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gives the remarkable results we have had during in series, commendatory in tone concerning rethe past year in treatment 21 cases of eclampsia sults. and pre eclamptic toxemia by a systematic plan We use scopolamin when indicated especially of procedure in which the mortality has been in high strung nervous patients and in these in less than in any other reports we have seen.
which a long tedious labor is anticipated. This Twenty-one cases have been under observation patient has had her second dose, the first having and all on a generalized plan. Elimination-re
been narcophin gr. .5 and scopolamin gr. 1-200, moval of foci of infection-combating acidosis
the second following in 34 hours scopolamin 1and in every instance where these prophylactic 200 alone. We have had no blue babies, no measures failed to reduce blood pressure or to hemorrhage nor other maternal grief. The only clear up classical barometic readings foretelling precaution being in these cases they must be the storm which was approaching the uterus has watched throughout as often the baby is born been emptied and usually by the Vorhees bag suddenly and unobserved otherwise, the mother method.
being only semi-rational under her analgesia. In those cases in which convulsions have • At 4 p. m. We have the satisfaction of showsucceeded each other in rapid sequence with long ing delivery of the patient on whose case inhard undilated cervix which menaced the pa- duction with the bag was done at 11 a. m. The tient if she were allowed to go on in labor voluntary delivery is without incident. Your atcaeserean section was done. Each of these pa- tention is called to the method of keeping the tients recovered. Of the entire number all re- head flexed to avoid laceration, and the sugcovered but one which had been delivered before gestion of the Rotunda Hospital, Dublin, a hemoentering the hopsital and who died from a gen- stat placed on the cord at the vulva to indicate eral septic infection three weeks after all con- by its dropping 2 inches outside, when the plavulsions had ceased.
centa is in the vagina. No effort is made to disI mention these facts to show you the promise lodge the placenta. A policy of watchful waiting held out in regard to a system of treatment is a way
is always best to follow in this stage. which is standardized. I hope this afternoon The final branch of our service is the tragic to be able to show you the results of this induc- one, “Northwest Three” in which you see our tion if you are in the hospital.
series of abortions. In these beds are the women
who in fancied desperation plot the destruction This second patient, Mrs. L., a primip aet. 22,
of their unborn children. Some of them are inhad her last menstrual period May 5, 1917. Her
evitable, of course, but the great majority delibpregnancy has been uneventful and laboratory
erately induced. We have now five cases of infindings negative. Her measurements show
complete infected abortion; at times there are crests 28 c.m., spines 24 c.m., and Baudelocque
in this ward teri and fifteen admissions a week. 20, blood pressure 124 systolic and 70 diastolic.
The results of treatment here constitute our McDonald 36 and Ahlfeld 27.5, which indicates
especial pride as we have, against much opposithat she is probably at term and the baby 50.5
tion, demonstrated the value of a conservative cm. length. She will have C. O. and Q. and then
or "hands off” policy in treating abortions as be allowed to wait developments for 48 hours
against active interference. if nothing transpires.
Several years ago, to be accurate, in 1914, we | The third case is a breech. Mrs. S., wife of a began to see that the universal curettement which
soldier, she entered the hospital expecting to be was fashionable at that time resulted in a vast confined within the week. Her McDonald is 34 morbidity and considerable mortality and comso as the presenting part is not engaged we esti- ing across the writings of Winter, who in 1911, mate she will probably go over for two weeks. showed a death rate ranging from 11 per cent
The next case, Mrs. O., a primip, has been in to 23 per cent in various clinic centers in Eulabor 4 hours, she is a normal case aet. 26 L. rope, we became convinced that a conservative 1. A., and is having twilight sleep given under method might give better results. Since that direction of our interne, Dr. Olsen. The re- time no abortion has been curetted in our servmarkable thing about scopolamine in labor is the ice and we will just glance at the record and call relief from shock which the woman experiences attention to the old regime in contrast: when under this semi-narcosis. While scopola- In the curettement series 1909 to 1914 a hunmin analgesia has been greatly criticized in this dred consecutive cases showed 2212 days in the country and was originally condemned in Eng- hospital, 72 per cent of complications cellulitis, land, a glance at recent British obstetric litera- abscesses, etc., mortality 8 per cent. From 1914 ture will convince one that the profession is be- until the present, these cases are treated by coming more and more appreciative of its bene- being placed in the modified Fowler position, fits. Articles have recently appeared in the Brit given an ice bag over the abdomen ; a brisk dose sh Medical Journal, the Medical Press and Cir- of mag. sulph., and when pain is excessive a hypo cular, and other journals giving results of cases of morph. Yg. We have now treated 358 cases
by this expectant plan and our results are days
NOTICE in hospital 8 1-3; complications 5 per cent; mor- The Illinois Vigilance Association has issued tality none. There have been two deaths which four pamphlets on the problem of venereal diswere of women who had been curetted outside eases for inexpensive or free distribution, as cirbefore admission.
