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tween the artery of the donor and the vein of the ing and emptying the syringe is so brief that the recipient. For the purpose of supporting the ves- blood does not undergo alteration. sels and holding the suture, he has devised an in
A number of other direct methods founded strument which he calls an arterial suture staff,
upon this idea of transfusion whole blood have by the aid of which he has been able to make an
been devised, but time does not permit of their anastomosis by turning out the intima of the vessels and bringing intima into contact with
description in this paper. They are all someintima by means of mattress sutures. The idea
what cumbersome, and require the near presence is practical, and in the hands of one skilled in
of the donor and the recipient. This is objectionblood vessel surgery, the method will be success
able, because the donor is frequently a near blood ful, but the occasional operator would perhaps
relative of the patient, and the psychic effect of better adopt some other method.
having one whose sympathies are so much in
volved take such an important part in the operaSo much for the direct methods of trans- tion is not conducive to the best welfare of the fusion. It will be seen that the direct methods patient or the donor. all require considerable surgical skill, and that The latest and perhaps the most practical they are all subject to great danger of transmit- method is known as the citrate method. This ting infection from the patient to the donor and method was worked out and brought to its presfrom the donor to the patient; and as I have said, ent state of safety and efficiency by Dr. Lewishon the amount of blood transfused cannot be gauged, of New York. The method is as follows: with the consequent danger attendant thereto. It has devolved upon the investigators of our pro
The donor is put on a table, a tourniquet is fession to find some way which these dangers and
applied to the arm and the vein punctured with inconveniences may be overcome, and out of this
a cannula. The blood is received in a sterile necessity has grown the indirect methods of
graduated glass jar containing 25 cc. of 2 per transfusion.
cent sterile solution of sodium citrate at the bot
tom. While the blood is running into the glass Dr. Edward Linderman of New York, de- receptacle it is well mixed with citrate solution veloped the method of indirect transfusion by by means of a glass rod. After 250 cc. of the means of two sets of cannulas; two tourniquets, blood have been taken, another 25 cc. of citrate twelve 20 cc. record syringes, and three assist- solution are added. If more or less than 500 cc. ants. The operation is as follows:
of blood are taken the citrate solution is inOne operator manages the syringe of the re
creased or diminished accordingly. The jar concipient, another manages the syringe of the
taning the blood is covered with a sterile towel donor; a third stands between the operators; the
and set aside until the patient is ready to receive donor and patient are placed in a comfortable re
it. The blood will keep without clotting for 48 cumbent position. The veins are selected, usu
hours, but the authors are all agreed that it ally the median basilic. The parts are prepared,
should be used as soon as practicable within at the tourniquets applied, a cannula is inserted into
least twelve hours. When ready to make the the vein of the patient and a syringe filled with
transfusion, the blood may be taken to the renormal salt solution is attached, and the salt solu
cipient's room, or to his home. He may be altion is allowed to flow slowly through the can
lowed to remain in his bed and the blood can be nula. A cannula is next inserted into the donor
Honor given to him in the same manner we have been
g and a syringe filled with warm normal salt solu
giving other kinds of intravenous treatments to tion attached. Everything is in readiness for
our patients. No special surgical dexterity is rethe transfusion. An empty syringe is substituted
quired. Anybody who is capable of making an
qui for the one containing the salt solution, and a
intravenous injection, may perform this operasyringe full of blood is quickly drawn from the
tion; and thus the great life saving measure of donor. The assistant passes the filled syringe to
blood transfusion is placed in the hands of all. the operator on the recipient, who removes the The good effects of transfusion by the citrate saline syringe and attaches the syringe contain- method are not different than those observed in ing the blood. The tourniquet has previously other methods. The post transfusion reaction been removed from the arm of the recipient and is perhaps a little more pronounced, but in bloods the blood is permitted to flow into the vein. A that have been accurately matched prior to the little salt solution is injected after each syringe- operation the ultimate results are the same in this ful of blood, and this is kept up until the desired method as the result in other methods. amount of blood has been transfused. With well trained assistants, this operation can be performed with great speed, and the quantity of blood We have spent over $500,000,000 to clothe our is definitely measured, the veins have not been soldiers. Every subscriber to the Liberty Loan destroyed and may be used again for subse- has had a part in this care of the Americans who quent transfusion, and the time between the fill- are fighting in France.
