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unjustifiable. Apparently the absorption of toxins in nature's effort to get rid of the devitalized tissue, and in some of them the hemorrhage was so persistent and severe that they were lost, weeks after apparent success of the treatment. The danger from prolonged anesthesia is too great in the slow process, because of the tax on the patient's strength. and blood damage. We are not justified in keeping these patients under prolonged anesthesia and to wait three or four months before you do your hysterectomy, to me, seems absurd, because if you have not by the cautery destroyed the carcinomatous mass, then hysterectomy is unnecessary and the results would be just as good if you did not do the hysterectomy. Don't burden your patient's resistance with a whole lot of necrotic tissue.

DR. POTTER: Reference has been made to the time consumed in the operation. I question if any man present, unless he has acquired more dexterity than the best operators can do a complete Wertheim operation in less than an hour or an hour and a half, and most will take one and three-quarters to two hours. When one dissects the ureters down to the bladder, and upwards for the glands, separates the uterine artery and removes most of the broad ligament, one cannot complete the operation under an hour and onequarter to an hour and a half.

The whole Percy technique ought not to take over one and a quarter or one and one-half hours, and no one questions that there is less shock to the patient than from the Ries-Wertheim operation.

A great many years ago cases were reported by Dr. Byrne of Brooklyn, who claimed that he could cut out the whole inside of the uterus with the redhot cautery. He reported very good end results.

I think enthusiasm over Percy's cautery has been largely a reflection of the enthusiasm of the man who invented it. Theoretically it looks beautiful, and if we could carry out the theories as advocated it would be splendid. But the reports are not showing that in the operable or inoperable cases, you have the net results seen after the Wertheim operation, in operable cases.

THE ABORTIVE TREATMENT OF SYPHILIS

GUSTAV A. LAU, M. D., St. Joseph, Mo. Our present situation in the world's war brings to our attention an enemy which is threatening the life and welfare of our nation as much, perhaps, as the most destructive weapon of modern invention. As long as history is known, there has been during a state of contention, an increase in venereal diseases. The eradication of the lues from the army would not only increase the efficiency of the soldiers, but also protect those who remain at home.

Lues, unfortunately, is one of the poorest managed diseases in medicine, for 60 per cent of tabes are caused by the doctor's ill advice. There is no excuse for this to go on any further with our splendid diagnostic facilities, and the increasing popularity of salvarsan.

*Read before the Buchanan County Medical Society, St. Joseph, Mo., Sept. 19, 1917.

The differential diagnosis of the primary lesion from epithelioma herpes progenitalia, chancroid given in our text books, is very much at fault and should be forgotten. The sound principle to follow always is to prove that the lesion is not syphilitic.

Laying stress on the presence or absence of pain is valued at nil. The solitary character does not mean syphilis any more than multiplicity excludes it. We all know of how little value induration is. The much referred base border feature is best thrown out of our mind. Incubation is absolutely untrustworthy and worthless. The only criteria of any clinical value are first, duration and refusal to heal, that is, a lesion that is properly treated for days or a week and showing no tendency to heal, is suspicious. The second factor of diagnostic value is the buboe.

Laying some stress on these factors, the main point and the one that confirms, is the finding of the treponema-pallida with the aid of the dark field illumination. If the offending organism is found, the situation is at once clear as to the next procedure-that of treatment. If not found, the diagnosis still rest in balance.

The requirements for that test are not manifold. An arc lamp is no longer necessary as a 100 k. w. nitrogen lamp will suffice and a dark field illumination can be readily adjusted to any microscope.

Of the greatest importance is to have an untreated lesion. Once the area is cauterized or dusting powders such as calomel or boric acid, etc., have been applied, the diagnosis becomes very difficult.

Briefly, the procedure of the dark field method is as follows: Clense the lesion with nor. salt solution, rub it vigorously to cause a flow of lymph to ooze from the surface. A sterilized glass slide is lightly touched to this serum, a covered glass applied, and this specimen is examined with oil immersion lense. Three or four of such examinations for one-half hour are sufficient to form an opinion. If the findings are negative, or a patient presents himself with a treated lesion, the next step is to resort to the hypodermic needle. Plunge this horizontally into the border of the lesion and by manipulations try to produce irritation so as to be able to aspirate some lymph into a syringe. Examine this in the same manner. Failing to find the organism from this area, our next procedure is to aspirate the nearest lymph gland. In doing this, one should be sure that the needle has passed through the gland capsule. If treponema pallida can be obtained from here it is of greatest importance, having recognition of highest value as a medical legal point. With little experience one can easily learn to differentiate the treponema pallida from the treponema re

fringens. In the latter, the individual twists are fewer, larger and more wave-like.

