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mass in each fornix continuous with the uterus. in inoperable cases with the hope that we may We made an additional diagnosis of extensive attain results which more nearly approach the broad ligament metastases which we thought results reported indefinitely by Percy. In suitwere probable on account of the youthfulness able cases we may use it as a preliminary to of the patient and her naturally healthy lympha- complete hysterectomy but until the reports justic channel for distribution of the local growth. tify its substitution, the Ries-Wertheim operaOperation Dec. 12, 1916.
tion, although a more formidable procedure Upon opening the abdomen an enormous
attended by a higher immediate mortality will double pyosalpinx was encountered long before be used in early cases because of its better endthe discovery of the carcinoma. A double sal- results. pingo-oophorectomy, was done and both uterine
DISCUSSION arteries instead of the internal iliacs were ligated JEROME MORLEY LYNCH, New York: Although for reasons explained before. The cautery was entirely outside of my province, I think we are very pushed well into the fundus and applied for 60
much indebted to Dr. Potter for a paper like this, minutes until the fundus could no longer be held.
because it is a very fair exposition of what can be
accomplished with cauterization. The same princiThe recovery was uneventful. She gained ples apply to carcinoma that is situated in the rectum; very rapidly in weight and strength and showed i. e., early diagnosis, radical operation, and in inmarked improvement for two and a half months.
operable cases one is justified in using any means
that will prolong the life of the patient. A report in the past week stated she has commenced to lose ground again and that her decline F. B. DORSEY, Keokuk: The few cases that we
have been able to observe that have been treated for the past three weeks has been as marked
by the Percy cautery method have been extremely as her improvement immediately following the unsatisfactory. I do not see that the patient has deuse of the cautery. She does not complain of rived any greater benefit than was derived from vaginal discharge or bleeding.
the curettement of the cancerous mass in the old
fashioned way and by the use of the Paqulin cautery. Except for number four the above cases have We have this advantage with the Paqulin cautery been followed to the end. From our own cases over the method proposed by Percy: that we have alone we are permitted to draw the following
none of the ill effects of long continued burning;
we do not have those pronounced symptoms in some conclusions :
of the cases that we have seen and as described (1) The Percy cautery alone is not suffi- by Dr. Potter, following the older method. I do not cient for the destruction of carcinoma of the
see that it is one iota in advance; or that it causes cervix either operable or inoperable.
the patient to live any longer; and for the mere fact
that it does away with the discharge does not justify (2) In operable cases it: (a) Prevents gen
us in resorting to such radical measures. If the eral disability and autointoxication from the
patient is in a condition that she can withstand the
application of a cautery of this kind, preceded by absorption of infectious material behind the
the operative measures that are necessary, it occurs mass. (b) Destroys the foul-smelling vaginal to me that a radical hysterectomy—I don't care discharge. - (c) Overcomes bleeding and the whose method you follow-your own or a modifica
tion of some one's else-should be done. You may secondary anemia.
have a high' mortality rate, but you have a higher (3) In operable cases it should never be percentage of recovery. Of course the earlier you used as the only weapon against the disease operate the higher your rate of recovery and the but should be followed subsequently in two or
less your mortality. Mortality rests a good deal, in
radical operations, on the dexterity of the operator. three months by a hysterectomy. In these cases
If a man is skilled and knows what he is doing, his it is doubtful if the preliminary use of the patient has a better chance. The Percy operation cautery owing to the fact that one must wait subjects the patient to all the manifestations of extwo or three months for the subsequent operation
tensive burns on the surface of the body. which gives a good chance for the growth to
C. E. RUTH, Des Moines: Eighteen years ago, progress is as safe as thorough preliminary cau- in attempting to deal with extensive carcinomas, one
case particularly comes to my mind now. It was a terization of the cervix and immediate hyster
patient in whom the growth was very extensive, and ectomy according to the technic of Wertheim.
