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The Medical Herald

Incorporating the kansas City Medical Inder-Lancet

Subscription. $1.00 a vear, in advance, including postage to any part of the United States, Mexico and Canada. Postage to foreign countries in the Universal Postal Union, including Newfoundland, 50 cents a year additional.

NEW SUBSCRIBERS Dr. T. W. Clark, Alliance, Ohio. Dr. H. H. Deck, Kodiak, Alaska. Dr. H. H. Francis, St. Joseph, Mo. Dr. Philip L. McBreen, New Kensington, Pa. Dr. H. E. Pace, Pontiac, Mo. Dr. P. H. Proff, Dutton, Mont. Dr. Jas. S. Sanders, So. Royalston, Mass. Dr. T. P. Scott, St. Joseph, Mo. Dr. Camille Simard, Quebec, Canada. Dr. G. E. Stanley, St. Joseph, Mo. Dr. F. G. Thompson, St. Joseph, Mo. Dr. E. P. Van Arsden, St. Joseph, Mo. Dr. E. R. Walker, Sedalia, Mo. Dr. P. E. Williams, St. Joseph, Mo.

The Medical Herald aims to reflect the progress in the sciences of medicine and surgery, especially throughout the Missouri Valley and Southwest, the territory of its greatest distribution.

Concise and practical articles, news and reports of interesting cases invited, and should be type-written.

The privilege of rejecting any communication is reserved, and all papers accepted must be for exclusive publication in this magazine, unless otherwise arranged.

To contributors of original articles a liberal number of copies of the Herald will be given (or mailed free of expense if addresses are furnished) and the publishers vill furnish reprints at printers' cost, application for same to be made when proof is returned

The editors are not responsible for the utterances of contributors or correspondents.

Illustrations will be furnished at reasonable rates, if drawings or photos are furnished.

Address all remittances, correspondence, articles for publication, books for review and exchanges to the Managing Editor.

Subscribers changing their addresses will please notify us promptly, as magazines cannot be forwarded without adding postage.

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Electrotypes and changes in advertising copy should be addressed to the Medical Herald, St. Joseph, Mo.

Advertising rates on application to the Managing Editor.

Poetic Reprints-Do not mutilate your Medical Herald by tearing out any piece of poetry that may strike your fancy. Write to the Managing Editor, and he will send you a reprint. Reprints are made of all verse appearing in this magazine.

To Our Subscribers-You will confer a favor on the publishers by remitting promptly on receipt of statement. The amount is very small to each one, but the expense of sending out duplicate bills is quite heavy. Kindly report change of address promptly, giving old address as well as the new location.

CAUTION!- Whenever the true merit of a preparation is authoritatively established, imitation is sure to make its pernicious appearance. To counteract the injurious results of another of these fraudulent pro ceedings—in this instance affecting firm name and reputation-Sander & Sons have been compelled to appeal to law, and in the action tried before the Supreme Court of Victoria, the testimony of a sworn witness revealed the fact that this witness suffered intense irritation from the application to an ulcer of the defendant's product, which was palmed off as “just as good as Sander's Eucalyptol.” Sander & Sons had the satisfaction to obtain a verdict with costs against this imitator, who is perpetually restrained from continuing his malpractice. Dr. Owen, in a report to the Medical Society of Victoria, and Dr. J. Benjamin, in the Lancet, London, both denounced, as others did before, on the strength of negative results, the application of unspecified eucalyptus products.

This forms convincing proof that only an authoritatively sanctioned article can be relied on. SANDER & SONS' EUCALYPTOL

(Ecalypti Extract) 1. Has stood the test of Government investigation.

2. It was proved at the Supreme Court of Victoria by experts to be an absolutely pure and scientifically standardized preparation.

3. It is honored by royal patronage.

4. It always produces definite therapeutic results.

Therefore, to safegaurd the physicians' interest and to protect their patients, we carnestly request you to specify “Sander's Eucalyptol” when prescribing eucalyptus.

The Meyer Bros. Drug Co., St. Louis, Mo., agents, will forward one original package (1 oz.) on receipt on One Dollar.