cumstances may require. When we view this merely from the stand
Copies will be sent free of charge to anyone point of the tax payer, leaving out the welfare sending a self-addressed and stamped envelope. of the patient, it is a startling picture, reducing The Association is a welfare organization incorthe expense of each patient two-thirds and of porated “Not for Profit." course the patient incidentally profits by the
The pamphlets are as follows: "Lord Kitchconservation. Friends and relations of patients ener's Instructions to Soldiers," "Three Great have stormed and outside physicians have often Army Records." "For Our Sons," a translation criticized the negative plan of treatment, in- from the French, by Prof. Alfred Fournier ; "For ternes look askance when the temperature moves
Our Daughters," a translation from the French to 105 and a foul smelling discharge persists, but by Dr. Charles Burlureaux, member of the Sothey are reassured and after observing a few ciety of Sanitary and Moral Prophylaxis of cases won over to our technique.
France. If we may summarize the service of a day's
Three Great Army Records and Prof. Fourdevelopment in the department, we should like
nier's pamphlet each contain unusual and exto call your attention to the following essential tremely valuable information. Lord Kitchener's points:
Instructions greatly improved condition in India, First, all examinations of prospective ma while the pamphlet For Our Daughters is an ternity patients are by external palpation auscu excellent pamphlet on a difficult problem. lation and pelvimetry. No vaginal examination is permitted in the division.
Removal—The Physicians Supply Company, Second, the McDonald and Ahlfeld measure
whose establishment at 1021 Grand Avenue was ments determine when the case is at term. Of
recently destroyed by fire, will occupy new and course, these are taken in connection with the
commodious quarters about the 15th of May in calendar history of the patient. On this de
the Lathrop Building, southeast corner of Grand pends the question of the maturity of the foetus.
Avenue and 10th Street. This company has been Third. All toxemics are endangered by the
doing business since 1887, and has established an burden they carry, and when prophylaxis fails
enviable reputation among the members of the to relieve them, the ideal mode of induction of
medical profession. The general manager of labor is by the Voorhees bag rather than by the company. Mr. Allan J. Hughes, wishes to digital or accouchment force dilatation.
extend his thanks to his patrons for their inFourth. Patients are tranquilized by scopol- dulgence during the time his company has been amin and suffer less from shock in twilight sleep. handicapped as a result of the fire. He wlil be We have seen no blue babies, nor ill effects from
pleased to have his friends call at the new quarthe use of scopolamin, but the benefits of its
ters and inspect his stock, which will include exhibition are apparent to any intelligent un
everything new and up to date in the line of surprejudiced observer.
gical and hospital supplies, with a special deFifth. Infection and its attendant grief to the
partment for fitting trusses, supporters, and elaspatient is practically ruled out of the General Hospitals in “West Three” wards by techniqueisolation of cases coming in with temperature, The Neurological Bulletin is the name of a avoidance of vaginal examination.
new monthly journal published under the ausSixth. The waiting policy of the third stage,
pices of Columbia University by Paul B. Hoeber no attempt to deliver the placenta until the hemo
in New York City. The editor is Dr. Frederick stat indicates it is in the vagina is the safe and Tilney. Professor of Nervous Diseases in the sane method of procedure.
Medical Department of Columbia University, Seventh. Daily examination and recording and the associate editor is Dr. Louis Casamajor. the height of fundus determines when the lying. The first two numbers, for January and Februin woman is convalescent. She goes home when
ary, have appeared and contain much valuable the fundus is not apparent to touch above the
material gathered from the weekly clinical consymphysis and the lochia has been for forty
ferences of the Neurological Department of the eight hours free from red or brown color.