I refused to operate. She begged to have me attempt (4) In borderline cases it has its greatest
relief and, without making any promises, I used the
cautery very thoroughly. But in that case I followed field of usefulness and here in all cases it should
the plan that I believe is best today, of rapid debe thoroughly used and followed in three to four struction of the carcinoma, for the reason that it months by a complete abdominal hysterectomy. was not then possible to operate on that case and do Whether the abdominal operation is to be a
a complete hysterectomy by any other method and
not disseminate the carcinomatous material in complete hysterectomy alone or a complete hys- freshly opened tissue. The patient lived for five terectomy after the technic of Wertheim can be years, and the result encouraged me to utilize the determined at the time.
method and to extend it; and now in every case of
carcinoma, wherever situated, I use the cautery In closing it may be added that although when possible. we cannot at present lay any claim to its advis- My mortality in following the early plan advo. ability for the cure we shall use it heroically cated by Percy, was so heavy that I abandoned it as
unjustifiable. Apparently the absorption of toxins The differential diagnosis of the primary in nature's effort to get rid of the devitalized tissue,
lesion from epithelioma herpes progenitalia, and in some of them the hemorrhage was so, persistent and severe that they were lost, weeks after
chancroid given in our text books, is very much apparent success of the treatment. The danger from at fault and should be forgotten. The sound prolonged anesthesia is too great in the slow pro- principle to follow always is to prove that the cess, because of the tax on the patient's strength lesion is not syphilitic. and blood damage. We are not justified in keeping these patients under prolonged anesthesia and to wait Laying stress on the presence or absence of three or four months before you do your hysterec- pain is valued at nil.
pain is valued at nil. The solitary character tomy, to me, seems absurd, because if you have not does not mean syphilis any more than multiby the cautery destroyed the carcinomatous mass,
plicity excludes it. We all know of how little then hysterectomy is unnecessary and the results would be just as good if you did not do the hysterec
value induration is. The much referred base tomy. Don't burden your patient's resistance with
border feature is best thrown out of our mind. a whole lot of necrotic tissue.
Incubation is absolutely untrustworthy and
worthless. The only criteria of any clinical DR. POTTER: Reference has been made to the time consumed in the operation. I question if any man
value are first, duration and refusal to heal, that present, unless he has acquired more dexterity than
is, a lesion that is properly treated for days or the best operators can do a complete Wertheim opera- a week and showing no tendency to heal, is tion in less than an hour or an hour and a hart, and
suspicious. The second factor of diagnostic most will take one and three-quarters to two hours.
value is the buboe. When one dissects the ureters down to the bladder, and upwards for the glands, separates the uterine
Laying some stress on these factors, the artery and removes most of the broad ligament, one main point and the one that confirms, is the findcannot complete the operation under an hour and one- ing of the treponema-pallida with the aid of quarter to an hour and a half.
the dark field illumination. If the offending The whole Percy technique ought not to take organism is found, the situation is at once clear over one and a quarter or one and one-half hours,
as to the next procedure—that of treatment. and no one questions that there is less shock to the patient than from the Ries-Wertheim operation.
If not found, the diagnosis still rest in balance. A great many years ago cases were reported by The requirements for that test are not maniDr. Byrne of Brooklyn, who claimed that he could fold. An arc lamp is no longer necessary as a cut out the whole inside of the uterus with the red
100 k..w. nitrogen lamp will suffice and a dark hot cautery. He reported very good end results. field illumination can be readily adjusted to any I think enthusiasm over Percy's cautery has been
microscope. largely a reflection of the enthusiasm of the man who invented it. Theoretically it looks beautiful, and if
Of the greatest importance is to have an we could carry out the theories as advocated it untreated lesion. Once the area is cauterized or would be splendid. But the reports are not showing dusting powders such as calomel or boric acid, that in the operable or inoperable cases, you have the
etc., have been applied, the diagnosis becomes net results seen after the Wertheim operation, in operable cases.
