentrifugation. 1:00 p.m., Uni- 
versity. of Chicago, Abbott Hall, 947 E. 58th 
St. 

Demonstration: The use of centrifugation for 
preparation and characterization of viruses. 
3.00 p.m., Abbott Hall. 

Friday, Sept. 21. 

Lecture: Electrophoresis. 
phitheatre, Presbyterian Hospital, 
Congress St. 

Demonstration: The use of electrophoresis for 
purification and characterization of viruses. 
3:00 p.m., Presbyterian Hospital. 

Saturday, Sept. 22. 

Lecture: Electron Microscopy. 9:30 a.m., Uni- 
versity of Illinois Research and Educational 
Hospitals, 1835 W. Polk St. 

Demonstration: The use of electron microscopy 
in the study of viruses. 11:00 a.m., Room 342, 
University of Illinois Dental-Medical-Pharmacy 
Building, 1853 W. Polk St. 

All interested are invited to attend the lectures. 
Because of space restrictions, however, the demon- 
strations must be limited to 20. All who wish to 
attend the lectures may register by writing to Dr. 
J. E. Kempf, Department of Bacteriology, Uni- 
versity of Illinois, 808 S. Wood St., Chicago 12, 
Illinois, before Sept. 15. 

Illinois Sole Administrator of Neuropsychiatric 
Institute—Through a newly enacted bill, the Illinois 
Neuropsychiatric Institute in Chicago has been trans- 
ferred from the State Department of Public Welfare 
to the University of Illinois. The Illinois Neuro- 
psychiatric Institute formerly was operated jointly 
by the two institutions. Professional services were 
in charge of Dr. Eric Oldberg and Dr. F. J. Gerty 
of the University of Illinois College of Medicine. 
Funds for nursing services were appropriated to 
and paid for by the State Department of Public 
Welfare. Funds for the physical plant operation 
of maintenance and for food service were appropri- 
ated to the Department, but the services were 
Provided by the University. 


1:00 p.m., North am- 
1753. W. 


Under the new plan of operation, all activities 
and operations of the Illinois Neuropsychiatric 
Institute are vested in the University of Illinois. 
This change was recommended by the Schaefer 
Commission on State Reorganization and was con- 


Fer September, 1951 


curred in by both the University of Illinois and 
the State Department of Public Welfare. In the 
University of Illinois Neuropsychiatric Institute 
as it is now constituted, Dr. Eric Oldberg will 
serve as Director of the Division of Neurology and 
Neurological Surgery and Dr. Francis J. Gerty as 
Director of the Division of Psychiatry. 

The plan will facilitate professional administration 
of the activities, and greatly simplify business pro- 
cedures in the University, the Department, and all 
state fiscal offices. 

The purpose of the Institute, as stated by the 
University of Illinois Board of Trustees, is to act 
as liaison between the Illinois State Mental Health 
Service and the University of Illinois in a coopera- 
tive effort to improve the quality of the medical 
personnel dealing with patients committed to their 
care and to seek new and improved methods of 
treatment for the afflictions from which they suffer. 

The operation of the State Psychopathic Institute 
and the Pathological Laboratory, which are housed 
in the Illinois Neuropsychiatric Institute, will re- 
main in the State Department of Public Welfare. 
Dr. Percival Bailey, professor of neurology and 
neurological surgery at the University, who previ- 
ously served as executive officer of the institute 
for the State Department of Public Welfare, will 
be in charge of these activities for the Department. 
The University, however, will assume the physical 
operation of the space used by these activities. 


The bill which has been passed by the General 
Assembly includes an appropriation of $1,405,700 
to the University of Illinois for the operation and 
maintenance of the Institute for the biennium be- 
ginning July 1, 1951. 


In 1941, the other units of the Research and 
Educational Hospitals were transferred from the 
State Department of Public Welfare to the Uni- 
versity of Illinois. Exceptions were the Illinois 
Neuropsychiatric Institute and the Institute for 
Juvenile Research. The latter continues in the 
Department. 


DE KALB 


Physician Honored.—The medical staff and friends 
of the Sycamore Municipal Hospital held a dinner 
August 30 in honor of Dr. John W. Ovitz in rec- 
ognition of his thirty years of outstanding medical 
service to the community. The dinner was held 
at the Kishwaukee Country Club in DeKalb. 


DE WITT 


Personal.—Dr. P. C. Sturmon, was elected presi- 
dent of the DeWitt-Piatt Bi-County board of 
health at a recent meeting. 


JEFFERSON 


Dr. Poole Honored.—Dr. C. J. Poole, seventy- 
seven year old retired Mount Vernon physician, 
was recently inducted into the Fifty Year Club 
of the Illinois State Medical Society at a staff 


217 





meeting of Good Samaritan Hospital. The presen- 
tation of the certificate and emblem signifying 
membership in the Club was made by Dr. Andy 
Hall. 


KANKAKEE 


Society News.—Dr. O. A. Phipps, Manteno, 
president of the Kankakee County Medical Society, 
was responsible for scheduling the following pro- 
grams for the society recently: Dr. Irwin Callen, 
Chicago, “Newer Developments in Coronary Dis- 
ease’; A. R. Goldfarb, Ph.D., Chicago, “Medical 
Aspects of Atomic Blast”; Dr. Wright Adams, 
Chicago, “Cardiovascular Diseases with Special 
Emphasis on the Medical Aspect of Hypertension”; 
Mr. Harry W. Ginty, Fort Wayne, Ind., “What is 
the Law?”; and Dr. Philip Thorek, Chicago, “Jaun- 
dice.” 


KNOX 


Society News.—At a recent meeting of the Knox 
County Medical Society in Galesburg, Dr. Philip 
Thorek, Chicago, spoke on “Jaundice.” 

Fifty Year Member.—Dr. E. N. Nash, who has 
been practicing in Galesburg for forty-seven years, 
was inducted into the membership of the Fifty 
Year Club of the Illinois State Medical Society at 
a meeting of the Knox County Medical Society in 
July. The presentation of the certificate and pin 
denoting membership was made by Dr. Charles P. 
Blair, Monmouth, Chairman of the Council of the 
Illinois State Medical Society. Prior to opening 
practice in Galesburg, Dr. Nash, who graduated at 
Rush Medical College, practiced in Oak Park. 


ROCK ISLAND 


Society News.—“The Doctor and His Estate” 
was the title of a talk given by Mr. Henry C. Black, 
Battle Creek, Mich., before the Rock Island County 
Medical Society recently. 


SANGAMON 


Personal—Mr. Frank R. Shank was recently 
named executive director of the Memorial Hospital 
of Springfield, filling the vacancy created by the 
death of Victor S. Lindberg. 


ST. CLAIR 


Society News.—At a recent buffet dinner meeting 
of the St. Clair County Medical Society and its 
auxiliary, Doctors Francis Bihss, Norman Shippey 


and Walter Broker discussed “Unusual Chest Pa- 
thology” and “The Present Day Management of 
Pulmonary Tuberculosis.” At a subsequent meet- 
ing, the society held its annual picnic and barbecue, 
always a popular event with the membership. 


GENERAL 


Hospitals Extend Facilities for Polio.—Facilities 
of 128 Illinois hospitals have been pledged for 
diagnosis or treatment of polio patients this sum- 


mer, Dr. Roland R. Cross, state director of public 
health, announced recently. 

“This is a culmination of many years of e‘fort 
on the part of various public health agencies to 
enlist the participation of administrators of general 
hospitals in admitting polio patients,’ Dr. Cross 
said. 

In the past, he explained, many hospitals have 
been reluctant to admit polio victims for fear of 
spread of this contagious disease to other patients, 

He praised the Illinois Polio Planning Com- 
mittee for stimulating state-wide recognition of the 
role general hospitals can assume in fighting polio 
and caring for its victims. This committee was 
formed a little more than a year ago on the recom- 
mendation of Governor Adlai E. Stevenson. 

The network of hospitals to care for polio patients 
in event of a serious outbreak is based upon a sur- 
vey which was made by this committee to determine 
possible needs at the peak of a polio season. The 
committee also has conducted a series of district 
meetings to inform hospital personnel in methods of 
caring for polio patients so that other patients will 
not be exposed to the disease. 

Of the 128 hospitals pledging help to polio vic- 
tims, 66 will provide diagnostic facilities only; 34 
will provide diagnostic service and treatment; 12 
will give diagnosis, treatment and rehabilitation care 
and 16 will provide convalescent and rehabilitation 
care. 

New Officers of Medical Research.— Dr. Anton 
J. Carlson, professor emeritus of physiology, Uni- 
versity of Chicago School of Medicine, was re- 
elected president, and Dr. Andrew C. Ivy, vice 
president and head of the professional colleges of 
the University of Illinois, vice president, of the 
Illinois Society for Medical Research. 

Dr. N. R. Brewer, superintendent of animal 
quarters, University of Chicago was elected secre- 
tary, and Dr. C. C. Pfeiffer, head of the depart- 
ment of pharmacology, University of Illinois, was 
elected treasurer. 

The Society, an affiliate of the National Society 
for Medical Research, is planning to expand its 
membership and activities. The membership and 
fund raising committee has drafted plans for a larger 
and wider membership and for a regular individual 
and institutional contribution program. A_ wide- 
spread public education program is being devised 
and committees have been appointed to carry out 
specific portions of the program of the Society. 

Essay Award.—The Board of Regents of the 
American College of Chest Physicians offers a cash 
prize award of two hundred fifty dollars to be given 
annually for the best original contribution, pref- 
erably by a young investigator, on any phase 
relating to chest disease. The prize is open to 
contestants of other countries as well as_ those 
residing in the United States. The winning con- 
tribution will be selected by a board of impartial 
judges and the award, together with a certificate 
of merit, will be made at the forthcoming annual 


Illinois Medical Journal 





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meeting of the College. Second and third prize 
certificates will also be awarded. All manuscripts 
submitted become the property of the American 
College of Chest Physicians and will be referred 
to the Editorial Board of the College journal, 
“Diseases of the Chest,” for consideration. The 
College reserves the right to invite the winner to 
present his contribution at the annual meeting. 
Contestants are advised to study the format of 
“Diseases of the Chest” as to length, form and 
arrangement of illustrations, to guide them in the 
preparation of the manuscript. The following con- 
ditions must be observed: Five copies of the manu- 
script, typewritten in English, should be submitted 
to the executive office, American College of Chest 
Physicans, 112 East Chestnut Street, Chicago 11, 
Illinois, not later than April 1, 1952. The only 
means of identification of the author or authors 
shall be a motto or other device on the title page, 
and a sealed envelope bearing the same motto on 
the outside, enclosing the name of the author or 
authors. 