College of Physicians and Surgeons. There is a great wealth of material in this department which
is worthy of permanent record and neurologists For prickly heat, apply with sponge, two or generally will welcome this journal which, while three times a day, a two per cent solution of sul- the most recently established, promises soon to phate of copper; cure in three days.
be among the leaders in neurological literature.
The Medical Herald
ing them with health facilities to make them
vigorous for action. Only healthy men can win Incorporating the kansas City medical Inder-Lancet
this war and the medical men must select them,
keep them well and save with great skill the Vol. XXXVII. May, 1918
No. 5 maimed. CHAS. WOOD FASSETT, Managing Editor
Without ranking authority, high efficiency 613 Lathrop Building, Kansas City, Mo.
can not be obtained and maintained. History
will repeat itself as in past wars; for instance, ASSOCIATE EDITORS
as in the Spanish-American war, when thousands
of preventable deaths resulted from preventable P. I. LEONARD, St. Joseph. J. M. BELL, St. Joseph.
diseases. And why? Because the little shoulder JNO. E. SUMMERS, Omaha.
straps of the medical man were too little to dicCONTRIBUTING EDITORS
tate orders to the big shoulder straps of the line H. ELLIOTT BATES, New_York.
officer. Thus recommendations got little furJOE BECTON, Greenville, Texas.
ther than the recommendation stage, disease HERMAN J. BOLDT, New York. A. L. BLESH, Oklahoma City.
producing conditions incubatingly flourished and G. HENRI BOGART, Paris, ni.
a long list of deaths was the sum total of a psyST. CLOUD COOPER, Fort Smith, Ark. W. T. ELAM, St. Joseph.
chological twist that keenly appreciated the JACOB GEIGER, St. Joseph.
sullied indignity of taking orders from an inS. S. GLASSCOCK, Kansas City, Kan. H. R. HARROWER, Los Angeles, Cal.
ferior in rank. The average schoolboy of reaJAS. W. HEDDENS, St. Joseph.
soning age would view this action as silly and VIRGINIA B. LE ROY, Streator, ni. DONALD MACRAE, Council Bluffs.
still it is true. It's wonderful how difficult it L. HARRISON METTLER, Chicago.
may be to communicate with a notch higher DANIEL MORTON, St. Joseph. D. A. MYERS, Lawton, Okla.
shoulder strap in some instances. Not that the JOHN PUNTON, Kansas City.
decoration is at fault, but the evolutized human W. T. WOOTTON, Hot Springs, Ark. HUGH H. YOUNG, Baltimore.
nature under it seemed to fail to humanize in its ascent.
There is no reason why a non-medical line
officer should pass on the merits of a medical The Editors' Forum
proposition made for life saving efficiency. He is incompetent though his shoulder straps be as big as the moon. Neither is he competent to
pass on the brilliancy or non-brilliancy of the Doctors May Contribute
medical diagnosis or the procedure of the operatto Magazines
ing room. That the talent of the most learned Washington, April 3, 1918. and scientific medical and surgical procedure Chas. Wood Fassett, M. D.
shall await condescending approval of the nonEditor Medical Herald,
medical line officer while preventable disease polKansas City, Missouri.
lutes and destroys, is all wrong. Medical and surDear Doctor:
gical efficiency in the army means medical rank In reply to your recent letter to Dr. Franklin with authority to enforce the carrying out of Martin of the Council of National Defense, the necessary medical orders without delay. The Surgeon General directs me to say that there is Owen-Dwyer bill, lingering in the files of the no objection to officers of the Medical Reserve senate military affairs committee, if passed favorCorps contributing articles for the medical press. ably, will largely authorize medical men to do
If, however, these articles in any way bear their duty without hindrance in keeping our solupon the writer's connection with the military diers well. Letting mothers' sons die of preventservice the manuscript should be referred to the able diseases in our armies is a crime against the Surgeon General's Office for permission to pub- hearts and homes that gave them. lish it, before it is sent to the printer.