tures, and finally well under the part to be reCHARLES J. DRUECK, M. D., Chicago.
moved. An elliptical incision is then made Associate Professor of Proctology, Post Graduate Medi
around the sinus. The encircled mass is then cal School.
grasped with toothed forceps and lifted out of In the region over the sacrum, coccyx or in its bed as the incision is carried underneath. the skin back of the anus there occur infoldings Every particle of the infolded epithelium must be of the skin which are congenital in origin as a removed or a fistula will result. The wound may result of imperfections of foetal development. be closed with deep sutures passing well under These skin pockets vary in depth from a shallow the cut surfaces or it may be allowed to granulate cleft in the skin to a sinus two inches long and as best suits the individual case. extending usually toward the anus. These re- 30 North Michigan Ave. cesses are very difficult to keep clean and become filled with epithelial debris and dirt, which causes chronic irritation and infection and finally ab
KEEP GORGAS ON OUTPOST DUTY scess (Fig. 1). When seen at this stage and it DR. G. HENRI BOGART, Shelbyville, Illinois.
General Gorgas stands out, today, as the greatest life saver in all history, his salvage of life, happiness and effectiveness applies to the present era, and like the brook, "flows on forever" with constantly increasing volume. His conservation of human life, joy and usefulness outnumbers the frightfulness of destruction of the German junkermism, because that will cease when we have mopped up kaiserism with fire, whereas the prophylactic forces set free by Gorgas will grow and expand without end.
When we occupied Cuba, Havana was the Figure I shows discharging point at coccyx.
scourge of the tropics, yellow fever and malarial is rarely found earlier, it may be mistaken for a
disease ran rampant, as permanent as the tides
or sunsets, until Gorgas waved the wand of rectal sin us. If suppuration has existed for
scientific sanitation and lo, the Pearl of the Anconsiderable time a complete fistula may exist
tilles became a health resort. (Fig. 2).
The dream of centuries was to be realized, the oceans were to wed at Panama, the most deadly bit of territory in this hemisphere, where the original railroad was represented by a' “corpse for every crosstie” and hand in hand Gorgas went with Goethals and the pesthouse of the tropics became the most salubrious residential location in America.
After the Boer war had opened the way for co-operation in unlocking the golden land of the Rand, a subtle pneumonia converted the country into a death trap. Britain called for Gorgas who
went to South Africa, applied the wizardry of Figure II—Probe passed in at ulcerating point and out
his intelligence and conquered the forces of
his intelligence and convered the again nearer the anus.
death and woe. Treatment—The postanal dimple is not
In the Spanish-American war, more men, 13 amenable to the treatment by incision and curet
times as many died of disease than from the tage as performed for external complete rectal
combat, most of them in the home land, and at fistula, because the postanal dimple is lined
that the majority of the death roll were victims with squamous epithelium (normal skin) and not
of disease in concentration camps through imperwith a pyogenic membrane. Sebaceous glands
fect sanitation. and hair follicles descend into the wall and must be removed to effect a cure.
In the Civil war, more men died and more
v satisfactory were invalided through disease than through Complete excision is the only satisfactory treatment and may be performed under local combat. anesthesia. As a careful complete dissection In the present stress of time and of men gathis necessary, a complete circle of anesthetic ered by millions, the death rate is less in the army wheals must be made around the operative field than with the same number of like ages in civil first in the integument then in the deeper struc- life, because Gorgas and those who learned un
der him have taken the entire matter of caring A Serum for Influenza—The United States for the physical need of our men.
government is advised that Doctor Park of the Sanitary surveys have done for our canton- New York Health Department has discovered a ments and camps what they did for Havana and serum which he declares will prevent Spanish the Panama zone.
influenza. General Gorgas will be automatically retired because of his age, in October, unless Congress Uncle Sam, M. D.-"The vast and complex shall intervene, by passing such legislation as will job of making over our peace doctors into war leave him at the helm until this war shall have doctors is the nearest thing to 100 per cent ended.
achievement that the government has yet perGermany has placed its old men who have formed in this war.” In "Uncle Sam, M. D.," in the proper experience at the head, Mackensen Collier's for September 21st, Samuel Hopkins was called from the discard and Hindenberg is Adams tells the story of this job and the way it past the age limit, and they are functioning as is being done. It is an article that holds lively the Allies can testify.
interest for every medical man. General Gorgas with his ripe experience is too valuable to be lost to the cause.