The India ink method, which was at one time popular, is very unreliable. One cannot distinguish the treponema pallida from the refringence as motility is lost. If no dark field is at hand, and one has to use this method, the ink should be first sterilized. Take one drop of ink and one drop of lymph, spread this on a glass slide, dry and examine with oil immersion lense. Having exhausted the various methods enumerated, and having failed in these attempts, the Wassermann test comes now into consideration. This valuable test marks the exit of the abortive cure. Practically three Wassermanns are taken, covering a period of three months. A better plan would be to take a daily test for the first two weeks, then one after four weeks and the last in the third month. One should never dismiss a case without resorting to, at least, three of these tests.

Having made a positive diagnosis of lues, which form of treatment is the best comes up for consideration. Our attention is first directed to the destruction of the primary lesion. Stokes found that buboes develope less frequently where the area is first treated by simply soaking it, for fifteen minutes, in a hot mercury bichloride solution 1-4000, every two hours. This being kept up until the base of lesions becomes clean. His final procedure is the simple application of a hot boric acid solution. This method should be given preference over cauterization with nitric acid, phenol, nitrate of silver, etc.

Leaving the local treatment our next step, and the one of absolute necessity, is to give an injection of salvarsan. Opinions differ as to the number of injections that should be given. Usually three are resorted to. The period elapsing between each injection is from seven to ten days. In the early stages of lues, the use of salvarsan is the one of choice, while in the later stages, neosalvarsan is to be preferred. Its selective action on the meninges is now well recognized. While salvarsan exceeds all the other known drugs in a rapid destruction of the treponema-pallida, no one would be willing to assure the patient a cure from these injec

tions alone.

Ever since the fifteenth century mercury has been recognized as a specific for lues and up to the present time, no drug has displaced its curative effect. The early method of application has withstood all modern advances, and today, inunction is still the surest route for a cure. While the injections of the insoluble salts of mercury offer advantages to rely on them alone, they are far behind the first mentioned method. Every syphilographer knows that sooner or later a marked fibrosis develops which

interferes with the absorption of the drug. To overcome this obstacle, preference is now given by those who adhere to this method to the soluble salts of mercury. The use of these require a careful watching of the kidneys.

Where we have an opportunity to observe that the inunctions are properly carried out, preference should always be given to this method. As no one is willing to deny its curative advantages over the injection. The objections of being dirty and consuming time should not come into consideration, when one's health is at stake. During the first year the first course of inunction is given, consisting of forty rubs immediately after the salvarsan injections are finished. The second course usually in the spring or fall, as the case may be. During the second year these are repeated in the fall and spring, dismissing the patient at the end of the second year.

Before discharging the patient, a thorough examination of the spinal fluid should be made and the patient advised to remain under observation during the coming three years.

Last of all, let us not forget that no harm can result from a properly conducted over-treatment, while on the other hand great danger will come to those who have received inadequate medication. Especially in those cases where only the internal treatment has been used.

Fewer Drink Cases in the Courts-A report recently submitted by the chief statistician of the City of New York shows that there has been a reduction in the number of intoxicated persons dealt with in the magistrates' courts of the city for the first nine months of the present year. During this period there were 4,508 intoxicated persons dealt with, as against 5,050 during the corresponding period of 1916.

Widespread Epidemics in Germany-A press correspondent, who is with the French armies near Verdun, reports that thousands of letters have been taken from German prisoners which describe in harrowing terms the ravages of dysentery, cholera, and typhus fever in Germany. These letters bear witness to the prevalence of such epidemics at Cologne, Mulheim, Coburg, Burgstadt, Guben, Alakenbourg, Langen, Lichtenberg, Staltach, Altona, Wiesbaden, Grunewald, and many other German cities. It is reported that over one-half the letters taken from the pristhese epidemics. The deduction seems to be waroners contain some reference to the spread of

ranted that if these letters have been allowed to pass the censors the actual conditions must be much worse than those mentioned which have been allowed to pass.

war.

Peace hath her health problems no less than

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ASSOCIATE EDITORS

P. I. LEONARD, St. Joseph.
J. M. BELL, St. Joseph.
JNO. E. SUMMERS, Omaha.

CONTRIBUTING EDITORS
H. ELLIOTT BATES, New York.
JOE BECTON, Greenville, Texas.
HERMAN J. BOLDT, New York.
A. L. BLESH, Oklahoma City.
G. HENRI BOGART, Paris, Ill.

ST. CLOUD COOPER, Fort Smith, Ark.
T. D. CROTHERS, Hartford, Conn.
W. T. ELAM, St. Joseph.

JACOB GEIGER, St. Joseph.

S. S. GLASSCOCK, Kansas City, Kan.
H. R. HARROWER, Los Angeles, Cal.
JAS. W. HEDDENS, St. Joseph.
VIRGINIA B. LE ROY, Streator, Ill.
DONALD MACRAE, Council Bluffs.
L. HARRISON METTLER, Chicago.
DANIEL MORTON, St. Joseph.