And another feature of unrecognized service. Yours truly, R. B. MILIER, Does any one realize that local examining boards
Colonel, Medical Corps, N. A. and medical advisory boards are supplying and (Authority to Publish)
paying their own expenses, giving all of their
time if necessary, and working their heads off Medical Official
all over this country, assembling the rudiments Rank
of our armies, cheerfully and untiringly doing Why not give medical officers official author- their bit, without even a button on the lapel to ity to enforce medical and sanitary recommenda- indicate they are serving our country? Why? tions? To do this official rank is necessary. Is it because they are just physicians? Is it like The medical man is the man of the hour today the negro, when chastized for beating his mule, in assembling our army recruits and surround- who said, “It's no bizness to bin a mule."
blindness. Regarding the ligation of the thyroid Dr. Halley
vessels, it still seems doubtful whether this proThe recent death of Dr. George Halley re cedure is followed by cure sufficiently often to moves another of Kansas City's pioneers in
justify its performance.”—Berry. medicine. He died in his 79th year. Dr. Halley 2. The contention that the operative mortalwas a Canadian by birth, a self made man, con- ity is less than five per cent does not mean retending with the obstacles of an undeveloped covery from Graves disease, as any fair-minded country and unassisted self exertions to obtain surgeon will admit. Surgical improvement does an education. But he got it and entered the not stand the test of time; in my inquiries of a study of medicine in 1865, attending the Long dozen eminent surgeons concerning complete surIsland College Hospital of Brooklyn, N. Y., and gical cures of Graves disease, I have not been the Victoria University of Toronto, Canada, able to secure satisfactory information about a where he received his M. D. degree in 1869. single instance of surgical cure of Graves disLocating in Kansas City, Dr. Halley began ease. In my own record of thirty-two cured teaching anatomy in the Kansas City Medical cases, three were previously operated on with College; from 1882 to 1891 he was professor of excellent surgical results, but with failure of surgery, resigning to accept the chair of surgery cure, the symptoms having recurred with a vehein the University Medical College of Kansas mence that necessitated the closest observation City. As a medical teacher he was popular, im- for several weeks. Partial thyroidectomy leaves parting his talent to many present day physicians part of the thyroid, from which sooner of later of south and west. Had Dr. Halley's active days the goitre redevelops with the reappearance of been spent in greater surroundings he would the syndrome. have attracted general attention as a superior 3. The frequent presence of sugar in the surgeon of his time. The Herald extends its urine is a contraindication to surgical procedure. sympathies to Dr. Halley's family in his death 4. The administration of general anesthetic and rejoices with them that his life was more
or even local anesthesia in a patient whose vital than not in vain.•
functions, especially the nervous system, are al
ready demoralized tends to aggravate matters Exophthalmic
and is therapeutically inconsistent. The surgical Goitre
shock in the presence of poor circulatory and
renal functions adds “insult to injury.” The general practitioner is interested in the treatment of exophthalmic goitre whether the
5. The frequently occurring post operative internist or surgeon plays the greater role. Dr.
myxedema as a result of thyroid enucleation is Bram, in the Archives of Diagnosis, has an elab
worse than Graves disease. Kocher states that orate article in which he maintains that sur
the average life of a case of myxedema is seven gical procedures do not cure the disease. The y co latter view is that held by neurologists.
6. Apparent surgical cures are due to post They maintain that Graves' disease should be operative nonsurgical treatment. All reliable considered strictly in the domain of medicine surgeons routinely refer their cases back to the and that the surgeon steps in only in the presence
family doctor for post operative treatment, and of malignant changes in the thyroid. or where the success or failure of the outcome depends this organ becomes so large as to cause dan- upon the degree of intelligence with which these gerous pressure symptoms.
post-operative dietetic, hygienic and medicinal To generalize, according to Bram, it may be measures are adoptel. said that non-surgical treatment to a successful 7. The occasional removal of the parathyoutcome must continue about the same length roids during a thyroidectomy with resulting of time as the previous duration of the disease. tetany, is by no means a rare occurrence. Many exceptions occur. Of course whether a 8. Injury to the recurent laryngeal nerve cure has been accomplished is a difference of directly through the operation, or subsequently opinion of the internist and neurologists on the by pressure of scar tissue, is not uncommon, leadone hand and the surgeon on the other, in many ing to paralysis of the vocal cords. cases, Dr. Bram summarizes as follows:
9. The surgical mortality rate is higher than 1. Surgery does not cure Graves disease. the stated five per cent, while the non-surgical This is attested by such men as Berry (“Diseases mortality if treatment be not too greatly postof the Thyroid Gland”), and implied in the state- poned, is practically nil. In my series of thirtyments of Musser (Am. Jour. Med. Sci., June, two cured cases of Graves disease extending 1912), Hall, White and Mackenzie. “The sym- over a period of six years there has not been a pathetic operation may slightly diminish exoph- single recurrence, and as far as I am able to thalmos, but may be followed by very serious ascertain, each patient is enjoying the best of results, such as inflammation of the eye or even health. At this writing I am treating ten cases
of exophthalmic goitre, and their progress leads charged from the service, and imprisoned for me to conclude that these will soon be added to three years. the list of complete cures.