War Work for Young Women—The Surgeon Every doctor who shall read this article
General's office, War Department, has issued an should assure himself that it is true, then he
urgent call for young women to serve in reconshould put all the influence he can bring to bear
struction hospitals at home and abroad. The on his congressman and senator to secure the Normal School of Physical Education, Battle retention of General Gorgas at the head of the Creek. Michigan, which is affiliated with the sanitation of our armies.
Battle Creek Sanitarium, wishing to do its share
toward winning the war, has inaugurated a course We have spent over $120,000,000 just for sta- in physiotherapy, which meets the requirements ple supplies for our army, such as flour, bacon, of the War Department. Courses begin Oct. 1st rice, etc. Every subscriber to the Liberty Loan and Feb. 1st. Length of course is 4 months. The helps feed our soldiers.
curriculum consists of anatomy, physiology, hy
giene, bandaging, active and passive movements, Medicine in Other Days — The distressing hydrotherapy, massage, electrotherapy, and clinnews came in a telegram vesterday that Doctor ics. The medical profession are asked to direct Hunter, brother of E. R. Hunter, the young the attention of young women who are planning physician who went from here a short time ago to engage in war work to this unusual opportunto volunteer his services in treating victims of ity. Further information may be obtained from the awful yellow fever scourge in Memphis, had Frank J. Born, M. D., Director of the School. .. himself been stricken with the dread disease. No particulars were given as to his condition, and no reply has yet come to the telegram sent at once
A SAD SWALLOW by Dr. J. D. Griffith asking for details. A let
Oh, he swallowed half a dollar ter written by Doctor Hunter to a friend in this
And it lodged down below the collar, city three days after his arrival in Memphis con
But by a stroke of scientific skill tains this graphic bit concerning the situation
The coin was excavated there: "The scene here baffles description. It
When the surgeon operated, resembles the ancient Golgotha when the living
And the man "coughed up" a twenty dollar bill! were too few to bury the dead. Most of the
-Cartoons Magazine. prominent citizens of Memphis, and practically all of those who had money enough to do so, have fled the pestilence, and those left are the abjectly
A VERY ANCIENT STORY poor whites and negroes, with comparatively few exceptions. At once on arrival I was assigned to Steadfast eyes in the heaven's blue; duty in the Fourth Ward. I am a little tired, but
Golden hair in the sunlight's gleams; otherwise I feel better today than when I left
Unshed tears in the morning dew
And the face of her in the dark of dreams. Kansas City. I have seen sixty-six yellow fever cases this morning and am waiting now for my Tender lips in the rose's blush; man and huggy to go out again. Have lost only
Shy, sweet words in the rippling seas; one case thus far. There are three doctors down
Soft, pink palms in the dawn's first flush
And the touch of her in the summer breeze. with the fever in this house. When my own time
But for these, and the swelling hills, will come I know not. I am ready for it, how
Stars and trees and the clouds above, ever, at any time. Please send me the Kansas Birds and flowers and fields and rills, City papers, as I can learn nothing here from
I would soon forget what I know of love. the outside world.”—K. C. Times, Sept. 14, 1878. --Kenneth L. Roberts in the N. Y. Evening Sun.
The Medical Herald
Incorporating the kansas City Medical Inder-Lancet Vol. XXXVII OCTOBER, 1918.
cago, the railroad surgeon, gave a splendid talk on unusual fractures and dislocations. Lord of Omaha, back from army service, gave first hand experiences in surgical life in the hospital.
The patriotic banquet on Thursday evening was essentially military in character. The center of attraction was Colonel Franklin Martin, chairman of medical affairs, fresh from Washington, D. C. His address concerned largely the Volunteer Medical Corps; it was a patriotic and scholarly appeal. Col. J. M. Banister of Omaha (U. S. Army, retired) reviewed the achievements of the military surgeon, and made us feel the debt we, as a profession, owe the camp surgeon. There were a hundred and fifty men in attendance upon the banquet.
In the election of officers the society paid its tribute to the seventeen years of faithful service of our secretary, Chas. Wood Fassett, by electing him to the presidency. The vote was unanimous.
Dr. Watson, of Diagonal, Iowa, was made first vice president; Dr. Aikin of Omaha, second vicepresident, and Dr. S. Grover Burnett of Kansas City, secretary. The name of Dr. Gebhart, now in France, was retained as treasurer, the secretary to do the work until Gebhart returns.