(Entered at the St. Joseph P. O. as second class matter.)

FOOD WILL WIN THE WAR • DON'T WASTE IT

Menstruation Uls—The Martin H. Smith Co. has served the profession for a good many years, specializing in ergoapiol (Smith), a preparation that contains two active drugs the value of which in disorders, particularly of the female genital organs, is as great as are the difficulties in the way of producing a preparation that is active, gives the best possible therapeutic effects of the drugs, and is free from undesirable by-effects. These conditions are excellently met in ergoapiol (Smith) which all these years has maintained its position as a useful remedy in various disturbances of menstruation. The Martin H. Smith Company, New York City, is always ready to serve you with samples and literature.

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“MEASLES AND PNEUMONIA IN OUR CAMPS”—Vaughan

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- 161918

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He Has TWO GOOD LEGS One Made by Nature

The Other by Marks

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READ WHAT HE SAYS:

To A. A. MARKS, N. Y.: I wish you to know how many days the leg you made for me worked during the year. During the month of January I worked 407 hours; February, 292; March, 358; April, 253; May, 280; June, 316; July, 337; August, 376; September, 337; October, 391; November, 375; December, 337.

If you will add up the number of hours you will find it amounts to 4,131, or more than 413 days for the year, and you know there are only 313 working days in the year, so I have worked a year and one hundred days in the year, wearing your artificial leg every hour of that time, and it has not cost me one cent for repairs. It is as good now as it ever was. The engine that I am firing is one of those big ones that

hauls coal from the mines to Pottsville, No. 148. I enclose a photograph of my engine, where you will see me at my post of duty. I get all over her with the same ease that I ever did. Sometimes I climb on top of the boiler when in motion. I can tell you more about what I am doing with my leg if you want it. The hard use I am giving your leg, and the excellent wear it is giving, proves it to be the best in the world. I am respectfully yours,

FRANK FAUST, Pottsville, Pa. This demonstrates that the loss of a leg does not debar a man from firing a 'locomotive.

Manual of Artificial Limbs and Measuring Sheet sent gratis. Address

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A. A. MARKS, 696 to 702 Broadway, New York

– Incorporating
The Kansas City Medical Index-Lancet

An Independent Monthly Magazine

l'ol. XXXVII.

MARCH, 1918

No. 3

immediately direct him around this obstacle so Original Contributions

that rarely will damage to the tooth follicle occur

if care is exercised. These sutures are passed ( EXCLUSIVELY FOR THE MEDICAL HERALD.)

into the bone tissue just about where the mucosa

folds upon itself. Lead plates which act as A FEW PRINCIPLES OF HARELIP AND splints are placed along the buccal. The bones CLEFT PALATE PROCEDURE*

are placed in their normal relationship to each WILLIAM L. SHEARER, M. D., D. D. S., Omaha, Neb.

other by the pressure of the thumbs. In this way

the silver wire and lead plates act only as supWhen we come to consider surgical proced- ports and are not employed in forcing the maxilure in harelip and cleft palate, one most import- lary plates together. After this is accomplished ant fact presents itself for serious thought, i. e., it is necessary to dissect the mucosa from the the babe does not have a voice in the choosing of ends of the maxillary bones so that bone tissue the one to serve him. All that is given him is will meet bone tissue and will thereby result in a cry and it is this cry which should be respected. bone union. A most deplorable picture is placed before our Normally the upper arch is smaller than the eyes. With this thought in mind I shall en- lower arch. If careful observations are taken of deavor to outline a few steps of the work which a child with cleft of the malar bones, it will be are necessary to accomplish the best results. found that the lower arch fits just inside of the

