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symptoms the duodenithe blood supply this
movements, the non-passage of gas, the rapid what re-agents; steam, ferments, alkali or acids, distention, the early vomiting, the increase in the ultimate cleavage is Amino acid. The biopulse rate, the critical picture with which the logical chemists have demonstrated that the physician is confronted. The mere fact that poisonous substances in the cleavage of proteids the bowel is obstructed is not the determining is an organic acid which is built upon a well factor in the prognosis. If the bowel is occluded known base. Vaughn, after the long research in by a thrombus in the mesentery or if all the proteid, announces that the toxic acid is a bencirculation is in any way cut off from a section zine derivative in which any atom of hydrogen of the bowel, there is something added to the is replaced by an hydroxyl group. He further pathology that is not easily explained. Again, observed that the only oxy-phynol compound if the obstruction is low down the patient is in the proteid molecule is Tyrosin. not so seriously ill from the beginning nor are the It is very evident that before we will be able symptoms as intense as when the obstruction is to solve the problem of synthesizing this toxic very near the duodenum. These two factors, acid into a non-irritating compound, it will be namely, cutting off the blood supply to the necessary for us to separate each from its proteid lumen together with the proximity of the ob- radical. understand its position in that radical, struction to the duodenum, serves as the basis how it would combine when liberated as a free of thought which I wish to present in this acid and its toxic effects upon the tissue. We paper. I heard a very noted surgeon in New readily see that we are confronted with a probYork make this statement that: “Obstruction lem that is not small. We are very conscious is simply a sewage proposition. The nearer the that the proteid molecule of every cell whether top you obstruct it the more quickly does it it be mammal or bacterial does contain this overflow”. I took issue with this statement be- poisonous group. Besides this poisonous group cause of the following facts : Should we obstruct from the proteid cleavage we have active withthe esophagus we know the patient will live for in the cell, the cell ferment, as is evidenced weeks and gradually die of starvation; should we by the autolysis of the liver after death. obstruct the Pyloric end of the stomach and with- We also have the ferment which is extrahold food from the stomach, the patient will live cellular as is evidenced in diphtheria. In thinkfor many weeks without the obstruction being ing of this problem we must know something of relieved.
the toxic acids derived from proteid cleavage Now let us place this obstruction in the first aside from the action of the ferments produced twelve inches of the jejunum or in the last por- by the cell. When the proteids are broken tion of the duodenum and what happens ? I down their cleavage acid is liberated from the will ask you to carry this for a moment and let molecule within the cell. They are unstable us return to our thrombus proposition. Given compounds that are capable of chemical change a patient with the thrombus in such a position and even affected by physical change. They that the circulation is cut off from the bowel unite when broken by cleavage as is evidenced for a distance of one foot. We open its lumen by their formation of urea for elimination. If above, establish drainage and forget the nature they are not so bound, they float free as poisons, of the pathology. We all fully realize that we an acid of negative electrical ions or corpuscles. have an entirely different problem than where Hence, we have a biological, physical, chemical the obstruction is due to a band of adhesions. and electrical imbalance. We know that through If that is true wherein do they differ? To me the study of Colloids, if a cell is hyper-acid it this is the very basis of all obstruction and its will swell with water until several alkalies are pathology. On examining the pathology closely, brought in to neutralize the acid. Hence, this we have first, the hyperemia which is soon fol- automatic action seems to prevent the breaking lowed by the death of millions of cells or by up of the cell balance if possible, or in other gangrene of tissue extensively. Then upon this tube the colloid may be found to be non-toxic. field is supra-implanted a bacterial infection By waiting a few moments, shaking the test which acts not only locally but generally by tube again and injecting the colloid into a guinea lowering the resistance of the patient. Over pig the substance is found to be exceedingly this mass of dead and dying tissue the pancreas toxic. This alone would make us think that pours its Trypsin constantly. We remember the proteid combination within the molecule Von Furth's statement that an inflamed bowel might be exceedingly unstable and would be will absorb faster than an un-inflamed one, which very prone to unite itself in combination with would suggest that the cleavage products of new organisms in case it was liberated. Many this dying mass would quickly be absorbed into illustrations of the unstability of the parts of the lymphatics and thrown into the general a molecule within a cell may be cited. A splendid circulation of the patient. Taylor, of Pennsyl- analogy may be drawn from the physics of vania, says that the cleavage products of proteid matter. The positive and negative corpuscles tissue is always Amino acid. No matter with of the gaseous ions are ever changing within