D. A. MYERS, Lawton, Okla.
JOHN PUNTON, Kansas City.

W. T. WOOTTON, Hot Springs, Ark.
HUGH H. YOUNG, Baltimore.

Editorial

THE OCULIST AND THE WAR

No. 1

The

clinical signs in such a manner as to arrive at a diagnosis, or, an operation may be advised.

The eye is an offshoot of the brain. Normally there is free communication within the vaginal sheath between the intradural cavity and the optic disk, and if there is any obstruction by local disease we expect it to be a sign of intracranial pressure. An interference with the return of blood in the retinal veins gives rise to their dilatation. Choked disks occur only as the result of high intracranial pressure.

Ramsey tells us that in modern warfare injuries are of very frequent occurrence, but, whatever their cause-bullet from rifle or shrapnel shell, high explosive shells, hand grenades, foreign bodies thrown up by explosion (stones, earth, glass, chips or metal, etc.), boiling pitch. petrol or other inflammable substance, or poisonous gases-it may be taken that they differ merely in degree and not in kind from those met with in ordinary civil life. First aid treatment will do much to lessen the three chief complications to be feared in war injuries-sepsis, teP. I. L. tanus, and sympathetic ophthalmia.

EVERY DOCTOR, IN THE MEDICAL RE-
SERVE CORPS

What an ideal situation it would be, if every doctor in the United States who is mentally, physically and morally fit, was in this corps. The time is coming, and in the immediate future, when the Medical Reserve Corps of the

to enable the Surgeon General to have at his command for immediate assignment, as conditions demand, a sufficient number of trained medical officers, let us take the above thought seriously.

The eye stands in close anatomic, physiologic Army must be immensely augmented, and so as and pathologic relationship to the brain. eye reveals many of the essential data necessary for the determination of operative procedures in injuries of the head. The war department expects the brain surgeon, neurologist, oculist and aurist, rhinologist and laryngologist, as well as the dentist, to do team work. They are to make the diagnoses in head injuries and to determine the therapeutic course to pursue. During the past ten years neurological surgery has taken a bold step in advance, as a result of a better understanding of diseased processes and an improved surgical technique.

The removal of brain tumors has not been as encouraging as the operation for post-traumatic cerebral conditions, or the treatment of intracranial increase of pressure by decompression.

A study of the optic disks and retinal vessels, as well as the pulse, temperature and blood pressure, not to forget lumbar puncture and the pressure of the cerebro spinal fluid, furnishes clinical evidence for or against an operation.

If we study the history of the case, escape of the cerebro spinal fluid from the ears, nose or mouth, ecchymoses, paresis and paralysis, disturbances of the reflexes, the aid furnished by the x-ray, and we may be able to interpret these

We all know, from past history, the conserving value of an efficient medical corps, and this means number, as well as training.

A statement made by one high in authority in the Surgeon General's office, "that our fighting forces would be disseminated by sickness and casualties in six months, were it not for an efficient army medical corps," clearly emphasizes the importance of every doctor in the United States, meeting the requirements above referred to, accepting a commission in the Medical Reserve Corps of the United States Army.

The struggle in which we are now engaged, and for which we are preparing to take such a prominent part, depends for its success as much upon the medical profession, as it does upon our combatant forces, and while we do not know that any such intention as herein suggested is in the mind of the Surgeon General, it would at least give him the necessary corps of medical officers, upon which to draw, and thus serve the best interests of our country, and the best interests of the medical officer serving.

THE CONTROL OF VENEREAL DISEASES

IN ROCHESTER

The health officer of Rochester, Dr. George W. Goler, has devised a unique method of keeping venereal disease patients under dispensary treatment. The plan calls for regular periodic visits to the department's clinic by each patient. He is told upon leaving when he is excepted to come back again, and if he does not appear a written notice is sent to his house, stating that unless he presents himself immediately for further advice and treatment he will be visited by a police officer. If he still persists in neglecting treatment a warrant for his arrest is sworn out and he is haled into the local police court and committed to the care of the health department for an indefinite period.

KANSAS CITY'S NEW MERCY HOSPITAL

The new Mercy Hospital, Kansas City's Home for Crippled Children, was recently completed, and the Star, in commenting upon its opening, said:

"Mercy Hospital moved into its new home at Independence and Woodland avenues yesterday in as peculiar a fashion as that remarkable institution, the greatest children's free hospital in America, has done everything else for twentyone years.

Across the rough back lots between the old home and the new, the forty-five hospital employes lugged babies, furniture and their own effects. Some of the children journeyed in the arms of nurses, some in baskets and the little white ambulance brought those who could not be carried. Trucks, loaned to the institution, moved the heavier furniture.