There seems to be a misunderstanding rela- upper arch. When this first operation is comtive to the time for surgical interyention in the pleted the transformation is as follows: The ridge different phases of this class of surgery, there- of the lower arch will be found to just overlap fore it is advisable to give the experience of men the ridge of the upper arch. In single cleft of deroting their time largely to this field. Brophy the malar bones the nose will be found decidedly has outlined this most clearly in his late work to the left or the right, as the case may be, of the and his conclusions are corroborated by many median line. This first operation do

median line. This first operation does not only surgeons,

bring the arches into position as above described, If the babe is presented with cleft palate in- but also places the nose in a position where, if a volving the alveolar border of the maxillary line were drawn from the middle of the forehead bones this operation should be done first. To to the center of the tip of the chin, bisecting the accomplish the best results it should be per- face, it would pass down over the center ridge of formed from the age of ten days to six or eight the nose. This will be illustrated with lantern weeks. It should be treated in the same manner slides to follow, also the technique. as an ununited fracture. The lip and soft palate The next operation should be done after the should not be considered until there is bone bone union, at any time the condition of the child union. It should be done early because the will justify. This involves the lip and making bones at this time are comparatively easily of the nostril. One of the most important surmoved into place and because the nervous mech- gical procedures is that necessary in the correcanism of the babe at this age is so slightly de- tion of the harelip. Indeed, so important from veloped that little shock follows.

the standpoint of cosmetics that I shall not enIt is advisable to repeat that the first under deavor to outline the steps in this paper, as they taking should be the closure of the cleft of the will also be definitely outlined with the lantern. bones because herein lies the future success of the The next operation, which will be upon the subsequent operations. The important steps in soft palate, should not be undertaken earlier this operation are as follows:

than from the fourteenth to the twentieth month, The silver wires are gently passed through or about the time the child endeavors to speak. the malar bone just under the floor of the orbit The closure of the cleft of the soft palate is by on either side. In so doing should a tooth folli- no means the most important part of this procle be encountered, the surgeon's tactile sense will cedure. The tissues must be placed in their 'Read before the Medical Society of Missouri Valley

proper positions so that the normal function will 21 Lincoln, Neb., Sept. 21, 1917.

be, insofar as possible, given to the individual. It must be borne in mind, in this branch of surgery, that unless the speech, etc., are materially benefited, even though the cleft is closed, the operation is largely a failure.

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Certain definite steps must be carefully carried out to give the child that flexibility and resiliency of the palate so much needed in speech. A specially designed periosteal elevator should be used to perfectly separate the soft tissue from its periosteal attachment. Great care is necessary in the very initial step of passing through the muscular mucosa down to the periosteum in the process of lifting the soft tissue. It should be freed all along the posterior border of the horizontal plates of the palate bones, extending down over the hamular process on either side. Very rarely is this accomplished in cleft palate procedure. When the horse-hair coaptation sutures are placed, no tension can be allowed, or sloughing will follow and the operation result in failure. It is necessary at this time to place tension sutures of silver wire supported by lead plates to prevent tension on the horse-hair sutures as described above. In this operation, post operative care is most essential. Isolation of bacteria being impossible it is necessary to carefully irrigate the parts after each feeding, and in some cases a half dozen times a day. When it is impossible to isolate an organism it must be combatted by other means, and in this instance constant irrigation is considered one of the laws of success.

In the last two operations, namely, the lip and nostril, and the soft palate, great care should be exercised not to traumatize the tissue more than is necessary, as sloughing, particularly in the soft palate, is apt to follow. Lateral incisions in the soft palate should never be made because in so doing the tensor palati muscle and nerve are very likely to be severed, and once severed do not reunite. Following in the wake of this unfor-. tunate procedure is deafness, owing to the fact that by traction in the act of swallowing and speaking the tensor palati muscle dilates the pharyngeal orifice of the eustachian tube.

Permanent sutures left in the mouth at the completion of any of these three operations should be silver wire, lead plates and horse-hair, for the reason that they do not absorb the saliva which is constantly contaminated with different forms of bacterial life.

It has not been the intention of the writer by any means to outline all of the steps in these three operations-only to give a general summary of the more important steps to insure success in this field of surgery. Nor does he claim any originality here; on the contrary he cannot consider the subject in hand without acknowledging with sincere gratitude and appreciation his friend and teacher, Dr. Truman W. Brophy, whose achievements in original research, and whose lofty ideals have been a constant inspira

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ti011.

Case B, Step No. 1.

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