the gaseous molecules. The instability of Ra- of the toxic group of all the proteids in nature dium, Thorium, Uranium and Helium are splen- yields a common poison. How to combine these did examples of the subject in hand. We know poisons is the problem for the chemist. This that Radio-active substances are constantly poison is not a ferment or at least most of the undergoing a chemical change; that the Radium biological chemists of the day do not think so. is being constantly given off; the little corpus- The chemistry of ferments is little known. We cles which are disseminating into the surround- feel that it is a proteid in construction but it is ing atmosphere are quickly united into the near- generally agreed that it is not the same poison est chemical combination available. We know as that found in proteid cleavage. They are a little of the nature of the Alpha rays; we labial chemical bodies resulting from the interknow that these tiny bodies are charged with molecular rearrangement in the proteid molepositive electricity, and that they are constantly cule of the cell. The proof of this is the change flying off heated metals only to recombine with in the character of the ferment liberated by the other substances. The heat acts as the cleavage cell when attacked by toxic proteins of differproduct. We do not know how they combine ent chemical consistency. Upon this we build nor why, we only know they do. The Beta rays our system of sensitization of the cells of the of Radium are similar in their deflection to the body. These ferments are thrown out for the force of a magnet from their course. The specific purpose of destroying the foreign proGamma rays or X-ray is unlike the Alpha and teid by absorption. Now in the cells that die Beta in that it is not subject to deflection. It in the bowel wall are broken down into cleavage will pass through opaque substances with ease products of Amino acid and without a doubt and record its transit upon the sensitized plate the ferments contained in them if liberated in from whence we obtain our skyagram. The the blood stream would naturally set up two physicist has taught us that the ultimate ex- forms of intoxication. The Amino acids must pression of matter is the electrical corpuscle of becombined into urea in the non-irritating the Alpha, Beta and Gamma ray. The spectrum form. In case they are not combined immediaterecords the presence of these rays as they bring ly because of a lack of combining elements they their messages from the ends of the universe. are thrown into the system in overwhelming
The most remote planet is studied by their quantities and we have set up what is known aid but who is able to know the orderly sequence as acidosis. of their relationship to the substances with which This acidosis is accentuated by the cleavage they combine. For instance; the Beta corpuscle from the bacterial infection which is also presof Radium and its relationship, step by step ent. In this class of cases it is not hard for the up through its various combinations to that of imagination to conceive, that after the attempt the constant flow from the great electrodes at of surgical interference that only fifty per cent. Niagara which are capable of crystalizing the of our patients recover. When we consider the sands of the desert into diamonds on the one appalling loss in the hands of the very best hand or its storage in the electrical fish who surgeons and after forty years of devoted efforts has commercialized it for obtaining his food we have not changed our mortality rate, and and bridled its power for his own defense. I do upon seeking diligently we find this problem not wish to stray from the mark but I only wish confronting us, we are not amazed that our past to show you how difficult it is for the biologi- efforts have not been rewarded with the solution cal chemist to give us the pure chemistry of the of the problem. toxins of substances whose combinations in the organic rings are far more complicated and as VESICAL CALCULUS FOLLOWING unstable as the example just cited. I believe
HERNIOTOMY* that it will not be hard for any of you to realize
C. R. KENNEDY, M. D., Omaha, Neb. that the Co2 index of the blood is not the most
Medicine. fundamental \thing in this study. The giving I wish to report two cases of calculus formaof soda is an adjuvans to the combining of these tion in the urinary bladder as a result of injury substances into a non-irritating urea is good, to the bladder during herniotomy. but the primary study is left for the chemist. Case A. Male, aged 55. Previous history To accomplish this in the presence of terrific
negative up to 2 years previous when he had an destruction of tissue which continually liberates
operation for the cure of a right inguinal hernia. more and more of these poisons is our problem.
Convalescence was normal and he remained In the subject in hand, that of intestinal ob
well for some months and then commenced to struction, we first call in the surgeon to repair
have pain in the bladder, frequent urination, the mechanical defects, after that the physiolo
passed pus and blood in the urine. gical chemist must come to the rescue of both
Cystoscopic examination revealed a high surgeon and internalist and until he does I feel
grade cystitis and a calculus the size of a hickory assured that little progress will be made in the treatment of this terrible malady.