Briefly, the procedure of the dark field
method is as follows: Clense the lesion with nor. THE ABORTIVE TREATMENT OF SYPH
salt solution, rub it vigorously to cause a flow of ILIS
lymph to ooze from the surface. A sterilized
glass slide is lightly touched to this serum, a GUSTAV A. LAU, M. D., St. Joseph, Mo. covered glass applied, and this specimen is exOur present situation in the world's war
amined with oil immersion lense. Three or four brings to our attention an enemy which is threat
of such examinations for one-half hour are sufening the life and welfare of our nation as much,
ficient to form an opinion. If the findings are perhaps, as the most destructive weapon of mod- negative, or a patient presents himself with a ern invention. As long as history is known,
treated lesion, the next step is to resort to the there has been during a state of contention, an
hypodermic needle. Plunge this horizontally increase in venereal diseases. The eradication
into the border of the lesion and by manipuof the lues from the army would not only in
lations try to produce irritation so as to be able crease the efficiency of the soldiers, but also
to aspirate some lymph into a syringe. Exprotect those who remain at home.
amine this in the same manner. Failing to find Lues, unfortunately, is one of the poorest is to aspirate the nearest lymph gland. In do
the organism from this area, our next procedure managed diseases in medicine, for 60 per cent of
ing this, one should be sure that the needle has tabes are caused by the doctor's ill advice. There
passed through the gland capsule. If treponis no excuse for this to go on any further with our splendid diagnostic facilities, and the in
ema pallida can be obtained from here it is of
greatest importance, having recognition of highcreasing popularity of salvarsan.
est value as a medical legal point. With little *Read before the Buchanan County Medical Society,
experience one can easily learn to differentiate St. Joseph, Mo., Sept. 19, 1917.
the treponema pallida from the treponema re
fringens. In the latter, the individual twists interferes with the absorption of the drug. To are fewer, larger and more wave-like.
overcome this obstacle, preference is now given The India ink method, which was at one time by those who adhere to this method to the soluble popular, is very unreliable. One cannot distin- salts of mercury. The use of these require a guish the treponema pallida from the refring- careful watching of the kidneys. ence as motility is lost. If no 'dark field is at Where we have an opportunity to observe hand, and one has to use this method, the ink that the inunctions are properly carried out, should be first sterilized. Take one drop of ink preference should always be given to this method. and one drop of lymph, spread this on a glass As no one is willing to deny its curative adslide, dry and examine with oil immersion lense. vantages over the injection. The objections of
Having exhausted the various methods enu- being dirty and consuming time should not come merated, and having failed in these attempts, into consideration, when one's health is at stake. the Wassermann test comes now into considera- During the first year the first course of inunction. This valuable test marks the exit of the tion is given, consisting of forty rubs immeabortive cure. Practically three Wassermanns diately after the salvarsan injections are finare taken, covering a period of three months. ished. The second course usually in the spring A better plan would be to take a daily test for or fall, as the case may be. During the second the first two weeks, then one after four weeks year these are repeated in the fall and spring, and the last in the third month. One should dismissing the patient at the end of the second never dismiss a case without resorting to, at year. least, three of these tests.
Before discharging the patient, a thorough Having made a positive diagnosis of lues, examination of the spinal fluid should be made which form of treatment is the best comes up and the patient advised to remain under obserfor consideration. Our attention is first di- vation during the coming three years. rected to the destruction of the primary lesion. Last of all, let us not forget that no harm Stokes found that buboes develope less fre- can result from a properly conducted over-treatquently where the area is first treated by simply ment, while on the other hand great danger soaking it, for fifteen minutes, in a hot mercury
will come to those who have received inadequate bichloride solution 1-4000, every two hours. medication. Especially in those cases where This being kept up until the base of lesions only the internal treatment has been used. becomes clean. His final procedure is the simple application of a hot boric acid solution. This Fewer Drink Cases in the Courts—A report method should be given preference over cau
recently submitted by the chief statistician of terization with nitric acid, phenol, nitrate of the City of New York shows that there has been silver, etc.
