Death of

Dr. Halley

The recent death of Dr. George Halley removes another of Kansas City's pioneers in medicine. He died in his 79th year. Dr. Halley was a Canadian by birth, a self made man, contending with the obstacles of an undeveloped country and unassisted self exertions to obtain an education. But he got it and entered the study of medicine in 1865, attending the Long Island College Hospital of Brooklyn, N. Y., and the Victoria University of Toronto, Canada, where he received his M. D. degree in 1869. Locating in Kansas City, Dr. Halley began teaching anatomy in the Kansas City Medical College; from 1882 to 1891 he was professor of surgery, resigning to accept the chair of surgery in the University Medical College of Kansas City. As a medical teacher he was popular, imparting his talent to many present day physicians of south and west. Had Dr. Halley's active days. been spent in greater surroundings he would have attracted general attention as a superior surgeon of his time. The Herald extends its sympathies to Dr. Halley's family in his death and rejoices with them that his life was more than not in vain..

Exophthalmic Goitre

The general practitioner is interested in the treatment of exophthalmic goitre whether the internist or surgeon plays the greater role. Dr. Bram, in the Archives of Diagnosis, has an elaborate article in which he maintains that surgical procedures do not cure the disease. The latter view is that held by neurologists.

They maintain that Graves' disease should be considered strictly in the domain of medicine, and that the surgeon steps in only in the presence of malignant changes in the thyroid, or where this organ becomes so large as to cause dangerous pressure symptoms.

To generalize, according to Bram, it may be said that non-surgical treatment to a successful outcome must continue about the same length of time as the previous duration of the disease. Many exceptions occur. Of course whether a cure has been accomplished is a difference of opinion of the internist and neurologists on the one hand and the surgeon on the other, in many cases, Dr. Bram summarizes as follows:

1. Surgery does not cure Graves disease. This is attested by such men as Berry ("Diseases of the Thyroid Gland"), and implied in the statements of Musser (Am. Jour. Med. Sci., June, 1912), Hall, White and Mackenzie. "The sympathetic operation may slightly diminish exophthalmos, but may be followed by very serious results, such as inflammation of the eye or even

blindness. Regarding the ligation of the thyroid vessels, it still seems doubtful whether this procedure is followed by cure sufficiently often to justify its performance."-Berry.

2. The contention that the operative mortality is less than five per cent does not mean recovery from Graves disease, as any fair-minded surgeon will admit. Surgical improvement does not stand the test of time; in my inquiries of a dozen eminent surgeons concerning complete surgical cures of Graves disease, I have not been able to secure satisfactory information about a single instance of surgical cure of Graves disease. In my own record of thirty-two cured cases, three were previously operated on with excellent surgical results, but with failure of cure, the symptoms having recurred with a vehemence that necessitated the closest observation for several weeks. Partial thyroidectomy leaves part of the thyroid, from which sooner of later the goitre redevelops with the reappearance of the syndrome.

3. The frequent presence of sugar in the urine is a contraindication to surgical procedure.

4. The administration of general anesthetic or even local anesthesia in a patient whose vital functions, especially the nervous system, are already demoralized tends to aggravate matters and is therapeutically inconsistent. The surgical shock in the presence of poor circulatory and renal functions adds "insult to injury."

5. The frequently occurring post operative myxedema as a result of thyroid enucleation is worse than Graves disease. Kocher states that the average life of a case of myxedema is seven years.

6. Apparent surgical cures are due to post operative nonsurgical treatment. All reliable surgeons routinely refer their cases back to the family doctor for post operative treatment, and the success or failure of the outcome depends upon the degree of intelligence with which these post-operative dietetic, hygienic and medicinal measures are adoptel.

7. The occasional removal of the parathyroids during a thyroidectomy with resulting tetany, is by no means a rare occurrence.

8. Injury to the recurent laryngeal nerve directly through the operation, or subsequently by pressure of scar tissue, is not uncommon, leading to paralysis of the vocal cords.