The ophthalmologist in military service must 10. In addition to further devitalization of cure inversion and eversion of the lids, ptosis, the patient, surgical procedures unduly delay trachoma, chronic dacryocystitis, pterygium and proper nonsurgical procedures, dangerously post
strabismus. Some of these are simple enough, poning the sought-for relief.
while others are not easily remediable.
P. I. L. 11. The scar and mutilation of the neck from | thyroid surgery is embarrassing in after life.
P. I. L.
We are reminded that somewhere in the Bible Trachoma
a certain philosopher advises us, to "cast out There is a rule in our army that those with the beam from our own eve before suggesting trachoma are to be accepted pending the results to our brothers the advisability of removing the of treatment. Specialists are of the opinion that motes from their eyes.” Acting upon the above it is contagious in its active stages and that it is injunction, the managing editor hied himself dangerous, obstinate to treat, often only appar- unto a hospital recently, where under the skilled ently cured, very liable to recur on some slight hand of that prince of optic architects, Dr. Joe irritation of the eyes and may infect those about Lichtenberg, a beautiful specimen of cataract them. Many cases are sent to the camps because was removed from our right orb of vision. It the physicians are unable to recognize the dis- is needless to remark that the operation was a ease.
success and sight fully restored. This is only a Clinically, trachoma presents itself in two sequel of the Lichtenberg method. During the forms: (1) Fulminating trachoma, and (2) weeks in which the writer has been more or less slow trachoma. The first applies to a very acute incapacitated, the editorial duties have largely inflammation, while "slow trachoma" applies to devolved upon members of the staff and we the ordinary forms of the disease. We may have hereby render grateful acknowledgment espethe papillary and the follicular granulations. cially to “J. M. B.," "S. G. B.” and “P. I. L.” for The largest follicles are found in the culdesac. their interesting contributions and general overThe disease always tends to cicatrization, and if sight. The World's War News department by the tarsal plate is involved the shrinkage and “P. I. L.” is proving to be an entertaining fearesulting deformities of this structure cause ture of each issue. entropion. If this is marked, the eyelids rub against the cornea, producing ulceration and
Dr. DeLamater's apacity, and thus vision may be lost.
Work Indorsed The specific causative agent of trachoma has
The Buchanan County Medical Society has not been discovered. The granules formed in trachoma are follicular formation plus tracho
voted unanimously for the retention of Health
Officer DeLamater. His administration speaks matous infection. In all cases of trachoma pan
for itself. He has given St. Joseph a good record mus is generally present, trachomatous inflam- in spite
in spite of many trying handicaps. Political mation of the cornea itself.
rumor has it that it is the wish of Mayor WhitMajor W. H. Wilder says: In Camp Taylor. sell that he should be supplanted, but it is hoped with men from southern Indiana, Illinois and this rumor is unfounded. Dr. DeLamater is a eastern Kentucky, we saw considerable trachoma, trained public health worker, who is a full term and the review board sent home 270 of such men officer and it would be a step backward to put in 65 per cent of the first draft sent to that can- in his place a doctor untrained for health work. tonment. Thirty or forty of these were doubt. It is hoped politics will not creep into the Board ful cases, but the board dismissed the men rather of Health and that the mayor will not attempt to than take the chance of spreading the disease. dictate to the Board its appointments, a thing In the other cantonments not so many trachoma contrary to the spirit of the charter. cases were seen, but many men with trachoma were sent to Camp Taylor on account of the American Medical Association–Next meetfailure of physicians to recognize it.
ing of the association will be held in Chicago, The idea went around that trachoma would June 10-14, under the presidency of Dr. Arthur te rejected, and there were instances of decep- Dean Bevan of Chicago. General headquarters, lion. In one, phenol (carbolic acid) was rubbed scientific and commercial exhibits and postoffice into the eye, in another ordinary soap, and or will be located in the Sherman Hotel. Further dinary dirt from the cap in another. These men information regarding the meeting will be pubwere arrested, court martialed, dishonorably dis- lished in the next issue of the Medical Herald.