*Read before the Medical Society of the Missouri ValThe analysis ley at Lincoln, Neb., Sept. 21, 1917.
nut lying in the bladder. A supra pubic cystot- To prevent injury to the bladder in these omy was done and one stone was found free in cases there is only one method, that is care in the bladder and a smaller one hanging from a operating. silk ligature in the fundus.
In a herniotomy we should give just as much Case B. Female, aged 72. Admitted to the thought to injury to the bladder as the intestine Methodist hospital, complaining of pain in the or any other organ, and if the operator will take bladder and supra-pubic region, frequent urina- time to identify every structure and to cut or tion, urine contained large quantity of pus and clamp nothing till he is sure what he has, he blood.
will never cut into a bladder. Vaginal examination revealed a mass in the There are a few points, though, which will bladder region and the cystoscope disclosed a aid us in avoiding injury to the bladder. calculus lying free in the bladder. This was re- First, if there is more than one sac, be very moved by vaginal section and on sawing the careful, and if necessary, pass a sound into the stone in two, a silk ligature was found in the bladder and outline its limits. center.
Second, if there is an extra amount of fat She gave a history of operation for a right around the sac, isolate it carefully as it is likely inguinal hernia 212 years before. The hernia has to come from the pre vesical space and may conrecurred.
tain the bladder. . There is no doubt that these patients had T hird, do not pull too strongly on the sac, and vesical hernias which were not recognized until be sure the neck is isolated from everything bethe bladder was injured and the defect was closed fore ligating, as you may ligate a portion of the with silk which acted as a nucleus for the de- bladder and get a slough later. posit of urinary solids.
If the bladder is present in the sac it should As to the frequency of this condition we can be carefully isolated, reduced and the usual closdraw no conclusions as there is little reference ure of the canal made. to it in the literature, but we do think it is a « In case of injury to the bladder before it is condition which should never occur, as it can recognized, it is still possible to prevent serious be prevented by correct technique in herniotomy. consequences.
Vesical hernia in itself is a rather frequent The bladder should be carefully isolated and occurrence. Brunner collected 180 cases up to
ases up to
closed with chromic
closed with chromic catgut sutures, the first row 1890, only 13 being diagnosed before operation,
peration, passing through all coats but the mucosa, the and Heineck in a recent article reviewing the second row going through the muscle and buryliterature from 1896 to 1914 and including Ger
ing the first. Some authorities advise a third man, French and English journals, has collected
row of Pagenstecher or silk but this should be 164 cases of vesical hernia in 159 patients, and I
avoided by all means as it is an established prindo not think half of the cases have been reported.
ciple that unabsorbable sutures in a hollow visAccording to his analysis, it occurs at all ages,
cera always find their way to the lumen of the but is uncommon up to 16 years. It occurs in
viscera, so if the third row is used make it women, as well as men, in direct, indirect, femoral
chromic catgut. and ventral hernias, as intraperitoneal and extraperitoneal and may be reducible, incarcerated or
The herniotomy should be finishel in the regstrangulated. From this we must conclude that
ular way and it is preferable to use no drain. If the bladder must be thought of in every herni
one is used it should be gutta percha folded up
or rolled into a tube as a gauze drain is apt to otomy. The diagnosis of vesical hernia is possible
cause a fistula. in a large number of cases and if we find a pa
The bladder should be kept empty either by tient with a hernia has any urinary disturbance
frequent catheterization or an indwelling cathesuch as frequent urination, decrease in the size ter. of the hernial swelling during urination or we Recovery is usually prompt, and if no perfind that pressure on the hernia causes a de- manent sutures are used there is no danger of sire to urinate we suspect the presence of the calculus formation later. bladder in the sac.
BIBLIOGRAPHY If we find on cystoscopic examination that there is a diverticulum in the region of the
Surgery Gynecology and Obstetrics-Vol. XXII, No. 5, hernia or if we can introduce the cystoscope into Moschowitz, A. V.-Johnson's Operative Therapeusis, this cavity and tranilluminate the hernia, or if
Chetwood-Urology, Second Edition, page 418. the hernia enlarges as we fill the bladder we are
Guiteras, Raymon-Urology, Vol. II, page 26. positive of it.
Keyes. Edward L.-Diseases of the Genito-l'rinary Still there remain a large number of cases
Greene and Brooks-Diseases of the Genito-Urinary in which we find none of these signs and still the bladder is present in the sac.