9. The surgical mortality rate is higher than the stated five per cent, while the non-surgical mortality if treatment be not too greatly postponed, is practically nil. In my series of thirtytwo cured cases of Graves disease extending over a period of six years there has not been a single recurrence, and as far as I am able to ascertain, each patient is enjoying the best of health. At this writing I am treating ten cases

of exophthalmic goitre, and their progress leads me to conclude that these will soon be added to the list of complete cures.

10. In addition to further devitalization of the patient, surgical procedures unduly delay proper nonsurgical procedures, dangerously postponing the sought-for relief.

11. The scar and mutilation of the neck from thyroid surgery is embarrassing in after life. P. I. L.

Trachoma

There is a rule in our army that those with trachoma are to be accepted pending the results of treatment. Specialists are of the opinion that it is contagious in its active stages and that it is dangerous, obstinate to treat, often only apparently cured, very liable to recur on some slight irritation of the eyes and may infect those about them. Many cases are sent to the camps because the physicians are unable to recognize the dis

ease.

Clinically, trachoma presents itself in two forms: (1) Fulminating trachoma, and (2) slow trachoma. The first applies to a very acute inflammation, while "slow trachoma" applies to the ordinary forms of the disease. We may have the papillary and the follicular granulations. The largest follicles are found in the culdesac. The disease always tends to cicatrization, and if the tarsal plate is involved the shrinkage and resulting deformities of this structure cause entropion. If this is marked, the eyelids rub against the cornea, producing ulceration and. apacity, and thus vision may be lost.

The specific causative agent of trachoma has not been discovered. The granules formed in trachoma are follicular formation plus trachomatous infection. In all cases of trachoma pannus is generally present, trachomatous inflammation of the cornea itself.

Major W. H. Wilder says: In Camp Taylor. with men from southern Indiana, Illinois and eastern Kentucky, we saw considerable trachoma. and the review board sent home 270 of such men in 65 per cent of the first draft sent to that cantonment. Thirty or forty of these were doubtful cases, but the board dismissed the men rather than take the chance of spreading the disease. In the other cantonments not so many trachoma cases were seen, but many men with trachoma were sent to Camp Taylor on account of the failure of physicians to recognize it.

The idea went around that trachoma would be rejected, and there were instances of deception. In one, phenol (carbolic acid) was rubbed into the eye, in another ordinary soap, and ordinary dirt from the cap in another. These men were arrested, court martialed, dishonorably dis

It

We are reminded that somewhere in the Bible a certain philosopher advises us to "cast out the beam from our own eye before suggesting to our brothers the advisability of removing the motes from their eyes." Acting upon the above injunction, the managing editor hied himself unto a hospital recently, where under the skilled hand of that prince of optic architects, Dr. Joe Lichtenberg, a beautiful specimen of cataract was removed from our right orb of vision. is needless to remark that the operation was a success and sight fully restored. This is only a sequel of the Lichtenberg method. During the weeks in which the writer has been more or less incapacitated, the editorial duties have largely devolved upon members of the staff and we hereby render grateful acknowledgment especially to "J. M. B.," "S. G. B." and "P. I. L." for their interesting contributions and general oversight. The World's War News department by "P. I. L." is proving to be an entertaining fea

ture of each issue.

Dr. DeLamater's Work Indorsed

The Buchanan County Medical Society has voted unanimously for the retention of Health Officer DeLamater. His administration speaks for itself. He has given St. Joseph a good record in spite of many trying handicaps. Political rumor has it that it is the wish of Mayor Whitsell that he should be supplanted, but it is hoped. this rumor is unfounded. Dr. DeLamater is a trained public health worker, who is a full term officer and it would be a step backward to put in his place a doctor untrained for health work. It is hoped politics will not creep into the Board of Health and that the mayor will not attempt to dictate to the Board its appointments, a thing contrary to the spirit of the charter.

American Medical Association-Next meeting of the association will be held in Chicago. June 10-14, under the presidency of Dr. Arthur Dean Bevan of Chicago. General headquarters, scientific and commercial exhibits and postoffice

will be located in the Sherman Hotel. Further information regarding the meeting will be published in the next issue of the Medical Herald.