a reduction in the number of intoxicated persons Leaving the local treatment our next step,
dealt with in the magistrates' courts of the city and the one of absolute necessity, is to give an
for the first nine months of the present year. injection of salvarsan. Opinions differ as to During this period there were 4,508 intoxicated the number of injections that should be given. persons dealt with, as against 5,050 during the Csually three are resorted to. The period elaps- corresponding period of 1916. ing between each injection is from seven to ten
Widespread Epidemics in Germany-A press days. In the early stages of lues, the use of şalvarsan is the one of choice, while in the correspondent, who is with the French armies later stages, neosalvarsan is to be preferred. have been taken from German prisoners which
near Verdun, reports that thousands of letters Its selective action on the meninges is now well
describe in harrowing terms the ravages of dysrecognized. While 'salvarsan exceeds all the other known drugs in a rapid destruction of These' letters bear witness to the prevalence of
entery, cholera, and typhus fever in Germany. the treponema-pallida, no one would be willing such epidemics at Cologne, Mulheim, Coburg, to assure the patient a cure from these injec- Burgstadt, Guben, Alakenbourg, Langen, Lichttions alone. Ever since the fifteenth century mercury has
enberg, Staltach, Altona, Wiesbaden, Grunewald,
and many other German cities. It is reported been recognized as a specific for lues and up to the present time, no drug has displaced its
that over one-half the letters taken from the priscurative effect. The early method of applica- these epidemics. The deduction seems to be war
oners contain some reference to the spread of tion has withstood all modern advances, and
ranted that if these letters have been allowed to today, inunction is still the surest route for a cure. While the injections of the insoluble salts
pass the censors the actual conditions must be of mercury offer 'advantages to rely on them
much worse than those mentioned which have
been allowed to pass. alone, they are far behind the first mentioned
Every syphilographer knows that Peace hath her health problems no less than sooner or later a marked fibrosis develops which
The Medical Herald
clinical signs in such a manner as to arrive at a
diagnosis, or, an operation may be advised.
is an offshoot of the brain. Norkansas City Medical inder-Lancet
mally there is free communication within the
vaginal sheath between the intradural cavity Vol. XXXVII. JANUARY, 1918
and the optic disk, and if there is any obstruction CHAS. WOOD FASSETT, Managing Editor
by local disease we expect it to be a sign of 613 Lathrop Building, Kansas City, Mo.
intracranial pressure. An interference with the
return of blood in the retinal veins gives rise to ASSOCIATE EDITORS
their dilatation. Choked disks occur only as the P. I. LEONARD, St. Joseph.
result of high intracranial pressure. J. M. BELL, St. Joseph.
Ramsey tells us that in modern warfare inJNO. E. SUMMERS, Omaha.
juries are of very frequent occurrence, but, whatCONTRIBUTING EDITORS
ever their cause—bullet from rifle or shrapnel H. ELLIOTT BATES, New York. JOE BECTON, Greenville, Texas.
shell, high explosive shells, hand grenades, forHERMAN J. BOLDT, New York.
eign bodies thrown up by explosion (stones,
earth, glass, chips or metal, etc.), boiling pitch,
sonous gases it may be taken that they differ JACOB GEIGER, St. Joseph.
merely in degree and not in kind from those met S. S. GLASSCOCK, Kansas City, Kan. H. R. HARROWER, Los Angeles, Cal.
with in ordinary civil life. First aid treatment JAS. W. HEDDENS, St. Joseph.
will do much to lessen the three chief compliVIRGINIA B. LE ROY, Streator, ill. DONALD MACRAE, Council Bluffs.
cations to be feared in war injuries—sepsis, teL. HARRISON METTI R, Chicago.
tanus, and sympathetic ophthalmia. P. I. L.