Coley, Wm. B.-Keen's Surgery, Vol. IV, page 80.
Heinech, Aime Paul-Hernias of the Bladder.
Vol. IV. pages 31-38.
De Quervain-Clinical Surg. Diagnosis. 391.
Organs, page 518.
Organs and Kidneys.
The Medical Herald
ation. Of "functional deafness” due to nervous
disturbance very little is known. Incorporating the
Shell shock is also due to the high air preskansas City Medical Inder-Lancet sure in the vicinity of the exploding shell and in Vol. XXXVII.
the most severe form the result is instantaneous APRIL, 1918
· No. 4
death, with no external lesion at all. ExaminaCHAS. WOOD FASSETT, Managing Editor tion of the tissues from these cases has shown 613 Lathrop Building, Kansas City, Mo.
the existence of microscopic hemorrhages, espe
cially in the nervous system and the kidneys, ASSOCIATE EDITORS
and bloody urine in non-fatal cases. There may
be secondary suppression of the adrenal secreP. I. LEONARD, St. Joseph. J. M. BELL, St. Joseph.
tion. JNO. E. SUMMERS, Omaha.
Men handling large guns have had as comCONTRIBUTING EDITORS
mon practice during the discharge the opening H. ELLIOTT BATES, New York.
of the mouth. It permits pressure on both sides JOE BECTON, Greenville, Texas. HERMAN J. BOLDT, New York.
of the tympanic membrane. For troops under A. L. BLESH, Oklahoma City.
fire this is useless, because they can not anticiG. HENRI BOGART, Paris, “Ill. ST. CLOUD COOPER, Fort Smith, Ark.
pate the time of the explosion.
Of little avail is the placing of the finger tips
in the ears. Plugging the meatus with cotton is H. R. HARROWER, Los Angeles, Cal.
the most common procedure. Dry, air containJAS. W. HEDDENS, St. Joseph. VIRGINIA B. LE ROY, Streator, Ill.
ing cotton is of little use, but if used with various DONALD MACRAE, Council Bluffs.
oils it fills the spaces. Solid obturators of many L. HARRISON METTLER, Chicago. DANIEL MORTON, St. Joseph.
shapes and materials have been made. Lizzati D. A. MYERS, Lawton, Okla.
raised two objections. The hardness of the maJOHN PUNTON, Kansas City. W. T. WOOTTON, Hot Springs, Ark.
terial irritates the skin and causes inflammations HUGH H. YOUNG, Baltimore.
and eczema, while they project and become the source of severe injury. The Elliott "ear drum
protector" used by many naval and artillery offiThe Editors' Forum
cers, is based on the principle of a double diaphragm with a tube in the center passing through
and supporting both diaphragms, with a narrow War Deafness and
air passage in the tube that has openings between
the spaced diaphragms and at the inner end, deIts Prevention
signed to permit slow changes of the air pressure. War deafness is important from several stand- It interferes with the hearing, but little is known points, but particularly that of prevention. It about its efficiency. There are many kinds of incapacitates trained men for shorter or longer obturators, some made of various wax mixtures periods and they must frequently quit the serv- and they are probably the most satisfactory. A ice, the victims are handicapped when they re- plug conforms exactly to the shape of the meatus. turn to civil life, and the government may have Guild of Ann Arbor, in the Journal of Laborato pay them a pension.
tory and Clinical Medicine in a long article sumThe present war has enormously increased marizes as follows: “In the first place, the those cases compared to former wars on account issuance and compulsory use of some preventive, of the great use of high explosive shells and even if it be nothing more than cotton with vasehand grenades. Much has been written on this line, is in the interest of efficiency in the army, subject. An editorial writer in the British Medi- and it is of economic importance. Protectors cal Journal on March 24, 1917, states that "at should be issued like clothing, rations, etc., to a recent meeting in Germany, at which concus all troops alike, and their use made compulsory.” sion wounds of the tympanum were discussed, it Some such method lies in the direction of the was authoritatively stated that no satisfactory prevention of war deafness.