Welfare Department Statistics—The resident 
population of all mental hospitals, June 30, 1951, 
was 46,127. During the period May 1, 1951 through 
June 30, 1951 there were 2,344 admissions as fol- 
lows: 1,216 mentally ill, 303 in need of mental 
treatment, 149 mentally defective and 676 voluntary 
commitments. There were, in addition 270 emer- 
gency admissions. The book population of these 
mental hospitals, June 30, 1951, was 51,188. This 
includes not only those present, but also all those 
in out-patient convalescent care. 

There were 41 severe injuries during the months 
of May and June, and 58 new tubercular cases were 
diagnosed. During these two months there were 
5 deaths from serious injuries, 18 from communic- 
able diseases, and 30 from tuberculosis. There 
were 53 coroner cases and 134 autopsies. 

The Veterans’ Rehabilitation Center in Chicago 
and the veterans clinics in Champaign, Peoria, and 
Rockford received 151 new cases during the months 
of May and June. During these two months there 
were 2,494 visits to the clinic in Chicago, 264 in 
Champaign, 76 in Poria and 44 in Rockford. Since 
opening these clinics, 7,249 veterans have received 
treatment in Chicago, 306 in Champaign, 121 in 
Peoria, and 120 in Rockford. 

On June 30, 1951 there were 3,694 veterans 
present in all state institutions. During the months 
of May and June, 566 veterans were admitted to 
these institutions. 

The Division of Community Clinics reported 444 
new cases during the months of May and June. 

There were 2,609 patients interviewed in out- 
patient psychiatric clinics during the months of 
May and June, and 4,937 visits were made to these 
clinics. 

State Training Schools for Boys and Girls, and 
Reformatories for Women and Boys reported 940 
juvenil delinquents, felons, and misdemeanants, 
Present June 30, 1951. One-hundred-sixty-nine 


For September, 1951 


were received from courts during May and June, 
and 109 were discharged during these two months. 

The pupils at Schools for Deaf and Blind were 
home for summer vacation June 30, 1951. There 
were 51 children present at Children’s Hospital 
School and 310 at Soldiers’ and Sailors’ Children’s 
School at end of June. 

The Institute for Juvenile Research interviewed 
289 new cases during the months of May and June. 
There were 561 tests and interviews with children 
and 511 with parents. 

Clinical and diagnostic services for Eye and Ear 
Infirmary reported 29,402 treatments during the 
months of May and June, while the clinics for 
Trachoma Control and Prevention of Blindness 
reported 2,061 treatments during these months, 


Meeting of General Practice.—The Illinois Acade- 
my of General Practice will hold its fourth annual 
convention, October 14-16, 1951, at the Sheraton 
Hotel, in Chicago. Dr. H. Marchmont-Robinson, 
president of the Illinois Academy of General Prac- 
tice; and Colonel James C. Crockett, will deliver the 
welcome address and introduction, respectively. 
Speakers participating in the assembly will be Dr. 
Earl H. Blair, “Duties of Physicians in Atomic 
Disaster”; Howard Shaughnessy, Ph.D., “Prevention 
and Control of Infectious Diseases During Atomic 
and Biological Warfare”; Dr. Lloyd Gittelson, “Dis- 
aster Anesthesia”; Dr. J. Garrott Allen, “Treatment 
of Radiation Sickness”; Dr. Harry A. Oberhelman, 
“Treatment of Blast Injuries’; Brigadier General 
Elbert De Coursey, “Atomic 'Bomb Effects: Teach- 
ing Aids from Armed Forces Institute of Path- 
ology”; Dr. Henrietta Herbolsheimer, ‘Medical 
Organization for Civil Defense”; Senator Everett 
McKinley Dirksen, banquet speaker; Dr. A. R. 
Colwell, “Diagnosis and Treatment of Diabetic 
Acidosis”; Dr. Herbert Rattner, “Common Skin 
Disorders and Their Treatment”; Dr. A. V. Parti- 
pilo, “Intestinal Obstruction”; Dr. Andrew C. Ivy, 
“Differential Therapeutic Diagnosis of Jaundice”; 
Dr. H. Close Hesseltine, “Prolonged Labor and Its 
Management”; Dr. H. C. Voris, “Emergency Treat- 
ment of Head Injuries”; Dr. W. C. Alvarez, “Why 
Are Some People So Nervous”; Dr. Karl A. Meyer, 
“Lesions of the Colon”; and Dr. Louis N. Katz, 
“Some Common E.K.G. Patterns Encountered in 
General Practice.” 


DEATHS 


Rosert G. BELL, Ottawa, who graduated at Rush 
Medical College in 1920, died July 28, aged 65. He 
was medical director of the former Ottawa Tubercu- 
losis Sanitarium for many years. 

KENNETH ADAMs Bispsy, Waukegan, who graduated 
at Queen’s University Faculty of Medicine, Kingston, 
Ont., Canada, in 1932, died March 22, aged 44, of 
pancreatic calculi. 

Roy S. BorHweEL., Batavia, who graduated at The 
Hahnemann Medical College and Hospital in 1890 and 
Rush Medical College in 1891, died July 14, aged 60. 


219 





He was a member of the “Fifty Year Club” of the 
Illinois State Medical Society. 

SANFORD R. CATLIN, Rockford, who graduated at 
Harvard Medical School in 1897, died, July 14, aged 
80. He had practiced medicine 54 years and was a 
member of the Illinois State Medical Society “Fifty 
Year Club.” 

WiLiiam W. CoLeMAN, retired, Lincoln, who gradu- 
ated at Missouri Medical College, St. Loius, in 1899, 
died June 28, aged 76. He practiced medicine in Lin- 
coln from June, 1904, until his retirement in 1949. 

WittiaM E. Franke, retired, Newton, who graduated 
at St. Louis College of Physicians and Surgeons in 
1892, died August 4, aged 81. He was a member of 
the “Fifty Year Club” of the Illinois State Medical 
Society. 

Harry C, GEBHART, Champaign, who graduated at 


Rush Medical College in 1916, died July 15, aged 64. 


He began his medical practice in Champaign-Urbana 
in 1926, 

HOMER JAMEs GoRDON, Chicago, who graduated at 
Chicago Medical School in 1921, died March 31, aged 
53, of carcinoma. 

JoHNn JAcop Hesser, Chicago, who graduated at 
Magyar Kiralyi Pazmany Petrus Tudomanyegyetem 
Orvosi Fakultasa,’ Budapest, Hungary, in 1909, died 
March 30, aged 64. 

Epwarp J. Horick, Elmhurst, who graduated at 
Rush Medical College in 1924, died July 26, aged 57. 


He was on the staff of the DuPage Memorial Hospital 
and had practiced medicine in Elmhurst since 1930, 

GeorGe A. LEACH, Morris, who graduated at The 
Hahnemann Medical College and Hospital in 1901, 
died July 21, aged 88. He had served as city health 
physician at Morris. 

WALTER C, REINEKING, Jacksonville, who graduated 
at Wisconsin College of Physicians and Surgeons in 
1907, died July 11, as the result of an automobile ac- 
cident. He was 70 years of age. He had served on 
the staff of Oak Lawn Sanatorium, Jacksonville, 

ArtHUR WILLIAM RoBersON, Chicago, who gradu- 
ated at Meharry Medical College, Nashville, Tenn,, in 
1919, died April 25, aged 56, of concussion of the brain 
resulting from a fall, 

Henry O. Rocier, retired, Mason City, who gradu- 
ated at St. Louis University School of Medicine in 
1906, died July 17, aged 70. 

CHARLES A. RUNYON, Elveston, who graduated at 
College of Physicians and Surgeons, Keokuk, Ia., in 
1884, died July 15, aged 90. He was a member of the 
“Fifty Year Club” of the Illinois State Medical So- 
ciety. 

ArtHur L, SHREFFLER, Joliet, who graduated at 
Northwestern University Medical School in 1911, died 
August 10, aged 66. He was on the staff of Silver 
Cross and St. Joseph Hospitals in Joliet, and was a 
past president of the Will-Grundy County Medical 
Society. 





“FOR THE COMMON GOOD” 


Health Talk on TV.—Since the last issue of the 
LLINOIS MEDICAL JOURNAL, the following 
telecasts have been presented by the Educational 
Committee over WGN-TV, Channel 9, on Tuesday 
evenings at 7:30 p.m. 

William B. Raycraft, July 31, The Rheumatic 
Heart. 

Louis R. Limarzi and Paul L. Bedinger, August 
7, The Story of Blood. The Precision Scientific 
Company provided equipment for this telecast. 

Albert H. Unger and Mr. Oren C. Durham, 
August 14, Hay Fever. 

Gordon H. Rovelstad, D.D.S. and Samuel Hoff- 
man, August 21, Preventing Tooth Decay. 

Your Doctor Speaks Over WFJL, Thursday 
evenings at 7:30 p.m., carried the following tran- 
scribed broadcasts under the auspices of the Edu- 
cational Committee since the last issue of the 
JOURNAL: 

George W. Holmes, August 2, Surgery in Tu- 
berculosis. 

Irwin Dritz, August 9, Modern Anesthesia. 

Earle I. Greene, August 16, That Lump in ‘Your 
Neck. 


Here Is Your Doctor Over WCFL, Saturday 
mornings at 11 a.m., weekly transcribed series 
is currently off the air but will be resumed some 
time in the fall. 

Lectures Arranged Through the Educational 
Committee: 

William W. Bolton, September 16, Young Mar- 
ried Couples Sunday Evening Club, Superstitions 
About Health. 

Edward Webb, Chicago, September 26, Mothers’ 
Study Club, in Elgin, on Prevention of Eye Prob- 
lems in Young Children. 

Lectures Arranged Through the Scientific Service 
Committee: 

William K. Riker, Chicago, September 11, Bureau 
County Medical Society, in Spring Valley, on Cer- 
tain Aspects of Pediatric Surgery, illustrated. 