"Breathes There

the Man"

I am asked to write a "rousing patriotic editorial-something that will stir the hearts of our readers and rouse them to the importance of doing their full patriotic duty." And this I wish to do. But, if the stirring events that are happening around us every day, almost every hour, do not arouse patriotic enthusiasm to a red-hot pitch, how can I hope to do it with any words of mine, which, even though they be as vivid as I want them to be, are still mere feeble shadows of the occasion itself?

It seems to me that the question is not, How can Americans be fired with patriotic passion, but, How can they escape it? If ever there was a war that made compelling appeal to every height and depth and length and breadth of American idealism, that searched out every nook and cranny of a man's manhood, physical, mental and moral, and tried it as by fire, surely this is the war! How any man, let alone any American, can hang back under such a call to his soul without blushing to himself in the dark, is more than I can fathom.

Take the fight itself. Can it be possible that anyone is still asking, What are we fighting for? Change the question a little; leave out the "for," and ask, rather, What are we fighting? The president answered it in his last ringing denunciation The Thing. The accursed, diabolical, unspeakable Thing, that holds nothing, nothing, sacred-not the virtue of women, nor the honor of men, nor the helplessness of little children nor beauty, nor decency, nor common right-but drives ruthlessly over them all, like a damned Juggernaut. As God liveth, we are fighting the seven-headed Beast; and, does any decent man or woman ask why?

It is the Beast that we are leagued together to fight. And if this be not the very elemental heart of patriotism, in God's name, what is? Make it as broad as you like; make it as personal as you please it is all one. No longer are you and I isolated savages, whose safety and honor are nothing to the other. We belong to one family. I am pledged to help defend your wife and children from the Beast; and you are pledged to help defend mine. We can no more evade our responsibility to each other than to our own families. If I fail, I can no longer look into your face; if you fail, you cannot meet my eyes. That is patriotism, stripped to the bone. Make no mistake; you and I cannot choose whether we will be responsible or not. We are. There is no elective heroism about accepting our responsibility and exercising our patriotism. There is deep, damning shame in repudiating or withholding it.

Suppose that in the city where you and I live, a brutal gang of degenerate Jack-the-Rippers

should stalk the streets in broad daylight, defying the police, murdering our boys, raping our women and our young girls, and mutilating our little children. Would you shrug your shoulders and keep an indifferent mien because it was my boy that was murdered and not yours, my daughter that was violated and not yours, my child that was tortured and not yours? Behold, a worse than Jack-the-Ripper is here. Murderer, liar, whoremonger, baby-killer-all, all of these is this vile Prussion Thing; not in the heat of passion, but in cold blood, as a demoniacal, Machiavellian system.

Aye, there's the rub There is where we pass from the fight itself to the crusade beyond the fight. After all, this damnable Prussian Thing is not a Great Exception. "Tis not a freak. "Tis but autocracy run to seed. It is the logical extreme development of the system which for centuries has held the Old World in its grip. France and England were strangled in its coils for hundreds of years; cast it off by violence two or three separate times before they were finally rid of it; and have lived ever since in the shadow of its sinuous form. Russia has just wrenched herself out of its grasp; and, no matter what may now be happening to Russia, or what may yet happen, anything, anything is better than the despotism from which she has finally escaped.

But America-America threw the damnable Thing off at birth; that was her birth. Her career has been, not a living protest against autocracy, but a living example of freedom from it. And now the hideous Thing has crept up on usUS and laid its horrid maw on us, and we are looking into its leering eyes, and feel its hot tigerish breath on our faces; and we realize that the world is not safe from it, never, never will be safe from it, till it be crushed. Yes, and we realize that we must help to crush it. We must hunt it down, like God's hounds hunting down evil, till it be cornered, snarling, and dragged to its death.

'Tis a solemn, deadly task that has been thrust upon us. There is no choice in the matter. In this war there are no volunteers, save those who volunteer to shirk and to slack. No decent man can make such a choice. He must, he must do, not only his "bit" but his all, or forevermore slink shamefaced from the scorn of his own selfrespect. Not the gift of his money and his possessions, alone, though these, too, are necessary; but, the splendidly reckless sacrifice of himself. of all his dearest hopes and plans, of all that life holds precious, even of life itself, is required of him. "He that loveth father or mother, or husband or wife, or lands, more than Me is not worthy of Me."