P. I. L. device has yet been found to prevent this and allied injuries.” Detonation effects on the ear are rupture of
Red Cross Seal Campaign the tympanic membrane, organic disturbances of
in Kansas City the labyrinth and functional disorders of the The sale of Red Cross seals during Christmas central nervous system. These may occur alone holidays in Kansas City brought a total of $14,or in combination. Rupture of the membrane 400 to the Kansas City Anti-Tuberculosis Somay bring about infection of the middle ear. ciety. The local organization turned over to the Pathologic changes occur simultaneously in all state and national Red Cross societies combined, parts of the organ of corti as a result of deton- $2,187, of which two-thirds goes to the national organization and one-third to the state society. Perhaps the most striking feature of the The local society has $10,157 net. It had remain- Chalfonte is the space devoted for lounging puring in bank $4,426, a total of $14,583 for use by poses. Long halls and large rooms, differently the Kansas City Anti-Tuberculosis Society dur- furnished and fitted out invite the restless guest ing this year.
to tarry for a time here and then to move to “The society is now maintaining about 175 some other part of the hotel, thus giving a sense tubercular and anemic children in open air of hominess and privacy that is lacking in so sehools,” said Mr. W. C. Root, president, "and many modern caravansaries. . soon expects to add at least fifty more.”
The Chalfonte is an ideal place in which to Two nurses are maintained in the schools who rest. Noise, glitter, glare are all noticeable by look after the condition of the children while their absence. The table leaves nothing to be there and follow them into their homes and ar- desired; there is employed variety and the qualrange for their diet and proper hygienic care ity of the food is above criticism. there. Four physicians also watch over the chil One does not have to remain long at the dren of the open air schools, advising as to treat- Chalfonte before one realizes that it is a place ment, diet and living conditions.
much favored and frequented by medical men Aside from these, two other nurses are em- and a little inquiry discloses the fact that hunployed to visit in the homes where persons are dreds of doctors send certain patients to the suffering from tuberculosis and give instructions Chalfonte for rest and recuperation. as to the proper care of patients.
There seems to be an idea in the minds of It has just come to the notice of the society many people that Atlantic City, being the great that many men summoned in the draft were re- pleasure resort that it is, must necessarily be jected because of tuberculosis. Many of them noisy and not adapted for those who require never even suspected they were so afflicted. quiet, peace, and restful surroundings. Thirty soldiers also have been sent home from. A visit to the Chalfonte will dispel such illuCamp Funston, it having been discovered in re- sions and not only this, will probably result in a examination there that they are victims of the return from time to time for a repetition of the white plague. The names of all of these have benefit to be secured within its walls. H. E.B. been furnished the society and these cases will be followed up and an effort made to benefit these sufferers.
Dr. Herbert Lee
Dr. Herbert Lee of St. Joseph, died Thursday, a Rendezvous
March 21, at his home, 1022 North Nineteenth
street. The doctor had been sick for six months There can be no question as to the therapeutic
or more, had spent several months in Texas, his value obtainable from a change of scene and a
former home, and returned to the city a month modification of environment. In fact, there are
ago, not much improved. He was born in Brisnumerous cases in which much more may be ob- tol, England, and before coming to America had tained by such means than by the use of drugs. been a buyer of Italian marble for his brother. Unfortunately, however, in many instances, mere He spoke Italian fluently. After coming to change of this sort does not prove beneficial, America he spent several years in Dallas, Texas. because the patient is not placed amid surround- Later he came to St. Joseph and graduated in ings that are congenial and is made to feel more medicine at the Central Medical College. After or less as if he or she had been transplanted into fifteen years of general practice, he became house an uncongenial soil. On the other hand, there physician at the Woodson Sanitarium. He conare places where such a feeling cannot exist and tinued there until his health began to fail a year an excellent example of such a place may be ago, when he resigned. Dr. Lee was of a highly found at the Hotel Chalfonte, in Atlantic City, cultured, studious, esthetic tendency, ill adapted N. J.
to the harsh commercialism of medical practice The first impression made upon the writer of the day. He was both gentle and loving, a when entering the hotel is the homelike char- man to be trusted with responsibility of duty as acter of the place. The hostelry is large and well as the intimacy of friendship. As a student, thoroughly equipped in every way to cater to a lover of books and an investigator, Dr. Lee the wish or whim of the tourist or pleasure has left a name and an individuality the loss of seeker. But at the same time, there is an entire which will be felt by a large coterie of friends absence of what might be called “hotel atmos in the Buchanan County Medical Society and
among the public. The body was put to rest by The service is of the best, but at the same the Masonic fraternity saturday the 23rd. time is not obtrusive or insistent.
J. M. B.