Walter Reich, Chicago, October 16, Iroquois 
County Medical Society, Watseka, Office Gyne- 
cology, illustrated. 

Elizabeth A. McGrew, Chicago, October 26, 
McDonough County Medical Society, Macomb, De- 
tection of Genital Tract Cancer in Asymptomatic 
Women by the Cytologic Method, illustrated. 


Hlinois Medical Journal 








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@ Itis quickly effective against the most com- 
mon urinary pathogens. 

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as B. proteus occur). 

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plications as gastric upset, skin rashes, blood 
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likely to occur. 

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simply administer 3 or 4 tablets t.i.d. 

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AMINE* lessens the probability of com- 
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medication. 


For September, 1951 


Suggested for use in the management 
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NON-ARTICULAR RHEUMATISM 


Richard Harold Freyberg, M. D. In BULLETIN OF 
NEW YORK ACADEMY OF MEDICINE, 27:- 
4:245, April 1951. 

The commonest form of 
affects the fibrous connective tissue and consequently 
has been called “fibrositis.” Its treatment is supportive 
and symptomatic. Usually it is helpful for the patient 
to avoid strenuous physical activity and to procure 
additional rest during the daytime, but it is a mistake 
to curtail ordinary activity and recreation that is not 
Mild exercise especially after ap- 
the stiffness and 


non-articular rheumatism 


fatigue-producing. 
plication of heat 
aching; however, prolonged physical activity commonly 
increases the discomfort. Heat relieves; massage 
gradually made rather “firm” usually is helpful. Hot 
packs are helpful for severe localized pain and warm 
baths are the best means of heating the whole body. 
Inflammation of a bursa is a common form of 
localized fibrositis. Since bursae exist about all 
large joints and some small ones, bursitis may occur 
Treatment should be directed to 
and to maintain function; reassurance 
should be that the disorder is localized and 
comparatively mild. Radiant heat or diathermy may 
relieve, but sometimes aggravate the pain; then cold 
applications usually relieve. Rest of the shoulder is 
advisable during the acute phase; graded exercises 
to restore motion should be instituted as soon as pain 
lessens. Procaine block of the superior cervical gang- 
lion or brachial plexus will give temporary relief and 
allow exercise of the shoulder to avoid stiffness. 
he shoulder-hand syndrome is an interesting and 
incompletely understood form of non-articular rheuma- 


usually relieves 


in many locations. 
pain 


given 


relieve 


52 


PHYSICAL MEDICINE ABSTRACTS 








tism which may -follow myocardial infarction or other 
paintul intrathoracic lesions, cerebral vascular accidents, 
irritative lesions in the neck or upper extremity, and 
sometimes exists without recognizable cause. It is 
characterized by pain in the shoulder or hand, common- 
ly in both parts; it may be unilateral or bilateral. 
Shoulder motion becomes limited and the affected hand 
becomes edematous and painful so that it is held stiff. 
After several weeks, atrophy occurs in the shoulder and 
hand and adhesions or contractures limit motion in the 
affected parts. Treatment with the usual physical 
measures and analgesics commonly fails. Procaine 
block of the brachial plexus or superior cervical gang- 
lion usually is an effective means of temporarily al- 
laying pain, which should be accomplished early in the 
illness, so that ftunctional exercises can be performed 
to prevent stiffness. If stiffness of shoulder and/or 
hand results,. rehabilitation depends upon persistent 
physical and occupational therapy. 


A STUDY OF THE ADJUSTMENT OF 500 PER- 
SONS OVER SIXTEEN YEARS OF AGE WITH 
DISABILITIES RESULTING FROM 
POLIOMYELITIS 


George G. Deaver, M. D. In NEW YORK MEDI- 

CINE, 7:7:16, April 5, 1951. 

There has been much speculation about the proportion 
of persons with residual disabilities from poliomyelitis, 
who having received extensive care and treatment 
through childhood, nevertheless by the time they ap- 
proach adult life, have not achieved their maximum 
capacity to perform the physical activities inherent in 

(Continued on page 54) 


Ilinois Medical Journal 








ther 
ants, 
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For September, 1951 











Physical Medicine (Continued) 


daily living and working. In order to obtain authentic 
information on this subject this study was undertaken, 
and the following conclusions were reached : 

(1) When patients with poliomyelitis are left with 
a residual disability, it is to be expected that some will 
have no handicap in performing the physical activities 
of daily living; others will be handicapped but able 
to meet these demands adequately; and others will have 
inadequate compensations. Inadequate follow-up of 
patients results in three times as many persons with 
inadequate compensation. 

If the disabled are taught to perform the activities 
of daily living, it is probable that only three per cent 
could not be trained and employed in positions suited 
to their abilities and disabilities. 

(2) The large majority have the mental and physical 
capacity to lead a normal life and achieve a satisfactory 
social and emotional adjustment. 

(3) Psychological factors are no less important than 
physical factors in the adjustment of the disabled and 
should receive scientific study and treatment to the 
same extent as physical factors. 

(4) Social service, with many exceptions in individual 
cases, was on the whole extremely inadequate for the 
group studied. 

(5) The educational attainment of these disabled 
persons seemed to be equal to that of the general 
population of the city. 

(6) The rate of employment for the group studied 
was 15 per cent lower than for the general population 
of New York City. 

(7) Deprivation in social activities seems to be an 
even more important factor in maladjustment than lack 
of vocational opportunities. 

(8) There is little difference between the sexes in 
regard to extent of disability, education and general 
adjustment, but women are worse off than men in 
regard to employability, economic status, social life, and 
attitude toward the disability. 

(9) Among the subjects that should receive further 
investigation, as indicated by the data of this study are: 

a. The use that is made of existing opportunities for 
vocational guidance and training. 

b. The role of social service in rehabilitation. 

c. The importance of emotional factors in adjust- 
ment, with particular reference to rehabilitation, edu- 
cation and employment. 

d. The effect of parental over-protection on social 
and emotional adjustment. 





FRACTURES ABOUT THE ANKLE 


Rex L. Diveley, M. D., Kansas City. In THE 
JOURNAL OF THE MISSOURI STATE 
MEDICAL ASSOCIATION, 48:6:437, June 1951. 
Diveley’s routine in fractures about the ankle 

is to reduce them at the earliest possible moment and 

immobilize in a plaster cast. Early weight-bearing 


54 





is highly satisfactory provided firm immobiliza- 
tion of the fragments can be maintained. At 
the end of two weeks, a heel piece or walking 
iron may be incorporated in the cast, and weight 
bearing insisted upon. 

The after-treatment or period of rehabilitation 
is most important in ankle fractures. At the end 
of from six to eight weeks, depending upon the 
severity of the fracture, the cast is bivalved and 
physical therapy in the form of massage, passive 
and active exercises with whirlpool is given. In 
ten days or two weeks, it the x-ray examination 
shows an adequate union of the fragments, the cast 
may be discarded and the foot fitted in a strong sup- 
porting shoe. Any existing foot imbalance must 
be corrected by supports and shoe alterations or 
both. 


PARKINSONISM AND RHEUMATOID 
ARTHRITIS 


Ralph O. Wallerstein, M. D., Boston, Mass. In 
ANNALS OF INTERNAL MEDICINE, 34:4: 
899, April 1951, 

Eighty years ago Charcot first called attention 
to the possible relationship between Parkinsonism 
and rheumatoid arthritis. Since then several in- 
vestigators have pointed out similarities between 
the two diseases. 

In an effort to evaluate critically the relationship 
between the two diseases, 19 patients with frank 
clinical paralysis agitans, and 28 patients with far 
advanced, chronic atrophic arthritis were examined. 

In most patients with Parkinsonism the onset of 
illness had been very gradual; weakness and tremor 
had been the first symptoms. In conducting the 
examinations, attention was focused primarily on 
the joints. In the majority of the patients, the 
appearance of the hands bore a marked resemblance 
to the hands found in chronic rheumatoid arthritis. 
There was ulnar deviation of the wrists and fingers, 
flexion at the metacarpophalangeal joints, extension 
at the phalangeal joints and adduction of the fingers 
and thumb; in other words, all muscles innervated 
by the ulnar nerve seemed overactive. Poverty of 
motion of trunk and face, with attitude of flexion 
at elbows and knees, enhanced this resemblance. 
But whereas in atrophic“ arthritis there is a true 
loss of mobility, affecting passive as well as active 
motion and usually ankylosis and deformity, full 
range of motion could be obtained in the joints 
of patients with Parkinsonism after overcoming 
the muscular rigidity by passively flexing and 
stretching all the large and small joints of the 
extremities. 

The patients suffering from rheumatoid arthritis 
had a definite story of onset with fever and joint 
pain. In all patients the disease had progressed to 
complete crippling, with joint destruction and anky- 
losis. 


(Continued on page 56) 












Illinois Medical Journal 


For § 


* 


w one oud off ins ations 


Ave 


0 Aymuplows 


but all 34 patients in this study carried End- 
amoeba histolytica! in their stools! Five were 
classified as asymptomatic and 18 were “‘per- 
sons with such poorly defined symptoms that 
they would not normally seek medical assis- 
tance...,” but a stool examination proved that 
all had amebic dysentery. 

In these instances, a course of treatment 
with Milibis-Aralen was completely success- 
ful. Milibis — bismuth glycolylarsanilate — a 
new intestinal amebacide, is one of the most 


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MILIBIS® 


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unobserved. 


Aralen (chloroquine) diphosphate has 
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1. Towse, R. C., Berberian, D. A., and Dennis, E. W.: New York State Jour. Med., 50:2035, Sept., 1950. 
2. Berberian, D. A., Dennis, E. W., and Pipkin, C. A.: Am. Jour, Trop. Med., 30:613, Sept., 1950. 


For September, 1951 














Physical Medicine (Continued) 


Only one patient appeared to have both diseases. 
In view of the number of cases of Parkinsonism 
(19) and rheumatoid arthritis (28) among a group 
of 500 patients, this coincidence cannot be con- 
sidered significant. 

There appears to be no increased incidence of 
rheumatoid arthritis among patients suffering from 
Parkinsonism. 





VISUAL AND MOTOR CHANGES IN PATIENTS 
WITH MULTIPLE SCLEROSIS: A RESULT OF 


INDUCED CHANGES IN ENVIRONMENTAL 
TEMPERATURE 


Thomas C. Guthrie, M. D., New York, New York. 
In ARCHIVES OF NEUROLOGY AND PSY- 
CHIATRY, 65:4:437, April 1951. 