There was no chapel in the old plant. When a baby died the body had to be laid away in a drawer or on a shelf where the other children could not see it. Now the dead will sleep in clean linen among flowers on a great table in the chapel. Not a mark will distinguish the room as a chapel unless it be the stained windows, and they will glow with bluebirds instead of the red scenes of Calvary.

"Atonement and resurrection are not for such as these," declares Doctor Richardson. "They merely return whence they came."

Instead of the usual metal donation plates that disfigure the doors and walls of many hospitals, Mercy has carved oaken tablets. One of these frankly chronicles the massage room and gymnasium as the gift of the "Mercy Diaper Club of the Jewish Educational Institute."

"At first the inscription rather jarred on me,' Doctor Richardson said yesterday. "But the girls declared, 'the Diaper Club it is, and no euphemism shall change it.' And I decided they

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of Louisville, Kentucky. For years he was chief surgeon N. G. Mo., rank Lieut. Col.; consulting surgeon for Home for Little Wanderers; consulting surgeon at Memorial Home for aged; lecturer on abdominal surgery St. Joseph's Hospital Training School for Nurses; surgeon Terminal Railroad Co., St. Joseph; chief surgeon St. Joseph & Grand Island R. R.; fellow associate military surgeons U. S.; member of the county, State and American Medical Association and Fellow American College of Surgeons. The doctor has been the moving spirit for many years, and the parent of the Missouri Hospital Corps, from which service he has recently withdrawn. In lines of reform both civic and medical, he has for years been prominent. Dr. Morton has had many honors acquired and merited, during past years, but to be elected by his fellow practitioners to lead the local body has pleased him more than all others. J. M. B.

KANSAS CITY MEDICAL AND SURGICAL

CLUB

The medical profession of Kansas City is entitled to a vote of thanks from its fellows in all this northwest territory for the clinical stunts put on last month at the General Hospital. The meeting was in keeping with energetic push and "get there" qualities of Kansas City. The clinical material was varied, ample and to the point. The teaching was masterly, so much so that the question was asked by those in attendance, "Why does not Kansas City maintain a polyclinic?" The instruction, both surgical and medical, was equal to that of any post-graduate course in the country. We hope it will be repeated soon. The delegation from St. Joseph is awating the date of the next session. J. M. B.

SMOKER: BUCHANAN COUNTY MEDICAL SOCIETY

The Buchanan County Medical Society celebrated the annual milestone with a smoker a smoker Wednesday, Dec. 19 in the rathskeller of the Robidoux Hotel. Plates were laid for 35 members. Good things galore and a little "moisture" demanded the attention of the boys for an hour, after which, under the charming good fellowship of the retiring president, Dr. Floyd H. Spencer, and the soothing influence of El Roy Tan, the balance of the evening was pleasantly floated away with speeches, talks reminiscences, jokes and stories.

Our venerable neurologic nestor, C. R. Woodson, objected to being considered an old man. Objection was sustained by the chair. Worsecase-I-ever-had-Spencer delivered in a masterly manner his farewell address. He will remain in practice, however. Secretary Goetze read a

"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.)

poem written by Lieut. Kenney. It will not be printed. Committeeman Carle explained a recent trip to K. C. His memory being at fault, Gustavus Berlin Lau gave the balance in detail. Almost-elected-president Willman indulged in reminiscences, and urologic Bansbach reiterated some brand new stories. The balance wheel of the evening was a masterly talk on the war situation by Daniel Morton. After some illumination on the health and political aspect of the town by Director De Lamater the boys adjruoned.

THE VALUE OF THE COMPLEMENT FIXATION TEST IN THE DIAGNOSIS OF INCIPIENT TUBERCULOSIS

Dr. R. B. H. Gradwohl, St. Louis, in concluding a paper read before the Mississippi Valley Medical Society, said: "The complement fixation test is absolutely specific for tuberculosis. It is not always present in all cases, and it seems to disappear when the process subsides. This test will be found a valuable addition to the diagnostic aids of the clinician. We have very few data on which to base a conclusion that negative reactions mean arrest of tuberculosis processes. The observation of the patient over long periods of time must still remain the proper method of adjudicating this question.'

War Relief Work in Rumania-The American Red Cross war council has appropriated $1,250,000 for emergency relief work in Rumania. There is a shortage of food, and especially food fats. The military hospitals also are in need of bedding and surgical and medical supplies in large quantities. No supplies of this kind are available there. Approximately $1,000,000 of the appropriation will be used for the purchase of 2,000 tons of foodstuffs. Another large item in the appropriation will supply 40,000 pairs of shoes. Medical supplies will be sent in large quantities. The need of relief in Rumania is particularly pressing because of the overcrowded condition of certain areas caused by the war operations. In a territory normally occupied by 1,000,000 persons there is now a population of 3,000,000, according to advices cabled by Red Cross workers in the field.

A Happy New Year to you!

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