The next meeting, Sept., 1919, will be held in Des Moines, where another profitable and interesting time is promised. We all left Omaha with the regretful air of longing for more, with the pleasant memory of the Thursday luncheon, given complimentary to the society by the Omaha Commerce Club.
J. M. B.
With the American Red "THE DAY has come when America is privileged to spend her blood and her might for the prin
Cross at the Front ciples that gave her birth and happiness, and the peace that she has treasured. God helping her, she
Arm and leg wounds compose a large macan do no other." WOODROW WILSON. jority of the injuries received in battle, hence
there is an enormous demand for splints—a
framework upon which the injured member may Annual Meeting Medical Society
rest in the most comfortable position. of the Missouri Valley
Contrary to the layman's preconceived opinion The 31st annual meeting of the Medical Society of the Missouri Valley was held at Omaha, Sept. 19-20, 1918. In spite of war time the sessions were up to the proverbial standard of attendance, interest and good fellowship. A fair sprinkling of military men added life and zest to the atmosphere. The Hotel Fontenelle, with its throng of guests, civil and military, maintained its reputation of life, gaiety and hospitality.
The program of 20 medical and surgical papers went along with a snap that kept interest at a high point. Our long distance guests added to the life of the meeting. Pottenger of California gave in an hour talk the present status of tuberculosis most comprehensively. Black- use of the American army, is of steel framework marr of Chicago occupied a half hour on radium with leather and felt padding. And most of them and x-ray treatment of cancer. Hopkins of Chi- of a splint, it is not a piece of wood, but, for the are of ingenious invention, being far from simple able position, so that injured muscles will not be affairs. The types are almost as numerous as moved by unconscious effort. Then there is the the injuries for which they are made to aid in U splint with an unmovable padded steel circle healing. The American Red Cross has taken at the top, which fits close to the leg or shoulder over the job of supplying all splints to the Amer- crotch. A splint of this type is also made with ican Expeditionary Forces, and in the vernacular hinges so that the arm or leg, stretched straight of the streets, it is “some job.” The demand for and fast, may be moved at the thigh or shoulder. these particular articles is increasing at a great rate due to the increasing activity of American troops on the battle front.
To meet this demand the Red Cross has establishsed a splint manufacturing plant of its own in a large French town not far from the battle front.
While the splint construction is not complicated, it must be exceedingly careful and delicate. The splints that fit on the upper portion of the leg or arın must be carefully padded with felt and sheepskin. This work is done by French women and by hand.
Most of the leg and arm splints are made of steel rods bent in the shape of a U and are about four feet in length. They taper from the bottom · up to the top where a semi-circular steel rod, attached to each end of the U by a hinge, is padded well and attached. Upon the padded part rests the thigh or shoulder of the injured member. The wounded or broken leg or arm is bandaged between the two sides of the U. The bottom of the U is dented in order that a bandage There are small wire splints for the foot, the may be attached to the bottom of the splint and hand and the wrist. the injured member for the purpose of pulling or
All of them are made by hand in this factory, because of the lack of machinery. Even the welding and varnishing of the steel and wire, as well as the nickeling, is done in the Red Cross factory.
This is only one of the many activities from which the American Red Cross has relieved the army. During the past few months the Red Cross has been forced to let contracts to various private manufacturers to furnish a sufficient supply of these necessary hospital appliances. But with the growth of its organization, it has established its own manufactory in the war zone of France, in order that there may be fewer transportion delays and better service in the work
of relieving as much suffering as possible among applying the necessary weight to force the broken American wounded.
W. D. H. bones or torn muscles into place. It also serves to attach the splint to the foot of a bed or the front of an ambulance so that the wounded leg or
Stomachs—Pathologic arm may be elevated to any position which will
or Otherwise give the greatest comfort to the sufferer.
There are many cases of “dyspepsia” that There are numerous variations of this basic have no pathology. They exist without anatomic, splint. Some have a hinge in the center of both pathologic or reflex causes. Stomachs, like indisides of the U, so that an injured leg or arm viduals, possess varying degrees of robustness of may be bent at the knee or elbow and bound into resistance. Some stand more indiscretion and position. Some have a hand rest at the end, by dissipation than others. Some fellows are diswhich the hand may be bandaged into an immov- turbed by a single "high ball,” others carry ten