Climate and temperature have been recognized 
as affecting the incidence of multiple sclerosis. 
Although sex and race appear not to be impor- 
tant factors in its occurrence, its geographical dis- 
tribution seems to vary significantly with the dis- 
tance of an area from the equator. According to 
one study of the mortality statistics in 14 countries, 
there is “an inverse and rather striking relationship 


between reported mortality due to multiple sclerosis 
and mean annual temperature. The colder the 
climate, the higher the crude death rates for 
multiple sclerosis.” A definite statistical relation- 
ship of multiple sclerosis to seasonal variations in 
temperature does not seem to exist. 

In the past, in an attempt by physicians to dis- 
cover effective therapeutic approaches to multiple 
sclerosis, patients have been subjected to various 
forms of heating. On the rationale that the disease 
may be caused by a virus and that a heat-sensitive 
organism may be found in the spinal fluid, 12 pa- 
tients were subjected to immersion in a hot bath 
at 110 F. and 10 minutes. After 115 baths given 
to the 12 patients, the condition of four showed 
improvement; that of six showed no change, and 
that of two became worse. In a general discussion 
of therapy with hot baths, to patients with multiple 
sclerosis, the observation was made that “muscle 
weakness ordinarily was not favorably influenced.” 

Several attempts have been made to treat multiple 
sclerosis with electropyrexia. With local diathermy, 
given over the spinal cord, to 13 patients, 10 showed 
improvement; one relapsed and was then cured; 
one became worse, and one had questionable results, 
but the criteria for improvement are vague, and no 
control series is reported. In general reference 


(Contimued on page 58) 








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illinois Medical Journal 





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Physical Medicine (Continued) 
to electropyrexia, the comment has been made that 
fever may bring out latent neurological abnormal- 
ities. 

In general, while hot baths, diathermy, fever cab- 
inets and pyrexia induced with foreign protein have 
been tried several times in the treatment of multiple 
sclerosis, inconclusive results have gradually led 
to their disrepute as effective agents. 

Of the changes that seem to appear during heat- 
ing, the generalized weakness, arm weakness, leg 
weakness and dysarthria have, in general but not 
always, been present in the patients with multiple 
sclerosis before heating. The effect of the hot 
baths seems mainly to have been one of rendering 
these dysfunctions more evident. 


AN ASSESSMENT OF THERAPY IN 
PARKINSON'S DISEASE 


Robert S. Schwab, M. D., Boston, and John S. 
Prichard, M. B., M.R.C.P., London, England. In 
ARCHIVES OF NEUROLOGY AND PSY- 
CHIATRY, 65:4:489, April 1951. 

Since 1817, when James Parkinson recognized the 
entity of paralysis agitans among the heterogeneous 
collection of tremors and paralyses, the most per- 


sistent attempts have been made to treat this 


disease. Charcot thought some of his patients were 
benefited by riding on horseback. Consequently, he 
had constructed a fauteil trepidant, on which he 
made his patients sit and shake for stated periods. 
A pupil of his, Gloreux, was so impressed with this 
idea that he prescribed for his patients a two hour 
ride each day on as bumpy a conveyance as was 
possible. 


During the past five years patients with paralysis 
agitans were given four types of treatment, as 
well as combinations of them: physical therapy, 
psychotherapy, surgical treatment, and drug ther- 
apy. 

The physical therapy consisted of either the 
routine therapy with massage and passive motion, 
or intensive progressive resistance exercises of the 
involved muscles under the direction of Dr. T. L. 
DeLorme. As concerns the effect of physical 
therapy of the routine type, namely, referral of 
the patient to the physical therapy department two 
or three times a week for massage and passive 
motion, or having a masseur come to the patient’s 
home two or three times a week for the same treat- 
ment, Schwab and Prichard formed the following 
impression: During the actual massage and pas- 
sive exercises the patient almost always felt better. 


(Continued on page 6)) 





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References: 


FOR THE TREATMENT of 
peptic ulcer and hyperacidity, the 
market has long afforded neutral- 
izing agents which are satisfactory 
to a degree. Frequently, however, 
a dosage sufficient for prompt, 
lasting pain relief brings in its 
wake a discouraging acid rebound. 


Doraxamin brand of dihydroxy 
aluminum aminoacetate rules out 
this reaction. Because it is a chem- 
ical combination of aluminum with 
glycine, one of the amino acids, 
it provides both rapid acid neu- 
tralization by the amino acid and 


a secondary prolonged buffering of 
acid by the decomposition of the 
aluminum salt of the glycine. 


Doraxamin raises the pH of arti- 
ficial gastric juice to approximately 
3.9 in ten minutes, and maintains 
a pH of above 3.0 for two hours. 
Repeated tests have shown con- 
clusively that, even when Doraxa- 
min is given in excess, the pH 
never reaches a maximum of more 
than 4.5. There is, therefore, no 
danger of alkalosis and no acid 
rebound. 


1 Krantz, Kibler and Bell: “The Neutralization of 
Gastric Acidity with Basic Aluminum Aminoace- 
tiod4). "J. Pharmacol, and Exper. Therap., 82:247 

2 Paul, w. D., and Rhomberg, C.: “Medical Mana 
ment of Uncomplicated Peptic Ulcer,’”’ J. Iowa 
Soc. 35:167-85 (1945). 

3 Holbert, J. M., Noble, Nancy, and Grote, I. W.: 
J.A.Ph.A., Scientific Edition, 36:149 (1947). 

4 Holbert, J. M., Noble, Nancy, and Grote, I.W.: 

J.A.Ph.A., Scientific Edition, 37:292-294 a 


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PREVENTING BORDERLINE NUTRITIONAL STATES 
IN CHILDREN 


N recent years increasing interest has 
been focused on the relationship be- 
tween nutrition and the physical, mental and 
emotional development of children. It is now 
well recognized that listlessness and apathy in 
the child frequently may be nothing other than 
manifestations of a borderline nutritional state 
resulting from faulty food selection and in- 
adequate consumption. Moreover, such seque- 
lae of faulty nutrition often respond dramati- 
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For preventing borderline nutritional states 
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Three servings of Ovaltine in milk furnish 
the supplementary amounts of nutrients shown 
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*Baumgartner, L.: Wider Horizons for Children; The Mid- 


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J. Am. Dietet, A. 27:281 (Apr.) 1951. 


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*Based on average reported values fer milk. 


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For September, 1951 





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Physical Medicine (Continued) 


He was more relaxed and comfortable. As soon as 
the patient left the physical therapy department, 
his symptoms returned, and the benefit of the treat- 
ment lasted only an hour or two at the very most. 
There was no evidence in this type of physical 
therapy of any true benefit, change in symptoms, 
improvement in signs or alteration in the progress 
or state of the disease. 

The special approach through progressive re- 
sistance exercises is a separate project, 
specific weakness or stiffness in one muscle group, 
for example, in left leg, or even both legs, rather 
than a generalized involvement, is the chief dis- 
ability. These patients are seen in consultation 
with Dr. T, L. DeLorme and are taken into this 
project only if they are willing to come in for two 
to three hours’ treatment, four times a week, for 
two to three months. The other forms of therapy, 
usually medication, which the patients have been 
receiving are kept exactly the same throughout this 
period of observation. Careful assessment is made 
each week as to changes in signs and in the pa- 
tient’s ability to perform his usual tasks at home 
and at work. At the end of the project the treat- 
ment is stopped for a period of at least a month to 
see whether any improvement attained has re- 
gressed. 

In a preliminary group of five patients receiving 
this type of treatment, three have greatly improved 
in their strength and muscle function and in the 
ability to use these muscles in normal activities, 
such as walking and climbing stairs. There has 
also been a favorable improvement in mood. How- 
ever, there is no alteration in the objective signs, 
such as tremor or rigidity or loss of associated 
movements. One patient in this group continued 
for six weeks and then reverted suddenly to the 
previous level after he had been badly shaken up 
in an automobile accident. This stress was suffi- 
cient to make the period of treatment following 
the accident (one month) ineffective. The fifth 
patient showed no improvement in any form, and 
the treatment was discontinued at the end of a 
month. 


in which a 


CLINICAL NOTES ON AN EPIDEMIC OF 
POLIOMYELITIS 


Ned M. Shutkin, M. D., Gastonia, N. C. In AN- 
NALS OF INTERNAL MEDICINE, 34:3:655, 
March 1951. 

Those cases with only spinal paralysis were put 
to bed, kept comfortable with analgesics and bar- 
biturates if necessary, and given physical therapy 
as early as possible but not until it could be done 
without adding to the patients’ discomfort. The 
controversies raging among the physical therapists 
as to the advisability of immediate or deferred 


(Continued on page 62) 


Ilinols Medical Journal 





IN 
VAGINAL 
AND 
CERVICAL 
SURGERY 


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can decrease greatly the slough, 

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These suppositories are indicated for 
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Literature on request 