EVERY DOCTOR, IN THE MEDICAL RE-
What an ideal situation it would be, if every Editorial
doctor in the United States who is mentally,
physically and morally "fit, was in this corps. THE OCULIST AND THE WAR
The time is coming, and in the immediate fu
ture, when the Medical Reserve Corps of the The eye stands in close anatomic, physiologic and pathologic relationship to the brain. The Army must be immensely augmented, and so as
to enable the Surgeon General to have at his comeye reveals many of the essential data necessary
mand for immediate assignment, as conditions for the determination of operative procedures in
demand, a sufficient number of trained medical injuries of the head. The war department ex
officers, let us take the above thought seriously. pects the brain surgeon, neurologist, oculist and
We all know, from past history, the conservaurist, rhinologist and laryngologist, as well as the dentist, to do team work. They are to make ing value of an efficient medical corps, and this
means number, as well as training. the diagnoses in head injuries and to determine
A statement made by one high in authority the therapeutic course to pursue. During the
in the Surgeon General's office, “that our fightpast ten years neurological surgery has taken a
ing forces would be disseminated by sickness and bold step in advance, as a result of a better un
casualties in six months, were it not for an effiderstanding of diseased processes and an im
cient army medical corps,” clearly emphasizes proved surgical technique.
the importance of every doctor in the United The removal of brain tumors has not been as
States, meeting the requirements above referred encouraging as the operation for post-traumatic to, accepting a commission in the Medical Recerebral conditions, or the treatment of intra
serve Corps of the United States Army. cranial increase of pressure by decompression.
The struggle in which we are now engaged, A study of the optic disks and retinal ves- and for which we are preparing to take such a sels, as well as the pulse, temperature and blood prominent part, depends for its success as much pressure, not to forget lumbar puncture and the the medical profession, as it does upon our pressure of the cerebro spinal fluid, furnishes combatant forces, and while we do not know that clinical evidence for or against an operation. any such intention as herein suggested is in the If we study the history of the case, escape
mind of the Surgeon General, it would at least of the cerebro spinal fluid from the ears, nose or give him the necessary corps of medical officers, mouth, ecchymoses, paresis and paralysis, dis- upon which to draw, and thus serve the best inturbances of the reflexes, the aid furnished by terests of our country, and the best interests of the x-ray, and we may be able to interpret these
the medical officer serving.
THE CONTROL OF VENEREAL DISEASES were right. Six years ago these girls came to me IN ROCHESTER
and asked what gave me the most difficulty. The health officer of Rochester, Dr. George nished the hospital diapers and we need two thou
Since then, day in and day out, they have furW. Goler, has devised a unique method of keep
sand." ing venereal disease patients under dispensary
In this splendid institution, built upon the treatment. The plan calls for regular periodic visits to the department's clinic by each patient. realizes a dream she
had more than 20 years ago,
most modern lines, Dr. Katherine B. Richardson He is told upon leaving when he is excepted to
and for which she has labored devotedly and uncome back again, and if he does not appear a
selfishly. 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
DANIEL MORTON, M. D., F. A. C. S. merely return whence they came.”
St. Joseph, Mo. Instead of the usual metal donation plates that The Buchanan County Medical Society, in disfigure the doors and walls of many hospitals, these days of national tension, has made a wise Mercy has carved oaken tablets. One of these selection of a president. A man of wide experifrankly chronicles the massage room and gym- ence in affairs medical, military and civic-Dr. nasium as the gift of the “Mercy Diaper Club of Daniel Morton. Of Kentucky origin—from a the Jewish Educational Institute.”
long line of Methodist Mortons, the new presi"At first the inscription rather jarred on me,” dent combines those stocky pioneer traits of the Doctor Richardson said yesterday. “But the fighting preacher blended with education, culture girls declared, 'the Diaper Club it is, and no and patriotism. Dr. Morton graduated in 1887 euphemism shall change it.' And I decided they from the medical department of the University