Upon your faithfulness and steadfastness and sacrifice depends more than you dream. "It will matter little in the day of judgment," says the

author of John Inglesant, "by what name you have been called, whether Catholic or Protestant, Jesuit or Jansenist, Jew or Gentile. These and similar things are mere accidents of birth and circumstance. But, it will matter greatly whether, having chosen your part, you follow it faithfully to the end. For, be sure that no misery is equal to that of the man who, when men have said 'So-and-so is there on guard, there is no need to take further heed,' has deserted his post, or faltered in the hour of danger, to the ruin of the cause he has made his choice. God grant such misery never may be yours."

America will triumph. No sane man has any doubt on that score. In this war

God has set

Himself to Satan. Who can spend

A moment's mistrust on the end?

God knows after what terrible violence. The sun shall be turned into darkness and the moon into blood; then shall the end come. But, there will be an end. The Beast will be slain, and all that he stands for. Empires and emperors, kingdoms and kings, will pass away; their day is done. The Republic of God is at hand. But, O my brother, will you and I share in the victory? Be not deceived. Do not expect to be swept into the final triumph on the crest of a universal wave. A wave there will be, without doubt; but, it will be the tremendous aggregate of individual effort, and they who drift passively and complacently on the surface, no less than they who vainly try to stem its progress, will be submerged in its resistless tide. Not even sympathy with the cause will avail anything; nothing short of being a part of it.

What are you doing?-Dr. T. G. Atkinson in the American Journal of Clinical Medicine, Chi

cago.

American Medical

Editors' Association

The next annual meeting of this organization will be held at Hotel LaSalle, Monday and Tuesday, June 10 and 11, under presidency of Geo. W. Kosmak, M. D. A full attendance of those interested in medical journalism requested. Joseph McDonald, Jr., M. D., Secretary..

Missouri State

Medical Association

The sixty-first annual meeting of this association will be held in Jefferson City, May 6-7-8; the first day being devoted, as usual, to sessions of the house of delegates; the scientific program begins on Tuesday morning, the 7th. The beautiful new state capitol, recently completed, will provide the meeting place of this association. The New Central Hotel will be headquarters. The program, which will no doubt prove very interesting, is now in preparation.

The World War News

P. I. LEONARD, M. D.

"Our country; its need is our need, its honor our honor, its responsibility our responsibility. To support it is a duty, to defend it a privilege, to serve it a joy. In its hour of trial we must be steadfast, in its hour of danger we must be strong, in its hour of triumph we must be generous. Though all else depart, and all we own be taken away, there will still remain the foundation of our fortunes, the bulwark of our hopes, a rock on which to build anew-our country, our homeland, America."-From American Medicine, May, 1917 (National Number.)

Apply at once for a commission in the Medical Reserve Corps and thus relieve the responsibility which you owe to your country, your profession and yourself.

The influence of tight collars on the vision, by impeding the circulation in the head by pressing on the jugular vein, is well known to military surgeons. Forster states that three hundred cases have come under his observation-the eyesight had been affected by the disturbance of the circulation caused by wearing collars that were too small.

The orthopedic surgeon, according to Silver, is at a very critical period on account of the vast responsibilities before him, and at present he has four roles to take: "1. In the creation of the army in teaching the rudiments of orthopedic surgery to medical officers, the care of the feet, the application of splints, and the various methods of securing immobilization. This should be done at the training camps. 2. It is important that orthopedic materials, apparatus, and methods should be simplified and standardized, so as to make them more readily applicable to the difficult conditions of modern warfare and offer a wider field of usefulness. 3. The orthopedic care of wounded at base hospitals. This work has already advanced far, and the only difficulty is in securing and training enough men for this work. 4. The orthopedic surgeon has an important part capable of taking up some useful employment ; in the reeducation of the crippled, in making him thus not only conserving his value, in some measure, to society, but, much more, assuring him the right-minded attitude toward his fellows and toward life in general."

At a recent meeting of the Societe de pathologie comparee, Drs. Polonowski and Durand described their method of wound treatment.

In