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For September, 1951 


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Physical Medicine (Continued) reasons. In the first place, a hot pack program 
carried out according to protocol would have com- 


stretching, gentle or forceful stretching, or the use pletely usurped the time and. efforts of the i 
° in- 
f ho s so many “storms s. a. 
9 . packs nde. 3 Ane teacup sufficient personnel, who were taxed to the utmost 
Approaching the subject on the basis of rational taking care of the direly ill bulbar and respiratory 
physiology, it should be obvious that stretching a cases. " Secondly, the great majécity ef. uac y 
: : : ses. ’ com- 
tight muscle, be it early or late, could not possibly fortable patients obtained prompt and adequate re 
alter a disease process located in the spinal cord. fief from judicious doses of aspirin and phencbas 
Furthermore, the precise reason for stretching bital, -Titaedly, twas deemed unwise to subjen 
: ; : . ’ s ec 
must be appreciated. One must differentiate be- our acutely ill patients, so many of them under oan 
tween the contraction of the presumably spastic oil age wee the sbdiiipast POET ik deh 
° s ’ ’ eny- 
scle he acute phase : 1e rac > z ; : 2 
muscle in the ye <P ayant and the ee acture of dration and electrolyte depletion attendant upon a 
the noncontractile connective tissue in and about full-scale hot pack program, particularly during th 
e ° ° “s ’ ; e 
the muscle following the acute phase. It is no ae seein -aniitie Most important oT all 
z 7 s Ss. B\ s ail, 
more reasonabie to expect stretching of the con- however, is the fact that hot packs were not ne 
° Cc- 
tracted muscle in the acute phase to produce relaxa- fy ae A f = 
E : essary. As previously stated, physical therapy 
t:on of the muscle than it would be reasonable to ye : . ye 
2 see ‘ prevented contractures, with only aspirin and 
expect relaxation of a spastic muscle from stretching eusitnaatibend il h , F I 
in a case of cerebral palsy. Hence it becomes ob- er ee eee eee? ededlies:: 
- me err i ‘ instances where muscle soreness and tightness were 
vious that the only valid reason for stretching a . : : 
: ‘ . é extreme, even to the extent of producing opistho- 
tight muscle in the acute phase is to obviate sub- : ie 
: ; tonus, hot packs were employed and, true enough, 
sequent contracture of the noncontractile con- : : Tee : 
i : i were effective in relieving the tightness, but only 
nective tissue elements in or about that muscle. It : A , . a 
: during the period they were applied. Following 
Was our experience that no contractures developed are : 
é : ‘ removal of the packs, the tightness promptly re- 
from gentle, unhurried muscle stretching done at 
: ; turned, and to a degree comparable to that present 
a time and at a pace that did not increase the : east { th Bs : 
: : i prior to application of the pack; nor was _ there 
patient’s discomfort. 
Hot packs were used only sparingly, for several (Continued on page 64) 





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Physical Medicine (Continued) 


any evidence indicating that the use of hot packs 
shortened the duration of the tightness. 

Following subsidence of the acute stage, therapy 
was directed toward three objectives: prevention 
of fixed contractures; strengthening, insofar as 
possible, surviving muscle elements, and coordina- 
tion of residual and substitute motion. Position 
of function was maintained, insofar as possible, 
by means of sand bags, foot boards, shoe bars, 
pillows, slings and other gadgets designed to fit 
the individual requirement. This aspect of con- 
valescent care cannot be too strenuously enforced, 
It is folly to expect a convalescent but otherwise 
healthy child to remain immobile in any fixed po- 
sition for days on end. As long as adequate daily 
physical therapy maintained suppleness in the soft 
tissues, no deformities occurred. Braces were em- 
ployed as early as feasible, not so much to obtain 
immobilization as to allow mobilization. It was 
felt that active use of weakened muscles while 
supported in a position of mechanical advantage 
abetted the strengthening process. Plaster casts 
were used infrequently, and only in those few cases 
where deformities occurred or seemed imminent 
as a result of muscle imbalance that defied the 
efforts of the physical therapist. Although not 
so deplorable as soft tissue contracture in the po- 
sition of deformity, contracture in the position of 
function, plus the disuse atrophy of surviving muscle 
elements from prolonged plaster immobilization, 
certainly is not much more desirable. 


NYLON ARTHROPLASTY IN RHEUMATOID 
AND OSTEO-ARTHRITIS 


John G. Kuhns and Theodore A. Potter, Boston, 
Mass. In ANNALS OF THE RHEUMATIC 
DISEASES, 10:1:22, March 1951. 

After operation. to form a new knee joint, the 
leg usually is kept elevated upon pillows for 48 
hours. Transfusions of one to two pints of blood 
usually are given as well as peniciilin as prophy- 
lactic measures. Muscle-setting exercises are begun 
before the end of the first week after oepration. 
Active exercises are begun after one week. Move- 
ment against gravity is begun as soon as the 
wound is healed. Weight-bearing with crutches 
and a plaster cylinder are begun in three weeks un- 
less there is much bony atrophy. Resistance ex- 
ercises (De Lorme and Watkins, 1948) are given 
to regain normal strength in the extensor muscles. 
Six months usually are required to regain normal 
strength and good function. 

Arthroplasty of the knee in chronic arthritis is 
always an operation of election. It does not pro- 


(Continued on page 66) 


Illinois Medical Journal 















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Physical Medicine (Continued) 


duce a normal knee joint but usually results in a 
useful joint with a fairly wide range of painless 
motion. In operations of this nature the post- 
operative period is most important, since motion de- 
pends upon the avoidence of complications and the 
early and persistent activity of the patient. The 
patient must begin motion or muscle-setting pro- 
cedures within a few days, and active and resistance 
exercises of increasing strenuousness must be per- 
formed after wound-healing to secure good motion 
and normal strength. In a few patients normal 
strength and good function have gradually come 
after a year and a half, but we do not advocate 
such slow convalescence; adhesions and muscular 
stiffness can develop too readily. 


The desideratum after arthroplasty of the knee 
has changed little in the last 50 years; it is a stable, 
painless knee with about 60° of motion. In a 
recent review, Speed and Trout (1949) stated that 
70° of motion made for the greatest endurance and 
stability, but many of our patients have over 90° of 
motion and all of them are stable and painless. The 
greater range of motion, we believe, has resulted 
from the vigorous use of the newer physical therapy 
technics, particularly resistance exercises. 


RUPTURES OF THE ROTATOR CUFF 


H. F. Moseley, Montreal, Canada. Hunterian Pro. 
fessor, Royal College of Surgeons of England; 
Assistant Professor of Surgery, McGill Univer. 
sity; Associate Surgeon, Royal Victoria Hospital, 
Montreal. In THE BRITISH JOURNAL OF 
SURGERY, 38:151:340, January 1951. 

In acute ruptures if the case is seen early and 
the diagnosis is doubtful, careful observation oj 
the progress of the case under active exercise 
therapy should be the course to follow. If im- 
provement in range and power rapidly occurs 
during the following three to six weeks, the surgeon 
can be content with nonoperative treatment. 

In chronic ruptures if there is considerable stiff- 
ness of the shoulder, especially when tested in adduc- 
tion, giving a limitation of external and _ internal 
rotation, active exercises under supervision should 
be arranged for several months before exploration 
is considered. 

In repair of the deltoid it is essential to obtain a 
perfect replacement and suture of the reflected del- 
toid. A pressure dressing is applied at operation 
which is removed the following day. Early ambula- 
tory treatment is routine. Time in hospital has 
varied, but averages less than one week. 

The problem of immobilizacion in adduction or 

(Continued on page 68) 








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Physical Medicine (Continued) 


abduction has not been resolved. During the winter 
months in Canada abduction splints and the plaster 
spica make clinic attendance almost impossible. For 
this reason these have been employed mostly jn 
repairs of chronic cases when the tension of suture 
was relieved by the position 90°, 30°, 30° as found at 
operation. The usual position has been in a sling 

The principle followed in this series is that the 
surgeon who has carried out the operation must 
supervise the process of reeducation. Gentle for- 
ward and backward movements of the arm, and the 
complete movements of the elbow, wrist, and hand 
are encouraged from the beginning. Movements of 
the shoulder itself are gradually begun after three 
weeks. All movements are initiated by using the 
relaxed muscle position. The patient is never 
permitted to attempt to abduct the arm without 
assistance for at least six weeks. The weight of 
the arm would be sufficient to injure the area 
of repair. Besides the use of the relaxed muscle 
position, abduction can be initiated by using the 
method of Colin MacKenzie. The patient rests 
supine on a couch and the arm is allowed to slide 
in abduction and adduction on a smooth surface. 
In this way the weight of the arm and friction are 
obviated. It usually is necessary to begin these 
movements in a position in front of the coronal 
plane. 

Depending upon the progress, the next step 
at four to six weeks is graduation to pulley exer- 
cises. Movements in forward flexion are encouraged 
before those in abduction, and the progress in 
the range of forward and backward flexion is 
always in advance of the range obtained in ab- 
duction. Every attempt is made to teach the pa- 
tient movements of the humeral joints and to avoid 
shrugging the shoulder by using the girdle move- 
ments which is the natural tendency. 


In time the physical therapist can employ in- 
creasing resistance to the muscles to augment 
their power, but this should not be an important 
part of the treatment until after three months. The 
range of movements always is first obtained before 
an effort is made to secure power. Supervision is 
required for four to six months to secure a good 
result. 

When the patient is treated in the position 90’, 
30°, 30°, movements above this plan are encouraged 
and the patient is taught to keep all the muscles of 
the limb in activity. This position usually has 
been maintained for six weeks and the case is 
readmitted for removal of the splint, as this may 
be painful and the arm should be gradually adducted 
while the patient is in bed. The program of reed- 
ucation should then follow the pattern outlined 
above. Sometimes a vascular disturbance occurs 
in the forearm and the hand after removal of the 
abduction splint. Corrective measures include active 


(Continued on page 70) 


Illinois Medical Journe! 





cd ) 


Winter 
plaster 
e. For 
stly in 
Suture 
ound at 
| Sling. 
lat the 
must 
le for- 
nd the 
1 hand 
ents of 
- three 
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never 
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rtant 

The 
efore 
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90°, 
aged 
es of 

has 
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-eed- 
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Physical Medicine (Continued) 


exercises of the fingers, hand, and wrist, together 
with the use of sympatketic block. 

The patient should return to light work for a 
period of several months before heavy labor is per- 
mitted. Depending upon his age and the state of 
degeneration of the cuff, it may be best permanently 
lifting and also exertion above the 

This tends to make the patient 
and there is little doubt that such 
the trained to greater 


to avoid heavy 
horizontal plane. 
the 


could 


limb, 
have 


lavor 
cases 


power by special exercise therapy. 


muscles 





THE EFFECT OF MICROWAVE RADIATION ON 
THE PERIPHERAL PULSE VOLUME, DIGITAL 
SKIN TEMPERATURE AND DIGITAL BLOOD 
FLOW IN MAN 


M. D., M.Sc., Philadelphia. In 
PHYSICAL MEDICINE, 32: 


Emery K. Stoner, 
ARCHIVES OF 
6:408, June 1951. 
Sixty experiments were performed on 16 sub- 

jects to obtain data on the effects of microwave 

irradiation applied to the forearm on digital blood 
flow, pulse volume, and temperature. Various types 
of directors and different power output were uti- 


lized. The heating period of 30 minutes and the 





5 cm. distance between the director and the skin were 


kept constant. 

On the basis of the experimental evidence the 
following conclusions can be supported: 

(1) Microwave irradiation of the forearm dos 
not increase oral temperature or pulse rate. 

(2) Vasodilatation is rapidly induced in 
hands at the same time and to about the same 
degree. 

(3) Complete vasodilatation was not produced jn 
any of our subjects by treatment with microwave. 

(4) The changes in digital pulse volume, tem- 
perature and blood flow of the upper extremities 
in response to heating the forearm with microwave 
radiation were parallel and varied directly with 
the power output that was applied. 

(5) Burns from microwave energy can be sus- 
tained with only minor discomfort during the 


time of exposure. 


both 





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A Textsook or Mepicine — Edited by: Russell L. 
Cecil, M.D., Sc.D., Professor of Clinical Medicine, 
Emeritus, Cornell University, New York. Robert 
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bia University, New York. Associate Editors: 
Alexander B. Gutman, M.D., Professor of Medicine, 
Columbia University, New York; Walsh McDermott, 
M.D., Associate Professor of Medicine, Cornell Uni- 
versity, New York; Harold G. Wolff, M.D., Associ- 
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sity, N.Y. New, 8th Edition. 1627 pages, 204 figures, 
40 tables. Philadelphia and London: W. B. Saunders 
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This is another revision of this well known standard 
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section on Viral Diseases. 

Eighty two new treatises on subjects previously 
covered have been necessary as the result of death or 
retirement of former contributors. 

The rearrangement and editing of this edition has 
shortened it by 136 pages without sacrificing any 
important material and many color plates are included. 


JOW HP. 


RECENT ADVANCES IN CHEMOTHERAPY — 3rd Edition —— 
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74 


BOOK REVIEWS 








to four volumes. This first volume deals with the 
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mittees and proprietory firms. The author has given 
as many names as possible but, as he suggests, standardi- 
zation is a matter for an organization like the World 
Health Organization. 


jl.C& 


Tue Foor Ann ANKLE. Philip Lewin, M.D., F.A.CS. 
Lea & Febiger, 847 pp., 389 illustrations, $11.00. 
This is the third edition of an excellent treatise on the 

foot and ankle in its fullest meaning. Many small tables 
are included which outline the subject quite thoroughly 
and cut down on a lot of explanation and also tends to 
impress the reader more with this style. The anatomy 
and physiology of the foot are taken up in detail so 
that as we progress through succeeding chapters in the 
book the pathological changes are taken up and dis- 
cussed and treatment advised. 

Fractures and dislocations of many bones and joints 
of the foot are gone into very thoroughly. An outline 
is presented whereby an estimation of foot and ankle 
disabilities may be determined based upon the normal 
function of the foot and ankle disorders. Credit is 
very liberally given to outside help and authors for 
their work on the subject presented. Practically all 
the diseases which affect the body and particularly those 

(Continued on page 76) 


Illinois Medical Journal 








1 the 


Toto- 


dif- 
ever, 
tion, 
finite 
ris 
Is is 

the 
>0m- 
ivett 
rdi- 


orld 





=— 





in the 
















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INDICATION TIME REQUIRED 

OR SURGERY FOR ANALGESIA 
Post-Appendectomy 3 minutes 
Post-Hemorrhoidectomy 3 minutes 
Post-Tonsillectomy 2 minutes 
Simple Headache Yo -3 minutes 
Menstrual Pain 5 minutes 


Many other dramatic 
cases reported. 


1. Hoffman, Murray M., Ill. Dent. JI., 19:439- 
445 (Oct., 1950) 


2. McNealy, Raymond W., Ill. Med. Jl., 97:150 
(Mar., 1950) 


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BOOK REVIEWS (Continued) 


affecting the foot and ankle location are considered 
from the point of view of the foot and ankle, the only 
exceptions are when treatment of the body as a whole 
must be considered. 

There is a very comprehensive chapter on tumors 
of the bones, joints, soft tissues, tendon sheath and 
primary tumors of the foot and ankle. Plantar warts, 
corns, ringworm of the foot and other common con- 
ditions are presented in detail including the treatment. 

The chapter on surgical technique is particularly 
illuminating and presents many good points which could 
well be followed by the surgeon doing this type of 
work. 

The book as a whole is an excellent text. 

R. Jom 





TREPHINE TECHNIQUE OF BoNE Marrow INFUusIons 
AND Tissue Biopsres: By Henry Turkel, B.A, 
M.A., M.D. Fourth Edition. Gale Printing Com- 
pany, Detroit, Michigan. 60 pages. Price $1.00. 
This is a most practical monograph. It describes the 

simple apparatus necessary and the techniques for 

intrameduallary infusions through the sternum, tibia, 
femur and iliac crest. 

Using the same apparatus, methods are described for 
obtaining biopsies from not only bone marrow but also 
soft tissue sites such as the prostate, lymph glands, 
breast and liver. 

A detailed bibliography is included in the final chapter 


concerning infusions and biopsies. 
JEAW AP: 





A. M. A. Primer on Fractures. Frederick A. Jostes, 
M.D., Gordon M. Morrison, M.D., Kellogg Speed, 
M.D. Paul B. Hoeber, Inc. 109 pp., 48 illustrations. 
$2.00. 

The sixth edition of this practical little book is writ- 
ten under the able supervision of Frederick A. Jostes, 
M.D., St. Louis, Gordon M. Morrison, M.D., Boston, 
and Kellogg Speed, M.D., Chicago. 

The terms “open” and “closed” fracture have been 
permanently established. The book serves very well 
for short concise use by students and _ practitioners. 
Practically all of the major fractures and the more 
common fractures are discussed and treatment is ad- 
vised. Short concise tables are presented to simplify 
this great field of treatment. There are approximately 
50 pages of tables, discussions and charts which very 
ably cover each of these important subjects. This very 
valuable little book is recommended to all students and 
practitioners. 


R. J.B. 





Surcery Or THe SuHoutper. A. F, DePalma, M.D. 
J. B. Lippincott Company, 438 pp., 454 illustrations. 
$17.50 a 
This is a beautifully written book with large clear 


(Continued on page 78) 


Illinois Medical Journal 





For 


| 


onsidered 
, the only 
S a whole 


n tumors 
leath and 
‘ar warts, 
mon con- 
reatment, 
rticularly 
‘ich could 

type of 


R. J.B 


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Zero curd tension, adequate 


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its and 





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BOOK REVIEWS (Continued) 
figures. The book starts out with comparative and 
then normal anatomy. A great many figures are taken 
from other texts. A large series of shoulders were 
obtained from different sources for study of the normal 
and pathological. This chapter is exceptionally well il- 
lustrated with photographs of the shoulder joint. 

The chapter on complete and incomplete tears of the 
musculotendinous cuff is well handled in the text by 
photographs, x-rays and by drawings. The treatment 
of this condition is very conservative and results appear 
satisfactory. 

The frozen shoulder is taken up in detail, and a rea- 
sonable explanation and treatment given. There is a 
long chapter on dislocations of the shoulder joint. Frac- 
tures and fracture-dislocations of the upper end of the 
humerus are well handled and with beautiful x-rays, 

Shoulder pain of neurogenic origin is discussed very 
much in detail including the scalenus anticus syndrome 
and obstetric paralysis. 

There is a very good chapter on bone tumors and 
a very comprehensive chapter on operative procedures 
and _ resections. 


R. J. B 


REGIONAL OrTHOPEDIC SuRGERY. Paul C. Colonna, M.D. 
W. B. Saunders Company, 706 pp., 474 illustrations, 
$11.50. 

This book is a reflection of the personal experiences 
of the author over a period of years. The basic facts 
about bones and joints are first presented and then 
the abnormal conditions are considered. This pathology 
of bones and joints again is the result of experience of 
the author and is an excellent treatise on the subjects 
presented. 

The chapter on the hip and pelvic ring is particularly 
well done and the methods outlined are very dogmatic 
yet considerate of the patient and the end result ob- 
tained. 

There is a very interesting chapter on Neuromuscular 
disabilities. 

The chapter on tumors of the bone is not too differ- 
ent from the experience of other authors. 

A very interesting chapter is presented on principles 
of apparatus. 

Physical medicine is presented with the views that 
it will aid in the care and treatment of the orthopedic 
surgery patient. 

The book is well done. 


R. J. 5 


i ettaal 


For a sick man or woman disease is an acutely per- 
sonal problem, but it is also a communal problem. And 
if the public is to cooperate with the medical profession 
in the treatment of disease in the individual it will, we 
believe, be able to do this more intelligently if it has 
some idea of the size of the problem to the nation at 
large. Tuberculosis is an obvious example. The 
medical profession is only too well aware of the per- 
sonal tragedies that have been caused by the purveyors 
of quack remedies for such dangerous diseases as 
cancer. Brit. Med. J., Ed., March 17, 1951. 


IMinois Medical Journal 











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REVIEW OF PHYSIOLOGICAL CHEMISTRY. 











BOOKS RECEIVED 











The following books have been received for reviewing, and 
are herewith acknowledged. This listing should be consid. 
ered as a sufficient return for the courtesy of the sender. 
Books that appear to be of unusual interest will be reviewed 
as space permits each month. Readers desiring additional 
information relative to books listed, may write the Editor who 
will gladly furnish same promptly. 


TopaccO AND THE CARDIOVASCULAR SYSTEM — The 
Effects of Smoking and of Nicotine on Normal 
Persons. By Grace M. Roth, Ph.D., Associate 
Professor of Experimental Medicine, Mayo Founda- 
tion for Medical Education and Research Graduate 
School, University of Minnesota and Consultant in 
Section on Physiology, Mayo Clinic, Rochester, Min- 
nesota. Charles C. Thomas, Publisher, Springfield, 
Illinois. 66 pages. $2.25. 

ManuAL THERAPY. By James B. Mennell, M.A,, 
M.D., B.C., (Cantab.) Consulting Physician in 
Physical Medicine, St. Thomas’s Hospital, Vice- 
President and Hon, Fellow, Chartered Society of 
Psysiotherapy, London, England, Gold Key of the 
American Congress of Physical Medicine, Gold Key 
of the American Physical Therapy Association, 
Honorary Life Member of the Netherlands Physical 
Therapy Association. 64 pages. $2.25. 


THE MANAGEMENT OF FRACTURES, DISLOCATIONS, AND 


Sprains. By John Albert Key, B.S., M.D. St. 
Louis, Missouri, Clinical Professor of Orthopedic 
Surgery, Washington University School of Medi- 
cine; Associate Surgeon, Barnes, Children’s, and 
Jewish Hospitals, and H. Earle Conwell, M.D. 
F.A.C.S., Birmingham, Alabama, Associate Professor 
of Orthopaedic Surgery, University of Alabama 
School of Medicine; Chief of the Orthopaedic 
Service, South Highland Infirmary; Consulting 
Orthopaedic Surgeon to Carraway Methodist Hos- 
pital and Baptist Hospitals; Attending Orthopaedic 
Surgeon, Children’s Hospital, Jefferson-Hillman Hos- 
pital, East End Memorial Hospital, and St. Vincent’s 
Hospital, Birmingham, Alabama. Fifth Edition. The 
C. V. Mosby Company, St. Louis, Missouri. 1232 
pages. $16.00. 


By Harold 
A. Harper, Ph.D., Professor of Biology (Bio- 
chemistry), University of San Francisco, Lecturer 
in Surgery, University of California School of 
Medicine, San Francisco, Biochemist Consultant to 
Metabolic Research Facility, U. S. Naval Hospital, 
Oakland, Director, Biochemistry Laboratory, St. 
Mary’s Hospital, San Francisco. Third Edition. 
University Medical Publishers, P. O. Box 761, Palo 
Alto, California. 260 pages. $3.50. . 


Low Soptum Diet — A Manual for the Patient. By 


Thurman B. Rice, A.M., M.D., Professor of Public 
Health, Indiana University School of Medicine, 
Indianapolis, Indiana. Lea & Febiger, Philadelphia, 
1951. 103 pages. 14 Food Charts, $2.75. 


(Continued on page 82) 


Illinois Medical Journal 

































































ig, and 
consid. 
sender, 
viewed 


litional 
or who 


- The 
ormal 
Ociate 
unda- 
duate 
nt in 

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efield, 


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Vice- 
‘y of 
f the 
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ation, 
ysical 


AND 
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fedi- 

and 
{.D., 
essor 
ama 
1edic 
Iting 
Hos- 
1edic 
Tos- 
ent’s. 
The 
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1. Best, C. H.; Lucas, C. C.; 
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2. Dolan, R. A.: Choline and 
other Lipotropic Factors: 
Mechanisms of Action and 
Significance in Chronic Liver 
Disease, Minnesota Med. 
31: 1198 (Nov.) 1948. 

3. Goldstein, M. R., and 
Rosahn, P. D.: Choline and 
Inositol Therapy of Cirrhosis 
of the Liver, Connecticut M. J. 
9:351 (May) 1945. 

4. Cogswell, R. C.; Schiff, L.; 
Safdi, S. A.; Richfield, D. F.; 
Kumpe, C. W., and Gall, E. A.: 
Needle Biopsy of the Liver, 
ee 140:385 (May 28) 


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BOOKS RECEIVED (Continued) 


Merasotic MerHops — Clinical Procedures in the 
Study of Metabolic Functions. By C. Frank Con- 
solazio, Chief of Biochemistry, United States Army, 
Medical Nutrition Laboratory, Chicago, Illinois, and 
Robert E. Johnson, M.D., D, Phil, (Oxford), Pro- 
fessor and Head of the Department of Physiology, 
University of Illinois, Urbana, Illinois, and Evelyn 
Marek, M.A., Biochemist, United States Army, 
Medical Nutrition Laboratory, Chicago, Illinois. 
Illustrated. The C, V. Mosby Company, St. Louis. 
471 pages. $6.75. 


A TeExtTBooK OF MEDICAL CONDITIONS FoR PHysIo- 
THERAPISTS. By Joan E. Cash, B.A., M.C.S.P., 
(Teachers’ Certificates). with a foreword by Frank 
D. Howitt, C.V.O., M.A., M.D., F.R.C.P., J. B. 
Lippincott Company, Philadelphia, London, Mon- 
treal. 350 pages. $5.00. 


CLINICAL PeEptAtric UroLtoGy: By Meredith Camp- 
bell, M.S., M.D., F.A.C.S., Professor of Urology, 
New York Post-Graduate Medical 
School. With a Section on Nephritis and Allied 
Diseases in Infancy and Childhood; by Elvira 
Goettsch, A.B., M.D.; and John D. Lyttle, A.B., 
M.D., 1113 pages with 543 figures. Philadelphia and 


London; W. B. Saunders Company, 1951. $18.00. 


University, 


SPONTANEOUS HERNIA ‘‘CURES”’ 
The prevailing cross section of opinion is that 
a small percentage of inguinal hernias will cure 
spontaneously during the first year of life, and 
that an occasional cure can be expected even to 
the age of 214 years. The term “cure” should 
be used in the sense that during the period of 
observation the hernia no longer protrudes. 
Failure to observe a protrusion does not neces- 
sarily mean a “cure” but, instead, may be due 
to the fact that the infant is almost always in 
a position of recumbency which favors reduction 
of the hernia, or that conditions at the time of 
observation do not favor herniation into the sac. 
Evidence points to the conclusion that true com- 
plete obliteration of the hernia sac after birth 
probably does not occur. Instead, the canal re- 
mains patent, waiting for conditions to become 
more favorable for refilling. These conditions 
include weakening of the surrounding muscula- 
ture and increase in intra-abdominal pressure, 
and they may not arrive until years later, Cases 
of inguinal hernias of infancy and childhood 
have been written off as spontaneously cured, 





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illinois Medical Journal 

















— | 


5’ 

is that 
1 cure 
a, and 
ven to 
should 
od of 
rudes. 
neces- 
e due 
ys in 
ction 
ne of 
» ae, 

com- 

birth 

1 Te- 

Pome 

tions 

cula- 

sure, 

Jases 

hood 

red, 








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only to recur from two to twenty years later. 
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the hernia was readily reduced and remained 
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funicular process down to the scrotum was 
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the fact that though no protrusion into this sac 
was ever noticed, the funicular process did not 
close. Excerpt: Surgery: The Practical Solu- ae OO 
tion of the Inguinal Hernia Problem of Infancy %.% a 


and Childhood, Carl J. Heifetz, M.D., St. Lows, 
J. Mussourt M, A., July, 1951. 








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THE COMPLETE HISTORY 

Central X-Ray & Clinical . » «There are three major obstacles that stand 
Laboratory in the way of obtaining a complete history: 

F. F. Schwartz M.D. After listening to a patient’s main complaints 
Director frequently physicians form a quick judgment as 
COMPLETE MEDICAL X-RAYS & to the diagnosis and then attempt to get a his- 
LABORATORY SERVICE, INCLUDING: tory confirming this rapid judgment. Through- 
Electroencephalograms out the taking of a history, the physician must 
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symptoms he quickly acquiesces and accepts the 
terms suggested by the physician without under- 
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patient thought was wrong. Often very reveal- 
ing statements are made by the patient who has 
a fairly good insight into the disease process. 
Nearly all patients encouraged by such a remark 
give a better chronological description of events 
of their illness. Excerpt: Gastrointestinal 
Symptoms Due to Extrinsic Organic Etiology: 
The Importance of History Taking, Harold C. 
Ineth, M.D., Omaha, Nebr., Nebr. S.MJ., July, 


1951. 





WISDOM IN THINKING 


Physicians should realize that their office is 
not only a place in which to transact the business 
of medicine but is also a place in which much 
material and spiritual relief can be given — 
then medicine 


again becomes a_ profession. 


Excerpt: Keeping Up With Medicine, Jonathan 
Forman, M.D., Editor, O.S.M.J., May 1961. 





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For September, 1951 


85 











Your Advertisers 


This is an index of those who serve the Medical Profession and support your Journal. All advertisers are ap- 


proved by your Journal Committee. 


it will help you to mention your Journal when writing them. 





BODY SUPPORTS 


Z0nn B. Piaherty (a; Ime, Bins; BY. <icccsvvcscs 85 
5. EB. leuger, toc., 527 S. Wells, Chee 5, TNs .icccsss 80 
CLASSIFIED 
TT ee, a ere ere ee 88 
EQUIPMENT 

General Electric Co., X-Ray Dept., 1417 W. Jackson, 
Ry Rs che ness ee ease kbns sake eeboe sus treseeres 43 
Rexair Div., Martin-Parry Corp., Toledo, O. .......... 70 


FINANCIAL AND INSURANCE 
Illinois Collectors Association, 201 N. Wells, Chgo 6, Ill. 88 


Medical Protective Co., Fort Wayne, Ind. ............ 80 
Physicians Casualty Co., First Nat’l Bank Bldg., Omaha 

et AL w:<.53) RoW Kek Me danie tees aad ee ne es eee ee 5 

FOODS 
American Meat Institute, Chgo, Tl... cccccsssevices 73 
Baker Laboratories, Inc., 4614 Prospect, Cleveland 3, O. 48 
Borden Co., 350 Madison Ave., New York 17, N.Y. .... 35 
M & R Laboratories, 585 Cleveland, Columbus 16, O. .. 77 
Mead Johnson & Co., Evansville, Ind. .... Inside Back Cover 
Nestle Co., Inc., Colorado Springs, Colo. ............ 50 
Wander Co., 360 N. Michigan Ave., Chgo 1, Ill. ...... 59 
LABORATORIES 

Central X-Ray and Clinical Lab, 111 N. Wabash, Chgo, 

BE, es Qlarans 65 oye Bho eao oly sac babe oho Sve pee aeae a eee 84 


Grant Hospital Isotope Lab, 551 Grand PI., Chgo 14, Ill. 83 
Physicians Radium Association, 55 E. Washington, Chgo 


RO eatin daakaWe ss Kee dase aees been sche eeeeeete 78 
PHARMACEUTICALS 
Abbott Laboratories, North Chicago, Ill. .............. 26 
Armour Laboratories, Chgo 9, TH. «..060<sesec0cece8, 29 
Averst, McKenna & Harrison, Ltd., 22 E. 40th St., New 
MORES NO HOLE NS .. Fea Riche Kes bgsieeeburoreh sc cee 19, 20, 75 
Bithuber-Knoll ‘Cocp:, ‘Orange, NJ... «65 es csccecccccavses 56 
Church Chemical Co., 75 E. Wacker, Chgo 1, Ill. ...... 76 


Ciba Pharmaceutical Products, Inc., Summit, N.J. .... 4 
C S C Pharmaceuticals, 17 E. 42nd St., New York 17, 
DRM CESSES ale SUT oN als SOI O RSD ie SEAT TRO 81 
Eaton Laboratories, Inc., Norwich, N.Y. 
Edison Chemical Co., 30 W. Washington, Chgo 2, Ill... 41 


Rreaetl 23, Bader la, ERG MO i cea coe seclosedtaslees 60 
Endo Products, Inc., Richmond Hill 18, N.Y. ........ 42 
Gold Pharmacal Co., P. O. Box 181, New York 24, N.Y. 85 
Hoffmann-LaRoche, Inc., Nutley 10, N.Y. ............ 8 
Hynson Westcott & Dunning, Charles & Chase St., 
CN BI aa Sinisinse Bmw sae Sw sessed Gea 68 


Interstate Pharmacal Co., P.O. Box 252, Beloit, Wise. .. 85 
E. E. Kunze, Inc., 1035 S. Fifth, Milwaukee 4, Wisc. .. 21 


86 





Lederle Laboratories, 30 Rockefeller Plaza, New York 
PO TMU. gran: ied alow p Sia REO Sa ae ta een 33 
Thos. Leeming, 155 E. 44th, New York 17, N.Y. .... 3 
Eki Lilly & Co., Indianapolis 6, Ind. ........s..006s- 45, 46 
S.. E: Masseagill Co; Bristol, Tentin. <ssccccecccivvscc 63 
Merck & Co,, ‘Uaic., anwar, Tl .. cikcvesese ce eres 23, $3 
Wm. S. Merrell Co., Cincinnati, O. ...... 6,2, 38; 39: a 
Nepera ‘Chemical Co., Yonkers 2, NiY.. 6 o-iccwsiseccce 51 
Nam Specialty Co., PiRtsDargh, Pai osc cece bse soesvies 83 
Numotizine, Inc., 900 N. Franklin, Chgo 10, Ill. ....... 66 
Gnminon. Tit. Keener HIG. ais 2 oa ees go weea cade 32 
Parke. Davis @ Co,, Deteeit, MICh. <2 s.05c.00 ceendewsncs 27 
EB. 2: Beech: Goi, Biaeaes SG. BI asSs a. 66s sks. oscece sis. 62 
Chas: Pizer & Co., Inc., Brooklyn 6, N. Y.. .,..<<.+ 13, 65 
Raymer Pharmacal Co., NE Cor. Jasper & Willard, 
MINOONE, 90 BIS ons cre Caio cowaninoescisiat maracas ce 40 
Riker Laboratories, Inc., 8480 Beverly Blvd., Los 
PRS SITE MME 6. Gig cso(atsia oh, o1c5.ois. GSN RAR RGIO wD RIKaA 36 


A. H. Robins Co., Inc., Richmond 20, Va. ......... 71, 7 
J. B. Roerig & Co., 536 Lake Shore Dr., Chgo 11, Ill... 3 


Sandoz Pharmaceuticals, 68 Charlton, New York 14, 

DEE) cieuactessod tee ar atemee esta eater aaa eal ert pares 64 
Schering’ Corn:, Bloomfield, Ni. Je cic c cic cvesceet-ta is 31 
Schieffelin & Co., 20 Cooper Sq., New York 3, N. Y. .. 34 
G. D. Searle & Co., P:O0. Box 5100, Chee, 10. .......- 

Pace gia ea Te a Moore Siacs States SE Seon iacsigrece Inside Front Cover 
Sharp & Dohme, Philedeiphia..1, Pa. <.oicisccsicce ace 16, 17 
Smith-Doreey,” Lincdia GS, Nee. cc occkie cckcvcesenccones 58 
Smith, Kline & French, Philadelphia, Pa. ............ 

PE ee ee Ce ER 9, 18, 30, 44, 47, 69, 87 
Tarbonis Co., 4300 Euclid, Cleveland 3, O. ............ 57 
U. S. Vitamin, 250 E. 43rd, New York 17, N. Y. ..... 12 
Upjohn, -alamazoo 99, “REICH... ssicisiediccscdcdicccesaswaene 22 
Wm. R. Warner & Co., 113 W. 18th St., New York, 

is ie nm aR rrr art ene PIs eraser OPES nrc urna Par ie CECE 24 
White Laboratories, Inc., Kenilworth, N. J. .........++ 25 
Whittaker Laboratories, Inc., Peekskill, N. Y. ......... 5 
Whittier Laboratories, Chgo 11, Ill. ............. 14, 15, 49 
Winthrop-Stearns Co., 70 Varick St., N. Y. ........ 14,55 
Weryeth, Tic, “Pimledelonta 2) PR ees saw taccs cess 10, 67 
Zemmmer Co., Piguii 23, Bee 6a oe onc d055 000be snces 88 


SANATORIA AND SANITARIA 


Bee Dozier Sanitariums, Box 288, Lake Zurich, Ill. ... 78 


pellevue Plgce, semeevans) WG be a kcke kee sion biaissesia wee <a 84 
Costeff Sanatorium, 1109 N. Madison, Peoria, Ill. ....... 83 
Edward Sanatorium, Naperville, TH. 2.4 ccccccccccoeses 84 


Fairview Sanitarium, 2828 S. Prairie, Chgo 16, Ill. .. 83 
Michell Sanatorium, 106 N. Glen Oak, Peoria, Ill. ..... 84 


Milwaukee Sanitarium, Wauwatosa, Wisc. ..... Back Cover 
Norbury Sanatorium, Jacksonville, Ill. ...........---: 85 
North Shore Health Resort, 225 Sheridan Rd., Winnetka, 
BE (CBW nSinids 40-60 t0:860n4 eR RESETS keSeme sc ses 82 
St. Joseph’s Health Resort, Wedron, Ill. .........-. 82 





Illinois Medical Journal 

























Before intranasal administration of After instillation of the Suspension 
Paredrine-Sulfathiazole Suspension. in the Proetz—or head-low—position. 









(Photographs slightly enlarged) 


These photographs show the advantages of a SUSPENSION 


| in treating INTRANASAL INFECTIONS 


Paredrine-Sulfathiazole Suspension—unlike antibacterial agents in solution—does not 
vig quickly wash away. It clings to infected areas for hours—assuring proivuged bacteriostasis. 
" 58 When instilled in the Proetz position, it reaches all of the sinal ostia, thus helping to pre- 
vent sinusitis. 
9, 87 
a Paredrine-Sulfathiazole Suspension is the most widely prescribed sulfonamide nose drop. 
22 No instances of sensitivity to its use have ever been reported. 
24 A suspension of ‘Micraform’ sulfathiazole, 5%, in an isotonic aqueous medium with ‘Paredrine’ 
. Hydrobromide (hydroxyamphetamine hydrobromide, S.K.F.), 1%; preserved with ortho-hydroxy- 
5, 49 phenylmercuric chloride, 1:20,000. 
1, 35 rye . e . 
0, 67 Smith, Kline & French Laboratories, Philadelphia 
88 
78 s \ a 
84 
‘1 Paredrine-Sulfathiazole Suspension 
84 
83 
84 ° P ° ® ° . 
over vasoconstriction in minutes...bacteriostasis for hours 
85 
82 “‘Paredrine’ & ‘Micraform’ T.M. Reg. U.S. Pat. Off. 








For September, 1951 


Iu The TREATMENT ¢¢ WHOOPING COUGH 


and Adult Irritating Bronchial Coughs 


Each 10 minims contains: Gold Tribromide — 1-30 gr. 


The pharmacologic action and the therapeutic effect of Auri-Tussin, 
a solution of Gold Tribromide, in Whooping-Cough is due to the 
antiseptic action of the Gold and the neuro-sedative action of the 


bromide. Supply in 1/4 oz. dropper bottles. 


request. 


Literature and prices on 


Chemists to the Medical Profession Since 1903 


THE ZEMMER COMPANY ° Pittsburgh 13, Pa. 





Classified Ads 











WANTED: EENT Specialist, bd. member or elig. Estab. clinic, new, air- 
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Write Box 175, Ill. Med. Jnl., 30 N. Michigan, Chgo. 2. 11/51 


FOR SALE: Combination Apartment and Office. Ideal location for doctor or 
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RELIEF OF PAIN VIA SURGERY 


Of the numerous operative procedures avail- 
able for the control of intractable pain, spino- 
thalamic chordotomy and prefrontal lobotomy 
are the most widely used and the most widely ap- 
plicable. The indications for such operative 
procedures are cases of intractable pain, partic- 
ularly malgnancies, which are inoperable and 
cannot be controlled adequately by other means. 
Also, of course, the patient should have a suffi- 
ciently long life expectancy to warrant surgery 


for the relief of pain. It is surprising, however, 
at times to see the improvement in the patient’s 
condition once his pain is brought under control 
and narcotics stopped, so that it is our feeling 
that any patient who looks as if his life expect- 
ancy would be a month to six weeks or more 
should have surgery in order to make him at 
least moderately comfortable for the remainder 
of his life. Excerpt: Surgical Control of In- 


tractable Pain, Jerome F. Grunnagle, M.D., 
Pittsburgh, Pa. Pa. M. J., June, 1951. 


ACCENT ON PREVENTION 

It is said that $8,000,000,000, or nearly $4 
out of each $100 spent in the United States 
during 1949, went for medical care. But no 
one knows how much of the money went for 
Hadacol or Dolcine tablets, how much to pay 
the physician, hospital or chiropractor or how 
much for health and accident insurance. 

A survey by Columbia University under the 
direction of Professor Oscar Serbein, Jr., of the 
Graduate School of Business, is expected to as- 
certain and publicize such items as the number 
of individuals covered by medical and hospital 
prepayment plans, the types of illness covered, 
the medical services provided for combating 
them and the possibilities for further progress 
in such plans. 

No doubt the job will be well done. Facts are 
needed first of all. It is important to under- 
stand the cost of medical care. Editorial from 
N.E.J.M., May 24, 1951. 








FOR DYING ACCOUNTS 


The Agency in Your Town Which is a 
Member of ATI 


3 
ILLINOIS COLLECTORS ASSN — AMERICAN COLLECTORS ASS 








Illinois Medical Journal 





ever, 
ent’s 
ntrol 
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pect- 
more 
m at 
nder 


y $4 


states 
t no 
for 
pay 
how 


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f the 
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gress 


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from